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Morrison AM, Kulp MT, Cotter SA, Scheiman MM, Jenewein EC, Roberts TL, Mitchell GL, Arnold LE, Retnasothi D, Bade A, Hertle R, Borsting E. One-year follow-up of clinical convergence measures in children enrolled in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial. Ophthalmic Physiol Opt 2024. [PMID: 39141379 DOI: 10.1111/opo.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To assess the long-term stability of clinical measures of convergence (near point of convergence [NPC] and positive fusional vergence [PFV]) in participants enrolled in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial (CITT-ART) who received 16 weeks of office-based vergence/accommodative therapy. METHODS A total of 310 children, 9-14 years old, with symptomatic convergence insufficiency were enrolled in CITT-ART. Some 270 completed both their 16-week primary outcome visit followed by a 1-year follow-up visit. Of those 270, 181 (67%) were randomised to the vergence/accommodative therapy. Of the 181 in the vergence/accommodative group, 121 (67%) reported not receiving any additional treatment after the 16-week primary outcome visit. The mean change in NPC, PFV and percentages of children classified by the predetermined success criteria of convergence (normal NPC [<6 cm] and/or improved by ≥4 cm; normal PFV [passing Sheard's criterion and base-out break >15Δ] and/or improved by ≥10Δ) were compared at the 16-week primary outcome visit and 1 year later. RESULTS Of the 121 who returned for their 1-year follow-up visit, there was no significant change in mean adjusted NPC (reduction of -0.2 cm; 95% CI: -1.0 to 0.5 cm) at 1 year. There was a statistically significant decrease in mean-adjusted PFV (-4.7∆; 95% CI: -6.5 to -2.8Δ) at 1 year. There were similar percentages of participants classified as 'normal' (p = 0.30), 'normal and/or improved' (p > 0.50) and 'normal and improved' (p > 0.14) based on NPC and PFV at the 1-year visit compared with the 16-week primary outcome visit. CONCLUSION The improvements in NPC and PFV following 16 weeks of vergence/accommodative therapy (with no reported additional treatment thereafter) in children with symptomatic convergence insufficiency persisted 1-year post-treatment.
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Grants
- 5U10EY022586 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022587 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022591 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022592 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022594 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022595 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022596 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022599 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022600 National Eye Institute of National Institutes of Health, Department of Health and Human Services
- 5U10EY022601 National Eye Institute of National Institutes of Health, Department of Health and Human Services
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Affiliation(s)
- Ann M Morrison
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, USA
| | - Mitchell M Scheiman
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Erin C Jenewein
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - G Lynn Mitchell
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - L Eugene Arnold
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Dashaini Retnasothi
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, USA
| | - Annette Bade
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | | | - Eric Borsting
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, USA
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Piñero DP, Barberán-Bernardos L, Martínez-Plaza E, Molina-Martín A, Bataille L. Professional perspective of vision therapy worldwide among optometrists and ophthalmologists. Clin Exp Optom 2024:1-8. [PMID: 39013551 DOI: 10.1080/08164622.2024.2378136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
CLINICAL RELEVANCE Perception of optometrists and ophthalmologists of vision therapy (VT) as well as their methods for performing the sessions is of great importance for understanding the problems that professionals face and what should be improved in their clinical practice. BACKGROUND The objective of this study was to determine the perception of VT and protocols used by eye care professionals globally. METHODS A cross-sectional study was performed among eye care professionals internationally. The participants completed via online (Google Forms) a questionnaire of 40 questions on their perception and clinical practice of VT. The survey only permitted one answer per email address and was only collected if professionals gave their consent to participate. RESULTS A total of 205 professionals from 43 countries answered the questionnaire (171 optometrists and 34 ophthalmologists). Accommodation and convergence problems were the main indication reported for VT (47.8%), followed by amblyopia (26.3%). The principal negative factor associated to VT was the limited number of professionals dedicated to this field (55.6%). The most common program of VT was the combination of VT sessions at home and at office (85.5%), with a great variability in terms of duration. Few professionals made use of the new technologies when programming VT, such as eye trackers (2.7%) or virtual reality (6.4%). European professionals surveyed had a more negative perception of VT (p < 0.031). CONCLUSIONS Eye care professionals globally perceive VT as a scientifically based procedure. Overall, they believe that it has low recognition and prestige, especially ophthalmologists. A great variability in the programming of VT sessions was found, which highlights the need for standardised protocols that professionals could follow in their clinical practice.
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Affiliation(s)
- David P Piñero
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Laura Barberán-Bernardos
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Elena Martínez-Plaza
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ainhoa Molina-Martín
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Laurent Bataille
- Visitrain S.L., Science Park of the University of Alicante, Alicante, Spain
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Piñero DP, Bataille L, Martínez-Plaza E, Molina-Martín A. Professional perspective and practice patterns of vision therapy in Spain. Clin Exp Optom 2024; 107:341-348. [PMID: 37218547 DOI: 10.1080/08164622.2023.2215383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
CLINICAL RELEVANCE An analysis of the professional perspective of vision therapy (VT) by eye care professionals allows understanding the current controversies about this therapeutic option of which aspects can be improved for its correct application in clinical practice. BACKGROUND The aim of the current study was to analyse the perception of VT and the clinical protocols in this context followed among optometrists and ophthalmologists in Spain. METHODS A cross-sectional survey among Spanish optometrists and ophthalmologists. Google Forms tool was used to collect data via an online questionnaire divided into 4 sections (40 questions): consent to participate, demographic characteristics, opinion of the professional perspective of VT, and protocols. Only one submission from each email address was permitted by the survey tool. RESULTS A total of 889 Spanish professionals answered (age, 25-62 years): 848 optometrists (95.4%) and 41 ophthalmologists (4.6%). VT was considered as a scientifically-based procedure by 95.1% of participants, but its recognition and prestige was considered as low. The main cause reported for this was bad reputation or perception of placebo therapy (27.3%). The main indication of VT according to the surveyed professionals was convergence and/or accommodation problems (72.4%). Significant differences were found in the perception of VT among optometrists and ophthalmologists (p ≤ 0.027). A total of 45.3% of professionals reported performing VT in their current clinical practice. A combination of training sessions in office and home was regularly prescribed by 94.5% of them, but with significant variability in the duration of such sessions. CONCLUSIONS VT is perceived by Spanish optometrists and ophthalmologists as a therapeutic option with scientific basis, but with limited recognition and prestige, although with more negative perception among ophthalmologists. A great variability was found in the clinical protocols followed between specialists. Future efforts should be focused on creating internationally recognised evidence-based protocols for this therapeutic option.
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Affiliation(s)
- David P Piñero
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
- Advanced Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - Laurent Bataille
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
| | - Elena Martínez-Plaza
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
- University of Valladolid, Valladolid, Spain
| | - Ainhoa Molina-Martín
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
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Kulp MT, Sinnott LT, Cotter SA, Borsting E, Toole AJ, Chen AM, Jenewein EC, Morrison AM, Plaumann MD, Jones-Jordan L, Mitchell GL, Tea YC, Scheiman MM. Does coexisting accommodative dysfunction impact clinical convergence measures, symptoms and treatment success for symptomatic convergence insufficiency in children? Ophthalmic Physiol Opt 2022; 42:59-70. [PMID: 34730250 PMCID: PMC10544663 DOI: 10.1111/opo.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether coexisting accommodative dysfunction in children with symptomatic convergence insufficiency (CI) impacts presenting clinical convergence measures, symptoms and treatment success for CI. METHODS Secondary data analyses of monocular accommodative amplitude (AA; push-up method), monocular accommodative facility (AF; ±2.00 D lens flippers) and symptoms (CI Symptom Survey [CISS]) in children with symptomatic CI from the Convergence Insufficiency Treatment Trial (N = 218) and CITT-Attention and Reading Trial (N = 302) were conducted. Decreased AA was defined as more than 2D below the minimum expected amplitude for age (15 - ¼ age); those with AA < 5 D were excluded. Decreased AF was defined as <6 cycles per minute. Mean near point of convergence (NPC), near positive fusional vergence (PFV) and symptoms (CISS) were compared between those with and without accommodative dysfunction using analysis of variance and independent samples t-testing. Logistic regression was used to compare the effect of baseline accommodative function on treatment success [defined using a composite of improvements in: (1) clinical convergence measures and symptoms (NPC, PFV and CISS scores) or (2) solely convergence measures (NPC and PFV)]. RESULTS Accommodative dysfunction was common in children with symptomatic CI (55% had decreased AA; 34% had decreased AF). NPC was significantly worse in those with decreased AA (mean difference = 6.1 cm; p < 0.001). Mean baseline CISS scores were slightly worse in children with coexisting accommodative dysfunction (decreased AA or AF) (30.2 points) than those with normal accommodation (26.9 points) (mean difference = 3.3 points; p < 0.001). Neither baseline accommodative function (p ≥ 0.12 for all) nor interaction of baseline accommodative function and treatment (p ≥ 0.50) were related to treatment success based on the two composite outcomes. CONCLUSIONS A coexisting accommodative dysfunction in children with symptomatic CI is associated with worse NPC, but it does not impact the severity of symptoms in a clinically meaningful way. Concurrent accommodative dysfunction does not impact treatment response for CI.
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Affiliation(s)
- Marjean T Kulp
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Loraine T Sinnott
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Susan A Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Eric Borsting
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Andrew J Toole
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Angela M Chen
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Erin C Jenewein
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| | - Ann M Morrison
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | | | - Lisa Jones-Jordan
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - G Lynn Mitchell
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Yin C Tea
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Mitchell M Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
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Wu Y, Zhang Z, Liao M, Li Q, Tang XL, Liu L. Effect of corneal refractive surgery on accommodative and binocular dysfunctions among civilian pilots in Southwest China. BMC Ophthalmol 2021; 21:95. [PMID: 33607948 PMCID: PMC7893863 DOI: 10.1186/s12886-021-01855-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023] Open
Abstract
Background To analyze whether corneal refractive surgery (CRS) is associated with the distribution of different accommodative dysfunctions (ADs) and binocular dysfunctions (BDs) in civilian pilots. A further aim was to analyze the percentages and visual symptoms associated with ADs and/or BDs in this population. Methods One hundred and eight civilian pilots who underwent CRS from January 2001 to July 2012 (age: 30.33 ± 4.60 years) were enrolled, the mean preoperative SE was − 1.51 ± 1.15 D (range: − 1.00- − 5.00 D). Ninety-nine emmetropic civilian pilots (age: 29.64 ± 3.77 years) who were age- and sex-matched to the CRS group were also enrolled. Refractive status, accommodative and binocular tests of each subject were performed. Visually related symptoms were quantified using the 19-item College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. The 19 items were summed to obtain visual symptom scores that might indicate visual dysfunctions. The chi-square test was used to analyze differences in percentages of ADs and/or BDs between the CRS and emmetropic groups. The Mann-Whitney U test was used to compare visual symptom scores between pilots with ADs and/or BDs and pilots with normal binocular vision. Results No significant difference was observed between the CRS and emmetropic groups in the overall prevalence of ADs and BDs (15.7% and 15.2% in the CRS and emmetropic groups, respectively; P = 0.185). ADs were present in 4.63% and 3.03% of the CRS and emmetropic group, respectively. BDs were observed in 11.1% and 12.1% of the CRS and emmetropic group, respectively, yielding no significant differences between the groups in the prevalence of ADs or BDs (AD: P = 0.094; BD: P = 0.105). Pilots with ADs and/or BDs had significantly more visual symptoms than pilots with normal binocular vision (p < 0.001). Conclusions CRS for civilian pilots with low-moderate myopia might not impact binocular functions. ADs and/or BDs commonly occur in both emmetropia pilots and pilots who undergo CRS, and pilots with ADs and/or BDs are associated with increased symptoms. This study confirms the importance of a full assessment of binocular visual functions in detecting and remedying these dysfunctions in this specific population. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01855-0.
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Affiliation(s)
- Ye Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, P. R. China
| | - Zhen Zhang
- Department of Ophthalmology, Chengdu Civil Aviation Medical Center, Chengdu, Sichuan Province, P. R. China
| | - Meng Liao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, P. R. China
| | - Qi Li
- Department of Internal, Chengdu Civil Aviation Medical Center, Chengdu, Sichuan Province, P. R. China
| | - Xue Lin Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, P. R. China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, P. R. China.
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Scheiman MM, Alvarez TL, Cotter SA, Kulp MT, Sinnott LT, Plaumann MD, Jhajj J. Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency. Optom Vis Sci 2021; 98:32-40. [PMID: 33394929 PMCID: PMC7789288 DOI: 10.1097/opx.0000000000001626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency. PURPOSE This study aimed to determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy. METHODS This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. RESULTS At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P < .001), time to peak velocity (P = .01), and response amplitude (P < .001). After therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/s; 95% confidence interval [CI], 6.6 to 16.62°/s), time to peak velocity (-0.12 seconds; 95% CI, -0.19 to -0.05 seconds), and response amplitude (1.47°; 95% CI, 0.83 to 2.11°), with measures no longer statistically different from the NBV cohort (P > .05). CONCLUSIONS Despite clinical NFV measurements that seem greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.
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Affiliation(s)
- Mitchell M Scheiman
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania
| | - Tara L Alvarez
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio
| | | | | | - Jasleen Jhajj
- Nova Southeastern University, College of Optometry, Ft. Lauderdale, Florida
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Nehad T, Salem T, Elmohamady MN. Combined Office-based Vergence Therapy and Home Therapy System for Convergence Insufficiency in Egyptian Children. Open Ophthalmol J 2018. [PMID: 29541278 PMCID: PMC5838637 DOI: 10.2174/1874364101812010012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Convergence Insufficiency (CI) is a common binocular vision disorder characterized by exophoria more at near than at far, a receded Near Point of Convergence (NPC), and decreased Positive Fusional Vergence (PFV) at near. This disorder is often associated with several symptoms that may disturb the person’s quality of life. Therefore, diagnosis and treatment of CI is a vital issue. Objectives: To compare therapeutic yield of Office Based Vision Therapy (OBVT) and combined OBVT with Home Therapy System (HTS) in patients with CI. Methods: The study included 102 patients with age range of 7-13 years. All patients underwent Convergence Insufficiency Symptom Survey (CISS) scoring, estimation of Near Point of Convergence (NPC) and determination of Positive Fusional Vergence at near (PFV) using Sheard’s criterion. Patients were randomly allocated in two groups: Group I: received Office-based Vision Therapy (OBVT) and Group II: received OBVT with home reinforcement using the Home Therapy System (HTS). At the end of 12th week of therapy; outcome was determined as Successful (all the following: CISS score of <16, NPC <6 cm and PFV >15Δ), Improved (CISS score of <16 or a 10 points-decrease and one of the following: NPC <6cm or improved by >4 cm, PFV >15Δ or increased by > 10Δ), Insufficient response (NPC <6cm or improved by >4 cm, PFV >15Δ or increased by > 10Δ) and non-responders. Results: At the end of the 12th week of therapy, the applied therapeutic polices were successful in 48 patients (47.1%), the symptoms were improved in 30 patients (29.4%), improvement was insufficient in 13 patients (12.7%) and 11 patients (10.8%) were considered as non-responders. There was significantly higher frequency of patients with improved outcome in group II (86%) compared to group I (69.2%). Conclusion: OBVT with home supplement using HTS provided a high success rate, and it seems to be superior to OBVT alone in treatment of children with convergence insufficiency after 12-week course of therapy.
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Affiliation(s)
- Tarek Nehad
- Ophthalmology Department, Faculty of Medicine, Benha University, Benha, Arab Republic of Egypt
| | - Tamer Salem
- Ophthalmology Department, Faculty of Medicine, Benha University, Benha, Arab Republic of Egypt
| | - Mohamed Nagy Elmohamady
- Ophthalmology Department, Faculty of Medicine, Benha University, Benha, Arab Republic of Egypt
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Eye exercises of acupoints: their impact on myopia and visual symptoms in Chinese rural children. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:349. [PMID: 27599547 PMCID: PMC5013592 DOI: 10.1186/s12906-016-1289-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chinese traditional "eye exercises of acupoints" have been advocated as a compulsory measure to reduce visual symptoms, as well as to retard the development of refractive error, among Chinese students for decades. The exercises are comprised of a 5-min, bilateral eye acupoint self-massage. This study evaluated the possible effect of these eye exercises among Chinese rural students. METHODS Eight hundred thirty-six students (437 males, 52.3 %), aged 10.6 ± 2.5 (range 6-17) years from the Handan Offspring Myopia Study (HOMS) who completed the eye exercises and vision questionnaire, the convergence insufficiency symptom survey (CISS) questionnaire, and had a cycloplegic refraction were included in this study. RESULTS 121 (14.5 %) students (64 males, 52.9 %) performed the eye exercises of acupoints in school. The multiple odds ratio (OR) and 95 % confidence interval (CI) for those having a "serious attitude" towards performing the eye exercises (0.12, 0.03-0.49) demonstrated a protective effect for myopia, after adjusting for the children's age, gender, average parental refractive error, and the time spent on near work and outdoor activity. The more frequently, and the more seriously, the students performed the eye exercises each week, the less likely was their chance of being myopic (OR, 95 % CI: 0.17, 0.03-0.99), after adjusting for the same confounders. However, neither the "seriousness of attitude" of performing the eye exercises (multiple β coefficients: -1.58, p = 0.23), nor other related aspects of these eye exercises, were found to be associated with the CISS score in this sample. CONCLUSIONS The traditional eye exercises of acupoints appeared to have a modest protective effect on myopia among these Chinese rural students aged 6-17 years. However, no association between the eye exercises and near vision symptoms was found.
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García-Muñoz Á, Carbonell-Bonete S, Cantó-Cerdán M, Cacho-Martínez P. Accommodative and binocular dysfunctions: prevalence in a randomised sample of university students. Clin Exp Optom 2016; 99:313-21. [PMID: 27027297 DOI: 10.1111/cxo.12376] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/18/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim was to analyse the prevalence of symptomatic accommodative and non-strabismic binocular dysfunctions in a randomised population of university subjects. METHODS A cross-sectional study was conducted with a randomised sample of 175 university students aged between 18 and 35 years. All subjects were given a visual examination in which their symptoms were recorded, as well as performing objective and subjective refractive examinations and accommodative and binocular tests. Each subject was tested for the presence of uncorrected refractive error. Accommodative dysfunctions (AD) and binocular dysfunctions (BD) were diagnosed according to the number of clinical signs associated with each disorder, considering the signs that could be associated with each dysfunction as fundamental or complementary. An accommodative or binocular dysfunction was diagnosed when the subjects met two conditions: presenting with any kind of visual symptom in their clinical history and presenting the fundamental sign associated with each dysfunction as well as two or more complementary signs. Those subjects who presented with only an uncorrected refractive error were considered within the group called refractive dysfunction (RD). RESULTS The overall prevalence of accommodative and/or binocular dysfunctions was 13.15 per cent and for refractive dysfunction it was 45.14 per cent. Accommodative dysfunctions were present in 2.29 per cent of the population, binocular dysfunctions were observed in eight per cent and accommodative dysfunctions together were found in 2.86 per cent of the university students. Within the accommodative and binocular disorders, the most prevalent dysfunctions were convergence insufficiency, with a prevalence of 3.43 per cent and convergence excess and accommodation excess, both with a prevalence of 2.29 per cent. CONCLUSION Binocular dysfunctions were more prevalent than accommodative dysfunctions or accommodative and binocular dysfunctions together in a randomised population of university students.
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Affiliation(s)
- Ángel García-Muñoz
- Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain.
| | - Stela Carbonell-Bonete
- Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain
| | - Mario Cantó-Cerdán
- Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain
| | - Pilar Cacho-Martínez
- Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain
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Jang JU, Park IJ. Prevalence of general binocular dysfunctions among rural schoolchildren in South Korea. Taiwan J Ophthalmol 2015; 5:177-181. [PMID: 29018694 PMCID: PMC5602136 DOI: 10.1016/j.tjo.2015.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/15/2015] [Accepted: 07/30/2015] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND/PURPOSE To assess the prevalence of nonstrabismic accommodative and vergence dysfunctions among primary schoolchildren in Hampyeong, a rural area of South Korea. METHODS Five hundred and eighty-nine primary schoolchildren, 8-13 years old, were each given a thorough eye examination, including binocular-vision testing, near point of convergence, horizontal phoria measurement by von Graefe, and negative and positive vergence amplitudes with prism bar, to determine any form of accommodative or vergence dysfunctions. RESULTS Of the 589 participants examined, 168 (28.5%) primary schoolchildren presented some form of nonstrabismic accommodative or vergence dysfunctions. The prevalence of accommodative dysfunctions and vergence dysfunctions was 13.2% and 9%, respectively. Convergence insufficiency (10.3%) was more prevalent than convergence excess (1.9%), and accommodative insufficiency (5.3%) was more prevalent than accommodative excess (1.2%). CONCLUSION This study suggests that nonstrabismic accommodative and vergence dysfunctions are prevalent in the rural area of South Korean primary schoolchildren, and convergence insufficiency was the most prevalent.
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Affiliation(s)
- Jung Un Jang
- Department of Optometry, Eulji University, Seongnam, South Korea
| | - Inn-Jee Park
- Department of Optometry, Kaya University, Gimhae, South Korea
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García-Muñoz Á, Carbonell-Bonete S, Cacho-Martínez P. Symptomatology associated with accommodative and binocular vision anomalies. JOURNAL OF OPTOMETRY 2014; 7:178-92. [PMID: 25323640 PMCID: PMC4213865 DOI: 10.1016/j.optom.2014.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/29/2014] [Accepted: 05/29/2014] [Indexed: 05/06/2023]
Abstract
PURPOSE To determine the symptoms associated with accommodative and non-strabismic binocular dysfunctions and to assess the methods used to obtain the subjects' symptoms. METHODS We conducted a scoping review of articles published between 1988 and 2012 that analysed any aspect of the symptomatology associated with accommodative and non-strabismic binocular dysfunctions. The literature search was performed in Medline (PubMed), CINAHL, PsycINFO and FRANCIS. A total of 657 articles were identified, and 56 met the inclusion criteria. RESULTS We found 267 different ways of naming the symptoms related to these anomalies, which we grouped into 34 symptom categories. Of the 56 studies, 35 employed questionnaires and 21 obtained the symptoms from clinical histories. We found 11 questionnaires, of which only 3 had been validated: the convergence insufficiency symptom survey (CISS V-15) and CIRS parent version, both specific for convergence insufficiency, and the Conlon survey, developed for visual anomalies in general. The most widely used questionnaire (21 studies) was the CISS V-15. Of the 34 categories of symptoms, the most frequently mentioned were: headache, blurred vision, diplopia, visual fatigue, and movement or flicker of words at near vision, which were fundamentally related to near vision and binocular anomalies. CONCLUSIONS There is a wide disparity of symptoms related to accommodative and binocular dysfunctions in the scientific literature, most of which are associated with near vision and binocular dysfunctions. The only psychometrically validated questionnaires that we found (n=3) were related to convergence insufficiency and to visual dysfunctions in general and there no specific questionnaires for other anomalies.
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Affiliation(s)
- Ángel García-Muñoz
- Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Spain.
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Lin Z, Vasudevan B, Jhanji V, Gao TY, Wang NL, Wang Q, Wang J, Ciuffreda KJ, Liang YB. Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children. Altern Ther Health Med 2013; 13:306. [PMID: 24195652 PMCID: PMC3828420 DOI: 10.1186/1472-6882-13-306] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 10/14/2013] [Indexed: 11/10/2022]
Abstract
Background Traditional Chinese eye exercises of acupoints involve acupoint self-massage. These have been advocated as a compulsory measure to reduce ocular fatigue, as well as to retard the development of myopia, among Chinese school children. This study evaluated the impact of these eye exercises among Chinese urban children. Methods 409 children (195 males, 47.7%), aged 11.1 ± 3.2 (range 6–17) years, from the Beijing Myopia Progression Study (BMPS) were recruited. All had completed the eye exercise questionnaire, the convergence insufficiency symptom survey (CISS), and a cycloplegic autorefraction. Among these, 395 (96.6%) performed the eye exercises of acupoints. Multiple logistic regressions for myopia and multiple linear regressions for the CISS score (after adjusting for age, gender, average parental refractive error, and time spent doing near work and outdoor activity) for the different items of the eye exercises questionnaire were performed. Results Only the univariate odds ratio (95% confidence interval) for “seriousness of attitude” towards performing the eye exercises of acupoints (0.51, 0.33-0.78) showed a protective effect towards myopia. However, none of the odds ratios were significant after adjusting for the confounding factors. The univariate and multiple β coefficients for the CISS score were -2.47 (p = 0.002) and -1.65 (p = 0.039), -3.57 (p = 0.002) and -2.35 (p = 0.042), and -2.40 (p = 0.003) and -2.29 (p = 0.004), for attitude, speed of exercise, and acquaintance with acupoints, respectively, which were all significant. Conclusions The traditional Chinese eye exercises of acupoints appeared to have a modest effect on relieving near vision symptoms among Chinese urban children aged 6 to 17 years. However, no remarkable effect on reducing myopia was observed.
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