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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
 
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.​​


Why is vision therapy controversial?

  • Vision therapy has been a controversial treatment option in the past, particularly because vision therapy is not usually prescribed by medical doctors (Ophthalmologists - DO/MDs) but is prescribed by optometrists (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 (References below).  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:


What types of vision therapy does Virginia Neuro-Optometry offer?

  • 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.

 
Can I do vision therapy at home?​

  • Due to the symptom provocation with vision therapy for patients with brain injury like dizziness/headache, the difficulty getting transportation to the office, and the inconvenience of having to schedule in-office vision therapy visits during the 9-5 work day for the majority of patients, Dr Theis can set you up with at-home vision exercises you can do either online with vision software, or with simple home-based equipment. 

  • This methodology allows patients to do vision therapy on their own schedule, with follow up visits with Dr Theis as needed to help guide you through the therapy, keep you motivated, and get you results!


What is neuro-optometric vision rehabilitation?

  • Neuro-optometric vision rehabilitation is the term used to describe the individualized treatment regimen for a patient with visual deficits as a direct result of neurological injury and disease.  This treatment plan is based off of the results of a comprehensive neuro-optometric examination and may include patient education on adaptive techniques to cope with neurologic vision loss, tinted lenses to improve contrast sensitivity/glare/light sensitivity, prism lenses to alleviate double vision or help with spatial orientation and neurologic visual field loss, and vision therapy.  For even more information on neuro-optometric rehabilitation we recommend you visit the NORA (Neuro-Optometric Rehabilitation Association) website (click here).



What types of symptoms does vision therapy alleviate?

  • Convergence and accommodative disorders are common eye movement abnormalities in pediatric development as well as post-concussion/TBI.  These conditions are prevalent in 2-17% of the general population and up to 50-80% of patients who have suffered a traumatic brain injury or other neurological disease like Parkinson's disease, and can cause patients to have difficulties with reading, visual clarity and computer tasks as well as physical symptoms like headaches/dizziness/nausea with visual tasks like reading/computer/grocery shopping/driving. 

  • Symptoms of convergence insufficiency and accommodative disorders with reading may include:

    • Double vision  ​

    • Intermittent blurry vision

    • Losing ones place while reading

    • Re-reading

    • Difficulties with concentration while reading

    • Eye fatigue

    • Eye pain/soreness/pulling sensation around the eyes

  • IF a patient is having difficulty with reading due to vergence or accommodative disorders, orthoptics vision therapy has been shown in clinical trials to remediate these oculomotor dysfunctions and alleviate symptoms.

    • It should be noted that eye coordination and focusing is only one of many aspects of reading.  So if a patient has difficulty with reading due to language disorders like dyslexia, then vision therapy will not remediate these language-related reading difficulties.  It is important for patients with reading difficulties to rule out the oculomotor system is not an additional barrier.​

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How do I know if I need vision therapy?

  • Not everyone is a candidate for vision therapy and not everything can be treated with vision therapy.  Some oculomotor disorders and double vision require prismatic correction and/or surgery for remediation and some patients are too young to start vision therapy.

  • A thorough neuro-optometric/oculomotor evaluation is needed to see if a patient has a problem that can be alleviated by vision therapy and if it is an age-appropriate treatment option for them.


How many vision therapy visits will a typical patient need?

  • Every patient is different and there is no definitive answer to this question.  However, Dr. Theis' goal is to get you better as soon as possible in the fewest number of office follow up visits!  

  • In her extensive clinical experience, the majority of orthoptics vision therapy can be successfully performed in a home-based daily vision therapy program with telemedicine/office follow-up visits to help guide the patient's success every 1-2 weeks.  This methodology is not only cost-effective for the patient, but reduces the burden on the patient/family to acquire transportation and take time off of work for weekly/biweekly in-office visits.  Additionally, this method reduces triggering symptoms in patients who are unable to tolerate vehicle transportation due to their brain injury.  

  • Dr. Theis will monitor the patient's on-going progress and tailor the rehabilitation program to the patient's oculomotor system to expedite recovery.  This is helpful for pediatric patients and patients with brain injury as it allows for flexibility in rehabilitation and recovery so it can fit into your life.


Will I have to do vision therapy forever?

  • Absolutely not.  Vision therapy should be a treatment - meaning once you finish, you should be done.  It is possible that some conditions require rechecks for stability in the future and/or glasses, but this is less common.  Once fully rehabbed, the therapy can be tapered and discontinued.  Symptoms usually only regress if the therapy is terminated prior to 100% completion/remediation.


References