Near Point of Convergence Norms Measured in Elementary School Children

Maples, Willis C.; Hoenes, Richard

doi:10.1097/opx.0b013e3180339f44

Cited by 55 publications

(64 citation statements)

References 17 publications

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“…Previous research suggests that normative NPC measures are equivalent across sex and age groups among healthy children and adults, with an established clinical cutoff of 5 cm from the nose. 21,25,35 As such, our findings regarding age and sex are consistent with the extant literature. However, these same demographic groups (eg, female patients, younger children) are reported to be at risk for poor outcomes or prolonged recovery after an SRC.…”

Section: Discussionsupporting

confidence: 92%

“…Our study did not measure divergence or recovery, which is a component of some diagnostic criteria for CI. 21,25 Divergence or recovery of binocularity is performed by slowly moving the target away from the patient until the patient reports 1 target or when the examiner sees the eyes regain triangulation on the target. 25 Patients may have normal NPC but also have abnormal divergence that may be clinically meaningful.…”

Section: Discussionmentioning

confidence: 99%

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Near Point of Convergence After a Sport-Related Concussion

et al. 2015

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Background Convergence insufficiency (CI) is a common binocular vision deficit after a sport-related concussion (SRC). CI may result in visual discomfort and vision-mediated functional difficulties such as slowed reading and compromised attention, leading to impaired academic, work, and sport performance. Purpose To test the reliability of repeated near point of convergence (NPC) measurements in a sample of athletes after an SRC; compare the symptoms and cognitive impairment of athletes with normal NPC to those with CI after an SRC; and explore the relationship among age, sex, learning disability, migraine history, and CI. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 78 athletes (mean age, 14.31 ± 2.77 years) who were seen a mean 5.79 ± 5.63 days after an SRC were administered 3 trials of an NPC assessment, along with neurocognitive (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]) and symptom assessments. Patients were divided into normal NPC (NPC ≤5 cm; n = 45) and CI (NPC >5 cm; n = 33) groups. Intraclass correlation coefficients (ICCs) and repeated-measures analyses of variance (ANOVAs) assessed the consistency of NPC across the 3 trials. The ANOVAs were employed to examine differences on neurocognitive composites and symptoms between the normal NPC and CI groups. Stepwise regressions (controlling for age and symptom scores on the Post-Concussion Symptom Scale [PCSS]) were conducted to evaluate the predictive utility of the NPC distance for neurocognitive impairment. Results Groups did not differ on demographic or injury characteristics. NPC differed between trial 1 and trials 2 (P = .02) and 3 (P = .01) for the CI group but not the normal NPC group. Internal consistency was high across NPC measurements (ICC range, 0.95–0.98). Patients with CI performed worse on verbal memory (P = .02), visual motor speed (P = .02), and reaction time (P = .001, η2 = .13) and had greater total symptom scores (P = .02) after the injury. Results of hierarchical regression revealed that the NPC distance contributed significantly to the model for reaction time (P < .001). Conclusion CI was common (~42%) in athletes evaluated within 1 month after an SRC. Athletes with CI had worse neurocognitive impairment and higher symptom scores than did those with normal NPC. Clinicians should consider routinely screening for NPC as part of a comprehensive concussion evaluation to help inform treatment recommendations, academic accommodations, and referrals for vision therapy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Near Point of Convergence After a Sport-Related Concussion

et al. 2015

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“…mentioned that the mean of NPC break in elementary school children for differential diagnosis of symptomatic from asymptomatic is 5.0 cm or less. [16] Jiménez et al . [17] reported a mean NPC break in children of 5.2 cm with a penlight.…”

Section: Discussionmentioning

confidence: 99%

The relationship between binocular vision symptoms and near point of convergence

Momeni‐Moghaddam

David

Ehsani

2013

Indian J Ophthalmol

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Aim and Background:Due to the relatively high prevalence of binocular vision anomalies, a regular examination including tests for assessment and determination of these anomalies is necessary. The aim of this study was to assess the relationship between near point of convergence (NPC) and near binocular vision symptoms and finding of an NPC cutoff point for symptoms in university students.Materials and Methods:In this cross-sectional study, 124 students of different majors of Zahedan University of Medical Sciences were randomly selected. If they met the inclusion criteria, they were divided into two groups (symptomatic and asymptomatic) according to the convergence insufficiency symptom survey questionnaire. For NPC measurement, a small isolated letter E of approximately 20/30 size on a metal rod was used. After data collection, data were analyzed in SPSS.17 software (SPSS for Windows, SPSS Inc., Chicago, IL) using descriptive and analytical statistics, including Mann–Whitney U test and receiver operating characteristic (ROC) curve.Results:The mean NPC findings in the symptomatic and asymptomatic groups were 11.7 ± 5.0 and 8.4 ± 3.4 cm, respectively, with a significant difference between the two groups (P < 0.001). The ROC curve suggests an NPC cutoff point of 9.5 cm for the presence of symptoms with the testing procedures used in this study.Conclusion:The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects.

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“…This is the case of the study of Scheiman et al [65], in which the authors have found cut-offs of 5 cm for NPC break in an adult population with similar ages to those of this investigation, that is, a nonpresbyopic population. Similarly, Maples and Hoenes [79] recommend using an NPC break of ≥5 cm as a criterion to differ between asymptomatic and symptomatic subjects associated with the diagnosis of a CI. Nevertheless it is necessary to take into account that the authors [79] analyzed a sample of children with ages between 5 and 10 years and therefore not comparable with the adult population examined in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Maples and Hoenes [79] recommend using an NPC break of ≥5 cm as a criterion to differ between asymptomatic and symptomatic subjects associated with the diagnosis of a CI. Nevertheless it is necessary to take into account that the authors [79] analyzed a sample of children with ages between 5 and 10 years and therefore not comparable with the adult population examined in our study. …”

Section: Discussionmentioning

confidence: 99%

Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

Cacho-Martínez

García-Muñoz

Ruiz-Cantero

2013

Journal of Ophthalmology

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Purpose. To analyze the diagnostic validity of accommodative and binocular tests in a sample of patients with a large near exophoria with moderate to severe symptoms. Methods. Two groups of patients between 19 and 35 years were recruited from a university clinic: 33 subjects with large exophoria at near vision and moderate or high visual discomfort and 33 patients with normal heterophoria and low visual discomfort. Visual discomfort was defined using the Conlon survey. A refractive exam and an exhaustive evaluation of accommodation and vergence were assessed. Diagnostic validity by means of receiver operator characteristic (ROC) curves, sensitivity (S), specificity (Sp), and positive and negative likelihood ratios (LR+, LR−) were assessed. This analysis was also carried out considering multiple tests as serial testing strategy. Results. ROC analysis showed the best diagnostic accuracy for receded near point of convergence (NPC) recovery (area = 0.929) and binocular accommodative facility (BAF) (area = 0.886). Using the cut-offs obtained with ROC analysis, the best diagnostic validity was obtained for the combination of NPC recovery and BAF (S = 0.77, Sp = 1, LR+ = value tending to infinity, LR− = 0.23) and the combination of NPC break and recovery with BAF (S = 0.73, Sp = 1, LR+ = tending to infinity, LR− = 0.27). Conclusions. NPC and BAF tests were the tests with the best diagnostic accuracy for subjects with large near exophoria and moderate to severe symptoms.

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Near Point of Convergence Norms Measured in Elementary School Children

Cited by 55 publications

References 17 publications

Near Point of Convergence After a Sport-Related Concussion

Near Point of Convergence After a Sport-Related Concussion

The relationship between binocular vision symptoms and near point of convergence

Diagnostic Validity of Clinical Signs Associated with a Large Exophoria at Near

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