Vision Therapy - Orthoptic Visual Therapy

Orthoptic Visual Therapy

Orthoptics aims to treat binocular vision disorders such as strabismus, and diplopia. Key factors involved include: Eye Movement Control, Simultaneous Focus at Far, Sustaining Focus at Far, Simultaneous Focus at Near, Sustaining Focus at Near, Simultaneous Alignment at Far, Sustaining Alignment at Far, Simultaneous Alignment at Near, Sustaining Alignment at Near, Central Vision (Visual Acuity) and Depth Awareness.

Some of the exercises used are:

• Near point of convergence exercises (i.e. "pencil push-ups"),
• Base-out prism reading, stereogram cards, computerized training programs are used to improve fusional vergence.
• The wearing of convex lenses
• The wearing of concave lenses
• "Cawthorne Cooksey Exercises" also employ various eye exercises, however, these are designed to alleviate vestibular disorders, such as dizziness, rather than eye problems.
• Antisuppression exercises - this is being less commonly practiced, although occasionally it may be used.

There is widespread acceptance of orthoptic therapy indications for:

• Convergence insufficiency. Patients who experience eyestrain, "tired" eyes, or diplopia (double vision) while reading or performing other near work, and who have convergence insufficiency may benefit from orthoptic treatment. Patients whose outward drift occurs at distance rather than at near distance are less ideal candidates for treatment.
• Intermittent exotropia. This is often linked to convergence insufficiency.

Convergence insufficiency is a common binocular vision disorder characterized by asthenopia, eye fatigue and discomfort. Asthenopia may be aggravated by close work and is thought by some to contribute to reading inefficiency. In 2005, the Convergence Insufficiency Treatment Trial (CITT) published two large, randomized clinical studies examining the efficacy of orthoptic vision therapy in the treatment of symptomatic convergence insufficiency. Although neither study examined reading efficiency or comprehension, both demonstrated that in-office vision therapy was more effective than "pencil pushups" (a commonly prescribed home-based treatment) for improving the symptoms of asthenopia and the convergence ability of the eyes. The design and results of at least one of these studies has been met with some reservation, questioning the conclusion as to whether intensive office-based treatment programs are truly more efficacious than a properly implemented home-based regimen. The CITT has since published articles validating its research and treatment protocols. Its most recent publication suggested that home-based computer therapy combined with office based vision therapy is more effective than pencil pushups or home-based computerised therapy alone for the treatment of symptomatic convergence insufficiency.