There exist a few different broad classifications of vision treatment philosophies, which have been traditionally divided between
optometrists,
ophthalmologists, and practitioners of alternative medicine. Orthoptic vision therapy, also known as
orthoptics, is a field pertaining to the evaluation and treatment of patients with disorders of the visual system with an emphasis on binocular vision and eye movements. Commonly practiced by
orthoptists, optometrists, behavioral optometrists,
pediatric ophthalmologists, and general ophthalmologists, traditional orthoptics addresses problems of
eye strain, visually induced
headaches,
strabismus,
diplopia and visual-related skills required for
reading. Behavioral vision therapy, or visual integration vision therapy (also known as
behavioral optometry), is a pseudoscientific field pertaining to the treatment of patients with various psychological disorders, such as
dyslexia,
developmental coordination disorder,
attention deficit hyperactivity disorder, among other learning disorders via orthoptic techniques. Evidence to support its use in treating amblyopia is unclear as of 2011. Much of the practice of orthoptists concerns refraction and muscular eye control. Orthoptists are trained professionals who specialize in orthoptic treatment. With specific training, in some countries orthoptists may be involved in monitoring some forms of eye disease, such as glaucoma, cataract screening, and diabetic retinopathy.
Behavioral vision therapy Behavioral vision therapy (BVT) aims to treat problems including difficulties of visual attention and concentration, which behavioral optometrists classify as visual information processing weaknesses. These manifest themselves as an inability to sustain focus or to shift focus from one area of space to another. Some practitioners assert that poor eye tracking may impact reading skills, and suggest that vision training may improve some of the visual skills helpful for reading. Behavioral vision therapy is practiced primarily by optometrists who specialize in the area. Historically, there has been some difference in philosophy among optometry and medicine regarding the efficacy and relevance of vision therapy, although none support its use in treating learning disorders. Major organizations, including the
International Orthoptic Association and the
American Academy of Ophthalmology, have concluded that there is no validity for clinically significant improvements in vision with BVT, and therefore do not practice it.
Behavioral optometry Behavioral optometry is a scientifically unproven branch of optometry that explores how visual function influences a patient's day-to-day activities. Behavioral vision therapy is a subset of behavioral optometry. In general, vision therapists attempt to improve the vision, and therefore day-to-day
well-being, of patients using "eye exercises," prism, and lenses, with more emphasis on the patient's visual function. Among schools of medicine, neither ophthalmology nor psychology see merit in the procedures surrounding many of behavioral optometry's practices, as there have not been enough studies of high enough rigor to warrant practicing behavioral vision therapy. According to the
American Association for Pediatric Ophthalmology and Strabismus, the behavioral aspects of vision therapy are considered scientifically unproven. • The wearing of
convex lenses. • The wearing of
concave lenses. • "Cawthorne Cooksey Exercises" also employ various eye exercises, however, these are designed to alleviate vestibular disorders, such as dizziness, rather than eye problems. • Antisuppression exercises for
amblyopia - this is no longer commonly practiced, although occasionally it may be used. Eye exercises used in behavioural vision therapy, also known as developmental optometry, aim to treat problems, including difficulties of visual attention and concentration, which are purported to manifest themselves as an inability to sustain focus or to shift focus from one area of space to another. Some of the exercises use: • Marsden balls • Rotation trainers • Syntonics • Balance board or beams • Saccadic fixators • Directional sequencers Fusional amplitude and relative fusional amplitude training are designed to alleviate
convergence insufficiency. The CITT study (Convergence Insufficiency Treatment Trial) was a randomized, double-blind multi-center trial (high level of reliability) indicating that orthoptic vision therapy is an effective method of treatment of convergence insufficiency (CI). Both optometrists and ophthalmologists were coauthors of this study. Fusional amplitude training is also designed to alleviate intermittent
exotropia and other less common forms of strabismus. Certain
do-it-yourself eye exercises are claimed by some to improve
visual acuity by reducing or eliminating
refractive errors. Such claims rely mainly on
anecdotal evidence, and are not generally endorsed by orthoptists, ophthalmologists or optometrists. The German optician
Hans-Joachim Haase developed a method to correct an alleged misalignment. His method, called the
MKH method, is not recognized as an evidence-based approach. Beginning in the early 1960s, the Chinese government, concerned about the high incidence of nearsightedness among the Chinese population, undertook a programme to combat this problem. In 1963, the government began requiring schoolchildren between the ages of 6 and 17 to perform eye exercises at school. Ever since, this has been a common practice at schools in the People's Republic. The actual method used by the schoolchildren to exercise their eyes is based on traditional Chinese massage therapy, involving self-massage of acupoints around the eyes. The programme's effectiveness, however, is very much in question, given that over the same time as that in which there have been regular school eye exercises, the prevalence of nearsightedness among Chinese children, quite contrarily to the government's intended goal, has risen significantly.
Conceptual basis and effectiveness Behavioral optometry is largely based on concepts that lack plausibility or which contradict mainstream
neurology, and most of the research done has been of poor quality. As with
chiropractic, there seems to be a spectrum of scientific legitimacy among practitioners: at one extreme there is some weak evidence in support of the idea that myopia may be affected by eye training; In 2008 Barrett concluded that "the continued absence of rigorous scientific evidence to support behavioural management approaches, and the paucity of controlled trials, in particular, represents a major challenge to the credibility of the theory and practice of behavioural optometry."
Sports vision training Practitioners of sports vision training claim to be able to enhance the function of an athlete's vision beyond what is expected in individuals with already healthy visual systems. == History ==