Convergence Insufficiency Convergence Insufficiency a Patient Quality of Life Concern

Convergence Insufficiency Convergence Insufficiency A Patient Quality of Life Concern

 Central vision based › Refractive conditions › Cataracts › Macular Degeneration › Amblyopia  Peripheral vision based › Glaucoma › Visual Field Loss after stroke (CVA)  Anterior segment › Acute Conjunctivitis › Dry Eyes › Allergies

 Strabismus  A disease that affects over 21 million in the United States  Massive research effort over 10 years by the CITT Group  Latest study (2008) NEI funded $6.1 M. multicenter including: The Mayo Clinic, Bascom Palmer and 6 Colleges of Optometry around the US.  Can cause behaviors that appear to be ADD/ADHD, reading and learning problems  There is a cure!

 What is convergence insufficiency (CI)? › Clinical presentation  What to look for in the patient exam? › Symptom profile › Easy screening test  What you can do to help

 Wikipedia: Convergence insufficiency is a sensory and neuromuscular anomaly of the binocular vision system, characterized by an inability of the eyes to approach each other, or sustain convergence

 Affects people of all ages  Impact on lives can be significant  It has had extensive research  The correct treatment is efficacious and permanent

 Missed in vision screenings  CI patients routinely have 20/20

 Children with CI may not complain about their eyes to their parents or tell the family physician

 Most CI patients have “quality of life” symptoms which are over looked in routine screenings

 Avoids near centered visual tasks like reading  Eyes hurt or strain with sustained reading  Headaches associated with sustained reading  Words have illusory movement or overlap (double) when reading  A patient who is a slow reader  A patient who is thought to have attention deficit disorder  A patient who is not trying or is just “lazy” when it comes to school work  Attention deficit for reading  Frustration with emotional overload  Reduced self esteem  Avoidance of academic work  Anxiety  Depression  Reduced social and physical involvement …if your reading did this?  What is the chance that a school-age child will have convergence insufficiency?  A. <1%  B. 2-4%  C. 5-13%  D. 20-25%  What is the chance that a school-age child will have convergence insufficiency?  A. <1%  B. 2-4%  C. 5-13%  D. 20-25%  1:12 children will have CI  Ask a few basic questions

 Run a basic, yet important screening test Does your child have trouble staying on task during a reading activity? Do they have headaches with reading? Turn to the child and ask, “Do you ever see words do this?”

Do you ever see words overlap when reading? (Double vision demo)

Do you have trouble staying on task during a reading activity?

Do you experience headaches or eye fatigue/strain with reading?

 The (NPC) is measured by bringing the test target to the nose and observing when the patient sees double, or one eye deviates out.  NPC ( receded 5cm or recovery greater than 7cm)

 Penlight Red/Green- Near Point of Convergence Test (PLRG NPC)

 ArchOphthalmol. 2008;126(10):1336-1349 › Scheiman, et al. Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children › $6.1million NEI funded › Multi-center study  Mayo Clinic, Bascom Palmer, University of California, OSU, SUNY, NOVA, PCO, UAB, SCCO, › Masked, Prospective, Placebo Controlled

 Pencil push-up “eye exercises”  Home-based activities on computer programs  Office-based professionally guided vision therapy with home reinforcement › Home-Based Pencil Push-ups (HBPP) no better than placebo therapy. Neither (HBPP) or placebo effective in reducing signs/symptoms of CI › Pencil push-ups and home-based computer vision therapy (HBCVAT+) no better than placebo therapy › Office-based vision therapy(OBVT) IS effective in treating CI in children

 Office-based, doctor supervised Optometric Vision Therapy Effective!  Screen  Recognize  Inform

 PLRG NPC

 Symptom Checklist

 Recognize the symptoms › Avoids near centered visual tasks like reading › Eyes hurt or strain with sustained reading › Headaches associated with sustained reading › Words have illusory movement or overlap (double) when reading  Diagnose receded NPC

 Provide CI literature  Advise further diagnostic evaluation  Prescribe treatment Optometric Vision Therapy IS NOT eye exercises!!

Vision Therapy is rehabilitation treatment of the visual brain with proven applications in neuroscience

1. Visual awareness

2. Feedback

3. Loading -Action, movement and relevance

 CITT Study – Archives of Ophthalmology  Near point of Convergence Normative Data Research – Journal of Vision Science  Scheiman –CI Website  VisionHelp Blog- http://visionhelp.wordpress.com › CI: The Private Eye Goes Public – Part 1 › CI:The Private Eye Goes Public -Part 3…who’s looking out for the kids? › All Topics on VisionHelp Blog on CI › Applying Neuroplasticity to Optometric Care  College of Optometrists in Vision Development www.covd.org