Convergence insufficiency should be viewed as a neuro problem not a muscle problem, and as such, treated with techniques that address both the mind and body, according to Gold Coast behavioural optometrists Paul and Meredith Graham.
The optometrists presented a course at the Australian College of Behavioural Optometrists (ACBO) conference held in Brisbane during October. The three-day course covered the aetiology of symptomatic convergence insufficiency (CI) and co-morbid conditions such as accommodation dysfunction, research demonstrating how to more effectively diagnose the condition with symptom surveys and more rigorous assessment, and the best practice for effective treatment of the condition.
Traditionally, convergence insufficiency has been perceived to be relatively easy to identify and treat with simple orthoptic exercises such as pencil push-ups and loose prisms.
However, the 30 optometrists and vision therapists who attended the course heard otherwise. According to the presenters, detection of CI requires a careful case history as the symptoms are often related to near-work performance and avoidance, as opposed to headaches, sore eyes or blur.
This course taught me an innovative, creative way to approach CI that combines the mind and the whole body
Additionally, they said, detection of CI requires rigorous repeated testing of the binocular system under different conditions. For example, a single near point of convergence measurement (NPC) is often inadequate. Instead, the NPC needs to be repeated with different target types to heighten the chances of adequately identifying convergence issues. Delegates also heard that Convergence Insufficiency Treatment Trial (CITT) research conducted over the past decade has consistently demonstrated that basic orthoptics, like pencil push-ups and computer vision therapy are no more effective than placebo in treating symptomatic CI. In fact, the only therapy to consistently and effectively treat the condition was office based vision therapy with home reinforcement, the conference heard.
Paul and Meredith Graham told delegates that because vision therapy uses the neuroplastic nature of the brain to create the changes observed, CI is a “neuro” problem rather than a “muscle” problem.
Delegates at the conference had hands-on experience with vision therapy activities and heard practical tips on how to program vision therapy, manage vision therapy within a primary care practice and how to manage patient expectations, motivation and compliance.
Wendy Saw, a final year optometry student at Queensland University of Technology, and a member of ACBO, who attended the conference said, as an emerging optometrist, she found the information extremely valuable.
“CI is the most common binocular vision problem that we come across as optometrists, so I felt it important to explore the other types of vision therapy used to treat this.
“This course taught me an innovative, creative way to approach CI that combines the mind and the whole body. While I think I’ll still use some aspects of the traditional approach of eye exercises when I do go into practice, I’ll also include the patient’s ability to use their mind to firstly aim and then control where they’re seeing, as the driving force behind the therapy. Teaching patients to relax in order to use their mind, and therefore their eyes, more effectively, was an important lesson I learnt which stretched my mind back to the early days of first year human anatomy and physiology.”
Future ACBO conference topics are listed at www.acbo.org.au. The next round of intensive vision therapy workshops are scheduled for March next year.
Meantime, ACBO has announced it will introduce a facility to allow optometrists to qualify for CPD points through online study. The “E-learning” platform will allow optometrists to answer online questions linked to an ACBO conference or seminar to earn CPD points.
ACBO President Paul Levi said the facility will be a huge benefit to people who need points urgently to make up their quota, and will be of particular benefit to country-based optometrists who find it difficult to attend conferences and seminars.
In other ACBO news, the organisation has introduced a new associate member category, saying it is a great option for those optometrists who may be taking an extended break from practice, as well as other healthcare professionals and referrers.