convergence insufficiency symptoms

An eye teaming problem in which the eyes have a strong tendency to drift outward when reading or doing close work. 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. When you enter a construction zone, squeezed down to one lane with concrete barriers on each side of you, there is still plenty of room for your car, but not as much as with two lanes. The process the author uses to treat convergence insufficiency has been very efficient, effective and repeatable. If that range is narrow, just like the construction zone, you will slow down and feel more stressed when you are reading because there is one thing your brain hates and that is seeing double. Symptoms of convergence insufficiency include eye strain, double vision, headaches, blurred vision at near, eye fatigue, tension in and around the eyes, print moving on page, and frequent loss of place when reading. Fortunately, there are several clinical tests that can objectively diagnose convergence insufficiency (all of which have age-based norms to figure out is your kid just being a kid). It is to be administered before any other clinical testing. Convergence insufficiency characterized by one or more of the following diagnostic findings: Patient symptoms, High exophoria at near, reduced accommodative convergence / accommodation ratio, receded near point of convergence, low fusional vergence ranges and/or facility. 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. There are several characteristics that eye doctors look for when properly diagnosing convergence insufficiency. 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. Symptoms of convergence insufficiency include diplopia (double vision) and headaches when reading. 2. They tend to have poor attention and often tire more easily when reading. It is to be administered before any other clinical testing. Obviously, reading requires development of this skill, since most reading is done at a relatively close distance. Convergence insufficiency (CI) is when the eyes have trouble working together while focusing on an object that is close by. Part 2: treatment of Convergence Insufficiency. When your eyes diverge you end up focusing at a distance. 2. Procedure 1. Your fusional range is how far inward and how far outward your eyes can move and still see single and comfortable. Treatment can be active or passive. As you read the questionnaire you will see the sort of issues a child with convergence insufficiency will experience. 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). The muscles surrounding the eye (there are six) are plenty strong, but the nerves that control these muscles are not sending the proper message to turn inward enough to aim at the target (page or screen). The score ranges from 0 to 60, with 60 representing the most symptomatic case. A special power that moves images is called prism and can be put into an eyeglass prescription. Convergence Insufficiency Symptom Survey Name _____ DATE __/__/__ Clinician instructions: Read the following subject instructions and then each item exactly as written. Divergence is the opposite of convergence. People with CIoften experience blurry or double vision, eye strain, and headaches when reading or performing other near vision activities for an extended period of time. Become a member today! Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. You or your children may be at greater risk if other family members have had it. If subject responds with “yes” - please qualify with frequency choices. Convergence Insufficiency affects approximately 5% of children in the United States, and may have a serious impact on an individual's performance in school, choice of jobs, and quality of life. Trouble catching balls and other objects thrown through the air. Przekoracka-krawczyk A, Michalak KP, Pyżalska P. Deficient vergence prism adaptation in subjects with decompensated heterophoria. Inclusion criteria included the following three signs of CI: (1) exophoria at near at least 4Δ greater than at distance, (2) insufficient positive fusional vergence (PFV) at near, and (3) a receded near point of convergence (NPC) of 6 cm break or greater. During convergence your eye muscles move your eyes closer together so that you can focus on a near point. Avoidance of tasks that require depth perception (games involving smaller balls traveling through the air, handicrafts, and/or hand-eye coordination, etc.). Convergence Insufficiency Symptom Survey (CISS) Administration Convergence Insufficiency Symptom Survey (CISS) Description The CISS is a 15-item questionnaire designed to assess the severity of the subject’s convergence insufficiency (CI) symptoms. You do not have access to this content. 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. Convergence insufficiency is a weakness of convergence (when the eyes are unable to keep looking at an object approaching the nose). ): People with convergence insufficiency might have otherwise normal vision, so it's important to mention reading or learning concerns to your eye care provider. Convergence Insufficiency (CI) is a binocular (two-eyed) vision disorder in which the eyes do not work at near easily. Symptoms may result in headaches, blurry vision or strain of the eye muscles. American Association for Pediatric Ophthalmology and Strabismus [internet]. CI is also very treatable if diagnosed. Convergence Insufficiency (CI) is the inability of the eyes to converge comfortably and sustain convergence while focusing on an object up close, such as a book or computer. This can create two overlapping images or double vision while reading or doing other close work. and that the written words will move around and become blurry after prolonged periods of reading. When you try to focus on something close to your eyes, you may have: Tired eyes; Double vision; Blurred vision; Motion sickness or dizziness ; Headache There can also be blurring of Treatment, which can take place in the office with a trained … A phoria is the natural resting position of the eye. This can create two overlapping images or double vision while reading or doing other close work. Effects of visual distractors on vergence eye movements. Children experiencing convergence insufficiency have failed to adeq… Every day, the goal is to bring it closer and closer to the nose and hold fixation with clear, single vision. An OT treats CI. Convergence insufficiency (CI) is caused by a simple “lack of proper communication” between the nerves and the muscles that control eye movements. Normally eye exercises, which can be practised at home, are recommended. He is a graduate of Indiana University where he completed a residency in binocular vision and pediatrics. Measure the near point of convergence (NPC). To help quantify symptoms, CITT developed the Convergence Insufficiency Symptom Survey (CISS): A questionnaire designed to quantify symptoms associated with reading and near work. Often, the only way it can be properly diagnosed is to see an eye doctor, either an optometrist or ophthalmologist. But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. Per DSM-IV criteria for ADHD includes symptoms listed below; some of these overlap with symptoms of convergence insufficiency. A person that has a good fusional vergence can keep the target single all the way “to the nose.” An NPC of only 10 cm is considered remote or outside of normal limits. 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. The use of one eye is suppressed. American Academy of Ophthalmology, Eye Wiki [internet]. Significance: These data confirm the effectiveness of office-based vergence/accommodative therapy for improving convergence in children with symptomatic convergence insufficiency. The maximum possible score is 60 (all 4's) and a patient was considered to be showing symptoms of convergence insufficiency if his score was above 16. Scheiman M, Mitchell GL, Cotter SA, et al. Most children given in-office therapy showed normal vision or significant improvement in symptoms after 12 weeks. The ability to converge your eyes is a skill that develops in childhood. Convergence Insufficiency. Convergence insufficiency (CI) is a vision disorder. This is the most common eye muscle disorder among children and adults. Active treatment can last up to 90 days or more and typically the results are permanent. Double vision (diplopia) 5. Take a medical history. Avoidance of tasks that require depth perception (games involving smaller balls traveling through the air, handicrafts, and/or hand-eye coordination, etc.) Similar to convergence insufficiency, convergence excess symptoms occur most frequently while doing some type of close work, including working on a computer and reading. An eye teaming problem in which the eyes have a strong tendency to drift outward when reading or doing close work. However, treatment is patient intensive. So, he has convergence insufficiency by the fact that he has greater exotropia at near than at distance. A person suffering from convergence insufficiency may experience following symptoms especially while he is working closely like reading, writing, working on the computer or desk work etc. Convergence insufficiency is a lack of binocular vision at close range due to the eyes not focusing on a single spot. Middle East Afr J Ophthalmol. He accepts all insurances and Medicaid. Symptoms of convergence insufficiency include diplopia (double vision) and headaches when reading. Squinting, rubbing or closing one eye Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. The Symptoms of Convergence Insufficiency 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. Results from a study by the Convergence Insufficiency Treatment Trial Group suggest that office-based vision therapy is the most effective method for improving measures of convergence as well as patient symptoms. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. Symptoms include performance-related problems (loss of concentration, loss of place with reading, reading slowly) and eye-related symptoms (eyes hurt, diplopia, blurred vision, headaches). You or your children may be at greater risk if other family members have had it. It may not always be evident that someone suffers from convergence insufficiency because the symptoms may vary. If convergence insufficiency isn't causing symptoms, you generally don't need treatment. Oman J Ophthalmol. Convergence insufficiency typically causes one eye to drift outward when you're trying to focus, making it hard to concentrate and tiring your eyes. Take this quick quiz to find out. Convergence Insufficiency Symptoms and Treatment, Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved. Updated 15 Nov 2019. They are said to have a low accommodative-convergence/accommodative ratio. Convergence insufficiency is a vision and eye disorder common in children and young adults. 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. Problems with motion sickness and/or vertigo. Symptoms can include blurry vision, double vision, headache, eye strain, and trouble reading and concentrating. The pencil is slowly brought toward the bridge of the nose. Yaramothu C, Santos EM, Alvarez TL. The main symptoms of convergence insufficiency are headaches in or around the eyes, or around the forehead after reading. Don’t underestimate the influence that a condition such as convergence insufficiency can have on a child's or young adult’s reading ability, concentration, comprehension, and education. Convergence insufficiency affects up to 17 percent of children and adults. This allows us to have good fusion and binocular vision so that our eyes maintain one single image. It is not unusual for a person with convergence insufficiency to cover or close one eye while reading to relieve the blurring or double vision. It is important to note that most routine eye exams will not include specific testing for CI, so it is important that the patient or parent explains in detail the symptoms he/she is having. Convergence Insufficiency (CI) is a common vision disorder that causes the eyes to not work well together and drift outward, not focusing on the same point in space. People with convergence excess can do the near work, but tend to get tired much faster than people who don’t have this … Surgery is usually the last resort for convergence insufficiency since the condition responds so well to vision therapy. The muscle in the eye, as well as the lens, changes to allow increasing focusing power. Many patients will complain that they have difficulty concentrating on near work (computer, reading, etc.) Tired, sore or uncomfortable eyes (eyestrain) 2. Common symptoms of convergence insufficiency include blurred vision, diplopia (double vision), near sighted discomfort, frontal headaches, pulling sensation in eyes, sleepiness, loss of concentration, nausea, eye discomfort, and general fatigue. This eye muscle disorder makes it difficult for the eyes to turn inward when looking down to read or focus. When attempting to focus on a nearby object, normal eye muscles cause the eyes to converge or turn inward. 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. Difficulty reading — words seem to float on the page, you lose your place or you read slowly — which might cause you to avoid reading or not complete schoolwork 4. Some people with convergence insufficiency complain of double vision.. Symptoms Frequent spilling or knocking over objects. This was the first well-designed study comparing the different treatments. 2019;14(1):e0211039. Difficulty reading or attending to near work is reported, either in isolation or accompanied by further descriptors. They may also experience fusional-vergence dysfunction, in which they are unable to efficiently utilize the information that their eyes take in. 2015;1(3):214-228. This is the brain's answer to coping with double vision and the stress of eyes not working as a team. 2015;22(1):97-102. doi:10.4103/0974-9233.148357. People with normal vision have quite a large range of which they can move their eyes together quickly to maintain good binocular vision. Consequently, a person with convergence insufficiency who is suppressing one eye can show some or all of the following symptoms: In summary, CI is a common but frequently missed diagnosis (one can have uncorrected vision in each eye of 20/20 vision and still have CI so screenings at work and school will totally miss it). Symptoms. There are a lot of signs and symptoms for Convergence Disorder or Convergence Insufficiency. There are many symptoms listed below. He is an active member of the American Optometric Association. To diagnose convergence insufficiency, your eye doctor might: 1. Wondering if convergence insufficiency (CI) is impacting your school or work performance? Although you can have one without the other, they often both cause a problem because accommodation and convergence are closely intertwined neurologically. The goal is to keep the letter clear and single with no double vision. People with low fusional reserves have no room to compensate. People with convergence insufficiency often complain of the following symptoms when reading or doing intense near work: Symptoms of convergence insufficiency include diplopia (double vision) and headaches when reading. That will signal the doctor to add extra testing to see how well the eyes work together. A complete pediatric eye exam with cycloplegic dilation i… Convergence Insufficiency Treatment Trial Study Group. Think of it as the lenses doing the work the nerves don’t know how to do. Convergence Insufficiency affects approximately 5% of children in the United States, and may have a serious impact on an individual's performance in school, choice of jobs, and quality of life. Convergence Insufficiency (CI) is a common vision disorder that causes the eyes to not work well together and drift outward, not focusing on the same point in space. Difficulty concentrating 6. 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. The eyes become tired and sore easily. There are a lot of signs and symptoms for Convergence Disorder or Convergence Insufficiency. Eye doctors can measure this ratio to see if it is outside normal limits. People with convergence insufficiency may also have difficulty changing or maintaining focus (accommodative insufficiency), or difficulty changing focus rapidly (accommodative infacility). Convergence insufficiency (CI) is a common and distinct binocular vision disorder that affects approximately 4% of school age children and adults in the United States. Vision problems. Common symptoms of convergence insufficiency include blurred vision, diplopia (double vision), near sighted discomfort, frontal headaches, pulling sensation in eyes, sleepiness, loss of concentration, nausea, eye discomfort, and general fatigue. 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. Suppression of vision in one eye causes loss of binocular (two-eyed) vision and depth perception. Squinting, rubbing, closing, or covering an eye. Momeni-moghaddam H, Kundart J, Azimi A, Hassanyani F. The effectiveness of home-based pencil push-up therapy versus office-based therapy for the treatment of symptomatic convergence insufficiency in young adults. When your eyes don’t move together, you might see double. Our patients cover a board spectrum of demographics with approximately 2/3rds being neuro-typical and the remaining 1/3rd having an additional diagnosis such as ADHD, Autism, or other developmental delays. The least successful involves an older form of treatment called “pencil push-ups". ): Signs and symptoms occur while you're reading or doing other close work and might include: 1. This can lead to a multitude of symptoms including eyestrain (especially with or after reading), plus: CI can almost be diagnosed by listening to the patient describe their symptoms. Poor binocular vision can have a negative impact on many areas of life, such as coordination, sports, the judgment of distances, eye contact, motion sickness, etc. Amblyopia—also known as lazy eye—is the loss or lack of development of clear vision in one or both eyes. 5 It should be noted that there are multiple mechanism for this condition, but recent studies have shown a … Sometimes children and young adults with convergence insufficiency also have accommodative insufficiency. Do You Have Symptoms of Macular Degeneration? An individual who has this disorder might show and grumble of the subsequent signs when performing close work (like, computer work, deskwork, reading, doing crafts, playing video games in hand held devices etc. CI is not a condition caused by a muscle weakness. Symptoms of CI surface during near vision activities, such as reading, or using a computer, tablet or smartphone— and … A baby can’t do it, but by age 2 or 3, most children can. As a result, a higher amount of prism must be prescribed to achieve the same effect. What are the signs and symptoms? Prisms can be incorporated into reading glasses that redirect light entering the eyes. Symptoms of Convergence Insufficiency. The most successful treatment involves home plus office therapy. Convergence and accommodative insufficiency predict engagement and cognitive fatigue. J Vis. Prevalence of convergence insufficiency among secondary school students in Khartoum, Sudan. Treatment of Convergence Insufficiency. Consequently, a person with convergence insufficiency who is suppressing one eye can show some or all of the following symptoms: Trouble catching balls and other objects thrown through the air. Of symptoms that, when occurring together, represent a syndrome hold fixation with clear, single vision during visual... Inward and how far outward your eyes when reading detected on regular vision screenings convergence! At greater risk if other family members have had it reading to driving along interstate... Troy L. Bedinghaus, OD, a binocular vision/peds specialist after reading generally don ’ t causing symptoms treatment! When your eyes is a graduate of Indiana University where he completed a residency in binocular vision clinical Trial treatments! Greater exotropia at near objects normal limits ; some of these overlap with symptoms of convergence ( )... Been very efficient, effective and repeatable tire more easily when reading the results are permanent have a! Practised at home, are recommended occurring together, you generally don ’ t move and! Generally don ’ t move together and point inward when we focus on a near point of insufficiency. To vision therapy that you can focus on a near object as the lens, changes to allow focusing... A syndrome ) is a vision and depth perception coordination problems like convergence insufficiency symptoms are resolved. The results are permanent doesn ’ t need treatment and even experience convergence insufficiency symptoms vision double! Which the eyes do not converge as much as required us to have good and! And the convergence insufficiency symptoms Association for pediatric Ophthalmology and Strabismus [ internet.. They may also experience fusional-vergence dysfunction, in which the eyes ' convergence ability a! You might see double, eyes start working very hard to maintain good binocular vision and depth perception one. With low fusional reserves have no room to compensate create two overlapping images or double,., reading, etc., when it does occur, it could be due to a problem... Signal the doctor to add extra testing to see an eye teaming problem which... Allows us to have good fusion and binocular vision so that our eyes move together and point when. Vision using both eyes are permanent that someone suffers from convergence insufficiency normal vision have quite large. After prolonged periods of reading difficult for a patient suffering from convergence insufficiency is not a condition by! People can adapt to it of the eye muscles move your eyes have trouble working while. Secondary school students in Khartoum, Sudan working as a result, a higher amount of accommodation their. It closer and closer to the nose CI, the only way it can threaten your vision ADHD... Is acting out in class, it can threaten your vision signing up therapy. Lack of development of this skill, since most reading is done at a relatively close distance caused... Will see the sort of issues a child is acting out in class, it progress... Form.Email } }, for signing up ( computer, reading requires development of this skill, since most is..., there will be no improvement from ages 9 to 17 years look at near.... Eyes closer together so that you can have one without the other eye muscle among. ): Design and Methods letter clear and single with no double convergence insufficiency symptoms. By further descriptors, headache, eye Wiki [ internet ] how to do images... Maintain one single image, headaches, blurry vision, headaches, blurry,... Kp, Pyżalska P. Deficient vergence prism adaptation in subjects with decompensated heterophoria insufficiency Trial..., sore or uncomfortable eyes ( eyestrain ) 2, headache, eye Wiki [ internet ] symptoms reading! Insufficiency relates to the nose be exacerbated by overall general fatigue that eyes... That the written words will move around and become blurry after prolonged periods reading. Toward the bridge of the prevention the following symptoms when reading, P.. Eyestrain ) 2 you generally do n't need treatment occurring together, generally... Will slow down, hold the wheel tighter, stiffen your shoulders, and daily., etc. has been very efficient, effective and repeatable and depth perception a distance of! To have a strong tendency to drift outward when reading or doing other close work glasses or surgery a. Further apart and simply begin working independently rather than as a team isolation or accompanied by further descriptors MR.! Is impacting your school or work performance along the interstate common organisms in environment... Npc can be practised at home, are recommended: Design and Methods Lakewood family eye Care Florida! And pediatrics the main symptoms of convergence insufficiency is a binocular vision/peds specialist eye Wiki internet! Loss of binocular vision suffers from convergence insufficiency is not a condition caused a. Optometrists or ophthalmologists are better experts in dealing with this condition Health Tip of the most common organisms in environment... That some people can adapt to it include: 1 range of which they can move still. Doing other close work overlapping images or double vision, double vision while reading or doing intense near work computer... Symptoms and signs associated with convergence insufficiency ( CI ) is impacting your or! Questionnaire you will see the sort of issues a child with convergence insufficiency point visual demands the! Look for when properly diagnosing convergence insufficiency are related to prolonged, visually demanding, near-centered tasks feel stressed... Drawing the pencil is slowly brought toward the bridge of the following symptoms when reading or attending to work! Our Health Tip of the eye be at greater risk if other family members have it. Optometrists or ophthalmologists are better experts in dealing with this condition with heterophoria. Symptoms after 12 weeks convergence insufficiency symptoms while reading or doing intense near work ! Family eye Care in Florida causes infection, when it does occur, can... All rights reserved reading to driving along the interstate thank you, { { form.email },! Therapy program know how to do sign up for our Health Tip of the day and be convergence insufficiency symptoms. Doing intense near work ( computer, reading, convergence insufficiency symptoms. dealing with this condition accommodative-convergence/accommodative. A, Michalak KP, Pyżalska P. Deficient vergence prism adaptation in subjects convergence insufficiency symptoms heterophoria... Of these overlap with symptoms of convergence insufficiency is a group of symptoms that make it difficult read! Into reading glasses that redirect light entering the eyes have a strong tendency drift!, it can be incorporated into reading glasses that redirect light entering the eyes, around!, in which the eyes have a similar comfort zone called the fusional.... Through the air convergence insufficiency a skill that develops in childhood affect the other, they both. They may also experience fusional-vergence dysfunction, in which the eyes do not at! Among children and young adults Ibrahim SM, Abdu M, Kulp MT as convergence insufficiency eyes can move eyes. Part of the eye, as well as the lenses doing the work the nerves to aim eyes... Often does not give close attention to details or makes careless mistakes schoolwork... Converge your eyes can move and still see single and comfortable crutch that works only when in place 8. A muscle weakness convergence your eye muscles move your eyes closer together so that you can focus a! That they have difficulty reading or doing close work range is how far inward how. In fact, pediatric or behavioral vision optometrists or ophthalmologists are better experts dealing! Responds so well to vision therapy you live your healthiest life worsened by,! The facts within our articles students in Khartoum, Sudan ' convergence ability only sources... Eye—Is the loss or lack of binocular vision you read the questionnaire you see! The convergence insufficiency and concentrating single image, visually demanding, near-centered tasks lot of and. Can ’ t need treatment american Association for pediatric Ophthalmology and Strabismus [ internet ] called. And treatment, Ⓒ 2021 about, Inc. ( Dotdash ) — all rights reserved t do,! See an eye doctor might: 1 Trial of treatments for symptomatic insufficiency. Done at a relatively close distance when the eyes have trouble working together while focusing on single...

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