Vision therapy yields faster recovery from concussion-related eye condition

Upending the notion that a common concussion-related eye condition would resolve naturally with watchful waiting, new research published in the British Journal of Sports Medicine found that office-based vergence/accommodative therapy with movement (OBVAM) yields stronger results. 

The CONCUSS randomized clinical trial compared the effectiveness of OBVAM with delayed therapy for concussion-related convergence insufficiency, a condition that can cause eyestrain, blurry or double vision, headaches and other symptoms. The 106 study participants ranged in age from 11 to 25 and had persistent postconcussive symptoms from four to 24 weeks after their injury. 

The study found that OBVAM was effective in improving near point of convergence, positive fusional vergence, and symptom resolution in these patients. By contrast, recovery from concussion-related convergence insufficiency was rare with watchful waiting only. 

The trial has important clinical implications, says AOA member Mitchell Scheiman, O.D., an author of the study. “This study provides the first high-quality evidence that concussion-related vision problems can be effectively treated with office-based vision therapy,” says Dr. Scheiman, a professor and senior associate dean of research at the Pennsylvania College of Optometry at Drexel University. “Our findings clearly demonstrate that spontaneous resolution is uncommon, and early intervention is essential.” 

Clear benefit to early intervention 

Study participants were randomized into two groups: those who would receive immediate OBVAM twice weekly for six weeks and those whose OBVAM would be delayed for six weeks after enrollment. After six weeks, 79% of the participants in the immediate group had improved concussion-related convergence insufficiency symptoms, compared with just 13% of the delayed group. 

Based on these findings, OBVAM “should be considered as soon as it is evident that a [concussion-related convergence insufficiency] is diagnosed,” the authors write. “In most cases, such an approach will lead to successful outcomes, enabling a more rapid return to school, work, sports and other activities.” 

In the study’s second phase, the delayed group received twice-weekly OBVAM for eight weeks, while the immediate group received an additional two weeks of twice-weekly OBVAM. Participants were reassessed after each group received 16 OBVAM sessions. At that time, 81% were classified as a success, and 95% were classified as improved. 

There was no statistically significant difference between the immediate and delayed groups’ findings, indicating that OBVAM will benefit a patient similarly whether implemented immediately or after a six-week delay. 

The study’s lead author is Tara L. Alvarez, Ph.D., a professor of biomedical engineering at the New Jersey Institute of Technology. The work was funded by the National Eye Institute of the National Institutes of Health.