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The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near-visual function, abnormal fatigue, headache, and abnormal postural adaptation, among others.
A large-scale randomized clinical trial known as the Convergence Insufficiency Treatment Trial (CITT) found that office-based vision therapy combined with at-home therapy was more effective than placebo therapy (in-office placebo treatments) for improving symptoms and clinical signs of convergence insufficiency in children and adults.
Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce. So, the patient uses excessive accommodation to stimulate accommodative convergence to overcome reduced PFV. [5]
Vision therapy is a broad concept that encompasses a wide range of treatment types. [3] These include those aimed at convergence insufficiency – where it is often termed "vergence therapy" or "orthoptic therapy" – and at a variety of neurological, educational and spatial difficulties. [3]
Near (1/3m): 15Δ BI → 35-40Δ BO; Distance (6m): 5-7Δ BI → 15Δ BO; Vertical: 3Δ BU → 3Δ BD; If patient results do not reflect the normal values, they may have the following issues: Convergence insufficiency - usually associated with accommodative difficulties, the fusional convergence range of these patients is reduced.
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Vision assessment and cycloplegic refraction should be done. If there is any refractive errors, it should be corrected before considering orthoptic treatments.The accommodative infacility is commonly treated with vision therapy/orthoptics; one study found that 12 weeks of treatment had a significant effect on visual accommodation.