When we think about good vision, we usually think about being able to see clearly. If you can read the 20/20 line on an eye chart, your vision must be working the way it should, right?
Not necessarily.
Seeing clearly is only one part of vision. Your eyes also need to focus, move accurately, and work together as a team. Most of the time, we don’t even notice these things happening. But when one of those skills isn’t working efficiently, activities like reading, working on a computer, or focusing up close can become much more difficult.
That’s where vision therapy can sometimes help.
Vision therapy is a structured treatment program designed to improve specific visual skills and the way the eyes and brain work together. And while it can be very effective for certain conditions, it isn’t a cure-all for every reading, learning, or attention problem.
Vision Is More Than Seeing 20/20
During an eye exam, we obviously care about how clearly you can see. But we also care about how your visual system functions.
For example, your eyes need to move smoothly across a line of text while you’re reading. When you look at something up close, both eyes need to turn inward and remain aligned on the same target. Your focusing system also has to adjust as you switch between near and far objects.
These skills are sometimes described as eye tracking, eye teaming, and focusing or accommodative ability.
Problems with binocular vision, or the way your two eyes work together, can make visually demanding tasks uncomfortable or inefficient even if each eye sees clearly on its own.
Someone may have 20/20 vision and still experience eye strain, headaches, double vision, difficulty concentrating on near work, or trouble keeping their place while reading.
I actually learned this firsthand.
How I Found Out I Needed Vision Therapy
When I was in optometry school learning about vision therapy, we performed a test that tracked our eye movements while we read.
When it was my turn, my eyes were all over the place. They jumped around the page instead of moving in a smooth line from word to word.
Suddenly, a few things from my school years started to make a lot more sense. I had always been a slow reader. There were also times when I would get a test back, see that I had answered a question incorrectly, and think, “I could have sworn that question said something different.”
For years, I assumed that was just how everyone read.
It wasn’t until optometry school that I realized some of my visual skills weren’t working as efficiently as they should. I ended up going through vision therapy myself to improve the way my eyes worked together.
My experience is a good example of why eyesight and visual function aren’t exactly the same thing. I could see the words clearly. The problem was what my visual system was doing as I tried to move through those words on a page.
How Vision Therapy Works
Vision therapy isn’t simply a collection of exercises intended to make your eye muscles “stronger.”
A better way to think about it is training the visual system to perform certain tasks more accurately and efficiently.
A vision therapy program is typically individualized based on the specific problem being treated. Depending on the patient, therapy may work on skills such as eye teaming, focusing, tracking, visual coordination, or the ability to quickly change focus from one distance to another.
Vision therapy exercises might involve:
- Specialized lenses
- Prisms
- Targets
- Computer-based activities
- Other tools
Patients may work with a vision therapist in an office and also be given activities to practice at home between visits.
The goal is to help the brain and eyes develop more efficient visual patterns that carry over into everyday activities.
Conditions That May Benefit From Vision Therapy
There are several binocular and focusing disorders for which vision therapy may be considered.
One of the best-known is convergence insufficiency.
When you look at something nearby, your eyes naturally turn slightly inward so that both are pointing at the same target. With convergence insufficiency, the eyes have difficulty maintaining that inward alignment during near work.
Someone with convergence insufficiency may experience headaches, tired eyes, blurry or double vision, difficulty concentrating while reading, or words that seem to move on the page. They may also lose their place frequently or avoid prolonged reading because it’s uncomfortable.
Depending on the patient, convergence insufficiency treatment can include structured vergence and accommodative therapy designed to improve the way the eyes work together at near.
Other binocular vision and focusing disorders may also benefit from targeted therapy, although the appropriate treatment depends heavily on the specific diagnosis.
That’s why vision therapy shouldn’t start with a generic list of exercises you found online. It should start with identifying what, if anything, isn’t functioning normally.
Where Vision Therapy Gets Overpromised
This is where the conversation around vision therapy can get tricky. There is a very real relationship between vision and reading. I experienced that myself.
If your eyes aren’t tracking accurately, staying aligned, or focusing comfortably, reading may be harder than it needs to be. Treating an underlying visual problem can make reading more comfortable and efficient for that person.
But that doesn’t mean every reading problem is caused by the eyes.
You’ll sometimes see vision therapy for dyslexia advertised as a way to treat or even cure dyslexia. Dyslexia is a language-based learning disorder, not a vision disorder. Vision therapy doesn’t treat the underlying cause of dyslexia.
The same distinction matters when discussing vision therapy for ADHD. A child with ADHD can also have a binocular vision problem. And a child struggling to keep their eyes comfortably focused on a page may appear to avoid reading, lose concentration, or become frustrated with schoolwork.
If a vision problem is present, it deserves to be treated. But treating that vision problem isn’t the same thing as treating ADHD.
This is why a good evaluation matters. We want to identify a specific visual problem and treat it, rather than assume vision therapy is the answer to every difficulty involving reading, attention, or school performance.
RELATED CONTENT: ADHD or Vision Problems?
Vision Therapy Isn’t Just for Kids
A lot of the conversation surrounding therapy focuses on vision therapy for kids or pediatric vision therapy. However, adults can have binocular vision problems too.
Sometimes the problem has been present since childhood and the person has simply adapted to it. That’s essentially what happened to me.
Other adults may develop visual difficulties following an injury or because the demands on their visual system have changed.
Depending on the condition, vision therapy for adults may be appropriate. Age alone doesn’t necessarily determine whether someone can benefit. The diagnosis, symptoms, and individual visual system matter much more.
Starting With the Right Diagnosis
There are many reasons someone may experience headaches, blurry vision, difficulty reading, or eye strain. Sometimes the answer is as simple as an updated glasses prescription. Sometimes we identify a focusing or binocular vision problem. And sometimes the eyes are functioning normally and another type of evaluation is more appropriate.
A comprehensive eye exam gives us a place to start.
If we identify a visual function problem that may benefit from therapy, we can talk about the appropriate next steps and whether a referral for a more specialized binocular vision evaluation or vision therapy program makes sense.
Vision Therapy FAQ
Does vision therapy work?
For certain diagnosed visual conditions, vision therapy can be an effective treatment. The evidence is strongest for specific binocular vision problems, particularly convergence insufficiency.
That doesn’t mean vision therapy is proven to treat every condition it’s sometimes advertised for. Success depends heavily on treating the right problem with the right type of therapy.
How long does vision therapy take?
There isn’t one standard timeline. A vision therapy program may last several weeks or months depending on the condition being treated, its severity, the patient’s response to treatment, and how consistently therapy is completed.
Can vision therapy help with reading?
It can help when a diagnosed visual problem is interfering with reading. For example, improving poor eye teaming or focusing may make reading more comfortable for someone with a binocular vision disorder. However, vision therapy doesn’t teach reading skills or treat language-based learning disorders such as dyslexia.
Is vision therapy only for children?
No. Both children and adults can have visual function problems, and vision therapy for adults may be appropriate for certain diagnoses.
