Aparna Raghuram1, Susan A Cotter2, Sowjanya Gowrisankaran3, Jameel Kanji4, David R Howell5, William P Meehan6, Ankoor S Shah7. 1. Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA. Electronic address: aparna.raghuram@childrens.harvard.edu. 2. Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA. 3. Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA. 4. New England College of Optometry, Boston, MA, USA. 5. The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Brain Injury Center, Boston Children's Hospital, Boston, MA, USA. 6. The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Brain Injury Center, Boston Children's Hospital, Boston, MA, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA. 7. Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA.
Abstract
PURPOSE: To determine the frequency of occurrence of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders. DESIGN: Retrospective cross-sectional study. METHODS: Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients < 21 years old who were > 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined. RESULTS: Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had convergence insufficiency and accommodation deficits; and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had convergence excess only; and 1 (1%) had both convergence excess and accommodative deficits. CONCLUSION: A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.
PURPOSE: To determine the frequency of occurrence of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders. DESIGN: Retrospective cross-sectional study. METHODS: Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients < 21 years old who were > 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined. RESULTS: Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had convergence insufficiency and accommodation deficits; and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had convergence excess only; and 1 (1%) had both convergence excess and accommodative deficits. CONCLUSION: A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.
Authors: Nathan Ernst; Philip Schatz; Alicia M Trbovich; Kouros Emami; Shawn R Eagle; Anne Mucha; Michael W Collins; Anthony P Kontos Journal: J Athl Train Date: 2020-08-01 Impact factor: 2.860
Authors: Sowjanya Gowrisankaran; Ankoor S Shah; Tawna L Roberts; Emily Wiecek; Ryan N Chinn; Karameh K Hawash; Michael J O'Brien; David R Howell; William P Meehan; Aparna Raghuram Journal: Brain Inj Date: 2021-08-12 Impact factor: 2.167
Authors: Jessie R Oldham; Christina L Master; Gregory A Walker; William P Meehan; David R Howell Journal: Optom Vis Sci Date: 2021-07-01 Impact factor: 2.106
Authors: Tara L Alvarez; Chang Yaramothu; Mitchell Scheiman; Arlene Goodman; Susan A Cotter; Kristine Huang; Angela M Chen; Matthew Grady; Anne E Mozel; Olivia E Podolak; Chris G Koutures; Christina L Master Journal: Vision Res Date: 2021-04-23 Impact factor: 1.984