Vision therapy

Abstract: Objective To compare vision therapy/orthoptics, pencil push-ups, and placebo vision therapy/orthoptics as treatments for symptomatic convergence insufficiency in children 9 to 18 years of age. Methods In a randomized, multicenter clinical trial, 47 children 9 to 18 years of age with symptomatic convergence insufficiency were randomly assigned to receive 12 weeks of office-based vision therapy/orthoptics, office-based placebo vision therapy/orthoptics, or home-based pencil push-ups therapy. Main Outcome Measures The primary outcome measure was the symptom score on the Convergence Insufficiency Symptom Survey. Secondary outcome measures were the near point of convergence and positive fusional vergence at near. Results Symptoms, which were similar in all groups at baseline, were significantly reduced in the vision therapy/orthoptics group (mean symptom score decreased from 32.1 to 9.5) but not in the pencil push-ups (mean symptom score decreased from 29.3 to 25.9) or placebo vision therapy/orthoptics groups (mean symptom score decreased from 30.7 to 24.2). Only patients in the vision therapy/orthoptics group demonstrated both statistically and clinically significant changes in the clinical measures of near point of convergence (from 13.7 cm to 4.5 cm; P P Conclusions In this pilot study, vision therapy/orthoptics was more effective than pencil push-ups or placebo vision therapy/orthoptics in reducing symptoms and improving signs of convergence insufficiency in children 9 to 18 years of age. Neither pencil push-ups nor placebo vision therapy/orthoptics was effective in improving either symptoms or signs associated with convergence insufficiency.

Abstract: Purpose. The purpose of this article is to compare vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics as treatments for symptomatic convergence insufficiency in adults 19 to 30 years of age. Methods. In a randomized, multicenter clinical trial, 46 adults 19 to 30 years of age with symptomatic convergence insufficiency were randomly assigned to receive 12 weeks of office-based vision therapy/orthoptics, office-based placebo vision therapy/orthoptics, or home-based pencil pushups. The primary outcome measure was the symptom score on the Convergence Insufficiency Symptom Survey. Secondary outcome measures were the near point of convergence and positive fusional vergence at near. Results. Only patients in the vision therapy/orthoptics group demonstrated statistically and clinically significant changes in the near point of convergence (12.8 cm to 5.3 cm, p 0.002) and positive fusional vergence at near (11.3 to 29.7 ,p 0.001). Patients in all three treatment arms demonstrated statistically significant improvement in symptoms with 42% in office-based vision therapy/orthoptics, 31% in office-based placebo vision therapy/orthoptics, and 20% in home-based pencil pushups achieving a score <21 (our predetermined criteria for elimination of symptoms) at the 12-week visit. Discussion. In this study, vision therapy/orthoptics was the only treatment that produced clinically significant improvements in the near point of convergence and positive fusional vergence. However, over half of the patients in this group (58%) were still symptomatic at the end of treatment, although their symptoms were significantly reduced. All three groups demon- strated statistically significant changes in symptoms with 42% in office-based vision therapy/orthoptics, 31% in office-based placebo vision therapy/orthoptics, and 20% in home-based pencil push-ups meeting our criteria for elimination of symptoms. (Optom Vis Sci 2005;82:E583-E595)

Abstract: Low vision rehabilitation is a new emerging subspecialty drawing from the traditional fields of ophthalmology, optometry, occupational therapy, and sociology, with an ever-increasing impact on our customary concepts of research, education, and services for the visually impaired patient. A multidisciplinary approach and coordinated effort are necessary to take advantage of new scientific advances and achieve optimal results for the patient. Accordingly, the intent of this paper is to outline the principles and details of a modern low vision rehabilitation service. All rehabilitation attempts must start with a first hand interview (the intake) for assessing functionality and priority tasks for rehabilitation, as well as assessing the patient's all-important cognitive skills. The assessment of residual visual functions follows the intake and offers a unique opportunity to measure, evaluate, and document accurately the extent of functional loss sustained by the patient from disease. An accurate assessment of residual visual functions includes assessment of visual acuity, contrast sensitivity, binocularity, refractive errors, perimetry, oculomotor functions, cortical visual integration, and light characteristics affecting visual functions. Functional vision assessment in low vision rehabilitation measures how well one uses residual visual functions to perform routine tasks, using different items under various conditions, throughout the day. Of the many functional vision skills known, reading skills is an obligatory item for all low vision rehabilitation assessments. Results of assessment guide rehabilitation professionals in developing rehabilitation plans for the individual and recommending appropriate low vision devices. The outcome from assessing residual visual functions is detection of visual functions that can be improved with the use of optical devices. Methods for prescribing devices such as image relocation with prisms to a preferred retinal locus, field displacement to primary gaze position, field expansion, and manipulation of light are practiced today in addition to, or instead of, magnification. Correction of refractive errors, occlusion therapy, enhancement of oculomotor skills, and field restitution are additional methods now available for prescribing devices leading to rehabilitation of visual functions. The outcome from assessing residual functional vision is detection of functional vision that can be improved with the use of vision therapy training. After restoration of optimal residual visual functions is achieved with optical devices, one can follow with training programs for restoration of lost vision-related skills. If an optical dispensary is available where prescribing of low vision devices routinely take place, this will help ensure familiarity and specialization of the dispensary and staff with low vision devices and their special dispensing requirements. The dispensing of low vision devices is an opportunity to introduce the device to the patient, train the patient in the correct use of the device for the task selected, and create a direct and continuous connection with the patient until the next encounter. Following assessment, prescribing, and dispensing of devices, a low vision practitioner, ophthalmologist or optometrist, is responsible for recommending and prescribing vision therapy training to improve residual functional vision. An attempt to present a template for a comprehensive modern low vision rehabilitation practice is made here by summarizing scientific developments in the field and stressing the multidisciplinary involvement required for this kind of practice. It is hoped that this paper and other initiatives from colleagues, the public, and government will promote and raise awareness of modern low vision rehabilitation for the benefit of all.

Abstract: BACKGROUND: Oculomotor dysfunctions are among the most common abnormalities found in the brain-injured population. The purpose of the current study was to determine retrospectively the effectiveness of conventional optometric vision therapy for oculomotor disorders of vergence and version in a sample of ambulatory, visually symptomatic, predominantly adult outpatients who had either mild traumatic brain injury (TBI) or cerebrovascular accident (CVA). METHODS: A computer-based query for acquired brain injury patients examined between the years of 2000 and 2003 was conducted in our clinic. This yielded 160 individuals with mild TBI and 60 with CVA. Of these patients, only those for whom vision therapy was prescribed and who completed an optometric vision therapy program for remediation of their oculomotor dysfunctions were selected. This included 33 with TBI and 7 with CVA. The criterion for treatment success was denoted by marked/total improvement in at least 1 primary symptom and at least 1 primary sign. RESULTS: Ninety percent of those with TBI and 100% of those with CVA were deemed to have treatment success. These improvements remained stable at retesting 2 to 3 months later. 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. Optometry 2008;79:18-22