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Authors
Alvarez, Tara L.; Vicci, Vincent R.; Alkan, Yelda; Kim, Eun H.; Gohel, Suril; Barrett, Anna M.∥; Chiaravalloti, Nancy; Biswal, Bharat B.

Vision Therapy in Adults with Convergence Insufficiency: Clinical and Functional Magnetic Resonance Imaging Measures

publication date
August 24, 2010
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Abstract/Introduction

Purpose

This research quantified clinical measurements and functional neural changes associated with vision therapy in subjects with convergence insufficiency (CI).

Methods. 

Convergence and divergence 4° step responses were compared between 13 control adult subjects with normal binocular vision and four CI adult subjects. All CI subjects participated in 18 h of vision therapy. Clinical parameters quantified throughout the therapy included: nearpoint of convergence, recovery point of convergence, positive fusional vergence at near, near dissociated phoria, and eye movements that were quantified using peak velocity. Neural correlates of the CI subjects were quantified with functional magnetic resonance imaging scans comparing random vs. predictable vergence movements using a block design before and after vision therapy. Images were quantified by measuring the spatial extent of activation and the average correlation within five regions of interests (ROI). The ROIs were the dorsolateral prefrontal cortex, a portion of the frontal lobe, part of the parietal lobe, the cerebellum, and the brain stem. All measurements were repeated 4 months to 1 year post-therapy in three of the CI subjects.


Conclusion/Results

RESULTS 

Wearing aspheric lenses with negative SA shifts the mean SA of the unaccommodated eyes from +0.05 μm (eyes only) to −0.029 μm (eyes + SVCL) and increases the negative SA for the eye + lens when accommodating from −0.029 to −0.07 μm for natural pupils. Aberration changes with accommodation were attenuated by the accommodative pupil miosis, which reduced binocular viewing pupil diameters from 3.9 to 3.3 mm. This alteration of the typical SA levels by the aspheric SVCL did not prevent accurate accommodation (mean ± standard deviation accommodative lag under binocular viewing were −0.08 ± 0.12D, −0.38 ± 0.12D, and −0.26 ± 0.08D for paraxial, minRMS, and peak IQ, respectively).

CONCLUSIONS 

These data clearly show that aspheric contact lenses designed to correct some or all of the unaccommodated eye’s positive SA do not interfere with accommodation.


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Such a nice optician. My grandson is only 4 and needs glasses. We were so sad, but he explained the issues, and we will follow up as he suggested.


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I had such a good experience with the clinic. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Thanks, American Family.


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Dr. Zurcher has gone above and beyond what any other eye doctor has ever done to figure out what is going on with my eyes. Very happy with American Family Vision.


Christine R.

Family Vision Clinic changed our lives! My daughter was frequently car sick, and she was getting headaches every day, often painful enough that they brought her to tears. We saw a string of doctors and therapists, but we made no progress. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. After ten weeks of eye therapy my daughter no longer gets headaches, and she no longer gets car sick. Daily tears are a thing of the past. I really can’t say enough about this clinic. It was fascinating to watch Dr. Zurcher work. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that I’ve ever had the good fortune to meet. We’re finished with eye therapy—yay!—and I have switched to American Family Vision Clinic for all of my family’s other eye health needs.


Lars Wulff

Very professional, yet kind and helpful. They do what they can to make the appointment comfortable. I was running a bit late, I made sure ti call. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. Thank you so much! Would recommend to anyone. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage.


Justin E.

The staff is friendly. The Doc is very knowledgeable. The office is family friendly and everyone is so patient with the little ones.


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