<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02207517</url>
  </required_header>
  <id_info>
    <org_study_id>Salus - HMS1310</org_study_id>
    <secondary_id>U10EY022599-01A1</secondary_id>
    <nct_id>NCT02207517</nct_id>
  </id_info>
  <brief_title>Office-based Vision Therapy for Improving Reading and Attention in Children With Convergence Insufficiency</brief_title>
  <acronym>CITT-ART</acronym>
  <official_title>Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART)</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Salus University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Eye Institute (NEI)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
    <collaborator>
      <agency>Marshall B. Ketchum University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Ohio State University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>University of Alabama at Birmingham</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>State University of New York College of Optometry</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Akron Children's Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Nova Southeastern University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Bascom Palmer Eye Institute</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Salus University</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      CITT-ART is a multicenter study (8 locations around the United States) of 324 children ages 9&#xD;
      to &lt;14 years with symptomatic convergence insufficiency (CI). The purpose of this study is to&#xD;
      see if office-based therapy for convergence insufficiency (CI) improves reading ability and&#xD;
      attention. CI is an eye-teaming problem where the eyes would like to drift outward when&#xD;
      reading or doing close work. When eyes drift out, double vision can happen. To prevent double&#xD;
      vision one must use extra effort to keep the eyes from going out. This extra effort can cause&#xD;
      symptoms that can interfere with reading and working comfortably at near. These symptoms&#xD;
      often include eyestrain, blurred vision, headaches, double vision, and loss of place when&#xD;
      reading or performing tasks at near. In a prior study we found that therapy improves these&#xD;
      symptoms. In this study we are looking at whether the therapy improves reading and attention&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Following the success of the NEI-funded Convergence Insufficiency Treatment Trials (CITT),&#xD;
      the next logical and important research issue is to determine if the successful treatment of&#xD;
      symptomatic convergence insufficiency (CI) (i.e., improvement of symptoms and ophthalmic&#xD;
      signs) impacts function (reading and attention).&#xD;
&#xD;
      It is well documented that children with symptomatic CI report significantly more symptoms&#xD;
      when reading and doing close work (e.g., blurred vision, headaches, double vision, loss of&#xD;
      concentration, frequent loss of place, trouble remembering what was read), manifest more&#xD;
      academic-impairing behaviors (e.g., difficulty finishing assignments), and score worse on&#xD;
      parent ratings of attention compared to children with normal binocular vision. Because&#xD;
      reduction of symptoms and adverse academic behaviors are established outcomes of successful&#xD;
      treatment of CI, we propose to test the hypothesis that resolution of these symptoms and&#xD;
      behaviors leads to improved reading performance and attention. Previous studies have found&#xD;
      improvements in reading comprehension reading speed and accuracy after successful treatment&#xD;
      of CI. In a recent pilot study, investigators also found significant improvement in reading&#xD;
      comprehension and attention after 16 weeks of successful treatment of symptomatic CI with&#xD;
      office-based vergence/accommodative therapy; however, there was no control group. To&#xD;
      definitively determine whether the successful treatment of symptomatic CI positively impacts&#xD;
      reading and attention requires a placebo-controlled randomized clinical trial.&#xD;
&#xD;
      Objective: We propose a multicenter, placebo-controlled, randomized clinical trial (RCT) of&#xD;
      324 children ages 9 to &lt;14 years (Grades 3-8) with symptomatic CI. [we will restrict&#xD;
      recruitment to children who do not have significant single word reading deficits.]&#xD;
      Participants will be randomized to 16 weeks of treatment with either [a] office-based&#xD;
      vergence/accommodative therapy with home reinforcement (OBVAT) or [b] office-based placebo&#xD;
      therapy with home reinforcement (OBPT). Outcomes (reading and attention) will be assessed&#xD;
      after 16 weeks of treatment. In addition, we will test the long-term effects on outcomes at 1&#xD;
      year after treatment completion. All analyses will test the null hypothesis of no difference&#xD;
      in outcomes between the two treatment groups.&#xD;
&#xD;
      Specific Aim 1 - Reading Performance: To compare reading comprehension outcomes for children&#xD;
      with symptomatic CI who receive 16 weeks of OBVAT and OBPT treatment. The primary outcome&#xD;
      measure of reading performance is the Wechsler Individual Achievement test (WIAT-III) reading&#xD;
      comprehension subtest score. In secondary analyses, we will examine the effects of the&#xD;
      treatment on word reading, pseudoword decoding, oral reading fluency, and listening&#xD;
      comprehension. We also will examine the correlation of changes in CI symptoms and ophthalmic&#xD;
      signs with reading outcomes. Analysis of the 1-year follow-up data will be used to determine&#xD;
      if any gains in reading performance observed after 16 weeks of treatment are sustained.&#xD;
&#xD;
      Specific Aim 2 - Attention: To investigate the effect of treatment on teacher- and&#xD;
      parent-rated measures of attention for children with symptomatic CI who receive 16 weeks of&#xD;
      OBVAT and OBPT intervention. The primary outcome measure of attention is the score on the&#xD;
      Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN). In secondary&#xD;
      analyses, we will examine the effects of treatment on a second parent-rated attention scale&#xD;
      called the SNAP. We also will examine the correlation of changes in CI-symptoms and&#xD;
      ophthalmic signs with attention outcomes. Analysis of the 1-year follow-up data will be used&#xD;
      to determine if any gains in attention observed after 16 weeks of treatment are maintained.&#xD;
&#xD;
      Scientific and Clinical Impact: The relationship between the treatment of symptomatic CI and&#xD;
      its effect on reading and attention in children is unknown. The results of the proposed study&#xD;
      will contribute to a better understanding of these relationships and help to resolve&#xD;
      controversy surrounding this issue. The results will have important implications for&#xD;
      educators, psychologists, eye professionals, and other health care providers who care for&#xD;
      children with reading and attention problems and guide hypothesis development for future&#xD;
      scientific investigations on evidence-based relationships between visual disorders and other&#xD;
      developmental disorders in children.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Active, not recruiting</last_known_status>
  <start_date type="Actual">May 2014</start_date>
  <completion_date type="Anticipated">November 2020</completion_date>
  <primary_completion_date type="Actual">July 2017</primary_completion_date>
  <phase>Phase 3</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Double (Participant, Investigator)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>The change in the Wechsler Individual Achievement Test-III (WIAT-III) reading comprehension score as measured after the completion of 16 weeks of assigned treatment (OBVAT or OBPT).</measure>
    <time_frame>After 16 weeks of treatment</time_frame>
    <description>This test requires the examinee to respond to multiple-choice questions after having read passages independently.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>The change in the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN)</measure>
    <time_frame>After 16 weeks of treatment</time_frame>
    <description>The SWAN is a behavior rating scale that has been used for many years as an assessment tool for ADHD.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Gates-McGintie 4</measure>
    <time_frame>After 16 weeks of treatment</time_frame>
    <description>The child must respond to multiple-choice questions after having read passages independently</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>d2 Test of Attention</measure>
    <time_frame>After 16 weeks of treatment</time_frame>
    <description>The d2 is a timed test of selective and sustained attention.The test measures processing speed, rule compliance, and quality of performance in response to the discrimination of similar stimuli, thereby allowing for an estimation of individual attention and concentration performance</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Academic Behavior Survey (ABS)</measure>
    <time_frame>After 16 weeks of treatment</time_frame>
    <description>The ABS is a 6-item survey designed to measure the frequency of adverse academic behaviors and parental worry about academic performance.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Curriculum Based Measurement (CBM)</measure>
    <time_frame>After 16 weeks of treatment</time_frame>
    <description>Curriculum Based Measurement is commonly used by educators to assess short-term progress in reading, skills as the child proceeds through the academic year The primary advantage of the CBM measure is the ability to track rate of improvement by initial reading level and by time of year. The addition of the CBM measure will assess reading at each outcome visit and allow us to track changes in a similar manner to attention and CI where we have measures at each outcome visit. In addition, CBM will provide an additional outcome measure for reading using a method that is commonly employed by school districts to monitor reading progress and will help to communicate the clinical significance of our results.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">311</enrollment>
  <condition>Convergence Insufficiency</condition>
  <arm_group>
    <arm_group_label>Office-based verg/accomm therapy (OBVAT)</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>OBVAT requires a participant to undergo a specific vision therapy regimen with 16 weekly, 60-minute in-office treatment sessions. Vision Therapists (O.D., M.D., Orthoptists, or specially-trained technicians) administer the therapy in the office. OBVAT procedures are then supplemented with various home therapy procedures</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Office-based placebo therapy (OBPT)</arm_group_label>
    <arm_group_type>Placebo Comparator</arm_group_type>
    <description>Office-based Placebo Therapy (OBPT) requires a participant to undergo a specific therapy regimen of 16 weekly, 60 minute, in-office treatment sessions. Vision therapists (optometrists, ophthalmologists, orthoptists, or specially-trained technicians) administer the therapy in the office. OBPT procedures are then supplemented with placebo home therapy procedures.&#xD;
The procedures for OBPT are designed with the intent of not providing a beneficial training effect on vergence, accommodation, saccadic accuracy, or visual attention beyond normal activities. However, the procedures are designed to simulate real vision therapy in such a way that it will be difficult for participants and parents to know that they have been assigned to the control group and thus are not receiving bonafide OBVAT</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Office-based vergence/accommodative therapy</intervention_name>
    <description>The OBVAT program has been divided into 4 phases. Within each phase there are a number of categories such as gross convergence, vergence, and accommodation. The therapy procedures in each category have been arranged sequentially from easiest to most difficult</description>
    <arm_group_label>Office-based placebo therapy (OBPT)</arm_group_label>
    <arm_group_label>Office-based verg/accomm therapy (OBVAT)</arm_group_label>
    <other_name>Vision Therapy</other_name>
    <other_name>Orthoptics</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          1. Age 9 to less than 14 years&#xD;
&#xD;
          2. Grades 3 through 8&#xD;
&#xD;
          3. CI Symptom Survey (CISS) score greater or equal to 16&#xD;
&#xD;
          4. Exophoria at near at least 4 prism diopters greater than at far&#xD;
&#xD;
          5. Receded near point of convergence (NPC) of 6 cm or greater break&#xD;
&#xD;
          6. Insufficient positive fusional vergence (PFV) at near (i.e., failing Sheard's or PFV&#xD;
             less than or equal to 15 BO break)&#xD;
&#xD;
          7. Best-corrected distance visual acuity of 20/25 or better in each eye&#xD;
&#xD;
          8. Random dot stereopsis appreciation of 500 seconds of arc or better&#xD;
&#xD;
          9. Wearing appropriate refractive correction (spectacles or contact lenses) for at least&#xD;
             2 weeks prior to final determination of eligibility for any of the following&#xD;
             uncorrected refractive errors (based on cycloplegic refraction within prior 12 months)&#xD;
&#xD;
               -  Myopia greater than -0.75D spherical equivalent (SE) in either eye&#xD;
&#xD;
               -  Hyperopia greater than +2.00D SE in either eye&#xD;
&#xD;
               -  SE anisometropia greater than 0.75D&#xD;
&#xD;
               -  Astigmatism greater than 1.00D in either eye&#xD;
&#xD;
             Correction for patients meeting above refractive error criteria must meet the&#xD;
             following guidelines:&#xD;
&#xD;
               -  SE anisometropia must be within 0. 75D of the full anisometropic correction&#xD;
&#xD;
               -  Astigmatism must be within 0.75D of full correction; axis must be within 6◦ if&#xD;
                  astigmatism greater than or equal to 1.00D&#xD;
&#xD;
               -  For hyperopia, the sphere can be reduced by up to 1.50 D provided reduction is&#xD;
                  symmetrical&#xD;
&#xD;
               -  For myopia, the SE must be within 0.75D of the full myopic correction&#xD;
&#xD;
         10. No use of BI prism or plus add at near for 2 weeks prior to study and for duration of&#xD;
             study&#xD;
&#xD;
         11. English is primary language spoken at home or child proficient in English as&#xD;
             determined by the school&#xD;
&#xD;
         12. Parent does not expect child to start any new ADHD medicine or change the dose of any&#xD;
             currently taken ADHD medicine while child is being treated in the study&#xD;
&#xD;
         13. Parental permission to contact the child's teacher(s) for study purposes&#xD;
&#xD;
         14. Parent and child understand protocol and are willing to accept randomization&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          1. Constant strabismus at distance or near&#xD;
&#xD;
          2. Esophoria of greater than or equal to 2∆ at distance&#xD;
&#xD;
          3. Vertical heterophoria greater than or equal to 2∆ at distance or near&#xD;
&#xD;
          4. greater than or equal to 2 line interocular difference in best-corrected distance&#xD;
             visual acuity&#xD;
&#xD;
          5. Monocular near point of accommodation greater than 20 cm (accommodative amplitude less&#xD;
             than 5D) in right eye&#xD;
&#xD;
          6. Manifest or latent nystagmus&#xD;
&#xD;
          7. Word Reading subtest score less than 80 on the Wide Range Achievement Test (WRAT-4)&#xD;
&#xD;
          8. Kaufman Brief Intelligence Test (KBIT-2) Matrices subtest score less than 70&#xD;
&#xD;
          9. History of prior strabismus, intraocular, or refractive surgery&#xD;
&#xD;
         10. CI previously treated with any form of office-based vergence/accommodative therapy or&#xD;
             home-based vergence therapy (e.g., computerized vergence therapy)&#xD;
&#xD;
         11. CI associated with head trauma or known disease of the brain&#xD;
&#xD;
         12. Diseases known to affect accommodation, vergence, or ocular motility&#xD;
&#xD;
         13. Inability to comprehend and/or perform any study-related test or therapy procedure&#xD;
&#xD;
         14. Speech-language disorder (e.g., stuttering) that would interfere with interpretation&#xD;
             of digital recordings of reading tests&#xD;
&#xD;
         15. Significant hearing loss&#xD;
&#xD;
         16. Household member enrolled in present CITT-ART, treated currently, or treated within&#xD;
             the past 6 months with any form of office-based vergence/accommodative therapy or&#xD;
             home-based vergence therapy (e.g., computerized vergence therapy)&#xD;
&#xD;
         17. Parent or other household member is an eye care professional, ophthalmic technician,&#xD;
             ophthalmology or optometry resident, or optometry student&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>9 Years</minimum_age>
    <maximum_age>13 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Mitchell Scheiman, OD</last_name>
    <role>Study Chair</role>
    <affiliation>Salus University</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Lynn MItchell, MAS</last_name>
    <role>Principal Investigator</role>
    <affiliation>Ohio State University</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University of Alabama, Birmingham College of Optometry</name>
      <address>
        <city>Birmingham</city>
        <state>Alabama</state>
        <zip>35294</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Southern California College of Optometry Marshall B. Ketchum University</name>
      <address>
        <city>Fullerton</city>
        <state>California</state>
        <zip>90037</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>NOVA Southeastern University College of Optometry</name>
      <address>
        <city>Fort Lauderdale</city>
        <state>Florida</state>
        <zip>33314</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Bascom Palmer Eye Institute</name>
      <address>
        <city>Miami</city>
        <state>Florida</state>
        <zip>33136</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>State University of Optometry College of Optometry</name>
      <address>
        <city>New York</city>
        <state>New York</state>
        <zip>10036</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Akron Children's Hospital</name>
      <address>
        <city>Akron</city>
        <state>Ohio</state>
        <zip>44302</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Ohio State University College of Optometry</name>
      <address>
        <city>Columbus</city>
        <state>Ohio</state>
        <zip>43210</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Pennsylvania College of Optometry at Salus University</name>
      <address>
        <city>Philadelphia</city>
        <state>Pennsylvania</state>
        <zip>19141</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <link>
    <url>http://www.optometry.osu.edu/research/CITT-ART/</url>
    <description>CITT ART Website</description>
  </link>
  <verification_date>March 2020</verification_date>
  <study_first_submitted>July 31, 2014</study_first_submitted>
  <study_first_submitted_qc>August 1, 2014</study_first_submitted_qc>
  <study_first_posted type="Estimate">August 4, 2014</study_first_posted>
  <last_update_submitted>March 16, 2020</last_update_submitted>
  <last_update_submitted_qc>March 16, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">March 17, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Salus University</investigator_affiliation>
    <investigator_full_name>Mitchell Scheiman</investigator_full_name>
    <investigator_title>Dean of Research</investigator_title>
  </responsible_party>
  <keyword>convergence insufficiency</keyword>
  <keyword>vision therapy</keyword>
  <keyword>reading</keyword>
  <keyword>attention</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Ocular Motility Disorders</mesh_term>
  </condition_browse>
  <pending_results>
    <submitted>December 10, 2020</submitted>
    <returned>January 7, 2021</returned>
  </pending_results>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02207517
org study id: Salus - HMS1310
secondary id: U10EY022599-01A1
nct id: NCT02207517
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: Yes
CITT-ART is a multicenter study (8 locations around the United States) of 324 children ages 9
      to <14 years with symptomatic convergence insufficiency (CI). The purpose of this study is to
      see if office-based therapy for convergence insufficiency (CI) improves reading ability and
      attention. CI is an eye-teaming problem where the eyes would like to drift outward when
      reading or doing close work. When eyes drift out, double vision can happen. To prevent double
      vision one must use extra effort to keep the eyes from going out. This extra effort can cause
      symptoms that can interfere with reading and working comfortably at near. These symptoms
      often include eyestrain, blurred vision, headaches, double vision, and loss of place when
      reading or performing tasks at near. In a prior study we found that therapy improves these
      symptoms. In this study we are looking at whether the therapy improves reading and attention
Following the success of the NEI-funded Convergence Insufficiency Treatment Trials (CITT),
      the next logical and important research issue is to determine if the successful treatment of
      symptomatic convergence insufficiency (CI) (i.e., improvement of symptoms and ophthalmic
      signs) impacts function (reading and attention).

      It is well documented that children with symptomatic CI report significantly more symptoms
      when reading and doing close work (e.g., blurred vision, headaches, double vision, loss of
      concentration, frequent loss of place, trouble remembering what was read), manifest more
      academic-impairing behaviors (e.g., difficulty finishing assignments), and score worse on
      parent ratings of attention compared to children with normal binocular vision. Because
      reduction of symptoms and adverse academic behaviors are established outcomes of successful
      treatment of CI, we propose to test the hypothesis that resolution of these symptoms and
      behaviors leads to improved reading performance and attention. Previous studies have found
      improvements in reading comprehension reading speed and accuracy after successful treatment
      of CI. In a recent pilot study, investigators also found significant improvement in reading
      comprehension and attention after 16 weeks of successful treatment of symptomatic CI with
      office-based vergence/accommodative therapy; however, there was no control group. To
      definitively determine whether the successful treatment of symptomatic CI positively impacts
      reading and attention requires a placebo-controlled randomized clinical trial.

      Objective: We propose a multicenter, placebo-controlled, randomized clinical trial (RCT) of
      324 children ages 9 to <14 years (Grades 3-8) with symptomatic CI. [we will restrict
      recruitment to children who do not have significant single word reading deficits.]
      Participants will be randomized to 16 weeks of treatment with either [a] office-based
      vergence/accommodative therapy with home reinforcement (OBVAT) or [b] office-based placebo
      therapy with home reinforcement (OBPT). Outcomes (reading and attention) will be assessed
      after 16 weeks of treatment. In addition, we will test the long-term effects on outcomes at 1
      year after treatment completion. All analyses will test the null hypothesis of no difference
      in outcomes between the two treatment groups.

      Specific Aim 1 - Reading Performance: To compare reading comprehension outcomes for children
      with symptomatic CI who receive 16 weeks of OBVAT and OBPT treatment. The primary outcome
      measure of reading performance is the Wechsler Individual Achievement test (WIAT-III) reading
      comprehension subtest score. In secondary analyses, we will examine the effects of the
      treatment on word reading, pseudoword decoding, oral reading fluency, and listening
      comprehension. We also will examine the correlation of changes in CI symptoms and ophthalmic
      signs with reading outcomes. Analysis of the 1-year follow-up data will be used to determine
      if any gains in reading performance observed after 16 weeks of treatment are sustained.

      Specific Aim 2 - Attention: To investigate the effect of treatment on teacher- and
      parent-rated measures of attention for children with symptomatic CI who receive 16 weeks of
      OBVAT and OBPT intervention. The primary outcome measure of attention is the score on the
      Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN). In secondary
      analyses, we will examine the effects of treatment on a second parent-rated attention scale
      called the SNAP. We also will examine the correlation of changes in CI-symptoms and
      ophthalmic signs with attention outcomes. Analysis of the 1-year follow-up data will be used
      to determine if any gains in attention observed after 16 weeks of treatment are maintained.

      Scientific and Clinical Impact: The relationship between the treatment of symptomatic CI and
      its effect on reading and attention in children is unknown. The results of the proposed study
      will contribute to a better understanding of these relationships and help to resolve
      controversy surrounding this issue. The results will have important implications for
      educators, psychologists, eye professionals, and other health care providers who care for
      children with reading and attention problems and guide hypothesis development for future
      scientific investigations on evidence-based relationships between visual disorders and other
      developmental disorders in children.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: Double (Participant, Investigator)
measure: The change in the Wechsler Individual Achievement Test-III (WIAT-III) reading comprehension score as measured after the completion of 16 weeks of assigned treatment (OBVAT or OBPT).
time frame: After 16 weeks of treatment
description: This test requires the examinee to respond to multiple-choice questions after having read passages independently.
measure: The change in the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN)
time frame: After 16 weeks of treatment
description: The SWAN is a behavior rating scale that has been used for many years as an assessment tool for ADHD.
measure: Gates-McGintie 4
time frame: After 16 weeks of treatment
description: The child must respond to multiple-choice questions after having read passages independently
measure: d2 Test of Attention
time frame: After 16 weeks of treatment
description: The d2 is a timed test of selective and sustained attention.The test measures processing speed, rule compliance, and quality of performance in response to the discrimination of similar stimuli, thereby allowing for an estimation of individual attention and concentration performance
measure: Academic Behavior Survey (ABS)
time frame: After 16 weeks of treatment
description: The ABS is a 6-item survey designed to measure the frequency of adverse academic behaviors and parental worry about academic performance.
measure: Curriculum Based Measurement (CBM)
time frame: After 16 weeks of treatment
description: Curriculum Based Measurement is commonly used by educators to assess short-term progress in reading, skills as the child proceeds through the academic year The primary advantage of the CBM measure is the ability to track rate of improvement by initial reading level and by time of year. The addition of the CBM measure will assess reading at each outcome visit and allow us to track changes in a similar manner to attention and CI where we have measures at each outcome visit. In addition, CBM will provide an additional outcome measure for reading using a method that is commonly employed by school districts to monitor reading progress and will help to communicate the clinical significance of our results.
arm group label: Office-based verg/accomm therapy (OBVAT)
arm group type: Experimental
description: OBVAT requires a participant to undergo a specific vision therapy regimen with 16 weekly, 60-minute in-office treatment sessions. Vision Therapists (O.D., M.D., Orthoptists, or specially-trained technicians) administer the therapy in the office. OBVAT procedures are then supplemented with various home therapy procedures
arm group label: Office-based placebo therapy (OBPT)
arm group type: Placebo Comparator
description: Office-based Placebo Therapy (OBPT) requires a participant to undergo a specific therapy regimen of 16 weekly, 60 minute, in-office treatment sessions. Vision therapists (optometrists, ophthalmologists, orthoptists, or specially-trained technicians) administer the therapy in the office. OBPT procedures are then supplemented with placebo home therapy procedures.
The procedures for OBPT are designed with the intent of not providing a beneficial training effect on vergence, accommodation, saccadic accuracy, or visual attention beyond normal activities. However, the procedures are designed to simulate real vision therapy in such a way that it will be difficult for participants and parents to know that they have been assigned to the control group and thus are not receiving bonafide OBVAT
intervention type: Procedure
intervention name: Office-based vergence/accommodative therapy
description: The OBVAT program has been divided into 4 phases. Within each phase there are a number of categories such as gross convergence, vergence, and accommodation. The therapy procedures in each category have been arranged sequentially from easiest to most difficult
arm group label: Office-based placebo therapy (OBPT)
arm group label: Office-based verg/accomm therapy (OBVAT)
other name: Vision Therapy
other name: Orthoptics
criteria: 
gender: All
minimum age: 9 Years
maximum age: 13 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Mitchell Scheiman, OD
role: Study Chair
affiliation: Salus University
last name: Lynn MItchell, MAS
role: Principal Investigator
affiliation: Ohio State University
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country: United States
url: http://www.optometry.osu.edu/research/CITT-ART/
description: CITT ART Website
responsible party type: Principal Investigator
investigator affiliation: Salus University
investigator full name: Mitchell Scheiman
investigator title: Dean of Research
mesh term: Ocular Motility Disorders
submitted: December 10, 2020
returned: January 7, 2021