Prepresbyopic patients with reduced accommodative amplitude (accommodative insufficiency) are commonly seen in optometric practice. Treatments include accommodative therapy and plus reading lenses. We did a prospective study of the effects of vision therapy and plus reading lenses on 15 patients (mean age 21.87 +/- 9.66 years) with accommodative insufficiency; presumed etiologies included head trauma (6 patients), thyroid disease (3 patients), seizures (1 patient), toxoplasmosis (1 patient), and idiopathic causes (4 patients). A 7-question scaled response pre- and post-treatment questionnaire assessed symptoms of two groups, vision therapy (idiopathic only) and progressive addition lenses (all patients). No idiopathic patient improved after 3 weeks of accommodative therapy. Progressive lenses with a near addition of + 1.00 or + 1.25 were then prescribed. Questionnaire results, which indicate that near additions provided more relief of symptoms than vision therapy for treatment of accommodation insufficiency, underscore the need for careful examination of prepresbyopic patients to determine those who would benefit from a near addition.