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Convergence Insufficiency

About 10 years ago while I was building out HelpSpot I started experiencing intermittent dizzy spells. Dizzy isn’t even the correct word, but it’s the best word I have for it. It’s somewhere between a ‘pang’ going through my eyes and feeling off balance. Not room spinning vertigo, but definitely uncomfortable.

I was working 12-16 hours a day at the time coding HelpSpot and just pushed through it. After that, there was always some reason to not deal with it. Babies, new releases, etc.

Over the past year I started to experience far more headaches than I ever had in the past, general anxiety and other physical symptoms. Driving became extremely difficult as feeling pangs of dizziness at high speed makes driving… uncomfortable 🙂

I have been seen by numerous doctors, ENTs, and optometrists over the years with nobody ever finding anything unusual. As I started to feel worse over the past year I became determined to figure out what was going on.

After seeing a bunch more doctors, I decided to try and find a more specialized optometrist who might be able to find something off with my eyes that all the others had missed.

It felt like a bit of a long shot, but I know I work my eyes really hard with all this close up computer work and as the more serious potential issues had been ruled out it seemed worthwhile. I ended up finding the Bernstein Center for Visual Performance in White Plains, NY about an hour from where I live.

The center specializes in weird eye stuff (my own words), unlike your local optometrist who is really only checking for your basic vision clarity (they do that also at Bernstein). In fact, even when I asked local optometrists if anything with my vision could cause these things I was always told my eyes were fine.

So, I went to the Bernstein Center somewhat desperate as I was basically out of ideas after them. After a thorough evaluation (when was the last time you spent an hour and a half with an optometrist?) it was determined I have Convergence Insufficiency along with a misalignment of my eyes.

Convergence Insufficiency is the inability of your eyes to converge together consistently. If one or both eyes move too far in/out they’re unable to focus properly on the correct place in space. This causes increased strain on your eyes, muscles, brain, etc.

Convergence Insufficiency is normally found in children as it often presents as learning disabilities. Sometimes even being misdiagnosed as ADHD or similar. But the child is not able to focus not because they have a chemical imbalance but because they literally aren’t seeing correctly.

My eyes are also about 1/4 inch off from each other vertically. Nobody had ever noticed this. Not other optometrists, not my wife, not even me!

The eye level difference and the Convergence Insufficiency could cause many of the symptoms I was experiencing. That, along with an improper vision correction prescription (too strong) and bad glasses (the online store you all probably buy your glasses from) made things worse.

Having a convergence issue doesn’t mean you necessarily can’t see clearly. Optometrists who don’t detect the Convergence Insufficiency can often keep you seeing “clearly” by increasing your prescription strength, but that only further strains your eyes, brain, etc making other problems worse.

So, how to fix this? First, in the office during that first visit the doctor put me in contacts. I used to always wear contacts before starting the business at which point I went to glasses full time (the same time I started experiencing these visual issues suspiciously). Instantly, in the office that second I felt better. Not 100% better, but a noticeable difference immediately.

To actually fix the issue would require 24-44 in office visits to go through vision therapy as well as homework each night at home. I spent a lot of time looking at a pencil 🙂

2015-02-27 11.25.47

Yesterday I finished my 24th session and am done for now. Each one requiring a 1 hour drive back and forth to White Plains along with the 40 minute session. It’s one of those times where having a bit of flexibility in your job and an amazing team to cover your absence pays off in far more than dollars.

Those early drives down were borderline terrifying as I mentioned above, driving was a bit scary. Now, I’m able to make the drive without even thinking about it. It’s one of the more pronounced differences for me. It’s also nice to be able to do my work without constant pangs of dizziness while on the screen.

I’m still not 100% done. I do get an occasional pang, but my eyes will continue to strengthen over time. We’ll be giving it 3 months to see how things go, it’s possible I could need another round of therapy but hopefully things continue to improve just through eye use with the proper prescriptions going forward.

It’s an amazing feeling when you find out something actually is wrong with you after you’ve always been told you’re fine. That’s one of the main reason I wanted to write this post.

If you or someone you know has dizziness, headaches, trouble reading or remembering what you’ve read you may have a vision issue. Your local optometrist probably won’t find this, especially if you’re an adult. Try and find a specialist, an optometrist that offers vision therapy as a service is likely a good sign. The one at the mall isn’t going to cut it in most cases.

I also want to again point out the impact Convergence Insufficiency has on kids. By impacting their ability to read, to pay attention, even their balance systems, it can often be misdiagnosed.

In fact, the vast majority of the people I was going through vision therapy with were kids between 7-12. It was great being around them and I loved the occasional “what is that adult doing in here?” question.

I suspect this condition is under diagnosed in adults, especially knowledge workers who spend 8+ hours a day looking at a fixed distance.

If you’re seeing any of these symptoms yourself definitely find a proper optometrist and get checked out. Those of you in the NYC metro area I can’t recommend the Bernstein Center for Visual Performance enough. It’s been truly a life changing experience working with them.


  1. Interesting. I have had more than my share of eye issues (short sight, retinal detachment, cryo-surgergy, posterior vitreous detachment) but I hadn’t heard of this one.

    BTW there is a brilliant charity I support called ‘Sightsavers’ that does amazing work helping people with eye problems in developing countries.

  2. Ah, that sounds interesting. I’ll have to check it out.

    Yikes, retinal detachment doesn’t sound good 🙂 Glad to see you’ve made it through all that though.

  3. I have also been experiencing these kind of symptoms! It’s so nice to hear of other people (adults) who have had success. I’m only 3 weeks into my vision therapy program but I’m hopeful that it’ll help me with almost instant fatigue while reading and just weird feeling eyes.

    My convergence problems started after using a nasal spray for allergies. 🙁

    Loved reading the article, thanks for sharing!

  4. Interesting. I am about to get evaluated for this. My symptoms came on with Lyme. I haven’t been able to drive for 18 mos. thanks for sharing!

  5. Hi! I have convergence insufficiency. I went through the eye therapy, also. I have had problems with my eyes hurting without my prism glasses when doing normal daily things and when looking at things close up, but not trying to read. I was researching if it is ok to use contacts with convergence insufficiency. So, I ran into this page. You mentioned you were put in contacts early on. Do you still use contacts and do you have any issues with it? My doctor did not recommend contacts, but I tried bifocals and they make me really dizzy.

    • I think it’s pretty dependent on the person. My doc said for some people it helps, for others it doesn’t. Seems like it probably would be something to try. I use contacts and then reading glasses over top when I’m working on the computer or reading books.

  6. Hi Ian,

    So do your glasses contain only a prism and your contacts have the focus magnification? Are your contacts bifocals?


    • My contacts are just normal, I have reading glasses with a slight prism for reading. The glasses I wear when my contacts are out have no prism. I usually only wear them at night. I do have another pair of glasses for reading without contacts that also have the slight prism.

  7. Hi Ian,
    I have been dealing with feeling off balance for over 10yrs and recently had my eyes examined and was diagnosed with moderate to severe convergence insufficiency. Like you, over those years, I have seen many different specialists (ENT, allergist, neurologist, etc) with no solution or improvement. So I was extremely excited when my CI was diagnosed. I subsequently started researching CI and then found your blog. I too live in the NY metro area and I am beginning vision therapy and have a couple of questions based on your experience. Can you elaborate on when you say you get a “pang” feeling?…I think I understand and for me it feels like a wash of nerves in my head when I make a sudden head/eye movement. Also, can you describe the exercises that you did during your treatment? Where there certain situations that would cause the feelings of off balance to be exacerbated (ie driving, shopping, walking, etc)? Lastly, how long into the therapy did it take to start seeing improvement?

    Thank you for taking the time to document you experience…it has definitely given me hope for a solution.

  8. Thank you so much for writing this! Having had an optometrist tell me that “you see 20/20 in each eye so I don’t know what the problem is” made me crazy enough to research why I still couldn’t see properly! Ok, they are each corrected to 20/20 – but I tend to use them both at the same time, and when I do – I can’t stop things from “vibrating”!

    I was thrilled to find Dr. Elliott Stendig, in Garland, Texas that quickly diagnosed my CI. He suggested Vision Therapy – but he was too far to drive to twice a week. Luckily, there was another Therapeutic Optometrist that was in my home town that does the therapy.

    So far I have been to 3 sessions so far, and while I don’t necessarily see a difference, I have much more hope now that I have read your article! So, no one else has stated this…but therapy can make me feel really stupid. I mean, logically, this can’t be that hard as little kids are doing it…right?!? But, honestly, it is difficult and frustrating and I leave physically exhausted! But, I guess if it was easy – I wouldn’t need to be there!

    My heart goes out to the child that already has self esteem issues, who is struggling with reading and grades – and the parents have been told there is nothing wrong with their vision!

    • 95% yes. After the vision therapy my eyes continue to get better. I’m able to drive and everything I did before.

  9. Hi,
    Thank you for sharing your experience. I have a child going through this, and as she grows it is getting worse.
    Vision therapy and prism lenses originally began to help. However after 6 months of vt, she started getting worse. Much worse. Stomach pain, constant nausea and now horrible dizziness. We have been through all the experts and are currently waiting for an mri.
    Would you mind addressing “Toms” questions above…I had similar one’s.

    • Yeah it tends to be found in kids, not sure how I skipped by. I thing it got worse when I started doing long hours on the computer and kinda put me over the edge.

      The pangs are pretty much exactly as Tom described though it’s really hard to truly describe the sensation but that’s close. I’ve found coffee/caffeine makes it much worse, obviously not an issue for a child.

      The exercises can absolutely make you feel worse. I definitely felt somewhat better after the VT but it continues to get better after it also as your eyes strengthen in the proper way and your brain resets a bit. I feel much better today than the day I stopped VT. There’s also a psychological component I think as you’re so used to feeling off that it takes some time to adjust to really not feeling off or feeling less off.

      Also for me moving to contacts made a huge difference. Apparently it does for some people but not always. Hard probably with a child but maybe something to consider. You’d want to talk to the doc of course.

  10. So happy I found this blog about CI. I’ve had it since childhood and remember doing some basic exercises but only for a short time. My optometrist figured out the problem when I was around 55. In March she increased the prisms in my glasses and in April I began to have severe vertigo and it started while I was driving. It lasted a week or so then came back mildly and now completely back again. Has anyone else had these issues? This is true vertigo so getting even on a step stool is dangerous. What everyone else is describing is more waves of “dizziness”, am I correct? I’ve already had heart issues ruled out because my blood pressure would shoot up when I would have severe attacks and now we’re at the ENT and getting an MRI.
    Thanks for any input. I’d love to get over this feeling.

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