Orthoptics (Vergence/Accommodative therapy), Visual Exercises or Training
© Blue Cross and Blue Shield of Montana
Current Effective Date:
November 26, 2013
Original Effective Date:
January 01, 1996
November 26, 2013
April 14, 2004, May 1, 2007, March 5, 2010, June 1, 2011, March 22, 2011; April 26, 2013; October 25, 2013
Orthoptic training is a technique of eye exercises intended to improve eye movements and/or visual tracking. In addition to its use in the treatment of convergence insufficiency (CI), orthoptic training has been investigated for treatment of attention deficient disorders, dyslexia, dysphasia, and reading disorders. Also known as vision therapy or ocular pursuit, the treatment may include the use of training glasses, prism glasses, or tinted or colored lenses.
Convergence insufficiency (CI) is a binocular vision disorder in the ability for the eyes to turn inward towards each other (e.g., when looking at near objects). 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, office-based vision therapy, and orthoptics have been evaluated for the treatment of convergence insufficiency. Home-based therapy should include push-up exercises using an accommodative target; push-up exercises with additional base-out prisms; jump-to-near-convergence exercises, stereogram convergence exercises; recession from a target; and maintaining convergence for 30 to 40 seconds.
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.
Disclaimer for coding information on Medical Policies
Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.
The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.
Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.
95.35, 315.00-315.09, 378.83
H51.11-H51.12, F81.0, F81.81, R48.0, F0CZ2KZ, F0CZ2LZ, F0CZ2NZ, F0CZ2PZ, F0CZ2QZ, F0CZ2SZ, F0CZ2TZ, F0CZ2YZ, F0CZ2ZZ
- Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Orthoptic training for the treatment of learning disabilities. TEC Assessments 1996; Volume 11, Tab 2.
- Cooper J, Selenow A, Ciuffreda KJ et al. Reduction of asthenopia in patients with convergence insufficiency after fusional vergence training. Am J Optom Physiol Opt 1983; 60(12):982-9.
- Heath EJ, Cook P, O'Dell N. Eye exercises and reading efficiency. Acad Ther 1976; 11:435-55.
- Rounds BB, Manley CW, Norris RH. The effect of oculomotor training on reading efficiency. J Am Optom Assoc 1991; 62(2):92-9.
- Weisz CL. Clinical therapy for accommodative responses: transfer effects upon performance. J Am Optom Assoc 1979; 50(2):209-16.
- Rawstron JA, Burley CD, Elder MJ. A systematic review of the applicability and efficacy of eye exercises. J Pediatr Ophthalmol Strabismus 2005; 42(2):82-8.
- Scheiman M, Gwiazda J, Li T. Non-surgical interventions for convergence insufficiency. Cochrane Database Syst Rev 2011; (3):CD006768.
- Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol 2008; 126(10):1336-49.
- Convergence Insufficiency Treatment Trial Study Group. Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. Optom Vis Sci 2009; 86(9):1096-103.
- Scheiman M, Cotter S, Kulp MT et al. Treatment of accommodative dysfunction in children: results from a randomized clinical trial. Optom Vis Sci 2011; 88(11):1343-52.
- Borsting E, Mitchell GL, Kulp MT et al. Improvement in academic behaviors after successful treatment of convergence insufficiency. Optom Vis Sci 2012; 89(1):12-8.
- Scheiman M, Rouse M, Kulp MT et al. Treatment of convergence insufficiency in childhood: a current perspective. Optom Vis Sci 2009; 86(5):420-8.
- Scheiman M, Cotter S, Rouse M et al. Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children. Br J Ophthalmol 2005; 89(10):1318-23.
- Scheiman M, Mitchell GL, Cotter S et al. A randomized clinical trial of treatments for convergence insufficiency in children. Arch Ophthalmol 2005; 123(1):14-24.
- Shin HS, Park SC, Maples WC. Effectiveness of vision therapy for convergence dysfunctions and long-term stability after vision therapy. Ophthalmic Physiol Opt 2011; 31(2):180-9.
- Dusek WA, Pierscionek BK, McClelland JF. An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties. BMC Ophthalmol 2011; 11:21.
- Stein JF, Richardson AJ, Fowler MS. Monocular occlusion can improve binocular control and reading in dyslexics. Brain 2000; 123 ( Pt 1):164-70.
- Christenson GN, Griffin JR, Taylor M. Failure of blue-tinted lenses to change reading scores of dyslexic individuals. Optometry 2001; 72(10):627-33.
- Grisham D, Powers M, Riles P. Visual skills of poor readers in high school. Optometry 2007; 78(10):542-9.
- Palomo-Alvarez C, Puell MC. Accommodative function in school children with reading difficulties. Graefes Arch Clin Exp Ophthalmol 2008; 246(12):1769-74.
- Ponsonby AL, Williamson E, Smith K et al. Children with low literacy and poor stereoacuity: an evaluation of complex interventions in a community-based randomized trial. Ophthalmic Epidemiol 2009; 16(5):311-21.
- Wright C. Learning disorders, dyslexia, and vision. Aust Fam Physician 2007; 36(10):843-5.
- American Academy of Pediatrics SoO, Council on Children with Disabilities; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists,. Joint statement--Learning disabilities, dyslexia, and vision. Pediatrics 2009; 124(2):837-44.
- Handler SM, Fierson WM, Section on Ophthalmology and Council on Children with Disabilities AAoO, American Association for Pediatric Ophthalmology and Strabismus, and American Association of Certified Orthoptists,. Learning disabilities, dyslexia, and vision. Pediatrics 2011; 127(3):e818-56.
- Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997. Available online at: www.aaopt.org (Last accessed December, 2011).
- Orthoptic Training for the Treatment of Vision or Learning Disabilities. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (January 2013) Other 9.03.03.
||Policy reviewed; no changes to current policy|
||Policy updated with literature search through November 2011; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary|
||Policy formatting and language revised. Policy statement unchanged. Title changed from "Vision Therapy--Orthoptics Training" to "Orthoptics (Vergence/Accommodative therapy), Visual Exercises or Training".|
||Document updated with literature review. Coverage unchanged.|