TY - JOUR
T1 - Vision therapy/orthoptics for symptomatic convergence insufficiency in children
T2 - Treatment kinetics
AU - Scheiman, Mitchell
AU - Kulp, Marjean Taylor
AU - Cotter, Susan
AU - Mitchell, G. Lynn
AU - Gallaway, Michael
AU - Boas, Mark
AU - Coulter, Rachel
AU - Hopkins, Kristine
AU - Tamkins, Susanna
PY - 2010/8
Y1 - 2010/8
N2 - Purpose. To evaluate the kinetics of change in symptoms and signs of convergence insufficiency (CI) during 12 weeks of treatment with commonly prescribed vision therapy/orthoptic treatment regimens. Methods. In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic CI were assigned to 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), or office-based placebo therapy with home reinforcement (OBPT). Symptoms and signs were measured after 4, 8, and 12 weeks of treatment. The outcome measures were the mean CI Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence (PFV), and proportions of patients who were classified as "successful" or "improved" based on a composite measure of CISS, NPC, and PFV. Results. Only the OBVAT group showed significant improvements in symptoms between each visit (p < 0.001). Between weeks 8 and 12, all groups showed a significant improvement in symptoms. Between-group differences were apparent by week 8 (p = 0.037) with the fewest symptoms in the OBVAT group. For each group, the greatest improvements in NPC and PFV were achieved during the first 4 weeks. Differences between groups became apparent by week 4 (p < 0.001), with the greatest improvements in NPC and PFV in the OBVAT group. Only the OBVAT group continued to show significant improvements in PFV at weeks 8 and 12. The percentage of patients classified as "successful" or "improved" based on our composite measure increased in all groups at each visit. Conclusions. The rate of improvement is more rapid for clinical signs (NPC and PFV) than for symptoms in children undergoing treatment for CI. OBVAT results in a more rapid improvement in symptoms, NPC and PFV, and a greater percentage of patients reaching pre-determined criteria of success when compared with HBPP, HBCVAT+, or OBPT.
AB - Purpose. To evaluate the kinetics of change in symptoms and signs of convergence insufficiency (CI) during 12 weeks of treatment with commonly prescribed vision therapy/orthoptic treatment regimens. Methods. In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic CI were assigned to 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), or office-based placebo therapy with home reinforcement (OBPT). Symptoms and signs were measured after 4, 8, and 12 weeks of treatment. The outcome measures were the mean CI Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence (PFV), and proportions of patients who were classified as "successful" or "improved" based on a composite measure of CISS, NPC, and PFV. Results. Only the OBVAT group showed significant improvements in symptoms between each visit (p < 0.001). Between weeks 8 and 12, all groups showed a significant improvement in symptoms. Between-group differences were apparent by week 8 (p = 0.037) with the fewest symptoms in the OBVAT group. For each group, the greatest improvements in NPC and PFV were achieved during the first 4 weeks. Differences between groups became apparent by week 4 (p < 0.001), with the greatest improvements in NPC and PFV in the OBVAT group. Only the OBVAT group continued to show significant improvements in PFV at weeks 8 and 12. The percentage of patients classified as "successful" or "improved" based on our composite measure increased in all groups at each visit. Conclusions. The rate of improvement is more rapid for clinical signs (NPC and PFV) than for symptoms in children undergoing treatment for CI. OBVAT results in a more rapid improvement in symptoms, NPC and PFV, and a greater percentage of patients reaching pre-determined criteria of success when compared with HBPP, HBCVAT+, or OBPT.
KW - asthenopia
KW - computer vergence/accommodative therapy
KW - convergence insufficiency
KW - exophoria
KW - eyestrain
KW - orthoptics
KW - pencil push-ups
KW - placebo therapy
KW - school children
KW - symptom survey
KW - vergence/accommodative therapy
KW - vision therapy
UR - http://www.scopus.com/inward/record.url?scp=77955469201&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77955469201&partnerID=8YFLogxK
U2 - 10.1097/OPX.0b013e3181e61bad
DO - 10.1097/OPX.0b013e3181e61bad
M3 - Article
C2 - 20543758
AN - SCOPUS:77955469201
VL - 87
SP - 593
EP - 603
JO - American Journal of Optometry and Physiological Optics
JF - American Journal of Optometry and Physiological Optics
SN - 1040-5488
IS - 8
ER -