Learn more about orthoptic therapy

It is not enough to have 20/20 vision and be able to clearly see a book or the board in a classroom. In order to see properly, we have to use our two eyes together in a very precise and coordinated fashion.

Every time we look at something, we must accurately aim our two eyes directly at the object of concern. Each eye sends an image to the part of the brain that is involved in the process of seeing. This part of the brain, called the visual cortex, then tries to combine these two images to make one fused image. If these images are identical, the result is normal, clear, single vision and a perception of depth. If, however, the two eyes are not performing in a coordinated manger, the visual cortex will receive two different images and will experience double vision.

As you can imagine, double vision is not something that a child or an adult can tolerate. It becomes very difficult to function—either at school, at play or at work—if double vision occurs.

The two most common types of eyeteaming problems are:

Convergence Insufficiency: Convergence insufficiency is an eyeteaming problem in which the eyes have a strong tendency to drift outward when the individual is reading or doing close work. If the eyes actually drift out, the person experiences double vision. To control this tendency for the eyes to drift, the individual must exert excessive effort to make the eyes turn back in.

Convergence Excess: Convergence excess is an eyeteaming problem in which the eyes have a strong tendency to drift inward when the individual is reading or doing close work. If the eyes actually drift inward, the person experiences double vision. To control this tendency for the eyes to drift, the individual must exert excessive effort to make the eyes turn back out.

Approximately 5 to 10% of children and young adults have eyeteaming problems that are significant enough to cause patient complaints.

Most people are not even aware that we have to focus our eyes, because, in most people, the focusing system of the eye operates so well that objects always appear in focus. In reality, though, a focusing adjustment is made every time we look from one place to another. This adjustment is made with the help of a muscle in the eye called the ciliary muscle or the focusing muscle.

When a child looks from the teacher to his desk, for instance, he must constrict or contract this muscle—which changes the shape of the lens in the eye and allows the child to see the print in his book clearly. When the child wants to look back to the teacher, he must now relax the focusing muscle, permitting clear vision at a distance.

A focusing problem occurs when the child is unable to quickly and accurately constrict or relax the focusing muscle, or if the child is unable to maintain this muscle contraction for adequate periods of time.

Approximately 5 to 10% of children and young adults have focusing problems that are significant enough to cause patient complaints.

The most common symptoms include:

• Eyestrain and headaches after reading for a short period of time
• Inability to concentrate when reading
• Short attention span
• Rubbing or closing an eye
• Words moving on the page
• Good decoding skills, but poor comprehension

Eyeteaming problems that result in such symptoms actually have more impact on learning and performance at work than do vision problems that cause a lack of clarity. Unfortunately, most school vision screenings are only designed to detect vision problems that cause a lack of clarity. Very few school screenings even test for eyeteaming disorders.

There are currently two methods used to treat eyeteaming problems. Sometimes, eyeglasses alone can be prescribed to provide relief from complaints associated with eyeteaming problems. These glasses are usually prescribed for just reading, and the glasses must be removed for seeing objects at a distance (like the blackboard in a classroom).

With very young children who would have trouble removing and putting on the glasses many times each day, bifocals can be prescribed so that the child can wear the glasses at all times while in school.

Often, eyeglasses alone are not sufficient to completely solve eyeteaming problems. While glasses may provide some relief, the symptoms of the eyeteaming problem may persist, and another form of treatment must be used. This is called Orthoptic Therapy.

Although most vision problems can very easily be corrected using eyeglasses or contact lenses, some problems require more sophisticated treatment. Problems such as eyeteaming, focusing and tracking disorders are not optical and cannot be corrected with eyeglasses. Rather, they are muscle-type problems and require orthoptic therapy.

Orthoptic therapy can sometimes be helpful before or after strabismus surgery. Before surgery, orthoptic therapy can help equalize the vision in both eyes and prepare the eyes to work together. After the surgeon straightens the eyes, orthoptic therapy can sometimes be helpful in stabilizing the alignment of the eyes.

Adults can also benefit from orthoptic therapy if they are experiencing eyestrain, headaches and the inability to perform well at work and have eyeteaming and focusing problems. These problems commonly affect adults working with computers.

Orthoptic therapy is unique at Eye Consultants of Pennsylvania. Here, a patient’s care is managed by both a pediatric ophthalmologist and a pediatric optometrist. This is one of the few practices in the country in which both specialists work together as a team. The therapy is administered by well-trained therapists under both medical and optometric supervision.

In addition to our goal of achieving the best possible outcomes for our patients, another important goal of our unique approach is to achieve those outcomes in the shortest period of time possible.

There are a significant number of research studies supporting the effectiveness of orthoptic therapy for the treatment of eyeteaming, focusing and tracking problems. These studies have been published in both the ophthalmic and optometric literature. If you would like to read some of this research, please ask our staff.

The average program for focusing, eyeteaming and tracking problems involves about 12 to 16 office visits, plus about 15 minutes of supportive home therapy three times per week. More complicated problems related to neurologic disease may require additional time.

Most major medical policies cover orthoptic therapy; however, because health insurance is always rapidly changing, we encourage you to check with your insurance carrier beforehand. Additionally, our office staff can help you complete any required insurance forms.