Convergence insufficiency (CI) is a common condition which causes a difficulty or inability to effectively converge or align both eyes together to perform near oriented visual tasks, like reading or computer work. Hold the other pencil with the other hand with your arm extended midway between your . Both can cause frustrations with any prolonged near work. This retrospective case series describes the diagnosis . Primary divergence insufficiency is generally a benign condition. . A. Most divergence insufficiency cases require optometric vision therapy, which incorporates the prescription of specific treatments in order to: reduce esophoria; enhance and develop fusional vergence ranges, stability, and flexibility Divergence Insufficiency: A Clinical Study *. In high-myopia patients without double vision, the ocular axis length was 27.6 1.3 mm. Face the wall directly and hold one pencil in one hand with your arm fully extended in front of your face. It is a type of vergence eye movement. Headaches. Many affected patients experience spontaneous resolution of double vision within several months. AC/A is only 3.5 /D in a DE patient if gradient testing is used (Plano phoria compared to +1.00 for example)! Divergence insufficiency, also known as "age-related distance esotropia," commonly manifests in elderly patients and presents . She could not specify when this double vision had begun. Convergence insufficiency (CI) is a vision disorder. Although the treatment of symptomatic convergence insufficiency (CI) with base-in (BI) prism in adults has a strong theoretical foundation, there have been very few studies addressing its efficacy. 1. When our two eyes don't team together properly to make a single image, it can lead to double-vision, headaches, poor depth-perception, and a significant handicap in reading and learning. Divergence insufficiency is a comitant esotropia that is present at distance but not at near, with full ductions and versions . This condition is diagnosed by taking measurements of eye alignment at near using . Divergence excess is an over-divergence when attempting to look at distant objects. Convergence Insufficiency and Double Vision. Individuals with divergence excess also complain of double vision (when the fusional vergence system is unable to make up the difference) headaches, eye strain, and avoidance of near tasks. This condition is diagnosed by taking measurements of eye alignment at distance using several different techniques, both with and without the patient's feedback. Others may experience sensitivity to light or sounds, as well as eye strain. Convergence Insufficiency and Convergence Excess describe a difficulty in the ability to point both eyes at a near target, like a book, tablet, or computer. Patients suffering from double vision first are commonly suspected to have acquired a neurological disorder. With exercises that adapt to each patient and their specific needs, it is an ideal solution for problems such as lazy eye, strabismus, convergence insufficiency, double vision, or other binocular problems. Divergence insufficiency is a rare ophthalmologic disorder manifesting itself among older adults. Convergence insufficiency is a common condition which is seen in both children and adults. Preoperatively, the surgeon . Common symptoms of convergence insufficiency include blurred vision, diplopia (double vision), near sighted discomfort, frontal headaches, pulling sensation in eyes, sleepiness, loss of concentration, nausea, eye discomfort, and general fatigue. You or your children may be at greater risk if other family members have had it. excess, conv. Convergence Insufficiency Symptoms. Abstract BACKGROUND: Divergence insufficiency is defined as esotropia or high esophoria at distance with much lower esophoria or normal fixation at near. Double vision is a common side effect of poor convergence ability. Using magnetic resonance imaging . Decompensated phoria, convergence or divergence insufficiency, myasthenia gravis, spasm of accommodation, cyclic esotropia, and superior oblique myokymia causes double vision that comes and goes i.e. excess and divergence (div.) Squinting or closing one eye. To diagnose convergence insufficiency, your eye doctor might: Take a medical history. This includes childhood and adult strabismus. I also am pretty myopic, so functionally I can't focus on anything past 6-10 feet. Changing a myope from spectacle to contact lens wear can alter their binocular vision (BV) function. This means the eyes do not like to move outward toward the ears and is problematic when trying to view a distant target. Diplopia is a common symptom in neuro-ophthalmology. For the most part I've been trying to . 0:00 / 0:30 . Learn More. As a result I have double vision at a distance, though up close my vision is okay. The most common symptom of convergence insufficiency (CI) is double vision. 132. . does not lead to a suppression scotoma in the dominant eye and the patient develops double vision. . insufficiency not only were each used to describe two totally different entities, one with excess or insufficiency of the fusional conv. It is an unusual form of strabismus with esotropia and diplopia only at distance and single binocular vision at near. When our two eyes don't team together properly, the result is often double-vision, headaches, poor depth-perception, and a significant handicap in reading and learning. 2005; 82: 583-595. In ophthalmology, divergence is the simultaneous outward movement of both eyes away from each other, usually in an effort to maintain single binocular vision when viewing an object. Other treatments include: glasses with prism to reduce double vision Divergence insufficiency is an ocular motor anomaly characterized by horizontal diplopia in the distance. The esodeviation remains comitant in all fields of gaze at distance and markedly lessens or resolves at near. The best available treatment option for Divergence Excess is Vision Therapy. . AAO, Basic and Clinical Science Course. Instead of the eyes moving too far out when they observe an object at distance, the eyes don't move far out enough. Patients often complain of eye strain when reading, closing one eye when . Head trauma 3. Actually it's not synonymous with divergence paralysis, but it is a separate clinical entity . . What causes convergence insufficiency? Double vision. The main difference in symptoms between an individual with convergence excess and divergence excess is that a convergence excess individual may complain that his or her eyes "feel stuck" when doing near . [Show full abstract] cases of high myopia (>-6 D) with divergence insufficiency, 20 cases of high myopia without double vision, and 10 normal cases as controls. Patients may be noted to squint or close . The examination should localize to supranuclear, nuclear, or infranuclear pathways. insufficiency and div. People with convergence insufficiency often have vision problems when they do close-up activities, like reading or using a computer. All patients with primary divergence insufficiency had been specifically asked whether their double vision was preceded by a specific event. Results: In high-myopia patients with divergence insufficiency, ocular axis measurements ranged from 24.8 to 31.0 (mean SD: 27.6 1.6) mm. The most common supranuclear causes of diplopia include convergence insufficiency . This Divergence Exercise Tutorial will teach you how to train your eyes' diverging (turning outward) ability. However, when both eyes incorrectly team together to make a single image, all the following symptoms may occur: Double vision Difficulty reading & writing Headaches Tired or sore eyes Rubbing or closing an eye Avoidance of near work Poor attention and concentration The eponyms of convergence (conv.) Living with divergence insufficiency, esotropia & double vision. March 3, 2022 in Optometry 0 I have esotropia that my ophthalmologist told me was divergence insufficiency because it is only present at a distance, though in this case distance basically means anything more than arm's length. Live. unlike myasthenia gravis that characteristically has double vision in the second . Divergence Insufficiency and Divergence Excess describe a difficulty in the ability to point both eyes at a distance target, like a the board at school or a TV screen. The purpose of this article is to compare vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics as treatments for . Call immediately for trouble with breathing or swallowing . reddened eyes, as well as the newly developed double vision that is made worse with left or right lateral gaze. Eight (40%) of the 20 patients recalled such an event, including a viral pro- drome in 3 patients, minor head trauma in 2 patients, and hospitalization for an unrelated illness in 3 pa- tients. 1. Double vision tests. Using magnetic resonance imaging (MRI), a coronal image 6 mm anterior to the eyeball-optic nerve junction was measured and used to examine the extraocular muscle (EOM) path shift and . Convergence insufficiency is usually diagnosed in school-age children and adolescents. Convergence insufficiency is present in one out of . Patients with divergence insufficiency may complain of intermittent double vision (diplopia) when looking at something in the distance, frequent "wandering" of the eyes, headaches, motion sickness, and eye fatigue that comes and goes and can vary from day-to-day depending on how tired the individual is. VISION THERAPY TREATMENT OF DIVERGENCE EXCESS. Volume 21, Issue 5, May 1938, Pages 510-518. Divergence insufficiency revisited: natural history of idiopathic cases and neurologic associations. CI may occur in children and adults. Filed Under: Vision Therapy Tagged With: costa mesa . Her double vision worsened when standing . Convergence Insufficiency Exercises for Children. Examination will show esodeviation that is comitant in all gazes at distance but profoundly reduced or even presenting exophoria at near. Severe eye discomfort, visual alteration, and headaches are common in many instances of diplopia. In normal cases, the ocular axis length was 23.5 1.0 mm. Divergence insufficiency or palsy: Neurologists point out correspondingly that . The myope reading through their spectacles experiences base-in prism at near, as demonstrated in the image above, which moves the image further away and decreases vergence demand. Divergence insufficiency esotropia, or acquired comitant esotropia that is at least 10 larger at distance than at near, is most often seen in older adults, and may also be known as "age-related distance esotropia.". Graefes Arch Clin Exp Ophthalmol (2013) 251:1641-1644 DOI 10.1007/s00417-013-2313-8 NEUROPHTHALMOLOGY Unilateral lateral rectus resection for horizontal diplopia in adults with divergence insufficiency David R. Stager Sr. & Trevor Black & Joost Felius Received: 7 February 2013 /Revised: 3 March 2013 /Accepted: 5 March 2013 /Published online: 22 March 2013 Springer-Verlag Berlin Heidelberg . amplitude, or fusional div. Some cases are successfully managed by the prescription of therapeutic lenses and/or prisms. Our optometry practice is located in Costa Mesa at 3151 Airway Ave. Suite J2, Costa Mesa, CA 92626. B. DIVERGENCE INSUFFICIENCY :- Divergence insufficiency refers to a clinically defined acquired disorder of ocular horizontal version . In divergence insufficiency, one or both eye(s) are unable to diverge appropriately to a given target. Divergence insufficiency is often managed conservatively with base-out prism corrective lenses, which may, however, cause diplopia . Convergence insufficiency (CI) is when the eyes have trouble working together while focusing on an object that is close by. double vision (diplopia) headaches blurry vision while reading squinting or closing one eye while reading words appearing to move around or float on the page while reading eyestrain or fatigue (asthenopia) Symptoms vary, and patients may be bothered by one or more. Symptoms of convergence insufficiency include diplopia (double vision) and headaches when reading. What are causes of convergence insufficiency? Convergence Insufficiency and Convergence Excess. Divergence insufficiency is the opposite of divergence excess. With CI, the eyes do not point together inward as one looks at objects close-up. A divergence of the eyes in the vertical direction is physiologically seen during a head tilt, due to vestibular signaling, and when viewing a rotating visual image. It is characterized by an inability to effectively converge or align the eyes . It is a disorder involving binocular vision vision using both eyes. CI is usually accompanied by a reduced near point of convergence (NPC), decreased convergence amplitudes or an exodeviation (usually > 10 prism diopters) at near. Additionally, vergence dysfunction disrupts the visual-vestibular system, which can . . All of which are common symptoms of a concussion. It is a disorder involving binocular vision vision using both eyes. Difficulty concentrating. Measure the near point of convergence (NPC). Wondering what exercises you guys doing for divergence insufficiency I feel like every exercise I can find is for convergence . Transient diplopia. 2. 1. Introduction. 02/17/2022 . When accommodation is relaxed, so is convergence. She could not specify when this double vision had begun. Convergence and divergence skills must be fast, accurate and consistent to maintain clear, single vision. Divergence insufficiency is the opposite problem of convergence insufficiency. AmblyoPlay is a vision therapy solution that is performed through playing therapeutic games and exercises on your tablet or computer for 30 minutes per day. Severe eye discomfort, visual alteration, and headaches are common in many instances of diplopia. Others may experience sensitivity to light or sounds, as well as eye strain. This condition causes one eye to turn outward instead of inward with the other eye, creating double or blurred vision. It tends to run in families. Convergence insufficiency (CI) is a vision disorder. Definition: Convergence insufficiency is a problem with 'eye teaming.' A person may be unable to converge their eyes or to sustain convergence. Prangen Convergence insufficiency is a condition in which your eyes are unable to work together when looking at nearby objects. It is idiopathic most often in children or young adults 2. Moving or overlapping words. Convergence insufficiency is harder to imitate on your own (optometrists have computer screens . Primary divergence insufficiency has no other neurological signs or symptoms. Get two different color pencils and stand about five feet in front of a solid-colored wall. Surgical treatment is often indicated for patients who do not tolerate prism therapy, or for those with large angles of . When our two eyes incorrectly team together, to make a single image, symptoms like double vision, headaches, poor depth perception, and tired or sore eyes may occur. This can result in discomfort and even double vision when performing near-point tasks such as reading. Author links open overlay panel Avery DeH. Convergence describes the way our eyes move together and point inward when we look at near objects. Three patients with primary divergence insufficiency continued to have esotropia at the time of their last evaluation, although 2 had shown improvement. Late onset strabismus can lead to double vision which we correct with prisms. Primary and secondary forms exist, with the latter more urgently addressed due to neurologic comorbidities. This is the opposite of Convergence. The history and exam should establish if the diplopia is monocular (typically ocular in origin) or binocular (misalignment). Note that some Internet resources confuse convergence and divergence dysfunction, reversing them. amplitude, and one with anomalies (high or low) of the AC/A ratio, but also were erroneously used to describe . Double vision. 131. Serving the communities of Costa Mesa, Irvine, Newport Beach, Tustin, Santa Ana, Huntington Beach, and Fountain Valley. With CI, the eyes do not point together inward as one looks at objects close-up. near-centered tasks. I'm a practicing orthopist and produced this video showing joining double vision. The most common symptoms are: Tired or sore eyes Blurry vision Double vision Headaches Trouble concentrating You may also have trouble reading. A few more really important ones.. 80% . . When our two eyes don't team together properly to make a single image, it can lead to double-vision, headaches, poor depth-perception, and a significant handicap in reading and learning. Divergence Insufficiency or Excess. Divergence means to move the eyes out away from each other and usually occurs when looking at an object moving further away. Divergence insufficiency is an unusual form of strabismus with esotropia and diplopia only at distance and single binocular vision at near. and that the written words will move around and become blurry after prolonged periods of reading. Call for worsening double vision. Sometimes, convergence insufficiency comes back after successful treatment with exercises. The way our eyes team together and focus directly affects our ability to read, process and understand information. We investigated 20 cases of high myopia (>6 D) with divergence insufficiency, 20 cases of high myopia without double vision, and 10 normal cases as controls. .Jacobson DM. . Blurred vision. The clinical neurologic evaluation is a powerful tool that distinguishes those with a primary disorder from those harboring an underlying Both can cause double vision when looking at distant objects. Additional Resources. Tired eyes. Convergence is the ability for the eyes to turn inward towards each other. For both monocular and binocular double vision refraction test, slit lamp test, and dilated fundus . When you try to focus on something close to your eyes, you may have: Tired eyes. Pencil pushupThis is one of the front-line exercises for convergence insufficiency, Hold a pencil at arm's length away from your nose. These conditions that affect convergence or divergence may cause symptoms such as seeing double at near or far while viewing an object. Looking away from the optical centre of the lens (while keeping . Progressive supranuclear palsy. This might include a health history as well as questions about problems you have with focusing, blurred or double vision, headaches, or other symptoms. Difficulty reading for any length of time. What is divergence insufficiency? For accommodative insufficiency, try crossing your eyes so that the print appears double or blurry. This exercise will strengthen the capacity . This test measures the distance from your eyes to where both . CI affects children and adults. Secondary divergence insufficiency has signs or symptoms of neurologic dysfunction. Schedule a visit with Dr. Valerie Lam or Dr. Thanh Mai to learn more. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near . People with convergence insufficiency often complain of the following symptoms when reading or doing intense near work: 1 . D etermining the etiology of a patient's complaint of double vision can be akin to a detective solving a mystery in a novel; it is best to approach the case in a stepwise fashion and ask the appropriate questions. This guide will help anatomically localize the . Convergence is a visual skill that is learned and developed. Symptoms often include difficulty reading and concentrating on reading tasks, avoidance of near . Convergence insufficiency is a sensory and neuromuscular anomaly of the . Divergence Insufficiency . Divergence Excess Treatment is often treated differently than other types of Exotropia (outward eye turn). Double vision may be caused by life-threatening conditions, such as infections or brain tumors, although these are uncommon. The patient also endorsed photophobia and reddened eyes, as well as the newly developed double vision that is made worse with left or right lateral gaze. Parkinson disease 4. The clue that a supranuclear palsy is present is that different types of eye movement (pursuit, saccadic, vestibulo-ocular, convergence . Eye exercises successfully treat the symptoms of convergence insufficiency in about 70 percent (7 out of 10) of patients. Convergence Insufficiency and Double Vision The way our eyes team together and focus directly affects our ability to read, process and understand information. Section 5: Neuro-Ophthalmology, 2013-2014. Any form of vergence dysfunction can result in symptoms such as double vision, blurred vision, headaches or visual discomfort. . Convergence Insufficiency and Double Vision About The way our eyes team together and focus directly affects our ability to read, process and understand information. Divergence insufficiency is a disorder present in older adults that manifests itself by horizontal diplopia at distance. divergence insufficiency: characteristics, diagnosis and treatment. Convergence Insufficiency (CI) is characterized by a decreased ability to converge the eyes and maintain binocular fusion while focusing on a near target. Here, we present a four-step process with 20 questions to ask or consider during an eye exam when a patient presents with diplopia. Symptoms can include blurry vision, double vision, headache, eye strain, and trouble reading and concentrating. CI affects children and adults. . Common symptoms include: headaches blurred vision double vision eye strain or fatigue sore or watery eyes after a near or far task Convergence Insufficiency & Double Vision The way our eyes team together and focus directly affects our ability to read, process and understand information. Convergence describes the way our eyes move together and point inward when we look at near objects. When our two eyes don't team together properly, the result is often double-vision, headaches, poor depth-perception, and a significant handicap in reading and learning. A stroke, tumor or degenerative disease within the brain can present with double vision by causing an ocular motor nerve palsy, an internuclear ophthalmoplegia (INO), a skew deviation or a supranuclear palsy. I've had strabismus (esotropia) that was uncorrected from childhood and have in the past few years struggled with strong double vision after my second surgery. Over many years, we have observed numerous elderly patients complaining of double pictures for distant objects but lacking any other neurologic symptom. Ultimately, the diagnosis of DI, particularly in the primary form, tends to be elusive. Double vision may be caused by life-threatening conditions, such as infections or brain tumors, although these are uncommon. They had experienced double vision for 5 weeks, 5 months, and 6 months, respectively, up to the time of their last evaluation, but did not return for further follow-up. Almost every athlete that I see with a concussion . Motion sickness or dizziness ( vertigo) Headache . The EOM angles in these patients ranged from 100 to . Restarting the eye exercises may help the symptoms go away again. A person with divergence insufficiency may have double vision at a distance, which mainly occurs with severe exhaustion and fatigue. The EOM angles in these patients ranged from 100 to 140 (112.9 9.7) degrees, which was significantly higher (P < 0.05) than that seen in the high-myopia patients without double vision (average EOM angle, 99.2 2.8 degrees) and normal cases (average EOM angle, 97.9 3.8 degrees). Many patients will complain that they have difficulty concentrating on near work (computer, reading, etc.)