[English] Convergence Insufficiency

[stephen at melbpc.org.au]

Not Autistic or Hyperactive. Just Seeing Double at Times 

By LAURA NOVAK
<http://www.nytimes.com>
Published: September 11, 2007

As an infant, Raea Gragg was withdrawn and could not make eye contact. By 
preschool she needed to smell and squeeze every object she saw.

“She touched faces and would bring everything to mouth,” said her mother, 
Kara Gragg, of Lafayette, Calif. “She would go up to people, sniff them 
and touch their cheeks.” 

Specialists conducted a battery of tests. The possible diagnoses mounted: 
autism spectrum disorder, neurofibromatosis, attention-deficit 
hyperactivity disorder, anxiety disorder. 

A behavioral pediatrician prescribed three drugs for attention deficit and 
depression. The only constant was that Raea, now 9, did anything she could 
to avoid reading and writing.

Though she had already had two eye exams, finding her vision was 20/20, 
this year a school reading specialist suggested another. 

And this time the ophthalmologist did what no one else had: he put his 
finger on Raea’s nose and moved it in and out. 

Her eyes jumped all over the place. 

Within minutes he had the diagnosis: convergence insufficiency, in which 
the patient sees double because the eyes cannot work together at close 
range. 

Experts estimate that 5 percent of school-age children have convergence 
insufficiency. They can suffer headaches, dizziness and nausea, which can 
lead to irritability, low self-esteem and inability to concentrate.

Doctors and teachers often attribute the behavior to attention disorders 
or seek other medical explanations. Mrs. Gragg said her pediatrician had 
never heard of convergence insufficiency.

Dr. David Granet, a professor of ophthalmology and pediatrics at the 
University of California, San Diego, said: “Everyone is familiar with 
A.D.H.D. and A.D.D., but not with eye problems, especially not with 
convergence insufficiency. 

But we don’t want to send kids for remedial reading and education efforts 
if they have an eye problem. This should be part of the protocol for eye 
doctors.” 

In 2005, Dr. Granet studied 266 patients with convergence insufficiency. 

Nearly 10 percent also had diagnoses of attention deficit or 
hyperactivity — three times that of the general population. The reverse 
also proved true: examining the hospital records of 1,700 children with 
A.D.H.D., Dr. Granet and colleagues found that 16 percent also had 
convergence insufficiency, three times the normal rate.

“When five of the symptoms of A.D.H.D. overlap with C.I.,” he said, “how 
can you not step back and say, Wait a minute?” 

Dr. Eric Borsting, an optometrist and professor at the Southern California 
College of Optometry who has also studied the links between vision and 
attention problems, agreed. “We know that kids with C.I. are more likely 
to have problems like loss of concentration when reading and trouble 
remembering what they read,” he said. “Doctors should look at it when 
there’s a history of poor school performance.”

Dr. Stuart Dankner, a pediatric ophthalmologist in Baltimore and an 
assistant clinical professor at Johns Hopkins, said that children should 
be tested for convergence difficulty, but cautioned that it was not the 
cause of most attention and reading problems.

Dr. Dankner recommended an overall assessment by a psychologist or 
education specialist. “An eye exam should be done as an adjunct,” he 
said, “because even if the child has convergence difficulty, they will 
usually also have other problems that need to be addressed.”

Doctors recommend a dilated eye exam and a check of eye teaming and 
focusing skills. Testing includes using a pen or finger to test for 
the “near point of convergence,” as well as a phoropter, which uses lenses 
and prisms to test the eyes’ ability to work together. 

There is no consensus on how to treat convergence insufficiency. Next 
spring, the National Eye Institute will announce the results of a $6 
million randomized clinical trial measuring the benefits of vision therapy 
in a doctor’s office versus home-based therapy.

For Raea Gragg, the treatment was relatively simple. For nine months she 
wore special glasses that use prisms to help the eyes converge inward. She 
then had three months of vision therapy. She has just entered fourth grade 
and is reading at grade level. 

“Raea didn’t know how to describe it because that’s all she’s ever known,” 
her mother said. “She felt like she had been telling us all along that she 
couldn’t see, but nobody listened.”
--

Cheers people
Stephen Loosley
Victoria, Australia