Study: Office-based therapy effective for treating convergence insufficiency in children

A large study has found that combining 12 weeks of office-based therapy with home reinforcement is more effective for treating children with convergence insufficiency than two home-based therapies and an office-based placebo therapy with home reinforcement.

Mitchell Scheiman, OD, and colleagues randomly assigned 221 children with symptomatic convergence insufficiency participating in the Convergence Insufficiency Treatment Trial to undergo 12 weeks of treatment via one of three methods or placebo. All children were between 9 and 17 years of age.

Specifically 54 patients were instructed to perform home-based pencil push-ups (group one), 53 patients were assigned to home-based computer vergence therapy and pencil push-ups (group two), 60 patients received office-based vergence therapy with home reinforcement (group three) and 54 patients received office-based placebo therapy with home reinforcement (group four).

At 12 weeks, the mean convergence insufficiency symptom survey score was significantly lower among patients in group three than in all other groups (P < .001), the authors reported.

Patients in group three also showed significantly more improvement in near point of convergence and positive fusional vergence at near vision (P = .005).

The investigators reported successful or improved outcomes in 73% of patients in group three, 43% of patients in group one, 33% of patients in group two and 35% of patients in group four, according to the study, published in the October issue of Archives of Ophthalmology.

This is the first adequately powered randomized clinical trial done to address the relative effectiveness of office-based treatment for convergence insufficiency vs. less expensive home-based therapies. The strengths of this study are that, by using randomization, the investigators controlled for known and unknown confounding variables. The sample size was sufficiently large to detect statistically significant differences between groups, and there was outstanding follow-up, with 99% of patients seen at the 12-week completion. A weakness is that treatment dosages for the two home-based therapy regimens were unequal, in that they were less intensive than office-based therapy, and these regimens did not have equal contact time with the therapist, which could influence patients’ survey responses. Even so, the authors give valuable data on success rates of various treatments for patients with symptomatic convergence insufficiency. Further studies are needed using more intensive and flexible home-based regimens and an evaluation of cost-effectiveness of different treatment options.

– David K. Wallace, MD, MPH
Duke University Eye Center, Durham, N.C.