Virtual Medical Centre

Eye Exercises: Visual Training for Eye Disorders

• Introduction to eye exercises
• History of visual training
• Effectiveness of visual training
  • Strabismus/convergence disorder
  • Amblyopia
  • Brain or optic nerve injury
  • Conditions not affected by visual training
• Eye exercises for the correction of visual disorders
  • Pencil push up therapy
  • Lens fixation
  • Prism fixation
  • Shifting fixation
  • Patching

Introduction to eye exercises

Visual training is the practice of exercising the eyes with the aim of overcoming vision disorders, in particular those relating to binocular function (i.e. vision difficulties stemming from the misalignment of the eyes). Eye exercises are also commonly used to relieve the eyes after long periods of focused vision (e.g. computer use). While eye exercises are commonly prescribed treatments for visual disorders, not all eye exercises have been proven effective in treating eye problems.

History of visual training

Visual training has been used for centuries, to treat visual disorders and other problems (e.g. academic performance). In its early days, visual training was typically applied to infants and largely involved strategically placing bright objects in the infant's environment to encourage it to look in particular directions. It was not necessarily applied for health reasons however. In some cultures where being cross-eyed was considered a mark of beauty, bright dots were drawn on children's foreheads to encourage them to look cross-eyed!

The practice of visual training by ophthalmologists began officially in 1928, when a branch of ophthalmology known as orthoptics was recognised in Britain for the first time. Since then, visual training has come to be practiced mainly by optometrists. The eye exercises currently involved in visual training have evolved significantly since its beginnings. In addition to numerous home-based eye exercises which typically involve shifting the focus of vision from near to distance objects, there now also exists a range of specialist equipment which is used to conduct supervised visual training in the office of an eye professional.

Effectiveness of visual training

Despite its long history, scientific evidence regarding the effectiveness of visual training is limited and exists for only a few vision disorders. These are discussed below.

Strabismus/convergence disorder

Strabismus, also known as convergence disorder, is a condition in which the eyes are not properly aligned. It is the condition which visual training has most commonly been used to treat and the condition for which there is the best evidence regarding the effectiveness of eye exercises. There is evidence that eye exercises are effective in correcting convergence disorders in both children and adults and that a combination of office and home based therapy is more effective than home based therapy alone.

Amblyopia

Amblyopia is a condition in which one eye is more dominant than the other. It is commonly treated by patching the dominant eye, in order to encourage activity in the lazy or amblyopic eye. While scientific evidence regarding the effectiveness of this treatment is limited, available evidence suggests that patching the dominant eye improves vision in the amblyopic eye. Patching for six hours per day appears to be equally as effective as full time patching. There is also evidence that the risk of amblyopia recurring is minimised by gradual reduction in the length of treatment (to two hours per day) before cessation.

Brain or optic nerve injury

Available evidence shows that visual training in patients who retain some residual vision following a brain or optic nerve injury can improve their field of vision.

Conditions not affected by visual training

There is currently insufficient evidence to support the use of eye exercises for the following disorders:

• Learning disabilities;
• Dyslexia;
• Age-related degenerative conditions such as macular degeneration and glaucoma;
• Refractive Errors; and
• Poor sports vision.

Eye exercises for the correction of visual disorders

A range of eye exercises have been used in home and office based visual training with the aim of correcting visual disorders. These are discussed further below.

Pencil push up therapy

Pencil push up therapy is the eye exercise most commonly prescribed by ophthalmologists. It is an eye exercise in which a pencil is held directly in front, at arm's length. The pencil is then drawn slowly towards the nose. The exerciser follows the pencil with his/her eyes, trying to keep it in clear focus. When the pencil starts to appear as a double image, the pencil should be drawn away from the nose again. The exercise is repeated several times per session, for several sessions per day. The aim is to correct binocular visual disorders, in particular strabismus.

Lens fixation

Lens fixation is an eye exercise conducted with the assistance of an ophthalmologist, using a series of lenses of different strengths. The patient views an object through these lenses to train the eyes to adjust to different visual fields.

Prism fixation

Prism fixation is an eye exercise conducted with the assistance of an ophthalmologist in which the patient looks into a series of prisms with specific orientations. The orientation of the prism will depend on the condition being treated.

Shifting fixation

Shifting fixation is an eye exercise conducted with the assistance of an ophthalmologist in which the patient is required to change focus from near to distant objects. It is used to train the eyes to adjust to different fields of vision.

Patching

Patching is the practice of covering one eye with a patch to encourage the patient to use the alternate eye. In some instances the patient will be asked to carry out exercises, such as focusing on distant letters, while the dominant eye is patched. It is typically used as a treatment for amblyopia.