The Incidence and Clinical Characteristics of Adult-Onset Convergence Insufficiency

Abstract

Objective The purpose of this study was to describe the clinical characteristics and natural history of convergence insufficiency (CI) in a population-based cohort of adults. Design Retrospectively reviewed population-based cohort. Participants Adult (≥19 years of age) residents of Olmsted County, Minnesota. Methods The medical records of all adults diagnosed with CI over a 20-year period were retrospectively reviewed. Main outcome measures Clinical characteristics and outcomes for adult-onset convergence insufficiency. Results A total of 118 adults (annual incidence of 8.44 per 100 000 patients older than 19 years) were diagnosed with CI during the 20-year period, comprising 15.7% of all forms of adult-onset strabismus observed in this population. The median age at diagnosis was 68.5 years (range 21.7 to 97.1 years) and 68 (57.6%) were female. The mean initial exodeviation at near was 14.1 PD (range 1 to 30 PD) and 1.7 PD (range 0 to 10 PD) at distance. The Kaplan-Meier rate of exotropia increasing by 7 prism diopters or more at near over time was 4.2% at 5 years, 13.5% at 10 years, and 24.4% at 20 years. Approximately 88% were managed with prisms while less than 5% underwent surgical correction. Conclusions Adult-onset convergence insufficiency comprised approximately 1 in 6 adults who were newly diagnosed with strabismus in this 20-year cohort. There was a significant increase in incidence with increasing age. Nearly one-fourth had an increase of their near exodeviation of at least 7 PD by 20 years after their diagnosis and most patients were managed conservatively.

Prevalence of non‐strabismic anomalies of binocular vision in Tamil Nadu: report 2 of BAND study

“…This trend may be related to the increased near visual demands in older children. In an adult population above 19 years of age, one in six adults was diagnosed with convergence insufficiency and a significant increase in exophoria of seven prism dioptres (PD) was seen by 20 years in one‐fourth of the sample after the initial diagnosis. Also, a significant association between reading and non‐strabismic anomalies of binocular vision has been reported in the literature .…”

Treatment and compliance with virtual reality and anaglyph‐based training programs for convergence insufficiency

“…6 CI has a reported prevalence of six to eight per cent (98 per cent CI four to eight per cent) in children, [7][8][9][10] with higher rates in those over 60 years of age. 11 It has higher prevalence in people with learning difficulties, attention deficit hyperactivity disorder, 12 neurological disorder and acquired brain injuries. 13 CI may be treated; however, a major barrier to successful coverage is that in-office treatments have better outcomes than home-based treatments.…”

Diplopia in Medically and Surgically Treated Patients with Glaucoma

“…Diplopia in glaucoma patients, not attributable to glaucoma surgery, has not been previously studied in detail, but we found that it reflected the occurrence of common strabismus conditions in this mostly elderly population, specifically convergence insufficiency, adult-onset distance esotropia, and small-angle hypertropia. 17 We also found that binocular diplopia in glaucoma patients, not attributable to glaucoma surgery, may also be caused by mechanical strabismus, such as following orbital trauma, old or new cranial nerve palsies, or co-existent retinal conditions that may be associated with central peripheral rivalry. 18, 19 In addition, other risk factors related to the glaucoma may further increase risk for diplopia, for example, visual field loss, and ocular surface compromise made exacerbated by topical ocular medications.…”