Why will one doctor recommend 10 weeks of vision therapy, and another recommend 25, 30, or 40? As a person evaluating your options for treatment, it may be difficult to understand why the difference.
Most of the time it comes down to your neuro-optometrist’s understanding of vision. There are a variety of different approaches, and at the risk of over-simplifying, we will boil it down to 2.
Convergence, accommodation, and saccades (tracking)
There is a school of thought in optometry that areas of vision are essentially separate. There may be a problem with convergence (how the two eyes come together), accommodation (how they focus), and/or saccadic function. Treatment is aimed at doing the thing that caused the person to fail that particular test, and only that thing. Particular skills are worked on for about 6-10 weeks, and then re-evaluated to see if they can now pass the test, showing that the condition was treated. Treatment is often extended for another 6-10 weeks to work on the same things. There may also be extensive testing to see if there are visual-processing deficits, looking at areas such as visual memory, sequential memory and more.
Vision as an integrated system
The other popular view is that vision is more of an integrated system where things like convergence, accommodation, and saccadic function are inter-related. For example, before the eyes can make an accurate movement (saccade), the brain needs to accurately calculate where they need to move. The eyes also need to be able to coordinate that movement together, or they end up in slightly different spots. If the accommodation is off target, it also effects how the eyes move together as the brain tries to compensate.This theory also looks at how the visual and vestibular systems work together, how depth and space are processed and more. The belief is that areas of vision do not function as separate silo’s, and when treating, it is essential to properly integrate everything together so that it continues to work that way. There are often dozens of exercises that need to be completed and treatment algorithms to be followed to achieve proper integration.This method of treating can take as little as 10 weeks, but most often the optometrist is able to give an estimate of a time-frame based on findings, that may range from 16-50 weeks time, with progress checks along the way. T Even though the official progress checks are often 10 weeks apart, each particular exercise has built in expectations so your optometrist will know each week if you’re on track.
Which is better?
I have practiced in both methods, so I’ve had a very good idea of the pros and cons of each. The ‘try 10 weeks’ approach is fantastic for creating a low barrier to entry. After all, 10 weeks doesn’t seem so bad. What I found though, was that it was possible to teach you to beat a test, without actually getting the full transfer to daily life (that is what gives true symptom improvement). It’s like teaching you to read a paragraph of Italian, so you could fluently read that paragraph, and then pass the test. But how would you do if you were plunked down in Italy? You learned to beat the test, but the skill transfer would be minimal. You failed the test because you didn’t know Italian, not because the paragraph itself was the problem. The same goes with vision. Often the test that is failed is the surface manifestation of an underlying problem. A great example of this is convergence.Often it’s thought that if you can’t follow your finger to your nose with both eyes, that you need to just practice more convergence. In reality, part of the problem is that there is a fundamental lack of spatial/depth processing, so your brain doesn’t truly understand where the finger is and what needs to be done to get the eyes to point at it. Simply doing more convergence exercises may mean that you can beat the test, and show some symptom improvement, but nowhere near the level of addressing the root cause.
The engineering brain in me screams that because of how fantastically integrated our vision is, it needs to all be calibrated to work together, so that it stays that way. Understanding this was a game-changer for the improvements seen by our patients. Based on our in-clinic research and trials, it has allowed us to develop models that can accurately (95-98%) predict within +-2 weeks how long will be needed for treatment. The models have become so strong that we can back it up with free treatment extensions for up to 3 months if needed, and a money-back guarantee on achieving our outcomes.
This approach has its’ downsides. Because we can estimate the time-frame, our patients are faced with a larger commitment that can seem daunting. For some people it’s too much, but from a clinical perspective it means that I know we are being set up for success.
So the try 10 weeks approach is great for getting a lot of people into vision therapy, but I found it severely lacked in actually getting the outcomes that mattered. The more integrated model means that people know what they are in for up-front (and may mean that some get scared off), and that results can be guaranteed.
When you’re evaluating your vision therapy options, ask your optometrist about their approach, their outcome measures, and how they stand by their recommendations.