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http://dx.doi.org/10.14479/jkoos.2016.21.3.235

Influence of Different Diagnostic Criteria on Frequency of Convergence Insufficiency  

Yu, Dong-Sik (Dept. of Optometry, Kangwon National University)
Cho, Hyun Gug (Dept. of Optometry, Kangwon National University)
Moon, Byeong-Yeon (Dept. of Optometry, Kangwon National University)
Publication Information
Journal of Korean Ophthalmic Optics Society / v.21, no.3, 2016 , pp. 235-242 More about this Journal
Abstract
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.
Keywords
Convergence insufficiency; Diagnostic criteria; Exophoria; Positive fusional vergence; Near point of convergence; Sheard's criterion; Percival's criterion;
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