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More Evidence that Vision Therapy Works!

ImageLast week I expressed my gratitude for my vision therapy journey because doing it for myself has meant that I discovered my daughter needed it and she had great results! Three weeks after that discovery, I took my 16-year-old son in for a routine exam. Because Dr. Davies does comprehensive exams, he discovered Andrew had convergence insufficiency. It was as bad as he had ever seen. Wow! Finally an explanation for why my son didn’t do his school work.

Andrew could do the work, but most of the time he chose not to. This had been the pattern for years. If he really liked his teacher, or the subject, he would do it, but usually not. He didn’t qualify for any special help because he was able to do the work. We had him tested in sixth grade for learning issues and he was ok. They said he could improve in a couple of categories, one being visual memory, but that alone didn’t seem to warrant their expensive program.

We did counseling through the school district, he participated in the study skills class, had extra time to do his work during a lunch/study program and still he was failing classes. If he completed an assignment, he got an A. He just didn’t do very many assignments.

After years of this pattern, and him thinking of himself as lazy, things didn’t shift immediately. Andrew completed vision therapy in 23 sessions and I anticipated he would begin to do all of his schoolwork, but he didn’t. Things improved, but he was still failing his classes.

A bright spot in the struggle was that he had been fixing broken screens on iPods and iPhones for friends as a hobby, usually for not much more than his cost. After vision therapy, he decided to place an online ad and start a business fixing broken screens, and charge a more reasonable rate. He has continued to do screen repair and he has business as long as he keeps his ad current. He’s also had repeat customers:)

A couple of months after finishing VT, we made a real paradigm shift and switched high schools. The new charter school was smaller, had less busy work and more in-depth discussions. He started participating more in class, smiling, making friends and was generally happier. It took longer to transition into doing all the coursework, but now he is on track to graduate from high school. Vision therapy has given him the focus to better reach his goals. His next regular checkup showed he had regressed a little, but he can do home therapy to hone his skills.

I wish we had discovered vision therapy when he was six instead of sixteen. My feeling is that his motivation and confidence could have been dramatically improved had that been the case. But we are getting there and I am extremely grateful!

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Misdiagnosing ADHD and Autism

I have heard public service messages lately regarding autism. The aim is to raise awareness about autism because about one in every 88 children are diagnosed with autism (or autism spectrum disorder), according to recent statistics  released by the CDC. That is also the figure quoted by the Autism Society. Alternately, experts estimate that five percent of school-age children (or 5 in 100) have convergence insufficiency. (The estimates also indicate that 25% of school age children have a vision issue that adversely affects their learning.)  That means that convergence insufficiency is much more prevalent than autism and I have not heard any awareness ads yet! I also haven’t seen any changes in the way we diagnose (or fail to diagnose) vision issues.

Not only are we failing to help children overcome their vision issues, we are also misdiagnosing! An article by Laura Novak in the New York Times dated September 11, 2007 entitled Not Autistic or Hyperactive. Just Seeing Double at Times details the experience of 9-year-old Raea Gragg, who had been diagnosed with ADHD and depression. A behavioral pediatrician treated the symptoms with three drugs. Then a school reading expert suggested she see a behavioral optometrist and she was quickly diagnosed with convergence insufficiency. Here’s part of the NYT article:

“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 optometrist 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.”

Studies since this article have shown a significant improvement when patients with convergence insufficiency are treated with vision therapy. Since the symptoms overlap so much, we should be screening all children for these vision disorders, particularly the ones who are having trouble in school. And, what constitutes having trouble in school? My son could do the work, but just didn’t want to. I can’t fathom how difficult it may have been for him to complete schoolwork while suffering from convergence insufficiency. What I’m also learning is that teaching the eyes to converge doesn’t automatically provide confidence, drive or good study habits. We’re still working on that part.

What about Convergence Insufficiency?

About three weeks ago, I took my son to the optometrist for his regular eye exam. He needed new contacts and the prescription had expired. I chose to take him to my vision therapist just in case there might be other issues, but I didn’t really suspect anything.

It turns out that my 16-year-old son has a pretty serious case of convergence insufficiency. It’s basically the opposite of what I have. His eyes give up on focusing together up close and then one eye turns out. (When eyes don’t focus together properly, the brain shuts off one image in order to avoid seeing double, and that’s when the eye turns in or out to move out of the way.)

As with my daughter, I had not noticed his eye turning out and he hadn’t complained about his vision. Andrew’s eyes have been red at times, but I attributed that to a lack of sleep. However, he has always had difficulty completing his schoolwork. It has been an all-or-nothing proposition: he either does it and gets an A, or doesn’t do it and gets an F. He tends to start out the school year OK and progressively go downhill. I think he just gets tired of fighting it. I know he’s extremely bright and all the learning tests have indicated he can do the work, but he hasn’t been doing it. Since he’s not motivated to do schoolwork, he convinced himself he’s lazy! I didn’t believe it before, and I certainly don’t believe it now!

The good news is that it’s really easy to teach the eyes how to converge properly and it should only take about four months of vision therapy. I’m wondering– how much frustration could we have avoided by having this diagnosis occur about 10 years ago, before he told himself he’s lazy? Isn’t it time we really tested VISION, not just 20/20 eyesight?