Early Vision Therapy Speeds Recovery From Concussion-Related Eye Disorders, Trial Finds

A large randomized clinical trial has found that office-based vergence and accommodative therapy with movement (OBVAM) can significantly accelerate recovery from concussion-related convergence insufficiency—a common yet often overlooked visual disorder that impairs reading, concentration, and daily functioning after head injury.

Published in the British Journal of Sports Medicine, the CONCUSS study marks the most rigorous evaluation to date of an active treatment for post-concussion vision dysfunction among adolescents and young adults aged 11 to 25. The results suggest that immediate intervention can cut recovery time nearly in half compared with standard “watchful waiting.”

The multicenter trial enrolled 106 participants who had sustained a concussion 4 to 24 weeks prior and continued to experience symptoms such as blurred or double vision, difficulty focusing, and eye strain. All participants met diagnostic criteria for convergence insufficiency, defined by abnormal near point of convergence (NPC) and reduced positive fusional vergence (PFV).

Participants were randomly assigned to begin OBVAM therapy immediately or after a six-week delay. The program involved two 60-minute sessions per week, guided by certified vision therapists, and targeted both eye coordination and accommodative control.

After six weeks—equivalent to 12 therapy sessions—88% of participants who received immediate OBVAM were rated as “successful” or “improved,” compared with only 8% in the delayed-treatment group (p<0.001).

Improvements were striking across all objective measures. The mean NPC improved by 7.9 cm in the immediate group versus 1.8 cm in controls, while PFV increased by 17.5 prism diopters compared with just 2.5 in the delayed group. Participants in the early-therapy arm also reported a 19-point average reduction in Convergence Insufficiency Symptom Survey (CISS) scores—roughly triple the improvement seen with observation alone.

By the study’s end, once both groups had completed 16 therapy sessions, clinical outcomes were comparable. This finding suggests that while OBVAM remains effective even after delayed initiation, earlier treatment shortens the duration of visual symptoms and facilitates a faster return to normal activities such as schoolwork and sports.

While previous trials had established OBVAM’s efficacy for typical (non-concussion) convergence insufficiency, this study provides the first high-quality evidence supporting its use after mild traumatic brain injury.

As concussion management evolves toward multidisciplinary care, these findings underscore the importance of early recognition and targeted treatment of vision disorders.