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Convergence Insufficiency Treatment & Management

  • Author: Michael J Bartiss, OD, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Oct 14, 2015

Medical Care

Convergence exercises (ie, orthoptics, vision therapy) and/or base-in prisms are the mainstays of treatment of convergence insufficiency.[8]

Orthoptics and vision therapy

Near point of convergence exercises: An accommodative target, such as a column of telephone numbers taped to a tongue depressor or piece of cardboard, is placed remote to the patient's near point of convergence and gradually brought toward the tip of the nose with the patient converging to avoid diplopia. Just before there is a break in fusion, the patient holds fixation on the target for 10 seconds. This so-called push-up is repeated 10 times, 2-4 times a day, until the patient is able to hold fixation to approximately 6-8 cm from the nose. The exercises can be tapered and then used on an as-needed basis when the patient notices a recurrence of symptoms.

Other forms of convergence training: Base-out prism reading and stereogram cards may be used by an orthoptist or a vision therapist to improve fusional convergence. New, affordable computerized fusional vergence training programs (eg, Computer Orthoptics) are also available. These self-paced programs can be used on a personal computer in the patient's home.

Base-in prisms for near only: These prisms can be ground into a separate pair of reading glasses, or Fresnel membrane prisms can be fitted over the reading segment of the patient's bifocals.

A paper by Scheiman et al[9] in a review of 3 multicenter randomized clinical trials, while recognizing some limitations of the summarized studies, reported that office-based vision therapy provides superior results as a treatment modality versus specific home-based therapies (pencil push-up and some computer-based therapy) or placebo.

A study is currently underway through the Pediatric Eye Disease Investigator Group (PEDIG) regarding the treatment of symptomatic convergence insufficiency. The purpose of this study is as follows:[10]

  • To determine the effectiveness of active home-based computer vergence/accommodative therapy versus placebo home-based computer vergence/accommodative therapy for the treatment of symptomatic convergence insufficiency in children aged 9-18 years.
  • To determine the effectiveness of home-based computer vergence/accommodative therapy compared with home-based near target push-ups for the treatment of symptomatic convergence insufficiency in children aged 9-18 years.

Surgical Care

The decision to proceed with surgery should be made with caution and only after all orthoptic efforts have failed.[11]

Bilateral medial rectus resection is usually the most effective operation for convergence insufficiency.[12] However, the patient should be warned about the possibility of uncrossed diplopia at distance fixation after surgery. This typically resolves within 1-3 months postoperatively. The exophoria at near often recurs after several years, although most patients remain asymptomatic.



Patient activities are not restricted.

Contributor Information and Disclosures

Michael J Bartiss, OD, MD Medical Director, Ophthalmology, Family Eye Care of the Carolinas and Surgery Center of Pinehurst

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, North Carolina Medical Society, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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