So You're Thinking About Vision Therapy?

There is an age old proverb that says “the eyes are the windows to the soul.” And today, we can take it even one step further and say that the eyes are windows to the mind, or perhaps more precisely, the brain. With some disorders, the eye literally allows physicians to peek at the inner workings of parts of the brain and observe structures such as nerves and other brain matter.

It is truly amazing to reflect on the science that has evolved during the past century about how the eyes work, how the brain receives and processes all sorts of sensory information, and how visual information maps onto the many different ways (involving hearing, balance, movement, emotion) that we understand and appreciate our world.

The eye is a complex organ that, when healthy and working properly, allows for sensory information to be transmitted to the brain and “processed” almost instantaneously, resulting in our being able to thinking, understand, make decisions and take actions. For individuals with dyslexia and other types of learning disabilities (LD) as well as those with AD/HD who struggle with reading, writing, math and related skills due to weaknesses in planning and organizing printed material, eye health and corrected vision (if needed) is critical to success.

What do we know about vision therapies and their proven benefit for those who struggle with learning?

Colored Overlays or Colored Lenses One treatment approach involves the use of colored lenses worn in glasses or thin plastic overlays that are placed over or in front of printed text. This approach is alleged to treat a condition called “scototopic sensitivity syndrome” or Irlen Syndrome, named after the person who first described the condition and this treatment approach. It has become increasingly popular because it is inexpensive (although being evaluated and fitted for lenses or a good color match can cost hundreds of dollars), the materials are easy to come by, and the approach is generally agreed to pose “no risk” to users.

Believers in this treatment have reported experiencing relief from eye strain and improved ability to see printed letters against a background when reading and scanning. Some have also said that when using these lenses and overlays, words no longer appear to move, dance, float, or shift on a page, and letters appear less blurry, scrunched together, pulled apart or double. Some people have also reported relief from headaches or nausea when reading.

The Irlen website cites that “this technology can improve reading fluency, comfort, comprehension, attention, and concentration while reducing light sensitivity” and “is not a method of reading instruction.” To its credit, the site does not state that these lenses, overlays or filters provide a cure for LD or AD/HD, stating that it “can be one piece of the solution puzzle” that “does not replace the need for instruction, remediation, or medical intervention.”

The bottom line on colored overlays or tinted lenses: Visit an ophthalmologist for a comprehensive eye exam if you have questions about eye health and for advice about whether (or how) to address issues of eye strain, visual acuity or other difficulties related to vision. Try this approach if you’re curious. If your reading problems go away, great! Just know that what you were treating was not LD (dyslexia) or AD/HD.

Vision TrainingAdvocates of this approach believe that “when a child struggles to read, write or fully participate in school, a visually- related learning disability could be the cause.” In some instances, the entire evaluation takes place in an optometrist’s office. In other instances, the evaluation includes testing by other professionals who assess intelligence, information processing, speech/ language development, academic achievement, attention skills, and social/emotional dynamics.

Visual therapy approaches programs vary widely, but almost always include eye exercises and what is referred to as perceptual training. Behavioral optometrists are the ones who offer this therapy, with treatments involving in-office visits and exercises to do at home, and often, the prescription of low-power lenses. Even when children are found to have good eye health, vision therapists report that those who struggle with learning may have subtle difficulties in such areas as:

• Sensitivity to certain light frequencies
• Eye movements and fixation
• Visual tracking (coordination of eye movements)
• Visual accommodation (eyes focusing)
• Binocular vision (eye teaming)
• Convergence (eyes aiming properly and working together at the same levels of accuracy and performance for different distances)
• Problems with sustaining visual attention, integration of vision with hand and body movements and mild muscle irregularities

According to this approach, these weaknesses can result in:

• Headaches, eye strain and poor posture
• Problems with reading, spelling, attention, hyperactivity, coordination, and learning in general
• Trouble with sports
• Low motivation and trouble working independently
• Impaired potential for achievement

Ophthalmologists and behavioral optometrists disagree about whether vision therapy is beneficial for individuals with LD and AD/HD. The American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology all say that there is insufficient evidence to recommend vision therapy as an effective treatment.

With regard to dyslexia, decades of research, including more recent neuroimaging studies, show us that reading is not a vision problem but rather a problem with language processing that takes place in highly specialized ways in the brain. We are lacking the kind of “proof” needed to determine whether vision therapy can result in any benefit for those with LD or AD/HD, and if so, for which individuals these treatments are likely to be effective.

The bottom line about vision therapy: The theoretic basis of vision therapy (for individuals with LD and AD/HD) does not fit with our scientific understanding of these disorders. While vision therapy seems like a logical approach, is not “invasive” and doesn’t demand that a child be labeled with a disability to receive treatment, it has not been proven to be any more effective than engaging a learning specialist to deliver tutoring or coaching that is targeted to specific areas of need. Vision therapy may not hurt but it may not help; it is often expensive, demands many weeks or months of treatment, and is not a reimbursable expense under most insurance plans. Even if vision therapy does decrease fatigue while reading, and encourage increased time on task because of reduced eye strain, there is no scientific evidence to prove that vision therapy will improve academic performance.