Focusing Problems in Children

Normally, your child's eyes work together to rapidly bring objects into sharp focus. The eyes shift focus and team together with almost no effort at all. This is done subconsciously as your child changes focus from distance to near and everywhere in between with no stress on his or her visual system. However, a number of accommodative and vergence dysfunctions, which are types of focusing problems, can affect kids.

Accommodative dysfunction affects the ways your eyes change focus from distance to near. Vergence dysfunction affects the way your eye muscles work that actually move your eyes around while changing your focus. Our eye muscles move our eyes slightly in while looking down at the reading material and slightly out while viewing objects in the distance. The word "vergence" refers to the way your eyes converge (turn in) or diverge (turn out). We discuss these dysfunctions together because both of our systems that control the way our eyes focus and the way our eye muscles move our eyes are tied together in our brain. What affects one system may cause problems in the other.

Boy in library holding digital tablet
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Signs and Symptoms

Accommodative and vergence dysfunction affects your child's eyes in two ways: the way the eyes focus and the way the eyes work together. Children with accommodation and vergence dysfunction often have the following symptoms:

  • Blurred vision
  • Headache
  • Ocular discomfort
  • Fatigue
  • Double vision
  • Motion sickness
  • Lack of concentration

If your child has a vision problem, he or she may act out in certain ways and may be inappropriately or appropriately diagnosed with dyslexia, ADD, or ADHD. Some children appear to learn normally but become frustrated quickly. Children with accommodative and vergence dysfunction may quit reading altogether because it creates too much stress for them.

Accommodative or vergence dysfunction can greatly impact your child's school performance, especially after third grade when visual demands increase. Reading smaller print becomes necessary and homework begins.


Treating accommodative and vergence dysfunction starts by addressing any underlying basic vision problem such as farsightedness, nearsightedness, or astigmatism that your child may have. Treatment may simply involve purchasing a pair of reading glasses for the classroom. Treating accommodative and vergence dysfunction may also entail vision therapy (VT). Some doctors deem vision therapy controversial, but VT usually works well for this particular condition. A course of VT may involve using different instruments and various lenses in combined with eye exercises performed in your eye doctor's office to improve your child’s focusing ability. In-office therapy is usually supplemented with at-home techniques. Not all eye doctors conduct VT in their office, so make your wishes known when searching for the right doctor.

Your child's doctor may suggest eye muscle surgery in order to correct an accommodative or vergence dysfunctions. Surgical treatment involves permanently adjusting your child's eye muscles.

Problems With Reading Glasses

Be aware that some children with certain accommodative and vergence dysfunction may be distracted wearing reading glasses as their primary mode of vision correction. Your child may become troubled putting his or her glasses on and taking them off repeatedly. These children may benefit from a progressive lens. Many people associate progressive lenses with people over 40 years of age. However, children with accommodative and vergence dysfunction may actually do better with this type of no-line bifocal. With a progressive lens, your child will be able to see at distance and near with ease without taking the eyeglasses off and still be able to look down to read comfortably, without taking the glasses on and off.

Prism is often prescribed for children to help treat accommodative and vergence dysfunction. Prism is a special type of power that can be put into eyeglass lenses to reduce the effort placed on the eye muscles to converge or diverge the eye muscles. The prism may be prescribed to move images in or out, and up or down. Prism can help your child by reducing eye strain and fatigue.

A Word From Verywell

Early detection of an accommodative or vergence dysfunction is important because your child's performance in the classroom can be greatly affected. Therefore, early eye examinations are especially important for children. If your child is diagnosed with an accommodative or vergence dysfunction, proper treatment usually fixes the problem.

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  • Caloroso, Elizabeth E and Michael W Rouse. Clinical Management of Strabismus. Butterworth-Heinemann, pp 148-155, 1993.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.