Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial-Attention & Reading Trial: A Randomized Clinical Trial
Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial-Attention & Reading Trial: A Randomized Clinical Trial
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DOI：
10.1097/opx.0000000000001443
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发表时间：
2019-11-01
影响因子：
1.4
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中科院分区：
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本研究的目的是报告来自一项多中心临床试验（会聚功能不全治疗试验-注意力和阅读试验[CITT-ART]）的会聚功能不全临床体征和症状的变化（次要结局指标），该试验评价了聚散/会聚治疗对改善症状性会聚功能不全儿童的阅读和注意力的有效性。方法311名9 ~ 14岁有症状性会聚功能不全的儿童被随机分配到16周的基于办公室的会聚/矫正治疗或安慰剂治疗组。治疗16周后，比较（1）近会聚点（NPC）、（2）正融合聚散度（PFV）和（3）自我报告症状（会聚不足症状调查[CISS]评分）的改善。结果：治疗组NPC平均改善10.4 cm，安慰剂组平均改善6.2 cm（平均差异为-4.2 cm [95%置信区间{CI}，-5.2至-3.2 cm; P < .001]）;在聚散/矫正和安慰剂治疗组中，平均PFV分别增加了23.2和8.8 Delta（平均差异为14.4 Δ [95% CI，12.1至16.8 Δ; P < .001]）。在聚散/矫正治疗组和安慰剂治疗组中，平均CISS评分分别提高了11.8和10.4分（平均差异为1.5分[95% CI，-3.8至+0.8分; P = 0.21]）。结论：我们的研究结果表明，基于办公室的聚散/矫正治疗是有效的改善症状性会聚功能不全儿童的NPC和PFV。然而，考虑到两个治疗组在自我报告的症状方面有相似的减少，单独使用CISS作为成功治疗的衡量标准可能并不谨慎。
PURPOSE The purpose of this study was to report changes in clinical signs and symptoms of convergence insufficiency (secondary outcome measures) from a multicenter clinical trial (Convergence Insufficiency Treatment Trial-Attention & Reading Trial [CITT-ART]) evaluating the effectiveness of vergence/accommodative therapy for improving reading and attention in children with symptomatic convergence insufficiency. METHODS Three hundred eleven children aged 9 to 14 years with symptomatic convergence insufficiency were randomly assigned to 16 weeks of office-based vergence/accommodative therapy or to placebo therapy. Improvements in (1) near point of convergence (NPC), (2) positive fusional vergence (PFV), and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were compared after 16 weeks of treatment. RESULTS Mean NPC improved 10.4 cm in the vergence/accommodative and 6.2 cm in the placebo therapy group (mean difference of -4.2 cm [95% confidence interval {CI}, -5.2 to -3.2 cm; P < .001]); mean PFV increased 23.2 and 8.8 Delta in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 14.4 Delta [95% CI, 12.1 to 16.8 Delta; P < .001]). The mean CISS score improved 11.8 and 10.4 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 1.5 points [95% CI, -3.8 to +0.8 points; P = .21]). CONCLUSIONS Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the NPC and PFV in children with symptomatic convergence insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, it may not be prudent to use the CISS alone as a measure of successful treatment.