There Is More to Vision Than Seeing 20/20
Although eye alignment seems to be exclusively a cosmetic problem to some, it is worth mentioning that eye alignment is important to visual efficiency and depth perception. One of the most devastating problems that comes with poor eye alignment is diplopia, or “double vision”. Diplopia might require a person to patch one eye just to be able to cope with daily living.
This and other issues were discussed on the webinar “BASICS OF EYE ALIGMENT”.
There were several excellent questions and comments that arose from the webinar’s Q&A that I would like to address more fully.
Question: How effective is Vision Therapy?
This is a question that we often hear. To address this question, I like to refer to the Convergence Insufficiency Treatment Trial (CITT) study. This was a National Eye Institute/ NIH funded study that showed the effectiveness of in office vision therapy with home-based support vs home based therapy alone. It has been published not only in Optometric literature, but also in Ophthalmological, Neurological and many other disciplines as well. The conclusion of the study was that in office vision therapy was effective in improving convergence to normal values in 75% of the subjects within 12 weeks, whereas only about 10% of the home therapy-based subjects with weekly contact and encouragement showed that amount of improvement. Those homebased subjects who were not contacted on a weekly basis to make sure they were indeed doing their therapy, showed almost no improvement.
“In translating the results into clinical practice, it is important to recognize that the results of our study can only be applied to children 9 to 17 years old with symptomatic CI. Adults with symptomatic CI may respond differently as suggested by our pilot study. The findings of this study indicate that the specific form of vision therapy/orthoptics described herein as office-based vergence/accommodative therapy with home reinforcement is the most effective of the treatments studied in this trial for symptomatic CI in children, with about 75% of patients achieving normalization of or improvement in symptoms and signs within a 12-week period.”
Regarding home-based therapy, it is important to note that the data reported in this study for the pencil push-ups group were derived from a therapy program designed with considerably closer follow-up than is typical in clinical practice. Patients were called on a weekly basis by a therapist, completed a home log, and returned for office visits every fourth week. It is possible that this treatment would be less effective if prescribed according to usual clinical practice, which does not include weekly telephone calls from a therapist and often has less frequent follow-up. The results of the CITT pilot study, in which the home-based pencil push-ups group did not receive weekly phone calls, provide some support for this hypothesis as none of the 11 patients (0/11) were classified as successful or improved.
References:
INSUFFI, CONVERGENCE. "Randomized clinical trial of treatments for symptomatic convergence insufficiency in children." Arch Ophthalmol 126.10 (2008): 1336-1349. Scheiman,
Mitchell, et al. "A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults." Optometry and Vision Science 82.7 (2005): E583-E595.
Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, Borsting E, London R, Wensveen J; Convergence Insufficiency Treatment Trial Study Group. A randomized clinical trial of treatments for convergence insufficiency in children. Arch Ophthalmol. 2005 Jan;123(1):14-24. doi: 10.1001/archopht.123.1.14. PMID: 15642806.
If you’d like to re-watch or share the webinar, you can do so here. Please make sure to Subscribe to BertecHQ on YouTube by clicking the link in the bottom right-hand corner of the video!
About the Author
Charlie Shearer, OD has been a nationally recognized leader in the areas of vision therapy, visually related learning problems and sports vision enhancement. He has worked with US Olympic athletes and teams, professional and amateur athletes, and coordinated national screening of both Special Olympics and Junior Olympics. Charlie is a leader in the field of instrumentation development as related to his role of Vision Science Consultant for Bertec Corporation, as well as his work with other companies. Charlie was born in Mishawaka, Indiana. He received his undergraduate and optometry degrees from Indiana University, upon graduation he returned to Mishawaka, Indiana, where he is in private practice. He has been a leader and innovator in of areas of pediatric vision, neuro-optometry, vision training and visual perceptual problems. He also has an interest in sports vision and continues to consult with the Colorado Rockies Major League Baseball team.
