Convergence Insufficiency

Convergence Insufficiency (CI) is a common eye-teaming problem which occurs when the eyes are unable to maintain the ocular posture necessary for reading or near tasks. Convergence Insufficiency results from misalignment of the eyes when focusing on up close, such as when reading. The eyes have a strong tendency to drift outward when reading or doing close up work. The exact cause is unknown.

How common is Convergence Insufficiency? More common than you may think. The CITT, or Convergence Insufficiency Treatment Trial, is a multi-center study funded by the National Institutes of Health. Members of the CITT found that Convergence Insufficiency occurs in approximately 10-15% of the general population; with 45% of children with Convergence Insufficiency reporting attention problems. A recent Romanian study revealed that approximately 3 in 5 (60.4%) of young adult patients who complained of blurred vision while performing near work suffered from Convergence Insufficiency. Studies conducted by the Southern California College of Optometry found that approximately 1 in 8 (13%) of fifth and six grade children examined had Convergence Insufficiency as did nearly 1 in 5 (17.6%) of 8 to 12 year olds.

Convergence Insufficiency is present in both children and adults, and is not a condition that people “out grow”. Convergence Insufficiency is most closely associated with reading difficulties. This often times leads parents or educators to suspect a learning disability or dyslexia (which is a language based disorder) rather than a vision problem. Symptoms of Convergence Insufficiency may include:

• Blurred vision

• Difficulty concentrating

• Difficulty reading

• Dizziness or motion sickness

• Double vision

• Eyestrain

• Headaches

• Short attention span

• Squinting or closing one eye

• Words that are blurry or seem to “move”, “float”, or “jump” on the page
   

It is not uncommon for a child with symptoms of Convergence Insufficiency to be referred for evaluation and testing for learning disabilities or ADHD because of the lack of attention and difficulty reading. This is because an individual can have 20/20 vision and still have Convergence Insufficiency, which is why most eye doctors do not identify Convergence Insufficiency. Testing for Convergence Insufficiency is specific, specialized testing which does not take place during a routine eye exam or vision screening.

Convergence Insufficiency is usually diagnosed during a Binocular Vision Assessment with a Residency Trained Neuro-Optometrist. A Binocular Vision Assessment is different from a comprehensive eye exam, and involves in-depth testing of vision function and the performance of the binocular vision system. In addition to specialized testing, a Binocular Vision Assessment can include a symptom survey with questions such as,

When reading or doing close work:

• Do your eyes feel tired?

• Do your eyes feel uncomfortable?

• Do you have headaches?

• Do you feel sleepy?

• Do you lose concentration?

• Do you have double vision?

• Do you see words move, jump, swim or appear to float on the page?

• Do you feel a pulling sensation around your eyes?

• Do you notice the words blurring or coming in and out of focus?

• Do you have to reread the same line of words?
   

Once diagnosed, Convergence Insufficiency can be treated most effectively using an in office based vision therapy program. A large-scale, randomized Convergence Insufficiency clinical trial was published in 2008. The clinical trial showed that office-based vision therapy was more effective than either home-based treatments or computer vision therapy. The results show that about 90% of the children in the office-based vision therapy group remained asymptomatic one year later.

An earlier CITT investigator group completed a randomized clinical trial in 2005 comparing the effectiveness of base-in prism reading glasses and placebo reading glasses. The results, published in the British Journal of Ophthalmology, showed that the base-in prism glasses were no more effective than placebo glasses. The conclusion of the group was that base-in prism glasses are not an effective treatment for children with symptomatic Convergence Insufficiency.

The CITT investigator group also completed the only two randomized clinical trials that have investigated the use of pencil push-ups in the treatment of Convergence Insufficiency. In both studies the results showed that pencil push-ups are no more effective than placebo treatment.

Patching is not an option to treat Convergence Insufficiency because wearing a patch over one eye will disrupt the ability to establish, enhance or strengthen binocular function (use the two eyes together). Some patients choose to patch one eye temporarily in order to relieve double vision during times of increased workload and duration of near work tasks.

There are no visible signs of Convergence Insufficiency. It can only be detected and diagnosed by an eye doctor specifically trained in binocular vision and vision therapy. A Residency Trained Neuro-Optometrist such as Ryan C. Johnson OD, FAAO can diagnose Convergence Insufficiency and prescribe an individualized vision therapy treatment program. The vision therapy programs at Advanced Vision Therapy Center are:

• Research-based treatment programs

• One-on-one with the therapist (no group sessions)

• Progressive programs of Convergence Insufficiency treatment

• Performed and monitored under the direction of Dr. Ryan Johnson

• Individualized and customized for each patient

• Conducted in-office, using twice weekly, thirty minute sessions
   

If you have concerns about reading in general, reading fluency, or reading comprehension the first place to start is with a comprehensive eye exam with either a Residency Trained Pediatric Optometrist or a Residency Trained Neuro-Optometrist. The results of the comprehensive eye exam will determine if a Binocular Vision Assessment is recommended. If a Binocular Vision Assessment is recommended be sure to seek out an eye doctor who has completed Residency Training in Binocular Vision, Vision Therapy and Neuro-Optometry. An eye doctor with this level of training is most qualified to diagnose and prescribe treatment for Convergence Insufficiency.

Dr. Ryan C. Johnson is accepting new patients, and a referral is not required. If you, or someone you know, is experiencing the symptoms of Convergence Insufficiency please call our office to schedule an appointment. We're here to help, and just a phone call away.