Convergence Insufficiency


Convergence Insufficiency_Mandel VisionConvergence Insufficiency (C.I.) is a frequently missed diagnosis, and is one of the most common causes of eyestrain and eye fatigue after prolonged reading and computer work.*  In fact, about 1 out of every 20 people (5%) have convergence insufficiency.[i]  The term convergence insufficiency means that your eyes do not fully turn inward, as they are supposed to, when you are focusing on near objects.  Here at Mandel Vision, Dr. Mandel treats a lot of adult patients with this condition, especially in this mobile world of ours in which more and more time is spent on social media sites on our smartphones, tablets and laptops.

Watch the following video to hear Dr. Mandel explain this very common condition:

Symptoms of convergence insufficiency may include:

  • Headaches
  • Difficulty reading for prolonged periods
  • Eye fatigue
  • Eyestrain
  • A “pulling” feeling around the eyes
  • Tired, sore eyes
  • A tendency to close one eye when reading, or focusing on near objects
  • Difficulty concentrating when reading
  • Squinting

The N.P.C. test is a test that you can do at home to determine if you may be suffering from C.I.   If upon trying this test at home, you realize that you are unable to keep an object, such as the point of a pen, single and/or clear, as you bring it toward your nose, you should make an appointment with your eye doctor for further testing.  Of course, this is not meant to be a substitute for seeing an ophthalmologist, especially if you experience any of the above symptoms.  C.I. could also be accompanied by other, more serious conditions that are sometimes silent in nature.  This is also not a substitute for a routine, thorough medical eye exam, including dilation.  All patients should have this exam annually, even if he/she does not wear glasses and/or contact lenses.

Watch the next video to see a demonstration of the near point of convergence test.

Additionally, there are other factors that could contribute to both C.I., as well as the above listed symptoms, which can be present with or without the presence of C.I.  One of these factors is a change in your glasses or contact lens prescription, or the introduction of glasses or contact lenses for those patients who are not currently wearing them.  If your prescription is no longer correct, or you don’t wear glasses but have developed the need for them, you can experience eye strain, as well as many of the above symptoms of C.I.  This is a result of your eyes accommodating, or changing focus with the help of your eye muscles, to compensate for a prescription change.  When your eyes are doing this all day long, your eye muscles become fatigued, just like your bicep muscle becomes fatigued after too many bicep curls.  Also, the symptoms for both C.I. and a prescription change can be similar.  Therefore, if you have both C.I. and need a change in your prescription, simply doing C.I. exercises may not be enough to alleviate your symptoms.  A full medical eye exam, including a very careful refraction with your ophthalmologist can reveal the need for a prescription change as well as the need for glasses or contact lenses, for the first time, for those patients who have never worn glasses or contact lenses in the past.  Additionally, if glasses are not ground properly, a prismatic effect may be induced, which can exacerbate C.I. symptoms. Therefore, a visit to your optician may be in order as well.

As we previously mentioned, when you are reading, your eyes should naturally converge, or turn inward.  This function is the job of your extraocular eye muscles.   In convergence insufficiency, the specific eye muscles that are responsible for making your eyes converge for reading (the medial rectus muscles) are weak.  Luckily, like any muscle in your body, your eye muscles can be strengthened with exercise.  These exercises are appropriately called convergence insufficiency exercises, or C.I. exercises.

At Mandel Vision, these exercises are recommended 5 times daily, for 5 repetitions each for the first two to three months after this condition is diagnosed.  It may seem like a big commitment, but it’s really only collectively 1 minute, 5 times a day.  We usually tell patients to do these exercises right after normal daily routines such as showering, brushing your teeth, going to the bathroom, etc., as it’s easiest to remember this way.  You can also set yourself an audible reminder on your smartphone.  After this initial two to three months, you will be asked to return for a follow up exam to see if the C.I. exercises have improved both your symptoms as well as your near point of convergence (N.P.C.).  If both have improved, Dr. Mandel will usually allow you to decrease the frequency of these C.I. exercises.  As the eye muscles can weaken again (and usually do), these exercises should be repeated once daily, indefinitely, even when your symptoms go away completely.

We hope this information is helpful to you.  More importantly, we hope that it helps you to be more comfortable, when reading and doing computer work, so that you can do these tasks for longer periods.

If you are experiencing any of the symptoms listed above, and would like to be evaluated for C.I., feel free to contact us, at 888-866-6381, to make an appointment with Dr. Mandel.

* To learn more about another common cause of eyestrain and fatigue (dry eye), click here to read our blog: “Dr. Mandel’s Reading and Computer Tips.”

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Harvard-trained corneal specialist and laser eye surgeon, Eric R. Mandel, M.D., specializes in LASIK and PRK laser vision correction.  Established in 1985, Dr. Mandel has trained eye surgeons, from all over the world, in his laser vision correction techniques.  Dr. Mandel is the only exclusive laser vision correction surgeon in New York named in America’s Top Doctors by Castle Connolly, for 12 consecutive years as well as New York Magazine’s Best Doctors, making Mandel Vision your premier laser vision correction center in New York.

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