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Therapy for CI is Good—Just Not for the Reason You Think it is

Posted by Ilena Di Toro | Posted on April 7, 2020

Convergence Insufficiency (CI) is where the eyes don’t work together when looking at a near object, (such as reading words on a page) so that the eyes are looking past the target point. As you can guess, many children are diagnosed with CI. Thankfully, there is vision therapy that improves eye coordination abilities and helps children when it comes to reading and other up-close work.

Results from the 2008 Convergence Insufficiency Treatment Trial (CITT) study, showed that vision therapy was effective in improving convergence, reducing symptoms and that the effects were long lasting. A new study known as Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART) was charged with seeing if vision therapy would improve reading skills.

For kids with CI, reading can lead to blurry or double vision, which can make it difficult to do school work. While studies showed the effectiveness of treatment for CI, the next step was to see if the treatment lead to an improvement in reading skills. The CITT-ART looked at 310 kids who ranged in age from 9 to 14 with CI. They were randomly assigned to two groups. Two thirds of the kids received vision therapy for 16 weeks and the remaining subjects received placebo therapy for the same amount of time. The “real” therapy was intended to improve focus and the ability of the eye to work together and the placebo therapy was designed to have no effect on CI.

The subjects reading performance and signs of CI were measured before and after the study. Reading comprehension was assessed using the Wechsler Individual Achievement Test- Version 3 (WIAT-III), as well as word reading, sounding out fake words and both oral and silent reading fluency. CI’s clinical signs included measurements via the Convergence Insufficiency Symptom Survey of how well the eyes worked together to converge on near objects.

All the subjects showed improvements in reading comprehension, yet the interesting thing was that there was no difference between the reading improvement for the CI treatment group and the placebo group. In addition, both vision therapy and placebo therapy didn’t lead to increases in standardized reading tests scores. Of course, vision therapy did help those with CI, since up to 80 percent of those in the vision therapy group did show improvement and fell into the normal range as compared to 30 percent of the placebo group. So, these results are similar to the original CITT study but they don’t show a significant difference in reporting improvement in symptoms. hat means clinical measures not self-reported symptoms are necessary for assessing the severity of CI in children.

“While in-office vision therapy can improve visual function for children with CI, this trial indicates that clinicians should not suggest that it will lead to increased reading performance,” said lead study author Mitchell Scheiman, O.D., Ph.D., of Salus University.

So, as great as it is to receive therapy for CI, it isn’t a panacea for all reading problems. The best bet is to first work on CI, then move on to improving the child’s reading comprehension.


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