Convergence Insufficiency Treatment Trial (CITT)

NCT ID: NCT00338611

Last Updated: 2010-03-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

221 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-07-31

Study Completion Date

2009-09-30

Brief Summary

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The purposes of the CITT are:

* To determine whether Home-based Pencil Push-up therapy, Home-based Pencil Push-ups with Computer Vision Therapy/Orthoptics or Office-based VT/Orthoptics more effective than placebo treatment, and whether there are differences between the three treatments in improving subject symptoms and signs.
* To evaluate whether improvements in outcome measures are still present after one year of observation.

Detailed Description

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Convergence insufficiency is a prevalent and distinct binocular vision disorder. Typical symptoms include double vision, eyestrain, headaches, and blurred vision while reading. It affects approximately 5% of children in the United States, and may have a serious impact on an individual's performance in school, choice of jobs, and quality of life.

There is no consensus regarding the most effective treatment for convergence insufficiency. Two commonly prescribed treatments are home-based pencil push-up therapy and office-based vision therapy/orthoptics. Significant differences exist between these two treatment modalities in cost and number of office visits required, with pencil push-up therapy being less expensive and less time intensive. There have been no well-designed studies that have compared the effectiveness of these two treatments.

The Convergence Insufficiency Treatment Trial (CITT) is a prospective, masked, placebo-controlled, multi-center clinical trial in which 208 subjects between the ages of 9 to \< 18 years will be randomly assigned to: 1) Home-based Pencil Push-Up Therapy, 2) Home-based Pencil Push-ups with Computer Vision Therapy/Orthoptics, 3) Office-based Vision Therapy/Orthoptics, or 4) Placebo Office-based Vision Therapy/Orthoptics. The primary outcome measure is a measure of symptoms using a 15-item survey, the CI Symptom Survey. Secondary outcome measures are two common clinical tests of the eyes' ability to converge when performing close work. Patients will be tested at the eligibility examination, and by masked examiners after 4, 8 and 12 weeks of treatment have been completed during the 12-week treatment phase. Long term follow-up will be assessed at 6 and 12 months after the completion of active treatment.

Conditions

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Convergence Insufficiency Binocular Vision Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Interventions

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Home-based Pencil Push-Up Therapy

Exercise in which patients visually followed a small letter on a pencil as they moved the pencil closer to the bridge of their nose

Intervention Type BEHAVIORAL

Home-based Pencil Push-ups with Computer Vision Therapy/Orthoptics

Exercise in which patients visually followed a small letter on a pencil as they moved the pencil closer to the bridge of their nose combined with additional computer vision therapy

Intervention Type BEHAVIORAL

Office-based Vision Therapy/Orthoptics

Weekly hour-long sessions of office-based vision therapy with a trained therapist and performed at-home reinforcement exercises

Intervention Type BEHAVIORAL

Placebo Office-based Vision Therapy/Orthoptics

Vision activities designed to simulate office-based therapy

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Children between the ages of 9 and 17 years with symptomatic convergence insufficiency
* Exophoria at near at least 4Δ greater than at far
* Insufficient positive fusional convergence at near
* A receded near point of convergence of ≥6 cm break
* CI Symptom Survey score ≥16

Exclusion Criteria

* Previous treatment with office-based vision therapy/orthoptics or pencil push-ups
* Systemic diseases known to affect accommodation, vergence and ocular motility
* Developmental disability, mental retardation, attention deficit hyperactivity disorder (ADHD), or learning disability diagnosis that in the investigator's discretion would interfere with treatment
Minimum Eligible Age

9 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Eye Institute (NEI)

NIH

Sponsor Role lead

Responsible Party

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Pennsylvania College of Optometry

Principal Investigators

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Mitchell Scheiman, OD

Role: STUDY_CHAIR

Pennsylvania College of Optometry

Locations

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University of Alabama at Birmingham School of Optometry

Birmingham, Alabama, United States

Site Status

Southern California College of Optometry

Fullerton, California, United States

Site Status

Ratner Children's Eye Center

La Jolla, California, United States

Site Status

NOVA Southeastern University College of Optometry

Fort Lauderdale, Florida, United States

Site Status

Bascom Palmer Eye Institute

Miami, Florida, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

State University of New York College of Optometry

New York, New York, United States

Site Status

The Ohio State University College of Optometry

Columbus, Ohio, United States

Site Status

Pennsylvania College of Optometry

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008 Oct;126(10):1336-49. doi: 10.1001/archopht.126.10.1336.

Reference Type RESULT
PMID: 18852411 (View on PubMed)

Scheiman M, Kulp MT, Cotter SA, Lawrenson JG, Wang L, Li T. Interventions for convergence insufficiency: a network meta-analysis. Cochrane Database Syst Rev. 2020 Dec 2;12(12):CD006768. doi: 10.1002/14651858.CD006768.pub3.

Reference Type DERIVED
PMID: 33263359 (View on PubMed)

CITT-ART Investigator Group. Treatment of Symptomatic Convergence Insufficiency in Children Enrolled in the Convergence Insufficiency Treatment Trial-Attention & Reading Trial: A Randomized Clinical Trial. Optom Vis Sci. 2019 Nov;96(11):825-835. doi: 10.1097/OPX.0000000000001443.

Reference Type DERIVED
PMID: 31651593 (View on PubMed)

Barnhardt C, Cotter SA, Mitchell GL, Scheiman M, Kulp MT; CITT Study Group. Symptoms in children with convergence insufficiency: before and after treatment. Optom Vis Sci. 2012 Oct;89(10):1512-20. doi: 10.1097/OPX.0b013e318269c8f9.

Reference Type DERIVED
PMID: 22922781 (View on PubMed)

Scheiman M, Kulp MT, Cotter S, Mitchell GL, Gallaway M, Boas M, Coulter R, Hopkins K, Tamkins S; Convergence Insufficiency Treatment Trial Study Group. Vision therapy/orthoptics for symptomatic convergence insufficiency in children: treatment kinetics. Optom Vis Sci. 2010 Aug;87(8):593-603. doi: 10.1097/OPX.0b013e3181e61bad.

Reference Type DERIVED
PMID: 20543758 (View on PubMed)

Rouse M, Borsting E, Mitchell GL, Kulp MT, Scheiman M, Amster D, Coulter R, Fecho G, Gallaway M; CITT Study Group. Academic behaviors in children with convergence insufficiency with and without parent-reported ADHD. Optom Vis Sci. 2009 Oct;86(10):1169-77. doi: 10.1097/OPX.0b013e3181baad13.

Reference Type DERIVED
PMID: 19741558 (View on PubMed)

Convergence Insufficiency Treatment Trial Study Group. Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. Optom Vis Sci. 2009 Sep;86(9):1096-103. doi: 10.1097/OPX.0b013e3181b6210f.

Reference Type DERIVED
PMID: 19668097 (View on PubMed)

Kulp M, Mitchell GL, Borsting E, Scheiman M, Cotter S, Rouse M, Tamkins S, Mohney BG, Toole A, Reuter K; Convergence Insufficiency Treatment Trial Study Group. Effectiveness of placebo therapy for maintaining masking in a clinical trial of vergence/accommodative therapy. Invest Ophthalmol Vis Sci. 2009 Jun;50(6):2560-6. doi: 10.1167/iovs.08-2693. Epub 2009 Jan 17.

Reference Type DERIVED
PMID: 19151384 (View on PubMed)

Other Identifiers

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NEI-107

Identifier Type: -

Identifier Source: org_study_id

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