Author: sang

Convergence Insufficiency – A Bright Spot in Advocacy

Inadequately treated convergence insufficiency (CI) can consign an individual to a needless lifetime of struggle.  We’re beginning to highlightbright spots in the effort to promote awareness of this significantly overlooked condition.  Research has firmly established the importance of this condition, and although studies to date have primarily focused on children ages 9 to 18, the long-lasting impact of the condition is now being recognized.

Difficulties for individuals with ADHD in society are well-known, and the link between CI and ADHD has been established by ophthalmologic as well as optometric groups.  My colleague, Dr. Carole Hong and I have reviewed the implications of CI in childhood behavioral disorders.  What happens when CI is inadequately treated in childhood?  CI doesn’t go away by itself.  Patients who find it difficult if not impossible to overcome the symptoms often abandon any hope of a course of study or occupation that involves sustained reading or other forms of near work.

Advocacy for the lifelong implications of improperly treated CI is championed by Helen Spencer, an attorney from Washington State.  Sometimes it takes someone from outside the system to point out how inadequately we address treatable conditions such as CI.  Ms. Spencer knows firsthand the frustrations that come about when patients are victimized by healthcare providers who make unfair and unwarranted value judgements about the significance of their condition.  I was reminded of Helen’s feelings as I came across a wonderful advocacy website, America’s Angel.  Among the many heartfelt experiences is one related by a mother who wrote the following letter to Dear Abby published on April 17, 2007:

Dear Abby: Please help me get the word out about a common condition that severely affects children’s ability to succeed in school because it inhibits reading, spelling and concentration.

My daughter, who was obviously bright, tested at first-grade reading level in fifth grade. She had undergone all the school testing for learning disabilities, plus two days of testing at a respected university hospital. None of these tests or specialists revealed what could be wrong with her.

My child’s self-esteem suffered. Her confidence faltered; she began acting out in school. At home she was a great kid, until it came time for schoolwork. Then the battles began. She thought she was dumb. She could read for only a very short time. She often begged me to read things to her. When working on spelling and assigned to rewrite the words she missed five times, she often recopied them wrong. We thought she just wasn’t trying.

After much research on the Internet, I came across a disorder called “Convergence Insufficiency Disorder.” This visual condition is the leading cause of eyestrain. Fortunately, we had the opportunity to have her tested at the Mayo Clinic, where her condition was confirmed, and she was successfully treated with vision therapy.

It was as though a miracle had occurred. After six months of treatment, my daughter is almost at her age-appropriate reading level. Her comprehension and retention have markedly increased, and her self-esteem and attitude about reading are much better.

Children with this condition will not benefit from tutoring, special education or extra help from teachers until the condition is diagnosed and treated. My child had 20/20 vision and still had this disorder. It’s not routinely checked with eye exams, and schools don’t test for it. I suspect that many children out there are undiagnosed or misdiagnosed and going untreated. The treatment for convergence insufficiency disorder is noninvasive, effective, and much of it can be done at home. Please help me get the word out so other families won’t have to go through what we experienced.

Angie W., Minnesota

The fact that Angie’s daughter was treated successfully for convergence insufficiency at the Mayo Clinic should come as no surprise.  Dr. Melissa Rice is an optometrist who was an integral part of the CITT study at the Clinic during the time that Angie’s daughter experienced her miraculous turnaround.  Dr. Rice has since moved to Washington State, where Helen Spencer continues her advocacy on behalf of CI awareness.

Brian Mohney, MD, is the Principal Investigator at Mayo Clinic for the CITT.  In a remarkable paper published in the journal Pediatrics, his research group reported that convergence insufficiency was associated with a significant  increase in the incidence of mental health disorders including ADHD, and the use of psychotropic medications, as compared to control subjects.

CI isn’t just an inconvenience.  It can seriously erode the quality of one’s life into adulthood.  For that reason, it deserves serious public health advocacy.  There are bright spots illuminating how we can better identify patients with CI and help them receive appropriate treatment.  We will continue to highlight their efforts.

Leonard J. Press, O.D., FAAO, FCOVD

 

Developmental Vision and Sensory Integration OT…A Co-Treatment Approach that Works

When it comes to helping children with developmental delays or those who have suffered a traumatic brain injury, one professional that has always impressed me for their empathy and advocacy for their patient is the occupational therapist. The year was  1988 when I was first contacted by an occupational therapist who was at the time the Director of Rehabilitation services for an acute care neuro-rehabiltation hospital in Southwest Michigan.  She was interested in adding neuro-optometric rehabilitative services to complement the existing repertoire of rehabilitative care offered by the facility then known as Visitors Hospital. I accepted her invitation and was brought on staff at the hospital where I provided neuro-optometric diagnostic and rehabilitative services. In addition to having the opportunity to serve a completely different patient population compared to private practice, it was at Visitors Hospital  that I had the special privilege to work side by side the occupational therapists which in turn gave me an inside look at one of the most caring and conscientious groups of professionals that I have ever known. In addition to the rehabilitative OT, I began to learn about and appreciate another special category of OT who works with the sensory development of children known as the Sensory Integration Occupational Therapist. (SI OT)

Now it has been over 25 years, and I have had the pleasure of serving along with SI OTs co-treating scores of patients who have had sensory modulation issues as well as developmental delays in their visual system. This professional relationship of co-treatment has many benefits to the patient because of the complementary function that each discipline brings to the improvements in the patient.

First it is important to understand that a child with developmental delays will often be lagging behind in their visual system development as well assensory modulation functions.  For instance, if a child has delays with sensory issues involving vestibular integration they will often have coexisting delays withbinocular, accommodative and oculomotor development.  The fact that they have delays in one sensory system often seriously complicates their progress in treatment in another. Therefore,  delays in the patient visual system will interfere with the treatment provided by the sensory integration OT and the sensory integration delays can interfere with the office-based optometric vision therapy provided by the developmental optometrist.

To gain a better understanding of the role of the sensory integration OT here is an informative video:

An excellent research article entitled, A Randomized Control Pilot Study of the Effectiveness of Occupational Therapy for Children with Sensory Modulation Disorder, shows that SI-OT is effective in treating children with sensory modulation disorders and was published in 2007 in The American Journal of Occupational Therapy.

Other excellent sources of information can be found at the Sensory Processing Disorder website as well as theSensory Processing Disorder Foundation website.

What warms the heart is to see a parents expression of pride as they react to observing their child making steady progress in treatment. It is especially gratifying to witness that child’s expressions of  confidence as they begin to experience success in their personal goals.  These gains can be attributed to a model of care that produces results…SI-OT sensory integration therapy and office-based doctor supervised optometric vision therapy a co-treatment approach that works!

Dan L. Fortenbacher, O.D., FCOVD