Eye exercises

Orthoptics (from the Greek words ortho meaning "straight", and optikas meaning "vision" is a discipline dealing with the diagnosis and treatment of defective eye movement and coordination (such as nystagmus), binocular vision, and amblyopia by eye care professionals.. There are five areas of treatment for orthoptic problems:

• corrective lenses (spherical, cylindrical lens, prismatic and Fresnel lenses)
• strabismic-related orthoptics as an "eye exercise" is limited to the treatment of eye coordination problems by increasing the range of binocular fusion.
• eyepatching
• pharmaceuticals, such as cycloplegics
• surgery

However the term orthoptics is sometimes used to refer simply to eye exercises which are a component of strabismic-related vision therapy.

Orthoptists

Orthoptists are Eye care professionals who specialise in the diagnosis and management of binocular vision problems alongside Ophthalmologists. Orthoptists are represented worldwide by the International Orthoptic Association.

Orthoptics is usually studied as a primary or master's degree, or as a 2 to 4 years post graduate training course. Orthoptists usually work in close cooperation with Ophthalmologists, pediatricians, and sometimes neurologists. Continuing professional development and registration is required in most countries.

History

Orthoptists and ophthalmologists introduced a wide variety of techniques for the improvement of binocular function in the 1930s. The first pioneer was Mary Maddox, the daughter of an English ophthalmologist.

The orthoptic health care profession evolved and specialised as scientific development increased in the diagnosis, management and pre/post-surgical care of patients with strabismus, binocular vision abnormalities and specific pediatric disorders. Because of their lower prevalence and variational presentation, these were beyond the realm of a primary eyecare consultation at a spectacle shop (where most Optometrists work) and beyond the Ophthalmologists' demanding surgical workload and practice. Hence, Orthoptists began to specialize in hospitals with these problems throughout more than 20 countries.

Current orthoptic practice

Orthoptists are mainly involved with diagnosing and managing patients with binocular vision disorders which relate to amblyopia, extraocular muscle balance such as with version, refractive errors, vergence, accommodation imbalances, (positive relative accommodation, negative relative accommodation) and pathological causes. They work closely with ophthalmologists to ensure that patients with eye muscle disorders are offered a full range of treatment options. According to the International Orthoptic Association, professional orthoptic practice involves the following:

• Primary activities
  • Ocular motility diagnosis & co-management
  • Vision screening
  • Assessment of special needs
  • Assessment and rehabilitation in neurological disorders
• Secondary activities
  • Low Vision assessment and management
  • Glaucoma assessment & stable glaucoma management
  • Biometry (includes sonography work)
  • Fundus photography & screening
  • Visual electrodiagnosis
  • Retinoscopy and refraction, such as using a phoropter to assess refractive errors
• Further activities
  • Specific outpatient waiting list initiatives to reduce the delay for children referred to the eye clinic (filter screening)
  • Joint multidisciplinary children’s vision screening clinics (orthoptics/optometry)
  • Organisation/prioritisation of the strabismus surgical admissions list according to agreed criteria
  • Assistance with surgical procedures

Eye Exercises

The eye exercises used in Orthoptic Vision Therapy can generally be divided into two groups; those employed for strabismic outcomes and those employed for non-strabismic outcomes, to improve eye health.

Some of the exercises used are

• Near point of convergence exercises (i.e. "pencil push-ups"),
• Base-out prism reading, stereogram cards, computerized training programs are used to improve fusional vergence.
• The wearing of convex lenses
• The wearing of concave lenses
• "Cawthorne Cooksey Exercises" also employ various eye exercises, however, these are designed to alleviate vestibular disorders, such as dizziness, rather than eye problems.
• Antisuppression exercises - this is no longer commonly practiced, although occasionally it may be used.

The eye exercises used in Behavioural Vision Therapy, also known as Developmental Optometry is practiced primarily by Behavioural Optometrists. Behavioural Vision Therapy therapy aims to treat problems including difficulties of visual attention and concentration, which may manifest themselves as an inability to sustain focus or to shift focus from one area of space to another.

Some of the exercises used are:

• Marsden balls
• Rotation trainers
• Syntonics
• Balance board/beams
• Saccadic fixators
• Directional sequencers

Ophthalmologists and orthoptists do not endorse these exercises as having clinically significant validity for improvements in vision. Usually they see these perceptual-motor activities being in the sphere of either speech therapy, occupational therapy or physical therapy.

Orthoptists, Optometrists and Ophthalmologists use of eye exercises

Orthoptists, Optometrists and Ophthalmologists primarily use eye exercises that relate to strabismus treatments.

Physical therapy:

• To reduce muscle contracture in an eye muscle palsy; assess action following ocular muscle surgery or botox injection.

Fusional Amplitude and Relative Fusional Amplitude training:

• Designed to alleviate convergence insufficiency. The CITT study (Convergence Insufficiency Treatment Trial) was is a randomized, double blind multi-centre trial (high level of reliability) indicates that Orthoptic Vision Therapy is an effective method of treatment of convergence insufficiency (CI). Both optometry and ophthalmology were co-authors of this study.

• Designed to alleviate intermittent exotropia or other less common forms of strabismus.

The consensus among Ophthalmologists, Orthoptists and Pediatricians is that "visual training" in non-strabismic Behavioural Vision therapy lacks documented scientific evidence of effectiveness. Although Ophthalmologists and Orthoptists believe that exercises can improve binocular vision control, they believe it does not purely improve monocular visual acuity such as that in amblyopia (rather, occlusion is the therapy of choice), change a person's refractive error, improve general physical fitness or agility or improve intelligence. It is probable that they do not change the accommodative/convergence ratio or enable someone to develop the ability for stereopsis. It is likely that they do not change the amplitude of accommodation to postpone or delay presbyopia.

Behavioral Optometrists use of eye exercises

Main article: Behavioral optometry

Practitioners in Behavioral optometry (also known as Functional optometrists or optometric vision therapists) practice methods that have been characterized as a complementary alternative medicine practice. A review in 2000 concluded that there were insufficient controlled studies of the approach and a 2008 review concluded that "a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated."

Other forms of eye exercise

Do-it-yourself eye exercises are claimed by some to improve visual acuity by reducing or eliminating refractive errors. Such claims rely mainly on anecdotal evidence, and are not generally endorsed by orthoptists, ophthalmologists or optometrists.

See also

• Bates method
• Convergence insufficiency
• Diplopia
• Dissociated Vertical Deviation
• Esotropia
• Exotropia
• Eye care professional
• Eyepatch
• Glasses
• Haploscope
• International Orthoptic Association
• Pediatric ophthalmology
• Pinhole glasses
• Strabismus
• Vision therapy

References

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