Purpose

Motor vehicle accidents (MVAs) are a pandemic associated with human suffering and a burden to national economies. Whiplash-associated disorders (WADs) after MVAs are associated commonly with disability claims, many of which are related to vision. Convergence insufficiency (CI) leads to visual disability associated with symptoms of ocular discomfort. We examined the incidence of symptoms and findings consistent with CI in a cohort of patients after MVA-related WAD compared with age-matched control participants.

Design

Prospective cohort study.

Participants

Patients with WAD after MVA were recruited from the Orthopedic Emergency Department between July 2014 and March 2017. Control participants were recruited among hospital personnel and relatives of WAD patients.

Methods

The Convergence Insufficiency Symptom Survey (CISS) questionnaire was completed by each participant, followed by a detailed visual examination including measurements of distance and near best-corrected Snellen visual acuity, distance and near cover test, Randot stereopsis, Maddox distance and Maddox-Thorington near heterophoria, near point of convergence, base-out step fusional reserves, and amplitude of accommodation using the push-away method.

Main Outcome Measures

The CISS score and binocular measure findings of CI were recorded and analyzed using Student's t test, the chi-square test, and multiple logistic regression adjusted for age and gender.

Results

A pathologic CISS score of 16 or more occurred in 26 of 57 WAD patients (45.6%) compared with 6 of 39 control participants (15.4%; P = 0.002). Absolute CISS score was higher in the WAD group compared with the control group (15.3±10.0 vs. 7.7±7.7; P < 0.001). Findings consistent with CI occurred in 7.0% of WAD patients and 7.7% of control participants (P = 0.90).

Conclusions

Visual symptoms suggestive of CI were reported more frequently among WAD patients compared with control participants, yet the incidence of examination findings indicating weakness of convergence was not increased. The discrepancy between subjective and objective measures of CI in WAD patients versus control participants stresses the importance of training healthcare personnel to assess disability using objective, validated standards of examination.

中文翻译：

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鞭打相关疾病与控制参与者的收敛性主观和客观测量之间的差异

目的

机动车事故（MVA）是与人类苦难相关的大流行，是国民经济的负担。MVA后的Whiplash相关疾病（WAD）通常与残疾索赔相关，其中许多与视觉有关。会聚不足（CI）会导致与眼部不适症状相关的视力障碍。我们检查了与年龄匹配的对照组参与者相比，在与MVA相关的WAD后的队列研究中，与CI一致的症状和发现的发生率。

设计

前瞻性队列研究。

参加者

在2014年7月至2017年3月之间，从骨科急诊科招募了MVA后的WAD患者。在医院工作人员和WAD患者的亲属中招募了对照参与者。

方法

每个参与者都完成了收敛不足症状调查表（CISS），然后进行了详细的视觉检查，包括距离和近视矫正的Snellen视敏度，距离和近遮盖力测试，Randot立体视，Maddox距离和Maddox-Thorington附近的测量异方差，会聚点附近，基出步骤融合储备和使用推入方法的适应幅度。

主要观察指标

记录和分析CI的CISS得分和双目测量结果，使用Student t检验，卡方检验以及针对年龄和性别进行调整的多元逻辑回归进行分析。

结果

57例WAD患者中有26例（45.6％）发生了16或更高的病理性CISS评分，而39例对照参与者中有6例（15.4％; P  = 0.002）。WAD组的CISS绝对评分高于对照组（15.3±10.0 vs. 7.7±7.7; P <0.001）。与CI一致的发现发生在7.0％的WAD患者和7.7％的对照组参与者中（P  = 0.90）。

结论

与对照组相比，在WAD患者中提示CI的视觉症状发生率更高，但检查结果表明收敛弱点的发生率并未增加。WAD患者与对照组相比，CI的主观和客观测量之间的差异强调了培训医护人员使用客观有效的检查标准评估残疾的重要性。