以PPT療法改善CI症狀不如VT/斜視矯正有效


  2003 年5月9日-雖然鉛筆伏地挺身療法(PPT) 是最常見的集合不足性視疲勞(CI)治療,但是根據一項在5月8 日視覺和眼科學協會年會所提出的隨機化試驗結果,證實這是無效的。研究人員要求進行一次大規模的視覺療法試驗(VT)/ 斜視矯正,這種療法在研究中證實是有效的。
  
  費城賓夕法尼亞Optometry學院的M. Scheiman博士表示,我們的資料指出治療效果會隨年齡而異。對兒童而言,VT/斜視矯正比PPT更加有效,實際上,儘管PPT是最常用來進行CI治療的方法,PPT在CI症狀的改善上,並不如安慰組的VT/斜視矯正有效。
  
  在六個臨床研究站點中,47名9到18歲的受試者及46名19到30歲的受試者經過隨機化之後,接受12個星期的PPT 、VT/斜視矯正,或安慰劑VT/斜視矯正治療。
  
  在較年輕的受試小組中,VT/斜視矯正組的治療後平均CI症狀測量級分(9.5 ± 8.2)顯著地比PPT小組 (25.9 ± 7.3) 或安慰劑VT/斜視矯正組(24.2 ± 11.9; P<.0001)佳。VT/斜視矯正組的近點聚合(NPC)及減少的正向像融像性輻輳(PFV),均比其它二組進步更多。
  
  三個成人組都有顯著的臨床症狀改善,其中的VT/斜視矯正組並未比其它小組的進步程度更顯著。但是,只有在VT/斜視矯正組中的成人,其NPC 和PFV獲得顯著的進展。
  
  雖然VT/斜視矯正組是CI症狀唯一達到臨床顯著性的組,60%在治療結束時仍有症狀。我們的資料認為,需要一次大規模隨機化臨床試驗,以測試VT/斜視矯正對於CI症狀的有效性。

Pencil Push-Ups Not Helpful fo

By Laurie Barclay, MD
Medscape Medical News

May 9, 2003 — Although pencil push-up therapy (PPT) is the most commonly prescribed therapy for convergence insufficiency (CI), it is ineffective, according to the results of a randomized trial presented on May 8 at the Association for Research in Vision and Ophthalmology annual meeting. The investigators call for a large-scale trial of visual therapy (VT)/orthoptics, which was shown to be effective in this study.

"Our data suggest a differential effect of treatment with age," write M. Scheiman, from the Pennsylvania College of Optometry in Philadelphia, and colleagues. "In children, VT/orthoptics was clearly more effective than PPT. In fact, despite PPT being the most commonly prescribed treatment for CI, PPT was no more effective than placebo VT/orthoptics for improving symptoms and signs of CI."

At six clinical sites, 47 subjects aged 9 to 18 years and 46 subjects aged 19 to 30 years were randomized to 12 weeks of treatment with PPT, VT/orthoptics, or placebo VT/orthoptics.

In the younger group, the mean CI Symptom Survey score after treatment was significantly better in the VT/orthoptics group (9.5 ± 8.2) than in the PPT group (25.9 ± 7.3) or in the placebo VT/orthoptics group (24.2 ± 11.9; P < .0001 for both comparisons). The VT/orthoptics group also fared better than the other two groups in terms of near point of convergence (NPC) and reduced positive fusional vergence (PFV).

All three groups of adults had a clinically significant improvement in symptoms, which was not significantly better in the VT/orthoptics group compared with the other groups. However, only those adults in the VT/orthoptics group had clinically meaningful improvements in NPC and PFV.

"Although the VT/orthoptics group was the only one that achieved clinically significant improvement in the signs of CI, 60% were still symptomatic at the end of treatment," the authors write. "Our data support the need for a large scale randomized clinical trial of the effectiveness of VT/orthoptics for CI."

The authors did not report any significant financial interests in this study.

ARVO 2003 Annual Meeting: Abstract 4247. Presented May 8, 2003.

Reviewed by Gary D. Vogin, MD

    
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