Frequently Asked Questions
What is Vision Therapy
O.K., are “orthoptics” and “vision therapy” the same thing?
What is the difference between an optometrist and an ophthalmologist?
What should patients or parents keep in mind while researching vision therapy on the Internet?
Can you be more specific?
Why would some ophthalmologists and their organizations claim that vision therapy doesn’t work?
- Insurance companies and single-payer systems outside of the U.S. have stricter medical standards in regards to approving payment of eye muscle surgery. Also, they do not pay as well for eye muscle surgery as insurance companies in the U.S.
- Non surgical therapy isn’t as economically rewarding for the surgeon in the U.S. due to the personnel and fees involved.
- Due to his lack of training in this area, the surgeon is reluctant to acknowledge the benefits of non surgical therapy for fear of losing patients.
Does the public assume that ophthalmologists (M.D.s) are the ultimate authorities about everything in eyecare, including vision therapy
Can you give an example of a case where the outcome depended on whether the parent relied on the opinion of an optometrist or an ophthalmologist?
Lauren’s mother finally decided to seek a second opinion from a vision specialist. I tested Lauren on the Visagraph, a standardized computer which records and analyzes eye movements while the patient is reading. Results showed that Lauren, age nineteen, was reading at a 4th grade level. At this point, I tested her eyesight with eyedrops in place and discovered that Lauren did not really have a lazy eye! Lauren’s so-called lazy eye could see 20/20 with the proper prescription lens. I prescribed glasses for reading, and a vision therapy program and Lauren has made great improvements. It is unfortunate that Lauren went so many years without proper treatment. In a perfect world, the ophthalmologist might have said: “Although I do not find any eye health problems or the need for glasses or medication, Lauren has significant problems and does not seem to be psychosomatic. Therefore, I will refer her to a vision specialist for more extensive testing.”
Can vision therapy help with learning problems?
- “The application of orthoptics [included in vision therapy] to all learning/reading disabled or deficient children who manifest convergence insufficiency should be the first line of therapy.”
- Regarding visual processing and learning disabilities, Corinne Smith, Ph.D., Associate Dean of Education at Syracuse University, noted in her 1997 text on Learning Disabilities, that students with visual perception disabilities have trouble making sense out of what they see.
- “The problem is not with their eyesight, but with the way their brains process visual information.”
Is there scientific evidence that vision therapy works?
In a word, yes. Studies on vision therapy are on a par with the published literature in parallel rehabilitative interventions such as physical therapy and occupational therapy. Furthermore, the data which supports vision therapy is considerably more impressive than the data which has substantiated other forms of visual intervention before these were put into public use by eyecare practitioners. The same profession (ophthalmology) which calls for “more scientific” studies of vision therapy had no qualms about recommending elective procedures such as eye muscle surgery or refractive surgery prior to any scientific study whatsoever.
What’s the position of educators regarding vision therapy?
- Have someone already on staff provide the therapy necessary or
- Deny that the therapy has anything to do with the child’s learning problems.
Some school systems try to adopt the latter approach, which leaves more money in the pot for services which are provided within the school system.
In the case of the former, the school might assign the child to a staff Occupational Therapist. OTs are highly skilled in helping children with developmental, gross motor, and fine motor activities particularly handwriting, but they are not trained or licensed in vision therapy. Specifically, occupational therapists can not administer important vision therapy procedures which involve lenses, prisms, and devices which insure that both eyes work together as a synchronous team
Fortunately, we are seeing an increase in schools which recommend that parents of children with visual problems seek evaluation and treatment with a licensed optometric vision therapist.
I’ve heard a lot about special lenses or filters which can improve reading. Can that be done instead of vision therapy?
Irlen, an educational psychologist, recognized the difference between routine eye examinations and a vision therapy evaluation. She noted:
“When individuals take a routine eye examination, the vision specialist normally assesses acuity, refractive status, and binocular function. When the exam is more than routine, additional tests will analyze the visual system in greater detail and will also evaluate focusing ability and tracking skills. The doctor will also check for the presence of eye diseases. For SSS treatment to be successful, existing visual problems need to be treated first. Perceptual skills are based on a solid visual foundation. It is essential for individuals to eliminate all visual problems prior to getting treatment for perception or other learning difficulties.”
Does insurance pay for vision therapy?
- What problems or concerns are you having with your vision or performance?
- What options have you tried other than vision therapy, and what has been the result?
- If you have not had success pursuing other interventions, and the doctor’s diagnosis and treatment proposal make sense, what value would you place on improvement?
Is it true that there are certain conditions, like lazy eye, where the patient is too old, or it’s too late to intervene with vision therapy?
Secondly, allow me to emphasize that, in regards to amblyopia and strabismus, the eye muscle training benefits of vision therapy are medically proven. There is no controversy there. Where eye doctors do not always agree is in regards to this question you have asked. There are eye surgeons who promote the idea that if a child has an eye turn, you must operate by age two to get meaningful results, and if there is amblyopia, or lazy eye, intervention of any kind is only meaningful before age 6 or 7. There are many scientific articles in optometric journals which prove that it’s never too late to treat a lazy eye, but I’d like to refer to an study by an eye surgeon.
In the American Journal of Ophthalmology, von Noorden, a well-known strabismus surgeon and researcher reviewed the records of 408 patients who had eye turns shortly after birth, and divided their surgical outcomes based on age at the time of surgery:
AGE SURGICAL OPTIONS PERCENTAGE:
4 months - 2 years
- Optimal 24%
- Desireable 4%
- Acceptable 36%
- Unacceptable 36%
AGE SURGICAL OPTIONS PERCENTAGE:
2 years - 4 Years
- Optimal 15%
- Desireable 5%
- Acceptable 44%
- Unacceptable 36%
AGE SURGICAL OPTIONS PERCENTAGE:
Older than 4 Years
- Optimal 16%
- Desirable 14%
- Acceptable 42%
- Unacceptable 28%
Re: surgical treatment, the data above shows that useful results can be obtained by intervening after age 2. The data also shows that there should be no rush to go to surgery after the age of 2, because the outcomes don’t differ that much after that age. By the way, the positive outcomes measured above include cosmetic improvement ONLY. Vision therapy aims to do more than simply straighten the appearance of the crossed or turned eyes. It aims to help patients develop useful binocular (two-eyed) vision.
Re: vision therapy treatment, you’ll always get the best results if you intervene at a young age, IF you can get a child’s cooperation. But, children have little motivation to cooperate. It’s been proven that a motivated adult with strabismus and/or amblyopia who works diligently at vision therapy can obtain meaningful improvement in visual function. As my patients are fond of saying: “I’m not looking for perfection; I’m looking for you to help me make it better”. It’s important that eye doctors don’t make sweeping value judgments for patients. Rather than saying “nothing can be done”, the proper advice would be: “You won’t have as much improvement as you would have had at a younger age; but I’ll refer you to a vision specialist who can help you if you’re motivated.”
Any concluding thoughts?
With the advent of computers in the work environment, we’re seeing more adults with eye strain-related vision problems which can be improved through vision therapy. Also, there are special needs patients with developmental or head injury problems which neuro-optometric diagnosis and vision therapy treatment can uniquely help. Still, the majority of my patients continue to be children with learning or reading problems who have been through all kinds of interventions. These children have been told that their eyes are healthy and that glasses aren’t necessary, but they continue to struggle with visual processing. Their visual processing problems or developmental vision problems can’t be detected unless the eye doctor specifically tests for them. I’d like to sum up with a quote from the web site of one of the world’s leading vision companies, Ciba Vision:
“Because reading problems usually have multiple causes, treatment must often be multidisciplinary. Educators, psychologists, eye care practitioners and other professionals often must work together to meet each person’s needs. The eye practitioner’s role is to help overcome any vision problems interfering with the ability to read. Once those are addressed the student is better prepared to respond to special reading education efforts.” (www.cibavision.com, 1999)