Vision Therapy Demonstrates Value in Treating Accommodative Infacility

Eye examination
Child in doctor’s office.
Improvements observed in children treated with vision therapy were nearly double in magnitude compared with those treated with low plus addition lenses, according to the report.

Vision therapy (VT) provides greater symptom relief than using low plus addition lenses (ADD) to treat accommodative infacility (AIF) in children, according to research published in Clinical Optometry. 

Researchers enrolled 19 children (age range 8-12 years, 12 girls) with a diagnosis of AIF in the study and assigned them to 1 of 2 treatment methods: ADD (n=10) or VT (n=9). Children in the ADD group wore their customary single vision spectacles for distance use and single vision lenses with a +0.50 add for intermediate and near tasks. Patients with emmetropia strictly wore a correction of +0.50 during intermediate and near work activities. Treatment with VT involved accommodative exercises conducted 5 days per week, 10 minutes per day using a Hart Chart. 

The team obtained monocular accommodation facility (MAF-R and MAF-L) and binocular accommodation facility (BAF) measurements and administered the convergence insufficiency symptom survey (CISS) to subjectively grade AIF symptoms. They noted no significant differences with respect to demographics or baseline measurements among the cohort. The study duration was 6 weeks.

At 6-week follow-up, the investigators noted significant changes from baseline measurements in both groups. Children in the ADD group experienced median changes of +4.5cpm, +4.5cpm, +3.2cpm, and -10.0 points in MAF-R, MAF-L, BAF, and CISS, respectively, while participants in the VT group experienced respective median changes of +7.0 cpm, +7.0 cpm, +10.0 cpm, and -17.0 points (P ≤.008 for all). 

“Both treatments showed significant improvement of facility and less symptoms after 6 weeks of treatment, however the improvements seen with active treatment with VT were nearly double in magnitude compared with those seen with passive treatment with ADD for both AF and symptoms,” according to the researchers. “As far as the immediate effects are concerned the results point toward VT as the treatment of choice in children with accommodative dysfunction with AIF as the most significant accommodative dysfunction.”

Study limitations include a small sample size, single center design, and short study duration.


Balke M, Skjöld G, Lundmark PO. Comparison of short-term effects of treatment of accommodative infacility with low plus addition in single vision Rx or vision therapy: a pilot study. Clin Optom. 2022;14:83-92. doi:10.2147/OPTO.S355508