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KMID : 1011420180230020117
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Journal of Korean Ophthalmic Optics Society
2018 Volume.23 No. 2 p.117 ~ p.123
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Binocular Accommodative Facility and Vergence Facility in University Students with Symptomatic Convergence Insufficiency
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Kim Yong-Ho
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Abstract
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Purpose: The purpose of this study was to suggest the diagnostic accuracy and criteria of binocular accommodative facility and vergence facility for subjects with symptomatic convergence insufficiency.
Methods: Seventy-five university students, between 19 and 30 years old, were recruited according to inclusion criteria and were given convergence insufficiency symptom survey (CISS). They were divided into 38 subjects with normal binocular vision and 21 subjects with symptomatic convergence insufficiency according to both total CISS score and difference of phoria between distance and near. Binocular accommodative facility and vergence facility were tested and the normative data were obtained. The diagnostic accuracy and cut-off values of binocular accommodative facility and vergence facility were obtained by using receiver operator characteristic (ROC) curve and were compared with those of scientific literature.
Results: The mean value of binocular accommodative facility and vergence facility for subjects with symptomatic convergence insufficiency was statistically lower than subjects with normal binocular vision (p<0.05). Normative value for binocular accommodative facility and vergence facility was 12.92±4.77 cpm and 14.95±6.69 cpm, respectively (p<0.05). AUC (area under the ROC curve) of binocular accommodative facility and vergence facility was 0.840 and 0.793, respectively (p<0.05). This confirms that binocular accommodative facility is more accurate diagnostic test to differentiate convergence insufficiency than vergence facility. For identifying subjects with symptomatic convergence insufficiency, the best sensitive and specific cut-off values was 8.5 cpm for binocular accommodative facility and was 9.5 cpm for vergence facility (p<0.05).
Conclusions: Binocular accommodative facility shows higher diagnostic accuracy than vergence facility for screening symptomatic convergence insufficiency. The cut-off value used generally in optometric settings, for binocular accommodative facility and for vergence facility, is 8 cpm and 15 cpm respectively. Their cut-off values were determined on the basis of normative data for normal binocular vision so they could be different from cut-off value for screening convergence insufficiency. In this study, the cut-off value with the best sensitivity and specificity was estimated by using ROC analysis with data obtained from confirmed convergence insufficiency group to improve diagnostic accuracy for convergence insufficiency. Therefore, the cut-off values obtained in this study can be appropriate clinical criterion to screen convergence insufficiency.
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KEYWORD
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Convergence insufficiency, Binocular accommodative facility, Vergence facility, Cut-off value
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