Eye Exercises

There have been many kinds of eye exercises claiming to treat a wide variety of vision disorders. Eye exercises go by a number of different names: vision therapy, orthoptics, vision rehab, vision training... It's easy to get confused by the different names and sometimes hard to tell if the exercises are legitimate or not. You may find yourself asking questions like, will this work for me? Or, how many times a day do I have to do these exercises in order for them to be effective? What about if I have a retinal detachment, can eye exercises help with that? These are legitimate questions that may need to be answered by a Developmental Optometrist. Below we will take a look at several topics within the eye exercises category and information. Keep reading to take a look at the history of "eye exercises" for lazy eye and other conditions.

The History of Eye Exercises

Early reports of eye exercises actually come from ophthalmology. In the late 19th century, Louis Émile Javal, a French ophthalmologist, thought an eye turn (strabismus) was likely due to poor or abnormal binocular (two-eye) fusion. Javal developed a series of eye training exercises that utilized occlusion, fusion, and stereopsis training that are used even today! Similar reports in the late 19th and early 20th century from clinicians such as Claude Worth, Sheila Mayou, and Martha Lyon expanded on the work of Javal, setting the foundation for vision rehabilitation of patients with poor visual acuity, fusion, or stereopsis due to a number of conditions.

Orthoptics vs. Vision Therapy

Although both may seem like they are similar eye exercises, there are a number of key differences. Orthoptics comes from the Greek words orthos (straight) + optikos (eyes or sight) - so "straight eyes" or "straight sight". Orthoptics in modern times has a primary focus on the oculomotor component of an eye turn (strabismus) or vergence (convergence/eyes in or divergence/eyes out) disorder. An orthoptist (someone who facilitates orthoptics exercises) often works with an eye surgeon (ophthalmologist) that performs eye muscle surgeries.

Vision therapy is a term more commonly used in an optometry clinic. Vision therapy (VT) does address oculomotor components of vision but has a wider scope that addresses the visual system as a whole. This includes eye coordination disorders, accommodative (focusing) disorders, vision processing disorders, and the more common disorders of amblyopia and strabismus.

Evidence-Based Eye Exercises

A group of ophthalmologists, optometrists, and vision scientists called the Pediatric Eye Disease Investigator Group have worked hard to combat disorders of binocular vision that affect children. PEDIG has published a number of large studies that help shape the knowledge and practice patterns use by clinicians when treating disorders such as amblyopia (lazy eye), strabismus, and convergence insufficiency.

Eye exercises of any type often us the concept of perceptual learning. Perceptual learning is a type of training that uses repetition to build and improve a certain skill. Perceptual learning may be single eye (monocular) tasks or both eye (binocular) tasks. The goal of a perceptual learning activity is to improve the neural pathway needed to effortlessly perform a skill. When the visual system is young (or in neurodevelopmental terms "plastic"), learning occurs naturally. The eyes develop and refine their anatomical structure at the same time as eye teaming and coordination tasks, such as 3D vision development. Targeted learning later in life becomes a form of active therapy - the patient works to improve a deficient visual skill such as visual acuity or 3D vision (stereopsis). Tools like red/green or red/blue glasses, polarized stereo slides, or virtual reality (VR) are often used to create fun, repeatable eye exercises to improve visual skills.

Take a look at the recommended reading section for links to papers that help build on the evidence-based nature of eye exercises.

Do be cautious though - not all eye exercises are the same! Exercises such as the Bates Method was a once-popular eye exercise routine that claimed to be able to cure the need for eyeglasses by changing the shape of the eye. That claim turned out to be false. An eye care provider should be able to provide evidence for the exercise or type of eye exercised used to treat a vision condition.

How Do I Do Eye Exercises? What Are Some Common Eye Exercises?

First of all, it's incredibly important that before starting any eye exercise routine, a patient has a full and comprehensive eye examination by a professional whenever visual symptoms such as eye strain, blurred vision, or headaches occur. An eye care provider will do a full health check of the eyes as well as test a patient's visual skills.

Some simple eye exercises anyone can do are:

Take a break! When working on a computer or reading for a long amount of time, work your focal system by looking far away after 20-30 minutes of near work
Fast focus changes - look away at something in the distance and quickly back to something close, like your finger
Tracking - hold your finger out and do a figure-8 with your arm/hand; try to focus and follow the tip of your finger with the right, left, and then both eyes
Visual memory games

More complex eye exercises may be needed if you have a binocular vision problem, such as amblyopia (lazy eye), strabismus (eye turn), or convergence or divergence problems. You may get exercises from your eye care provider that include:

Exercises for convergence and accuracy, such as the Brock string
Depth perception exercises with special glasses and 3D objects or VR
Focusing exercises that use lenses to make the eye focus or relax

If you ever have a question if you should or shouldn't do an eye exercise, it's best to ask your eye care professional.

References and Recommended Reading

Levi, Knill, and Bavelier. Stereopsis and Amblyopia: A Mini-Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519435/

Scheiman. Establishing an Evidence-Based Literature for Vision Therapy - a 25 Year Journey. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078795/

Scheiman, Mitchell, Cotter, et al. A Randomized Clinical Trial of Treatments for Convergence Insufficiency in Children. https://jamanetwork.com/journals/jamaophthalmology/article-abstract/416768

Press, Overton, and Leslie. https://www.acbo.org.au/images/News_Views_FAQs/Evidence_landing_page/A_Discussion_and_Analysis_of_Barrett_Paper.pdf

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