Vision Therapy | In Depth

Though all parents hope for their children to have perfect eyesight, vision problems are quite common among kids: they affect about one in 20 preschoolers and one in four school-age children, according to the National Commission on Vision and Health. Many of these youngsters simply need corrective aids, like eyeglasses and contact lenses.  A few may need eye surgery for a more serious issue.

But for children with certain kinds of eye problems, vision therapy may provide another treatment option. Unlike glasses or surgery, it aims to “teach” the visual system to work more efficiently through a series of supervised exercises. At Children’s Hospital Boston, we may prescribe vision therapy for children (and some adults, too) who have one or more of the following:

  • tracking problems, also called oculomotor problems. These are difficulties with controlling eye movement, and revolve around three key skills:
    • Fixation refers to the ability to continue looking at a stationary target.
    • Pursuits refers to the ability to continue looking at a moving target.
    • Saccades refers to the ability to smoothly change fixation quickly and accurately from one target to another (saccades are especially important in reading, for example).
  • teaming problems, also called vergence problems. This means the eyes aren’t working in coordination with each other. A common example is convergence insufficiency, which is when the eyes don’t turn inward together when focusing on a nearby object.
  • focusing problems, also called accommodative problems. Examples include difficulties in switching eye focus from far to near and trouble focusing the eyes during close work, like reading.

Saving Andie’s eyes

Seeing Andie Ormiston’s sparkling blue eyes and radiant smile, you'd never guess this petite 3-year-old’s entry into the world was touch-and-go. Learn how precise laser surgery at Boston Children’s Hospital saved Andie’s sight.

Learn how precise laser surgery at Boston Children’s Hospital saved Andie Ormiston


Q: Is vision therapy the same thing as orthoptics?
While the two terms are sometimes used interchangeably, orthoptics refers to specific eye muscle exercises prescribed by an optometrist or orthoptist. Orthoptists, who often assist ophthalmologists, are trained to evaluate and measure eye alignment problems; they prescribe orthoptic exercises, but not other types of vision therapy.

Q: Are “pencil push-ups” part of vision therapy? 
A: Easy to say and easy to remember, pencil push-ups are fairly well known as an exercise for convergence insufficiency. But although pencil push-ups may still be used as part of an overall vision therapy plan, there are often other, more effective (and less boring!) exercises for this vision problem.

Q: What are conditions are most commonly treated with vision therapy?
A: At Children’s Hospital Boston, most patients come to us for help with generaltracking problems (difficulties in controlling eye movement). We also see a lot ofintermittent exotropia (a type of strabismus in which one eye turns outward sometimes, but not always) and convergence insufficiency (a condition in which the eyes don't turn inward properly when focusing on a nearby object). 

Q: At what age can children begin vision therapy?
Around age 6 or 7 is usually the soonest that vision therapy can begin. Younger children may also receive vision therapy, but it’s much harder for them to understand and comply with the process.

Q: How soon will vision therapy show results?
If a child sticks faithfully to the exercise plan, there should be improvement every week. Most children begin actually noticing a difference within six to eight weeks, about midway through the typical therapy program.

Q: Will my child’s vision problem come back later in life?
Generally speaking, children who successfully complete their vision therapy do not need further treatment. Studies are under way nationally to assess how well children maintain their skills after vision therapy for convergence insufficiency. 

Giving Heather New Confidence

The day Heather Barlow came to Boston Children's Hospital for surgery to correct the misaligned eye (strabismus) she had lived with for a decade, it never occurred to her that she would be going home the same day with straight eyes.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If you are meeting with the doctor to discuss vision therapy for your child, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need. (If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.)

Some of the questions you may want to ask include: 

  • What specific kind of vision problem does my child have?
  • Is vision therapy the only option for treating this problem?
  • How long will my child’s vision therapy program last?
  • Does my child need both in-office and at-home therapy sessions?
  • What can I do as a parent to help make the therapy program more successful?
  • How can I tell if the therapy program is working?
  • How many other children have you treated for this problem?
  • What kind of success rate have you seen with them?
  • How much will it cost?

Restoring Brennan's vision

Diagnosed with a cataract at 12 months, Brennan Hughes-Shiverick needed surgery to extract the clouded lens in his left eye. Brennan's ophthalmologist at a local hospital planned to remove the cataract, but didn't have the expertise to perform the implant — so Brennan's parents brought him to Boston Children's Hospital.