Elsevier

Ophthalmology

Volume 122, Issue 5, May 2015, Pages 1056-1059
Ophthalmology

Original article
The Incidence and Clinical Characteristics of Adult-Onset Convergence Insufficiency

https://doi.org/10.1016/j.ophtha.2014.12.010Get rights and content

Objective

The purpose of this study was to describe the clinical characteristics and natural history of convergence insufficiency (CI) in a population-based cohort of adults.

Design

Retrospectively reviewed population-based cohort.

Participants

Adult (age ≥19 years) residents of Olmsted County, Minnesota.

Methods

The medical records of all adults diagnosed with CI over a 20-year period were reviewed retrospectively.

Main Outcome Measures

Clinical characteristics and outcomes for adult-onset CI.

Results

A total of 118 adults (annual incidence, 8.44 per 100 000 patients older than 19 years) were diagnosed with CI during the 20-year period, constituting 15.7% of all forms of adult-onset strabismus observed in this population. The median age at diagnosis was 68.5 years (range, 21.7–97.1 years), and 68 (57.6%) were female. The mean initial exodeviation at near was 14.1 prism diopters (PD; range, 1–30 PD) and 1.7 PD (range, 0–10 PD) at distance. The Kaplan-Meier rate of exotropia increasing over time by 7 PD or more at near was 4.2% at 5 years, 13.5% at 10 years, and 24.4% at 20 years. Approximately 88% were managed with prisms, whereas less than 5% underwent surgical correction.

Conclusions

Adult-onset CI included approximately 1 in 6 adults who were newly diagnosed with strabismus in this 20-year cohort. There was a significant increase in incidence with increasing age. Nearly one-fourth had an increase of their near exodeviation of at least 7 PD by 20 years after their diagnosis, and most patients were managed conservatively.

Section snippets

Methods

The medical records of all patients 19 years of age or older who were newly diagnosed with CI as residents of Olmsted County, Minnesota, from January 1, 1985, through December 31, 2004, were reviewed. Institutional review board approval was obtained for this study. Patients were identified based on resources of the Rochester Epidemiology Project, a medical record linkage system designed to capture data on any patient–physician encounter in Olmstead County, Minnesota.7 The population of this

Results

A total of 118 patients older than 19 years were newly diagnosed with CI in Olmsted County, Minnesota, during the 20-year study period, corresponding to an annual age- and gender-adjusted incidence of 8.44 (95% confidence interval, 6.90–9.99) per 100 000 residents older than 19 years or a prevalence of 1.38%. Table 1 shows the historical and initial clinical characteristics of the 118 study patients. The median age at diagnosis was 68.5 years (range, 21.7–97.1 years), with a distribution by

Discussion

Adult-onset CI was diagnosed in 118 patients and constituted approximately 1 in 6 adults who were newly diagnosed with strabismus in this 20-year cohort.9 Females in the seventh decade of life were most prevalent. Although progression of the angle was common, with the rate being highest among patients older than 70 years, most patients in this cohort were managed conservatively with prisms and convergence exercises, and only 4 patients were managed surgically.

There is a considerable variability

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  • Convergence insufficiency: Review of clinical diagnostic signs

    2022, Journal of Optometry
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    Based on the diagnostic criteria listed in Elsayed and Abdou24 (Table 3), patient #2 with an NPC of 6 cm would not have been considered CI. Conversely, none of the patients reported diplopia as a symptom, and would not all have been considered CI according to the diagnostic criteria detailed by Ghadban et al.25 (Table 1). Even if diplopia had been reported by all three patients, only patient #1 has a near heterophoria greater than 10Δ, and would have been regarded as CI.

  • Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology

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    In adults, CI may be acquired secondary to neurologic disorders including neurodegenerative diseases and traumatic brain injury. Adult-onset CI also occurs in older individuals with reduced accommodative convergence.9 Because the mechanisms that underlie CI in adults likely differ from typical childhood-onset CI, we did not include studies of individuals with neurologic disease or presbyopic adults in this assessment.

  • Population trends in adult strabismus surgery

    2019, Canadian Journal of Ophthalmology
  • The Discrepancy between Subjective and Objective Measures of Convergence Insufficiency in Whiplash-Associated Disorder versus Control Participants

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    Another limitation of this study is the varied period by which participants were examined after the accident (21.1±21.8 days; median, 15 days). Although CI is a listed form of disability worldwide and commonly is ascribed to WAD after MVAs, it is not unique to WAD, with an estimated incidence in the general population of approximately 8%.11 In this study, designed to investigate whether the incidence of CI is increased in the setting of WAD, we found that although the incidence of visual symptoms was increased among WAD patients (a greater proportion of WAD patients had pathologic CISS results, 45.6% vs. 15.4%; P = 0.002), the number of patients meeting clinical criteria for measurable signs of CI was not increased compared with control participants (7.0% vs. 7.7%; P = 0.90).

  • Diplopia in Medically and Surgically Treated Patients with Glaucoma

    2017, Ophthalmology
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    In our study, diplopia occurred in 16% of medically treated glaucoma patients. Diplopia in patients with glaucoma not due to glaucoma surgery has not been studied in detail, but we found that it reflected the occurrence of common strabismus conditions in this mostly elderly population, specifically convergence insufficiency, adult-onset distance esotropia, and small-angle hypertropia.17 We also found that binocular diplopia in patients with glaucoma not due to glaucoma surgery also may be caused by mechanical strabismus, such as after orbital trauma, old or new cranial nerve palsies, or coexistent retinal conditions that may be associated with central peripheral rivalry.18,19

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Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Supported in part by the National Institutes of Health, Bethesda, Maryland (grant nos.: UL1RR024150 and R01AG034676); and by an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY.

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