Does Vision Therapy have long-term results?

[wydors]

I recently found out that my DD has some vision issues - convergence being one of them.  The Dr. we saw does some sort of vision training that he insists is not the same as vision therapy.  He claims that traditional vision therapy does not have long-term results.  IE, it doesn't actually solve the problem and there will be regression.  

 

Can I get some experienced opinions?  

 

Please share what problems were being corrected, how long the VT sessions lasted, and how long the VT results have lasted if you can.

 

Thank you very much.  I look forward to hearing from those of you who have already been down this road.

[Black-eyed Suzan]

We just started and are only doing exercises at home so I don't have any personal information for you. 

From the Mayo Clinic:
http://www.mayoclinic.com/health/convergence-insufficiency/DS01146/DSECTION=treatments-and-drugs

My understanding is that it can be cured, but may come back if the person is tired.

 

From the Cochrane Database:
http://summaries.cochrane.org/CD006768/non-surgical-treatments-for-eyes-with-convergence-insufficiency

Are you on Facebook? I found 2 groups that relate to vision therapy - Convergence Deficiency/Insufficiency and Vision Therapy Parents Unite. They may be another resource for you.

Hope that helps!

[sbgrace]

Well, my son couldn't converge and couldn't track at all prior to therapy. He can do both now. I've never had him retested formally. But there was major impairment and no sign of any issues now. He completed therapy 4-5 years ago.

[SKL]

Yes, the results are lasting, but yes, there may be regression.  In my daughter's case, she started VT a little before her 4th birthday.  At that time she could barely write one single letter, and she could recognize only about half of the capital letters.  (This was after being exposed daily for years.)  18 weeks of VT had her recognizing and writing most letters and numerals.  It also trained her to "use her eyes" efficiently to accomplish tasks.  A few months later she was recruited for early KG, so I guess she was a little advanced.  Since then she's been a slightly above-average reader and an average student overall.

 

Two years later, a vision test showed that she needed prism glasses and 9 more weeks of vision therapy (which she completed this past summer).  Now when I watch her eyes, I notice them sometimes moving more independently than I think they should.  She has a vision exam coming up soon, so we'll see if there is a problem.  However, she continues to be a good reader, and her other subjects are improving as well.  I have no doubt that vision therapy has had lasting benefits, but that's not to say the physical improvement is permanent (if that makes any sense).

[bluedarling]

My oldest had 12 weeks of VT when he was 8.  It had very little effect.  We moved, and he had 1.5 years of VT with a new doc at age 13.  The new doc said the previous therapy had "laid a foundation," but I'm not as convinced of its usefulness.  I think the results of the 2nd round have been lasting because of the length of therapy.

 

My 2nd child had OT focused on vision at age 6ish who referred us on for no progress after a few months.  Then he saw a neurodevelopmental chiropractor for another 4-6 months which included interactive metronome, again with no progress.  He told us he must need prisms, and referred us on.  Then we moved at he had 1.5 years with same doc as above...lots of interactive metronome, computer work at home, and vision exercises there.  Totally successful (without prisms).  I believe the difference was the length of therapy.

--Deidre

[OrganicAnn]

When I was 11 years old, I had Vision Therapy.   I had tracking issues and convergence issues.   I'm 52 and the issues haven't resurfaced yet.   :)

[PeterPan]

Well Wydors never came back and replied, but I'll just observe that lasting, not lasting, having an effect, not having an effect has way more going into it than simply whether you do VT.  With VT you're making pathways in the brain.  They've got MRIs showing the brain changes, so that's actual progress.  And of course, with most therapies what you USE you maintain.

 

The thing is, say someone has a confounding issue neurologically (retained primitive reflexes, for instance), then they know the therapy isn't going to stick and might not even work in the first place.  So you get a doc who doesn't work on sensory integration, doesn't integrate the retained primitive reflexes, doesn't acknowledge this and that, and then the VT mysteriously "doesn't stick" and was the issue the doc or the VT?  

 

You also have kids who are low tone.  Not all are.  Kids (and adults) with low tone will lose the tone they gain with therapy if they don't keep using it and working on it.  Tone and brain pathways are not one in the same.  Not all kids have low tone.  So with a kid like mine, who is low tone, yes you could have the kid have some regression where they need to touch it up and work on it again.  But that's because the VT was actually hitting both things for the eyes, their muscles AND the brain pathways.  But it's not like the brain pathways just disappeared and went to 0, and that's not all kids.  

 

There are people (sometimes OTs, not certified vision therapists) doing paper therapy.  So there you're getting into the definition of VT and what is thorough therapy and what is superficial, I opened a book and photocopied stuff therapy.  You've got therapists who are totally the other direction, who do all the therapy while the kid is in motion.  So it's not like all VT is alike.  That too will explain some differences in outcomes.  You've got people being sold software for the full extent of their VT.  That too will explain some differences in outcomes.  You just sorta have to take these practitioners with a grain of salt.  They're pretty niched, so they might be good at handling one type of child with one type of problems and not really have the experience to handle a more complex situation with more issues going on.  It's why people can get burnt with one practitioner or another and yet have the practitioner be fine for someone else.  Some kids are more complex, and you're really the only one in the gap, researching and asking the questions.

[wydors]

Thank you so much for the responses.  Food for thought for sure.  

 

I have made an appointment to see a vision therapist and we'll see what happens from there.  We will also go back for further consultation with the first doctor and get some more questions answered.  Hopefully, after talking with both and comparing their plans, we can make the best choice for our daughter.

 

OhElizabeth, I am fascinated by the brain tone information.  I will search to see if you have other posts on that topic.  If not, how do you test for such a thing?  We are just beginning to figure out some of our issues and only want to the first vision doc to rule out vision issues.  I was shocked to find out that there was truly something there.  I don't know that vision is the only issue though and I'm not real sure which roads to travel.  I will be gleaning lots of info from this board.

 

Thanks!

[PeterPan]

Oh, sorry not to be clear!  Low *muscle* tone.  There are degrees of it and causes.  You'll see the term "benign congenital hypotonia" and then the debate over whether it's ever benign.  If you research it enough, you find it connected with mitochondrial disorders, etc.

 

Yes, I totally agree with you that vision is the start for people, not the end.  People are complex, so I don't think that's too shocking.  But it's a process you go through, one step at a time.  :) 

[geodob]

Rather than 'long term results'?

What needs to be highlighted, is that vision requires long term maintenance.

Our eyes rely on a complex network of muscles, for their operation.

Where just as with any muscles, they need to be regularly exercised, or they will deteriorate.

So that while vision therapy can correct an issue.

The basic exercises used in the therapy, need to be integrated into daily life.  So that the benefits are maintained.

 

With convergence issues, one of the best strategies, is to have ones work desk under a window.

So that one can regularly look out the window at a distant point, and then to points in between, and back to our desk.

Where everyone should do this daily, which only takes a few seconds, but is actually important to maintain good convergence.

 

So basically I would suggest that in regard to vision therapy having long term results?

This could be answered as; Having corrected an issue with vision therapy, long term maintenance of the correction, relies on ongoing daily maintenance.

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[MerryAtHope]

Well Wydors never came back and replied, but I'll just observe that lasting, not lasting, having an effect, not having an effect has way more going into it than simply whether you do VT.  With VT you're making pathways in the brain.  They've got MRIs showing the brain changes, so that's actual progress.  And of course, with most therapies what you USE you maintain.

 

The thing is, say someone has a confounding issue neurologically (retained primitive reflexes, for instance), then they know the therapy isn't going to stick and might not even work in the first place.  So you get a doc who doesn't work on sensory integration, doesn't integrate the retained primitive reflexes, doesn't acknowledge this and that, and then the VT mysteriously "doesn't stick" and was the issue the doc or the VT?  

 

You also have kids who are low tone.  Not all are.  Kids (and adults) with low tone will lose the tone they gain with therapy if they don't keep using it and working on it.  Tone and brain pathways are not one in the same.  Not all kids have low tone.  So with a kid like mine, who is low tone, yes you could have the kid have some regression where they need to touch it up and work on it again.  But that's because the VT was actually hitting both things for the eyes, their muscles AND the brain pathways.  But it's not like the brain pathways just disappeared and went to 0, and that's not all kids.  

 

There are people (sometimes OTs, not certified vision therapists) doing paper therapy.  So there you're getting into the definition of VT and what is thorough therapy and what is superficial, I opened a book and photocopied stuff therapy.  You've got therapists who are totally the other direction, who do all the therapy while the kid is in motion.  So it's not like all VT is alike.  That too will explain some differences in outcomes.  You've got people being sold software for the full extent of their VT.  That too will explain some differences in outcomes.  You just sorta have to take these practitioners with a grain of salt.  They're pretty niched, so they might be good at handling one type of child with one type of problems and not really have the experience to handle a more complex situation with more issues going on.  It's why people can get burnt with one practitioner or another and yet have the practitioner be fine for someone else.  Some kids are more complex, and you're really the only one in the gap, researching and asking the questions.

 

Excellent break-down (and while I knew about the primitive reflex issue, I never really thought about low muscle tone with regard to eyes--this makes so much sense to me!)

 

 

Rather than 'long term results'?

What needs to be highlighted, is that vision requires long term maintenance.

Our eyes rely on a complex network of muscles, for their operation.

Where just as with any muscles, they need to be regularly exercised, or they will deteriorate.

So that while vision therapy can correct an issue.

The basic exercises used in the therapy, need to be integrated into daily life.  So that the benefits are maintained.

 

With convergence issues, one of the best strategies, is to have ones work desk under a window.

So that one can regularly look out the window at a distant point, and then to points in between, and back to our desk.

Where everyone should do this daily, which only takes a few seconds, but is actually important to maintain good convergence.

 

So basically I would suggest that in regard to vision therapy having long term results?

This could be answered as; Having corrected an issue with vision therapy, long term maintenance of the correction, relies on ongoing daily maintenance.

 

Yes, and the window idea is so practical!

[Atilla the Mom]

Both my kids had vision therapy at ages 14 and 8 respectively.  They are now 23 and 16. No sign of regression thus far.  I had vision therapy for convergence insufficiency at age 23. They told me that I would need to do the exercises for the rest of my life but I am 56, and have not done so since 24, and I don't have insufficiency.  I agree that since vision therapy especially with respect to convergence insufficiency is basically exercises for the visual muscles, yeah, there could be regression. If there is, presumably one restarts doing pushups for the muscles involving vision. 

[prairiewindmomma]

I'm not sure if this was a zombie thread that got resurrected by cittalta, but since others are chiming in, ds went in for his annual appointment with his non-COVD opthamologist. (He also is seen by his COVD optometrist.) Dh wants verifiable outside measurements/oversight because dh's an analytical guy and he wants numbers and graphs to justify the $$$$ we pay for therapy out of pocket. The ped opth could improvement in his convergence insufficiency but not a complete "fix" at the one year post-therapy. Now we are two years post-therapy and things are the same. We continue to save for more therapy.  Two of my kids have congenital 4th cn palsy, so not everything is going to be fixable; his superior oblique seems to be paralyzed rather than just weak.

[SKL]

An update on my daughter's situation.  I mentioned above that she seemed to still have some issues and had an eye appointment coming up.  We went for the eye appointment and the doctor said that her continuing problems are related to a retained primitive reflex (RPR) issue that hasn't completely resolved.  I have not been very good about making her do the RPR therapy this year.  He said more vision therapy won't help much if the RPR issue is not resolved.  So that is on my agenda for the summer.

[Heathermomster]

An update on my daughter's situation.  I mentioned above that she seemed to still have some issues and had an eye appointment coming up.  We went for the eye appointment and the doctor said that her continuing problems are related to a retained primitive reflex (RPR) issue that hasn't completely resolved.  I have not been very good about making her do the RPR therapy this year.  He said more vision therapy won't help much if the RPR issue is not resolved.  So that is on my agenda for the summer.

Which prim reflex was identified as not fully incorporated?

[SKL]

Which prim reflex was identified as not fully incorporated?

 

Honestly, I don't remember and I didn't take notes.  She is in therapy for several RPRs but we are close to being done, or so I thought.  It has something to do with her being able to move different body parts (including her eyes) independently.  So if she's on her knees and her head moves one way, her rear/legs shouldn't move automatically too ....  Another one she is still working on has to do with responding to feeling at her extremities.  Sorry I can't be more scientific about it....