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How is Convergence Insufficiency Treated?

Most eye care professionals treat CI using a home-based therapy called “pencil push-ups.” With his eyes, the child follows a small letter on a pencil as the pencil is moved toward the bridge of his nose. His goal is to keep the letter clear and single, but to stop if the letter becomes double. The child is told to try and get the pencil closer and closer each day. Pencil push-ups are practiced for 15 minutes, 5 days per week.

The Convergence Insufficiency Treatment Trial (CITT) was conducted because there was no consensus regarding the most effective treatment for CI. Additionally, a well-designed study had not been conducted comparing the various treatments. The CITT study compared three forms of vision therapy (orthoptics). Two of these were performed at home (home-based therapy) and one was performed in the office (office-based therapy by a trained therapist). The study also included an office-based placebo therapy.

The study was designed as a randomized clinical trial. It included 221 children aged 9 to 17 years who had symptomatic CI. Participants were assigned to 1 of 4 groups:

  1. Office-based vision therapy with a trained therapist along with home reinforcement
  2. Home-based pencil push-up therapy
  3. Home-based computer vision therapy and pencil push-ups
  4. Office-based placebo therapy

Nine clinical centers from around the country participated in the study. After 12 weeks of therapy, the children were re-examined by eye care professionals who were unaware of which treatment the children received. Researchers then compared the effectiveness of each of the 3 forms of vision therapy and the placebo therapy option for decreasing symptoms and improving the physical measurements of the convergence problem.

Office-based vision therapy with a trained therapist along with home reinforcement. Children in this group came to the office once per week for a 60-minute therapy session with a trained therapist. During these sessions, the children worked on 4-6 procedures designed to improve the ability to converge the eyes. The children in this group also did home therapy for 15 minutes, 5 days per week to practice the procedures learned during the office visits.

Home-based pencil push-ups therapy. In this group, the child had to follow a small letter on a pencil as the pencil was moved toward the bridge of his nose. His goal was to keep the letter clear and single, but to stop if the letter became double. The child was told to try and get the pencil closer and closer to the bridge of his nose each day. This was practiced for 15 minutes, 5 days per week.

Home-based computer vision therapy and pencil push-ups. In this group, the child was given complex exercises using a computer program plus pencil push-ups.

Office-based placebo therapy. This group was given placebo vision activities designed to simulate office-based therapy.

The 12-week study, known as the Convergence Insufficiency Treatment Trial (CITT), found that approximately 75 percent of those who received in-office therapy by a trained therapist plus at-home treatment reported fewer and less severe symptoms related to reading and other near work. Symptoms of CI include loss of place, loss of concentration, reading slowly, eyestrain, headaches, blurry vision, and double vision.

There are 2 important messages:

  1. Parents should know that CI is a common vision problem in school-age children. Children with this problem may experience numerous symptoms that can make it more difficult to read.
  2. We now have quality evidence showing that office-based vision therapy with a trained therapist plus at-home reinforcement can effectively treat CI in children 9 to 17 years old. This treatment can improve symptoms and physical measurements of the condition.

The results of this study demonstrate that a 12-week program of office-based therapy by a trained therapist along with additional home reinforcement is more effective than a 12-week program of home-based treatment for CI. The study results apply to children who have symptomatic CI and are aged 9 to 17 years. The CITT will provide eye care professionals with research to assist children who have this condition.

 
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