Vision and Learning

Convergence Insufficiency – A Bright Spot in Advocacy

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

Inadequately treated convergence insufficiency (CI) can consign an individual to a needless lifetime of struggle.  We’re beginning to highlight bright 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.