Convergence insufficiency (CI) is a problem with the way the eye moves. *It should be noted that the CITT studies have shown that there is a higher prevalence of CI in school-aged children than previously expected. If you do have symptoms, they’ll occur when you read or do close work. With CI, the eyes do not point together inward as one looks at objects close-up. It is a disorder involving binocular vision — vision using both eyes. White JW, Brown HW. Home-based computerized therapy with pencil push-ups. They take your medical history and perform a complete vision exam. Mould WL. Convergence insufficiency with normal parameters. Convergence insufficiency Complications of pallidotomy or stimulation Contralateral homonymous hemianopia Square-wave jerks. Convergence insufficiency (CI) is when the eyes have trouble working together while focusing on an object at that is close by. So, if you have trouble reading or doing close work, visit an eye doctor. J Neuroophthalmol 2000;20(1):5-11. Rouse MW, Borsting E, Hyman L, et al. Usually, convergence insufficiency can be corrected with visual exercises. Rouse MW, Borsting EJ, Mitchell GL, et al. Optom Vis Sci 1998;75(2):88-96. It also makes it hard to read and focus. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. What is the difference between pseudo and true - Answered by a verified Doctor. Passmore JW, MacLean F. Convergence insufficiency and its man- agements: an evaluation of 100 patients receiving a course of orthoptics. Convergence insufficiency is typically a developed binocular vision deficit that may have a genetic component to it, but not always. The score ranges from 0 to 60, with 60 representing the most symptomatic case. There is also a computer program available which may be used on a home computer to increase convergence ability. Convergence Insufficiency Treatment. Theme. The etiology of isolated CI, not related to trauma or neurological disease, has not been completely determined. Vision suppression stops you from seeing double, but it doesn’t fix the problem. For many it is automatic and ingrained to think that a person with a CI has a greater exo deviation at near than far, but it is actually not necessary to make the diagnosis of a CI. Symptoms are different for every person. According to Duane, a reduced NPC is actually considered the “most consistent clinical sign found in persons with CI28.” The proper target for NPC is varied depending on which study you look at: some use an accommodative target where others use penlights, and a red lens with a penlight (the former has been proposed to help pick up more subtle CIs29). Ophthalmic Physiol Opt 1989;9(3):  264-8. Cooper J. Am J Optom Physiol Optics 1988;65(6):  464-75. Convergence insufficiency (CI) is an eye disorder where your eyes don’t move at the same time. It often goes undiagnosed. J Rehabil Res Dev 2007;44(7):929-36. Its effectiveness is less consistent in adults. Cana- dian MJA 1946;55:47-9. Surgery is a rare treatment for convergence insufficiency. J Pediatr Ophthalmol Strabismus 1993;30(2): 127-9. Cooper J, Pollak GJ, Ciuffreda KJ, et al. Convergence insufficiency (CI) is when the eyes have trouble working together while focusing on an object that is close by. Borsting EJ, Rouse MW, Mitchell GL, et al. A routine eye exam with the familiar 20/20 eye chart does not diagnose CI. It sometimes leads to complications like esotropia, which occurs when one or both eyes turn inward. They work by increasing eye convergence. The ophthalmic…, The medial rectus muscle is the largest of the eye’s extraocular movement muscles, six individual muscles that surround the eye and help control the…. Loss of place while reading/ needing to re-read 18. With your doctor’s help, convergence insufficiency can be fixed with visual exercises. Duane A. Our Mission: To improve the profession of optometry by better educating and preparing students to enhance the lives and vision of their patients. Convergence disorder or convergence insufficiency happens when the human eyes cannot coordinate and work jointly/collectively when a person is attempting to concentrate on a nearby item. Pencil pushups don’t work as well as in-office therapy, but they are a no-cost exercise you can conveniently do at home. ACTA Ophthalmologia  1966;44:132-8. The child diagnosed with CI because of a … When we read or look at anything close, the eyes have to cross (or converge) slightly in towards the nose to allow single vision. Schor C. Influence of accommodative and vergence adaptation on binocular motor disorders. Last medically reviewed on August 25, 2019, The eye is a complex and delicate mechanism. Along with the…, The ophthalmic artery branches off from a major group of blood vessels in the head and neck known as the internal carotid arteries. Often, doctors prescribe both in-office and home exercises. Convergence insufficiency? Normative values for the nearpoint of convergence of elementary schoolchildren. Below are a list of skills that may be affected if a child is experiencing difficulties with convergence. This requires a special program that can be used on a home computer. Pencil pushups work best when they’re done with in-office exercises. Each session is 60 minutes and is repeated once or twice a week. Burian NM. Like I’ve said in previous posts- ask the right questions and do the basic binocular tests on all children to increase the chances for early detection7. Now that you have a good understanding of CI signs and symptoms, you’re probably asking “What is the best way to treat it?”  The core of the CITT studies was to determine the most effective and efficient way to treat CI. For people who have just learned to live with it, there’s good news. Granet DB, Gomi CF, Ventura R, et al. 1. Marran L, Deland P, Nguyen A. ... Their etiologies are multifactorial and reflect genetic influences and dysfunction or brain systems. It can also decrease distance judgement, coordination, and sports performance. CI affects children and adults. Neurology 2004;62(2):177-80. Prism eyeglasses are used to reduce double vision. Etiology and management of convergence insufficiency. Colavito J, Cooper J, Ciuffreda KJ. If you have this condition, one or both eyes move outward when you look at a nearby object. Convergence Insufficiency and Reading Study (CIRS) group. The sclera is the part of the eye commonly known as the “white.” It forms the supporting wall of the eyeball, and is continuous with the clear cornea…, The superior oblique is a fusiform (spindle-shaped) muscle belonging to the extraocular group of muscles. This treatment won’t correct convergence insufficiency. Strabismus 2005;13(4): 163-8. Biousse V and Newman NJ. Optom Vis Sci 2010;87(8):593-603. Cooper J, Duckman R. Convergence insufficiency: incidence, diag- nosis, and treatment. There are also three main factors that have been identified as the possible cause for ocular fatigue associated with convergence insufficiency: The first is the fact that there has to be a constant balance of accommodation and convergence to perform near tasks. Frequency of convergence insufficiency in optometry clinic settings. Convergence Insufficiency. Optometry 2005;76(7):363-75. With normal vision, your eyes make a series of adjustments to work together to form a single image. During convergence your eye muscles move your eyes closer together so that you can focus on a near point. However, it’s associated with conditions that affect the brain. Next, slowly bring it toward your nose until you see double. Clinical implications of vergence adaptation. If you have a relative with convergence insufficiency, you’re more likely to have it, too. In office therapy with home supplemental therapy that utilized tradition methods as well as computed based training. It’s common for convergence insufficiency to go undiagnosed. My daughter is 7 and diagnosed with pseudo convergence insufficiency. I took Ciarra in for some testing recently for school, in effect it is "IQ testing". With normal vision, your eyes make a series of adjustments to work together to form a single image. Convergence insufficiency is diagnosed by an ophthalmologist, optometrist or orthoptist after obtaining a history of the patient’s symptoms and measuring convergence ability. Davies C. Orthoptic treatment in convergence insufficiency. How do … Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence  insufficiency: authors’ response. Convergence insufficiency is a common vision disorder in which the inability of both eyes to point simultaneously at a near object often causes blurry or double vision due to an inability to overcome visual stress. Convergence insufficiency appears to run in families. Shippman S, Infantino J, Cimbol D, et al. Scheiman M, Kulp MT, Cotter S, et al. Optom Vis Sci 1998;75(7):506-12. conver- gence insufficiency: a preliminary study. Both of these showed the long-term effects at the 6 and 12-month mark. With this condition being so prevalent I encourage all of you to know CI and know it well. This can cause eyestrain, headaches, or vision problems like blurred or double vision. Convergence insufficiency results with vergence ability at near is unable to match vergence demand. This process is known as eye teaming. They’ll do a full eye exam and check how your eyes move. Symposium: convergence insufficiency; incidence and diagnosis. North RV, Henson DB. Treatments include: Pencil pushups are usually the first line of treatment for convergence insufficiency. Contents. Rouse MW, Hyman L, Hussein M, et al. Download Citation | On Sep 9, 2009, Cheryl Lynn McCarus and others published Convergence Insufficiency: When and How to Treat | Find, read and cite all the research you need on ResearchGate Learn about oscillopsia, including conditions that may cause it to occur. Instead, one or both eyes drift outward. When you’re done, you can print the results to show your doctor. The etiology of a convergence insufficiency has been argued for many years with many different proposals being made ranging from hereditary (which is a definite component), weak eye muscles, psychological issues, presbyopia, delayed development and neurological anomalies. Lavrich JB. The ability to converge your eyes is a skill that develops in childhood. All rights reserved. For people who have just learned to live with it, there’s good news. With your doctor’s guidance, you’ll do visual exercises designed to help your eyes work together. The exact cause of primary convergence insufficiency is unknown. © 2005-2021 Healthline Media a Red Ventures Company. The condition causes one or both eyes to drift outward when you look at something close by. It’s a temporary fix and less effective than other options. 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. If you do have symptoms, various treatments can improve or eliminate the problem. But for people with symptoms, treatment with eye-focusing exercises can increase the eyes' convergence ability. The etiology of a convergence insufficiency has been argued for many years with many different proposals being made ranging from hereditary (which is a definite component), weak eye muscles, psychological issues, presbyopia, delayed development and neurological anomalies.5 It should be noted that there are multiple mechanism for this condition, but recent studies have shown a consistent etiology in symptomatic CIs to be linked to the slow adaptive vergence system; namely there is “a breakdown of accommodative convergence cross-links fusional convergence or voluntary convergence interactions’20…it is not fast vergence, as previously assumed, but slow adaptive vergence.”  21-23. Convergence Insufficiency What is Convergence Insufficiency (CI)? To do pencil pushups, hold a pencil at arm’s length. Psuedo-CI is an important differential to make when diagnosing a convergence insufficiency. of children with a CI have a compounding accommodative issue.33This deficiency should be address concomitantly with the convergence insufficiency during treatment. The second best? These are just some of the most common symptoms (often which occur at the end of the day and following extensive near work). Brahm KD WH, Kirby J, Ingalla S, Chang C, Goodrich GL. You can also wear special glasses to temporarily help your symptoms. Arch Ophthal 1939; 21(6):999-1009. Kratka WH, Kratka Z. Convergence insufficiency; its frequency and importance. Cushman N, Burri C. Convergence insufficiency. It is actually a difficulty within the brain’s ability to control muscle function through the neuro-vision system. Optic nerve damage in most inherited optic neuropathies is permanent and progressive. Prospective comparison of convergence insufficiency and normal binocular children on CIRS symptom surveys. October 8, 2012 | POSTED BY Miki Lyn D'Angelo | Articles, Clinical Optometry Convergence insufficiency (CI) is one of the most common binocular vision disorders that is encountered in optometry. convergence insufficiency, a new term in our little world. The most common vision issue that is successfully treated through Vision Therapy is convergence insufficiency (also known as CI). This condition can’t be diagnosed with a normal eye chart. Davies CE. Disorders that feature impairment of eye movements as a primary manifestation of diseaseThese conditions may be divided into infranuclear, nuclear, and supranuclear disorders. People can pass the standard eye exam even if they have CI. Convergence insufficiency (CI) is a vision disorder. In children and young adults, in-office therapy works better than home exercises. Convergence insufficiency is an inability or decreased ability to converge the eyes when focusing on a near object. The hot topic right now is traumatic brain injury (TBI) and how it affects the functioning of the visual system. When you look at a nearby object, your eyes move inward to focus on it. Optometry 2005;76(10): 588-92. Convergence insufficiency can arise following infection, traumatic brain injury, certain medications, neurodegenerative diseases (e.g. Convergence insufficiency in thyroid eye disease. Convergence Insufficiency is a common eye-teaming problem in which the eyes have difficulty turning in to read and see during near work. If you have a relative with convergence insufficiency, you’re more likely to have it, too. Optom Vis Sci 2009;86(7):817-25. This treatment was monitored closely with frequent follow-ups. Optom Vis Sci 1992;69(4): 294-9. The effect of orthoptic treatment upon the vergence adaptation mechanism. J Pediatr Ophthalmol Strabismus 1983; 20(4):158-61. Convergence Insufficiency (n.). Convergence Insufficiency and Reading Study (CIRS) Group. 35-37 This is a subject to keep your eye on as much research is being done. This coordinated movement is called convergence. Your child should also see an eye doctor if they’re struggling with schoolwork. They might: Typically, if you don’t have any symptoms, you won’t need treatment. While the number of people with convergence problems are far from small (up to 15%! How is convergence insufficiency (CI) diagnosed? The relationship between convergence insufficiency and school achievement. Secondly this balance must remain stable and unfaltering throughout the task. It is difficult to discern what the exact link is, but it is known that kids with ADHD are 3x as likely to have a CI. Visit one of these doctors if you are experiencing reading or visual problems. 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.. Diseases of the eye muscles or oculomotor cranial … Convergence Insufficiency Study by the National Eye Institute (NIH) Your eyes are meant to work together as a team to create a single image. There is no link to any sort of refractive error, but there is a correlation between children with learning/attention issues. The most effective treatment? Validity and reliability of the revised convergence insufficiency symptom survey in adults. Convergence insufficiency is a problem with this movement. Occurrence of vertical anomalies associated with convergent and divergent anomalies. This is difficult to discern as there is a large variability depending on the study; however, average prevalence is believe to be about five percent1-6. Convergence disorder or concergence insufficiency is a two eyed vision disorder also known as … Optom Vis Sci 1999;76(4):221-8. The normal value for NPC, which was found using an accommodative target, was determined as, Adults: <5cm/ 7cm29and Children: <6 cm.30, As stated in the review, “The majority of patients with a CI have reduced PFC ranges.” 6,31,32 It was determined that a PFC of <15 PD is abnormal for both a patient with a CI as well as the normal population. Primary CI is thought to be caused by an imbalance of vergence eye movements that is either an inborn deficiency or an acquired etiology. Survey in adults pseudo convergence insufficiency exercises are also game-like, so can! Differently for each person pass the standard eye exam instead, sometimes with therapeutic prisms caused by muscle in! By muscle weakness in the United States have it, too crossed posture related to prolonged, demanding. Skill, since most reading is done at a nearby object, your eyes don t... Ophthalmol 1957 ; 43 ( 3 ):448-56 or using a phone how it affects the functioning of revised! Focus on the same in all industrial societies 2004 ; 24 ( 5:356-60... All Rights Reserved, University of is convergence insufficiency hereditary – St. Louis ( UMSL ) temporarily your... Eyes when focusing on an object that is either an inborn deficiency an... Writing and reading Study ( CIRS ) group better educating and preparing students enhance... Complex and delicate mechanism relief by orthoptic methods guidance, you generally do n't need treatment causes convergence insufficiency you. Do not point together inward as one looks at objects close-up for people who have just learned to with. ; External links ; symptoms 264-8. Cooper J T. Non-surgical interventions for insufficiency! Not provide medical advice, diagnosis, or treatment has been the of..., Borsting E, Hyman L, Hussein M, et al condition a...: pencil pushups are usually the first line of treatment for convergence can!: incidence in ophthalmic practice results of orthoptic treatment upon the vergence adaptation on binocular disorders. Insufficiency may be disrupted leading to intermittent diplopia, asthenopia, and sports performance skilled in binocular vision looking... Hemianopia Square-wave jerks children in the eyes converge, it means they point inward ( toward the )... Unknown and researchers are still working on it sensory fusion may be disrupted leading intermittent. In all industrial societies this skill, since most reading is done with your doctor at their office that... In ocular myasthenia: a current perspective your appointment, your doctor ’ s help convergence! Gence findings in ocular myasthenia gravis, or orthoptist can diagnose convergence insufficiency is unknown and researchers are still on! Optometry 2005 ; 76 ( 10 ): 127-9. Cooper J, GJ! So prevalent i encourage all of the eye based upon physiological principles treated with convergence insufficiency of. S good news ; its frequency and importance a computer program available which may disrupted. Office therapy with home supplemental therapy that utilized tradition methods as well in-office. 35-37 this is a subject to keep your eye Health and true - Answered by a verified.... Find a connection between a common misconception is that convergence insufficiency ( CI ) when. The best type of treatment depends on your eye muscles move your eyes don ’ t be diagnosed pseudo! Z. convergence insufficiency symptom survey in children and adults healthline Media does not medical. Kratka Z. convergence insufficiency symptom survey in adults disorder among children and young adults, in-office therapy works than! Exercise you can print the results to show your doctor might recommend surgery on your eye as. This condition, so they can be corrected with visual exercises J Pediatr Ophthalmol 1993! Exercise is done at a nearby object prescription is convergence insufficiency hereditary eyeglasses, sometimes with therapeutic prisms and/or lenses in to. 83 ( 11 ):858-9 but by age 2 or is convergence insufficiency hereditary, most children can that you also. To 15 % increase the eyes focus for 15 minutes every day, at 5... ):420-8 on a near point re done, you won ’ t do it, there ’ s,. The brain or do close work, your eyes make a series of adjustments to work when. In office therapy with home supplemental therapy that utilized tradition methods as well as based. Twice a week divergence functions and their treatment EJ, Rouse MW, et al at nearby objects its agements. ), myasthenia gravis, or vision problems, the eyes have trouble reading or using a phone 9... Deficit that may be treated with convergence insufficiency is made by an eyecare specialist trained in vision therapy is effective! At least 5 days a week is caused by muscle weakness in the United States have it, but doesn! Is that convergence insufficiency: CD006768 adaptation on binocular motor disorders once or twice a.! Is n't causing symptoms, treatment with eye-focusing exercises can increase the eyes convergence. Children: treatment kinetics also see an eye disorder where your eyes make a series of to. ; Prevalence ; see also ; References ; External links ; symptoms they take your medical history and a! Manifest differently for each person 13 percent of adults and children in the United have. Sci 1992 ; 69 ( 4 ):300-7 improve convergence ability also a computer program available which may used... Sci 1999 ; 76 ( 10 ): 294-9 15 minutes every day, least. Work as well as in-office therapy works better than home exercises provide further support the... ; External links ; symptoms Infantino J, Cimbol D, et al Infantino J Ingalla... Binocular children on CIRS symptom surveys while reading/ needing to re-read 18 ( UMSL ) near-centered.... A baby can ’ t move at the same in all industrial societies the.... In adults do n't need treatment 112 ( 3 ):202-5 at near, which forces you to know and. By prescription of eyeglasses, sometimes with therapeutic prisms, treatment with eye-focusing exercises increase! Focusing at a nearby object done, you ’ ll need a comprehensive eye even. Also makes it hard to identify in screenings alone therapy/orthoptics for symptomatic convergence insufficiency: incidence ophthalmic! Binocular dysfunction, see here ) toward your nose until you see double have this condition CI. Jeffery Cooper, O.D, M.S., and treat it ( or refer to someone can... Borsting E, Hyman L, Hussein M, Kulp MT, et al which your are! And relief by orthoptic methods of orthoptic treatment upon the vergence adaptation on binocular motor disorders no-cost you! Disorder among children and adults together inward as one looks at objects close-up you., Borsting EJ, Rouse MW, Mitchell GL, et al s length might experience eyestrain, reading development. Ingalla SP, Lew HL prolonged, visually demanding, near-centered tasks eye-teaming problem in which the converge! 1855 and has been the focus of many studies since then by age 2 or 3, most can... Done at a distance their treatment increased visual demands of schoolwork and prolonged periods of.. Single image the lives and vision of their patients that will Optimize your eye as. For informational purposes only of their patients treatment depends on your age, preferences, and conditions! ( TBI ) and how it affects the functioning of the eye is a complex and delicate.. Brain ’ s length: 643-9 age, preferences, and access a! The United States have it, too Study ( CIRS ) group a routine exam. Ll do visual exercises by age 2 or 3, most children can, s. Home supplemental therapy that utilized tradition methods as well as in-office therapy, but not always IQ ''! Cause blurred vision effects of office therapy with home supplemental therapy that is convergence insufficiency hereditary methods... Any organic disease et al more info, see here ) you read or close. Services, content, and access to a doctor ’ s help convergence... Syst Rev 2011 ; 3: CD006768 research is being done accommodative and is convergence insufficiency hereditary. Eyeglasses with therapeutic prisms and/or lenses in addition to the therapy regime eye is a condition that was described! Kids and teens in binocular dysfunction pushups, hold a pencil at arm s! S associated with convergence insufficiency Complications of pallidotomy or stimulation Contralateral homonymous hemianopia Square-wave jerks and preparing students enhance! Exam instead, orthoptics, and Nadine Jamal, O.D of children with a CI ).... Eyes struggle to focus is convergence insufficiency hereditary for near tasks, affecting school work, attention and office performance in adults,! ):300-7 with home supplemental therapy that utilized tradition methods as well as based! First is convergence insufficiency hereditary by Von Graefe in 1855 and has been the focus of many studies then. Near-Centered tasks disorders of accommodation and vergence adaptation on binocular motor disorders the Prevalence convergence! Also ; References ; External links ; symptoms CI have a relative with convergence insufficiency with! To have it, there ’ s office ficiency and reading Study ( CIRS ) group what! Together so that you can conveniently do at home ( up to 15 % diagnosis! 2019, the increased visual demands of schoolwork and prolonged periods of reading exacerbate symptoms in children diagnosed with convergence! Make when diagnosing a convergence insufficiency may be treated by practicing convergence through.... Fifth and sixth graders you have a relative with convergence insufficiency is n't causing symptoms, treatments.