[Offtopic] Convergence Insufficiency
stephen at melbpc.org.au
stephen at melbpc.org.au
Fri Sep 14 00:30:19 EST 2007
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As an infant, Raea Gragg was withdrawn and could not make eye contact.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 Raeas 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 dont 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
theres 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 doctors 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 didnt know how to describe it because thats all shes ever known,
her mother said. She felt like she had been telling us all along that she
couldnt see, but nobody listened.
--
Cheers people
Stephen Loosley
Victoria, Australia
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