Convergence Insufficiency
Convergence Insufficiency
A Patient Quality of Life Concern
Central vision based
› Refractive conditions
› Cataracts
› Macular Degeneration
› Amblyopia
Peripheral vision based
› Glaucoma
› Visual Field Loss after stroke (CVA)
Anterior segment
› Acute Conjunctivitis
› Dry Eyes
› Allergies
Strabismus
A disease that affects over 21 million in the United States
Massive research effort over 10 years by the CITT Group
Latest study (2008) NEI funded $6.1 M. multicenter including: The Mayo Clinic, Bascom Palmer and 6 Colleges of Optometry around the US.
Can cause behaviors that appear to be ADD/ADHD, reading and learning problems
There is a cure!
What is convergence insufficiency (CI)?
› Clinical presentation
What to look for in the patient exam?
› Symptom profile
› Easy screening test
What you can do to help
Wikipedia: Convergence insufficiency is a
sensory and neuromuscular anomaly of the
binocular vision system, characterized by an
inability of the eyes to approach each other,
or sustain convergence
Affects people of all ages
Impact on lives can be significant
It has had extensive research
The correct treatment is efficacious and
permanent
Missed in vision screenings
CI patients routinely have 20/20
Children with CI may not complain about their eyes to their parents or tell the family physician
Most CI patients have “quality of life” symptoms which are over looked in routine screenings
Avoids near centered visual tasks like
reading
Eyes hurt or strain with sustained reading
Headaches associated with sustained
reading
Words have illusory movement or overlap
(double) when reading
A patient who is a slow reader
A patient who is thought to have attention
deficit disorder
A patient who is not trying or is just “lazy”
when it comes to school work
Attention deficit for reading
Frustration with emotional overload
Reduced self esteem
Avoidance of academic work
Anxiety
Depression
Reduced social and physical involvement
…if your reading did this?
What is the chance that a school-age child
will have convergence insufficiency?
A. <1%
B. 2-4%
C. 5-13%
D. 20-25%
What is the chance that a school-age child
will have convergence insufficiency?
A. <1%
B. 2-4%
C. 5-13%
D. 20-25%
1:12 children will have CI
Ask a few basic questions
Run a basic, yet important screening test
Does your child have trouble staying on task
during a reading activity?
Do they have headaches with reading?
Turn to the child and ask, “Do you ever see words
do this?”
Do you ever see words overlap when reading?
(Double vision demo)
Do you have trouble staying on task during a
reading activity?
Do you experience headaches or eye
fatigue/strain with reading?
The (NPC) is measured by bringing the test
target to the nose and observing when the
patient sees double, or one eye deviates out.
NPC ( receded 5cm or recovery greater than
7cm)
Penlight Red/Green- Near Point of
Convergence Test (PLRG NPC)
ArchOphthalmol. 2008;126(10):1336-1349
› Scheiman, et al. Randomized Clinical Trial of
Treatments for Symptomatic Convergence
Insufficiency in Children
› $6.1million NEI funded
› Multi-center study
Mayo Clinic, Bascom Palmer, University of California, OSU,
SUNY, NOVA, PCO, UAB, SCCO,
› Masked, Prospective, Placebo Controlled
Pencil push-up “eye exercises”
Home-based activities on computer
programs
Office-based professionally guided vision
therapy with home reinforcement
› Home-Based Pencil Push-ups (HBPP) no better
than placebo therapy. Neither (HBPP) or placebo
effective in reducing signs/symptoms of CI
› Pencil push-ups and home-based computer vision
therapy (HBCVAT+) no better than placebo
therapy
› Office-based vision therapy(OBVT) IS effective in
treating CI in children
Office-based, doctor supervised Optometric Vision
Therapy Effective!
Screen
Recognize
Inform
PLRG NPC
Symptom Checklist
Recognize the symptoms › Avoids near centered visual tasks like reading
› Eyes hurt or strain with sustained reading
› Headaches associated with sustained reading
› Words have illusory movement or overlap (double) when reading
Diagnose receded NPC
Provide CI literature
Advise further diagnostic evaluation
Prescribe treatment
Optometric Vision Therapy IS NOT eye exercises!!
Vision Therapy is rehabilitation treatment of the visual brain with proven applications in neuroscience
1. Visual awareness
2. Feedback
3. Loading -Action, movement and relevance
CITT Study – Archives of Ophthalmology
Near point of Convergence Normative Data Research – Journal of Vision Science
Scheiman –CI Website
VisionHelp Blog- http://visionhelp.wordpress.com › CI: The Private Eye Goes Public – Part 1
› CI:The Private Eye Goes Public -Part 3…who’s looking out for the kids?
› All Topics on VisionHelp Blog on CI
› Applying Neuroplasticity to Optometric Care
College of Optometrists in Vision Development www.covd.org
CITT Study – Archives of Ophthalmology
Near point of Convergence Normative Data Research – Journal of Vision Science
Scheiman –CI Website
VisionHelp Blog- http://visionhelp.wordpress.com › CI: The Private Eye Goes Public – Part 1
› CI:The Private Eye Goes Public -Part 3…who’s looking out for the kids?
› All Topics on VisionHelp Blog on CI
› Applying Neuroplasticity to Optometric Care
College of Optometrists in Vision Development www.covd.org