When Vision Therapy is Not Indicated


Those of us experienced in vision therapy encounter myths from time to time.  We’ve addressed a couple of these items in the Facts and Fallacies area of www.visionhelp.com.  I just finished doing a parent conference that reminded me of another fallacy, which is that “everyone needs vision therapy”.

In our practice we’re seeing more adult patients than ever, but we’re also seeing children at a younger age.  Part of this is due to early intervention services, and part due to an increasing awareness on the part of the public that 20/20 eyesight isn’t synonymous with adequate visual development.  This was the case with Katie, a four and one half year old, whose mother is a special education teacher.  Mom was concerned about Katie’s tendency to put items visually in reverse order, among a few other concerns.  She has been in speech therapy, and mother will be having her start OT shortly to see if it can further bootstrap her articulation issues.  It was dad, though, who brought Katie in for her testing.

We divided Katie’s testing into two segments, one during which we tested more traditional visual skills and one during which we adminstered the Wachs Analysis of Cognitive Sturctures (WACS) Test.  Katie did a wonderful job on the WACS and her percentile ranks were great.  In addition, her performance on the Farnsworth Color Cap Test showed that she had very good facility in visual discrimination for sequencing attributes based on color.  We do this just as much in our practice to gain perceptual/developmental insights as we do for color vision purposes.  She did a marvelous job with visual projection on cheiroscpic tracing, and had no visual abnormalities involving refraction, amblyopia, strabisumus, accommodation, crossing the midline, etc.

The bottom line is that I was very pleased with the results in all aspects of Katie’s testing.  At the end of my review I advised Katie’s parents that I did not feel that vision therapy was indicated at this time.

There are times when I hold a conference with parents to review my results, and issues will surface that didn’t present themselves previously.  When vision therapy is indicated, we talk about goals that parents will establish for their expectations, and I match that with what my goals are from a doctor’s therapeutic standpoint.

In Katie’s case, I advised her parents that I would like to hear from her OT about any concerns she may have regarding sensory development and vision.  My evaluation is a snapshot in time, but since she’ll be receiving other interventions her visual needs may change.  Much as mother has the insight that OT may bootstrap speech development, we may find down the road that VT will bootstrap Katie’s development. Katie’s parents were very pleased with this approach, emphasizing a holistic framework and empathy.

– Leonard J. Press, O.D., FCOVD, FAAO

4 thoughts on “When Vision Therapy is Not Indicated

  1. Hi, I like to traslate this article for my optometric College here in México, if you are agree, and post in social media optometric related.

    Regards from Veracruz.

  2. I never thought about using the Farnsworth for that purpose for some reason! What a great idea. Thanks for sharing.

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