A major cause of eyestrain, blurred vision, attention span, double vision (diplopia), and/or headaches.

  • Convergence insufficiency is one of the most common binocular eye problems.
  • Convergence insufficiency interferes with a person’s ability to read, learn, and work within arms reach.
  • Without proper testing, convergence insufficiency will go undetected because testing is not performed in a basic eye examination, school screenings or your pediatricians office.

A person can have 20/20 visual acuity and still have convergence insufficiency.

  • Treatments can vary from home based or office based vision therapy to glasses that have prisms, depending on the severity of the condition.
  • cientific research has proven that office-based vision therapy has the highest success rate in treatment.
  • Pencil pushup therapy is the most commonly prescribed treatment, but scientific studies show that this treatment has a low success rate.
  • Eye surgery is not an option.
  • Convergence insufficiency can be and is treated at any age.

Convergence Insufficiency (CI) is an eye teaming problem in which the eyes have a problem working together at close working range. One or both eyes tend to drift outward when reading or doing close work. This rarely causes double vision but will create a number of symptoms. These can include eyestrain, headaches, blurred vision, sleepiness after reading a short time, poor concentration, movement of print while reading as if seasick, acting like some signs of ADD, or loss of comprehension after short periods of reading or performing close activities.

It is not uncommon for a person with convergence insufficiency to cover or close one eye, turn their head at an angle,or resting their head on one arm while reading to relieve the strain on the eyes.

Some people who have CI may not complain of any symptoms because the brain will shut down or ignore the vision in one eye, commonly called suppression. This occurs even though both eyes are healthy and capable of good vision individually.

This can carry over to other common daily activities that require the eyes to converge properly. Consequently, a person with convergence insufficiency who suppresses one eye can also have one of the following symptoms:

  • trouble catching a thrown ball or other projectiles
  • avoidance of tasks that require depth perception. Eg: handicrafts
  • apparent clumsiness due to misjudgment of physical distances.
  • tripping on uneven surfaces, stairs, and curbs.
  • spilling or knocking over items when reaching for something
  • bumping into doors, furniture and other stationary objects
  • problems with motion/ car sickness

If untreated, in some severe cases, CI can lead to the eye turning outward, commonly called a “wall eye”, that comes and goes (intermittent exotropia).

Detection and Diagnosis of Convergence Insufficiency

A basic eye exam or school screening is not adequate for the detection of convergence insufficiency (and many other visual conditions). Testing needs to include a comprehensive history, eye teaming tests, as well as focusing tests by an eye doctor who tests binocular (both eyes teaming together) vision and who can refer or provide for in-office vision therapy is recommended for all individuals, particularly children.

Convergence insufficiency disorder frequently goes undetected in children. Many times they are being treated for ADD, ADHD, Scotopic Sensitivity Syndrome, etc. and not even looking at a possible eye problem.

The good news is that convergence insufficiency responds well to proper treatment, the bad news is this: due to lack of testing for convergence insufficiency , many people are not getting the help they need. Many are never discovered and go through life with a visual handicap. Children, teenagers and adults who remain undiagnosed and untreated tend to avoid reading and close work, or use various strategies to adapt to the symptoms.

Treatments for CI include prism glasses or vision therapy. Prism glasses do not correct the problem but can decrease some of the symptoms. The individual will be dependent on the prism and may require higher levels of prism in the future.

Vision therapy has proven to be the most effective treatment choice for CI. A National Eye Institute study concluded that the best treatment was in office vision therapy with home therapy performed on a daily basis. It also showed that 75% of the children in the study saw marked improvement or full remediation of their problem within 12 weeks of the approved protocol.

Pencil Push-ups are used by many ophthalmologists and optometrists as a home-based therapy but scientific research does not support this method. Studies done on pencil pushups have shown it to be ineffective in eliminating symptoms.

Surgical Care is not an option for CI.


References:

1. Bartiss, M. Extraocular Muscles: Convergence Insufficiency. eMedicine.com, Inc., eMedicine Specialties, Ophthalmology. 2005.

2. Scheiman M, Mitchell GL, Cotter S, et al; the Convergence Insufficiency Treatment Trial (CITT) Study Group. A randomized clinical trial of treatments for convergence insufficiency in children. Archives of Ophthalmology. 2005;123:14-24. Complete article – PDF version

3. Birnbaum MH, Soden R, Cohen AH. Efficacy of vision therapy for convergence insufficiency in an adult male population. J Am Optom Assoc. 1999;70:225-232.

4. Scheiman M, Cooper J, Mitchell GL, et al. A survey of treatment modalities for convergence insufficiency. Optom Vis Sci. 2002;79:151-157.

5. Gallaway M, Scheiman M, Malhotra K. Effectiveness of pencil pushups treatment of convergence insufficiency: a pilot study. Optom Vis Sci. 2002;79:265-267.

6. Rouse MW, Borsting E, Hyman L, Hussein M, Cotter SA, Flynn M, Scheiman M, Gallaway M, De Land PN. Frequency of convergence insufficiency among fifth and sixth graders. Optom Vis Sci. 1999 Sep;76(9):643-9.

7. Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Archives of Ophthalmology. 2008 Oct;126(10):1336-49.