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Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study
M W Rouse1, E Borsting, L Hyman
1Southern California College of Optometry, Fullerton 92631-1699, USA.
Insights
Convergence insufficiency (CI) affects 13% of children in fifth and sixth grades. Many children with CI also experience accommodative insufficiency (AI), indicating a significant visual health concern.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Convergence insufficiency (CI) is a common binocular vision disorder.
- Early identification and management of CI in children are crucial for academic success and visual comfort.
Purpose of the Study:
- To determine the prevalence of convergence insufficiency (CI) in 9- to 13-year-old children.
- To investigate the clinical characteristics and associated conditions, such as accommodative insufficiency (AI), in children with CI.
Main Methods:
- School-based screening of fifth and sixth graders across three study sites.
- Standardized protocol to evaluate CI presence and severity, including exophoria, fusional convergence, and near point of convergence.
- Classification of children based on the number of clinical signs of CI and AI.
Main Results:
- Out of 453 children with complete data, 13% were diagnosed with definite or high suspect CI.
- CI prevalence varied significantly by ethnicity and study site.
- A high percentage (78.9%) of children with definite CI also exhibited signs of accommodative insufficiency (AI).
Conclusions:
- Convergence insufficiency (CI) is a prevalent condition in school-aged children, affecting approximately 13% of fifth and sixth graders.
- There is a significant association between CI and accommodative insufficiency (AI), suggesting a need for comprehensive visual assessments.
Purpose:
To estimate the frequency of convergence insufficiency (CI) and its related clinical characteristics among 9- to 13-year-old children.
Methods:
Fifth and sixth graders were screened in school settings at three different study sites. Eligible children with 20/30 or better visual acuity, minimal refractive error, no strabismus, and exophoria at near were evaluated according to a standardized protocol to determine the presence and severity of CI. These children were classified according to the presence and number of the following clinical signs: (1) exophoria at near > or =4delta than far, (2) insufficient fusional convergence, and (3) receded nearpoint of convergence. Also, children were classified as accommodative insufficient (AI) if they failed Hofstetter's minimum amplitude formula or had greater than a + 1.00 D lag on Monocular Estimate Method retinoscopy.
Results:
Of 684 children screened, 468 (68%) were eligible for further evaluation. Of these, 453 had complete data on CI measurements and were classified as: no CI (nonexophoric at near or exophoric at near and < 4delta difference between near and far) (78.6%); low suspect CI (exophoric at near and one clinical sign: exophoria at near > or =4delta than far) (8.4%); high suspect CI (exophoric at near and two clinical signs) (8.8%); and definite CI (exophoric at near and three clinical signs) (4.2%). CI status varied according to ethnicity and study site (p < 0.0005), but not gender. The frequency of AI increased with the number of CI-related signs. For CI children with three signs, 78.9% were classified as also having AI.
Conclusions:
These findings suggest that CI (defined as high suspect and definite) is frequent (13%) among fifth and sixth grade children. In addition, there is a high percentage of CI children with an associated AI.
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