Pediatric eye care · Binocular vision
Convergence Insufficiency the binocular disorder with trial-backed therapy.
Convergence insufficiency makes close work uncomfortable: tired eyes, blur, double vision, headaches and losing place while reading. It is the binocular vision condition with the strongest randomized trial evidence for office-based therapy, which makes it the anchor diagnosis for many vision therapy services.
Quick answer
Office-based therapy, with home reinforcement.
The Convergence Insufficiency Treatment Trial found that 12 weeks of office-based vergence and accommodative therapy with home reinforcement improved symptoms and clinical measures more than home pencil push-ups, home computer therapy or placebo. A later trial found that this therapy did not improve standardized reading scores, so set expectations around comfort and function rather than academics.
Key takeaways
- 73 percent of children in office-based therapy reached success or improvement in CITT.
- The comparison groups reached 33 to 43 percent.
- CITT-ART found no reading score benefit over placebo therapy at 16 weeks.
- The NEI notes it can take 12 weeks or more to notice a change.
- Aetna covers up to 12 orthoptic therapy sessions for convergence insufficiency.
What the evidence shows.
From the CITT and CITT-ART publications and NEI guidance.
CITT symptom results
After 12 weeks, the office-based group's CISS score averaged 15.1, versus 21.3 to 24.7 in the other groups.
Clinical measures
Office-based therapy also improved near point of convergence and positive fusional vergence more than the alternatives.
Reading outcomes
In children 9 to 14, office-based therapy was no more effective than placebo for reading test scores after 16 weeks.
Symptoms to ask about
Tired or sore eyes, blur, double vision, headaches, trouble concentrating and losing place when reading.
Time course
Change can take 12 weeks or more, and symptoms can return with illness, poor sleep or heavy near work.
Coverage
Aetna considers up to 12 orthoptic therapy sessions medically necessary for CI where plans do not exclude it.
CITT success rates at 12 weeks.
Percent of children with a successful or improved outcome.
| Treatment group | Success or improved | Setting |
|---|---|---|
| Office-based vergence/accommodative therapy with home reinforcement | 73% | Office plus home |
| Home-based pencil push-ups | 43% | Home |
| Home-based computer vergence/accommodative therapy plus pencil push-ups | 33% | Home |
| Office-based placebo therapy | 35% | Office |
Use a validated symptom survey before and after therapy. It documents need for payers, shows families progress in numbers and mirrors how the CITT measured success.
Frequently asked questions
What is convergence insufficiency?
A condition in which the eyes do not turn inward together well for near work, causing strain, blur or double vision, per the NEI.
What treatment has the best evidence?
Office-based vergence and accommodative therapy with home reinforcement, based on the 2008 CITT.
Do pencil push-ups work?
In CITT, home pencil push-ups helped fewer children than office-based therapy: 43 percent versus 73 percent.
Will therapy improve reading scores?
CITT-ART found no reading score benefit compared with placebo therapy in children 9 to 14.
How long does therapy take?
CITT used 12 weeks, and the NEI notes it can take 12 weeks or more to see change.
Is therapy covered?
Some plans cover it. Aetna, for example, covers up to 12 sessions for convergence insufficiency when the plan does not exclude vision therapy.
References
- Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008;126(10):1336-1349. PubMed
- CITT-ART Investigator Group. Effect of vergence/accommodative therapy on reading in children with convergence insufficiency. Optom Vis Sci. 2019;96(11):836-849. PubMed
- National Eye Institute. Convergence insufficiency. NEI
- Aetna. Clinical Policy Bulletin 0489: Vision therapy. Aetna
- Every source used across these guides is listed on the Vision Rescue sources page.
About this guide
Written for licensed eye care practices by the Vision Rescue team. Questions: providers@visionrescue.com or 1-855-692-8024.
Important notes and disclosures
Information only, not clinical or legal advice. Product names are trademarks of their owners and appear for identification; Vision Rescue does not endorse or review them. Scope of practice, coverage and coding rules vary by state and payer, so confirm locally. Clinical decisions rest with the treating eye doctor.
Anchor your therapy service in evidence.
Diagnose carefully, treat with an office-based program and measure symptoms before and after.