‘Everyone is entitled to (their) own opinion, but not (their) own facts’
–Daniel Patrick Moynihan
‘Vision therapy does not work.’ I hear this all the time, and so have thousands of the people I have worked with. It comes from teachers, spouses, friends, optometrists, and especially doctors. This statement has caused kids to continue to suffer, kept people with head injury from being able to get better, and caused major friction in families. I used to be in that camp, but my opinion was changed when I examined the actual neurology, and thought about it logically. I questioned the opinions I was given, and looked at fact. So I invite you to follow me as I break down the statement, then use your own logic, approach things with curiosity, and form your own opinion.
Define ‘vision therapy’
Too often anything visual that seems like an exercise is considered vision therapy. So the unfortunate part is that there is a lot of ‘vision therapy’ that doesn’t work. We all had teachers growing up who ‘did teaching’ yet were incredibly ineffective. Successful vision therapy has similar criteria to any other medical intervention.
Effective vision therapy depends on 3 things:
- Proper case selection
- Skilled technique appropriate for the case
- Good old fashioned work.
Without these criteria being met. It’s easy to have vision therapy, surgery, medication, or any other type of intervention that doesn’t work.
Define ‘does not work’
This is often taken to mean is not effective. Effective against what? Cavities? Again this comes down to ensuring that vision therapy is being used to treat a visual condition. Now that visual condition may be causing symptoms associated with other diagnosis (difficulty paying attention, reversing letters, flipping words etc). For example, vision therapy will not be effective in treating a learning disability, unless a part of the problem is how the eyes track and work together. Vision therapy will be helpful in concussion recovery, if part of the problem is vision. You get the point. If a vision problem that can be treated with vision therapy is properly identified, and proper vision therapy is used, then vision therapy will work.
Let’s look at the most common arguments.
I actually remember a time 9 years ago when I told a patient “don’t do vision therapy, it’s quackery and a waste of money”. I had never read anything to indicate otherwise. My professors and friends had this opinion. So it must be true. It’s funny how the human brain makes us feel so certain of things we have never researched. Ego and confirmation bias are some of the biggest dangers in medicine.
There is no research that shows that vision therapy works.
There is a double-blind placebo controlled study (highest possible calibre) called the Convergence Insufficiency Treatment Trial that was published in the journal of ophthalmology that proves vision therapy is effective. There are numerous other studies demonstrating the effectivity of vision therapy, when properly done. This argument needs to be changed to “I have not read, or refuse to read any material that does not support my current view”. With that in mind, there are definitely limitations in some of the research due to ethics on giving struggling people fake vision therapy for long periods of time, and a lack of funding because there are no huge companies benefiting from the studies.
There are papers that show that vision therapy doesn’t work.
I have looked really hard into this, and all of these papers are actually literature reviews. This means that a person has reviewed literature and then written a summary and opinion. Oddly enough, most of these reviews are done by people beginning with an anti-vision therapy opinion, and only reading papers that support their position.
When opinion sneak into lectures
Part of the problem lies in how medical school, optometry school, and undergrad teach us about the visual system. It’s taught that it is static, not dynamic. It’s taught that vision therapy is about addressing muscle problems, when it’s really about changing how the brain is actually using the muscles, and processing the incoming information. Opinions are past from professor to student, and taken as truth.
We know that it’s harder for people to change an opinion once they have stated a position. The fragility of the ego, admitting that our view may have been ‘incorrect, and going against our peers all stand in the way of absorbing and applying new information.
The irony of it is that during that time we are at a school to learn new information, and improve a particular skillset. So we are there, because the brain can learn to more accurately process and use information, and we can learn new thought and motor patterns (eg surgery). That is literally all that vision therapy is. Learning to more accurately process the input, and having more accurate motor responses/skills (eg eye tracking while reading).
If the basis of vision therapy is learning new processing and motor responses, and this is not possible, we should immediately close all universities, and all sports coaches, dance instructors and teachers should be let go.
Proper vision therapy and rehabilitation is solidly based in neurology and evidence
All it takes is a dive into a decent text on the neurology of vision such as Suter and Harvey’s: Vision Rehabilitation, multi-disciplinary care of the brain injury patient to be able to understand the actual underpinnings of how vision therapy works.
Research papers are abundant and even the small collection I have put together does not do it justice. A quick look at the end of each chapter in Suter and Harvey’s book shows the hundreds of research papers that went into publishing it.
So the next time someone says ‘vision therapy does not work’. Ask them to define what they really mean by ‘does not work’, how they came to their opinion, and if their opinion would change given adequate evidence. Mine did. Although, we all know how many people will not change their mind no matter what evidence is presented.