Sir,

Behavioural vision therapy is a branch of optometry that attempts to improve visual efficiency through the prescription of treatments such as hand–eye co-ordination activities. Here we report an unfortunate adverse event associated with such therapy.

Case report

A 43-year-old female, presented to the Gold Coast Hospital, Queensland suffering a large, vertical, ragged, and shelfed corneal laceration, which occurred while assisting her son to perform a behavioural vision therapy exercise. The vision therapy task belonged to a group of vision therapies known as ‘visual-motor integration’ activities, promoted for the treatment of reading dysfunction. To perform the exercise, the patient is instructed to attach a tennis ball to a string (via a hook previously screwed into the tennis ball) and hang the string from the ceiling. The task for the patient’s son was to gently strike the ball with a wooden rolling pin, which is ringed by coloured bands. Using different sequences of colours, the ball is hit towards a target held by his mother. During the activity, the tennis ball came free of the screw, and the screw (still attached to the string) recoiled against the patient’s right eye.

Surgical repair was undertaken and at the most recent review, 1 month following the initial injury, pinhole visual acuity was R 6/18.

Comment

Behavioural optometry is concerned with visual dysfunction that proponents believe can exist despite the presence of good visual acuity, no refractive error or ocular disease, normal accommodation, normal binocular vision, and normal ocular motility.1 Examples of behavioural vision therapy tasks include hand-eye co-ordination activities, coloured overlay lenses, trampolines, or balance boards. A recent critical appraisal of vision therapy by Barrett2 found no significant evidence to support the vast majority of behavioural management approaches advocated by behavioural optometrists, a similar finding to an earlier review by Jennings, 2000.3

Our patient was unfortunate to suffer a severe penetrating eye injury while helping her son perform a task of uncertain benefit to his visual development. Any equipment used for such exercises should be as safe as possible to minimise the potential harms of therapy. The use of exercises in which balls are propelled at against a flat surface should be certainly be appraised in this light.