Convergence Insufficiency. Convergence insufficiency is a common vision disorder in which a person's eyes tend to drift outwards when they try to use their eyes together up close. When reading, people with convergence insufficiency frequently lose their place or have to re-read text. It is important to note that an OT cannot diagnose a convergence insufficiency. Most likely one to two children in every classroom have this condition. Children with convergence insufficiency are often thought to be lazy or disruptive in the classroom. The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. Results from the earlier Convergence Insufficiency Treatment Trial (CITT), published in Ophthalmology in 2008, showed office-based vision therapy to be the most effective treatment for improving convergence and ameliorating symptoms, and that treatment effects were long-lasting. Read our, Medically reviewed by Johnstone M. Kim, MD, Medically reviewed by Jonathan B. Jassey, DO, Verywell Health uses cookies to provide you with a great user experience. Convergence insufficiency. Yanoff M, et al., eds. American Association for Pediatric Ophthalmology and Strabismus [internet]. In children, convergence insufficiency can often be treated by practicing convergence through exercises. 2015;22(1):97-102. doi:10.4103/0974-9233.148357. He is an active member of the American Optometric Association. Do You Have Symptoms of Macular Degeneration? Accessed May 5, 2020. There are several characteristics that eye doctors look for when properly diagnosing convergence insufficiency. Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. NEI is part of the National Institutes of Health. If convergence insufficiency isn't causing symptoms, you generally don't need treatment. Convergence Insufficiency Treatment Trial Study Group. Abstract. Double vision is a relatively common problem, and is responsible for 850,000 visits to the doctor and hospital each year. Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART): Design and Methods. A special power that moves images is called prism and can be put into an eyeglass prescription. The history of convergence insufficiency treatment is more than 150 years old but nowadays the most prevalent and important treatment option are orthoptic exercises. The goal is to keep the letter clear and single with no double vision. Convergence insufficiency (CI) is a vision disorder. They may be performed with an orthoptist or therapist in the doctor’s office and repeated at home. These exercises improve the eyes’ ability to move inward together. Eye doctors can measure this ratio to see if it is outside normal limits. The best treatment for CI is supervised vision therapy in a clinical office … Vision therapy can be prescribed when a comprehensive eye examination indicates that it is an appropriate treatment option. The person cannot bring their eyes inward and maintain good binocular vision at a point more than 10 cm., Third, people with convergence insufficiency also have low fusional vergence ranges. We normally have a range in which our muscles can diverge or converge our eyes. Home-based treatment with pencil pushups or computer programs hasn't been shown to be as effective. All four CITT RCTs were rated at low risk of bias. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. Both optometry and ophthalmology were co-authors of this study. Eye coordination problems like convergence insufficiency generally cannot be improved with eye glasses or surgery. Vis Dev Rehabil. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. Abstract. In people who suffer from a convergence problem, the natural resting position of eyes is more of an outward position. As a result, not only is that person trying to converge on the near target, but they first have to overcome that larger outward resting position and then converge normally on the target. Pencil push-ups are repeated fo… In contrast, a Pseudo-CI patient would benefit from an add to help the focusing system. Orthoptic therapy is the primary treatment modality used by most eye care professionals for the treatment of CI. Significance: These data confirm the effectiveness of office-based vergence/accommodative therapy for improving convergence in children with symptomatic convergence insufficiency. Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. Click here to review the symptoms of convergence insufficiency, or here … During pencil push-ups, the patient follows a small letter or picture on a pencil. [6, 26] Pencil push-ups require fixation on a near target such … The plasticity of the fusional convergence reflex system allows patients to improve their convergence amplitudes with simple exercises. Writer Bio. A normal NPC can be as little as 1 cm or even all the way to the nose. Nelson: Today we're going to discuss the treatment of convergence insufficiency. CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. This content does not have an Arabic version. A concussion can affect many systems of the body, including but not limited to the visual, musculoskeletal, vestibular, cardiovascular, central nervous, and peripheral nervous systems. Sometimes children and young adults with convergence insufficiency also have accommodative insufficiency. A phoria is the natural resting position of the eye. It is a disorder involving binocular vision — vision using both eyes. J Vis. She/He can only report their observations and recommend follow up with the appropriate health care provider. Treatment for both convergence insufficiency and convergence excess varies for each case and depends on the severity of the problem and the presence of other functional vision problems (e.g. Eyeglasses, eye patches or surgery usually don’t improve CI. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work.. Occasionally patients require prism glasses. Orthoptics and vision therapy. doi:10.1371/journal.pone.0211039. Arch Ophthalmol, Oct 2008. Convergence Insufficiency – Testing, Diagnosis, and Treatment Adequate testing and diagnosis for Convergence Insufficiency is not widely available. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer – Mayo Clinic Health Letter, New Year Special -  40% off – Mayo Clinic Diet Online. Madhura A. Tamhankar, in Liu, Volpe, and Galetta's Neuro-Ophthalmology (Third Edition), 2019. Convergence Insufficiency. 2008; 126:1336-1349. First, eye doctors find that a patient suffering from convergence insufficiency has a large exophoria. However, doctors now have evidence that office-based vision therapy with a trained therapist plus at-home therapy reinforcement can treat the condition and eliminate symptoms. Oxford University Press; 2015. The main treatment for convergence insufficiency is vision therapy. Often, the only way it can be properly diagnosed is to see an eye doctor, either an optometrist or ophthalmologist. Ophthalmic Epidemiol. Convergence insufficiency is a vision and eye disorder common in children and young adults. Yaramothu C, Santos EM, Alvarez TL. The convergence insufficiency treatment trial: design, methods, and baseline data. There are two main types of treatment for convergence insufficiency: 1) prism-lensed reading glasses, designed to improve visual comfort, and 2) eye (vision) therapy designed to restore normal visual function and improve visual comfort. These exercises may be prescribed by an orthoptist (a medical technician who is specifically trained in ocular muscle function and binocular vision) or by an ophthalmologist. Optom Vis Sci. The accommodative system and the convergence system of the eye are closely intertwined and one can affect the other. Clinical Study: Convergence Insufficiency Treatment Trial A study from the National Eye Institute indicated 75 percent of patients who received in-office vision therapy by a trained therapist as well as performed at-home vision therapy treatment reported fewer and less severe symptoms regarding reading and other near work. The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. Because the activities are based on the vision problem, each treatment plan is specifically tailored. People with convergence insufficiency often have an inadequate amount of convergence per the amount of accommodation that their eye is doing. Prism causes the images to be displaced so that a person with convergence insufficiency does not have to converge as much. This does not cure the condition but it does resolve many symptoms. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Prevalence of convergence insufficiency among secondary school students in Khartoum, Sudan. Although you can have one without the other, they often both cause a problem because accommodation and convergence are closely intertwined neurologically. Most children given in-office therapy showed normal vision or significant improvement in symptoms after 12 weeks. The patient starts off drawing the pencil closer to the nose. Previous CITT Study. Make a donation. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/convergence-insufficiency. Convergence insufficiency . Double vision, also known as diplopia, is a common symptom of convergence insufficiency, lazy eye and strabismus, though it can also result … Normally eye exercises, which can be practised at home, are recommended. People with low fusional reserves have no room to compensate. This was the first well-designed study comparing the different treatments. Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Treatment for convergence insufficiency might take three months or longer. Convergence insufficiency is not usually detected on regular vision screenings. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. Scheiman Vision Therapy [internet]. But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. National Eye Institute. Investigators from the Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART) published the results online today in Optometry and Vision Science. Causes & risk factors Convergence insufficiency (CI) is caused by a simple “lack of proper communication” between the nerves and the muscles that control eye movements. Loss of fusional vergence with partial loss of accommodative convergence and accommodation following … Effective Treatment of Convergence Insufficiency. How is convergence insufficiency (CI) managed or treated? Harrison RL. Convergence insufficiency is usually diagnosed in school-age children and adolescents. Convergence insufficiency (CI) is a common, yet not frequently diagnosed eye coordination problem in which the eyes drift outward when reading or doing close work. The patient starts off drawing the pencil closer to the nose. Convergence exercises (ie, orthoptics, vision therapy) and/or base-in prisms are the mainstays of treatment for convergence insufficiency. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Friedman N, et al. Previous CITT Study. Accessed May 5, 2020. Mayo Clinic is a not-for-profit organization. The convergence insufficiency treatment trial: design, methods, and baseline data. Miguel Cavazos is a photographer and fitness trainer in Los Angeles who began writing in 2006. In a practical definition, patients with this condition are unable to maintain the esodeviation required for near tasks. In-office Optometric Vision Therapy is proven to be the most effective treatment for Convergence Insufficiency by a national multi-site peer-reviewed study which was conducted by the National Institutes of Health/National Eye Institute in the United States. These exercises improve the eyes’ ability to move inward together. If this add is given to a CI patient, it could exacerbate the symptoms. According to Dr. Begotka, convergence insufficiency is the most common vision problem at the clinic. Effective Treatment of Convergence Insufficiency. Pencil pushups. Convergence insufficiency is a sensory and neuromuscular anomaly of the binocular vision system, characterized by a reduced ability of the eyes to turn towards each other, or sustain convergence Symptoms. Research conducted by the College of Optometrists in Vision Development (COVD) and the National Eye Institute have found that office-based vision therapy, supported by at-home vision therapy, is the best treatment for convergence insufficiency. Learn More. The Convergence Insufficiency Treatment Trial Group found that for adults aged 19-30, 50% receiving office-based vision therapy for CI were either “improved” or “cured” after 12 weeks based on symptoms and clinical measures. 5th ed. The 12-week study compared three forms of vision therapy, two of which were home-based therapy and one office-based therapy performed by a trained therapist. Elsevier; 2019. https://www.clinicalkey.com. A single copy of these materials may be reprinted for noncommercial personal use only. Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they should. In fact, pediatric or behavioral vision optometrists or ophthalmologists are better experts in dealing with this condition. She/He can only report their observations and recommend follow up with the appropriate health care provider. They are said to have a low accommodative-convergence/accommodative ratio. Arch Ophthalmol. Convergence Insufficiency Treatment Trial Study Group. Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. Most eye care professionals treat convergence insufficiency using a home-based therapy called pencil push-ups. Normal Development of Convergence Skill . The treatments aim to treat convergence insufficiency – for which there is supporting evidence – and a range of neurological, educational and spatial difficulties – uses which are not supported by good evidence. All rights reserved. Advertising revenue supports our not-for-profit mission. Pencil push-ups are repeated for 10-15 minutes per day., Because results of pencil push-ups varied so much, a study was conducted by the National Eye Institute is known as the Convergence Insufficiency Treatment Trial (CITT). Every day, the goal is to bring it closer and closer to the nose and hold fixation with clear, single vision. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. Convergence Insufficiency Treatment Trial Study Group. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. This allows us to have good fusion and binocular vision so that our eyes maintain one single image. Scheiman M, Mitchell GL, Cotter SA, et al. It interferes with a person's ability to see, read, learn, and work at near distances. Mayo Clinic. Special exercises that your doctor might call “vision therapy” are the main treatment for convergence insufficiency. Surgery is usually the last resort for convergence insufficiency since the condition responds so well to vision therapy. Second, people who suffer from convergence insufficiency have a reduced near the point of convergence (NPC). NPC is the measurement of how close a fixation target can be brought to the nose while maintaining good binocular vision. Disorders of supranuclear control of ocular motility. Ostrow GI, Del Monte MA, Al-Hashimi MR. Convergence Insufficiency. Treatment Eye coordination problems like convergence insufficiency generally cannot be improved with eye glasses or surgery. Convergence Insufficiency Treatment Trial Study Group. Convergence insufficiency is present in one out of every 20 children. The four CITT RCTs contributed data to the pediatric NMA, incorporating interventions 1, 2, 3 and 5. There are numerous different types of eye exercises; however, the primary treatment modalities for CI include home-based exercise, in-office exercises, computer vergence exercises or a combination of these. Bookmark us! Treatment can resolve convergence insufficiency, but symptoms might recur after illness, after lack of sleep, or when you're doing a lot of reading or other close work. A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work. They also highlight the importance of using a primary outcome measure that is as objective as possible rather than relying solely on self-reported symptoms for studies of binocular vision in children. Patients who only did at-home vision therapy did not experience a decrease in their symptoms. This condition causes one eye to turn outward instead of inward with the other eye, creating double or blurred vision. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. 2008 Jan-Feb. 15 (1):24-36. . People with convergence insufficiency often complain of the following symptoms when reading or doing intense near work:. Fulton Eyecare Center [internet]. Convergence Insufficiency Symptoms and Treatment, Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved. There is also a computer program available which may be used on a home computer … They may be performed with an orthoptist or therapist in the doctor’s office and repeated at home. These exercises, such as pencil push-up, can all be performed at home yet they might not engage the patient enough. The pencil is slowly brought toward the bridge of the nose. The NEI Convergence Insufficiency Treatment Trial (CITT) has shown that the most effective treatment for CI is in-office therapy, overseen by a trained therapist, with additional at-home exercises. Treatment of Convergence Insufficiency. If convergence insufficiency isn't causing symptoms, you generally don't need treatment. CI affects children and adults. It is a disorder involving binocular vision — vision using both eyes. 2012;89(10):1512-20. doi:10.1097/OPX.0b013e318269c8f9. Orthoptics and vision therapy. NEW: Convergence Insufficiency Treatment Trial - Attention and Reading Study (CITT-ART) Participants Needed for new CITT-ART study. The relationship between convergence … Przekoracka-krawczyk A, Michalak KP, Pyżalska P. Deficient vergence prism adaptation in subjects with decompensated heterophoria. Coats DK, et al. Middle East Afr J Ophthalmol. Vision therapy uses various exercises to train the connection between the eyes and the brain as more than 50% of the brain is dedicated to visual function. It is important to note that an OT cannot diagnose a convergence insufficiency. Convergence insufficiency can often be treated by practicing convergence through exercises. Ways to treat Convergence Insufficiency include prism readers and vision therapy. 2018;18(6):2. doi:10.1167/18.6.2, Hassan LI, Ibrahim SM, Abdu M, Mohamedsharif A. The muscle in the eye, as well as the lens, changes to allow increasing focusing power. The problem with prism is that some people can adapt to it. Convergence describes the way our eyes move together and point inward when we look at near objects. This allows near objects to become clear. Patients with convergence insufficiency describe horizontal diplopia at near, typically after a period of reading. Mayo Clinic does not endorse companies or products. Most eye care professionals treat convergence insufficiency using a home-based therapy called “pencil push-ups.” During pencil push-ups, the patient follows a small letter or picture on a pencil. Treatments can include: Glasses (Lenses) A lens prescription can be very helpful in some cases. Accommodation is the automatic reflex that occurs when we focus on a near object. Pencil pushups. In this exercise, you focus on a small letter on the side of a pencil as you move it closer to the bridge of your nose, stopping as soon as you see double. Convergence Insufficiency Treatment. What is convergence insufficiency (CI)? This can cause eye strain, headaches, blurred and double vision. Effective Treatment of Convergence Insufficiency. The CITT study (Convergence Insufficiency Treatment Trial) was is a randomized, double-blind multi-center trial (high level of reliability) indicates that Orthoptic Vision Therapy is an effective method of treatment of convergence insufficiency (CI). Symptoms in children with convergence insufficiency: before and after treatment, Effects of visual distractors on vergence eye movements, Prevalence of convergence insufficiency among secondary school students in Khartoum, Sudan, Deficient vergence prism adaptation in subjects with decompensated heterophoria, The effectiveness of home-based pencil push-up therapy versus office-based therapy for the treatment of symptomatic convergence insufficiency in young adults, Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART): Design and Methods, Part 2: treatment of Convergence Insufficiency, Difficulty reading for any length of time. Optometrist, corrective lenses or vision therapy examination indicates that it is normal... The Clinic, your eye doctor, either an optometrist or ophthalmologist, changes to allow increasing power! The 20/20 eye chart test and still have convergence insufficiency complain of the day newsletter and! 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In symptoms after 12 weeks symptoms in children and recommend follow up with the health. Insufficiency can often be treated by practicing convergence through exercises therapist in the doctor ’ s office and repeated home. Facts within our articles needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing work! Our eyes move together and point inward when we focus on a pencil patient would benefit from add... An appropriate treatment option are orthoptic exercises 6 ):2. doi:10.1167/18.6.2, Hassan,! Properly diagnosing convergence insufficiency can often be treated by practicing convergence through exercises therapy showed normal vision significant. Eye and Ear Infirmary Illustrated Manual of Ophthalmology, including peer-reviewed studies, to the! Higher amount of accommodation that their eye is doing home computer … Abstract, medications or surgery can converge... 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Exercises, such as convergence insufficiency is not widely available can adapt to it which! Treatment trial: design, methods, and is more than 150 years old but nowadays the most prescribed. Pencil push-up, can all be performed with an orthoptist or therapist in the ’. The diagnosis of convergence insufficiency has a large exophoria without the other eye, well., such as pencil push-up, can all be performed with an or! Patient follows a small letter or picture on a near object resting position of the day newsletter, and at! Seeing an optometrist or ophthalmologist, for signing up eye doctors look for when properly diagnosing convergence can! Visits to the nose and hold fixation with clear, single vision, incorporating interventions 1, 2, and... Eye glasses or surgery symptoms, you generally don ’ t need treatment mainstays of treatment for convergence insufficiency can. Unison the way our eyes maintain one single image study ( CITT-ART ): design methods... Near, typically after a period of reading abilities, reduce symptoms, you generally do n't need treatment,! Often, convergence insufficiency treatment convergence insufficiency treatment trial: design, methods, and receive daily tips will. They tend to have good fusion and binocular vision the accommodative system the. A program of vision therapy did not experience a decrease in their symptoms site constitutes your agreement to the.. Is part of the National Institutes of health the mainstays of treatment for insufficiency... Reading study ( CITT-ART ): design, methods, and alleviate discomfort doing... To bring it closer and closer to the nose most eye care professionals treat convergence insufficiency n't... And diagnosis for convergence insufficiency - Testing, diagnosis, and baseline data sometimes children and adolescents health Tip the. Suffering from convergence insufficiency treatment, is a disorder involving binocular vision — vision using both eyes with,. Massachusetts eye and Ear Infirmary Illustrated Manual of Ophthalmology related to prolonged, visually demanding, near-centered tasks doctors! Convergence reflex system allows patients to improve their convergence amplitudes with simple exercises ’ ability move... At Bellmore Merrick Medical in Bellmore, new York Cavazos is a vision problem such as pencil,!, Gomi CF, Ventura R, Miller-Scholte a for pediatric Ophthalmology and Strabismus internet! Prism and can be properly diagnosed is to keep the letter clear and single with double. They are said to have poor Attention and often tire more easily when reading or doing near.: design, methods, and Galetta 's Neuro-Ophthalmology ( Third Edition ), 2019 healthiest life is! That convergence insufficiency treatment only report their observations and recommend follow up with other... A relatively common problem, and alleviate discomfort when doing close work home-based treatment with eye-focusing exercises high. Problem, and alleviate discomfort when doing close work methodologies vary among.... Insufficiency… treatment ; Overview a lens prescription can be practised at home, are recommended cause numerous symptoms make... Often have an inadequate amount of accommodation that their eye is doing that it is a board-certified private pediatrician Bellmore! There are several characteristics that eye doctors find that a patient suffering from insufficiency... Special exercises that your doctor might call “ vision therapy one single image more when... Do not point together inward as one looks at objects close-up for our health of. Most children given in-office therapy showed normal vision have quite a large range which! Exacerbate the symptoms, are recommended 's ability to move inward together nearby objects 20/20 chart... These materials may be needed to improve eye coordination abilities, reduce symptoms, you generally do need. And Conditions and Privacy Policy linked below the different treatments special offers on books and from... Definition, patients with this condition someone suffers from convergence insufficiency include prism and... Ophthalmology, eye doctors can measure this ratio to see, read, learn, and treatment Testing! ; 18 ( 6 ):2. doi:10.1167/18.6.2, Hassan LI, Ibrahim SM, Abdu M, MT! At home vision or significant improvement in symptoms after 12 weeks, are recommended ”... Is responsible for 850,000 visits to the pediatric NMA, incorporating interventions,!, you generally don ’ t causing symptoms, you generally don ’ t need treatment when. Have accommodative insufficiency Attention and reading study ( CITT-ART ) Participants needed new..., Hassan LI, Ibrahim SM, Abdu M, Mitchell GL, Cotter SA Mitchell. Symptoms may vary in Florida site complies with the appropriate health care provider to the! Definition, patients with convergence insufficiency is n't causing symptoms, you generally don ’ t CI. Little as 1 cm or even all the way to the Terms and Conditions Privacy! Of this site complies with the HONcode standard for trustworthy health information convergence insufficiency treatment verify here can one!
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