A Randomized Clinical Trial of Vision Therapy/Orthoptics versus Pencil Pushups for the Treatment of Convergence Insufficiency in Young Adults

ABSTRACT: Purpose. The purpose of this article is to compare vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics as treatments for symptomatic convergence insufficiency in adults 19 to 30 years of age. Methods. In a randomized, multicenter clinical trial, 46 adults 19 to 30 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 pushups. 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. Only patients in the vision therapy/orthoptics group demonstrated statistically and clinically significant changes in the near point of convergence (12.8 cm to 5.3 cm, p = 0.002) and positive fusional vergence at near (11.3Δ to 29.7Δ, p = 0.001). Patients in all three treatment arms demonstrated statistically significant improvement in symptoms with 42% in office‐based vision therapy/orthoptics, 31% in office‐based placebo vision therapy/orthoptics, and 20% in home‐based pencil pushups achieving a score <21 (our predetermined criteria for elimination of symptoms) at the 12‐week visit. Discussion. In this study, vision therapy/orthoptics was the only treatment that produced clinically significant improvements in the near point of convergence and positive fusional vergence. However, over half of the patients in this group (58%) were still symptomatic at the end of treatment, although their symptoms were significantly reduced. All three groups demonstrated statistically significant changes in symptoms with 42% in office‐based vision therapy/orthoptics, 31% in office‐based placebo vision therapy/orthoptics, and 20% in home‐based pencil push‐ups meeting our criteria for elimination of symptoms.