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Convergence Insufficiency

Convergence Insufficiency

Convergence Insufficiency (CI) is a very common, though often subtle, deficit in visual information processing of the eye teaming variety. Put simply, CI shows up as an inability to effortlessly and consistently aim the two eyes at the same target. Our two eyes must converge in order to aim at the same thing at the same time. The closer the object or task, the greater the amount of convergence needed. CI is not a muscle problem (very few visual problems are) it is a problem of the brain not being able to use the two eyes in an integrated way while doing close work. CI is almost always responsive to vision therapy and proper lenses.


Nice convergence kiddo!

A study, begun in 1995 and published in 2005, looked at the efficacy of treatments for CI. The study was done under the auspices of National Eye Institute of the National Institutes of Health. The Convergence Insufficiency Treatment Trial (CITT), a rare cooperative endeavor between optometry and ophthalmology, determined unequivocally that office-based, optometric vision therapy provided much better outcomes than simple pencil push-ups. Pencil push-ups were essentially the only thing ophthalmologists prescribed for people with CI for many years. This procedure is nothing more than what it sounds like - look at a pencil and watch it as you move closer and farther from your nose. Seems simple enough, and it is. The only problem? It really doesn’t work, and even if it does, the effects typically don’t last very long.

The premise of pencil push-ups is that the eye muscles are too weak and will get stronger if you do push-ups with them. This sounds sensible unless you know that the eye muscles are much stronger than they need to be to do what they need to do. Damaged eye muscles are very rare, and if you had one, your visual problems would be much worse and more obvious than CI. Vision therapy is based on the understanding that CI is not a muscle problem, but a problem with the signals the brain is sending the eyes. Vision therapy provides a much more comprehensive approach to helping the brain learn how to use the eyes better.

Most eye doctors, pediatricians, school psychologists, teachers, etc. remain unaware of the presence of and complications resulting from CI. Convergence Insufficiency often results in behaviors and school performance deficits similar to those with ADD or ADHD. In fact, many children with CI are misdiagnosed as having ADD or ADHD.

Reading is an activity that requires a significant amount of convergence. Unfortunately, iPhones and similar hand-held devices demand even more convergence. Computers need slightly less since they tend to be a little farther away. People who have difficulty converging their eyes properly may get headaches, take much longer to complete work, avoid reading and/or develop adverse behaviors.

Unfortunately most regular eye exams will not uncover the condition. Complaints that make it obvious to a behavioral optometrist that there is an eye teaming problem, will often be brushed aside by most other doctors. Contact the Optometric Extension Program Foundation to find a behavioral optometrist near you.

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