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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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© ARVO (1962-2015); The Authors (2016-present)
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.
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