convergence insufficiency treatment

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. Investigators from the Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART) published the results online today in Optometry and Vision Science. Jonathan Jassey, DO, is a board-certified private pediatrician at Bellmore Merrick Medical in Bellmore, New York. Convergence Insufficiency (CI) is a common binocular (two-eyed) vision disorder in which the eyes do not work at near easily. Occasionally patients require prism glasses. doi:10.1371/journal.pone.0211039. In contrast, a Pseudo-CI patient would benefit from an add to help the focusing system. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. 2008; 126:1336-1349. Accessed May 5, 2020. 2009; 86:1096-1103. 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. Convergence describes the way our eyes move together and point inward when we look at near objects. It is a disorder involving binocular vision — vision using both eyes. Treatment for convergence insufficiency might take three months or longer. Although you can have one without the other, they often both cause a problem because accommodation and convergence are closely intertwined neurologically. 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. Effective Treatment of Convergence Insufficiency. Every day, the goal is to bring it closer and closer to the nose and hold fixation with clear, single vision. Softing Hataye AL (expert opinion). The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. 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. How is convergence insufficiency (CI) managed or treated? Abstract. But home treatment costs less and is more convenient and more readily available. All rights reserved. Convergence Insufficiency. The relationship between convergence … 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 pencil is slowly brought toward the bridge of the nose. All four CITT RCTs were rated at low risk of bias. There are several characteristics that eye doctors look for when properly diagnosing convergence insufficiency. The Neurology of Eye Movements. Middle East Afr J Ophthalmol. eye focusing and/or eye movement problems). This content does not have an English version. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. A phoria is the natural resting position of the eye. Convergence Insufficiency Treatment Trial Study Group. This site complies with the HONcode standard for trustworthy health information: verify here. Causes of horizontal strabismus in children. Convergence insufficiency (CI) is a vision disorder. Abstract. 2018;18(6):2. doi:10.1167/18.6.2, Hassan LI, Ibrahim SM, Abdu M, Mohamedsharif A. There is also a computer program available which may be used on a home computer … Orthoptic therapy is the primary treatment modality used by most eye care professionals for the treatment of CI. Accessed May 5, 2020. American Association for Pediatric Ophthalmology and Strabismus [internet]. PLoS ONE. Make a donation. Prevalence of convergence insufficiency among secondary school students in Khartoum, Sudan. Home-based treatment with pencil pushups or computer programs hasn't been shown to be as effective. It interferes with a person's ability to see, read, learn, and work at near distances. 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.. https://aapos.org/glossary/convergence-insufficiency. 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. If a child is acting out in class, it could be due to a vision problem such as convergence insufficiency. Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. Pencil pushups. 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. CI affects children and adults. Bookmark us! Przekoracka-krawczyk A, Michalak KP, Pyżalska P. Deficient vergence prism adaptation in subjects with decompensated heterophoria. Oman J Ophthalmol. Eye movement exercises treat CI. But for people with symptoms, treatment with eye-focusing exercises can increase the eyes' convergence ability. The best treatment for CI is supervised vision therapy in a clinical office … 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. Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. 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. Vis Dev Rehabil. Standard eyeglasses, contact lenses, medications or surgery can not fix 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. Symptoms in children with convergence insufficiency: before and after treatment. Both optometry and ophthalmology were co-authors of this study. They may be performed with an orthoptist or therapist in the doctor’s office and repeated at home. Vision therapy can be prescribed when a comprehensive eye examination indicates that it is an appropriate treatment option. A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work.. Convergence insufficiency is usually diagnosed in school-age children and adolescents. Harrison RL. Concussion Treatment: Convergence Insufficiency . Convergence Insufficiency Treatment. When reading, people with convergence insufficiency frequently lose their place or have to re-read text. The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. 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. Treatment of Convergence Insufficiency. Pencil pushups. The plasticity of the fusional convergence reflex system allows patients to improve their convergence amplitudes with simple exercises. Convergence insufficiency is a vision and eye disorder common in children and young adults. 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. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer – Mayo Clinic Health Letter, New Year Special -  40% off – Mayo Clinic Diet Online. During pencil push-ups, the patient follows a small letter or picture on a pencil. She/He can only report their observations and recommend follow up with the appropriate health care provider. Convergence Insufficiency. Because the activities are based on the vision problem, each treatment plan is specifically tailored. It is important to note that an OT cannot diagnose a convergence insufficiency. 5. Granet DB, Gomi CF, Ventura R, Miller-Scholte A. First, eye doctors find that a patient suffering from convergence insufficiency has a large exophoria. NEW: Convergence Insufficiency Treatment Trial - Attention and Reading Study (CITT-ART) Participants Needed for new CITT-ART study. 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. Double vision is a relatively common problem, and is responsible for 850,000 visits to the doctor and hospital each year. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. 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. 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. When reading, people with convergence insufficiency frequently lose their place or have to re-read text. If convergence insufficiency isn’t causing symptoms, you generally don’t need treatment. Ostrow GI, Del Monte MA, Al-Hashimi MR. Convergence Insufficiency. J Vis. Convergence Insufficiency Treatment Trial Study Group. 2019;14(1):e0211039. As a result, they cannot converge as much as required. Effects of visual distractors on vergence eye movements. 2015;22(1):97-102. doi:10.4103/0974-9233.148357. This new clinical trial, CITT-ART, was designed to determine whether treating symptomatic CI would … 2015;1(3):214-228. He is an active member of the American Optometric Association. Most eye care professionals treat convergence insufficiency using a home-based therapy called pencil push-ups. Treatments can include: Glasses (Lenses) A lens prescription can be very helpful in some cases. Pencil pushups are usually the first line of treatment for convergence insufficiency. These exercises improve the eyes’ ability to move inward together. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. Treatment . Oxford University Press; 2015. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. 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. If this add is given to a CI patient, it could exacerbate the symptoms. Advertising revenue supports our not-for-profit mission. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). 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. 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. 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. Mayo Clinic is a not-for-profit organization. They tend to have poor attention and often tire more easily when reading. Learn More. These exercises improve the eyes’ ability to move inward together. Eye doctors can measure this ratio to see if it is outside normal limits. Barnhardt C, Cotter SA, Mitchell GL, Scheiman M, Kulp MT. Convergence exercises (ie, orthoptics, vision therapy) and/or base-in prisms are the mainstays of treatment for convergence insufficiency. Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. Nelson: Today we're going to discuss the treatment of convergence insufficiency. The patient starts off drawing the pencil closer to the nose. To diagnose convergence insufficiency, your eye doctor might: If convergence insufficiency isn't causing symptoms, you generally don't need treatment. 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. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. Arch Ophthalmol, Oct 2008. This can cause eye strain, headaches, blurred and double vision. Some people with convergence insufficiency complain of double vision.. Previous CITT Study. 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. 2008 Jan-Feb. 15 (1):24-36. . But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. 2012;89(10):1512-20. doi:10.1097/OPX.0b013e318269c8f9. According to Dr. Begotka, convergence insufficiency is the most common vision problem at the clinic. However, doctors now have evidence that office-based vision therapy with a trained therapist plus at-home therapy reinforcement can treat the condition and eliminate symptoms. American Association for Pediatric Ophthalmology and Strabismus. Convergence describes the way our eyes move together and point inward when we look at near objects. Convergence insufficiency. Nelson: Today we're going to discuss the treatment of convergence insufficiency. A number of research studies have proven the effectiveness of the vision therapy treatment of convergence insufficiency. Click here to review the symptoms of convergence insufficiency, or here … Pencil pushups. 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. Convergence insufficiency is not usually detected on regular vision screenings. This allows us to have good fusion and binocular vision so that our eyes maintain one single image. 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). The main treatment for convergence insufficiency is vision therapy. 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. Accessed May 5, 2020. Convergence Insufficiency – Testing, Diagnosis, and Treatment Adequate testing and diagnosis for Convergence Insufficiency is not widely available. Orthoptics and vision therapy. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Of these, the Convergence Insufficiency Treatment Trial (CITT) Investigator Group completed four RCTs with 737 participants. Convergence Insufficiency Treatment Trial Study Group. Optom Vis Sci. NEI is part of the National Institutes of Health. Ways to treat Convergence Insufficiency include prism readers and vision therapy. Coats DK, et al. Optom Vis Sci. The most commonly prescribed treatment is home-based exercises, such as pencil push-ups, although specific methodologies vary among practitioners. Previous CITT Study. Convergence insufficiency can often be treated by practicing convergence through exercises. 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. Scheiman M, Mitchell GL, Cotter SA, et al. 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. Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. Elsevier; 2021. https://www.clinicalkey.com. The goal is to keep the letter clear and single with no double vision. Scheiman et al. Accommodation is the automatic reflex that occurs when we focus on a near object. Updated 26 Feb 2019. The history of convergence insufficiency treatment is more than 150 years old but nowadays the most prevalent and important treatment option are orthoptic exercises. CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. The treatments aim to treat convergence insufficiency – for which there is supporting evidence – and a range of neurological, educational and spatial difficulties – uses which are not supported by good evidence. Yaramothu C, Santos EM, Alvarez TL. In contrast, a Pseudo-CI patient would benefit from an add to help the focusing system. People with convergence insufficiency might have otherwise normal vision, so it's important to mention reading or learning concerns to your eye care provider. 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. 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. Arch Ophthalmol. With CI, the eyes do not point together inward as one looks at objects close-up. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. What is the method of treatment for convergence insufficiency? Normally eye exercises, which can be practised at home, are recommended. A program of vision therapy may be needed to improve eye coordination abilities, reduce symptoms, and alleviate discomfort when doing close work. In: Ophthalmology. Convergence insufficiency (CI) is a vision disorder. Eye movement exercises treat CI. Effective Treatment of Convergence Insufficiency. 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. A person can pass the 20/20 eye chart test and still have convergence insufficiency. People with low fusional reserves have no room to compensate. Accessed May 5, 2020. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. … Friedman N, et al. Updated 15 Nov 2019. A special power that moves images is called prism and can be put into an eyeglass prescription. What are your criteria for making the diagnosis of convergence insufficiency… R. John Leigh and David S. Zee. If convergence insufficiency isn't causing symptoms, you generally don't need treatment. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/convergence-insufficiency. People with convergence insufficiency often have an inadequate amount of convergence per the amount of accommodation that their eye is doing. Treatment of Convergence Insufficiency. As a result, a higher amount of prism must be prescribed to achieve the same effect. 5th ed. 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. Elsevier; 2019. https://www.clinicalkey.com. The convergence insufficiency treatment trial: design, methods, and baseline data. Discuss treatment options with your eye care professional. Arch Ophthalmol, Oct 2008. A normal NPC can be as little as 1 cm or even all the way to the nose. 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 … American Academy of Ophthalmology, Eye Wiki [internet]. The accommodative system and the convergence system of the eye are closely intertwined and one can affect the other. The pencil is slowly brought toward the bridge of the nose. It is a disorder involving binocular vision — vision using both eyes. Loss of fusional vergence with partial loss of accommodative convergence and accommodation following … But for people with signs, treatment with eye-focusing exercises can high the eyes’ convergence ability. 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. People with normal vision have quite a large range of which they can move their eyes together quickly to maintain good binocular vision. Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they should. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Although earlier studies of the treatment of convergence insufficiency were less rigorous, a review by Grisham 5 at the University of California, Berkeley School of Optometry, had found that optometric vision therapy corrected problems in 72% of cases. The most common issues that tend to arise and be addressed at physical therapy include musculoskeletal issues to the cervical spine and head, … Often, the only way it can be properly diagnosed is to see an eye doctor, either an optometrist or ophthalmologist. Pencil push-ups are repeated for 10-15 minutes per day., Because results of pencil push-ups varied so much, a study was conducted by the National Eye Institute is known as the Convergence Insufficiency Treatment Trial (CITT). 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. 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. Diagnostic criteria and outcome measures were identical or similar among these trials. Prism causes the images to be displaced so that a person with convergence insufficiency does not have to converge as much. This does not cure the condition but it does resolve many symptoms. A single copy of these materials may be reprinted for noncommercial personal use only. Accessed May 5, 2020. It is important to note that an OT cannot diagnose a convergence insufficiency. National Eye Institute. June 28, 2020. Standard eyeglasses, contact lenses, medications or surgery can not fix Convergence Insufficiency. Patients who only did at-home vision therapy did not experience a decrease in their symptoms. Scheiman Vision Therapy [internet]. Mayo Clinic. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Convergence insufficiency treatment. This was the first well-designed study comparing the different treatments. In children, convergence insufficiency can often be treated by practicing convergence through exercises. If convergence insufficiency isn't causing symptoms, you generally don't need treatment. Yanoff M, et al., eds. These exercises, such as pencil push-up, can all be performed at home yet they might not engage the patient enough. The value of differentiating Convergence Insufficiency from a Pseudo-CI is catering the treatment. [6, 26] Pencil push-ups require fixation on a near target such … 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. If our eyes do not converge sufficiently, we may have difficulty reading and even experience double vision.

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