Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 May;86(5):420-8.
doi: 10.1097/OPX.0b013e31819fa712.

Treatment of convergence insufficiency in childhood: a current perspective

Affiliations

Treatment of convergence insufficiency in childhood: a current perspective

Mitchell Scheiman et al. Optom Vis Sci. 2009 May.

Abstract

Purpose: To provide a current perspective on the management of convergence insufficiency (CI) in children by summarizing the findings and discussing the clinical implications from three recent randomized clinical trials in which we evaluated various treatments for children with symptomatic CI. We then present an evidence-based treatment approach for symptomatic CI based on the results of these trials. Finally, we discuss unanswered questions and suggest directions for future research in this area.

Methods: We reviewed three multi-center randomized clinical trials comparing treatments for symptomatic (CI) in children 9 to 17 years old (one study 9 to 18 years old). Two trials evaluated active therapies for CI. These trials compared the effectiveness of office-based vergence/accommodative therapy, office-based placebo therapy, and home-based therapy [pencil push-ups alone (both trials), home-based computer vergence/accommodative therapy, and pencil push-ups (large-scale study)]. One trial compared the effectiveness of base-in prism reading glasses to placebo reading glasses. All studies included well-defined criteria for the diagnosis of CI, a placebo group, and masked examiners. The primary outcome measure was the Convergence Insufficiency Symptom Survey score. Secondary outcomes were near point of convergence and positive fusional vergence at near.

Results: Office-based vergence/accommodative therapy was significantly more effective than home-based or placebo therapies. Base-in prism reading glasses were no more effective than placebo reading glasses for the treatment of symptomatic CI in children.

Conclusions: Recent clinical trials showed that office-based vision therapy was successful in about 75% of patients (resulting in normal or significantly improved symptoms and signs) and was the only treatment studied which was more effective than placebo treatments for children with symptomatic CI. Eye care providers who do not currently offer this treatment may consider referring these patients to a doctor who provides this treatment or consider expanding the treatment options available within their practice to manage this condition.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean improvement adjusted for baseline in (A) CI Symptom Survey, (B) Near Point of Convergence Break (cm), and (C) Positive Fusional Vergence (Δ).OBVAT: Office-based vergence/accommodative therapy with home reinforcement; OBPT: Office-based placebo therapy with home reinforcement; HBPP: Home-based pencil push-up therapy; HBCVAT+: Home-based computer vergence/accommodative therapy and pencil push-ups.
Figure 1
Figure 1
Mean improvement adjusted for baseline in (A) CI Symptom Survey, (B) Near Point of Convergence Break (cm), and (C) Positive Fusional Vergence (Δ).OBVAT: Office-based vergence/accommodative therapy with home reinforcement; OBPT: Office-based placebo therapy with home reinforcement; HBPP: Home-based pencil push-up therapy; HBCVAT+: Home-based computer vergence/accommodative therapy and pencil push-ups.
Figure 1
Figure 1
Mean improvement adjusted for baseline in (A) CI Symptom Survey, (B) Near Point of Convergence Break (cm), and (C) Positive Fusional Vergence (Δ).OBVAT: Office-based vergence/accommodative therapy with home reinforcement; OBPT: Office-based placebo therapy with home reinforcement; HBPP: Home-based pencil push-up therapy; HBCVAT+: Home-based computer vergence/accommodative therapy and pencil push-ups.

Comment in

References

    1. Rouse MW, Borsting E, Hyman L, Hussein M, Cotter SA, Flynn M, Scheiman M, Gallaway M, De Land PN The Convergence Insufficiency and Reading Study (CIRS) group. Frequency of convergence insufficiency among fifth and sixth graders. Optom Vis Sci. 1999;76:643–649. - PubMed
    1. Letourneau JE, Ducic S. Prevalence of convergence insufficiency among elementary school children. Can J Optom. 1988;50:194–197.
    1. Letourneau JE, Lapierre N, Lamont A. The relationship between convergence insufficiency and school achievement. Am J Optom Physiol Opt. 1979;56:18–22. - PubMed
    1. Daum KM. Convergence insufficiency. Am J Optom Physiol Opt. 1984;61:16–22. - PubMed
    1. Cooper J, Duckman R. Convergence insufficiency: incidence, diagnosis, and treatment. J Am Optom Assoc. 1978;49:673–680. - PubMed

Publication types