한국안광학회지 (Journal of Korean Ophthalmic Optics Society)

한국안광학회 (The Korean Ophthalmic Optics Society)
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진단기준 차이가 폭주부족의 빈도에 미치는 영향

Influence of Different Diagnostic Criteria on Frequency of Convergence Insufficiency

  • 투고 : 2016.07.27
  • 심사 : 2016.08.10
  • 발행 : 2016.09.30
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초록

목적: 다른 진단기준의 적용이 폭주부족의 빈도에 미치는 영향을 알아보고자 하였다. 방법: 평균 나이 22.54세(20~27세)의 81명을 대상으로 평가하였다. 굴절검사 후 조절성 시표에 의한 폭주근점(NPC)검사, 폰 그래페에 의한 사위검사, 포롭터에 의한 양성융합이향운동(PFV)검사를 실시하였다. 근거리 외사위가 원거리 사위보다 큰 기준($exo{\geq}4{\Delta}$, >$6{\Delta}$), 융합이향운동 기준(PFV의 흐린점 ${\leq}11{\Delta}$, PFV의 분리점 ${\leq}15{\Delta}$, 쉐어드기준, 퍼시발 기준), 폭주근점 기준($NPC{\geq}6cm$, ${\geq}7.5cm$, >10 cm)을 이용하여 폭주부족을 진단하였다. 결과: 하나의 진단기준에 의한 폭주부족 빈도는 6.2%~77.8%의 범위로 분포하였고, 기준에 따라 과대평가되거나 과소평가되었다. 두 가지 이상의 진단기준에 의한 폭주부족 빈도는 6.2%~43.2%로 변동성이 줄어들었으며, 특히 사위 기준과 쉐어드를 포함하는 진단기준일 때 폭주부족의 빈도는 24.7%~28.4%로 줄어들어 낮은 변동성을 보였다. 점수 척도의 전체 징후와 사위, 측정 값의 사위와 쉐어드 기준의 상관관계가 각각 0.772와 -0.654로 유의하게 높았다(p<0.001). 폭주근점 기준은 변동성이 컸으며, 다른 진단기준과의 상관관계는 낮거나 유의하지 않았다. 징후에 따른 폭주부족의 진단기준과 적용순서로 $exo{\geq}4{\Delta}$, 쉐어드 기준, 폭주근점${\geq}7.5cm$로 제시한다. 결론: 폭주부족의 빈도는 진단기준에 따라 과대, 과소평가 될 가능성이 있다. 임상징후로서 사위, 쉐어드 기준과 폭주근점의 절단값과 절차는 폭주부족과 관련된 진단에서 명확하게 제시되어야 한다.

Purpose: This study was to investigate whether the application of different diagnostic criteria affected the frequency of convergence insufficiency (CI). Methods: Eighty one subjects with mean age of 22.54 years (20 to 27 years) were evaluated. Binocularity tests after refraction were performed as the following tests: near point of convergence (NPC) with an accommodative target, phoria using von Graefe method, positive fusional vergence (PFV) with a phoropter. Subjects with CI were diagnosed when exophoria (exo) was greater at near than at distance ($exo{\geq}4{\Delta}$, or >$6{\Delta}$), fusional vergence was $PFV{\leq}11{\Delta}$ for blur, $PFV{\leq}15{\Delta}$ for break, Sheard's or Percival's criterion, and NPC was $NPC{\geq}6cm$, ${\geq}7.5cm$ or >10 cm. Results: Frequency of CI with one diagnostic criterion was ranged from 6.2% to 77.8%, and was overestimated or underestimated according to criteria. It was reduced to the range of 6.2% to 43.2% with diagnostic criteria more than two, especially to the range of 24.7% to 28.4% with lower variability in diagnostic criteria including phoria and Sheard's criterion. There were high relationship between total score of signs and phoria score (r = 0.772, p<0.001), and measured phoria and Sheard's criterion (r = -0.654, p<0.001), but NPC had a high variability and a weak or no significant relationship with other diagnostic criteria. Results suggested $exo{\geq}4{\Delta}$, Sheard's criterion and $NPC{\geq}7.5cm$ for diagnostic criteria of signs and sequence for CI. Conclusions: Frequency of CI is likely to be over- and underestimated with diagnostic criteria. Cutoff values and procedures for phoria, Sheard's criterion and NPC as clinical signs should be suggested definitely in diagnosis associated with CI.

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참고문헌

  1. American Optometric Association. Optometric clinical practice guidelines: care of the patient with accommodative and vergence dysfunctions, 2011. http://www.aoa.org/documents/optometrists/CPG-18.pdf(23 July 2016).
  2. Garcia-Munoz A, Carbonell-Bonete S, Cacho-Martinez P. Symptomatology associated with accommodative and binocular vision anomalies. J Optom. 2014;7(4):178-192. https://doi.org/10.1016/j.optom.2014.06.005
  3. Cooper J, Duckman R. Convergence insufficiency: incidence, diagnosis, and treatment. J Am Optom Assoc. 1978;49(6):673-680.
  4. Simons HD, Grisham JD. Binocular anomalies and reading problems. J Am Optom Assoc. 1987;58(7):578-587.
  5. Granet DB, Gomi CF, Ventura R, Miller-Scholte A. The relationship between convergence insufficiency and ADHD. Strabismus. 2005;13(4):163-168. https://doi.org/10.1080/09273970500455436
  6. Gronlund MA, Aring E, Landgren M, Hellstrom A. Visual function and ocular features in children and adolescents with attention deficit hyperactivity disorder, with and without treatment with stimulants. Eye. 2007;21(4):494-502. https://doi.org/10.1038/sj.eye.6702240
  7. Cacho Martinez P, Garcia Munoz A, Ruiz-Cantero MT. Treatment of accommodative and nonstrabismic binocular dysfunctions: a systematic review. Optometry. 2009;80(12):702-716. https://doi.org/10.1016/j.optm.2009.06.011
  8. Cooper J, Jamal N. Convergence insufficiency-a major review. Optometry. 2012;83(4):137-158.
  9. Dwyer P. The prevalence of vergence accommodation disorders in a school-age population. Clin Exp Optom. 1992;75(1):10-18. https://doi.org/10.1111/j.1444-0938.1992.tb01010.x
  10. Paniccia SM, Ayala AR. Prevalence of accommodative and non-strabismic binocular anomalies in a Puerto Rican pediatric population. Optometry and Visual Performance. 2015;3(3):158-164.
  11. Daum KM. Characteristics of convergence insufficiency. Am J Optom Physiol Opt. 1988;65(6):426-438. https://doi.org/10.1097/00006324-198806000-00002
  12. Momeni-Moghaddam H, Goss DA, Sobhani M. Accommodative response under monocular and binocular conditions as a function of phoria in symptomatic and asymptomatic subjects. Clin Exp Optom. 2014;97(1):36-42. https://doi.org/10.1111/cxo.12074
  13. Rouse MW, Borsting EJ, Mitchell GL, Scheiman M, Cotter SA, Cooper J et al. Validity and reliability of the revised convergence insufficiency symptom survey in adults. Ophthalmic Physiol Opt. 2004;24(5):384-390. https://doi.org/10.1111/j.1475-1313.2004.00202.x
  14. Garcia A, Cacho P, Lara F. Evaluating relative accommodations in general binocular dysfunctions. Optom Vis Sci. 2002;79(12):779-787. https://doi.org/10.1097/00006324-200212000-00010
  15. Porcar E, Martinez-Palomera A. Prevalence of general binocular dysfunctions in a population of university students. Optom Vis Sci. 1997;74(2):111-113. https://doi.org/10.1097/00006324-199702000-00023
  16. Scheiman M, Herzberg H, Frantz K, Margolies M. A normative study of step vergence in elementary schoolchildren. J Am Optom Assoc. 1989;60(4):276-280.
  17. Sheard C. Zones of ocular comfort. Optom Vis Sci. 1930;7(1):9-25. https://doi.org/10.1097/00006324-193001000-00001
  18. Worrell BE Jr, Hirsch MJ, Morgan MW. An evaluation of prism prescribed by Sheard's criterion. Am J Optom Arch Am Acad Optom. 1971;48(5):373-376. https://doi.org/10.1097/00006324-197105000-00001
  19. Scheiman M, Wick B. Clinical management of binocular vision: heterophoric, accommodative, and eye movement disorders, 4th Ed. Philadelphia: Lippincott Williams & Wilkins, 2014;99-100.
  20. Hayes GJ, Cohen BE, Rouse MW, De Land PN. Normative values for the nearpoint of convergence of elementary schoolchildren. Optom Vis Sci. 1998;75(7):506-512. https://doi.org/10.1097/00006324-199807000-00019
  21. Cacho-Martinez P, Garcia-Munoz A, Ruiz-Canterob MT. Do we really know the prevalence of accomodative and nonstrabismic binocular dysfunctions?. J Optom. 2010;3(4):185-197. https://doi.org/10.1016/S1888-4296(10)70028-5
  22. Hofstetter HW. Useful age-amplitude formula. Optom World. 1950;38:42-45.
  23. Rouse MW, Hyman L, Hussein M, Solan H, Frequency of convergence insufficiency in optometry clinic settings. Convergence Insufficiency and Reading Study (CIRS) Group. Optom Vis Sci. 1998;75(2):88-96. https://doi.org/10.1097/00006324-199812001-00036
  24. Scheiman M, Gallaway M, Frantz KA, Peters RJ, Hatch S, Cuff M et al. Nearpoint of convergence: test procedure, target selection, and normative data. Optom Vis Sci. 2003;80(3):214-225. https://doi.org/10.1097/00006324-200303000-00011
  25. Chen AH, O'Leary DJ, Howell ER. Near visual function in young children. Part I: Near point of convergence. Part II: Amplitude of accommodation. Part III: Near heterophoria. Ophthalmic Physiol Opt. 2000;20(3):185-198. https://doi.org/10.1016/S0275-5408(99)00056-3
  26. Shim HS, Shim MS, Kim SH. Comparison of binocular function in normal subjects and convergence insufficiency. J Korean Ophthalmic Opt Soc. 2010;15(3):287-291.
  27. Lee H, Rhee KO. Prevalence of general binocular dysfunctions in a population of college students. Korean J Vis Sci. 2004;6(1):77-85.
  28. Shin JA. Prevalence of accommodative insufficiency and convergence insufficiency in college students. Korean J Vis Sci. 2004;6(1):95-102.
  29. Kim JD, Kim HJ, Hwang JH. Relation between gradient and calculated AC/A ratios according to binocular vision types. Korean J Vis Sci. 2012;14(4):373-380.
  30. Ko EJ, Kim HJ. Correlation between convergence insufficiency with CISS and attentiveness in children. J Korean Ophthalmic Opt Soc. 2015;20(4):511-518. https://doi.org/10.14479/jkoos.2015.20.4.511
  31. Shin JA, Lee OJ. Relationship between subjective symptoms with near work and binocular function. J Korean Ophthalmic Opt Soc. 2007;12(3):125-130.
  32. Benjamin WJ. Borish's clinical refraction, 2nd Ed. St. Louis: Butterworth-Heinemann, 2006;968-972.
  33. Elliott DB. Clinical procedures in primary eye care, 3rd Ed. Edinburgh: Butterworth-Heinemann, 2007;180-184.
  34. Bade A, Boas M, Gallaway M, Mitchell GL, Scheiman M, Kulp MT et al. Relationship between clinical signs and symptoms of convergence insufficiency. Optom Vis Sci. 2013;90(9):988-995. https://doi.org/10.1097/OPX.0000000000000012
  35. Hamed MM, David AG, Marzieh E. The relationship between binocular vision symptoms and near point of convergence. Indian J Ophthalmol. 2013;61(7):325-328. https://doi.org/10.4103/0301-4738.97553

피인용 문헌

  1. Binocular Accommodative Facility and Vergence Facility in University Students with Symptomatic Convergence Insufficiency vol.23, pp.2, 2018, https://doi.org/10.14479/jkoos.2018.23.2.117
  2. Comparative Interpretation of Clinical Data and Their Correlations in Binocular Tests vol.23, pp.1, 2018, https://doi.org/10.14479/jkoos.2018.23.1.31
  3. Receiver operating characteristic curve analysis of clinical signs for screening of convergence insufficiency in young adults vol.15, pp.1, 2016, https://doi.org/10.1371/journal.pone.0228313
  4. Sensitivity and Specificity of Sheard and Percival’s Criteria for the Diagnosis of Young People with Near-heterophoria vol.9, pp.2, 2020, https://doi.org/10.3889/oamjms.2021.6399