When a child is having problems in school, poor vision may be to blame. For some patients, however, corrective lenses may not be enough, says Sarah Dille, OD, a pediatric optometrist and Chief of Vision Therapy at UAB Eye Care.
“If a person continues to have vision issues even with corrective lenses, we listen for common symptoms that may include eye strain, blurred vision, headaches, or double vision, especially when reading for extended periods,” she says. “Once we determine that the eyes are healthy and seeing clearly individually, we assess how the two eyes are working together. For eye turns requiring muscle surgery, we maintain a close working relationship with area pediatric ophthalmologists. Other disorders of binocular vision may be amenable to vision therapy.”
At UAB Eye Care, doctors perform an eye health exam, including dilating drops, followed by a visual efficiency exam to evaluate how well the visual system is working. The exam also helps determine when vision therapy is an option.
“Common skills treated in the Vision Therapy Clinic include eye tracking and focusing in addition to accurate convergence and divergence. Convergence insufficiency (CI) is one diagnosis that may interfere with a person’s ability to see the computer, read, and work at close distances for extended times,” Dille says.
When a person has CI, the eyes have a strong tendency to drift outward when reading or working up close. If the eyes drift out, the person could experience double vision. To prevent the double vision, the individual exerts extra effort to turn the eyes back in which can lead to other problems including blurred vision, headaches, an inability to concentrate, and frequent loss of place in the reading materials.
Vision therapy can help strengthen the eye muscles to better support the eyes when performing close-up tasks. A combination of in-office and home eye exercises is used to train the visual system to work more efficiently and accurately. The duration of therapy generally is 12 to 30 weeks, depending on the severity of the signs and symptoms.
“Our therapy is based on National Institutes of Health research conducted through a national, multi-center CI study that evaluated whether in-office vision therapy helps these patients. The study concluded that vision therapy worked in the large majority of participants,” she says.
The National Eye Institute’s randomized clinical trial studied 221 children ages 9 to 17 with symptomatic CI. The objective was to compare 12 weeks of home-based therapies with 12 weeks of office-based vergence/accommodative therapy with home reinforcement. The study concluded that the 12-week office-based therapy with home reinforcement resulted in “significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success” when compared with home-based therapies only.
Dille says their therapy sessions incorporate the methods tested in the study which includes a weekly one-hour in-office therapy visit with additional prescribed procedures to be performed at home for 15 minutes a day, five days a week. Each child has an individualized therapy program which typically consists of a plan of treatment procedures using lenses, prisms, instrumentation, visual exercises and occlusion to address the person’s concerns. The home therapy is used to reinforce skills learned at the doctor’s office.
Improvements in visual function may result in a higher quality of life for individuals who have suffered with these types of vision problems. Dille says her office keeps a book of success stories for their patients. “Many of our patients have had trouble in school and are frustrated when they come to us. One seven-year-old boy came to us frustrated and did not like to read. He is a smart boy, but he did not want to be here,” she says. “At the end of his therapy, he wrote in our book, ‘My eyes are better. This time was well spent. Thank you.’ His mom was happy and thrilled with the improvements he made.”
In addition to the vision therapy provided to hundreds of patients over the past 15 years, Dille says that UAB will be a site for future federally funded studies to determine the long-term effects of vision therapy. “We are committed to being part of the team that provides state-of-the-art, evidence-based care to each of our patients,” she says.