Convergence insufficiency: symptoms, treatment and tracking prescribed exercises

Convergence insufficiency is an eye teaming condition in which the eyes do not turn inward together easily for close work such as reading. It is the one condition where eye exercises have strong evidence, when they are prescribed and supervised by an optometrist or orthoptist.

When you look at something close, both eyes turn slightly inward (converge) so they point at the same spot. With convergence insufficiency, holding that position takes extra effort, especially over longer periods.

• Eyestrain or tired eyes during reading or close work
• Headaches after close work
• Blurred or double vision up close
• Words seeming to move on the page, or losing your place
• Difficulty concentrating on reading

These symptoms have other causes too, so an eye examination is needed to find out what's going on.

An optometrist, orthoptist or ophthalmologist checks how close you can bring a target before your eyes stop working together (the near point of convergence), how your eyes align at near and distance, and your focusing. Symptom questionnaires are often used as well.

Treatment is set by your clinician and may include:

• Office-based vision therapy with exercises to practise at home. In the CITT trial, this approach was successful or improved in 73 percent of children, compared with 35 percent with placebo.
• Home exercises such as pencil push-ups and the Brock string, usually reviewed regularly. At Cambridge University Hospitals, for example, orthoptists review progress every one to two weeks.

A 2020 Cochrane review found high-certainty evidence that office-based therapy works better than pencil push-ups or placebo in children. Evidence for adults is less certain.

Home programs are easier to review when you record what you did. Note the exercise, how many times, and how your eyes felt. Bring the record to each review. Our eye exercise log guide shows a simple format.

This guide is part of our complete guide to eye exercises.