Research Reports - Concurrent vision dysfunctions in convergence insufficiency with traumatic brain injury

Optom Vis Sci. 2012 Dec;89(12):1740-51

Alvarez TL, Kim EH, Vicci VR, Dhar SK, Biswal BB, Barrett AM

PURPOSE: This study assessed the prevalence of convergence insufficiency (CI)
with and without simultaneous vision dysfunctions within the traumatic brain
injury (TBI) sample population because although CI is commonly reported with TBI,
the prevalence of concurrent visual dysfunctions with CI in TBI is unknown.
METHODS: A retrospective analysis of 557 medical records from TBI civilian
patients was conducted. Patients were all evaluated by a single optometrist.
Visual acuity, oculomotor function, binocular vision function, accommodation,
visual fields, ocular health, and vestibular function were assessed. Statistical
comparisons between the CI and non-CI, as well as inpatient and outpatient
subgroups, were conducted using χ and Z tests.
RESULTS: Approximately 9% of the TBI sample had CI without the following
simultaneous diagnoses: saccade or pursuit dysfunction; third, fourth, or sixth
cranial nerve palsy; visual field deficit; visual spatial inattention/neglect;
vestibular dysfunction; or nystagmus. Photophobia with CI was observed in 16.3%
(21 of 130), and vestibular dysfunction with CI was observed in 18.5% (24 of 130)
of the CI subgroup. Convergence insufficiency and cranial nerve palsies were
common and yielded prevalence rates of 23.3% (130 of 557) and 26.9% (150 of 557),
respectively, within the TBI sample. Accommodative dysfunction was common within
the nonpresbyopic TBI sample, with a prevalence of 24.4% (76 of 314). Visual
field deficits or unilateral visual spatial inattention/neglect was observed
within 29.6% (80 of 270) of the TBI inpatient subgroup and was significantly more
prevalent compared with that of the outpatient subgroup (p < 0.001). Most TBI
patients had visual acuities of 20/60 or better in the TBI sample (85%; 473 of
557).
CONCLUSIONS: Convergence insufficiency without simultaneous visual or vestibular
dysfunctions was observed in about 9% of the visually symptomatic TBI civilian
population studied. A thorough visual and vestibular examination is recommended
for all TBI patients.

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