@article {1598037, title = {Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology}, journal = {Ophthalmology}, volume = {128}, number = {12}, year = {2021}, month = {2021 12}, pages = {1756-1765}, abstract = {PURPOSE: To review home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency (CI) in children and young adults up to 35 years of age. METHODS: Literature searches were conducted through October 2020 in the PubMed database for English-language studies. The combined searches yielded 359 abstracts, of which 37 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. RESULTS: Of the 12 studies included in this assessment, 8 were graded as level I evidence, 2 were graded as level II evidence, and 2 were graded as level III evidence. Two of the level I studies included older teenagers and young adults; the remainder of the studies exclusively evaluated children. Two randomized controlled trials found that office-based vergence and accommodative therapies were effective in improving motor outcomes in children with symptomatic CI. However, the studies reported conflicting results on the efficacy of office-based therapy for treating symptoms of CI. Data were inconclusive regarding the effectiveness of home-based therapies (including pencil push-ups and home computer therapy) compared with home placebo. In young adults, office-based vergence and accommodative therapies were not superior to placebo in relieving symptoms of CI. CONCLUSIONS: Level I evidence suggests that office-based vergence and accommodative therapies improve motor outcomes in children with symptomatic CI, although data are inconsistent regarding symptomatic relief.\ Evidence is insufficient to determine whether home-based therapies are effective.}, keywords = {Academies and Institutes, Accommodation, Ocular, Adolescent, Adult, Child, Eye Movements, Home Care Services, Humans, Ocular Motility Disorders, Ophthalmology, Orthoptics, Patient Compliance, Patient Satisfaction, Physicians{\textquoteright} Offices, Technology Assessment, Biomedical, United States, Vision, Binocular, Young Adult}, issn = {1549-4713}, doi = {10.1016/j.ophtha.2021.05.017}, author = {Chang, Melinda Y and Morrison, David G and Binenbaum, Gil and Heidary, Gena and Trivedi, Rupal H and Galvin, Jennifer A and Pineles, Stacy L} }