Randomized clinical trial of treatments for symptomatic convergence insufficiency in children

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.

Figures

Figure 1. CI Symptom Survey

Clinician instructions: Read the following subject instructions and then each item exactly as written. If subject responds with “yes” - please qualify with frequency choices. Do not give examples. Subject instructions: Please answer the following questions about how your eyes feel when reading or doing close work.

Figure 1. CI Symptom Survey

Clinician instructions: Read the following subject instructions and then each item exactly as written. If subject responds with “yes” - please qualify with frequency choices. Do not give examples. Subject instructions: Please answer the following questions about how your eyes feel when reading or doing close work.

Figure 2. Flow Diagram of CITT Randomized Clinical Trial

Figure 3. Cumulative distribution of CI Symptom Survey data collected during the eligibility examination and at the week 12 masked examination, by treatment group

3A. Baseline examination 3B. Outcome Examination

Figure 4. Cumulative distribution of near point of convergence (cm) data collected during the eligibility examination and at the week 12 masked examination, by treatment group

4A. Baseline examination 4B. Outcome Examination

Figure 5. Cumulative distribution of positive fusional vergence (Δ) data collected during the eligibility examination and at the week 12 masked examination, by treatment group

5A. Baseline examination 5B. Outcome Examination