Study Finds Best Treatment for Common Childhood Eye Problem

A combination of in-office therapy and at-home treatment is the best solution for a common childhood eye problem, optometrists at Nova Southeastern University (NSU) have found.

The team, led by Stacey Coulter, O.D., worked with researchers across the country to determine which treatment works best for a condition known as convergence insufficiency.

Convergence insufficiency, which is common among children, is a condition in which patients cannot accurately point their eyes together, so they see double or have eye strain. Other symptoms of convergence insufficiency include loss of place, loss of concentration, reading slowly, headaches, and blurry vision. It affects some patients’ ability to learn.

“This study has sparked a lot of interest because people are concerned about conditions that can impact learning,” Coulter says.

Traditionally, the majority of eye care professionals treated children diagnosed with convergence insufficiency using some form of home-based therapy. This study concludes that office-based treatment by a trained therapist along with at-home reinforcement is more effective.

The research, reported in the Oct.13 issue of Archives of Ophthalmology, was funded by the National Eye Institute, part of the National Institutes of Health.

The 12-week Convergence Insufficiency Treatment Trial (CITT) study 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.

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 convergence insufficiency. 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.

The study involved NSU and eight other universities, eye institutes, and medical centers. NSU received a $387,764 grant from the National Eye Institute for the project. Coulter completed this project with seven other NSU College of Optometry faculty members -- Annette Bade, O.D., Jackie Rodena, O.D., Mary Bartuccio, O.D., Yin Tea, O.D., Deborah Amster, O.D, Greg Fecho, O.D., and Tanya Mahaphon, O.D.