Clinical Policy Bulletins:
Vision Therapy
Number: 0489
Policy
Note: Some Aetna plans specifically exclude benefits for vision therapy (orthoptic training). Under these plans, charges for orthoptic and/or pleoptic training (eye exercises) and training aids or vision therapy for any diagnosis should be denied based on this contractual exclusion.
Under plans with no such exclusion, Aetna considers up to 32 vision therapy visits or sessions medically necessary for treatment of the following conditions:
Amblyopia
Strabismic amblyopia
Suppression amblyopia
Deprivation amblyopia
Refractive amblyopia
Strabismus (concomitant)
Monocular esotropia
Alternating esotropia
Monocular exotropia
Alternating exotropia
Intermittent esotropia, monocular
Intermittent esotropia, alternating
Intermittent exotropia, monocular
Intermittent exotropia, alternating
Accommodative component in esotropia
Non-strabismic disorder of binocular eye movements
Convergence insufficiency
Convergence excess
Anomalies of divergence
Non-presbyopic accommodative inability for members over twelve years old.
Requests for vision therapy exceeding 32 visits for these indications are subject to medical review.
Note: Under Aetna plans that cover vision therapy, orthoptic or pleoptic training aids are covered as durable medical equipment.
Vision therapy for the following diagnoses may be considered medically necessary upon medical review:
Heterophoria
Esophoria
Exophoria
Note: Heterophoria that requires treatment should be causing asthenopia or fusion with defective stereopsis.
Myopia
Nystagmus.
Aetna considers vision therapy experimental and investigational for any of the following:
Eccentric fixation
Anomalous retinal correspondence
Traumatic brain injury (TBI)
Dyslexia and learning disabilities (see CPB 078 - Learning Disabilities, Dyslexia, and Vision )
Any diagnoses not listed above.
Eccentric fixation and anomalous retinal correspondence are adaptations to either amblyopia or strabismus and do not exist in their absence. Vision therapy in TBI, dyslexia and learning disabilities has not been shown to be effective treatment. Note: In addition, most Aetna benefit plans exclude coverage of services, treatment, education testing or training related to learning disabilities, or developmental delays. Please check benefit plan descriptions.
Background
Vision therapy encompasses a wide variety of non-surgical methods to correct or improve specific visual dysfunctions. It may include the use of eye patches, penlights, mirrors, lenses, prisms, and patches, as well as eye exercises. Other modalities in use by vision therapy proponents that are considered unproven include sensory, motor, and perceptual activities. Orthoptics and pleoptics are common forms of vision therapy. Orthoptics are exercises designed to improve the function of the eye muscles. These exercises are considered particularly useful in the treatment of strabismus (cross-eyes). Pleoptics are exercises designed to improve impaired vision when there is no evidence of organic eye diseases.
There is a broad range of vision therapy techniques and methods among practitioners who perform vision therapy making the practice of vision therapy difficult to standardize and evaluate. The National Eye Institute (NEI) of the National Institutes of Health (NIH) acknowledges the need for clinical trials of noninvasive treatments (such as orthoptics and vision training) to determine the presence of improvement in eye alignment and visual function in patients with early vision abnormalities such as amblyopia and impaired stereoscopic vision. The American Academy of Ophthalmology (AAO) accepts eye exercises and other non-surgical treatments, usually provided by an orthoptist (a professional eye specialist who works under the supervision of an ophthalmologist), as beneficial for individuals who have eye muscle problems. However, the AAO believes that these treatments should not be confused with vision therapy. The American Academy of Pediatrics (AAP), American Association for Pediatric Ophthalmology (AAPOS), and the AAO issued a joint statement in July 1992 stating that there is no scientific evidence to support the claim “that the academic abilities of dyslexic or learning-disabled children can be improved with treatment based on (a) visual training, including muscle exercises, ocular pursuit, tracking exercises, or ‘training’ glasses (with or without bifocals or prisms); (b) neurological organizational training (laterality training, crawling, balance board, perceptual training): or (c) tinted or colored lenses. It is the opinion of these organizations that any claims of improved reading and learning with the use of these methods usually are based on poorly controlled studies. Thus, there are no eye or visual causes for dyslexia and learning disabilities, and there is no effective treatment.
The American Academy of Optometry and American Optometric Association issued a joint policy statement in 1997 on vision, learning, and dyslexia, maintaining that vision therapy does not treat learning disabilities or dyslexia directly, but is a treatment to improve visual efficiency and visual processing to allow an individual to be more responsive to educational instruction. However, there is little data available on the efficacy of vision therapy for treating learning disabilities or dyslexia. In addition, Aetna does not cover services, treatment, education testing or training related to learning disabilities, or developmental delays.
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