The United States Department of Health and Human Services, National Eye Institute just released the results of the landmark $6.1 million multicenter Convergence Insufficiency Treatment Trial (CITT) on October 13, 2008. According to the National Institute of Health, scientists have now proven that office-based vision therapy is the only effective treatment for convergence insufficiency (CI) compared to the other common methods used by doctors to treat CI.
Convergence Insufficiency (CI) is a public health concern due to the relative high incidence among children. Studys have shown that CI occurs as often as 5-18% within children of elementary school age in the US.
The CITT research investigators tested the efficicacy of 4 approaches to treatment of Convergence Insufficiency.
- Pencil Push-ups Therapy (PPT). This form of treatment has been a commonly prescribed by eye doctors to parents for their children with CI and involves looking at the letters on a pencil while the pencil is brought closer to the end of the child's nose. The goal is for the patient to try to maintain convergence on the pencil while the target is progressively brought closer to the eyes. PPT is a home based eye-exercise approach to treating CI.
- Home-based computer programs along with pencil push-up therapy (HBCVAT+). This approach uses computer based programs to help with convergence and eye focusing along with pencil push-ups.
- Office-based Placebo Therapy (OBPT). This treatment was the placebo group in the research project who "thought" they were receiving regular vision therapy along with home reenforcement activities. In this case while the patient thought they were getting vision therapy, instead they were being provided a series of drills that mimicked vision therapy and therefore served as the "control group".
- Office-based Vision Therapy (OBVT). This treatment group received weekly sessions of 60 minute in-office therapy (following a standardized approach) along with home reenforcement activities.
The research was conducted by a team of investigators at the following sites:
- Bascom Palmer Eye Institute - Miami Florida
- Mayo Clinic - Rochester, Minnesota
- University of California - San Diego Ratner Children's Eye Center
- State University of New York College of Optometry
- University of Alabama at Birmingham School of Optometry
- NOVA Southeastern University - Fort Lauderdale, Florida
- Pennsylvania College of Optometry - Philadelphia, Pennsylvania
- The Ohio State University- Columbus, Ohio
- Southern California College of Optometry - Fullerton, California
The results found that only Office-based Vision Therapy (OBVT) was effective in treating convergence insufficiency in children and that "pencil push-up" therapy, as well as the home based computer programs plus pencil push-up therapy, was no more effective than placebo therapy.
The public health conclusion from this research is that children who have been diagnosed with Convergence Insufficiency should be sure to work with a doctor who provides or will refer to a doctor who provides office based vision therapy. To find a doctor who provides vision therapy, be sure to contact the doctor locator at the College of Optometrists in Vision Development (COVD). Those who are Fellows are Board Certified in Vision Therapy.
Dan L. Fortenbacher, O.D., FCOVD
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