Convergence Insufficiency, Not a Learning Disability

More than half of patients that are enrolled in a Vision Therapy program with me have a vergence (which means eye coordination) problem.

The most common type of vergence problem is called convergence insufficiency. Convergence insufficiency can lead to reading difficulties including seeing double, getting fatigued quickly, feeling like your eyes are not working together, and headaches.

Eyes are designed to work together to give us single, clear vision. With convergence insufficiency, the two eyes don’t not work together the way they should.

In most cases, this condition develops in early childhood years but the child neglects to tell anyone about their symptoms. They think it’s normal to see this way because they’ve never known anything different. These children struggle with reading, often avoiding it. They may be able to read out loud in a broken manner, but they likely don’t remember what they read. These types of issues often cause parents or teachers to think that the child has a learning disability, such as dyslexia.

Some of the symptoms your child might be having, even if they don’t know to tell you about them, are:

  • Loss of place
  • Loss of concentration
  • Re-reading the same line
  • Reading slowly
  • Trouble remembering what was read
  • Feeling sleepy
  • Words blurring
  • Headache
  • Double vision
  • Eyes hurt
  • Eyes feel tired
  • Eyes feel uncomfortable
  • Eyes feel sore
  • Words move/jump/swim
  • Pulling feeling

Since your child might not know how to express these symptoms to you, here are some things you can look for:

  • trouble catching balls and other objects thrown through the air
  • avoiding tasks that require depth perception (games with small balls traveling through the air, handicrafts, and anything requiring hand-eye coordination)
  • frequent misjudgment of physical distances, such as:
    • trips and stumbles on uneven surfaces, stairs, and curbs, etc.
    • frequent spilling or knocking over of objects
    • bumping into doors, furniture and other stationary objects
    • sports accidents
  • avoiding eye contact
  • poor posture while doing activities requiring near vision
  • one shoulder is noticeably higher
  • frequent head tilt
  • problems with motion sickness

Watch this video to see an example of what convergence insufficiency looks like. You can see this boy’s left eye swing out as the target gets closer to him.

Convergence insufficiency means that your eyes won't turn inward properly while focusing on a nearby object. When you read or look at a close object, your eyes are supposed to converge (turn inward together to focus), but if you have convergence insufficiency, you won't be able to move your eyes inward to focus normally – as you can clearly see with the boy in this video.

It’s also important to note that most children who have convergence insufficiency have 20/20 vision. So a comprehensive eye exam testing for more than just 20/20 vision is very important.

The good news is that this condition is easily diagnosed during a comprehensive eye examination and has a very high cure rate when treated with vision therapy.

In my practice right now I have an 8-year-old boy who did not enjoy reading at all, he had difficulty staying focused for near activities and (unbeknownst to his parents) he saw double at near. No one thought to ask him if he saw double and he never thought to tell anyone, he assumed that was the way everyone saw. Since starting his vision therapy 10 weeks ago, we've seen his attention for near activities improve dramatically. His mother tells me he now perseveres and reads more than he did before, and just as importantly he's so proud of the improvements he's made! The importance of being able to read with ease is paramount to success in learning. In this boy’s case, vision therapy will have a significant impact on his reading ability and therefore his success in school and life.

By Dr. Nazima Sangha of Family Eyecare Centre