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Concurrent Vision Dysfunctions in Convergence Insufficiency With Traumatic Brain Injury

Alvarez, Tara L.*; Kim, Eun H.*; Vicci, Vincent R.; Dhar, Sunil K.*; Biswal, Bharat B.*; Barrett, A. M.

doi: 10.1097/OPX.0b013e3182772dce

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 χ2 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.




Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (TLA, EHK, BBB); Private Practice, Westfield, New Jersey (VRV); Kessler Institute for Rehabilitation, West Orange, New Jersey (VRV); Department of Mathematical Sciences, Center for Applied Mathematics and Statistics, New Jersey Institute of Technology, Newark, New Jersey (SKD); and Kessler Foundation, West Orange, New Jersey (AMB).

Tara L. Alvarez New Jersey Institute of Technology Department of Biomedical Engineering University Heights Newark New Jersey 07102 e-mail:

© 2012 American Academy of Optometry