1. Convergence Insufficiency

2. Convergence Insufficiency
A Patient Quality of Life Concern

4.  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

5.  Strabismus

6.  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!

8.  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

9.  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

12.  Affects people of all ages
 Impact on lives can be significant
 It has had extensive research
 The correct treatment is efficacious and
permanent

13.  Missed in vision screenings

14.  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

15.  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

16.  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

17.  Attention deficit for reading
 Frustration with emotional overload
 Reduced self esteem
 Avoidance of academic work
 Anxiety
 Depression
 Reduced social and physical involvement

18. …if your reading did this?

19.  What is the chance that a school-age child
will have convergence insufficiency?
 A. <1%
 B. 2-4%
 C. 5-13%
 D. 20-25%

20.  What is the chance that a school-age child
will have convergence insufficiency?
 A. <1%
 B. 2-4%
 C. 5-13%
 D. 20-25%

21.  1:12 children will have CI

22.  Ask a few basic questions
 Run a basic, yet important screening test

23. 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?”

24. 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?

25.  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)

26.  Penlight Red/Green- Near Point of
Convergence Test (PLRG NPC)

29.  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

30.  Pencil push-up “eye exercises”
 Home-based activities on computer
programs
 Office-based professionally guided vision
therapy with home reinforcement

31. › 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

32.  Office-based, doctor supervised Optometric Vision
Therapy Effective!

33.  Screen
 Recognize
 Inform

34.  PLRG NPC
 Symptom Checklist

35.  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

36.  Provide CI literature
 Advise further diagnostic evaluation
 Prescribe treatment

37. Optometric Vision Therapy IS NOT eye
exercises!!
Vision Therapy is rehabilitation treatment
of the visual brain with proven applications
in neuroscience

38. 1. Visual awareness
2. Feedback
3. Loading -Action, movement and
relevance

42.  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

43.  wow@wowvision.net
 www.wowvision.com
 www.visionhelp.com
 Facebook: Wow Vision Therapy
 www.sovoto.com
 2909 Division Street, Saint Joseph, MI 49085
 269-983-3309
 http://visionhelp.wordpress.com/author/dfortenbacher
 THANK YOU!