Non-Surgical Interventions for Convergence Insufficiency

A Cochrane review [Abstract] 1 on the effectiveness of non-surgical interventions for ocular convergence insufficiency included 6 studies (3 in children, 3 in adults) with a total of 475 subjects. Evidence from the 4 studies graded at low risk of bias suggests:

• Base-in prism reading glasses was no more effective than placebo reading glasses in improving clinical signs or symptoms in children (1 trial).
• Outpatient vision therapy/orthoptics was more effective than home-based convergence exercises (or pencil push-ups as used in the US) in children. At 12 weeks, the mean difference in change in near point of convergence, positive fusional vergence, and CISS score from baseline was 3.99 cm (95% CI 2.11 to 5.86), 13.13 diopters (95% CI 9.91 to 16.35), and 9.86 points (95% CI 6.70 to 13.02), respectively (2 trials).
• Outpatient vision therapy/orthoptics in a young adult population was more effective than home-based convergence exercises in improving positive fusional vergence at near (7.7 diopters, 95% CI 0.82 to 14.58), but not the other outcomes (1 trial).
• Outpatient vision therapy/orthoptics was more effective than home-based computer vision therapy/orthoptics in children (1 trial comparing 4 interventions). At 12 weeks, the mean difference in change in near point of convergence, positive fusional vergence, and CISS score from baseline was 2.90 cm (95% CI 0.96 to 4.84), 7.70 diopters (95% CI 3.94 to 11.46), and 8.80 points (95% CI 5.26 to 12.34), respectively. Evidence was less consistent for other pair-wise comparisons.

In adult population, evidence of the effectiveness of various non-surgical interventions is less consistent.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).

References

• Scheiman M, Gwiazda J, Li T. Non-surgical interventions for convergence insufficiency. Cochrane Database Syst Rev 2011;3:CD006768 [PubMed]