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Randomized Controlled Trial
. 2011 Nov;88(11):1343-52.
doi: 10.1097/OPX.0b013e31822f4d7c.

Treatment of accommodative dysfunction in children: results from a randomized clinical trial

Mitchell Scheiman  1 , Susan Cotter, Marjean Taylor Kulp, G Lynn Mitchell, Jeffrey Cooper, Michael Gallaway, Kristine B Hopkins, Mary Bartuccio, Ida Chung; Convergence Insufficiency Treatment Trial Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Treatment of accommodative dysfunction in children: results from a randomized clinical trial

Mitchell Scheiman et al. Optom Vis Sci. 2011 Nov.

Abstract

Purpose: To report the effectiveness of various forms of vision therapy/orthoptics in improving accommodative amplitude and facility in children with symptomatic convergence insufficiency (CI) and co-existing accommodative dysfunction.

Methods: In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic CI were assigned to one of four treatments. Of the enrolled children, 164 (74%) had accommodative dysfunction; 63 (29%) had a decreased amplitude of accommodation with respect to age, 43 (19%) had decreased accommodative facility, and 58 (26%) had both. Analysis of variance models were used to compare mean accommodative amplitude and accommodative facility for each treatment group after 4, 8, and 12 weeks of treatment.

Results: After 12 weeks of treatment, the increases in amplitude of accommodation [office-based vergence/accommodative therapy with home reinforcement group (OBVAT) 9.9 D, home-based computer vergence/accommodative therapy group (HBCVAT+) 6.7 D, and home-based pencil push-up therapy group (HBPP) 5.8 D] were significantly greater than in the office-based placebo therapy (OBPT) group (2.2 D) (p-values ≤0.010). Significant increases in accommodative facility were found in all groups (OBVAT: 9 cpm, HBCVAT+: 7 cpm, HBPP: 5 cpm, OBPT: 5.5 cpm); only the improvement in the OBVAT group was significantly greater than that found in the OBPT group (p = 0.016). One year after completion of therapy, reoccurrence of decreased accommodative amplitude was present in only 12.5% and accommodative facility in only 11%.

Conclusions: Vision therapy/orthoptics is effective in improving accommodative amplitude and accommodative facility in school-aged children with symptomatic CI and accommodative dysfunction.

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Figures

Figure 1
Figure 1
Mean accommodative amplitude (D) for patients with decreased accommodative amplitude by study visit and treatment group.
Figure 2
Figure 2
Mean accommodative facility (cpm) for patients with decreased accommodative facility, by study visit and treatment group.
Figure 3
Figure 3
Mean improvement in accommodative amplitude (D) for patients with decreased accommodative amplitude by treatment group.
Figure 4
Figure 4
Mean improvement in accommodative facility (cpm) for patients with decreased accommodative facility, by treatment group.
See this image and copyright information in PMC

References

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    1. Rouse MW. Management of binocular anomalies: efficacy of vision therapy in the treatment of accommodative deficiencies. Am J Optom Physiol Opt. 1987;64:415–20. - PubMed
    1. Scheiman M, Wick B. Clinical Management of Binocular Vision: Heterophoric, Accommodative and Eye Movement Disorders. 3. Philadelphia: Lippincott, Williams and Wilkins; 2008.

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