scholarly journals Convergence Insufficiency/Divergence Insufficiency Convergence Excess/Divergence Excess: Some Facts and Fictions

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Edward Khawam ◽  
Bachir Abiad ◽  
Alaa Boughannam ◽  
Joanna Saade ◽  
Ramzi Alameddine
Keyword(s):  
Convergence Insufficiency ◽  
Inappropriate Treatment ◽  
Treatment Models ◽  
Distance Fixation ◽  
Divergence Insufficiency ◽  
Convergence Excess

Great discrepancies are often encountered between the distance fixation and the near-fixation esodeviations and exodeviations. They are all attributed to either anomalies of the AC/A ratio or anomalies of the fusional convergence or divergence amplitudes. We report a case with pseudoconvergence insufficiency and another one with pseudoaccommodative convergence excess. In both cases, conv./div. excess and insufficiency were erroneously attributed to anomalies of the AC/A ratio or to anomalies of the fusional amplitudes. Our purpose is to show that numerous factors, other than anomalies in the AC/A ratio or anomalies in the fusional conv. or divergence amplitudes, can contaminate either the distance or the near deviations. This results in significant discrepancies between the distance and the near deviations despite a normal AC/A ratio and normal fusional amplitudes, leading to erroneous diagnoses and inappropriate treatment models.

scholarly journals Symptomatic vergence disorders in junior high school children in Ghana

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Charles Darko-Takyi ◽  
Naimah E. Khan ◽  
Urvashni Nirghini
Keyword(s):  
High School ◽  
Binocular Vision ◽  
Junior High School ◽  
Junior High ◽  
Cape Coast ◽  
Cross Sectional ◽  
School Based ◽  
Convergence Insufficiency ◽  
Vision Assessment ◽  
Divergence Insufficiency

Background: Optometrists in Ghana are hampered in performing comprehensive binocular vision assessments, because of the lack of appropriate instruments leading to a paucity of data on vergence disorders and their association with asthenopia among Ghanaian school children.Aim: To establish the prevalence of symptomatic vergence disorders among junior high school (JHS) children in Cape Coast Metropolis, Ghana, in their habitual (vision) states and investigate if there were any associations between these disorders and specific asthenopic symptoms.Methods: A prospective cross-sectional school-based study using a multistage sample of 627 participants aged 12–17 years from JHSs in Cape Coast Metropolis. Participants completed a reliable asthenopic symptoms questionnaire and 220 participants who expressed two or more severe or very severe symptoms were selected for comprehensive binocular vision assessment in their habitual vision state.Results: The prevalence of symptomatic vergence disorders among JHS children in Cape Coast Metropolis was 14.8%. For specific symptomatic vergence disorders, the prevalence was: 1.4% basic esophoria, 1.4% basic exophoria, 8.6% convergence insufficiency, 1.8% convergence excess, 0.8% fusional vergence dysfunctions and 0.8% divergence excess. No participant had symptomatic divergence insufficiency. The study revealed significant associations between some specific symptomatic vergence disorders and specific asthenopic symptoms even though all of these asthenopic symptoms overlapped in other vergence disorders.Conclusion: Presenting complaints of specific asthenopic symptoms does not differentiate between specific types of vergence disorders. A comprehensive binocular vision assessment is vital in the diagnosis and management of these disorders to relieve asthenopia.

scholarly journals A review of the classification of nonstrabismic binocular vision anomalies

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Charles Darko-Takyi ◽  
Naimah Ebrahim Khan ◽  
Urvashni Nirghin
Keyword(s):  
Binocular Vision ◽  
Systemic Disease ◽  
Clinical Signs ◽  
Review Literature ◽  
Test Procedures ◽  
Convergence Insufficiency ◽  
Different Types ◽  
Proper Diagnosis ◽  
Divergence Insufficiency

There are conflicting and confusing ideas in literature on the different types of accommodative and vergence anomalies as different authors turn to classify them differently. This paper sought to review literature on the different classifications and types of nonstrabismic binocular vision anomalies and harmonize these classifications. Search engines, namely Google scholar, Medline, Cinahl and Francis databases, were used to review literature on the classification of accommodative and vergence dysfunctions using keywords like <em>binocular vision dysfunctions</em>, <em>classification of nonstrabismic binocular vision disorders or anomalies</em>, <em>accommodative disorders/anomalies classification</em> and <em>vergence disorders/anomalies classifications</em>, and included works that described these anomalies. Nonstrabismic binocular vision anomalies are classified as accommodative and vergence anomalies. There are three different major types of accommodative anomalies, namely accommodative insufficiency, accommodative infacility (accommodative inertia), and accommodative excess (accommodative spasm), and seven different types of vergence anomalies (convergence insufficiency, convergence excess, divergence insufficiency, divergence excess, basic esophoria, basic exophoria and fusional vergence dysfunctions), which are functional in origin. Functionally, there is a commonly reported interaction between accommodative and convergence insufficiency referred to as pseudoconvergence insufficiency. Accommodative paralysis (subtype of accommodative insufficiency) and vergence anomalies – <em>i.e.</em>, convergence paralysis, convergence spasm and divergence paralysis – are non-functional in origin with underlying systemic disease etiologies. Systemic convergence insufficiency, associated with subnormal accommodation, is a non-functional interaction between the accommodative and convergence insufficiency. The classification of nonstrabismic binocular vision anomalies is based on the description of the clinical signs and the underlying etiology either functional or non-functional in origin. Proper diagnosis and management involves investigation of the underlying etiology in addition to the battery of binocular vision test procedures.

scholarly journals Vergence and Accommodative Dysfunctions in Emmetropic and Myopic Chinese Young Adults

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Martin Ming-Leung Ma ◽  
Anna Chwee Hong Yeo ◽  
Mitchell Scheiman ◽  
Xiang Chen
Keyword(s):  
Binocular Vision ◽  
Refractive Error ◽  
Linear Trend ◽  
Common Finding ◽  
Sample Population ◽  
Chi Square ◽  
Cross Sectional ◽  
Convergence Insufficiency ◽  
Chinese Young Adults ◽  
Divergence Insufficiency

Purpose. To investigate the association between refractive error and common binocular vision and accommodative dysfunctions in Chinese adults and to report the percentage of these disorders in this sample population. Methods. This was a single-site, prospective cross-sectional clinic-based study. A total of 415 Chinese participants aged between 21 and 38 years were grouped into 4 refractive error groups (emmetropia, low, moderate, and high myopia) based on the spherical equivalent power of noncycloplegic refraction. Baseline testing including binocular vision and accommodative testing was performed on all eligible participants. A multiple-sign classification system was used to analyze these data for the diagnosis of common nonstrabismic binocular vision and accommodative dysfunctions. Associations between the diagnosis and refractive error groupings were examined by the chi-square test for the linear trend. Results. Associations with refractive error groupings were found for convergence insufficiency (p=0.008, r = −0.13) and divergence insufficiency (p=0.008, r = 0.131). The 3 most common dysfunctions in this sample population were basic exophoria (10.8%), convergence insufficiency (9.6%), and divergence insufficiency (7.0%). Approximately 40% of the sample population demonstrated at least one type of binocular vision dysfunction. Conclusion. Convergence insufficiency and divergence insufficiency were associated with refractive error groupings. Binocular vision dysfunction was a common finding in this sample population.

scholarly journals Refractive and binocular vision status of optometry students, Ghana

2016 ◽  
Vol 5 (2) ◽  
pp. 24-29
Author(s):  
C. Darko-Takyi ◽  
A. Owusu-Ansah ◽  
C. Appiah-Eduenu ◽  
E.K. Abu ◽  
S.B. Boadi-Kusi ◽  
...  
Keyword(s):  
Binocular Vision ◽  
Cross Sectional Study ◽  
Refractive Errors ◽  
Biomedical Sciences ◽  
Cape Coast ◽  
Cross Sectional ◽  
Exact Test ◽  
Convergence Insufficiency ◽  
Divergence Insufficiency ◽  
Optometry Students

To investigate the refractive and non-strabismic binocular vision status of Optometry students in University of Cape Coast, Ghana and to establish any associations between these conditions. A cross sectional study of 105 Optometry students were taken through a comprehensive optometric examination to investigate the refractive and non-strabismic binocular vision status. Fisher’s exact test (IBM SPSS version 21) was used to assess association between these conditions. Prevalence of refractive error and non-strabismic binocular vision dysfunctions were 59.0% and 34.3% respectively. Prevalence of specific refractive errors were 17.1% myopia, 19.0% hyperopia and 22.9% astigmatism. Non-strabismic accommodative and vergence dysfunctions were found to be 21.9% and 12.4% respectively. Specific types of accommodative and vergence disorders were as follows: accommodative fatigue (8.6%), accommodative infacility (6.7%), accommodative insufficiency (4.7%) and accommodative excess (1.9%), convergence insufficiency (1.9%), convergence excess (1.0%), divergence insufficiency (2.9%), basic exophoria (1.9%), and basic esophoria (4.7%). There was a significant association between refractive errors in general and accommodative fatigue (p = 0.030) and between myopia and accommodative excess (p= 0.028). It is critical that potential primary eye care practitioners become aware of their refractive and non-strabismic binocular vision status.Journal of Medical and Biomedical Sciences (2016) 5(2), 24-29

Pharmacology Issues Related to Dementia Syndrome of Depression in Elderly Residents of Long-Term Care Settings

2015 ◽  
Vol 25 (2) ◽  
pp. 61-69
Author(s):  
Angel L. Ball ◽  
Adina S. Gray
Keyword(s):  
Depressive Symptoms ◽  
The Elderly ◽  
Environmental Communication ◽  
Pharmacological Intervention ◽  
Team Approach ◽  
Discussion Paper ◽  
Term Care ◽  
Anticholinergic Medications ◽  
Inappropriate Treatment ◽  
Dementia Syndrome

Pharmacological intervention for depressive symptoms in institutionalized elderly is higher than the population average. Among the patients on such medications are those with a puzzling mix of symptoms, diagnosed as “dementia syndrome of depression,” formerly termed “pseudodementia”. Cognitive-communicative changes, potentially due to medications, complicate the diagnosis even further. This discussion paper reviews the history of the terminology of “pseudodementia,” and examines the pharmacology given as treatment for depressive symptoms in the elderly population that can affect cognition and communication. Clinicians can reduce the risk of misdiagnosis or inappropriate treatment by having an awareness of potential side effects, including decreased attention, memory, and reasoning capacities, particularly due to some anticholinergic medications. A team approach to care should include a cohesive effort directed at caution against over-medication, informed management of polypharmacology, enhancement of environmental/communication supports and quality of life, and recognizing the typical nature of some depressive signs in elderly institutionalized individuals.

Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART): Design and Methods

2015 ◽  
pp. 214-228 ◽  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Health Care Providers ◽  
Developmental Disorders ◽  
Attention Problems ◽  
Secondary Outcome ◽  
Care Providers ◽  
Treatment Trial ◽  
Additional Hypothesis ◽  
Convergence Insufficiency

Objective: To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic convergence insufficiency (CI). Methods: CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention. Conclusion: The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.

Vision and Reading Deficits in Post-Concussion Patients: A Retrospective Analysis

2015 ◽  
pp. 206-213
Keyword(s):  
Retrospective Chart Review ◽  
Health Examination ◽  
Common Symptom ◽  
Reading Deficits ◽  
Grade Levels ◽  
Convergence Insufficiency ◽  
Return To Learn ◽  
Vision Deficits ◽  
Accommodative Facility

The prevalence of vision deficits in the pediatric/young adult concussion population in the private optometric practice setting remains unknown. Thus, a retrospective chart review in this area was conducted in the practice of the first author. Twenty-five consecutive patients with a medical diagnosis of concussion received a comprehensive vision and ocular health examination, which also included an objectively-based Visagraph reading assessment and clinical vergence/accommodative facility testing. Three primary categories of oculomotor-based deficits were found: convergence insufficiency (56%), accommodative insufficiency (76%), and oculomotor-based reading dysfunctions (68-82%). The most common symptom was headaches (84%), with 25% of the symptoms related to reading. 68% (15/22) were categorized as reading at least 2 grade levels below their current school grade level for reading eye movements based on the Visagraph findings. These overall findings are consistent with the general oculomotor-based/reading findings in the concussion/mTBI literature. The present results have important practical ramifications regarding the importance of preconcussion baseline oculomotor and Visagraph testing, as well as post-concussion follow-up testing, to help assess a student’s ability to return-to-learn (RTL).

Vision Therapy’s Role in Basic Intermittent Exotropia: A Case Report

2020 ◽  
pp. 64-73
Keyword(s):  
Treatment Option ◽  
Intermittent Exotropia ◽  
Effective Treatment Option ◽  
Control Scale ◽  
Case Presentation ◽  
Therapy Program ◽  
Convergence Insufficiency ◽  
Hispanic Male ◽  
Vision Therapy ◽  
Accommodative Function

Introduction: Vision therapy has been shown to be a successful treatment option for basic intermittent exotropia as long as a complete workup is performed to assess prognosis and appropriate management. Case Presentation: A 9 year old hispanic male presented to the clinic for a comprehensive exam and was subsequently diagnosed with a basic type intermittent exotropia with a V-pattern deviation. After thorough evaluation of binocular skills and accommodative function with a binocular vision evaluation, he was referred for a vision therapy program to improve fusional ranges, accommodative function, and symptoms. This program consisted of 20 sessions and significantly improved his binocular skills. Discussion: Basic intermittent exotropia can be treated in various ways. Vision Therapy is a worthwhile option. Surgical correction and overminus treatment have also been effective treatments. Assessment should include the intermittent exotropia control scale and the convergence insufficiency symptom survey. Vision therapy treatments focus on diplopia awareness, antisuppression, and fusional vergence ranges. Conclusion: Though more research is necessary, vision therapy has been proven to be a very effective treatment option in basic intermittent exotropia.

Transdiagnostic Approaches With Children

2018 ◽  
Author(s):  
Andrea B. Temkin ◽  
Mina Yadegar ◽  
Christine Cho ◽  
Brian C. Chu
Keyword(s):  
Mental Disorders ◽  
Externalizing Symptoms ◽  
Case Conceptualization ◽  
Common Elements ◽  
Transdiagnostic Treatment ◽  
Treatment Models ◽  
Different Types ◽  
Internalizing And Externalizing ◽  
Internalizing And Externalizing Symptoms

In recent years, the field of clinical psychology has seen a growing movement toward the research and development of transdiagnostic treatments. Transdiagnostic approaches have the potential to address numerous issues related to the development and treatment of mental disorders. Among these are the high rates of comorbidity across disorders, the increasing need for efficient protocols, and the call for treatments that can be more easily disseminated. This chapter provides a review of the current transdiagnostic treatment approaches for the treatment of youth mental disorders. Three different types of transdiagnostic protocols are examined: mechanism-based protocols, common elements treatments, and general treatment models that originated from single-disorder approaches to have broader reach. A case study illuminates how a mechanism-based approach would inform case conceptualization for a client presenting with internalizing and externalizing symptoms and how a transdiagnostic framework translates into practice.

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