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Reduced stereoacuity as a predictor for clinically significant convergence insufficiency
  1. Ari Leshno1,2,
  2. Chaim Stolovitch2,3,
  3. Ofira Zloto1,2,
  4. Sharon Blum Meirovitch1,2,
  5. Daphna Mezad-Koursh2,3
  1. 1 Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
  2. 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3 Department of Ophtalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  1. Correspondence to Daphna Mezad-Koursh, Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; dmezad{at}


Background Stereoacuity relies on accurate binocular alignment. Convergence insufficiency (CI) a binocular motor disorder, interferes with near work.

Objective To investigate the association between convergence amplitude (CA) and stereoacuity in a large paediatric cohort.

Methods Retrospective chart review included patients aged 6–17 years; excluded patients with amblyopia, manifest strabismus or visual acuity <20/30 in either eye. Stereoacuity, measured by Randot test was defined as normal (≤40arcsec), subnormal (50–400arcsec) and poor (>400 arcsec). CA, measured using base out prism bar was defined by fusion break point (BP) and recovery point (RP), as none (BP=0), poor (BP <20 prism diopter (PD)), borderline (BP <30 PD or RP <20 PD), good (BP ≥30 PD and RP ≥20 PD) and excellent (does not break at 40PD).

Results In 2200 subjects included, we found an increased prevalence of normal stereoacuity as convergence ability improves (χ2 test, p<0.001) with a negative correlation between stereoacuity and BP (Pearson correlation −0.13, p<0.001).

CI was significantly associated with below normal stereopsis OR 1.86 (95% CI 1.3 to 2.7, p<0.001). Conversely, prevalence of CI was similar, whether or not CI-symptoms were reported. Follow-up data of at least 2.5 years from presentation was available for a small subgroup of 21 patients treated for CI. Convergence improved in 14 (66%), rate of normal stereoacuity increased from 29% at baseline to 76% at last follow-up (p=0.006).

Conclusions CA affects stereoacuity function in children. Evaluation of CA is required in all cases with poor stereoacuity, especially when other etiologies are amiss. The role of convergence improvement exercise on stereoacuity warrants further investigation.

  • vision
  • muscles

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available upon request.

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