Conrad Joseph Samuel, Mitchell G Lynn, Kulp Marjean Taylor
*OD, MS †MAS, FAAO ‡OD, MS, FAAO The Ohio State University College of Optometry, Columbus, Ohio (all authors).
Optom Vis Sci. 2017 Jan;94(1):101-107. doi: 10.1097/OPX.0000000000000937.
To prospectively evaluate the effectiveness of home-based computer vergence therapy for the treatment of binocular vision disorders in adults at least 3 months after an acquired brain injury.
Eligibility criteria included presence of binocular dysfunction characterized by receded near point of convergence (≥6 cm break), insufficient positive fusional vergence at near (failing Sheard's criterion or <15△ blur or break), insufficient negative fusional vergence at near (<12△ blur or break), and/or reduced vergence facility at near (<15 cycles per minute with 12△BO/3△BI). Participants were prescribed 12 weeks of home-based computer vergence therapy. Phoria (cover test), negative fusional vergence, positive fusional vergence, near point of convergence, vergence facility, and symptoms (convergence insufficiency symptom survey [CISS]) were assessed at baseline and after 4, 8, and 12 weeks of prescribed therapy. ANOVA was used to evaluate change in each measure. Percentage successful was also determined.
Nineteen participants were enrolled (mean age 45.4 ± 12.9 years); six participants were lost to follow-up. Baseline findings were orthophoria at distance, 7.2△ exophoria at near, near point of convergence break = 17.5 cm, near point of convergence recovery = 21.8 cm, negative fusional vergence = 12.3△, positive fusional vergence blur = 8.4△, vergence facility = 3.9 cycles per minute, and CISS = 32.1. ANOVA showed a statistically significant improvement for near point of convergence break (p = 0.002) and recovery (p < 0.001), positive fusional vergence blur (p < 0.0001), break (p < 0.0001), and recovery (p < 0.0001), negative fusional vergence blur (p = 0.037), break (p = 0.003), and recovery (p = 0.006), vergence facility (p < 0.0001), and CISS (p = 0.0001). The percentage of patients who were classified as "successful" or "improved" was 69% for near point of convergence (<6 cm or decrease of ≥4 cm), 77% for positive fusional vergence (>15△ and passing Sheard's criterion or increase of ≥10△), 77% for negative fusional vergence (≥12△ or increase of ≥6△), 62% for positive fusional vergence and near point of convergence composite, and 92% for vergence facility (15 cycles per minute or increase of 3 cycles per minute).
The majority of participants who completed the study experienced meaningful improvements in signs and symptoms.
前瞻性评估基于家庭的电脑融合治疗对成年后天性脑损伤至少3个月后的双眼视觉障碍的疗效。
纳入标准包括存在双眼功能障碍，其特征为集合近点后退（≥6 cm破裂点）、近距正融合性聚散不足（未达到谢尔德准则或模糊或破裂点<15△）、近距负融合性聚散不足（模糊或破裂点<12△）和/或近距融合性聚散灵活度降低（12△BO/3△BI时<15周/分钟）。参与者被规定进行为期12周的基于家庭的电脑融合治疗。在基线以及规定治疗的4周、8周和12周后评估隐斜（遮盖试验）、负融合性聚散、正融合性聚散、集合近点、融合性聚散灵活度和症状（集合不足症状调查[CISS]）。采用方差分析评估各项指标的变化。还确定了成功的百分比。
19名参与者入组（平均年龄45.4±12.9岁）；6名参与者失访。基线检查结果为远距离正位视、近距离7.2△外隐斜、集合近点破裂点 = 17.5 cm、集合近点恢复点 = 21.8 cm、负融合性聚散 = 12.3△、正融合性聚散模糊点 = 8.4△、融合性聚散灵活度 = 3.9周/分钟以及CISS = 32.1。方差分析显示集合近点破裂点（p = 0.002）和恢复点（p < 0.001）、正融合性聚散模糊点（p < 0.0001）、破裂点（p < 0.0001）和恢复点（p < 0.0001）、负融合性聚散模糊点（p = 0.037）、破裂点（p = 0.003）和恢复点（p = 0.006）、融合性聚散灵活度（p < 0.0001）以及CISS（p = 0.0001）有统计学显著改善。集合近点（<6 cm或减少≥4 cm）被分类为“成功”或“改善”的患者百分比为69%，正融合性聚散（>15△且达到谢尔德准则或增加≥10△）为77%，负融合性聚散（≥12△或增加≥6△）为77%，正融合性聚散和集合近点综合为62%，融合性聚散灵活度（15周/分钟或增加3周/分钟）为92%。
完成研究的大多数参与者在体征和症状方面有显著改善。
