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Convergence Insufficiency: When and How to Treat

From the Department of Ophthalmology, Greater Baltimore Medical Center, Baltimore, Maryland.

Correspondence: Requests for reprints should be addressed to: Cheryl Lynn McCarus, C.O., C.O.M.T., Department of Ophthalmology, Greater Baltimore Medical Center, 6569 N. Charles St., Physicians’ Pavilion West, Suite 505, Baltimore, MD 21204.

Introduction and Purpose: The purpose of this paper is to identify conditions prompting consideration of therapy for convergence insufficiency, to recognize the symptoms of convergence insufficiency and the presenting complaints of adults with asthenopia. The evaluation of the patient with convergence insufficiency and the Convergence Insufficiency Symptom Score (CISS) questionnaire are reviewed. A "Trio for Treatment" is identified. The goals for the classic treatment for convergence insufficiency are highlighted.

Method: The ophthalmologic and optometric literature on convergence insufficiency were reviewed including treatment modalities employed from 1850 to the present. A summary of this literature, along with historical data and current multi-centered nationwide randomized studies, provide data that concludes that under certain clinical conditions therapy for convergence insufficiency is both necessary and productive. Results of recent studies show the majority of patients reporting abatement of symptoms and a CISS score less than 16.

Conclusion: Treatment of convergence insufficiency is suggested when the patient has symptoms, presents with clinical signs and has a CISS score greater than 16. Goals of treatment are to eliminate and relieve symptoms for comfortable binocular vision at near, improve the near point of convergence, increase fusional amplitudes, increase diplopia awareness, and lower the CISS score to less than 16. Success is achieved when the patient has fewer and less severe symptoms related to reading and near work.

Key words: asthenopia, near point of convergence and convergence amplitudes, fusional amplitudes, Convergence Insufficiency Symptom Survey (CISS), Convergence Insufficiency Treatment Trial (CITT)