Last week I saw a healthy, six year old little girl who presented for a general eye examination in a primary eyecare practice.åÊ Her mom had specific concerns because her daughter had recently been complaining that words, “don’t look right on the page” during near tasks. This was the patient’s first eye exam, and her mom wanted to rule out any vision related issue.åÊ After completing a few tests that check how the eyes are teaming together, I found that this patient had a common binocular vision disorder called convergence insufficiency, or CI.
Patients with CI often present with symptoms such as: eye strain, headaches, avoidance of near work, skipping words, complaints that letters or lines run together, difficulty with concentration and covering or closing an eye. However in young children they may not be complaining of any problems. It largely depends on the child’s reading demands and if they are using large font text in their story books, the problem with “seeing double” can be overlooked.
CI affects approximately five percent of all school-age children, yet can be overlooked at routine eye examinations.åÊ When the eyes do not work together efficiently, there is an inability for the eyes to maintain a clear, steady image. The signs and symptoms of CI can lead to a diagnosis of ADD/ADHD, when in fact the underlying problem may be a binocular vision issue.
When performing the history in an eye exam it’s often difficult, especially for a child, to articulate what they are truly experiencing.åÊ When asked if they see double they will often say “no”, but after using the following demonstration they will often know what you are talking about.
Place both of your hands together, palm to palm.åÊ Stand directly in front of the child, holding your hands up and say, “Do you ever notice, especially late in the school day, or if you’re tired, that the letters on the page seem to do this…?” slide one hand slowly to one side to give the appearance of a double image.åÊ You may also ask, “If you ‘re ever really tired, do you ever see the two images slide completely apart, like this?”åÊ Slide your two hands slowly apart and have them separate by a few inches.
Another easy method is to ask the child, “Do you ever see words look like these when reading?”
Once diagnosed with CI, the next step would be to be schedule an evaluation by an optometrist that specializes in developmental optometry and can recommend the appropriate vision therapy treatment program.åÊ Research has shown that vision therapy is more effective in decreasing signs and symptoms of CI compared to other treatment methods.åÊ With early detection and treatment of binocular vision disorders, patients are given the opportunity to succeed withoutåÊ having to overcome the unnecessary struggles caused by an untreated vision related issue.
Lindsey Stull, O.D.