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 (CI).Methods-In a randomized clinical trial, 221 children 9 to 17 years with symptomatic CI were assigned to one of four treatments.Main Outcome Measures-Convergence Insufficiency Symptom Survey (CISS) score after 12 weeks of treatment. Secondary outcomes were near point of convergence (NPC) and positive fusional vergence at near (PFV).Results-After 12 weeks of treatment the OBVAT group's CISS score (15.1) was statistically significantly lower than the HBCVAT+, HBPP, and OBPT groups' scores of 21.3, 24.7, and 21.9, respectively (P < 0.001). The OBVAT group also demonstrated a significantly improved NPC and PFV compared with the other groups (P <= 0.005). A successful or improved outcome for the OBVAT, HBPP, HBCVAT+, and OBPT groups was found in 73%, 43%, 33%, and 35%, respectively.Conclusion-Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of NPC and PFV and a greater percentage of patients reaching predetermined criteria of success when compared with HBPP, HBCVAT+, or OBPT.
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