Long-Term Effectiveness of Treatments for Symptomatic Convergence Insufficiency in Children

Abstract

Purpose To assess the long-term stability of improvements in symptoms and signs in 9- to 17-year-old children enrolled in the Convergence Insufficiency Treatment Trial who were asymptomatic after treatment for convergence insufficiency (CI). Methods Seventy-nine patients who were asymptomatic after a 12-week therapy program for CI were followed for 1 year [33/60 in office-based vergence/accommodative therapy (OBVAT), 18/54 in home-based pencil push-ups (HBPP), 12/57 in home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), and 16/54 in office-based placebo therapy (OBPT)]. Symptoms and clinical signs were measured 6 months and 1 year after completion of the 12-week therapy program. The primary outcome measure was the mean change on the CI Symptom Survey (CISS). Secondary outcome measures were near point of convergence (NPC), positive fusional vergence at near (PFV), and proportions of patients who remained asymptomatic or who were classified as successful or improved based on a composite measure of CISS, NPC, and PFV. Results One-year follow-up visit completion rate was 89% with no significant differences between groups (p=0.26). There were no significant changes in the CISS in any treatment group during the 1-year follow-up. The percentage who remained asymptomatic in each group was 84.4% (27/32) for OBVAT, 66.7% (10/15) for HBPP, 80% (8/10) for HBCVAT+, and 76.9% (10/13) for OBPT. The percentage who remained either successful or improved 1-year post-treatment was 87.5% (28/32) for OBVAT, 66.6% (10/15) for HBPP, 80% (8/10) for HBCVAT+, and 69.3% (9/13) for OBPT. Conclusions Most children aged 9 to 17 years who were asymptomatic after a 12-week treatment program of OBVAT for CI maintained their improvements in symptoms and signs for at least 1 year after discontinuing treatment. Although the sample sizes for the home based and placebo groups were small, our data suggest that a similar outcome can be expected for children who were asymptomatic after treatment with HBPP and HBCVAT+.

Functional activity within the frontal eye fields, posterior parietal cortex, and cerebellar vermis significantly correlates to symmetrical vergence peak velocity: an ROI-based, fMRI study of vergence training

“…Clinical signs and symptoms were sustained 1 year post-therapy for most subjects (CITT, 2009). OBVAT is composed of symmetrical, horizontal convergence movements.…”

“…The reduction of visual symptoms is sustained 1 year post-therapy in most subjects (CITT, 2009). Clinicians commonly prescribe vergence training (also known as vision therapy, vision rehabilitation, or orthoptic exercises) to reduce visual symptoms (Scheiman et al, 2011; Cooper and Jamal, 2012).…”

Vision Therapy in Adults with Convergence Insufficiency: Clinical and Functional Magnetic Resonance Imaging Measures

“…12,50 Successful was defined as a score < 16 on the CISS, a normal NPC (<6 cm), and normal PFV (> 15 Δ). Improved was defined as a score < 16 on CISS or a 10-point decrease in CISS and at least one of the following: normal NPC, improvement of NPC more than 4 cm, normal PFV, or an increase in PFV of more than 10 Δ.…”

Symptoms in Children with Convergence Insufficiency

“…20 While the overall CISS scores at baseline and outcome and after 1 year of follow-up have been reported, 20–22 the frequency of occurrence of specific symptoms at baseline, and the relationship between patient characteristics and symptom severity have not been evaluated. The purpose of this report is to describe symptom patterns and to evaluate the relationship between patient characteristics and symptom severity before and after treatment.…”