PMID- 29371010
OWN - NLM
STAT- MEDLINE
DCOM- 20190906
LR  - 20190906
IS  - 1549-4713 (Electronic)
IS  - 0161-6420 (Linking)
VI  - 125
IP  - 6
DP  - 2018 Jun
TI  - The Discrepancy between Subjective and Objective Measures of Convergence 
      Insufficiency in Whiplash-Associated Disorder versus Control Participants.
PG  - 924-928
LID - S0161-6420(17)33033-6 [pii]
LID - 10.1016/j.ophtha.2017.11.030 [doi]
AB  - PURPOSE: Motor vehicle accidents (MVAs) are a pandemic associated with human 
      suffering and a burden to national economies. Whiplash-associated disorders 
      (WADs) after MVAs are associated commonly with disability claims, many of which 
      are related to vision. Convergence insufficiency (CI) leads to visual disability 
      associated with symptoms of ocular discomfort. We examined the incidence of 
      symptoms and findings consistent with CI in a cohort of patients after 
      MVA-related WAD compared with age-matched control participants. DESIGN: 
      Prospective cohort study. PARTICIPANTS: Patients with WAD after MVA were 
      recruited from the Orthopedic Emergency Department between July 2014 and March 
      2017. Control participants were recruited among hospital personnel and relatives 
      of WAD patients. METHODS: The Convergence Insufficiency Symptom Survey (CISS) 
      questionnaire was completed by each participant, followed by a detailed visual 
      examination including measurements of distance and near best-corrected Snellen 
      visual acuity, distance and near cover test, Randot stereopsis, Maddox distance 
      and Maddox-Thorington near heterophoria, near point of convergence, base-out step 
      fusional reserves, and amplitude of accommodation using the push-away method. 
      MAIN OUTCOME MEASURES: The CISS score and binocular measure findings of CI were 
      recorded and analyzed using Student's t test, the chi-square test, and multiple 
      logistic regression adjusted for age and gender. RESULTS: A pathologic CISS score 
      of 16 or more occurred in 26 of 57 WAD patients (45.6%) compared with 6 of 39 
      control participants (15.4%; P = 0.002). Absolute CISS score was higher in the 
      WAD group compared with the control group (15.3+/-10.0 vs. 7.7+/-7.7; P < 0.001). 
      Findings consistent with CI occurred in 7.0% of WAD patients and 7.7% of control 
      participants (P = 0.90). CONCLUSIONS: Visual symptoms suggestive of CI were 
      reported more frequently among WAD patients compared with control participants, 
      yet the incidence of examination findings indicating weakness of convergence was 
      not increased. The discrepancy between subjective and objective measures of CI in 
      WAD patients versus control participants stresses the importance of training 
      healthcare personnel to assess disability using objective, validated standards of 
      examination.
CI  - Copyright (c) 2018 American Academy of Ophthalmology. Published by Elsevier Inc. 
      All rights reserved.
FAU - Stiebel-Kalish, Hadas
AU  - Stiebel-Kalish H
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 
      Neuro-Ophthalmology Division, Department of Ophthalmology, Rabin Medical Center, 
      Petah Tikva, Israel. Electronic address: kalishhadas@gmail.com.
FAU - Amitai, Amir
AU  - Amitai A
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of 
      Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel.
FAU - Mimouni, Michael
AU  - Mimouni M
AD  - Department of Ophthalmology, Rambam Health Care Campus, associated with 
      Technion-Israel Institute of Technology, Haifa, Israel.
FAU - Bach, Michael
AU  - Bach M
AD  - Eye Center, Medical Center, University of Freiburg, Faculty of Medicine, 
      University of Freiburg, Freiburg, Germany.
FAU - Saban, Tal
AU  - Saban T
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 
      Neuro-Ophthalmology Division, Department of Ophthalmology, Rabin Medical Center, 
      Petah Tikva, Israel.
FAU - Cahn, Michelle
AU  - Cahn M
AD  - Neuro-Ophthalmology Division, Department of Ophthalmology, Rabin Medical Center, 
      Petah Tikva, Israel.
FAU - Gantz, Liat
AU  - Gantz L
AD  - Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, 
      Israel.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180119
PL  - United States
TA  - Ophthalmology
JT  - Ophthalmology
JID - 7802443
SB  - IM
MH  - *Accidents, Traffic
MH  - Accommodation, Ocular/physiology
MH  - Adult
MH  - Cohort Studies
MH  - Depth Perception/physiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ocular Motility Disorders/*diagnosis/physiopathology
MH  - Prospective Studies
MH  - Surveys and Questionnaires
MH  - Vision Disorders/*diagnosis/physiopathology
MH  - Vision, Binocular/physiology
MH  - Visual Acuity/physiology
MH  - Whiplash Injuries/*diagnosis/physiopathology
MH  - Young Adult
EDAT- 2018/01/27 06:00
MHDA- 2019/09/07 06:00
CRDT- 2018/01/27 06:00
PHST- 2017/10/11 00:00 [received]
PHST- 2017/11/17 00:00 [revised]
PHST- 2017/11/22 00:00 [accepted]
PHST- 2018/01/27 06:00 [pubmed]
PHST- 2019/09/07 06:00 [medline]
PHST- 2018/01/27 06:00 [entrez]
AID - S0161-6420(17)33033-6 [pii]
AID - 10.1016/j.ophtha.2017.11.030 [doi]
PST - ppublish
SO  - Ophthalmology. 2018 Jun;125(6):924-928. doi: 10.1016/j.ophtha.2017.11.030. Epub 
      2018 Jan 19.