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Effect of Vergence/Accommodative Therapy on Attention in Children with Convergence Insufficiency: A Randomized
Insights
Vergence/accommodative therapy does not improve attention in children with convergence insufficiency compared to placebo. Significant attention improvements in both groups were likely due to non-specific therapy effects.
Area of Science:
- Ophthalmology and Vision Science
- Pediatric Optometry
- Child Psychology
Background:
- Convergence insufficiency (CI) is a common binocular vision disorder in children.
- Attention deficits are sometimes anecdotally linked to CI, prompting investigation into therapeutic benefits.
- The Convergence Insufficiency Treatment Trial-Attention and Reading Trial (CITT-ART) investigated various interventions.
Purpose of the Study:
- To compare the efficacy of 16-week vergence/accommodative therapy versus placebo therapy for improving attention in children with CI.
- To determine if specific vision therapy for CI offers advantages over non-specific treatment effects on attention.
Main Methods:
- A randomized clinical trial involving 310 children (9-14 years) diagnosed with CI.
- Participants received either office-based vergence/accommodative therapy or a placebo therapy for 16 weeks.
- Attention was assessed using the SWAN scale, Swanson, Nolan, and Pelham checklist, Homework Problems Checklist, and d2 Test of Attention at baseline and post-treatment.
Main Results:
- No statistically significant differences in attention measures (inattention, hyperactivity/impulsivity) were found between the vergence/accommodative therapy and placebo groups.
- Both groups showed substantial within-group improvements in attention, homework completion, and selective/sustained attention.
- Effect sizes for between-group differences were small, indicating minimal impact of specific therapy over placebo.
Conclusions:
- Vergence/accommodative therapy is not superior to placebo therapy for enhancing attention in children with convergence insufficiency.
- Observed improvements in attention are likely attributable to non-specific effects of intensive therapy regimens, such as increased engagement and expectation.
- Clinicians should avoid overstating the benefits of vision therapy for attention-related symptoms in children with CI.
Significance:
The results of this study suggest that clinicians providing vergence/accommodative therapy for convergence insufficiency in children should not suggest that such treatment will lead to improvements in attention when compared with placebo treatment.
Purpose:
This study aimed to compare the effects of 16 weeks of vergence/accommodative therapy and placebo therapy on changes in attention for children in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial.
Methods:
Three hundred ten children 9 to 14 years old with convergence insufficiency were assigned to receive treatment with office-based vergence/accommodative therapy or placebo therapy. Attention tests were administered at baseline and after 16 weeks of treatment. The primary measure of attention was the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior (SWAN) scale. Other measures included the Swanson, Nolan, and Pelham checklist; the Homework Problems Checklist; and the d2 Test of Attention. Within and between-group differences are reported using Cohen d effect sizes.
Results:
For the SWAN, there was no significant difference between the groups for the inattention scale parental report (d = 0.036; 95% confidence interval, -0.21 to 0.28) or for the hyperactivity impulsivity scale parental report (d = -0.003; 95% confidence interval, -0.24 to 0.24). Similar results were found for teacher reports and the secondary measures (d estimates from -0.97 to +0.10). There were, however, large within-group changes with d ≥ 1 in both treatment groups for the SWAN, the Homework Problems Checklist, and the d2 Test of Attention.
Conclusions:
These results suggest that vergence/accommodative therapy is no better than placebo therapy in improving attention. Large improvements in inattention, completing homework, and selective and sustained attention were found in each group. However, these improvements cannot be attributed to improvements in vergence and accommodation and are likely due to nonspecific effects of an intensive therapy regimen.
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