Are your eyes working as a team?

Eye teaming problems (technically known as Convergence Insufficiency) is when you have trouble keeping both eyes turned in to point in the same position when you are doing close work like reading, writing, computer work.

People who can't keep their eyes converged generally have very few visual symptoms. However they do tend to have poorer fine eye-hand and visual motor skills and may avoid near-centered tasks.


Why does my child have a convergence problem?

Your child does not have a muscle problem. It's not that they can't turn either eye inwards. Rather they are unable to turn both eyes inwards together, and sustain this posture. Occasionally the problem is congenital or occurs very early in life. However, it's nearly always a fatigue problem caused by close work. One of the reasons for this may be that the child has never refined this ability. With the start of school work and learning to read, this problem becomes more apparent. Another reason may be that the visual system may be tired and allowing one eye to drift out. There is a breakdown in the ability to sustain near alignment of the eyes due to visual fatigue.

Symptoms

People who can't keep their eyes converged generally have very few visual symptoms. However they do tend to have poorer fine eye-hand and visual motor skills and may avoid near-centered tasks.

Those children who have acquired the convergence insufficiency problem tend to have more symptoms, particularly when doing prolonged near centered tasks. These symptoms may include, but are not necessarily limited to the following:

  • Difficulty sustaining attention at visually demanding tasks
  • Headaches
  • Occasionally a child will also complain of double vision or the letters moving or running (swirling)
  • Abnormal posture when trying to center on near tasks, including head tilting or holding their work very close
  • Squinting when reading
  • Closing an eye when reading
  • Sore, red or tired eyes
  • Blurred near vision
  • Avoidance of reading
  • Poor comprehension and/or poor reading fluency
  • Holding a book too close when reading or tromboning it back and forth to see words clearly

Management

Case management and duration of treatment will depend on why the child has the convergence insufficiency problem. If it is because they have never refined this ability, then a broader optometric visual therapy program will be required, of which developing convergence skills is but one aspect. In these cases, usually spectacle lenses are not required.

Treatment of acquired convergence insufficiency will require the prescription of spectacles. In some cases, because these lenses reduce the visual demands on the visual system this is all that is needed. In other cases however, visual therapy will also be needed to rebuild and develop the visual stamina and convergence skills. It is important that the glasses are worn in the classroom as well as for all homework, reading, computer, or any prolonged close work tasks.

In an uncomplicated case, vision therapy may take between 4 to 6 in-office visits which are usually spaced one to two weeks apart. For the developmental convergence insufficiency case, a longer period may be required to develop and teach all the required visual skills

What About the Future?

Often the reading glasses need to be worn at least 12 to 36 months after the completion of any visual therapy. Usually, by then the child will have developed good stamina and we will then be able to gradually wean them out of their glasses, or reduce wearing time. Periodic follow up should then be provided at least every 12 months during the child's school life since the demands of the classroom increase throughout the school years.

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