Abstract
Purpose :
Deficits in vergence and saccades have been reported in patients with vertigo, dizziness, and postural instability. We performed a retrospective observational clinical study to evaluate whether deficits in vergence and accommodation occur in children and adolescents with common vestibular diagnoses.
Methods :
A retrospective analysis was conducted on patients who underwent vestibular and optometric evaluations by the two senior authors at Boston Children’s Hospital between November 2011 and August 2018. Inclusion criteria were <22 years of age; presence of a vestibular diagnosis; 20/30 vision or better in each eye; assessment of oculomotor function; and no strabismus, amblyopia, or other ocular pathology. Results were compared to a pediatric control group (n=33; age 9.4 ± 1.3 years) with no prior history of vestibular or visual symptoms that was collected between April and October 2016. Vergence and accommodation deficits were based on established criteria. Chi-square analysis assessed differences in group distribution.
Results :
Of the 81 patient records reviewed, 50 (67%) had a vestibular diagnosis and met inclusion criteria (36/50 females; age 14.38 ±3.61 years). Of the remaining 31 (33%) records, 19 had only concussion diagnosis, 6 (8%) had non-vestibular diagnosis and 6 (8%) did not fit inclusion criteria. Vestibular diagnosis comprised of 15 (30%) having more than one diagnosis: 32 (64%) with benign paroxysmal positional vertigo, 23 (46%) with vestibular migraine, 14 (28%) with persistent postural-perceptual dizziness and 5 (10%) with other vestibular diagnoses. Diagnosis of concussion was noted in 20/50 (40%) records with vestibular diagnosis. Vergence and/or accommodation deficits were observed in 34 (68%) records with vestibular diagnosis: 21 of 50 (42%) had a vergence deficit and 19 of 45 (42%) had an accommodation deficit. In 14 of 45 (31%) records both vergence and accommodation deficits were observed. Records with a vestibular diagnosis were more likely to have a deficit of accommodation (42% vs. 12%) or vergence (42% vs. 9%) compared to the control group (p<0.001).
Conclusions :
Vergence and accommodation deficits were observed at a high frequency in patients with a vestibular diagnosis (68%). Detailed vergence and accommodation assessments may be important in the care of patients with vestibular diagnosis due to coexisting deficits, which could influence treatment and resolution of symptoms.
This is a 2020 ARVO Annual Meeting abstract.