After I wrote The 12 Week Vision Therapy Challenge, a colleague called and asked my advice about a young teenage patient who was referred to his office by a pediatric ophthalmologist. The OMD advised the parent that she was referring her daughter for “orthoptics”, but the patient also had amblyopia and wore a plus lens Rx full time. We may be seeing a trend of pediatric ophthalmologists who are following the guideline of the CITT, but that also raises the issue of professional judgement on the part of the optometrist who is going to take the patient on for treatment.
Dr. Mitchell Scheiman is an optometrist who is a principal investigator of the CITT. Dr. Scheiman writes in his textbook on Clinical Management of Binocular Vision that office-based treatment of convergence insufficiency generally requires 12 to 24 office visits. The total number of visits depends on the severity of the condition, the age of the patient, and his or her motivation and compliance with home therapy procedures. He concludes that motivated adults can sometimes successfully complete vision therapy for convergence insufficiency in as few as 12 visits.
Several points are worth highlighting here. The visits referred to here are generally one hour sessions of therapy. So the fewest number of hours of office-based therapy in which one can reasonably expect a motivated adult with an uncomplicated condition of CI to complete therapy in 12. That would translate to 24 units of therapy if each session were 30 minutes in length. Generally the treatment is closer to 24 hours of office therapy, or 48 units of therapy, if the patient’s case is not idealized. The more complicating factors, the longer the duration of therapy. Bear in mind that guidelines gleaned from the CITT are very generalized, and in clinical practice there are many mitigating factors that determine the length of therapy.
A young or immature child? Count on therapy going longer.
A developmentally delayed child? Count on the therapy going longer.
A teenager with amblyopia? Count on therapy going longer.
A patient who has encountered brain injury? Count on therapy going longer.
Inconsistency in office visits or compliance with home therapy? Count on therapy going longer.