Reliability of Binocular Vision Measurements Used in the Classification of Convergence Insufficiency

There are conflicting and confusing ideas in literature on the different types of accommodative and vergence anomalies as different authors turn to classify them differently. This paper sought to review literature on the different classifications and types of nonstrabismic binocular vision anomalies and harmonize these classifications. Search engines, namely Google scholar, Medline, Cinahl and Francis databases, were used to review literature on the classification of accommodative and vergence dysfunctions using keywords like binocular vision dysfunctions, classification of nonstrabismic binocular vision disorders or anomalies, accommodative disorders/anomalies classification and vergence disorders/anomalies classifications, and included works that described these anomalies. Nonstrabismic binocular vision anomalies are classified as accommodative and vergence anomalies. There are three different major types of accommodative anomalies, namely accommodative insufficiency, accommodative infacility (accommodative inertia), and accommodative excess (accommodative spasm), and seven different types of vergence anomalies (convergence insufficiency, convergence excess, divergence insufficiency, divergence excess, basic esophoria, basic exophoria and fusional vergence dysfunctions), which are functional in origin. Functionally, there is a commonly reported interaction between accommodative and convergence insufficiency referred to as pseudoconvergence insufficiency. Accommodative paralysis (subtype of accommodative insufficiency) and vergence anomalies – i.e., convergence paralysis, convergence spasm and divergence paralysis – are non-functional in origin with underlying systemic disease etiologies. Systemic convergence insufficiency, associated with subnormal accommodation, is a non-functional interaction between the accommodative and convergence insufficiency. The classification of nonstrabismic binocular vision anomalies is based on the description of the clinical signs and the underlying etiology either functional or non-functional in origin. Proper diagnosis and management involves investigation of the underlying etiology in addition to the battery of binocular vision test procedures.

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Effect of Binocular Vision Problems on Childhood Academic Performance and Teachers' Perspective

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i2.896 ◽

2020 ◽

Vol 36 (2) ◽

Author(s):

Saif Hassan Alrasheed ◽

Abd Elaziz Mohamed Elmadina

Keyword(s):

Academic Performance ◽

Binocular Vision ◽

Sampling Technique ◽

Cross Sectional Study ◽

Sectional Study ◽

Eye Care ◽

Cross Sectional ◽

Convergence Insufficiency ◽

Teachers Perspectives ◽

Academic Record

Purpose: To see the effect of binocular vision problems on childhood academic performance and to record the teacher's perspectives about childhood eye care in Khartoum State of Sudan. Place and Duration of Study: A descriptive cross-sectional study done among the school going children in the Khartoum State of Sudan during the year 2018. Study Design: Descriptive cross sectional study. Material and Methods: Three hundred and forty (340) primary school children’s were recruited for study by convenient sampling technique during the academic year 2018. After relevant history, ocular examination was performed. It included visual acuity measurement, assessment of refractive errors and binocular function tests. Academic performance of the children was recorded from academic records of the children. Finally, the qualitative data was derived from teachers’ perspectives about childhood eye care. Results: Mean age of the participants was 11.96 ± 1.63 years. The findings revealed that (78.6%) of children achieved poor academic performances with decompensated exophoria at near. 52.7% children with poor academic performances had weak positive fusion reserve at near P = 0.04. 37.2% of the poor performers had convergence insufficiency. Fort eight percent of females with ocular complaints achieved poor academic performances P = 0.034. With regard to teacher's perspectives about childhood eye care, 98.8%believed that the vision problems had effect on the academic record of the children. Seventy percent of the teachers reported that the students did not undergo eye examinations before joining school. Conclusion: Convergence Insufficiency and weak positive fusional reserve at near has a significant effect on academic performances.

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Symptomatic vergence disorders in junior high school children in Ghana

African Vision and Eye Health ◽

10.4102/aveh.v75i1.333 ◽

2016 ◽

Vol 75 (1) ◽

Author(s):

Charles Darko-Takyi ◽

Naimah E. Khan ◽

Urvashni Nirghini

Keyword(s):

High School ◽

Binocular Vision ◽

Junior High School ◽

Junior High ◽

Cape Coast ◽

Cross Sectional ◽

School Based ◽

Convergence Insufficiency ◽

Vision Assessment ◽

Divergence Insufficiency

Background: Optometrists in Ghana are hampered in performing comprehensive binocular vision assessments, because of the lack of appropriate instruments leading to a paucity of data on vergence disorders and their association with asthenopia among Ghanaian school children.Aim: To establish the prevalence of symptomatic vergence disorders among junior high school (JHS) children in Cape Coast Metropolis, Ghana, in their habitual (vision) states and investigate if there were any associations between these disorders and specific asthenopic symptoms.Methods: A prospective cross-sectional school-based study using a multistage sample of 627 participants aged 12–17 years from JHSs in Cape Coast Metropolis. Participants completed a reliable asthenopic symptoms questionnaire and 220 participants who expressed two or more severe or very severe symptoms were selected for comprehensive binocular vision assessment in their habitual vision state.Results: The prevalence of symptomatic vergence disorders among JHS children in Cape Coast Metropolis was 14.8%. For specific symptomatic vergence disorders, the prevalence was: 1.4% basic esophoria, 1.4% basic exophoria, 8.6% convergence insufficiency, 1.8% convergence excess, 0.8% fusional vergence dysfunctions and 0.8% divergence excess. No participant had symptomatic divergence insufficiency. The study revealed significant associations between some specific symptomatic vergence disorders and specific asthenopic symptoms even though all of these asthenopic symptoms overlapped in other vergence disorders.Conclusion: Presenting complaints of specific asthenopic symptoms does not differentiate between specific types of vergence disorders. A comprehensive binocular vision assessment is vital in the diagnosis and management of these disorders to relieve asthenopia.

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The Presentations of Convergence Insufficiency among Young Adults (18-25 Years)

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210732 ◽

2021 ◽

Vol 11 (7) ◽

pp. 235-242

Author(s):

Jacqueline E. Obioma-Elemba ◽

Nnenne U. Onu ◽

Okechi U. Amaechi

Keyword(s):

Young Adults ◽

Binocular Vision ◽

Clinical Signs ◽

Cross Sectional Study ◽

State University ◽

Blurred Vision ◽

Cross Sectional ◽

Imo State ◽

Convergence Insufficiency ◽

Study Population

Convergence Insufficiency is a major binocular vision dysfunction commonly found among the youth. The prevalence of convergence insufficiency has been studied extensively; however there are limited data available on the prevalence of the various presentations of convergence insufficiency among young adults. Convergence insufficiency is associated with symptoms such as fatigue, blurred vision at near, intermittent diplopia at near, “eye strain,” tension in and around the eyes, and the sensation of the print moving while reading. However, convergence insufficiency may present with or without symptoms. The exact prevalence of convergence insufficiency is not known. This study assessed the various presentations of convergence insufficiency among the young adults (aged 18 – 25 years) within the Imo State University community, Owerri, Nigeria, using a cross-sectional study design. Through purposive sampling, a sample size of 162 participants was used for this study after screening and pre-assessment. The Convergence Insufficiency Symptom Survey (CISS), the near point of convergence test, the Von Graefe phoria tests (at far and at near) and the positive fusional vergence tests were administered to all of the study participants. Convergence insufficiency among the young adults of Imo State University presented with symptoms (without clinical signs, 14.2%; with clinical signs, 16.6%) and without symptoms convergence insufficiency (27.8%). The study revealed that convergence insufficiency with symptoms was the more prevalent presentation of convergence insufficiency within the study population. A high percentage of young adults within the study population tested positive for convergence insufficiency, presenting with symptoms (with or without clinical signs) or without symptoms. Key words: Binocular vision, convergence insufficiency, young adult, symptoms, diplopia, phoria.

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Refractive Errors and Binocular Vision Anomalies among Young University Students

Global Journal of Health Science ◽

10.5539/gjhs.v14n1p23 ◽

2021 ◽

Vol 14 (1) ◽

pp. 23

Author(s):

Waleed M. Alghamdi ◽

Muhammed S. Alluwimi ◽

Sulaiman A. Aldakhil ◽

Majid A. Moafa ◽

Mansour A. Alghamdi

Keyword(s):

Saudi Arabia ◽

Academic Performance ◽

University Students ◽

Binocular Vision ◽

P Value ◽

Refractive Errors ◽

Work Related ◽

Convergence Insufficiency ◽

Near Work ◽

Cover Test

It has been reported that refractive errors (RE) and binocular vision (BV) anomalies are common among university students. In this study we aimed to assess RE and BV status among university students in Saudi Arabia, and its relation to the academic performance. We recruited 109 participants (aged from 18 to 21 years). Visual acuity (VA) and objective refraction were used to assess the refractive status. Cover test, near-point convergence (NPC) and stereopsis tests were used to assess the BV status. Convergence insufficiency symptom survey (CISS) was applied to quantify near-work related symptoms. Mann-Whitney U test (p value was set as p < 0.05) was used to compare VA, CISS, NPC and the academic performance between the groups who had heterophoria versus orthophoria. We found that there was only 38% emmetrope, while the percentage of heterophoria was 45.8%. The academic performance was not statistically different among the two groups, but CISS and stereopsis scores were significantly different (p < 0.03). We concluded that RE and BV anomalies were common among university students in Saudi Arabia, but did not affect the academic performance. More studies are warranted to understand the low scores of CISS and stereoacuity, and their association with RE and BV anomalies.

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Vergence and Accommodative Dysfunctions in Emmetropic and Myopic Chinese Young Adults

Journal of Ophthalmology ◽

10.1155/2019/5904903 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Martin Ming-Leung Ma ◽

Anna Chwee Hong Yeo ◽

Mitchell Scheiman ◽

Xiang Chen

Keyword(s):

Binocular Vision ◽

Refractive Error ◽

Linear Trend ◽

Common Finding ◽

Sample Population ◽

Chi Square ◽

Cross Sectional ◽

Convergence Insufficiency ◽

Chinese Young Adults ◽

Divergence Insufficiency

Purpose. To investigate the association between refractive error and common binocular vision and accommodative dysfunctions in Chinese adults and to report the percentage of these disorders in this sample population. Methods. This was a single-site, prospective cross-sectional clinic-based study. A total of 415 Chinese participants aged between 21 and 38 years were grouped into 4 refractive error groups (emmetropia, low, moderate, and high myopia) based on the spherical equivalent power of noncycloplegic refraction. Baseline testing including binocular vision and accommodative testing was performed on all eligible participants. A multiple-sign classification system was used to analyze these data for the diagnosis of common nonstrabismic binocular vision and accommodative dysfunctions. Associations between the diagnosis and refractive error groupings were examined by the chi-square test for the linear trend. Results. Associations with refractive error groupings were found for convergence insufficiency (p=0.008, r = −0.13) and divergence insufficiency (p=0.008, r = 0.131). The 3 most common dysfunctions in this sample population were basic exophoria (10.8%), convergence insufficiency (9.6%), and divergence insufficiency (7.0%). Approximately 40% of the sample population demonstrated at least one type of binocular vision dysfunction. Conclusion. Convergence insufficiency and divergence insufficiency were associated with refractive error groupings. Binocular vision dysfunction was a common finding in this sample population.

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Symptomatic classic convergence insufficiency treated with dot card orthoptic exercise

Optometry Reports ◽

10.4081/optometry.2016.5566 ◽

2016 ◽

Vol 5 (1) ◽

Author(s):

Charles Darko-Takyi ◽

Kofi Asiedu

Keyword(s):

Developing Countries ◽

Binocular Vision ◽

Refractive Error ◽

Female Student ◽

Convergence Insufficiency ◽

Vision Assessment ◽

African Patients ◽

Vision Therapy

Although lots of studies have been reported on convergence insufficiency (CI), no specific case of CI among African patients has been reported. We report a case of symptomatic classic convergence insufficiency in a female student who previously had been misdiagnosed and managed for refractive error. This case highlights the need for comprehensive binocular vision assessment, administration of validated symptom questionnaires in cases of suspicious CI, and the use of simple and inexpensive vision therapy procedures to manage CI in optometric centres in developing countries.

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The Influence of Binocular Vision Symptoms on Computerized Neurocognitive Testing of Adolescents With Concussion

Clinical Pediatrics ◽

10.1177/0009922820927477 ◽

2020 ◽

Vol 59 (11) ◽

pp. 961-969

Author(s):

Adam J. Peiffer ◽

James MacDonald ◽

Drew Duerson ◽

Gladys Mitchell ◽

Andrew T. E. Hartwick ◽

...

Keyword(s):

Binocular Vision ◽

Test Performance ◽

Predictive Accuracy ◽

Symptom Burden ◽

Control Group ◽

Vision Disorders ◽

Vision Disorder ◽

Convergence Insufficiency ◽

Neurocognitive Test ◽

The Relationship

Binocular vision disorders are commonly found postconcussion and associated with high symptom burden. We investigated the relationship between binocular vision symptoms and neurocognitive test performance. Thirty-four adolescents with concussion and 18 without concussion were assessed for cognitive performance using the CogState Brief Battery. Binocular vision disorders were determined using clinical examination and vision symptoms with the Convergence Insufficiency Symptoms Survey (CISS). A cutoff CISS score of 13 had high predictive accuracy for identifying individuals with a binocular vision disorder. CogState scores for processing speed and attention were significantly lower in the concussion group compared with the control group. Within the concussion group, scores for attention, learning, and working memory were significantly lower in those with vision symptoms. The presence of vision symptoms did not significantly affect CogState scores within the control group. The presence of vision symptoms in individuals with concussion is associated with significantly reduced scores on individual components of the CogState.

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Clinical Characteristics of Patients Presenting with Headache at Binocular Vision Clinic: A Hospital Based Study

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1046 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Saif Hassan Alrasheed

Keyword(s):

Binocular Vision ◽

Clinical Characteristics ◽

Fixation Disparity ◽

Cross Sectional ◽

Convergence Insufficiency ◽

Significance Levels ◽

Chi Squared ◽

History Of ◽

Maddox Rod ◽

The Relationship

Purpose: To assess the clinical characteristics of patients presenting with headache at binocular vision clinic.Place and Duration of Study: Al-Neelain eye hospital, Sudan, from February to October 2018.Study Design: Cross-sectional study.Material and Methods: One hundred fifty patients with history of headache were included in study. Dissociated heterophoria was measured using Maddox Wing and Maddox Rod. Associated heterophoria was assessed by the Mallett unit fixation disparity and fusional vergence was measured using a prism bar. The relationship between measures was determined using the chi-squared analysis. For all statistical determinations, significance levels were set at p < 0.05.Results: Mean age was 25 ± 3.5 years. Femalesconstituted 78% and headache was significantly associated with females (P < 0.0001). Majority of patients (82%)presented with exophoria (mean = 4.74 ± 0.75 Δ Base-In) at near fixation, 10.7% were orthophoric and7.34percentage were esophoric (mean = 3.24 ± 0.5 Δ Base-Out). The association between near heterophoria andheadache was statically significant (χ2 = 7.426; p = 0.001). Association between distance heterophoria andheadache was not statistically significant (χ2 = 22.172; p = 0.265). The association between headache andpositive fusional vergence at near fixation was statically significant (p = 0.03). Leading cause of headache wasconvergence weakness exophoria (39.3%; p = 0.001), followed by convergence insufficiency (24%; p = 0.02).Conclusion: Headache was more common in females and was associated with exophoria, convergenceinsufficiency and inadequate positive fusional vergence at near fixation

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Convergence Insufficiency - Perception Error: A Review Article

Journal of Ophthalmology & Clinical Research ◽

10.33140/jocr.04.02.01 ◽

2020 ◽

Vol 4 (2) ◽

Keyword(s):

Binocular Vision ◽

Reading Performance ◽

Vision Disorders ◽

Eye Care ◽

Visual Discomfort ◽

Convergence Insufficiency ◽

Single Vision ◽

Vision Assessment ◽

Proper Diagnosis ◽

Binocular Single Vision

Ocular asthenopia associated with headaches and visual discomfort are the major complaints, clients have these days. Intensive near and digital works have brought many non-strabismic binocular vision disorders (NSBVD) in the clients. Convergence insufficiency (CI) is one of the most prevalent NSBVD. CI is a binocular vision dysfunction, characterized by the patient’s inability to accurately converge, or sustain accurate convergence when focusing on near objects. Apart from visual symptoms, CI is known to have effects on a children’s academics and a person’s daily life. In addition to visual discomfort, children with CI report symptoms affecting reading performance, such as loss of pace, loss of concentration, reading slowly, and trouble remembering what was read. Proper diagnosis of convergence insufficiency is simple, but it has been complicated by the unavailability of essential orthoptic tools; the attitude of practitioner and their knowledge adds to the hurdle. Why don’t we introduce term “CI Suspect” like “Glaucoma-Suspect” so that every individual if matches one or more criteria for CI diagnosis is subjected undergo a complete binocular single vision assessment? This will properly diagnose and manage the case and also make orthoptics as a proper sub-specialty for eye care practitioners.

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