Convergence insufficiency and accommodative insufficiency in children

BMC Ophthalmol. 2019 Feb 21;19(1):58. doi: 10.1186/s12886-019-1061-x.


Purpose: Convergence and accommodative insufficiency represent the main cause of complaints during close visual work and can reduce visual performance and comfort. Knowing their prevalence among schoolchildren is fundamental to define strategies for action. The purpose of this study was to estimate the frequency of these conditions in children in 5th and 6th school years in inland Portugal and to assess the impact that each visual condition has on their quality of life, based on the level of visual symptoms.

Methods: a cross-sectional study was carried out with children enrolled in the 5th and 6th school years. 372 children (192 girls) were assessed, with average ages of 10.9 ± 0.9 years. Refractive error and binocular vision assessment, integrating accommodative parameters, were used to analyse the visual condition. Symptoms were quantified using the Portuguese version of the CISS (Convergence Insufficiency Symptom Survey).

Results: The prevalence of definite Convergence Insufficiency (CI) in the children assessed was 2%. A prevalence of 6,8% could be considered if clinically significant CI (high suspect and definite categories) cases are accounted. In relation to Accommodative Insufficiency (AI), a frequency rate of 10% was recorded, with 3% of the evaluated children presenting AI and CI simultaneously. The symptoms score was higher in AI than in CI.

Conclusions: A frequency of approximately 10% was found for each one of the visual syndromes, and it was verified that visual discomfort is common among teenagers who carry these conditions. In cases of asthenopia, such as headaches and loss of concentration, associated with near vision activities, there is a requirement to evaluate the quality of binocular vision.

Keywords: Accommodative insufficiency; Children; Convergence insufficiency; Normal binocular vision; Visual discomfort.

MeSH terms

  • Accommodation, Ocular*
  • Adolescent
  • Child
  • Convergence, Ocular*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Ocular Motility Disorders / epidemiology*
  • Portugal / epidemiology
  • Prevalence
  • Quality of Life
  • Vision Disorders / epidemiology*
  • Vision, Binocular