Purpose To determine the effectiveness of office‐based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction. Methods We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial – Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. Results From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). Conclusion Office‐based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.

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Purpose To evaluate the impact of surgical factors such as incision type, number of sutures, and technique of closure on postoperative astigmatism in infants undergoing cataract extraction with or without intraocular lens implantation. Methods The IATS is a multicenter (n=12) clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with intraocular lens (IOL) placement or contact lens aphakic correction. Surgical videos were reviewed with regard to incision type and location, whether the incision was extended, the number of sutures placed, and technique of closure. Corneal astigmatism was measured using a handheld keratometer prior to surgery and at 1 year of age. Results Corneal astigmatism decreased from a mean of 1.92 D at baseline to 1.62 D at age 1 year in the CL group, but remained almost unchanged from 2.00 D to 2.09 D in the IOL group (p=0.023). There was no statistical difference between the amount of corneal astigmatism irrespective of incision type (p=0.214) and no increase in astigmatism with extension of the incision to facilitate IOL placement (p=0.849) at 1 year. The number of sutures and technique of closure did not influence the amount of astigmatism at 1 year. Conclusions At the age of one year following cataract extraction in infants, contact lens correction and the lack of IOL placement are associated with a significant decrease in postoperative corneal astigmatism compared to intraocular lens placement. No other surgical factors considered in this study had a statistically significant impact on corneal astigmatism.