Showing posts with label convergence insufficiency. Show all posts
Showing posts with label convergence insufficiency. Show all posts

Tuesday, March 31, 2015

ADHD Drugs and suicide risk


On this blog we often write about ADHD and the fact that ADHD symptoms often mimic the symptoms of common eye movement disorders such as convergence insufficiency. It is important for parents to be alive to the possibility that what was thought to be ADHD is actually a treatable eye movement disorder. Treatment of the eye  movement disorder may make the symptoms go away and avoid unnecessary medication.

A recent warning issued by health Canada about ADHD drugs underscore the importance of seeing in optometrist to test for eye  movement disorders such as convergence insufficiency before excepting a diagnosis of ADHD. 

Health Canada has warned that ADHD drugs may increase suicidal thoughts in patients. Here is a link to a news story that discuss the new warning:

http://www.cbc.ca/m/news/health/adhd-drugs-to-add-suicide-risk-warnings-1.3015562

To learn more about the connection between ADHD's type symptoms and convergence insufficiency click here:

http://www.visiontherapy.ca/adhd_convergence.html


Wednesday, December 3, 2014

Vision and learning Ted Talk

Here is a new (and excellent) Ted Talk by Dr. Vicky Vandervort on how treatable vision problems can cause learning problems, including a great explanation and demonstration of the most common eye movement problem that interferes with learning: convergence insufficiency.

The video also includes a demonstration of a real patient's eyes as they move inefficiently across a page in an attempt to read.

As explained in the video, many well meaning professionals, including many eye doctors, are not aware of an do not test for eye movement disorders, leaving patients without any help. Developmental optometrists (like Dr. Randhawa) diagnose and treat eye movement problems that interfere with learning.  To find one near you visit www.covd.org.




Wednesday, June 4, 2014

Eye movement dysfunctions, their treatment and reading related problems in patients with mild traumatic brain injury (mTBI)

We have large vision therapy practice at our Vancouver vision and eye clinic where one category of patients that we treat come to us with traumatic brain injuries that have caused vision problems in the patients, including reading difficulties.  

Reading is a complex task involving a number of functions, abilities and visual skills.  Reading has oculomotor, sensory, cognitive, and attentional components, and all of these must be integrated. If any one of them is affected by a brain injury, they reading is likely to be negatively affected as well.   For example, accurate eye movements are essential for efficient reading. This means that if a traumatic brain injury (TBI) has affected the normal control of eye movements, then reading will likely be adversely impacted.

How can doctors fix these problems?  That was the issue investigated by the authors of a study published in 2007 in the Journal of Behavioral Optometry.  The researchers looked at three studies done by their research group which involved versional oculomotor dysfunctions, their related reading problems, and treatment in a group of patients with mild TBI whose injury affected their vision and reading ability.

Let's take a second to make sure we understand a few of those scientific terms.  A "version" is an eye movement involving both eyes moving together as a team in the same direction.  A "versional oculomotor dysfunction" is a problem in the way the eyes move together as a team.

The results have shown that in a large clinical sample (160 patients), approximately 90% had one or more oculomotor deficits, such as convergence insufficiency or abnormal saccadic tracking- a saccade is a fast movement of the eye like the moments the eye does when tracking words on a printed page.  Deficits in these areas have the potential to interfere with reading performance.  

Out of the 160 patients examined, thirty-three of them completed a program of vision therapy. Of the patients who received vision therapy, an impressive ninety percent of them experienced improvement in at least one related sign and one related symptom. 

The researchers also laboratory-tested 9 of the study subjects who had  eye-movement-related reading problems and found that all of them improved their overall reading performance and versional eye tracking ability after vision therapy.

There are a number of conclusions to draw from this study:
  1. eye movement dysfunctions are common in individuals with mild TBI;
  2. vision therapy can effectively treat eye movement dysfunctions;
  3. the positive vision therapy findings demonstrate that the adult brain can be changed and molded (re-wired) with vision therapy and this shows the presence of considerable neuroplasticity in adults with mild traumatic brain injury;
  4. optometric vision therapy should be used to treat  visually symptomatic patients with TBI who have eye-movement-based reading problems.

More information

To learn more about vision therapy and brain injuries, visit: www.braininjuries.org
Another excellent resource is the website of NORA, the Neuro-Optometric Rehabilitation Association.

NORA


Related Articles
Traumatic brain injury often results in convergence insufficiency 
Dec 11, 2012

Brain injuries and vision problems
Nov 04, 2012

Eye movement dysfunctions, their treatment and reading relateed problems in patients with traumatic brain injury
Dec 28, 2012

Vision problems after car accident are caused by brain injury 
Nov 07, 2012

- See more at: http://www.visiontherapy.ca/braininjury.html

Image courtesy of Victor Habbick / FreeDigitalPhotos.net

Thursday, February 20, 2014

Vision therapy for vergence and accommodation


Vision therapy success - Dr. M.K. Randhawa
A new case report was published in the latest issue of the Journal Optometry & Visual Performance, which supports the effectiveness of in-office vision therapy for the treatment of vergence and accommodation dysfunctions.

Vergence is the simultaneous movement of both eyes in opposite directions to obtain or maintain single binocular vision.

Accommodation  is the process by which the eye changes its focusing power to maintain a clear focus on an object as its distance from the eye varies.

The case report discussed a patient who was 10-years and 10 months old and underwent 16 visits for vision-based therapy along with home reinforcement (vision therapy homework). The authors used several methods to measure accomodation and vergence before and after therapy, including the Convergence Insufficiency Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence range at near (PFV), accommodative amplitude, and accommodative facility. The measures taken showed decreased symptom severity following therapy.

The in-office vision therapy program used in the study was identical to that used in the well known Convergence Insufficiency Treatment Trial studies and produced measurable changes in vergence and accommodation in the case subject, who also had convergence insufficiency.

The results not only demonstrate the efficacy of vision therapy but also provide an illustration of the plasticity of the oculomotor system, which is not fully developed at 10 years of age and responds well to interventions like vision therapy.

Source

Optometry & Visual Performance
Objective Assessment of Vergence and Accommodation After Vision Therapy for Convergence Insufficiency in a Child: A Case Report Optometry and visual performance 2014 Feb 04;2(1)7-12, M Scheiman, KJ Ciuffreda, P Thiagarajan, B Tannen, DP Ludlam




Monday, October 21, 2013

Life demands more than 20/20

In order for children to learn well, they need to see well. Parents may not realize there is more to good vision than 20/20 and that there are conditions that vision screenings can miss. Two optometrists conducted a visual experiment where common visual problems known to affect learning in kids are simulated in 4 adult teachers, and their experience and reaction are discussed.

 

Related Articles


Behaviors in children that indicate a visual-perceptual problem requiring a visit to a developmental optometrists

Saturday July 27, 2013


Research confirms vision therapy can Improve reading comprehension and improve a child's overall attention in the classroom
Friday, July 5, 2013

Visual Input Important in Developmental Dyslexia
Tuesday, July 2, 2013

If your child has reading problems, treatable vision and eye movement disorders may be the reason
Sunday, June 9, 2013

Visual processing and learning disorders 
Apr 17, 2013

60% of learning disabled students failed two or more binocular vision tests
Oct 20, 2012

More visual symptoms means lower academic performance
Feb 29, 2012

Vision therapy for convergence insufficiency improves academic performance ...
Jan 16, 2012

82% of teachers report an improvement in students after vision therapy 
Jun 16, 2012

Binocular vision dysfunctions ate my homework 
Mar 31, 2012

Study proves that vision problems interfere with learning

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Sunday, October 20, 2013

This is what convergence insufficiency looks like

This is what convergence insufficiency looks like (thanks to the VisionHelp Blog):

People with convergence insufficiency may still see 20/20 when measured using a standard eye chart and basic vision screenings that are done in schools and pediatrician offices.  

However, what the eye chart does not measure is how their eyes move and work together when doing work close up.  That's why convergence insufficiency is so often missed -  until a patients goes to a developmental optometrist. 

For more information on convergence insufficiency, visit www.convergenceinsufficiency.ca

To find a developmental optometrist near your, visit www.covd.org.

Tuesday, July 9, 2013

Developmental optometrists in Vancouver treat adults with convergence insufficiency


Some people are are wondering about whether vision therapy is as effective for adults with convergence insufficiency, as it is for children.  

The developmental optometrists at our Vancouver eye clinic have successfully treated many adults with convergence insufficiency using vision therapy.


And, if that clinical experience were not enough, the scientific research backs it up.

In 2005 Scheiman et al. published a clinical trial in Optometry and Vision Science on the vision therapy treatment of convergence insufficiency in young adults ages 19-30.
  
Basically, the results were that vision therapy was an effective treatment for convergence insufficiency in this age group and that pencil push-ups were not effective.  Here is a quote from the study where the authors state their conclusions:

"This first multicenter, randomized clinical trial of the treatment of symptomatic CI in young adults demonstrated that of the three treatment modalities, only vision therapy/orthoptics was effective in achieving normal clinical values for both the near point of convergence and positive fusional vergence. Patients in the pencil pushups group achieved normal values only for positive fusional vergence at near and patients in the placebo vision therapy/orthoptics group did not achieve normal findings for either the near point of convergence or positive fusional vergence at near.Therefore, the effectiveness of vision therapy/orthoptics in improving the near point of convergence and positive fusional convergence values at near in adults cannot be explained on the basis of a placebo effect. Based on the results of this preliminary study, it would appear that pencil pushups, the most popular treatment for CI, is not effective for achieving clinically significant improvements in symptoms or signs associated with CI in young adults." [emphasis added]

You can learn more here: http://www.visiontherapy.ca/binocularvision.html
and here: http://www.visiontherapy.ca/convergence.html

Saturday, April 13, 2013

What is Convergence Insufficiency?


Convergence insufficiency is one of the most common vision disorders that interferes with a patient's ability to see, read, learn and work at close distances. In fact, because the symptoms are similar, many children are misdiagnosed with ADHD when they actually have convergence insufficiency.  

Convergence insufficiency was recently the focus of a scientific study in the United States funded by the National Institutes of Health and the National Eye Institute. The study found that in-office Vision Therapy was the best available treatment for convergence insufficiency, replacing conventional therapies such as "pencil push-ups", with 75% of patients showing significant improvement following vision therapy.


Convergence insufficiency is a vision problem where the two eyes don't work together in unison the way they should. With convergence insufficiency the eyes have a strong tendency to drift outward when reading or doing close work. The result can cause double vision and, at minimum, make reading and learning very difficult.



Syptoms of Convergence Insufficiency


The most common signs that your child is suffering from convergence insufficiency are the following:

  • eyestrain (especially with or after reading)
  • 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
It is estimated that least one out of every 20 school-age children is impacted by convergence insufficiency. Some studies even put the number as high as 15%. However, there are other visual abnormalities to be considered. It is estimated that over 60% of problem learners have undiagnosed vision problems contributing to their difficulties.


The latest research shows vision therapy is effective


The good news is the majority of these vision problems can be treated with a program of optometric vision therapy.

Even though the study by the NEI found that in-office vision therapy was the best treatment for convergence insufficiency, some doctors who are not up-to-date on the latest scientific research still tell their patients that "pencil push-ups" are the only treatment available that if if "pencil push-ups" don't work the patient is out of luck. This is not correct. The NEI study found that in-office vision therapy was significantly more effective than "pencil push-ups" and the only treatment that was more effective than a placebo. A number of follow up studies have been done; you may read about these on the binocular vision page.

There have also been follow-up studies by Scheiman et al. showing that the results obtained from vision therapy are were long-lasting and that the treatment kinetics are favorable – meaning that that rate at which patients get better with vision therapy makes office-based vision therapy an effective and practical treatment.

In 2005 Scheiman et al. published a clinical trial in Optometry and Vision Science on the vision therapy treatment of convergence insufficiency in young adults ages 19-30. Once again, the results proved the efficacy of vision therapy treatment over other modalities that were in use at the time. The study authors concluded:

"This first multicenter, randomized clinical trial of the treatment of symptomatic CI in young adults demonstrated that of the three treatment modalities, only vision therapy/orthoptics was effective in achieving normal clinical values for both the near point of convergence and positive fusional vergence. Patients in the pencil pushups group achieved normal values only for positive fusional vergence at near and patients in the placebo vision therapy/orthoptics group did not achieve normal findings for either the near point of convergence or positive fusional vergence at near.Therefore, the effectiveness of vision therapy/orthoptics in improving the near point of convergence and positive fusional convergence values at near in adults cannot be explained on the basis of a placebo effect. Based on the results of this preliminary study, it would appear thatpencil pushups, the most popular treatment for CI, is not effective for achieving clinically significant improvements in symptoms or signs associated with CI in young adults." 

A study published in 2010 by Alvarez et al. in Optometry and Vision Science adds to the depth of the scientific evidence by showing that vision therapy produced demonstrated changes in eye movements together with significantly increased functional activity within the frontal areas of the brain, the cerebellum, and brain stem. These regions of the brain are likely to ―participate in a collicular-cortical dorsal visual networks and may reflect increased processing of visual material specific to near space. This study demonstrates the motor and neurological mechanism by which vision therapy operates. The brainscan images published in the Alvarez study are worthy of review.

Related articles:


The gold standard treatment for convergence insufficiency

What does convergence insufficiency look like?

Vision therapy for convergence insufficiency improves academic behaviors

Is your child smart in everything but school? The ultimate infographic

Problem readers may have convergence insufficiency

Adults with convergence insufficiency

New research on the connection between convergence insufficiency and ADHD

Convergence Insufficiency Treatment Success Rate

Pencil push-ups are so last decade

Binocular vision dysfunctions ate my homework

Your iphone can be a pain in the eye

60% of students labeled "learning disabled" failed two or more binocular vision tests

For more information visit: www.convergenceinsufficiency.org

To read success stories about Vision Therapy and convergence
insufficiency visit: www.visiontherapystories.org/convergence_insufficiency.html

Thursday, April 4, 2013

ADHD dianoses skyrocket - are children being inappropriately diagnosed? Vision problems can cause the same symptoms.

Vancouver optometrist finds that ADHD is sometimes really a vision problem
It is shocking that 11% of children have received a diagnosis of attention deficit hyperactivity disorder (ADHD).  This sharp rise in ADHD diagnoses over the last decade is cause many to worry about inappropriate diagnosis and the unnecessary overmedication of children.

Even more troubling, we can expect over-treatment to increase in the near future because, according to the New York Times:

the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment. A.D.H.D. is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills.
There are many reasons for the increase.  Experts believe that some doctors are quick to jump to the conclusion that a child has ADHD when they present with any indication of inattention.  Another factor may be advertising by the pharmaceutical industry that presents medication as something that can drastically improve a child's life.  Some people blame the parents for pressuring doctors into doing something to improve a child's academic performance.

ADHD medications such as Adderall, Ritalin, Concerta and Vyvanse can be dangerous.  Some children who are put on the drugs will end up with abuse and dependency problems.  Moreover, some studies suggest that 30% of the pills go to friends who take them without any medical advice.

One reason for the rise in ADHD diagnoses may be that doctors are simply not thorough enough in ruling out other treatable disorders that cause similar symptoms.  Numerous studies have shown that people with eye movement disorders such as convergence insufficiency have the same symptoms as ADHD and that vision therapy treatment of the eye disorder results in a reduction or elimination of symptoms.  Studies have proven that vision therapy is the best treatment for convergence insufficiency.

Here are some articles on the connection between convergence insufficiency and ADHD:

Related Articles:


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

New research on the connection between convergence insufficiency and ADHD

Is your child smart in everything but school?

Vision therapy for attention skills greatly improves reading performance

Tuesday, December 11, 2012

Traumatic brain injury often results in convergence insufficiency. But could there be more vision problems?

Brain injuries and vision problems.
Traumatic brain injury often results in convergence insufficiency.  But could there be more vision problems?  That is the question that researchers investigated in a recent study published in Optometry & Vision Science.

The researchers looked at the medical records of 557 brain injury patients and assessed the visual acuity, oculomotor function, binocular vision function, accommodation, visual fields, ocular health, and vestibular function for each patient.

Only 9% of the TBI brain injury patients had convergence insufficiency without the following simultaneous diagnoses: saccade or pursuit dysfunction; third, fourth, or sixth cranial nerve palsy; visual field deficit; visual spatial inattention/neglect; vestibular dysfunction; or nystagmus.

It was far more common for the brain injury patients to have convergence insufficiency with other vision problems.  Here are some examples:

  • Photophobia (light sensitivity) together with convergence insufficiency was observed in 16.3% (21 of 130), 
  • vestibular dysfunction together with convergence insufficiency was observed in 18.5% (24 of 130) 
  • Convergence insufficiency and cranial nerve palsies were present in 23.3% (130 of 557) and 26.9% (150 of 557), respectively

Other vision disorders were also present.   Accommodative dysfunction was common, as were visual field deficits or unilateral visual spatial inattention/neglect.

The study findings support the idea that patients who have suffered a traumatic brain injury need a comprehensive eye exam that tests for a wide variety of vision problems.  Where visual problems are found to result from a brain injury, vision therapy is an effective treatment. 


Image courtesy of Victor Habbick / FreeDigitalPhotos.net

Monday, November 19, 2012

Vision and learning

At Vision Source Vancouver, optometrists help children learn by treating vision problems that interfere wit learning.

At our Vancouver optometry clinic one of the most professionally and personally rewarding things we do is to help children reach their full academic and intellectual potential by treating vision problems that interfere with learning.  There are a number of vision problems that interfere with learning beyond the obvious one that can be fixed with glasses or contact lenses and need to be treated by a developmental optometrist using vision therapy.  These include visual information processing and binocular vision disorders, convergence insufficiency and accomodative insufficiency. These disorders are sometimes the result of traumatic brain injury.

That's because these are not problems with visual accuity,which means that even if a child has 20-20 vision as measured with the eye chart, the child's vision could be substantially deficient if she has one of these visual problems.


For who want to learn more about vision and learning, here are some informative articles:

More visual symptoms means lower academic performance
Feb 29, 2012

Vision therapy for convergence insufficiency improves academic performance ...
Jan 16, 2012

82% of teachers report an improvement in students after vision therapy
Jun 16, 2012

Binocular vision dysfunctions ate my homework
Mar 31, 2012


Study proves that vision problems interfere with learning and cause dyslexia
Apr 25, 2012


60% of students labled "learning disabled" students failed two or more binocular vision tests
Oct 20, 2012

Symptoms of some vision problems are a lot like ADHD - make sure your child is not misdiagnosed and unnecessarily medicated.

To find a doctor visit www.covd.org

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.

Related articles:


Saturday, October 20, 2012

60% of learning disabled students failed two or more binocular vision tests



The College of Optometrists in Vision Development  (COVD), of which Dr. Randhawa a member, is the world's leading organization devoted to the study and treatment of developmental visual problems which can often be treated with vision therapy and which often impact a child's ability to learn and do well in school.
Right now, the COVD annual meeting is happening in Texas and very important research done by the University of Waterloo on the connection between binocular vision problems and learning was presented yesterday. This is how the COVD website reported on the study:
Drs. Lisa Christian, Angela Peddle, and 4th year students Shannon Pennifeod and Beth Schellenberg presented the preliminary results of a very important study.

The doctors and students from Waterloo School of Optometry reviewed the records of young patients, all of whom  had been identified as learning disabled by the district school board.  Before writing an individual education plan (IEP) for each, the school board advised that each student have a comprehensive vision examination performed by the pediatric service of Waterloo School of Optometry.
The records of 68 students ranging in age from 6-12 years were reviewed.  None of them had ever had a previous eye exam.  Children requiring spectacles were not included in the study.  The number of vision problems discovered in this population was astounding.
  • 43% had reduced stereo vision
Six measurements of binocularity were obtained; 60% of patients failed two or more of those tests.
Children with reading problems who require individual education plans are at high risk for vision problems. What would have happened if these children were not referred for a comprehensive vision examination?  They would have continued to struggle with undiagnosed vision problems.  We need comprehensive vision examinations for ALL children entering school.  Many of theses children will also require vision therapy.
Does your child have a reading or learning disability?  Please make sure that child has a comprehensive vision examination.  Make it happen.
Find a doctor in your area.
Read more about comprehensive eye examinations here.
To learn more about the treatment of binocular vision disorders visit www.visiontherapy.ca and to learn more about children's vision development visit www.kidsvision.ca.

Below are some related articles from this blog:


Feb 29, 2012
In a study published in 2006 in the journal, Optometry, researchers set out to determine whether there was an association between vision-related quality-of-life factors and academic performance. To answer the question, the ...
Jan 16, 2012
We now have a study that confirms that academic behaviours, as measured by the Academic Behavior Survey (ABS), improve following successful treatment of convergence insufficiency. The study was published in the ...
Jun 16, 2012
between vision problem detection, academic achievement and vision therapy intervention. ... The result is also expected from all the studies that have been done on vision therapy and its impact on academic performance.
Mar 31, 2012
Most developmental optometrists have stories of patients whose academic behaviours and performance have improved following vision therapy treatment of their binocular vision problems. Research studies have shown the ...
http://seeforlife.blogspot.com/



Apr 25, 2012
The researchers (consisting of professors of optometry and occupational therapy), set out to compare visual and visual-information processing skills between children with and without mild reading and academic problems and ...

Friday, August 31, 2012

The gold standard treatment for convergence insufficiency


Convergence insufficiency (CI) patients are unable to properly make their eyes move inward when doing near work like reading. Often, the intensity of symptoms in CI depends on the amount and type of near work a patient does.  Students obviously do lots of near work their symptoms may be severe and diminish their academic performance.

The problem of CI is serious enough that the National Eye Institute (one of the National Institutes of Health in the United States) funded a number of studies to determine the best treatment for CI.  These studies are known as the Convergence Insufficiency Treatment Trials (CITT).  Most of the CITT studies can be found here.  The treatments investigated by the CITT included office-based accommodative–vergence therapy with supplemental home therapy, placebo office-based vision therapy, home-based computerized vision therapy with pencil push-ups, and pencil push-ups. 

A major review of the CI research to date was published in the journal Optometry earlier in 2012.  You can read the entire review here.

Patients who participated in the CITT were assessed at the end of 12 weeks of  therapy. In-office vision therapy supplemented with home therapy was found to be the most effective treatment. Long-term effects were determined at 6 months and 12 months of follow-up and the beneficial effects of vision therapy were found to be lasting.

Vision therapy is the gold standard for treating CI.

Saturday, July 14, 2012

Vision Therapy information from the Health Insurance Network


The Vision Help Blog has uncovered some great information on vision therapy from the Health Insurance Network.  As noted by Vision Help, it was not always easy to find knowledgeable, up-to-date and bias-free information about vision therapy from groups outside of optometric organizations.  Indeed, other groups generally lack the in-depth knowledge to talk about vision therapy intelligently.

The Health Insurance Network has succeeded in putting together some accurate, easy to understand and basic information on vision therapy that should be very informative for anyone seeking information about vision therapy or developmental optometry.  It's so good that we may start printing it and giving it to patients who are referred to us by other doctors for vision therapy as a good introduction.

Here is the Health Insurance Network on vision therapy:

Vision Therapy for Children


Vision therapy is a type of treatment that can be prescribed by optometrists in order to improve and correct certain types of vision problems. Usually, these types of vision problems cannot be helped solely by the use of glasses or contact lenses that are soft, so vision therapy is used in order to provide patients with some relief. Like physical therapy helps the body, vision therapy helps the eyes. Both visual function and performance are improved when patients use this therapy, and it’s a popular option for dealing with disorders in kids.

Vision therapy is mostly used to treat problems that children have when they are using their eyes up close for activities such as reading or writing, especially when they are doing so at school. If a child has problems when it comes to eye teaming, tracking, or focusing, it can make it virtually impossible for the child to focus on the tasks at hand and to learn anything in school. Vision therapy can also be used to treat lazy eyes or crossed eyes, and these treatments are done all without the use of surgery.

Vision therapy programs are all different, so your child needs to be seen by a doctor for an evaluation and a diagnostic. The optometrist will look at your child’s eye health as well as tell his or her visual acuity. Overall, the doctor is going to be looking at an evaluation of the child’s tracking, eye teaming, focusing, and eye-hand coordination skills. Sometimes, doctors take computerized recordings of a child’s eye movement while he or she is reading, as this can help to determine what the real issues are. If you want your child to go through a visual therapy program, all of this needs to be done.

Undergoing Vision Therapy


If your child needs vision therapy, his or her course of treatment is going to depend on what your eye doctor thinks is best. Your child’s doctor may rely on a variety of different procedures that include the use of things like prisms, lenses, and other instrumentation. The doctor will lead your child through a variety of different visual exercises that are designed to help your child return to normal vision. Keep in mind that your child’s treatment is going to differ from treatment used on others. Keep faith that your eye doctor is going to know what is best.

Vision therapy is something that your child will have to really take seriously, and it will often require work outside the doctors office. Most of the time, your eye doctor is going to recommend home therapy as a means of reinforcing the skills that your child is learning during treatment. Throughout the course of the therapy, the child is going to be seen regularly by the doctor in order to determine progress, but this therapy might be something that goes on for a number of months. Treatment goals will need to be met before moving on.

Vision Therapy and Learning


The great thing about vision therapy for children is that it can go a long way in helping your child with vision-based learning problems. A lot of children have these type of problems and they can go unnoticed for a long time. If you take the time to talk with your child about his or her vision and you consider using vision therapy, you could help your child have a lot more academic success. If you suspect that your child might have a vision issue that is making learning difficult, see an eye doctor as soon as possible.


Image courtesy of Ambro / FreeDigitalPhotos.net

Thursday, June 14, 2012

Is your child smart in everything but school? The ultimate convergence insufficiency info-graphic.

Here is a great info-graphic on convergence insufficiency.  It comes from the Vision Help blog, which is one of the world's best sources for information on vision development, developmental optometry, vision therapy and eye movement disorders.

Convergence insufficiency is one of the most common eye-movement disorders.  It prevents the eyes from focusing properly when doing near work.  It can interfere with school, learning and reading and it has signs and symptoms that are similar to attention deficit/hyperactivity disorder.  That means that some kids who have been diagnosed with ADHD may actually have convergence insufficiency which is most effectively treated with vision therapy. Vision therapy for convergence insufficiency has been shown in studies to improve academic behaviours.



Thursday, May 17, 2012

What does convergence insufficiency look like?


This is what reading is like for someone with convergence insufficiency.  

What is convergence insufficiency?


To understand convergence insufficiency, it is first necessary to understand what convergence is.  Convergence is the coordinated movement and focus of our two eyes inward.  This is what normal eyes do when a person is performing close work such as reading that requires us to focus both of our eyes inward on close objects (books, papers, computer screens, etc.).  Humans learn to converge very early in life.

A person who cannot converge properly has a problem with the coordinated movement of their eyes inward to look at close objects. The most common convergence problem is convergence insufficiency.

When we are not able to converge our eyes easily and accurately, problems may develop, such as:
  • Eye strain
  • Headaches
  • Double vision
  • Difficulty reading and concentrating
  • Avoidance of near work
  • Poor sports performance
  • Dizziness or motion sickness
Here is a video on convergence insufficiency from the National Eye Institute:


Treatment of Convergence Problems


Eye coordination problems like convergence insufficiency generally cannot be improved with eye glasses or surgery. A program of Vision Therapy may be needed to improve eye coordination abilities and reduce symptoms and discomfort when doing close work.

Studies support vision therapy to treat convergence insufficiency


The National Eye Institute, a division of the National Institutes of Health for the U.S. Department of Health and Human Services, released a statement concerning the effectiveness of office-based vision therapy for treatment of Convergence Insufficiency. Dr. Mitchell Scheiman, FCOVD, who completed the 12-week study, known as the Convergence Insufficiency Treatment Trial (CITT), found that approximately 75 percent of those who received in-office therapy by a trained therapist plus at-home treatment reported fewer and less severe symptoms related to reading and other near work after the office-based vision therapy.

"This NEI-funded study compared the effectiveness of treatment options for convergence insufficiency," said Paul A. Sieving, M.D., Ph.D., director of the NEI. "The CITT will provide eye care professionals with the research they need to assist children with this condition."

"There are no visible signs of this condition; it can only be detected and diagnosed during a comprehensive eye examination," said principal investigator Mitchell Scheiman, O.D., FCOVD, 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."

Notably, the study also found that the most popular treatment typically offered by ophthalmologists, pencil push-ups, was not effective. The press release issued by the National Eye Institute to announce the findings of the RCT provides a short summary of the study.

There have also been follow-up studies by Scheiman et al. showing that the results obtained from vision therapy are were long-lasting and that the treatment kinetics are favorable – meaning that that rate at which patients get better with vision therapy makes office-based vision therapy an effective and practical treatment

In 2005 Scheiman et al. published a clinical trial in Optometry and Vision Science on the vision therapy treatment of convergence insufficiency in young adults ages 19-30. Once again, the results proved the efficacy of vision therapy treatment over other modalities that were in use at the time. The study authors concluded:
"This first multicenter, randomized clinical trial of the treatment of symptomatic CI in young adults demonstrated that of the three treatment modalities, only vision therapy/orthoptics was effective in achieving normal clinical values for both the near point of convergence and positive fusional vergence. Patients in the pencil pushups group achieved normal values only for positive fusional vergence at near and patients in the placebo vision therapy/orthoptics group did not achieve normal findings for either the near point of convergence or positive fusional vergence at near.Therefore, the effectiveness of vision therapy/orthoptics in improving the near point of convergence and positive fusional convergence values at near in adults cannot be explained on the basis of a placebo effect. Based on the results of this preliminary study, it would appear thatpencil pushups, the most popular treatment for CI, is not effective for achieving clinically significant improvements in symptoms or signs associated with CI in young adults." 

A study published in 2010 by Alvarez et al. in Optometry and Vision Science adds to the depth of the scientific evidence by showing that vision therapy produced demonstrated changes in eye movements together with significantly increased functional activity within the frontal areas of the brain, the cerebellum, and brain stem. These regions of the brain are likely to ―participate in a collicular-cortical dorsal visual networks and may reflect increased processing of visual material specific to near space. This study demonstrates the motor and neurological mechanism by which vision therapy operates. The brainscan images published in the Alvarez study are worthy of review.

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