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Convergence Insufficiency: Making reading a chore!

happy senior woman wearing eyeglasses 640Q: I just read a letter in Dear Abby about a lady with problems reading comfortably…..and it sounded just like me. How common is this, and is age a factor?

A: I also read those advice columns, you just could not make this stuff up! The case you mention is actually a fairly common, and is not really “age- related”. Many people find that reading for a long time is very tiresome or uncomfortable. Some people even have some doubled vision while reading. In fact, some researchers believe that underlying eye problems may cause “reading avoidance”……and of course learning problems.

We fairly commonly see patients whose glasses prescription is correct for each eye, but there has been no testing or prescribing for how your two eyes work together. This “eye teaming” or binocularity is critical for effortless and comfortable reading. The specific condition you mention is called “convergence insufficiency”. When we read our eyes automatically do three things…..they turn inward ( convergence ) to align on a letter or word at close distance, our internal eye muscles contract or “work” to change our focus from distance to near
( accommodation ), and our pupils constrict a little ( miosis ). Only first two really affect our reading skills.

A thorough eye examination should include testing to determine if your eyes actually do converge and align as a precise team for close work. We can actually measure how much your eyes converge, or turn inward, to properly align for reading. Deficiencies in your binocularity can be compensated by using “prism” lenses. These not only contain your Rx for seeing clearly, but also additional correction to make your eye alignment accurate and easy.

Then, step two is to be certain that your eyeglass lens lab actually fabricates your lenses to exactly match your eye alignment measurements. This is commonly missed these days by optical laboratories, I suppose due to cost or time or lack of care. Having the right prescription in each lens is only part of the process for restore clear and comfortable vision.

While we do find these binocularity disorders in patients of any age, it is more likely found in children because has noted they are not keeping up with the other children in reading speed or comprehension. Usually a teacher or parent will bring the child in because of this reading problem. For adults, no one is checking so it would be up to you to be sure your eye exam is thorough enough to find binocularity disorders.

Lastly, I should add that over the counter “readers” never have prism correction included. In fact, readers always have the same Rx in each lens ( while real people usually are not identical ) and they never include correction for astigmatism, the most common vision disorder of all. So be sure you are getting a truly thorough vision exam, and be sure your glasses are made accurately. Reading should be easy and enjoyable!