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