Vision Therapy for Children

Looking into vision therapy for your child can be a bewildering experience: not only are there many different names for it, but doctors also disagree about whether it's effective or a waste of money. The simple explanation is that many different activities are lumped together as vision therapy; some of them have evidence supporting their effectiveness, while others ... don't.

Before we can make sense of this, we need to sort out all those names. Vision therapy is sometimes called vision training, visual training, behavioral optometry or developmental optometry.

Other names are actually types of vision therapy. Orthoptics, also called optometric vision therapy, is the use of eye exercises for conditions such as amblyopia and strabismus. You might hear about vision therapy for children with learning disabilities as well: usually, tinted lenses (also called Irlen lenses) or eye exercises. Another branch is dedicated to reducing refractive errors, such as nearsightedness. Finally, syntonics, also called optometric phototherapy or photoretinology, is the use of colored lights for a wide range of visual ailments.

Orthoptics, the use of eye exercises to improve vision, is the most widely studied type of vision therapy. Clinical studies have shown it to be effective in treating amblyopia, strabismus, convergence insufficiency and certain accommodation problems.

So what exactly are these eye exercises? Actually, there are many exercises available and the therapy is individualized for each child. Exercises to improve accommodation, for example, may involve looking at a specific far object with one eye covered, then looking at a specific near object (with the eye remaining covered); the child would repeat these actions several times, then switch eyes.

Orthoptics is not the only type of treatment available for these conditions. Other strabismus and amblyopia treatments include: eyeglasses, patching, eyedrops and surgery. For convergence insufficiency and accommodation dysfunctions, eyeglasses may be appropriate.

Doctors recommend a multidisciplinary approach to treating learning disabilities such as dyslexia and attention deficit disorder (ADD); what this means is that several doctors may be involved, such as a pediatrician, a psychologist, a neurologist and so forth. The types of vision therapy most often recommended for learning disabilities are tinted lenses (Irlen lenses) and eye exercises.

Most eye doctors do not recommend using tinted lenses, citing lack of scientific evidence that they work.

Treating a learning disability with eye exercises is an area of controversy amongst eye doctors. What they agree on: your first vision-care step should be to take your child to an eye doctor to rule out visual problems that impede learning, but are not learning disabilities, such as being too nearsighted to read a blackboard. At this point, optometrists and ophthalmologists part ways.

Most optometrists support eye exercises as part of the multidisciplinary approach to learning disabilities. The exercises may include those intended to correct accommodation, vergence, processing and motor function. Processing refers to how the brain interprets information from the eyes; dyslexics, for example, have a processing problem in which letters or words appear to be in reversed order. Motor function refers to movement such as saccades, where the eye jumps from looking at one point to another (such as when you read), and pursuits, where the eye tracks moving objects.
 

Most ophthalmologists, on the other hand, feel that both tinted lenses and eye exercises don't work. In a joint policy statement on the topic, the American Academy of Ophthalmology and the American Academy of Pediatrics said that "visual problems are rarely responsible for learning difficulties." And,

"No scientific evidence supports claims that the academic abilities of children with learning disabilities can be improved with treatments that are based on 1) visual training, including muscle exercises, ocular pursuit, tracking exercises, or 'training' glasses (with or without bifocals or prisms), 2) neurologic organizational training (laterality training, crawling, balance board, perceptual training), or 3) colored lenses. These more controversial methods of treatment may give parents and teachers a false sense of security that a child's reading difficulties are being addressed, which may delay proper instruction or remediation. The expense of these methods is unwarranted, and they cannot be substituted for appropriate educational measures. Claims of improved reading ... are almost always based on poorly controlled studies that typically rely on anecdotal information. These methods are without scientific validation. Their reported benefits can be explained by the traditional educational remedial techniques with which they are usually combined."

Correcting children's and adults' refractive errors (nearsightedness, farsightedness and astigmatism) with eye exercises is an increasingly popular idea, particularly with companies selling self-help kits of instructions and journals directly to consumers, but few doctors support the practice. Why? There's simply no scientific evidence to back it up.

Organizations promoting the idea cite anecdotal evidence and even that is unimpressive: only some people see an improvement and even they usually still need to wear their glasses. Plus, they have to keep up the exercises for the rest of their lives, for about half an hour each day.

Syntonics is the branch of vision therapy in which the practitioner directs colored lights into the patient's eyes for a variety of problems, including amblyopia and strabismus. The patient's condition determines what color is used. While it does have some devoted supporters, there is no scientific research showing that it actually works.

To read more about your child's condition, see our articles on amblyopia, strabismus and learning disabilities. Also read up on computer vision syndrome, especially if your child spends a couple of hours or more at the computer each day.

If you think vision therapy would be appropriate for your child, or would like to determine which type of treatment would best help his or her specific condition, schedule an appointment with your eye doctor to discuss what your next step should be.