• Neuro-Ophthalmology/Orbit, Pediatric Ophth/Strabismus

    This Ophthalmic Technology Assessment evaluates home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency (CI) in young patients. 

    Study design

    Of the 12 studies included in this review, 8 were level 1, 2 were level 2, and 2 were level 3. Ten studies assessed therapies for symptomatic CI in children 18 years or younger; the other 2 studies evaluated older teenagers and young adults up to the age of 35 years.

    Outcomes

    Level 1 evidence suggests office-based therapy is effective in improving oculomotor parameters in children with CI, but there was conflicting data on whether this therapy improves symptoms. These therapies do not appear helpful in the treatment of CI symptoms in young adults. There was insufficient level 1 and 2 evidence to determine whether home therapies—including pencil push-ups and home computer therapy—are beneficial in treating symptomatic CI in children. However, level 3 data indicated that home computer therapy with or without pencil push-ups may improve near point convergence and symptoms.

    Limitations

    Evaluating symptom improvement is inherently subjective, making it difficult to assess. Some of the trials suffered from poor recruitment, high participant drop-out and poor compliance, which may have weakened potential beneficial outcomes.

    Clinical significance

    This report provides an excellent summary of the clinical trials assessing therapies for CI in children and young adults. Office-based vergence and accommodative therapies appear to be effective for improving oculomotor parameters in children with CI, but the optimal treatment dose and duration require further investigation. Future studies must also identify therapies for patients with symptomatic CI who do not respond to initial vergence and accommodative exercises.