An Evaluation of Clinical Treatment of Convergence Insufficiency For Children With Reading Difficulties

Wolfgang A Dusek; Barbara K Pierscionek; Julie F McClelland

BMC Ophthalmol. 2011;11(21)

Conclusions

The importance of diagnosing and treating a problem like CI that has the potential to lead to significant problems that could severely undermine scholastic achievement should not be underestimated. Further investigations into the contribution of CI in reading, writing and learning difficulties are needed to define the extent of the problem and to consolidate and harmonise treatment practices. The present study demonstrates that prismatic correction offers an effective treatment option for children with CI and reading difficulties that arise from causes not linked to intellectual ability.

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Competing interests
The authors declare that they have no competing interests.

Authors' contributions
All authors read and approved the final version of the manuscript. All authors participated in the design of the study, data analysis and preparation of the manuscript. All data were collected by WD.

Acknowledgements
The authors would like to acknowledge the parents and children for participating in the study and Professor Gordon Rae from the University of Ulster for valuable advice on statistical analyses.

Cite this: An Evaluation of Clinical Treatment of Convergence Insufficiency For Children With Reading Difficulties - Medscape - Aug 11, 2011.

Table 1. Age and gender distribution of the subject group
Age (years)	Number (n) (%)		Percentage (%)
	Female	Male
7	5 (3.73)	10 (7.46)	11.2
8	17 (12.69)	18 (13.43)	26.1
9	14 (10.45)	14 (10.45)	20.9
10	6 (4.48)	12 (8.96)	13.4
11	8 (5.97)	13 (9.70)	15.7
12	2 (1.49)	7 (5.22)	6.7
13	2 (1.49)	3 (2.24)	3.7
14	0 (0)	3 (2.24)	2.2

Table 2. Mean total reading time for each subject group at the first and second visit
Group	Mean total reading time (seconds) ± SD
	First visit	Second visit	Mean difference (seconds) ± SD
Control group	130.88 ± 61.46 (n = 32)	127.03 ± 60.59 (n = 32)	3.84 ± 4.04 (n = 32)
HTS	113.98 ± 48.83 (n = 51)	101.61 ± 37.53 (n = 51)	12.37 ± 16.22 (n = 51)
Reading spectacles with 8Δ base-in	108.49 ± 48.68 (n = 51)	87.00 ± 39.60 (n = 51)	21.49 ± 13.53 (n = 51)

Table 3. Mean reading error score for each subject group at the first and second visit
Group	Mean reading error score ± SD
	First visit	Second visit	Mean difference ± SD
Control group	5.34 ± 3.5 (n = 32)	4.66 ± 2.9 (n = 32)	0.69 ± 1.20 (n = 32)
HTS	4.53 ± 3.06 (n = 51)	2.86 ± 1.9 (n = 51)	1.67 ± 1.90 (n = 51)
Reading spectacles with 8Δ base-in	4.92 ± 4.06 (n = 51)	2.12 ± 1.9 (n = 51)	2.80 ± 2.82 (n = 51)

Table 4. Mean amplitude of accommodation at each visit for each subject group
Group	Amplitude of accommodation (D) ± SD
	First visit	Second visit	Mean difference (D) ± SD
Control group	12.66 ± 2.3 (n = 32)	12.97 ± 1.6 (n = 32)	0.31 ± 1.28 (n = 32)
HTS	11.86 ± 2.6 (n = 51)	12.88 ± 1.7 (n = 49)	1.02 ± 1.50 (n = 51)
Reading spectacles with 8Δ base-in	11.51 ± 2.5 (n = 51)	12.92 ± 1.5 (n = 51)	1.41 ± 1.37 (n = 51)

Table 5. Mean binocular accommodative facility test score at each visit for each subject group
Group	Binocular accommodative facility test score (cycles per minute) ± SD
	First visit	Second visit	Mean difference (cycles per minute) ± SD
Control group	5.59 ± 3.2 (n = 30)	6.38 ± 2.5 (n = 30)	0.78 ± 1.58 (n = 32)
HTS	6.20 ± 3.9 (n = 51)	9.78 ± 3.4 (n = 51)	3.59 ± 2.98 (n = 51)
Reading spectacles with 8 Δ base-in	5.53 ± 2.9 (n = 51)	8.88 ± 2.9 (n = 51)	3.35 ± 2.11 (n = 51)

Table 6. Mean vergence facility test score at each visit for each subject group
Group	Vergence facility test score (cycles per minute) ± SD
	First visit	Second visit	Mean difference ± SD
Control group	5.44 ± 3.7 (n = 30)	6.63 ± 3.7 (n = 30)	1.19 ± 1.63 (n = 32)
HTS	5.80 ± 4.6 (n = 51)	9.78 ± 3.8 (n = 51)	3.98 ± 3.83 (n = 51)
Reading spectacles with 8 Δ base in	4.96 ± 4.3 (n = 51)	8.96 ± 3.7 (n = 51)	4.00 ± 2.61 (n = 51)

Table 7. Factorial analysis results
Outcome measure	Time × treatment (interaction effect)		Time (within subjects effects)		Treatment (between subjects effects)
	F (degrees of freedom)	p	F (degrees of freedom)	p	F (degrees of freedom)	p
Total reading time	18.04 (2,131)	< 0.001	115.75 (1, 131)	< 0.001	4.17 (2,131)	0.018
Reading error score	9.58 (2,131)	< 0.001	79.23 (1, 131)	< 0.001	3.14 (2,131)	0.047
Amplitude of accommodation	6.04 (2,131)	0.003	54.21 (1,131)	< 0.001	0.88 (2,131)	0.417
Binocular accommodative facility	15.56 (2,131)	< 0.001	148.32 (1, 131)	< 0.001	4.46 (2,131)	0.013
Vergence facility	10.81 (2,131)	< 0.001	134.72 (1,131)	< 0.001	2.19 (2,131)	0.116
Near phoria	0.40 (2,131)	0.673	31.71 (1,131)	< 0.001	0.783 (2,131)	0.459
Near point of convergence	2.41 (1,131)	0.094	18.01 (1,131)	< 0.001	0.606 (2,131)	0.547
MEM retinoscopy	0.223 (1,126)	0.800	6.59 (1,126)	0.011	0.768 (2,126)	0.466