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Normative Values for the Nearpoint of Convergence of Elementary Schoolchildren

HAYES, GREGORY J. OD; COHEN, BRETT E. OD; ROUSE, MICHAEL W. OD, MS; DE LAND, PAUL N. PhD
Optometry and Vision Science: July 1998
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ABSTRACT:

Background.

Nearpoint of convergence (NPC) values of 8 to 10 cm are widely used to diagnose binocular dysfunctions such as convergence insufficiency. However, there are no published age-related normative values in the literature to substantiate these values.

Methods.

Subjects were 297 schoolchildren in kindergarten, third grade, and sixth grade who had passed a school-based Modified Clinical Technique vision screening. Each child had the NPC break and recovery taken three times using a standardized protocol developed by the Convergence Insufficiency and Reading Study group. The examiners used an Astron International (ACR/21) Accommodative Rule with a movable column of 20/30 letters as the target.

Results.

For each grade, the distribution of NPC break was right skewed, with a concentration of values between 1 and 6 cm. At least 85% of the subjects in each grade had an NPC break<6 cm. NPC break values (mean ± SD) were 3.3 ± 2.6 cm for kindergartners, 4.1 ± 2.4 cm for third graders, and 4.3 ± 3.4 cm for sixth graders, and the means were found to be statistically different (analysis of variance, p=0.031). NPC recoveries (mean ± SD) for the three groups were 7.3 ± 4.8 cm, 8.7 ± 4.2 cm, and 7.2 ± 3.9 cm, respectively, which were also significantly different (analysis of variance, p=0.027). The recovery distributions were more symmetric and less skewed than those for break. For each grade level, there was a strong positive relationship between NPC recovery and NPC break, but the difference between NPC recovery and break had a low correlation with the NPC break.

Summary.

Kindergartners had somewhat better NPC breaks than third or sixth graders, whereas no clear age trend was present for NPC recovery. A supporting study using a random sample of clinic patients (aged 10–2 years) suggests that patients with NPC breaks>6 cm are more than twice as likely to be symptomatic than patients with NPC breaks <6 cm. Based on these results and the NPC break distributions in this study, a clinical cutoff value of 6 cm is suggested for patients of elementary school age. A cutoff value in the 6- to 10-cm range is recommended for children of elementary school age in a screening context. The exact value within this range depends on the level of concern with identifying patients who have visual signs and symptoms associated with a receded NPC.

© 1998 American Academy of Optometry