Making Vision Therapy Exercises Fun
PART II: CONVERGENCE
Because I spent three years as a head vision therapist working for a very progressive developmental optometrist, I often get asked how to make home vision therapy exercises enjoyable so children will stick with them on their own. Our therapy staff was committed to making vision exercises innovative and fun, so I'm going to share our secrets here with you.
NOTE: Please consult with your behavioral optometrist before doing home vision therapy exercises to be sure you're focusing on the right skills needed for your child. And please don't use these helpful hints as a substitute for attending regular vision therapy appointments for the full amount of time that your optometrist recommends. In-office visits have a powerful and fast effect on vision skills that you don't want to go without if possible.
Convergence Insufficiency is when the eyes have trouble coming together to focus on near objects, and it is the most common diagnosis in the “Eye Teaming” category. Lack of proper eye teaming means simply that the eyes don't work together as a team. They're each doing their own thing, which causes a host of problems, from double vision to poor depth perception to “lazy eye” or “wandering eye” syndrome.
Convergence Insufficiency (again when the eyes have trouble coming together to focus at near), usually causes exhaustion and headache when reading, writing, or doing other near tasks for extended periods of time. I hate convergence headaches! I have this problem myself, and when one of these nasty buggers sets in, nothing gets rid of it but a nap. Painkillers don't work for some reason. You can easily recognize a convergence headache because it's usually right behind the eyes and in the forehead, and it can get bad enough to cause nausea, so it's often misdiagnosed as a migraine headache. Convergence Insufficiency has nothing to do with the physical ability of the eyes to focus on near objects. It's not the same as farsightedness (the ability to only see things clearly at a distance). According to optometric testing, your eyes may have perfect 20/20 vision and not need corrective lenses at all, and yet you still may have convergence insufficiency and regularly enjoy the lovely headaches that come along with it. When treating convergence insufficiency, most developmental optometrists recommend glasses that enlarge near objects, even though you're not farsighted because the magnification takes some of the strain off the eyes when trying to focus near for reading. However they also recommend exercises in-office and at home to train the brain to have better communication with the eyes, thereby reducing resistance and strain from looking near.
There are a few more things you need to know about eye teaming and convergence, and then we'll get to some exercises to do at home. There are different levels of severity in a convergence insufficiency diagnosis, from the eyes just getting tired after looking close for a while to eso/exotropia that may require surgery to fix (explained further below). All kinds of things could be happening with the eyes; for instance, one eye may converge correctly while the other is reluctant to turn in, or both eyes may have trouble pulling inward together. When one eye is stuck turning outward and doesn't make the natural turn inward that it should to view near objects, it's called “exotropia.” Marty Feldman (Igor in the movie Young Frankenstein) is a famous exotrope. Of course, his case is severe. Many exotropes are hard to spot because their “wandering eye” is only a tiny bit off the target. Milder cases of this phenomenon, where one or both eyes tend to travel outward but aren't fixed outward all the time, fall under the lesser diagnosis of “exophoria.” Likewise, if one or both eyes turn inward in a cross-eyed fashion, it's called “esotropia” if it's constant, or “esophoria” if it's just a tendency. Exotropia/phoria is the one that has the most trouble with convergence, however, so I'll address that one here.
Exotropia or exophoria requires in-office visits where the optometrist may prescribe prism lenses (glasses where the lens is thicker on the outer edge and thinner near the nose, thereby forcing the eyes to push inward), or an eye patch to be worn regularly (but beware of patching one eye for more than a few hours at a time because it can weaken the “good” eye), occlusion on the glasses (taping the outer edge or near the nose of the glasses so that you can't see through those parts and it forces the eyes one direction or the other), and in extreme cases, surgery. An important note about surgery... if you have it done to correct an exo or esotropia, you have to do vision therapy exercises for at least a year after the surgery is done because without the vision training, the eyes will eventually move back to the same position again and nothing will change. My mother had to have numerous surgeries for her esotropia when she was a young child because the eyes kept going back to their inward position, but this was in the days before vision therapy was invented. Surgery is not a quick fix for eye turn problems. It can help, sure, but if you don't follow it up with vision exercises, the eyes will go right back to the position that was comfortable for them in the beginning. This is true of lasik surgery as well. If you just got a correction for near or farsightedness, it's a good idea to do some vision therapy and retrain your brain how to use the eyes to their maximum potential.
Now for the exercises at home...
Convergence is just a matter of getting the eyes to focus together on a close object, so you can do that by wearing an eye patch (10-20 minutes each eye, and then no patch at all) while sewing, reading, doing crafts, coloring, cooking, cutting, pasting, etc. But you have to make sure to take lots of breaks to look far away (out a window at the farthest object the eyes can find) to keep focus flexibility in good order. Look near for a bit on the project you're working on, then look far for a minute or two, then back to the near again.
Convergence can also be practiced in the car quite well. Just put a small sticker on the window nearest the child, and instruct him/her to look at the sticker for a few seconds, then to look outside at the farthest thing their eyes can find, then back at the sticker again. It's hard work to get the eyes to come back to the window itself after looking at something far away through it, but it's one of the best exercises you can do. Have your child do this at least 10 times every time they get in the car. There you go, no extra time out of your day to do this! Or they can practice the same thing with the bathroom mirror when brushing their teeth. Look at the sticker on the mirror, then look at themselves through the mirror, then back to the sticker again.
The optometrist will probably give you something like a yard stick or a Brock String to work with. Both have pins or beads at varying lengths along the stick or string and you're supposed to look at the farthest pin or bead and try to force your eyes into double vision (because if you're using both eyes correctly, you'll get doubles of whatever you're not looking directly at). It should make a backwards V shape when looking at the farthest fixation point. Then you look at the middle pin or bead and you should get a double image that looks like an X. Then to the nearest fixation point for a front wards V shape. This is a really good and very important eye teaming exercise, but it's also not very fun. So I'd do it just a few times a day, in-between the other more fun convergence activities that you're working on.
There are other eye teaming exercises your optometrist will recommend, such as red/green glasses, but not all of these have anything to do with convergence, so I'll leave the other suggestions for next time when I talk about eye teaming.
Parents, please use caution and take it slow with the convergence exercises because they can cause headaches, exhaustion, irritability and even nausea (just as all eye teaming exercises can). Be patient with your children and allow them to work their way up from just minutes a day to longer spans of time as they can handle more. And don't forget to consult with your optometrist BEFORE doing home vision exercises to be sure you're focusing on the right ones for the child's needs.
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