Treating Convergence Insufficiency

What is convergence insufficiency?

Have you ever noticed that your eyes move in towards your nose when looking at your phone or computer?

Your eyes are converging, or moving inwards, in order to focus on an object that is close to you.

Unfortunately, some people have a hard time concentrating when working at near distances due to the inability of moving their eyes inward, which is something they cannot control.

Convergence insufficiency occurs when one or both eyes cannot move inwards at near distances; usually one eye will spontaneously turn outward when looking at near objects.

It is characterized by an intermittent exotropia, meaning the eye does not swing out all the time.

Convergence insufficiency affects 5 out of every 100 children, sometimes causing behavior that is reminiscent of ADD/ADHD or dyslexia.

It is not uncommon to experience difficulty reading and concentrating due to double vision, headache, and strain caused by the eyes focusing on different spots.

Stressful situations, illness, or even tiredness can lead to a more frequent and noticeable outward turning of the eye.

Closing an eye or squinting will alleviate the symptoms but does not help treat the actual convergence insufficiency.

Oftentimes convergence insufficiency is missed in school vision screenings because visual acuity, or the sharpness of vision, is not affected.

Will patching help?

Contrary to earlier practices, patching on its own is no longer the recommended method of treating convergence insufficiency.

Because the eye swings out only when working at near distances rather than all the time, patching will not correct convergence insufficiency.

While patching the good eye would force the patient to use only their deviant eye for near distances, once the eyes are both unoccluded, that same eye would continue to turn outwards.

Without properly training the eye to turn inwards even when both eyes are open, the convergence insufficiency will continue to be an issue.

In addition, patching would cause hindrance of vision at far distances due to the loss of binocular function. Binocularity and depth perception are dependent on using both eyes together, and unfortunately patching would disrupt these abilities. 

Will glasses help?

Regular glasses lenses will not treat convergence insufficiency or symptoms associated with it since they will only improve the clarity of vision.

Glasses with prism lenses, however, may be prescribed. The prism in the lenses will bend light so the object is perceived to be in a different location than where it is actually located.

As a result, the eye will still turn outwards, but the double vision will disappear as both eyes seem to be focusing on the same object.

Unfortunately, prism lenses will not correct the outward turn of the eye; rather the symptoms associated with convergence insufficiency will be alleviated while wearing the glasses.

The outward turn of the eye at near distances will physically remain both when the glasses are worn and when they are not.   

The answer: Vision Therapy!

Unlike patching and glasses, vision therapy will directly treat the convergence insufficiency so that the eye turns inward properly when looking at near objects.

One of the most well-known vision therapy exercises used to correct convergence insufficiency is known as “pencil push-ups.”

A small letter or picture is placed on the end of a pencil, and the patient follows this image with their eyes as the pencil is repeatedly moved in towards their nose and away.

The goal is to keep the letter clear and single, indicating that both eyes are converging and focusing on the same place.

Although it may seem that you could simply perform this exercise at home without the help of a trained vision therapist, you may not achieve your desired results.

Research conducted by the College of Optometrists in Vision Development (COVD) and the National Eye Institute have found that office-based vision therapy, supported by at-home vision therapy, is the best treatment for convergence insufficiency.

Patients who only did at-home vision therapy did not experience a decrease in their symptoms.

Vision therapy at an office with a trained vision therapist is beneficial because they can make the appropriate corrections and keep track of progress based on measurements and evaluations.

In addition, they can also incorporate other effective exercises to improve convergence as well as other visual skills.

Where is Insight Vision Center Optometry?

Serving the communities of Costa Mesa, Irvine, Newport Beach, Tustin, Santa Ana, Huntington Beach, and Fountain Valley. Schedule a visit with Dr. Valerie Lam or Dr. Thanh Mai to learn more. Our optometry practice is located in Costa Mesa at 3151 Airway Ave. Suite J2, Costa Mesa, CA 92626. We offer vision therapy and orthokeratology services.