Title : Efficacy of manual based versus software based vision therapy in young adults with accommodative insufficiency
Abstract:
Purpose: To compare the efficacy of manual versus software - based vision therapy in young adults (aged 18-35 years) with accommodative insufficiency.
Methodology: This was a single centre non-blinded (open label) RCT taking young adults (aged 18-35 years) diagnosed with accommodative insufficiency, having BCVA of 6/6, N6 and good compliance with glasses or contact lenses. After taking informed consent, patients were divided randomly into two groups. After a detailed orthoptic assessment, one group was treated with manual vision therapy and the other group with software - based vision therapy for 10 consecutive days in phase 1 and then for another 10 consecutive days in phase 2 for 1hour/day. Manual orthoptics therapy was given with the help of accommodative flipper, life saver card, tranaglyph, loose lens rack, brockstring, aperture ruler and Synoptophore. Software based vision therapy was given with the help of VTS-4 software & its tool. We assessed the outcomes initially after 10 sessions (phase 1), then after 20 sessions (phase 2) and compare the outcomes in these two groups after each phase. The outcomes assessed included both subjective and objective parameters. Subjective outcomes included improvement in symptoms by CISS score. Objective outcomes included stereopsis at distance and near, accommodative facility, accommodative amplitude, PRA, NRA, NPC, NPA, fusional vergence, AC/A ratio, HBT and extraocular motility assessment. The patients were followed up after 1month, 3 months and 6 months.
Results: Patients in the software-based vision therapy group showed better outcomes as compared to those in the manual group, which was statistically significant (p-value <0.05).
Conclusion: Software - based vision therapy is more effective, has better patient adherence, but less cost-effective than manual vision therapy in treating patients with accommodative insufficiency.
Clinical implications: Software-based vision therapy offers standardization, positive reinforcement and reduced therapist bias, whereas manual vision therapy provides a more personalized approach and is comparatively cost-effective.
