In some cases, the symptoms of CI don’t go away with treatment. A person can pass the 20/20 eye chart test and still have convergence insufficiency. Approximately 81 per cent (52/64) of the subjects with low accommodative amplitude, 50 per cent (28/56) of those with 2–3 signs of convergence insufficiency and 66 per cent (12/18) of those with three signs of convergence insufficiency were symptomatic (Figure 2). Then, they will test your eyes and give you a routine eye examination. And the eyes move slightly inward (converge). Or you may notice you squint or close one of your eyes while reading. CISS, near point of convergence, positive fusional vergence, accommodative amplitude of the right eye, and accommodative facility of the right eye were performed according to CITT protocol.16 The CISS was administered before tests of vergence or accommodative function by a screener masked to the other screening tests. In Convergence Insufficiency: Part 1 we discussed the signs and symptoms of convergence insufficiency, a common eye teaming deficit. Convergence Insufficiency and Reading Study (CIRS) Group, Treatment of accommodative dysfunction in children: results from a randomized clinical trial, The convergence insufficiency treatment trial: design, methods, and baseline data, Maximization of the sum of sensitivity and specificity as a diagnostic cutpoint criterion, Associated convergence and accommodative insufficiency, The relationship between convergence insufficiency and ADHD, Asthenopia in schoolchildren, orthoptic and ophthalmological findings and treatment, How do you make the diagnosis of convergence insufficiency? When the eyes converge, it means they point inward (toward the midline) to focus on something close. You are mostly likely to have symptoms of CI when doing work close up, such as reading or writing. Similar to Rouse et al.2 this study found a high frequency of accommodative dysfunction accompanying convergence insufficiency. It is to be administered before any other clinical testing. Retinoscopy was performed while the child wore retinoscopy glasses and watched a video. We bet you can get a pencil cheaper than $0.99, but if you can’t, here’s an app for you. Convergence insufficiency and accommodative insufficiency in children. Monocular near visual acuities were measured using a standard equivalent Snellen near card. Convergence insufficiency (CI) is a common binocular vision disorder which often causes symptoms when doing near work. The ratio of positive fusional vergence to phoria was among the top three tests for identifying both three signs of convergence insufficiency and symptomatic three signs of convergence insufficiency. One eye may turn out instead of looking inward. Near point of convergence break and recovery were measured three times (recorded to the nearest half‐centimetre) and the mean was used for analysis. Draw a straight line in the middle and across the length of a sheet of paper or cardboard. Let the ink dry for a few minutes and raise the sheet of paper up to your nose 2. Choosing the cut‐point which maximises the sum of sensitivity and specificity equates to choosing the value of the clinical test which minimises the sum of the false positive and false negative rates.17 Using this cut‐point ensures that the correct classification is maximised or, conversely, that misclassification is minimised. Although there are some significant differences among these conditions, they are grouped together based on the … Primary CI is thought to be caused by an imbalance of vergence eye movements that is either an inborn deficiency or an acquired etiology. He or she will also test how your eyes converge. Partial funding provided by T35‐EY07151 and the Ohio Lions Eye Research Foundation. It is noteworthy that the CISS was not designed as a screening test for use in the absence of clinical testing, rather it was designed and validated for use in differentiating between those with symptomatic convergence insufficiency and normal binocular vision when used in conjunction with clinical signs, and for use in monitoring changes in symptoms with treatment.5, 6. Monocular amplitude of accommodation was assessed using a single column of letters of 6/9 equivalent at 40 cm and a near point rule. There may be problems in the complex actions that the brain and eyes do. These numbers are similar to those reported by Rouse et al.,14 who found that 47 per cent of those with suspect (1–2 signs) convergence insufficiency, and 72.7 per cent of those with definite (three signs) convergence insufficiency were symptomatic. It is the most common cause of … The ability of common tests of alignment, vergence and accommodative function was evaluated to identify children with convergence insufficiency. Convergence Insufficiency (CI) is a common binocular (two-eyed) vision disorder in which the eyes do not work at near easily. Your eye doctor may prescribe special prism glasses for reading. Light Sensitivity. These are all needed to determine if you do have convergence insufficiency. Convergence insufficiency (CI) is a problem with the way the eye moves. A wide range of findings were observed for each test. Jobs that need you to use your eyes a lot may also raise your risk. The Ohio State University Institutional Review Board reviewed and approved the research study and informed consent documents. In this study, approximately 20 per cent of subjects had 2–3 signs of convergence insufficiency and six per cent showed three signs of convergence insufficiency. Blur, break and recovery values were measured three times. Procedure: • Tie one end of the string to a door knob or tape it to the wall, and hold the other end of the string up … Modified Thorington (phoria near test card, Bernell, Mishawaka, Indiana, USA) was performed at 40 cm. But it does not help correct CI. They are often steady after that. To diagnose convergence insufficiency, the eye doctor might: 1… Draw five or more dots equally spaced along the line with different color inks or alternating colors. The eye and brain work together to make all of these changes. Testing was performed by optometrists experienced in working with children. Sixteen of the 282 subjects had a near visual acuity of 6/12 or worse in one or both eyes, but had a refractive error of less than +1.50 D on dry screening retinoscopy. They can also measure how the eyes are getting better over time. Three hundred and forty‐nine children between the ages of nine and 14 years from eight central Ohio private and public schools were screened. The Orthoptic Evaluation of Traumatic Brain Injury. It interferes with a person's ability to see, read, learn, and work at near distances. The etiology of isolated CI, not related to trauma or neurological disease, has not been completely determined. Near point of convergence recovery was also often among the best tests, but had smaller areas under the curve than near point of convergence break. 2006 26: 507-522. We recommend that you follow-up this test with a full vision evaluation by a vision care specialist. Convergence insufficiency (CI) is an eye disorder where your eyes don’t move at the same time. Phoria as measured by cover testing was used to define convergence insufficiency and positive fusional vergence/phoria. Opt. Convergence Insufficiency is a common vision problem that can make reading or staying on-task quite difficult for school-aged children. A non‐elastic string was attached to the card to help maintain the correct distance during testing. Convergence insufficiency. A ROC curve shows the trade‐offs between the false positive rate (1‐specificity) versus the true positive rate (sensitivity). However, school screenings often focus on detection of reduced visual acuity, rather than binocular vision dysfunction such as convergence insufficiency, and the best test to screen for the presence of convergence insufficiency is not known. Mild forms of convergence insufficiency can be fixed with contacts or eyeglasses. Astigmatism. Shane Foster, Michael Kennedy, Cayti McDaniel, Kristin Oblad Lewis, Joseph Osmond, Amy Anderson, Marielle Serenda and Ivy Madson. While the focus of treatment is often on symptomatic convergence insufficiency,9 this study evaluates screening for both symptomatic and any convergence insufficiency given that there may be interest in the detection of all children with convergence insufficiency (symptomatic and asymptomatic) to allow referral for follow up. Convergence insufficiency is normally seen in school-age children and adolescents at the age of 16. Computer programs can help treat CI. Researchers are not yet sure what causes CI. In very rare cases, an eye care doctor may advise surgery. 2. Eye specialists called optometrists or ophthalmologists diagnose CI. One eye may turn out instead of looking inward. The test finding which most frequently achieved one of the largest areas under the curve was near point of convergence break. A patient who is not having difficulty with near tasks but tests positive for convergence insufficiency in the office does not require any treatment but should be followed. The Influence of COVID-19 Isolation on Physical Activity Habits and Its Relationship with Convergence Insufficiency. Learn more. Of these 16 children, three (18.8 per cent) were classified as having 2–3 signs of convergence insufficiency while 11 (68.8 per cent) had low accommodative amplitude. Journal of Binocular Vision and Ocular Motility. This study found that approximately 61 per cent of children with symptomatic two or three signs of convergence insufficiency had an accompanying low accommodative amplitude which is comparable to the 55–78.9 per cent and to the 26–77.8 per cent association reported by Rouse et al.2 and Borsting et al.3 for two or three signs of convergence insufficiency, respectively. How is convergence insufficiency (CI) diagnosed? Number of times cited according to CrossRef: Correlations between clinical measures and symptoms: Report 2: Accommodative and vergence measures with symptoms. Children who wore glasses were tested while wearing their correction. Only eye care professionals can take decisions on medical treatment, diagnosis or prescription. You will be shown how to do these exercises. Binocular accommodative facility was also assessed using a Suppression Vectogram number 9 and Polaroid filter glasses (Stereo Optical, Chicago, Illinois, USA). The cut‐point which maximised the sum of sensitivity and specificity was also identified for tests with the largest areas under the curve which were significantly greater than 0.50. One common prob­lem Ms. Waskiewicz sees in concussion patients is convergence insufficiency, which often causes eyestrain and headache. Distance visual acuity was tested monocularly using a light box and a logMAR Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Near point of convergence (along with binocular accommodative facility) has also been reported to have the best diagnostic validity for identification of symptomatic, high near exophoria in subjects aged 19–35 years.23 The test with the highest sum of sensitivity and specificity was also most frequently near point of convergence break; however, the best cut‐point (to maximise the sum of sensitivity and specificity) varied. In some cases, a health condition can contribute to CI, such as: If you use a computer for long periods, you may also be at greater risk for CI. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Percentages of children with convergence insufficiency and low amplitude of accommodation (AA), Percentages of subjects classified with binocular or accommodative dysfunction, by symptom level, orcid.org/http://orcid.org/0000-0003-3066-5102, orcid.org/http://orcid.org/0000-0003-0486-6998, I have read and accept the Wiley Online Library Terms and Conditions of Use, Screening for symptomatic 2–3 signs of CI, Screening for symptomatic three signs of CI, Screening for symptomatic 2–3 signs of CI with accommodative dysfunction. Signed parental permission and assent were obtained from the participating parents and children, respectively. 2 Karania R, Evans BJW. Convergence insufficiency has a reported prevalence among children and adults in the United States of 2.5 to 13% 1). Near point of convergence break was also the best test for identification of convergence insufficiency when defined as receded near point of convergence and reduced positive fusional vergence at near in the presence of any phoria (area under curve 0.835; cut‐point ≥ 6 cm; sensitivity = 0.847; specificity = 0.743).18. The hole that lets light into the eye (pupil) becomes smaller. People can pass the standard eye exam even if they have CI. Please check your email for instructions on resetting your password. Modified Clinical Technique Screening was performed in order to identify and exclude children with amblyopia or significant uncorrected refractive error. CI can cause blurred vision, double vision, and eyestrain. cm: centimetre, CISS: Convergence Insufficiency Symptom Survey. Receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of each test (positive fusional vergence range blur, break, recovery; near point of convergence break, recovery; accommodative amplitude; accommodative facility; CISS; Modified Thorington; near visual acuity) and ratio of positive fusional vergence over the phoria to discriminate between subjects with and without convergence insufficiency. Auxiliary lighting was brought to each screening to ensure appropriate illumination. Procedure 1. The purpose of this study was to evaluate the ability of common tests of binocular and accommodative function to identify children with CI in a school screening setting. Sixty‐seven subjects (19 per cent) were excluded from the study due to inability to complete the testing due to developmental delay (n = 8), reduced distance visual acuity (n = 39), and/or meeting the Modified Clinical Technique referral criteria for refractive error (n = 20). The authors would like to thank the following people for assisting in conducting the school screenings: Molly Biddle, Drs. Near Vision 1. Data analyses were performed using Statistical Analysis System (version 9.2, SAS Institute Inc., Cary, North Carolina, USA) and Statistical Package for the Social Sciences (version 15, SPSS Inc., Chicago, Illinois, USA). The child was instructed to: ‘look at the letters and report when they become double or break into two, but try to keep the target one/single as long as possible’. Vestibular and Oculomotor Function in Children with CP: Descriptive Study. Convergence insufficiency 1. If diplopia was not reported but the examiner observed a loss of fusion during the measurement of near convergence ranges, the point at which fusion was lost was recorded as the ‘break’ finding. Inability to obtain and/or maintain adequate binocular convergence for any length of time without undue effort. All rights reserved. Use the link below to share a full-text version of this article with your friends and colleagues. Subjects were classified as having convergence insufficiency if they had an exophoria at near and exhibited two or three clinical signs of convergence insufficiency. Positive fusional vergences, near point of convergence (NPC), accommodative amplitude, accommodative facility, Modified Thorington, and the Convergence Insufficiency Symptom Survey were evaluated. Scores for responses ranged from zero for ‘never’ to four for ‘always’; the total score could range from zero to 60. Working off-campus? Screening tests of vergence and accommodative function were performed by trained student optometric clinicians. The nearpoint of convergence was measured three ways, with an accommodative target, a penlight, and a penlight with red and green glasses. One half of 2–3 signs of CI and 66 per cent of three signs of CI subjects were symptomatic. There is only ONE diagnosis, convergence insufficiency, that has ever proven to benefit from “eye exercises.” AND standard convergence insufficiency treatment requires one piece of equipment — an ordinary pencil! Unilateral and alternate cover testing was performed at distance and 40 cm using a 6/9 (20/30) letter as a fixation target. This might include questions about problems you have with focusing, blurred or double vision, headaches, and symptoms. Convergence insufficiency means the eyes struggle to focus easily for near tasks, affecting school work, attention and office performance in adults. With CI, the eyes have trouble doing this. An area of 1.0 would signify a perfect test while an area of 0.5 is associated with a weak test (that is, no better than flipping a fair coin). It also does not give you practice working with both eyes together, which is important in order to correct CI. Although measures of vergence and alignment were included in the classification of convergence insufficiency, these results show which of these commonly used tests perform best in identifying children with convergence insufficiency in a screening setting when it may only be possible to perform one test. But to work well, they need to be done regularly. Amplitude of accommodation was among the top three tests for identifying those with symptomatic three signs of convergence insufficiency. The first sustained blur was considered the endpoint. Tables 2 and 3 provide a summary of the tests which achieved the largest area under the curve and the cut‐point which maximised the sum of sensitivity and specificity. A routine eye exam with the familiar 20/20 eye chart does not diagnose CI. © 2000-2021 The StayWell Company, LLC. What is convergence Insufficiency? The break value was used in the analysis if no blur value was reported. You may also notice that one of your eyes sometimes turns outward as you read. The Mallett Fixation Disparity Test: influence of test instructions and relationship with symptoms Ophthal. If you have this condition, one or both eyes move outward when you look at a nearby object. Convergence insufficiency is a common disorder of binocular vision in children and young adults. This may be because of genes. Convergence insufficiency is a common binocular vision condition with a prevalence of approximately two to eight per cent in which a person is unable to adequately converge for near work.1-4 Symptoms associated with convergence insufficiency often include blurred vision, eyestrain, headache, diplopia, frequent loss of place, difficulty concentrating on near work and/or avoidance of near work.1, 5, 6 In addition, Rouse et al.7, 8 found that parents of children with symptomatic convergence insufficiency report a significantly higher number of academic performance symptoms (such as difficulty completing assignments, careless mistakes, avoidance of near work, inattentiveness and worry about school performance), as compared to parents of children with normal binocular vision. Convergence Insufficiency - Often Misdiagnosed as ADD/ADHD ... How to test for Convergence Insufficiency (Wow Vision Therapy) - Duration: 4:17. This information is not intended as a substitute for professional medical care. People with convergence insufficiency might have otherwise normal vision, so it's important to mention reading or learning concerns to your eye care provider. Background: To evaluate the impact of treatment of symptomatic convergence insufficiency using office-based vergence/accommodative therapy on reading skills in children. The ability of the positive fusional vergence/phoria ratio was also investigated because this ratio is also commonly used in the diagnosis of convergence insufficiency.9, Ocular alignment was assessed using both cover testing and Modified Thorington, but only the latter was evaluated for its ability to identify children with convergence insufficiency in a screening setting because cover testing requires a high level of training and skill. To diagnose convergence insufficiency, your eye doctor might: 1. Your symptoms may go away in a fairly short period of time. 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