Convergence and accommodation insufficiency after concussion in 9yo - what should we be doing?

[detestedDIL]

Does anyone have advice on whether we should be doing anything more than we're doing to try to improve DS9's convergence and accommodation insufficiency?

DS9 has been mildly longsighted (different prescription in each eye) since he was 4.
In February last year (i.e. 18 months ago) he had a bad concussion when he was hit by someone riding an e-scooter at high speed and smashed his head into the footpath. He did physio eye exercises for about 8 months after the concussion (visual scanning & pencil pushups) and was discharged by the physio who said his vision was fine. She was a concussion specialist, who mostly worked on visual problems, so I'd expect her to have a clue.

This year he has really struggled to read. He used to be a novel a day kind of reader. Now he will read a page and drift off to do something else. If asked, he can read a 10-page chapter aloud, but by the end of it he is clearly very visually fatigued and having lots of scanning issues as well as squinting. He also has difficulty sustaining visual scanning on music - he really struggles to focus in pieces longer than about 3 minutes where he needs to look at the music. Before the concussion last year he had no difficulty with pieces 12-15 minutes long.

Orthoptist at the hospital ophthalmology dept (in May) said significant convergence and accommodation insufficiency, very different from how it has looked at yearly checks since he was 4, other than last year post-concussion. She gave him pencil pushups to do. His longsightedness hasn't changed. Ophthalmologist check said everything is fine other than the convergence and accommodation.

Three months later, nothing much has changed with the reading, other than that he's now developed an eye-rolling squinting tic which happens when he's concentrating on visual input. I know pencil pushup improvement takes a while, but is there anything else we can do or should do?

Orthoptist appointment is booked for September...

Just on the music reading, he gets around it by memorizing everything, so is still playing quite long and dense pieces. But he runs into major issues if he is actually required to read consistently for more than about 2 pages. He basically needs a prompter.

Both my dcs, now YA, had difficulty with convergence insufficiency. There probably is some chat about it on here somewhere. One very clever MNetter developed a computer program/ game to help with this. It helped both my DCs. In fact, my dd was referred to an optometrist at local hospital for help but was immediately discharged after initial appointment because she/dd had made such good progress with the program that the optometrist could detect no difficulties.

I’ve had a google and it appears that the program is still available … there may be other similar ones too but I can only vouch for this one. I would say that it is definitely worth a go!

https://literacygold.co.uk/EngagingEyes

I’m an Orthoptist and have seen people with convergence and accommodation problems following head injuries sometimes these can be very severe giving a complete palsy of convergence/accommodation , it can be a temporary problem but if things have not improved after 18 months and he has stuck to the exercises he is likely to need other intervention such as a bifocal or better varifocal lens to give additional plus lens for the loss of accommodation. If the convergence is reduced enough to give him double vision for close viewing he might also need prism.