Convergence Insufficiency in the Geriatric Population

Hashemi, Hassan; Nabovati, Payam; Yekta, Abbasali; Aghamirsalim, Mohamadreza; Rafati, Shokoofeh; Ostadimoghaddam, Hadi; Razmjoo, Hassan; Khabazkhoob, Mehdi

doi:10.1097/opx.0000000000001709

Cited by 6 publications

(10 citation statements)

References 46 publications

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“…In this prospective study using pre-specified diagnostic criteria for binocular vision anomalies, at baseline NSBVAs were common (33%), with the majority having convergence insufficiency (28%). A similar high frequency (21.5%) of convergence insufficiency was reported by Hashemi et al 30 in a geriatric population using the same diagnostic criteria (3-sign criterion). There was no significant change in the frequency of binocular vision anomalies after cataract surgery.…”

Section: Discussionsupporting

confidence: 84%

“…Rather, binocular vision conditions are considered syndromes and the diagnosis is based on a series of test results. 24,30 Thirdly, most previous studies were retrospectively designed, which precluded us from determining whether the post-operative binocular vision disorders are new or represent decompensation of previously existing conditions. In addition, there is a lack of use of a validated symptom survey in previous studies, and typically, only the symptom of diplopia was studied.…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of a binocular vision disorder is not generally reached on the results of a single test. Rather, binocular vision conditions are considered syndromes and the diagnosis is based on a series of test results 24,30 …”

Section: Introductionmentioning

confidence: 99%

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Cataract surgery is not associated with post‐operative binocular vision anomalies in age‐related cataract patients

Tan

Lewis

Lan

et al. 2022

Ophthalmic Physiologic Optic

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Purpose To compare the binocular vision status of patients pre‐ and post‐cataract surgery, and to investigate the risk factors for patients who develop binocular vision anomalies post‐surgery. Methods A prospective study of patients (≥50 years) who elected to undergo bilateral cataract surgery was implemented. A comprehensive binocular vision test battery including stereopsis, ocular alignment, fusional vergence, vergence facility, near point of convergence and the Convergence Insufficiency Symptom Survey (CISS) was administered before the first surgery and at the third visit after surgery on the second eye. A detailed diagnostic classification protocol was applied to identify the presence of binocular vision anomalies pre‐ and post‐surgery. Results Seventy‐three participants were included at baseline, 24 (33%) of whom were diagnosed with non‐strabismic binocular vision anomalies (NSBVA), mainly convergence insufficiency (18/73, 25%). Fifty‐one participants completed the post‐operative evaluation, 17 (33%) of whom had NSBVA pre‐surgery and 13 (26%) post‐surgery (p = 0.48). There were a number of conversions from NSBVA to normal binocular vision and vice versa. Logistic regression showed that the adjusted odds ratio of pre‐existing NSBVA diagnosis for predicting the risk of post‐operative NSBVA was 6.37 (p < 0.01). There were no significant changes in most binocular vision measures post‐surgery, except for a significant improvement in the CISS score (p < 0.01, Cohen's d = 0.83). Conclusions Binocular vision anomalies, especially convergence insufficiency, are prevalent in the age‐related cataract population. Cataract surgery does not appear to be a significant risk factor for the development of new binocular vision anomalies. A pre‐existing binocular vision anomaly is the main risk factor for predicting a post‐operative binocular vision anomaly in this population.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cataract surgery is not associated with post‐operative binocular vision anomalies in age‐related cataract patients

Tan

Lewis

Lan

et al. 2022

Ophthalmic Physiologic Optic

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“…In addition, our study cohort does not represent the spectrum of adults with symptomatic convergence insufficiency, and therefore, our results are generalizable only to those with similar clinical and demographic characteristics. For example, approximately two-thirds of the adult participants in the vision therapy/exercise group were younger than 35 years, with few in the age range with the highest prevalence of convergence insufficiency (older than 60 years) 4 . It is unknown whether the associations we found would differ (stronger or weaker) in older persons.…”

Section: Discussionmentioning

confidence: 87%

Relationships among Clinical Factors and Patient-reported Outcome Measures in Adults with Convergence Insufficiency

Lorenzana¹,

Hatt

Dean

et al. 2022

Optom Vis Sci

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SIGNIFICANCE: When exploring relationships among clinical measures and patient-reported outcome measures in adults with convergence insufficiency, worse symptoms (Convergence Insufficiency Symptom Survey [CISS] score) seemed to be correlated with worse reading function domain score (Adult Strabismus-20 quality-of-life questionnaire). After treatment, improved symptoms were associated with improved reading function quality of life.PURPOSE: This study aimed to explore relationships between clinical measures and patient-reported outcome measures in adults undergoing treatment for symptomatic convergence insufficiency. METHODS:In a prospective multicenter observational study, we evaluated adults with symptomatic convergence insufficiency (i.e., clinical measures of near exodeviation, receded near point of convergence, reduced near positive fusional vergence; CISS score ≥21). Fifty-seven participants treated with vision therapy/exercises (n = 35) or base-in prism (n = 22) were analyzed. Spearman correlation coefficients (R) were used to assess associations among the three clinical measures and patient-reported outcome measures (CISS, Diplopia Questionnaire, four Adult Strabismus-20 quality-of-life domains) before treatment (baseline) and after 10 weeks and 1 year. Associations were interpreted to be present when the lower limit of the 95% confidence interval (CI) was moderate to strong (R ≥ 0.4).RESULTS: Among multiple exploratory analyses, the only moderate to strong baseline correlation was between worse CISS and worse Adult Strabismus-20 reading function scores (R = 0.62; 95% CI, 0.43 to 0.76). Regarding change in measures with treatment, the only moderate to strong correlations were between improved CISS and improved Adult Strabismus-20 reading function scores for prism at 10 weeks (R = 0.78; 95% CI, 0.52 to 0.91) and 1 year (R = 0.85; 95% CI, 0.65 to 0.94) and for vision therapy/exercises at 1 year (R = 0.78; 95% CI, 0.57 to 0.89). CONCLUSIONS:In exploratory analyses, we found positive correlations between CISS symptom scores and reading function quality-of-life scores. The absence of correlations between symptoms and individual clinical measures is consistent with clinical experience that, in convergence insufficiency, symptoms and clinical findings can be discordant.

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“…Therefore, it would be helpful to find simple and preferably objective routine clinical methods to help identify MCI. Near point of convergence (NPC) refers to the maximum convergence capability of the eyes and consists of four distinct elements including tonic convergence, proximal convergence, accommodative convergence, and fusional convergence [17] . A receded NPC is the most important clinical sign used by optometrists to diagnose convergence insufficiency; the most prevalent binocular vision anomaly, especially in the elderly population [17] .…”

Section: Introductionmentioning

confidence: 99%

Receded near point of convergence as a predictor of mild cognitive impairment in the general geriatric population: results from a population-based study

Doostdar¹,

Nabovati²,

Asharlous³

et al. 2023

Int J Ophthalmol

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AIM: To investigate the relationship between near point of convergence (NPC) and mild cognitive impairment (MCI) in the general elderly population. METHODS: The present report is a part of the Tehran Geriatric Eye Study (TGES): a population-based cross-sectional study conducted on individuals 60 years of age and above living in Tehran, Iran using the multi-stage stratified random cluster sampling method. Cognitive status was assessed using the Persian version of the Mini-Mental State Examination (MMSE). All study participants underwent complete ocular examination including measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, cover testing, NPC measurement, and slit-lamp biomicroscopy. RESULTS: The data of 1190 individuals were analyzed for this report. The mean age of the participants analyzed was 66.82±5.42 (60-92y) and 728 (61.2%) of them were female. Patients with MCI had a significantly more receded NPC compared to subjects with normal cognitive status (10.89±3.58 vs 7.76±2.71 cm, P<0.001). In the multivariable logistic regression model and in the presence of confounding variables, a receded NPC was statistically significantly associated with an increased risk of MCI (odds ratio: 1.334, 95% confidence interval: 1.263 to 1.410, P<0.001). According to receiver operating characteristic (ROC) analysis, a cut point NPC> 8.5 cm (area under the curve: 0.764, P<0.001) could predict the presence of MCI with a sensitivity and specificity of 70.9% and 69.5%, respectively. CONCLUSION: A receded NPC can be clinically proposed as a predictor of MCI in older adults. It is recommended that elderly with a receded NPC>8.50 cm undergo detailed cognitive screening for a definite diagnosis of MCI. In this case, the necessary interventions can be carried out to slow down MCI progression to dementia.

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Convergence Insufficiency in the Geriatric Population

Cited by 6 publications

References 46 publications

Cataract surgery is not associated with post‐operative binocular vision anomalies in age‐related cataract patients

Cataract surgery is not associated with post‐operative binocular vision anomalies in age‐related cataract patients

Relationships among Clinical Factors and Patient-reported Outcome Measures in Adults with Convergence Insufficiency

Receded near point of convergence as a predictor of mild cognitive impairment in the general geriatric population: results from a population-based study

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