Developmental Optometry and Vision Therapy for Children

What is Developmental Optometry & Vision Therapy?

Developmental or behavioral optometrists offer vision therapy as a series of in-office sessions, often weekly, plus home exercises. Activities may use lenses, prisms, computer programs, and targets to train eye teaming (binocular vision), focusing (accommodation), and eye movements.

It helps to separate two uses. Orthoptic therapy for specific eye-muscle coordination problems, especially convergence insufficiency, is accepted by both optometrists and ophthalmologists and has strong trial evidence. Broader 'behavioral' or 'perceptual' vision therapy, promoted for learning disabilities, dyslexia, ADHD, or developmental conditions, is where the disagreement lies.

Convergence insufficiency causes symptoms during close work such as eyestrain, headaches, blurred or double vision, losing one's place, or words seeming to move. A full eye exam by an optometrist or ophthalmologist can diagnose it.

Who is it for?

Who provides it?

Vision therapy is usually provided by an optometrist (OD) or by trained vision therapists working under an optometrist's supervision. Some developmental optometrists hold a fellowship from the College of Optometrists in Vision Development (FCOVD). Pediatric ophthalmologists (MDs) and certified orthoptists also treat convergence insufficiency with prescribed eye exercises. In Illinois, optometrists and physicians are licensed by IDFPR. AAPOS advises families to consider a second opinion from an ophthalmologist experienced with children when vision therapy is recommended.

What do families and practitioners report?

Many families report that after vision therapy, their child had fewer headaches, less eye strain, and more stamina for reading and homework. Developmental optometrists argue that subtle eye-teaming and focusing problems are often missed by school screenings, and that treating them can remove a barrier to learning even if it does not cure dyslexia.

Does it work? What the research says

Convergence insufficiency (CI) has the strongest support. The Convergence Insufficiency Treatment Trial (CITT, Archives of Ophthalmology, 2008; 221 children ages 9 to 17) found that 12 weeks of office-based vergence/accommodative therapy with home reinforcement improved symptoms and eye measures more than home pencil push-ups, home computer therapy, or placebo therapy. A 2011 Cochrane review agreed that office-based therapy works better than home-based exercises for children with CI.

However, the CITT-ART trial (Optometry and Vision Science, 2019; 310 children ages 9 to 14 with CI) found that office-based therapy was no better than placebo therapy for improving standardized reading scores after 16 weeks, even though it improved eye measures. The joint statement 'Learning Disabilities, Dyslexia, and Vision' from the AAP, American Academy of Ophthalmology, AAPOS, and orthoptists (2009, reaffirmed 2014) states that vision problems do not cause dyslexia and that scientific evidence does not support eye exercises, behavioral vision therapy, or tinted lenses for improving long-term educational performance. It notes that treating symptomatic CI can make reading more comfortable but does not improve decoding or comprehension.

Is it covered by insurance in Illinois?

Coverage is limited and varies. Some commercial plans cover a set number of orthoptic or vision therapy visits for convergence insufficiency; for example, Aetna's clinical policy considers up to 12 sessions medically necessary for CI and considers vision therapy for learning disabilities and most other uses unproven. Many families pay out of pocket for longer programs. Illinois Medicaid/All Kids covers medically necessary vision care for children, but vision therapy coverage is limited. Vision services are part of IDEA Part C (Early Intervention) for eligible infants and toddlers, and schools address vision needs through IEPs, though schools rarely provide vision therapy for reading problems.

What to consider and ask

• Get a comprehensive eye exam to identify a specific diagnosis, such as convergence insufficiency, before starting therapy.
• Ask what diagnosis is being treated, what measurements will track progress, and how many sessions are planned.
• If reading is the concern, also request a school evaluation and evidence-based reading instruction.
• Ask whether office-based therapy (the approach tested in CITT) is being used.
• Consider a second opinion from a pediatric ophthalmologist if a long or expensive program is proposed.
• Get the cost and insurance coverage in writing before you commit.