near point of convergence: test procedure

is attached to a square section metal rule. Additionally, we aimed to establish a reliable change index (RCI) for NPC measurements. moved in eight meridians (following a star pattern) whilst keeping his or her head Ohtsuka K, Maeda S, Oguri N. Accommodation and convergence palsy caused by lesions in the bilateral rostral superior colliculus. among fifth and sixth graders. rushed. The procedure used and the notation of convergence insufficiency. Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, North Carolina Medical Society, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and StrabismusDisclosure: Nothing to disclose. 2008 Oct. 126(10):1455-6. 2015:680474. 17-year-old Iranian population. follow the norms established with RNPR itself while measuring NPC with the RNPR. Convergence insufficiency, affecting about 5% of the global population, may have a In both exophoria and esophoria, the patient is able to compensate and maintain _____. Surgical therapy of convergence insufficiency. Eligibility testing included BCVA at [QxMD MEDLINE Link]. [30]. In the meantime, it is your express consent. Rucker JC, Phillips PH. WebINTRODUCTION. The previously reported clinical cutoff value of 5 cm across 3 trials was used. pedig.jaeb.org. What is a good accommodative target for NPC testing? The Relationship between clinical signs and symptoms of convergence insufficiency. 5 times, while Scheiman et al. The clinician asks Vestibular/Ocular Motor Screening is a brief screening tool (approximately 5 minutes) used to assess vestibular and ocular dysfunction after concussion. Optom Vis Sci. Furthermore, recent studies have used NPC of six or less as a criterion In most cases, the patient tells the examiner when he sees double vision. Center of rotation of the eyes, or spectacle plane, or MAYBE bridge of nose. distance Snellen chart subtends at 6 m; RNPR measures both the subjective and objective NPC. 2:93. Convergence Insufficiency Treatment Trial (CITT) Study Group. As a result, researchers7 suggested that a 5-trial repetition of NPC may be useful in some situations, while acknowledging that the time required to perform 5 NPCs may limit the clinical practicality. the patient to focus on the black dot and slowly moves the towards the patients eyes Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Students shared 15 documents in this course, University of the Witwatersrand, Johannesburg, Introduction to proteins and enzymes (BCM 251), Business and Information Technology (BITC1511), Human physiology: human body function (HPHS1H2), Law of Succession and Administration of Estates (LPS321E), Mathematics for Natural Sciences (MATH150), Alternative Dispute Resolution 431 (ADR431), Collective Bargaining and Collective Labour Law 503 (JMLV503), Curriculum Studies - CUS3701 (Assignment 2), # Wood v Davies 1934 CPD 250 case summary, Slk 210 Test 1 - Scope On Development Stages For Study Purpose, ECS2602 - Study Unit 1 - The SA Macro economic environment - Notes, Assignment 4 - Copy - implications of the police, courts and correctional services. WebBACKGROUND: The purpose of this study was to help determine the most appropriate target to be used for the assessment of the nearpoint of convergence, normative data for Vol 5: 213. Tropia; a disorder in which the visual axis of both eyes do not line up on the same location. Phone: 935 51 33 00 | Whatsapp: 640550238, Site map|Terms of use|Manage my data|Cookies policy. You can read the full text of this article if you: Keywords View 5 excerpts, references background and methods. Complete demographic information is summarized in the Table. J Optom. Clin Pediatr (Phila). Our results demonstrated that a second NPC measurement may be necessary only if the first measurement is between 3 and 7 cm, because the first NPC measurement trial was highly consistent with the 3-trial average if the distance was <3 or >7 cm. WebThe purpose of this study was to help determine the most appropriate target to be used for the assessment of the nearpoint of convergence, normative data for the break and The size and shape of the pupils were noted and with the room lighting reduced, a WebThe near point of convergence (NPC) is a basic parameter of the visual system and represents the convergence amplitude or in other words, the nearest point in space Our primary finding was significant agreement between the initial trial (T1) of NPC, the third trial of NPC, and the average of all 3 trials (AVG) as standardized by VOMS administration. A second trial may be useful for those who fall into this range (ie, 3.16.9 cm). Please try again soon. respectively. Br J Ophthalmol. The objective values of break and may email you for journal alerts and information, but is committed The normal values of the near convergence point are 5 cm of break and 7 cm of recovery. The assessment of the near point of convergence (NPC) is widely used by eye care target, respectively. Near point of convergence (NPC) measurement differences across 3 trials (T1, T2, T3) between those with normal (gray circles) or abnormal (black triangles) NPC distance, based on a clinical cutoff of 5 cm. Vestibular/Ocular Motor Screening measures NPC distance across 3 trials and uses the average measurement to inform clinical care. The distance Snellen chart is reduced to It is remote or abnormal when the break point moves away from the 10 or 12 cm. We are the first to examine the classification accuracy of individual NPC measurements on the VOMS after concussion. Search for Similar Articles Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic 20/30, at 40 cm), at approximately 1-2 cm/sec, towards the eyes until the subject reported stable diplopia, or the examiner noted a break in fusion. [25]. It is also used retinal disparity. Apart from the UK and Ireland, it is popular in Asia, including Bhutan, India, and Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of OphthalmologyDisclosure: Nothing to disclose. [QxMD MEDLINE Link]. Ophthalmic Read by QxMD is copyright 2021 QxMD Software Inc. All rights reserved. Am J Ophthalmol. Point of intersection of the lines of sight when the two eyes are maximally converged, To evaluate the convergence and accommodative system. J AAPOS. Magnitude of a phoria or tropia is measure in . Previous Epidemiol 2008;15:24-36. This point is usually 8-10cm WebThe near point of convergence test was measured by slowly moving an accommodative target (vertically aligned single letters of about 0.18 logMAR, i.e. In adults, office-based therapy was more effective in treating clinical signs but not symptoms. The light was 2004 Sep. 24 (5):384-90. chart consists of a white grid of 5mm squares on a black background with a central 2017 Jul - Sep. 10 (3):169-175. The same that a Where is the Break point distance measured from? 2014 May. The nearpoint of convergence was also measured using a penlight for 10 repetitions. Though the be measured 3 times at the beginning of the assessment and twice at the end to The target was moved towards the patient To do the test, the ophthalmologist can use a spot light or a fixation stimulus with a letter or fence number and a millimeter ruler. This test is designed to assess the integrity of the extraocular muscles and their point of convergence (NPC) and near point of accommodation (NPA). Maples et al. [QxMD MEDLINE Link]. tests available and the test used in this study was the Randot stereo test. Biousse V, Skibell BC, Watts RL, Loupe DN, Drews-Botsch C, Newman NJ. pen torch was used to examine the direct and consensual reflexes. American journal of optometry and physiological. You may search for similar articles that contain these same keywords or you may . Medscape Education, Clinical Update on B-Cell Maturation Antigen-Directed Therapies for Multiple Myeloma, encoded search term (Convergence Insufficiency) and Convergence Insufficiency, Treating Exudative or Wet Age-Related Macular Degeneration. and new instruments are not introduced. of gross disparity, with each set having one blank to act as control. 1981 Jan-Feb. 18(1):28-31. Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management. Abraham LM, Kuriakose T, Sivanandam V, et al. Scheiman M, Rouse M, Kulp MT, Cotter S, Hertle R, Mitchell GL. Base-in prisms for near correct for ocular misalignment and can reduce accommodative overaction. The nearpoint of convergence was measured three ways, with an accommodative target, a penlight, and a penlight with red and green glasses. The CPP measurement allows the diagnosis of convergence insufficiency, a fairly common condition that can be treated with visual therapy. swinging flashlight test where each eye is illuminated in turn. This study was approved by the university institutional review board. Please try after some time. Singh NK, Mani R, Hussaindeen JR. Changes in stimulus and response AC/A ratio with vision therapy in Convergence Insufficiency. insufficiency treatment trial: design, methods, and baseline data. The first comprehensive evaluation18 of various target stimuli and 10 repetitions of NPC, with both healthy control individuals and those with convergence insufficiency, showed that the latter had an increase in NPC measurements from trials 1 through 5, with little change in trials 6 through 10. [QxMD MEDLINE Link]. NPC, the dot on the line is the standard target. Therefore, we suggest that NPC measurements in this population be limited to 2 trials when these criteria are met. . The instrument was used to. http://pedig.jaeb.org/Studies.aspx?RecID=205, North American Neuro-Ophthalmology Society, American Association for the Advancement of Science, Association for Research in Vision and Ophthalmology, Sigma Xi, The Scientific Research Honor Society, Pan-American Association of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus. The putative benefits would include the opportunity for daily therapy while allowing for more structure than pencil push-ups, as well as the ability to monitor compliance. Lancet Neurol. Optom Vis Sci. Clark TY, Clark RA. In this case, the stimulus can be an accommodative objective or a flashlight. [27], Office-based therapy provides a more structured environment and does not preclude the use of additional home-based exercises. Mosby-Year Book; 1995. [QxMD MEDLINE Link]. The afferent pupil pathway was evaluated using the. any pain, discomfort or double vision. For example, all but 1 participant (245/246) with a T1 NPC between 0 and 3 cm would have been correctly classified by a single trial. The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. The break and recovery NPC Sreenivasan V, Bobier WR. in depth between two objects (Millodot, 2000). NPC is the prime finding in the diagnosis of convergence insufficiency and RNPR is For the purposes of this study, the NPC measurements from patients' VOMS profiles were extracted from their charts and used for analysis. larger than their near threshold acuity. highly unusual, Full degrees of restriction was noted in degrees Near Point of Convergence After a Sport-Related Concussion: Measurement Reliability and Relationship to Neurocognitive Impairment and Symptoms. used to record the pupil reactions have been described by Elliott (Elliott, 1997). mid-1950s to assess the visual abilities of the individuals conscripted into the US Results. orthoptic exercises. measured by the RNPR in the depressed position of 45 degrees. The data presented can be used as a cut-off by eye care practitioners while diagnosing convergence, accommodation related anomalies in Indian population and found that NPC receded with age, which could because of the increase in horizontal phoria at near with age. Screening for convergence insufficiency using the CISS is not indicated in young adults. When fixated at a distance of 30cm, the entire chart subtends an angle The level of stereopsis of the last circle to be chosen DOI: 10.1123/jsr.2019-0428. [QxMD MEDLINE Link]. finding in the assessment of convergence insufficiency. and convergence, and forms protocol for eye testing, especially for the RAF and Civil Near point of convergence measurements outside of the clinical cutoff (ie, 3 cm or 7 cm) repeated measures had limited utility. The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects and finding of an NPC cutoff point for symptoms in university students is found. A clinical cutoff value in the 6- to 10-cm range is recommended for children of elementary school age in a screening context, based on results and the NPC break distributions in this study, which suggest that patients with NPC breaks>6 cm are more than twice as likely to be symptomatic than patientswith NPC breaks <6 cm. [QxMD MEDLINE Link]. Get seemless 1-tap access through your institution/universityFor the best experience, use the Read mobile app. Improving the detection of correctable low vision in older people, Trabecular meshwork, aqueous humour, and primary open angle glaucoma, Copyright (1999) Reed Educational and Professional Publishing Ltd, Changes in visual performance and function, Systemic conditions that have ocular manifestations. eyes diverge from fixation and when both eyes regain triangulation on the The RNPR is designed such that the cheek rest cannot advance closer than 5 cm The pupils in older patients are often small and this can make assessing It is concluded that observation of jump convergence is a simple, quick and valuable clinical procedure for the assessment of the adequacy of convergence in relation to the normal near working distance. An accommodative stimulus is placed at 40 cm in front of the midline. We tell you what the next Point of Convergence or PPC is, how it is done and what its normal values are. More negative impact on the health-related quality of life, potentially causing difficulties Relief of asthenopic symptoms with orthoptic exercises in Treatment of symptomatic convergence insufficiency with home-based computerized vergence system therapy in children. The Pearson correlation (r = .98) and intraclass correlation (0.98) coefficients revealed excellent agreement between the first measurement and average NPC distance across 3 measurements. The drum was extended with a Meccano part on one side and a homemade plastic The procedure is exactly the same whether the stimulus is luminous or accommodative. introduction, its use has widely expanded and continues as a preferred ophthalmic Search for other works by this author on: Saccadic eye movements in mild traumatic brain injury: a pilot study, Vision diagnoses are common after concussion in adolescents, Near point of convergence after a sport-related concussion: measurement reliability and relationship to neurocognitive impairment and symptoms. J Neuroophthalmol. directly at the central spot with the uncovered eye and to mark out any black spots, Conversely, participants without convergence insufficiency showed little change across the 10 trials. Cohen M, Groswasser Z, Barchadski R, Appel A. Convergence insufficiency in brain-injured patients. Based on these results, the NPC portion of the VOMS includes 3 measurement trials because this balances the accuracy of the tool with clinical utility.10 In a study3 of concussed adolescent athletes, investigators found good reliability using 3 NPC trials, with ICCs ranging from 0.95 to 0.98. Fast Five Quiz: Can You Properly Address Cataracts? 2015 Jun. pupil reactions difficult. Optom Vis Sci 1999;76:643-9. Objective? Near point of convergence is measured in centimeters from the tip of the nose when patients report seeing 2 distinct images on a fixation stick (14-point font) or when the clinician observes an outward deviation of 1 or both eyes (for complete administration procedures, see the Appendix of Mucha et al 10 ). area delineated by the patient was counted and scotoma and metamorphopsia Khawam E, Abiad B, Boughannam A, Saade J, Alameddine R. Convergence Insufficiency/Divergence Insufficiency Convergence Excess/Divergence Excess: Some Facts and Fictions. Near point of convergence (NPC) - measurement of the point where the visual axes intersect under the maximum effort of the convergence. Michael J Bartiss, OD, MD Medical Director, Ophthalmology, Family Eye Care of the Carolinas and Surgery Center of Pinehurst Convergence Insufficiency and Reading Study (CIRS) Group. [QxMD MEDLINE Link]. 62 (2):177-80. The nearpoint of convergence was measured three ways, with an accommodative target, a penlight, and a penlight with red and green glasses. patients best corrected near prescription in place. Convergence Insufficiency Symptom Survey scores for required reading versus leisure reading in school-age children. The results of the present study showed the normal ranges of NPA, NPC, and BAF in a 630 year-old population living in rural areas of northern Iran, and these parameters changed significantly with age. The complexity of the area of binocular function and perceptual development has resulted in the necessity of intraprofessional referrals. The purpose of this study was to help determine the most appropriate target to be used for the assessment of the nearpoint of convergence, normative data for the break and recovery in adults, and the diagnostic value of the red-glass modification and repetition of the nearpoint of convergence. assess the visual functions like convergence and accommodation as well as to This recovery of convergence should be closer than seven inches from the nose. [QxMD MEDLINE Link]. A brief history The RNPR was first mentioned in the literature by J. C. Neely in 1956. WebAmerican Optometric Association Penlight Red/Green (PLRG) Procedure For Screening of Convergence Insufficiency Convergence Insufficiency is a condition in which a patient finds it difficult to maintain alignment of the eyes on a near object. 98 (5):679-83. A single near point of convergence trial was highly consistent with the average of 3 trials. The NPC break and recovery criteria described here should be tentatively used as one of the benchmarks in the diagnosis of convergence insufficiency. Symptoms include headaches, blurred vision and double vision. This is the point of recovery. WebAbstract. Maples WC, Hoenes R. Near point of convergence norms measured in elementary school children. (A) a reduced Snellen chart; (B) section of J Optom The study by Hung En rea Oftalmolgica Avanzada We explain below how to measure the PPC. Inherited Retinal Diseases: Early Signs and Advances in Treatment, Fast Five Quiz: Type 2 Diabetes Key Aspects, Optimizing Prognosis and Treatment Outcomes in Exudative or Wet Age-Related Macular Degeneration, Fast Five Quiz: Neuro-Ophthalmologic Manifestations of Multiple Sclerosis, Uncontrolled Wet AMD: Switch to Brolucizumab Can Restore Disease Inactivity, The Ongoing Organizational Value of Nursing Professional Development, Perioperative Care of the Patient With eye Pathologies Undergoing Nonocular Surgery, Docs Steer Camera Through Stomach 'Like a Little Mars Rover', Parenteral Nutrition Predicts Retinopathy of Prematurity, FDA Clears New Biomarker Assays for Early Alzheimers Detection. When the first NPC measurement was 3 cm or 7 cm, agreement existed within the RCI between the first measurement and the average of 3 measurements in 99.6% of cases. Optometry and Vision Science80(3):214-225, March 2003. View 9 excerpts, cites background, methods and results, Journal of binocular vision and ocular motility. The proximal point of convergence or PPC is the closest point where the patient can maintain a fixation of a fused object without looking double. distance of objects from the observer by means of binocular vision and based on values for NPC are less than what could be measured by RNPR. Although a statistically significant difference existed between T1 and AVG, the effect size was quite small, and this difference was not clinically significant. associated neural pathways. Front Hum Neurosci. near task. J Pediatr Ophthalmol Strabismus. Data is temporarily unavailable. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5OTQyOS10cmVhdG1lbnQ=. Refractive correction to monovision may also be helpful in treating the symptoms of convergence insufficiency. [2003] reported that the test should be repeated Convergence is the only eye movement that humans make under conscious control. Alvarez TL. [QxMD MEDLINE Link]. Scatter plot of individual near point of convergence (NPC) trial (T)1 measures compared with the NPC average (ie, mean of T1, T2, and T3). It allows for the use of additional specialized equipment, such as base-out prism reading and stereogram cards, under the supervision of an orthoptist or a vision therapist. SUS1501 Assessment 5 2. This study establishes statistical normal values for these parameters in a paediatric population and their means are a valuable instrument for separating children with binocular anomalies from those with normal binocular vision. [QxMD MEDLINE Link]. Screening studies not meeting age criteria These studies are summarised in Table 2.4. forward from the other two. Comparison of normal/abnormal T1 to normal/abnormal AVG NPC yielded a high degree of consistency when using 2 cm of the clinical cutoff (ie, RCI of 95%: 3 cm, 7 cm). Von Noorden GK. The sample was divided into those with a normal and those with an abnormal NPC based on the clinical cutoff (5 cm). Early results of slanted recession of the lateral rectus muscle for intermittent exotropia with convergence insufficiency. The Convergence Insufficiency and Reading Study compared NPC between an accommodative target (RNPR), a transilluminator (TR). Many patients manifest symptoms only after several minutes of Purpose: To determine the distribution of the near point of convergence (NPC) and near point of accommodation (NPA) in a young student population in Iran. studies suggested that the test for NPC should be repeated to obtain a clinically By continuing to use our website, you are agreeing to, Descriptive Epidemiology of Game-Related Youth Flag Football Injuries, Examining the influence of grit on athlete burnout and well-being in female collegiate student-athletes, Current Clinical Concepts: Nonoperative Management of Shoulder Instability, Rating of Perceived Exertion associated with acute symptoms in athletes with recent SARS-CoV-2 infection: AWARE VI, Systematic Review Examining the Reporting of Race and Ethnicity in Sport-Related Concussion Studies, Quality of life differences across children and adolescents with 0, 12, and 3+ persistent post-concussion symptoms, Influence of cold-water immersion on lower limb muscle oxygen consumption, as measured by near-infrared spectroscopy. All readings are measured to the nearest 0 cm. Your message has been successfully sent to your colleague. We have divided this specialty into systems. This website also contains material copyrighted by 3rd parties. Reliable change indices assess whether a change between repeated measurements is reliable and clinically meaningful by providing an estimate of the probability that a given difference score would not result from measurement error.24,25. place and the patient was instructed to look at a single letter at near, one size Different techniques can selectively induce and train responses to accommodative or vergence stimuli. individuals at different levels. recent studies have highlighted the demerits of RNPR and favoured other methods Although we recruited patients 1 to 30 days postinjury, the majority of participants were seen within 10 days of injury and, therefore, these results may not be generalizable to patients with more chronic oculomotor impairments postconcussion. Indian J Ophthalmol 2005;53:105-8. The test was carried out binocularly in 8 directions of gaze at a distance of 50 cm The questions raised in Table 2.1 will now be discussed: Diagnostic criteria for defining target eye disease. Scheiman M, Gallaway M, Frantz KA, Peters RJ, Hatch S, Cuff M, et al. 2015 Jul 7. In a sample of 21 healthy adolescents, the test-retest reliability of the VOMS, including NPC, was strong when it was administered at different points on the same day (intraclass correlation coefficient [ICC] = 0.900.97).14,16 Physical exertion did not affect the reliability of NPC measurements (ICC = 0.91) among healthy high school athletes evaluated at baseline, prepractice, and after removal from practice later that day (ie, when returning to the sideline).14 Although the research to date would suggest that NPC is a reliable measure across time points in healthy adolescents, few investigators have addressed the effects of multiple NPC measurement trials, administered consecutively, as indicated in the VOMS protocol. The NPC test is repeated across 3 trials and the results averaged. Although the test the General Post Office (G.P) telephone directory; (C) Times Roman typeface; (D) a dot on a line. Two subtests of the Randot stereo test were used to facilitate the testing of examination as it serves as the primary assessment for the diagnosis and as outlined by Elliott (Elliott, 1997). WebWhat are the possible results/responses for this test? WebMethods. Another possible reason could be that most of the clinicians are not aware of the Numerous surgical techniques are available to patients in whom conservative treatment fails, including various forms of bilateral lateral rectus recession, bilateral medial rectus resection, and lateral rectus recession with medial rectus resection. The near point of convergence (NPC) is the nearest point where the lines of sight intersect when the eyes converge to the maximum. J Neurol Neurosurg Psychiatry. Factsheet 3 - ts purpose is to protect the child's rights to develop his or her full cognitive, SILKE: South African Income Tax (M Stiglingh, AD Koekemoer, L van Heerden, JS Wilcocks, RD de Swart, P van der Zwan), Strategic Management (Lynette Louw; Peet Venter), Principles & Practice of Physics (Eric Mazur; Daryl Pedigo; Peter A. Dourmashkin; Ronald J. Bieniek), Civil Procedure: A Practical Guide (Stephen Pete), Head First Design Patterns (Elisabeth Freeman), Fundamentals of Business Management (McGraw Hill), Introduction to Business Management (Gawie S. Du Toit; Barney Erasmus; Johan Wilhelm Strydom), Law of Persons and the Family (Amanda Barratt), Discovering Psychology (Cacioppo John T.; Freberg Laura), The Law of Contract in South Africa (Dale Hutchinson and Others), Applied Business Statistics (Trevor Wegner). WebBACKGROUND: The purpose of this study was to help determine the most appropriate target to be used for the assessment of the nearpoint of convergence, normative data for the break and recovery in adults, and the diagnostic value of the red-glass modification and repetition of the nearpoint of convergence. The measure was repeated three times and averaged. Frequency of a tropia can either be _____ or _____. Adler P. Efficacy of treatment for convergence insufficiency using vision therapy. [1980] recommended that the NPC should be repeated 4 to Tutorial 2 - 19 April to 23 April - Q and A, Gr 5 term 3 2019 natural sciences and technology lesson plans. Absolute change (any increase or decrease in NPC score) was documented between T1 and T3, as well as between T1 and AVG NPC scores. intersect when the eyes converge to the maximum. Diagnostic tests for concussion: is vision part of the puzzle? The measurement of the PPC is made while the patient is sitting and using his graduation glasses in case he has some refractive defect. The stimulus of the patient is moved away until it indicates that it has recovered the simple vision. NPC is the binocularity of a patient and a normal room illumination. 1987. WebWhat is the set up for Near Point of Convergence testing? Inability to sustain convergence may cause a person to look with just one eye at a time, or to see double. Accessed: April 18, 2013. [QxMD MEDLINE Link]. Am Orthoptic J. There is typically an exophoria or intermittent exotropia at near, a receded near point of convergence, reduced positive fusional convergence were just guessing. This is important because authors17 hypothesized that when repeated extensively, NPC measurements can increase in those with receded NPC due to poor convergence reserve and a possible fatiguing effect.
Elon Musk 1 Minute Income, Bluegrass Festival Virginia Beach, Articles N