The impact of convergence insufficiency on selective visual attention among university students

Alnawmasi, Mohammed M. · 2025 · Crossref

DOI: 10.1371/journal.pone.0336715

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Summary

This study investigates the impact of convergence insufficiency (CI), a common binocular vision disorder, on selective visual attention. While CI is known to cause symptoms like eye strain and reading difficulties, its specific effect on cognitive domains such as attention remains underexplored. The research was motivated by neuroimaging evidence linking CI to reduced activation in brain regions responsible for both oculomotor control and attentional networks, as well prior findings suggesting CI affects executive function. The primary objective was to determine if CI impairs selective visual attention, specifically examining processing speed and accuracy, and to assess whether symptom severity correlates with these cognitive deficits. The study involved 42 male university students: 20 diagnosed with CI and 22 age-matched controls with normal binocular vision. Participants completed a computerized modified visual search task designed to assess selective attention. The task required identifying the presence or absence of a specific radial frequency pattern among distractors, with difficulty modulated by varying target-distractor similarity and the number of distractors. Performance was measured via accuracy (percentage correct) and reaction time (RT). Statistical analyses included two-way ANOVA to compare groups across task conditions and linear regression to evaluate the relationship between CI symptom severity, measured by the Convergence Insufficiency Symptom Survey (CISS), and task performance. Results indicated that individuals with CI exhibited significantly slower reaction times across all task conditions compared to controls (mean RT: 1.21 ± 0.15 s vs. 0.97 ± 0.12 s; p < 0.0001). However, there was no significant difference in accuracy between the groups (CI: 86.3% ± 5.7%; controls: 87.1% ± 6.1%; p = 0.97). Task difficulty significantly affected both accuracy and reaction time for all participants, but no interaction effects were observed between group and condition. Furthermore, linear regression revealed a significant positive correlation between CISS scores and reaction time within the CI group (R² = 0.30, p = 0.01), indicating that higher symptom severity was associated with greater cognitive processing delays. No such correlation existed for the control group or for accuracy measures. The findings demonstrate that CI negatively impacts visual processing speed without compromising accuracy during attentionally demanding tasks. This suggests that the cognitive deficit associated with CI is characterized by delayed processing rather than impaired target discrimination. The study highlights the importance of incorporating visual processing speed assessments into clinical evaluations of CI, as traditional metrics may overlook these functional impacts. Given the link between symptom severity and processing delay, the results imply that therapeutic interventions improving CI symptoms may also enhance cognitive efficiency. These insights have significant implications for understanding the academic and occupational challenges faced by individuals with CI, supporting the integration of attentional assessments in diagnosis and treatment planning.

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