College of Optometry, State University of New York, New York, New York, USA.
Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA.
Ophthalmic Physiol Opt. 2024 Jul;44(5):936-944. doi: 10.1111/opo.13316. Epub 2024 Apr 15.
To report the change in the magnitude of near exodeviation in children with symptomatic convergence insufficiency successfully treated with office-based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial.
A total of 131 children 9-14 years of age with symptomatic convergence insufficiency classified as successfully treated with office-based vergence/accommodative therapy at the 16-week outcome visit were included. Masked examiners measured the near ocular deviation by the prism and alternate cover test at baseline, primary outcome and 1-year post-treatment. The mean change in near deviation was calculated from baseline to primary outcome, from primary outcome to 1-year post-treatment and from baseline to 1-year post-treatment.
Of the 131 participants successfully treated with vergence/accommodative therapy, 120 completed the 1-year post-treatment visit. A significant change in near exodeviation was observed at baseline to primary outcome (2.6Δ less exo, p < 0.001, moderate effect size d = 0.61) and at baseline to 1-year post-treatment (2.0Δ less exo; p < 0.001, small effect size d = 0.45). The change from primary outcome to 1-year post-treatment (0.6Δ more exo; p = 0.06, small effect size d = 0.11) was not significant. Forty per cent (48/120) of participants had a decrease in near exodeviation >3.5∆ (expected test/retest variability) between baseline and the primary outcome examination. Of the 120 participants, one (1.0%) was esophoric at the primary outcome and was subsequently exophoric at 1-year post-treatment. Four participants (3.3%) who were orthophoric or exophoric at the primary outcome were esophoric (all ≤3∆) at the 1-year post-treatment visit.
On average, the near exodeviation was smaller in size immediately after the discontinuation of vergence/accommodative therapy (2.6∆, moderate effect size) and 1 year post vergence/accommodative therapy (2.0∆, small effect size) in children with convergence insufficiency who were successfully treated; 40% had a clinically meaningful decrease in exophoria. The development of near esophoria was rare.
报告在《集合不足治疗试验-注意和阅读试验》中，通过基于办公室的集合/调节治疗成功治疗的有症状集合不足的儿童中近外斜视幅度的变化。
共有 131 名 9-14 岁的有症状集合不足的儿童被纳入，他们在第 16 周的结果访问中被归类为成功接受基于办公室的集合/调节治疗。掩蔽检查者在基线、主要结果和治疗后 1 年使用棱镜和交替遮盖试验测量近眼偏斜。从基线到主要结果、从主要结果到治疗后 1 年以及从基线到治疗后 1 年计算近偏离的平均变化。
在成功接受集合/调节治疗的 131 名参与者中，有 120 名完成了治疗后 1 年的随访。在基线到主要结果（2.6Δ少外，p<0.001，中度效应大小 d=0.61）和基线到治疗后 1 年（2.0Δ少外；p<0.001，小效应大小 d=0.45）观察到近外斜视的显著变化。从主要结果到治疗后 1 年（0.6Δ更多外；p=0.06，小效应大小 d=0.11）的变化不显著。40%（48/120）的参与者在基线和主要结果检查之间，近外斜视的减少量>3.5∆（预期的测试/复测变异性）。在 120 名参与者中，1 名（1.0%）在主要结果时为内斜视，随后在治疗后 1 年时为外斜视。在主要结果时为正或外斜视的 4 名参与者（3.3%）在治疗后 1 年时为内斜视（均≤3∆）。
在成功接受集合/调节治疗的集合不足儿童中，治疗停止后（2.6∆，中度效应大小）和治疗后 1 年（2.0∆，小效应大小），近外斜视的幅度较小；40%有明显的外斜视减少。近内斜视的发展很少见。
