Eye exercises and vision therapy, what the evidence says
Someone has recommended a programme of eye exercises for your child and you cannot tell whether it is treatment or a sales pitch. Here is the line the evidence actually draws, and the questions that get you a straight answer.
- Eye exercises are not a single treatment, and most arguments about them are really arguments about which type is being offered.
- Orthoptic exercises are a recognised treatment for convergence insufficiency, where the eyes will not stay turned in together for close work.
- Behavioural or perceptual vision therapy has not been shown to improve reading, attention or school performance.
- There is no evidence that any eye exercise slows short sight, and low power training glasses have been found unhelpful.
- A short course is what the evidence supports. Long programmes have not been shown to add anything.
This question reaches me in two moods. Sometimes a parent is hopeful: a programme of eye exercises has been recommended, it sounds gentle and drug free, and she wants to know whether to start. Sometimes she is already annoyed: a quotation is sitting in her handbag and she wants to know whether she is being sold something.
Both of them are asking the same thing, and neither can get a straight answer online, because the question is usually put the wrong way round. Eye exercises are not one treatment. The argument about whether they work is really an argument about which of several quite different things is being offered.
Do eye exercises actually work?
For one specific, measurable problem, yes, and they are a recognised treatment for it. For nearly everything else these exercises get recommended for, no. That is the whole answer, and the rest of this article is about telling the two apart before you commit a year of Saturday mornings.
Three different things travel under these names. There are orthoptic exercises, used by paediatric eye doctors and orthoptists to improve how the two eyes work together, taught in the clinic and then done at home. AAPOS calls orthoptics a proven treatment, delivered by orthoptists, who are specialised eye care providers working alongside ophthalmologists. There is behavioural or perceptual vision therapy, aimed at visual processing and visual understanding, which AAPOS states has not been proven by science to work. And there are exercises offered to prevent or treat short sight, which I will come to.
Same shopfront, sometimes the same room, and three completely different levels of evidence underneath. So the first question to ask is never "do eye exercises work". It is "which one is this, and what is it being asked to fix".
Which problem do exercises genuinely treat?
Convergence insufficiency, which is when a child cannot keep the two eyes turned in together for close work. Typically one eye drifts outward while focusing on a word or an object at near. It causes double vision, headache and eye strain while reading, difficulty holding concentration on near work, and words that start to move and blur after a while.
If your child has those symptoms and the measurements confirm it, exercises are the right treatment and I recommend them. The measuring, the pattern that points to it, and what treatment does and does not do for schoolwork are all in the article on the homework headache, and I would rather you read that one than have me repeat it here.
One qualifier matters more than parents expect. Treatment is needed only where there are symptoms. Some children with convergence insufficiency have none at all, and a child who tests poorly in my room but reads happily for an hour at home does not need treating, only watching. That is not me being casual. It is because the test is easy to fail for reasons that have nothing to do with the eyes: a child who is shy, tired, over excited, or who simply did not understand what I asked them to do will produce a poor result on a good pair of eyes.
What is the difference between an orthoptist and vision therapy?
One is a person and the other is a name for a set of treatments, which is exactly why the two get muddled. An orthoptist is a specialised eye care provider who works with ophthalmologists, measures how the two eyes work as a pair, and teaches the exercises that are done at home. Vision therapy is a term used by optometrists for a broader attempt to develop visual skills, improve visual comfort, and change visual processing or the understanding of visual information.
Inside that broader term sits the narrow exercise that works. Around it sit the wider claims: that exercises improve reading, attention, school results, or visual processing generally. Those are the ones the evidence does not support, and the joint statement written by four professional bodies puts it plainly. Other than treatment for convergence insufficiency, scientific evidence does not support the idea that vision therapy corrects subtle visual defects, and it does not show eye exercises or behavioural vision therapy to be effective for learning disabilities, directly or indirectly.
While we are separating tools from each other: a patch is not the treatment for a convergence problem. Wearing a patch makes a child use one eye at a time, and the entire difficulty here is the two eyes working together. Patching has its own job and does it well, and that job is treating a lazy eye, which is a different condition with a different timetable.
Will eye exercises stop her short-sightedness getting worse?
No. There is no evidence that vision therapy slows short sight or makes it better, and low power training glasses have been studied and found not to be much help. If a programme is being sold to you on the promise of holding your daughter's power steady, that promise is not supported.
I say this without much pleasure, because it is the one every parent wants to hear a yes to. Power going up year after year feels like something you should be able to exercise away, in the same way a muscle can be trained. The eye is not doing that kind of work. It is growing slightly too long, and no amount of looking at a pencil changes its length.
What does have evidence behind it is duller and cheaper. Time outdoors is the habit with the strongest support, which is why I keep returning to the two hours outside, and understanding why so many Malaysian children are becoming short sighted makes the rest of the advice make sense. There are also medical treatments for slowing short sight that your eye doctor can discuss with you. Exercises are not among them.
We have been offered a long programme. Is that normal?
A short course is what the evidence supports. Studies have not shown any one of the treatment options to be better than another, most show that a short course helps with the symptoms, and therapy carried on for long periods does not show extra benefit and is usually not necessary. Much of it can be done at home.
So a programme that runs on and on, without a measurement that is being followed, is worth a question. Not an accusation, a question: what number are we tracking, has it moved, and what will tell us we are finished? A good answer exists for the child who genuinely needs this. If the answer is only that your child seems more settled, that is not a measurement.
Symptoms can also come back later, after an illness, a run of short nights, or a term with heavier near work, and a further short course at that point is perfectly reasonable. That is different from a treatment with no end written into it.
How do I ask about this without insulting anyone?
By asking about the claim rather than about the person. AAPOS suggests the exact wording: if vision therapy is being recommended for a child with learning problems, ask whoever is recommending it for the scientific information that shows how it helps with learning problems. That is a fair question and any practitioner can answer it or say honestly that the evidence is thin.
The other step is a second opinion from an eye doctor experienced in caring for children, and it is worth taking even if you have decided to go ahead. Nobody here is a villain. A teacher who watches a child struggle to write or read aloud very reasonably wonders whether the eyes are at fault, and that thought deserves acting on. It is one of the more sensible things a well meaning adult can suspect, and the way to settle it is an examination rather than an argument.
There are only two ways that examination can end, and both are useful. Either we find something treatable and treat it, or the eyes are cleared and the search moves to where the difficulty actually lives, which is usually the classroom and the people who assess learning. The risk of an unproven programme was never the exercises themselves. It is the year that passes while everybody feels reassured that something is being done.
- Your child sees double, at any distance, or has headaches that wake them from sleep or come with vomiting.
- One eye has visibly turned and stays turned, or has started turning recently.
- Your child covers or closes one eye to read, or tilts their head to see.
- The sight in one eye has changed, or your child says things are blurred far away as well as near.
- A programme has been recommended and nobody has yet examined your child's eyes properly.
Common questions
Do eye exercises actually work?
What is the difference between an orthoptist and vision therapy?
Will eye exercises stop her short-sightedness getting worse?
The test said his convergence is poor but he has no complaints. Do we treat it?
We were told he needs a year of therapy. Is that normal?
Can eye exercises fix a lazy eye?
How do I ask about this without insulting anyone?
- AAPOS · Vision therapy · aapos.org
- AAPOS · Convergence insufficiency · aapos.org
- American Academy of Pediatrics, AAPOS, AACO and American Academy of Ophthalmology · Joint statement: learning disabilities, dyslexia and vision · www.aao.org
- Convergence Insufficiency Treatment Trial · Randomised clinical trial of treatments for symptomatic convergence insufficiency in children, Arch Ophthalmol 2008 · europepmc.org
- CITT-ART · Effect of vergence/accommodative therapy on reading in children with convergence insufficiency, Optom Vis Sci 2019 · pmc.ncbi.nlm.nih.gov