Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults OTA

A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel

Melinda Y. Chang, MD,³ David G. Morrison, MD,¹ Gil Binenbaum, MD, MSCE,² Gena Heidary, MD, PhD,⁴ Rupal H. Trivedi, MD, MSCR,⁵ Jennifer A. Galvin, MD,⁶ Stacy L. Pineles, MD⁷ 

Ophthalmology, Vol. 128, 1756-1765, © 2021 by the American Academy of Ophthalmology. Click here for free access to the OTA.

Purpose: To review home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency (CI) in children and young adults up to 35 years of age.

Methods: Literature searches were conducted through October 2020 in the PubMed database for English-language studies. The combined searches yielded 359 abstracts, of which 37 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist.

Results: Of the 12 studies included in this assessment, 8 were graded as level I evidence, 2 were graded as level II evidence, and 2 were graded as level III evidence. Two of the level I studies included older teenagers and young adults; the remainder of the studies exclusively evaluated children. Two randomized controlled trials found that office-based vergence and accommodative therapies were effective in improving motor outcomes in children with symptomatic CI. However, the studies reported conflicting results on the efficacy of office-based therapy for treating symptoms of CI. Data were inconclusive regarding the effectiveness of home-based therapies (including pencil push-ups and home computer therapy) compared with home placebo. In young adults, office-based vergence and accommodative therapies were not superior to placebo in relieving symptoms of CI.

Conclusions: Level I evidence suggests that office-based vergence and accommodative therapies improve motor outcomes in children with symptomatic CI, although data are inconsistent regarding symptomatic relief. Evidence is insufficient to determine whether home-based therapies are effective.

¹Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, Californiaanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee

²Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee

³Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

⁴Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston Massachusetts

⁵Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina

⁶Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut

⁷Jules Stein Eye Institute, Los Angeles, California