Vision Therapy and the Treatment of Reading Problems


Optometrist who specialize in vision therapy contend that vision therapy can be beneficial for some children suffering from reading problems and learning disabilities.  Critics concede that vision therapy may help correct certain binocular vision disorders, but they say no scientific evidence exists that proves vision therapy can correct the developmental and neurological conditions that cause many reading problems and learning disorders.

Ophthalmology’s Opinion

In 1998, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Pediatrics, and the Committee on Children with Disabilities issued a joint policy statement entitled Learning Disabilities, Dyslexia, and Vision.  In this document the organizations say,

 Vision problems are rarely responsible for learning difficulties.  No scientific evidence exists for the efficacy of eye exercises (“vision therapy”) or the use of special tinted lenses in the remediation of these complex pediatric neurological conditions.

The joint policy statement goes on to state,

 No scientific evidence supports claims that the academic abilities of children with learning disabilities can be improved with treatments that are based on 1) visual training, including muscle exercises, ocular pursuit, tracking exercises, or “training” glasses (with or without bifocals or prism); 2) neurological organizational training (laterality training, crawling, balance board, perceptual training); or 3) colored lenses. 

These more controversial methods of treatment may give parents and teachers a false sense of security that a child’s reading difficulties are being addressed, which may delay proper instruction and remediation.  The expense of these methods is unwarranted, and they cannot be substituted for appropriate educational measures. 

Claims of improved reading and learning after visual training, neurological organization training, or the use of colored lenses, are almost always based on poorly controlled studies that typically rely on anecdotal information.  These methods are without scientific validation.

Optometry’s Point of View

Optometry, on the other hand, feels that ophthalmology’s blanket rejection of the use of vision therapy in the treatment of learning problems is unwarranted and that it distorts optometry’s view of the role of vision therapy in such cases.

In their own joint policy statement entitled, Vision, Learning and Dyslexia that was issued in 1997, the American Academy of Optometry and the American Optometric Association say,

The role of the optometrist when evaluating people for learning-related vision problems (e.g. dyslexia) is to conduct a thorough assessment of eye health and visual functions and communicate the results and recommendations.  The management plan may include treatment, guidance and appropriate referral.

The expected outcome of optometric intervention is an improvement in visual function with alleviation of associated signs and symptoms.  Optometric intervention for people with learning-related vision problems consists of lenses, prisms, and vision therapy. 

Vision therapy does not directly treat learning disabilities or dyslexia.  Vision therapy is a treatment to improve visual efficiency and visual processing, thereby allowing the person to be more responsive to educational instruction.  It does not preclude any other form of treatment and should be a part of a multidisciplinary approach to learning disabilities.

They go on to say,

Unresolved visual deficits can impair the ability to respond fully to educational instruction.  Management may require optical correction, vision therapy, or a combination of both. 

Vision therapy, the art and science of developing and enhancing visual abilities and remediating visual dysfunctions, has a firm foundation in vision science, and both its application and efficacy have been established in the scientific literature. 

Some sources have erroneously associated optometric vision therapy with controversial and unfounded therapies, and equate eye defects with visual dysfunctions.

Areas of Agreement

Though they are at odds on the role of vision therapy in the treatment of reading problems and learning disabilities, both optometry and ophthalmology agree that:

1. Early diagnosis of reading and learning problems is important.

2. Learning disabilities should be evaluated and managed by a multidisciplinary team of professionals.

3. Treatment should consist of methods shown to be effective by scientific evidence.

What To Do

To determine if your child has a vision problem that may be contributing to a reading or learning problem, start by having a routine eye exam.  If you suspect a vision problem remains after the exam (and the prescription of eyeglasses or contact lenses, if needed) consider seeing an optometrist who specializes in vision therapy for a binocular vision evaluation.

A binocular vision evaluation includes a number of visual skills tests that are not typically performed during a routine eye exam.  These tests may include:

  • Eye alignment testing – Though basic eye alignment testing is performed during a routine eye exam, a vision therapy specialist may perform additional tests to determine how easily your child can maintain proper eye alignment and whether they are likely to experience eye fatigue because of a difficulty in maintaining eye alignment during reading and other near vision tasks.
  • Eye focusing tests – To evaluate how easily your child can change focus and whether they are likely to experience eye fatigue, blurred vision, or reading problems from inadequate focusing skills.
  • Eye movement tests – To evaluate the accuracy and speed of eye movements during simulated reading tasks to determine if poor eye movement skills may be contributing to a reading problem.
  • Eye teaming tests – To evaluate how well your child’s eyes work together as a team for a variety of visual tasks involving changes in eye alignment, focusing, and positioning.

Additional tests may also be performed.

The vision therapist will then compare your child’s visual skills test performance to established norms for children of the same age.  If one or more visual skills appear to be deficient, a program of vision therapy may be prescribed.  

But before pursuing a vision therapy treatment program, ask the optometrist for a detailed explanation of the visual skills requiring treatment, the relationship these skills have to the processes of reading and learning, the estimated time and cost involved, and the desired outcome.