Changes in the disparity vergence main sequence after treatment of symptomatic convergence insufficiency in children

Mitchell Scheiman,Tara L Alvarez,Chang Yaramothu

doi:10.16910/jemr.12.4.6

Abstract

This study investigates the underlying physiological mechanisms that may lead to improved outcomes for symptomatic convergence insufficiency (CI) patients after 12 weeks of office-based vergence/accommodation therapy (OBVAT) by evaluating the change in the main sequence of vergence and saccadic eye movements. In this prospective trial, 12 participants with symptomatic CI were recruited and treated with 12 weeks of OBVAT. Outcome measures included the objective assessment of the following: peak velocity, time to peak velocity, latency, response amplitude, and clinical changes in the near point of convergence (NPC), positive fusional vergence (PFV) and symptoms via the Convergence Insufficiency Symptom Survey (CISS). Ten of the twelve participants (83%) were categorized as “successful” and two were “improved” based on pre-determined published criteria (CISS, NPC, PFV). There were statistically significant changes in peak velocity, time to peak velocity, and response amplitude for both 4° and 6° symmetrical convergence and divergence eye movements. There was a significant change in the main sequence ratio for convergence post-OBVAT compared to baseline measurements (P=0.007) but not for divergence or saccadic responses. Phasic/step vergence movements adjust the underlying neural control of convergence and are critical within a vision therapy program for CI patients.

Highlights

Convergence insufficiency (CI) is defined as a condition in which there is greater exophoria at near than at distance, a receded near point of convergence, and reduced positive fusional vergence at near (Rouse et al, 1999; Scheiman & Wick, 2014)
The results of this study are consistent with previous clinical trials (Scheiman et al, 2008; Scheiman, Cotter, et al, 2005; Scheiman, Talasan, & Alvarez, 2019; Scheiman et al, 2016) and show statistically significant and clinically meaningful changes in clinical and objective measures of vergence in participants with symptomatic convergence insufficiency treated with officebased vergence/accommodation therapy (OBVAT) for 12 weeks
The new contribution from this study is that statistically significant changes were found for the main sequence ratio for convergence step responses, while there were no significant changes for either divergence or saccades responses postOBVAT

Summary

Introduction

Convergence insufficiency (CI) is defined as a condition in which there is greater exophoria at near than at distance, a receded near point of convergence, and reduced positive fusional vergence at near (Rouse et al, 1999; Scheiman & Wick, 2014).

Methods

Results

Conclusion