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

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....