Relationships Among Clinical Factors and Patient-Reported Outcome Measures of Symptoms and Quality of Life in Adults with Convergence Insufficiency

Abstract

Purpose : Convergence insufficiency is associated with a variety of symptoms, but the relationship between symptoms and quality of life has not been studied. We explored associations among clinical measures, symptoms, and quality of life before and after treatment in adults with symptomatic convergence insufficiency.

Methods : In a prospective observational study we evaluated 57 adults with symptomatic convergence insufficiency (near exodeviation ≥4Δ and at least 4Δ larger than distance, reduced near point of convergence, reduced near positive fusional vergence, and Convergence Insufficiency Symptom Survey [CISS] score ≥ 21 points). 35 participants were treated with vision therapy/exercises and 22 with base-in prism. Spearman correlation coefficients (R) and 95% confidence intervals (CI) were used to assess associations among near clinical measures (exodeviation magnitude, near point of convergence, positive fusional vergence) and patient-reported outcome measures (CISS, Diplopia Questionnaire, and the Adult Strabismus (AS)-20 quality-of-life (QOL) questionnaire [general function, reading function, interactions, and self-perception domains]) prior to treatment (baseline), and 10 weeks and 1 year after treatment initiation. To account for multiplicity, associations were interpreted as present only when the lower limit of the 95% CI indicated a moderate to strong association [R ≥ 0.4].

Results : At baseline, the only moderate to strong correlation was between the CISS and AS-20 reading function scores (R = 0.62; 95% CI: 0.43 − 0.76). For change from baseline, the only moderate to strong correlations were between change in CISS score and change in AS-20 reading function score at 1 year in the vision therapy group (R = 0.78; 95% CI: 0.57 − 0.89), and at 10 weeks (R = 0.78; 95% CI, 0.52 − 0.91) and 1 year (R = 0.85; 95% CI, 0.65 − 0.94) in the prism group.

Conclusions : In adults with symptomatic convergence insufficiency, baseline symptoms correlated with reading function QOL, and improvements in symptoms following treatment with vision therapy/exercises or prism correlated with improvements in reading function QOL. There were no correlations between clinical measures and symptoms or QOL. Patient-reported outcome measures appear useful in the assessment and management of convergence insufficiency in adults.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.