Are Orthoptic Exercises an Effective Treatment for Convergence and Fusion Deficiencies?

Aziz, Samir; Cleary, Marie; Stewart, Hannah; Weir, Clifford R.

doi:10.1080/09273970601026185

Cited by 35 publications

(27 citation statements)

References 16 publications

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“…The studies of Borsting et al [6], Rouse et al [28, 29], and Gallaway et al [76] use a cut-off value of ≥7.5 cm for a receded NPC break. Several researches consider 6 cm to establish a receded NPC for CI [1, 7, 8, 11–14, 22, 30, 74]. However, others have used cut-offs of 10 cm [9, 20, 21, 24, 25, 69, 72, 73, 77] and some authors have considered 20 cm [26].…”

Section: Discussionmentioning

confidence: 99%

“…However, others have used cut-offs of 10 cm [9, 20, 21, 24, 25, 69, 72, 73, 77] and some authors have considered 20 cm [26]. As it can be observed there are more studies which use the cut-offs of 6 cm and 10 cm even when only studies of adult population are considered [7, 9, 12, 24, 69, 73, 74, 76]. For NPC recovery, there are also differences between authors.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

Cacho-Martínez

García-Muñoz

Ruiz-Cantero

2013

Journal of Ophthalmology

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Purpose. To analyze the diagnostic validity of accommodative and binocular tests in a sample of patients with a large near exophoria with moderate to severe symptoms. Methods. Two groups of patients between 19 and 35 years were recruited from a university clinic: 33 subjects with large exophoria at near vision and moderate or high visual discomfort and 33 patients with normal heterophoria and low visual discomfort. Visual discomfort was defined using the Conlon survey. A refractive exam and an exhaustive evaluation of accommodation and vergence were assessed. Diagnostic validity by means of receiver operator characteristic (ROC) curves, sensitivity (S), specificity (Sp), and positive and negative likelihood ratios (LR+, LR−) were assessed. This analysis was also carried out considering multiple tests as serial testing strategy. Results. ROC analysis showed the best diagnostic accuracy for receded near point of convergence (NPC) recovery (area = 0.929) and binocular accommodative facility (BAF) (area = 0.886). Using the cut-offs obtained with ROC analysis, the best diagnostic validity was obtained for the combination of NPC recovery and BAF (S = 0.77, Sp = 1, LR+ = value tending to infinity, LR− = 0.23) and the combination of NPC break and recovery with BAF (S = 0.73, Sp = 1, LR+ = tending to infinity, LR− = 0.27). Conclusions. NPC and BAF tests were the tests with the best diagnostic accuracy for subjects with large near exophoria and moderate to severe symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

Cacho-Martínez

García-Muñoz

Ruiz-Cantero

2013

Journal of Ophthalmology

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“…As the blood fl ood to the brain returns to normal, the blood vessels in the brain may dilate in a pulsatile way, manifesting as a throbbing, severe headache. 9 Migraine can be associated with aura; a constellation of neurologic symptoms, including dizziness, tinnitus, scotomata, photo-or phono-phobia; and visual hallucinations (such as zigzag lines), also called scintillating scotomata. 12 Less commonly, migraine aura can also occur without any headache, an event termed acephalgic migraine.…”

Section: Discussionmentioning

confidence: 99%

Convergence Insufficiency Associated with Migraine: A Case Series

Singman

Matta

Silbert

2014

American Orthoptic Journal

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“…A similar phenomenon has been reported in patients with convergence insufficiency who perform convergence exercises and enjoy a prolonged effect on reading symptoms despite no significant change in angle after tapering convergence exercises. 16 After convergence exercises, improvement in reading has been attributed to improved fusional vergence. It is possible that improvement in vergence occured in our patients as well, but this was not measured systematically in our study.…”

Section: Discussionmentioning

confidence: 99%

Sustained improvement of reading symptoms following botulinum toxin A injection for convergence insufficiency

Saunte

Holmes

2014

Strabismus

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Introduction We evaluated the use of botulinum toxin A in adults with convergence insufficiency in whom prior treatment had failed. Methods We studied 8 patients (median age 36 years, range 17 to 77 years) with reading symptoms due to convergence insufficiency defined as an exodeviation greater at near, not exceeding 10 PD in the distance measured by prism and alternate cover test, and either convergence near point >6 cm or reduced fusional amplitudes. All patients were still symptomatic after prior treatment by convergence exercises (n = 8), base-in prism glasses (n = 5) or strabismus surgery (n = 2). Five patients received injection of 5 IU botulinum toxin in 0.1 ml saline to one lateral rectus muscle, two received 2.5 IU, and one received 2.5 IU to both lateral rectus muscles. Results At 1 month post injection, all patients had an initial reduction of exodeviation from baseline (median 9 PD, p = 0.008) at near, although 2 patients had a temporary intermittent esotropia in the distance with diplopia associated with difficulty driving. At 6 months, when the pharmacological effect of botulinum toxin had completely worn off, patients still maintained a small reduction of exodeviation (median 4 PD, p = 0.3) at near. Reading symptoms improved in 7 of 8 patients at 1-month post injection, and in all patients at 6 months. Two patients had health-related quality of life assessed with the Adult Strabismus 20 Questionnaire, showing improved Reading Function scores at 6 months. Interestingly, 3 patients reported improved reading despite returning to the baseline angle at 6 months, and 2 of 4 with 12-month follow-up still reported improvement. Conclusions In adult convergence insufficiency, botulinum toxin injection to a lateral rectus muscle improves reading symptoms beyond the duration of the pure pharmacological effect. Botulinum toxin injection may be useful in management of adult convergence insufficiency, although repeat injections may be needed.

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Are Orthoptic Exercises an Effective Treatment for Convergence and Fusion Deficiencies?

Abstract: Orthoptic exercises are an effective means of reducing symptoms in patients with convergence insufficiency and decompensating exophoria, and appear to target the proximal and fusional components of convergence. Their role in esophoria is unclear and needs further study.

Cited by 35 publications

References 16 publications

Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

Convergence Insufficiency Associated with Migraine: A Case Series

Sustained improvement of reading symptoms following botulinum toxin A injection for convergence insufficiency

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