Effectiveness of vergence/accommodative therapy for accommodative dysfunction in children with convergence insufficiency. (29th October 2020)

• Record Type: Journal Article
• Authors: Chen, Angela M; Roberts, Tawna L; Cotter, Susan A; Kulp, Marjean T; Sinnott, Loraine T; Borsting, Eric J; Tea, Yin C; Jones‐Jordan, Lisa A; Hertle, Richard; Mitchell, G Lynn; Eugene Arnold, L; Chase, Christopher; Scheiman, Mitchell M
• Other Names: Cooper Jeffrey investigator.; Schulman Erica investigator.; Hamian Kimberly investigator.; Iacono Danielle investigator.; Larson Steven investigator.; Leung Valerie investigator.; Meeder Sara investigator.; Ramos Elaine investigator.; Ritter Steven investigator.; Steiner Audra investigator.; Stormann Alexandria investigator.; Vricella Marilyn investigator.; Zhu Xiaoying investigator.; Tamkins Susanna investigator.; Aguilera Naomi investigator.; Brafman Elliot investigator.; Capo Hilda investigator.; Cavuoto Kara investigator.; Crespo Isaura investigator.; Dowling Monica investigator.; Draskovic Kristie investigator.; Farag Miriam investigator.; Fischer Vicky investigator.; Grace Sara investigator.; Gutierrez Ailen investigator.; Manchola‐Orozco Carolina investigator.; Martinez Maria investigator.; McKeown Craig investigator.; Osigian Carla investigator.; Pham Tuyet‐Suong investigator.; Small Leslie investigator.; Townsend Natalie investigator.; Gallaway Michael investigator.; Boas Mark investigator.; Calvert Christine investigator.; Franz Tara investigator.; Gerrouge Amanda investigator.; Hayden Donna investigator.; Jenewein Erin investigator.; Margolies Zachary investigator.; Meiyeppen Shivakhaami investigator.; Myung Jenny investigator.; Pollack Karen investigator.; Shoge Ruth investigator.; Tang Andrew investigator.; Tannen Noah investigator.; Trieu Lynn investigator.; Trujillo Luis investigator.; Buckland Michelle investigator.; Ellis Allison investigator.; Fogt Jennifer investigator.; McDaniel Catherine investigator.; McGann Taylor investigator.; Morrison Ann investigator.; Mulvihill Shane investigator.; Peiffer Adam investigator.; Plaumann Maureen investigator.; Pierce Gil investigator.; Preston Julie investigator.; Reuter Kathleen investigator.; Stevens Nancy investigator.; Teeny Jake investigator.; Toole Andrew investigator.; Widmer Douglas investigator.; Zimmerman Aaron investigator.; Barnhardt Carmen investigator.; Chu Raymond investigator.; Huang Kristine investigator.; Parker Susan investigator.; Retnasothie Dashaini investigator.; Wu Judith investigator.; Clark Penny investigator.; Culp Kelly investigator.; Fraley Kathy investigator.; Grant Drusilla investigator.; Hanna Nancy investigator.; Knox Stephanie investigator.; Lawhon William investigator.; Li Lan investigator.; Mitcheff Sarah investigator.; Ricker Isabel investigator.; Solis Casandra investigator.; Wall Palak investigator.; Zaczyk Samantha investigator.; Hopkins Kristine investigator.; Marsh‐Tootle Wendy investigator.; Bowen Michelle investigator.; Call Terri investigator.; Domnanovich Kristy investigator.; Frazier Marcela investigator.; Guyette Nicole investigator.; Hayes Oakley investigator.; Houser John investigator.; Lee Sarah investigator.; Montejo Jenifer investigator.; Oechslin Tamara investigator.; Spain Christian investigator.; Turner Candace investigator.; Weise Katherine investigator.; Coulter Rachel investigator.; Amster Deborah investigator.; Bansal Surbhi investigator.; Falco Laura investigator.; Fecho Gregory investigator.; Green Katherine investigator.; Irizarry Gabriela investigator.; Jhajj Jasleen investigator.; Patterson Nicole investigator.; Rodena Jacqueline investigator.; Tyler Julie investigator.; Weiss Dana investigator.; Zakaib Lauren investigator.; Lorenzana Ingryd investigator.; Meza Yesena investigator.; Mann Ryan investigator.; Quezada Mariana investigator.; Rein Scott investigator.; Rudaitis Indre investigator.; Stepleton Susan investigator.; Wajs Beata investigator.; Redford Maryann investigator.; Denton Carolyn investigator.; Wee Sharyl investigator.; Dahl‐Leonard Katlynn investigator.; Powers Kenneth investigator.; Alaniz Amber investigator.; Diener‐West Marie investigator.; Good William V investigator.; Grisham David investigator.; Kratochvil Christopher J investigator.; Revicki Dennis investigator.; Wanzek Jeanne investigator.; Abraham Mustafa investigator.; Dangelo Julianne investigator.; Hegedus Jordan investigator.; Jones Ian investigator.; Junglas Alexander investigator.; Lee Jihyun investigator.; Nettles Jadin investigator.; Mitchell Curtis investigator.; Osman Mawada investigator.; Scott‐Tibbs Gloria investigator.; Teasley Chloe investigator.; Vang Victor investigator.; Varghese Robin investigator.;
• Is Part Of: Ophthalmic and physiological optics. Volume 41:Number 1(2021)
• Page Start: 21
• Page End: 32
• Publication Date: 2020-10-29
• Subjects: accommodative dysfunction -- accommodative amplitude -- accommodative facility -- vergence/accommodative therapy -- convergence insufficiency; Ophthalmology -- Periodicals; Physiological optics -- Periodicals; Optometry -- Periodicals; Optics -- Periodicals; Vision -- Periodicals; 617.75
• DOI: 10.1111/opo.12747
• Languages: English
• ISSNs: 0275-5408

Abstract

Abstract: 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.