BlueCross BlueShield of Tennessee Medical Policy Manual

Orthoptic Training for the Treatment of Vision or Learning Disabilities

DESCRIPTION

NOTE: This policy addresses office-based orthoptic training and does not address standard vision therapy with lenses, prisms, filters or occlusion.

Orthoptic training refers to techniques designed to correct accommodative and convergence insufficiency (or convergence dysfunction). Regimens may include push-up exercises using an accommodative target; usually a pencil or could be letter, number or picture. To perform this exercise individuals hold a pencil on front of them at arm's length. The pencil should be vertical, with the tip of the sharpened pencil at the top. The pencil should be directly in front of their face, with the tip just below eye level. Move the pencil slowly toward the face, concentrate and focus on the point. When they see two pencils rather than one, they stop and repeat.

Convergence insufficiency is a binocular vision disorder in which the eyes turn inward towards each other. Symptoms of this common 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, office-based vision therapy and orthoptics have been evaluated for the treatment of convergence insufficiency.

Some learning disabilities, particularly those in which reading is impaired, have been associated with deficits in eye movements and/or visual tracking. For example, many dyslexic persons may have unstable binocular vision and report that letters may appear to move around, causing visual confusion. Currently, orthoptic training is being investigated for treatment of attention deficient disorders, dyslexia, dysphasia, and reading disorders.

Orthoptic training is also known as vision training, visual therapy, optometric vision therapy, orthoptics-eye exercises, orthoptic vision therapy, and syntonic optometry.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

There is insufficient evidence in published studies to state whether orthoptic training for the treatment of vision or learning disabilities other than convergence insufficiency is effective.

SOURCES 

American Academy of Ophthalmology, (2014). Joint statement: Learning disabilities, dyslexia, and vision – reaffirmed 2014. Retrieved July 18, 2016 from http://www.aao.org/clinical-statement/joint-statement-learning-disabilities-dyslexia-vis.

Bharadwai, S. R., & Candy, T. R. (2009). Accommodative and vergence responses to conflicting blur and disparity stimuli during development. Journal of Vision, 9 (11), 1-18.(Level 3 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2017). Orthoptic for the treatment of learning disabilities (9.03.03). Retrieved May 16, 2017 from BlueWeb. (23 articles and/or guidelines reviewed)

Convergence Insufficiency Treatment Trial Study Group. (2009). Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. Optometry and Vision Science, 86 (9), 1096-1103. (Level 3 evidence)

Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus (2011). Joint technical report - learning disabilities, dyslexia, and vision. Pediatrics, 127 (3), e818-e856.

Kulp, M., Mitchell, G. L., Borsting, E., Scheiman, M., Cotter, S., Rouse, M., et al. (2009). Effectiveness of placebo therapy for maintaining masking in a clinical trial of vergence/accommodative therapy. Investigative Ophthalmology & Visual Science, 50 (6), 2560-2566. (Level 3 evidence)

Ramsay, M., Davidson, C., Ljungblad, M., Tjärnberg, M., Brautaset, R., Nilsson, M..(2014, December) Can vergence training improve reading in dyslexics? Strabismus; 22(4): 147-51. (Level 4 evidence)

Scheiman, M., Rouse, M., Kulp, M. T., Cotter, S., Hertle, R., & Mitchell, G. L. (2009). Treatment of convergence insufficiency in childhood: A current perspective. Optometry and Vision Science, 86 (5), 420-428. (Level 2 evidence)

Schieman, M. (2009) Long-term effectiveness of treatments for symptomatic convergence insufficiency in children convergence insufficiency treatment trial study group. Optometry and Vision Science, 86(9): 1096-1103. (Level 3 evidence)

Sreenivasan, V. and Bobier, W. (2014, July) Increased onset of vergence adaptation reduces excessive accommodation during the orthoptic treatment of convergence insufficiency. Vision Research 111 (2015) 105-113. (Level 4 evidence)

Winifred S. Hayes, Inc. Medical Technology Directory. (2012, July; last update search May 2016). Vision therapy for dyslexia and other reading and learning disabilities. Retrieved July 18, 2016 from www.Hayesinc.com/subscribers.  (84 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  3/1/1994

MOST RECENT REVIEW DATE:  7/13/2017

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.