Vision Therapy

Policy Number: MA 4.007

Effective Date: 1/1/2026

Policy

Vision therapy may be considered medically necessary for symptomatic convergence insufficiency. Some examples (not all-inclusive) of conditions that can cause convergence insufficiency are the following:

• Amblyopia
• Strabismus
• Accommodative dysfunction
• General binocular dysfunction
• Mild traumatic brain injury (mTBI)
• Concussion
• Stroke

More than 24 sessions of vision therapy are considered investigational per symptomatic occurrence (see policy guidelines).

Vision therapy is considered investigational for all other indications. There is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with this procedure.

Orthoptic eye exercises are considered investigational for the treatment of learning disabilities in the absence of symptomatic convergence insufficiency.

A home computer orthoptic program consisting of eye exercises performed when following a computer-based orthoptic program tailored to the individual’s personal symptoms is considered investigational. There is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with this procedure for these indications.

Policy Guidelines

This policy addresses office-based orthoptic training. This policy does not address standard vision therapy that lenses, prisms, filters or occlusion (i.e., for treatment of amblyopia or occlusion applied prior to surgical intervention).

Up to 12 sessions of office-based vision therapy, typically performed once per week, has been shown to improve symptomatic convergence insufficiency. If individuals remain symptomatic after 12 weeks of orthoptic training, yet there is documentation of improvement through examination notes, then another 12 sessions may be needed.

Cross-References

• MP 2.084 Medical Treatments of Autism Spectrum Disorders
• MP 6.018 Therapeutic Lenses, Spectacle Correction, and Prism

Product Variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.

FEP PPO – Refer to FEP Medical Policy Manual.

Description/Background

Common forms of vision therapy are known as orthoptics and pleoptics. Orthoptics is a technique of eye exercises intended to improve eye movements and/or visual tracking. Pleoptics are eye exercises used to improve impaired vision when there is no evidence of organic eye diseases. A related but distinct training technique is behavioral or perceptual vision therapy, in which eye movement and eye hand coordination training techniques are used to improve learning efficiency by optimizing visual processing skills.

The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) states that optometrists define vision therapy as an attempt to develop or improve visual skills and abilities; improve visual comfort, ease, and efficiency; and change visual processing or interpretation of visual information. The AAPOS states that there are three main categories of vision therapy which are orthoptic vision therapy, behavioral/perceptual vision therapy, and vision therapy for prevention or correction of myopia (nearsightedness). Orthoptic vision therapy includes eye exercises to improve binocular function whereas behavioral/perceptual vision therapy includes eye exercises to improve visual processing and visual perception. Orthoptic eye exercises can be beneficial in the treatment of symptomatic convergence insufficiency.

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). It is most common in children and young adults when they begin to experience symptoms from prolonged periods of near work. Symptoms of this 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 with pencil push-ups, and office-based vision therapy and orthoptics have been evaluated for the treatment of convergence insufficiency. Prism reading glasses tend to treat the symptom of double vision but does not actually treat the condition itself. The goal of vision therapy in the treatment of CI is to stimulate the communication between the brain and eyes, to enable clear and comfortable vision at all times.

In addition to its use in the treatment of accommodative and convergence dysfunction, vision therapy is being investigated for the treatment of attention deficient disorders, dyslexia, dysphasia, and reading disorders. The American Academy of Ophthalmology, in a joint statement on learning disabilities, dyslexia, and vision, concluded that:

Currently, there is no adequate scientific evidence to support the view that subtle eye or visual problems cause learning disabilities. Furthermore, the evidence does not support the concept that vision therapy or tinted lenses or filters are effective, directly or indirectly, in the treatment of learning disabilities. Thus, the claim that vision therapy improves visual efficiency cannot be substantiated. Diagnostic and treatment approaches that lack scientific evidence of efficacy are not endorsed or recommended.

Computer based programs

RevitalVision received FDA clearance for its vision training software program which provides home-based vision training to people 9 years of age and older with amblyopia.

The CureSight system is a non-invasive eye tracking system designed for remote binocular vision treatment in pediatric patients (aged 4 to 9 years) suffering from amblyopia. The proprietary screen allows for treatment while the child watches their favorite streamed content in the comfort of their home.

Rationale

Summary of Evidence

For individuals who have convergence insufficiency who receive office-based orthoptic training, the evidence includes a TEC Assessment, several randomized controlled trials (RCTs), and nonrandomized comparative studies. Relevant outcomes are symptoms and functional outcomes. The most direct evidence on office-based orthoptic training comes from a 2008 RCT that compared office-based orthoptic training with home-based orthoptic training and placebo. The study found a greater percentage of patients who had a home-based vision exercise program consisting of pencil push-ups or home computer vision exercises. Subsequent analyses of data from orthoptic convergence insufficiency treatment trials, and a prospective study of factors associated with convergence insufficiency symptoms, support the conclusion that the technology results in an improvement in the net health outcome.

For individuals who have learning disabilities who receive office-based orthoptic training, the evidence includes a TEC Assessment as well as nonrandomized comparative studies and noncomparative studies. Relevant outcomes are functional outcomes. A 1996 TEC Assessment did not find evidence that orthoptic training improves outcomes for individuals with learning disabilities. Since then, additional studies have not definitively demonstrated improvements in reading or learning outcomes with orthoptic training. At least 2 earlier studies that have addressed other types of vision therapies reported mixed improvements in reading. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have received computer-based orthoptic therapy, the evidence includes a prospective study to evaluate the efficacy of perceptual vision therapy in enhancing best corrected visual acuity and contrast sensitivity function in amblyopic patients. The authors concluded the results demonstrate the efficacy of perceptual vision therapy in improving visual acuity. Long-term follow-up and further studies are needed. The evidence is insufficient to determine the effects of the technology on health outcomes.

Definitions

Accommodation is the adjustment of the crystalline lens of the eye to keep an object in focus on the retina as its distance from the eye varies.

Esotropia refers to an abnormal ocular condition in which the visual axes of the eyes are not directed at the same point.

Binocular Vision is the visual sensation that is produced when the images perceived by each eye are fused to appear as one.

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as required by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the member’s benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding Information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement. The codes need to be in numerical order.

Investigational; therefore, not covered:

Covered when medically necessary:

References

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Policy History

• MA 4.007
• 8/19/2025 Creation of policy.