A quantitative synthesis of VR-based treatments for convergence insufficiency: A systematic review

Purpose: Convergence insufficiency (CI), a common binocular vision disorder, impairs near eye alignment, causing eyestrain, headaches, and blurred vision. This systematic review aims to synthesize quantitative evidence on the efficacy of virtual reality (VR)-based treatments for CI, comparing their effectiveness to traditional therapies (e.g., pencil push-ups, office-based vision therapy) and assessing clinical outcomes and patient engagement. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, and Web of Science (2000–2025) for randomized controlled trials (RCTs) and observational studies on VR-based interventions for CI. Inclusion criteria included CI diagnosis, VR interventions, and quantitative outcomes (near point of convergence [NPC], positive fusional vergence [PFV], Convergence Insufficiency Symptom Survey [CISS] scores). Study quality was evaluated using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Meta-analyses employed random-effects models, with heterogeneity (I²) and publication bias (Egger’s test) assessed. Results: From 342 articles, 12 studies (7 RCTs, 5 observational, n=589, ages 7–35) were included. VR interventions (headsets, anaglyph systems, gamified platforms) yielded moderate effect sizes (SMD=0.48–0.65), with NPC reductions of 2.5–4.8 cm, PFV increases of 8–12 prism diopters, and CISS score reductions of 10–15 points, outperforming traditional therapies. Compliance was higher (80–95%) with VR due to immersive engagement. Moderate heterogeneity (I²=45–60%) and minimal publication bias (p>0.05) were observed. Conclusion: VR-based treatments are promising for CI, offering enhanced outcomes and compliance. Larger, standardized trials are needed to confirm efficacy and address accessibility.