In the JournalsPerspective

Study shows vision therapy does not improve reading in convergence insufficiency

Children with a diagnosis of symptomatic convergence insufficiency saw no additional improvement in reading comprehension with office-based vergence/accommodation therapy compared with office-based placebo therapy, according to findings published in Optometry and Vision Science.

Members of the Convergence Insufficiency Treatment Trial — Attention and Reading Trial (CITT-ART) evaluated the effect of office-based vergence/accommodative therapy on reading performance in 310 children 9 to 14 years old with symptomatic convergence insufficiency.

The children were randomized to receive 16 weeks of either office-based vergence/accommodative therapy or office-based placebo therapy, and the primary outcome was change in reading comprehension on the Wechsler Individual Achievement Test, third edition (WIAT-III).

The investigators found that the adjusted mean improvement in WIAT-III reading comprehension was 3.7 (95% CI, 2.6-4.7) in the vergence/accommodative therapy group and 3.8 (95% CI, 2.4-5.2) in the placebo group. There was an adjusted mean group difference of -0.12 (95% CI, -1.89 to 1.66) that was not statistically significant, they said.

“While in-office therapy can improve visual function for children with [convergence insufficiency], this trial indicates that clinicians should not suggest that it will lead to increased reading performance,” co-author Mitchell Scheiman, OD, PhD, said in a press release. – by Earl Holland Jr.

Disclosures: The authors report no relevant financial disclosures.

Children with a diagnosis of symptomatic convergence insufficiency saw no additional improvement in reading comprehension with office-based vergence/accommodation therapy compared with office-based placebo therapy, according to findings published in Optometry and Vision Science.

Members of the Convergence Insufficiency Treatment Trial — Attention and Reading Trial (CITT-ART) evaluated the effect of office-based vergence/accommodative therapy on reading performance in 310 children 9 to 14 years old with symptomatic convergence insufficiency.

The children were randomized to receive 16 weeks of either office-based vergence/accommodative therapy or office-based placebo therapy, and the primary outcome was change in reading comprehension on the Wechsler Individual Achievement Test, third edition (WIAT-III).

The investigators found that the adjusted mean improvement in WIAT-III reading comprehension was 3.7 (95% CI, 2.6-4.7) in the vergence/accommodative therapy group and 3.8 (95% CI, 2.4-5.2) in the placebo group. There was an adjusted mean group difference of -0.12 (95% CI, -1.89 to 1.66) that was not statistically significant, they said.

“While in-office therapy can improve visual function for children with [convergence insufficiency], this trial indicates that clinicians should not suggest that it will lead to increased reading performance,” co-author Mitchell Scheiman, OD, PhD, said in a press release. – by Earl Holland Jr.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    DeAnn Fitzgerald

    DeAnn Fitzgerald

    Cheers to the researchers studying this complex topic.

    First, they cite two other studies (Atzmon et al., Dusek et al.) as papers that showed improvement in reading ability with vision therapy. This paper uses convergence insufficiency and accommodation as the areas trained to increase reading ability.

    Second, this study had a “control group” that still received a type of therapy. It was hardly a placebo treatment because the children were given individual attention and encouragement. Per the study itself, the tasks required the child to keep the target clear and single (and they were instructed to do so), they required high levels of visual attention and required visual processing skills such as visual closure, figure ground, visual spatial or visual discrimination of patterns. These types of tasks sound exactly like a description of vision therapy, even if convergence and accommodation were not directly trained.

    Third, they were average readers to begin with. Why did the study expect to significantly improve reading ability among a group of children who were, on average, already within normal range for reading performance?

    Last, the WIAT-III test used to measure reading comprehension and fluency has only one test form, which means the children read the exact same passages at baseline and 16 weeks later. This means that the children would be familiar with the passage and the questions and may remember it from before.

    Reading falls within the language category of the neuro exam — it is a network! In other words, there is not one place that makes or breaks the improvement with reading, just like pain, speech and autonomics are networks, to name a few.

    In conclusion, isolated splinter skills are difficult to equate to reading. Gross motor skills, peripheral work, movement and visual perceptual skills are included in the structure of vision therapy most optometrists offer. Why? Because it is spatial — reading is a dynamic activity that requires good posture, physical endurance and timing.

    References:

    Atzmon D, et al. Binocul Vis Q Eye Muscle Surg. 1993;8:91–106.

    Dusek WA, et al. BMC Ophthalmol. 2011.doi:10.1186/1471-2415-11-21.

    • DeAnn Fitzgerald, OD
    • Private practitioner, Cedar Rapids, Iowa
      Vice president and education chair
      Neuro-Optometric Rehabilitation Association

    Disclosures: Fitzgerald reports no relevant financial disclosures.