CONVERGENCE

INSUFFICENCY

INTRODUCTION
Convergence Insufficiency

:
Convergence Insufficiency (CI) is the leading
cause of eyestrain, blurred vision, double
vision (diplopia), and/or headaches.

CASE DETAILS
14YRS/M, visited sankara eye
hospital with chief complains of
frontal an temporal headache during
near work and mobile using.

CASE HISTORY
Ocular history: No suspected of
ocular history.
Systemic history: No suspected of
systemic history.
Birth history: Full Time Normal
Delievery with normal birth weight
Family history: No suspect of family
history.
Medication: Nill
Allergy: Not aware off.

Clinical details
Vn: OD:- 6/6 N6 @ 30-40 cm
OS:- 6/6 N6 @ 30-40 cm
Refraction:
OD:- +0.50DS Vn 6/6; N-6
OS:- +0.50DS Vn 6/6; N-6
Wet Refraction/ dilated retinoscopy
OD:+0.75DS
OS:+0.75DS

ADVICE
Patient is adviced for follow up after
two days for PMT and Binocular
evaluation.

FOLLOW UP

Orthoptics Evaluation:Stereopsis: 40 sec of arc

WFDT: fusion Present (In both near and distance)
EOM:
OD: SAFE
OS: SAFE
Near Point Of Convergence(NPC):x/20/25cm
Near Point Of Accommodation(NPA):
OD:7cm
OS:7cm

 Cover Test:

Distance: Exophoria
Near: Exophoria
Maddox Rod Test:
Distace:2.. Exophoria
Near: 10.. exophoria
AC/A Ratio: 3:1
Amplitude Of Accommodation(AA):
OD:100/7=14.285 D
OS:100/7=14.285 D

 Negative Relative Accommodation (NRA):

+1.75
Positive Relative Accommodation(PRA):
-2.75
MEM:
OD:+0.75D
OS:+0.75D
Negative Fusional Vergence(NFV):
Distance: x/12/8
Near: x/14/12

 Positive Fusional Vergence(PFV):

Distance: x/10/8
Near: x/6/4
Vergence Facilities: 2cpm (difficulty with base
out)
Accommodative Facilities:
OD:7cpm
OS:6cpm
OU:3cpm
-difficulties with plus lens

 Diagnosis: CONVERGENCE
INSUFFIENCY
Advice: VISION THERAPY
Vision therapy was given for 2
months thrice a week.

Post Therapy Examination

Date:-After two month
N.P.C:-x/6/7
N.P.A:OD:-6Cm
OS:-6Cm
A.A:
OD:-16.6D
OS:-16.6D

 Cover Test:D:-Orthophoria
N:-3 Exophoria
AC/A Ratio:-2:1
P.F.V:D:-X/12/8
N:-X/18/12
N.F.V:D:- X/10/8
N:-X/12/10

 Accommodative Facilities:
OD:-10 CPM
OS:-10 CPM
OU:-10 CPM
N.R.A:- +2.50 D
P.R.A:- -2.50 DMEM:OD:- +0.75 D
OS:- +0.75 D
MEM:OD:- +0.75 D
OS:- +0.75 D

Discussion
According to ............. Out of 300 population
of convergence insufficiency, 34% showed
improvement with pencil push-up therapy,
22% with vision therapy/orthoptics and
20% with base in prism glass therapy.
The studies conducted by CITT investigator
group have shown that the only treatment
for CI was office vision therapy for 45-60
minute weekly was more effective than
placebo vision therapy.

DISCUSSION
Convergence is indispensable for
maintenance of single binocular
vision for all distances nearer to
infinity. Study had indicated that
almost every second person
presenting with headache with
normal vision and fundus was found
to be suffering from convergence
insufficiency.

CONCLUSION
CI more common in patients between
20-40 years, especially those
engaged in near work.
Therefore Binocular examination in
all cases of eye strain and headache
is essential.

Reference
Jeffrey Cooper, M.S. , O.D. , and
Nadine Jamal, O.D.
Scheimanm, Rouse M and Kulp MT, et
al. Treatment of convergence
insufficiency in childhood. A cument
prespective optom vis sci 2009 may;
86(5): 420-428

ACKNOWLEDGEMENT
SANKARA EYE HOSPITAL
CHITKARA UNIVERSITY
FACULTY MEMBER OF SANKARA
COLLEGE OF OPTOMETRY