Evidence Based Vision Therapy for Reading and Learning

Optometric Vision Therapy: Evidence Based Treatment for Vision Problems Related to Reading and Learning


For a long time vision has been taken for granted with relation to reading and learning.  If a child or adult can see clearly, and has healthy eyes it is assumed that vision is not part of the problem.  This can lead to missed diagnoses, and mis-diagnoses.


Evidence Review


Effect of treatment of symptomatic convergence insufficiency on reading in children: a pilot study.
Scheiman M1Chase C2Borsting E3Lynn Mitchell G4Kulp MT4Cotter SA3CITT-RS Study Group.
Clin Exp Optom. 2018 Mar 25

‘After treatment for convergence insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001).’

Improvement in academic behaviors after successful treatment of convergence insufficiency.
Borsting E1Mitchell GLKulp MTScheiman MAmster DMCotter SCoulter RAFecho GGallaway MFGranet DHertle RRodena JYamada TCITT Study Group.
Optom Vis Sci. 2012 Jan;89(1):12-8. doi: 10.1097/OPX.0b013e318238ffc3.

‘A successful or improved outcome after CI treatment was associated with a reduction in the frequency of adverse academic behaviors and parental concern associated with reading and school work as reported by parents.’


Improvement of Vergence Movements by Vision Therapy Decreases K-ARS Scores of Symptomatic ADHD Children.
Lee SH1, Moon BY2, Cho HG2.
J Phys Ther Sci. 2014 Feb;26(2):223-7. doi: 10.1589/jpts.26.223. Epub 2014 Feb 28.

Conclusion: Convergence insufficiency symptoms are closely related to symptoms screened for ADHD, and vision therapy to improve vergence movements is an effective method of decreasing the K-ARS scores.

Behavioral and Emotional Problems Associated With Convergence Insufficiency in Children: An Open Trial.
Borsting E1, Mitchell GL2, Arnold LE2, Scheiman M3, Chase C4, Kulp M2, Cotter S5; CITT-RS Group.
J Atten Disord. 2016 Oct;20(10):836-44. doi: 10.1177/1087054713511528. Epub 2013 Nov 22

Conclusion: ‘In an open trial, attention and internalizing problems improved significantly following treatment for CI (Convergence Insufficiency).’

Randomized clinical trial of treatments for symptomatic convergence insufficiency in children.
Convergence Insufficiency Treatment Trial Study Group1.
Arch Ophthalmol. 2008 Oct;126(10):1336-49. doi: 10.1001/archopht.126.10.1336.

Conclusion: ‘Twelve weeks of OBVAT (office based vergence accommodative therapy) results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with HBPP(home based pencil pushups), HBCVAT+ (home based computer vergence and accommodative vergence therapy), and OBPT (office based placebo therapy). Application to Clinical Practice Office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency.’



Efficacy of vision therapy in children with learning disability and associated binocular vision anomalies.
Hussaindeen JR1Shah P2Ramani KK3Ramanujan L4.
J Optom. 2018 Jan – Mar;11(1):40-48. doi: 10.1016/j.optom.2017.02.002. Epub 2017 Jun 7.

‘Children with specific learning disorders have a high frequency of binocular vision disorders and vision therapy plays a significant role in improving the BV parameters. Children with SLD should be screened for BV anomalies as it could potentially be an added hindrance to the reading difficulty in this special population.’

Differences in eye movements and reading problems in dyslexic and normal children.
Eden GF1Stein JFWood HMWood FB.
Vision Res. 1994 May;34(10):1345-58.

Conclusion: ‘… A qualitative assessment of saccadic eye movements revealed that dyslexics exhibit fixation instability at the end of saccades… Sex, handedness, IQ or the presence of attention deficit disorder (ADD) did not appear to influence the children’s performances on any of the eye movement tasks. The presence of oculomotor abnormalities in a non-reading task strongly suggests that the underlying deficit in the control of eye movements seen in dyslexics is not caused by language problems alone.’

Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls.
Quaid P1Simpson T.
2013 Jan;251(1):169-87. doi: 10.1007/s00417-012-2135-0. Epub 2012 Aug 29.

‘This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.’