Convergence Insufficiency and How to Treat It!

An inability or decreased ability to converge the eyes whilst focusing on a near object is described as convergence insufficiency. Those who suffer from convergence insufficiency cannot properly maintain binocular vision when focusing on the near objects. This is of great importance especially when writing or reading.

Convergence Insufficiency Symptoms

To alleviate the discomfort and eyestrain during reading or writing or any kind of near activities, patients often close one eye when performing them. Thus, they ameliorate the symptoms of improper binocular fusion, which include:

  • Headaches,
  • double vision,
  • blurry vision,
  • fatigue,
  • tension in the eyes,
  • trouble reading due to loss of focus.

The connection between Strabismus and Convergence Insufficiency

Roughly 10-20 % of those who have strabismus also experience convergence insufficiency to some degree.

Considering that about 1-3 percent of people experience strabismus, the burden of convergence insufficiency in the population is not at all small. There is a lot of debate about why convergence insufficiency ensues, and the truth is that we still do not know precisely. It is believed to be related to a combination of factors, including eye muscle imbalance, genetics, prolonged near work, trauma, and neurological factors. Read more about convergence insufficiency here.

Orthoptic Exercises are the Way to go

More than 150 years ago the first treatment for convergence insufficiency was proposed, and since then many different treatment options, the most important being orthoptic exercises, have been suggested.

Generally, treatment options include home-based exercises, some special in-office exercises, and newly developed computer program-based training.

Pencil Push-Ups

One of the most commonly used home-based exercise to tackle convergence insufficiency is pencil push-up. Whilst slowly moving the tip of the pencil towards their nose the patient tries to maintain binocular single vision, thus better their convergence abilities. T

he studies have shown that simple pencil push-ups can be as effective as much more complex and pricier in-office exercises if they are performed correctly and frequently enough.

Instructions for Pencil Push-Ups Eye Exercises

One of the most commonly used home-based exercise to tackle convergence insufficiency is pencil push-up.
  1. Hold the pencil: Take the pencil in your dominant hand, holding it vertically at arm’s length (about 16-18 inches) from your eyes. The pencil should be positioned at your eye level.
  2. Focus on the tip of the pencil: Concentrate on the pencil’s tip as you would when looking at any object.
  3. Slowly bring the pencil closer: Start moving the pencil slowly towards your nose, while maintaining your focus on its tip. Keep your eyes on the pencil’s tip at all times. Your eyes should be working to keep the image single and clear.
  4. Watch for double vision: As you bring the pencil closer, you may notice the appearance of two pencil tips instead of one. This is normal, as your eyes are adjusting to the convergence.
  5. Stop if you see double: When you notice double vision, hold the pencil steady at that distance. Do not try to force your eyes to converge further if you experience discomfort or excessive blurriness.
  6. Hold for a few seconds: Maintain your gaze on the pencil’s tip at the distance where you see only one clear image. Hold this position for about 5-10 seconds.
  7. Slowly move the pencil away: After holding for a few seconds, start moving the pencil away from your nose, back to the original arm’s length position. Continue to focus on the pencil’s tip during this movement.
  8. Rest for a moment: Take a brief break of about 5-10 seconds before repeating the exercise.
  9. Perform several repetitions: Aim to do 10-15 repetitions of pencil pushups in one session.
  10. Do multiple sessions: You can perform these sessions 2-3 times a day or as recommended by your eye care professional.

Compliance Issues with Standard Eye Exercises

The problem is that especially younger children often find such exercises extremely boring, leading to compliance issues. For those exercises such as convergence cards, stereograms and computer-based convergence exercises were introduced. Especially computer-based convergence exercises are becoming more and more popular as they enable much greater involvement and are therefore much more interesting and entertaining for younger children.

In some very refractory and rare cases, surgery might be the last resort option, although it is rarely used due to the high risk of inducing diplopia at distance after surgery. Convergence insufficiency is more often than not solved using exercises and training that we briefly touched upon in this article.

Luckily, as boring as convergence insufficiency exercises may be, they are extremely effective, as it is believed that the success rate is about 80%. Frequent follow-up visits combined with good compliance to prescribed convergence exercises should bring the results everyone wishes for.

AmblyoPlay Against Convergence Insufficiency

AmblyoPlay is a gamified vision therapy that helps with convergence insufficiency by using dichoptic vision therapy. As we split the image that each eye receives while maintaining focal points, we engage the brain to start creating a single image. It can be used at home on your devices and only requires active subscription and AmblyoPlay Box. You can check it HERE!

Vision therapy can be an effective diplopia treatment.

 With exercises that adapt to each patient and their specific needs, it is an ideal solution for problems such as lazy eye, strabismus, convergence insufficiency, double vision, or other binocular problems.

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