A Systematic Review and Meta-analysis of Convergence Insufficiency Prevalence and Management Options

Background: Convergence insufficiency (CI) is one of the most common binocular vision disorders. The condition negatively affects the quality of life through its impact on near activities, while there is a large gap in the information on its global prevalence and consensus on treatment. Objectives: The purpose of this systematic review and meta-analysis was to assess the prevalence and treatment options available for convergence insufficiency. Methods: The study was performed in 2023 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-2020) guidelines. The authors have searched Google Scholar, Research Gate, Scopus, PubMed, Index Medicus, Web of Science, and the JAMA network. This review included peer-reviewed studies published between January 2000 to January 2023 that assessed the prevalence and treatment modalities of convergence insufficiency. Results: The authors screened 13250 studies, 20 for prevalence and 15 for treatment from 12 countries that met the inclusion criteria for the study. The overall pooled prevalence of convergence insufficiency was 7.98%, and the heterogeneity between the studies was highly significant P < 0.0001. Majorities of the studies 12(80%) reported that office-based vision therapy is the most effective treatment of CI, form those studies 5(42.0%) highlighted that office-based vergence/accommodative therapy with home reinforcement is the best modality of treatment. Whereas, home-based pencil push-up therapy, vision therapy with modified refractive correction, and vision therapy with prismatic correction were reported as effective treatment options for CI. The reviewed studies showed that vision therapy is highly effective to recover from symptomatic CI in both adults and children. Conclusion: The prevalence of convergence insufficiency was high, there was highly significant heterogeneity between the reviewed studies. Office-based vergence/accommodative therapy with home reinforcement is the best modality of treatment, followed by home-based pencil push-up therapy, vision therapy with modified refractive correction, and vision therapy with prismatic correction. There is consensus among reviewed studies that vision therapy is highly effective to recover from symptomatic CI in both adults and children.