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Mitchell Scheiman - One of the best experts on this subject based on the ideXlab platform.

  • disparity vergence differences between typically occurring and concussion related Convergence Insufficiency pediatric patients
    Vision Research, 2021
    Co-Authors: Tara L Alvarez, Mitchell Scheiman, Susan A Cotter, Chang Yaramothu, Arlene Goodman, Kristine Huang, Angela M Chen, Matthew F Grady, Anne E Mozel, Olivia E Podolak
    Abstract:

    Abstract This study sought to test the hypothesis that significant differences would be observed in clinical measures, symptoms, and objective assessments of vergence eye movements between children with typically developing Convergence Insufficiency (TYP-CI) and children with persistent post-concussion symptoms with Convergence Insufficiency (PPCS-CI). Data from age-matched binocularly normal controls (BNC) were used for comparison. Data from three groups of children 11 to 17 years of age are presented: BNC (N = 11), TYP-CI (N = 10), and PPCS-CI (N = 15). Clinical measures of vergence, accommodation, and symptom severity were collected. Symmetrical 4° disparity vergence eye movements were quantified with an eye tracker integrated into a head-mounted display (Oculus DK2). Peak velocity and final response amplitude of Convergence and divergence eye movement responses were assessed. The mean near point of Convergence (break) was more receded (worse), the amplitude of accommodation more deficient, and convergent and divergent peak velocities slower in the PPCS-CI group compared with the TYP-CI and BNC groups. These results suggest that PPCS-CI may be a different clinical entity than TYP-CI. Hence, more research is warranted to determine whether the therapeutic interventions that are effective for TYP-CI can also be used for PPCS-CI populations.

  • Underlying neurological mechanisms associated with symptomatic Convergence Insufficiency.
    Scientific reports, 2021
    Co-Authors: Tara L Alvarez, Mitchell Scheiman, Cristian Morales, Suril Gohel, Ayushi Sangoi, Elio M Santos, Chang Yaramothu, John Vito D'antonio-bertagnolli, Bharat B Biswal
    Abstract:

    Convergence Insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work, such as reading. The Convergence Insufficiency Neuro-mechanism Adult Population Study (NCT03593031) investigates the mechanistic neural differences between 50 binocularly normal controls (BNC) and 50 symptomatic CI participants by examining the fast and slow fusional disparity vergence systems. The fast fusional system is preprogrammed and is assessed with Convergence peak velocity. The slow fusional system optimizes vergence effort and is assessed by measuring the phoria adaptation magnitude and rate. For the fast fusional system, significant differences are observed between the BNC and CI groups for Convergence peak velocity, final position amplitude, and functional imaging activity within the secondary visual cortex, right cuneus, and oculomotor vermis. For the slow fusional system, the phoria adaptation magnitude and rate, and the medial cuneus functional activity, are significantly different between the groups. Significant correlations are observed between vergence peak velocity and right cuneus functional activity (p = 0.002) and the rate of phoria adaptation and medial cuneus functional activity (p = 0.02). These results map the brain-behavior of vergence. Future therapeutic interventions may consider implementing procedures that increase cuneus activity for this debilitating disorder.

  • negative fusional vergence is abnormal in children with symptomatic Convergence Insufficiency
    Optometry and Vision Science, 2021
    Co-Authors: Mitchell Scheiman, Susan A Cotter, Tara L Alvarez, Marjean Taylor Kulp, Loraine T Sinnott, Maureen Daley Plaumann, Jasleen Jhajj
    Abstract:

    Significance Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic Convergence Insufficiency. Purpose This study aimed to determine whether NFV is normal in untreated children with symptomatic Convergence Insufficiency and whether NFV improves after vergence/accommodative therapy. Methods This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic Convergence Insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. Results At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P .05). Conclusions Despite clinical NFV measurements that seem greater than normal, children with symptomatic Convergence Insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.

  • Convergence Insufficiency neuro mechanism in adult population study randomized clinical trial clinical outcome results
    Optometry and Vision Science, 2020
    Co-Authors: Tara L Alvarez, Mitchell Scheiman, Elio M Santos, Chang Yaramothu, John Vito Dantoniobertagnolli
    Abstract:

    SIGNIFICANCE These data confirm the effectiveness of office-based vergence/accommodative therapy for improving the near point of Convergence and positive fusional vergence in young adults with symptomatic Convergence Insufficiency within a double-masked longitudinal randomized clinical trial. PURPOSE This study aimed to report changes in clinical signs and symptoms of Convergence Insufficiency from a randomized clinical trial evaluating the effectiveness of office-based vergence/accommodative therapy for young adults with symptomatic Convergence Insufficiency. METHODS In this double-masked, randomized clinical trial, Convergence Insufficiency patients (n = 50; average age, 21 ± 3 years; range, 18 to 32 years) were randomized to either office-based vergence/accommodative therapy or office-based placebo therapy. Improvements in (1) near point of Convergence, (2) positive fusional vergence, and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were evaluated after twelve 1-hour sessions of treatment within the office comparing the results from the vergence/accommodative therapy and the placebo therapy groups. RESULTS The mean near point of Convergence improved by 6.0 and 3.1 cm in the vergence/accommodative and placebo therapy groups, respectively (mean difference of -2.9 cm; 95% confidence interval [CI], -4.6 to -1.0 cm; P < .01). The mean positive fusional vergence increased by 17.3 and 7.4Δ in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 9.9Δ; 95% CI, 4.9 to 16.0Δ; P < .001). The mean CISS score improved by 12.4 and 10.1 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 2.3 points; 95% CI, -8.3 to +4.6 points; P = .56). CONCLUSIONS Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the near point of Convergence and positive fusional vergence in young adults with symptomatic Convergence Insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, we recommend that the CISS be revised if it is to be used as an outcome measure in future studies of Convergence Insufficiency.

  • the Convergence Insufficiency neuro mechanism in adult population study cinaps randomized clinical trial design methods and clinical data
    Ophthalmic Epidemiology, 2020
    Co-Authors: Tara L Alvarez, Mitchell Scheiman, Cristian Morales, Elio M Santos, Chang Yaramothu, Bharat B Biswal, John Vito Dantoniobertagnolli, Suril Gohel
    Abstract:

    Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults ...

Susan A Cotter - One of the best experts on this subject based on the ideXlab platform.

  • disparity vergence differences between typically occurring and concussion related Convergence Insufficiency pediatric patients
    Vision Research, 2021
    Co-Authors: Tara L Alvarez, Mitchell Scheiman, Susan A Cotter, Chang Yaramothu, Arlene Goodman, Kristine Huang, Angela M Chen, Matthew F Grady, Anne E Mozel, Olivia E Podolak
    Abstract:

    Abstract This study sought to test the hypothesis that significant differences would be observed in clinical measures, symptoms, and objective assessments of vergence eye movements between children with typically developing Convergence Insufficiency (TYP-CI) and children with persistent post-concussion symptoms with Convergence Insufficiency (PPCS-CI). Data from age-matched binocularly normal controls (BNC) were used for comparison. Data from three groups of children 11 to 17 years of age are presented: BNC (N = 11), TYP-CI (N = 10), and PPCS-CI (N = 15). Clinical measures of vergence, accommodation, and symptom severity were collected. Symmetrical 4° disparity vergence eye movements were quantified with an eye tracker integrated into a head-mounted display (Oculus DK2). Peak velocity and final response amplitude of Convergence and divergence eye movement responses were assessed. The mean near point of Convergence (break) was more receded (worse), the amplitude of accommodation more deficient, and convergent and divergent peak velocities slower in the PPCS-CI group compared with the TYP-CI and BNC groups. These results suggest that PPCS-CI may be a different clinical entity than TYP-CI. Hence, more research is warranted to determine whether the therapeutic interventions that are effective for TYP-CI can also be used for PPCS-CI populations.

  • negative fusional vergence is abnormal in children with symptomatic Convergence Insufficiency
    Optometry and Vision Science, 2021
    Co-Authors: Mitchell Scheiman, Susan A Cotter, Tara L Alvarez, Marjean Taylor Kulp, Loraine T Sinnott, Maureen Daley Plaumann, Jasleen Jhajj
    Abstract:

    Significance Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic Convergence Insufficiency. Purpose This study aimed to determine whether NFV is normal in untreated children with symptomatic Convergence Insufficiency and whether NFV improves after vergence/accommodative therapy. Methods This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic Convergence Insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. Results At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P .05). Conclusions Despite clinical NFV measurements that seem greater than normal, children with symptomatic Convergence Insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.

  • effectiveness of vergence accommodative therapy for accommodative dysfunction in children with Convergence Insufficiency
    Ophthalmic and Physiological Optics, 2021
    Co-Authors: Angela M Chen, Eric Borsting, Susan A Cotter, Marjean Taylor Kulp, Loraine T Sinnott, Richard W Hertle, Tawna L Roberts, Yin C Tea, Lisa A Jonesjordan, Lynn G Mitchell
    Abstract:

    PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic Convergence Insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic Convergence Insufficiency and coexisting accommodative dysfunction.

  • postconcussion receded near point of Convergence is not diagnostic of Convergence Insufficiency
    American Journal of Ophthalmology, 2019
    Co-Authors: Susan A Cotter, Aparna Raghuram, Sowjanya Gowrisankaran, Jameel Kanji, David R Howell, William P Meehan, Ankoor S Shah
    Abstract:

    Purpose To determine the frequency of occurrence of receded near point of Convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of Convergence Insufficiency and other oculomotor disorders. Design Retrospective cross-sectional study. Methods Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined. Results Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had Convergence Insufficiency and accommodation deficits; and 6 (8%) had Convergence Insufficiency only. Six (8%) had a Convergence deficit other than Convergence Insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had Convergence excess only; and 1 (1%) had both Convergence excess and accommodative deficits. Conclusion A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of Convergence Insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.

  • effect of treatment of symptomatic Convergence Insufficiency on reading in children a pilot study
    Clinical and Experimental Optometry, 2018
    Co-Authors: Mitchell Scheiman, Eric Borsting, Marjean Taylor Kulp, Chris Chase, G L Mitchell, Susan A Cotter
    Abstract:

    BACKGROUND To evaluate the impact of treatment of symptomatic Convergence Insufficiency using office-based vergence/accommodative therapy on reading skills in children. METHODS Children (n = 44) ages nine to 17 years with symptomatic Convergence Insufficiency were administered the following four reading tests: Wechsler Individual Achievement Test II; Test of Word Reading Efficiency; Test of Silent Word Reading Fluency; and the Gray Oral Reading Test, at baseline and eight weeks after completion of a 16-week program of office-based vergence/accommodative therapy. To determine whether significant change occurred with therapy, change in performance was compared to zero. Treatment response was determined using a composite score of symptoms and signs at the conclusion of treatment and at the 24-week outcome visit. Participants were classified as early responders, late responders, or non-responders based upon whether criteria for successful treatment were met at the completion of 16 weeks of treatment, at the 24-week outcome visit, or not met at either visit, respectively. RESULTS After treatment for Convergence Insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001). No significant improvements were observed for single word reading or reading fluency as measured by the Test of Word Reading Efficiency, the Test of Silent Word Reading Fluency or the Gray Oral Reading Test. CONCLUSION Improvements in reading comprehension and reading composite were found after office-based vergence/accommodative therapy, with the greatest improvements in those who responded early to treatment.

Eric Borsting - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of vergence accommodative therapy for accommodative dysfunction in children with Convergence Insufficiency
    Ophthalmic and Physiological Optics, 2021
    Co-Authors: Angela M Chen, Eric Borsting, Susan A Cotter, Marjean Taylor Kulp, Loraine T Sinnott, Richard W Hertle, Tawna L Roberts, Yin C Tea, Lisa A Jonesjordan, Lynn G Mitchell
    Abstract:

    PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic Convergence Insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic Convergence Insufficiency and coexisting accommodative dysfunction.

  • effect of treatment of symptomatic Convergence Insufficiency on reading in children a pilot study
    Clinical and Experimental Optometry, 2018
    Co-Authors: Mitchell Scheiman, Eric Borsting, Marjean Taylor Kulp, Chris Chase, G L Mitchell, Susan A Cotter
    Abstract:

    BACKGROUND To evaluate the impact of treatment of symptomatic Convergence Insufficiency using office-based vergence/accommodative therapy on reading skills in children. METHODS Children (n = 44) ages nine to 17 years with symptomatic Convergence Insufficiency were administered the following four reading tests: Wechsler Individual Achievement Test II; Test of Word Reading Efficiency; Test of Silent Word Reading Fluency; and the Gray Oral Reading Test, at baseline and eight weeks after completion of a 16-week program of office-based vergence/accommodative therapy. To determine whether significant change occurred with therapy, change in performance was compared to zero. Treatment response was determined using a composite score of symptoms and signs at the conclusion of treatment and at the 24-week outcome visit. Participants were classified as early responders, late responders, or non-responders based upon whether criteria for successful treatment were met at the completion of 16 weeks of treatment, at the 24-week outcome visit, or not met at either visit, respectively. RESULTS After treatment for Convergence Insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001). No significant improvements were observed for single word reading or reading fluency as measured by the Test of Word Reading Efficiency, the Test of Silent Word Reading Fluency or the Gray Oral Reading Test. CONCLUSION Improvements in reading comprehension and reading composite were found after office-based vergence/accommodative therapy, with the greatest improvements in those who responded early to treatment.

  • behavioral and emotional problems associated with Convergence Insufficiency in children an open trial
    Journal of Attention Disorders, 2016
    Co-Authors: Eric Borsting, Mitchell Scheiman, Marjean Taylor Kulp, Lynn G Mitchell, Eugene L Arnold, Chris Chase, Susan A Cotter
    Abstract:

    Objective: This study investigated behavioral and emotional characteristics of children with Convergence Insufficiency (CI), before and after treatment with office-based vergence accommodative ther...

  • Convergence Insufficiency treatment trial attention and reading trial citt art design and methods
    Vision development and rehabilitation, 2015
    Co-Authors: Mitchell Scheiman, Eric Borsting, Marjean Taylor Kulp, S A Cotter, Chris Chase, G L Mitchell, E Arnold, C Denton, Richard W Hertle
    Abstract:

    OBJECTIVE To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic Convergence Insufficiency (CI). METHODS CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention. CONCLUSION The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.

  • improvement in academic behaviors after successful treatment of Convergence Insufficiency
    Optometry and Vision Science, 2012
    Co-Authors: Eric Borsting, Mitchell Scheiman, Susan A Cotter, Marjean Taylor Kulp, Lynn G Mitchell, Michael Gallaway, Deborah Amster, Rachael Coulter, Gregory Fecho, David B Granet
    Abstract:

    Purpose—To determine whether treatment of symptomatic Convergence Insufficiency (CI) has an effect on Academic Behavior Survey (ABS) scores. Methods—The ABS is a 6-item survey developed by the Convergence Insufficiency Treatment Trial (CITT) Group that quantifies the frequency of adverse school behaviors and parental concern about school performance on an ordinal scale from 0 (never) to 4 (always) with total scores ranging from 0 to 24. The ABS was administered at baseline and after 12 weeks of treatment to the parents of 218 children ages 9-17 years with symptomatic CI, who were enrolled in the CITT and randomized into: 1) home-based pencil push-ups (HBPP); 2) home-based computer vergence/ accommodative therapy and pencil push-ups (HBCVAT+); 3) office-based vergence/ accommodative therapy with home reinforcement (OBVAT); and 4) office-based placebo therapy with home reinforcement (OBPT). Participants were classified as successful (n=42), improved (n=60), or non-responder (n=116) at the completion of 12 weeks of treatment using a composite measure of the symptom score, near point of Convergence, and positive fusional vergence. Analysis of covariance methods were used to compare the mean change in ABS between response to treatment groups while controlling for the ABS score at baseline. Results—The mean ABS score for the entire group at baseline was 12.85 (SD=6.3). The mean ABS score decreased (improved) in those categorized as successful, improved, and non-responder by 4.0, 2.9, and 1.3 points, respectively. The improvement in the ABS score was significantly related to treatment outcome (p<0.0001), with the ABS score being significantly lower (better) for children who were successful or improved after treatment as compared to children who were nonresponders (p=0.002 and 0.043, respectively).

Marjean Taylor Kulp - One of the best experts on this subject based on the ideXlab platform.

  • negative fusional vergence is abnormal in children with symptomatic Convergence Insufficiency
    Optometry and Vision Science, 2021
    Co-Authors: Mitchell Scheiman, Susan A Cotter, Tara L Alvarez, Marjean Taylor Kulp, Loraine T Sinnott, Maureen Daley Plaumann, Jasleen Jhajj
    Abstract:

    Significance Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic Convergence Insufficiency. Purpose This study aimed to determine whether NFV is normal in untreated children with symptomatic Convergence Insufficiency and whether NFV improves after vergence/accommodative therapy. Methods This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic Convergence Insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies. Results At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P .05). Conclusions Despite clinical NFV measurements that seem greater than normal, children with symptomatic Convergence Insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.

  • effectiveness of vergence accommodative therapy for accommodative dysfunction in children with Convergence Insufficiency
    Ophthalmic and Physiological Optics, 2021
    Co-Authors: Angela M Chen, Eric Borsting, Susan A Cotter, Marjean Taylor Kulp, Loraine T Sinnott, Richard W Hertle, Tawna L Roberts, Yin C Tea, Lisa A Jonesjordan, Lynn G Mitchell
    Abstract:

    PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic Convergence Insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic Convergence Insufficiency and coexisting accommodative dysfunction.

  • effect of treatment of symptomatic Convergence Insufficiency on reading in children a pilot study
    Clinical and Experimental Optometry, 2018
    Co-Authors: Mitchell Scheiman, Eric Borsting, Marjean Taylor Kulp, Chris Chase, G L Mitchell, Susan A Cotter
    Abstract:

    BACKGROUND To evaluate the impact of treatment of symptomatic Convergence Insufficiency using office-based vergence/accommodative therapy on reading skills in children. METHODS Children (n = 44) ages nine to 17 years with symptomatic Convergence Insufficiency were administered the following four reading tests: Wechsler Individual Achievement Test II; Test of Word Reading Efficiency; Test of Silent Word Reading Fluency; and the Gray Oral Reading Test, at baseline and eight weeks after completion of a 16-week program of office-based vergence/accommodative therapy. To determine whether significant change occurred with therapy, change in performance was compared to zero. Treatment response was determined using a composite score of symptoms and signs at the conclusion of treatment and at the 24-week outcome visit. Participants were classified as early responders, late responders, or non-responders based upon whether criteria for successful treatment were met at the completion of 16 weeks of treatment, at the 24-week outcome visit, or not met at either visit, respectively. RESULTS After treatment for Convergence Insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001). No significant improvements were observed for single word reading or reading fluency as measured by the Test of Word Reading Efficiency, the Test of Silent Word Reading Fluency or the Gray Oral Reading Test. CONCLUSION Improvements in reading comprehension and reading composite were found after office-based vergence/accommodative therapy, with the greatest improvements in those who responded early to treatment.

  • screening for Convergence Insufficiency in school age children
    Clinical and Experimental Optometry, 2018
    Co-Authors: Anne M Menjivar, Marjean Taylor Kulp, Lynn G Mitchell, Andrew J Toole, Kathleen Reuter
    Abstract:

    Background Convergence Insufficiency (CI) is a common binocular vision disorder which often causes symptoms when doing near work. However, the best screening test for CI is unknown. The purpose of this study was to evaluate the ability of common tests of binocular and accommodative function to identify children with CI in a school screening setting. Methods Children aged nine to 14 were invited to participate. Positive fusional vergences, near point of Convergence (NPC), accommodative amplitude, accommodative facility, Modified Thorington, and the Convergence Insufficiency Symptom Survey were evaluated. Results Of the 282 children tested, approximately 20 per cent had 2-3 signs of CI. One half of 2-3 signs of CI and 66 per cent of three signs of CI subjects were symptomatic. Approximately 61 per cent of subjects with symptomatic 2-3 signs of CI had an accompanying low accommodative amplitude. The largest area under the receiver operating characteristic curve was obtained using NPC break measurements. NPC break ≥ 6 cm for CI and NPC break ≥ 7 cm for symptomatic CI were the cut points that maximised the sum of sensitivity and specificity. Conclusion NPC break performed best in identifying children with CI.

  • home based therapy for symptomatic Convergence Insufficiency in children a randomized clinical trial
    Optometry and Vision Science, 2016
    Co-Authors: Mitchell Scheiman, Susan A Cotter, Marjean Taylor Kulp, Michael Gallaway, Darren L Hoover, Elizabeth L Lazar, Raymond T Kraker, David K Wallace, Erin Jenewein, Indre Rudaitis
    Abstract:

    Purpose To compare the effectiveness of home-based (HB) computer vergence/accommodative therapy (HB-C) to HB near target push-up therapy (HB-PU) and to HB placebo treatment (HB-P) among children aged 9 to <18 years with symptomatic Convergence Insufficiency (CI).

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  • effectiveness of vergence accommodative therapy for accommodative dysfunction in children with Convergence Insufficiency
    Ophthalmic and Physiological Optics, 2021
    Co-Authors: Angela M Chen, Eric Borsting, Susan A Cotter, Marjean Taylor Kulp, Loraine T Sinnott, Richard W Hertle, Tawna L Roberts, Yin C Tea, Lisa A Jonesjordan, Lynn G Mitchell
    Abstract:

    PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic Convergence Insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic Convergence Insufficiency and coexisting accommodative dysfunction.

  • screening for Convergence Insufficiency in school age children
    Clinical and Experimental Optometry, 2018
    Co-Authors: Anne M Menjivar, Marjean Taylor Kulp, Lynn G Mitchell, Andrew J Toole, Kathleen Reuter
    Abstract:

    Background Convergence Insufficiency (CI) is a common binocular vision disorder which often causes symptoms when doing near work. However, the best screening test for CI is unknown. The purpose of this study was to evaluate the ability of common tests of binocular and accommodative function to identify children with CI in a school screening setting. Methods Children aged nine to 14 were invited to participate. Positive fusional vergences, near point of Convergence (NPC), accommodative amplitude, accommodative facility, Modified Thorington, and the Convergence Insufficiency Symptom Survey were evaluated. Results Of the 282 children tested, approximately 20 per cent had 2-3 signs of CI. One half of 2-3 signs of CI and 66 per cent of three signs of CI subjects were symptomatic. Approximately 61 per cent of subjects with symptomatic 2-3 signs of CI had an accompanying low accommodative amplitude. The largest area under the receiver operating characteristic curve was obtained using NPC break measurements. NPC break ≥ 6 cm for CI and NPC break ≥ 7 cm for symptomatic CI were the cut points that maximised the sum of sensitivity and specificity. Conclusion NPC break performed best in identifying children with CI.

  • behavioral and emotional problems associated with Convergence Insufficiency in children an open trial
    Journal of Attention Disorders, 2016
    Co-Authors: Eric Borsting, Mitchell Scheiman, Marjean Taylor Kulp, Lynn G Mitchell, Eugene L Arnold, Chris Chase, Susan A Cotter
    Abstract:

    Objective: This study investigated behavioral and emotional characteristics of children with Convergence Insufficiency (CI), before and after treatment with office-based vergence accommodative ther...

  • relationship between clinical signs and symptoms of Convergence Insufficiency
    Optometry and Vision Science, 2013
    Co-Authors: Annette Bade, Mitchell Scheiman, Susan A Cotter, Marjean Taylor Kulp, Lynn G Mitchell, Michael Gallaway, Mark Boas, Michael W Rouse
    Abstract:

    Purpose The percentage of children who are symptomatic has been shown to increase with the number of signs of Convergence Insufficiency (CI). Our goal was to investigate whether there is a relationship between the severity of the clinical signs of CI and symptom level reported in children with 3-sign symptomatic CI.

  • symptoms in children with Convergence Insufficiency before and after treatment
    Optometry and Vision Science, 2012
    Co-Authors: Carmen Barnhardt, Mitchell Scheiman, Susan A Cotter, Lynn G Mitchell, Marjean Taylor Kulp
    Abstract:

    ABSTRACTPurpose.To investigate symptom patterns and evaluate the relationship between patient characteristics and symptom severity before and after treatment for symptomatic children with Convergence Insufficiency (CI).Methods.In a randomized clinical trial, the Convergence Insufficiency symptom sur