This prospective cases series aimed to identify the average values and sensitivity of clinical measurements of convergence to aid diagnosis of convergence insufficiency (CI). Children and adults presenting over a two-year period with symptoms including diplopia when reading, headache with near activities, asthenopia, blurred near vision or reading difficulties were included in the study. Those who had received previous strabismus treatment, diagnosis of recent concussion, divergence insufficiency or other ocular / neurological pathology were excluded. Participants were asked to complete the Convergence Insufficiency Symptom Scale (CISS) and the following clinical assessments were completed: best-corrected visual acuity, ocular alignment, near point of convergence, quality of convergence movement, fusional convergence and divergence amplitudes and quality of fusional movements in that set order. Details of the methods are outlined. Assessments were conducted by one of two ophthalmologists. Demographics and previous ocular history were extracted from medical notes. A total of 254 participants completed the study. The three most common presenting symptoms were diplopia, reading difficulties, and headache associated with near activities. The most sensitive assessment for detection of CI were found to be manifest or latent strabismus at near (98.8%), quality of convergence movement (98.4%), abnormal quality of fusional movement (94.5%), convergence using red lens (93.3%), with the CISS only having a sensitivity of 62.9%. The authors suggest that division of CI into subtypes may be possible. However, these subtypes require further assessment in response to treatment. Limitations of this study are acknowledged including that only symptomatic patients were included potentially inflating the sensitivity of tests. Near point of convergence with red lens and quality of convergence movement are recommended as simple quick assessments which can be performed on patients of all ages and could potentially make useful screening tests.
Being more consistent with screening for convergence insufficiency
Reviewed by Lauren Hepworth
Creating consistency in the diagnosis of convergence insufficiency: screening methods.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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