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      Effectiveness of Vision Therapy in School Children with Symptomatic Convergence Insufficiency

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          Abstract

          Purpose:

          To determine the effectiveness of vision therapy among Korean elementary school children with convergence insufficiency.

          Methods:

          A total of 235 elementary schoolchildren, 10.13 ± 2.45 years of age, were subjected to thorough eye examination including binocular vision testing. Of them, 32 individuals with symptomatic convergence insufficiency without strabismus, amblyopia, and ocular disease were chosen to receive vision therapy via brock string, barrel card, mirror stereoscope, prism goggles, and aperture rule for a duration of 8 weeks.

          Results:

          The results showed that most of the participants had severe problems in near point of convergence. After the vision therapy, the average near point of convergence improved by approximately 5.48 ± 0.96 cm in all participants. Moreover, vision therapy had an effect on increasing near positive fusional vergence and decreasing exophoria. Negative relative accommodation improved to 2.54 ± 0.51 and positive relative accommodation improved to −3.10 ± 1.08 diopters. After treatment, near phoria was 4.19 ± 1.66 and distance phoria was 1.61 ± 0.71 prism diopters.

          Conclusion:

          Among convergence insufficiency symptoms, the following improved in particular: near point of convergence, exophoria, and near positive fusional vergence. These findings suggest that vision therapy is very effective to recover from symptomatic convergence insufficiency.

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          Most cited references15

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          Randomized clinical trial of treatments for symptomatic convergence insufficiency in children.

          (2008)
          To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency. In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic convergence insufficiency were assigned to 1 of 4 treatments. Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near. After 12 weeks of treatment, the OBVAT group's mean Convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of 21.3, 24.7, and 21.9 in the HBCVAT+, HBPP, and OBPT groups, respectively (P < .001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (P
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            Prevalence of general binocular dysfunctions in a population of university students.

            Although some authors report that the prevalence of general binocular dysfunctions (nonstrabismic) for nonpresbyopes in the clinical population is greater than any condition except refractive error, limited research is available to support this statement. This clinical study determined the presence and clinical implications of these conditions in a population of university students with heavy near visual demands. From a group of second year students who were given a thorough eye examination, 65 students were selected. The criteria for selection were the absence of significant uncorrected refractive error, healthy eyes, and no strabismus or amblyopia. 32.3% of the subjects showed general binocular dysfunctions. In 10.8% of the cases, accommodative excess was present. 7.7% had convergence insufficiency with accommodative excess. 6.2% showed accommodative insufficiency. 3.1% had basic exophoria. Convergence excess with accommodative insufficiency, basic esophoria, and fusional vergence dysfunction all showed the same prevalence of 1.5%. Accommodative and nonstrabismic binocular vision problems are prevalent in this population. Accommodative excess is the most common condition. Because these dysfunctions may have a negative effect on performance, appropriate vision evaluation for this population is important.
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              Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children.

              To compare base-in prism reading glasses with placebo reading glasses for the treatment of symptomatic convergence insufficiency (CI) in children aged 9 to <18 years. In a randomised clinical trial, 72 children aged 9 to <18 years with symptomatic CI were assigned to either base-in prism glasses or placebo reading glasses. Symptom level, measured with a quantitative symptom questionnaire (CI Symptom Survey-V15), was the primary outcome measure. Near point of convergence and positive fusional vergence at near were secondary outcomes. The mean (SD) CI Symptom Survey score decreased (that is, less symptomatic) in both groups (base-in prism glasses from 31.6 (10.4) to 16.5 (9.2); placebo glasses from 28.4 (8.8) to 17.5 (12.3)). The change in the CI Symptom Survey scores (p = 0.33), near point of convergence (p = 0.91), and positive fusional vergence (p = 0.59) were not significantly different between the two groups after 6 weeks of wearing glasses. Base-in prism reading glasses were found to be no more effective in alleviating symptoms, improving the near point of convergence, or improving positive fusional vergence at near than placebo reading glasses for the treatment of children aged 9 to <18 years with symptomatic CI.
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                Author and article information

                Journal
                J Ophthalmic Vis Res
                J Ophthalmic Vis Res
                JOVR
                Journal of Ophthalmic & Vision Research
                Medknow Publications & Media Pvt Ltd (India )
                2008-2010
                2008-322X
                Apr-Jun 2017
                : 12
                : 2
                : 187-192
                Affiliations
                [1 ] Department of Optometry, Eulji University, Seongnam, South Korea
                [2 ] Department of Sport Health, Jellanamdo Office of Education, Republic of Korea
                [3 ] Gradute School of Technology Management, Kyung Hee University, Republic of Korea
                [4 ] Department of Sports & Outdoors, College of Health Industry Eulji University, South Korea
                Author notes
                Correspondence to: Hwang Woon Moon. Department of Sports and Outdoors, College of Health Industry, Eulji University, Sanseong-daero, Sujeong-gu, Seongnam si, Gyeonggi-do 461-713E, South Korea. E-mail: mhwgo21@ 123456eulji.ac.kr
                Article
                JOVR-12-187
                10.4103/jovr.jovr_249_15
                5423373
                d2bec114-eead-457f-8b8f-b5d7506ae6fa
                Copyright: © 2017 Journal of Ophthalmic and Vision Research

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 16 November 2015
                : 02 November 2016
                Categories
                Original Article

                Ophthalmology & Optometry
                convergence insufficiency,near point of convergence,school children,vision therapy

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