Treatment of convergence insufficiency in childhood: a current perspective.
Treatment of convergence insufficiency in childhood: a current perspective.
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DOI：
10.1097/opx.0b013e31819fa712
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Mitchell GL
中科院分区：
文献类型：
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作者：
Scheiman M;Rouse M;Kulp MT;Cotter S;Hertle R;Mitchell GL
通过总结最近三项随机临床试验的结果并讨论其临床意义，提供当前儿童CI管理的观点，我们在这些试验中评估了症状性CI儿童的各种治疗方法。然后，我们提出了一个基于证据的治疗方法，症状CI的基础上，这些试验的结果。最后，我们讨论了未回答的问题，并建议在这一领域的未来研究方向。我们回顾了3项多中心随机临床试验，比较了9至17岁儿童症状性CI的治疗方法（一项研究年龄为9至18岁）。两项试验评价了CI的活性治疗。这些试验比较了基于办公室的聚散/矫正治疗、基于办公室的安慰剂治疗和基于家庭的治疗（单独的铅笔俯卧撑[两项试验]、基于家庭的计算机聚散/矫正治疗和铅笔俯卧撑[大规模研究]）的有效性。一项试验比较了底座内棱镜阅读眼镜和安慰剂阅读眼镜的有效性。所有研究均包括明确定义的CI诊断标准、安慰剂组和设盲检查者。主要结果测量是会聚不足症状调查评分。次要结局为近点会聚和近点正融合聚散度。以家庭为基础的聚散/分散疗法比以家庭为基础的或安慰剂疗法显著更有效。在治疗儿童症状性脑梗死方面，底座内棱镜阅读眼镜并不比安慰剂阅读眼镜更有效。最近的临床试验表明，基于办公室的视力治疗在大约75%的患者中是成功的（导致正常或显著改善的症状和体征），并且是唯一一种比安慰剂治疗更有效的治疗方法。目前不提供这种治疗的眼科护理提供者可能会考虑将这些患者转介给提供这种治疗的医生，或者考虑扩大其实践中可用的治疗选择来管理这种情况。
To provide a current perspective on the management of CI in children by summarizing the findings and discussing the clinical implications from three recent randomized clinical trials in which we evaluated various treatments for children with symptomatic CI. We then present an evidence-based treatment approach for symptomatic CI based upon the results of these trials. Finally, we discuss unanswered questions and suggest directions for future research in this area. We reviewed 3 multi-center randomized clinical trials comparing treatments for symptomatic CI in children 9 to 17 years old (one study 9 to 18 years old). Two trials evaluated active therapies for CI. These trials compared the effectiveness of office-based vergence/accommodative therapy, office-based placebo therapy, and home-based therapy (pencil push-ups alone [both trials], home-based computer vergence/accommodative therapy and pencil push-ups [large-scale study]). One trial compared the effectiveness of base-in prism reading glasses to placebo reading glasses. All studies included well-defined criteria for the diagnosis of CI, a placebo group, and masked examiners. The primary outcome measure was the Convergence Insufficiency Symptom Survey score. Secondary outcomes were near point of convergence and positive fusional vergence at near. Office-based vergence/accommodative therapy was significantly more effective than home-based or placebo therapies. Base-in prism reading glasses were no more effective than placebo reading glasses for the treatment of symptomatic CI in children. Recent clinical trials showed that office-based vision therapy was successful in about 75% of patients (resulting in normal or significantly improved symptoms and signs) and was the only treatment studied which was more effective than placebo treatments for children with symptomatic CI. Eye care providers who do not currently offer this treatment may consider referring these patients to a doctor who provides this treatment or consider expanding the treatment options available within their practice to manage this condition.