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.
Original language | English (US) |
---|---|
Pages (from-to) | 21-32 |
Number of pages | 12 |
Journal | Ophthalmic and Physiological Optics |
Volume | 41 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2021 |
Keywords
- accommodative amplitude
- accommodative dysfunction
- accommodative facility
- convergence insufficiency
- vergence/accommodative therapy
ASJC Scopus subject areas
- Ophthalmology
- Optometry
- Sensory Systems
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In: Ophthalmic and Physiological Optics, Vol. 41, No. 1, 01.2021, p. 21-32.
Research output: Contribution to journal › Article › peer-review
}
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 - Diener-West, Marie
N1 - Funding Information: Funding/Support: This work was supported by National Eye Institute of National Institutes of Health, Department of Health and Human Services (grant number 5U10EY022599 to MMS, 5U10EY022601 to GLM, 5U10EY022595 to SC, 5U10EY022592 to MK, 5U10EY022586 to ES, 5U10EY022600 to RH, 5U10EY022587 to MG, 5U10EY022596 to RC, 5U10EY022594 to KH, and 5U10EY022591 to ST). The funding organisation had no role in the design or conduct of this research. Meeting presentation: This manuscript was presented in part at the American Academy of Optometry Annual Meeting (November 2019 in Orlando, FL). Funding Information: This study was supported through a cooperative agreement with the National Eye Institute of the National Institutes of Health (USA) and conducted according to the Declaration of Helsinki by the CITT‐ART Investigator Group at nine clinical centres. Each site’s institutional review board approved the protocol and the Health Insurance Portability and Accountability Act‐compliant informed consent and assent forms. Written informed consent was obtained from the parent or guardian of each participant and written assent (if required) was obtained from each participant prior to study‐related data collection. An independent data and safety monitoring committee provided oversight (see Acknowledgments). The study is registered at the ClinicalTrials.gov website ( www.clinicaltrials.gov ) as the Convergence Insufficiency Treatment Trial‐Attention and Reading Trial (NCT02207517). The full study protocol and Manual of Procedures are available on the CITT‐ART study website ( https://u.osu.edu/cittart/ ; accessed 01/28/2020). Funding Information: Funding/Support: This work was supported by National Eye Institute of National Institutes of Health, Department of Health and Human Services (grant number 5U10EY022599 to MMS, 5U10EY022601 to GLM, 5U10EY022595 to SC, 5U10EY022592 to MK, 5U10EY022586 to ES, 5U10EY022600 to RH, 5U10EY022587 to MG, 5U10EY022596 to RC, 5U10EY022594 to KH, and 5U10EY022591 to ST). The funding organisation had no role in the design or conduct of this research. Meeting presentation: This manuscript was presented in part at the American Academy of Optometry Annual Meeting (November 2019 in Orlando, FL). The Convergence Insufficiency Treatment Trial – Attention & Reading Trial Investigator Group Clinical Sites 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. Personnel are listed as (PI) for principal investigator, (SC) for coordinator, (ME-ART) for masked examiner or attention and reading testing, (ME-VIS) for masked examiner for visual function testing, (VT) for vision therapist, and (UnM) for unmasked examiners for baseline testing. Study Centre: SUNY College of Optometry (45) Jeffrey Cooper, MS, OD (PI 06/14 – 04/15); Erica Schulman, OD (PI 04/15 - present); Kimberly Hamian, OD (ME-VIS); Danielle Iacono, OD (ME-VIS); Steven Larson, OD (ME-ART); Valerie Leung, Boptom (SC); Sara Meeder, BA (SC); Elaine Ramos, OD (ME-VIS); Steven Ritter, OD (VT); Audra Steiner, OD (ME-VIS); Alexandria Stormann, RPA-C (SC); Marilyn Vricella, OD (UnM); Xiaoying Zhu, OD (ME-VIS). Study Centre: Bascom Palmer Eye Institute (44) Susanna Tamkins, OD (PI); Naomi Aguilera, OD (VT); Elliot Brafman, OD (ME-VIS); Hilda Capo, MD (ME-VIS); Kara Cavuoto, MD (ME-VIS); Isaura Crespo, BS (SC); Monica Dowling, PhD (ME-ART); Kristie Draskovic, OD (ME-VIS); Miriam Farag, OD (VT); Vicky Fischer, OD (VT); Sara Grace, MD (ME-VIS); Ailen Gutierrez, BA (SC); Carolina Manchola-Orozco, BA (SC); Maria Martinez, BS (SC); Craig McKeown, MD (UnM); Carla Osigian, MD (ME-VIS); Tuyet-Suong Pham, OD (VT); Leslie Small, OD (ME-VIS); Natalie Townsend, OD (ME-VIS). Study Centre: Pennsylvania College of Optometry (43) Michael Gallaway, OD (PI); Mark Boas, OD, MS (VT); Christine Calvert, Med (ME-ART); Tara Franz, OD (ME-VIS); Amanda Gerrouge, OD (ME-VIS); Donna Hayden, MS (ME-ART); Erin Jenewein, OD,MS (VT); Zachary Margolies, MSW, LSW (ME-ART); Shivakhaami Meiyeppen, OD (ME-VIS); Jenny Myung, OD (ME-VIS); Karen Pollack, (SC), Mitchell Scheiman, OD, PhD (ME-VIS); Ruth Shoge, OD (ME-VIS); Andrew Tang, OD (ME-VIS); Noah Tannen, OD (ME-VIS); Lynn Trieu, OD, MS (VT); Luis Trujillo, OD (VT) Study Centre - The Ohio State University College of Optometry (40) Marjean Kulp, OD, MS (PI); Michelle Buckland, OD, MS (ME-VIS); Allison Ellis, BS, MEd (ME-ART); Jennifer Fogt, OD, MS (ME-VIS); Catherine McDaniel, OD, MS (ME-VIS); Taylor McGann, OD (ME-VIS); Ann Morrison, OD, MS (ME-VIS); Shane Mulvihill, OD, MS (VT); Adam Peiffer, OD, MS (ME-VIS); Maureen Plaumann, OD (ME-VIS); Gil Pierce, OD, PhD (ME-VIS); Julie Preston, OD, PhD, MEd (ME-ART); Kathleen Reuter, OD (VT); Nancy Stevens, MS, RD, LD (SC); Jake Teeny, MA (ME-ART); Andrew Toole, OD, PhD (VT); Douglas Widmer, OD, MS (ME-VIS); Aaron Zimmerman, OD, MS (ME-VIS) Study Centre: Southern California College of Optometry (38) Susan Cotter, OD, MS (PI); Carmen Barnhardt, OD, MS (VT); Eric Borsting, OD, MSEd (ME-ART); Angela Chen, OD, MS (VT); Raymond Chu, OD, MS (ME-VIS); Kristine Huang, OD, MPH (ME-VIS); Susan Parker (SC); Dashaini Retnasothie (UnM); Judith Wu (SC) Study Center: Akron Childrens Hospital (34) Richard Hertle, MD (PI); Penny Clark (ME-ART); Kelly Culp, RN (SC); Kathy Fraley CMA/ASN (ME-ART); Drusilla Grant, OD (VT); Nancy Hanna, MD (UnM); Stephanie Knox (SC); William Lawhon, MD (ME-VIS); Lan Li, OD (VT); Sarah Mitcheff (ME-ART); Isabel Ricker, BSN (SC); Tawna Roberts, OD (VT); Casandra Solis, OD (VT); Palak Wall, MD (ME-VIS), Samantha Zaczyk, OD (VT) Study Centre: UAB School of Optometry (32) Kristine Hopkins, OD (PI 12/14 - present); Wendy Marsh-Tootle, OD, MS (PI 06/14 – 2/14); Michelle Bowen, BA (SC); Terri Call, OD (ME-VIS); Kristy Domnanovich, PhD (ME-ART); Marcela Frazier, OD MPH (ME-VIS); Nicole Guyette, OD, MS (ME-ART); Oakley Hayes, OD, MS (VT); John Houser, PhD (ME-ART); Sarah Lee, OD, MS (VT); Jenifer Montejo, BS (SC); Tamara Oechslin, OD, MS (VT); Christian Spain (SC); Candace Turner, OD (ME-ART); Katherine Weise, OD, MBA (ME-VIS) Study Centre: NOVA Southeastern University (31) Rachel Coulter, OD (PI); Deborah Amster, OD (ME-VIS); Annette Bade, OD, MCVR (SC); Surbhi Bansal, OD (ME-VIS); Laura Falco, OD (ME-VIS); Gregory Fecho, OD (VT); Katherine Green, OD (ME-VIS); Gabriela Irizarry, BA (ME-ART); Jasleen Jhajj, OD (VT); Nicole Patterson, OD, MS (ME-ART); Jacqueline Rodena, OD (ME-VIS); Yin Tea, OD (VT); Julie Tyler, OD (SC); Dana Weiss, MS (ME-ART); Lauren Zakaib, MS (ME-ART) Study Centre: Advanced Vision Care (15) Ingryd Lorenzana, OD (PI); Yesena Meza (ME-VIS); Ryan Mann (ME-ART); Mariana Quezada, OD (VT); Scott Rein, BS (ME-ART); Indre Rudaitis, OD (ME-VIS); Susan Stepleton, OD (ME-VIS); Beata Wajs (VT) National Eye Institute, Bethesda, MD Maryann Redford, DDS, MPH CITT-ART Executive Committee Mitchell Scheiman, OD, PhD; G. Lynn Mitchell, MAS; Susan Cotter, OD, MS; Richard Hertle, MD; Marjean Kulp, OD, MS; Maryann Redford, DDS, MPH; Carolyn Denton, PhD; Eugene Arnold, MD; Eric Borsting, OD, MSEd; Christopher Chase, PhD CITT-ART Reading Centre Carolyn Denton, PhD (PI); Sharyl Wee (SC); Katlynn Dahl-Leonard (SC); Kenneth Powers (Research Assistant); Amber Alaniz (Research Assistant) Data and Safety Monitoring Committee Marie Diener-West, PhD, Chair; William V. Good, MD; David Grisham, OD, MS, FAAO; Christopher J. Kratochvil, MD; Dennis Revicki, PhD; Jeanne Wanzek, PhD CITT-ART-Study Chair Mitchell Scheiman, OD, PhD (study chair); Karen Pollack (study coordinator); Susan Cotter, OD, MS; (vice chair); Marjean Kulp, OD, MS (vice chair) CITT-ART Data Coordinating Centre G Lynn Mitchell, MAS (PI); Mustafa Abraham (Student worker); Julianne Dangelo, BS (Program Assistant); Jordan Hegedus (Student worker); Ian Jones (Student worker); Lisa A Jones-Jordan, PhD (Epidemiologist); Alexander Junglas (Student worker); Jihyun Lee (Programmer); Jadin Nettles (Student worker); Curtis Mitchell (Student worker); Mawada Osman (Student worker); Gloria Scott-Tibbs, BA (Project Coordinator); Loraine Sinnott, PhD (Biostatistician); Chloe Teasley (Student worker); Victor Vang (Student worker); Robin Varghese (Student worker). 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
UR - http://www.scopus.com/inward/record.url?scp=85094676839&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85094676839&partnerID=8YFLogxK
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 -