Vision therapy, also known as visual training, vision training, or visual therapy, is a group of techniques attempting variously to correct or improve presumed ocular, oculomotor, visual processing, and perceptual disorders. " ^[1] Vision therapy encompasses a wide variety of non-surgical methods^[2] which some have divided into two broad categories: 1) orthoptic vision therapy, also known as orthoptics, and 2) behavioral vision therapy, also known as behavioral or developmental optometry. Behavioral optometry (also known as "functional optometry" is an expanded area of optometric practice that uses a holistic approach in the treatment of vision and ^[1]

Orthoptics aims to treat binocular vision disorders such as strabismus, and diplopia. Binocular vision is vision in which both Eyes are used together Strabismus (from Greek: στραβισμός strabismos, from στραβίζειν strabizein "to squint" from στραβός strabos Diplopia, commonly known as double vision, is the simultaneous Perception of two images of a single object It is practiced by optometrists and ophthalmologists, as well as orthoptists and occupational therapists under the guidance of some ophthalmologists and pediatric ophthalmologists. Optometry is a health care profession concerned with Eyes and related structures as well as vision, Visual systems and vision information Ophthalmology is the branch of Medicine which deals with the diseases and surgery of the visual pathways including the Eye, Brain Pediatric ophthalmology is a sub-speciality of Ophthalmology concerned with Eye diseases and vision care in children

Behavioral vision therapy is practiced primarily by optometrists who specialize in this field. It treats additional problems including difficulties of visual attention and concentration, which may manifest as an inability to sustain focus or to shift focus from one area of space to another. The ability to shift the focus of visual attention from one place in space to another affects many aspects of life including reading, most vocations and most avocations. Eye doctors may also prescribe vision therapy to sufferers from eye strain and visually-induced headaches. Asthenopia (aesthenopia or eye strain is an ophthalmological condition that manifests itself through nonspecific Symptoms such as fatigue red eyes eye strain pain A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted However, not all such therapy is limited to disorders of the visual system. The visual system is the part of the Nervous system which allows organisms to see. Professional athletes, for example, may use vision therapy to enhance sensitivity to peripheral vision on the playing field or increase responsiveness to fast moving objects. Professional sports, as opposed to amateur Sports are those in which athletes receive payment for their performance Peripheral vision is a part of vision that occurs outside the very center of gaze

Contents 1 History 2 Indications 3 Efficacy 4 Policy 5 See also 6 References 7 External links

History

Various forms of visual therapy have been used for centuries. ^[3] The concept of vision therapy was introduced in the late nineteenth century for the non-surgical treatment of misaligned eyes. The 19th century of the Common Era began on January 1, 1801 and ended on December 31, 1900, according to the Gregorian calendar This early and traditional form of vision therapy is what is now known as 'orthoptics. ' Collaboration of some eye care professionals with educators and neuroscientists produced an expansion of vision therapy into the treatment of other eye teaming (binocular) deficits (the use of the flow through the right and left eyes simultaneously to the brain) as well as dysfunctions in visual focusing, perception, tracking and motor skills. Focusing is a naturally occurring human process carefully observed and made teachable by philosopher and psychotherapist Eugene Gendlin. In Psychology, visual perception is the ability to interpret information from Visible light reaching the Eyes The resulting Perception is also Eye tracking is the process of measuring either the point of Gaze ("where we are looking" or the motion of an Eye relative to the head A motor skill is generally agreed as a learned skill that involves voluntary movement to complete a task

As a result of this expansion and ensuing confusion over what the term "vision therapy" includes, there is some controversy as to the use of vision therapy for individuals with learning disorders. In the United States and Canada, the term learning disability (LD refers to a group of disorders that affect a broad range of academic and functional skills including

Although ophthalmologists and orthoptists often perform several components of visual therapy, most non-strabismic VT is performed by optometrists. ^[3]

Indications

There is widespread acceptance of orthoptic therapy indications for convergence insufficiency. Patients who experience eyestrain, "tired" eyes, or diplopia (double vision) while reading or performing other near work, and who have convergence insufficiency may benefit from orthoptic treatment. Patients whose outward drift occurs at distance rather than at near distance are less ideal candidates for treatment.

Major optometric organizations, including the American Optometric Association, the American Academy of Optometry, the College of Optometrists in Vision Development, and the Optometric Extension Program, support the assertion that vision therapy does not directly treat learning disorders, but rather addresses underlying visual problems which are claimed to affect learning potential. The American Optometric Association (AOA represents Optometrists nationally in the USA. The American Academy of Optometry (AAO is an organization of Optometrists Its goal is to maintain and enhance excellence in optometric practice by both promoting research and The College of Optometrists in Vision Development (COVD is an international non-profit optometric membership organization that provides education evaluation and board certification programs in The Optometric Extension Program (OEP is an international non-profit organization dedicated to the advancement of the discipline of optometry through the gathering and dissemination of ^[4]

Advocates cite a number of indications for the use of vision therapy. Some assert that poor eye tracking affects reading skills, and that improving tracking can improve reading. Eye tracking is the process of measuring either the point of Gaze ("where we are looking" or the motion of an Eye relative to the head ^[5]

Efficacy

In 1988, a review of 238 scientific articles was published in the Journal of the American Optometric Association defining vision therapy as "a clinical approach for correcting and ameliorating the effects of eye movement disorders, non-strabismic binocular dysfunctions, focusing disorders, strabismus, amblyopia, nystagmus, and certain visual perceptual (information processing) disorders. " The paper concluded, "It is evident from the research that there is scientific support for the efficacy of vision therapy in modifying and improving oculomotor, accommodative, and binocular system disorders, as measured by standardized clinical and laboratory testing methods for patients of all ages for whom it is properly undertaken and employed. "^[6]

A 2005 review concluded that "small controlled trials and a large number of cases support the treatment of convergence insufficiency. Convergence insufficiency is a sensory and neuromuscular anomaly of the Binocular vision system characterized by an inability of the Eyes to approach each other Less robust, but believable, evidence indicates visual training may be useful in developing fine stereoscopic skills and improving visual field remnants after brain damage. As yet there is no clear scientific evidence published in the mainstream literature supporting the use of eye exercises in the remainder of the areas reviewed, and their use therefore remains controversial. "^[7]

Convergence insufficiency is a common binocular vision disorder characterized by asthenopia, eye fatigue and discomfort. Convergence insufficiency is a sensory and neuromuscular anomaly of the Binocular vision system characterized by an inability of the Eyes to approach each other Binocular vision is vision in which both Eyes are used together Asthenopia (aesthenopia or eye strain is an ophthalmological condition that manifests itself through nonspecific Symptoms such as fatigue red eyes eye strain pain ^[8] Asthenopia may be aggravated by close work and is thought by some to contribute to reading inefficiency. ^[1] In 2005, the Convergence Insufficiency Treatment Trial published two large, randomized clinical studies examining the efficacy of orthoptic vision therapy in the treatment of symptomatic convergence insufficiency. Although neither study examined reading efficiency or comprehension, both demonstrated that in-office vision therapy was more effective than "pencil pushups" (a commonly prescribed home-based treatment) for improving the symptoms of asthenopia and the convergence ability of the eyes. In ophthalmology convergence is the simultaneous inward movement of both Eyes toward each other usually in an effort to maintain single Binocular vision when viewing ^[9][10] The design and results of at least one of these studies has been met with some reservation, questioning the conclusion as to whether intensive office-based treatment programs are truly more efficacious than a properly implemented home-based regimen. ^[11]

Policy

Other than for strabismus and convergence insufficiency, the consensus among ophthalmologists and pediatricians is that visual training lacks documented evidence of effectiveness. Strabismus (from Greek: στραβισμός strabismos, from στραβίζειν strabizein "to squint" from στραβός strabos Convergence insufficiency is a sensory and neuromuscular anomaly of the Binocular vision system characterized by an inability of the Eyes to approach each other ^[3][7] In 1998, the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus issued a policy statement regarding the use of vision therapy specifically for the treatment of learning problems and dyslexia. The American Academy of Pediatrics ( AAP) is an organization of Pediatricians physicians trained to deal with the medical care of infants children and adolescents The American Academy of Ophthalmology ( AAO) is a Medical association of ophthalmologists &ndash medical doctors (MDs specializing in eye The American Association for Pediatric Ophthalmology and Strabismus (AAPOS is an academic association of pediatric ophthalmologists and strabismus surgeons According to the statement: "No scientific evidence exists for the efficacy of eye exercises ('vision therapy'). . . in the remediation of these complex pediatric neurological conditions. " ^[12] More recently, in 2004, the American Academy of Ophthalmology released a position statement asserting that there is no evidence that vision therapy retards the progression of myopia, no evidence that it improves visual function in those with hyperopia or astigmatism, or that it improves vision lost through disease processes. ^[13]

Optometrists take a slightly different view. In 1999 a joint statement by the American Academy of Optometry, the American Optometric Association, the College of Optometrists in Vision Development and Optometric Extension Program Foundation reported: "Many visual conditions can be treated effectively with spectacles or contact lenses alone; however, some are most effectively treated with vision therapy. The American Academy of Optometry (AAO is an organization of Optometrists Its goal is to maintain and enhance excellence in optometric practice by both promoting research and The American Optometric Association (AOA represents Optometrists nationally in the USA. The College of Optometrists in Vision Development (COVD is an international non-profit optometric membership organization that provides education evaluation and board certification programs in . . . Research has demonstrated that vision therapy can be an effective treatment option for ocular motility problems, non-strabismic binocular disorders, strabismus, amblyopia, accommodative disorders (and) visual information processing disorders. "^[14]

Although skeptics assert that vision therapists may have a financial bias in proclaiming the efficacy of the practice^[15], proponents and advocates of vision therapy claim that other eye professionals have a similar bias in rejecting its claims. ^[16]

See also

• Bates method, a controversial method aimed at correcting refractive errors

References

External links

• American Academy of Pediatric Ophthalmology
• VisionTherapy.org - Optometrists Network
• College of Optometrists in Vision Development
• Optometric Extension Program Foundation

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