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To provide a current perspective on the management of convergence insufficiency (CI) in children by summarizing the findings and discussing the clinical implications from three recent randomized clinical trials in which we evaluated various treatments for children with symptomatic CI. We then present an evidence-based treatment approach for symptomatic CI based on the results of these trials. Finally, we discuss unanswered questions and suggest directions for future research in this area.
We reviewed three multi-center randomized clinical trials comparing treatments for symptomatic (CI) in children 9 to 17 years old (one study 9 to 18 years old). Two trials evaluated active therapies for CI. These trials compared the effectiveness of office-based vergence/accommodative therapy, office-based placebo therapy, and home-based therapy [pencil push-ups alone (both trials), home-based computer vergence/accommodative therapy, and pencil push-ups (large-scale study)]. One trial compared the effectiveness of base-in prism reading glasses to placebo reading glasses. All studies included well-defined criteria for the diagnosis of CI, a placebo group, and masked examiners. The primary outcome measure was the Convergence Insufficiency Symptom Survey score. Secondary outcomes were near point of convergence and positive fusional vergence at near.
Office-based vergence/accommodative therapy was significantly more effective than home-based or placebo therapies. Base-in prism reading glasses were no more effective than placebo reading glasses for the treatment of symptomatic CI in children.
Recent clinical trials showed that office-based vision therapy was successful in about 75% of patients (resulting in normal or significantly improved symptoms and signs) and was the only treatment studied which was more effective than placebo treatments for children with symptomatic CI. Eye care providers who do not currently offer this treatment may consider referring these patients to a doctor who provides this treatment or consider expanding the treatment options available within their practice to manage this condition.
Vision therapy is well worth the response, time and effort. Our Son had a hard time focusing and writing neatly. After vision therapy Seth could complete a task in half the time if previously took. His abilities to focus improved greatly and so did his handwriting.
Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.
Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.
Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.
Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.
He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.
It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.
Dr. McBryar , Kristen and John are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!
Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.
Seems much less frustrated with life
Reads non-stop and fast
Spelling abilities have been hugely improved
Seems much more confident
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