Vision Therapy Controversy

By: Carmen Willings
teachingvisuallyimpaired.com
​Revised June 25, 2025

What is Vision Therapy?

A subset of optometrists—known as developmental or behavioral optometrists—have practiced vision therapy for decades. Also referred to as vision training, this individualized, supervised treatment program is primarily used for children (and sometimes adults) with binocular vision problems. These include:
  • Convergence insufficiency
  • Focusing issues
  • Tracking and eye teaming difficulties
  • Visual perceptual challenges
The goal of vision therapy is to help the brain process visual information more efficiently. Most programs involve weekly office visits to work with an optometrist or trained vision therapist, using exercises designed to improve specific visual skills. Tools used may include:
  • Lenses and prisms
  • Filters and occluders
  • Specialized equipment
  • Computer-based programs
In addition, short daily activities (about 15 minutes) are often assigned for home practice. A typical program may last several weeks to months and is closely monitored by the vision therapist.

What is the Controversy?

Vision therapy is generally prescribed by optometrists, not medical doctors or ophthalmologists. While some individual cases report success, many ophthalmologists question its overall effectiveness, citing a lack of rigorous, peer-reviewed research and few randomized, controlled trials supporting the therapy's benefits.
Additional concerns include:
  • High cost: Therapy may cost thousands of dollars.
  • Limited insurance coverage: Most insurance providers do not cover vision therapy. However, some optometrists have successfully billed it as physical therapy, depending on the insurance company and state regulations.

Do Schools provide Vision Therapy?

Vision therapy is a clinical service provided by licensed vision therapists or optometrists, not by Teachers of Students with Visual Impairments (TVIs). It is generally not part of school-based services, although school districts may choose to fund outside therapy on a case-by-case basis.
Under IDEA and the Every Student Succeeds Act (ESSA), schools are required to use evidence-based educational practices. Since vision therapy lacks a strong body of scientific evidence, it is not considered an educational intervention and is not provided by TVIs.
Note: A few states, such as California, do employ vision therapists as part of school services. These professionals are separate from TVIs. 

Vision Therapy and the IEP

Vision therapy is typically considered a medical service, and as such, is excluded from IEPs in most states. If a family chooses to pursue therapy, it should be arranged privately through an optometrist or vision therapy clinic.
It’s important to distinguish between vision therapy and visual efficiency training. TVIs do provide instruction in visual efficiency skills (such as using residual vision effectively), and this instruction can be included in a student’s IEP as part of the Expanded Core Curriculum.

​Accommodations in the Classroom

While students receiving vision therapy may not require or qualify for special education under the category of visual impairment, accommodations may still be helpful in the classroom. Such accommodations are usually simple to implement and may be recommended by the student’s optometrist. These might include:
  • Using a line guide or bookmark to assist with tracking
  • Positioning books on a slant board or an incline
  • Providing copies of board notes
  • Preferential seating near the board
It is important to address any visual-related barriers to learning with appropriate supports. This may include school-based occupational therapy, particularly if sensory processing issues are present. They might also benefit from support from a reading specialist or intervention team.

Sources & Position Papers

This summary draws from resources including:
  • Boston Children's Hospital FAQs on Vision Therapy
  • The Optometrist Network
For additional professional guidance: Both documents can be downloaded for reference.
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