Accommodative insufficiency

Abstract: Objective To compare vision therapy/orthoptics, pencil push-ups, and placebo vision therapy/orthoptics as treatments for symptomatic convergence insufficiency in children 9 to 18 years of age. Methods In a randomized, multicenter clinical trial, 47 children 9 to 18 years of age with symptomatic convergence insufficiency were randomly assigned to receive 12 weeks of office-based vision therapy/orthoptics, office-based placebo vision therapy/orthoptics, or home-based pencil push-ups therapy. Main Outcome Measures The primary outcome measure was the symptom score on the Convergence Insufficiency Symptom Survey. Secondary outcome measures were the near point of convergence and positive fusional vergence at near. Results Symptoms, which were similar in all groups at baseline, were significantly reduced in the vision therapy/orthoptics group (mean symptom score decreased from 32.1 to 9.5) but not in the pencil push-ups (mean symptom score decreased from 29.3 to 25.9) or placebo vision therapy/orthoptics groups (mean symptom score decreased from 30.7 to 24.2). Only patients in the vision therapy/orthoptics group demonstrated both statistically and clinically significant changes in the clinical measures of near point of convergence (from 13.7 cm to 4.5 cm; P P Conclusions In this pilot study, vision therapy/orthoptics was more effective than pencil push-ups or placebo vision therapy/orthoptics in reducing symptoms and improving signs of convergence insufficiency in children 9 to 18 years of age. Neither pencil push-ups nor placebo vision therapy/orthoptics was effective in improving either symptoms or signs associated with convergence insufficiency.

Abstract: :PurposeTo estimate the frequency of convergence insufficiency (Cl) and its related clinical characteristics among 9- to 13-year-old children. Methods. Fifth and sixth graders were screened in school settings at three different study sites. Eligible children with 20/30 or better visual acuit

Abstract: BACKGROUND The purpose of this article was to investigate the association between convergence insufficiency (CI) and accommodative insufficiency (AI) and symptoms in a group of school-aged children. METHODS Children ages 8 to 15 years were recruited from two public and 2 private elementary schools in Southern California. The CI Symptom Survey (CISS) was administered to all children before a Modified Clinical Technique vision screening. Children with normal visual acuity, minimal uncorrected refractive error, and no strabismus were tested for CI and Al. RESULTS Four hundred sixty nine children were initially screened and 392 participated in testing for CI and AI. Fifty-five percent of the children (218) were classified as having normal binocular vision (NBV), 4.6% (18) had three signs of CI, 12.7% (50) had two signs of CI, 10.5% (41) were classified as AI (with no signs of CI), and 16.6% (65) were classified as other. The symptom score was 3.78 for the NBV group, 4.6 for the two-sign CI group, 6.67 for the three-sign CI group, and 6.37 for the Al group. The three-sign CI and the Al groups scored significantly higher than the NBV group on the CISS (p < or = 0.001). CONCLUSION CI and AI are common conditions in school-age children and are associated with increased symptoms.

Abstract: BACKGROUND The purpose of this study was to fill a significant void in the ophthalmic literature by performing a large scale, comprehensive, prospective study of the prevalence of vision disorders and ocular pathology in a clinical pediatric population using well-defined diagnostic criteria. METHODS A prospective study was performed on 2,023 consecutive patients between the ages of 6 months and 18 years presenting for an initial comprehensive examination at the Eye Institute of The Pennsylvania College of Optometry. There were 373 subjects between 6 months and 5 years, 11 months of age, and 1,650 subjects between 6 years and 18 years of age. RESULTS The most important finding from this study is that other than refractive anomalies, the most common conditions optometrists are likely to encounter in a pediatric population are binocular vision and accommodative disorders. The prevalence of accommodative and binocular (strabismic and non-strabismic) vision disorders is 9.7 times greater than the prevalence of ocular disease in children 6 months to 5 years of age, and 8.5 times greater than the prevalence of ocular disease in children 6 to 18 years of age. CONCLUSIONS The data from this study has great significance for clinicians, optometric educational institutions, health care planners, and administrators. This data suggests that other than refractive anomalies, the most prevalent conditions in the clinical pediatric population are binocular and accommodative disorders. Clinicians should use a minimum data base that includes assessments of accommodation and binocular vision that will allow them to detect conditions with the highest prevalence.