CI is a common eye-teaming problem in which the eyes have a strong tendency to drift outward when reading or doing work close up. If an eye drifts out, double vision occurs. To avoid seeing double, a person with CI must use extra effort to make the eyes turn back in. This extra effort can lead to annoying symptoms that can interfere with the ability to read and work comfortably up close.

CI is a common condition that affects approximately 5 out of every 100 children in the United States.

Common symptoms when reading or doing work up close include:

• frequent loss of place
• loss of concentration
• double vision
• blurred vision
• headaches
• reading slowly
• eyestrain
• tired eyes
• sleepiness
• trouble remembering what was read
• the need to re-read the same line of words

Symptomatic CI in children is treated with office-based vision therapy, home-based therapy, or prism glasses. Studies have shown that office-based therapy is the most effective treatment. The percentage of children who were successfully treated or improved after therapy was 73% for office-based therapy versus 33-43% for home-based therapy and 35% for control therapy.¹ Prism glasses have been found to be no more effective than placebo glasses for the treatment of symptomatic CI in children.

Vision therapy is a sequence of office-based therapeutic activities individually prescribed and monitored by a doctor to eliminate or improve symptoms and signs associated with specific eye disorders of eye teaming, focusing, alignment, tracking, and visual processing. Patients are often instructed to perform home therapy procedures to reinforce the office-based treatment. Lenses, prisms, filters, patching, specialized instruments, and computer programs are typically used. Vision therapy programs are based on the results of a thorough diagnostic evaluation, the patient’s specific signs and symptoms, and the needs of the patient

The CITT-ART study is designed to find out whether office-based vision therapy for convergence insufficiency (CI) improves reading and attention. Children with CI frequently have more symptoms when reading and show worse attention than children without CI. We know that vision therapy for CI often improves these symptoms and there are some recent studies that suggest that treatment also may result in improvements in reading and attention. However, to know for sure we need to study this question in a larger group of children using a randomized clinical trial design with some children receiving a harmless control therapy that is not designed to treat CI.

The CITT-ART study is being conducted at 8 pediatric eye care centers across the United States. The study is funded by the National Eye Institute, which is part of the National Institutes of Health. About 325 children will take part in this study.

A computer program decides whether each child receives active therapy or control therapy. This is similar to flipping a coin. Two out of every 3 children will receive the active therapy and 1 of every 3 children with receive the control therapy. Any child who still has symptoms at the end of the study will be offered alternative therapy at no cost.

The National Eye Institute is providing funds to cover all therapy sessions, follow-up visits, and therapy equipment. To cover travel and other visit-related expenses, participants are paid between $25 and $50 per visit, depending upon the length and type of visit.

Children enrolled into the CITT-ART study are part of a national research study designed to provide answers about how the treatment of CI affects reading and attention. Participating children will receive treatment for CI at no cost and their parents will receive a summary of their reading test results. The information gained from this study will be very important for eye doctors to treat children with CI in the future.

Contact the study coordinator or principal Investigator at one of the 8 clinical centers for more information. The child can be scheduled for a visit to see if he/she meets the study criteria.

Children who take part in the study will:

• Have weekly in-office therapy sessions for 16 weeks in a row (after school appointments are available)
• Do therapy exercises at home for 15 minutes/day
• Have repeat vision, reading, and attention testing after the 16-week therapy program and then 1 year later