The Symptoms

What is Convergence Insufficiency?

Convergence insufficiency palsy syndrome is the general name given to several functional eye  problems ,which are related to the coordination of both eyes together  while  focusing, particularly for near.

“Convergence insufficiency is a common condition that is characterized by a patient ‘s inability to maintain proper binocular eye alignment on objects as they approach from distance to near. There is typically an exophoria or intermittent exotropia at near, a receded near point of convergence, reduced positive fusional convergence amplitudes, and a low accommodation convergence/accommodation (AC/A) ratio. The symptoms associated with convergence insufficiency vary from mild to severe, but they are often extremely troublesome for patients with this condition, especially when associated with a small angle exotropia at the near working distance causing binocular diplopia.” (MichaelJ Bartiss, OD, MD; Chief Editor: Hampton Roy Sr, MD)

Who suffers from convergence insufficiency?

Convergence insufficiency might appear at any age. At the same time, it primarily affects 7%-20% children in the lower grades, particularly during the period when there is an increasing need for lengthy reading periods and reading comprehension. Students during exam period might also suffer from these problems due to the significant strain on the vision that is required.

What are common convergence insufficiency problems?

Common vision focus problems include:

• Difficulty in focusing on reading material over a lengthy period of time
• Difficulty of eyes converging inwards during reading or in looking at objects that are close by
• Strabismus of one eye in a certain direction, occasionally.
• Hidden strabismus (Phoria), a condition in which the eye’s muscles regularly strain to prevent strabismus and during fatigue, do not manage to overcome the problem.
• Difficulty in focusing during the transition between distant sight vision to near sighted vision or vice versa, e.g. when copying off the blackboard into a notebook.

What are the symptoms of convergence insufficiency?

Every one of these problems might cause headaches and eye pain,intermittent double vision or blurring, fatigue, difficulty in reading, difficulty in near-sighted vision, excessive blinking and general discomfort.

In children, this may be reflected in learning difficulties, attention deficit, learning disorders, tiredness or hyperactivity etc.

From a functional standpoint, people might be able to read for short periods of time only, frequently close one eye throughout the day, tilt their head in a certain direction when trying to read or see from a distance, and stand excessively close to the television screen or close to the book.

Is there a correlation between ADD or ADHD and convergence insufficiency?

Experts are divided!

At the same time, there is no question that a child suffering from focus problems might find studies difficult, might lack focus and might be disruptive.

As such, before carrying out a diagnosis for ADHD, a convergence insufficiency test, which is relatively easy to carry out, should be performed. This would prevent in many cases a child from being misdiagnosed with ADHD while he is actually suffering from convergence insufficiency.

The possibility of both problems existing should not be ruled out, and this makes the test particularly important.

Convergence insufficiency stems from the lack of normal coordination between both eyes – although each eye can demonstrate completely normal function – the eyes are incapable of focusing together on the same point. The source of the problem is not definitively known but some hypotheses posit that the problem is physiology of the eye muscles or linked to the brain center responsible for visual convergence on the observed object. This problem is apparently genetic, and frequently can be found among members of one family.

Convergence insufficiency generally appears in childhood but occasionally might appear in adulthood. Common signs that characterize CI include complaints of headaches, fatigue when reading (which occurs after fifteen minutes), switching of letters, blurred vision, blinking as well as double vision that occasionally occurs when tired. Double vision is significant, indicating that at other times, this can be avoided with a great deal of effort.

C.I.and dyslexia: Some of the symptoms of convergence insufficiency are extremely similar to those that characterize dyslexia. Children who suffer from CI might read the same line on a page several times because their eyes ability to focus is lost during the transition between lines, and they must use their finger to mark their place on the page. They occasionally find it difficult to copy text off the blackboard, suffer from accompanying attention deficit (when the eyes are not focused or see double, neither is their attention). For this reason, many are wrongly diagnosed with dyslexia while their real problem remains undiagnosed

Proper treatment of CI alleviates the symptoms and allows children (and adults) to fully maximize their skills. The lack of a proper diagnosis might lower the children’s selfesteem since their classmates tend to tease them and call them names. As a result, the children might become violent.

Other symptoms that might appear in small children include closing of the eye in bright light, awkward movement, running into table corners, fear of heights and field trips. CI can trigger family problems due to the decline in the child’s educational achievements.

In most cases, the teachers and preschool teachers generally notice that the child is not responding as expected. Despite the tremendous importance of a correct diagnosis, ophthalmologists and optometrists occasionally fail to do so. So it happens that mothers go to the ophthalmologists or another party and think that their child is suffering from something else because the issue of focus was tested and the eyes appeared normal!

For this reason, if a child complains of double vision, even if he has been tested in the past, parents must suspect that he is suffering from CI because double vision indicates an eye problem and is not related to dyslexia. In certain cases, a child has been discovered to be suffering from CI after he asked his mother if it was all right if he saw objects one or two times. Parents should ask themselves if the child is seeing double.

During the diagnosis, the child’s visual acuity was tested by the standard vision table. In addition, an eye cover test that examines whether the eyes have strabismus or not is carried out. Another test examines the convergence ability to focus separate images into one single  image, with the help of a special device. This device separates the image seen by one eye and the image seen by the other eye, and even allows for an examination of the maximal range in which the child is capable of holding the merged image (obtained from the merger of the 2 images seen by both eyes). Another test examines convergence using a prism bar (to clarify, eye convergence occurs when a finger approaches the nose).

Treatment is aimed to improve coordination between the two eyes through eye exercises.

Computer Vision Syndrome

In recent years, with the development of technology , the daily use of the computer both as work tools and as a source of enrichment and games,we can see the parallel development of CVS. CVS stands for Computer Vision Syndrome. Professional literature defines CVS as eyestrain resulting from prolonged and continuous use of a computer.CVS affects particularly convergence insufficiency’s suffering persons.the complaints are often very acute,like sore eyes, burning eyes, blurring or severe eyes pain, some can no more be able to maintain their gaze on the computer screen and have no choice but treat urgently.