Table 1.

CITT-ART Eligibility and Exclusion Criteria.

Eligibility Criteria
Age 9 to 14 years
Grades 3 through 8
CI Symptom Survey (CISS) score ≥ 16
Exophoria at near (40 cm) at least 4Δ greater than at far (4 meters)
Receded near point of convergence of ≥ 6 cm break
Insufficient positive fusional vergence at near (40 cm) (i.e., failing Sheard’s criterion or positive fusional vergence ≤15Δ base-out break)
Best-corrected distance (4 meters) and near visual acuity (40cm) of 20/25 or better in each eye
Random dot stereopsis appreciation of 500 seconds of arc or better (40 cm)
Willing to wear refractive correction for any of the following uncorrected refractive errors (based on cycloplegic refraction within prior 6 months). (Correction must be worn for at least 2 weeks):   – Myopia > −0.75 D spherical equivalent in either eye   – Hyperopia > +2.00 D spherical equivalent in either eye   – Anisometropia > 0.75 D spherical equivalent   – Astigmatism > 1.00 D in either eye   • Refractive error corrections adhered to the following guidelines: full hyperopic sphere power or symmetrically reduced by no more than 1.50 D, spherical equivalent myopia and spherical equivalent anisometropia within 0.75 D of full correction; and astigmatism within 0.75 D of full correction and axis within 6 degrees for magnitudes of ≥ 1.00 D.
Not wearing BI prism or plus add at near for 2 weeks prior to study enrollment and for duration of study
The timing of enrollment must allow a participant to be attending school at both the baseline and the 16-week outcome examination
English is primary language spoken at home or child proficient in English as determined by the school
Parental permission to contact the child’s teacher(s) for study purposes
Parent and child understand protocol and are willing to accept randomization
Parent does not expect child to start any new ADHD medicine or change the dose of any currently taken ADHD medicine while child is being treated in the study
Exclusion Criteria
Constant strabismus at distance or near
Esophoria of ≥ 2Δ at distance
Vertical heterophoria ≥ 2Δ at distance or near
≥ 2-line interocular difference in best-corrected distance visual acuity
Monocular near point of accommodation >20 cm (accommodative amplitude <5D) as measured by push-up method
Manifest or latent nystagmus
Word Reading subtest score < 80 on the Wide Range Achievement Test (WRAT-4)
Kaufman Brief Intelligence Test (KBIT-2) Matrices subtest score <70
History of prior strabismus, intraocular, or refractive surgery
CI previously treated with any form of office-based vergence/accommodative therapy or home-based vergence therapy (e.g., computerized vergence therapy)
CI associated with head trauma or known disease of the brain
Diseases known to affect accommodation, vergence, or ocular motility such as multiple sclerosis, Graves orbitopathy, myasthenia gravis, diabetes mellitus, Parkinson disease
Any ocular or systemic medication known to affect accommodation or vergence such as anti-anxiety agents (e.g., Librium or Valium), anti-arrhythmic agents (e.g., Cifenline, Cibenzoline), anti-cholinergics, bladder spasmolytic drugs (e.g., Propiverine), hydroxychloroquine, chloroquine, phenothiazines (e.g., Compazine, Mellaril, Thorazine), tricyclic antidepressants (e.g., Elavil, Nortriptyline, Tofranil)
Inability to comprehend and/or perform any study-related test or procedure
Speech-language disorder (e.g., stuttering) that would interfere with interpretation of digital recordings of reading tests
Significant hearing loss
Household member enrolled in present CITT-ART or treated within the past 6 months with any form of office-based vergence/accommodative therapy or home-based vergence therapy (e.g., computerized vergence therapy)
Household member is an eye care professional, ophthalmic technician, ophthalmology or optometry resident, or optometry student