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A large-scale randomized clinical trial known as the Convergence Insufficiency Treatment Trial (CITT) found that office-based vision therapy combined with at-home therapy was more effective than placebo therapy (in-office placebo treatments) for improving symptoms and clinical signs of convergence insufficiency in children and adults.
In studies that used standardized definitions of convergence insufficiency, investigators have reported a prevalence of 4.2–6% in school and clinic settings. The standard definition of convergence insufficiency is exophoria greater at near than at distance, a receded near point of convergence, and reduced convergence amplitudes at near. [5]
Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce. So, the patient uses excessive accommodation to stimulate accommodative convergence to overcome reduced PFV. [5]
Vision therapy is a broad concept that encompasses a wide range of treatment types. [3] These include those aimed at convergence insufficiency – where it is often termed "vergence therapy" or "orthoptic therapy" – and at a variety of neurological, educational and spatial difficulties. [3]
Accommodative insufficiency (AI) involves the inability of the eye to focus properly on an object. Accommodation is the adjustment of the curvature of the lens to focus on objects near and far. In this condition, amplitude of accommodation of a person is lesser compared to physiological limits for his age. [ 1 ]
Near (1/3m): 15Δ BI → 35-40Δ BO; Distance (6m): 5-7Δ BI → 15Δ BO; Vertical: 3Δ BU → 3Δ BD; If patient results do not reflect the normal values, they may have the following issues: Convergence insufficiency - usually associated with accommodative difficulties, the fusional convergence range of these patients is reduced.
Vision assessment and cycloplegic refraction should be done. If there is any refractive errors, it should be corrected before considering orthoptic treatments.The accommodative infacility is commonly treated with vision therapy/orthoptics; one study found that 12 weeks of treatment had a significant effect on visual accommodation.
This unfortunately makes treatment much more difficult as the side effect of dry eyes and corneal damage can occur. France, Australia, Canada, and the United Kingdom do have limited availability of BAK-free eye drops available in unidose, and they must be imported to the United States with a physician's letter to the FDA [ 2 ] enclosed with the ...