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diagnosis of chronic asthenopia
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diagnosis of chronic asthenopia

Although I have 20/20 vision, over the last 5 and a half years I have had eye strain symptoms (beginning at age 23, I am now 28). For the first three years the eye-strain occured only periodically - during exam/essay period at uni. The symptoms were: muscle tension between eyebrows; difficulty sustaining vision; sensitivity to light (the symptoms appeared quicker and stronger when watching TV or using a computer than when reading). Although I could always effectively see what I was reading (not blurry) I felt as though my eyesight was looking 'through the page' and that I had to keep struggling to bring focus back in, and eventually I feel an  almost physically necessity to to stop reading due to major discomfort from the effort of the strain. These symptoms would eventually trail off a month or so after study had finished.

At the end of those three years the symptoms no longer trailed off but remained as chronic. 5 minutes of using a computer will often cause eye strain for 2 hours. A couple of hours will cause strain for the whole day, including sensitivity to wind - sometimes I could only read two pages per day. I had to drop out of university (2 years ago), and have not had a job which used the eyes since. I have now also given up reading novels; sometimes watching people's faces causes strain, as does driving. Watching TV is the most difficult thing. However, I find that when visiting the cinema my eyes feel relaxed - this is only the case after the room-lights are turned off.

I have seen 4 different opthamologists and 4 optometrists (and many other professionals). The opthamologists have never found anything wrong with my eye sight, as such: one suggested bepharitus and two suggested dry eyes - I do not believe I have the former, and the latter occurs only after long periods of eye strain.

Recently I have been diagnosed with "excess convergence" - and prescribed +.75 glasses with 2 degrees inward refraction. I researched the condition in medical journals and tentatively concluded that I had "ill-sustained accommodation"; I sought out a vision therapist to treat me for this condition; they diagnosed me with "accommodative insufficiency" and prescribed +1.25 (.25 ? for distance) reading glasses with a vertical refracting prism. I have not purchased these glasses yet -I have already purchased 3 other prescription glasses to no avail.

One of the professionals on this forum suggested that "latent hyperopia" is a common cause of "accommodative insufficiency" symptoms. I have however had "cylcoplegic refraction" performed on me by an opthamologist about 2.5 years ago with no remark made. And I am not quite convinced that reading glasses will improve my issue since I have major problems watching TV also.

I really need some guidance to help me make my next move as fruitful as possible. Does anyone else have experience with what I have described? If anyone thinks the prescription of +1.25 might solve the issue (or has another solution), could you please try to explain the physiology?

The short list of my symptoms is:
tension headaches
chronic asthenopia; problems at close distance, but also medium distance (TV), sensitivity to light.
excess convergence
accommodation insufficiency
(possible latent hyperopia)

Additional information: I have taken periods of break from reading (5 month overseas travel) but symptoms soon emerge when I have to read something for any extended period of time. I had difficulty learning to read as a child (slower than other children); but once I had learnt and found an interest my reading skills excelled beyond most others; at university I would often print journal articles 4 to 1 page (25%) as I found this format easier to comprehend - and did not feel strain until frantic exam period. I no longer do this.

This was a long post, thanks very much for reading.
Tags: asthenopia, accommodative insufficiency, latent hyperopia, cylcoplegic refraction, eyestrain, Headaches, diagnosis, Eye Strain
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711220_tn?1251894727
You mentioned a cycloplegic refraction but not the result.  Some patient may have as little as .75 to 1.00 diopter and have similar problems to you.

I would suggest you see a pediatric ophthalmologist to diagnosis both a latent hyperopia, decrease accommodative amplitude and phoria/tropia.

Dr. O.
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711220_tn?1251894727
You mentioned a cycloplegic refraction but not the result.  Some patient may have as little as .75 to 1.00 diopter and have similar problems to you.

I would suggest you see a pediatric ophthalmologist to diagnosis both a latent hyperopia, decrease accommodative amplitude and phoria/tropia.

Dr. O.
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Avatar_f_tn
Thank you for your quick reply.
I have seen an optrometrist this morning, and now have a two month wait to see the opthamologist.

I have another question I hope you can assist with. With the 'phoria test card', as I understand it, it is the right eye's image which is usually projected above the left eye's (I tried testing this this morning). Yet for me this upper image travels (3points) to the right - into the yellow rather than into the blue. Doesn't this suggest that I have convergence insufficiency instead of convergence excess?





P.S I did not mention the result of the cycloplegic refraction because that opthamologist at that time said that my eyes were fine (he himself did not mention the results).
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Avatar_f_tn
I have seen an ophthalmologist specialising in strabismus - After cycloplegic refraction I was informed that I had +1 in each eye; this was later referred to as .05 latent hyperopia.

Without magnification my eyes over-converge 3-4 points. If a +2 lens is added, they diverge about 2 points.

The specialist did not think that anything that was observed could explain why I have chronic eyestrain. It may be that the consultation format did not induce enough strain on my eyes to show the full effects of my symptoms.

[The severity of my symptoms has improved since wearing +.5 - +1.25 progressive lenses, doing eye exercises and relaxing (becoming more aware of eye habits) over the past 6 weeks.]
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Avatar_f_tn
Also, when initially unfatigued, with a +/-2 flipper and either eye covered I get on average, 14 CPM. With both eyes uncovered the average CPM is 15 - 20% lower; and if I continue to flip (for 10 minutes), at around the 6 minute mark the CPM begins to decline steadily - so that at 10minutes I may only get 4-5 CPM. However, if instead I cover either eye and continue to flip CPM does not decline much, if at all.

With the lower (binocular) CPM results above, it is not that I cannot read the text, but that my focus flickers back and forth by minute increments, so that it might initially appear in focus, but after a fraction of a second it goes out of focus.

In addition, my nearpoint of focus is 12 - 13 cm.

I hope these results are helpful for a diagnosis.
Thank you.
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Avatar_m_tn
d
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Avatar_m_tn
Hi,

did you receive a successful treatment for your eyestrain?

With best regards,

Andri
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Avatar_f_tn
I have responded to andri77 privately but I thought I should also provide an update on my situation here.

Firstly, my eye site (symptoms) have improved greatly. That said, I did not really find any formal treatment to have helped much, though they may have helped a little.

My eye problems appear to have been caused by a combination of many factors: light-sensitive eyes, over use and bad habits, and anxiety (there may be other factors that I don't know about). It's very difficult to point to one of those factors and state that it was the MAIN cause, as they were all intertwined - particularly the anxiety, for the obvious reason that I became anxious about being unable to use my eyes effectively.

However, I do believe that for me the most significant factor that led to improvement was undertaking meditation, relaxation and eye exercise routines privately (meditation/relaxation being mostly cupping the eyes and seeing black, letting the muscles relax, eye exercises being accommodation and convergence exercises). Through this procedure I was able to become aware of what I believe were very bad eye habits - I was always straining my eyes; a kind of prejudice, as though I always expected to be unable to read without straining, and therefore strained, which made my symptoms worse. This straining of mine was done subconsciously -only through the exercises above (particularly pencil pushups) did I become aware that I was straining my eyes beyond what was required to keep things in focus and once I was aware of this I could remind myself to loosen up the strain. From that time on my eye sight began to improve greatly. First I could read books again, now it seems I can do whatever I want, though I still have to be mindful about strain caused by light - I use a program called Flux on my computer. I *think* this helps.


Other things that were helpful for me are to use a desk lamp whenever I use a computer, so there is not one single source of light.

I also stopped watching TV entirely, so I don't know whether or not I am still bothered by TV.

I have since moved country and don't have the "flipper" tool here with me, so I cannot test to see whether the binocular focusing of my eyes has improved upon the results I last had.
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Avatar_f_tn
I feel that my reply above seems a bit too "optimistic" - the changes I speak about did not happen over night - it took many months to get to where I am today. And many details about that struggle are not included in the above.
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Avatar_f_tn
I have similar symptoms and it turns out that my eyes are not working well together. My right eye prefers to drift upward (hyperphoria), and the effort required to keep that eye in primary position causes the eye strain and headaches. I find that covering my right eye relieves the strain and helps me focus when reading.

Do you still have symptoms? Do you ever have double vision?
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Avatar_f_tn
Hi wishless.
Have you had an doctor/optometrist or ophthalmologist confirm that you have hyperphoria? If so then I think your issue is quite different from mine.

There appeared to be no real sign of my issue to outsider observers. The figures for "excess convergence" that I quoted above were only noteworthy because of problems I was experiencing. The flipper tests that I quote were my subjective experience of focusing the eyes.

I never experienced double vision.

I still have some symptoms; however for the most part I am now fine.
I have returned back to my home country and have discovered that I still have sensitivity to the light from certain TVs.The difference is that now I no longer have the anxiety which in the past accompanied it and made the symptoms worse, and I had removed bad habits of habitually over-straining.

If you have been confirmed to have hyperphoria, that's good in at least one sense: you have a diagnosis you can work with.

Following my own experience, it may be worth asking yourself whether anxiety about the problem might be making the strain worse.

Best of luck to you.
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