Please select the eligibility criteria that correspond to the clinical trial below.
Title: Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART)
Brief Summary: 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


Options:
A: Inclusion Criteria:

* Children between the ages of 9 and 17 years with symptomatic convergence insufficiency
* Exophoria at near at least 4Δ greater than at far
* Insufficient positive fusional convergence at near
* A receded near point of convergence of ≥6 cm break
* CI Symptom Survey score ≥16

Exclusion Criteria:

* Previous treatment with office-based vision therapy/orthoptics or pencil push-ups
* Systemic diseases known to affect accommodation, vergence and ocular motility
* Developmental disability, mental retardation, attention deficit hyperactivity disorder (ADHD), or learning disability diagnosis that in the investigator's discretion would interfere with treatment
B: Inclusion Criteria:

1. Age 9 to less than 14 years
2. Grades 3 through 8
3. CI Symptom Survey (CISS) score greater or equal to 16
4. Exophoria at near at least 4 prism diopters greater than at far
5. Receded near point of convergence (NPC) of 6 cm or greater break
6. Insufficient positive fusional vergence (PFV) at near (i.e., failing Sheard's or PFV less than or equal to 15 BO break)
7. Best-corrected distance visual acuity of 20/25 or better in each eye
8. Random dot stereopsis appreciation of 500 seconds of arc or better
9. Wearing appropriate refractive correction (spectacles or contact lenses) for at least 2 weeks prior to final determination of eligibility for any of the following uncorrected refractive errors (based on cycloplegic refraction within prior 12 months)

   * Myopia greater than -0.75D spherical equivalent (SE) in either eye
   * Hyperopia greater than +2.00D SE in either eye
   * SE anisometropia greater than 0.75D
   * Astigmatism greater than 1.00D in either eye

   Correction for patients meeting above refractive error criteria must meet the following guidelines:
   * SE anisometropia must be within 0. 75D of the full anisometropic correction
   * Astigmatism must be within 0.75D of full correction; axis must be within 6◦ if astigmatism greater than or equal to 1.00D
   * For hyperopia, the sphere can be reduced by up to 1.50 D provided reduction is symmetrical
   * For myopia, the SE must be within 0.75D of the full myopic correction
10. No use of BI prism or plus add at near for 2 weeks prior to study and for duration of study
11. English is primary language spoken at home or child proficient in English as determined by the school
12. 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
13. Parental permission to contact the child's teacher(s) for study purposes
14. Parent and child understand protocol and are willing to accept randomization

Exclusion Criteria:

1. Constant strabismus at distance or near
2. Esophoria of greater than or equal to 2∆ at distance
3. Vertical heterophoria greater than or equal to 2∆ at distance or near
4. greater than or equal to 2 line interocular difference in best-corrected distance visual acuity
5. Monocular near point of accommodation greater than 20 cm (accommodative amplitude less than 5D) in right eye
6. Manifest or latent nystagmus
7. Word Reading subtest score less than 80 on the Wide Range Achievement Test (WRAT-4)
8. Kaufman Brief Intelligence Test (KBIT-2) Matrices subtest score less than 70
9. History of prior strabismus, intraocular, or refractive surgery
10. CI previously treated with any form of office-based vergence/accommodative therapy or home-based vergence therapy (e.g., computerized vergence therapy)
11. CI associated with head trauma or known disease of the brain
12. Diseases known to affect accommodation, vergence, or ocular motility
13. Inability to comprehend and/or perform any study-related test or therapy procedure
14. Speech-language disorder (e.g., stuttering) that would interfere with interpretation of digital recordings of reading tests
15. Significant hearing loss
16. Household member enrolled in present CITT-ART, treated currently, 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)
17. Parent or other household member is an eye care professional, ophthalmic technician, ophthalmology or optometry resident, or optometry student
C: Inclusion Criteria:

* Age: 9 to \<19 years.
* Best corrected visual acuity of ≥20/25 in each eye at distance and near
* Willingness to wear eyeglasses or contact lenses to correct refractive error, if necessary
* Willingness to wear glasses for reading and other near work
* Exophoria at near at least 4 greater than at far
* Insufficient positive fusional convergence (fails Sheard's criterion)
* Receded near point of convergence of  6 cm break
* Random dot stereopsis appreciation using a 500 seconds of arc target.
* CI Symptom Survey score  16

Exclusion Criteria:

* Amblyopia (\> 2 line difference in best corrected visual acuity between the two eyes).
* Constant strabismus
* History of strabismus surgery.
* Anisometropia  2D in any meridian between the eyes.
* Prior refractive surgery.
* Vertical heterophoria greater than 1 .
* Systemic diseases known to affect accommodation, vergence and ocular motility such as: multiple sclerosis, Graves thyroid disease, myasthenia gravis, diabetes, Parkinson disease.
* Any ocular or systemic medication known to affect accommodation or vergence (Anti-anxiety agents (Librium or Valium), Anti-arrhythmic agents (Cifenline or Cibenzoline), Anticholinergics (Motion sickness patch (scopolamine), Bladder spasmolytic drugs (Propiverine), Chloroquine, Phenothiazines (Compazine, Mellaril, or Thorazine), Tricyclic antidepressants (Elavil, Nortriptyline, or Tofranil)
* Accommodative amplitude \<5 D in either eye as measured by the Donder's push-up method.
* Manifest or latent nystagmus.
* Developmental disability, mental retardation, attention deficit hyperactivity disorder (ADHD), or learning disability diagnosis in children that in the investigator's discretion would interfere with treatment.
* Household member or sibling already enrolled in the BI-CITT.
* Any eye care professional, ophthalmic technician, ophthalmology or optometry resident or optometry student.
D: Inclusion Criteria:

1. Age: 9 to \<18 years
2. Patient has access to a computer with a CD/DVD drive and internet access for the next 12 weeks
3. Best-corrected visual acuity of ≥20/25 in each eye at distance and near
4. Exophoria at near at least 4 pd greater than at distance
5. Reduced positive fusional convergence at near (\<20 pd or fails Sheard's criterion that the PFV measures less than twice the magnitude of the near phoria). PFV is recorded as the prism magnitude where vision is first blurred (or break if no blur is reported).
6. Near point of convergence of ≥6 cm break
7. Randot Preschool stereoacuity of at least 400 seconds of arc
8. CI Symptom Survey score ≥16
9. No use of a plus add for near or base-in prism for at least 2 weeks preceding enrollment
10. Patient must be wearing appropriate refractive correction (spectacle or contact lenses) for at least 2 weeks prior to enrollment if refractive error is present (based on a cycloplegic refraction within the last 6 months) that meets the following:

    * Myopia more than -0.75D spherical equivalent (SE) in either eye
    * Hyperopia more than +2.00D SE in either eye
    * SE anisometropia \>1.00D
    * Astigmatism \> 1.00D or \> 1.50D of meridional difference in either eye Refractive correction for patients meeting the above refractive error criteria must meet the following guidelines:
    * SE anisometropia must be within 0.25D of the full anisometropic correction.
    * Astigmatism cylinder must be within 0.50D of full correction and axis must be within 5 degrees.
    * For hyperopia, the spherical component can be reduced by up to 1.50D at investigator discretion provided the reduction is symmetrical and results in residual (i.e., uncorrected) SE hyperopia that does not exceed +2.00D.
    * For myopia, the SE must be within 0.25D of the full myopic correction.
11. Parent and patient understand the protocol and are willing to accept randomization.
12. Parent has home phone (or access to phone) and is willing to be contacted by Jaeb Center staff.
13. Relocation outside of area of an active PEDIG site within the next 15 months is not anticipated.

Exclusion Criteria:

1. ≥2 logMAR line difference in best-corrected visual acuity between the two eyes
2. Constant or intermittent exotropia at distance; constant exotropia at near
3. Any esotropia at distance or near
4. Distance exophoria \> 10 pd
5. History of strabismus surgery
6. Anisometropia ≥2.00D in any meridian between the eyes
7. Prior intraocular or refractive surgery
8. Primary vertical heterophoria greater than 1 pd
9. Diseases known to affect accommodation, vergence, and ocular motility such as multiple sclerosis, Graves orbitopathy, myasthenia gravis, diabetes mellitus, or Parkinson disease
10. Current use of 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 (e.g., Motion sickness patch (scopolamine), bladder spasmolytic drugs (e.g., Propiverine), hydroxychloroquine, chloroquine, phenothiazines (e.g., Compazine, Mellaril, Thorazine), tricyclic antidepressants (e.g., Elavil, Nortriptyline, Tofranil)
11. Near point of accommodation \>20 cm in the right eye
12. Manifest or latent nystagmus evident clinically
13. History of chronic headaches unrelated to reading activity
14. Active symptomatic allergic conjunctivitis
15. Developmental disability, mental retardation, attention deficit hyperactivity disorder (ADHD), or learning disability diagnosis that in the investigator's discretion would interfere with treatment or evaluation
16. Household member or sibling already enrolled in the CITS OR previously enrolled in the CITT
17. Household member is an eye professional, ophthalmic technician, ophthalmology or optometry resident, orthoptist, or optometry student, or employed in an eye care setting
18. Acquired brain injury
19. Previous office- or home-based vision therapy, orthoptics, home-based near- target push-ups, pencil push-ups, or home-based computer therapy

Answer: B