Diagnostic Factors

Convergence insufficiency is characterized by one or more of the following diagnostic findings:

1. High exophoria at near
2. Tight Accommodative-Convergence/Accommodation ratio
3. Receded near-point of convergence
4. Low fusional vergence ranges and/or facility
5. Exo-fixation disparity with steep forced vergence slope

NOTE: Additional testing may be appropriate as part of the differential diagnostic workup for convergence insufficiency to rule out other concurrent medical conditions and to differentiate associated visual conditions.

Therapeutic Considerations

1. Management
   
   The doctor of optometry determines appropriate diagnostic and therapeutic modalities, and frequency of evaluation and follow-up, based upon the urgency and nature of the patient’s condition and unique needs. The management of the case and duration of treatment would be affected by:
    
   1. The severity of symptoms and diagnostic factors including onset and duration of the problem
   2. Implications of patient’s general health and associated visual conditions
   3. Extent of visual demands placed upon the individual
   4. Patient compliance
   5. Prior interventions
       
2. Treatment
   
   A small percentage of cases are successfully managed by prescription of therapeutic prisms and/or lenses. However, most convergence insufficiencies require orthoptics/vision therapy. Optometric vision therapy usually incorporates the prescription of specific treatments in order to:
    
   1. Normalize the near-point of convergence
   2. Normalize fusional vergence ranges and facility
   3. Eliminate suppression
   4. Normalize associated deficiencies in ocular motor control and accommodation
   5. Normalize accommodative/convergence relationship
   6. Normalize depth judgment and/or stereopsis
   7. Integrate binocular function with information processing

Duration of Treatment

The following treatment ranges are provided as a guide for third party claims processing and review purposes. Treatment duration will depend upon the particular patient’s condition and associated circumstances. When duration of treatment beyond these ranges is required, documentation of the medical necessity for additional treatment services may be warranted.

1. The most commonly encountered convergence insufficiency usually requires 24 to 32 hours of office therapy.
2. Uncomplicated convergence insufficiency characterized by only a remote near-point of convergence: up to 12 hours of office therapy.
3. Convergence insufficiency complicated by:
   1. restricted fusional ranges: up to an additional 12 hours of office therapy.
   2. suppression: up to an additional 6 hours of office therapy.
   3. an accommodative element: up to an additional 8 hours of office therapy.
   4. other diagnosed visual anomalies: may require additional office therapy.
   5. associated conditions such as stroke, head trauma, or other systemic conditions: may require substantially more office therapy.

Follow-up Care