title: Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?
abstract: OBJECTIVE
  To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes.
  
  
  METHODS
  We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool.
  
  
  RESULTS
  The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients' symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency.
  
  
  CONCLUSIONS
  Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.
authors.affiliation: Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain. Electronic address: cacho@ua.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Cacho-Martínez
authors.affiliation: Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: García-Muñoz
authors.affiliation: Área de Medicina Preventiva y Salud Pública, Universidad de Alicante, CIBERESP, Alicante, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Ruiz-Cantero
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology*; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D006801:Humans; D015203:Reproducibility of Results; D014786:Vision Disorders / Q000175:diagnosis*; D015348:Vision, Binocular / Q000502:physiology*
keywords: Accommodation, ocular; Acomodación, ocular; Desórdenes de la visión; Diagnosis; Diagnóstico; Review literature as topic; Revisión de la literatura; Vision disorders; Vision, binocular; Visión, binocular