Convergence insufficiency

Convergence Insufficiency
Classification and external resources
ICD-10	H51.1
ICD-9	378.83
eMedicine	oph/553
MeSH	D015835

Convergence insufficiency or Convergence Disorder is a sensory and neuromuscular anomaly of the binocular vision system, characterized by an inability of the eyes to turn towards each other, or sustain convergence.

Symptoms

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. Note that some Internet resources confuse convergence and divergence dysfunction, reversing them.

Prevalence

In studies that used standardized definitions of Convergence insufficiency, investigators have reported a prevalence of 4.2% to 6% in school and clinic settings. The standard definition of Convergence insufficiency is exophoria greater at near than at distance, a receded near point of convergence, and reduced convergence amplitudes at near.

Diagnosis

Diagnosis of convergence insufficiency is made by an eye care professional skilled in binocular vision dysfunctions to rule out any organic disease. 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. Some patients with convergence insufficiency have concurrent accommodative insufficiency—accommodative amplitudes should therefore also be measured in symptomatic patients.

Treatment

Convergence insufficiency may be treated with convergence exercises prescribed by an eyecare specialist trained in orthoptics or binocular vision anomalies. Some cases of convergence insufficiency are successfully managed by prescription of eyeglasses, sometimes with therapeutic prisms.

Pencil push-ups therapy is performed at home. Patient brings a pencil slowly to within 2–3 cm of the eye just above the nose about 15 minutes per day 5 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 5 minutes of therapy. Computer software may be used at home or in an orthoptists office to treat convergence insufficiency. A weekly 60-minute in-office therapy visit may be prescribed. This is generally accompanied with additional in home therapy.

In 2005, the Convergence Insufficiency Treatment Trial (CITT) published two randomized clinical studies. The first, published in Archives of Ophthalmology demonstrated that computer exercises when combined with in-office based vision therapy was more effective than "pencil pushups" or computer exercises alone for convergency insufficiency in 9 to 18 year old children. The second found similar results for adults 19 to 30 years of age.

Surgical correction options are also available, but the decision to proceed with surgery should be made with caution as convergence insufficiency generally does not improve with surgery. Bilateral medial rectus resection is the preferred type of surgery. However, the patient should be warned about the possibility of uncrossed diplopia at distance fixation after surgery. This typically resolves within 1–3 months postoperatively. The exophoria at near often recurs after several years, although most patients remain asymptomatic.

See also

• Amblyopia
• Negative relative accommodation
• Positive relative accommodation
• Strabismus
• Orthoptics
• Ophthalmology
• Optometry

External links

• www.convergenceinsufficiency.org
• International Orthoptic Association
• New York Times article on convergence insufficiency
• Vision Disorder Responds Best to Office-Based Therapy Combined with Home-Based Computer Therapy peer-reviewed article from MedPage Today