Vergence Exercises for Six Weeks Induce Faster Recovery of Convergence Insufficiency Than Accommodation Exercises in School Children.

Purpose: Convergence insufficiency (CI) is characterized by abnormal vergence eye movement frequently accompanied by abnormal accommodation and subjective symptoms, such as headache, blurred vision, and diplopia. CI is treated with vergence and accommodation exercises that are integrated so that the relative contributions of vergence and accommodation exercises to the outcome are concealed. The purpose of the present study was to determine the individual contributions of vergence and accommodation exercises for the treatment of CI in school children. Methods: In a prospective crossover study 44 children aged 9 to 13 years with CI were randomized to perform either vergence exercises followed by accommodation exercises each for 6 weeks or the 2 treatment regimes in the reverse order. The outcome measures were recovery from CI and the parameters vergence facility, positive fusional vergence, near point of convergence, monocular amplitude, and facility of accommodation. Results: After the first 6-week period, full recovery from CI was significantly more frequent in the group commencing vergence exercises than in the group commencing monocular accommodation exercises (p = 0.01), whereas there was no significant difference between these proportions after the second 6-week period (p = 0.45). Vergence facility and positive fusional vergence improved significantly more after the period with vergence exercises than after the accommodation exercises, whereas there was no significant difference between the effects of the two types of exercises on the other studied parameters. Conclusions: Vergence treatment induces a faster recovery of CI than accommodation treatment in school children. This may be used to improve compliance and success rate of the treatment.

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

BACKGROUND: To determine the sensitivity and specificity of school nurse screening for hypermetropia and convergence insufficiency exophoria (CIE) in schoolchildren. METHODS: Near point of convergence and distance visual acuity with +2.00D lenses were measured in 2097 children (6-15 years) during standard school nurse screening in the municipality of Randers, Denmark. One hundred and ninety-four children with positive screening results (near point of convergence >10 cm and/or distance visual acuity improved or maintained with +2.00D) and 182 controls with negative screening results received a full vision assessment, including cycloplegic refraction and orthoptic evaluation. RESULTS: Sensitivity and specificity of screening was 0.75 and 0.69 for CIE and 0.59 and 0.87 for hypermetropia (≥+2.00), respectively. While precision of screening for CIE was significantly higher for symptomatic children aged 9-15 than for younger and asymptomatic children, precision of screening for hypermetropia was independent of age and presence of visually related symptoms. CONCLUSION: While precision of screening for CIE and hypermetropia (>+2.00) was low, additional vision evaluation of children older than 9 years with asthenopic symptoms identified most children with CIE with a low absolute number of false positives.