One study compared prism reading glasses against placebo reading glasses, and found no evidence of a difference in improvement in convergence or symptoms. However, compliance with treatment is problematic, as patients often cease treatment when symptoms start to improve and before treatment is complete. Arch Ophthalmol, Oct 2008. The trial found no evidence of a difference with this intervention in NPC or PFV. A person can pass the 20/20 eye chart test and still have convergence insufficiency. There is also a computer program available which may be used on a … Study Design CITT-ART is a multicenter, placebo-controlled, randomized clinical trial. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. Different types of vision therapy are prescribed for the treatment of convergence insufficiency that aim to improve the affected person’s convergence ability (the ability of eyes to turn inwards). Excellent adherence was reported for office-based vergence/accommodative therapy (96.6% or higher) in two trials. Off. Ways to treat Convergence Insufficiency include prism readers and vision therapy. If this add is given to a CI patient, it could exacerbate the symptoms. Convergence insufficiency (CI) is a neuromuscular deficiency of binocular eye alignment (Grisham, 1988) characterized by a reduction in the degree of convergence or the inability to maintain the necessary convergence of the eyes on a near target while keeping this target single, clear, and comfortable to look at.CI is associated with a wide range of symptoms, … The value of differentiating Convergence Insufficiency from a Pseudo-CI is catering the treatment. Primary CI is thought to be caused by an imbalance of vergence eye movements that is either an inborn deficiency or an acquired etiology. Children responded quickly to this treatment … If convergence insufficiency isn't causing symptoms, you generally don't need treatment. Enrollment began in August 2015 and will end in March 2017. Treatment, which can take place in the office of a trained therapist or at your home, might include: Pencil pushups. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. Convergence Insufficiency (CI) Nowadays, there appears to be sufficient evidence supporting vision therapy (orthoptic therapy) for the treatment of symptomatic CI. Sci. In the Convergence Insufficiency Treatment Trial (CITT),1 the patient answers each question with the following: never, infrequently, sometimes, fairly often, and always. Writer Bio. Please note, this page is printable by selecting the normal print options on your computer. The study also evaluates the associated symptoms before and after therapy. The associated visual symptoms include headaches, intermittent … Convergence Insufficiency Treatment Trial Study Group. 82, 583–595 (2005). Dr. Moore will provide a full examination and evaluation to determine the presence of this condition and then the level of care needed. Convergence Insufficiency Treatment. The Convergence Insufficiency Treatment Trial–Attention & Reading Trial Investigator Group Clinical Sites. The most common issues that tend to arise and be addressed at physical therapy include musculoskeletal issues to the … Diagnostic criteria and outcome measures were identical or similar among these trials. There are two main types of treatment for convergence insufficiency: 1) prism-lensed reading glasses, designed to improve visual comfort, and 2) eye (vision) therapy designed to restore normal visual function and improve visual comfort. In children, convergence insufficiency can often be treated by practicing convergence through exercises. Chic. If the affected individual is motivated, the prognosis/ outcome for successful treatment of Convergence Disorder or Convergence Insufficiency … In this exercise, you focus on a small letter on the side of a pencil as you move it closer to the bridge of your nose, stopping as soon as you see double. CI is most often treated with special exercises. Children responded quickly to this treatment … St Louis Mo 83, 137–158 (2012). Diagnostic criteria and outcome measures were identical or similar among these trials. We rated only one RCT at low risk of bias. Sites are listed in order of the number of participants enrolled in the study, with the number enrolled listed in parentheses preceded by the clinical site name and location. & Jamal, N. Convergence insufficiency-a major review. Ill 1960 126, 1336–1349 (2008). Optom. 246 Convergence Insufficiency Treatment Trial (CITT), demonstrated that a 12-week program of 247 office-based vergence/ accommodative therapy with home reinforcement was more effective 248 than home-based near target pencil push-ups, home-based computer accommodative therapy 249 plus pencil push-ups, or office-based placebo therapy in treating the symptoms … Treatment for convergence insufficiency. Optom. For adults, the comparative effects of these interventions are less clear. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. 2,3,4 Convergence Insufficiency Treatment Trial Study Group. Symptoms of convergence insufficiency typically manifest … When reading, people with convergence insufficiency frequently lose their place or have to re-read text. Miguel Cavazos is a photographer and fitness trainer in Los Angeles who began writing in 2006. The benefit of … AmblyoPlay® is a vision therapy solution for children with lazy eye, mild strabismus or convergence insufficiency that is performed through playing therapeutic games and exercises every day for 30 minutes. Ophthalmol. Arch. Scheiman, M. et al. Convergence Insufficiency (CI) is a common eye-teaming problem in which the eyes have difficulty turning in to read and see during up close work. To assess the comparative effectiveness and relative ranking of non-surgical interventions for convergence insufficiency through a systematic review and network meta-analysis (NMA). Symptoms may include eye strain, headaches, double vision, print moving on the page, frequent loss of place when reading, inability to concentrate, and short attention span. Ill 1960 126, 1336–1349 (2008). Copyright © 2021 The Cochrane Collaboration. What did we find? We thus were limited to comparing the mean difference (MD) between interventions for improving NPC, PFV, and CISS scores individually using data from three RCTs (107 participants; interventions 1, 2, 4 and 5). Acad. We found 12 studies with a total of 1289 people with convergence insufficiency. Efficacy of treatment for convergence insufficiency using vision therapy Adler, Paul 2002-11-01 00:00:00 Introduction Convergence insufficiency (CI) is characterised by some authors primarily by an extended near point of convergence (NPC) and is frequently associated with asthenopic symptoms for near work. Why is this question important? Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they should. Optom. 82, 583–595 (2005). Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. St Louis Mo 83, 137–158 (2012). Convergence insufficiency is a common vision disorder in which a person's eyes tend to drift outwards when they try to use their eyes together up close. A concussion can affect many systems of the body, including but not limited to the visual, musculoskeletal, vestibular, cardiovascular, central nervous, and peripheral nervous systems. Effective Treatment of Convergence Insufficiency. Ophthalmol. CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. The study is registered at ClinicalTrials.gov as the Convergence Insufficiency Treatment Trial-ART (CITT-ART: NCT02207517). It is a disorder involving binocular vision — vision using both eyes. Treatment for Convergence Disorder or Convergence Insufficiency comprise of: Pencil pushup treatment for Convergence Disorder or Convergence Insufficiency. Activities to Improve Convergence Skills **DISCLAIMER** I am … The etiology of isolated CI, not related to trauma or neurological disease, has not been completely determined. A recent study by the Convergence Insufficiency Treatment Trial Investigator Group gathered important data about the symptoms of convergence insufficiency in a series of studies (2008 Reference, 2005 Reference ?). It often leads to loss of concentration/attention when reading. There was no difference between treatments for changes in symptoms reported by adults. Computer … Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. When treatment … Arch. Convergence insufficiency treatment. Follow the link to activate your Optonet Vision Unit. 2,3,4 Immediate, accurate, consistent and unbiased feedback is provided by the computer, regarding correct and incorrect responses. Off. Search. Ill 1960 123, 14–24 (2005). Pencil pushups are usually the first line of treatment for convergence insufficiency. Some of these exercises are done while looking through prisms. In general, looking at a close object causes the eyes to turn inward, allowing them to focus. For improving convergence ability, high-certainty evidence showed that office-based therapy with home reinforcement is better than placebo, home-based computer therapy, and home-based pencil push-ups. We reviewed the evidence from research studies to compare the effectiveness of these different treatments (prism reading glasses, office-based therapy with home reinforcement, and home-based treatments), and also to determine whether the treatments are associated with adverse (unwanted) effects. Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial-Attention & Reading Trial: A Randomized Clinical Trial Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the NPC and PFV in children with symptomatic convergence insufficiency. Concussion Treatment: Convergence Insufficiency . He has contributed health, fitness and nutrition articles to various online publications, … A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. If the eyes drift outward, this prevents accurate focusing and is labeled convergence insufficiency. We compared the results and summarized the evidence from all the studies. However, there was no evidence of a difference for improvement in convergence. Optom. Six RCTs in the adult population randomized 321 participants. Convergence insufficiency is an eye disorder in which the eyes do not work together properly when focusing on a nearby object. Objectives: To … Compared with placebo treatment, office-based vergence accommodative therapy was relatively more effective in improving PFV (MD 16.73, 95% CI 6.96 to 26.60), but there was no evidence of a difference for NPC or the CISS score. We searched CENTRAL, MEDLINE, Embase, PubMed and three trials registers up to 20 September 2019. to diagnose convergence insufficiency. Exercises to treat CI work well for most people. Children with convergence insufficiency usually have one eye turn outward while trying to focus on a word or object closer than a certain distance 2.Convergence insufficiency symptoms include double vision, headaches when reading, squinting, problems concentrating … What are the benefits of the exercises? Diagnosis of CI was based on the published criteria from the “Convergence insufficiency treatment trial (CITT)” 18, 19: (1) exophoria at near (0.4 m) at least four prism diopters (∆) greater than at far (6 m); (2) a receded NPC break of 6 cm or greater; and (3) insufficient PFV at near (PFV less than twice the amount of the near phoria) or a break on PFV of ≤15 ∆ base‐out. He or she and may need to do them regularly at home. Six studies were conducted in children aged seven to 18 years, five studies in young adults aged 15 to 40 years, and one study in adults aged 40 years and older. But for people with symptoms, treatment with eye-focusing exercises can increase the eyes' convergence ability.Treatment, which can take place in the office of a trained therapist or at your home, might include: 1. These were the first studies that used a scientifically valid and reliable symptom questionnaire. All four CITT RCTs were rated at low risk of bias. Although various treatments are prescribed for patients with CI, there is a lack of studies regarding the most effective treatment. How did we identify and evaluate the evidence? Convergence insufficiency is a common eye muscle co-ordination problem in which the eyes have a strong tendency to drift outward (exophoria) when reading or doing close work. If your child does the exercises regularly, his or her symptoms may go away in a fairly short period of time. The study analyzed 18 patients with convergence insufficiency who were assigned either to anaglyphs or a VR game called “Snakes.” The prescribed training regimen was 20 minutes, three times a week for six weeks. Chic. Objective: This report describes the design and methodology of the Convergence Insufficiency Treatment Trial (CITT), the first large-scale, placebo-controlled, randomized clinical trial evaluating treatments for convergence insufficiency (CI) in children.We also report the clinical and demographic characteristics of patients. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. Diagnostic criteria and outcome measures were identical or similar among these trials. 3. One RCT evaluated the effectiveness of base-in prism reading glasses in children. During this blog we will discuss the good stuff; diagnosis and treatment of convergence insufficiency. Results in children Convergence Insufficiency Treatment Trial Study Group. 1. Cooper, J. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Eyes feel sore, uncomfortable or hurt. Investimentos - Seu Filho Seguro. Doctors who do … Normally eye exercises, which can be practised at home, are recommended. The Optonet Vision Unit also includes a vision therapy module specially designed to achieve the standardization goal via the Optonet Project for both Office-based and Home-based (remotely supervised) treatments. These may include some or all of the following: • frontal … Studies lasted for between six weeks and six months. The study also evaluates the associated symptoms before and after therapy. For improving convergence ability, as well as symptoms reported by children (such as headaches or frequent loss of place when reading), low- to moderate-certainty evidence suggested that office-based therapy with home reinforcement is better than placebo, home-based computer therapy, and home-based pencil push-ups. You will also be given an information leaflet as a reminder on how to perform them. Purpose: The purpose of this study was to determine if vision therapy (VT), as practised within the constraints of UK optometric practice, employing graded routine eye exercises, is as an effective method for treatment of convergence insufficiency (CI) as previously published data suggest. 3. Search. In-office Optometric Vision Therapy is proven to be the most effective treatment for Convergence Insufficiency by a national multi-site peer-reviewed study which was conducted by the National Institutes of … The muscles surrounding the eye (there are six) are plenty strong, but the nerves that control these muscles are not sending the proper message to turn inward enough to aim at the target (page or screen). Treatment for amblyopia caused by obstructed vision, Different treatments for a squint (deviation of the eye) that occurs within the first six months of life, Vision screening programmes for amblyopia (lazy eye), Botulinum toxin for the treatment of strabismus, Treatment for a type of childhood strabismus where one or both eyes intermittently turn outwards. Alternatively, it can consist of a sequence of activities individually prescribed and monitored by the doctor, administered by trained therapists in an office setting along with practice at home (office-based therapy with home reinforcement). He or she and may need to do them regularly at home. Trials evaluated seven interventions: 1) office-based vergence/accommodative therapy with home reinforcement; 2) home-based pencil/target push-ups; 3) home-based computer vergence/accommodative therapy; 4) office-based vergence/accommodative therapy alone; 5) placebo vergence/accommodative therapy or other placebo intervention; 6) prism reading glasses; and 7) placebo reading glasses. Convergence describes the way our eyes move together and point inward when we look at near objects. Chic. The NEI Convergence Insufficiency Treatment Trial (CITT) has shown that the most effective treatment for CI is in-office therapy, overseen by a trained therapist, with additional at-home exercises. Treatment can be self-administered at home using only a pencil (pencil push-ups) or a computer software program (home-based computer therapy). Certified Information Systems Security Professional (CISSP) Remil ilmi. The evidence in this Cochrane Review is current to September 2019. Patients’ completing a course of exercises for convergence insufficiency benefit by being able to read and focus more comfortably. Objective: This report describes the design and methodology of the Convergence Insufficiency Treatment Trial (CITT), the first large-scale, placebo-controlled, randomized clinical trial evaluating treatments for convergence insufficiency (CI) in children.We also report the clinical and demographic characteristics of patients. These exercises may be prescribed by an orthoptist (a medical technician who is specifically trained in ocular muscle function and binocular vision) or by an ophthalmologist. These exercises, such as pencil push-up, can all be performed at home yet they might not engage the patient enough. Background: Convergence insufficiency (CI) is one of the most common causes of ocular discomfort among students that it may have a negative effect on the student's school performance. CI is most often treated with special exercises. Current research suggests that office-based vergence/accommodative therapy with home reinforcement is more effective than home-based pencil/target push-ups or home-based computer vergence/accommodative therapy for children. Patients’ completing a course of exercises for convergence insufficiency benefit by being able to read and focus more comfortably. Below you will find information about convergence, including convergence insufficiency, and activities to improve convergence skills. There are two main types of treatment for convergence insufficiency… Orthoptics and vision therapy. People with convergence insufficiency often complain of the following symptoms when reading or doing intense near work: When treatment success was defined by a composite outcome requiring both clinical measures of convergence to be normal, and also show a pre-specified magnitude of improvement, we found high-certainty evidence that office-based vergence/accommodative therapy with home reinforcement increases the chance of a successful outcome, compared with home-based computer vergence/accommodative therapy (risk ratio (RR) 1.96, 95% confidence interval (CI) 1.32 to 2.94), home-based pencil/target push-ups (RR 2.86, 95% CI 1.82 to 4.35); and placebo (RR 3.04, 95% CI 2.32 to 3.98). Treatment for convergence insufficiency. There is only ONE diagnosis, convergence insufficiency, that has ever proven to benefit from “eye exercises.” AND standard convergence insufficiency treatment requires one piece of equipment — an ordinary pencil! When a child visits our team, we'll work through several steps. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. However, there may be no evidence of any treatment difference between home-based computer vergence/accommodative therapy and home-based pencil/target push-ups (RR 1.44, 95% CI 0.93 to 2.24; low-certainty evidence), or between either of the two home-based therapies and placebo therapy, for the outcome of treatment success. : CD006768. Your child will be shown how to do these exercises. Orthoptics Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham B15 2GW Telephone: 0121 371 6462 The Trust provides free monthly health talks … The study found that in-office Vision Therapy was the best available treatment for convergence insufficiency, replacing conventional therapies such as "pencil push-ups", with 75% of patients showing significant improvement following vision therapy. & Jamal, N. Convergence insufficiency-a major review. Practice the exercises as often as directed by … Computer … An experienced practitioner is not always required to conduct the therapy. These activities can be used by occupational therapists in treatment as indicated by vision screening and based on the individual needs of the child as determined by assessment. CI affects children and adults. DOI: 10.1002/14651858.CD006768.pub3. Some of these exercises are done while looking through prisms. Some of these exercises are done while looking through prisms. A pulling sensation can be felt around the eyes. But for people with symptoms, treatment with eye-focusing exercises can increase the eyes' convergence ability. Convergence Insufficiency Treatment Trial Study Group. You can do these exercises at home. Participants age 9 to14 years in grades 3 to 8 are randomized to: 1) office-based … Treatment that is typically recommended by optometrists includes either … Overtime, the more you train your brain, the easier and more … In adults, evidence of the effectiveness of various non-surgical interventions is less clear. [6, 26] Pencil push-ups require fixation on a … We bet you can get a pencil cheaper than $0.99, but if you can’t, here’s an app for you. It may not always be evident that someone suffers from convergence insufficiency because the symptoms may vary. Six RCTs in the pediatric population randomized 968 participants. A randomized clinical trial of treatments for convergence insufficiency in children. BACKGROUND: Convergence insufficiency is a common binocular vision disorder in which the eyes have a strong tendency to drift outward (exophoria) with difficulty turning There was no evidence of any treatment difference between home-based pencil push-ups and home-based computer vergence/accommodative therapy, or between either of the two home-based therapies and placebo therapy. We performed NMAs separately for children and adults. It is not clear (low- to moderate-certainty evidence) whether there is a difference for improving convergence alone, or convergence and symptoms as reported by children, between home-based computer therapy and home-based pencil push-ups, or between these two home-based treatments and placebo. Writer Bio. Convergence Insufficiency (CI) Nowadays, there appears to be sufficient evidence supporting vision therapy (orthoptic therapy) for the treatment of symptomatic CI. Your orthoptist will tell you which exercises may be suitable for you and will demonstrate them. After comparing vision before and after the treatment period, the researchers noted a significant effect for near point of convergence, near positive … Vis. When reading, people with convergence insufficiency frequently lose their place or have to re-read text. Results from recent scientific studies show that at least 1 out of every 20 people (5%) have Convergence Insufficiency. Sci. When unresponsive to orthoptic therapy, other treatment options include optical correction with base-in prisms or surgical intervention in cases associated with a near exophoria. The Convergence Insufficiency Treatment Trial study conducted by the National Eye Institute (NEI) revealed that supervised vision therapy with home reinforcement is the most effective treatment for CI. Methods: We prospectively randomized children … Optom. Acad. Pencil pushups. It may seem like an exaggeration but having convergence insufficiency can influence life's path and treating it can be truly life … This can cause eye strain, headaches, blurred and double vision. The most effective treatment for this condition is office-based vision therapy, but prism can be considered in patients who are unable to undergo this treatment modality. How-up-to date is this review? 4. There was no evidence of difference for any other comparisons for any outcomes. Scheiman, M. et al. Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T. Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T. Interventions for convergence insufficiency: a network meta-analysis. CI is most often treated with special exercises. Convergence exercises (ie, orthoptics, vision therapy) and/or base-in prisms are the mainstays of treatment for convergence insufficiency. If exercises are administered regularly, improvement is typically quite rapid and within a couple … We focus on vision therapy as the most effective treatment for convergence insufficiency. Evidence from three studies indicated that office-based therapy could be more effective than placebo for improving convergence when it was measured one way (‘positive fusional vergence’), but not when measured another way (‘near point convergence’). As a result, the two eyes’ visual axes do not intersect on the object being viewed. This type of study provides the strongest evidence about the effects of a treatment. Convergence Insufficiency We are committed to making our publications as accessible as possible. Convergence insufficiency (CI) is a treatable near vision disorder and eye muscle coordination problem that can not be repaired with eye surgery, medications, standard eyeglasses, or contact lenses. It often goes undiagnosed. Arch. Scheiman, M. et al. No adverse effects related to study treatments were reported for any of the included studies. A randomized clinical trial of treatments for convergence insufficiency in children. Patients responses, performance and adherence are quantified, verified and monitored by the software. Vis. 9 … Ophthalmol. All four CITT RCTs were rated at low risk of bias. If you need this document in an alternative format, for example, large print, Braille or a language other than English, please contact the Communications Office by emailing Communications@wsht.nhs.uk or speak to a member of the orthoptic department. High-certainty evidence indicates that, office-based therapy with home reinforcement is more effective than home-based pencil push-ups, home-based computer therapy, and placebo for treating convergence insufficiency in children. The exercise … No study, in children or adults, reported any adverse effects related to study treatments. 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