From time to time, a third party payer/insurance company will insist upon 12 weeks of out of office vision therapy before supporting an in office vision therapy program. This 12 week out of office therapy mandate is not supported by clinical trials, other levels of research and expert consensus.

The Convergence Insufficiency Treatment Clinical Trials, which were sponsored by the National Institutes of Health National Eye Institute, clearly and unequivocally demonstrate that in office vision therapy is the most efficacious therapeutic approach to remediating binocular vision problems.

The researchers of this study state that : “….Twelve weeks of Office Based Vergence/Accommodation Therapy results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with home-based pencil push-ups, home-based computer vergence/accommodative therapy and pencil push-ups, and  office-based placebo therapy with home reinforcement…..[1]

In office vision therapy was the only intervention that not only improved or eliminated symptoms, but also improved outcome clinical measures (vergence and accommodative ability)[2]. A follow up study showed that these gains were long lasting as well[3]. It should be noted that a Cochrane Review of non-surgical intervention for binocular vision problems also agreed that in office vision therapy was the most efficacious approach[4]. Other populations that showed significant improvement in vision function after in office vision therapy include those with traumatic brain injury[5],[6], amblyopia, and strabismus [7],[8].

The American Optometric Association has compiled Clinical Practice Guidelines that also support active in office vision therapy as well[9]. This document was compiled by experts in the field and lists a substantial amount of supportive research in its reference section. This research includes evidence that supports in office vision therapy for accommodative disorders, vergence disorders and oculomotor anomalies[10],[11]. Additional information and references can be found at the College of Optometrists in Vision Development and Optometric Extension Program Foundation websites.

Vision therapy is a science based mode of treatment that has been utilized for decades to benefit patients[12]. Third parties that insist on 12 weeks of out of office therapy risk the lack of appropriate treatment in a timely manner. This should be considered unacceptable, unethical and perhaps, a form of malpractice as dictated by a non-doctor entity. Our patients deserve better and deserve the fiscal support third parties should make immediately available for in office optometric vision therapy.


Vision TherapyDominick M. Maino, OD, MEd, FAAO, FCOVD-A     Professor, Pediatrics/Binocular Vision Illinois College of Optometry/Illinois Eye Institute; Lyons Family Eye Care, Chicago, Il






The Primary Investigator of the CITT studies, Dr. Mitch Schieman, discusses vision therapy in a National Eye Institute video below:

[1] Available from accessed 10/2014.

[2] Available from accessed 10/2014

[3] Available from accessed 10/2014

[4] Available from accessed 10/2014

[5] Available from  accessed 10/2014

[6] Available from accessed 10/2014

[7] Duckman R. Management of binocular anomalies: efficacy of vision therapy, exotropia. Am J Optom Physiol Opt 1987; 64: 421-429.

[8] Available from accessed 10/2014

[9] Available from accessed 10/2014

[10] Suchoff IB, Petito GT. The efficacy of visual therapy: accommodative disorders and non-strabismic anomalies of binocular vision. J Am Optom Assoc 1986; 57: 119-125

[11]  Rouse M. Management of binocular anomalies: effi cacy of vision therapy in the treatment of accommodative defi ciencies. Am J Optom Physiol  Opt 1987; 64: 415-420.

[12] Ciuffreda KJ. The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders.  Optometry 2002; 73: 735-762