TY - JOUR
T1 - Effectiveness of vergence/accommodative therapy for accommodative dysfunction in children with convergence insufficiency
AU - the Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART) Investigator Group
AU - Chen, Angela M.
AU - Roberts, Tawna L.
AU - Cotter, Susan A.
AU - Kulp, Marjean T.
AU - Sinnott, Loraine T.
AU - Borsting, Eric J.
AU - Tea, Yin C.
AU - Jones-Jordan, Lisa A.
AU - Hertle, Richard
AU - Mitchell, G. Lynn
AU - Eugene Arnold, L.
AU - Chase, Christopher
AU - Scheiman, Mitchell M.
AU - Cooper, Jeffrey
AU - Schulman, Erica
AU - Hamian, Kimberly
AU - Iacono, Danielle
AU - Larson, Steven
AU - Leung, Valerie
AU - Meeder, Sara
AU - Ramos, Elaine
AU - Ritter, Steven
AU - Steiner, Audra
AU - Stormann, Alexandria
AU - Vricella, Marilyn
AU - Zhu, Xiaoying
AU - Tamkins, Susanna
AU - Aguilera, Naomi
AU - Brafman, Elliot
AU - Capo, Hilda
AU - Cavuoto, Kara
AU - Crespo, Isaura
AU - Dowling, Monica
AU - Draskovic, Kristie
AU - Farag, Miriam
AU - Fischer, Vicky
AU - Grace, Sara
AU - Gutierrez, Ailen
AU - Manchola-Orozco, Carolina
AU - Martinez, Maria
AU - McKeown, Craig
AU - Osigian, Carla
AU - Pham, Tuyet Suong
AU - Small, Leslie
AU - Townsend, Natalie
AU - Gallaway, Michael
AU - Boas, Mark
AU - Calvert, Christine
AU - Franz, Tara
AU - Kratochvil, Christopher J.
N1 - Publisher Copyright:
© 2020 The Authors Ophthalmic & Physiological Optics © 2020 The College of Optometrists
PY - 2021/1
Y1 - 2021/1
N2 - Purpose: To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction. Methods: We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial – Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. Results: From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). Conclusion: Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.
AB - Purpose: To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction. Methods: We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial – Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. Results: From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). Conclusion: Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.
KW - accommodative amplitude
KW - accommodative dysfunction
KW - accommodative facility
KW - convergence insufficiency
KW - vergence/accommodative therapy
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U2 - 10.1111/opo.12747
DO - 10.1111/opo.12747
M3 - Article
C2 - 33119180
AN - SCOPUS:85094676839
SN - 0275-5408
VL - 41
SP - 21
EP - 32
JO - Ophthalmic and Physiological Optics
JF - Ophthalmic and Physiological Optics
IS - 1
ER -