Abstract
SIGNIFICANCE
The results of this study suggest that clinicians providing vergence/accommodative therapy for convergence insufficiency in children should not suggest that such treatment will lead to improvements in attention when compared with placebo treatment.
PURPOSE
This study aimed to compare the effects of 16 weeks of vergence/accommodative therapy and placebo therapy on changes in attention for children in the Convergence Insufficiency Treatment Trial–Attention and Reading Trial.
METHODS
Three hundred ten children 9 to 14 years old with convergence insufficiency were assigned to receive treatment with office-based vergence/accommodative therapy or placebo therapy. Attention tests were administered at baseline and after 16 weeks of treatment. The primary measure of attention was the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior (SWAN) scale. Other measures included the Swanson, Nolan, and Pelham checklist; the Homework Problems Checklist; and the d2 Test of Attention. Within and between-group differences are reported using Cohen d effect sizes.
RESULTS
For the SWAN, there was no significant difference between the groups for the inattention scale parental report (d = 0.036; 95% confidence interval, −0.21 to 0.28) or for the hyperactivity impulsivity scale parental report (d = −0.003; 95% confidence interval, −0.24 to 0.24). Similar results were found for teacher reports and the secondary measures (d estimates from −0.97 to +0.10). There were, however, large within-group changes with d ≥ 1 in both treatment groups for the SWAN, the Homework Problems Checklist, and the d2 Test of Attention.
CONCLUSIONS
These results suggest that vergence/accommodative therapy is no better than placebo therapy in improving attention. Large improvements in inattention, completing homework, and selective and sustained attention were found in each group. However, these improvements cannot be attributed to improvements in vergence and accommodation and are likely due to nonspecific effects of an intensive therapy regimen.
The results of this study suggest that clinicians providing vergence/accommodative therapy for convergence insufficiency in children should not suggest that such treatment will lead to improvements in attention when compared with placebo treatment.
PURPOSE
This study aimed to compare the effects of 16 weeks of vergence/accommodative therapy and placebo therapy on changes in attention for children in the Convergence Insufficiency Treatment Trial–Attention and Reading Trial.
METHODS
Three hundred ten children 9 to 14 years old with convergence insufficiency were assigned to receive treatment with office-based vergence/accommodative therapy or placebo therapy. Attention tests were administered at baseline and after 16 weeks of treatment. The primary measure of attention was the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior (SWAN) scale. Other measures included the Swanson, Nolan, and Pelham checklist; the Homework Problems Checklist; and the d2 Test of Attention. Within and between-group differences are reported using Cohen d effect sizes.
RESULTS
For the SWAN, there was no significant difference between the groups for the inattention scale parental report (d = 0.036; 95% confidence interval, −0.21 to 0.28) or for the hyperactivity impulsivity scale parental report (d = −0.003; 95% confidence interval, −0.24 to 0.24). Similar results were found for teacher reports and the secondary measures (d estimates from −0.97 to +0.10). There were, however, large within-group changes with d ≥ 1 in both treatment groups for the SWAN, the Homework Problems Checklist, and the d2 Test of Attention.
CONCLUSIONS
These results suggest that vergence/accommodative therapy is no better than placebo therapy in improving attention. Large improvements in inattention, completing homework, and selective and sustained attention were found in each group. However, these improvements cannot be attributed to improvements in vergence and accommodation and are likely due to nonspecific effects of an intensive therapy regimen.
| Original language | English |
|---|---|
| Pages (from-to) | 222-233 |
| Number of pages | 12 |
| Journal | Optometry and Vision Science |
| Volume | 98 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2021 |
Bibliographical note
ErratumThe authors of the articles listed below report the following errors:
CITT-ART Investigator Group. Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial – Attention & Reading Trial: A Randomized Clinical Trial. Optom Vis Sci 2019;96(11):825–835.
CITT-ART Investigator Group. Effect of Vergence/Accommodative Therapy on Reading in Children with Convergence Insufficiency: A Randomized Clinical Trial. Optom Vis Sci 2019;96(11):836–849.
CITT-ART Investigator Group. Effect of Vergence/Accommodative Therapy on Attention in Children with Convergence Insufficiency: A Randomized Clinical Trial. Optom Vis Sci 2021;98(3):222–233.
The total sample size for the analyses in the above articles incorrectly included 10 (3.2%) children who were randomized to therapy but retrospectively determined to be ineligible (6 of 206 randomized to the vergence/accommodative therapy group and 4 of 104 assigned to placebo therapy). All 10 failed to meet the single eligibility criterion of “insufficient positive fusional vergence.”. Each child completed the 16-week primary outcome evaluation. Sensitivity analyses, as reported in the following tables, showed little to no impact of exclusion on the previously published findings.
Portion of Table 5 from Effect of Vergence/Accommodative Therapy on Reading in Children with Convergence Insufficiency: A Randomized Clinical Trial. (Optom Vis Sci 2019;96(11):836–849).
Treatment difference*,† estimates for measures of reading
Table 4 from Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial – Attention & Reading Trial: A Randomized Clinical Trial. (Optom Vis Sci 2019;96(11):825–835).
Mean change (95% confidence interval) in outcome measures at 16 weeks by treatment group
Portion of Tables 5 & 6 from CITT-ART Investigator Group. Effect of Vergence/Accommodative Therapy on Attention in Children with Convergence Insufficiency: A Randomized Clinical Trial. (Optom Vis Sci 2021;98(3):222–233).
Cohen’s d and 95% confidence interval (CI) for between group difference‡ in each measure of attention using all participants and excluding those ineligible
Optometry and Vision Science. 99(11):834-836, November 2022.