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Saikia M, Pant K, Dutta J. Diagnostic Protocol for Accommodative and Vergence Anomalies - A Review. J Binocul Vis Ocul Motil 2024; 74:48-64. [PMID: 38899986 DOI: 10.1080/2576117x.2024.2347663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/22/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To review the diagnostic protocols of non-strabismic binocular vision anomalies. METHODS We carried out a literature search on published articles of non-strabismic accommodative and vergence anomalies in different international optometry and ophthalmology journals found in the Pubmed, ResearchGate, Google Scholar, and MEDLINE databases. RESULTS The diagnostic criteria and normative data from the nine articles selected show discrepancies and variability in methodologies and techniques in the overall assessment of Non-Strabismic Binocular Vision Anomalies (NSBVA). Near point of convergence measurement is the most common assessment, whereas the vergence facility is the least commonly used assessment in terms of evaluating convergence insufficiency. Near point of convergence > 10 cm alone is the most sensitive sign to detect convergence insufficiency in a community set-up but high positive relative accommodation (>3.50D) is the most sensitive sign to diagnose accommodative excess. On the other hand, monocular accommodative facility < 7 CPM has the highest sensitivity to confirm the diagnosis of accommodative infacility. This review also indicates that the more clinical signs that are included in a set of diagnostic criteria, the lower the prevalence rate for that diagnosis. CONCLUSIONS There is no standardized and diagnostically validated protocol for the assessment of NSBVAs. Variable cutoff values obtained using different methods and the selection of diagnostic criteria by various researchers have led to discrepancies that highlight the need for diagnostic validity of available protocols (combination of tests) for each anomaly. Clinical signs such as positive relative accommodation (PRA) for accommodative excess, near point of convergence (NPC) for convergence insufficiency and monocular accommodative facility (MAF) for accommodative infacility were found to be useful diagnostic signs of these anomalies. Studies should be carried out for accommodative and vergence dysfunctions using proper designs and methods to validate diagnostic criteria for all age groups. Standardization of assessment protocol and cutoff criteria will also aid in calculating prevalence for non-strabismic binocular vision anomalies.
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Affiliation(s)
- Mousumi Saikia
- Department of Optometry and Vision Science, Amity Medical School, Amity University Haryana, Gurgaon, India
| | - Kamal Pant
- Department of Optometry, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - Joydeep Dutta
- Department of Chemistry, Amity School of Applied Sciences, Amity University Haryana, Gurgaon, India
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Ma J, Yang X, Liu Z, Fu H, Fan S, Wang K, Li Y, Huang L, Zhao M. The Impact of Vergence Dysfunction on Myopia Control in Children Wearing Defocus Spectacle Lenses. Clin Ophthalmol 2024; 18:799-807. [PMID: 38495679 PMCID: PMC10944170 DOI: 10.2147/opth.s453731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To investigate the impact of vergence dysfunction on myopia progression in children with Defocus incorporated multiple segments (DIMS) spectacle lenses. Patients and Methods We retrospectively enrolled children prescribed DIMS spectacle lenses to slow myopic progression. Baseline vergence dysfunction was determined according to phoria at distance and near. Axial length (AL) measurement and cycloplegic subjective refraction were performed before fitting the lenses and at six-month and one-year follow-ups. The six-month and one-year AL and spherical equivalent (SE) change from baseline were calculated and compared in subgroups stratified with the type of vergence dysfunction. Results Two hundred and ninety-two myopic children were included. Significant AL elongation and SE progression were observed at six months and one year (P < 0.05 for all comparisons). Multiple regression demonstrated that AL elongation at six months (P < 0.001) and one year (P < 0.001) was negatively correlated with age, and SE progression at six months was associated with age (P = 0.002). The AL elongation at six months in children with convergence excess was significantly greater than in normal myopic subjects (P = 0.011) and subjects with convergence insufficiency (P = 0.008), divergence excess (P = 0.007), divergence insufficiency (P = 0.024) and basic esophoria (P = 0.048) at six months. Conclusion The present research demonstrated that vergence dysfunction influences myopia progression for myopic children with DIMS, and the children with convergence excess suffer from the greatest myopia progression among different types of vergence dysfunction.
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Affiliation(s)
- Jiahui Ma
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xue Yang
- Department of Ophthalmology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Zhiming Liu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Hao Fu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Sizhou Fan
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Kai Wang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yan Li
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Lvzhen Huang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
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Kaliugavaradhan A, Ramamurthy D. Accommodative Facility and Response Time before and after Computer Task of Varying Durations in Young Adults. Br Ir Orthopt J 2023; 19:85-95. [PMID: 37868656 PMCID: PMC10588489 DOI: 10.22599/bioj.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/06/2023] [Indexed: 10/24/2023] Open
Abstract
Aim To investigate the changes in near accommodative facility and response time in young adults following computer work of 30 minutes and 1 hour in duration. Methods A total of 50 young adults (37 females, 13 males) with mean age of 20.68 ± 1.33 years were included in this experimental study. Monocular near accommodative facility was measured using ±2.00 Dioptre Sphere (DS) flipper at 40 cm using the N6 (the smallest print size that can be read by an individual with normal visual acuity) target before and after two reading tasks. Both pre- and post-task measurements were video recorded using a smart phone and the number of cycles per minute, positive response time (time taken to stimulate accommodation), and negative response time (time taken to relax accommodation) were calculated from the video recording. Data were analysed using SPSS Version 22.0. Results Out of the 50 participants, 29 were emmetropes (Mean SER: 0.16 ± 0.29 D), and 21 were myopes (Mean SER: -1.89 ± 1.16 D). The mean pre-task accommodative facility was 6.79 ± 3.52 cycles per minute, and the post-task accommodative facility was 6.25 ± 3.65 cycles per minute (p = 0.10) for the 30-minutes task and 5.76 ± 3.89 cycles per minute (p = 0.01) for 1-hour task. The mean pre-task positive response time was 2.87 ± 1.55 seconds, and the post-task positive response times for 30 minutes and 1 hour were 2.86 ± 1.67 seconds (p = 0.88) and 2.98 ± 2.33 seconds (p = 0.42), respectively. The mean pre-task negative response time was 8.77 ± 8.83 seconds, and the post-task negative response times for 30 minutes and 1 hour task were 11.83 ± 14.28 seconds (p = 0.16) and 14.72 ± 17.32 seconds (p = 0.03), respectively. Conclusion Monocular near accommodative facility was significantly reduced, and negative response time was delayed following 1 hour of computer work.
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Dungan ME, Scheiman M, Yaramothu C. Vision Quality of Life with Time Survey: Normative Data and Repeatability. CLINICAL OPTOMETRY 2023; 15:205-212. [PMID: 37719026 PMCID: PMC10505015 DOI: 10.2147/opto.s406407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023]
Abstract
Purpose To develop a novel Vision Quality of Life (QoL) survey that emphasizes the amount of time a visual activity can be performed before symptoms occur. Methods The Vision Quality of Life with Time (VisQuaL-T) survey was developed with 10 daily activities and a list of common visual symptoms. Participants were recruited from a university campus. Participants were not excluded based on binocular impairments to obtain a normative dataset. Participants were instructed to denote when they first experience symptoms within certain time ranges. If participants did not engage in one of the 10 activities, they were instructed to denote "N/A". A composite score (range 0-3) was determined by only accounting for the questions that were answered. Results The normative data cohort had a sample size of 376 participants and the repeatability cohort had 54 participants. The normative, test, and retest datasets had a mean composite score of 2.47±0.54, 2.69±0.42, and 2.67±0.49 and 95% confidence interval of 2.38-2.71, 2.58-2.81, 2.54-2.80, respectively. There was good reliability and high correlation between the test and retest timepoints with an ICC of 0.825 and a Pearson correlation coefficient of 0.839 in the repeatability cohort. The normative data cohort showed good internal consistency with a Cronbach's alpha value of 0.803. Test and retest timepoints showed no statistical significance among the individual questions (p > 0.1). Conclusion A lower bound score of 2.4 can potentially be used to differentiate visually normal and symptomatic participants. Statistical analysis showed the survey is repeatable and reliable. Using time as a metric for assessing symptomology could be a useful method for identifying patients with QoL issues and for assessing effectiveness of binocular vision, accommodative, and eye movement treatments.
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Affiliation(s)
- Michaela E Dungan
- School of Applied Engineering and Technology, New Jersey Institute of Technology, Newark, NJ, USA
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, PA, USA
| | - Chang Yaramothu
- School of Applied Engineering and Technology, New Jersey Institute of Technology, Newark, NJ, USA
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
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Owusu E, Shasteen NM, Mitchell GL, Bailey MD, Kao CY, Toole AJ, Richdale K, Kulp MT. Impact of accommodative insufficiency and accommodative/vergence therapy on ciliary muscle thickness in the eye. Ophthalmic Physiol Opt 2023; 43:947-953. [PMID: 37184092 DOI: 10.1111/opo.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Recent evidence suggests that the ciliary muscle apical fibres are most responsive to accommodative load; however, the structure of the ciliary muscle in individuals with accommodative insufficiency is unknown. This study examined ciliary muscle structure in individuals with accommodative insufficiency (AI). We also determined the response of the ciliary muscle to accommodative/vergence therapy and increasing accommodative demands to investigate the muscle's responsiveness to workload. METHODS Subjects with AI were enrolled and matched by age and refractive error with subjects enrolled in another ciliary muscle study as controls. Anterior segment optical coherence tomography was used to measure the ciliary muscle thickness (CMT) at rest (0D), maximum thickness (CMTMAX) and over the area from 0.75 mm (CMT0.75) to 3 mm (CMT3) posterior to the scleral spur of the right eye. For those with AI, the ciliary muscle was also measured at increasing levels of accommodative demand (2D, 4D and 6D), both before and after accommodative/vergence therapy. RESULTS Sixteen subjects with AI (mean age = 17.4 years, SD = 8.0) were matched with 48 controls (mean age = 17.8 years, SD = 8.2). On average, the controls had 52-72 μm thicker ciliary muscles in the apical region at 0D than those with AI (p = 0.03 for both CMTMAX and CMT 0.75). Differences in thickness between the groups in other regions of the muscle were not statistically significant. After 8 weeks of accommodative/vergence therapy, the CMT increased by an average of 22-42 μm (p ≤ 0.04 for all), while AA increased by 7D (p < 0.001). CONCLUSIONS This study demonstrated significantly thinner apical ciliary muscle thickness in those with AI and that the ciliary muscle can thicken in response to increased workload. This may explain the mechanism for improvement in signs and symptoms with accommodative/vergence therapy.
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Affiliation(s)
- Emmanuel Owusu
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | | | - G Lynn Mitchell
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Melissa D Bailey
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Chiu-Yen Kao
- Department of Mathematical Sciences, Claremont McKenna College, Claremont, California, USA
| | - Andrew J Toole
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn Richdale
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Marjean T Kulp
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Alrasheed SH, Osman TM, Aljohani S, Alshammeri S. Clinical features of Sudanese patients presenting with binocular vision anomalies: A hospital-based study. J Med Life 2023; 16:1251-1257. [PMID: 38024832 PMCID: PMC10652681 DOI: 10.25122/jml-2023-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
Binocular vision anomalies are major causes of asthenopia symptoms, particularly among the younger population. This study aimed to report the clinical characteristics of Sudanese patients with binocular disorders who attended the orthoptic clinic at Al-Neelain Eye Hospital. In this retrospective hospital-based study, we analyzed data from 304 patients with binocular vision anomalies who visited the orthoptic clinic between October 2020 and June 2021. We collected information on demographics, symptoms, and eye tests such as visual acuity (VA), refractive error (RE), angle of deviation, and the assessment of fusional vergence. Our findings indicated that exophoria was the most common binocular vision anomaly, affecting 79.8% of males and 71.6% of females (p=0.731). Children between 6 and 17 years old showed the highest prevalence of exophoria (75.9%) (p=0.0001). Among patients with exophoria, 100% reported itching associated with tearing during fixation, while 89.5% experienced difficulty in fixation. Refractive error varied by the type of binocular vision disorders (p=0.0001), with higher hyperopia observed in cases of unilateral esotropia and alternate esotropia (+3.571±1.238 D and +3.023±1.553 D, respectively). Positive fusional vergence (PFV) differed by types of binocular vision disorders (p=0.0001) with high PFV in esophoria (18.063±6.848∆) compared to low PFV in exophoria (12.80±5.313∆). The most common types of exophoria were convergence weakness exophoria (45.39%), followed by convergence insufficiency (20.39%). The study concluded that exophoria was the most common binocular vision anomaly among Sudanese patients, with convergence weakness and convergence insufficiency being the predominant anomalies. Headache was commonly prevalent among patients with binocular vision problems. Higher hyperopia was found in esodeviation, while low PFV was associated with exodeviation.
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Affiliation(s)
- Saif Hassan Alrasheed
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
- Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan
| | - Tarteel Mohammed Osman
- Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan
| | - Saeed Aljohani
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
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Pang Y, Gabriel H, Tan QQ. Convergence insufficiency symptom survey: A tool to evaluate convergence excess in young adults. Ophthalmic Physiol Opt 2023. [PMID: 36763061 DOI: 10.1111/opo.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To determine the effectiveness of the Convergence Insufficiency Symptom Survey (CISS) in evaluating visual symptoms in young adults with convergence excess (CE). METHODS A cross-sectional study was performed based on a population of optometry students. Comprehensive binocular vision tests including cover test, near point of convergence, fusional vergence and accommodative amplitude, were performed. Participants were categorised into three groups: normal binocular vision (NBV), CE and CE + accommodative insufficiency (AI) (i.e., CE + AI). The CISS was administered to each participant. An analysis of variance with Bonferroni correction was performed to compare clinical measures among the three groups. A receiver-operating characteristic (ROC) curve was constructed to evaluate the ability of CISS to differentiate CE from the NBV population. RESULTS A total of 181 participants were enrolled, including 96 in the NBV group, 66 in the CE group and 19 in the CE + AI group. A significant difference in CISS score was detected between the three groups (p < 0.001). Post-hoc tests showed significantly higher CISS scores in the CE group (16.7 ± 10.8) and the CE + AI group (19.7 ± 10.9) compared with the NBV group (12.2 ± 7.8) (p = 0.01 and p = 0.005, respectively), with no difference between the CE and the CE + AI groups (p = 0.52). The ROC curve showed the CISS poorly (but significantly) differentiated CE from NBV (area under the curve = 0.62, p = 0.01). The optimal cutoff value for a CISS score to differentiate CE was 16, with sensitivity and specificity of 52% and 72%, respectively. CONCLUSIONS Young adults with CE had significantly higher CISS scores than those with NBV. Although using the CISS solely for diagnosing CE is not recommended, it can be used to provide a measure of symptoms in individuals identified as having CE based on clinical measurements.
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Affiliation(s)
- Yi Pang
- Illinois College of Optometry, Chicago, Illinois, USA
| | - Helen Gabriel
- Illinois College of Optometry, Chicago, Illinois, USA
| | - Qing-Qing Tan
- Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,Medical School of Ophthalmology & Optometry, North Sichuan Medical College, Nanchong, China
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Rovira-Gay C, Mestre C, Argiles M, Vinuela-Navarro V, Pujol J. Feasibility of measuring fusional vergence amplitudes objectively. PLoS One 2023; 18:e0284552. [PMID: 37141181 PMCID: PMC10159156 DOI: 10.1371/journal.pone.0284552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023] Open
Abstract
Two tests to measure fusional vergence amplitudes objectively were developed and validated against the two conventional clinical tests. Forty-nine adults participated in the study. Participants' negative (BI, base in) and positive (BO, base out) fusional vergence amplitudes at near were measured objectively in an haploscopic set-up by recording eye movements with an EyeLink 1000 Plus (SR Research). Stimulus disparity changed in steps or smoothly mimicking a prim bar and a Risley prism, respectively. Break and recovery points were determined offline using a custom Matlab algorithm for the analysis of eye movements. Fusional vergence amplitudes were also measured with two clinical tests using a Risley prism and a prism bar. A better agreement between tests was found for the measurement of BI than for BO fusional vergence amplitudes. The means ± SD of the differences between the BI break and recovery points measured with the two objective tests were -1.74 ± 3.35 PD and -1.97 ± 2.60 PD, respectively, which were comparable to those obtained for the subjective tests. For the BO break and recovery points, although the means of the differences between the two objective tests were small, high variability between subjects was found (0.31 ± 6.44 PD and -2.84 ± 7.01 PD, respectively). This study showed the feasibility to measure fusional vergence amplitudes objectively and overcome limitations of the conventional subjective tests. However, these tests cannot be used interchangeably due to their poor agreement.
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Affiliation(s)
- Cristina Rovira-Gay
- Centre for Sensors, Instruments, and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Terrassa, Spain
| | - Clara Mestre
- Centre for Sensors, Instruments, and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Terrassa, Spain
- School of Optometry, Indiana University, Bloomington, IN, United States of America
| | - Marc Argiles
- Centre for Sensors, Instruments, and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Terrassa, Spain
| | - Valldeflors Vinuela-Navarro
- Centre for Sensors, Instruments, and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Terrassa, Spain
| | - Jaume Pujol
- Centre for Sensors, Instruments, and Systems Development (CD6), Universitat Politècnica de Catalunya (UPC), Terrassa, Spain
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Sánchez‐González MC, Palomo‐Carrión R, De‐Hita‐Cantalejo C, Romero‐Galisteo RP, Gutiérrez‐Sánchez E, Pinero‐Pinto E. Visual system and motor development in children: a systematic review. Acta Ophthalmol 2022; 100:e1356-e1369. [PMID: 35118800 PMCID: PMC9790241 DOI: 10.1111/aos.15111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/26/2021] [Accepted: 01/20/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to review the available scientific literature on the possible relationship between the visual system and motor development in children. METHODS This study was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement recommendations. The review protocol is available in PROSPERO (CRD42021245341). Four different databases, namely Scopus, PubMed, CINAHL and Web of Science, were assessed from April 2005 to February 2021. To determine the quality of the articles, we used the Critical Appraisal Skills Programme (CASP) Quality Appraisal Scale, and a protocol was followed to define the levels of evidence on the basis of the Centre for Evidence-Based Medicine Levels of Evidence. The search strategy included terms describing motor development in children and adolescents with visual disorders. RESULTS Among the identified studies, 23 were included in the study. All selected articles examined the relationship between the visual system and development in children. The quality of most of the studies was moderate-high, and they were between evidence levels 2 and 4. CONCLUSIONS Our systematic review revealed that all included studies established a relationship between the visual system and development in children. However, the methods for measuring the visual system and motor skills lacked uniformity.
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Affiliation(s)
| | - Rocío Palomo‐Carrión
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of PhysiotherapyUniversity of Castilla‐La ManchaCiudad RealSpain
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Gantz L, Stiebel-Kalish H. Convergence insufficiency: Review of clinical diagnostic signs. JOURNAL OF OPTOMETRY 2022; 15:256-270. [PMID: 34963569 PMCID: PMC9537264 DOI: 10.1016/j.optom.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Convergence insufficiency (CI) is a common binocular vision (BV) disorder characterized by difficulty in maintaining motor fusion at near, which affects approximately 7.5 percent of the population. Diagnostic criteria for the disorder are inconsistent, ranging from one to many clinical signs. Methodology for clinical tests is inconsistent in measurement technique, visual targets, required repetitions, and normative values. This manuscript demonstrates the inconsistencies amongst published studies, and highlights the importance of consistent clinical diagnostic signs, measurement techniques, visual targets, and cut-off criteria. For each clinical sign, the recommended methodology for the procedure is described. Several studies do not take age into account when diagnosing CI in their cohorts. As such, the review emphasizes changes in diagnostic signs with age. This manuscript highlights the need for consistent and clear procedures and diagnostic criteria amongst clinicians and provides the basis for future studies in terms of diagnostic testing required for CI of varying age groups.
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Affiliation(s)
- Liat Gantz
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
| | - Hadas Stiebel-Kalish
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Felsenstein Research Medical Center; Neuro-Ophthalmology Division, Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
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11
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Shrestha P, Kaiti R. Non-strabismic Binocular Vision Dysfunction among the Medical Students of a Teaching Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:693-696. [PMID: 36705215 PMCID: PMC9446491 DOI: 10.31729/jnma.7615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/28/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Non-strabismic binocular vision dysfunctions are visual disorders that affect the person's binocular vision and visual outcome while performing near tasks and are very common among medical students. This study aimed to find out the prevalence of non-strabismic binocular vision dysfunction among the medical students of a teaching hospital. Methods A descriptive cross-sectional study was conducted among medical students of a teaching hospital from 25 April 2022 to 25 May 2022. Ethical approval was obtained from the Institutional Review Committee of the same institute (Reference number: 139/17). A detailed ocular evaluation including history, visual acuity, refraction, and detailed orthoptic evaluation was done. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results Out of 284 students, 79 (27.81%) (22.60-33.02, 95% Confidence Interval) had non-strabismic binocular vision dysfunctions. Convergence insufficiency was the commonest one seen in 38 (48.10%), followed by divergence excess seen in 8 (10.12%) and convergence excess seen in 8 (10.12%) students. Conclusions The prevalence of non-strabismic binocular vision dysfunction among medical students was lower than in other studies conducted in similar settings. Keywords binocular vision; convergence excess; convergence insufficiency; prevalence.
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Affiliation(s)
- Pooja Shrestha
- Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal,Correspondence: Dr Pooja Shrestha, Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. , Phone: +977-9851082192
| | - Raju Kaiti
- Department of Optometry, Nepal Eye Hospital, Tripureshwor, Kathmandu, Nepal
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Nandagopal P, Srinivasan K, Bhat JR, Thasmia. Methodological variations in studies reporting normative data for binocular vision parameters: a scoping review protocol. JBI Evid Synth 2021; 19:1749-1757. [PMID: 36521067 DOI: 10.11124/jbies-20-00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to map the methodological variations and population characteristics of the studies that report normative data for accommodation and vergence parameters. INTRODUCTION Accommodation and vergence are the two important parameters required for normal binocular vision. The presence of accommodation and vergence anomalies impairs the quality of life of an individual by interfering with their daily visual activities. Diagnosis of accommodative and vergence anomalies requires a series of test procedures. The test procedure or the tool used could influence the outcome measured. Different study designs and methods have been used to estimate the normative data; therefore, we aim to explore the variation in terms of population characteristics and methods used to measure accommodative and vergence parameters. INCLUSION CRITERIA This scoping review will include published literature that assesses normative function of various binocular vision parameters with a focus on mapping the methodological differences. METHODOLOGY JBI methodological framework for scoping reviews will be followed. The review will also be conducted in accordance with the Preferred Reporting Item for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Three-phase searches for identifying relevant articles will be conducted in the following electronic databases: PubMed, Scopus, CINAHL, Web of Science, African Journals Online, LILACS, China National Knowledge Infrastructure, and Google Scholar. The review undertakes two stages of screening: i) title/abstract screening and ii) full-text screening. The data will be extracted from the retrieved full text. The results will be tabulated and summarized descriptively.
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Affiliation(s)
- Pooja Nandagopal
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Abstract
SIGNIFICANCE The present study is the first population-based study to examine the prevalence of convergence insufficiency and its associations specifically in the geriatric population. Knowledge of the population-based determination of prevalence of this disorder in the elderly is necessary to support proper clinical diagnosis and management. PURPOSE This study aimed to determine the prevalence of convergence insufficiency and its associated factors in a geriatric population. METHODS In this study, all residents older than 60 years in Tehran city were selected through random stratified cluster sampling. All participants underwent a complete ocular examination including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, binocular vision assessments including unilateral and alternating cover tests, measurement of the near point of convergence, the positive fusional vergence, and finally ocular health examination. RESULTS In this population-based sample of 1793 participants, the overall prevalences of two-sign and three-sign convergence insufficiency were 29.6% (95% confidence interval, 27.2 to 32.0%) and 21.5% (95% confidence interval, 19.5 to 23.6%), respectively. There were no statistically significant differences in the prevalence of both two-sign (P = .19) and three-sign (P = .41) convergence insufficiency between men and women. The highest and lowest prevalences of two-sign and three-sign convergence insufficiency were in the age groups 70 to 74 and 75 to 79 years, respectively. The prevalence showed no significant trend with age (P = .26 for two-sign convergence insufficiency, P = .33 for three-sign convergence insufficiency). In the multiple logistic regression model, none of the variables, including age, sex, and refractive errors, showed a significant relationship with convergence insufficiency (all, P > .05). CONCLUSIONS The results of the present study showed a high prevalence of convergence insufficiency in the geriatric population. Clinicians should give special attention to this binocular vision disorder in this age group.
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Hussaindeen JR, Rakshit A, Singh NK, George R, Swaminathan M, Kapur S, Scheiman M, Ramani KK. Prevalence of non‐strabismic anomalies of binocular vision in Tamil Nadu: report 2 of BAND study. Clin Exp Optom 2021; 100:642-648. [DOI: 10.1111/cxo.12496] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/24/2016] [Accepted: 09/15/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jameel Rizwana Hussaindeen
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry (in collaboration with Birla Institute of Technology & Science, Pilani), Unit of Medical Research Foundation, Thomas Mount, Chennai, India,
- Sankara Nethraralya – ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Nungambakkam, Chennai, India,
| | - Archayeeta Rakshit
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry (in collaboration with Birla Institute of Technology & Science, Pilani), Unit of Medical Research Foundation, Thomas Mount, Chennai, India,
- Sankara Nethraralya – ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Nungambakkam, Chennai, India,
| | - Neeraj Kumar Singh
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry (in collaboration with Birla Institute of Technology & Science, Pilani), Unit of Medical Research Foundation, Thomas Mount, Chennai, India,
- Sankara Nethraralya – ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Nungambakkam, Chennai, India,
| | - Ronnie George
- Glaucoma Services, Sankara Nethralaya, Nungambakkam, Chennai, India,
| | - Meenakshi Swaminathan
- Sankara Nethraralya – ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Nungambakkam, Chennai, India,
| | - Suman Kapur
- Birla Institute of Technology & Science, Pilani, Hyderabad, India,
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA,
| | - Krishna Kumar Ramani
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry (in collaboration with Birla Institute of Technology & Science, Pilani), Unit of Medical Research Foundation, Thomas Mount, Chennai, India,
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Singh A, Saxena V, Yadav S, Agrawal A, Ramawat A, Samanta R, Panyala R, Kumar B. Comparison of home-based pencil push-up therapy and office-based orthoptic therapy in symptomatic patients of convergence insufficiency: a randomized controlled trial. Int Ophthalmol 2021; 41:1327-1336. [PMID: 33392946 DOI: 10.1007/s10792-020-01689-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess and compare the effectiveness of home-based pencil push-up therapy (PPT) and office-based orthoptic therapy (OBOT) in patients with convergence insufficiency. METHODS In this randomized clinical trial, 176 symptomatic patients with convergence insufficiency, aged between 9 to 30 years, were randomly assigned to receive 6 weeks of home-based PPT (Group I) or OBOT (Group II) after determining refractive error, near point of convergence (NPC), convergence insufficiency symptom survey (CISS) score, near phoria and positive fusional vergences (PFV) at near. The participants of Group I underwent home-based PPT (pencil push-ups exercises15 minutes per day, daily for 6 weeks) and those of Group II OBOT (convergence fusional exercises on synoptophore for 20 min per day, 3 days a week, for 6 weeks) without home reinforcement. Patients were re-examined at 3 and 6 weeks after initiation of treatment. NPC and CISS score were the primary and secondary outcome measures, respectively. Statistical analysis was performed with the independent samples t-test, Friedman test and the analysis of variance (ANOVA). Statistical significance was indicated by p-value < 0.05. RESULTS Participants of both the groups had statistically significant improvement in NPC, CISS score, PFV and near phoria (p < 0.001), but there was no statistically significant difference between the two groups (p > 0.05). However, patients of Group II had significantly better PFV after final visit than those of Group I (p < 0.001). CONCLUSION Home-based PPT with good suppression control and with compliance ensured by log book entries, is a simple, cheap, less time consuming and comparably effective alternative to more expensive OBOT for patients suffering from CI. CTRI registration number: REF/2016/11/012,732, Date of registration 25/04/ 2016, Retrospectively Registered.
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Affiliation(s)
- Anupam Singh
- Ophthalmology Department, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Vartika Saxena
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Sandhya Yadav
- Ophthalmology Department, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Ajai Agrawal
- Ophthalmology Department, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Achala Ramawat
- Ophthalmology Department, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Ramanuj Samanta
- Ophthalmology Department, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Rakesh Panyala
- Ophthalmology Department, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India
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Chen AM, Roberts TL, Cotter SA, Kulp MT, Sinnott LT, Borsting EJ, Tea YC, Jones-Jordan LA, Hertle R, Mitchell GL, Arnold LE, Chase C, Scheiman MM. Effectiveness of vergence/accommodative therapy for accommodative dysfunction in children with convergence insufficiency. Ophthalmic Physiol Opt 2021; 41:21-32. [PMID: 33119180 PMCID: PMC10545079 DOI: 10.1111/opo.12747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.
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Affiliation(s)
- Angela M. Chen
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | - Tawna L. Roberts
- Department of Ophthalmology, Stanford University School of Medicine, CA
| | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | | | | | - Eric J. Borsting
- Southern California College of Optometry at Marshall B. Ketchum University, CA
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Vision Development Differences between Slow and Fast Motor Development in Typical Developing Toddlers: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103597. [PMID: 32443815 PMCID: PMC7277625 DOI: 10.3390/ijerph17103597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022]
Abstract
Many studies have established a relationship between visual function and motor development in toddlers. This is the first report to study two-year-olds via an assessment of their visual and motor skills. The purpose of this study is to describe the possible changes that can occur between visual and motor systems in typical developing toddlers. A total of 116 toddlers were included in this observational, descriptive, and cross-sectional study. Their mean age was 29.57 ± 3.45 months. Motor development variables studied were dominant hand/foot; stationary, locomotion, object manipulation, grasping, visual motor integration percentiles; gross motor, fine motor, and total motor percentiles; and gross motor, fine motor, and total motor quotients. Visual development variables were assessed including visual acuity, refractive error, ocular alignment, motor fusion and suppression, ocular motility, and stereopsis. Our findings demonstrated that typical developing toddlers with slow gross motor development had higher exophoria and further near point of convergence values compared to toddlers with fast gross motor development (p < 0.05). No statistically significant differences were found in visual acuity and stereopsis between slow and fast gross motor development toddlers.
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Atowa UC, Hansraj R, Wajuihian SO. Accommodative anomalies among schoolchildren in Abia State, Nigeria. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Atowa UC, Wajuihian SO, Hansraj R. Vergence Profile and Prevalance of Non-Strabismic Vergence Anomalies Among School Children in Abia State, Nigeria. Ophthalmic Epidemiol 2018; 26:121-131. [DOI: 10.1080/09286586.2018.1532523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Uchenna C. Atowa
- Discipline of Optometry, University of KwaZulu-Natal, Durban, South Africa
| | | | - Rekha Hansraj
- Discipline of Optometry, University of KwaZulu-Natal, Durban, South Africa
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Corwin DJ, Zonfrillo MR, Wiebe DJ, Master CL, Grady MF, Arbogast KB. Vestibular and oculomotor findings in neurologically-normal, non-concussed children. Brain Inj 2018; 32:794-799. [PMID: 29584455 PMCID: PMC6094364 DOI: 10.1080/02699052.2018.1458150] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/20/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the proportion of non-concussed, neurologically normal children with failures on a vestibular and oculomotor examination for concussion performed in an acute setting. DESIGN This was a cross-sectional study of subjects 6-18 years old presenting to a paediatric emergency department with non-neurologic chief complaints. The examination was administered by a paediatric emergency medicine physician, and includes assessments of dysmetria, nystagmus, smooth pursuits, saccades, gaze stability, near-point of convergence, and gait/balance testing. RESULTS Of the 295 subjects enrolled, 24% failed at least one element of testing. About 13% had >1 failed element and 5% had >2 failed elements. About 29% of females and 19% of males had failed examinations. By age, 15% of subjects 6-8 years old, 32% 9-11 years, 32% 12-14 years, and 26% 15-18 years had failed examinations. Overall, 10% were unable to complete the exam due to developmental age. CONCLUSIONS The provider should be aware that a proportion of non-concussed children may demonstrate failure on a single element of the vestibular and oculomotor exam. While this testing is of benefit to the acute care provider in diagnosing paediatric concussion, its utility is greatest in the context of an injury history with acute onset of concussion symptoms.
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Affiliation(s)
- Daniel J Corwin
- a Division of Emergency Medicine , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
- b Center for Injury Research and Prevention, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
- f Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Mark R Zonfrillo
- c Departments of Emergency Medicine and Pediatrics , Alpert Medical School of Brown University and Hasbro Children's Hospital , Providence , RI , USA
| | - Douglas J Wiebe
- d Department of Biostatistics and Epidemiology , University of Pennsylvania , Philadelphia , PA , USA
- f Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Christina L Master
- e Sports Medicine and Performance Center , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
- f Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Matthew F Grady
- e Sports Medicine and Performance Center , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
- f Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Kristy B Arbogast
- a Division of Emergency Medicine , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
- b Center for Injury Research and Prevention, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
- f Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
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Hussaindeen JR, Rakshit A, Singh NK, Swaminathan M, George R, Kapur S, Scheiman M, Ramani KK. The minimum test battery to screen for binocular vision anomalies: report 3 of the BAND study. Clin Exp Optom 2017; 101:281-287. [PMID: 29150866 DOI: 10.1111/cxo.12628] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/18/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aims to report the minimum test battery needed to screen non-strabismic binocular vision anomalies (NSBVAs) in a community set-up. When large numbers are to be screened we aim to identify the most useful test battery when there is no opportunity for a more comprehensive and time-consuming clinical examination. METHODS The prevalence estimates and normative data for binocular vision parameters were estimated from the Binocular Vision Anomalies and Normative Data (BAND) study, following which cut-off estimates and receiver operating characteristic curves to identify the minimum test battery have been plotted. In the receiver operating characteristic phase of the study, children between nine and 17 years of age were screened in two schools in the rural arm using the minimum test battery, and the prevalence estimates with the minimum test battery were found. RESULTS Receiver operating characteristic analyses revealed that near point of convergence with penlight and red filter (> 7.5 cm), monocular accommodative facility (< 10 cycles per minute), and the difference between near and distance phoria (> 1.25 prism dioptres) were significant factors with cut-off values for best sensitivity and specificity. This minimum test battery was applied to a cohort of 305 children. The mean (standard deviation) age of the subjects was 12.7 (two) years with 121 males and 184 females. Using the minimum battery of tests obtained through the receiver operating characteristic analyses, the prevalence of NSBVAs was found to be 26 per cent. Near point of convergence with penlight and red filter > 10 cm was found to have the highest sensitivity (80 per cent) and specificity (73 per cent) for the diagnosis of convergence insufficiency. For the diagnosis of accommodative infacility, monocular accommodative facility with a cut-off of less than seven cycles per minute was the best predictor for screening (92 per cent sensitivity and 90 per cent specificity). CONCLUSION The minimum test battery of near point of convergence with penlight and red filter, difference between distance and near phoria, and monocular accommodative facility yield good sensitivity and specificity for diagnosis of NSBVAs in a community set-up.
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Affiliation(s)
- Jameel Rizwana Hussaindeen
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, India.,ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, India
| | - Archayeeta Rakshit
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, India.,ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, India
| | - Neeraj Kumar Singh
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, India.,ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, India
| | - Meenakshi Swaminathan
- ORBIS Pediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, India
| | - Ronnie George
- Glaucoma services, Sankara Nethralaya, Chennai, India
| | - Suman Kapur
- Birla Institute of Technology and Science, Hyderabad, India
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| | - Krishna Kumar Ramani
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, India
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Singh NK, Mani R, Hussaindeen JR. Changes in stimulus and response AC/A ratio with vision therapy in Convergence Insufficiency. JOURNAL OF OPTOMETRY 2017; 10:169-175. [PMID: 28126262 PMCID: PMC5484784 DOI: 10.1016/j.optom.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/25/2016] [Accepted: 10/03/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To evaluate the changes in the stimulus and response Accommodative Convergence to Accommodation (AC/A) ratio following vision therapy (VT) in Convergence Insufficiency (CI). METHODS Stimulus and response AC/A ratio were measured on twenty five CI participants, pre and post 10 sessions of VT. Stimulus AC/A ratio was measured using the gradient method and response AC/A ratio was calculated using modified Thorington technique with accommodative responses measured using WAM-5500 open-field autorefractor. The gradient stimulus and response AC/A cross-link ratios were compared with thirty age matched controls. RESULTS Mean age of the CI and control participants were 23.3±5.2 years and 22.7±4.2 years, respectively. The mean stimulus and response AC/A ratio for CI pre therapy was 2.2±0.72 and 6.3±2.0 PD/D that changed to 4.2±0.9 and 8.28±3.31 PD/D respectively post vision therapy and these changes were statistically significant (paired t-test; p<0.001). The mean stimulus and response AC/A ratio for controls was 3.1±0.81 and 8.95±2.5 PD/D respectively. CONCLUSIONS Stimulus and response AC/A ratio increased following VT, accompanied by clinically significant changes in vergence and accommodation parameters in subjects with convergence insufficiency. This represents the plasticity of the AC/A crosslink ratios that could be achieved with vision therapy in CI.
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Affiliation(s)
- Neeraj Kumar Singh
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Chennai, India(1)
| | - Revathy Mani
- Binocular Vision and Vision Therapy Clinic, Sankara Nethralaya, Chennai, India
| | - Jameel Rizwana Hussaindeen
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Chennai, India(1); Binocular Vision and Vision Therapy Clinic, Sankara Nethralaya, Chennai, India.
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Hussaindeen JR, Rakshit A, Singh NK, Swaminathan M, George R, Kapur S, Scheiman M, Ramani KK. Binocular vision anomalies and normative data (BAND) in Tamil Nadu: report 1. Clin Exp Optom 2016; 100:278-284. [PMID: 27796049 DOI: 10.1111/cxo.12475] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/06/2016] [Accepted: 05/12/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This population-based, cross-sectional study was designed to determine normative data for binocular vision and accommodative testing in rural and urban populations of Tamil Nadu. METHODS A sample of 936 was determined, based on a previous pilot study. The epidemiological field work included a comprehensive eye examination and a binocular vision and accommodative assessment carried out in a total of four public schools, two each in the rural and urban arms of Chennai. An overall sample of 3,024 children between seven and 17 years of age was screened in the four schools and 920 children were included in the study. RESULTS We found significant differences in expected values from the current clinical criteria for near point of convergence (NPC) with penlight, distance and near horizontal phorias, vergence facility, accommodation convergence/accommodation (AC/A) ratio, accommodative amplitudes, monocular and binocular accommodative facility (t-test: p < 0.001). The mean and standard deviation break/recovery values for NPC (in centimetres) with an accommodative target and penlight with red filter was 3 ± 3/4 ± 4 and 7 ± 5/10 ± 7, respectively. The mean accommodative amplitudes for the population could be estimated from the linear regression equation 16 - 0.3 × (age). The vergence facility was 12 ± 4 cycles/minute and 14 ± 4 cycles/minute in the seven to 10 and 11 to 17 age groups, respectively. Monocular accommodative facility was 11 ± 4 cycles/minute and 14 ± 5 cycles/minute and binocular accommodative facility was 10 ± 4 cycles/minute and 14 ± 5 cycles/minute in the seven to 12 and 13 to 17 age groups, respectively. The mean calculated AC/A ratio was 5.4 ± 0.6/1. CONCLUSION The normative data for vergence and accommodative parameters for the Indian children between seven and 17 years of age are reported. The developmental trend of accommodation and vergence differences and significant differences in cut-off between the current data and available literature are reported. These differences have clinical implications for the interpretation, diagnosis and management of anomalies of binocular vision.
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Affiliation(s)
- Jameel Rizwana Hussaindeen
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India.,Birla Institute of Technology and Science, Pilani, Hyderabad, India.,Sankara Nethralaya - ORBIS Paediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Archayeeta Rakshit
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India.,Sankara Nethralaya - ORBIS Paediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Neeraj Kumar Singh
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Meenakshi Swaminathan
- Sankara Nethralaya - ORBIS Paediatric Ophthalmology Learning and Training Center, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie George
- Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Suman Kapur
- Birla Institute of Technology and Science, Pilani, Hyderabad, India
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| | - Krishna Kumar Ramani
- Srimathi Sundari Subramanian Department of Visual Psychophysics, Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
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