Treatment of Convergence Insufficiency. Convergence Insufficiency (CI) is a common binocular (two-eyed) vision disorder in which the eyes do not work at near easily. 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. Surgery is usually the last resort for convergence insufficiency since the condition responds so well to vision therapy. Randomized clinical trial of treatments for convergence insufficiency in children. If a child is acting out in class, it could be due to a vision problem such as convergence insufficiency. The Convergence Insufficiency Treatment Trial (CITT) is a prospective, masked, placebo-controlled, multi-center clinical trial in which 208 subjects between the ages of 9 to < 18 years were randomly assigned to: 1) Home-based Pencil Push-Up Therapy, 2) Home-based Pencil Push-ups with Computer Vision Therapy/Orthoptics, 3) Office-based Vision Therapy/Orthoptics, or 4) Placebo Office-based Vision … Prevalence of convergence insufficiency among secondary school students in Khartoum, Sudan. Harrison RL. Effective Treatment of Convergence Insufficiency. Accessed May 5, 2020. The study found that approximately 75 percent of those who received in-office therapy by a trained therapist plus at-home treatment reported fewer and less severe symptoms related to reading and other near work compared to individuals who had home-based vision therapy alone.. Patients who only did at-home vision therapy did not experience a decrease in their symptoms. First, eye doctors find that a patient suffering from convergence insufficiency has a large exophoria. Updated 15 Nov 2019. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Treatment of Convergence Insufficiency. Softing Hataye AL (expert opinion). 2019;14(1):e0211039. Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they should. In a practical definition, patients with this condition are unable to maintain the esodeviation required for near tasks. People with convergence insufficiency often complain of the following symptoms when reading or doing intense near work:. Eye movement exercises treat CI. 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. Every day, the goal is to bring it closer and closer to the nose and hold fixation with clear, single vision. Orthoptics and vision therapy. This content does not have an English version. The patient starts off drawing the pencil closer to the nose. All rights reserved. Vergence Eye Movements. A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work.. NEI is part of the National Institutes of Health. It is a disorder involving binocular vision — vision using both eyes. A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work. Disorders of supranuclear control of ocular motility. Bookmark us! Accessed May 5, 2020. As a result, they cannot converge as much as required. Madhura A. Tamhankar, in Liu, Volpe, and Galetta's Neuro-Ophthalmology (Third Edition), 2019. Parents should know that convergence insufficiency can cause numerous symptoms that make it difficult to read and comprehend. 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. Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. The convergence insufficiency treatment trial: design, methods, and baseline data. The Convergence Insufficiency Treatment Trial Group found that for adults aged 19-30, 50% receiving office-based vision therapy for CI were either “improved” or “cured” after 12 weeks based on symptoms and clinical measures. There is also a computer program available which may be used on a home computer … A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work.. This allows near objects to become clear. J Vis. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. Effective Treatment of Convergence Insufficiency. Scheiman M, Mitchell GL, Cotter SA, et al. How is convergence insufficiency (CI) managed or treated? These exercises improve the eyes’ ability to move inward together. But for people with symptoms, treatment with eye-focusing exercises can increase the eyes' convergence ability.Treatment, which can take place in the office of a trained therapist or at your home, might include: 1. Friedman N, et al. To diagnose convergence insufficiency, your eye doctor might: If convergence insufficiency isn't causing symptoms, you generally don't need treatment. A number of research studies have proven the effectiveness of the vision therapy treatment of convergence insufficiency. Arch Ophthalmol, Oct 2008. The CITT study (Convergence Insufficiency Treatment Trial) was is a randomized, double-blind multi-center trial (high level of reliability) indicates that Orthoptic Vision Therapy is an effective method of treatment of convergence insufficiency (CI). In this exercise, you focus on a small letter on the side of a pencil as you move it closer to the bridge of your nose, stopping as soon as you see double. Normally eye exercises, which can be practised at home, are recommended. NEW: Convergence Insufficiency Treatment Trial - Attention and Reading Study (CITT-ART) Participants Needed for new CITT-ART study. Convergence Insufficiency - Testing, Diagnosis, and Treatment Adequate testing and diagnosis for Convergence Insufficiency is not widely available. Treatment, which can take place in the office with a trained therapist or at your home, might include: Recent studies indicate that office-based therapy with home reinforcement is the most effective treatment for convergence insufficiency. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Ophthalmic Epidemiol. They may be performed with an orthoptist or therapist in the doctor’s office and repeated at home. 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. Treatment for convergence insufficiency might take three months or longer. Eyeglasses, eye patches or surgery usually don’t improve CI. Convergence Insufficiency – Testing, Diagnosis, and Treatment Adequate testing and diagnosis for Convergence Insufficiency is not widely available. As a result, a higher amount of prism must be prescribed to achieve the same effect. PLoS ONE. But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. Eye coordination problems like convergence insufficiency generally cannot be improved with eye glasses or surgery. This condition causes one eye to turn outward instead of inward with the other eye creating double or blurred vision.Convergence insufficiency is usually diagnosed in school-age children and adolescents. A single copy of these materials may be reprinted for noncommercial personal use only. During pencil push-ups, the patient follows a small letter or picture on a pencil. Convergence insufficiency. The pencil is slowly brought toward the bridge of the nose. Make a donation. Often, the only way it can be properly diagnosed is to see an eye doctor, either an optometrist or ophthalmologist. Orthoptic therapy is the primary treatment modality used by most eye care professionals for the treatment of CI. But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. The accommodative system and the convergence system of the eye are closely intertwined and one can affect the other. Concussion Treatment: Convergence Insufficiency . She/He can only report their observations and recommend follow up with the appropriate health care provider. By using Verywell Health, you accept our, Lacrimal Bone: Anatomy, Function, and Treatment, How to Use Visual Therapy Exercises for Lazy Eye, Focusing Problems in Children and How to Fix Them, 8 Ways to Reduce Eye Strain While Working From Home, What You Should Know About Viral Conjunctivitis. Convergence insufficiency is a vision and eye disorder common in children and young adults. Convergence insufficiency is not usually detected on regular vision screenings. Convergence Insufficiency. Convergence Insufficiency. Learn More. A special power that moves images is called prism and can be put into an eyeglass prescription. These exercises improve the eyes’ ability to move inward together. 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. Sometimes children and young adults with convergence insufficiency also have accommodative 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. 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. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. The problem with prism is that some people can adapt to it. But for people with symptoms, treatment with eye-focusing exercises can increase the eyes' convergence ability. They may be performed with an orthoptist or therapist in the doctor’s office and repeated at home. Yaramothu C, Santos EM, Alvarez TL. NEW: Convergence Insufficiency Treatment Trial - Attention and Reading Study (CITT-ART) Participants Needed for new CITT-ART study. Coats DK, et al. Learn More. 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. 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. Treatment for both convergence insufficiency and convergence excess varies for each case and depends on the severity of the problem and the presence of other functional vision problems (e.g. The value of differentiating Convergence Insufficiency from a Pseudo-CI is catering the treatment. https://aapos.org/glossary/convergence-insufficiency. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. What are your criteria for making the diagnosis of convergence insufficiency… Jonathan Jassey, DO, is a board-certified private pediatrician at Bellmore Merrick Medical in Bellmore, New York. This can cause eye strain, headaches, blurred and double vision. The Neurology of Eye Movements. 2018;11(2):129-133. doi:10.4103/ojo.OJO_170_2017. This condition causes one eye to turn outward instead of inward with the other eye, creating double or blurred vision. It is important to note that an OT cannot diagnose a convergence insufficiency. In-office Optometric Vision Therapy is proven to be the most effective treatment for Convergence Insufficiency by a national multi-site peer-reviewed study which was conducted by the National Institutes of Health/National Eye Institute in the United States. Accessed May 5, 2020. People with low fusional reserves have no room to compensate. June 28, 2020. Treatment Eye coordination problems like convergence insufficiency generally cannot be improved with eye glasses or surgery. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. Investigators from the Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART) published the results online today in Optometry and Vision Science. Causes of horizontal strabismus in children. CI affects children and adults. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. Convergence Insufficiency Treatment Trial Study Group. Vis Dev Rehabil. Convergence insufficiency (CI) is a vision disorder. This new clinical trial, CITT-ART, was designed to determine whether treating symptomatic CI would … Arch Ophthalmol. Occasionally patients require prism glasses. The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. Accessed May 5, 2020. The history of convergence insufficiency treatment is more than 150 years old but nowadays the most prevalent and important treatment option are orthoptic exercises. This was the first well-designed study comparing the different treatments. Accessed May 5, 2020. Convergence insufficiency . Concussion Treatment: Convergence Insufficiency A concussion can affect many systems of the body, including but not limited to the visual, musculoskeletal, vestibular, cardiovascular, central nervous, and peripheral nervous systems. Ostrow GI, Del Monte MA, Al-Hashimi MR. Convergence Insufficiency. Loss of fusional vergence with partial loss of accommodative convergence and accommodation following … Eye coordination problems like convergence insufficiency generally cannot be improved with eye glasses or surgery. Home-based treatment with pencil pushups or computer programs hasn't been shown to be as effective. Scheiman Vision Therapy [internet]. Double vision, also known as diplopia, is a common symptom of convergence insufficiency, lazy eye and strabismus, though it can also result … Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. Arch Ophthalmol, Oct 2008. Patients who only did at-home vision therapy did not experience a decrease in their symptoms. Treatment; Overview. 2015;1(3):214-228. If this add is given to a CI patient, it could exacerbate the symptoms. According to Dr. Begotka, convergence insufficiency is the most common vision problem at the clinic. Convergence exercises (ie, orthoptics, vision therapy) and/or base-in prisms are the mainstays of treatment for convergence insufficiency. 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. If convergence insufficiency isn't causing symptoms, you generally don't need treatment. Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART): Design and Methods. But home treatment costs less and is more convenient and more readily available. People with convergence insufficiency often have an inadequate amount of convergence per the amount of accommodation that their eye is doing. What is the method of treatment for convergence insufficiency? 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 treatment. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. The study found that in-office Vision Therapy was the best available treatment for convergence insufficiency, replacing conventional therapies such as "pencil push-ups", with 75% of patients showing significant improvement following vision therapy. Scheiman et al. The best treatment for CI is supervised vision therapy in a clinical office … The relationship between convergence … Convergence describes the way our eyes move together and point inward when we look at near objects. In contrast, a Pseudo-CI patient would benefit from an add to help the focusing system. Convergence Insufficiency Symptoms and Treatment, Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. Thank you, {{form.email}}, for signing up. With CI, the eyes do not point together inward as one looks at objects close-up. Treatment of Convergence Insufficiency. Results from the earlier Convergence Insufficiency Treatment Trial (CITT), published in Ophthalmology in 2008, showed office-based vision therapy to be the most effective treatment for improving convergence and ameliorating symptoms, and that treatment effects were long-lasting. A person can pass the 20/20 eye chart test and still have convergence insufficiency. Every day, the goal is to bring it closer and closer to the nose and hold fixation with clear, single vision. National Eye Institute. Pencil pushups are usually the first line of treatment for convergence insufficiency. Abstract. This content does not have an Arabic version. How is convergence insufficiency (CI) managed or treated? Most likely one to two children in every classroom have this condition. Children with convergence insufficiency are often thought to be lazy or disruptive in the classroom. The muscle in the eye, as well as the lens, changes to allow increasing focusing power. A normal NPC can be as little as 1 cm or even all the way to the nose. The goal is to keep the letter clear and single with no double vision. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). This allows us to have good fusion and binocular vision so that our eyes maintain one single image. The most common issues that tend to arise and be addressed at physical therapy include musculoskeletal issues to the cervical spine and head, … 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 Symptoms. Mayo Clinic is a not-for-profit organization. The patient starts off drawing the pencil closer to the nose. Ophthalmic Epidemiol. Mayo Clinic. Pencil pushups. Fulton Eyecare Center [internet]. Optom Vis Sci. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. In children, convergence insufficiency can often be treated by practicing convergence through exercises. A concussion can affect many systems of the body, including but not limited to the visual, musculoskeletal, vestibular, cardiovascular, central nervous, and peripheral nervous systems. 5th ed. Background: Convergence insufficiency is a common binocular vision disorder in which the eyes have a strong tendency to drift outward (exophoria) with difficulty turning the eyes inward when reading or doing close work. It is important to note that an OT cannot diagnose a convergence insufficiency. People with convergence insufficiency might have otherwise normal vision, so it's important to mention reading or learning concerns to your eye care provider. These exercises, such as pencil push-up, can all be performed at home yet they might not engage the patient enough. This site complies with the HONcode standard for trustworthy health information: verify here. Read our, Medically reviewed by Johnstone M. Kim, MD, Medically reviewed by Jonathan B. Jassey, DO, Verywell Health uses cookies to provide you with a great user experience. Convergence Insufficiency Treatment Trial Study Group. Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. RESULTS: At baseline, the Convergence Insufficiency Treatment Trial cohort’s mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. Treatment can resolve convergence insufficiency, but symptoms might recur after illness, after lack of sleep, or when you're doing a lot of reading or other close work. Pencil push-ups are repeated fo… 5th ed. Normally eye exercises, which can be practised at home, are recommended. Discuss treatment options with your eye care professional. Both optometry and ophthalmology were co-authors of this study. The convergence insufficiency treatment trial: design, methods, and baseline data. Sometimes the treatment can be as simple as a set of glasses with an appropriate prism in the lenses, but in my experience the treatment usually ends up being vision therapy. The pencil is slowly brought toward the bridge of the nose. Most eye care professionals treat convergence insufficiency using a home-based therapy called pencil push-ups. Vision therapy uses various exercises to train the connection between the eyes and the brain as more than 50% of the brain is dedicated to visual function. Elsevier; 2021. https://www.clinicalkey.com. 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. The main treatment for convergence insufficiency is vision therapy. Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. Significance: These data confirm the effectiveness of office-based vergence/accommodative therapy for improving convergence in children with symptomatic convergence insufficiency. Nelson: Today we're going to discuss the treatment of convergence insufficiency. Orthoptics and vision therapy. Occasionally patients require prism glasses. Diagnostic criteria and outcome measures were identical or similar among these trials. Eye doctors can measure this ratio to see if it is outside normal limits. Convergence insufficiency (CI) is a vision disorder. In fact, pediatric or behavioral vision optometrists or ophthalmologists are better experts in dealing with this condition. Convergence Insufficiency Treatment Trial Study Group. Przekoracka-krawczyk A, Michalak KP, Pyżalska P. Deficient vergence prism adaptation in subjects with decompensated heterophoria. Yanoff M, et al., eds. Elsevier; 2019. https://www.clinicalkey.com. The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. Some people with convergence insufficiency complain of double vision.. Previous CITT Study. 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. Advertising revenue supports our not-for-profit mission. 2008 Jan-Feb. 15 (1):24-36. . Writer Bio. They are said to have a low accommodative-convergence/accommodative ratio. Do You Have Symptoms of Macular Degeneration? There are several characteristics that eye doctors look for when properly diagnosing convergence insufficiency. Patients with convergence insufficiency describe horizontal diplopia at near, typically after a period of reading. Although you can have one without the other, they often both cause a problem because accommodation and convergence are closely intertwined neurologically. The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. Research conducted by the College of Optometrists in Vision Development (COVD) and the National Eye Institute have found that office-based vision therapy, supported by at-home vision therapy, is the best treatment for convergence insufficiency. Miguel Cavazos is a photographer and fitness trainer in Los Angeles who began writing in 2006. Abstract. If our eyes do not converge sufficiently, we may have difficulty reading and even experience double vision. Clinical Study: Convergence Insufficiency Treatment Trial A study from the National Eye Institute indicated 75 percent of patients who received in-office vision therapy by a trained therapist as well as performed at-home vision therapy treatment reported fewer and less severe symptoms regarding reading and other near work. 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. 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. With CI, the eyes do not point together inward as one looks at objects close-up. There are numerous different types of eye exercises; however, the primary treatment modalities for CI include home-based exercise, in-office exercises, computer vergence exercises or a combination of these. Click here to review the symptoms of convergence insufficiency, or here … 5. What is convergence insufficiency (CI)? https://www.uptodate.com/contents/search. 2012;89(10):1512-20. doi:10.1097/OPX.0b013e318269c8f9. Pencil pushups. People with normal vision have quite a large range of which they can move their eyes together quickly to maintain good binocular vision. The plasticity of the fusional convergence reflex system allows patients to improve their convergence amplitudes with simple exercises. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. It often goes undiagnosed. Oxford University Press; 2015. In contrast, a Pseudo-CI patient would benefit from an add to help the focusing system. In this exercise, you focus on a small letter on the side of a pencil as you move it closer to the bridge of your nose, stopping as soon as you see double. Therapy is the primary treatment modality used by most eye care professionals for treatment... Prisms are the main treatment for convergence insufficiency generally can not converge as much as required in which eyes! ( MFMER ) insufficiency symptoms and signs associated with convergence insufficiency: and! Ⓒ 2021 About, Inc. ( Dotdash ) — all rights reserved a period of reading problems like insufficiency..., typically after a period of reading your agreement to the nose and hold fixation with clear, vision... Than 150 years old but nowadays the most prevalent and important treatment convergence insufficiency treatment nearby... Letter clear and single with no double vision are diagnosed by an optometrist, lenses! Lenses or vision therapy may be needed to improve eye coordination problems like convergence insufficiency: before and after...., and treatment, Ⓒ 2021 About, Inc. ( Dotdash ) — all rights.... Which your eyes are unable to work together when looking at nearby objects Strabismus [ internet ] generally can diagnose. 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