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Oculomotor Dysfunction pertains to eye muscle and fixation and tracking difficulty. Causes can be developmental or acquired (neurological problems such as CVAs or TBIs). Symptoms can include loss of place, skipping words/lines, copying/writing difficulty, and problems in sports (especially inconsistent performance).
Accommodative problems occur when the eyes’ focusing ability is inefficient. Focusing skills are typically learned and develop as the child grows. Focusing diagnoses fall into 3 categories:
- Insufficiency – Inability to sustain clear focus at near
- Infacility – Inability to shift focus, far to near or vice-versa
- Excess – Difficulty in releasing focus after sustained near work, resulting in distance blur
This often results in nearsightedness (commonly found among computer users).
Often reading glasses are helpful in the early stages (insufficiency). Most of the time, Vision Therapy is also needed, especially with accommodative insufficiency and excess.
Eye Teaming Disorders include the following:
- Exophoria/Convergence Insufficiency or “C.I.” is the most common condition. This is when the eyes tend to drift/aim outward during near task activities. This effort to hold the eyes aligned becomes too strenuous and can cause the following: eye strain, headaches, double vision, lowered comprehension/concentration, blurring of print, words moving on the page or avoidance of near tasks.
Prescription lenses and prism glasses reduce symptoms and improve performance. Vision Therapy, involving office visits and home practice, is the treatment of choice.
- Esophoria/Convergence Excess or “C.E.” is the opposite of “C.I.” Here, the eyes tend to turn inward too much during near tasks. The effort needed to stop this and avoid double vision can cause significant eyestrain, headaches and reduced efficiency in school or on the job.
Reading glasses are often very helpful. Prisms might also be recommended. Vision Therapy is usually needed to develop the necessary visual skills to overcome “C.E.”
Binocular Dysfunction occurs when the two eyes do not work together as a team. Poor eye muscle control can lead to double vision and depth perception difficulties affecting reading, sports or driving. Words run together when reading, words “swim” or “float” on the page, intermittent double vision, eye fatigue, blur, clumsiness, motion sickness, eye pain and headaches may all occur as well.
By working with special lenses, prisms and 3-D glasses, one can train the brain to control eye muscles more efficiently, thus developing binocular stability. This can be achieved through Vision Therapy.
Amblyopia occurs when thesightin one eye is reduced (in the absence of eye disease) and cannot be corrected with glasses or contacts. When this happens, the brain chooses images/information coming in from the dominant eye only. There are two main causes of amblyopia:
- Refractive – When there is a significant difference between the Rx in each eye and the brain shuts off the weaker/blurrier image to eliminate confusion.
- Strabismus – The eye may turn in (esotropia), out (exotropia), or up (hypertropia). When an eye turn is present, the brain shuts off the turned eye to avoid double vision, also causing a loss of depth perception. Strabismic amblyopia (lazy eye, cross eye, wall eye) is much more complex and harder to treat than refractive.
Both forms of amblyopia often require prescription glasses (or contact lenses), patching and Vision Therapy.
Strabismus affects 4%of the population and falls into the following categories:
- Unilateral strabismus- in which only one eye deviates
- Alternating strabismus – in which the turn can be present in either eye
- Constant strabismus – in which the turn is present at all times
- Periodic strabismus – in which the turn occurs at different testing distances
Esotropia (eye turn in) or exotropia (eye turn out) can occur in any of the above circumstances.
If Vision Therapy and/or prism glasses are prescribed prior to surgery, the surgical success rate is much higher.
Developmental Problems can be due to poor visual perceptual motor skills and learning related vision perceptual delays. Some problems you may have noticed are reversals when reading or writing, knowing left from right, omission of small words, short attention span, poor handwriting, posture and the need to use a finger to keep one’s place. Skills are developed, not innate, and can therefore be trained and enhanced to override these problems.
You, or your child exhibits one or more of the above conditions listed above. Since they are functional (not structural problems of the eyes), Vision Therapy can help develop those visual areas that are inadequate for either schoolwork, on the job performance, sports, or a combination of these areas. In all functional vision conditions, improving visual hygiene conditions (good lighting, proper posture, rest breaks) is of primary importance.
Convergence Insufficiency (CI) is a common binocular vision disorder of deficient eye teaming skills. Individuals with CI have difficulty keeping their eyes aligned while performing near tasks. When reading or on the computer, it is essential that the eyes work together comfortably to comprehend what is read.
CI is the leading visual cause of eyestrain and double vision (diplopia). It is not unusual for a person with CI to close or cover one eye while reading to relieve blurred or double vision.
Symptoms of CI - A patient who has CI may show and/or complain of the following while doing close work such as reading, computer work, desk work, playing handheld video games, doing crafts, etc.:
- Eyestrain (especially with or after reading)
- Headaches
- Blurred vision
- Double vision
- Inability to concentrate
- Short attention span
- Frequent loss of place
- Squinting, rubbing the eyes, closing or covering an eye
- Feeling sleepy during an activity
- Trouble remembering what was read
- Words appearing to move, jump, swim or float
- Problems with motion sickness
All of the above symptoms may be intensified by illness, lack of sleep, anxiety, and/or prolonged close work.
Convergence Insufficiency may have a significant negative impact on one’s quality of life, potentially interfering with school, work performance and leisure activities.
Detection and Diagnosis of CI - A basic eye exam or screening with the 20/20 eye chart does not detect CI. A patient can pass the 20/20 test at distance and still have CI because the convergence problem is at near.
Functional near testing is not typically performed during eye tests at annual exams or school eye screenings, and may not be performed at a routine eye examination, leaving CI frequently undetected in school-aged children.
A Behavioral Optometrist performs a functional vision evaluation for convergence, accommodation, depth perception, eye hand coordination and visual processing. This testing gives an accurate diagnosis of CI and other binocular conditions.
To find out more about Convergence Insufficiency and the practice, please download our brochure here or visit these websites:
- www.optometrists.org/schulman
- www.covd.orgwww.convergenceinsufficiency.org
- www.clinicaltrials.gov (Search CITT)
- www.nei.nih.gov
