Wow Vision Therapy Blog

What ifåÊyour child is struggling to play the piano? Let say he is a brightåÊ10 year-old boy who finds playing the pianoåÊdifficult.åÊ He just doesn‰Ûªt get it! You ask yourself, why is he having this difficulty‰Û_he just seems to be unable to coordinate his fingers to play?åÊåÊ So, as any concernedåÊparent, you seek professional help. But first,åÊ you go on-line to research the possibilities foråÊa solution to this problem and stumble acrossåÊa website that says,åÊåÊ ‰ÛÏHelp your child become a piano virtuoso with simple finger exercises!‰Û

Now wait a minute, that‰Ûªs hard to believe right!? We all know that is illogical.åÊ Doing simple finger exercises will not teach anyone how to become a skilled piano player! His fingers are strong enough to move the keys on the piano, his brain just does not know how to coordinate his fingers to play the music. The answer to his problem is found when you locate a good piano ‰ÛÏcoach‰Û who can guide him along a process of learning the skills for playing the piano. Then with practice he will improve.åÊ So, you dismiss the internet offer as another example of someone trying to promoteåÊan unproven and implausible self-help program.

Now let‰Ûªs consider another scenario.åÊ This time it is youråÊ10-year-oldåÊsonåÊwho is struggling to read and keep up in school. He åÊlosesåÊhis åÊplace easily when reading.åÊHe is åÊhaving trouble concentrating on a reading task and become very frustrated. He says his eyes hurt and sometimes he gets a headache when he reads. It sounds like he could be having a vision problem.

So you seek professional help and schedule him to have hisåÊeyes examined by your family optometrist, Dr. A.åÊ Your son has his eye exam with Dr.åÊA. and what you learn from the doctor is that hisåÊeyes are healthy and heåÊhas normal 20/20 eye sight. But, åÊhe is having difficulty withåÊcoordinating his eyes together as a team when he tries to look at a bookåÊto read. SpecificallyåÊhe has trouble with his binocular vision (eye teaming). The doctor called it Convergence Insufficiency(CI). As it turns out, Convergence Insufficiency occurs in about 8-12% of children; affectingåÊabout 21.5 million peopleåÊin the US (adultsåÊincluded).åÊ Often times a person with CI (especially children) will experience symptoms involvingåÊ stress and strain around the eyes and have occasional double vision and avoidance behaviors. Often these symptoms look likeåÊADD (Attention Deficit Disorder) too.

Doctor A. turns to you and says your child has a problem with proper eye coordination. His visual brain has not developed the correct neuromotoråÊcoordination abilities resulting in poor eye teaming when he attempts to do near vision work. This condition is treatable withåÊ25-30 hours ofåÊoffice-based, doctor supervised, optometricåÊvision therapy. While Dr. A.åÊ does not provide this service in his office, he recommends another doctor whoseåÊpracticeåÊis dedicated to treating patients with office-based optometric vision therapy and makes the referral.

Gosh, you were hoping for an easy fix like a new pair of glasses! åÊBut what you are hearing is that it is much more complicated and will take several trips to another doctor over an extended period of time.

In the mean time, you think about it and decide to check around on your own and take your son toåÊanother doctor, Dr. B. for a secondåÊeye examination.åÊ Dr. B. completes hisåÊeye examåÊof your sonåÊand agrees with the diagnosis‰Û_yes, he has CI. But this doctor‰ÛªsåÊapproach is entirely different. åÊDr. B. describes the problem with your son‰Ûªs eyes is that he juståÊhas ‰ÛÏweak eye muscles‰ÛåÊ which need to be strengthened. He advises you thatåÊ your child‰Ûªs problem can be solvedåÊ with some simple ‰ÛÏeye exercises‰Û! All you have to do is make his eye muscles stronger by asking himåÊ to look at the tip ofåÊa åÊpencil as you move it closer to his nose.åÊåÊIn addition you are given some ‰ÛÏwork books‰Û that have your son doing ‰ÛÏtracking exercises‰Û. You are puzzled by the lack of consistent treatment recommendations between the two doctors but since the recommendation is coming from a doctor, it must be true‰Û_right? Besides he accepts the minimal payment by your insurance and the treatmentåÊplan sounds a lot easier than what Dr. A was recommending.

So‰Û_who do you believe? Why if both doctors agree on the diagnosis, don‰Ûªt åÊthey agree on the method of treatment? Who has got it right, Dr. A or Dr. B?

First, let‰Ûªs remember the first example of the 10-year-old boy who was having trouble playing the piano. Is it logical to think that doing simple finger exercises will help him learn how to successfully play the piano? The answer seems pretty obvious right?

Surely the coordination of a person‰Ûªs eyes is equally as complex as coordinating ones fingers to play a piano. So it would seem illogical that doing simple eye exercises would be effective at treating a problem with both eyes coordinating when attempting to read. However, over 50 years ago, many doctors wereåÊåÊtaught that Convergence Insufficiency (CI) was a problem with eye muscle strength.åÊWhile techniques in the area ofåÊvisual rehabilitation were also beginning to emerge about that time,åÊthere were still someåÊtext books that the had the old-fashioned remedy for CI as juståÊ a ‰ÛÏseries of simple eye exercises‰Û. The problem was that the eye-exercise model of treatment was based on an assumption and not based on research.åÊ Therefore, many doctors to this day still hang on to an old outdated model of treatment that was never based on proven research.

Therefore theåÊanswer to the question, ‰ÛÏWho has got it right, Dr. A. or Dr. B‰Û, åÊcan only be answered based on double-blind multicenter research. What‰Ûªs more, the researchåÊon the best methods to treat CI åÊwas completed in 2008. It is a landmark study called the Convergence Insufficiency Treatment Trial (CITT). The CITTåÊwas funded with a $6.1 million grantåÊåÊby the National Institute of Health and conducted through the National Eye Institute along with several sites around the country including Mayo Clinic and Bascom Palmer plus 6 Colleges of Optometry.

What this double-blind, multicenter research did was to compare office-based doctor supervised vision therapy (OBVT) to home based eye exercises called ‰ÛÏpencil push-up therapy‰Û as well as compared to a placebo, called ‰ÛÏplacebo therapy‰Û

What did the research prove? It found that the ‰ÛÏeye exercise therapy‰Û had about the same effectiveness asåÊthe placebo. In fact the research proved that both the ‰ÛÏeye exercise therapy‰Û and the placebo therapy were found to be ineffective in treating Convergence Insufficiency.

However, office-based vision therapy was found to be effective and in subsequent research found to be the cure for convergence insufficiency. Dr A was correct!

The research is clear. So why do some doctors persist to advise patients about old-fashioned and ineffective treatmentåÊfor Convergence Insufficiency? This can be difficult to answer in each case, but certainly when this condition, Convergence Insufficiency (CI) is accepted by the entire optometric and medical community as an important public health issue, then and only then will the majority of doctors get it right.

To address this fundamentalåÊpublic health problem and its realitive importanceåÊin the eye-care community, I wrote an article that was published in the Journal of Behavioral Optometry (Vol 21/2010/#2) entitled:åÊåÊ“Does Convergence Insufficiency Really Matter”(download)

Dan L. Fortenbacher, O.D.,FCOVD