One half of 2–3 signs of CI and 66 per cent of three signs of CI subjects were symptomatic. Children aged nine to 14 were invited to participate. However, the best screening test for CI is unknown. In this study, approximately 20 per cent of subjects had 2–3 signs of convergence insufficiency and six per cent showed three signs of convergence insufficiency. Near point of convergence and amplitude of accommodation testing are tests that a nurse and/or lay screeners may be able to be trained to perform; therefore, further research should evaluate the effectiveness of screening for convergence insufficiency with one or both of these tests when performed by a nurse and/or lay screeners. Diagnosis of Convergence Insufficiency (CI) Individuals with convergence insufficiency might have otherwise normal vision (20/20), so it is important to mention reading or learning concerns to your eye care provider. The CISS score was also included because convergence insufficiency is frequently associated with near work symptoms.6, 13, 14 Tests of accommodative ability were also included because convergence insufficiency is commonly accompanied by accommodative dysfunction, and the vergence and accommodative systems are linked.2, 15. When reading, the eyes and brain also have to do quick, complex eye movements to look across and down a page. CI is most often treated with special exercises. 1 Mallett RFJ (1964) The investigation of heterophoria at near and a new fixation disparity technique. When the eyes converge, it means they point inward (toward the midline) to focus on something close. These results suggest that near point of convergence testing with a referral criterion of 6 cm or greater for break (reported double or observation of loss of fusion) performs best for identifying children with convergence insufficiency in general and a near point of convergence with a referral criterion of 7.5 cm or greater for break performs best for identifying children with symptomatic convergence insufficiency (2–3 signs). Convergence insufficiency (CI) is a condition in which a person’s eyes have a tendency to drift outward when looking at objects at near distances, and their ability to converge (rotate the eyes towards each other) is inadequate. A routine eye exam with the familiar 20/20 eye chart does not diagnose CI. Convergence Insufficiency (CI) is a binocular vision disorder, first described by von Graefe¹ in 1855 and later elaborated by Duane² and is typically characterized by the following signs: 1) exophoria that is greater at near than distance, 2) a remote near point of convergence (NPC), i.e., a breakdown in Survey results, Diagnostic validity of clinical signs associated with a large exophoria at near, Normative values for the nearpoint of convergence of elementary schoolchildren. Working off-campus? It is possible that some subjects who were not symptomatic had suppression, but this was not assessed directly in this study. 1,8 A study did not find a significant difference in the signs or symptoms of children with convergence insufficiency who wore base-in prism compared with children who wore placebo lenses. Optician December 1964:4-5. He or she will also test how your eyes converge. AA: accommodative amplitude, AUC: area under ROC curve, CI: convergence insufficiency, CISS: Convergence Insufficiency Symptom Survey score, MT: Modified Thorington, NPC: near point of convergence, PFV: positive fusional vergence, ROC: receiver operating characteristic. (Tests not listed did not achieve the largest area under the curve.) The first sustained blur was considered the endpoint. Convergence insufficiency is a common binocular vision condition with a prevalence of approximately two to eight per cent in which a person is unable to adequately converge for near work. Convergence insufficiency (CI) is a problem with the way the eye moves. and you may need to create a new Wiley Online Library account. The association between convergence insufficiency and low amplitude of accommodation and the percentages of subjects classified as having binocular or accommodative dysfunction by symptom level are shown in Figures 1 and 2, respectively. One hundred and twenty children were identified as symptomatic (162 non‐symptomatic). Testing was performed by optometrists experienced in working with children. Please check your email for instructions on resetting your password. If diplopia was not reported but the examiner observed a loss of fusion during the measurement of near convergence ranges, the point at which fusion was lost was recorded as the ‘break’ finding. Of these 16 children, three (18.8 per cent) were classified as having 2–3 signs of convergence insufficiency while 11 (68.8 per cent) had low accommodative amplitude. In Convergence Insufficiency: Part 1 we discussed the signs and symptoms of convergence insufficiency, a common eye teaming deficit. You may also notice that one of your eyes sometimes turns outward as you read. It is noteworthy that the CISS was not designed as a screening test for use in the absence of clinical testing, rather it was designed and validated for use in differentiating between those with symptomatic convergence insufficiency and normal binocular vision when used in conjunction with clinical signs, and for use in monitoring changes in symptoms with treatment.5, 6. Each subject was asked to report when the letters blurred or became double (split into two) and to keep the target single as long as possible. We recommend that you follow-up this test with a full vision evaluation by a vision care specialist. Inability to obtain and/or maintain adequate binocular convergence for any length of time without undue effort. Convergence insufficiency. Screenings were performed in a large, quiet room at each school. Convergence Insufficiency Pavan H. Shroff Dept. It is interesting to note that a study by Rouse et al.22 revealed that near point of convergence is often used as the sole means of diagnosing convergence insufficiency in clinical practice. The condition is caused by poor eye coordination (eye teaming), which prevents the eyes from working together, especially when … Current concepts in convergence insufficiency. The number and frequency of individuals with 3‐Sign, 2‐Sign, and 1‐Sign convergence insufficiency as well as no convergence insufficiency group were 25 (2.7 per cent), 119 (12.8 per cent), 303 (32.6 per cent) and 481 (51.8 per cent), respectively. To diagnose convergence insufficiency, your eye doctor might: 1. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. Jobs that need you to use your eyes a lot may also raise your risk. The near point of convergence cut‐point of ≥ 6 cm is in agreement with the 6 cm cut‐off used for convergence insufficiency classification in the CITT16 and both cut‐points are in accord with the 6–10 cm cut‐off for school screenings recommended by Hayes et al.24. The CISS was used to assess symptoms and testing was performed by a trained lay screener. The Mallett Fixation Disparity Test: influence of test instructions and relationship with symptoms Ophthal. Light Sensitivity. Receiver operating characteristic curve analysis was performed to evaluate the ability of each test to identify subjects who were classified as having convergence insufficiency. Convergence insufficiency has a reported prevalence among children and adults in the United States of 2.5 to 13% 1). But to work well, they need to be done regularly. Signed parental permission and assent were obtained from the participating parents and children, respectively. Distance visual acuity was tested monocularly using a light box and a logMAR Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Two per cent classified themselves as Hispanic or Latino, 76 per cent reported not being Hispanic or Latino, and 22 per cent did not report their ethnicity. Amplitude of accommodation with a referral criterion of 10.00 D or less was also among the best tests for identifying children with symptomatic three signs of convergence insufficiency. The Convergence Insufficiency Treatment Trial (CITT) showed that approximately 80 per cent of children with symptomatic convergence insufficiency were improved or successfully treated with vergence/accommodative therapy, demonstrating that therapy is effective in improving the signs and symptoms of convergence insufficiency.9 Furthermore, fewer performance symptoms, less parental concern and improved attention have been reported after successful or improved treatment outcome.10, 11 Despite its common occurrence, many children with convergence insufficiency are unaware that they have convergence insufficiency. If you do not receive an email within 10 minutes, your email address may not be registered, What is convergence Insufficiency? One eye may turn out instead of looking inward. Low amplitude was observed in 26 per cent (10/38) of those with two signs and in 72 per cent (13/18) of those with three signs of convergence insufficiency (Figure 1). Convergence changes the angle between the two eyes’ visual axes by engaging each medial rectus muscle, the curvature of the crystalline lens is increased due to constriction of the ciliary muscle, and the pupil constricts; divergence engages the lateral recti, the lens flattens as the ciliary muscle relax… CISS, near point of convergence, positive fusional vergence, accommodative amplitude of the right eye, and accommodative facility of the right eye were performed according to CITT protocol.16 The CISS was administered before tests of vergence or accommodative function by a screener masked to the other screening tests. Primary CI is thought to be caused by an imbalance of vergence eye movements that is either an inborn deficiency or an acquired etiology. Monocular accommodative facility (cycles/minute) was assessed only on the right eye. They are often steady after that. It is to be administered before any other clinical testing. Screening to detect convergence insufficiency may allow identification and referral for management. Convergence insufficiency (CI) is a problem with the way the eye moves. The near point of convergence (NPC) is a simple test performed in clinic that can reveal abnormalities about the binocular vision system.A reduced NPC in isolation is synonymous with a diagnosis of Gross Convergence Insufficiency.Convergence ability can be affected in traumatic brain injuries or be inherent to a weakened binocular vision system. Convergence Insufficiency (CI) is a common binocular (two-eyed) vision disorder in which the eyes do not work at near easily. People can pass the standard eye exam even if they have CI. You may need to close one eye when reading. The signs of convergence insufficiency were: (1) presence of exophoria 4∆ greater at near than at distance on cover testing; (2) insufficient positive fusional vergence (that is, failing Sheard’s criterion or positive fusional vergence < 15∆ base‐out) at near; and (3) a receded near point of convergence of ≥ 6.0 cm.2, 14 Esophoria at near was defined as ≥ 3∆ at near. The instructions that accompany the Modified Thorington were read to the subject to help ensure understanding of the test and consistency of instructions. Individuals with convergence insufficiency have problems maintaining binocular vision when looking at near, which affects their everyday activities such as writing and reading. They can also measure how the eyes are getting better over time. International Journal of Environmental Research and Public Health. 2. A person can pass the 20/20 eye chart test and still have convergence insufficiency. Convergence Insufficiency Symptom Survey (CISS) Administration Convergence Insufficiency Symptom Survey (CISS) Description The CISS is a 15-item questionnaire designed to assess the severity of the subject’s convergence insufficiency (CI) symptoms. The tester recorded the response to each of the 15 questions. Opt. The Influence of COVID-19 Isolation on Physical Activity Habits and Its Relationship with Convergence Insufficiency. Then, they will test your eyes and give you a routine eye examination. Furthermore, specificity for CISS was low (approximately 61–63 per cent) and 12.6 per cent of children had a symptomatic score in the absence of meeting the criteria for any binocular or accommodative dysfunction. Traumatic Brain Injury in Children: Do the Eyes Have It? We do know that between 4 and 17 percent of children and adults are thought to have CI. Amplitude of accommodation was among the top three tests for identifying those with symptomatic three signs of convergence insufficiency. Methods: A total of 175 subjects with normal binocular vision and 38 subjects with convergence insufficiency were evaluated. Choosing the cut‐point which maximises the sum of sensitivity and specificity equates to choosing the value of the clinical test which minimises the sum of the false positive and false negative rates.17 Using this cut‐point ensures that the correct classification is maximised or, conversely, that misclassification is minimised. Near point of convergence break consistently achieved one of the highest areas under the curve for detection of convergence insufficiency and was, therefore, one of the best tests for identification of convergence insufficiency in a screening setting. You are mostly likely to have symptoms of CI when doing work close up, such as reading or writing. Purpose: To improve the ability of your eyes to work together, especially when looking at close objects. Receiver operating characteristic curve analysis of clinical signs for screening of convergence insufficiency in young adults. Shane Foster, Michael Kennedy, Cayti McDaniel, Kristin Oblad Lewis, Joseph Osmond, Amy Anderson, Marielle Serenda and Ivy Madson. People with convergence insufficiency might have otherwise normal vision, so it's important to mention reading or learning concerns to your eye care provider. Symptomatic 2–3 signs of CI with accommodative dysfunction. Unilateral and alternate cover testing was performed at distance and 40 cm using a 6/9 (20/30) letter as a fixation target. Let the ink dry for a few minutes and raise the sheet of paper up to your nose 2. Eye specialists called optometrists or ophthalmologists diagnose CI. CI can cause blurred vision, double vision, and eyestrain. The Ohio State University Institutional Review Board reviewed and approved the research study and informed consent documents. Always follow your healthcare professional's instructions. Modified Clinical Technique Screening was performed in order to identify and exclude children with amblyopia or significant uncorrected refractive error. Draw a straight line in the middle and across the length of a sheet of paper or cardboard. To diagnose convergence insufficiency, the eye doctor might: 1… Extreme tiredness (fatigue) also can bring on symptoms. Positive fusional vergences, near point of convergence (NPC), accommodative amplitude, accommodative facility, Modified Thorington, and the Convergence Insufficiency Symptom Survey were evaluated. A wide range of findings were observed for each test. Binocular accommodative facility was also assessed using a Suppression Vectogram number 9 and Polaroid filter glasses (Stereo Optical, Chicago, Illinois, USA). These can help you read more comfortably. CI: convergence insufficiency, CISS: Convergence Insufficiency Symptom Survey score, MT: Modified Thorington, NPC: near point of convergence. Near point of convergence break and recovery were measured three times (recorded to the nearest half‐centimetre) and the mean was used for analysis. Convergence Insufficiency is a common eye condition in both children and adults. Regression was not performed to assess the ability of each clinical measure to identify children with accommodative dysfunction because only accommodative amplitude and facility were performed due to time limitations. Number of times cited according to CrossRef: Correlations between clinical measures and symptoms: Report 2: Accommodative and vergence measures with symptoms. Convergence Insufficiency - Often Misdiagnosed as ADD/ADHD ... How to test for Convergence Insufficiency (Wow Vision Therapy) - Duration: 4:17. These problems may go away once CI is treated. The most effective treatment for this condition is office-based vision therapy, but prism can be considered in patients who are unable to undergo this treatment modality. Children who met the Modified Clinical Technique referral criteria for reduced distance visual acuity (6/12 [20/40] or worse in either eye), hyperopia (≥ +1.50 D in either eye), astigmatism (cylinder of ≥ +1.0 D in either eye), and/or anisometropia (≥ 1.0 D) were excluded and referred for care by an eye care professional.12 As distance visual acuity is generally effective in identifying children with myopia and children may over‐accommodate slightly on dry retinoscopy, children were not excluded for apparent low myopia (for example −0.50 or −0.75) on dry screening retinoscopy if visual acuity was 6/9.5 (20/32) or better in each eye. Of the 282 children tested, approximately 20 per cent had 2–3 signs of CI. Convergence insufficiency 1. The test finding which most frequently achieved one of the largest areas under the curve was near point of convergence break. This might include questions about problems you have with focusing, blurred or double vision, headaches, and symptoms. Partial funding provided by T35‐EY07151 and the Ohio Lions Eye Research Foundation. How is convergence insufficiency (CI) diagnosed? Although there are some significant differences among these conditions, they are grouped together based on the … International Journal of Pediatric Otorhinolaryngology. Your eye doctor may prescribe special prism glasses for reading. The break value was used in the analysis if no blur value was reported. Near point of convergence cut‐points of 0.25 or 0.75 cm were rounded up to the nearest half centimetre. It also does not give you practice working with both eyes together, which is important in order to correct CI. Of the 282 subjects included in the analysis, approximately 60 per cent were female, 81.5 per cent identified themselves as White, 11 per cent as African American, 2.5 per cent as other, and five per cent did not report race. Orthophoria with convergence dysfunction was classified as orthophoria with positive fusional vergence ≤ 15∆ to base‐out blur (break if no blur) and a receded near point of convergence of ≥ 6.0 cm. cm: centimetre, CISS: Convergence Insufficiency Symptom Survey. Learn about our remote access options, The Ohio State University College of Optometry, Columbus, Ohio, USA. Physiol. Only eye care professionals can take decisions on medical treatment, diagnosis or prescription. Convergence insufficiency is a common binocular vision condition with a prevalence of approximately two to eight per cent in which a person is unable to adequately converge for near work.1-4 Symptoms associated with convergence insufficiency often include blurred vision, eyestrain, headache, diplopia, frequent loss of place, difficulty concentrating on near work and/or avoidance of near work.1, 5, 6 In addition, Rouse et al.7, 8 found that parents of children with symptomatic convergence insufficiency report a significantly higher number of academic performance symptoms (such as difficulty completing assignments, careless mistakes, avoidance of near work, inattentiveness and worry about school performance), as compared to parents of children with normal binocular vision. In very rare cases, an eye care doctor may advise surgery. Draw five or more dots equally spaced along the line with different color inks or alternating colors. Learn more. The largest area under the receiver operating characteristic curve was obtained using NPC break measurements. High schools were not invited due to the difficulty of screening children with varied schedules, essentially limiting the upper age of enrolment to age 14 years. Near point of convergence testing was performed using a single column of letters of 6/9 (20/30) equivalent at 40 cm on a near point rule (Gulden Ophthalmics, Elkins Park, Pennsylvania, USA). With CI, the eyes have trouble doing this. It makes it hard to focus on things nearby. Near Vision 1. Who gets Convergence Insufficiency? Convergence insufficiency and accommodative insufficiency in children. Each subject viewed the Modified Thorington card with a Maddox rod placed over the right eye. This condition causes one eye to turn outward instead of inward with the other eye creating double or blurred vision.Convergence insufficiency is usually diagnosed in school-age children and adolescents. 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