Aetna considers visual perceptual training experimental and investigational for the treatment of perceptual dysfunctions and for all other indications because its effectiveness has not been validated in well-designed prospective clinical studies.

Note: Visual perceptual training should be distinguished from optometric vision therapy. See CPB 489 - Vision Therapy.

Visual perceptual training is a psychoeducational intervention that focuses on perceptual dysfunctions that are claimed to contribute to delay in speech and language development in preschool children. The Handbook of Visual Perceptual Training (Cunningham & Reagan, 1972) (the Handbook) defines visual perception as "that process by which impressions observed through the medium of the eye are transmitted to the brain where relationship to past experiences takes place."

According to the Handbook, "it is concluded that visual perceptual deficits fall into patterns of a syndrome and that each component may impinge upon any number of other factors or may function independently. Visual perceptual dysfunction does not include lack of visual perceptual stimulation; it does involve improper choice of ontogenetic sequencing for such stimulation. It is not a matter of either-or; rather it is a matter of degree. It represents an inefficient developmental functioning that is a handicap to cognitive process. It is related to both cognition and emotional development" (Cunningham & Reagan, 1972). The authors of the Handbook further note that "concomitant factors of visual perceptual dysfunction may be short attention span, hyperactivity, distractibility, social adjustment difficulties, delayed motor perceptual ability, depressed academic achievement, inadequate body image and low frustration level." "Visual perception dysfunction," according to the Handbook, "is to be classified as a learning disability and language disorder."

Visual perception training programs involve an "integrated program involving speech and language activities, a wide range of sensory modalities and visual-motor perceptual activities" (Cunningham and Reagan, 1972). These activities include motor rhythm activities, body image training, as well as training in spatial and directional relationships. "Suggested activities are grouped under five main headings: coordination of eye-motor movements, distinguishing foreground from background, visual memory, spatial position and relationship to space ... Included in the activities are speech, language and visual-motor perceptual tasks that involve use of all senses."

Although vision perception training may include some exercises similar to vision therapy exercises, visual perceptual training should be distinguished from optometric vision therapy.  Visual perceptual training is directed toward perceptual dysfunctions that allegedly affect language and learning abilities, whereas vision therapy is a set of exercises directed toward specific deficiencies in the movements and/or focusing of the eye (e.g., strabismus, convergence insufficiency, esophoria, disorders of accommodation, etc.). Patients receive vision therapy to treat visual disturbances that may theoretically cause developmental delays and learning disabilities, whereas patients may receive vision perception training to remedy developmental delays and learning disabilities without having any identified dysfunction of eye movements or focusing.

Patients receive vision therapy from eye care professionals, whereas visual perceptual training is generally performed by psychologists, psychotherapists, and other behavioral health professionals.

A position statement by the American Academy of Pediatrics (AAP), the American Academy of Pediatric Ophthalmology and Strabismus (AAOPOS), and the American Academy of Ophthalmology (1998) concluded that there is insufficient scientific evidence to support claims that academic abilities of children with learning disabilities can be improved with visual perceptual training.