Home-Based Vision Therapy


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Another nail in the coffin of home-based vision therapy as being a substitute for office-based vision therapy comes from a new study just published by the PEDIG group.  PEDIG is the cousin of CITT, another multi-center transdisciplinary group that conducts impeccable scientific studies through prospective, randomized clinical trials funded by NEI/NIH.  Just published online in Optometry and Vision Science, the study compared the effectiveness of home-based computer vergence/accommodative therapy (HB-C) to HB near target push-up therapy (HB-PU) and to HB placebo treatment (HB-P) among children aged 9 to <18 years with symptomatic convergence insufficiency (CI).

The percentage of individuals with successful outcomes were as follows:

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The study noted that estimates of success are not precise, and comparisons across groups were difficult to interpret due to differential dropout rates.  Based on prior CITT studies and this new PEDIG study, it’s fair to conclude that office-based vision therapy is far superior to home-based vision therapy, and that home-alone therapy suffers from the tendency of patients not to do it and drop out of follow up care.  Think of office-based therapy as “visual weight watchers” – aside from the guiding knowledge of interacting with a therapist hands-on each week, there is the improved compliance with home therapy because you know that someone is going to be re-assessing your performance.

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Why do insurance carriers and pediatric ophthalmologists advise parents to try home-alone therapy prior to even considering office-based optometric vision therapy?  Well … on the surface, home-based therapy saves time and money.  The problem is, there’s no contemporary scientific evidence that it works.  Valuable time is wasted chasing after ineffective cures and worse, the discouraged patient/family  comes to the conclusion that “we tried vision therapy before, and it doesnt work”.  So the next time someone asks For what age is home-based therapy most suitable? you’ll be able to provide this answer:  It was appropriate for The Stone Age.

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10 thoughts on “Home-Based Vision Therapy

  1. Drs. Press and Cook, if you’ll permit the intrusion: Do you not prescribe at home VT? Or are you referring to DIY solutions, where there is no doc involved? ALL of my patients do at home work, so much so that if they are unwilling to do so, I will not accept the case.

    • Yes – we’re considering home-based therapy as home-alone therapy. That is the connotation of “home-based”, as distinct from office-based”, as derived from the CITT and as implemented in this PEDIG study. So we agree with you (as utilized in the CITT as in our practices) that home therapy is very useful adjunct to in-offic therapy: new learning typically occurs under guided conditions in the office, and home therapy is used to reinforce and consolidate learned skills.

  2. Great post Len. Quite apt, your nail analogy. But it will probably take a while longer for the death of this idea. Can’t wait.

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