Orthoptist Therapy Or Visual Therapy: Which Approach Is The Right Choice For You?

Many people suffer from headaches, eye strain, or trouble reading despite having "normal" eyesight on a standard eye chart. This is because routine eye exams typically check only visual acuity (20/20 vision) and can miss underlying coordination problems.

For instance, adults with convergence insufficiency who often complain of double vision and fatigue, yet they pass the visual acuity assessment. In such cases, orthoptist vision therapy for adults may offer relief. Vision therapy is a non-surgical approach led by trained eye-care professionals. Instead of relying solely on glasses, it focuses on improving the coordination between the eyes and brain, which can reduce discomfort during reading and close work.

What is an orthoptist?

Orthoptists are allied health professionals trained to diagnose and manage binocular vision problems. They work closely with ophthalmologists and optometrists to support conditions such as strabismus, amblyopia, and convergence insufficiency.

A key distinguishing factor is that orthoptists focus on non-surgical treatment, so they may prescribe glasses or prisms and provide targeted exercises (orthoptic exercises) to improve vision. In fact, orthoptists are qualified to design and manage programs of non-surgical treatment for binocular vision disorders in both children and adults.

What is orthoptist vision therapy & how does it work?

Vision therapy (sometimes called orthoptic therapy) is a personalised program of eye-brain exercises prescribed and closely monitored by an orthoptist or vision specialist. The goal is not simply to strengthen the eye muscles, but to enhance the neural coordination between the eyes and the brain. Sessions typically occur weekly under expert supervision (often provided by an orthoptist), and patients also practice prescribed exercises at home.

The therapy works by training the brain to control eye movements more effectively, gradually building new visual skills. A vision therapy program targets explicitly the core visual abilities:

• Eye teaming (Binocular Vision):

Orthoptists often prescribe exercises that help both eyes align accurately on a shared visual target. When eye teaming breaks down, as in convergence insufficiency, the eyes may drift outward during near tasks. This leads to blurred vision, double vision, or fatigue. Vision therapy retrains this coordination system, helping to improve the brain's ability to merge two slightly different images from each eye into a single, unified view.

• Focusing (Accommodation):

Accommodation involves the eye's ability to maintain a sharp image at near distances and switch focus efficiently between far and near distances. Therapy may include lens flipper drills, near-far shifts, or accommodative rock exercises to build both flexibility and stamina. Accommodation and convergence are linked, so deficits in one often affect the other.

•  Eye tracking (Oculomotor Control):

Accurate tracking is vital for tasks like reading, where the eyes must move from word to word. Weak tracking can cause skipping words, re-reading lines, or losing place. Therapy often includes activities such as reading charts or following a ball to enhance these movements.

When followed through correctly, orthoptic eye exercises can effectively address many binocular vision dysfunctions, such as convergence insufficiency and accommodative dysfunction. This reduces symptoms such as eyestrain, blurriness, and double vision. Personalised therapy sessions teach the eyes and brain to work together more smoothly and efficiently. The benefit is improved comfort and performance.

Common conditions supported by orthoptist vision therapy

Vision therapy can address a variety of binocular vision problems. Common conditions include:

• Convergence Insufficiency (CI): This is a very common binocular vision disorder where the eyes struggle to converge for near tasks. Patients often complain of headaches, difficulty reading, eye fatigue or double vision when doing close work. Standard exams may miss CI, so many individuals go undiagnosed for years. However, orthoptic vision therapy provides convergence insufficiency treatment, a non-surgical program that involves specific exercises such as pencil push-ups and computer activities. The goal is to retrain the eye muscles and nerves to work together.

• Amblyopia (Lazy Eye): Amblyopia occurs when one eye is significantly weaker, and the brain suppresses its input. The standard treatment for amblyopia involves patching or medicating the stronger eye to force the brain to use the weaker eye. Vision therapy can complement these treatments by incorporating tasks and games that strengthen the neural connections of the weaker eye while both eyes are open. Orthoptic therapy focuses on visual processing and eye teaming to help the brain incorporate the weaker eye.

• Double Vision (Diplopia): Persistent double images can arise from strabismus or nerve/muscle problems. Therapy aims to reduce double vision by training the eyes to align. Orthoptists design vision programs (often using prisms, exercises, or filtered lenses) to minimise diplopia and improve depth perception. In some cases, if the underlying cause is structural, surgery may eventually be needed; however, orthoptic training and prisms can often alleviate symptoms.

• Visual Stress & Digital Eye Strain: Prolonged screen use can lead to visual stress (sometimes called computer vision syndrome). Symptoms include sore or tired eyes, blurred vision, and headaches. Vision therapy can help individuals with these conditions by improving visual endurance and coordination. Exercises that strengthen eye focusing, teaming, and tracking can make screen use more comfortable and sustainable.

How vision therapy differs from glasses or surgery

Vision therapy approaches vision problems actively, whereas glasses and surgery address structural or refractive issues. The table below summarises the differences:

Feature	Glasses/Lenses	Surgery	Orthoptist Vision Therapy
Goal	They address refractive (focusing) errors.	It realigns or shortens eye muscles to straighten the eyes	Helps improve the eye-brain coordination and binocular function
How it works	They use curved lenses to redirect light onto the retina	Surgical adjustment of extraocular muscles to change eye position	It uses guided eye exercises and therapeutic activities (such as orthoptic exercises) to strengthen the neural control of eye movements
When to use	For blurriness from myopia and other refractive errors.	When a structural misalignment (strabismus) or muscle issue cannot be managed non-surgically	When underlying visual skills (eye teaming, focusing, tracking) are weak or inefficient

The table above highlights Orthovision's root cause philosophy. Glasses and surgery offer passive solutions for focusing or aligning the eyes, but they do not train the visual system itself. Orthoptic vision therapy, on the other hand, is an active training approach that develops the skills necessary for comfortable vision.

How Orthovision approaches: holistic, personalised vision therapy in Singapore

Orthovision delivers expert-led, comprehensive programs designed by world-renowned specialists. Our approach has two key pillars:

• Expert-led foundation: Every program starts with a thorough visual assessment conducted by our founder, Dr Zoran Pejic, a world-renowned orthoptist and his team. We evaluate each patient's history and vision challenges to recommend a customised therapy program. For example, our team uses in-depth Developmental Visual Cognitive Assessments for children and Functional Vision Assessments for adults to diagnose issues in teaming, focusing, perceptual skills and more. This holistic evaluation identifies each person's unique hurdles, whether it is head posture, learning behaviours, or sensory factors, before therapy begins.

• Advanced clinical method: Based on the assessment, we develop a personalised ICORE therapy program. ICORE (Integrated Cognitive Orthoptic Remediation) is our evidence-based system for retraining visual skills. We combine ICORE exercises with the INPP method (Institute of Neuro-Physiological Psychology) screening to address neurological development factors. Therapy is delivered in concentrated 3-week blocks, where each week includes a 40-minute in-clinic session, plus daily 30-minute home exercises, all tailored to the individual. We adapt the program as needed to enhance eye coordination, eye-hand coordination, comfort and learning capacity.

After each 3-week block, we review progress and update the plan. By combining orthoptic training with cognitive and sensory integration, our approach addresses the underlying causes of vision dysfunction. Patients often experience reduced headaches, better focus, and improved reading or learning performance.

If you or your child struggles with reading, headaches or double vision, consider an orthoptic vision therapy evaluation. Singapore's Orthovision team is here to guide you through a non-surgical, science-based therapy program. Contact us for a comprehensive assessment and start improving your visual comfort and coordination today.