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Amer. Orthoptic Jrnl. 59(1):10-13 (2009); doi:10.3368/aoj.59.1.10
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Symposium: Drifting Apart from Birth to Adulthood: How to Manage Exotropia

Convergence Insufficiency: When and How to Treat

Cheryl Lynn McCarus, C.O., C.O.M.T and Mary Louise Zimmerman Collins, M.D.

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.


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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)


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  1. von Noorden GK, Campos EC: Binocular Vision and Ocular Motility , 6th ed. St. Louis: Mosby; 2002, p. 502.
  2. Sheard C: Zones of ocular comfort. Am J Optom 1930; 7:9–25.
  3. Arnoldi K: A review of convergence insufficiency: What are we really accomplishing with exercises? Am Orthopt J 2007; 57:123–130.[CrossRef]
  4. Granet DB, et al.: The relationship between convergence insufficiency and ADHD. Strabismus 2005; 13:163–168.[CrossRef][Medline]
  5. Convergence Insufficiency Treatment Trial (CITT) Study Group: The convergence insufficiency treatment trial: Design, methods, and baseline data. Ophthalmic Epidemiol 2008; 15:24–36.[Medline]
  6. Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, Borsting E, London R, Wensveen J, CITT Study Group: A randomized clinical trial of treatments for convergence insufficiency in children. Arch Ophthalmol 2005; 123:14–24.[Abstract/Free Full Text]
  7. McCarus C: Drifting apart from birth to adulthood: How to manage exotropia. AAO/AOC/AACO Symposium, November 2008, Atlanta, GA.
  8. Arnoldi K, McCarus C: Orthoptic therapy interactive workshop. AACO Joint Regional Meeting, June 2006, Baltimore, MD.




This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
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Right arrow Articles by McCarus, C. L.
Right arrow Articles by Collins, M. L. Z.
Right arrow Search for Related Content

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