Divergence Insufficiency Revisited<subtitle>Natural History of Idiopathic Cases and Neurologic Associations</subtitle>

Abstract

To determine the natural history of primary divergence insufficiency and to identify clinical features that distinguish patients with this neurologically isolated form of divergence insufficiency from those harboring neurologic disorders. Methods: Retrospective survey of patients with divergence insufficiency. Patients were categorized into 2 groups, primary (ie, neurologically isolated based on clinical criteria) and secondary (ie, associated with a neurologic or systemic disorder). Long-term follow-up and clinical features of the 2 groups were compared.

Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus

“…33–38 Both Mittelman 33 and Jacobson 34 found that the median age of individuals affected by divergence insufficiency was in the mid-seventies, which is consistent with the present study. They suggest a microvascular ischemic insult to a “divergence center” in the brain as a potential cause, with some investigators reporting focal lesions of the pons or midbrain post-mortem of individuals with divergence insufficiency.…”

Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus

“…33–38 Both Mittelman 33 and Jacobson 34 found that the median age of individuals affected by divergence insufficiency was in the mid-seventies, which is consistent with the present study. They suggest a microvascular ischemic insult to a “divergence center” in the brain as a potential cause, with some investigators reporting focal lesions of the pons or midbrain post-mortem of individuals with divergence insufficiency.…”

Update on Divergence Insufficiency

“…16 In 2000, Jacobson 5 found similar results in a study with 35 patients with divergence insufficiency; 20 patients had primary divergence insufficiency and 15 patients had secondary divergence insufficiency. The purpose of the study was to determine which signs and symptoms differentiated neurologic divergence insufficiency from idiopathic divergence insufficiency.…”

Surgical Management of Adult Onset Age-Related Distance Esotropia

“…However, numerous studies have failed to show any consistent significant neurologic abnormalities among these patients. [3][4][5] In addition, there is little evidence to support the existence of a center within the brain regulating ocular divergence. 6 Thus, use of the term divergence insufficiency for this condition is a misnomer and should be discarded.…”

Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus

“…33–38 Both Mittelman 33 and Jacobson 34 found that the median age of individuals affected by divergence insufficiency was in the mid-seventies, which is consistent with the present study. They suggest a microvascular ischemic insult to a “divergence center” in the brain as a potential cause, with some investigators reporting focal lesions of the pons or midbrain post-mortem of individuals with divergence insufficiency.…”

Update on Divergence Insufficiency

“…16 In 2000, Jacobson 5 found similar results in a study with 35 patients with divergence insufficiency; 20 patients had primary divergence insufficiency and 15 patients had secondary divergence insufficiency. The purpose of the study was to determine which signs and symptoms differentiated neurologic divergence insufficiency from idiopathic divergence insufficiency.…”

Surgical Management of Adult Onset Age-Related Distance Esotropia

“…However, numerous studies have failed to show any consistent significant neurologic abnormalities among these patients. [3][4][5] In addition, there is little evidence to support the existence of a center within the brain regulating ocular divergence. 6 Thus, use of the term divergence insufficiency for this condition is a misnomer and should be discarded.…”

Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus

“…33–38 Both Mittelman 33 and Jacobson 34 found that the median age of individuals affected by divergence insufficiency was in the mid-seventies, which is consistent with the present study. They suggest a microvascular ischemic insult to a “divergence center” in the brain as a potential cause, with some investigators reporting focal lesions of the pons or midbrain post-mortem of individuals with divergence insufficiency.…”

Update on Divergence Insufficiency

“…16 In 2000, Jacobson 5 found similar results in a study with 35 patients with divergence insufficiency; 20 patients had primary divergence insufficiency and 15 patients had secondary divergence insufficiency. The purpose of the study was to determine which signs and symptoms differentiated neurologic divergence insufficiency from idiopathic divergence insufficiency.…”

Surgical Management of Adult Onset Age-Related Distance Esotropia

“…However, numerous studies have failed to show any consistent significant neurologic abnormalities among these patients. [3][4][5] In addition, there is little evidence to support the existence of a center within the brain regulating ocular divergence. 6 Thus, use of the term divergence insufficiency for this condition is a misnomer and should be discarded.…”