AI-Guided Home-Based Therapy for Convergence Insufficiency: A Comparative Feasibility Study with Pencil Push-Ups

Background: Convergence insufficiency (CI) is a common binocular vision disorder that causes eye strain, headaches, and blurriness. Although pencil push-ups (PPU) are widely used to treat CI, their real-world effectiveness may be limited by inconsistent performance and poor adherence. MobileS (the App) is an AI-based smartphone application that tracks eye movements through the front camera, enabling guided “digital push-ups” with instant visual feedback and automatic performance monitoring. This follow-up study evaluated the feasibility, recorded adherence, and preliminary clinical signals of MobileS as a home-based therapy for CI compared with conventional PPU. Methods: Twenty-five participants with CI were randomly assigned to either the App group (n = 12) or the PPU group (n = 13) for 8 weeks of home-based training. Both groups performed convergence push-ups—using the app or a pencil. NPC was measured using a RAF ruler at baseline, mid-point, and endpoint. Symptom severity was assessed using the Convergence Insufficiency Symptom Survey (CISS), and adherence was recorded automatically by the app or manually by participants. Results: All 25 randomized participants completed all three NPC assessment points. The App group showed a statistically significant improvement in NPC from baseline to study completion (mean improvement = 2.81 cm, p = 0.007), whereas the PPU group showed no significant change. Recorded adherence was higher in the App group compared with the PPU group (90.1% vs. 75.4%, p = 0.0069). The App group showed a significant reduction in symptom severity (p = 0.049). Between-group differences in symptom change were not statistically significant. Conclusions: MobileS appears feasible as a home-based CI management tool, and was associated with higher recorded adherence and preliminary NPC improvement signals. Larger, adequately powered studies are needed to confirm efficacy, particularly for symptoms, and guide teleophthalmology implementation.