Treating Convergence Insufficiency

Scientists have found a more effective treatment for a common childhood eye muscle coordination
problem called convergence insufficiency (CI). For words on a page to appear in focus a child's
eyes must turn inward, or converge. In CI, the eyes do not converge easily, and as a result, additional
muscular effort must be used to make the eyes turn in.

While the majority of eye care professionals treat children diagnosed with CI using some form of
home-based therapy, a new study concludes that office-based treatment by a trained therapist along
with at-home reinforcement is more effective. The 12-week study, known as the Convergence
Insufficiency Treatment Trial (CITT), found that approximately 75 percent of those who received
in-office therapy by a trained therapist plus at-home treatment reported fewer and less severe
symptoms related to reading and other near work. Symptoms of CI include loss of place, loss of
concentration, reading slowly, eyestrain, headaches, blurry vision, and double vision.

The CITT, which included 221 children age 9 to 17, is the first to compare three forms of vision therapy
and a placebo therapy option. The first therapy was the current treatment standard known as
home-based pencil push-up therapy, an exercise in which patients visually followed a small letter on a
pencil as they moved the pencil closer to the bridge of their nose. The goal was to keep the letter clear
and single, and to stop if it appeared double.

The second group used home-based pencil push-ups with additional computer vision therapy. The
third attended weekly hour-long sessions of office-based vision therapy with a trained therapist and
performed at-home reinforcement exercises. The last group was given placebo vision activities
designed to simulate office-based therapy.

After 12 weeks of treatment, nearly 75 percent of children who were given the office-based vision
therapy along with at-home reinforcement achieved normal vision or had significantly fewer symptoms
of CI. Only 43 percent of patients who completed home-based therapy alone showed similar results, as
did 33 percent of patients who used home-based pencil push-ups plus computer therapy and 35
percent of patients given a placebo office-based therapy.

"There are no visible signs of this condition; it can only be detected and diagnosed during an eye
examination," said principal investigator Mitchell Scheiman, O.D., of Pennsylvania College of
Optometry at Salus University near Philadelphia, Pa. "However, as this study shows, once diagnosed,
CI can be successfully treated with office-based vision therapy by a trained therapist along with
at-home reinforcement. This is very encouraging news for parents, educators, and anyone who may
know a child diagnosed with CI."

The National Eye Institute (NEI) a component of the National Institutes of Health is the federal
government's lead agency for vision research that leads to sight saving treatments and plays a key role
in reducing visual impairment and blindness. For more information, visit the NEI Web site at
www.nei.nih.gov/.