Understanding the AAPOS Position on Vision Therapy — And What It Gets Wrong

April 07, 2026
​​​​​​​By Dr. Eric Chow

Parents often come to my office seeking a second opinion after their child has been diagnosed with conditions such as amblyopia or strabismus by another optometrist or ophthalmologist. Fortunately with the growing accessibility of information and tools like artificial intelligence, many families arrive having already explored their options and understanding that treatment may go beyond traditional approaches like patching or simple pencil push-up exercises.

What often stands out is that some parents report being told by their eyecare providers that vision therapy “doesn’t work” or is “a waste of money.” This creates confusion and more importantly, it can prevent a child from receiving care that could meaningfully improve their function.

Over time, it has become clear that many ophthalmologists (and some optometrists) are not deeply familiar with what modern vision therapy actually entails. That, in itself, is understandable because no provider is expected to be an expert in every field. However, when strong statements are made (like “vision therapy doesn’t work”) without a full understanding of the treatment, it can lead to unintended harm, especially given the level of trust patients place in medical professionals.

In this article, we’ll take a closer look at how the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) defines vision therapy (https://aapos.org/glossary/vision-therapy) and examine where that perspective falls short.

Find the PDF version of their statement here.

What AAPOS Claims

According to their glossary, vision therapy is described as a series of exercises intended to improve visual skills and processing. Their broader stance can be summarized as follows:

• Vision therapy is supported primarily for convergence insufficiency and some accommodative issues

• It is considered controversial or unsupported for most other conditions

• It should not be used for learning disabilities such as dyslexia That is the core of their position. Let’s break it down into six parts.

1. An Oversimplified Definition of Vision Therapy

AAPOS reduces vision therapy to “eye exercises,” which is fundamentally misleading.

Vision therapy is not simply about moving the eyes. It is a structured neuro-rehabilitative process targeting:
 

• Eye teaming (vergence)

• Focusing (accommodation)

• Eye movements (oculomotor control: saccades, pursuits, fixations)

• Visual processing and interpretation

• Sensorimotor integration (eye–body coordination)

• Visual attention and sustained focus

• Visual memory (short-term and working memory)

• Visual sequential memory

• Visual discrimination (identifying similarities/differences)

• Spatial awareness and orientation

• Laterality and directionality (left/right awareness)

• Visual–motor integration (hand–eye coordination)

• Visual form constancy (recognizing objects despite changes in size/orientation)

• Visual closure (identifying incomplete images)

• Visual figure-ground (finding objects in cluttered environments)

• Peripheral awareness and central–peripheral integration

• Depth perception and stereopsis

It incorporates lenses, prisms, filters, and carefully designed therapy protocols.

Framing vision therapy as “just exercises” is similar to describing physical therapy as “just stretching.” It minimizes the complexity and intent of the intervention.

Professional organizations where you can learn more include: https://www.covd.org/, https://noravisionrehab.org/, https://www.aoa.org/, https://www.oepf.org/, https://visionhelp.com/, and https://aaopt.org/

 

2. A Limited View of What Vision Actually Is

AAPOS approaches vision primarily through a disease and surgical lens. But vision is not just about eye health. It is a brain-based process.

Patients can have 20/20 eyesight and still struggle with:
 

• Eye tracking

• Sustained focus

• Coordination between the eyes

• Visual endurance

This highlights a key distinction:

• Ophthalmology focuses on structure and pathology

• Vision therapy focuses on function and performance

These are not competing approaches. They address different layers of the same system.

3. The “Only Convergence Insufficiency” Argument Is Too Narrow

There is strong, high-level evidence supporting vision therapy for convergence insufficiency. This is well established (https://pubmed.ncbi.nlm.nih.gov/26942226/)

With over a decade of clinical experience in vision therapy, I have seen firsthand that its benefits extend well beyond convergence insufficiency, helping patients with conditions such as convergence excess, divergence insufficiency, divergence excess, and a wide range of other binocular vision disorders.

The reality is that the first CITT paper was published in 2005, with follow-up work extending through 2019, representing at least 14 years of ongoing research, not even accounting for when the study initially began. Over that time, the National Institutes of Health invested approximately $14–16 million to rigorously study just one condition and demonstrate the effectiveness of vision therapy. Expecting similarly large-scale, long-term funding for every visual condition before acknowledging the value of vision therapy is simply not a realistic standard.

Unfortunately, I have repeatedly seen that even when a child clearly presents with convergence insufficiency, vision therapy is not always recommended. This may reflect a lack of familiarity, limited training, or even prior experiences with the treatment, highlighting how personal and professional bias can influence clinical decision-making.  See the list of research supporting vision therapy here. 

4. A Misleading Narrative Around Learning Disorders

AAPOS often states that vision therapy does not treat dyslexia.

That statement is technically correct, but it is also commonly misinterpreted.

No responsible developmental optometrist claims that vision therapy “cures dyslexia.” Dyslexia is a language-based disorder.

The accurate clinical position is: Visual dysfunction can contribute to reading difficulty.

We know that:
 

• Convergence insufficiency can impair reading performance

• Poor eye tracking affects reading fluency

• Reduced visual efficiency impacts attention and endurance

So the correct distinction is: Vision therapy treats visual barriers to learning. It does not treat cognitive learning disorders themselves.

5. Differences in Training Shape the Perspective

AAPOS represents pediatric ophthalmologists—physicians trained primarily in medical and surgical management.
They are not trained in:

• Behavioral or developmental optometry

• Structured vision therapy delivery

As a result, their conclusions are shaped by:

• A pathology-based model of care

• Limited exposure to functional vision treatment

This is not about right versus wrong. it is about differences in training, experience, and clinical focus.

6. Insurance Coverage Does Not Define Clinical Value

Part of the AAPOS stance aligns closely with insurance coverage policies:

• If insurance covers convergence insufficiency, it is considered “valid”

• If it does not cover other conditions, they are viewed as unsupported

However, insurance companies frequently deny coverage for:

• Traumatic brain injury rehabilitation

• Cognitive therapy

• Other well-supported interventions

The Bigger Picture

Vision therapy exists at a unique intersection between the eyes and the brain.

While traditional ophthalmology focuses on diagnosing and treating eye disease, vision therapy focuses on how the visual system functions in everyday life, such as reading, learning, movement, and attention

The strongest evidence supports its use in convergence insufficiency. At the same time, growing clinical experience and emerging research suggest broader applications, particularly in binocular vision dysfunction and neuro-visual rehabilitation.

Final Takeaway

The AAPOS perspective on vision therapy is:

• Reductionistic in definition

• Limited in scope

• Rooted in a surgical and disease-based model

• Dismissive of functional vision science

As our understanding of the brain and visual system continues to evolve, so too should our approach to care.

At the end of the day, the priority is simple: ensuring patients receive the most comprehensive and effective treatment available, not limiting options based on outdated or incomplete perspectives.