Convergence Insufficiency Disorder: An Eye Disorder and Not a Learning Disability

Convergence Insufficiency Disorder (C.I.) is defined as the inability of the eyes to turn inward correctly while focusing on a nearby object (www.mayoclinic.com). According to medical studies, it is the leading cause of eyestrain, blurred vision, double vision, and headaches.

When a person is reading or looking at a close object the eyes should turn inward to allow for focusing in order to provide binocular vision to see a single image. Those with convergence insufficiency are unable to move their eyes inward to focus normally (www.mayoclinic.com).

C.I. is often diagnosed in children and adolescents and causes difficulty with reading and with focusing on homework. However, the initial reaction of parents or teachers is to think the child has a learning disability instead of an eye disorder.

It is also important to note that the exact cause of C.I. is unknown. The muscles of the eye are weaker and unable to focus correctly, the cause of that muscle weakness is not known (www.mayoclinic.com).

C.I. – Why is It Undetected?

C.I. is a disorder which is difficult to detect, which only serves to exacerbate the problem and symptoms as well as providing increased probability for misdiagnosis.

The main reasons why this eye disorder frequently goes undetected are:

1.     The test for C.I. is not included in pediatric eye examinations

2.     The test for C.I. is not included in the school provided eye screenings

3.     The test for C.I. is not included in a basic eye exam with an eye doctor

(www.convergenceinsufficiency.org)

The reason why the standard tests and school screening tests do not detect C.I. is because those tests measure the child’s ability to see objects at a distance. They do not test the ability of the eye to see near objects, or to read up close. This is an important distinction, and can lead to the misdiagnosis I mentioned earlier of a learning disability.

Another factor is that the inability to read or focus on objects up close is a sensitive situation for a child. The thought that they could have a learning disability can really shake their self-esteem.

 I would know, I had a different eye disorder as a child from a very young age. I had to see several eye specialists including one in Manhattan, to finally get the disorder diagnosed and treated correctly. I having been wearing eyeglasses ever since, which I actually never had a problem with, though the other kids at school were not so understanding.

However, I had problems with eye hand coordination that the eyeglasses corrected, which went a long way toward helping my self-esteem.

Current Issues and Treatment

In my research of this disorder, the most troubling fact I found was this:

A person could pass the eye test, the 20/20 eye test, and have C.I.

That is the biggest current issue with this eye disorder which leads to it being misdiagnosed as something else whether it is a learning disability or another condition.

The two types of treatment, according to the National Eye Institute, are as follows:

1.     Passive treatment ( prism lenses/ corrective eyewear)

2.     Active treatment (in office therapy)

Eye surgery is rarely recommended according to the various sources I consulted.

In a study conducted by the National Eye Institute, the office based therapy was shown to be the most effective treatment option. The study showed 75% of patients had either a full recovery or showed significant improvement within 12 weeks.

The symptoms of C.I. are:

·        Eye strain

·        Blurry vision/ double vision

·        Headaches

·        Difficulty reading or focusing on close objects

The treatment of C.I. varies and is largely dependent on the individual treating practitioner. In a study conducted and published in the “Archives of Ophthalmology” which explains that ophthalmologists and optometrists frequently do not refer patients to vision therapy departments for treatment of C.I. (www.ontrackreading.com).

The study continues to explain that pencil push-ups are the only tool that ophthalmologists and optometrists use for treatment of this disorder. In this same study, the use of pencil push-ups was so ineffective, that group of patients performed lower than the placebo group in terms of symptom improvement.

Furthermore, the study states that Developmental optometrists are more likely to diagnose C.I. and refer those patients to vision therapy. The study looked at various tests:

1.     Near point of Convergence: measures how close the patient can focus

2.     Positive Fusional Vergence: done by having the patient focus on an object at comfortable distance, then placing prisms in front of each eye which force convergence of the eyes to maintain focus.

 This test is harder than the other test because the changing of prisms forces the child to make repeated adjustments to convergence. This is harder than the first test where the eyes can smoothly converge to the near object (www.ontrackreading.com).

Both tests measure the ability to focus both eyes at the same time on a close object. However, Developmental optometrists will conduct more extensive tests if their observation yields a potential problem. These tests determine the child’s ability to sustain the effort of focusing their eyes (www.ontrackreading.com).

Some children can pass the convergence tests the first time, but in repeating the test several times in a row the C.I. effected patient loses the ability to converge. This can explain why a C.I. effected patient starts reading well and then will struggle reading on page two (www.ontrackreading.com). I know someone who has a child who was eventually diagnosed with C.I. after passing all of the initial screening tests and then the Near point of Convergence and the Positive Fusional Vergence tests.

It was only after the repeated testing of the Positive Fusional Vergence test that the C.I. was detected and diagnosed. Other doctors were ready to diagnose the child with dyslexia.

Solutions and Moving Forward

The best potential solution or treatment option for C.I., according to medical studies conducted by the National Eye Institute and the National Institutes of Health, stated that a weekly hour-long session of in-office therapy combined with at-home reinforcement exercises was the most effective method.

The study was conducted on a sample group of patients ages 9-17 with C.I. and evaluated them based on a variety of treatments. The in-office therapy was successful about 75% of the time to correct the issue or provide measured improvement in 3 months (www.mayoclinic.com).

However, the in-office therapy sessions can be expensive. Another effective potential treatment option is the use of computer vision therapy. This therapeutic option involves the use of specialized software to provide exercises to the patient on the family PC, and has shown in these studies to be a fairly effective approach to the treatment of this disorder.

My advice to parents is if you observe your child having trouble reading or focusing, take them to an eye specialist as soon as possible. I would also ask them to utilize some of the testing methods included in this article.

The potential for misdiagnosis and the effect it will have on your child and their developmental years are well worth the trip to see the eye specialist. The way forward for a child with C.I. is manageable and treatable if it is diagnosed properly.