Convergence insufficiency

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. The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near-visual function, abnormal fatigue, headache, and abnormal postural adaptation, among others. In some cases, difficulty with making eye contact have been noted as a complaint amongst those affected. Note that some Internet resources confuse convergence and divergence dysfunction, reversing them. Diagnosis of convergence insufficiency is made by an eye care professional skilled in binocular vision dysfunctions, such as an orthoptist, to rule out any organic disease. Convergence insufficiency is 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, and low fusional vergence ranges and/or facility. Some patients with convergence insufficiency have concurrent accommodative insufficiency—accommodative amplitudes should therefore also be measured in symptomatic patients. Convergence insufficiency can cause difficulty learning to read. Convergence insufficiency may be treated with convergence exercises prescribed by an eyecare specialist trained in orthoptics or binocular vision anomalies (see: vision therapy). Some cases of convergence insufficiency are successfully managed by prescription of eyeglasses, sometimes with therapeutic prisms. Pencil push-ups therapy is performed at home. The patient brings a pencil slowly to within of the eye just above the nose about fifteen minutes per day five times per week. Patients should record the closest distance that they could maintain fusion (keep the pencil from going double as long as possible) after each five minutes of therapy.