Convergence insufficiency (CI) is a common visual disorder that is characterized by great difficulty maintaining binocular eye alignment when looking at something close up (such as a book or a writing assignment). This landmark study, funded by the National Eye Institute, provides strong evidence that office-based vision therapy is the most effective treatment for CI. Treatment success can and should be measured 2 ways: objectively (looking at changes in measurements used in the diagnosis of CI) and subjectively (looking at changes in symptomology associated with CI).
The Convergence Insufficiency Symptom Survey (CISS) was developed to quantify the frequency and severity of symptoms reported by patients with CI. The 15 symptoms on the CISS can be divided into 2 categories: performance- related and eye-related. There are 6 performance-related symptoms evaluating visual efficiency when reading and/or performing near work:
- Loss of place
- Loss of concentration
- Having to re-read
- Reading slowly
- Trouble remembering what you read
- Getting sleepy when reading
The 9 eye-related symptoms include blur, headaches, double vision, tired, sore, uncomfortable eyes, words that move and jump, and pulling sensations around the eyes.
This study evaluated the symptomology of children with Convergence Insufficiency before and after optometric vision therapy. Before vision therapy, the six most frequently reported symptoms were the six performance -related items. Fifty percent of all the children in the study responded “fairly often or always” when asked if they lose their place when reading. Similarly, 45% of the children reported loss of concentration and having to re-read; 40% read slowly; 38% have trouble remembering what they read; and 37% get sleepy when they read.
Children with parent-reported ADHD (attention-deficit hyperactivity disorder) had significantly higher symptom scores on the CISS and the higher score was almost entirely attributed to an increase in the frequency and severity of these performance-related symptoms.
The good news is that ALL the children who responded to treatment reported a decrease in ALL their symptoms. And while this study did not look at academic performance, the authors do note this relationship when they state: “the treatment of symptomatic CI may have a positive impact on reading performance and attention.”
What is the take home message? If your child has a convergence insufficiency, it is important to consider both eye-related and performance-related symptoms. Your child may not be complaining of blurred or double vision, but they still might have performance-related symptoms. Loss of place, re-reading, poor reading comprehension, slow reading, sleepiness, poor concentration….. am I describing your child’s symptoms? Have you considered a vision problem as a possible explanation?