Research Papers2019-01-22T00:03:22+00:00

Research Papers

The principles behind effective vision therapy treatment have supporting evidence in research despite hurdles such as funding (there are no giant companies that benefit).  For your benefit there are two recent summaries and a list of links to PDFs at the bottom of the page.

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.

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

Conclusion:
‘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.

Conclusion:
‘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.

Conclusion:
‘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.

Conclusion:
‘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.’

Frequency of Visual Deficits in Children With Developmental Dyslexia.

Conclusion:

‘These findings suggest that deficits in visual function are far more prevalent in school aged children with developmental dyslexia than in typically developing children, but the possible cause and clinical relevance of these deficits are uncertain.  Further study is needed ot determine the extent to which treating these deficits can improve visual symptoms or reading parameters.

Raghuram A, Gowrisankaran S, Swanson E, Zurakowski D, Hunter DG, Waber DP. Frequency of Visual Deficits in Children With Developmental Dyslexia. JAMA Ophthalmol. Published online July 19, 2018. doi:10.1001/jamaophthalmol.2018.2797

Concussion and Head Injury

The new standards of care have recognized the importance of identifying and treating vision disorders after head injury.

In his position statement on Vision Therapy and Traumatic Brain Injury, Dr. Eric Singman MD, PHD, Milton and Muriel Shurr Director of Johns Hopkins Hospital says:

‘Among the critical members of this (rehab) team, there should be vision specialists dedicated to working with patients who demonstrate deficiencies in eye teaming, loss of visual acuity and/or visual field as well as uncoupling of ‘visuospatial awareness’.  For the most part, optometric and neuropsychological communities have embraced visual rehabilitation efforts; notably, these providers have documented successes in helping brain injury patients improve their quality of life’.

Vision Therapy for Binocular Dysfunction Post Brain Injury

Conrad, Joseph Samuel; Mitchell, G. Lynn; Kulp, Marjean Taylor.  Optometry and Vision Science: January 2017 – Volume 94 – Issue 1 – p 101–107

Conclusion:

 ‘In this case series, post-concussion vision problems were prevalent and CI and AI were the most common diagnoses. Vision therapy had a successful or improved outcome in the vast majority of cases that completed treatment. Evaluation of patients with a history of concussion should include testing of vergence, accommodative, and eye movement function.’

Vision Therapy for Post-Concussion Vision Disorders

Gallaway, Michael; Scheiman, Mitchell; Mitchell, G. Lynn. Optometry and Vision Science: January 2017 – Volume 94 – Issue 1 – p 68–73

Conclusion:

‘The majority of participants who completed the study experienced meaningful improvements in signs and symptoms.’

Vision Diagnoses Are Common After Concussion in Adolescents

Christina L. Master, MD, CAQSM, Mitchell Scheiman, OD, Michael Gallaway, OD, Arlene Goodman, MD, CAQSM, Roni L. Robinson, RN, MSN, CRNP, Stephen R. Master, MD, PhD, Matthew F. Grady, MD, CAQSM

Clinical Pediatrics  Vol 55, Issue 3, pp. 260 – 267 First Published July 7, 2015

 

Conclusion:

Vision diagnoses are prevalent in adolescents with concussion and include convergence insufficiency, accommodative disorders and saccadic dysfunction. Symptoms of these problems may include double vision, blurry vision, headache, difficulty with reading or other visual work, such as the use of a tablet, smartphone, or computer monitor in the school setting. This likely represents a significant morbidity for adolescents whose primary work is school, which is heavily visually oriented. Recognition of these deficits is essential for clinicians who care for patients with concussion and the CISS may prove to be a useful screening tool for use in the future. Identification of these vision diagnoses will help physicians design necessary academic accommodations for patients who have visual deficits and are attempting to reintegrate into school and learning while recovering from concussion.’

Vision rehabilitation interventions following mild traumatic brain injury: a scoping review.

Simpson-Jones ME1, Hunt AW1,2.Disabil Rehabil. 2018 Apr 10:1-17. doi: 10.1080/09638288.2018.1460407.

Conclusion:

‘There are promising interventions for vision deficits following mild traumatic brain injury. However, there are multiple gaps in the literature that should be addressed by future research. Implications for Rehabilitation Mild traumatic brain injury may result in visual deficits that can contribute to poor concentration, headaches, fatigue, problems reading, difficulties engaging in meaningful daily activities, and overall reduced quality of life. Promising interventions for vision rehabilitation following mild traumatic brain injury include the use of optical devices (e.g., prism glasses), vision or oculomotor therapy (e.g., targeted exercises to train eye movements), and a combination of optical devices and vision therapy. Rehabilitation Professionals (e.g., optometrists, occupational therapists, physiotherapists) have an important role in screening for vision impairments, recommending referrals appropriately to vision specialists, and/or assessing and treating functional vision deficits in individuals with mild traumatic brain injury.’

Visual dysfunction is underestimated in patients with acquired brain injury.

Berthold-Lindstedt M1, Ygge JBorg K.J Rehabil Med. 2017 Apr 6;49(4):327-332. doi: 10.2340/16501977-2218.

Conclusion:

‘Visual impairments are common after acquired brain injury, but some patients do not define their problems as vision-related. A structured questionnaire, covering the most common visual symptoms, is helpful for the rehabilitation team to facilitate assessment of visual changes.’

Consequences of traumatic brain injury for human vergence dynamics.

Tyler CW1, Likova LT2, Mineff KN2, Elsaid AM2, Nicholas SC2.

Front Neurol. 2015 Feb 3;5:282. doi: 10.3389/fneur.2014.00282. eCollection 2014.

Conclusion:

‘The results support the hypothesis that occult injury to the oculomotor control system is a common residual outcome of mTBI.’

Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury.

Thiagarajan P1, Ciuffreda KJ.J Rehabil Res Dev. 2013;50(9):1223-40. doi: 10.1682/JRRD.2012.12.0235.

Conclusion:

‘Vergence-based OR was effective in individuals with mTBI who reported nearwork-related symptoms. Overall improvement in nearly all of the critical, abnormal measures of vergence was observed both objectively and clinically. Improved vergence motor control was attributed to residual neural visual system plasticity and oculomotor learning effects in these individuals. Concurrently, nearwork-related symptoms reduced, and visual attention improved.’

Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability

Heitger MH1Jones RDMacleod ADSnell DLFrampton CMAnderson TJ.Brain. 2009 Oct;132(Pt 10):2850-70. doi: 10.1093/brain/awp181. Epub 2009 Jul 16

Conclusion:

‘Our results indicate that eye movement function is impaired in PCS, the deficits being unrelated to the influence of depression or estimated intellectual ability, which affected some of the neuropsychological tests. The majority of eye movement deficits in the PCS group were found on measures relating to motor functions executed under both conscious and semi-conscious control (directional errors; poorer visuospatial accuracy; more saccades and marginally poorer timing and rhythm keeping in memory-guided sequences; smaller number of self-paced saccades; deficits in OSP). Importantly, the PCS group also had poorer performance on several eye movement functions that are beyond conscious control and indicative of subcortical brain function (slowed velocity of self-paced saccades and indications of longer saccade durations of self-paced saccades, anti-saccades and larger amplitude memory-guided saccades). Cognitive functions likely affected in the PCS group based on the eye movement deficits include decision making, response inhibition, short-term spatial memory, motor-sequence programming and execution, visuospatial information processing and integration and visual attention (Pierrot-Deseilligny et al., 2004; Leigh and Zee, 2006). These results indicate that brain function in the PCS group had not returned to normal and contrasted that seen in patients with good recovery.’

Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis

Ciuffreda KJ1, Rutner DKapoor NSuchoff IBCraig SHan ME. Optometry. 2008 Jan;79(1):18-22.

Conclusion:

‘Nearly all patients in the current clinic sample exhibited either complete or marked reduction in their oculomotor-based symptoms and improvement in related clinical signs, with maintenance of the symptom reduction and sign improvements at the 2- to 3-month follow-up. These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population. Furthermore, it shows considerable residual neural plasticity despite the presence of documented brain injury.’

Vision therapy effective in improving binocular function after head injury.

Background. Brain lesions may disturb binocular fusion and stereopsis, leading to blurred vision, diplopia, and reduced binocular depth perception for which no evaluated treatment is currently available. Objective. The study evaluated the effects of a novel binocular vision treatment designed to improve convergent fusional amplitude and stereoacuity in patients with [...]

Post Concussion Guidelines Emphasize Vision Therapy

POST-CONCUSSION SYNDROME MANAGEMENT GUIDELINES INTRODUCTION The most recent Consensus Statement on Concussion in Sport has defined a concussion as a“complex pathophysiological process affecting the brain, induced by traumatic biomechanicalforces”. Concussions can be caused by a blow to the head, face, neck or body. This trauma willresult in a set of [...]

Children on an IEP have more problems with eye movements.

Background Approximately one in ten students aged 6 to 16 in Ontario (Canada) school boards have an individual edu- cation plan (IEP) in place due to various learning disabil- ities, many of which are specific to reading difficulties. The relationship between reading (specifically objectively deter- mined reading speed and eye [...]

Effect of treatment of symptomatic convergence insufficiency on reading in children: a pilot study.

Effect of treatment of symptomatic convergence insufficiency on reading in children: a pilot study. Scheiman M1, Chase C2, Borsting E3, Lynn Mitchell G4, Kulp MT4, Cotter SA3; CITT-RS Study Group. Clin Exp Optom. 2018 Mar 25 Conclusion: ‘After treatment for convergence insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite [...]

Post concussion impaired eye movements show sub-optimal brain function and not affected by depression, malingering, or intellectual ability.

Post-concussion syndrome (PCS) can affect up to 20%–30% of patients with mild closed head injury (mCHI), comprising incomplete recovery and debilitating persistence of post-concussional symptoms. Eye movements relate closely to the functional integrity of the injured brain and eye movement function is impaired post-acutely in mCHI. Here, we examined whether [...]

Johns Hopkins director statement on vision therapy

Vision Therapy and Traumatic Brain Injury Eric Singman MD PhD Milton & Muriel Shurr Director, Wilmer General Eye Services Clinic Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St., Baltimore, MD Vision difficulties after traumatic brain injury (TBI) are common and often difficult to recognize1,2. I have had an opportunity [...]

Vision Therapy Research Papers

Dr.-Singman-statement-on-VT  Dr. Singman MD PHD, Director at Milton and Muriel Shurr, Wilmer General Eye Services Clinic Johns Hopkins Hospital discusses how critical vision therapy is in head injury rehabilitation

Neuroimaging Of Amblyopia And Binocular Vision: A Review  The purpose is to review recent studies from our laboratory that used the visual-evoked potential (VEP) to assess attention in both the visually-normal (VN) and mild traumatic brain injury (mTBI) populations. The VEP (amplitude and latency), and attention-related alpha band responses, were assessed. The alpha responses were abnormal in those with mTBI. Furthermore, these values […]

VEP and Human Attention: Translation from Laboratory to Clinic  The purpose is to review recent studies from our laboratory that used the visual-evoked potential (VEP) to assess attention in both the visually-normal (VN) and mild traumatic brain injury (mTBI) populations. The VEP (amplitude and latency), and attention-related alpha band responses, were assessed. The alpha responses were abnormal in those with mTBI. Furthermore, these values […]

Summary of Research on the Efficacy of Vision Therapy for Specific Visual Dysfunctions Vision therapy, like any area in a health profession, is practiced differently by various clinicians. I will restrict this discussion to the most commonly practiced and largest portion of the area of vision therapy: treatment of accommodative and vergence anomalies, including strabismus. These categories include the majority of patients treated by optometrists providing vision therapy […]

Reading speed, cycloplegic refractive error & oculomotor function in reading disabled children (1)  This document is available for download

PTVS Information – Professional  This document is available for download

PTVS Information – Patient  This document is available for download

PostConcussionVisionStudy  This document is available for download

Post-Concussion-Treatment-Guidelines  This document is available for download

Post Trauma Vision Syndrome Article  This document is available for download

Perceptual_relearning_of_binocular_fusio  This document is available for download

Optometry & Vision Science Article–Home-Based Therapy for Symptomatic Convergence Insufficiency in Children  This document is available for download

Occurrence-of-oculomotor-dysfunctions-in-acquired-brain-injury-Ciuffreda  This document is available for download

jpts-223  This document is available for download

VT-for-oculomotor-dysfunctions-in-acquired-ABI-Ciuffreda  This document is available for download

Vision training for Goaltenders  This document is available for download

VDR1-1_articlefeat_Yadav_Web  This document is available for download

University Of Cincinnati Concussion Study  This document is available for download

Thiagarajan_et_al-2011-Ophthalmic_and_Physiological_Optics  This document is available for download

Dr Shelly O’Connor  This document is available for download

CITT_children_Scheiman  This document is available for download

10.15-Using-the-VEP-for-Better-Patient-Outcomes-in-Mild-Traumatic-Brain-Injury-Ciuffreda-Yadav-Ludlam  This document is available for download

05_sci_basis_vt_Ciuffreda  This document is available for download