The Evolution of Vision Therapy: From Conventional Orthoptic Techniques to Modern Digital and Artificial Intelligence-Driven Rehabilitation Systems

Abstract

Aim: To critically review the evolution of vision therapy (VT) from traditional orthoptic methods to contemporary digital, virtual reality (VR), and artificial intelligence (AI)-assisted systems, with a focus on VTS4, HoloLens, and Cognihab platforms.
Methods: A structured narrative review was conducted using peer-reviewed literature indexed in PubMed, Scopus, and Web of Science (2000–2026). The study surveys original research papers on over 30 - 40 verified platforms, evaluating software-based advantages and clinical success rates.
Results: Traditional office-based therapy remains effective for convergence insufficiency (73–75% success). The Visual Training System 4 (VTS4), particularly with HoloLens AR integration, provides true 3D color vergence training with independent eye tracking. AI-driven VR suites like Cognihab have reported an 85% success rate in visual acuity improvement within 12 weeks. AI and machine learning (ML) integration has catalyzed a massive expansion in home-based programs, which now demonstrate adherence rates as high as 94% compared to 40 to 57% for traditional patching.
Conclusion: Vision therapy has transitioned into an integrated neuro-rehabilitation specialty. The integration of ML-based adaptive algorithms has shifted the focus toward scalable, home-based models that offer objective monitoring and enhanced patient engagement while maintaining clinical standards.