Randomized clinical trial of treatments for symptomatic convergence insufficiency in children

Mitchell Scheiman, Susan Cotter, G. Lynn Mitchell, Marjean Kulp, Michael Rouse, Richard Hertle, Maryann Redford, Jeffrey Cooper, Rachel Coulter, Michael Gallaway, David Granet, Kristine Hopkins, Brian G. Mohney, Susanna Tamkins

Research output: Contribution to journalArticle

108 Citations (Scopus)

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≤.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.

Original languageEnglish (US)
Pages (from-to)1336-1349
Number of pages14
JournalArchives of Ophthalmology
Volume126
Issue number10
DOIs
StatePublished - Oct 2008
Externally publishedYes

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Ocular Motility Disorders
Randomized Controlled Trials
Therapeutics
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ASJC Scopus subject areas

  • Ophthalmology

Cite this

Scheiman, M., Cotter, S., Mitchell, G. L., Kulp, M., Rouse, M., Hertle, R., ... Tamkins, S. (2008). Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Archives of Ophthalmology, 126(10), 1336-1349. https://doi.org/10.1001/archopht.126.10.1336

Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. / Scheiman, Mitchell; Cotter, Susan; Mitchell, G. Lynn; Kulp, Marjean; Rouse, Michael; Hertle, Richard; Redford, Maryann; Cooper, Jeffrey; Coulter, Rachel; Gallaway, Michael; Granet, David; Hopkins, Kristine; Mohney, Brian G.; Tamkins, Susanna.

In: Archives of Ophthalmology, Vol. 126, No. 10, 10.2008, p. 1336-1349.

Research output: Contribution to journalArticle

Scheiman, M, Cotter, S, Mitchell, GL, Kulp, M, Rouse, M, Hertle, R, Redford, M, Cooper, J, Coulter, R, Gallaway, M, Granet, D, Hopkins, K, Mohney, BG & Tamkins, S 2008, 'Randomized clinical trial of treatments for symptomatic convergence insufficiency in children', Archives of Ophthalmology, vol. 126, no. 10, pp. 1336-1349. https://doi.org/10.1001/archopht.126.10.1336
Scheiman, Mitchell ; Cotter, Susan ; Mitchell, G. Lynn ; Kulp, Marjean ; Rouse, Michael ; Hertle, Richard ; Redford, Maryann ; Cooper, Jeffrey ; Coulter, Rachel ; Gallaway, Michael ; Granet, David ; Hopkins, Kristine ; Mohney, Brian G. ; Tamkins, Susanna. / Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. In: Archives of Ophthalmology. 2008 ; Vol. 126, No. 10. pp. 1336-1349.
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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≤.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.",
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AU - Hertle, Richard

AU - Redford, Maryann

AU - Cooper, Jeffrey

AU - Coulter, Rachel

AU - Gallaway, Michael

AU - Granet, David

AU - Hopkins, Kristine

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AU - Tamkins, Susanna

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