May 2003
Volume 44, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2003
A Randomized Trial of Vision Therapy/Orthoptics vs Pencil Push-Ups for Convergence Insufficiency: Convergence Insufficiency Treatment Trial (CITT) Pilot Study
M. Scheiman; L. Mitchell; S. Cotter; J. Cooper; M. Kulp; R. London; J. Wensveen; M. Rouse; E. Borsting; Convergence Insufficiency Trtmnt Trial Study Group
Author Affiliations & Notes
  • M. Scheiman
    Eye Institute, Pennsylvania College of Optometry, Philadelphia, PA, United States
  • L. Mitchell
    Optometry Coordinating Center, The Ohio State University, Columbus, OH, United States
  • S. Cotter
    Southern California College of Optometry, Fullerton, CA, United States
  • J. Cooper
    College of Optometry, State University of New York, New York, NY, United States
  • M. Kulp
    College of Optometry, The Ohio State University, Columbus, OH, United States
  • R. London
    Pacific University College of Optometry, Forest Grove, OR, United States
  • J. Wensveen
    College of Optometry, University of Houston, Houston, TX, United States
  • M. Rouse
    College of Optometry, University of Houston, Houston, TX, United States
  • E. Borsting
    College of Optometry, University of Houston, Houston, TX, United States
  • Convergence Insufficiency Trtmnt Trial Study Group
    College of Optometry, University of Houston, Houston, TX, United States
  • Footnotes
    Commercial Relationships  M. Scheiman, None; L. Mitchell, None; S. Cotter, None; J. Cooper, None; M. Kulp, None; R. London, None; J. Wensveen, None; M. Rouse, None; E. Borsting, None.
  • Footnotes
    Support  NEI R21 EY13164-01
Investigative Ophthalmology & Visual Science May 2003, Vol.44, 4247. doi:
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      M. Scheiman, L. Mitchell, S. Cotter, J. Cooper, M. Kulp, R. London, J. Wensveen, M. Rouse, E. Borsting, Convergence Insufficiency Trtmnt Trial Study Group; A Randomized Trial of Vision Therapy/Orthoptics vs Pencil Push-Ups for Convergence Insufficiency: Convergence Insufficiency Treatment Trial (CITT) Pilot Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4247.

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Abstract

Abstract: : Purpose: To compare the efficacy of two of the most commonly prescribed treatments for convergence insufficiency (CI) - pencil push-up therapy (PPT) and vision therapy (VT)/orthoptics. Methods: 47 subjects age 9-18 years and 46 subjects age 19-30 years from 6 clinical sites were randomized to 1 of 3 treatment groups: Pencil push-up therapy (PPT), VT/orthoptics, or Placebo VT/orthoptics. The primary outcome measure, severity of symptoms as determined by the CI Symptom Survey (CISS), and the secondary outcome measures of near point of convergence (NPC) and reduced positive fusional vergence (PFV) at near were measured at baseline and after 12 weeks of treatment. Results: For the younger group, the mean symptom score after treatment was significantly better (p<0.0001) in the VT/orthoptics group (mean=9.5, SD=8.2) compared to the PPT (mean=25.9, SD=7.3) and Placebo VT/orthoptics (mean 24.2, SD=11.9) groups. Similar findings were observed for NPC and PFV. All 3 groups of adult subjects showed statistically and clinically significant improvements in symptoms [VT/orthoptics (mean=20.7, SD=10.2), PPT (mean=26.5, SD=7.3), and Placebo VT/orthoptics (mean=25.2, SD=10.3)]; however, the VT/orthoptics group was not significantly better than the other treatment arms. For adults, only those in the VT/orthoptics group demonstrated clinically meaningful changes in NPC and PFV. Conclusions: Our data suggest a differential effect of treatment with age. In children, VT/orthoptics was clearly more effective than PPT. In fact, despite PPT being the most commonly prescribed treatment for CI, PPT was no more effective than Placebo VT/orthoptics for improving symptoms and signs of CI. A similar trend was evident in the adult group, but without statistical significance. Although the VT/orthoptics group was the only one that achieved clinically significant improvement in the signs of CI, 60% were still symptomatic at the end of treatment. Our data support the need for a large scale randomized clinical trial of the effectiveness of VT/orthoptics for CI.

Keywords: binocular vision/stereopsis 
© 2003, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Permission to republish any abstract or part of an abstract in any form must be obtained in writing from the ARVO Office prior to publication.
Copyright © 2024 Association for Research in Vision and Ophthalmology.
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