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Old 04-14-2017, 10:51 PM #1
bachissimo bachissimo is offline
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bachissimo bachissimo is offline
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Default testing for convergence insufficiency (wonkish)

I have been relying thus far on a couple of doctors (neuro-ophtalomo and OD) to examine my convergence. Each use their own method. Both see major convergence deficit/ high level of CI.

Recently I saw a neuro-ophtalmologist who came to the conclusion that I do not have much CI. She did this with two tests. One that is quite new to me: she asks me to look at an object that is far and she passes something in front of each eye very rapidly and examine my eye movement. She said she does not see an issue. I asked her whether she would be willing to use the prism ruler.

I am not sure how many of you are familiar with the prism measurement. Usually, the way I understood it, they test how high up you can go on prisms (diopters) before the image becomes blurry and then doubles. The higher the value the better is the convergence (the smaller is the CI).

So far, with my original doctor, he finds out that very soon I start to double, meaning my reading is very low, consistent with bad convergence.

The new doctor instead interpreted the fact that the image doubles so quick, at 2-3 diopters!, to mean that I do NOT have CI because, the fact I cannot handle a prism means I do not need a prism.

Everything I read so far (and I am very limited in my ability to read) suggests that whatever she was doing is in contradiction with not only what my doctor does but also with the textbook. Some videos are available online.

Both doctors are in top hospitals in the US. My doctor is more senior while the new doctor is a new assistant prof. But I cannot imagine any doctor making mistakes about CI readings...

Any thoughts?
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Old 04-20-2017, 03:34 PM #2
MVTBI MVTBI is offline
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Originally Posted by bachissimo View Post
I have been relying thus far on a couple of doctors (neuro-ophtalomo and OD) to examine my convergence. Each use their own method. Both see major convergence deficit/ high level of CI.

Recently I saw a neuro-ophtalmologist who came to the conclusion that I do not have much CI. She did this with two tests. One that is quite new to me: she asks me to look at an object that is far and she passes something in front of each eye very rapidly and examine my eye movement. She said she does not see an issue. I asked her whether she would be willing to use the prism ruler.

I am not sure how many of you are familiar with the prism measurement. Usually, the way I understood it, they test how high up you can go on prisms (diopters) before the image becomes blurry and then doubles. The higher the value the better is the convergence (the smaller is the CI).

So far, with my original doctor, he finds out that very soon I start to double, meaning my reading is very low, consistent with bad convergence.

The new doctor instead interpreted the fact that the image doubles so quick, at 2-3 diopters!, to mean that I do NOT have CI because, the fact I cannot handle a prism means I do not need a prism.

Everything I read so far (and I am very limited in my ability to read) suggests that whatever she was doing is in contradiction with not only what my doctor does but also with the textbook. Some videos are available online.

Both doctors are in top hospitals in the US. My doctor is more senior while the new doctor is a new assistant prof. But I cannot imagine any doctor making mistakes about CI readings...

Any thoughts?


Same boat for me, my Orthopist doesn't see anything, my Opthamologist does, my Optham sent me to a vision therapy clinic that understand post traumatic vision syndrome and how it relates to concussions, they found a list of other things as well and it has made a big difference, honestly if you feel something is haywire, and someone tells you it is, I would go with that if you no longer have problems or didnt have problems with anxiety, trust your gut

For me I spent over an hour and half with the optham who did more than just one sliding prism test, we then spoke about fatigue and how it influences how my vision feels, I was prescribed low powered prism (sorry I dont know the correct terminology) for when I do feel tired or am starting to have problems with screens etc, and it helps decrease the load.

If your eye is slightly turned in or out or not working right, leaving it up to the human eye to determine that cannot be that reliable.

Just to re enforce our gut feelings, i was cleared of any peripheral vision lost by regular eye doctors, orthopists etc, but in doing vision therapy I was found to have significant visual suppression, and I was shown where and why and I can feel it. It feels like vindication when you finally get an answer or a diagnoses.

When you are talking about the brain and vision, you're talking about a complex relationship that I don't think we understand.

While my vision is not perfect, a lot of my problems, headaches are less, fatigue is less, sleep is better, waking up is better, playing sports is better, all just a little but its made an enormous difference in quality of life if something is wrong or you feel it is, push until you get an answer, "good enough" or within "normal limits" is not what you or I or anyone should have to accept.

one thing this entire process has taught me is that, doctors are not perfect, and do not have all the answers thats why we have to get 2nd, 3rd opinions, It can be so incredibly frustrating to hear, oh your fine when you know your not, and for me it clouded my judgement when it came to returning to work early and etc...

I hope it works out for you keep pushing until you get answers, hopefully you find a doctor with the answer or at the very least that may even just say "I dont know" which for me is more helpful than, I didnt figure it out, so nothing there.
All the best
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PCS since 07/14 Symptoms: Vision(double,tracking, contrasts) Headache, Motion sensitivity, Psych issues, low stress tolerance, minor tinitus, sensitivity to noise and light, sleep issues.
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