Home Exercises to Improve Convergence Insufficiency Patient
Transcription
Home Exercises to Improve Convergence Insufficiency Patient
Home Exercises to Improve Convergence Insufficiency Patient Information Orthoptic Department Author ID: Leaflet Number: Name of Leaflet: Date Produced: Review Date: 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 Page 2 of 8 • 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. • 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. • 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 Page 3 of 8 • These are double-sided dot/letter cards for measuring the near point of convergence and of accommodation and for home exercises. • Dot cards treat convergence insufficiency more effectively than simple pen push-up exercises by ensuring correct ocular alignment. • 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. • 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. • 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. • When you see this furthest dot singly, all the other dots should appear double and they will fan outwards towards you. This is normal. • If you can make the furthest dot single, count up to 10 slowly whilst keeping the dot single. • 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. • 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). • 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! Home Exercises to improve Convergence Insufficiency Page 4 of 8 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 Home Exercises to improve Convergence Insufficiency Page 5 of 8 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. 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Home Exercises to improve Convergence Insufficiency Page 6 of 8 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 [email protected]. Home Exercises to improve Convergence Insufficiency Page 7 of 8 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: • • • Telephone freephone 0800 073 1477 Email [email protected] 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 Home Exercises to improve Convergence Insufficiency Page 8 of 8