Send to

Choose Destination
Am J Sports Med. 2017 Aug;45(10):2388-2393. doi: 10.1177/0363546517705640. Epub 2017 May 16.

Convergence Insufficiency Identifies Athletes at Risk of Prolonged Recovery From Sport-Related Concussion.

Author information

Department of Sports Medicine, Crozer-Keystone Health System, Springfield, Pennsylvania, USA.
Department of Family and Community Health, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.



Sensitive and specific screening methods are needed to identify athletes at risk of prolonged recovery after sport-related concussion (SRC). Convergence insufficiency (CI) is a common finding in concussed athletes.


To assess the relationship between CI and recovery after SRC at the initial office visit.


Case-control study; Level of evidence, 3.


In this retrospective cohort study, 270 athletes (147 male, 123 female), mean ± SD age 14.7 ± 2.0 years (range, 10-21 years), with the diagnosis of SRC who presented for initial office visit between January 2014 and January 2016 were evaluated for near point of convergence (NPC). The athletes were categorized into 2 groups: normal near point of convergence (NPC ≤6 cm), and convergence insufficiency (NPC >6 cm). These athletes were then followed to determine recovery time.


Athletes presented for initial office visit at a mean of 5.2 ± 4.2 days (range, 1-21 days) after SRC. Half of the athletes had CI after SRC (50.4%; n = 136). Athletes with CI (NPC 12.3 ± 4.7 cm) took significantly longer to recover after SRC, requiring 51.6 ± 53.9 days, compared with athletes with normal NPC (4.1 ± 1.3 cm), who required 19.2 ± 14.7 days ( P < .001). After controlling for potential confounding variables, CI significantly increased the odds of prolonged recovery (≥28 days from injury) by 12.3-fold ( P < .001; 95% confidence interval, 6.6-23.0). CI screening correctly classified 75.2% of our sample with 84.2% sensitivity and 70.0% specificity. The positive predictive value for CI and prolonged recovery was 62.5%, and the negative predictive value was 88.1%.


CI at the initial office visit identified athletes at increased risk of prolonged recovery after SCR. Clinicians should consider measuring NPC in concussed athletes as a quick and inexpensive prognostic screening method.


clinical assessment/grading scales; eye injuries; head injuries/concussion; pediatric sports medicine

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center