Purpose. To analyze the diagnostic validity of accommodative and binocular tests in a sample of patients with a large near exophoria with moderate to severe symptoms. Methods. Two groups of patients between 19 and 35 years were recruited from a university clinic: 33 subjects with large exophoria at near vision and moderate or high visual discomfort and 33 patients with normal heterophoria and low visual discomfort. Visual discomfort was defined using the Conlon survey. A refractive exam and an exhaustive evaluation of accommodation and vergence were assessed. Diagnostic validity by means of receiver operator characteristic (ROC) curves, sensitivity (S), specificity (Sp), and positive and negative likelihood ratios (LR+, LR？) were assessed. This analysis was also carried out considering multiple tests as serial testing strategy. Results. ROC analysis showed the best diagnostic accuracy for receded near point of convergence (NPC) recovery (area？=？0.929) and binocular accommodative facility (BAF) (area？=？0.886). Using the cut-offs obtained with ROC analysis, the best diagnostic validity was obtained for the combination of NPC recovery and BAF (S？ = ？0.77, Sp = 1, LR+ = value tending to infinity, LR？ = 0.23) and the combination of NPC break and recovery with BAF (S？ = ？0.73, Sp？=？1, LR+ = tending to infinity, LR？ = 0.27). Conclusions. NPC and BAF tests were the tests with the best diagnostic accuracy for subjects with large near exophoria and moderate to severe symptoms. 1. Introduction Convergence insufficiency (CI) is a sensory motor anomaly that is characterized by an inability to accurately converge or sustain convergence at near, which can cause substantial symptomatology during reading and near visual tasks [1, 2]. It is a common vision anomaly usually characterized as a binocular vision disorder with a low AC/A ratio in which the patient may have an orthophoria or exophoria at distance, with a moderate to high exophoria at near, greater than the distance phoria [3, 4], reporting as clinical characteristics, several symptoms and signs that can be present during the visual examination [1, 5–10]. In recent years, several randomized clinical trials [11–14] have studied the effectiveness of treatments for CI in children and adults, showing that office-based vision therapy with home reinforcement is the most effective treatment for CI. In fact, several reviews have shown there is sufficient evidence to support the use of vision therapy for CI [15–18]. According to epidemiology, numerous studies have suggested that this nonstrabismic binocular vision
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