Randomized clinical trial of treatments for symptomatic convergence insufficiency in children

Objective: To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and Pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency. Methods: In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic convergence insufficiency were assigned to 1 of 4 treatments. Main Outcome Measures: Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near. Results: After 12 weeks of treatment, the OBVAT group's mean convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of 21.3, 24.7. and 21.9 in the HBCVAT+, HBPP, and OBPT groups, respectively (P<.001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (P <=.005 for all comparisons). A Successful or improved outcome was found in 73%, 43%, 33%, and 35% of patients in the OBVAT, HBPP, HBCVAT+, and OBPT groups, respectively. Conclusions: Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with HBPP, HBCVAT+, and OBPT. Application to Clinical Practice: office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency.