Essay on Vision Therapy: Literature Review

Over the past century, there have been many developments in Optometry that have transformed the way in which practitioners conduct examinations and diagnose patients. Although such transformations have been introduced with the objective of enhancing the practitioner’s ability to identify and rectify vision-related conditions and to provide the patient with the best possible eye care, developments such as Behavioural Optometry, also known as Vision Therapy, have become debatable amongst Optometrists and scientists with regards to its validity and effectiveness in practice. Vision therapy is described as a process whereby a practitioner employs a specific therapeutic regimen in order to address vision-related disorders. This can be applied to both older and younger patients with the aim of reducing the development of vision disorders, providing them with a form of rehabilitation for disorders that have developed or optimized their visual skills in order to achieve effective visual performance. Through an analysis of both Doyle and Barrett’s articles, the differing views on behavioral optometry can be observed and a critical judgment can be applied.

In his article, Vision Therapy in the modern Behavioural Optometry Practice, Doyle aims to display the advantageous perspective of Behavioural Optometry and how it can be used as effectively as a traditional evidence-based practice to diagnose a patient. Through referring to various research papers, Doyle explains Behavioural Optometry as the “oculomotor integration with the head, neck, limbs and overall body to form temporality efficient and coordinated vision”. He represents the validity of Behavioural Optometry by mentioning its history in the 1930s and how it has been further developed over time through further research. This can be seen where the Optometric community came to the realization that there could be further forms of treatment for vision-related disorders other than the use of traditional lenses. The practices of French Ophthalmologist Louis Javal justify this as he formulated and utilised non-surgical means for the correction of strabismus, a condition which is usually corrected through the use of lenses. Such practices which are shown to be successful from an era of low technological advancements represent the foundational evidence that behavioral optometry can be used in diagnosing vision disorders.

Throughout his article, Doyle aims to represent his support for Behavioural Optometry and seeks to represent it as an effective and valid remedy for vision-related disorders. This can be seen through a 2011 study “Treatment of symptomatic convergence insufficiency with home-based computer orthoptic exercise program” which showed patients with symptomatic convergence insufficiency. It presented that a twelve-week course of home-based computer therapy programs showed significantly greater improvement in both near points of convergence and positive fusional vergence in both adults and non-communicating children in comparison to typical lens correction remedies prescribed by optometrists. He further proves his point by disregarding Barrett’s statement of “further assessment of whether convergence insufficiency can be permanently resolved in an individual or whether repeated treatment is needed” by mentioning the CITT Investigator Group’s research in their article “Convergence Insufficiency Treatment Trial” where they conducted these practices on patients on regular intervals for a year and found that most of the symptoms were eradicated but the consistent treatment of 12-24 visits in a year was required. However, this consistency applies and is always required for a successful outcome with any form of a vision disorder remedy.

Doyle further emphasizes the effectiveness and validity of Behavioural Optometry by mentioning the article “The efficiency of vision therapy for convergence excess” which illustrates the effectiveness of such practices on older patients who suffered from esophoria. Through their clinical trial, they were able to eliminate symptoms of esophoria in 80% of the patients after five months of sequential therapy procedures which goes to contradict Barrett’s statement of “the role of orthoptic exercises in the treatment of esophoria, however, remains unclear and needs further study” as through this study and the result it produced, it is clearly evident that Behavioural Optometry is both effective and valid in its ability to act as a remedy for those suffering from vision-related disorders.

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The effectiveness of Vision Therapy can be further emphasized when Doyle mentions its ability in aiding “vulnerable groups” such as children with intellectually limited capabilities. Although Barrett agrees that most referrals from doctors to Behavioural Optometrists are mentally ill children, he does not see “evidence that optometrists adopting a behavioral approach can offer therapy that will positively influence the lives of these children”. In such cases behavioral optometrists only attain the role of diagnosing factors from these diseases which affect the visual system. It is very common for children from these population groups to not be able to read, write or have a basic education level due to their inability to see or concentrate properly. Doyle mentions the article “Optometric Vision Therapy for Visual Deficits and Dysfunctions: A suggested model for evidence-based practice”, where it was found performing simple exercises such as matching numbers together allowed substantial eye movement with concentration to occur. Through consistent practice time, which is tailored to each patient, there was a significant gain in the patient’s comprehension levels, oculomotor readiness and visual attention. Henceforth, Doyle has effectively shown how Visual Therapy is both an effective and valid means of therapy for a wide range of populations including older adults and “vulnerable” mentally impaired children.

In his article “A critical evaluation of the evidence supporting the practice of behavioral vision therapy”, Barrett seeks to justify his view on the ineffectiveness and baseless evidence surrounding Behavioural Optometry. Through targeting ten separate groups which Behavioural Optometrists are currently treating, Barrett concludes that “there is a lack of controlled clinical trials to support behavioral management strategies”. However, throughout his article Barrett makes conflicting and baseless claims which see him diverge away from his conclusion. This can be seen through his justification that Behavioural Optometry practices are ineffective in treating conditions such as Dyspraxia in children. Although Barrett agrees that symptoms such as reading and learning difficulties are directly related to dysfunction in the visual system, he seeks to disagree with the idea that vision therapy can lead to an improvement in these symptoms. He represents his justification as rather unsatisfactory as he mentions a report published in an Ophthalmic Literature Journal drawing effective correlations between behavioral optometry practices and improvements in the vision of those suffering from Dyspraxia. Although the evidence seems to exist about the effectiveness of behavioral Optometry in this field, due to “little concrete evidence” existing, Barrett views these practices as baseless and ineffective.

Bennett’s conflicting views can be furthered through his view on the use of low-plus powered lenses at near to slow the progression of myopia. In the studies of Zadnik, the behavioral approach to reducing myopia in younger patients is adding small plus powered lenses, such as +0.25D, +0.50D and +0.75D, to aid them in their accommodation. These lenses will enable them to exert less accommodative power and clinically has been found to reduce the progression of myopia as proven effective by the studies of Rosenfield and Gilmartin, both of which Bennett refers to. However, Bennett makes note of a 2003 study where it is seen that only moderate powered plus lenses of +1.50D and above will contribute effectively in the reduction of myopia progression, and further mentions that little reference was made of weaker powered lenses which are used by behavioral optometrists. He further proceeds to state that even though “behavioral optometry can explain this result, this does not necessarily mean that that the behavioral view is correct”, representing his conflicting claims when he has clearly stated the effectiveness of the behavioral approach. At the same time, he takes stance with the non-behavioral approach for sole reason that the “non-behavioral approach also explains the result”. This represents Bennett’s biased towards behavioural optometry, aiming to prove its ineffectiveness and invalidity on unsatisfactory grounds.

Further down his article, Bennett attempts to make mention of the ineffectiveness of behavioural optometry practices in sports vision. Mentioning the controlled studies of both Wood and Abernethy in 2001, who conducted behavioral optometry practices on various athletes and found “significant pre-to-post training differences were seen in the results of some measures”, signifying the effectiveness, to a certain extent, of behavioral optometry on athletes and their motor and vision abilities. Bennett however, interprets these improvements in the results as the athletes attaining “test familiarity”, stating this with no scientific research to back it up, displaying how he is attempting to force his conclusion. The views of Bennett can further be contradicted by the 2012 study “The Impact of a Sports Vision Training Program in Youth Field Hockey Players” where after conducting vision therapy on a group of hockey players, improvement was seen in their peripheral perception and their ability to track moving items. Through these various studies, it can be seen that the effectiveness of vision therapy in sports can date back to early 2001 and is continually showing its effectiveness in the modern era.

Through analyzing both the articles of Doyle and Bennett, the two different views on behavioural optometry can be explained. Although Bennett attempts to prove the ineffectiveness of vision therapy in modern-day practice, he does so in an unsatisfactory manner where he constructs baseless, conflicting, and biased claims in order to forcefully achieve his conclusion that “there is a lack of controlled clinical trials to support behavioural management strategies”. Doyle on the other hand presents vision therapy as both an effective and valid means of treatment that can and is being used for a variety of population groups. Through his presentation on the history and current use of behavioural optometry practices, which are backed by valid scientific research, he effectively invalidates Bennett’s conclusion and ultimately presents behavioural optometry as an effective form of vision management that can be as effective as the traditional evidence-based practice across all patient types.