Drifting Away

If your child dislikes reading, vision convergence insufficiency could be to blame

When a child dislikes reading, parents may brush it off, or they may think their child has attention issues or a learning disorder. But a vision problem called convergence insufficiency may be to blame.

The condition, which can cause reading problems, eye strain, or headaches, affects between 4% and 17% of children and adults, according to the National Eye Institute. With this condition, the eyes have difficulty working together, or converging, when looking at nearby objects. One eye may drift outward, resulting in double vision, blurred vision, and trouble reading.

Signs and symptoms

With convergence insufficiency, “the eyes do not naturally maintain alignment at a closer distance, but rather have a strong tendency to drive apart outward,” says Neil Margolis, OD, a developmental optometrist at the Visual Symptoms Treatment Center in Arlington Heights. “This condition is most likely to cause symptoms when the individual is carrying out sustained near-visual activities such as reading, computer, or cell phone activities.”

When looking at objects at near distances, children might also experience symptoms such as short visual attention span, loss of place tracking when reading, or blurry or ghosting images.

This is exactly what Sara Shacter, who lives in Chicago’s North Center neighborhood, noticed with her son, Benjamin, 17. “When he was 8 or 9, we noticed that every now and then, his right eye would suddenly float off to the side for a second or two before he could pull it back into place,” she says. “That’s when we knew something was up.”

But things took a sharper turn when, in second grade, Benjamin brought home a reading quiz that he didn’t do well on. Benjamin was always a skilled reader, Shacter says, so this confused her. After talking to her son, she realized what happened. “The text he had to read was in two columns,” she says. “He could not get his eyes to read down one column without skipping over to the other column.” Benjamin gave up and entered guesses for all the questions on the quiz.

Reading reluctance

Convergence insufficiency affects kids with their daily activities, especially when focusing on near objects, says Brenda Bohnsack, MD, PhD, pediatric ophthalmologist and division head of ophthalmology at the Ann & Robert H. Lurie Children’s Hospital of Chicago. “[They can experience] difficulty in maintaining convergence during near work, and it may cause early fatiguing with near work and a dislike of reading and schoolwork.”

The visual strain can affect reading accuracy and comprehension. Some children may turn their heads to the side or cover one eye to avoid the strain of converging their eyes when reading. “It can affect academic performance due to reluctance to read,” Margolis says.

“He could not get his eyes to read down one column without skipping over to the other column.”

While some people with convergence insufficiency might complain about seeing double, many, like Benjamin, have no complaints. For many children, “The response is, ‘I thought everybody sees this way,’” Margolis says.

Specialists diagnose convergence insufficiency by evaluating a person’s ability to converge their eyes to a near-point target without an eye turning outward and without double vision. They may also use polarized glasses or red/green glasses to assess a person’s vision and indicate if the individual is ignoring the image from one eye to avoid seeing double vision.

Vision therapy

Convergence insufficiency responds well to a combination of in-office therapy, vision-rehab exercises, and home therapy. For Benjamin, Margolis recommended approaches that not only strengthened Benjamin’s eye muscle control, but also taught him how to compensate for the insufficiency while reading.

Eye exercises teach people how to get their eyes to work together as a coordinated team. “Therapy teaches the individual how to recognize the type of effort required to converge or cross their eyes as targets are brought closer to their face,” Margolis says.

If children don’t have symptoms, they may not require treatment, Bohnsack says. But if they do have symptoms or if the condition is affecting their schoolwork, treatment can help counter eye strain and fatigue.

Exercises improve the ability for the eyes to converge and stay aligned when looking at a close object, Bohnsack says. With pencil pushup exercises, the individual holds a pencil that displays letters or shapes. As they move the pencil closer to their nose, they try to adjust their eyes to keep the images clear, without blurring or double vision.

Prism reading glasses can help. The glasses bend light so the individual perceives the object to be in a different location than where it is actually located. In severe cases, Bohnsack says, eye muscle surgery may help.

Margolis says that convergence insufficiency can often be treated within 12 weeks for children who follow their treatment plan.

Benjamin did eye coordination exercises to train his eyes and manage his symptoms when he was younger. But with college looming, he says that reading still wears him out.

“His convergence insufficiency isn’t as bad as it was in elementary school, but there is still an issue,” Shacter says. Now Benjamin is doing a short course of therapy and exercises to get back to an optimal place.

For children with the condition, it’s a relief to know that reading problems have a cause that they can address. With a proper diagnosis and vision therapy, they can keep their eyes firmly focused on the future.