Randomized clinical trial of treatments for symptomatic convergence insufficiency in children

Arch Ophthalmol. 2008 Oct;126(10):1336-49. doi: 10.1001/archopht.126.10.1336.

Abstract

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 <or= .005 for all comparisons). A successful or improved outcome was found in 73%, 43%, 33%, and 35% of patients in the OBVAT, HBPP, HBCVAT+, and OBPT groups, respectively.

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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • 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

Associated data

  • ClinicalTrials.gov/NCT00338611

Grant support