DETECTION AND MEASUREMENT OF

CONVERGENCE INSUFFICIENCY AMONG THE I.T.

COMPANY EMPLOYEES (25-30 YEARS OF AGE) IN
HYDERABAD

A PROJECT REPORT
SUBMITTED BY - BIBHASH NATH
BACHELOR IN CLINICAL OPTOMETRY
TRIPURA INSTITUTE OF PARAMEDICAL SCIENCES
REGISTRATION NUMBER – 17477 OF 2014-15

(ACADEMIC YEAR 2014-2018)

ACKNOWLEDGEMENT
 ACKNOWLEDGEMENT
I wish to express my deep sense of gratitude and sincere thanks to Dr. Krishnapriya
Madam for her incessant guidance for completing my project and helping me in
completing the project in a correct and perfect way.
I especially thank to our respected Medical Director of Dr. Agarwal Eye Hospital,
Hyderabad Dr. Vamshidhar and Cluster Optom. of Dr. Agarwal Eye Hospital, Hyderabad
Optom.Venkatesh for helping me in every possible way and attending to us whenever we
required and the support which paved way for the successful completion of my project.
I extend my immense thanks to Optom Surekha, Optom Dayakar, Optom Bhargavi,
Optom Neelima, Optom Ateeq, Optom Mounika and Optom Supriya for their help and
support on various aspects of my work.
I thank my dear friends Rupak Debnath and Jhutan Sukla Das for helping me constantly
in all the works of my project.
CERTIFICATE
 CERTIFICATE

This is to certify that the dissertation titled “Urbanization In India” submitted to

the department of optometry and vision sciences, Tripura Institute of Paramedical
Sciences, in partial fulfilment of the requirement of the award of the degree of
Bachelor in Clinical Optometry for the academic year (2014-2018), is a bonafide
record of the original work done by Bibhash Nath, under my guidance.

Signature of the Doctor Signature of

HOD
DECLARATION
 DECLARATION

I hereby declare that the findings reported in the study titled “Prevalence & distribution
of refractive errors in school going children from 8-15 years of age in Hyderabad” are the
result of my own original work carried out by me under the guidance of Optom
Venkatesh in partial fulfilment of the award of Bachelor in Clinical Optometry, for the
academic year (2014-2018).

Signature of the Guide Signature of the

Candidate
CONTENTS
 CONTENTS

SL. NO. TITLES

01. Abstract
02. Introduction
03. Methodology
04. Data Analysis
05. Result
06. Discussion
07. Conclusion
08. References
 ABSTRACT

ABSTRACT
NEED FOR THE STUDY: Most of the people are not aware of phoria; in such cases
appropriate diagnosis is required in order to determine the amount of heterophoria. They
might have asthenopic symptoms but the reason for it is still unknown to them. This
research is mainly concerned with detection and measurement of convergence
insufficiency among the I.T. company employees.

AIM: Detection and management of convergence insufficiency among the I.T. company
employees (25-30 years of age) in Hyderabad.

PARTICIPANTS: Sixty (60) employees of different I.T. companies.

INTERVENTION: The study was conducted on 60 people belonging to the age group
between 25-30 year both being female & male who are working in various I.T. companies
of Hyderabad. Near Point of Convergence (NPC) was measured for each subjects with the
help of RAF ruler and cover tests were performed over each and every subjects to ensure
the presence of phoria. Among these subjects many were having convergence
insufficiency and many of them were having exo-phoria. And the common symptoms of
these patients were asthenopic symptoms. And at last we have suggested convergence
exercises to those subjects who were having convergence insufficiency. The findings of
the study indicate that there is significant amount of convergence insufficiency in young
boys than the young girls.

RESULT: Among 60 people between the age group of 25-30 years, 12 people were having
convergence insufficiency. Maximum subjects were found to be with exo-deviation,
among them 22 subjects were having exo-deviation whereas only 1 subject was having
eso-deviation & others were ortho.

CONCLUSION: According to this study many people are suffering from convergence
insufficiency in this age group. So, proper diagnosis & treatment of this condition is very
important.

KEY WORDS: Convergence insufficiency; asthenopic symptoms; phoria; exo-deviation.

INTRODUCTION

CONVERGENCE
  Convergence is a disjugate movement in which both eyes rotate inward so that the
lines of sight intersect in front of the eyes.

 It does not deteriorate with increasing age, as doe’s accommodation but may
deteriorate under certain abnormal conditions.

 The power of convergence can be increased by exercises.

 It allows bi-foveal single vision to be maintained at any fixation distance.

TYPES OF CONVERGENCE:

1. Voluntary Convergence

 It is the convergence of visual axes that can be produced at will.

2. Reflex Convergence

 It is the convergence of visual axes which is not under voluntary

control.

 It is classified into four types, as follows:-

i. Tonic convergence.

ii. Fusional convergence.

iii. Accommodative convergence.

iv. Proximal convergence

CONVERGENCE INSUFFICIENCY
Convergence insufficiency is the inability to obtain or maintain adequate binocular
convergence due to reduced ability of the eyes to turn inwards. It is the most common
cause of ocular asthenopic symptoms.

 REASONS BEHIND CONVERGENCE INSUFFICIENCY:

1. Primary or idiopathic.

 Exact aetiology is unknown.

 It can be associated with a wide IPD and delayed functional

development.

2. Refractive errors.

 It can be associated with uncorrected high hypermetropia and myopia.

3. High hypermetropia.

 Usually make no effort to accommodate.

4. Myopia.

 May not need accommodation and thus there will be a lack

accommodative convergence.

5. Presbyopia.

 The near point of eye recedes and so there is less use of convergence.

6. Muscular imbalance.

 EOM imbalance in the form of exo-phoria, intermittent exo-tropia and

vertical muscle imbalance; which if neglected may be associated with
convergence insufficiency.

SIGNS AND SYMPTOMS

SYMPTOMS OF CONVERGENCE INSUFFICIENCY:

 Asthenopia and headache

  Intermittent blur.

 Burning and tearing.

 Inability to concentrate and sustain.

 Sleepiness when reading.

 Slow reading.

 If the exo-phoria is large at distance, many of the above symptoms may be present
at distance as well.

SIGNS OF CONVERGENCE INSUFFICIENCY:

 Greater Exo-phoria at near than at distance.

 Reduced positive fusional vergence at distance and near.

 Reduced vergence facility at near and possibly at distance with base out prism.

 Intermittent suppression at near.

 Low AC/A ratio.

 Exo-fixation disparity at distance near.

TREATMENT OF CONVERGENCE INSUFFICIENCY:
1.Optical Treatment:
Proper refraction should be carried out and the correct glasses should be prescribed for any
associated refractive error. Myopes are given full correction and hyperopes
undercorrection to stimulate their accommodation which will simultaneously stimulate
convergence. In adults above the age of40 years, proper presbyopic correction should also
be done.

2. Orthoptic Treatment:
Aim of convergence exercises is to improve the binocular convergence and to increase the
amplitude of fusional convergence. Various exercises are as follows:

A. Exercises to improve NPC are:

--- Advancement exercises.
--- Jump exercises.
---Exercise with pen tip.

B. Exercises to increase amplitude of fusional convergence:

---Convergence exercises with prism.
---Convergence exercises using synoptophore.
---Exercises using convergence card.
C. Training of voluntary convergence.

D. Prismotherapy:
When all the exhaustive orthoptic exercises fail,
the prismotherapy may be tried to relieve symptoms:

--- Base in prism reading glasses or bifocals with prisms

in the lower segment are useful as relieving prisms.

---Relieving prisms and bifocals in young age should be

avoided.

3. Surgical Treatment:
As a last resort, when all other measures fail, especiall wyhen convergence insufficiency is
associated with a large exophoria at near vision, medial rectus muscle resection can be
performed in one or both eyes. In some cases, exophoria at near fixation tends to occur.
 METHODOLOGY

EXAMINATIONS FOR CONVERGENCE INSUFFICIENCY

Convergence insufficiency is diagnosed through a comprehensive eye exam. Testing for
strabismus, with special emphasis on how the eyes focus and move may include:

 PATIENT HISTORY:

A patient history is obtained to determine any symptoms the patient is experiencing or the
patient is observing, and to not the presence of any general health problems, medication
taken or environmental factors that may be contributing to the symptoms.

The following question should be asked;

1. Since when the subject is squint?

2. Has the subject felt any deviation?

3. Does the subject complain for any problem?

4. Any ophthalmologic problem in the family?

5. Was the subject examined and treated ophthalmology?

6. Is the patient taking any medication at present?

 VISUAL ACUITY:

Visual acuity measurement is taken to assess the extent to which vision may be affected.
As part of testing, the patient will be asked to read letter on distance and near reading
chart. The normal distance visual acuity is 6/6.

 REFRACTION :

A refraction is conducted to determine the appropriate lens power compensate for any
refractive error.

 NPC:
Near point of convergence is measured with the help of RAF ruler.

 COVER TESTS :
It is used for diagnosis of heterophoria. These tests allow the examiner to differentiate
manifest from latent squint, to detect the direction and approximate size of deviation
.These tests are based on the patient`s ability to fixate. They are performed for near and
distance fixation with or without spectacle correction.

COVER-UCOVER TEST:

• To detect heterophoria for both distance and near.

• The patient fixates straight –ahead at a distance target (6mtr) first.

• Start with covering and uncovering the right eye. Note for any movement of that
eye.

• No movement indicates orthophoria.

• Adduction of the right eye to take up fixation indicates exotropia; abduction

indicates esotropia.

• Downward movement indicates hyperphoria and upward movement, hypophoria.

• The test is repeated on the opposite eye.

• Then the test is done at near (33cm) distance.

• The test is done with and without spectacle correction.

ALTERNATE COVER TEST:

• Is done to detect heterophoria both for near and distance, it confirms whether the
squint is unilateral or alternating.

• The patient fixates a straight –ahead distance target.

• The examiner covers the left eye and after 2-3 second removes the cover and shifts
the cover to the other eye. This is done several times.

• The just uncovered eye is observed for movement.

• No movement indicates the orthophoria

• It is a dissociation test which reveals the total deviation when fusion is suspended.

• The patient with a well –compensated heterophoria will have straight eyes before
after the test has been performed whereas a patient with poor control may
decompensate to a manifest deviation formed whereas a patient with poor control
may decompensate.
COVER
UNCOVER
TEST

ALTERNATE
COVER TEST
 MADDOX ROD TEST :

• This is done to detect and assess the quantification of heterophoria in the subject.
• It’s a purely subjective test.

A-Eso deviation; B-Exo deviation; C- Hypo deviation; D- Hyper deviation; E- Orthophoria

DATA ANALYSIS
 DATA ANALYSIS
The present research studied the detection and measurement of convergence insufficiency
in 25-30 Years of both male and female. The data collected from the sample was analysed
with the help of manual calculations to check if any convergence insufficiency error is
present or not.

The details have been given below:

TABLE-1
SUB VISION COVER-UNCOVER TEST NPC

RE LE Distance Near
1 6/6 6/6 Ortho Ortho 8cm
2 6/6 6/6 Ortho Ortho 8cm
3 6/6 6/6 Ortho Ortho 8cm
4 6/6 6/6 Ortho Exo 8cm
5 6/6 6/6 Ortho Exo 8cm
6 6/6 6/6 Ortho Exo 8cm
7 6/6 6/6 Ortho Exo 8cm
8 6/6 6/6 Ortho Ortho 8cm
9 6/6 6/6 Ortho Exo 12cm
10 6/6 6/6 Ortho Exo 8cm
11 6/6 6/6 Ortho Ortho 8cm
12 6/6 6/6 Ortho Ortho 8cm
13 6/6 6/6 Ortho Ortho 12cm
14 6/6 6/6 Ortho Exo 8cm
15 6/6 6/6 Ortho Ortho 8cm
16 6/6 6/6 Ortho Ortho 8cm
17 6/6 6/6 Ortho Ortho 12cm
18 6/6 6/6 Ortho Ortho 8cm
19 6/6 6/6 Ortho Ortho 8cm
20 6/6 6/6 Ortho Exo 8cm
21 6/6 6/6 Ortho Exo 8cm
22 6/6 6/6 Ortho Ortho 12cm
23 6/6 6/6 Ortho Ortho 8cm
24 6/6 6/6 Ortho Ortho 8cm
25 6/6 6/6 Ortho Eso 8cm
26 6/6 6/6 Ortho Ortho 8cm
27 6/6 6/6 Ortho Ortho 8cm
28 6/6 6/6 Ortho Ortho 12cm
29 6/6 6/6 Ortho Ortho 8cm
30 6/6 6/6 Ortho Exo 12cm
TABLE-2:

SUB VISION COVER-UNCOVER TEST NPC

RE LE Distance Near
31 6/6 6/6 Ortho Exo 12cm
32 6/6 6/6 Ortho Exo 8cm
33 6/6 6/6 Ortho Ortho 8cm
34 6/6 6/6 Ortho Ortho 8cm
35 6/6 6/6 Ortho Ortho 8cm
36 6/6 6/6 Ortho Ortho 8cm
37 6/6 6/6 Ortho Exo 12cm
38 6/6 6/6 Ortho Ortho 8cm
39 6/6 6/6 Ortho Exo 8cm
40 6/6 6/6 Ortho Exo 8cm
41 6/6 6/6 Ortho Ortho 8cm
42 6/6 6/6 Ortho Exo 8cm
43 6/6 6/6 Ortho Ortho 12cm
44 6/6 6/6 Ortho Exo 8cm
45 6/6 6/6 Ortho Ortho 8cm
46 6/6 6/6 Ortho Ortho 8cm
47 6/6 6/6 Ortho Exo 12cm
48 6/6 6/6 Ortho Ortho 8cm
49 6/6 6/6 Ortho Ortho 8cm
50 6/6 6/6 Ortho Exo 8cm
51 6/6 6/6 Ortho Exo 8cm
52 6/6 6/6 Ortho Ortho 12cm
53 6/6 6/6 Ortho Ortho 8cm
54 6/6 6/6 Ortho Ortho 8cm
55 6/6 6/6 Ortho Exo 8cm
56 6/6 6/6 Ortho Ortho 8cm
57 6/6 6/6 Ortho Ortho 8cm
58 6/6 6/6 Ortho Ortho 8cm
59 6/6 6/6 Ortho Ortho 8cm
60 6/6 6/6 Ortho Exo 12cm
PIE DIAGRAM-1:

DEVIATIONS OBSERVED AMONG THE STUDY GROUP

ORTHOPHORIA

ESOPHORIA

EXOPHORIA

19
2

PIE DIAGRAM -2:

NORMAL CONVERGENCE AND CONVERGENCE INSUFFICIENCY

5

NORMAL CONVERGENCE

CONVERGENCE
INSUFFICIENCY

25
RESULT
 RESULT
 The study was conducted on 60 samples belonging to the age group between 25-30
years both being female & male in I.T. companies of Hyderabad. The findings of the
study indicate that there is significant amount of convergence insufficiency in boys
than the girls.

 The most common type of problem is detected in this study was exo – deviation.

 Among 60 subjects 12 subjects were having convergence insufficiency and other 48

subjects were having normal convergence.

 Among the 60 subjects maximum numbers of subjects were suffering from

asthenopic symptoms and those 4 subjects who were suffering from convergence
insufficiency were having severe asthenopic symptoms.
DISCUSSION
 DISCUSSION

 The purpose of this study was to detect and measure convergence insufficiency
among the age group of 25-30 years of age; a total number of 60 subjects were
screened for convergence insufficiency (both girls and boys). A stratified random
sampling technique was used to pick up the subjects having convergence
insufficiency .The finding of the study indicates that there is significant amount of
convergence insufficiency in young boys and girls but it was more in boys. The
most common type of convergence of insufficiency detected in our study was exo
-deviation. This error is seen more in girls than in boys.

 Most of the people are not aware of phoria but we have to identify the exact
condition and we have to give perfect solution to the patient otherwise it will remain
unknown to them and they will suffer. Convergence insufficiency is also a major
problem now-a-days it has to be treated with correct solutions otherwise it will lead
to severe conditions to the patients in later stages.
CONCLUSION
 CONCLUSION

 The most common type of problem detected was exo –deviation. The convergence
error was seen more in boys than in girls. The result suggests that the more number
of boys are having CI than the girls.

 Mainly in this age group of people are more prone to get convergence insufficiency
according to the result. The result from this study also showed that convergence
insufficiency is found in frequent percentage now a day.

 We can’t neglect this problem of convergence insufficiency because this problem

can give us more trouble after a period certain of time.

 It has to be treated by orthoptic treatment which is very less effective for that
maximum time orthoptic exercise is to be advised along with reading glasses.

 Appropriate plus lenses and base in prism is the perfect treatment of choice for
convergence insufficiency.
 REFERENCES

REFERENCES
1. Theory and Practice of Squint and Orthoptics (Second Edition).

-A.K. Khurana.

2. www.google.com
3. Clinical management of binocular vision (Second Edition ).

4. https://en.m.wikipedia.org

5. Foundations of binocular vision (A clinical perspective).

-Scott B. Steinmen.
6. Studies on binocular vision.

7. https://www.medicinenet.com

8. https://opto.ca