Authors' objectives: Recently, the Evidence-Based Practice Group (EBPG) received a question regarding an opinion submitted to the Board on the efficacy of Visual (a.k.a. Vision) Therapy in treating a patient with a concussion. In this opinion, 214 articles were referenced to support the evidence of the efficacy and/or effectiveness of vision therapy in treating a patient who had a concussion. With regard to vision therapy, in 2009 the EBPG conducted a systematic review, investigating its efficacy and/or effectiveness and concluded that at the time ?there is low quality evidence on the efficacy and/or effectiveness of vision therapy in treating convergence insufficiency, amblyopia, strabismus, ocular motility disorder, low vision, dyslexia, ADHD (attention-deficit/hyperactivity disorder), and learning difficulties, as well as for athletic performance enhancement?. This 2009 systematic review was then updated in 2017, focusing on its efficacy and/or effectiveness for traumatic brain injury (TBI) patients. The 2017 systematic review found low level, low quality evidence in support of this intervention in treating patients with mild TBI (MTBI).

Authors' results and conclusions: By combining the appraisals from part I and part II of the search results, overall, there are six primary studies that are appraised and summarized in this systematic review. Our updated 2022 systematic review highlighted the persistent problems reported in the 2017 systematic review. The relevant evidence identified from the submitted references also highlighted the same problems the EBPG found in the studies investigating the efficacy and/or effectiveness of Vision Therapy (VT). These problems include low-level and low-quality primary studies, heterogeneity in the diagnosis criteria of MTBI, heterogeneity of the VT protocols, heterogeneity in the outcomes, relatively short-term follow-up for potentially chronic clinical problems and unaccounted potential effect of bias, chance and confounding in influencing the reported outcomes. As such, to this date, although there may be some evidence on the efficacy and/or effectiveness of VT in treating post-MTBI visual problems, this evidence has to be interpreted with caution since bias, chance and confounding cannot be completely excluded from the reported outcomes.

Authors' recommendations: By combining the appraisals from part I and part II of the search results, overall, there are six primary studies that are appraised and summarized in this systematic review. Our updated 2022 systematic review highlighted the persistent problems reported in the 2017 systematic review. The relevant evidence identified from the submitted references also highlighted the same problems the EBPG found in the studies investigating the efficacy and/or effectiveness of Vision Therapy (VT). These problems include low-level and low-quality primary studies, heterogeneity in the diagnosis criteria of MTBI, heterogeneity of the VT protocols, heterogeneity in the outcomes, relatively short-term follow-up for potentially chronic clinical problems and unaccounted potential effect of bias, chance and confounding in influencing the reported outcomes. As such, to this date, although there may be some evidence on the efficacy and/or effectiveness of VT in treating post-MTBI visual problems, this evidence has to be interpreted with caution since bias, chance and confounding cannot be completely excluded from the reported outcomes.

Authors' methods: Given these circumstances, for the question of the opinion on efficacy and/or effectiveness of vision therapy recently sent to the EBPG and the availability of systematic review of the same topic conducted in 2017, we decided to pursue answering these two questions by: A.) Appraising the 214 articles in the references sent to the Board by the attending optometrist, in a similar way as the EBPG conducts systematic reviews, i.e. by assessing the titles and abstracts of the articles for relevancy, retrieving those articles thought to be relevant in full for further appraisal, appraising the fully retrieved articles, and summarizing and presenting the results. B.) Updating the systematic review the EBPG conducted in 2017. The subsequent writing of this systematic review is then divided into two parts including: I. investigating the efficacy and/or effectiveness of the evidence submitted by the optometrist and II. updating the EBPG?s 2017 systematic review on vision therapy in treating patients post-TBI.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2022

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/vision-therapy-treatment-traumatic-brain-injury-2022-update?lang=en

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC