Evidence-based management of convergence insufficiency

Is convergence insufficiency (CI) diagnosed with too few clinical signs? Is management is too basic?

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Introduction

Of the binocular vision disorders encountered in optometric practice, convergence insufficiency (CI) is the one most likely to be diagnosed and managed within the practice setting. Clinical definitions of CI vary from simply a near point of convergence (NPC) more remote than the expected value, remote NPC with (presumed) associated symptoms to more complex diagnosis based on abnormal test values across a range of clinical tests of binocular vision and accommodation. But are we appropriately diagnosing and managing CI in UK optometric practice? From a personal perspective, it seems that CI in the UK may be diagnosed with too few clinical signs and management is too basic. This may be due to lack of equipment and familiarity with  a range of tests as well as reluctance to charge for additional time for investigation and treatment and short-term follow-up of treatment effectiveness. Where eye exercises or vision training are given there are time pressures to fit this within the sight test appointment structure. 
 Referral might be made to an orthoptics department for management where the need for more intensive vision training is determined, but this is not always the most convenient way for a patient to access services.

 

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