Convergence Insufficiency

Today my daughter had an eye appointment that I made almost three months ago. It was with an ophthalmologist who specializes in diagnosing and treating convergence insufficiency. What is that? you ask. Good question.

Until three months ago I had never heard of convergence insufficiency. I didn’t think much of it the first couple of times it was mentioned on the closed FB page for the diet we were following, but after the third or fourth time I started to take note. Whenever a mom posted to express concern about her child’s struggles to read or write, testing for convergence insufficiency was recommended. Once this problem was treated, kids who had previously struggled to read and write began to thrive.

So what is it? Convergence insufficiency is when the eyes struggle to work together to focus on one thing to create a single picture. Individually each eye sees fine–they may even work together well to see far away–it’s coming together at close range that poses a problem. People with convergence insufficiency have to work really hard to see words on a page, even the ones they are writing. They become physically exhausted trying to manage even simple tasks that involve fine motor skills.

Usually children are tested for convergence insufficiency when they are struggling to read and write. My daughter is only in Kindergarten, where everyone is struggling to read and write, so how did I know to get her tested? Once I knew what convergence insufficiency was, I started to recognize some signs.

She has always really struggled with fine motor tasks like drawing, cutting and writing letters. I didn’t think much of it at the time because… normal child development, but in retrospect her level of frustration surrounding these tasks, and the fact that that level of frustration never really dissipated even after the initial learning periods, was a red flag. She also periodically complained of her eyes bothering her. She rubbed her eyes a lot, and would sometimes cover one while doing her homework. When she was reading books, words that she read easily at first became increasingly difficult by the end, at which point she seemed mostly to be guessing what the sentences said based on the illustrations. She was always excited to read when we first sat down, but hated reading by the last page, complaining that she couldn’t read and she’d never be able to. There was also the fact that the OT had placed her in the 10th percentile for visual acuity–evidently she was really bad at copying simple pictures, even for a five year old.

The ophthalmologist recognized right away that my daughter has convergence (and focus) insufficiency, but it wasn’t until I watched her perform a simple test that I saw it for myself. Late in the 1.5 hour appointment the doctor asked my daughter to read two columns of one digit numbers printed in 12 pt font. It took her 31 seconds to read the numbers from the first page–she recited them quickly and easily. She was asked to read numbers again on an almost identical page (only the order of the numbers had changed) immediately after finishing the first, but this time it took her 75 seconds to recite them all, and you could see how fatigued she was and how much she was struggling. The doctor had to remover her hand from the page (she was covering the numbers above the one she was reading to help her focus) multiple times on the second page as well. It was heartbreaking to see how hard it had become for her and I cringed thinking of all the times I’d asked her to finish just one more page of her homework before bed.

The bad news is, my daughter has really been struggling to see so many things for the past couple of years. The good news is 10-12 weeks of in-home and professional therapy should resolve her insufficiencies, probably forever. She doesn’t even need to wear glasses. The other good news is that homework and reading should be much easier and more enjoyable once this problem is resolved.

The last bit of good news is that my intuition was right. I suspected she was struggling and someone validated my concern. After so many weeks of arguing with my husband about what I can and can’t possibly know or determine about my daughter and her behavior, someone confirmed what I believed was true–that something wasn’t right, that my daughter needed help.

I will admit that in the past few weeks I wasn’t feeling super confident that the appointment would be worth it. I worried that I was making more of my daughter’s frustration than was warranted. I mean, didn’t all young kids struggle to read and feel frustrated when they couldn’t? Surely most five-year-olds write their letters and numbers backwards (her teacher had suggested as much). Was I expecting my daughter to be better and smarter than everyone else and then running to a doctor when she wasn’t?

Was I looking for problems when they weren’t there?

After the stress of implementing a diet to address behavior concerns without spousal support, that last question weighed heavily on my mind. And with all the financial stress of our increased childcare expenditures, the idea of throwing away hundreds of dollars on piece of mind seemed like an unforgivable waste. I even had to take an hour off work to get to the appointment in time!

I spent much of today nervous that they would tell me everything was fine, and then guilty that I wanted something to be wrong. It wasn’t until I saw my daughter struggling that I was relieved by her diagnosis, because now I see all the ways this has made her life harder, and I know we can help her so that these everyday tasks are as easy as they should be.

Over 1/3 of kids who are diagnosed with ADD have convergence insufficiency. So many kids with this vision problem are mis- or incompletely diagnosed. The doctor told me that now it is recommended for any child that is receiving an ADD diagnoses be tested for convergence insufficiency before the diagnoses is given. I would bet a lot of money that my sister had it, she was diagnoses with ADD and was the lone person in our family who hated reading and school until early in her adult life (by which time she has probably created strategies to minimize her insufficiencies). I feel so incredibly fortunate that I joined that FB group and learned about this now, so that we can correct it before my daughter develops negative associations with school and reading and her ability to be successful at both.

And now we enter the world of convergence insufficiency. I’m thankful it should be a short stay, and that my daughter will be a happier, less stressed kid, when we leave.

20 Comments

  1. This is great news. It must be such a good feeling to have a hunch like that and have it be proven right, since so often parenting all feels like guesswork. Does your school do eye tests? J was tested in kindergarten and the school nurse found some problems, but when I took him to an ophthalmologist, everything tested fine. I’m glad we got it checked out, though.

    1. That is exactly it: so much of parenting does feel like guesswork and it’s nice to be told you’ve guessed right once in a while.

      My daughter’s school does do eye exams and she was referred by her teacher to get one because her teacher had noticed many of the same things I did, but an optometrist doesn’t see convergence insufficiency because they don’t test for it–they mostly test each eye individually or both at a distance, not how the eyes work together at close range or how quickly they become fatigued. She had passed both her school and pediatrician’ eye exams with no problems.

      1. That’s weird – our school’s eye test definitely measured the ability for J’s eyes to work together. I was told the rest had a lot of false positives, which was the case for us, but it was good because now we know for sure.

  2. Thanks for the heads up. I’ve never heard of this. My kids see the eye dr next month for their annual check–I’ll ask about it.

      1. So my kids had their annual exam with the eye doctor last week. I spoke to the eye doc and they do indeed test for it as a routine part of the exam. I didn’t realize what part that was until he showed me–they take a little toy and ask the child to focus on it until it touches their nose. He explained that if the child had CI one or both eyes will look away as the toy comes closer. He was very knowledgeable and explained what happens if a child has CI.

        So although I’d never heard of it, it’s always been done as part of their annual eye exam and the doctors are well versed in it, which makes me feel comfortable about this.

        1. I’m so glad it’s part of the regular exam. I’m realizing that I had never taken my daughter to an eye exam of any kind, really. I figured that since she was cleared at the pediatrician, I didn’t have to. I will definitely be taking my son to the eye doctor sooner rather than later.

    1. I really do think it will make life much easier for me and for my daughter, once we get past the initial hard part.

  3. Wow – I’m so glad you followed your gut on this and found a way to make her life immeasurably easier moving forward. That’s awesome!

  4. Please tell your Fbk group ‘thank you’.
    Please share this information to her teacher, the person who does the eye exam at school, her pediatrician because everyone needs to learn and no one knows everything.
    What a huge difference this will make for your daughter … and for many other children.
    Despite a background in early childhood education I had never heard of it. Now more people will know, and more children will be helped sooner.
    MANY MANY THANKS and much praise!
    Congratulations to you and Hurrahs for help for your daughter!!!!!!!!

    1. The first thing I did was tell my FB group thank you. I tell them thank you all the time. They are a very supportive group of women.

      And I have a parent/teacher conference with my daughter’s teacher next week. You can bet we will be talking about this. I may even ask if we can forgo homework for a little bit because 20-25 minutes of vision therapy a night is going to be challenging to accommodate.

      I think convergence insufficiency has only been recently understood, so it’s not surprising that you haven’t heard of it. I had never heard of it before that FB group and no one that I’ve talked to about it has heard of it either.

  5. Have you considered Dyslexia as a possible problem? A study published in the British Journal of Ophthalmology found convergence problems were more common in dyslexic children than the general population.
    “The most conspicuous common denominator in those with dyslexia was convergence insufficiency …”

    My son had lots of these problems at school and is dyslexic – writing letters and numbers the wrong way round can be a pointer for dyslexia.
    Hope you don’t mind me suggesting this – maybe you have already ruled out dyslexia.I hope she can find improvement over the next few weeks with the therapy.

    1. I have considered dyslexia, though I haven’t looked into when they can diagnose it because it seems pretty developmentally standard to be writing letters and number backwards in Kindergarten. I will definitely ask her teacher and ophthalmologist about if/when we should start considering that a possibility.

  6. This is fascinating – thank you for sharing! I’m so glad you figured it out so soon, too! I can imagine how this could slip by so easily or be attributed to the wrong things.

  7. Interesting! I have never heard of this, but will be asking my cousin about it next time I see him (he’s an optometrist who can refer me to the right person). I’m sure Matthew is fine, but why not check it out just in case?

  8. Oh, so happy you did this and figured it out. For both you AND your daughter!

    (And also? Remember this when your instincts are saying something and you’re being questioned. Your gut rarely lies!)

  9. Wow! I’ve never heard of this, and I’m going to watch D closely when he is doing his homework. He often seems tired and rubs his eyes, but maybe I won’t be so quick to dismiss it as simple fatigue.

    And good for you for going with your gut AND that it paid off. What did your husband say?

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