Sensitivity and specificity of school nurse screening for hypermetropia and convergence insufficiency exophoria in primary schoolchildren in Denmark

Abstract

Background To determine the sensitivity and specificity of school nurse screening for hypermetropia and convergence insufficiency exophoria (CIE) in schoolchildren. Methods Near point of convergence and distance visual acuity with +2.00D lenses were measured in 2097 children (6–15 years) during standard school nurse screening in the municipality of Randers, Denmark. One hundred and ninety‐four children with positive screening results (near point of convergence >10 cm and/or distance visual acuity improved or maintained with +2.00D) and 182 controls with negative screening results received a full vision assessment, including cycloplegic refraction and orthoptic evaluation. Results Sensitivity and specificity of screening was 0.75 and 0.69 for CIE and 0.59 and 0.87 for hypermetropia (≥+2.00), respectively. While precision of screening for CIE was significantly higher for symptomatic children aged 9–15 than for younger and asymptomatic children, precision of screening for hypermetropia was independent of age and presence of visually related symptoms. Conclusion While precision of screening for CIE and hypermetropia (>+2.00) was low, additional vision evaluation of children older than 9 years with asthenopic symptoms identified most children with CIE with a low absolute number of false positives.

Vergence Exercises for Six Weeks Induce Faster Recovery of Convergence Insufficiency Than Accommodation Exercises in School Children

“…Also of relevance, there was no difference in the effects of the two treatment regimens at the end of the 12-week treatment period. This study corroborates previous findings 5,6 that a vast majority of children with CI have accommodation insufficiency, which according to clinical guidelines should be treated with a combination of vergence and accommodation exercises. 8 The similar rate of recovery of monocular accommodation parameters in the two treatment groups imply that vergence exercises and monocular accommodation exercises are equally efficient at treating accommodation insufficiency.…”

“… 3 The clinical examination shows receded near point of convergence, reduced positive fusional vergence, and larger exodeviation at near than at distance. 4 Several studies have shown that school children diagnosed with CI have abnormal accommodation, 5 , 6 which is reflected in clinical guidelines for the treatment of CI that include exercises for both monocular accommodation and vergence, the latter including exercises for antisuppression and awareness of diplopia. 7 The effect of exercises aimed at improving vergence is assessed by measuring positive fusional vergence, vergence facility, and near point of convergence, whereas the effect on accommodation is assessed by measuring amplitude of accommodation and accommodation facility.…”