Symptoms in Children with Convergence Insufficiency

Abstract

Purpose To investigate symptom patterns and evaluate the relationship between patient characteristics and symptom severity before and after treatment for symptomatic children with convergence insufficiency (CI). Methods In a randomized clinical trial, the Convergence Insufficiency Symptom Survey (CISS) was administered pre- and post-treatment to 221 children 9 to <18 years with symptomatic CI. Frequency of symptom type was determined at baseline, mean change in performance-related versus eye-related symptoms for treatment responders was compared, and the relationship between patient characteristics and symptom severity at baseline for the entire cohort and after treatment for those who responded to treatment, was determined. Results At baseline, the score for performance-related symptoms was greater than that for eye-related symptoms (mean response of 2.3 vs. 1.8, p<0.001) regardless age, sex, race/ethnicity, or presence of parent-reported ADHD. Symptom severity increased with age for both the overall and eye-related subscale scores (p=0.048, p=0.022, respectively). Children with parent-reported ADHD were more symptomatic (p=0.005) than those without parent-reported ADHD because of a higher performance-related score (p<0.001). A significant and equal improvement (p<0.01) for the performance-related and eye-related symptoms was found in treatment responders. Girls had significantly lower performance-related symptoms than boys (p=0.014) and African-American children reported less eye-related symptoms than White children (p=0.022). Children without parent-reported ADHD had significantly less symptoms overall and less eye-related symptoms than children with parent-reported ADHD (p=0.019, p=0.011, respectively). Conclusions Because of a high frequency of both performance- and eye-related symptoms, clinicians should perform a targeted history that addresses both types of symptoms to help identify children with symptomatic CI. Future study regarding the relationship of CI and symptoms and their potential influence on ADHD, reading performance, and attention is warranted.

Sensitivity and specificity of school nurse screening for hypermetropia and convergence insufficiency exophoria in primary schoolchildren in Denmark

“…() and Barnhardt et al. (), the frequency of symptoms increased with age for both children with normal binocular vision (p < 0.001) and for children with CIE (p = 0.009), possibly due to increasing near work demands in school as the child grows older. We found age and frequency of symptoms to be correlated with CIE, and that considering both factors increased the precision of the screening for CIE and significantly reduced the number of false positive referrals from 4.2% (89/2097) to 1.2% (26/2097).…”

“…The questionnaire consists of 15 items related to frequency of eye and visually related symptoms when the child reads or does other close work (Barnhardt et al. ; Phillips ). Questions were read aloud to the child by the examiner.…”

Relationship Between Clinical Signs and Symptoms of Convergence Insufficiency

“…eyes hurt, blurred vision, headaches, diplopia). 18 Also, a high percentage of children with symptomatic, 3-sign CI report that these performance-related symptoms occur fairly often or always. Thus, the lack of any further association between severity of clinical signs and level of symptoms may indicate a plateau in symptoms as measured by the CISS.…”

Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study

“…1,2 These symptoms may interfere with reading performance and other near-related activities. 3 The prevalence of CI in the general population has been estimated to be about 2.25% to 8.3%.…”