Frequently Asked Quesitons


What is Vision Therapy?

 

Vision Therapy is physical therapy for the eyes and brain.  It is important not to forget the brain's role in vision.  In fact, we actually see with our brains not with our eyes.  Vision therapy works on the science of neuroplasticity and in this respect it has a mechanism similar to occupational therapy and speech therapy.


Are "orthoptics" and Vision Therapy the same thing?

 

Orthoptics, which means "straightening of the eyes", goes back to the nineteenth century and was limited to eye muscle training and cosmetic straightening of the eyes.  Vision Therapy includes orthoptics but has advanced far beyond the limited scope of orthoptics.  Vision Therapy includes training and rehabilitation for the eye-brain connections involved in vision.  There are many connections between the scientific developments in Vision Therapy and those in neuroscience.

In fact, one of the most famous vision therapy patients is neuroscientist Dr. Susan Barry, who, through vision therapy, was able to see in three dimensions for the first time in her life at age 47. Her experience had such a profound effect on her personally and intellectually, that she wrote a book, Fixing My Gaze, about it and was the subject of an article in the New Yorker by Oliver Sacks.

 

 

Dr. Susan Barry gave this TED Talk about depth perception and vision therapy:

 


What is the difference between an optometrist and an ophthalmologist?

 

There are two kinds of eye doctors: optometrists and ophthalmologists.  An optometrist is a doctor of optometry (OD) who diagnoses and treats problems of the visual system.  Some optometrists specialized in vision therapy.  An ophthalmologist is a doctor of medicine (MD) who specializes in surgery and diseases of the eye.

 

 

What do teachers say about vision therapy?


At study published in the Journal of Behavioral Optometry surveyed 150 teachers in Michigan through an online survey.  The purpose was to examine the perceptions of teachers concerning the connection between vision problem detection, academic achievement and vision therapy intervention. Learn more.

 

Why do some ophthalmologists and their organizations claim that vision therapy does not work?

 

Ophthalmologists are not trained in non-surgical treatments for vision disorders.  Therefore, they naturally are not fully aware of non-surgical treatments such as vision therapy for conditions like strabismus.  This problem was the subject of a worldwide study by Dr. Paul Romano, MD, editor of the journal Eye Muscle Surgery Quarterly.  Dr. Romano asked surgeons around the world whether they were in favour of a surgical or non-surgical treatment of intermittent exotropia (a form of strabismus).

In the international group of doctors, 85% were in favour of non-surgical treatments.  However, in the American group, only 52% of doctors were in favour of non-surgical treatments.  Dr. Romano proposed three reasons for why there was this difference:

 

1. Insurance companies and single-payer systems outside the USA have stricter medical standards in regards to approving payment of eye muscle surgery.  Also, they do not pay as well fro eye muscle surgery as insurance companies in the USA.

2.  Non-surgical therapy isn't as economically rewarding for the surgeon as surgery .

3.  Due to his lack of training in the area, the surgeon is reluctant to acknowledge the benefits of non-surgical treatment for fear of loosing patients.

 

Vision therapy has been proven effective in treating strabismus but ophthalmologists began to prefer surgery because of the theory of the "critical period"


Dr. Susan Barry published an editorial in 2010 in the Journal of the American Optometric Association where she addressed the history of the treatment of strabismus to illustrate the reason why many ophthalmologists only recommend surgery only to correct problems like strabismus which can be (and have been) effectively treated with vision therapy.  Dr. Barry herself underwent 3 strabismus surgeries as a child which failed to give her stereo vision (since birth she was unable to see in three dimensions).  She saw an optometrist in her 40's who treated her with vision therapy and allowed her to see in 3D for the first time in her life.  The following is an excerpt from Dr. Barry's editorial:

 

 Armed with the concept of the critical period, ophthalmologists began to operate on strabismic infants in the first year of life with some success.  With the push for early surgery and an emphasis on treating very young children, they abandoned, for the most part, the orthoptic [eye training exercises] techniques pioneered in the late 1800s by Louis Emile Javal.  These procedures had been effective in straightening the eyes and promoting stereopsis in adult patients, but the time and effort involved in this training was considered prohibitive.  It was left to a small group of optometrists to develop better rehabilitation techniques.

 

Frederick Brock and William Ludlam as well as other optometrists spent their careers examining not only how their strabismic patients moved their eyes but what it was that their patients actually saw.  They realized that strabismus is as much an adaptation to underlying binocular imbalances as it is a cause of a poor ability to fuse.  With these observations, they modified and expanded orthoptics into a series of vision training or vision therapy procedures that were enormously effective.  In one study of 149 adult strabismics, Ludlam reported that straight eyes and binocular vision developed in 75% of patients, none of whom had had surgery.  From the 1930's  through the 1950's Brock published extensively in optometric journals.  However, with the growing momentum for the concept of the critical period and the push for early strabismic surgery, these studies were largely ignored.

 

Today, a relatively small group of optometrists still practice and continue to perfect optometric vision therapy techniques.  ...  Yet, it is difficult for a strabismic patient to learn about, much less access, this type of clinician.  Many ophthalmologists are hostile to and ignorant of optometric vision therapy and do not recommend, or may actively discourage, their patients from pursuing these treatments.  I was indeed lucky enough to consult an optometrist who saw my need for vision therapy and who referred me to an optometric colleague who was skilled in these techniques.  Finally, optometric vision therapy may not be covered by medical insurance, creating the impression that the therapy is either dubious or unaffordable.  When adult strabismics are told that they are too old to change, that those who provide optometric vision therapy are practicing unproven regimes, that the therapy is not covered by insurance, and that their subnormal vision is good enough, it's no wonder a story like mine is "one in a million".  The barriers to better vision for a strabismic patient originate more from old dogma and professional prejudice that from the underlying biological cause"

 

It is recognized that ophthalmologists are not trained to diagnose visual information processing disorders and that patients should be referred to an optometrist for assessment. Raymond et al. recommend the assessment of visual processing should be done by an optometrist – not an ophthalmologist. The ophthalmologist, according to the authors, does not have the expertise to make the assessment. The study authors note that patients: 

 

"should be referred to a behavioral or neuro-optometrist. It was also noted that referrals made to an ophthalmologist may be insufficient, as they are primarily concerned with the health of the eye only, and ophthalmologists are mostly experienced with acute medical problems rather than rehabilitation issues. This assertion is supported by considering the typical components of an ophthalmologic exam, which may yield a lack of specificity, and/or provide information which is inadequately defined in terms of rehabilitation consequence. Trobe, Acosta, Kirscher and Trick identify a lack of measurement in areas of distance and near acuities, contrast sensitivity and confrontation, while Gianutsos and Matheson describe a need for greater quantification in terms of field gradations and boundaries, and binocularity conditions. A more thorough investigation is important for the rehabilitative efforts of all patients who demonstrate visual processing deficits.

 

Ophthalmologists are excellent surgeons and expert at treating acute disease but their expertise does not to extend to the diagnosis or treatment of visual processing deficits."

Are optometrists or ophthalmologists the ultimate authorities on eye care and vision therapy?

 

The public needs to be aware that ophthalmologists are not the ultimate authorities in all areas of visual health.  Ophthalmologists are excellent surgeons and knowledgeable authorities on eye disease.  However, as a rule, they are not well informed about vision care subjects such as visual processing, convergence insufficiency, accommodation and vision therapy.  In fact, many ophthalmologists agree with this. 


For example, in the journal, Transactions of the American Ophthalmological Society, surgeon and researcher Dr. David Guyton wrote that, "[ophthalmologists] have probably abdicated the study of accommodation and convergence to the optometric profession.  A perusal of the literature with reveal that most of the advances in this area are being made in the optometric institutions by vision scientists who use definitions and terms with which we are not even familiar."  


Ophthalmologists, while excellent surgeons, are not trained in and do not have expertise in vision therapy and many who criticize vision therapy simply have not done their homework.  Optometrists who specialize in vision therapy are the most credible authorities on vision therapy and developmental vision.

 

How long has Dr. Randhawa been doing vision therapy?

 

Since 2005

 

Will my family doctor be able to talk to me about vision therapy?

 

Probably not.  Your family doctor spends four years in medical school (following four years of undergraduate education) learning about the body and its systems generally.  Optometrists spend four years in optometry school (following four years of undergraduate education) concentrating on the eyes, vision, and vision disorders.  Therefore,  optometrists are the experts in vision science.  If you have a family optometrist, that doctor will be able to talk to you about vision therapy and we encourage you to speak to your optometrist. 

 

What is Dr. Randhawa's success rate with vision therapy?

 

100% of Dr. Randhawa's patients have experienced improved vision, ocular motor skills, and visual processing.  This includes patients with strabismus who have achieved perfect and normal alignment of their eyes along with normal binocular vision through vision therapy.  These patients have avoided surgery and the risks that go along with it.  Dr. Randhawa's success with vision therapy is due to a  number of factors.  Dr. Randhawa does not recommend vision therapy unless there is a very strong likelihood of seeing improvement in the patient.  It is also due to the fact that vision therapy is a very effective treatment for the visual problems and ocular motor disorders for which Dr. Randhawa prescribes it. 

 

Vision therapy does not work for every condition and every patient and if this is the case Dr. Randhawa will recommend alternative treatments or make a referral to another doctor.

 

Statements from MDs about Vision Therapy

Here is the COVD's collection of statements from MDs about vision therapy:

 

Pediatrician and Parent Advocate for the National Center for Learning Disabilities


Dr. Debra Walhof is a Pediatrician who specializes in Integrative Medicine.  During the past 20 years, she has practiced in hospital, academic and community-based clinical settings.  Her work has focused primarily on multi-cultural and under served populations who present as "at risk" across many developmental and behavioral domains.  According to Dr. Walhof:


“It is important to remember that normal sight may not necessarily be synonymous with normal vision... That being said, if there is a vision problem, it could be preventing the best tutoring and learning methods from working. Now that certainly doesn't mean every dyslexic child needs vision therapy, however in my opinion, skills such as focusing, tracking and others are essential foundational tools for reading. In general, if your child has trouble with reading or learning to read, getting a vision evaluation to assess these skills from a qualified Developmental Optometrist would be a smart move.”


Psychiatrist & Physician


Dr. Katherine Donovan, a Psychiatrist from Charleston, S.C., was one of those parents who didn’t give up, “It wasn’t until my own child had problems with reading that I discovered that my medical training was missing a very valuable piece of information which turned out to be the key to helping my daughter, Lily. While I had taken Lily to many ophthalmologists and learning specialists, desperate to understand why this very bright child still could not read well, or write legibly at age 12, I always got the same answers:  ‘her vision’s fine’ and ‘she’s dyslexic.’”


“As a physician, I had been taught that vision therapy was controversial and could not treat learning disabilities. However, my personal experience with my daughter proved to me that vision therapy worked, when nothing else did,” Dr. Donovan shares. “While vision therapy cannot treat learning disabilities, per se, it absolutely corrected a vision problem which was blocking Lily from being able to learn. After a visit with a developmental optometrist who tested over 15 visual skills critical to reading and learning, I was shocked to learn that Lily was seeing double out to three FEET—which meant that when she tried to read, the words were double. No wonder she hated to read!” Following optometric vision therapy, “Lily now reads 300 pages a day, in her free time; she puts down ‘reading’ as her favorite hobby; and she has a 95-average at Buist Academy with NO help from me on her homework! Prior to this, I’d been spending three to four hours each night, for many years, tutoring Lily,” Dr. Donovan shares with delight. 


 Physician and Medical Expert Witness for Medico-Legal Cases


Even though there is a wealth of optometric research which proves vision therapy works, as Dr. Donovan mentioned, there is false information in the medical community about vision therapy.  This can be confusing for parents, especially when it comes from their child’s pediatrician.  


Dr. Joseph Manley, a physician and medical expert witness for medico-legal cases, states, “The conclusions (particularly the failure to recommend vision therapy for children likely to benefit from it) of the American Academy of Pediatrics report on Learning Disabilities, Dyslexia and Vision are based on exclusion of the most relevant data and inconsistent application of the Academy's stated criteria for selecting evidence.  They fail to acknowledge abundant published and anecdotal evidence supporting the use of vision therapy.  This overlooked evidence includes controlled trials, observational studies, case reports and consensus of experts - the same kinds of data that underpin the daily practice of medical professionals.”

Neurologists & Leading Clinicians on Learning Disabilities


Brock Eide, M.D., M.A. and Fernette Eide, M.D., leading clinicians and writers on learning disabilities, state, “In spite of the very positive research findings validating the role vision plays in learning, some are still claiming visual dysfunction plays little or no role in the reading challenges that dyslexics face. This is a shame. When we look specifically at the results of studies performed to address specific visual issues, the evidence supporting visual therapy is quite strong.”


The Eides run the Eide Neurolearning Clinic in Edmonds, Washington, are authors of the popular book, The Mislabeled Child:  How Understanding Your Child’s Unique Learning Style Can Open the Door to Success, and lecture throughout the U.S. and Canada to parents, educators, therapists, and doctors. Drs.  Eides have published extensively in the fields of gifted education, learning disabilities, and twice exceptionalities such as giftedness and dyslexia, and served as consultants to the President's Council on Bioethics.

 “While not all children or adults with dyslexia have visual processing problems, many --at least two-thirds in some studies-- do. This makes sense from a neurological standpoint, because several of the structural neurological features associated with dyslexia appear to predispose to visual difficulties,” Dr. Brock Eide adds.


“Not surprisingly, several types of visual difficulties are more common in dyslexic than non-dyslexic children. In one study of dyslexic children, just one type of visual problem, near-point convergence insufficiency, was present in 30-40% of the dyslexic children, compared to just 20% of controls. As can be seen from this control figure, visual processing problems are also quite common in non-dyslexic school-age children,” Eide continues.


Dr. Fernette Eide explains, “The bottom line is that visual problems are common, though not universal, in children who struggle to read; and optometric vision therapy can help address visual problems in children with significant visual dysfunction. A good visual examination is an important part of the workup of every struggling reader.” 


Ophthalmologists


Ophthalmologist, Dr. Bruce Sumlin, writes, “Optometric vision therapy makes sense.  It is very similar to other kinds of treatment and therapies we provide in the medical disciplines which help to develop neural connections in the brain.”John B. Ferguson III, MD, an ophthalmologist who has been in practice for over 34 years, was not always a strong believer in vision therapy.  When asked what made him change his mind, Dr. Ferguson shared, "Among ophthalmologists, vision therapy has been thought to be reserved for certain eye muscle disorders. I was unaware, and I believe many other ophthalmologists are also unaware, of the significant effects that these eye muscle disorders have on the attitude and behavior of some children. I thought that at the most these children, if left untreated, might experience headaches or read less efficiently. However, I had the opportunity to speak with children and the parents of children who went through vision therapy and I was very impressed by the dramatic and positive academic and behavioral changes they experienced."


According to ophthalmologist, Robert Abel, in his book The Eyecare Revolution: 
“Vision therapy is taught at optometry schools; ophthalmologists know very little about it … It can change people’s lives, as it has for President Lyndon Baines Johnson’s daughter, Lucy, whose dyslexia was helped greatly by vision therapy.”
In an editorial responding to an article, “Optometric Vision Therapy &Training for Learning Disabilities and Dyslexia,” Dr. Paul Romano, ophthalmologist and editor of the Binocular Vision & Strabismus Quarterly states:


“…why should I think that my fellow ophthalmologists are correct about dyslexia and learning disabilities virtually never being a real eye problem and amenable to some eye directed therapy? I must trust my own 30 years of personal experience.”
“There is no doubt in my mind that the exams most orthoptists, ophthalmic technicians and ophthalmologists, including pediatric ophthalmologists, perform for the learning disabled or the dyslexic child are too often inadequate or incomplete and are unable to find these ‘subtle abnormalities of monocular and binocular vision which may give rise to these problems...”


“Also I simply do not believe the current organized ophthalmology-pediatric ophthalmology mantra that virtually nothing with regard to binocular vision (except maybe convergence insufficiency) can be affected, altered or improved by anything other than surgery. There are too many other areas in medicine where change is achieved without drugs or surgery.”


How to Identify a Vision Problem

Children should be referred for a comprehensive eye exam whenever visual symptoms are noticed or if they are not achieving their potential. Many of these vision problems will not be detected during a school vision screening or limited vision assessment as part of a school physical or routine pediatric health evaluation. 

Locate a Doctor in your area who is experienced and knowledgeable in diagnosing and treating learning-related vision problems.

 

 

 

 

 

Videos

Strabismus, 3D & VT

Children's Vision

Saving a Mom's Vision

Life-Saving Eye Exam