Diagnostic Criteria for Convergence Excess: Diagnostic Validity of Clinical Signs Associated with Near Esophoria

To propose which tests may be used for diagnosing convergence excess. A prospective study of a consecutive clinical sample was performed. Patients (18-35 years) attending optometric care underwent subjective refraction, cover test, and Symptom Questionnaire for Visual Dysfunctions (SQVD). Based on cover test and SQVD scores, two groups were recruited: 64 symptomatic subjects with near esophoria and 64 asymptomatic with normal binocular vision. Accommodative and binocular tests were assessed, identifying those with significant statistical differences between groups. Diagnostic validity was analysed using ROC curves, sensitivity, specificity, and likelihood ratios. A serial testing strategy combining tests was also evaluated. ROC analysis showed best diagnostic accuracy for binocular accommodative facility (BAF) failing with -2.00 D (area under the curve, AUC = 0.865) and vergence facility (VF) failing with base-in prisms (AUC = 0.864). Using cutoffs from ROC analysis (BAF: ≤8.25 cpm and VF ≤ 12.75 cpm), their combination showed best validity (S = 0.625, Sp = 0.938, LR+ = 10, LR- = 0.4). The combined AUC was 0.932. The proposal for diagnosing convergence excess is to use, in addition to near esophoria with normal distance heterophoria, the combination of failing BAF with negative lenses and failing vergence facility with base-in prisms.