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Vision Therapy: Snake Oil or Miracle Cure?

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A new visual treatment is on the market, claiming to help children with special needs. But is it legit?

kid at eye doctor

Kate Tuttle: Parents of children struggling with dyslexia, ADHD, or autism spectrum disorders often find themselves struggling to find therapies and specialists to help their children overcome obstacles and succeed in school, home and life. Those of us whose kids have any type of health or learning issues know that we'd do just about anything to help them -- which makes us good parents, but also leaves us deeply vulnerable to being hoodwinked by false promises.

In an article in the Sunday New York Times Magazine, Judith Warner writes of a new therapy that advocates say can cure or alleviate conditions as serious as autism, and that skeptics warn is an unproven, profit-driven batch of snake oil. Vision Therapy, offered by folks who identify as behavior optometrists, focuses on how the eyes work together, especially when it comes to close-vision tasks like reading. Using both regular eyeglasses (often with weak prescriptions) and prisms to "alter sensory input," VT practitioners say they help kids improve their performance in reading, gross-motor skills, and even speech and social interaction. Sites promoting the services contain testimonials from scores of satisfied customers. VT has changed their kids' lives, they say -- bringing formerly non-verbal kids who couldn't make eye contact or catch a ball back to life, making them capable of interacting, playing and learning. And it's non-invasive, non-surgical, and involves no brain-chemistry-altering drugs.

So what's the problem? For one, these therapies can be incredibly expensive (upwards of several thousand dollars, typically not covered by health insurance). For another, as Warner details in her article, no studies have proven its effectiveness. Doctors and scientists who have studied VT say that reported gains could be due to what's known as the "Hawthorne Effect," whereby nearly any patient will find improvement -- even when given totally nonsensical therapy -- just because they respond positively to the one-on-one positive attention and nurturing afforded by frequent visits to this kind of specialist. Ophthalmologists, who tend to poo-pooh VT, say that certain vision problems can lead to learning disabilities -- in particular, problems with binocular vision and close focusing while reading -- but that VT is unproven and not a substitute for evaluation by a medical doctor.

Optometrists, who typically attend a four-year optometry college after (or, in some places, instead of) an undergraduate degree, are licensed to perform eye exams and prescribe vision correction; ophthalmologists are MDs whose post-graduate training includes four years of medical school, four years of residency, and an additional several years of special training in ophthalmology. I'm not sure if VT is snake oil -- I had a lazy eye as a child that was fixed through visual exercises using prisms (prescribed and monitored by an ophthalmologist) -- but I do think it's a red flag any time a medical practitioner claims his or her own specialty can cure such a wide range of problems.



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11 comments so far | Post a comment now
C March 14, 2010, 7:42 AM

Sometimes, it’s worth the thousands of dollars, the time, the false hope, etc. for a parent to know they tried everything that had a chance of helping their special needs child. I hate seeing people waste so much for all of the MANY snake-oil treatments that are sucking these families dry, but there’s some solace for the parents to know they didn’t withhold a chance from their kids.

Rachel Cooper March 14, 2010, 9:36 AM

Please note that vision therapy as it is practiced by optometrists is not at all new. It has been around for at least six decades. Today, one could meet many adults with lazy eye, deviating eyes, and other visual problems who were successfully helped by optometric vision therapy as children. The writer was lucky to find an ophthalmologist who used prisms and exercises to help her lazy eye as a child. My understanding is that 21st century ophthalmologists are, first and foremost, surgical specialists. Also, optometrists who provide in-office vision therapy typically have post-doctoral or residency training as well. Lastly, optometrists do NOT claim that vision therapy is a direct treatment for autism or learning disabilities. Vision Therapy treats visual problems.

John Hayes March 14, 2010, 12:14 PM


The problem with vision therapy is that of diagnosing by assuming all learning disabilities are vision based and that vision therapy is the answer.

Being professional is all about having knowledge that can analyse a situation and make conclusions based on information. To assume that rare conditions such as CI that may be a factor in reading difficulties and may respond to visual therapy can be extrapolated to include all learning difficulties is poor practice for a professional.

That people can believe vision therapy is effective for all learning disorders and also can have such a high failure rate that vision therapists have no financial guarantees is a real red flag that financial gain is the real agenda.

The fact that they can’t identify who might or might not benefit from their product/service leaves much to be desired.

Edward Schoelwer March 15, 2010, 9:22 AM

Hello. Former adult patient of vision therapy who had CI and reading problems and was significantly helped by the optometric vision therapy. Optometrists do NOT assume that all learning disabilities are vision based. John Hayes claim that optometrists diagnose this way is prejudicial and very misleading. Plus, where are the scientific studies that support John Hayes’s claim that CI is a RARE condition? I have never heard of a big study of this question. Bottom line: in my opinion, children and adults with CI and lazy eyes deserve effective treatment and Vision Therapy is just that — effective treatment for binocular (two-eyed) VISUAL PROBLEMS.

Nathan Bonilla-Warford, OD March 15, 2010, 11:44 AM

John Hayes said, “The problem with vision therapy is that of diagnosing by assuming all learning disabilities are vision based and that vision therapy is the answer.”

Mr. Hayes, the problem you allude to is that people who do not understand vision therapy assume that those who do assume “that all learning disabilities are vision based.” This simply is not true. I am a provider of vision therapy and I only recommend treatment for visual problems, not learning disabilities. I challenge you or anyone to document any element of the optometric curriculum that supports the idea that optometrists treat learning problems directly rather than vision problem. It simply isn’t the case.

“To assume that rare conditions such as CI that may be a factor in reading difficulties and may respond to visual therapy can be extrapolated to include all learning difficulties is poor practice for a professional.”

First, CI isn’t rare. It may or may not be symptomatic or require treatment, but one in twenty to thirty children is not rare. Second, I repeat, optometrists do not extrapolate the CI study results to all learning difficulties.

That people can believe vision therapy is effective for all learning disorders and also can have such a high failure rate that vision therapists have no financial guarantees is a real red flag that financial gain is the real agenda.

I do not believe that most medical intervention or academic intervention comes with a “financial guarantee.” why place such a burden on vision therapy?

“The fact that they can’t identify who might or might not benefit from their product/service leaves much to be desired.”

If this was true, it would leave much to be desired. Fortunately those who practice vision therapy are quite able to predict who will be successful. As in occupational therapy or other forms of therapy, there are cases when it is hopeful, but not certain, that vision therapy will benefit the patient. This is clearly explained prior to treatment.

My recommendation, Mr. Hayes, is that you spend some time at a vision therapy clinic and get to know the criteria for diagnosis and treatment of vision problems. I do believe that you would find the experience enjoyable and enlightening. You could start with any of the schools and colleges of optometry, or my office in Tampa, FL.

Ruth Villeneuve March 15, 2010, 4:06 PM

As a teacher, mother, and vision therapist I am thrilled that my children attend a school that has incorporated Vision Therapy into the curriculum. Although not all learning disabilities are vision based, there are some that have a connection to vision. When our school opened its doors there were 54 children on Ritalin, by the end of the year, only 4 continued to need the drug. What are these people afraid of? Do they only want children to be treated with drugs and surgery? Do a search on Facebook and twitter to hear more about what parents have to say regarding vision therapy. Mr. Hayes you are invited to visit our office and school as well!

Thank you

Leonard Press, O.D., FCOVD, FAAO March 15, 2010, 6:40 PM

Here are two key misconceptions you leave your readers with:

1. You wrote: “Doctors and scientists who have studied VT say that reported gains could be due to what’s known as the “Hawthorne Effect,” whereby nearly any patient will find improvement — even when given totally nonsensical therapy — just because they respond positively to the one-on-one positive attention and nurturing afforded by frequent visits to this kind of specialist.”

—- The Hawthorne effect rarely applies to vision therapy. Invariably these children have had load of other interventions prior to vision therapy. If TLC were what they were responding to, the issues that the parents are bringing them to us to help with would have already resolved. Again, OT, PT, and SLP are three common early interventions that many of the children we see have already had, involving positive attention, nurturing and frequent visits. Your framing vision therapy in the context of nonsensical therapy is a form of bias well-recognized in behavioral economics and statistics.


2. You speculated: “Optometrists, who typically attend a four-year optometry college after (or, in some places, instead of) an undergraduate degree, are licensed to perform eye exams and prescribe vision correction; ophthalmologists are MDs whose post-graduate training includes four years of medical school, four years of residency, and an additional several years of special training in ophthalmology.

—- Terribly outdated information, Kate, no doubt taken from an anti-Optometry or anti-vision therapy source. 98% of all students graduating with Doctor of Optometry degree in the U.S. have completed their undergraduate degrees, so modern day Optometry is very much a post-graduate profession. The opportunity to attend a College of Optometry straight out of high school was commonplace in the 1940s when my son’s grandfather graduated. Optometry Residency programs have been steadily growing since the 1970s, as are Board Certification programs in vision therapy. Ophthalmology residencies offer no exposure to optometric vision therapy, and their training in this field is limited to orthoptics, an antiquated precursor to optometric vision therapy, and the mode of treatment you describe having received as a child.

The comments in forums like this provide welcome opportunities for education and awareness that ultimately will serve the public good.

LPP March 22, 2010, 3:40 PM

My bright 1st grade daughter couldn’t read. I knew something was wrong physically.

Our ophthalmologist (head of the department at our local children’s hospital) shook his finger in my face and told me to go back to school and tell them it was an education problem.

He was rude and he was WRONG. Vision therapy worked for my daughter…and saved our family from a lifetime of heartache.

Need more proof? Checkout the facebook site Vision Therapy Changed My Life.

Rob Fox March 23, 2010, 11:14 AM

Gee, I’d just love to see one put as much time into researching the Hawthorne effect before using it to discount a vision therapy program. A few minutes of time on the internet will show that the Hawthorne effect is anecdotal and attempts to repeat the initial experiments have often been unsuccessful. That being said to account the improvements seen in vision therapy to attention discounts the fact that most of the children seen have had countless hours of OT, PT, Speech, tutoring, and the like. I have no trouble with some healthy skepticism, but the fact is that vision therapy has been around for decades and has a healthy track record of helping an enormous number of children.

Stephanie Leary March 24, 2010, 7:54 PM

I cannot thank my eye doctor enough for all that his vision therapy program has done for both my son and me. The transformation that has taken place in both of us is profound and absolutely life changing! I am writing our story in hopes that it will be given to any person diagnosed as needing vision therapy. I hope that our story will help them decide to pursue the treatment. I know that they are skeptical and I thought that hearing our story from the perspective of a college educated mother who herself experienced vision therapy with her son might shed some light on very unfamiliar territory. I want them to understand the varying degrees of these vision problems and their implications behaviorally. I want them to know that no matter what the severity, pursuing vision therapy treatment will help. Unlike psychology, which is subjective, vision therapy is measured and you will see the results, in black and white, printed out for you from the Visagraph. The computer will show you what your eyes are doing while you read and evaluate your comprehension. The Gardner Test will further evaluate your visual abilities, including things like visual memory and visual discrimination.
The following two paragraphs describe what I mean about varying degrees of vision problems and their implications behaviorally and academically for that matter. The Visagraph showed that my eyes jumped 110 times, 70 is the norm for adults, and that I had poor tracking. My symptoms were that I lost my place while reading. When I got to the end of the line I had trouble getting to the next line of text and would often skip lines. As a child, I went to a reading tutor who taught me to put a piece of paper under the line of text that I was reading so that I could not skip lines. I read slow and hated doing it. I could not remember half of what I read so I learned to become an excellent listener and take great notes. I watched every book that I ever had to read in high school. I rented the super old version of the movie, you know the one that they would show you in class after you read the book and took the test. I avoided reading. I could do it, I just wasn’t very good at it. My brother had to read the movie Dances with Wolves to me because I could not keep up with the subtitles. I could not do a puzzle for the life of me and I was gifted a C in high school geometry. I simply did not understand it but I tried, I went to after school tutoring, so my teacher passed me. I graduated from college with a 3.24 grade point average and a degree in both management and marketing. I did not know that I had a problem and I thought that I was smart. When the Gardner Test was administered and scored I could not believe how poorly I had done. I mean embarrassingly low scores, no pathetic. My visual memory score fell in the negative 1 percentile and many other scores were in the 3rd and 11th percentile. When I told my grandmother who was a teacher, she asked how I ever got through school. I told her that it was certainly not by reading the books. I compensated by listening really well. I was the master at taking notes.
In contrast, my son’s Visagraph results showed that his eyes were jumping 400+ times when 100 was the norm for children, and that he too had tracking problems. When he looked at print on paper, it literally moved around the page. It did not sit still. Because this is how he had always seen, he did not know that others did not see things the same way and I had never thought to ask what it was that he was seeing. Below is the rest of our story and how we found our miracle – Vision Therapy. All I can say is that this treatment is worth every penny. I know that it can be expensive if insurance does not cover any of it but I hope that you will consider this. It is not any more than you would spend on braces for your child and it is so much more important. This treatment can mean the difference in being “learning disabled” and being at the top of your class. That was certainly the case with my son. There is not a person alive that would not benefit from vision therapy, but some people will not be successful without it.
I had this little guy that was struggling. He seemed so very angry at a very young age. I could not figure out why at ages 3, 4 and 5 that he was so angry. His behavior was out of control and punishment did not affect him at all. He did not seem to care. He would not look you in the eyes and he avoided doing any type of schoolwork like flashcards, coloring or writing. He would not even play hand held video games. He would say that he was not smart and that he wanted to switch brains with me and with his little brother. He just seemed frustrated/angry all the time. You had to threaten him in order to get him to do anything. I was sure that when school started that I would be in the principal’s office every day.
At age 3, I took him to a psychologist. She labeled him ADHD/ODD/Pervasive Developmental Disorder (Autism category) and many other things. She suggested that we go to developmental preschool, which was free through our school district, and see her again when he was 5, just before entering Kindergarten. He received speech and occupational therapy through the school and it helped a little. The summer before Kindergarten, I went back to see the doctor as instructed. I was hopeful but was shattered by the doctor’s analysis. She said that he had all of the things listed above and that he was going to be in a self contained special ed class and need an Aid to get through school. I was mortified! She continued to tell me that therapy would not work, that I could spend millions of dollars and would just be wasting my time and money. The only thing that would help in her opinion was medication, “a magic pill”. My reply was with a question with which the answer disturbed me immensely. “You said that he has numerous disorders, yes? You would not give someone with ADD/ADHD the same medication as you would someone with Autism or ODD, correct?” She replied that she would give my son ADHD medication and based on his reaction that would tell her if he definitively had ADHD. It was her theory that you rule out possible disorders based on chemically altering a child and observing their behavior. In other words, she wanted to use my 5 year old as her lab rat to rule out possible disorders. I now refer to this doctor as Dr. Rx. I said that I did not believe in medicating a five year old and that I would go waste my time and money on therapy. How dare she portray the bleakest of futures for my son! I refuse to let that happen. I will show her, nothing motivates me more than being told that I can’t. I dedicated the summer to private therapy. I was determined to prove Dr. Rx wrong and fix my son before he ever had a chance to fail in school.
I went to the pediatrician to tell her of the experience that I had with Dr. Rx from their referral and asked if they knew of a psychologist that believed in therapy and not medication. Even the pediatrician made the comment that it was ok to explore therapy as long as it was not affecting the other kids at school. Again, another pro-medicator. There are tons of them out there. She gave me another referral and I went to check out. I happened to push over one of those free Arizona kids magazines onto the check out ladies desk. She looked at me disgusted, so I immediately picked it up. It was all about summer camps around the valley. I took it home and began my summer of therapy. I decided that the things that one needs to be successful in life are to read, write, speak and hear. Inside the magazine I found an ad for a handwriting summer camp. I thought to myself how cool, exactly what I need, so I gave them a call. The owner answered. I told her that my son was entering Kindergarten in August and he was still fisting the pencil. I told her our story and said that I was not sure if he could just take the class or if he would need more help than just that. She said that she was an OT that specialized in handwriting and would evaluate him. They offered private OT as well as the classes so we would see where he would best fit. She evaluated my son and thought that he had convergence insufficiency. She said that when you look at something on a piece of paper, your eyes come together to look at the point (converge) and when you look up, your eye separate back out to normal. She said that she was not seeing that with him and she wanted us to see a behavioral optometrist for screening.
I had never heard of such a thing. I came home and started researching all this stuff: Behavioral Optometrist, Vision Therapy, Convergence Insufficiency. I discovered that I also had a form of this so I made an appointment for us both to be screened. Turns out that yes, we both needed vision therapy. How can this be? I had been to an optometrist every year and worn glasses since I was in the sixth grade. I have never had an eye exam as thorough as the one I received from my COVD certified Optometrist. He not only asked me to read an eye chart to evaluate my eyesight, he went further and evaluated my vision at close range. This further probe evaluates the skills needed for reading and schoolwork. Since Dr. Rx said that therapy did not work, I decided that I would go through it with my 5 year old son and see for myself. OMG – it was the most amazing thing that we have ever experienced! With every single visit, I noticed a considerable difference in my son’s behavior. After 4 units in five short months, he was cured. He never talks about not being smart anymore. In fact it is all about how brilliant he is. Vision Therapy was able to solve his problem before he was ever unsuccessful in school and disliked it. Before it ever had a chance to affect his self esteem. We were very fortunate to have found this when we did and I am eternally grateful! Prior to vision therapy, my son did not know his ABC’s and just yesterday he brought home an all-star student award from his school and he gets to go to an NBA basketball game as a reward. Only the top three kids academically and behaviorally were chosen from each classroom. This is no easy feat, as my son goes to a college prep elementary school where they are doing 1st grade work in Kindergarten. His success brings me to tears – happy tears!
Speaking from someone who has experienced vision therapy. It makes everything in your or your child’s life easier. Things that I could never do before now come so easily. My speed and comprehension in reading have more than doubled! I am able to process information more quickly, therefore I think faster and react faster. My peripheral vision has also increased. I am so fascinated and awed by the transformation that has taken place in both myself and my son, that I want to be trained as a vision therapist. I have an overpowering need to help others and save them from the struggle I, and more so, my son experienced. I need to save all the children from medication! I want to use my marketing background to spread the word. Vision therapy is the cure for learning related issues and most behavioral issues. The change that has taken place in both of us is so profound and so powerful that it feels like I have the “cure for cancer” and I want to shout it from the rooftops!! How can people not know about this?
Please share our story with potential clients. I want them to know that if they are skeptical or hesitant at all, please know that they have made a wonderful decision to pursue vision therapy. It is worth every penny that you will spend on it and then some!! It makes everything in your or your child’s life easier!
For all of the parents out there who have children that have been diagnosed with some form of Autism Spectrum Disorder and have been sold false hope time and time again, this is the treatment for you. THIS ONE WILL WORK! It can change your family forever in a way that you never thought possible. It will change your life and that of your child’s forever in the most positive way imaginable. Your retina is actually made up of brain tissue. Your eyes are actually an extension of your brain (80% of learning is done through the visual system) and by changing how your child’s visual system behaves, you will open up and change their brain forever. Visual skills are learned and your child has an underdeveloped system. Learning to use your eyes is like learning to ride a bike, once you get it, you never forget. If you are still skeptical, I beg you to give it a shot. Do it to prove me wrong if you must, but just do it, I dare you! Give it one last shot, take one more leap of faith, it certainly won’t hurt. The very worst that can happen is that nothing changes. I bet that you will be pleasantly surprised, no make that ecstatic about the results. Please share your stories and experiences, both good and bad, with me at www.visiontherapyadvocate@gmail.com. I will be your biggest cheerleader and I wish you and your family the best of luck!

Sincerely,
Stephanie Leary

tabletki na pryszcze April 3, 2011, 7:32 AM

Very interesting info, i am waiting for more !!! Keep updating your site and you will have a lot o readers


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