What is Convergence Insufficiency?

Convergence insufficiency is one of the most frequently encountered binocular vision problem in children and adults. It is often associated with a variety of symptoms, including eyestrain, headaches, blurred vision, diplopia [double vision], sleepiness, difficulty concentrating, movement of print while reading, and loss of comprehension after short periods of reading or performing close activities. Have your doctor diagnose and treat this significant visual problem.

1. Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor of Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
Optometrist, Lyons Family Eye Care
What is Convergence
Insufficiency (CI)?

2. What is Convergence Insufficiency?
...Convergence insufficiency is a sensory and neuromuscular
disorder that inhibits a person’s ability to accurately view a
near target…. Your ability to turn your eyes in at near is
poor.
http://www.optometrystudents.com/convergence-insufficiency-the-ultimate-guide/

3. What is Convergence Insufficiency?
…Convergence insufficiency (CI)… is often associated
with a variety of symptoms, including eyestrain,
headaches, blurred vision, diplopia [double vision],
sleepiness, difficulty concentrating, movement of print
while reading, and loss of comprehension after short
periods of reading or performing close activities. …
Archives of Ophthalmology. 2008;126(10):1336-1349

4. What is the Prevalence of CI?
CI is the most frequently encountered
eye coordination problem
CI in adults is between 1 and 25 % of clinic patients
Median prevalence of CI in the population is 7 %
CI in 5th and 6th graders 4.2 %
OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ACCOMMODATIVE AND VERGENCE DYSFUNCTION

5. Does CI affect Attention?
There is …an apparent three-fold greater incidence
of Attention Deficit Hyperactivity Disorder among
patients with CI when compared with the incidence
of ADHD in the general US population…. We also
note a …three-fold greater incidence of CI in the
ADHD population….
Strabismus, 2005, Vol. 13, No. 4 : Pages 163-168.

6. Does CI affect Attention?
Yes!
It is recommend that any child with CI be
assessed for attention problems and any child
with attention problems be assessed for the
presence of convergence insufficiency

7. Does CI affect Attention?
Diagnosing Attention Problems
A well researched computerized tool to assess
attention deficit hyperactivity disorder, attention deficit,
inattention, impulsivity and other anomalies of
attention is the TOVA (Test of Variables Attention).
Survey based tests are also frequently used but the
TOVA may be more reliable.
J Clin Psychol. 1998 Jun;54(4):461-76.

8. An Undiagnosed/Untreated CI could
lead to an Eye Turn.
Strabismus is an even more serious
problem of binocular vision.
Exotropia: an outward eye turn

9. At What Age Can You Treat
Convergence Insufficiency?
Despite what you may hear from those who
have not kept up with the latest research,
CI can be treated AT ANY AGE!
Children, Adults and Seniors
may all benefit from treatment.

10. How Do You Treat
CI?
Treatment always starts with the best
prescription glasses possible. This
prescription may change over time as the
functional vision problems improve.

11. How Do You Treat CI?
Optometric vision therapy
Vision therapy is a doctor-supervised, non-surgical, customized program of
therapeutic procedures designed to prevent, remediate, and/or enhance
vision problems and/or improve visual skills.
Vision therapy can include the use of lenses, prisms, filters, computerized
procedures and non-computerized instrumentation. The goal of vision
therapy is to treat vision problems that cannot usually be treated
successfully with eyeglasses, contact lenses and/or surgery alone, and help
individuals of all ages achieve single, clear, comfortable binocular (two-eyed)
vision using the scientific principles of neuroplasticity.

12. How Do You Treat CI?
… clinical trials showed that office-based vision therapy was
successful in about 75% of patients (resulting in normal or significantly
improved symptoms and signs) and was the only treatment studied
which was more effective than placebo treatments for children with
symptomatic CI. Eye care providers who do not currently offer this
treatment may consider referring these patients to a doctor who
provides this treatment or consider expanding the treatment options
available within their practice to manage this condition…..
Optom Vis Sci. 2009 May ; 86(5): 420–428. doi:10.1097/OPX.0b013e31819fa712
How Successful is Optometric Vision Therapy?

13. Convergence Insufficiency FAQs
Where do I find a doctor that treats CI and who provides
vision therapy?
In Chicago go to Lyons Family Eye Care (LFEC).
To find a doctor close to you go to the
College of Optometrists in Vision Development,
Optometric Extension Program Foundation and
American Optometric Association websites.

14. CI FAQs
What credentials should my doctor have so I know he/she
will provide the best care?
Your doctor should have one or more of the following:
Completed a residency in pediatrics, binocular vision and vision
therapy
Fellowship and/or membership in the College of Optometrists in Vision
Development
Membership in the Optometric Extension Program Foundation
Diplomate in Pediatrics/Binocular Vision from the American Academy
of Optometry

15. CI FAQs
This was
previously
described
•Hand-eye
•Focusing
•Eye
movement
•Same as
noted in
monocular
phase and
anti-
suppression
•Same as
noted
previously
plus
convergence
and
divergence
therapy
•Hand-eye, eye
movement,
focusing,
convergence
and divergence
therapy done
simultaneously
Monocular
Glasses
Biocular Binocular
Integration
&
Stabilization
Tell me more about vision therapy
There are 4 phases to vision therapy

16. Convergence Insufficiency FAQs
Tell me more about the vision therapy program
Functional optometrists will use computer programs,
lenses, prisms, and other specialized equipment during the
therapy both in office and for you to use at home.

17. CI FAQs
Tell me about home vision therapy
Home vision therapy can vary from doctor to
doctor. I recommend a minimum of 20 to 30
minutes per day, 5 days per week. Some doctors
do not prescribe home vision therapy, but I find
that the in office therapy program progresses at a
faster rate of speed if home therapy is conducted.

18. CI FAQs
What does vision therapy cost?
This will vary from office to office but is
comparable in cost to occupational, physical,
and/or speech/language therapy. Some offices
charge for each individual visit while others have
a “program” similar to that of having braces
applied by your dentist.

19. CI FAQs
Does insurance cover the cost of vision therapy?
Yes. No. Maybe. Some time ago most insurance
would have picked up about 80% of the cost. Then
my impression was that the insurance companies
just seemed to stop reimbursement for therapy. Now
they are once again picking up some of the cost.
Know your insurance policy. Do not take “NO” for an
answer. Your doctor’s office will usually assist you
when it comes to insurance, but it is ultimately your
responsibility.

20. CI FAQs
Where do I learn more about treatment, especially
from a parent’s or patient’s point of view?
Go to:
Parents Active in Vision Education
Vision Therapy Parents Unite!
Vision Therapy Changed My Life
Convergence Deficiency/Insufficiency
Living with Diplopia

21. CI FAQs
Where can I get additional information on pediatrics,
binocular vision, vision therapy, children wearing
glasses and more?
MainosMemos
VisionHelp blog
COVD blog
Discovering Vision Therapy blog
Wow Vision Therapy blog
SOVOTO
Little Four Eyes

22. CI FAQs
Reading List
Fixing My Gaze: A Scientists Journey into Seeing in 3 Dimensions
By Susan Barry, PhD
Eyes For Learning: Preventing and Curing Vision-Related Problems
By Antonia Orfield
When Your Child Struggles: The Myths of 20/20 Vision
By David Cook, OD
The Suddenly Successful Student: A Parents’ and Teachers’ Guide to Learning & Behavior
Problems: How Behavioral Optometry Helps
By Hazel Dawkins, E. Edelman, O.D. & C. Forkiotis, O.D.
Suddenly Successful: How Behavioral Optometry Helps You Overcome Learning, Health &
Behavior Problems
By Hazel Dawkins, E. Edelman, O.D. & C. Forkiotis, O.D.
Thinking Goes To School
By Hans G Furth, Harry Wachs, O.D.
Your Child’s Vision
By Richard Kavner, O.D.
See Vision Therapy Rocks
for more resources

23. CI FAQs
Where can I get additional help?
Call or email us at Lyons Family Eye Care.
Lyons Family Eye Care
3250 N. Lincoln Ave.
Chicago, IL 60657
Click here to view a map of our location
Phone Number: 773-935-2020
Email: [email protected]
“LIKE” us at Vision Therapy at Lyons Family Eye Care

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24. CI FAQs
Where can I get additional help?
More information about Lyons Family Eye Care
Wild Chicago Harlem Shake Artists LFEC Jingle
“LIKE” us at Vision Therapy at Lyons Family Eye Care
“LIKE” us at Lyons Family Eye Care

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25. About Dr. Stephanie Lyons

26. About Dominick M. Maino, OD, MEd, FAAO, FCOVD-A