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Eye doctors are trained to diagnose and treat eye and vision conditions. As with any profession, certain eye doctors sub-specialize in an area of eye care. Within the areas of vision therapy and Neuro-Optometric Vision Rehabilitation, there exist optometrists who have received advanced, post-graduate residency training in the areas of vision therapy and neuro-optometry. Despite the availability of these specialists, individuals outside of eyecare perform 'eye exercises'. So what are eye exercises and should you perform them?

We have many patients who ask if there are eye exercises they can perform. Some are hoping to prevent the need for reading glasses (sorry exercises won't prevent that), others are hoping to get rid of their prescription (nope, won't work for that either), and others are hoping to make their eyes work as a team (enter vision therapy and Neuro-Optometric Vision Rehabilitation).

We also have patients who have been prescribed eye exercises. Some have been prescribed eye exercises by a primary care eye doctor, others have been prescribed these activities by someone outside of eye care. Typically eye exercises involve following a target (a bead or a pencil for example) or performing jumps between objects. These eye exercises have their appeal; you are actively doing something to improve some aspect of your vision – whether it be tracking, eyestrain, or double vision. But are they effective? Will they deliver the results that were promised? Could they actually do more harm than good?

As innocent as these eye exercises may seem, they have the potential to modify the visual system (that is the goal after all isn't it). Vision is our dominant sense and it is extremely complex. Improper modification can result in poor depth perception, headaches and even double vision. This is why doctors are specifically trained in the areas of binocular vision, vision therapy and neuro-optometry. The decision to prescribe intervention is based on clinical decision making that factors in your current level of visual functioning and your potential to properly modify your visual system. It should seem odd if someone outside of eye care tells you to do eye exercises, yet it happens.

Eye exercises often fail because they are an over-simplified attempt at treatment for a very complex visual problem. Tracking exercises, for example, are marketed to improve reading fluency. Did you know that there are several visual skills that must be in place BEFORE you even work on tracking? Performing tracking exercises without foundational visual skills is like studying calculus without knowing addition, subtraction, multiplication or division. A type of eye exercise called 'pencil pushups' is frequently prescribed by eye doctors who are not trained in vision therapy in an attempt to treat convergence insufficiency. The thought is that if someone can't cross their eyes then have them watch a pencil come towards their nose. So in essence, if someone can't do something perhaps pointing that fact out may fix it... Unfortunately the underlying visual mechanisms that result in convergence insufficiency are far more complex than an inability to look at a pencil with two eyes. In fact, research has shown the underwhelming response to pencil pushups in the treatment of convergence insufficiency. Research has also shown vision therapy to be the most effective treatment for convergence insufficiency.

Eye exercises prescribed outside of optometrists residency-trained in binocular vision, vision therapy or neuro-optometry often miss the mark. What may surprise you even more is that eye exercises not only have the potential to be ineffective, but they also have the potential to make things worse. Take tracking exercises for example. Many kids go through tracking exercises who need a comprehensive treatment. Some kids fail to improve, so you could argue the harm is that you have delayed proper intervention and prevented them from having success in school for the year. But what happens if a kid seems to improve their reading speed after these tracking activities? Is this a success? Many kids develop a scanning strategy to improve their reading rate. They realize that they get praise for going fast so they go faster. Unfortunately, many of these children sacrifice comprehension. They may initially test well on factual yes/no questions but as they progress in school their reading strategy prevents them from developing a deeper understanding of reading material. You end up with a speed reading kid who doesn't grasp what they have read.

These may not seem like significant things for some, but ultimately they provide barriers to success. Remember that eye exercises have the potential to modify the visual system? This is where the real potential harm lies. If you modify how the two eyes work together you have the potential to induce suppression or double vision. Suppression is a mechanism where the brain ignores the signal from one eye. It essentially shuts off the input from that eye. This means degradation of depth perception and variable visual input – which leads to variable performance. Double vision occurs when the two eyes are attended to by the brain but do not have the ability to work in a coordinated manner. If eye exercises are performed that make the brain pay attention to both eyes but do not train the necessary skills to effectively use this binocular vision, double vision, headaches and eye strain can result.

An optometrist who is residency-trained in binocular vision, vision therapy or neuro-optometry has the knowledge and expertise to safely and effectively prescribe vision therapy and Neuro-Optometric Vision Rehabilitation. These evidence-based interventions are designed to modify the visual system to improve visual performance. So the next time you ask 'are eye exercises a treatment option?', make sure you are asking a residency-trained optometrist if vision therapy or Neuro-Optometric Vision Rehabilitation are appropriate treatment options for your vision condition.

Check out Part 1: Vision Therapy to learn more about vision therapy.

Check out Part 2: Vision Rehabilitation