His visual acuities were 20/15 at distance and at near OD, OS and OU. The patient’s quality of life score was a 25, which was a red flag. He was an average student, read on grade-level and took Vyvanse (lisdexamfetamine dimesylate, Shire) for attention deficit hyperactivity disorder. The headaches were not task-specific or associated with visual blur, nausea or vomiting. His primary care physician referred him to determine if his vision was the issue, as sinus-related causes were also under investigation. Click image to enlarge.Īn 11-year-old male presented with a history of frontal headaches for two years. The spectrum of signs and symptoms of any condition, including CI, is similar to the color spectrum. These three cases all seen by the same student in the same morning session on the same day will help highlight our treatment philosophy. 1,2 Other signs include a low AC/A ratio, reduced vergence facility, low MEM, low negative relative accommodation and trouble clearing plus on accommodative facility. 1,2 The patients needed to be symptomatic as well. 1,2 In those studies, the diagnosis of CI was based on reduced near point of convergence (6cm or greater), reduced base-out vergence ranges at near (having a positive fusional vergence value of less than twice that of the near phoria and failing Sheard’s criterion or having a minimum base-out break of 15 on the positive fusional vergence) and a greater exophoria at near (at least 4). From double-blind, placebo-controlled studies, we believe that in-office vision therapy is superior to all other treatments. One of the most common binocular vision conditions is convergence insufficiency (CI). This column will focus on approaching conditions as if they are a spectrum and not a single set of findings that must occur to earn a specific label. In the world of binocular vision, it is rare that a diagnosis is as textbook or straightforward as we are led to believe. Just as there is a spectrum of colors, there too is a spectrum for many of the conditions we diagnose every day. We tend to categorize things as black or white, leaving little opportunity for grey. Too often, we focus on the details and, in doing so, miss the bigger picture.
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