Curunt and future management of convergence insufficiency

Abstract

Introduction: The existing literature indicated a lack of consensus on the most effective protocol for treating primary convergence insufficiency (CI), resulting in variability in treatment approaches and reported efficacy rates. This thesis investigates the treatment protocols for primary CI and their effectiveness. In addition, the role of tele-appointments in primary CI treatment. Method: Four studies were conducted: Study 1: A retrospective service evaluation of CI patients who were treated with orthoptic exercises. Study 2: A cohort study of primary CI patients comparing standard treatment to simple convergence exercises, as well as face-to-face appointments versus tele-appointments. Study 3: Visually normal young adults were recruited to compare simple convergence exercises with a placebo and to evaluate the effectiveness of tele-appointments. Study 4: Online questionnaires aimed at clinicians to explore the numbers of primary CI patients, treatment, and the use of tele-appointments. Results: The service evaluation identified the standard treatment for primary CI and highlighted variability in treatment protocols. The cohort study of primary CI patients encountered unexpected recruitment challenges following COVID-19, resulting in no recruited patients. Simple convergence exercises targeting disparity demonstrated improvement in vergence and accommodation responses over placebo exercises, and tele-appointments were found to be as effective as face-to-face appointments. The questionnaire revealed variability among clinicians in the treatment of primary CI and limited use of tele-appointments. Conclusion: There is variability in the protocols used by clinicians to treat primary CI, with no standardised approach yet. The improvement seen with simple convergence exercises targeting disparity is not attributed to the placebo effect. The use of tele-appointments for treating primary CI is still limited.