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M. Scheiman, M. Kulp, G. Mitchell, S. Cotter, M. Rouse, R. Hertle, Convergence Insufficiency Treatment Trial Study Group; Long-Term Effectiveness of Treatments for Symptomatic Convergence Insufficiency in Children 9 to 17 Years Old. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1205.
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To assess the long-term stability of improvements in symptoms and signs in 9- to 17-year-old children enrolled in the Convergence Insufficiency Treatment Trial who were asymptomatic after treatment for convergence insufficiency (CI).
79 patients who were asymptomatic after a 12-week therapy program for CI [33 in office-based vergence/accommodative therapy (OBVAT), 18 in home-based pencil push-ups (HBPP), 12 in home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), and 16 in office-based placebo therapy (OBPT)] were followed for 1 year. Maintenance therapy was prescribed for the first 6 months and no treatment for the second 6 months. Symptoms and clinical signs were measured 6 months and 1 year after completion of the 12-week therapy program. Outcome measures were the mean change on the Convergence Insufficiency Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence at near (PFV), and proportions of patients who remained asymptomatic on the CISS or who were classified as successful or improved based on a composite measure of CISS, NPC, and PFV.
1-year follow-up visit completion rate was 89% (32/33 OBVAT, 15/18 HBPP, 10/12 HBCVAT+, and 13/16 OBPT) with no significant differences between groups (p = 0.26). Eight patients (10%) reported seeking alternative treatment subsequent to the completion of the 12-week therapy program but prior to the 1-year follow-up visit (1 OBVAT, 3 HBPP, 2 HBCVAT+, and 2 OBPT). Among the remaining 62 patients (31 OBVAT, 12 HBPP, 8 HBCVAT+, and 11 OBPT), there were no significant changes in the CISS, NPC, or PFV in any treatment group during the 1-year follow-up (p-values ≥ 0.077). Twenty-seven of the 32 patients (84%) in the OBVAT group remained asymptomatic and, using the composite measure, 87% remained either successful (56%) or improved (31%) 1-year post-treatment.
Improvements in symptoms and clinical signs occurring after office-based vergence/accommodative therapy with home reinforcement are maintained in most children aged 9 to 17 years for at least 1 year after discontinuing treatment.
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