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Vision Therapy > The Evidence Base for Vision Therapy > Flashcards

The Evidence Base for Vision Therapy Flashcards

1
Q

T/F you must discount the validity and importance of qualitative and clinical research

A

false, some conditions cannot be studied with double-blind, placebo-controlled methods

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2
Q

Why is it hard to get double-blind research for VT?

A

funding is difficult to obtain or completely unavailable

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3
Q

What form of study are many of the VT papers?

A

anecdotal/case-based evidence

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4
Q

What was the convergence insufficiency treatment trial?

A

a randomized clinical trial of treatments for symptomatic convergence insufficiency in children 2008

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5
Q

What are commonly prescribed therapies for CI?

A

pencil push-up, home computer-based therapy, office-based therapy

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6
Q

What are the CITT methods?

A

9 centers throughout the US, children 9-17, randomized into 4 treatment groups

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7
Q

What was the CITT inclusion criteria?

A

near exo at 4 prism diopters greater than distance (or more), receded NPC, insufficient PFV at near, symptomatic on CISS (>16)

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8
Q

What were the 4 treatments groups of the CITT?

A

1) home-based pencil push-ups 2) home-based computer-based vergence/accommodative therapy and pencil push-ups 3) office-based vergence/accommodative therapy with home reinforcement 4)office-based placebo therapy (monocular)

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9
Q

What were the primary outcomes of CITT?

A

improvement/elimination of symptoms, statistically significant improvement of symptoms for office-based VT group vs other groups, no difference between other three groups

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10
Q

What were the secondary outcomes of CITT?

A

improvement in clinical signs, statistically significant improvement in clinical signs for office-based VT groups vs. the other three groups

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11
Q

What does success mean in CITT?

A

improvement or normal findings for symptoms, NPC, AND PFV

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12
Q

What does improved mean in CITT?

A

improvement or normal findings for symptoms and NPC OR PFV

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13
Q

What statement describes the overall improvement of CITT?

A

statistically significant number of successful and improved patients in the office-based VT groups vs. other 3 groups

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14
Q

What are the main discussion points of CITT?

A

OBVT showed greatest improvements compared to other 3 groups, there was not a no treatment group, results are applicable to 9-17 need further study for adults, 12 weeks chosen b/c likely to show improvements without significant dropout rate

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15
Q

T/F all CITT groups showed some improvements in symptoms and signs

A

true

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16
Q

Were the CITT results based on placebo effect?

A

no, although there was no “no treatment” group, the placebo effect should have affected all groups similarly

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17
Q

Would having the trial run more than 12 weeks effect the CITT findings?

A

maybe, it is possible that more therapy may show more improvement (may become statistically significant for other groups)

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18
Q

What was the treatment of accommodative dysfunction study?

A

data from CITT with the same cohorts analyzed for accommodation results, 2011

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19
Q

What are the most common accommodative disorders in children?

A

AI and Acc infacility

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20
Q

What are common treatments for accommodative dysfunction?

A

plus lenses at near or VT/orthoptics

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21
Q

What were the treatment of accommodative dysfunction study methods?

A

same as CITT because it was analysis of CITT study data

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22
Q

What were the four randomized groups for the treatment of accommodative dysfunction study?

A

same as CITT 1)HBPP 2)HBCVAT+ 3)OBVAT and 4) OBPT

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23
Q

What were the accommodative amplitude results for the treatment of accommodative dysfunction study?

A

all treatment groups showed improvement at 4 weeks, OBVT showed the greatest increase, also showed improvements at 8 and 12 weeks

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24
Q

Which VT skill improves first?

A

accommodation, at about 4 weeks

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25
Q

What were the accommodative facility results in the treatment of accommodative dysfunction study?

A

all treatment groups showed improvement, OBVT and HBVT showed improvement at 4 and 8 weeks visits, pencil push-ups showed improvement at 8 weeks visit

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26
Q

What group showed the only statistically significant increased compared to placebo in the treatment of accommodative dysfunction study?

A

office based VT

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27
Q

What is the treatment of accommodative dysfunction study discussion main points?

A

OBVT showed the most effective treatment of accommodation, changes in accommodation should be noted at a 4 week VT progress evaluation, some changes were noted in the placebo group

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28
Q

What was the progression of therapy in the OBVT group that proved to be an effect treatment of accommodation?

A

monocular –> bi-ocular –> binocular

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29
Q

What should you do if no improvement in accommodation is seen by 4 weeks?

A

consider consistency of therapy or other conditions

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30
Q

Why were some changes noted in the placebo group?

A

may be placebo effect or regression to mean

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31
Q

What is the treatment of CI and academic behaviors study?

A

CITT protocol with new study participants 2012 investigating academic behaviors following successful treatment of convergence insufficiency

32
Q

What is the background of the treatment of CI and academic behaviors study?

A

parents of children with CI reported significantly greater adverse school behaviors compared to parents of children with normal BV, parents worry about children’s school performance

33
Q

What are common symptoms of a CI?

A

visual fatigue, headaches, and diplopia when reading or studying

34
Q

What are possible school behaviors that stem from having a CI?

A

difficulty completing school work, avoiding reading and studying, inattentiveness or distraction during reading

35
Q

What are the treatment of CI and academic behaviors methods?

A

9 centers throughout US, children 9-17

36
Q

What is the inclusion criteria for the treatment of CI and academic behaviors study?

A

near exo at 4 prism diopters greater than distance (or more), receded NPC, insufficient PFV at near, symptomatic on CISS (>16)

37
Q

What are the randomized treatment groups for the treatment of CI and academic behaviors study?

A

The same as CITT 1) HBPP 2)HBCVAT+ 3)OBVAT 4)OBPT

38
Q

What is the methods of the treatment of CI and academic behaviors study?

A

parents filled out the academic behaviors survey (ABS) before and after treatment, regardless of child’s success with treatment, parent not allowed to consult with child during survey (parent perception only), evaluated change in baseline and post-treatment ABS score

39
Q

How long was the academic behavior survey?

A

6 questions, low score is better

40
Q

What was the overall improvement of the treatment of CI and academic behaviors study?

A

statistically significant number of successful and improved patients in the office based VT groups vs the other 3 groups

41
Q

What were the secondary outcomes of the treatment of CI and academic behaviors study?

A

ABS score was significantly lower for subjects considered successful or improved compared to non-responders, no significant difference in scores between successful and improved children, improvement in ABS score was significantly correlated with a reduction in symptom score on the CISS

42
Q

What was the discussion of the treatment of CI and academic behaviors study?

A

patients who were successful or improved in their clinical signs showed an overall reduction in frequency of adverse academic behaviors, parental concern about the child’s school performance decreased

43
Q

What are the downsides of the treatment of CI and academic behaviors study?

A

ABS is a relatively new survey with only 6 questions, unable to tell whether parents sought outside educational intervention during the study

44
Q

What was the BI prism reading glasses for CI study?

A

randomized clinical trial of the effectiveness of BI prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children

45
Q

What is the introduction for the BI prism reading glasses for CI study?

A

ophthalmic textbooks recommend BI prism glasses, previous studies did not have control group, randomization or masked examiners

46
Q

What are common treatments for CI?

A

pencil push-up, VT/orthoptics, BI prism reading glasses

47
Q

What are the methods for BI prism reading glasses for CI?

A

9 centers across the US, children 9-18

48
Q

What are the inclusion criteria for the BI prism reading glasses for CI study?

A

must have symptomatic CI based on CISS, must have SIGNS of CI based on cover test, fusion vergence at near, NPC, and monocular accommodative testing

49
Q

What glasses were prescribed in the BI prism reading glasses for CI study?

A

hyperopia >/=1.50, myopia >/=0.50, astigmatism >/=0.75, anisometropia >/=0.75 sphere and >/=1.50 cyl

50
Q

What two groups were patient randomized into for the BI prism reading glasses for CI study?

A

glasses with prism or glasses without prism

51
Q

How was prism determined for the BI prism reading glasses for CI study?

A

sheard’s criterion; prism= 2/3 phoria - 1/3 compensating fusional vergence

52
Q

What was the range of prism glasses for the BI prism reading glasses for CI study?

A

1-10 prism diopters, average 4.14 prism diopters

53
Q

When did patient have to use their glasses during the BI prism reading glasses for CI study?

A

when doing near work of more than 5 minutes, wore glasses for 6 weeks before re-eval

54
Q

Before starting the BI prism reading glasses for CI, at baseline there was…

A

no significant difference between groups on CISS, NPC, or PFV break at near

55
Q

What were the main results of the BI prism reading glasses for CI study?

A

BOTH groups showed statistically significant changes in their mean CISS scores but there was no significant difference between groups, neither groups showed a clinically significant change according to the CISS requirement (10 point difference), no clinically significant change in NPC or PFV in either group

56
Q

T/F prism glasses were no more effective at reducing symptoms than placebo glasses

A

true, change in symptoms was likely a placebo effect for both groups, no change in clinical signs

57
Q

What were the conclusions of the adults with CI fMRI results study?

A

CI subjects participating in CT showed that the near point of convergence, recovery point of convergence, and near dissociated phoria significantly decreased. Furthermore, the positive fusional vergence, average peak velocity from 4 convergence steps, and the amount of functional activity within the frontal areas, cerebellum, and brainstem significantly increased.

58
Q

What were the conclusions of the VT for OMD in ABI study?

A

90% of those with TBI and 100% of those with CVA were deemed to have treatment success. Furthermore, it shows considerable residual neural plasticity despite the presence of documented brain injury

59
Q

What was the conclusion of the effectiveness of VT in school children w/ symptomatic CI (symptomatic CI, Korean children) study?

A

Near point of convergence improved by approximately 5.48 cm in all participants. NRA improved 2.54 and PRA improved -3.10 diopters.

60
Q

What did the reading comprehension and eye movement abilities: a comparison of digital and print presentations study find?

A

faster reading speed and lower fixation rate for digital

61
Q

What did the comparison of accommodative responses to e-ink vs LCD vs standard ink on hard copy study find?

A

cisarik found the accommodation response is the same for paper, e-ink, and LCD presentations

62
Q

What did the binasal occlusion for the tx of visual motion sensitivity after TBI a case series find?

A

binasal occlusion is effective for tx of visual motion sensitivity following TBI

63
Q

What did the horizontal head and eye rotations of non-expert baseball batters study find?

A

non-expert hitters use a similar pattern to expert hitters BUT showed more difficulty cancelling VOR

64
Q

What did the reliability of computerized eye-tracking reaction time tests in non-athletes, athletes, and individuals with TBI study show?

A

good test/retest reliability for all groups, athletes performed the best, significant variability for TBI patients

65
Q

What did the prescribing yoked prism in patients with autism study of inter and intra examiner agreement find?

A

inter and intra examiner agreement was better with video scoring of the kaplan nonverbal battery rather than live presentation, validates the use of video for NBEO part 3

66
Q

T/F there is value in the literature reviews/meta-analysis on VT topics

A

true, ex: screen time in pediatric population review

67
Q

What is the over-minus lens therapy for children 3 to 10 with intermittent exotropia?

A

randomized clinical trial with 56 sites over 2 year period, 386 children age 3-10 2021

68
Q

What were the two groups of the over-minus lens therapy for children with IXT?

A

plano lenses or over-minus step-down

69
Q

What are the conclusions of the over-minus lens therapy for children 3-10 with IXT study?

A

improvement greater for OM group at 12 months BUT did not persist to 18 months, additionally OM group had a greater risk of myopic shift >-1.00D

70
Q

What are good search terms for VT research?

A

rehabilitation, neuro-ophthalmology, neuro-optometry

71
Q

When should we see significant improvement in fusion and decrease in symptoms?

A

12 weeks

72
Q

What is the review point for prism glasses?

A

prism glasses are no more beneficial than placebo glasses for patient with CI

73
Q

When do you Rx lenses and prism?

A

consider Rx prior to therapy

74
Q

When would you refer for surgery?

A

consider surgery as a last resort

75
Q

T/F adverse academic behaviors improve with successful treatment of CI

A

true

Vision Therapy (21 decks)

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