Vision therapy (VT), or behavioral optometry, is an umbrella term for alternative medicine treatments using eye exercises, based around the pseudoscientific claim that vision problems are the true underlying cause of learning difficulties, particularly in children. Vision therapy has not been shown to be effective using scientific studies, except for helping with convergence insufficiency. Most claims—for example that the therapy can address neurological, educational, and spatial difficulties—lack supporting evidence. Neither the American Academy of Pediatrics nor the American Academy of Ophthalmology support the use of vision therapy.
Definition and conceptual basis Behavioral vision therapy is based on the proposition that many learning disabilities in children are based on vision problems, and that these can be cured by performing eye exercises. Behavioral vision therapy lacks sound evidence, has been characterized as a pseudoscience and its practice as quackery. Vision therapy is a broad concept that encompasses a wide range of treatment types. These include those aimed at convergence insufficiency – where it is often termed "vergence therapy", "orthoptics/vision therapy" or "orthoptic therapy" – and at a variety of neurological, educational and spatial difficulties.
Efficacy There is no good evidence that behavioral vision therapy is of any benefit in treating learning disabilities, reading, dyslexia, or ADHD. However, there is evidence that orthoptic vision therapy may help treat convergence disorder in healthy people. As of 2020, the consensus among ophthalmologists, orthoptists and pediatricians is that non-strabismic visual therapy lacks documented evidence of effectiveness. A review in 2000 concluded that there were insufficient controlled studies of the approach of behavioral vision therapy. A 2008 review of the literature also noted that there were insufficient controlled studies of behavioral vision therapy, and concluded that the approaches "are not evidence-based, and thus cannot be advocated." There is no good evidence supporting the use of behavioral vision therapy in the rehabilitation of patients with mild traumatic brain injury, although orthoptic vision therapy may be useful for the treatment of post-traumatic convergence insufficiency and accommodative insufficiency.
Treatment types There exist a few different broad classifications of vision treatment philosophies, which have been traditionally divided between optometrists, ophthalmologists, and practitioners of alternative medicine. Orthoptic vision therapy, also known as orthoptics, is a field pertaining to the evaluation and treatment of patients with disorders of the visual system with an emphasis on binocular vision and eye movements. Commonly practiced by orthoptists, optometrists, behavioral optometrists, pediatric ophthalmologists, and general ophthalmologists, traditional orthoptics addresses problems of eye strain, visually induced headaches, strabismus, diplopia and visual-related skills required for reading. Behavioral vision therapy, or visual integration vision therapy (also known as behavioral optometry), is a pseudoscientific field pertaining to the treatment of patients with various psychological disorders, such as dyslexia, developmental coordination disorder, attention deficit hyperactivity disorder, among other learning disorders via orthoptic techniques. There is currently insufficient evidence to support behavioral vision therapy as a treatment for these conditions, and it is typically regarded as pseudoscientific.
Orthoptic vision therapy
Orthoptics emphasises the diagnosis and non-surgical management of strabismus (wandering eye), amblyopia (lazy eye), and eye movement disorders. Evidence to support its use in treating amblyopia is unclear as of 2011. Much of the practice of orthoptists concerns refraction and muscular eye control. Orthoptists are trained professionals who specialize in orthoptic treatment. With specific training, in some countries orthoptists may be involved in monitoring some forms of eye disease, such as glaucoma, cataract screening, and diabetic retinopathy.
Behavioral vision therapy Behavioral vision therapy (BVT) aims to treat problems including difficulties of visual attention and concentration, which behavioral optometrists classify as visual information processing weaknesses. These manifest themselves as an inability to sustain focus or to shift focus from one area of space to another. Some practitioners assert that poor eye tracking may impact reading skills, and suggest that vision training may improve some of the visual skills helpful for reading. Behavioral vision therapy is practiced primarily by optometrists who specialize in the area. Historically, there has been some difference in philosophy among optometry and medicine regarding the efficacy and relevance of vision therapy, although none support its use in treating learning disorders. Major organizations, including the International Orthoptic Association and the American Academy of Ophthalmology, have concluded that there is no validity for clinically significant improvements in vision with BVT, and therefore do not practice it. However, 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 non-strabismic visual therapy does address underlying visual problems which are claimed to affect learning potential. These optometric organizations are careful to distinguish, though, that vision therapy does not directly treat learning disorders.
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