Frequency of convergence insufficiency in optometry clinic settings

Abstract

Purpose. To estimate the frequency of convergence insufficiency (CI) and its related characteristics among 8- to 12-year-old children randomly selected from 2 optometry clinic populations. Methods. Clinic records of 620 children were randomly selected and reviewed according to a standard protocol, using a systematic sampling method based on the total number of 8- to 12-year-old children seen over a 1-year period at 2 optometry clinics. Records were reviewed for demographic and clinical data. Data on CI-related symptoms were obtained at one of the sites. Records that met the eligibility criteria of: good visual acuity (20/30 or better in both eyes); minimal refractive error (-0.50 to +1.00 D and ≤1.00 D of astigmatism in either eye, and ≤1.00 D of anisometropia); and no strabismus were evaluated for CI- related characteristics. Eligible children were classified according to the direction of their near heterophoria and the number of the following clinical signs present: (1) exophoria at near ≤4 Δ than at far; (2) insufficient fusional convergence [i.e., failing Cheered's criterion or minimum normative positive fusional vergence (PFV) of 12 Δ base-out (BO) blur/15 Δ BO break]; and (3) receded nearpoint of convergence (NPC) of ≤7.5 cm break or ≤10.5 cm recovery. Children were then classified as: no CI (nonexophoric at near or ≤4 Δ difference between far and near); low suspect (exophoric at near and 1 sign); high suspect (exophoric at near and 2 signs); or definite CI (exophoric at near and 3 signs). Results. Sixty-seven percent (415/620) of the records met the eligibility criteria and had complete data on phoria, NPC, and PFV. The age (mean ±SD) of the study population was 10.2 ± 1.2 years. Ethnicity data were available for 85% of those eligible; the ethnic distribution was 36% African American, 29% Caucasian, 19% Hispanic, and 1% Asian. About one-half of the 415 children were classified as either low suspect (33%); high suspect (12%); or definite CI (6%). Clinically significant CI (high suspect and definite categories) was identified in 17.6% of the children. The percentage of children rated as symptomatic increased with the number of CI-related clinical signs present. Conclusions. These findings suggest a high frequency of CI in optometry clinic populations and a potential correlation between patient symptoms and the number of CI signs present.