Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency.
Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency.
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DOI：
10.1097/opx.0000000000001626
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发表时间：
2021-01-01
期刊：
影响因子：
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通讯作者：
Convergence Insufficiency Treatment Trial Investigator Group
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文献类型：
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作者：
Scheiman MM;Alvarez TL;Cotter SA;Kulp MT;Sinnott LT;Plaumann MD;Jhajj J;Convergence Insufficiency Treatment Trial Investigator Group
在有症状的会聚功能不全儿童中，用客观眼动记录发现的视差发散缺陷可能不明显，而用标准的负融合性聚散度（NFV）临床测量。确定未经治疗的症状性会聚功能不全儿童的NFV是否正常，以及在聚散/矫正治疗后NFV是否改善。在基于诊所的聚散/矫正治疗前后对NFV测量的二次分析报告了以下变化：1）12名症状性会聚功能不全儿童与10名正常双眼视觉（NBV）儿童对4 °视差发散阶跃刺激的客观眼动记录反应; 2）在三项会聚功能不全治疗试验中成功治疗的580名儿童的临床NFV测量（CITT）研究。基线时，CITT队列的平均NFV断裂（14.6 ± 4.8 Δ）和恢复（10.6 ± 4.2 Δ）值显著大于（P <0.001）正常值。治疗后模糊、断裂和恢复的平均改善分别为5.2 Δ、7.2 Δ和1.3 Δ，具有统计学显著性（P <.0001）。与NBV组相比，会聚功能不全组对4 °视差发散阶跃刺激的平均治疗前反应在峰值速度（P <.001）、达到峰值速度的时间（P =.01）和反应幅度（P <.001）方面更差。治疗后，会聚功能不全组的平均峰值速度有统计学显著改善（11.63 °/sec; 95% CI：6.6 - 16.62），达到峰值速度的时间（− 0.12秒; 95% CI：− 0.19至− 0.05），以及响应幅度（1.47 °; 95%CI：0.83 - 2.11），与NBV队列相比，测量值不再具有统计学差异（P> 0.05）。尽管临床NFV测量值似乎大于正常值，但有症状的会聚功能不全儿童在客观眼动记录测量时可能存在NFV不足。NFV的客观和临床测量都可以通过聚散/矫正治疗来改善。
Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency. To determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy. This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in: 1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and 2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial (CITT) studies. At baseline, the CITT cohort’s mean NFV break (14.6±4.8Δ) and recovery (10.6±4.2Δ) values were significantly greater (P <.001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2∆, 7.2Δ, and 1.3∆, respectively, were statistically significant (P <.0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P<.001), time to peak velocity (P=.01), and response amplitude (P<.001). Post therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/sec; 95% CI: 6.6—16.62), time to peak velocity (−0.12 sec; 95% CI: −0.19 to −0.05), and response amplitude (1.47°; 95% CI: 0.83—2.11), with measures no longer statistically different from the NBV cohort (P>.05). Despite clinical NFV measurements that appear greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.