Randomized clinical trial of treatments for symptomatic convergence insufficiency in children

OBJECTIVE

To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency.

METHODS

In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic convergence insufficiency were assigned to 1 of 4 treatments.

MAIN OUTCOME MEASURES

Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near.

RESULTS

After 12 weeks of treatment, the OBVAT group's mean Convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of 21.3, 24.7, and 21.9 in the HBCVAT+, HBPP, and OBPT groups, respectively (P < .001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (P

CONCLUSIONS

Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with HBPP, HBCVAT+, and OBPT. Application to Clinical Practice Office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00338611.

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Key Words

• convergence insufficiency
• asthenopia
• vision therapy
• orthoptics
• vergence/accommodative therapy
• pencil push-ups
• computer vergence/accommodative therapy
• placebo therapy
• exophoria
• eyestrain
• symptom survey

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MESH Headings

• Adolescent
• Child
• Confidence Intervals
• Convergence, Ocular
• Female
• Home Nursing
• Humans
• Male
• Multivariate Analysis
• Ocular Motility Disorders/diagnosis
• Ocular Motility Disorders/therapy
• Office Visits
• Ophthalmology/methods
• Orthoptics/methods
• Patient Compliance
• Probability
• Recovery of Function
• Reference Values
• Sensitivity and Specificity
• Severity of Illness Index
• Strabismus/diagnosis
• Strabismus/therapy
• Treatment Outcome
• Vision, Binocular
• Visual Acuity

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Grants

• U10 EY014712 NEI NIH HHS
• U10 EY014676-02 NEI NIH HHS
• U10 EY014712-04 NEI NIH HHS
• U10 EY014659-03 NEI NIH HHS
• U10 EY014676-01A1 NEI NIH HHS
• U10 EY014713-01A2 NEI NIH HHS
• U10 EY014713-02 NEI NIH HHS
• U10 EY014715-01A1S1 NEI NIH HHS
• U10 EY014716-04 NEI NIH HHS
• U10 EY014710-04 NEI NIH HHS
• U10 EY014676 NEI NIH HHS
• U10 EY014706-01A1S1 NEI NIH HHS
• U10 EY014713 NEI NIH HHS
• U10 EY014709 NEI NIH HHS
• U10 EY014659-01A2 NEI NIH HHS
• U10 EY014715-04 NEI NIH HHS
• U10 EY014712-01A1 NEI NIH HHS
• U10 EY014713-03 NEI NIH HHS
• U10 EY014706-01A1 NEI NIH HHS
• U10 EY014715-02 NEI NIH HHS
• U10 EY014709-03 NEI NIH HHS
• U10 EY014715-03 NEI NIH HHS
• U10 EY014676-04 NEI NIH HHS
• U10 EY014715 NEI NIH HHS
• U10 EY014716-03 NEI NIH HHS
• U10 EY014710-02 NEI NIH HHS
• U10 EY014709-04 NEI NIH HHS
• U10 EY014716-02 NEI NIH HHS
• U10 EY014716-02S1 NEI NIH HHS
• U10 EY014706-02 NEI NIH HHS
• U10 EY014713-04 NEI NIH HHS
• U10 EY014709-02 NEI NIH HHS
• U10 EY014712-03 NEI NIH HHS
• U10 EY014706-04 NEI NIH HHS
• U10 EY014710-01A1S1 NEI NIH HHS
• U10 EY014710-01A1 NEI NIH HHS
• U10 EY014659-04 NEI NIH HHS
• U10 EY014676-03 NEI NIH HHS
• U10 EY014712-01A1S1 NEI NIH HHS
• U10 EY014659-02 NEI NIH HHS
• U10 EY014676-01A1S1 NEI NIH HHS
• U10 EY014716-01A1 NEI NIH HHS
• U10 EY014709-01A1 NEI NIH HHS
• U10 EY014706-03 NEI NIH HHS
• U10 EY014716-01A1S1 NEI NIH HHS
• U10 EY014716 NEI NIH HHS
• U10 EY014715-01A1 NEI NIH HHS
• U10 EY014709-01A1S1 NEI NIH HHS
• U10 EY014712-02 NEI NIH HHS
• U10 EY014710-03 NEI NIH HHS
• U10 EY014659 NEI NIH HHS

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