Convergence Insufficiency 101: Symptoms, Treatments & Exercises

1.1 How common is convergence insufficiency?

It is difficult to determine the prevalence of convergence insufficiency, as it is a condition that can be difficult to accurately diagnose and may not always be reported.

It affects a reported 2.25% to 8.3% of children and adults in the United States. [4]

1.2 Is convergence insufficiency serious?

Convergence insufficiency is a common binocular dysfunction. It's annoying, and can decrease the productivity and effectiveness of a child or adult. It therefore, should be treated properly.

But in comparison with brain cancer, it can not be considered a 'serious' disability.

1.3 What causes convergence insufficiency?

There are several factors that can contribute to the development of convergence insufficiency. These include:

1. Genetics: Some people may have a genetic predisposition to developing convergence insufficiency.
2. Developmental issues: Children who have developmental delays or conditions such as autism may be more likely to develop convergence insufficiency.
3. Eye muscle problems: Weakness or imbalance in the eye muscles that control eye movement (extraocular muscles) can lead to convergence insufficiency.
4. Other eye conditions: Some people may develop convergence insufficiency as a result of other eye conditions, such as a misalignment of the eyes (strabismus) or a problem with the focusing mechanism of the eye (accommodative dysfunction).
5. Trauma or injury: Head injuries or other types of trauma to the eye or brain can cause convergence insufficiency. [5]

1.4 Are you born with convergence insufficiency?

Convergence insufficiency is not typically present at birth and is usually acquired later in life.

However, some people may have a genetic predisposition to developing convergence insufficiency, which means that they are more likely to develop the condition due to inherited factors. In addition, certain developmental conditions or eye muscle problems that are present at birth or develop early in life can increase the risk of convergence insufficiency.

1.5 Who is at risk of convergence insufficiency?

There are several factors that can increase a person's risk of developing convergence insufficiency. These include:

1. Age: Convergence insufficiency is more common in children and adolescents, although it can occur at any age.
2. Genetics: Some people may have a genetic predisposition to developing convergence insufficiency, which means that they are more likely to develop the condition due to inherited factors.
3. Eye muscle problems: Weakness or imbalance in the eye muscles that control eye movement (extraocular muscles) can lead to convergence insufficiency.
4. Other eye conditions: Some people may develop convergence insufficiency as a result of other eye conditions, such as a misalignment of the eyes (strabismus) or a problem with the focusing mechanism of the eye (accommodative dysfunction).

The most common symptoms of convergence insufficiency include:

1. Eyestrain (tired eyes): People with convergence insufficiency may experience eyestrain, fatigue, or discomfort when reading or doing other close work.
2. Headaches: Some people with convergence insufficiency may experience frequent or recurrent headaches, especially when reading or doing other close work.
3. Blurred vision (vision problems): Some people with convergence insufficiency may have difficulty seeing clearly when reading or doing other close work, or may experience double vision (diplopia).
4. Difficulty reading (trouble focusing): People with convergence insufficiency may have difficulty reading or following a line of text, or may experience discomfort when reading for long periods of time.
5. Poor performance in school: Children and adolescents with convergence insufficiency may have difficulty keeping up with their schoolwork or may have lower grades due to their difficulty reading and doing close work.
6. Difficulty with fine motor tasks: Some people with convergence insufficiency may have difficulty with tasks that require fine motor skills, such as writing or drawing. Or have trouble catching balls. [7]

2.4 Is double vision the most common symptom of convergence insufficiency?

Double vision (diplopia) is not the most common symptom of convergence insufficiency. Eyestrain, fatigue, or discomfort when reading or doing other close work are more commonly reported symptoms of convergence insufficiency.

Double vision can be a symptom of convergence insufficiency, but it is not the most common symptom.

3.1 What is the best treatment for CI?

The most effective treatment for convergence insufficiency depends on the severity of the condition and the specific symptoms that the person is experiencing. The goal of treatment is to improve the ability of the eyes to converge and maintain single vision (increase convergence ability).

In doing so, reading speed will be improved - and eyestrain or discomfort will be reduced.

Treatment options for convergence insufficiency include (sorted from most effective - to less effective, according to a recent randomized trial. [8]

3.2 Vision Therapy

Vision therapy is a type of treatment that involves a series of exercises and activities that are designed to improve eye movements, eye alignment, and visual processing skills. It may be performed in the office of an eye doctor or vision therapist, or at home using special equipment.

In the above randomized trial [9], office-based vision therapy was most effective. So visit a vision therapist at least 1x per week for absolute best results.

The second most effective therapy (next to the office-based vision therapy), was at home based vision therapy without a weekly visit.

According to the randomized trial above [10], the accountability of the vision therapist added an additional improvement stimuli. So in general, office based vision therapy is better than at-home-based vision therapy for maximum results.

3.3 Eye exercise (Pencil push ups):

Eye exercises are the next best treatment method according to the convergence insufficiency treatment trial above. [11]

They can help improve the strength and coordination of the eye muscles, which can improve convergence ability. These exercises may be performed at home with the guidance of an eye doctor or vision therapist.

1. Put a sticker ('post it' will do) on a wall, and grab a pencil. You will do the exercise with the pencil, yet the 'post it' will serve as a suppression check.
2. Stand about 2-3m away from the wall, and lift the pencil up to your nose and focus on it. You should see 2 stickers in the back.
3. Move the pencil within 2 to 3 cm of the brow
4. Aim to keep the target (pencil) single and clear, while checking that you see 2x 'post its' in the back.
5. Move it back.
6. Repeat this for 15min, 5x per week.

3.4 An additional note on treatment for convergence insufficiency:

It is important to work with an eye doctor or vision therapist to determine the most appropriate treatment for your specific situation. In many cases, a combination of treatments may be needed to achieve the best results.

If strabismus is the underlying issue of the convergence insufficiency, the easiest, and most effortless way to start training might be with our artificial intelligence software.

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Refrences:

[1] Convergence Insufficiency: https://www.ncbi.nlm.nih.gov/books/NBK554390/

[2]  The significance of inadequate convergence: https://pubmed.ncbi.nlm.nih.gov/7339524/

[3] Convergence insufficiency: https://pubmed.ncbi.nlm.nih.gov/6702996/

[4] Prevalence of general binocular dysfunctions in a population of university students: https://pubmed.ncbi.nlm.nih.gov/9097328/

[5] Convergence insufficiency in brain-injured patients: https://pubmed.ncbi.nlm.nih.gov/2471568/

[6] Validity of the Convergence Insufficiency Symptom Survey: A Confirmatory Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779473/

[7] Convergence insufficiency and accommodative insufficiency in children: https://pubmed.ncbi.nlm.nih.gov/30791877/

[8] Randomized clinical trial of treatments for symptomatic convergence insufficiency in children: https://pubmed.ncbi.nlm.nih.gov/18852411/

[9] Randomized clinical trial of treatments for symptomatic convergence insufficiency in children: https://pubmed.ncbi.nlm.nih.gov/18852411/

[10] Randomized clinical trial of treatments for symptomatic convergence insufficiency in children: https://pubmed.ncbi.nlm.nih.gov/18852411/

[11] Randomized clinical trial of treatments for symptomatic convergence insufficiency in children: https://pubmed.ncbi.nlm.nih.gov/18852411/

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