Each year, the American Academy of Ophthalmology conducts technology assessments to evaluate procedures, drugs and diagnostic screening tests. These projects consist of systematic reviews of available research, which are then submitted to the Academy for consideration in official statements. A recent report from the Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel on vergence and accommodative therapies found that office-based therapies can improve motor outcomes in children with symptomatic convergence insufficiency (CI).

The literature review of children and young adults up to age 35 included 359 abstracts. Only 12 were considered appropriate for inclusion in the Academy assessment. The panel methodologist assigned each study a level of evidence rating.

The methodologist graded eight of the 12 studies as level I evidence. Two were graded as level II evidence, and two were graded as level III evidence. The studies evaluated children exclusively, except for two of the level I studies, which included older teenagers and young adults.

“Two randomized controlled trials found that office-based vergence and accommodative therapies were effective in improving motor outcomes in children with symptomatic CI,” the reviewers noted in the assessment. “However, the studies reported conflicting results on the efficacy of office-based therapy for treating symptoms of CI. Data were inconclusive regarding the effectiveness of home-based therapies (including pencil push-ups and home computer therapy) compared with home placebo.” They noted that office-based vergence and accommodative therapies weren’t superior to placebo in young adults when it came to relieving symptoms of CI.

Level II evidence suggested that the benefits of any treatment for symptomatic CI may be retained up to one year after therapy and that children whose symptoms are reduced as a result of any treatment, including placebo, demonstrate improved academic behaviors. However, the reviewers noted, “Level I evidence suggests that office therapy doesn’t improve reading comprehension more than office placebo.”

The panel concluded that further research is needed to establish the efficacy of home-based vergence and accommodative therapies for children with symptomatic CI, especially because they’re prescribed frequently by specialists in pediatric eye care. “Outcomes are particularly difficult to assess in CI because the primary objective of treatment is to improve symptoms, which are inherently subjective,” they added. “Research studies designed to elucidate the underlying pathophysiologic features in CI and potentially to identify different mechanisms may help to direct an individualized treatment approach.”

Chang MY, Morrison DG, Binenbaum G, et al. Home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency in children and young adults: a report by the American Academy of Ophthalmology. Ophthalmology. 2021;1-10.