As our children head back to school, we may notice that our child appears to have difficulty with his or her studies. Many school performance issues can actually be linked to poor vision in school aged children. When you read something or look at something held in your hand, your eyes need to turn inward together (or converge) in order to focus. This muscle motion activates your binocular vision, enabling you to see a single image that is close up. When these muscles aren’t working together properly, a convergence insufficiency can result in your child having difficulty reading and showing a reluctance to participate in classroom activities.

Convergence insufficiency is among the most common types of eye muscle dysfunctions. Diagnosis and treatment of convergence insufficiency can often make significant improvements to one’s quality of life. Reports vary widely, but the prevalence of convergence insufficiency has been reported at up to 13 percent of the pediatric population in the United States. Under normal circumstances, the eyes converge while reading or performing near work; in convergence insufficiency, the eyes don’t turn inward as they should. The eye muscles fight and strain to turn the eyes inward but are inadequate.

Symptoms of convergence insufficiency include:

  1. Eyestrain (especially when reading)
  2. Headaches
  3. Blurred vision or double vision
  4. Poor concentration and trouble remembering what was read
  5. Squinting, rubbing, closing, or covering an eye
  6. Sleepiness while reading
  7. Short attention span
  8. Words move, jump, swim, or float on the page
  9. Problems with motion sickness

A skilled eye care provider usually suspects convergence insufficiency based solely on the history and complaints of the patient and parent. Exam room testing will confirm the diagnosis, and an action plan will be prescribed, depending on the severity of the insufficiency. The fastest way to relieve the symptoms of this condition is a pair of eyeglasses designed for near vision use only.

Reading glasses for convergence insufficiency incorporate prisms ground into the lenses. These prisms act to bend light outward to the eyes that are not properly turning in. Rather than the eyes being forced to struggle, the prisms bend light outward to arrive where the eyes already are, without requiring convergence. This takes the demand off the eye muscles and allows clear, binocular vision without the previous struggle. Reading glasses with prisms will normally resolve the symptoms very quickly. Be aware, though, that the eyes usually don’t require the prism at distance, so the reading glasses can actually make the distance vision uncomfortable. For this reason, the person with convergence insufficiency almost always removes the glasses to see far away.

Various forms of vision therapy are also often effective ways of treating convergence insufficiency. Some people’s eyes respond well to training of the eye muscles in order to strengthen their ability to converge. The most common method of vision therapy is called “Pencil Push-Ups.” Pencil Push-Up Therapy (PPT) has been shown to have high success rates in reducing the symptoms of convergence insufficiency, but it requires perseverance on the part of both the parents and child to be effective. Remembering and sticking to the training regimen becomes tedious quickly, especially for a child.

PPT consists simply of holding a pencil with the eraser side up held at arm’s length from the eyes. The patient slowly brings the eraser in a straight line toward their nose while maintaining focus on the eraser as long as possible. This exercise is performed for 10–20 minutes a day, twice a day, for several weeks. In many cases, the patient is able to gradually bring the pencil eraser closer to their nose before the image blurs and convergence ceases. Strengthening the eye muscles in this way is an adjunct, and sometimes eventually a replacement, for the prism reading glasses.

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