Comparative analysis of orthoptic training and prism correction in the management of convergence insufficiency among young adults

Purpose. To compare the effectiveness of orthoptic training and prism correction in the management of convergence insufficiency (CI) among young adults.

Material and methods. A prospective comparative clinical trial was conducted on 60 young adults aged 18–25 years diagnosed with CI. Participants were randomly assigned to Group A (orthoptic training; n =3 0) or Group B (prism correction; n = 30). Group A underwent 6 weeks of supervised orthoptic exercises (pencil push-ups, brock string, jump convergence, computer-based therapy), while Group B received base-in prisms prescribed according to Sheard’s criterion. Outcome measures included near point of convergence (NPC), positive fusional vergence (PFV), Convergence Insufficiency Symptom Survey (CISS), stereoacuity, and reading speed.

Results. Group A showed significant improvement in NPC (13.5 ± 2.8 cm to 7.2 ± 1.8 cm; p < 0.001), PFV (12.4 ± 3.1 Δ to 22.8 ± 4.2 Δ; p < 0.001), and CISS score (31.6 ± 5.2 to 15.8 ± 4.0; p < 0.001). Group B demonstrated smaller improvements in NPC (13.3 ± 2.5 cm to 10.5 ± 2.2 cm; p = 0.002), PFV (12.1 ± 2.9 Δ to 14.5 ± 3.3 Δ; p = 0.04), and CISS (31.3 ± 5.5 to 22.6 ± 5.1; p < 0.001). Stereoacuity improved significantly in Group A (140 ± 35 arc sec to 80 ± 25 arc sec; p < 0.01), but not in Group B. Between-group comparisons confirmed superior outcomes in Group A across primary measures (p < 0.01).

Conclusion. Both interventions were effective, but orthoptic training provided superior improvements in vergence parameters, symptom reduction, and stereoacuity. Prism correction may serve as an adjunct for immediate symptomatic relief, while orthoptic therapy should be prioritized for long-term management.

1. Almahmoud OH, Mahmmod KM, Mohtaseb SA, et al. Assessment of digital eye strain and its associated factors among school children in Palestine. BMC Оphthalmology. 2025 Feb 19; 25 (1): 81. doi: 10.1186/s12886-025-03919-x

2. Wang X, Zeng L, Xian Y, et al. Prevalence of myopia and refractive parameters among children and adolescents in Hi-tech District of Chengdu City (2021–2023). Front Pediatr. 2025 Feb 3; 12: 1502660. doi: 10.3389/fped.2024.1502660

3. Cardona G, Argiles M, Pérez-Mañá L. Accuracy of a Large Language Model as a new tool for optometry education. Clinical & experimental optometry. 2025; 108 (3): 343–6. https://doi.org/10.1080/08164622.2023.2288174

4. Mohamed Z, Alrasheed S H. A systematic review and meta-analysis of convergence insufficiency prevalence and management options. The Open Ophthalmology Journal. 2023; 17 (1). https://doi.org/10.2174/18743641-v17-20230712-2023-8

5. Kumari P, Azam S, Abbas S, et al. Effect of vision therapy on fusional vergences in intermittent exotropia. Advances in Ophthalmology & Visual System. 2022; 12 (1): 3–8. https://doi.org/10.15406/aovs.2022.12.00408

6. Alghamdi WM, Alluwimi MS, Aldakhil SA, Moafa MA, Alghamdi MA. Refractive errors and binocular vision anomalies among young university students. Global Journal of Health Science. 2021; 14 (1): 23. https://doi.org/10.5539/gjhs.v14n1p23

7. Hajebrahimi F, Sangoi A, Scheiman M, et al. From convergence insufficiency to functional reorganization: A longitudinal randomized controlled trial of treatment-induced connectivity plasticity. CNS Neurosci Ther. 2024; 30: e70007. doi: 10.1111/cns.70007

8. Singh A, Saxena V, Yadav S, et al. Comparison of home-based pencil push-up therapy and office-based orthoptic therapy in symptomatic patients of convergence insufficiency: a randomized controlled trial. International Ophthalmology. 2021; 41(4): 1327–36. https://doi.org/10.1007/s10792-020-01689-7

9. Martin TL, Murray J, Garg K, et al. Fixation eye movement abnormalities and stereopsis recovery following strabismus repair. Sci Rep. 2021; 11: 14417. https://doi.org/10.1038/s41598-021-93919-w

10. Huang S, Su H, Hu Y, et al. Immediate effects of vergence exercises using automatic dual rotational Risley prisms on accommodative lag and facility. Ophthalmology and Therapy. 2023; 12 (6): 3361–72. https://doi.org/10.1007/s40123-023-00832-8

11. Aletaha M, Daneshvar F, Mosallaei M, Bagheri A, Khalili MR. Comparison of three vision therapy approaches for convergence insufficiency. Journal of Ophthalmic and Vision Research. 2018; 13 (3): 307. https://doi.org/10.4103/jovr.jovr_99_17

12. Rosa A, Rosa P, Kochana M, Ordon AJ, Loba P. The effect of low hypermetropia correction and office-based orthoptic training on binocular vision parameters in children with convergence insufficiency. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2025; 104–15. https://doi.org/10.1016/j.jaapos.2025.104115

13. Powers M, Fisher WP. Functional binocular vision: toward a PersonCentered metric. In: Springer series in measurement science and technology. 2022: 151–64. https://doi.org/10.1007/978-3-031-07465-3_6

14. Liu Z, Chen Z, Gao L, et al. A new dichoptic training strategy leads to better cooperation between the two eyes in amblyopia. Front Neurosci. 2020; 14: 593119. doi: 10.3389/fnins.2020.593119

15. Panico F, Schintu S, Trojano L. Editorial: Uncovering the neural correlates of prism adaptation: Evidence from the brain network approach. Front Psychol. 2022; 13: 1076307. doi: 10.3389/fpsyg.2022.1076307