Monday, October 22, 2012

Convergence insufficiency symptoms - doctors need to pay attention to performance related symptoms such as reading performance, attention and ADHD-like symptoms

In a study published in October 2012 in the journal Optometry & Vision Science, researchers set out to to investigate the symptoms that children with convergence insufficiency experienced and to determine whether certain categories of patients (grouped by age, sex, ethnicity, children who's parents reported that they had ADHD  etc.) experienced symptoms in a common way.  In short, the study sought to figure out whether there was a pattern to convergence insufficiency symptoms.

The study is a validation of the approach we take in our Vancouver optometry clinic, where we always assess performance related symptoms. it is performance related symptoms that make convergence insufficiency a problem in the first place and the reason why patients with convergence in sufficiency need treatment.

Here is how the study was conducted.  The researchers conducted a a randomized clinical trial in which they administered the convergence insufficiency symptom survey before and after treatment.  There were 221 children aged 9 to 18 years with symptomatic convergence insufficiency who participated in the study. Performance-related vs. eye-related symptoms for was compared.  Performance-related symptoms are symptoms such as having difficulty reading or concentrating on school work.

At baseline, the score for performance-related symptoms was greater than that for eye-related symptoms  regardless of age, sex, race/ethnicity, or presence of parent-reported Attention Deficit Hyperactivity Disorder (ADHD). Symptom severity increased with age. Children with parent-reported ADHD were more symptomatic than those without parent-reported ADHD. This study adds to the literature linking ADHD to convergence insufficiency.

There was a significant improvement for the performance- and eye-related symptoms in the children who responded to treatment for convergence insufficiency. It was found that girls had significantly lower performance-related symptoms than boys, and black children reported less eye-related symptoms than white children. Children without parent-reported ADHD had significantly less symptoms overall and less eye-related symptoms than children with parent-reported ADHD.

The study authors concluded that because of a high frequency of both performance- and eye-related symptoms, eye doctors should perform a targeted history that addresses both types of symptoms to help identify children with symptomatic convergence insufficiency. In other words, doctors who ignore performance related symptoms and just focus narrowly on the eye are liable to miss patients who have convergence insufficiency.  The study focuses attention on the important relationship of convergence insufficiency and symptoms and their potential influence on ADHD, reading performance, and attention.

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