Vision Therapy FAQs
An Eye Doctor Answers Questions on Vision Therapy
The following is an interview of Dr. Leonard J. Press, author of the textbook Applied Concepts in Vision Therapy, by Rachel Cooper, co-author and designer of the edutainment science book, Magic Eye: How to See 3D and founder of Find a Doctor.
In this FAQ interview, Dr. Press examines current questions and opinions concerning vision therapy and refers the reader to relevant medical literature and web pages. He also discusses the many applications of vision therapy to a wide range of visual and learning difficulties. Questions and answers are presented in a sequential order.
You can think of vision therapy as physical therapy for the eyes and the brain. The neurological aspect is very important because the eyes are direct physical extensions of the brain. We see with our brains and minds, not just our eyes. There are plenty of web pages which give accurate definitions of vision therapy. Let's move on to some frequently asked questions which aren't covered on lots of other pages.
Orthoptics, which literally means "straightening of the eyes", dates back to the 1850s and is limited in scope to eye-muscle training and the cosmetic straightening of eyes. Vision therapy includes orthoptics, but has advanced far beyond it to include training and rehabilitation of the eye-brain connections involved in vision. Clinical and research developments in vision therapy have been closely allied with developments in neuroscience throughout this century.
Vision problems often can and do interfere with reading and learning. Optometrists do not claim that vision therapy is a direct treatment for learning disabilities, such as LD, dyslexia or ADD. Vision therapy is directed toward resolving visual problems which interfere with educational instruction. The statement on vision therapy and learning disabilities by the American Optometric Association and the American Academy of Optometry makes it clear that a multidisciplinary approach to learning disabilities is recommended, and that vision is but one aspect of the overall picture. Statements to the effect that vision therapy has no place in the treatment of learning disabilities are inaccurate and misleading.
Vision therapy can improve visual function so the patient/student is better equipped to benefit from educational instruction. In 1991, Firmon Hardenbergh, M.D., the Chief of Ophthalmology at Harvard University Health Services, had this to say regarding a double-blind scientific study of children with reading disability and convergence difficulty:
"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."
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.
According to law in many states, if a child is classified as having a specific learning disability, the school is required to either provide the necessary therapy, or to pay for the parents to obtain the necessary help not provided by the school. This puts educators in a tight spot. Funds are limited, so schools understandably try to minimize expenditures. Regarding perceptual impairment or visual processing disorders, educators are sometimes faced with two basic choices:
a. have someone already on staff provide the therapy necessary or
b. 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.
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)