What is convergence insufficiency?

15 percent of children suffer form convergence insufficiencyConvergence insufficiency is one of the most common vision disorders that interferes with a patient's ability to see, read, learn and work at close distances. It was recently the focus of a scientific study in the United States funded by the National Institutes of Health and the National Eye Institute. The study found that in-office Vision Therapy was the best available treatment for convergence insufficiency, replacing conventional therapies such as "pencil push-ups", with 75% of patients showing significant improvement following vision therapy.

Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they should. With convergence insufficiency the eyes have a strong tendency to drift outward when reading or doing close work. The result can cause double vision and, at minimum, make reading and learning very difficult.

The good news is the majority of these vision problems can be treated with a program of optometric vision therapy.

 

Even though the study by the NEI found that in-office vision therapy was the best treatment for convergence insufficiency, some doctors who are not up-to-date on the latest scientific research still tell their patients that "pencil push-ups" are the only treatment available that if if "pencil push-ups" don't work the patient is out of luck. This is not correct. The NEI study found that in-office vision therapy was significantly more effective than "pencil push-ups" and the only treatment that was more effective than a placebo. A number of follow up studies have been done; you may read about these on the binocular vision page.


The latest research on convergence insufficiency

There have also been follow-up studies by Scheiman et al. showing that the results obtained from vision therapy are were long-lasting and that the treatment kinetics are favorable – meaning that that rate at which patients get better with vision therapy makes office-based vision therapy an effective and practical treatment.

In 2005 Scheiman et al. published a clinical trial in Optometry and Vision Science on the vision therapy treatment of convergence insufficiency in young adults ages 19-30. Once again, the results proved the efficacy of vision therapy treatment over other modalities that were in use at the time. The study authors concluded:

This first multicenter, randomized clinical trial of the treatment of symptomatic CI in young adults demonstrated that of the three treatment modalities, only vision therapy/orthoptics was effective in achieving normal clinical values for both the near point of convergence and positive fusional vergence. Patients in the pencil pushups group achieved normal values only for positive fusional vergence at near and patients in the placebo vision therapy/orthoptics group did not achieve normal findings for either the near point of convergence or positive fusional vergence at near. Therefore, the effectiveness of vision therapy/orthoptics in improving the near point of convergence and positive fusional convergence values at near in adults cannot be explained on the basis of a placebo effect. Based on the results of this preliminary study, it would appear that pencil pushups, the most popular treatment for CI, is not effective for achieving clinically significant improvements in symptoms or signs associated with CI in young adults.

study published in 2010 by Alvarez et al. in Optometry & Vision Science adds to the depth of the scientific evidence by showing that vision therapy produced demonstrated changes in eye movements together with significantly increased functional activity within the frontal areas of the brain, the cerebellum, and brain stem. These regions of the brain are likely to ―participate in a collicular-cortical dorsal visual networks and may reflect increased processing of visual material specific to near space. This study demonstrates the motor and neurological mechanism by which vision therapy operates.

The brain scan images published in the Alvarez study are dramatic. They show changes in the brain before and after vision therapy and at a follow up MRI scan:

MRI images before and after vision therapy for convergence insufficiency

 

Symptoms of convergence insufficiency

The most common signs that your child is suffering from convergence insufficiency are the following:

It is estimated that least one out of every 20 school-age children is impacted by convergence insufficiency. Some studies even put the number as high as 15%. However, there are other visual abnormalities to be considered.

 

Convergence insufficiency articles

Only vision therapy is effective in treating convergence insufficiency: National Eye Institute

 

quotable

"of the three treatment modalities, only vision therapy/orthoptics was effective in achieving normal clinical values for both the near point of convergence and positive fusional vergence."

Scheiman et al. A Randomized Clinical Trial of Vision Therapy/ Orthoptics versus Pencil Pushups for the Treatment of Convergence Insufficiency in Young Adults. Optometrist & Vision Science 2005

 

> Is your child smart in everything except school? It could be convergence insufficiency. Click to learn more.
Convergence insufficiency infographic

 

Did you know?

Vision therapy for convergence insufficiency improves academic behaviors.

A recent study that confirms that academic behaviors, as measured by the Academic Behavior Survey (ABS), improve following successful treatment of convergence insufficiency.  The study was published in the January 2012 issue of Optometry and Vision Science

The study's conclusion was that "A successful or improved outcome after convergence insufficiency treatment was associated with a reduction in the frequency of adverse academic behaviors and parental concern associated with reading and school work as reported by parents."  

 

What does convergence insufficiency look like?

This image simulates what reading is like for a person with covergence insufficiency

This image shows what reading is like for a person with convergence insufficiency.

 

national eye institute study concludes that vision therapy is the most effective treatment

"Scientists have found a more effective treatment for a common childhood eye muscle coordination problem called convergence insufficiency (CI). For words on a page to appear in focus a child’s eyes must turn inward, or converge. In CI, the eyes do not converge easily, and as a result, additional muscular effort must be used to make the eyes turn in.

While the majority of eye care professionals treat children diagnosed with CI using some form of home-based therapy, a new study concludes that office-based treatment by a trained therapist along with at-home reinforcement is more effective. The research, reported in the Oct.13 issue of Archives of Ophthalmology, was funded by the National Eye Institute (NEI), part of the National Institutes of Health."

NATIONAL INSTITUTES OF HEALTH
National Eye Institute Press Release 
Monday, October 13, 2008

 

ADHD and convergence insufficiency

Individuals with convergence insufficiency may be misdiagnosed with ADHD and unnecessarily medicated.  Click to learn more.