Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology

Melinda Y. Chang, David G. Morrison, Gil Binenbaum, Gena Heidary, Rupal H. Trivedi, Jennifer A. Galvin, Stacy L. Pineles

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalOphthalmology
DOIs
StateAccepted/In press - 2021

Keywords

  • asthenopia
  • binocular visual disorder
  • convergence insufficiency
  • diplopia
  • ocular motility disorders
  • orthoptic exercises
  • orthoptics.
  • pencil push-ups therapy
  • vision therapy

ASJC Scopus subject areas

  • Ophthalmology

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