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