Interventions for convergence insufficiency: a network meta-analysis

Scheiman, Mitchell; Kulp, Marjean Taylor; Cotter, Susan A.; Lawrenson, John G; Wang, Lin; Li, Tianjing

doi:10.1002/14651858.cd006768.pub3

Cited by 30 publications

(29 citation statements)

References 91 publications

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“…The overall success rate of 71% after 12 weeks was comparable to previous studies in which vergence and monocular accommodation exercises had been combined for the entire treatment period. 7 Among the participants with partial recovery and among nonresponders, the improvement of objective measures (82.4%) was better than that of subjective measures (52.9%; data not shown) suggesting that acquired oculomotor skills may have required conscious efforts with a consequent induction of fatigue. 18 , 19 This suggests that an extension of the treatment period beyond 12 weeks might have been beneficial for a minority of the children.…”

Section: Discussionmentioning

confidence: 85%

“… 4 Several studies have shown that school children diagnosed with CI have abnormal accommodation, 5 , 6 which is reflected in clinical guidelines for the treatment of CI that include exercises for both monocular accommodation and vergence, the latter including exercises for antisuppression and awareness of diplopia. 7 The effect of exercises aimed at improving vergence is assessed by measuring positive fusional vergence, vergence facility, and near point of convergence, whereas the effect on accommodation is assessed by measuring amplitude of accommodation and accommodation facility. 8 It has been shown that these measures of vergence and accommodation develop independently of each other in the age group of 7 to 15 year olds.…”

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confidence: 99%

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Vergence Exercises for Six Weeks Induce Faster Recovery of Convergence Insufficiency Than Accommodation Exercises in School Children

Maagaard¹,

Nisted²,

Bek

2021

Invest. Ophthalmol. Vis. Sci.

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Purpose Convergence insufficiency (CI) is characterized by abnormal vergence eye movement frequently accompanied by abnormal accommodation and subjective symptoms, such as headache, blurred vision, and diplopia. CI is treated with vergence and accommodation exercises that are integrated so that the relative contributions of vergence and accommodation exercises to the outcome are concealed. The purpose of the present study was to determine the individual contributions of vergence and accommodation exercises for the treatment of CI in school children. Methods In a prospective crossover study 44 children aged 9 to 13 years with CI were randomized to perform either vergence exercises followed by accommodation exercises each for 6 weeks or the 2 treatment regimes in the reverse order. The outcome measures were recovery from CI and the parameters vergence facility, positive fusional vergence, near point of convergence, monocular amplitude, and facility of accommodation. Results After the first 6-week period, full recovery from CI was significantly more frequent in the group commencing vergence exercises than in the group commencing monocular accommodation exercises ( p = 0.01), whereas there was no significant difference between these proportions after the second 6-week period ( p = 0.45). Vergence facility and positive fusional vergence improved significantly more after the period with vergence exercises than after the accommodation exercises, whereas there was no significant difference between the effects of the two types of exercises on the other studied parameters. Conclusions Vergence treatment induces a faster recovery of CI than accommodation treatment in school children. This may be used to improve compliance and success rate of the treatment.

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Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

Vergence Exercises for Six Weeks Induce Faster Recovery of Convergence Insufficiency Than Accommodation Exercises in School Children

Maagaard¹,

Nisted²,

Bek

2021

Invest. Ophthalmol. Vis. Sci.

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“…The use of vectograms in vision therapy is a common procedure to improve vergence fusional ranges and step vergences [ 1 , 2 , 3 , 4 , 7 ]. In natural conditions (dual closed loop), multiple monocular and binocular cues, such as target blur, disparity, and proximity, elicit accommodative and vergence responses [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Vision therapy has been employed in optometry to effectively improve binocular dysfunctions such as convergence insufficiency [ 1 , 2 , 3 , 4 ] and accommodative insufficiency [ 5 ]. Target blur, disparity, and proximity may be minutely altered through visual therapy to normalize the accommodative system, the vergence system and their interactions [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Vergence and Accommodation Cues in Stereo-Localization during the Small-In Large-Out (SILO) Effect

Argilés

Cardona

Hosa-Vila

et al. 2022

Vision

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A typical procedure in vision therapy is the use of Quoits vectograms to train fusional vergence ranges by improving stereo-localization, which is the ability to correctly locate the target stimulus in space. With this procedure, the Small-In Large-Out (SILO) effect is usually reported in patients with normal binocular vision and accommodation. In this study, the influence of vergence and accommodation cues, as determined with the accommodative-convergence over accommodation (AC/A) ratio, to correctly locate the Quoits vectograms in space was investigated. Twenty participants, aged 29.2 ± 2.8 (mean ± standard deviation) years, without amblyopia or strabismus, were recruited. A geometrical formula was obtained to calculate the theoretical distance to the target stimulus for different vergence demands. Theoretical values were compared with measured distances to the perceived stimuli and stereo-localization accuracy was determined. Stereo-localization accuracy was significantly worse at 10∆ Base In vergence demand (p < 0.001). A statistically significant positive correlation was found between AC/A ratio and stereo-localization accuracy (i.e., worse accuracy) at 10Δ Base Out vergence demand (rho = 0.446, p = 0.049). These findings highlight that AC/A ratio may be a secondary cue for stereo-localization when using vectograms in which the SILO effect is manifest. These results assist in the understanding of the physiological basis of vision therapy procedures.

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“…Surgical treatment of the convergence-insufficiency type X(T) includes RR, modified RR, slanted or nonslanted BLR (upper horn based on distance deviation angle and lower horn based on near deviation angle), slanted or non-slanted uni-/bilateral medial rectus (UMR/BMR) resection with or without an adjustable suture, and medial rectus plication [20,21,24,[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]. The corresponding success rates ranged from 18 to 92%, and most studies concluded that the duration of consecutive esotropia or diplopia was shorter than 4 weeks, with a tendency to exodrift with time following any of the surgical methods.…”

Section: Surgical Treatment In Convergence-insufficiency Type X(t)mentioning

confidence: 99%

How to Better Treat Patients with Intermittent Exotropia: A Review of Surgical Treatment of Intermittent Exotropia

Hwang

2022

Korean J Ophthalmol

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Intermittent exotropia (X(T)) is the most common form of strabismus, especially in Asians. Treatment of X(T) includes occlusion, over-minus lens, and surgery, of which, surgery is the mainstay of treatment.Commonly performed surgical procedures for X(T) are bilateral lateral rectus muscle recession or unilateral lateral rectus recession with medial rectus resection; however, it is unclear which of the two surgeries is more effective. The purpose of this review is to provide an insight on the surgical treatment of X(T). Randomized controlled trials, comparative observational studies, and case series with a large number of patients as well as a long follow-up period of over a year were included.

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Interventions for convergence insufficiency: a network meta-analysis

Abstract: Editorial group: Cochrane Eyes and Vision Group. Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 12, 2020.

Cited by 30 publications

References 91 publications

Vergence Exercises for Six Weeks Induce Faster Recovery of Convergence Insufficiency Than Accommodation Exercises in School Children

Vergence Exercises for Six Weeks Induce Faster Recovery of Convergence Insufficiency Than Accommodation Exercises in School Children

Vergence and Accommodation Cues in Stereo-Localization during the Small-In Large-Out (SILO) Effect

How to Better Treat Patients with Intermittent Exotropia: A Review of Surgical Treatment of Intermittent Exotropia

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