Purpose: To examine whether age-related changes in refraction covary with changes in parameters describing accommodation and convergence over time in a group of Danish school children. Methods: Two-hundred and seventy-eight unselected Danish school children (7.1-13.9 years) without manifest strabismus were studied at baseline and after two years. Each examination included measurement of distance visual acuity, unilateral cover test, non-cycloplegic autorefraction, monocular amplitude of accommodation, monocular accommodation facility, near phoria, near point of convergence, and positive and negative fusional vergence. The changes in the measured parameters were studied over time, followed by the testing for dependencies in the development of these parameters. Results: After two years there was a significant increase in distance visual acuity (p=0.04), monocular accommodation facility (p<0.001), near point exophoria (p=0.04), near point of convergence (p=0.01), and fusional range (p<0.001), a significant reduction in hyperopia (p=0.01) and monocular amplitude of accommodation (p<0.001), while the midpoint of the fusional range changed significantly towards convergence (p<0.001). The increase in near point of convergence correlated significantly with the decrease in monocular amplitude of accommodation (p<0.001) and the convergent shift in the midpoint of the fusional range was significantly correlated with a larger fusional range (p<0.001). The changes in all other parameters were independent. Conclusions: The development of refraction, accommodation, and convergence parameters in school children over two years are independent. This may be due to separate processes regulating development, and suggests that therapeutic intervention may be performed on each of the parameters individually without a derived effect on the other parameters.

Background To determine the sensitivity and specificity of school nurse screening for hypermetropia and convergence insufficiency exophoria (CIE) in schoolchildren. Methods Near point of convergence and distance visual acuity with +2.00D lenses were measured in 2097 children (6–15 years) during standard school nurse screening in the municipality of Randers, Denmark. One hundred and ninety‐four children with positive screening results (near point of convergence >10 cm and/or distance visual acuity improved or maintained with +2.00D) and 182 controls with negative screening results received a full vision assessment, including cycloplegic refraction and orthoptic evaluation. Results Sensitivity and specificity of screening was 0.75 and 0.69 for CIE and 0.59 and 0.87 for hypermetropia (≥+2.00), respectively. While precision of screening for CIE was significantly higher for symptomatic children aged 9–15 than for younger and asymptomatic children, precision of screening for hypermetropia was independent of age and presence of visually related symptoms. Conclusion While precision of screening for CIE and hypermetropia (>+2.00) was low, additional vision evaluation of children older than 9 years with asthenopic symptoms identified most children with CIE with a low absolute number of false positives.

Purpose Convergence insufficiency (CI) is characterized by abnormal vergence eye movement frequently accompanied by abnormal accommodation and subjective symptoms, such as headache, blurred vision, and diplopia. CI is treated with vergence and accommodation exercises that are integrated so that the relative contributions of vergence and accommodation exercises to the outcome are concealed. The purpose of the present study was to determine the individual contributions of vergence and accommodation exercises for the treatment of CI in school children. Methods In a prospective crossover study 44 children aged 9 to 13 years with CI were randomized to perform either vergence exercises followed by accommodation exercises each for 6 weeks or the 2 treatment regimes in the reverse order. The outcome measures were recovery from CI and the parameters vergence facility, positive fusional vergence, near point of convergence, monocular amplitude, and facility of accommodation. Results After the first 6-week period, full recovery from CI was significantly more frequent in the group commencing vergence exercises than in the group commencing monocular accommodation exercises ( p = 0.01), whereas there was no significant difference between these proportions after the second 6-week period ( p = 0.45). Vergence facility and positive fusional vergence improved significantly more after the period with vergence exercises than after the accommodation exercises, whereas there was no significant difference between the effects of the two types of exercises on the other studied parameters. Conclusions Vergence treatment induces a faster recovery of CI than accommodation treatment in school children. This may be used to improve compliance and success rate of the treatment.