1The Wilmer Eye Institute at John Hopkins Hospital, Baltimore, Maryland, USA
Convergence insufficiency is a common disorder of binocular vision affecting older children, teenagers, and adults. Patients with convergence insufficiency report symptoms of reading difficulty, eyestrain or discomfort associated with near activities, blurred vision, and headache. Affected individuals are unable to maintain fusional convergence during near activities. The diagnosis is made based on a remote near point of convergence and decreased positive fusional vergence amplitudes at near fixation. Treatment of convergence insufficiency includes orthoptic exercises designed to build convergence amplitudes, spectacles to address presbyopia, computer orthoptics that simulate the vergence demands addressed by traditional orthoptic exercises, and office and home-based vision therapy.
Researchers have sought to compare the advantages of more costly, contemporary treatments to inexpensive, simple home therapies with widely varying results. No consensus exists as to superiority of one treatment over the next in terms of reduction of symptoms, or improved objective clinical measures, regardless of cost. Simple, orthoptic convergence training exercises for use at home continue to perform well in patients with symptomatic convergence insufficiency. Three cases treated successfully with simple jump vergence exercises that preserve the fundamental neuro-sensory relationship between convergence and accommodation are presented to illustrate how compliance and adequate treatment application of inexpensive home therapies continues to improve objective measurement of convergence amplitudes and near point of convergence, and subjective symptoms. A review of the visual sciences literature reveals how asthenopic symptoms have been shown to develop in healthy volunteers in laboratory conditions after prolonged viewing of simulated 3-dimensional images on a flat-panel computer monitor like those used in popular computer vergence training programs.
1 Ophthalmology Department, Queensland Children's Hospital, Brisbane, Australia
Ophthalmology departments in public health systems worldwide are overburdened with high referral numbers and long wait times. This has necessitated the development of new models of care to improve patient access and maximise clinic efficiency. Nasolacrimal duct obstructions (NLDO) and chalazia are two common paediatric conditions that have a high chance of resolution with conservative management alone. The Queensland Children’s Hospital developed a phone call clinic to manage these referrals to better triage and prioritise children and encourage initiation of conservative management prior to outpatient presentation. This paper describes the clinical processes and protocols in the design of this phone call clinic and a retrospective discussion of its outcomes. Two hundred and seventy appointments were made available within a 16-month timeframe, with no additional staff or resources required. The findings of this review would suggest that orthoptists can be utilised in the triaging process to help with clinic efficiency and patient care.