Scheiman Mitchell, Kulp Marjean Taylor, Cotter Susan, Mitchell G Lynn, Gallaway Michael, Boas Mark, Coulter Rachel, Hopkins Kristine, Tamkins Susanna
Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania 19141, USA.
Optom Vis Sci. 2010 Aug;87(8):593-603. doi: 10.1097/OPX.0b013e3181e61bad.
To evaluate the kinetics of change in symptoms and signs of convergence insufficiency (CI) during 12 weeks of treatment with commonly prescribed vision therapy/orthoptic treatment regimens.
In a randomized clinical trial, 221 children aged 9 to 17 years with symptomatic CI were assigned to home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), or office-based placebo therapy with home reinforcement (OBPT). Symptoms and signs were measured after 4, 8, and 12 weeks of treatment. The outcome measures were the mean CI Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence (PFV), and proportions of patients who were classified as successful or improved based on a composite measure of CISS, NPC, and PFV.
Only the OBVAT group showed significant improvements in symptoms between each visit (p < 0.001). Between weeks 8 and 12, all groups showed a significant improvement in symptoms. Between-group differences were apparent by week 8 (p = 0.037) with the fewest symptoms in the OBVAT group. For each group, the greatest improvements in NPC and PFV were achieved during the first 4 weeks. Differences between groups became apparent by week 4 (p < 0.001), with the greatest improvements in NPC and PFV in the OBVAT group. Only the OBVAT group continued to show significant improvements in PFV at weeks 8 and 12. The percentage of patients classified as "successful" or "improved" based on our composite measure increased in all groups at each visit.
The rate of improvement is more rapid for clinical signs (NPC and PFV) than for symptoms in children undergoing treatment for CI. OBVAT results in a more rapid improvement in symptoms, NPC and PFV, and a greater percentage of patients reaching pre-determined criteria of success when compared with HBPP, HBCVAT+, or OBPT.
评估在采用常用的视觉疗法/视光学治疗方案进行12周治疗期间，集合不足（CI）症状和体征的变化动力学。
在一项随机临床试验中，221名9至17岁有症状性CI的儿童被分配至家庭式铅笔俯卧撑训练（HBPP）、家庭式电脑集合/调节疗法与铅笔俯卧撑训练（HBCVAT+）、门诊式集合/调节疗法并辅以家庭强化训练（OBVAT）或门诊式安慰剂疗法并辅以家庭强化训练（OBPT）。在治疗4周、8周和12周后测量症状和体征。结果指标包括CI症状调查（CISS）平均分、集合近点（NPC）、正融合性集合（PFV），以及根据CISS、NPC和PFV综合指标被归类为成功或改善的患者比例。
仅OBVAT组在每次就诊时症状均有显著改善（p < 0.001）。在第8周和第12周之间，所有组的症状均有显著改善。到第8周时组间差异明显（p = 0.037），OBVAT组症状最少。对于每组，NPC和PFV在最初4周内改善最大。到第4周时组间差异明显（p < 0.001），OBVAT组NPC和PFV改善最大。仅OBVAT组在第8周和第12周时PFV仍有显著改善。根据我们的综合指标，每组中被归类为“成功”或“改善”的患者百分比在每次就诊时均增加。
接受CI治疗的儿童中，临床体征（NPC和PFV）的改善速度比症状更快。与HBPP、HBCVAT+或OBPT相比，OBVAT能使症状、NPC和PFV改善更快，且达到预定成功标准的患者百分比更高。
