OBJECTIVE: To assess the long-term stability of clinical measures of convergence (near point of convergence [NPC] and positive fusional vergence [PFV]) in participants enrolled in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial (CITT-ART) who received 16 weeks of office-based vergence/accommodative therapy.
METHODS: A total of 310 children, 9-14 years old, with symptomatic convergence insufficiency were enrolled in CITT-ART. Some 270 completed both their 16-week primary outcome visit followed by a 1-year follow-up visit. Of those 270, 181 (67%) were randomised to the vergence/accommodative therapy. Of the 181 in the vergence/accommodative group, 121 (67%) reported not receiving any additional treatment after the 16-week primary outcome visit. The mean change in NPC, PFV and percentages of children classified by the predetermined success criteria of convergence (normal NPC [<6 cm] and/or improved by ≥4 cm; normal PFV [passing Sheard\'s criterion and base-out break >15Δ] and/or improved by ≥10Δ) were compared at the 16-week primary outcome visit and 1 year later.
RESULTS: Of the 121 who returned for their 1-year follow-up visit, there was no significant change in mean adjusted NPC (reduction of -0.2 cm; 95% CI: -1.0 to 0.5 cm) at 1 year. There was a statistically significant decrease in mean-adjusted PFV (-4.7∆; 95% CI: -6.5 to -2.8Δ) at 1 year. There were similar percentages of participants classified as \'normal\' (p = 0.30), \'normal and/or improved\' (p > 0.50) and \'normal and improved\' (p > 0.14) based on NPC and PFV at the 1-year visit compared with the 16-week primary outcome visit.
CONCLUSIONS: The improvements in NPC and PFV following 16 weeks of vergence/accommodative therapy (with no reported additional treatment thereafter) in children with symptomatic convergence insufficiency persisted 1-year post-treatment.

UNASSIGNED: Lifestyle in the modern era has drastically changed across the globe, and the healthcare profession was no exception. The increased time spent in the virtual space for various purposes, including online classes and webinars, is hypothesized to increase the risk of vision-related disorders such as asthenopia, dry eyes, and visual fatigue. The purpose of this study was to evaluate fusional vergence and ocular accommodation among optometry professionals in a tertiary eye care center during the immediate post-coronavirus disease 2019 (post-COVID-19) lockdown period.
UNASSIGNED: Optometrists posted in the general out-patient department, specialty clinics, and the ocular diagnostics department were included in the study. A total of 65 optometrists were included in the study. All optometrists underwent a comprehensive binocular vision assessment. Convergence Insufficiency Symptom Survey questionnaires were administered to all optometrists at the beginning of the assessment.
UNASSIGNED: Out of 65 optometrists, 48 (73.8%) were women. The mean (standard deviation) age of the participants was 24 (3) years. Eleven (16.9%) optometrists had normal binocular vision parameters, and the rest 54 (83.1%) had non-strabismic binocular vision anomalies. Reduced accommodative facility and convergence insufficiency were seen among 43 (66.2%) optometrists, whereas 30 (46.2%) had reduced accommodative facility alone. Twelve (18.5%) participants were symptomatic as per the convergence insufficiency symptom survey.
UNASSIGNED: This study highlights the fact that a large proportion of optometrists have undetected non-strabismic binocular vision anomalies in a tertiary eye care center. It is important for eye care professionals to undergo regular binocular vision assessments in association with ophthalmic examinations and relevant management. This will ensure that these dysfunctions do not impede work productivity and overall quality of life.

OBJECTIVE: To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire (COVD-QOL) and the Convergence Insufficiency Symptom Survey (CISS) in detecting convergence insufficiency and to compare their diagnostic value in clinical applications.
METHODS: Using the diagnostic test method, 62 adult patients with convergence insufficiency (age: 24.74±3.75y) and 62 normal participants (age: 23.61±3.13y) who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included. All subjects completed the CISS and COVD-QOL. Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed.
RESULTS: The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5% and 71.0%, respectively, while the specificity was 96.8% and 67.7%, respectively. Compared to the CISS alone, the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity. The areas under the receiver operating characteristic curve of CISS, COVD-QOL and CISS combined with COVD-QOL were 0.806, 0.694 and 0.782, respectively.
CONCLUSIONS: Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL, it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.

BACKGROUND: Convergence insufficiency is a common issue in the field of binocular vision. Various treatment options have been suggested for managing this condition, but their efficacy in individuals with presbyopia remains unclear. The objective of this study is to compare the effectiveness of home-based vision therapy and prism prescription, in presbyopic patients with convergence insufficiency.
METHODS: It is a randomized, prospective, double-blind clinical trial, with total of 150 participants randomly assigned to the three groups. The Control Group will receive a new near glasses as a conventional prescription, along with aimless and random eye movement exercises that do not have any convergence or accommodation effects. The Home Vision Therapy Group will receive new near glasses with accommodative and convergence eye exercises. The Prism Group will receive a near prismatic glasses prescribed using the Sheard\'s criterion. All treatments will be administered for a period of 2 months, and measurements of the modified convergence insufficiency symptoms survey (CISS), near point convergence, near phoria, and positive fusional vergence will be taken at baseline, one month later, and at the end of the treatment.
CONCLUSIONS: We aim to identify which component - either the prism prescription or the home vision therapy - is more effective in improving binocular abilities and reducing patients\' symptom scores.
BACKGROUND: ClinicalTrials.gov NCT05311917 with last update on 04/22/2023.

OBJECTIVE: To report the change in the magnitude of near exodeviation in children with symptomatic convergence insufficiency successfully treated with office-based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial.
METHODS: A total of 131 children 9-14 years of age with symptomatic convergence insufficiency classified as successfully treated with office-based vergence/accommodative therapy at the 16-week outcome visit were included. Masked examiners measured the near ocular deviation by the prism and alternate cover test at baseline, primary outcome and 1-year post-treatment. The mean change in near deviation was calculated from baseline to primary outcome, from primary outcome to 1-year post-treatment and from baseline to 1-year post-treatment.
RESULTS: Of the 131 participants successfully treated with vergence/accommodative therapy, 120 completed the 1-year post-treatment visit. A significant change in near exodeviation was observed at baseline to primary outcome (2.6Δ less exo, p < 0.001, moderate effect size d = 0.61) and at baseline to 1-year post-treatment (2.0Δ less exo; p < 0.001, small effect size d = 0.45). The change from primary outcome to 1-year post-treatment (0.6Δ more exo; p = 0.06, small effect size d = 0.11) was not significant. Forty per cent (48/120) of participants had a decrease in near exodeviation >3.5∆ (expected test/retest variability) between baseline and the primary outcome examination. Of the 120 participants, one (1.0%) was esophoric at the primary outcome and was subsequently exophoric at 1-year post-treatment. Four participants (3.3%) who were orthophoric or exophoric at the primary outcome were esophoric (all ≤3∆) at the 1-year post-treatment visit.
CONCLUSIONS: On average, the near exodeviation was smaller in size immediately after the discontinuation of vergence/accommodative therapy (2.6∆, moderate effect size) and 1 year post vergence/accommodative therapy (2.0∆, small effect size) in children with convergence insufficiency who were successfully treated; 40% had a clinically meaningful decrease in exophoria. The development of near esophoria was rare.

UNASSIGNED: To estimate the prevalence of convergence insufficiency (CI) in adult patients with post-concussion syndrome and determine the impact of CI on symptom load.
UNASSIGNED: Cross-sectional study of 103 patients with neurological symptoms 2-6 months after a concussion. Symptoms were assessed with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and CI was diagnosed using near point of convergence, vergence facility, and the Convergence Insufficiency Symptom Survey. The RPQ score for patients with and without CI was compared, and sensitivity, specificity, and area under the receiver operating characteristic curve for the two visually related RPQ questions as indicators of CI were calculated.
UNASSIGNED: The proportion of patients diagnosed with symptomatic CI was 20.4% (95% confidence interval: 13.1-29.5%). The RPQ score was significantly higher for patients with symptomatic CI both before (p = .01) and after removal of the two visually related questions in the RPQ-questionnaire (p = .03). The two visually related RPQ questions were unable to detect CI.
UNASSIGNED: In patients with post-concussion syndrome, the load of nonvisual symptoms is higher in the presence of CI. A prospective interventional study on CI is required to study the relationship between CI and other post-concussion symptoms.

BACKGROUND: Convergence insufficiency (CI) is an oculomotor abnormality characterised by exophoria and inadequate convergence when focusing on nearby objects. CI has been shown to cause symptoms when reading. However, the downstream consequences on brain structure have yet to be investigated. Here, we investigated the neural consequences of symptomatic CI, focusing on the left arcuate fasciculus, a bundle of white matter fibres which supports reading ability and has been associated with reading deficits.
METHODS: We compared the arcuate fasciculus microstructure of participants with symptomatic CI versus normal binocular vision (NBV). Six CI participants and seven NBV controls were included in the analysis. All participants were scanned with 3 T magnetic resonance imaging (MRI), and anatomical and diffusion-weighted images were acquired. Diffusion-weighted images were processed with TRACULA to identify the arcuate fasciculus in each participant and compute volume and radial diffusivity (RD).
RESULTS: Compared with NBV controls, those with symptomatic CI had significantly smaller arcuate fasciculi bilaterally (left: t = -3.21, p = 0.008; right: t = -3.29, p = 0.007), and lower RD in the left (t = -2.66, p = 0.02), but not the right (t = -0.81, p = 0.44, false discovery rate (FDR)-corrected p > 0.05) arcuate fasciculus. Those with higher levels of reading symptoms had smaller arcuate fasciculi (r = -0.74, p = 0.004) with lower RD (r = -0.61, p = 0.03).
CONCLUSIONS: These findings suggest that symptomatic CI may lead to microstructural changes in the arcuate fasciculus. Since it is highly unlikely that abnormalities in the arcuate fasciculus are the cause of the neuromuscular deficits in the eyes, we argue that these changes may be a potential neuroplastic consequence of disruptions in sustained reading.

OBJECTIVE: To investigate the frequency and associated factors of accommodation and non-strabismic binocular vision dysfunction among medical university students.
METHODS: Totally 158 student volunteers underwent routine vision examination in the optometry clinic of Guangxi Medical University. Their data were used to identify the different types of accommodation and non-strabismic binocular vision dysfunction and to determine their frequency. Correlation analysis and logistic regression were used to examine the factors associated with these abnormalities.
RESULTS: The results showed that 36.71% of the subjects had accommodation and non-strabismic binocular vision issues, with 8.86% being attributed to accommodation dysfunction and 27.85% to binocular abnormalities. Convergence insufficiency (CI) was the most common abnormality, accounting for 13.29%. Those with these abnormalities experienced higher levels of eyestrain (χ2=69.518, P<0.001). The linear correlations were observed between the difference of binocular spherical equivalent (SE) and the index of horizontal esotropia at a distance (r=0.231, P=0.004) and the asthenopia survey scale (ASS) score (r=0.346, P<0.001). Furthermore, the right eye\'s SE was inversely correlated with the convergence of positive and negative fusion images at close range (r=-0.321, P<0.001), the convergence of negative fusion images at close range (r=-0.294, P<0.001), the vergence facility (VF; r=-0.234, P=0.003), and the set of negative fusion images at far range (r=-0.237, P=0.003). Logistic regression analysis indicated that gender, age, and the difference in right and binocular SE did not influence the emergence of these abnormalities.
CONCLUSIONS: Binocular vision abnormalities are more prevalent than accommodation dysfunction, with CI being the most frequent type. Greater binocular refractive disparity leads to more severe eyestrain symptoms.

UNASSIGNED: Vision is crucial for football players, impacting decision-making and athletic performance. Despite its global popularity, football lacks comprehensive evaluations of the impact of digital device use on ocular symptoms during high-demand activities.
UNASSIGNED: To gain knowledge about the time spent by football players in high visual demand activities, the symptoms associated with binocular vision dysfunction, and their relationship with sports performance.
UNASSIGNED: A cross-sectional observational study was conducted in 2020 using an online survey targeting football players from Portugal, England, Spain, and Saudi Arabia. The survey, distributed over 5 weeks, aimed to collect data from approximately 5,000 football players. Information on player profiles, competitive levels, vision habits, and symptoms related to binocular vision dysfunctions was collected. The Convergence Insufficiency Symptom Survey (CISS) employed a 5-point Likert scale to indicate the average frequency of each symptom. Due to non-normality, non-parametric tests were used (p < 0.05). Specifically, Mann-Whitney U, Kruskal-Wallis, Chi-square, and Spearman\'s rank correlation tests were used as appropriate.
UNASSIGNED: Analyzing male professional football players (mean age: 27.4 ± 5.0 years, 95% CI, 26.7-28.1), it was found that 38.1% of the players had been called up to the national team and 6.9% had played over 50 games. Self-rated last season\'s performance had a mean score of 6.5 ± 2.1 (95% CI, 6.2-6.8)(on a scale of 1 to 10). Smartphone use exceeded 1 h daily for all players, with 36.0% surpassing 4 h. Visual symptoms, notably associated with smartphone use (35.5%), were observed. Regarding the CISS score, the mean was 7.1 ± 7.7 (IC95%: 6.6 to 8.8). A weak negative correlation (rho = -0.215, p = 0.003) emerged between CISS scores and self-perceived sports performance. Football players using prescription lenses had significantly higher CISS scores (11.9 ± 10.4, 95% CI, 12.3-7.7) compared to non-users (6.2 ± 6.8, 95% CI, 7.8-5.7) (p < 0.001).
UNASSIGNED: This study reveals that professional football players engage in high visual demand tasks, notably on smartphones. One-third of the players link smartphone use to ocular symptoms. The Convergence Insufficiency Symptoms Survey indicates that 6.3% exhibit binocular vision dysfunction symptoms. Those with fewer ocular symptoms perceive that they have better sports performance than their counterparts.

Binocular vision anomalies are major causes of asthenopia symptoms, particularly among the younger population. This study aimed to report the clinical characteristics of Sudanese patients with binocular disorders who attended the orthoptic clinic at Al-Neelain Eye Hospital. In this retrospective hospital-based study, we analyzed data from 304 patients with binocular vision anomalies who visited the orthoptic clinic between October 2020 and June 2021. We collected information on demographics, symptoms, and eye tests such as visual acuity (VA), refractive error (RE), angle of deviation, and the assessment of fusional vergence. Our findings indicated that exophoria was the most common binocular vision anomaly, affecting 79.8% of males and 71.6% of females (p=0.731). Children between 6 and 17 years old showed the highest prevalence of exophoria (75.9%) (p=0.0001). Among patients with exophoria, 100% reported itching associated with tearing during fixation, while 89.5% experienced difficulty in fixation. Refractive error varied by the type of binocular vision disorders (p=0.0001), with higher hyperopia observed in cases of unilateral esotropia and alternate esotropia (+3.571±1.238 D and +3.023±1.553 D, respectively). Positive fusional vergence (PFV) differed by types of binocular vision disorders (p=0.0001) with high PFV in esophoria (18.063±6.848∆) compared to low PFV in exophoria (12.80±5.313∆). The most common types of exophoria were convergence weakness exophoria (45.39%), followed by convergence insufficiency (20.39%). The study concluded that exophoria was the most common binocular vision anomaly among Sudanese patients, with convergence weakness and convergence insufficiency being the predominant anomalies. Headache was commonly prevalent among patients with binocular vision problems. Higher hyperopia was found in esodeviation, while low PFV was associated with exodeviation.