causes of convergence insufficiencycauses of convergence insufficiency

[21] Centrally acting medications also contribute to vergence dysfunction. Convergence insufficiency is diagnosed by an ophthalmologist, optometrist or orthoptist after getting a history of the patient's symptoms and measuring convergence ability. Convergence insufficiency, or convergence palsy, is one of the most common vision conditions resulting from a mild traumatic brain injury. [20] Improvement of convergence with levodopa treatment has been reported. _________________________________________________________________. Symptoms [ edit] The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. This computer-based assessment of focused and divided visual function requires the patient to complete three subtests with variable numbers of objects and background noise.15,26 UFOV may serve as a more effective evaluation of ones visual attention in an environment of distraction, or noise, and may better predict an individuals visual function in real-world situations. We have offices located in Brookfield and Madison, and our patients typically visit us from all over southeastern Wisconsin and northern Illinois. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. [QxMD MEDLINE Link]. 2002;4:271-80. (TBI) encompasses a plethora of situations that range from mild to severe, clinicians often look for greater precision in the definitions and categorization of TBI. What is divergence insufficiency? [Full Text]. [citation needed] Note that some Internet resources confuse convergence and divergence dysfunction, reversing them. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near-visual function, abnormal fatigue, headache, and abnormal postural adaptation, among others. A standardized questionnaire, the Convergence Insufficiency Symptom Survey, was established for research purposes but may be helpful in identifying symptoms, although it lacks specificity as a screening tool. 1. Divergence insufficiency is a comitant esotropia that is present at distance but not at near, with full ductions and versions. Ghadban R, Martinez JM, Diehl NN, Mohney BG. Danchaivijitr C, Kennard C. Diplopia and eye movement disorders. 2015. Near Point of Convergence After a Sport-Related Concussion: Measurement Reliability and Relationship to Neurocognitive Impairment and Symptoms. There is typically an exophoria or intermittent exotropia at near, a receded near point of convergence, reduced positive fusional convergence amplitudes, . LEARN MORE:Vision Therapy for Children. Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, et al. Dysfunction of the VOR may occur with damage to the semicircular canals in the ears, the oculomotor nerve (CNIII), the abducens nerve (CNVI), the acoustic nerve (CNVIII), or any neurological structures integrating these components. [QxMD MEDLINE Link]. Is there convergence insufficiency in adults? Homonymous hemianopias create significant safety challenges, especially when associated with neglect and any activities that require an accurate awareness of ones surroundings.4,7,25. The maximum prism at which either the patient is observed to lose binocular fixation or reports diplopia is the positive fusional vergence amplitude. ", "Convergence Insufficiency | National Eye Institute", "The convergence insufficiency treatment trial: design, methods, and baseline data", "Treatment of Convergence Insufficiency in Childhood: A Current Perspective", "Relief of asthenopic symptoms with orthoptic exercises in convergence insufficiency is achieved in both adults and children", "Interventions for convergence insufficiency: a network meta-analysis", "Frequency of Convergence Insufficiency Among Fifth and Sixth Graders", Thygeson's superficial punctate keratopathy, Chronic progressive external ophthalmoplegia, https://en.wikipedia.org/w/index.php?title=Convergence_insufficiency&oldid=1152382796, Disorders of ocular muscles, binocular movement, accommodation and refraction, Short description is different from Wikidata, Articles with unsourced statements from October 2022, Creative Commons Attribution-ShareAlike License 4.0, This page was last edited on 29 April 2023, at 22:35. Be sure to rule out any possible ocular inflammatory processes, such as uveitis, that may develop following trauma. Convergence Insufficiency Diagnosis Treatment for Convergence Insufficiency What is Convergence Insufficiency? [6] Mild traumatic brain injury may be associated with subsequent convergence insufficiency. 5. The convergence insufficiency masquerade. Visual rehabilitation: visual scanning, multisensory stimulation and vision restoration trainings. Brain Injury/Professional. 133. Convergence insufficiency and convergence excess are two relatively unknown conditions, despite how commonly they occur. Am J Sports Med. J Neurophysiol. Test each eye monocularly and binocularly. This results in double and blurred vision. Horizontal conjugate deviation of the eyes may be found with acute lesions of either hemisphere or the brainstem. 2009 May. Visual Field DefectsVarious presentations of visual field defects may occur following TBI as a result of damage to any portion of the visual pathway from the visual cortex of the brain onward to the retina.4,7,25,26. People with convergence excess can do the near work, but tend to get tired much faster than people who dont have this functional vision problem. Mosby-Year Book; 1995. When something interrupts this process, misalignment occurs and disrupts vision. Convergence insufficiency (CI) is a common vision condition that affects up to 17 percent of children and adults. 2015 Oct. 19 (5):417-21. Convergence insufficiency may be treated with convergence exercises prescribed by an eyecare specialist trained in orthoptics or binocular vision anomalies (see: vision therapy). In some cases, a health condition can help lead to CI. Oxford University Press; 2015. Recently, head injuries among athletes and military service personnelthe two most common patient populations at risk for TBIhave shone a spotlight on the consequences affecting individuals with mTBI. Defects may include constriction of the fields and either isolated or multiple scattered defects throughout the fields, with or without a generalized decrease in sensitivity.4,7,25 Lateralized field defects such as homonymous hemianopias may also occur with or without neglect, in which patients are fully unaware of objects located in space within the visual field defects. [QxMD MEDLINE Link]. Photophobia is typically addressed with filters, visors and attention to proper illumination. 1996-2023 Optometrists Network - Powered by EyeCarePro - 70 North Meadow Crescent, Thornhill ON L4J 3B1, Canada. Patching is not a good option to strengthen convergence because wearing a patch will have the patient use one eye at a time and not use the two eyes together. How is convergence insufficiency treated? Faul M, Xu L, Wald M, Coronado V. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths (2002-2006). 2012;26(11):1338-59. Journal of American Optometric Association. Convergence insufficiency (CI) occurs in adults as well as children. [QxMD MEDLINE Link]. Anthony J Brune, III, DO is a member of the following medical societies: American Academy of Neurology, American Osteopathic Association, North American Neuro-Ophthalmology Society, Sigma Sigma Phi Osteopathic Honor SocietyDisclosure: Nothing to disclose. Bade A, Boas M, Gallaway M, Mitchell GL, Scheiman M, Kulp MT, et al. In Parkinson disease, decreased convergence amplitudes have been demonstrated early in the disease course. This is generally accompanied with additional in-home therapy. Can Adults Have Convergence Insufficiency? 26. How Is Convergence Insufficiency Diagnosed? Words may seem to move around while reading and computer tasks may be problematic due to monitor light flicker or sensitivity to scrolling motions. Symptoms of visual field defects include mobility issues (e.g., patients bumping into objects), reading difficulties and trouble locating items in tasks of daily living such as eating. In children, convergence insufficiency can often be treated by practicing convergence (pulling the eyes inward toward the nose) through exercises. A licensed ophthalmologist or optometrist diagnoses CI during a comprehensive eye exam. 1. Optom Vis Sci. A study from the National Eye Institute indicated 75 percent of patients who received in-office vision therapy by a trained therapist as well as performed at-home vision therapy treatment reported fewer and less severe symptoms regarding reading and other near work. The crystalline lens may develop a cataract or become dislocated in response to traumatic insult, causing vision distortion or diplopia. Optom Vis Sci. Patients with convergence insufficiency may be permanently cured after exercises to strengthen their convergence. Brain Injury. In some cases, a health condition can contribute to CI, such as: Head injury and concussion Graves disease Myasthenia gravis Parkinson disease Alzheimer disease If you use a computer for long periods, you may also be at greater risk for CI. Reproduction in whole or in part without permission is prohibited. Duffy et al, 1978). Leigh R, Zee D. The neurology of eye movements. 2003 Mar. Borsting EJ, Rouse MW, Mitchell GL, Scheiman M, Cotter SA, Cooper J, et al. These include refractive errors, such as astigmatism, and convergence insufficiency,. What is congenital ocular motor apraxia? Vitreoretinal changes can include hemorrhages, detachments, floaters, maculopathies or other pathologies, any of which may lead to visual impairment. Some patients with convergence insufficiency have no symptoms at all. Convergence insufficiency is a sensory and neuromuscular anomaly of the binocular vision system, characterized by a reduced ability of the eyes to turn towards each other, or sustain convergence. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. Sabates N, Gonce M, Farris B. Neuro-ophthalmological findings in a closed head trauma. These patients may be retested at another time or simply watched for symptoms of diplopia or headaches with near work in the future. Accessed: April 18, 2013. Alvarez T, Kim E, Vicci V, et al. It can also be seen with head trauma, intracranial hypotension, cerebellar lesions, and a midbrain mass. Based on these findings, research suggests that with a program of vision therapy, adults with CI can still learn how to use their fusional convergence skills for clear, single vision without straining their eyes to see. Vitreoretinal changes can include hemorrhages, detachments, floaters, maculopathies or other pathologies, any of which may lead to visual impairment.4,9,15,16. Binocular Vision & Ocular Motility: Theory & Management of Strabismus. 2015. 1998 Feb. 75 (2):88-96. In our offices, we will all ultimately see patients who have had TBI, whether it be from an athletic or service injury, motor vehicle accident or fall. Convergence Insufficiency Symptom Survey scores for required reading versus leisure reading in school-age children. It is characterized by an exophoria at near fixation and reports of horizontal diplopia and eye strain with prolonged reading. Du T, Ciuffreda K, Kapoor N. Elevated dark adaptation thresholds in traumatic brain injury. In monocular exotropia, the turning involves one eye. Occurrence of oculomotor dysfunctions in acquired brain injury: A retrospective analysis. Diagnosis of convergence insufficiency is made by an eye care professional skilled in binocular vision dysfunctions, such as an orthoptist, to rule out any organic disease. Questions: 125. On the other hand, a child with good convergence in the office may have some symptoms at home or school that are seen with convergence insufficiency. [QxMD MEDLINE Link]. The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. 40:94-7. Experts are not yet sure what causes CI. Neurology 2011 Apr 26;76(17):1456-62. Scheiman M, Gallaway M, Frantz KA, Peters RJ, Hatch S, Cuff M, et al. Any ophthalmic examination following TBI must include a meticulous objective and subjective refraction so that any refractive errors can be precisely corrected. What is convergence insufficiency? 133. Unlike convergence insufficiency, a person with convergence excess is able to converge their eyes but over-converges them. The results of the computer program are often followed by your eye care professional with print outs that can be brought in to the office visit. Neurology. Am J Ophthalmol. [QxMD MEDLINE Link]. Eye muscles and nerves must coordinate to look inward (converge) and focus on an object up close. HHS Vulnerability Disclosure. If you suspect your symptoms could stem from convergence insufficiency, communicate them to your optometrist and inquire about whether they may be from CI. Moreover, while using the focusing lens to help you to see clearly may suffice through early adulthood, the lens will begin to lose flexibility as you age, causing the focusing system to weaken. 2015; Aug 19. Visual disturbances common in mTBI patients can include photophobia, blurred vision, reading difficulties, eyestrain, diplopia, visual field defects, color vision changes and vestibular dysfunctions. These patients often have visual concerns that range in complexity and severity. Patients should record the closest distance that they could maintain fusion (keep the pencil from going double as long as possible) after each five minutes of therapy. However, relying on the focusing lens will hide any convergence difficulties. Studies associate TBI trauma with physical changes in various ocular structures that may result in vision blur or distortion. Curr Treat Options Neurol. Treatment of convergence insufficiency in childhood: a current perspective. Some cases of convergence insufficiency are successfully managed by prescription of eyeglasses, sometimes with therapeutic prisms. What causes convergence insufficiency? Ductions should be tested with the fellow eye covered. Optometry. Optom Vis Sci. 2007;78:155-61. Anomalies of the visual fields or damage to various vision-mediating neurological structures can affect these eye movements.10,16 Dysfunction of versional eye movements may cause symptoms such as significant reading difficulties including reduced reading speed, loss of place when reading and re-reading text.4,7,9,10, The King-Devick (KD) test evaluates saccades through rapid number reading on a series of three testing cards, which become progressively more challenging due to variability in spacing between numbers. Clin Ophthalmol. A similar technique is used for rehabilitation: the patient is instructed to do push-up exercises (looking at an object intermittently moved in and out from the bridge of the nose) daily at home to decrease the near point of convergence.Divergence InsufficiencyDivergence insufficiency is characterized as follows: Comitant esotropia is present at distance but not at near. Ductions and versions are full. It is most often related to raised intracranial pressure or Chiari malformation.Classic causes of divergence insufficiency include the following: Raised intracranial pressure Chiari malformation Head trauma Intracranial hypotension (low CSF pressure syndrome) Cerebellar lesions Midbrain massAbnormal Horizontal Conjugate DeviationsGaze deviations are relatively common in large cerebral and pontine lesions (Fig. New York, NY: Demos Medical Publishing; 2009;407-23. Effective management begins with a thorough history that accounts for the patients experience of the specific lighting conditions associated with their symptoms. Ophthalmic Epidemiol. Treatment options for symptomatic convergence insufficiency. (need for glasses to help focus) and good vision. Also, a consultation with an occupational therapist may be beneficial for an evaluation and assistance for mobility purposes. Convergence insufficiency is surprisingly easy to diagnose. Convergence insufficiency is when it is not possible to keep the two eyes working together (also called binocular function) while working close up. A weekly 60-minute in-office therapy visit may be prescribed. This condition causes the two eyes to point in different directions while one eye focuses straight ahead, the other eye may turn either inward , outward , upward (hypertropia), or downward (hypotropia). Visual symptoms can impair rehabilitation and create significant restrictions with occupational, educational and other activities of daily living.4-14. In some cases, convergence insufficiency can be the underlying cause of difficulty learning to read. Convergence insufficiency is often seen in healthy children or aging patients. Monocular near visual acuity should also be evaluated. Base-in prism glasses (prisms in the opposite direction to what was just described) can be used to help keep the eyes in good position for reading. Traumatic brain injury: - people who have gone through any traumatic accident are likely to develop this disease. Suchoff I, Kapoor N, Ciuffreda K, et al. Testing of these areas post-treatment along with subjective improvement of symptoms will indicate outcome and help the clinician develop a means of hopefully improving visual function. [12][13] 122 (5):1056-9. Arch Ophthalmol. What is congenital ocular motor apraxia? Be sure to inform your eye doctor of any changes to your general health, and any medications you currently take on a regular basis. Symptoms can vary with convergence insufficiency and not all symptoms are present in every patient. 2003 Dec. 80 (12):832-8. While vision problems that develop as a result of stress are usually temporary, they can be quite uncomfortable and lead to an increase in stress levels. In some cases, difficulty with making eye contact have been noted as a complaint amongst those affected. 1 The CDC estimates that 3.8 million concussions are diagnosed in ERs each year, with many more going undiagnosed. Supported by Eric R Eggenberger, DO, MS, FAAN is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, American Osteopathic Association, North American Neuro-Ophthalmology SocietyDisclosure: Nothing to disclose. These nondiplopic binocular symptoms are easily diagnosed in the symptomatic patient by checking monocular eye closure, which alleviates binocular symptoms. If you or your child experience vision symptoms associated with convergence insufficiency, contact your eye doctor right away. Convergence insufficiency can cause difficulty learning to read.[1][2][3]. Strabismus. Eye doctors effectively correct convergence insufficiency with vision therapy. Anomalies of the visual fields or damage to various vision-mediating neurological structures can affect these eye movements. Thiagarajan P, Ciuffreda K. Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury. 18. Compensatory techniques such as scrolling and tilting the material away from field loss may help. Convergence excess is also a problem with eye teaming. When a person has convergence excess and looks at a nearpoint target, their eyes converge to a point that is closer than where the target actually is. Pediatric Eye Disease Investigator Group. WHAT IS THE DIFFERENCE BETWEEN CONVERGENCE INSUFFICIENCY AND EXOTROPIA? In this condition, amplitude of accommodation of a person is lesser compared to physiological limits . These exercises may be prescribed by an orthoptist (a medical technician who is specifically trained in eye movements and use of both eyes together) or by an ophthalmologist. Relationship between clinical signs and symptoms of convergence insufficiency. Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work,. Optometry. She also has an interest in Eastern medicine practices and learning about integrative medicine. Ophthalmic Physiol Opt. Symptoms of vergence disorders occur only under binocular viewing conditions and may include eyestrain, double vision and headaches.4,7,9,10,15, The most common vergence dysfunction in TBI patients is a convergence insufficiency, usually occurring as a result of damage to the oculomotor nerve or the medial rectus muscles, causing symptoms to be most evident when reading or performing other near tasks.20-22 Patients with convergence insufficiency characteristically have exophoria at near distances greater than far, a reduced nearpoint of convergence and a reduced positive fusional vergence range.9,10,14 Positive fusional vergence range values that are less than double that of the exophoric posture are likely to be associated with symptomatic convergence insufficiency.9,10,14. Other accommodative disorders may include accommodative infacility and pseudomyopia. in journalism from California State University, Chico. Both accommodative infacility and insufficiency may be improved with oculomotor rehabilitation.9, Oculomotor DysfunctionsBoth versional and vergence oculomotor dysfunctions can occur in TBI patients. Summary Some eye conditions are more common in people with attention deficit hyperactivity disorder (ADHD). Menu. The clinician should inquire about any avoidance behavior in patients who are asymptomatic despite clinical findings consistent with convergence insufficiency. Causes of Convergence Insufficiency Convergence Insufficiency Treatment What is Convergence Insufficiency? When shes not working, Dr. Huang loves reviewing new skin care products, trying interesting food recipes, or hanging with her adopted cats.