Treatment of accommodative and nonstrabismic binocular dysfunctions: A systematic review

BACKGROUND: The aim of this study was to analyze the scientific evidence available on the nonsurgical treatment of accommodative and nonstrabismic binocular dysfunctions, identifying the types of treatment used and their efficacy. METHODS: A systematic review of reports published from 1986 to 2007 was completed using several health science databases: FRANCIS, Medline, Cinahl, and PsycINFO. Those papers that analyzed the treatment of accommodative and nonstrabismic binocular anomalies were included. RESULTS: Of the 565 articles identified, 16 met the inclusion criteria. Only 3 were clinical trials. All analyzed treatment of convergence insufficiency. Results of clinical trials support the conclusion that vision therapy improves symptoms and signs for convergence insufficiency. Further, the evidence indicates that pencil push-up treatment is not as effective as vision therapy and that prism glasses are no more effective than placebo glasses. For the other nonstrabismic binocular conditions and accommodative disorders, there is a lack of published randomized, clinical trials that support the evidence for the efficacy of each treatment. CONCLUSION: Scientific evidence exists for the efficacy of vision therapy for convergence insufficiency. Insufficient scientific evidence exists on the best therapeutic options for treatment of the other nonstrabismic binocular anomalies and accommodative disorders. Optometry 2009;80:702-716