7 - non-strab conditions: CI

What are the 3 signs needed to dx convergence insufficiency?

1. exophoria greater at near

2. receded NPC

3. insufficient PFV

How does age affect CI?

worsens with age

What are the signs of CI?

1. greater exo at near (≥4pd more)

2. decreased PFV at near → inadequate BO ranges (sheards or morgans)

3. receded NPC (≥6cm)

4. exo fixation disparity

5. low AC/A

6. decreased accommodative ability

what are the symptoms of CI?

1. worsen throughout the day

2. increase with work or fatigue

What is pseudoconvergence insufficiency?

reduced ability to accommodate

What are the signs of pseudoconvergence insufficiency?

1. exo worse at near

2. reduced PFV at near

3. reduced AA

4. difficulty with minus on accom facility testing

5. reduced PRA

6. high lag

What is the treatment for pseudoconvergence insufficiency?

treat accommodative dysfunction:

therapy and/or lenses

What is the differential diagnosis for convergence insufficency?

1. basic exophoria

2. divergence excess

underlying pathology

What is the treatment for convergence insufficiency in kids?

correct RE

therapy only → (#1) office based

-if can't, then home based computer therapy

What is the treatment for convergence insufficiency in adults (>18 years)?

correct RE

therapy → (#1) office based

-if can't, then home based computer therapy

BI prism (for presbyopes)

When treating CI with therapy, what improves first, the signs or the symptoms?

the signs improve first

What type of therapy is best for CI?

office based VT (OBVAT) is more effective than both home-based computer therapy with pencil push ups, or just pencil push ups alone

What can elicit a positive response in the CISS survey?

comorbid conditions (allergies, dry eye)

other binocular/accommodative dysfunction

Did the duration of therapy (12 vs 16 weeks) affect the outcome for CI patients?

NO → although 16 wks allow for 4 more wks of improvement

Do the results from therapy for CI stay after 1 year?

yes in majority

How does VT for CI affect the brain?

changes cortical activity

Does OBVAT (CI treatment) improve reading outcomes like comprehension, fluency, or attention ?

no → same results as placebo

How does CISS change with visual function with therapy?

CISS may no longer adequately quantify changes in symptoms attributable to change in visual function with therapy