Vision Therapy Myths Debunked: Myth #3 - Vision Therapy Must Be Repeated

During our Vision Therapy Myths Debunked series we have already talked about the myth that vision therapy is only for kids and the myth that all vision therapy programs are the same. Today's blog is going to debunk the myth that vision therapy must be repeated. One of the most common comparisons that I hear is when people call vision therapy “eye exercises” and liken it to sending your eyes to the gym.

This makes vision therapy sound like strengthening exercises. Enter the concern for regression and the need for repeat vision therapy programs. By the time to finish reading this blog you will have a better understanding of why vision therapy is not just eye exercises and why vision therapy does not need to be repeated.
I think it is important to start by saying the muscles responsible for moving the eyes are “over built”. They are too strong for the job they need to do; move an eyeball that weighs less than 30 grams. The idea that you need to strengthen the eye muscles to resolve binocular vision dysfunction (convergence insufficiency, eye turn, tracking difficulties, etc) is not true. In fact, most people with an eye turn can move their eyes in all directions (there are exceptions of course). So if we are not strengthening the eyes, what are we doing with vision therapy?

When performed properly, vision therapy is an individualized treatment protocol developed by an optometrist with advanced training in binocular vision and vision therapy. This treatment is designed to improve binocular vision functioning (eye teaming), accommodation (eye focusing), oculomotor functioning (eye tracking), visual perception, and visual processing. Improvements in visual functioning are made by developing the neural pathways within the brain that are responsible for the above mentioned visual skills. 66% of the neural connections in the brain are involved in vision, visual perception, and the integration of vision with the other senses. With that in mind, you can begin to see how much potential there is for improvement.

Rather than “strengthening”, you could think of vision therapy as improving “coordination” of the eyes and the brain. Instead of thinking about vision therapy like strength training where there is a “use it or lose it” effect, think of vision therapy like riding a bike. Once you have developed the neural pathways and “coordination” of the eyes, it is there to stay. This is why vision therapy does NOT need to be repeated later in life. The great news... every time the vision therapy graduate uses their eyes and brain to read, learn, and play sports or games, they are reinforcing their new visual skills (riding the bike so to speak).

When performed properly, vision therapy should not have to be repeated. Take the following steps to ensure that vision therapy is being performed properly by trained individuals:

• Make sure the optometrist is Residency-Trained in binocular vision and vision therapy.
  Residency-training is optional for optometrists. A residency is a year of focused studies in one aspect of optometry (vision therapy/binocular vision, pediatrics, disease management, etc) that occurs after graduation from optometry school. Optometrists who graduate optometry school and are not accepted into a residency program lack this in-depth training. Very few optometrists are residency-trained in binocular vision and vision therapy. In fact, Dr. Ryan Johnson is Idaho's only optometrist residency-trained in vision therapy. He completed his residency in binocular vision, neuro-optometry, and vision therapy at the University of California, Berkeley prior to returning to Idaho.

• Make sure the therapist is a licensed therapist with experience in vision therapy.
  Anyone can be employed as a vision therapist. At Advanced Vision Therapy Center our director of services and vision therapist is a licensed occupational therapist with advanced training in vision therapy. She has nearly 20 years experience working with children and adults with a wide range of abilities. Be sure to ask if the therapist working with your child is a licensed therapist and how much experience and training they have working with a child like yours.

• Make sure the vision therapy does not have a computer-based component.
  Some practices supplement in-office vision therapy with computer programs that a performed either in-office or at home. Current research in the treatment of convergence insufficiency has shown that computer-based vision therapy is NOT effective. In fact, it was less effective than the control placebo (fake) therapy. Computer-based vision therapy has the potential to embed poor visual habits. When these bad habits are embedded, vision therapy must be repeated as the faulty system falls apart again. Consistent with current research in vision therapy, our practice does not prescribed computer-based vision therapy. This allows us to have an amazing success rate in a very short amount of time; a typical vision therapy program only lasts a few months.

• Make sure the vision therapy sessions are performed one-on-one rather than in groups.
  Every person's visual system responds at different rates during vision therapy. Without one-on-one attention your child is at high risk for developing poor visual skills. Therapy will then take longer than expected, fail to provide improvements, or be inadequate for your child's needs; all leading to the likelihood that repeat vision therapy will be recommended. We provide one-on-one vision therapy at every visit with every child, allowing for results that last throughout the child's life.

• Do your research.
  There is a great deal of research available on the topic of vision therapy, some of which is available on our website. The efficacy of vision therapy and the physiologic basis for its success is documented in several journals. Knowing that vision therapy is most effective, and does not need to be repeated, when performed in-office with a trained therapist over the course of a few months will allow you to better understand what the doctor should be recommending and why.

So there you have it, when performed properly by trained individuals, vision therapy does not need to be repeated. If you are being told that your child needs a year or more of vision therapy or that vision therapy must be repeated, ask the doctor to show you the research to support this treatment plan and more importantly, seek a second opinion from a doctor with residency-training in binocular vision and vision therapy.