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Convergence insufficiency

Last edited: 4/14/2026

Overview

Convergence insufficiency (CI) is a common binocular vision disorder characterized by difficulty in converging the eyes for near tasks, often leading to symptoms such as eye strain, headaches, and blurred vision during activities like reading or using digital devices. 726

Diagnosis

  • Key Diagnostic Criteria: Near point of convergence (NPC) greater than 10 cm, positive fusional vergence, and symptoms exacerbated by near work.
  • Recommended Tests: Cover test, alternate cover test, NPC measurement, and sometimes accommodative facility tests.
  • Grading: Often assessed based on symptom severity and clinical findings, though standardized grading scales may vary. 711

    • Management

  • First-Line Treatments:
    • - Home-Based Therapy: Pencil push-ups and computer-based vergence/accommodative exercises. - Office-Based Therapy: Structured vision therapy/orthoptic exercises.
  • Adjunctive Treatments:
    • - Base-In Prism: Lenses with base-in prisms to help with convergence. - Reading Glasses: In some cases, to reduce accommodative demands. 71920

    Special Populations

  • Pediatrics: Effective treatments include both home-based and office-based therapies, with randomized trials supporting their efficacy in children aged 9 to 17 years. 1920
  • Comorbidities: No specific guidelines provided in the abstracts regarding management adjustments for comorbidities. 7

    • Key Recommendations

  • Use Home-Based or Office-Based Vision Therapy for Symptomatic CI: Effective treatments include home-based pencil push-ups and computer-based exercises, as well as office-based vision therapy, with evidence from randomized clinical trials supporting their efficacy. (Evidence: Strong 1920)
  • Consider Base-In Prism Lenses for Symptomatic Relief: Incorporate base-in prism lenses to assist with convergence difficulties, particularly in managing symptoms during near tasks. (Evidence: Moderate 7)
  • Regular Monitoring and Reinforcement Essential: Ensure consistent follow-up and reinforcement of therapy to achieve optimal outcomes, especially in pediatric populations. (Evidence: Expert opinion 7)

    • References

    1 Zunza M, Thabane L, Kuhn L, Els C, Lombard C, Cotton MF et al.. A randomized controlled, trial on effects of mobile phone text messaging in combination with motivational interviewing versus standard infant feeding counselling on breastfeeding and child health outcomes, among women living with HIV. International breastfeeding journal 2025. link 2 Mor M, Levi A, Rafaeli-Yehudai T, Ezratty J, Shiber Y, Smorgick N et al.. Should it really be called a heroic cerclage? The obstetrical results of emergency late second-trimester cerclage compared with early history-indicated elective cerclage: a retrospective trial. Archives of gynecology and obstetrics 2024. link 3 Yi X, Zhang D, Yang J, Gao H, Cai H, Cong J et al.. Analysis of perinatal outcomes for emergency cervical cerclage in singleton pregnancies at 24-28 weeks of gestation. Archives of gynecology and obstetrics 2024. link 4 Espersen R, Ejlsmark-Svensson H, Madsen LR, Nebel C, Danielsen M, Dalsgaard TK et al.. Influence of food matrix delivery system on the bioavailability of vitamin D. Nutrition (Burbank, Los Angeles County, Calif.) 2023. link 5 Espersen R, Correia BSB, Rejnmark L, Bertram HC. The Diurnal Blood Metabolome and Effects of Vitamin D Supplementation: A Randomised Crossover Trial in Postmenopausal Women. International journal of molecular sciences 2022. link 6 Delgado A, Cleberg R, Gimovsky AC. A Novel Transvaginal Cervical Cerclage Model for Resident Training. MedEdPORTAL : the journal of teaching and learning resources 2021. link 7 Chang MY, Morrison DG, Binenbaum G, Heidary G, Trivedi RH, Galvin JA et al.. Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology. Ophthalmology 2021. link 8 Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis. Acta obstetricia et gynecologica Scandinavica 2020. link 9 Wang Y, Zhou C. China should take more measures to raise its breastfeeding rate. Bioscience trends 2019. link 10 Pang Q, Jia X, Chen L. Perinatal Outcomes After Emergency Cervical Cerclage for Cervical Insufficiency with Prolapsed Membranes. Medical science monitor : international medical journal of experimental and clinical research 2019. link 11 Menjivar AM, Kulp MT, Mitchell GL, Toole AJ, Reuter K. Screening for convergence insufficiency in school-age children. Clinical & experimental optometry 2018. link 12 Sperling JD, Dahlke JD, Gonzalez JM. Cerclage Use: A Review of 3 National Guidelines. Obstetrical & gynecological survey 2017. link 13 Mauvais FX, Gonzales E, Davit-Spraul A, Jacquemin E, Brauner R. Cholestasis Reveals Severe Cortisol Deficiency in Neonatal Pituitary Stalk Interruption Syndrome. PloS one 2016. link 14 Heyboer M, Grant WD, Byrne J, Pons P, Morgan M, Iqbal B et al.. Hyperbaric oxygen for the treatment of nonhealing arterial insufficiency ulcers. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2014. link 15 Lekich C, Campbell W, Walton S, Hannah P. Anomalous high bifurcation of the common femoral artery at the groin: management of GSV incompetence with endovenous laser ablation. Phlebology 2013. link 16 Karim Y, Turner C, Dalton N, Roplekar R, Sankaralingam A, Ewang M et al.. The relationship between pro-resorptive inflammatory cytokines and the effect of high dose vitamin D supplementation on their circulating concentrations. International immunopharmacology 2013. link 17 Gallagher JC, Yalamanchili V, Smith LM. The effect of vitamin D on calcium absorption in older women. The Journal of clinical endocrinology and metabolism 2012. link 18 Patwardhan SD, Sharma P, Saxena R, Khanduja SK. Preferred clinical practice in convergence insufficiency in India: a survey. Indian journal of ophthalmology 2008. link 19 . Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Archives of ophthalmology (Chicago, Ill. : 1960) 2008. link 20 Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M et al.. A randomized clinical trial of treatments for convergence insufficiency in children. Archives of ophthalmology (Chicago, Ill. : 1960) 2005. link 21 Scheiman M, Cooper J, Mitchell GL, de LP, Cotter S, Borsting E et al.. A survey of treatment modalities for convergence insufficiency. Optometry and vision science : official publication of the American Academy of Optometry 2002. link 22 Cattaneo A, Buzzetti R. Effect on rates of breast feeding of training for the baby friendly hospital initiative. BMJ (Clinical research ed.) 2001. link 23 Hill PD. Insufficient milk supply syndrome. NAACOG's clinical issues in perinatal and women's health nursing 1992. link 24 Hill PD. Effects of education on breastfeeding success. Maternal-child nursing journal 1987. link 25 Pino RM. Restriction to endogenous plasma proteins by a fenestrated capillary endothelium: an ultrastructural immunocytochemical study of the choriocapillary endothelium. The American journal of anatomy 1985. link 26 Cooper J, Duckman R. Convergence insufficiency: incidence, diagnosis, and treatment. Journal of the American Optometric Association 1978. link 27 Fiorani P, Pistolese GR, Faraglia V, Spartera C. Indications for surgical treatment of cerebrovascular insufficiency. European neurology 1978. link 28 Liddicoat JE, Bekassy SM, Daniell MB, De Bakey ME. Inadvertent femoral artery "stripping": surgical management. Surgery 1975. link 29 Mahto RS. Eye strain from convergence insufficiency. British medical journal 1972. link

    Original source

    1. [1]
      A randomized controlled, trial on effects of mobile phone text messaging in combination with motivational interviewing versus standard infant feeding counselling on breastfeeding and child health outcomes, among women living with HIV. — Zunza M, Thabane L, Kuhn L, Els C, Lombard C, Cotton MF et al. International breastfeeding journal (2025)
    2. [2]
      Should it really be called a heroic cerclage? The obstetrical results of emergency late second-trimester cerclage compared with early history-indicated elective cerclage: a retrospective trial. — Mor M, Levi A, Rafaeli-Yehudai T, Ezratty J, Shiber Y, Smorgick N et al. Archives of gynecology and obstetrics (2024)
    3. [3]
      Analysis of perinatal outcomes for emergency cervical cerclage in singleton pregnancies at 24-28 weeks of gestation. — Yi X, Zhang D, Yang J, Gao H, Cai H, Cong J et al. Archives of gynecology and obstetrics (2024)
    4. [4]
      Influence of food matrix delivery system on the bioavailability of vitamin D — Espersen R, Ejlsmark-Svensson H, Madsen LR, Nebel C, Danielsen M, Dalsgaard TK et al. Nutrition (Burbank, Los Angeles County, Calif.) (2023)
    5. [5]
      The Diurnal Blood Metabolome and Effects of Vitamin D Supplementation: A Randomised Crossover Trial in Postmenopausal Women. — Espersen R, Correia BSB, Rejnmark L, Bertram HC International journal of molecular sciences (2022)
    6. [6]
      A Novel Transvaginal Cervical Cerclage Model for Resident Training. — Delgado A, Cleberg R, Gimovsky AC MedEdPORTAL : the journal of teaching and learning resources (2021)
    7. [7]
      Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology. — Chang MY, Morrison DG, Binenbaum G, Heidary G, Trivedi RH, Galvin JA et al. Ophthalmology (2021)
    8. [8]
      Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis. — Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G Acta obstetricia et gynecologica Scandinavica (2020)
    9. [9]
      China should take more measures to raise its breastfeeding rate. — Wang Y, Zhou C Bioscience trends (2019)
    10. [10]
      Perinatal Outcomes After Emergency Cervical Cerclage for Cervical Insufficiency with Prolapsed Membranes. — Pang Q, Jia X, Chen L Medical science monitor : international medical journal of experimental and clinical research (2019)
    11. [11]
      Screening for convergence insufficiency in school-age children. — Menjivar AM, Kulp MT, Mitchell GL, Toole AJ, Reuter K Clinical & experimental optometry (2018)
    12. [12]
      Cerclage Use: A Review of 3 National Guidelines. — Sperling JD, Dahlke JD, Gonzalez JM Obstetrical & gynecological survey (2017)
    13. [13]
      Cholestasis Reveals Severe Cortisol Deficiency in Neonatal Pituitary Stalk Interruption Syndrome. — Mauvais FX, Gonzales E, Davit-Spraul A, Jacquemin E, Brauner R PloS one (2016)
    14. [14]
      Hyperbaric oxygen for the treatment of nonhealing arterial insufficiency ulcers. — Heyboer M, Grant WD, Byrne J, Pons P, Morgan M, Iqbal B et al. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society (2014)
    15. [15]
      Anomalous high bifurcation of the common femoral artery at the groin: management of GSV incompetence with endovenous laser ablation. — Lekich C, Campbell W, Walton S, Hannah P Phlebology (2013)
    16. [16]
      The relationship between pro-resorptive inflammatory cytokines and the effect of high dose vitamin D supplementation on their circulating concentrations. — Karim Y, Turner C, Dalton N, Roplekar R, Sankaralingam A, Ewang M et al. International immunopharmacology (2013)
    17. [17]
      The effect of vitamin D on calcium absorption in older women. — Gallagher JC, Yalamanchili V, Smith LM The Journal of clinical endocrinology and metabolism (2012)
    18. [18]
      Preferred clinical practice in convergence insufficiency in India: a survey. — Patwardhan SD, Sharma P, Saxena R, Khanduja SK Indian journal of ophthalmology (2008)
    19. [19]
      Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Archives of ophthalmology (Chicago, Ill. : 1960) (2008)
    20. [20]
      A randomized clinical trial of treatments for convergence insufficiency in children. — Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M et al. Archives of ophthalmology (Chicago, Ill. : 1960) (2005)
    21. [21]
      A survey of treatment modalities for convergence insufficiency. — Scheiman M, Cooper J, Mitchell GL, de LP, Cotter S, Borsting E et al. Optometry and vision science : official publication of the American Academy of Optometry (2002)
    22. [22]
      Effect on rates of breast feeding of training for the baby friendly hospital initiative. — Cattaneo A, Buzzetti R BMJ (Clinical research ed.) (2001)
    23. [23]
      Insufficient milk supply syndrome. — Hill PD NAACOG's clinical issues in perinatal and women's health nursing (1992)
    24. [24]
      Effects of education on breastfeeding success. — Hill PD Maternal-child nursing journal (1987)
    25. [25]
      Restriction to endogenous plasma proteins by a fenestrated capillary endothelium: an ultrastructural immunocytochemical study of the choriocapillary endothelium. — Pino RM The American journal of anatomy (1985)
    26. [26]
      Convergence insufficiency: incidence, diagnosis, and treatment. — Cooper J, Duckman R Journal of the American Optometric Association (1978)
    27. [27]
      Indications for surgical treatment of cerebrovascular insufficiency. — Fiorani P, Pistolese GR, Faraglia V, Spartera C European neurology (1978)
    28. [28]
      Inadvertent femoral artery "stripping": surgical management. — Liddicoat JE, Bekassy SM, Daniell MB, De Bakey ME Surgery (1975)
    29. [29]
      Eye strain from convergence insufficiency. — Mahto RS British medical journal (1972)
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