title: The effectiveness of home-based pencil push-up therapy versus office-based therapy for the treatment of symptomatic convergence insufficiency in young adults.
abstract: OBJECTIVE
  To compare the effectiveness of pencil push-up therapy (PPT) versus office-based vision therapy in patients with convergence insufficiency.
  
  
  METHODS
  In this study, 60 students from Zahedan University of Medical Sciences with convergence insufficiency were selected. After determining their refractive error (with a retinoscope), near point of convergence (by millimeter ruler), near heterophoria (by alternate prism cover test), and positive fusional vergence at near (by prism bar), subjects were divided into two groups to receive PPT (at least three times a day for 5 minutes each time) or office-based therapy (two times each week for 60 minutes each visit) without home reinforcement. Subjects were re-examined 4 and 8 weeks after initiation of treatment. Statistical analysis was performed with the independent samples t-test and the analysis of variance (ANOVA). Statistical significance was indicated by P < 0.05.
  
  
  RESULTS
  The near point of convergence, phoria, and positive fusional vergence were not statistically different between the two groups before treatment (P > 0.05). After 4 and 8 weeks of therapy, only the positive fusional vergence was statistically significantly different between groups (P = 0.001). Results from ANOVA indicated a considerable difference between the two groups in general but the observed difference was related only to positive fusional vergence.
  
  
  CONCLUSIONS
  PPT and office-based vision therapy are comparable for treatment of convergence insufficiency. While we do not deny the more efficacious nature of office-based therapy, it is not always practical, may be too expensive, and may not be locally available. A home-based therapy offers a cost-effective reasonable alternative.
authors.affiliation: Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Momeni-Moghaddam
authors.affiliation: College of Optometry, Pacific University, Forest Grove, Oregon, USA.
authors.forename: James
authors.initials: J
authors.lastname: Kundart
authors.affiliation: School of Paramedical Sciences, Mashad University of Medical Sciences, Mashad, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Azimi
authors.affiliation: Department of Optometry, Zahedan University of Medical Sciences, Zahedan, Iran.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Hassanyani
mesh_terms: D003290:Convergence, Ocular / Q000502:physiology*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D015835:Ocular Motility Disorders / Q000503:physiopathology / Q000628:therapy*; D009819:Office Visits; D009988:Orthoptics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Convergence Insufficiency; Office-Based Therapy; Pencil Push-up Therapy; Vision Therapy