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Aparna Raghuram, Susan A Cotter, Ankoor S Shah; Is a Receded Near Point of Convergence (NPC) Diagnostic of Convergence Insufficiency in Post-Concussion Patients?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1953.
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A receded near point of convergence (NPC), which is commonly observed post-concussion, is often presumed to be diagnostic of convergence insufficiency (CI). Our objective was to determine the proportion of patients with chronic concussion-related visual symptoms and a receded NPC who had the clinical diagnosis of CI and/or other vergence and accommodative dysfunctions.
A retrospective chart review of all patients 9 to <23 years with chronic concussion-related visual symptoms examined in the Multidisciplinary Brain Injury Clinic or the Department of Ophthalmology at Boston Children’s Hospital from 2012 to 2016 was performed. Inclusion criteria included best-corrected vision of 20/25 or better and having undergone a comprehensive sensorimotor evaluation; exclusion criteria included preexisting ocular pathology, prior vision therapy, or the diagnosis of conversion disorder. Specific diagnostic criteria for CI, convergence excess (CE), accommodative dysfunction (AD), and non-specific vergence dysfunction were applied to establish the proportion of patients with a receded NPC of >7cm from the lateral canthus and the proportion with these clinical diagnoses.
101 post-concussion patients with chronic symptoms (median presentation 116 days post-concussion) met inclusion criteria with 92 (91.1%) having a receded NPC. Of those with a receded NPC, the following diagnoses were found: 22 (23.9%) CI, 7 (7.6%) CE, 17 (10.9%) AD, 27 (29.4%) CI & AD, 3 (3.3%) CE & AD, 2 (2.2%) non-specific vergence dysfunction & AD, and 14 (15.2%) with otherwise normal vergence and accommodation findings.
While the vast majority of the chronic post-concussion patients examined had a receded NPC, only 1 in 5 had the diagnosis of CI-only; the remainder had an accommodative dysfunction with or without some type of vergence dysfunction. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that post-concussion patients with a receded NPC undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and the most appropriate treatment implemented.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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