Video Games and VR for Convergence Insufficiency: What the Trials Show

Updated 2026-10-21

Written by the Optics Trainer team from published research, with every source linked below.

Computer programs, games and VR headsets are used in vergence therapy for convergence insufficiency (CI), at home and in the office. The question clinicians face is what the trials support. This guide summarises the Convergence Insufficiency Treatment Trial (CITT) and CITT-ART, the PEDIG home-therapy trial, the 2020 Cochrane network meta-analysis, and the small but growing set of VR and game studies, with the outcomes, populations and limits of each.

The CITT trial: home computer therapy versus office therapy

CITT randomised 221 children aged 9 to 17 with symptomatic CI to 12 weeks of one of four treatments: home pencil push-ups; home computer vergence/accommodative therapy (the Home Therapy System software) plus push-ups; office vergence/accommodative therapy with home reinforcement; or office placebo therapy. The home computer arm was asked to do 15 minutes of software therapy and 5 minutes of push-ups a day, 5 days a week, with monthly office visits and weekly therapist phone calls.

Office therapy with home reinforcement did best on symptoms, near point of convergence (NPC) and positive fusional vergence (PFV). On the composite outcome, 73% of the office therapy group were rated successful or improved, compared with 43% for push-ups, 33% for home computer therapy plus push-ups and 35% for placebo. Neither home arm differed significantly from placebo.

The home arms had more support than many clinics provide, and the trial tested one software package in children over 12 weeks.

CITT-ART: signs, symptoms and reading

The Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART) randomised 311 children aged 9 to 14 to 16 weeks of office vergence/accommodative therapy or office placebo therapy. Both arms had weekly office sessions plus 15 minutes of home therapy 5 days a week, which included a home computer program.

Active therapy improved NPC by 4.2 cm more than placebo and PFV by 14.4 prism dioptres more. Symptom scores on the CI Symptom Survey improved in both arms (11.8 and 10.4 points), with no significant difference, and the investigators cautioned against judging success on the symptom survey alone. A companion paper found office therapy did not improve standardised reading comprehension more than placebo.

Home-only computer therapy: the PEDIG trial

The Pediatric Eye Disease Investigator Group (PEDIG) tested home-based therapy alone in 204 children: home computer therapy, home push-ups, or home placebo, all through customised versions of the same software, for 12 weeks. Composite success was 23%, 22% and 16%, with no significant differences. Most children did not succeed in any arm, and some on placebo did. The trial reached only 34% of its recruitment target, so its estimates are imprecise.

What the Cochrane review concludes

The 2020 Cochrane network meta-analysis (12 trials, 1,289 participants) analysed children and adults separately. In children, it found high-certainty evidence that office therapy with home reinforcement is more likely to achieve convergence success than home computer therapy, home push-ups or placebo. Home computer therapy and home push-ups did not clearly differ from each other or from placebo.

In adults the evidence was less clear: only one adult trial was at low risk of bias, and a network analysis of treatment success was not possible.

Across the included trials, no treatment-related adverse effects were reported.

VR and game-based vergence therapy: the evidence so far

Randomised evidence for VR or games in CI is limited to two small trials in adults, summarised in a 2026 meta-analysis:

Li and colleagues (2022) ran a pilot trial in young adults: 33 with CI and 30 with accommodative dysfunction received VR vision therapy or office therapy for 12 weeks. In the CI participants, symptoms, NPC, PFV and near phoria improved in both groups. There was no placebo arm, so the trial cannot show VR beats no treatment.
Boon and colleagues (2020) randomised 18 adults to a gamified VR program or anaglyph training. NPC and positive fusional reserves improved in both groups, with no difference between the two programs. Time played, used as the compliance measure, was higher with VR (82% versus 51%), and the authors concluded gamified VR was feasible and associated with better compliance.
A 2026 systematic review and meta-analysis by Martinez-Perez and colleagues found only four randomised trials of VR or digital orthoptic therapy (184 participants), two of them in CI. For CI it found a small change in near phoria and no significant effect on NPC or PFV, with low-to-moderate certainty, and advised against extrapolating to first-line practice.

VR trials in intermittent exotropia are not CI trials

Two VR trials studied intermittent exotropia, a different condition. In a placebo-controlled trial that randomised 88 patients aged 13 and older (62 analysed, after 26 were excluded for insufficient VR use or missed visits), Yang and colleagues found a convergence-inducing VR game reduced near exodeviation, while symptoms improved in both groups. In a trial that randomised 177 children to home VR or observation without a sham, Jing and colleagues reported a modest improvement in distance exotropia control score; in a subgroup analysis, children with over 75% adherence improved more than controls. Their results should not be applied to CI.

Adherence

Adherence is a recurring theme. In the Cochrane review, two trials reported high adherence to office therapy, while adherence to home therapy was less consistent. In CITT-ART, 96.8% of office visits were completed, while home adherence ("most of the time" or "always") averaged 64% in the active-therapy arm and 76% in the placebo arm. In the PEDIG home trial, completion of more than 75% of prescribed therapy ranged from 49% to 68% across arms. Small studies suggest games may help engagement, but none has shown that better engagement produces better outcomes in CI.

What this means in practice

For children with symptomatic CI, the strongest evidence supports office vergence/accommodative therapy with home reinforcement. Home computer programs and push-ups alone have not outperformed placebo in children. One small adult study found higher compliance with a VR game, but VR and games are not yet supported by placebo-controlled trials in CI. The AAPOS and AAO patient pages list home, office and computer-based exercises as options; AAPOS says only symptomatic patients need treatment, and AAO notes exercises are not recommended for every patient.

Where Optics Trainer fits

Optics Trainer VR runs vergence, stereo acuity and motor fusion activities on a Meta Quest headset, controlled from a tablet or clinic browser, and with Optics Trainer home training, clinics set each patient's home program from the clinic dashboard, for a Quest headset, phone or tablet, and review at-home activity alongside in-clinic VR sessions.

None of the trials above tested Optics Trainer, and their results do not apply to it. It is not a treatment for convergence insufficiency and does not replace an evidence-based treatment plan.

Frequently asked questions

Do video games help convergence insufficiency?

There is no randomised evidence yet that a game or VR program beats placebo for CI. One small adult study suggests gamified VR is feasible and may help engagement, and a 2026 meta-analysis found no significant effect on near point of convergence or fusional vergence in CI.

Is home computer vergence therapy as good as office therapy?

Not in children, on current evidence. In CITT, home computer therapy plus push-ups did not differ significantly from placebo, and the 2020 Cochrane review found high-certainty evidence that office therapy with home reinforcement is more effective than home computer therapy.

Does VR vision therapy work for convergence insufficiency?

Evidence is limited to two small adult trials. In one, symptoms and convergence measures improved with both VR and office therapy, but it had no placebo arm, and a 2026 meta-analysis rated the certainty low to moderate.

Does treating convergence insufficiency improve reading?

In CITT-ART, office vergence/accommodative therapy did not improve standardised reading comprehension more than placebo after 16 weeks.