Enrollment began in August 2015 and will end in March 2017. Convergence insufficiency is a common eye muscle co-ordination problem in which the eyes have a strong tendency to drift outward (exophoria) when reading or doing close work. What are the benefits of the exercises? Our health evidence - how can it help you. The most common issues that tend to arise and be addressed at physical therapy include musculoskeletal issues to the … Treatment for convergence insufficiency. Objective: This report describes the design and methodology of the Convergence Insufficiency Treatment Trial (CITT), the first large-scale, placebo-controlled, randomized clinical trial evaluating treatments for convergence insufficiency (CI) in children.We also report the clinical and demographic characteristics of patients. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. No. Cochrane Database of Systematic Reviews 2020, Issue 12. Compared with placebo treatment, office-based vergence accommodative therapy was relatively more effective in improving PFV (MD 16.73, 95% CI 6.96 to 26.60), but there was no evidence of a difference for NPC or the CISS score. Writer Bio. Efficacy of treatment for convergence insufficiency using vision therapy Adler, Paul 2002-11-01 00:00:00 Introduction Convergence insufficiency (CI) is characterised by some authors primarily by an extended near point of convergence (NPC) and is frequently associated with asthenopic symptoms for near work. There are two main types of treatment for convergence insufficiency: 1) prism-lensed reading glasses, designed to improve visual comfort, and 2) eye (vision) therapy designed to restore normal visual function and improve visual comfort. Orthoptics Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham B15 2GW Telephone: 0121 371 6462 The Trust provides free monthly health talks … Art. Convergence Insufficiency (CI) Nowadays, there appears to be sufficient evidence supporting vision therapy (orthoptic therapy) for the treatment of symptomatic CI. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. This can cause eye strain, headaches, blurred and double vision. CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. No experience or expertise needed, just 30 minutes to volunteer for a study where you will read 2 summaries and answer questions. The Convergence Insufficiency Treatment Trial–Attention & Reading Trial (CITT-ART) was a multicenter, double-masked, randomized clinical trial designed to determine if office-based vergence/accommodative therapy resulted in improvements in reading 16 and attention in 9- to 14-year-old children with symptomatic convergence insufficiency. A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. When a child visits our team, we'll work through several steps. Optom. Primary CI is thought to be caused by an imbalance of vergence eye movements that is either an inborn deficiency or an acquired etiology. Acad. A randomized clinical trial of treatments for convergence insufficiency in children. The study is registered at ClinicalTrials.gov as the Convergence Insufficiency Treatment Trial-ART (CITT-ART: NCT02207517). Convergence insufficiency (CI) is a neuromuscular deficiency of binocular eye alignment (Grisham, 1988) characterized by a reduction in the degree of convergence or the inability to maintain the necessary convergence of the eyes on a near target while keeping this target single, clear, and comfortable to look at.CI is associated with a wide range of symptoms, … If this add is given to a CI patient, it could exacerbate the symptoms. Participants were children and adults with symptomatic convergence insufficiency. One trial evaluated base-in prism glasses prescribed for near-work activities and found that the prism glasses group had fewer symptoms compared with the placebo glasses group at three months (MD -8.9, 95% CI -11.6 to -6.3). Convergence Insufficiency Treatment Trial Study Group. However, there may be no evidence of any treatment difference between home-based computer vergence/accommodative therapy and home-based pencil/target push-ups (RR 1.44, 95% CI 0.93 to 2.24; low-certainty evidence), or between either of the two home-based therapies and placebo therapy, for the outcome of treatment success. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. Investimentos - Seu Filho Seguro. 1. Cooper, J. The study found that in-office Vision Therapy was the best available treatment for convergence insufficiency, replacing conventional therapies such as "pencil push-ups", with 75% of patients showing significant improvement following vision therapy. You will be shown how to do these exercises. He has contributed health, fitness and nutrition articles to various online publications, … Off. The evidence in this Cochrane Review is current to September 2019. Patients’ completing a course of exercises for convergence insufficiency benefit by being able to read and focus more comfortably. Convergence describes the way our eyes move together and point inward when we look at near objects. Convergence insufficiency is a common vision disorder in which a person's eyes tend to drift outwards when they try to use their eyes together up close. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Ophthalmol. Convergence Insufficiency Treatment. 3. Diagnostic criteria and outcome measures were identical or similar among these trials. The Convergence Insufficiency Treatment Trial–Attention & Reading Trial Investigator Group Clinical Sites. Eyes (or the person) feels tired or fatigued after a short amount of near work. Please note, this page is printable by selecting the normal print options on your computer. Optom. When treatment … The study also evaluates the associated symptoms before and after therapy. Jump convergence and dotted card are the other exercises for Convergence Disorder or Convergence Insufficiency. Convergence Insufficiency Is a condition where there is difficulty coordinating the eyes to focus on near objects closer than 10cm from the nose. In-office Optometric Vision Therapy is proven to be the most effective treatment for Convergence Insufficiency by a national multi-site peer-reviewed study which was conducted by the National Institutes of … The CISS is a 15-item questionnaire designed to assess the severity of the subject’s convergence insufficiency (CI) symptoms. Chic. He has contributed health, fitness and nutrition articles to various online publications, … CI affects children and adults. Results from recent scientific studies show that at least 1 out of every 20 people (5%) have Convergence Insufficiency. When unresponsive to orthoptic therapy, other treatment options include optical correction with base-in prisms or surgical intervention in cases associated with a near exophoria. When treatment success was defined as the composite convergence and symptom success outcome, we found moderate-certainty evidence that participants who received office-based vergence/accommodative therapy with home reinforcement were 5.12 (95% CI 2.01 to 13.07) times more likely to achieve treatment success than those who received placebo therapy. Scheiman, M. et al. There are two main types of treatment for convergence insufficiency… We followed standard Cochrane methodology. Publ. With convergence insufficiency … We bet you can get a pencil cheaper than $0.99, but if you can’t, here’s an app for you. In general, looking at a close object causes the eyes to turn inward, allowing them to focus. & Jamal, N. Convergence insufficiency-a major review. Scheiman, M. et al. These exercises may be prescribed by an orthoptist (a medical technician who is specifically trained in ocular muscle function and binocular vision) or by an ophthalmologist. No study, in children or adults, reported any adverse effects related to study treatments. Participants age 9 to14 years in grades 3 to 8 are randomized to: 1) office-based … 2. At Artisan Optics we diagnose and treat convergence insufficiency. We focus on vision therapy as the most effective treatment for convergence insufficiency. Methods: We prospectively randomized children … When treatment … Evidence from three studies indicated that office-based therapy could be more effective than placebo for improving convergence when it was measured one way (‘positive fusional vergence’), but not when measured another way (‘near point convergence’). Different types of vision therapy are prescribed for the treatment of convergence insufficiency that aim to improve the affected person’s convergence ability (the ability of eyes to turn inwards). St Louis Mo 83, 137–158 (2012). A pulling sensation can be felt around the eyes. A concussion can affect many systems of the body, including but not limited to the visual, musculoskeletal, vestibular, cardiovascular, central nervous, and peripheral nervous systems. Abstract. A recent study by the Convergence Insufficiency Treatment Trial Investigator Group gathered important data about the symptoms of convergence insufficiency in a series of studies (2008 Reference, 2005 Reference ?). We rated only one RCT at low risk of bias. Vis. Search. The study analyzed 18 patients with convergence insufficiency who were assigned either to anaglyphs or a VR game called “Snakes.” The prescribed training regimen was 20 minutes, three times a week for six weeks. Ill 1960 123, 14–24 (2005). As a result, the two eyes’ visual axes do not intersect on the object being viewed. Below you will find information about convergence, including convergence insufficiency, and activities to improve convergence skills. The exercises I have been given Date Exercise Minutes Times per day. Am. Objectives: To … Ophthalmol. It often goes undiagnosed. We found low-certainty evidence that participants who received office-based vergence/accommodative therapy with home reinforcement might be 4.41 (95% CI 1.26 to 15.38) times more likely to achieve treatment success than those who received home-based pencil push-ups, and 4.65 (95% CI 1.23 to 17.54) times more likely than those who received home-based computer vergence/accommodative therapy. There was no evidence of any treatment difference between home-based pencil push-ups and home-based computer vergence/accommodative therapy, or between either of the two home-based therapies and placebo therapy. Stage Design - A Discussion between Industry Professionals. Arch. Treatment that is typically recommended by optometrists includes either … One study compared prism reading glasses against placebo reading glasses, and found no evidence of a difference in improvement in convergence or symptoms. It may not always be evident that someone suffers from convergence insufficiency because the symptoms may vary. to diagnose convergence insufficiency. & Jamal, N. Convergence insufficiency-a major review. Investimentos - Seu Filho Seguro. These may include some or all of the following: • frontal … Results depend on your active participation and compliance with the program, whether in-office or at home. You can do these exercises at home. High-certainty evidence indicates that, office-based therapy with home reinforcement is more effective than home-based pencil push-ups, home-based computer therapy, and placebo for treating convergence insufficiency in children. Results in adults Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. Diagnostic criteria and outcome measures were identical or similar among these trials. Alternatively, it can consist of a sequence of activities individually prescribed and monitored by the doctor, administered by trained therapists in an office setting along with practice at home (office-based therapy with home reinforcement). Children responded quickly to this treatment … Current studies in the form of randomized control trials (RCT) indicate that office-based therapy together with home therapy is the most effective treatment at reducing symptoms and clinical findings. Studies lasted for between six weeks and six months. Convergence insufficiency treatment. Arch. With CI, the eyes do not point together inward as one looks at objects close-up. The study also evaluates the associated symptoms before and after therapy. 4. Convergence Insufficiency (CI) is one of the leading causes of eyestrain, blurred vision, double vision (diplopia), and/or headaches.1, Nowadays, there appears to be sufficient evidence supporting vision therapy (orthoptic therapy) for the treatment of symptomatic CI. How did we identify and evaluate the evidence? The Convergence Insufficiency Treatment Trial study conducted by the National Eye Institute (NEI) revealed that supervised vision therapy with home reinforcement is the most effective treatment for CI. Orthoptic therapy to increase fusional convergence amplitudes and enhance voluntary convergence is the primary treatment of convergence insufficiency. We found 12 studies with a total of 1289 people with convergence insufficiency. Convergence insufficiency treatment exercises may use specialized equipment and tools such as prisms, lenses, and computerized technology, to stimulate the brain to better control the two eyes simultaneously. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. Six RCTs in the adult population randomized 321 participants. When reading, people with convergence insufficiency frequently lose their place or have to re-read text. Symptoms of convergence insufficiency typically manifest … Symptoms may include eye strain, headaches, double vision, print moving on the page, frequent loss of place when reading, inability to concentrate, and short attention span. It may seem like an exaggeration but having convergence insufficiency can influence life's path and treating it can be truly life … Miguel Cavazos is a photographer and fitness trainer in Los Angeles who began writing in 2006. 9 … There is only ONE diagnosis, convergence insufficiency, that has ever proven to benefit from “eye exercises.” AND standard convergence insufficiency treatment requires one piece of equipment — an ordinary pencil! Convergence Insufficiency (CI) is a common binocular (two-eyed) vision disorder in which the eyes do not work at near easily. For improving convergence ability, high-certainty evidence showed that office-based therapy with home reinforcement is better than placebo, home-based computer therapy, and home-based pencil push-ups. In adults, evidence of the effectiveness of various non-surgical interventions is less clear. 17 The results showed that … Some of these exercises are done while looking through prisms. Optom. Based on our assessments, we categorized the evidence as being of very low-, low-, moderate-, or high-certainty. Publ. No adverse effects related to study treatments were reported for any of the included studies. Orthoptics Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham B15 2GW Telephone: 0121 371 6462 The Trust provides free monthly health talks … If your child does the exercises regularly, his or her symptoms may go away in a fairly short period of time. Sci. St Louis Mo 83, 137–158 (2012). Convergence insufficiency is a common vision disorder in which a person's eyes tend to drift outwards when they try to use their eyes together up close. One study compared glasses with prism lenses against placebo glasses, and found that adults with prism glasses reported fewer symptoms. Chic. In Convergence Insufficiency: Part 1 we discussed the signs and symptoms of convergence insufficiency, a common eye teaming deficit. Children responded quickly to this treatment … It is the #1 visual issue to cause eyestrain, blurry vision, double vision (diplopia), as well as headaches. The NEI Convergence Insufficiency Treatment Trial (CITT) has shown that the most effective treatment for CI is in-office therapy, overseen by a trained therapist, with additional at-home exercises. People with convergence insufficiency often complain of the following symptoms when reading or doing intense near work: The four CITT RCTs contributed data to the pediatric NMA, incorporating interventions 1, 2, 3 and 5. In children, convergence insufficiency can often be treated by practicing convergence through exercises. During this simple workout, you centre on a tiny letter on the edge of a pencil while you move it nearer to the point of your nose, ending the movement when you hold double vision . These activities can be used by occupational therapists in treatment as indicated by vision screening and based on the individual needs of the child as determined by assessment. Diagnosis of CI was based on the published criteria from the “Convergence insufficiency treatment trial (CITT)” 18, 19: (1) exophoria at near (0.4 m) at least four prism diopters (∆) greater than at far (6 m); (2) a receded NPC break of 6 cm or greater; and (3) insufficient PFV at near (PFV less than twice the amount of the near phoria) or a break on PFV of ≤15 ∆ base‐out. CI is classically defined as exophoria at near with reduced near point of convergence (NPC) and reduced … Scheiman, M. et al. Off. Stage Design - A Discussion between Industry Professionals. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. Are there any adverse effects from treatment? During this blog we will discuss the good stuff; diagnosis and treatment of convergence insufficiency. Patients’ completing a course of exercises for convergence insufficiency benefit by being able to read and focus more comfortably. 2. Symptoms often associated with poor convergence. Convergence insufficiency may be treated by visual exercises designed to increase convergence while maintaining single, clear, binocular vision. Copyright © 2021 The Cochrane Collaboration. Your child will be shown how to do these exercises. Search. Convergence insufficiency (CI) is a treatable near vision disorder and eye muscle coordination problem that can not be repaired with eye surgery, medications, standard eyeglasses, or contact lenses. Pencil pushups are usually the first line of treatment for convergence insufficiency. What does this mean? Acad. Chic. Convergence Insufficiency Treatment Trial Study Group. Convergence Insufficiency (CI) is a common eye-teaming problem in which the eyes have difficulty turning in to read and see during up close work. These questions can give the pediatrician an … DOI: 10.1002/14651858.CD006768.pub3. In contrast, a Pseudo-CI patient would benefit from an add to help the focusing system. 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