1. health and fitness
2. exercise

Home Exercises to Improve
Convergence Insufficiency
Patient Information
Orthoptic Department
Author ID:
Leaflet Number:
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SM
Orth 013
Home Exercises to Improve Convergence Insufficiency
May 2012
May 2014
What is Convergence Insufficiency?
Under normal circumstances the eye muscles will pull both eyes inwards towards the nose
smoothly when looking at an object close up. Normally this occurs without effort and
allows comfortable use of binocular (both eyes) vision whilst reading or doing other close
work. Weakness of these eye muscles may cause problems in co-ordinating the eyes at
close range – this is called Convergence Insufficiency.
What Causes Convergence Insufficiency?
There are many different causes but the possibilities include a change of occupation
involving increased close work, an intensive period of close work (e.g. studying for exams),
over work, worry, recent illness or whiplash. Sometimes no reason is found.
What symptoms does Convergence Insufficiency cause?
Typical symptoms are headaches in the front of the head and around the eyes, eye strain
and sometimes difficulty in changing focus from distance to near. Blurred vision or double
vision may also be noticed
What treatment is available?
Normally eye exercises, which can be practiced at home, will be recommended. If
exercises are carried out regularly, improvement is usually quite rapid and within a few
weeks symptoms should improve. Some people do need longer to improve and may take
several months to get completely better. The eye exercises will be supervised by an
Orthoptist, who is a specialist in eye muscle balance and co-ordination. The Orthoptist will
explain which exercises are best for each individual patient and explain how to carry them
out. Advice will be given on the frequency and duration of the exercises and a follow-up
appointment will be arranged. It is important to attend the follow-up appointment to check
on progress and to change the exercises if necessary.
What will happen if the symptoms are not cured by exercises?
The Orthoptist will probably recommend further tests with an Ophthalmologist to determine
if there is any other cause of the symptoms.
Exercises explained
Convergence to a pen
It is probably best to get somebody to read these instructions to you as you do the
exercise.
These are basic instructions and variations on these, may be given by the Orthoptist,
tailored to your needs.
You may be advised to use a pen or sometimes a small picture or piece of reading print
attached to a small wooden stick. For the purposes of these instructions a pen is
described but the principles are the same whatever target is used.
Home Exercises to improve Convergence Insufficiency
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With your head straight, start with the pen at arms length, straight ahead and at eyelevel or slightly below eye-level. Focus on the tip of the pen and make sure it is single
and clear. Move the pen slowly towards your nose making sure that the pen stays
single for as long as possible.
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If the pen goes double (i.e. you see 2 pens) stop moving the pen immediately but
continue to look at it and use your eye muscles to “pull” the images together to make
one pen again. Do not do this by closing one eye, by blinking or by looking away from
the pen, as this will not exercise the muscles. The sensation you will feel is one of
going cross – eyed; do not worry, this is normal and is necessary to achieve results. If
you can make the stationery pen single again by pulling your eyes in then start to
slowly move the pen towards you until it doubles up again. Repeat the process of
stopping, trying to use your eyes to make the pen single again and then proceeding as
before.
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If you can only move the pen in towards your nose so far before it goes double, and if
you are unable to make it single again despite trying hard to do so, try taking the pen
back a short distance (2 or 3 centimeters) away from the nose and try again. Do not go
right back to the beginning each time the pen doubles up. You need to work hard
around the area where the pen starts to go double – this will improve your convergence
insufficiency.
The aim of the exercises is to be able to watch the pen move slowly all the way to the end
of your nose and to keep it single all the way. The closer you get towards your nose the
harder the exercise will become.
If you are in any doubt about the pen convergence exercises, ask the Orthoptist to
demonstrate it to you at your next visit.
Incidentally, if whilst doing this exercise you happen to notice that you can see double of
other objects in front of or behind the pen, do not worry. This is a normal phenomenon
called physiological diplopia, just ignore it.
The Orthoptist will advise you how frequently and for how long to do this exercise.
The Dot Card
Home Exercises to improve Convergence Insufficiency
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These are double-sided dot/letter cards for measuring the near point of convergence
and of accommodation and for home exercises.
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Dot cards treat convergence insufficiency more effectively than simple pen push-up
exercises by ensuring correct ocular alignment.
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Dots are placed at 3cm intervals along the card, which is held lengthwise touching the
end of the nose so that the dots are 6cm to 24cm from the eye. Clear instructions are
included, but additional information for correct treatment of convergence insufficiency
should be given by a qualified practitioner.
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Keep your head straight, hold one end of the dot card against the tip of your nose.
Hold the card straight or angled slightly downwards in a position where you can see all
the dots properly.
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Look at the furthest dot and try to make your eyes see this as one (i.e. singly) by gently
using the eye muscles to pull the eyes inwards.
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When you see this furthest dot singly, all the other dots should appear double and they
will fan outwards towards you. This is normal.
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If you can make the furthest dot single, count up to 10 slowly whilst keeping the dot
single.
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Once you are able to do this look at the next dot up the line closer to you and do the
same. Make it single by gently pulling inwards with the eye muscles.
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When this dot appears single all the other dots should appear double – making an X
pattern crossing through the dot you are looking at. This is normal. Again hold this
position, keeping the dot single, for a short count of 10 (slowly).
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Continue in the same way up the line of dots towards you making sure each one is
single and holding each one for a count of 10. If you cannot make a dot single go back
to the previous dot and try again. If you are unable to make even the furthest dot single
it may be that this exercise is too advanced for you at this stage in which case the
Orthoptist will advise you. However some people do find this exercise difficult at first
so do persevere.
Make sure you make a conscious effort to pull your eyes in to look at the dots – the
sensation is one of going “cross eyed”. Sometimes discomfort is felt during the exercises.
This is normal and it is necessary to keep exercising despite this discomfort but the
exercise should not cause actual pain or bring on a headache – consult the Orthoptist if
this happens.
If you can only get a short way down the dots but no further – keep practicing!
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Take each dot in turn slowly and do not proceed to the next dot until you are able to hold
the previous one single for a count of 10. The aim of the exercise is to be able to see the
dot closest to your nose singly and hold it for a count of 10.
The Orthoptist will advise you how often to do this exercise and will tell you about
relaxing your eyes after exercising.
Relaxation
It is extremely important to relax the eye muscles properly following exercising. This will
avoid problems such as convergence spasm which can occur in very rare cases if some of
the eye muscles do not relax sufficiently.
The eyes may feel uncomfortable following exercising and this is to be expected but too
much exercising and/or not enough relaxation may make the eyes feel more
uncomfortable than is necessary.
Do not practice for longer periods than advised by the Orthoptist and try to avoid
exercising when your eyes are particularly tired or you are unwell.
After the exercises make sure you either close your eyes for one minute or look far into the
distance (e.g. out of the window) for a minute before undertaking any other activity. This is
as important as doing the exercises themselves.
Always follow the instructions carefully and ask if you are unsure about anything.
Contact information
If you have any questions regarding this leaflet please telephone the Orthoptic department
on: 01942 822310
Orthoptic Department
Entrance B
Second Floor
Wigan Health Centre
Frog Lane
Wigan
WN6 7LB
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Research
Research is undertaken to add to the existing scientific knowledge on a particular subject.
There are a number of staff within the Trust who conduct Research studies. It is possible that
during the course of your treatment you may be asked to take part in a research study,
however, you do have the right to refuse, and this will not affect the care that you receive.
Your NHS Number, Keep it Safe
Every person registered with the NHS in England and Wales has their own
unique NHS Number. It is made up of 10 digits for example 123 456 7890.
Everyone needs to use the NHS Number to identify you correctly. It is an important step
towards improving the safety of your healthcare.
Always bring your NHS number with you to all hospital appointments or quote it if you need to
telephone the hospital for any enquires. This will allow staff to check that they have the right
patient details by checking this against your NHS number.
To improve safety always check your NHS Number on correspondence the NHS sends to you.
Ways of finding out your NHS Number
If you do not know your NHS number you can contact your GP Practice. You may be asked
for proof of your identity, for example a passport or other form of identity, this is to protect your
privacy. Once you have obtained your NHS Number write it down and Keep it Safe.
My NHS Number
Information Rights and Access
The Trust will keep your information secure and confidential at all times. The Data Protection
Act 1998 states that personal and sensitive information must be processed fairly, lawfully and
securely. This applies to all information we hold whether on paper or electronically on
computer systems. All personal information is processed fairly, lawfully and as transparently
as possible so that you:
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Understand the reasons for us processing your personal information
Give your consent for the disclosure and use of information where necessary
Gain trust in the way we handle your information
Know that you have the right to request access to personal information we hold about you
Information relating to the business of the Trust is available under the Freedom of Information
Act 2000. For example, what we spend and what we do. You can find out more by visiting the
Trust website or submitting a Freedom of Information request to the Trust for this information.
For further information regarding data protection, please read our leaflet called “How we use
your personal information”. For Freedom of Information, please read our leaflet called “The
Freedom of Information Act and You”. You can also visit the Information Governance pages
on the Trust website.
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Patient Relations
The Patient Relations/PALS Department provides confidential on the spot advice, information
and support to patients, relatives, friends and carers. We will do our best to help you to
resolve any concerns you may have about the care you received. We can also give you
information on the services provided by the Trust.
If you have a concern or there is a problem, the best way to get it resolved is usually to tell
someone there and then. If you are on a ward, talk to the sister or charge nurse on duty, in a
clinic, talk to the receptionist or one of the nursing staff. If you want to talk to a senior manager
or to someone who has not been directly involved in your care and treatment, we can usually
arrange this during office hours. You can also ask to speak to a member of the Patient
Relations/PALS Department.
Staff in any ward or department will be able to contact a member of the team for you, or you
can telephone 01942 822376. The Patient Relations/PALS Department is open Monday to
Friday, 9am to 4pm. Outside of these hours there is an answer-phone service.
In addition to Patient Relations/PALS Service you can contact CARE LINE. This is available
from 9am to 9pm Monday to Friday excluding Bank Holidays, and 9am to 5pm at
weekends. Please telephone CARE LINE on 01942 773377 and follow the instructions given.
If you wish to make a formal complaint you can telephone or write to:
The Patient Relations/PALS Manager
Wrightington, Wigan and Leigh NHS Foundation Trust
Royal Albert Edward Infirmary
Wigan Lane
Wigan WN1 2NN
Telephone: 01942 822376
Your views of the service that we provide are important. You can also let us know how you
feel by posting your comments on the Patient Opinion website. You can access this from the
Trust website on www.wwl.nhs.uk or via www.patientopinion.org.uk
Social Media
Along with keeping patients, visitors and staff up to date with news and events on our internet
site, the Trust also has Facebook and Twitter pages.
Facebook: www.facebook.com/wwlnhs
Twitter: www.twitter.com/wwlnhs
Wrightington, Wigan and Leigh Health Services Charity
Wrightington, Wigan and Leigh Health Services Charity (Registered Charity Number 1048659)
aims to further improve the quality of the patient experience and care. The Charity relies on
the generosity and support of the local community.
If you feel you can help or would like more information please visit our website at
www.wwl.nhs.uk/charity or contact our Fundraising Officer via elizabeth.titley@wwl.nhs.uk.
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Membership
As a Foundation Trust we are keen to build a successful and engaging membership group.
As a member of your local hospital you will be kept up to date with news, service
developments and future improvements.
Why become a Member?
Membership provides local people, patients and service users with an opportunity to have a
greater say in how we deliver our services. For further information please call freephone 0800
073 1477.
Who can become a Member?
Anyone can become a member – you just need to be 16 years of age or over and live in the
UK. As a member it will be up to you how much you want to get involved.
How to become a Member?
To apply to become a Member:
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Telephone freephone 0800 073 1477
Email foundationtrust@wwl.nhs.uk
Visit www.wwl.nhs.uk
Stop Smoking Support
A visit to hospital is very often the trigger for many people to quit smoking, and we know that
70% of people that smoke would like to quit. The Trust is a smoke free area and smoking is
prohibited in all buildings, grounds and car parks.
For patients wishing to quit smoking following their admission to hospital, or if patients simply
require support during their hospital stay, there is a designated specialist Stop Smoking Team
available.
Patients that aren’t staying in hospital or are planning to quit ahead of their hospital stay can
also access specialist support. The Wigan Stop Smoking Service community team provides
support across the borough. You can call us on 01942 482539 or free on 0500 7867 669 to
speak to a member of the team or visit www.alwch.nhs.uk/stopsmoking for further information.
This leaflet is also available in audio, large print, Braille and other languages upon request.
For more information call 01942 773106.
© Wrightington, Wigan and Leigh NHS Foundation Trust
All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
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