Vision Therapy Vs

Vision Therapy vs. Education of the Visually Impaired

Vision Therapy from a Certified Optometrist

Vision therapy, also known as visual training, vision training, or visual therapy, is a group of techniques attempting variously to correct or improve presumed ocular, oculomotor, visual processing, and perceptual disorders." [1] Vision therapy encompasses a wide variety of non-surgical methods[2] which some have divided into two broad categories: 1) orthoptic vision therapy, also known as orthoptics, and 2) behavioral vision therapy, also known as behavioral or developmental optometry.[1]

Orthoptics aims to treat binocular vision disorders such as strabismus, and diplopia. It is practiced by optometrists and ophthalmologists, as well as orthoptists and occupational therapists under the guidance of some ophthalmologists and pediatric ophthalmologists.

Behavioral vision therapy is practiced primarily by optometrists who specialize in this field. It treats additional problems including difficulties of visual attention and concentration, which may manifest as an inability to sustain focus or to shift focus from one area of space to another. The ability to shift the focus of visual attention from one place in space to another affects many aspects of life including reading, most vocations and most avocations. Eye doctors may also prescribe vision therapy to sufferers from eye strain and visually-induced headaches. However, not all such therapy is limited to disorders of the visual system. Professional athletes, for example, may use vision therapy to enhance sensitivity to peripheral vision on the playing field or increase responsiveness to fast moving objects.

History

Various forms of visual therapy have been used for centuries.[3] The concept of vision therapy was introduced in the late nineteenth century for the non-surgical treatment of misaligned eyes. This early and traditional form of vision therapy is what is now known as 'orthoptics.' Collaboration of some eye care professionals with educators and neuroscientists produced an expansion of vision therapy into the treatment of other eye teaming (binocular) deficits (the use of the flow through the right and left eyes simultaneously to the brain) as well as dysfunctions in visual focusing, perception, tracking and motor skills.

As a result of this expansion and ensuing confusion over what the term "vision therapy" includes, there is some controversy as to the use of vision therapy for individuals with learning disorders.

Although ophthalmologists and orthoptists often perform several components of visual therapy, most non-strabismic VT is performed by optometrists.[3]

Indications

There is widespread acceptance of orthoptic therapy indications for convergence insufficiency. Patients who experience eyestrain, "tired" eyes, or diplopia (double vision) while reading or performing other near work, and who have convergence insufficiency may benefit from orthoptic treatment. Patients whose outward drift occurs at distance rather than at near distance are less ideal candidates for treatment.

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 vision therapy does not directly treat learning disorders, but rather addresses underlying visual problems which are claimed to affect learning potential.[4]

Advocates cite a number of indications for the use of vision therapy. Some assert that poor eye tracking affects reading skills, and that improving tracking can improve reading.[5]

Efficacy

In 1988, a review of 238 scientific articles was published in the Journal of the American Optometric Association defining vision therapy as "a clinical approach for correcting and ameliorating the effects of eye movement disorders, non-strabismic binocular dysfunctions, focusing disorders, strabismus, amblyopia, nystagmus, and certain visual perceptual (information processing) disorders." The paper concluded, "It is evident from the research that there is scientific support for the efficacy of vision therapy in modifying and improving oculomotor, accommodative, and binocular system disorders, as measured by standardized clinical and laboratory testing methods for patients of all ages for whom it is properly undertaken and employed."[6]

A 2005 review concluded that "small controlled trials and a large number of cases support the treatment of convergence insufficiency. Less robust, but believable, evidence indicates visual training may be useful in developing fine stereoscopic skills and improving visual field remnants after brain damage. As yet there is no clear scientific evidence published in the mainstream literature supporting the use of eye exercises in the remainder of the areas reviewed, and their use therefore remains controversial."[7]

Convergence insufficiency is a common binocular vision disorder characterized by asthenopia, eye fatigue and discomfort.[8] Asthenopia may be aggravated by close work and is thought by some to contribute to reading inefficiency.[1] In 2005, the Convergence Insufficiency Treatment Trial published two large, randomized clinical studies examining the efficacy of orthoptic vision therapy in the treatment of symptomatic convergence insufficiency. Although neither study examined reading efficiency or comprehension, both demonstrated that in-office vision therapy was more effective than "pencil pushups" (a commonly prescribed home-based treatment) for improving the symptoms of asthenopia and the convergence ability of the eyes.[9][10] The design and results of at least one of these studies has been met with some reservation, questioning the conclusion as to whether intensive office-based treatment programs are truly more efficacious than a properly implemented home-based regimen.[11]

In 2006, noted neurologist Oliver Sacks published a case study about "Stereo Sue", a woman who had regained her stereo vision, absent for 25 years, after undergoing vision therapy. The article was published in The New Yorker magazine, which is not peer-reviewed, very few details were given of the exact therapies used and the article discussed only one case of stereo rehabilitation. Caution should therefore be advised in interpreting Sacks' conclusions.[12]

Controversy

Other than for strabismus and convergence insufficiency, the consensus among ophthalmologists and pediatricians is that visual training lacks documented evidence of effectiveness.[3][7] In 1998, the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus issued a policy statement regarding the use of vision therapy specifically for the treatment of learning problems and dyslexia. According to the statement: "No scientific evidence exists for the efficacy of eye exercises ('vision therapy')... in the remediation of these complex pediatric neurological conditions." [13] More recently, in 2004, the American Academy of Ophthalmology released a position statement asserting that there is no evidence that vision therapy retards the progression of myopia, no evidence that it improves visual function in those with hyperopia or astigmatism, or that it improves vision lost through disease processes.[14]

Optometrists take a slightly different view. In 1999 a joint statement by the American Academy of Optometry, the American Optometric Association, the College of Optometrists in Vision Development and Optometric Extension Program Foundation reported: "Many visual conditions can be treated effectively with spectacles or contact lenses alone; however, some are most effectively treated with vision therapy....Research has demonstrated that vision therapy can be an effective treatment option for ocular motility problems, non-strabismic binocular disorders, strabismus, amblyopia, accommodative disorders (and) visual information processing disorders."[15]

Although skeptics assert that vision therapists may have a financial bias in proclaiming the efficacy of the practice[16], proponents and advocates of vision therapy claim that other eye professionals have a similar bias in rejecting its claims.[17]

References

1.  ^ a b c American Academy of Ophthalmology. Complementary Therapy Assessment: Vision Therapy for Learning Disabilities. Retrieved August 2, 2006.

2.  ^ Aetna. Aetna Clinical Policy Bulletins: Vision Therapy. Retrieved August 2, 2006.

3.  ^ a b c Helveston EM. "Visual training: current status in ophthalmology." Am J Ophthalmol. 2005 Nov;140(5):903-10. PMID 16310470.

4.  ^ "Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association." J Am Optom Assoc. 1997 May;68(5):284-6. PMID 9170793.

5.  ^ http://www.childrensvision.com/vision_therapy.htm

6.  ^ The 1986/1987 Future of Visual Development/Performance Task Force. "Special Report: The efficacy of optometric vision therapy." J Am Optom Assoc. 1988;59:95-105. PMID 3283203

7.  ^ a b Rawstron JA, Burley CD, Elder MJ (2005). "A systematic review of the applicability and efficacy of eye exercises.". J Pediatr Ophthalmol Strabismus 42 (2): 82–8.

8.  ^ Bartiss M. "Convergence Insufficiency." eMedicine.com. Retrieved August 2, 2006.

9.  ^ Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, Borsting E, London R, Wensveen J; Convergence Insufficiency Treatment Trial Study Group. "A randomized clinical trial of treatments for convergence insufficiency in children." Arch Ophthalmol. 2005 Jan;123(1):14-24. PMID 15642806.

10.  ^ Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M, Borsting E, London R, Wensveen J. "A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults." Optom Vis Sci. 2005 Jul;82(7):583-95. PMID 16044063.

11.  ^ Kushner BJ. "The treatment of convergence insufficiency." Arch Ophthalmol. 2005 Jan;123(1):100-1. PMID 15642819.

12.  ^ Oliver Sacks (June 19, 2006). "A Neurologist's Notebook: "Stereo Sue"", The New Yorker, pp.64.

13.  ^ "Policy Statement: Learning Disabilities, Dyslexia, and Vision". American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. (September, 1998).

14.  ^ "Complementary Therapy Assessment: Vision Training for Refractive Errors". American Academy of Ophthalmology (2004). Retrieved on 2008-04-09.

15.  ^ "Vision Therapy a joint organizational policy statement". American Academy of Optometry (1999).

16.  ^ Worrall, RS; Nevyas, J; Barrett, S.. "Eye-Related Quackery". Quackwatch. Retrieved on 2006-08-02.

17.  ^ Cooper, R.. "Why would some ophthalmologists and their organizations claim that vision therapy doesn't work?". VisionTherapy.org.

http://en.wikipedia.org/wiki/Vision_therapist

Vision Education from a Teacher of the Visually Impaired (TVI)

Compensatory or Functional Academic Skills, Including Communication Modes

Compensatory and functional skills include such learning experiences as concept development, spatial understanding, study and organizational skills, speaking and listening skills, and adaptations necessary for accessing all areas of the existing core curriculum. Communication needs will vary, depending on degree of functional vision, effects of additional disabilities, and the task to be done. Children may use braille, large print, print with the use of optical devices, regular print, tactile symbols, a calendar system, sign language, and/or recorded materials to communicate. Regardless, each student will need instruction from a teacher with professional preparation to instruct students with visual impairments in each of the compensatory and functional skills they need to master. These compensatory and functional needs of the visually impaired child are significant, and are not addressed with sufficient specificity in the existing core curriculum.

Orientation and Mobility

As a part of the expanded core curriculum, orientation and mobility is a vital area of learning. Teachers who have been specifically prepared to teach orientation and mobility to blind and visually impaired learners are necessary in the delivery of this curriculum. Students will need to learn about themselves and the environment in which they move - from basic body image to independent travel in rural areas and busy cities. The existing core curriculum does not include provision for this instruction. It has been said that the two primary effects of blindness on the individual are communication and locomotion. The expanded core curriculum must include emphasis on the fundamental need and basic right of visually impaired persons to travel as independently as possible, enjoying and learning from the environment through which they are passing to the greatest extent possible.

Social Interaction Skills

Almost all social skills used by sighted children and adults have been learned by visually observing the environment and other persons, and behaving in socially appropriate ways based on that information. Social interaction skills are not learned casually and incidentally by blind and visually impaired individuals as they are by sighted persons. Social skills must be carefully, consciously, and sequentially taught to blind and visually impaired students. Nothing in the existing core curriculum addresses this critical need in a satisfactory manner. Thus, instruction in social interaction skills becomes a part of the expanded core curriculum as a need so fundamental that it can often mean the difference between social isolation and a satisfying and fulfilling life as an adult.

Independent Living Skills

This area of the expanded core curriculum is often referred to as "daily living skills." It consists of all the tasks and functions persons perform, in accordance with their abilities, in order to lead lives as independently as possible. These curricular needs are varied, as they include skills in personal hygiene, food preparation, money management, time monitoring, organization, etc. Some independent living skills are addressed in the existing core curriculum, but they often are introduced as splinter skills, appearing in learning material, disappearing, and then re-appearing. This approach will not adequately prepare blind and visually impaired students for adult life. Traditional classes in home economics and family life are not enough to meet the learning needs of most visually impaired students, since they assume a basic level of knowledge, acquired incidentally through vision. The skills and knowledge that sighted students acquire by casually and incidentally observing and interacting with their environment are often difficult, if not impossible, for blind and visually impaired students to learn without direct, sequential instruction by knowledgeable persons.

Recreation and Leisure Skills

Skills in recreation and leisure are seldom offered as a part of the existing core curriculum. Rather, physical education in the form of team games and athletics are the usual way in which physical fitness needs are met for sighted students. Many of the activities in physical education are excellent and appropriate for visually impaired students. In addition, however, these students need to develop activities in recreation and leisure that they can enjoy throughout their adult lives. Most often sighted persons select their recreation and leisure activity repertoire by visually observing activities and choosing those in which they wish to participate. The teaching of recreation and leisure skills to blind and visually impaired students must be planned and deliberately taught, and should focus on the development of life-long skills.

Career Education

There is a need for general vocational education, as offered in the traditional core curriculum, as well as the need for career education offered specifically for blind and visually impaired students. Many of the skills and knowledge offered to all students through vocational education can be of value to blind and visually impaired students. They will not be sufficient, however, to prepare students for adult life, since such instruction assumes a basic knowledge of the world of work based on prior visual experiences. Career education in an expanded core curriculum will provide the visually impaired learner of all ages with the opportunity to learn first-hand the work done by the bank teller, the gardener, the social worker, the artist, etc. It will provide the student opportunities to explore strengths and interests in a systematic, well-planned manner. Once more, the disadvantage facing the visually impaired learner is the lack of information about work and jobs that the sighted student acquires by observation.