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Journal article - Includes Student Work
Near and distance vergence facility provides complementary clinical information in concussion-related convergence insufficiency
Optometry and Vision Science, v 103(9), e70097
Sep 2026
PMID: 42717267
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Abstract
Purpose
To compare near and distance vergence facility testing in adolescents and young adults with concussion-related convergence insufficiency and evaluate changes following office-based vergence/accommodative therapy (OBVAM).
Methods
This secondary analysis of the CONCUSS randomized clinical trial evaluated vergence facility at near (40 cm) and distance (4 m) using a 12Δ base out/3Δ base in prism flipper. Participants aged 11–25 years with concussion-related convergence insufficiency were randomized to immediate or 6 weeks delayed OBVAM. Vergence facility was assessed at baseline, outcome time 1 assessment (after 12 therapy sessions for the immediate group and 6 weeks of watchful waiting for the delayed group), and outcome time 2 assessment (after both groups completed 16 therapy sessions). Agreement between near and distance vergence facility classifications was evaluated, and treatment-related changes were compared between groups.
Results
Of the 106 enrolled participants, 102 completed all study visits. At baseline, the near and distance vergence facility classifications demonstrated substantial discordance. Among 101 participants with both measures available, 49 demonstrated reduced distance vergence facility despite normal near vergence facility, whereas only two showed the opposite pattern (Cohen's κ = 0.12; p < 0.0001). Vergence facility improved following therapy in both treatment groups, with larger early improvements in the immediate-treatment group.
Conclusions
Near and distance vergence facility testing provided complementary rather than interchangeable clinical information in adolescents and young adults with concussion-related convergence insufficiency. Both measures improved following vergence/accommodative therapy, supporting consideration of both testing distances in clinical assessment.
Significance
Distance vergence facility testing identified reduced vergence facility, often missed by near vergence facility testing, in adolescents and young adults with concussion-related convergence insufficiency. These findings support testing the vergence facility at both distances during clinical assessment of concussion-related vision symptoms.
Metrics
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Details
- Title
- Near and distance vergence facility provides complementary clinical information in concussion-related convergence insufficiency
- Creators
- Mitchell Scheiman (Corresponding Author) - Drexel University, Pennsylvania College of Optometry (PCO)Tara L. Alvarez - New Jersey Institute of TechnologyFarzin Hajebrahimi - New Jersey Institute of TechnologyMelissa Noble - New Jersey Institute of TechnologyMatthew L Robich - The Ohio State UniversityRebecca S Baro - Drexel University, Pennsylvania College of Optometry (PCO)Josie Ann Bachman - Drexel University, Pennsylvania College of Optometry (PCO)Christina L Master - Children's Hospital of PhiladelphiaArlene Goodman - MED Institute
- Publication Details
- Optometry and Vision Science, v 103(9), e70097
- Publisher
- Wiley
- Number of pages
- 10
- Grant note
- National Eye Institute of the National Institutes of Health: NEI R01EY023261
This publication was made possible, in part, by the National Eye Institute of the National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA, NEI R01EY023261 (Alvarez). CONCUSS Study Group: Katie Rownd, MEd- Clinical Research Coordinator; Jordan Wentz, OTR/L - Vision Therapist; Melissa Crawford, OTR/L - Vision Therapist; Regina Antoni, OTR/L - Vision Therapist.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pennsylvania College of Optometry (PCO)
- Web of Science ID
- WOS:001871558000001
- Other Identifier
- 991022206779504721