Citation

Raghuram A, Cotter S, Gowrisankaran S, Kanji J, Howell DR, Meehan WP, Shah AS. Am. J. Ophthalmol. 2019; ePub(ePub): ePub.

Affiliation

Department of Ophthalmology, Boston Children's Hospital, Boston, MA; Department of Ophthalmology, Harvard Medical School; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.ajo.2019.04.008

PMID

31004592

Abstract

PURPOSE: To determine the frequency of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms, and among those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders. STUDY: Design: Retrospective cross-sectional study METHODS: Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients <21 years old who were >28 days post-concussion, had chronic concussion-related symptoms, had normal visual acuity, and received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined.

RESULTS: Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only, 21 (28%) had convergence insufficiency and accommodation deficits, and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders), 4 (5%) had both a non-specific vergence dysfunction and accommodation deficits, 2 (3%) had convergence excess only, and 1 (1%) had both convergence excess and accommodative deficits.

CONCLUSION: A receded NPC was present in the majority of young patients with chronic post-concussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.

Copyright © 2019. Published by Elsevier Inc.

Language: en