title: Vision therapy/orthoptics for symptomatic convergence insufficiency in children: treatment kinetics.
abstract: OBJECTIVE
  To evaluate the kinetics of change in symptoms and signs of convergence insufficiency (CI) during 12 weeks of treatment with commonly prescribed vision therapy/orthoptic treatment regimens.
  
  
  METHODS
  In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic CI were assigned to 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), or office-based placebo therapy with home reinforcement (OBPT). Symptoms and signs were measured after 4, 8, and 12 weeks of treatment. The outcome measures were the mean CI Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence (PFV), and proportions of patients who were classified as successful or improved based on a composite measure of CISS, NPC, and PFV.
  
  
  RESULTS
  Only the OBVAT group showed significant improvements in symptoms between each visit (p < 0.001). Between weeks 8 and 12, all groups showed a significant improvement in symptoms. Between-group differences were apparent by week 8 (p = 0.037) with the fewest symptoms in the OBVAT group. For each group, the greatest improvements in NPC and PFV were achieved during the first 4 weeks. Differences between groups became apparent by week 4 (p < 0.001), with the greatest improvements in NPC and PFV in the OBVAT group. Only the OBVAT group continued to show significant improvements in PFV at weeks 8 and 12. The percentage of patients classified as "successful" or "improved" based on our composite measure increased in all groups at each visit.
  
  
  CONCLUSIONS
  The rate of improvement is more rapid for clinical signs (NPC and PFV) than for symptoms in children undergoing treatment for CI. OBVAT results in a more rapid improvement in symptoms, NPC and PFV, and a greater percentage of patients reaching pre-determined criteria of success when compared with HBPP, HBCVAT+, or OBPT.
authors.affiliation: Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania 19141, USA. mscheiman@salus.edu
authors.forename: Mitchell
authors.initials: M
authors.lastname: Scheiman
authors.forename: Marjean Taylor
authors.initials: MT
authors.lastname: Kulp
authors.forename: Susan
authors.initials: S
authors.lastname: Cotter
authors.forename: G Lynn
authors.initials: GL
authors.lastname: Mitchell
authors.forename: Michael
authors.initials: M
authors.lastname: Gallaway
authors.forename: Mark
authors.initials: M
authors.lastname: Boas
authors.forename: Rachel
authors.initials: R
authors.lastname: Coulter
authors.forename: Kristine
authors.initials: K
authors.lastname: Hopkins
authors.forename: Susanna
authors.initials: S
authors.lastname: Tamkins
mesh_terms: D000065:Accommodation, Ocular; D000293:Adolescent; D002648:Child; D003290:Convergence, Ocular; D006699:Home Care Services; D006801:Humans; D007700:Kinetics; D015835:Ocular Motility Disorders / Q000503:physiopathology / Q000628:therapy*; D009819:Office Visits; D009988:Orthoptics / Q000379:methods; D016896:Treatment Outcome