Pencil Push-Ups Not Helpful for Convergence Insufficiency

Laurie Barclay, MD

May 09, 2003

May 9, 2003 — Although pencil push-up therapy (PPT) is the most commonly prescribed therapy for convergence insufficiency (CI), it is ineffective, according to the results of a randomized trial presented on May 8 at the Association for Research in Vision and Ophthalmology annual meeting. The investigators call for a large-scale trial of visual therapy (VT)/orthoptics, which was shown to be effective in this study.

"Our data suggest a differential effect of treatment with age," write M. Scheiman, from the Pennsylvania College of Optometry in Philadelphia, and colleagues. "In children, VT/orthoptics was clearly more effective than PPT. In fact, despite PPT being the most commonly prescribed treatment for CI, PPT was no more effective than placebo VT/orthoptics for improving symptoms and signs of CI."

At six clinical sites, 47 subjects aged 9 to 18 years and 46 subjects aged 19 to 30 years were randomized to 12 weeks of treatment with PPT, VT/orthoptics, or placebo VT/orthoptics.

In the younger group, the mean CI Symptom Survey score after treatment was significantly better in the VT/orthoptics group (9.5 ± 8.2) than in the PPT group (25.9 ± 7.3) or in the placebo VT/orthoptics group (24.2 ± 11.9; P < .0001 for both comparisons). The VT/orthoptics group also fared better than the other two groups in terms of near point of convergence (NPC) and reduced positive fusional vergence (PFV).

All three groups of adults had a clinically significant improvement in symptoms, which was not significantly better in the VT/orthoptics group compared with the other groups. However, only those adults in the VT/orthoptics group had clinically meaningful improvements in NPC and PFV.

"Although the VT/orthoptics group was the only one that achieved clinically significant improvement in the signs of CI, 60% were still symptomatic at the end of treatment," the authors write. "Our data support the need for a large scale randomized clinical trial of the effectiveness of VT/orthoptics for CI."

The authors did not report any significant financial interests in this study.

ARVO 2003 Annual Meeting: Abstract 4247. Presented May 8, 2003.

Reviewed by Gary D. Vogin, MD


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