Vision Therapy vs Pencil Push-ups

Vision therapy can be a bit unfamiliar to some people. We are going to begin this blog by discussing briefly when vision therapy is used. Many visual conditions can be effectively treated and managed with prescription glasses or contact lenses. However, for other visual conditions (convergence insufficiency, binocular vision dysfunction, etc) prescription glasses or contact lenses cannot correct the vision problem. It is in these cases that vision therapy may be prescribed.

Vision therapy is an individualized treatment program to correct visual system deficits. The most effective vision therapy programs offer in-office vision therapy appointments and treatment is under the guidance of a doctor. The duration of treatment varies depending on the severity of the visual condition(s). The vision therapy treatment program itself is based on the results of standardized tests and the specific diagnoses.

Vision therapy is typically prescribed and monitored at regularly scheduled intervals by a residency trained neuro-optometrist or a residency trained binocular vision therapy optometrist. This is an important point because only optometrists who have completed residency training in neuro-optometry or binocular vision therapy possess the training and clinical expertise to prescribe and monitor vision therapy. Vision therapy should not be prescribed or administered by someone who has not completed formal training.

So, why is it that doctors and occupational therapists who are not trained in the field of neuro-optometry or vision therapy routinely prescribe pencil pushups and base-in reading glasses in an attempt to correct convergence insufficiency, binocular vision dysfunction, etc.? These two treatment modalities (pencil pushups and base-in reading glasses) are commonly prescribed by both optometrists and ophthalmologists – with 87% prescribing these two treatment modalities fairly often, often, or always for young patients who are symptomatic for convergence insufficiency. But do they work?

There are several studies evaluating the effectiveness of in-office vision therapy and pencil pushups. One such study revealed that after 12 weeks of therapy the convergence insufficiency score was significantly reduced in the in-office vision therapy group from 32.1 to 9.5. However, after 12 weeks of pencil pushups the convergence insufficiency score decreased from 29.3 to 25.9. It is of particular interest to note that pencil pushup therapy was found to be no more effective than the placebo therapy.

It is important to remember that the Convergence Insufficiency Symptom Survey used for the Convergence Insufficiency Treatment Trial established that a score of 16 or greater is considered significant for symptoms associated with Convergence Insufficiency. Comparing the establlished score of 16 to the score of 9.5 following 12 weeks of in-office vision therapy and to the score of 25.9 following 12 weeks of pencil pushups, it is easy to understand why pencil pushups are considered an ineffective form of therapeutic treatment.

Another study looked at adults 19 to 30 years of age with symptomatic convergence insufficiency. This study was also 12 weeks in duration and compared in-office vision therapy to pencil pushups and placebo therapy. In this particular study, only in-office vision therapy produced clinically significant improvements in convergence insufficiency. At the end of 12 weeks of therapy 58% of in-office vision therapy patients were symptomatic, while 80% of pencil pushup patients continued to be symptomatic. The study summarized the results as: After only 12 weeks of treatment 50% of all patients who participated in in-office vision therapy were considered “cured”, indicating that treatment beyond 12 weeks would further improve results. Conversely, none of the patients who participated in either the pencil pushup program or the placebo program were “cured”.

Based on the results of both of the studies mentioned above, indications are that pencil pushups, the most frequently used treatment for convergence insufficiency, are not effective in achieving clinically significant improvements in symptoms in either children or young adults.

In another study of children 9 to 18 years of age, one group was prescribed 12 weeks of home based computerized vision therapy while another group was prescribed home based pencil pushups. The results revealed that the majority of participants in the home based computerized vision therapy program as well as the home based pencil pushup group were not successful. In other words, neither group showed any clinically significant improvement, and children treated with the placebo therapy achieved equal results.

Its interesting to circle back around to the question of why pencil pushups are prescribed so often by doctors and occupational therapists. In large part it may be due to cost – literally the cost of purchasing a pencil. It is also easy for the doctor or occupational therapist to prescribe - it is easy to show a patient how to do a pencil pushup. Beyond these two reasons however, it is difficult to understand why anyone would consider prescribing pencil pushups - a therapy modality that multiple studies have proven to be completely ineffective.

So, if you are someone you know have symptoms of convergence insufficiency be sure to begin with a comprehensive evaluation with a residency trained neuro-optometrist or a residency trained binocular vision therapy optometrist. Relying on the doctor's specialized training, standardized testing, and an accurate diagnosis will help determine the best course of treatment. Remember, there's much more to vision therapy then ill prescribed pencil pushups.