A randomized clinical trial of treatments for convergence insufficiency in children.

Abstract

OBJECTIVE:

To compare vision therapy/orthoptics, pencil push-ups, and placebo vision therapy/orthoptics as treatments for symptomatic convergence insufficiency in children 9 to 18 years of age.

METHODS:

In a randomized, multicenter clinical trial, 47 children 9 to 18 years of age with symptomatic convergence insufficiency were randomly assigned to receive 12 weeks of office-based vision therapy/orthoptics, office-based placebo vision therapy/orthoptics, or home-based pencil push-ups therapy.

MAIN OUTCOME MEASURES:

The primary outcome measure was the symptom score on the Convergence Insufficiency Symptom Survey. Secondary outcome measures were the near point of convergence and positive fusional vergence at near.

RESULTS:

Symptoms, which were similar in all groups at baseline, were significantly reduced in the vision therapy/orthoptics group (mean symptom score decreased from 32.1 to 9.5) but not in the pencil push-ups (mean symptom score decreased from 29.3 to 25.9) or placebo vision therapy/orthoptics groups (mean symptom score decreased from 30.7 to 24.2). Only patients in the vision therapy/orthoptics group demonstrated both statistically and clinically significant changes in the clinical measures of near point of convergence (from 13.7 cm to 4.5 cm; P < .001) and positive fusional vergence at near (from 12.5 prism diopters to 31.8 prism diopters; P < .001).

CONCLUSIONS:

In this pilot study, vision therapy/orthoptics was more effective than pencil push-ups or placebo vision therapy/orthoptics in reducing symptoms and improving signs of convergence insufficiency in children 9 to 18 years of age. Neither pencil push-ups nor placebo vision therapy/orthoptics was effective in improving either symptoms or signs associated with convergence insufficiency.

• Authors: Mitchell Scheiman, G Lynn Mitchell, Susan Cotter, Jeffrey Cooper, Marjean Kulp, Michael Rouse, Eric Borsting, Richard London, Janice Wensveen, Convergence Insufficiency Treatment Trial Study Group
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 123 Issue 1 Pg. 14-24 (Jan 2005) ISSN: 0003-9950 [Print] United States
• PMID: 15642806 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adolescent
• Child
• Convergence, Ocular
• Female
• Humans
• Male
• Ocular Motility Disorders (diagnosis, therapy)
• Ophthalmology (methods)
• Orthoptics (methods)
• Patient Compliance
• Patient Satisfaction
• Patient Selection
• Pilot Projects
• Vision, Binocular
• Visual Acuity