Vision Therapy and Vision Rehabilitation
Many parents of children or patients with brain injury are told they or their child should be evaluated for vision therapy, vision training, and vision rehabilitation. There is a lot of controversy about vision therapy and in this section we hope to answer the most frequently asked questions and provide some evidence-based resources
What is vision therapy?
Vision therapy is a very broad, non-specific term that can encompass a variety of different types of treatment. The non-standardization of the term "vision therapy" is frustrating for patients and providers alike as they try to find the right treatment option and provider, especially because it is rarely covered by insurance.
In general, vision therapy has been prescribed for developmental pediatric patients as well as patients of all ages with brain injury who have visual difficulties with reading due to eye tracking/coordination difficulties like convergence insufficiency, accommodative dysfunction, and saccadic dysfunction.
Vision therapy has been a controversial treatment option in the past, particularly because vision therapy is not usually prescribed by medical physicians (Ophthalmologists - DO/MD) but is prescribed by optometric physicians (ODs) who specialize in this area, and there has been limited scientific evidence in the past. However, over the last two decades there has been a wealth of randomized, controlled clinical trials showing the benefit of vision therapy on accommodative and convergence disorders in children, as well as the active rehabilitation of visual/vestibular dysfunction in the brain injury population. This emerging research is revolutionizing the field of vision therapy and providing the much needed science to back its utility.
"Orthoptics vision therapy" is the scientifically, evidence-based type of vision therapy for oculomotor dysfunctions including convergence insufficiency (eye crossing difficulty) and accommodative (focusing) disorders we have been discussing on this page. It is currently supported by numerous national organizations including:
Types of Vision Therapy Offered
There are many different types of vision therapy offered across the country. We offer orthoptics/oculomotor vision therapy as well as visual processing adaptation training and neuro-optometric rehabilitation.
Brain Injury and Concussion Vision Therapy
Dr. Theis is a pioneer in active rehabilitation of post-traumatic brain injury vision therapy and rehabilitation. By offering home-based and telemedicine services, this therapy is accessable to patients of all ages and injury types. It is individualized and patient-centered.
Eye Tracking and Reading Vision Therapy
It takes 6+ eye movements to work seamlessly together to be able to read quickly, efficiently, and comfortably. By targeting eye movement abnormalities specific to the patient, this rehab works to improve eye coordination and tracking skills while reading.
Visual Processing Rehabilitation
The first step in understanding why the brain has trouble processing visual information is to isolate which visual processing skill is abnormal. Skills like visual discrimination, memory, spatial relations, and visual crowding can be worked on with lifestyle adaptations and active rehab techniques
Scheiman M, Cotter S, Rouse M, Mitchell GL, Kulp M, Cooper J, Borsting E; Convergence Insufficiency Treatment Trial Study Group. Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children. Br J Ophthalmol. 2005 Oct;89(10):1318-23. doi: 10.1136/bjo.2005.068197. PMID: 16170124; PMCID: PMC1772876.
Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008 Oct;126(10):1336-49. doi: 10.1001/archopht.126.10.1336. PMID: 18852411; PMCID: PMC2779032.
Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M, Borsting E, London R, Wensveen J. A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. Optom Vis Sci. 2005 Jul;82(7):583-95. doi: 10.1097/01.opx.0000171331.36871.2f. PMID: 16044063.
Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, Hopkins KB, Bartuccio M, Chung I; Convergence Insufficiency Treatment Trial Study Group. Treatment of accommodative dysfunction in children: results from a randomized clinical trial. Optom Vis Sci. 2011 Nov;88(11):1343-52. doi: 10.1097/OPX.0b013e31822f4d7c. PMID: 21873922; PMCID: PMC3204163.
McGregor ML. Convergence insufficiency and vision therapy. Pediatr Clin North Am. 2014 Jun;61(3):621-30. doi: 10.1016/j.pcl.2014.03.010. PMID: 24852157.
Gallaway M, Scheiman M, Mitchell GL. Vision Therapy for Post-Concussion Vision Disorders. Optom Vis Sci. 2017 Jan;94(1):68-73. doi: 10.1097/OPX.0000000000000935. PMID: 27505624.
Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody DL, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin RJ, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R. Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery. 2016 Dec;79(6):912-929. doi: 10.1227/NEU.0000000000001447. PMID: 27741219; PMCID: PMC5119544.
Fox SM, Koons P, Dang SH. Vision Rehabilitation After Traumatic Brain Injury. Phys Med Rehabil Clin N Am. 2019 Feb;30(1):171-188. doi: 10.1016/j.pmr.2018.09.001. Epub 2018 Oct 31. PMID: 30470420.
Ciuffreda KJ, Rutner D, Kapoor N, Suchoff IB, Craig S, Han ME. Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2008 Jan;79(1):18-22. doi: 10.1016/j.optm.2007.10.004. PMID: 18156092.