Problem readers may have convergence insufficiency

Image: freedigitalphotos.net/photostock

Convergence insufficiency (CI) is one of the most common childhood ocular motor disorders. It can make reading very difficult and consequently cause a child to fall behind in school.
In my office many parents of kids with convergence insufficiency report that their child is a slow reader, intensely dislikes school and is generally performing very poorly. Often, the paradox of an intelligent child who performs poorly in school is explained by a treatable ocular-motor disorder like CI.

Studies estimate that 5-15% of children are affected by convergence insufficiency.

It is vital for parents and teachers to know that a even if a child has 20/20 vision, she still may have CI. The standard eye chart only tests for visual acuity and not for ocular motor function, which is just as important for the performance of visual work such as reading and playing sports. Generally, CI can only be found in an eye examination.

The good news is that convergence insufficiency is very treatable. A recent study funded by the National Eye Institute found that optometric vision therapy is the best treatment for convergence insufficiency, with a 75% success rate.

According to the press release issued by the National Eye Institute:



“There are no visible signs of this condition; it can only be detected and
diagnosed during an eye examination,” said principal investigator Mitchell Scheiman, O.D., of Pennsylvania College of Optometry at Salus University near Philadelphia, Pa. “However, as this study shows, once diagnosed, CI can be successfully treated with office-based vision therapy by a trained therapist along with at-home reinforcement. This is very encouraging news for parents, educators, and anyone who may know a child diagnosed with CI.”

Common symptoms of CI are:

headaches

blurred vision

double vision

inability to concentrate

short attention span

frequent loss of place

squinting, rubbing

closing or covering an eye

sleepiness during the activity

trouble remembering what was read

words appear to move, jump, swim or float

problems with motion sickness and/or vertigo

Parents should ensure that they take their children to the eye doctor every year and that the doctor is testing for ocular motor disorders like CI. Don't be afraid to ask the right questions to ensure that nothing is being missed.

Only 38 years old and risking blindness

May is vision health month. So it is appropriate that Global News did a story on the six o'clock news on Victoria Day highlighting the dangers of getting automated sight tests from opticians rather than a comprehensive eye exam from a doctor of optometry. You are risking blindness.



Eye exams by a doctor of optometry assess the health of your eye and its component parts like the optic nerve. This is only way to diagnose glaucoma and other diseases early enough to prevent permanent vision loss.

Jason Inman was getting automated sight tests from an optician for years. He thought he was too young to need an eye exam from an eye doctor. He was wrong and and tragic consequence was permanent vision loss.

In his interview he talks about having a permanent smudge in his vision. This will likely never go away. For his eyes to get this bad, he must have suffered severe and permanent vision loss. Going by what he said in his interview, he is probably barely legal to drive, if is he is legal at all.

The good news is that now that he has gone to his optometrist, his disease is diagnosed and can be treated and the progression can be halted. The tragedy, of course, is that if he just visited his optometrist regularly he would not have suffered permanent vision loss. The thing that makes glaucoma so dangerous is that the person with the disease will not know that he has it until serious vision loss has already occurred.

It is true that this blog emphasizes glaucoma and eye exams but everyone out there needs to take their health seriously and be proactive and you need to see the eye doctor regularly. The consequences are just not worth it.

Another point is that BC's eye care regulations are obviously not rational if they allow automated sight testing because people are being lulled into a false sense of security regarding their health. Like Jason Inman said in his interview, he really did not think about whether his eye health was being looked after. That is understandable. In this busy world we often don't have time to think about our health. That is why we have doctors to look after us. I think that many people are just like Jason Inman. But I hope that they don't suffer the same consequences.

Are your kids dangerously inactive? It shows up in their eyes.

We already know that many diseases like diabetes and heart disease show up first in the eyes.
A new study shows that changes in the back of the eye can tell us if a child is on the path to future diseases. A new Australian study published in the journal Arteriosclerosis, Thrombosis and Vascular Biology concludes that dangerously inactive children have narrow arteries in the retina, the back of the eye that contains the cells that send visual information to the brain.

In today's world, where children spend hours sitting in front of the TV or the computer, inactivity is a major problem. Narrow retinal arteries are a marker for increased risk of high blood pressure, heart disease, and diabetes down the road. The study found that children with the highest levels of physical activity, one and half hours a day, had significantly wider average retinal arteries than those who spent less than half an hour a day being physically active.

The study shows us that knowledge (and an eye exam) is power. Because optometrists can detect narrow arteries in an eye health exam, we can identify the risk early enough in life and do something about it to prevent often deadly chronic diseases from showing up in adulthood. The doctor can then monitor the retina to track improvement or worsening of the arteries.

Retinal examinations are done by most optometrists during an eye health exam.

Health warning on eye drops

I've noticed something troubling lately.  People may be misusing eye drops that contain steroids (usually when prescribed by doctor who is not an eye specialist).  Steroid eye drops need to be carefully regimented and their use needs to be monitored by an eye doctor. They should never be taken "as needed". 

If not used properly, steroids can cause glaucoma - a disease that raises the pressure in the eye, damaging the optic nerve and causing permanent vision loss that starts with the peripheral vision and works its way to the center   I've seen this problem in my clinic and it is the last thing that a patient expects.  The only way to catch it before it's too late is to see your optometrist for an eye exam.

There are so many things that can sneak up on your health.  People need to see their doctors (not just optometrists) regularly so that issues like this can be nipped in the bud.  I bet dentists could tell similar stories.  Another point is that doctors shouldn't stray beyond their comfort zone or level and area of expertise.  When in doubt, refer the patient.


Eye drops image courtesy of marin / FreeDigitalPhotos.net.