Vision Therapy FAQ
Many parents of children or patients with brain injury are told they or their child should be evaluated for vision therapy, vision training, and vision rehabilitation. There is a lot of controversy about vision therapy and in this section we hope to answer the most frequently asked questions and provide some evidence-based resources
How common are eye movement disorders in brain injury and the general population?
Convergence and accommodative disorders are common eye movement abnormalities in pediatric development as well as post-concussion/TBI. These conditions are prevalent in 10-17% of the general population and up to 50-80% of patients who have suffered a traumatic brain injury or other neurological disease like Parkinson's disease, and can cause patients to have difficulties with reading, visual clarity and computer tasks as well as physical symptoms like headaches/dizziness/nausea with visual tasks like reading/computer/grocery shopping/driving.
What symptoms does vision therapy alleviate?
Common symptoms of eye movement disorders may include:
-
Double vision ​
-
Intermittent blurry vision
-
Losing ones place while reading
-
Re-reading
-
Difficulties with concentration while reading
-
Eye fatigue
-
Eye pain/soreness/pulling sensation around the eyes
-
Headaches, dizziness, nausea, anxiety, and brain fog with visual tasks like reading, computer, walking, or being in the car
Can vision therapy fix dyslexia?
No. Dyslexia is a language disorder that causes people to have trouble interpreting the language of words and text. The symptoms of learning disorders and dyslexia may overlap with eye movement dysfunction so it is important to have a neuro-optometric exam to rule out an eye movement problem that someone may have instead of or in addition to their learning disorder, as the eye movement problem can often be remediated which can help improve reading.
What is neuro-optometric vision rehabilitation?
Neuro-optometric vision rehabilitation is the term used to describe the individualized treatment regimen for a patient with visual deficits as a direct result of neurological injury and disease. This treatment plan is based off of the results of a comprehensive neuro-optometric examination and may include patient education on adaptive techniques to cope with neurologic vision loss, tinted lenses to improve contrast sensitivity/glare/light sensitivity, prism lenses to alleviate double vision or help with spatial orientation and neurologic visual field loss, and vision therapy. For even more information on neuro-optometric rehabilitation we recommend you visit the NORA (Neuro-Optometric Rehabilitation Association) website (click here).
Does everyone need vision therapy?
Not everyone is a candidate for vision therapy and not everything can be treated with vision therapy. Some oculomotor disorders and double vision require prismatic correction and/or surgery for remediation and some patients are too young to start vision therapy.
A thorough neuro-optometric/oculomotor evaluation is needed to see if a patient has a problem that can be alleviated by vision therapy and if it is an age-appropriate treatment option for them.
Can I do vision therapy at home?
Due to the symptom provocation with vision therapy for patients with brain injury like dizziness/headache, the difficulty getting transportation to the office, and the inconvenience of having to schedule in-office vision therapy visits during the 9-5 work day for the majority of patients, Dr Theis recommends at-home vision exercises you can do either online with vision software, or with simple home-based equipment for the majority of her patients. This methodology allows patients to do vision therapy on their own schedule, with follow up visits with Dr Theis as needed to help guide you through the therapy, keep you motivated, and get you results!
How many visits will I need?
Every patient is different and there is no definitive answer to this question. However, Dr. Theis' goal is to get you better as soon as possible in the fewest number of office follow up visits!
In her extensive clinical experience, the majority of orthoptics vision therapy can be successfully performed in a home-based daily vision therapy program with telemedicine/office follow-up visits to help guide the patient's success every 1-2 weeks. This methodology is not only cost-effective for the patient, but reduces the burden on the patient/family to acquire transportation and take time off of work for weekly/biweekly in-office visits. Additionally, this method reduces triggering symptoms in patients who are unable to tolerate vehicle transportation due to their brain injury. Dr. Theis will monitor the patient's on-going progress and tailor the rehabilitation program to the patient's oculomotor system to expedite recovery. This is helpful for pediatric patients and patients with brain injury as it allows for flexibility in rehabilitation and recovery so it can fit into your life.
Will I have to do vision therapy forever!?
Absolutely not. Vision therapy should be a treatment - meaning once you finish, you should be done. It is possible that some conditions require rechecks for stability in the future and/or glasses, but this is less common. Once fully rehabbed, the therapy can be tapered and discontinued. Symptoms usually only regress if the therapy is terminated prior to 100% completion/remediation.
​References
-
Scheiman M, Cotter S, Rouse M, Mitchell GL, Kulp M, Cooper J, Borsting E; Convergence Insufficiency Treatment Trial Study Group. Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children. Br J Ophthalmol. 2005 Oct;89(10):1318-23. doi: 10.1136/bjo.2005.068197. PMID: 16170124; PMCID: PMC1772876.
-
Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008 Oct;126(10):1336-49. doi: 10.1001/archopht.126.10.1336. PMID: 18852411; PMCID: PMC2779032.
-
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. doi: 10.1097/01.opx.0000171331.36871.2f. PMID: 16044063.
-
Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, Hopkins KB, Bartuccio M, Chung I; Convergence Insufficiency Treatment Trial Study Group. Treatment of accommodative dysfunction in children: results from a randomized clinical trial. Optom Vis Sci. 2011 Nov;88(11):1343-52. doi: 10.1097/OPX.0b013e31822f4d7c. PMID: 21873922; PMCID: PMC3204163.
-
McGregor ML. Convergence insufficiency and vision therapy. Pediatr Clin North Am. 2014 Jun;61(3):621-30. doi: 10.1016/j.pcl.2014.03.010. PMID: 24852157.
-
Gallaway M, Scheiman M, Mitchell GL. Vision Therapy for Post-Concussion Vision Disorders. Optom Vis Sci. 2017 Jan;94(1):68-73. doi: 10.1097/OPX.0000000000000935. PMID: 27505624.
-
Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody DL, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin RJ, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R. Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery. 2016 Dec;79(6):912-929. doi: 10.1227/NEU.0000000000001447. PMID: 27741219; PMCID: PMC5119544.
-
Fox SM, Koons P, Dang SH. Vision Rehabilitation After Traumatic Brain Injury. Phys Med Rehabil Clin N Am. 2019 Feb;30(1):171-188. doi: 10.1016/j.pmr.2018.09.001. Epub 2018 Oct 31. PMID: 30470420.​
-
Ciuffreda KJ, Rutner D, Kapoor N, Suchoff IB, Craig S, Han ME. Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2008 Jan;79(1):18-22. doi: 10.1016/j.optm.2007.10.004. PMID: 18156092.