Dominick M. Maino, OD, MEd, FAAO, FCOVD-AProfessor of Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
Optometrist, Lyons Family Eye Care
What is Convergence Insufficiency (CI)?
What is Convergence Insufficiency?
...Convergence insufficiency is a sensory and neuromuscular disorder that inhibits a person’s ability to accurately view a near target…. Your ability to turn your eyes in at near is poor.
http://www.optometrystudents.com/convergence-insufficiency-the-ultimate-guide/
What is Convergence Insufficiency?
…Convergence insufficiency (CI)… is often associated with a variety of symptoms, including eyestrain, headaches, blurred vision, diplopia [double vision], sleepiness, difficulty concentrating, movement of print while reading, and loss of comprehension after short periods of reading or performing close activities. …
Archives of Ophthalmology. 2008;126(10):1336-1349
What is the Prevalence of CI?
CI is the most frequently encountered eye coordination problem
CI in adults is between 1 and 25 % of clinic patientsMedian prevalence of CI in the population is 7 %
CI in 5th and 6th graders 4.2 %
OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ACCOMMODATIVE AND VERGENCE DYSFUNCTION
Does CI affect Attention?
There is …an apparent three-fold greater incidence of Attention Deficit Hyperactivity Disorder among patients with CI when compared with the incidence of ADHD in the general US population…. We also note a …three-fold greater incidence of CI in the ADHD population….
Strabismus, 2005, Vol. 13, No. 4 : Pages 163-168.
Does CI affect Attention?
Yes!It is recommend that any child with CI be assessed for attention problems and any child with attention problems be assessed for the presence of convergence insufficiency
Does CI affect Attention?
Diagnosing Attention Problems
A well researched computerized tool to assess attention deficit hyperactivity disorder, attention deficit, inattention, impulsivity and other anomalies of attention is the TOVA (Test of Variables Attention). Survey based tests are also frequently used but the TOVA may be more reliable.
J Clin Psychol. 1998 Jun;54(4):461-76.
An Undiagnosed/Untreated CI could lead to an Eye Turn.
Strabismus is an even more serious problem of binocular vision.
Exotropia: an outward eye turn
At What Age Can You Treat Convergence Insufficiency?
Despite what you may hear from those who have not kept up with the latest research, CI can be treated AT ANY AGE!
Children, Adults and Seniors may all benefit from treatment.
How Do You Treat CI?
Treatment always starts with the best prescription glasses possible. This prescription may change over time as the functional vision problems improve.
How Do You Treat CI?
Optometric vision therapyVision therapy is a doctor-supervised, non-surgical, customized program of therapeutic procedures designed to prevent, remediate, and/or enhance vision problems and/or improve visual skills.
Vision therapy can include the use of lenses, prisms, filters, computerized procedures and non-computerized instrumentation. The goal of vision therapy is to treat vision problems that cannot usually be treated successfully with eyeglasses, contact lenses and/or surgery alone, and help individuals of all ages achieve single, clear, comfortable binocular (two-eyed) vision using the scientific principles of neuroplasticity.
How Do You Treat CI?
… clinical trials showed that office-based vision therapy was successful in about 75% of patients (resulting in normal or significantly improved symptoms and signs) and was the only treatment studied which was more effective than placebo treatments for children withsymptomatic CI. Eye care providers who do not currently offer this treatment may consider referring these patients to a doctor who provides this treatment or consider expanding the treatment options available within their practice to manage this condition…..
Optom Vis Sci. 2009 May ; 86(5): 420–428. doi:10.1097/OPX.0b013e31819fa712
How Successful is Optometric Vision Therapy?
Convergence Insufficiency FAQsWhere do I find a doctor that treats CI and who provides vision therapy?
In Chicago go to Lyons Family Eye Care (LFEC).
To find a doctor close to you go to the College of Optometrists in Vision Development, Optometric Extension Program Foundation and American Optometric Association websites.
CI FAQsWhat credentials should my doctor have so I know he/she will provide the best care?
Your doctor should have one or more of the following:
Completed a residency in pediatrics, binocular vision and vision therapyFellowship and/or membership in the College of Optometrists in Vision DevelopmentMembership in the Optometric Extension Program FoundationDiplomate in Pediatrics/Binocular Vision from the American Academy of Optometry
CI FAQs
This was previously described
• Hand-eye• Focusing• Eye
movement
• Same as noted in monocular phase and anti-suppression
• Same as noted previously plus convergence and divergence therapy
• Hand-eye, eye movement, focusing, convergence and divergence therapy done simultaneously
MonocularGlasses
Biocular BinocularIntegration &Stabilization
Tell me more about vision therapy
There are 4 phases to vision therapy
Convergence Insufficiency FAQsTell me more about the vision therapy program
Functional optometrists will use computer programs, lenses, prisms, and other specialized equipment during the therapy both in office and for you to use at home.
CI FAQs
Tell me about home vision therapy
Home vision therapy can vary from doctor to doctor. I recommend a minimum of 20 to 30 minutes per day, 5 days per week. Some doctors do not prescribe home vision therapy, but I find that the in office therapy program progresses at a faster rate of speed if home therapy is conducted.
CI FAQs
What does vision therapy cost?
This will vary from office to office but is comparable in cost to occupational, physical, and/or speech/language therapy. Some offices charge for each individual visit while others have a “program” similar to that of having braces applied by your dentist.
CI FAQsDoes insurance cover the cost of vision therapy?
Yes. No. Maybe. Some time ago most insurance would have picked up about 80% of the cost. Then my impression was that the insurance companies just seemed to stop reimbursement for therapy. Now they are once again picking up some of the cost.
Know your insurance policy. Do not take “NO” for an answer. Your doctor’s office will usually assist you when it comes to insurance, but it is ultimately your responsibility.
CI FAQsWhere do I learn more about treatment, especially from a parent’s or patient’s point of view?
Go to:
Parents Active in Vision EducationVision Therapy Parents Unite!
Vision Therapy Changed My LifeConvergence Deficiency/Insufficiency
Living with Diplopia
CI FAQsWhere can I get additional information on pediatrics, binocular vision, vision therapy, children wearing glasses and more?
MainosMemosVisionHelp blog
COVD blog
Discovering Vision Therapy blog
Wow Vision Therapy blog
SOVOTO
Little Four Eyes
CI FAQsReading List
Fixing My Gaze: A Scientists Journey into Seeing in 3 DimensionsBy Susan Barry, PhD
Eyes For Learning: Preventing and Curing Vision-Related ProblemsBy Antonia Orfield
When Your Child Struggles: The Myths of 20/20 VisionBy David Cook, OD
The Suddenly Successful Student: A Parents’ and Teachers’ Guide to Learning & Behavior Problems: How Behavioral Optometry Helps
By Hazel Dawkins, E. Edelman, O.D. & C. Forkiotis, O.D.Suddenly Successful: How Behavioral Optometry Helps You Overcome Learning, Health
& Behavior ProblemsBy Hazel Dawkins, E. Edelman, O.D. & C. Forkiotis, O.D.
Thinking Goes To SchoolBy Hans G Furth, Harry Wachs, O.D.
Your Child’s VisionBy Richard Kavner, O.D.
See Vision Therapy Rocksfor more resources
CI FAQsWhere can I get additional help?
Call or email us at Lyons Family Eye Care.
Lyons Family Eye Care3250 N. Lincoln Ave.Chicago, IL 60657Click here to view a map of our location
Phone Number: 773-935-2020Email: [email protected]
“LIKE” us at Vision Therapy at Lyons Family Eye Care
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CI FAQsWhere can I get additional help?
More information about Lyons Family Eye Care
Wild Chicago Harlem Shake Artists LFEC Jingle
“LIKE” us at Vision Therapy at Lyons Family Eye Care
“LIKE” us at Lyons Family Eye Care
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About Dr. Stephanie Lyons
About Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
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