Medical policy: Vision Therapy

Número de política: MP 4.007

Fecha de entrada en vigor: 4/1/2026

Política

Vision therapy may be considered medically necessary for symptomatic convergence insufficiency. Some examples (not all-inclusive) of conditions that can cause convergence insufficiency are the following conditions:

• Amblyopia
• Strabismus
• Accommodative dysfunction
• General binocular dysfunction
• Mild traumatic brain injury (mTBI)
• Concussion
• Stroke

More than 24 sessions of vision therapy are considered investigational per symptomatic occurrence (see policy guidelines).

Vision therapy is considered investigational for all other indications. No hay pruebas suficientes que respalden una conclusión con respecto a los resultados o beneficios en la salud asociados con este procedimiento.

Orthoptic eye exercises are considered investigational for the treatment of learning disabilities in the absence of symptomatic convergence insufficiency.

A home computer orthoptic program consisting of eye exercises performed when following computer instructions that is tailored to the individual’s personal binocular problem is considered investigational. There is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with this procedure for these indications.

Directrices de la política

This policy addresses office-based orthoptic training. This policy does not address standard vision therapy with lenses, prisms, filters or occlusion (i.e., for treatment of amblyopia or acquired esotropia prior to surgical intervention).

Up to 12 sessions of office-based vision therapy, typically performed once per week, has been shown to improve symptomatic convergence insufficiency. If individuals remain symptomatic after 12 weeks of orthoptic training, yet there is documentation of improvement through examination notes, then another 12 sessions may be needed.

The American Association for Pediatric Ophthalmology and Strabismus states on their website:

At times, convergence insufficiency symptoms will resurface after illness, lack of sleep or increased near work demand. If treatment had been successful previously, an additional course of treatment may be successful at resolving recurrent symptoms.

A diagnosis of convergence insufficiency is based on asthenopic symptoms (sensations of visual and ocular discomfort at near point combined with difficulty sustaining convergence).

Convergence insufficiency and stereoacuity are documented by:

• Exodeviation at near vision at least 4 prism diopters greater than at far; AND
• Insufficient positive fusional vergence at near (positive fusional vergence [PFV] less than 15 prism diopters blur or break on PFV testing using a prism bar; AND
• Near point of convergence (NPC) break more than 6 cm; AND
• Appreciation by the patient of at least 500 seconds of arc on stereoacuity testing.

Referencias cruzadas

• MP 2.304 Medical Treatments of Autism Spectrum Disorders
• MP 6.058 Intraocular Lenses, Spectacle Correction, and Iris Prosthesis

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios. Consulte la información adicional a continuación.

FEP PPO - Consulte el Manual de Políticas Médicas de FEP.

Descripción/antecedentes

Common forms of vision therapy are known as orthoptics and pleoptics. Orthoptics is a technique of eye exercises intended to improve eye movements and/or visual tracking. Pleoptics are eye exercises used to improve visual when there is no evidence of organic eye disease. A related but distinct training technique is behavioral or perceptual vision therapy, in which eye movement and eye coordination training techniques are used to improve learning efficiency by optimizing visual processing skills.

The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) states that optometrists define vision therapy as an attempt to develop or improve visual skills and abilities; improve visual comfort, ease and efficiency; and change visual processing or interpretation of visual information. The AAPOS states that there are main categories of vision therapy which are orthoptic vision therapy, behavioral/perceptual vision therapy, and vision therapy for prevention or correction of myopia (nearsightedness). Orthoptic vision therapy includes eye exercises to improve binocular function whereas behavioral/perceptual vision therapy includes eye exercises to improve visual processing and visual perception. Orthoptic eye exercises can be beneficial in the treatment of symptomatic convergence insufficiency.

Convergence insufficiency (CI) is a binocular vision disorder. The ability for the eyes to turn inward toward each other (e.g., when looking at near objects). It is most common in children and young adults when they begin to experience symptoms from prolonged periods of near work. Symptoms of this condition may include eyestrain, headaches, blurred vision, diplopia, sleepiness, difficulty concentrating, movement of print, and loss of comprehension after short periods of reading or performing close activities. Prism reading glasses, home therapy with pencil push-ups, and office-based vision therapy and orthoptics have been evaluated for the treatment of convergence insufficiency. Prism reading glasses tend to treat the symptom of double vision but does not actually correct the condition itself. The goal of vision therapy in the treatment of CI is to stimulate the communication between the brain and eyes, to enable clear and comfortable vision at all times.

In addition to its use in the treatment of accommodative and convergence dysfunction, vision therapy is being indicated for the treatment of attention deficit disorders, dyslexia, and reading disorders. The American Academy of Ophthalmology, in a joint statement on learning disabilities, dyslexia, and vision, concluded that:

Currently, there is no adequate scientific evidence to support the view that subtle eye or visual problems cause learning disabilities. Furthermore, the evidence does not support the concept that vision therapy or tinted lenses or filters are effective, directly or indirectly, in the treatment of learning disabilities. Thus, the claim that vision therapy improves visual efficiency cannot be substantiated. Diagnostic and treatment approaches that lack scientific evidence of efficacy are not endorsed or recommended.

Computer-based programs

RevitalVision received FDA clearance for its vision training software program which provides home-based vision training to people 9 years of age and older with amblyopia.

The CureSight system is a non-invasive eye tracking system designed for remote binocular vision treatment in pediatric patients (aged 4 to 9 years) suffering from amblyopia. The proprietary screen allows for treatment while the child watches their favorite streamed content in the comfort of their home.

Fundamento

Summary of evidence

For individuals who have convergence insufficiency who receive office-based orthoptic training, the evidence includes a TEC Assessment, several randomized controlled trials (RCTs), and nonrandomized comparative studies. Relevant outcomes are symptoms and functional outcomes. The most direct evidence on office-based orthoptic training comes from a 2008 RCT that demonstrated improved visual symptoms of convergence insufficiency in a greater percentage of patients than a home-based vision exercise program consisting of pencil push-ups or home computer vision exercises. Subgroup analyses of this RCT demonstrated improvements in accommodative vision, parental perception of academic behavior, and specific convergence insufficiency symptoms. Las pruebas son suficientes para determinar que la tecnología da lugar a una mejora en el resultado neto para la salud.

For individuals who have learning disabilities who receive office-based orthoptic training, the evidence includes a TEC Assessment as well as nonrandomized comparative studies. Relevant outcomes are symptoms and functional outcomes. A 1996 TEC Assessment did not find evidence that orthoptic training improves outcomes for individuals with learning disabilities. Since this publication, peer-reviewed studies have not directly demonstrated improvements in reading or learning outcomes with orthoptic training. At least 2 earlier studies that have addressed other types of vision therapies reported mixed improvements in reading. La evidencia es insuficiente para determinar los efectos de esta tecnología en los resultados de salud.

For individuals who have received computer-based therapy programs, the evidence includes a prospective study to evaluate the efficacy of perceptual vision therapy in enhancing best corrected visual acuity and contrast sensitivity function in amblyopic patients. The authors concluded the results demonstrate the efficacy of perceptual vision therapy in improving visual acuity. Long-term follow-up and further studies are needed. La evidencia es insuficiente para determinar los efectos de esta tecnología en los resultados de salud.

Definiciones

Accommodation is the adjustment of the optics of the eye to keep an object in focus on the retina as its distance from the eye varies.

Amblyopia is reduced vision, typically in one eye, that results from the brain suppressing input from the affected eye due to unequal visual signals from each eye leading to poor development of visual acuity in the affected eye.

Binocular vision is the visual sensation that is produced when the images perceived by each eye are fused to appear as one.

Strabismus refers to an abnormal ocular condition in which the visual axes of the eyes are not directed at the same point.

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen un consejo médico y están sujetas a cambios según lo permita la ley o la evidencia clínica aplicable de las pautas de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios del miembro, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Nota: Es posible que esta lista de códigos no sea exhaustiva y que los códigos estén sujetos a cambios en cualquier momento. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado.

Bajo investigación; por lo tanto, no se cubre:

Cubierto cuando sea médicamente necesario:

Referencias

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3. Scheiman M, Gwiazda J, Li T. Non-surgical interventions for convergence insufficiency. Cochrane Database Syst Rev. Mar 16 2011(3):CD006768. PMID 21142896
4. Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. Oct 2008;126(10):1336-1349. PMID 18852411
5. Scheiman M, Mitchell GL, Cotter S, et al. Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. Optom Vis Sci. Sep 2009;86(9):1096-1103. PMID 19668097
6. Scheiman M, Cotter S, Kulp MT, et al. Treatment of accommodative dysfunction in children: results from a randomized clinical trial. Optom Vis Sci. Nov 2011;88(11):1343-1352. PMID 21870222
7. Borsting E, Mitchell GL, Kulp MT, et al. Improvement in academic behaviors after successful treatment of convergence insufficiency. Optom Vis Sci. Jan 2012;89(1):12-18. PMID 22080400
8. Barnhardt C, Cotter SA, Mitchell GL, et al. Symptoms in children with convergence insufficiency before and after treatment. Optom Vis Sci. Oct 2012;89(10):1512-1520. PMID 22922781
9. Scheiman M, Cotter S, Rouse M, et al. Randomized clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children. Br J Ophthalmol. Oct 2005;89(10):1318-1323. PMID 16170124
10. Scheiman M, Mitchell GL, Cotter S, et al. A randomized clinical trial of treatments for convergence insufficiency in children. Arch Ophthalmol. Jan 2005;123(1):14-24. PMID 15642806
11. Shin HS, Park SC, Maples WC. Effectiveness of vision therapy for convergence dysfunctions and long-term stability after vision therapy. Ophthalmic Physiol Opt. Mar 2011;31(2):180-189. PMID 21309805
12. Dusek W, Pierscionek BK, McClelland JF. An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties. BMC Ophthalmol. Aug 11 2011;11:21. PMID 21835034
13. Lee SH, Moon BY, Cho HG. Improvement of convergence movements by vision therapy decreases K-ARS scores of symptomatic ADHD children. J Phys Ther Sci. Feb 2014;26(2):223-227. PMID 24648636
14. Momeni-Moghadam H, Kundarti A, Azimi A, et al. The effectiveness of home-based pencil push-up therapy versus office-based therapy for the treatment of symptomatic convergence insufficiency in young adults. Middle East Afr J Ophthalmol. Jan-Mar 2015;22(1):97-102. PMID 25624682
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16. Ramsay MW, Davidson C, Ljungblad M, et al. Can convergence training improve reading in dyslexics? Strabismus. Dec 2014;22(4):147-151. PMID 25333204
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19. Grisham JD, Powers MK. Visual skills of poor readers in high school. Optometry. Oct 2007;78(10):542-549. PMID 17904495
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22. Joint statement: learning disabilities, dyslexia, and vision reaffirmed 2014. American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists, et al. Updated July 2014.
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