According to the American Optometric Association, 60 percent of students identified as “problem learners” may actually have undetected vision problems. One of those problems could be something called convergence insufficiency.

“They said, ‘Oh he does have this convergence insufficiency in his eyes,’ and I thought, ‘Oh that’s a big name for something, what is it?” recalled mother Patty Walcott.

Walcott was surprised to learn that despite having 20/20 vision, her son, Clark, has C.I.

Convergence insufficiency is an eye movement disorder where the eyes don’t turn inward when focusing on a nearby object. For example, when you read or look at something up close you may not realize it, but your eyes should naturally turn inward. People with c-i have have to work harder to do this…

“I was getting a lot of headaches,” said Clark.

Headaches are one symptom, while others include difficulty concentrating, squinting or closing one eye, blurred vision, double vision and difficulty reading. For students, that can translate into a short attention span, fatigue and a tough time maintaining good grades.

Clark’s parents didn’t make a connection right away. They didn’t think his complaints matched what you would think to be an eye condition.

It’s estimated that anywhere from 5-12 percent of U.S. children may have the condition. But there may be many more that go undiagnosed because it can only be found with special eye-focusing tests. C.I. usually isn’t caught with standard eye chart tests.

Eye condition may seem like a learning problem-ABC7 Chicago

Pediatric optometrist with vision therapy training and specialized equipment can  correct this condition.

Larry Fitzgerald with his grandfather, Dr. Robert Johnson, and aunt, Dr. Stephanie Johnson-Brown.

AURORA, Ohio, July 31 /PRNewswire-USNewswire/ –

Arizona Cardinals 2008 NFC West Champions’ wide-receiver, Larry Fitzgerald, is helping eye doctors spread the word to parents that vision problems can interfere with a child’s ability to pay attention, read and learn. “Even if you have been told your child has perfect vision or 20/20 vision, your child could still be at-risk of having a learning-related vision problem,” warns Fitzgerald

Do you have a child who takes forever to do homework? Or hates to read? Learning-related vision problems directly affect how we learn, read, or do close work.

The College of Optometrists in Vision Development (COVD) launched their annual campaign, August is National Children’s Vision & Learning month , to educate the public on the steps they can take to ensure their children aren’t struggling with reading and learning because of undiagnosed vision problems . “Parents don’t realize that you need over 15 visual skills to succeed in reading, learning, sports, and in life. Seeing ‘20/20′ is just one of those visual skills,” says Fitzgerald.

During the many pre- and post-Super Bowl press interviews, Fitzgerald explained that one of the keys to his success was having vision therapy as a child. He had a vision problem that was making it difficult to pay attention in school and his grandfather, Dr. Robert Johnson, a developmental optometrist in Chicago, Illinois, diagnosed the vision problem and the appropriate treatment.

Fitzgerald went through vision therapy under his aunt’s guidance, Dr. Stephanie Johnson-Brown, who is currently the executive director of the Plano Child Development Center, a not-for-profit vision care service corporation which was co-founded by her father, Dr. Johnson, in 1959, which specializes in vision education and the identification and remediation of vision development problems in children and adults.

According to a report from the New Jersey Commission on Business Efficiency of the Public School, “Undiagnosed and untreated vision-related learning problems are significant contributors to early reading difficulties and ultimately to special education classification.”  “There is abundant evidence that the academic abilities of children with learning problems that were the result of underlying vision problems improve after receiving vision therapy,” Dr. Carol Scott, President of COVD states. “It is important to understand that vision therapy treats vision problems that interfere with reading and learning; we do not treat dyslexia or other learning disabilities.”
“It is unfortunate that many children struggle for years despite tutoring and other special services before their parents find a developmental optometrist,” Scott continues. “Parents continually share their frustration with us that they wish they had found us sooner.”

Fitzgerald is joining COVD this year to help spread the word that 20/20 is NOT perfect vision and that if your children are struggling with reading you need to take them to see a developmental optometrist. You can visit COVD’s Web site to find a developmental optometrist near you.

“Vision problems can have a serious impact on a child’s education. Don’t wait to see if this next school year will be better; take action today!” Fitzgerald encourages parents.
Convergence insufficiency , one of the most common vision disorders that interferes with reading, was recently the focus of a scientific study funded by the National Institutes of Health and the National Eye Institute. This is a vision problem where the two eyes don’t work together in unison the way they are supposed to when one is reading. The result can make reading very difficult.

While at least one out of every 20 school-age children is impacted by convergence insufficiency, 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 good news is the majority of these vision problems can be treated with a program of optometric vision therapy. The study by the NEI found that in-office vision therapy was the best treatment for convergence insufficiency.

The five most common signs that a vision problem may be interfering with your child’s ability to read and learn are:
1. Skips lines, rereads lines
2. Poor reading comprehension
3. Takes much longer doing homework than it should take
4. Reverses letters like b’s into d’s when reading
5. Has a short attention span with reading and schoolwork
Any one of these symptoms is a sign of a possible vision problem. A more in-depth symptom checklist is available on COVD’s Web site.

Not all eye doctors test for learning-related vision problems, so it is important for parents to ask the right questions. Call your eye doctor’s office and ask the following two questions:
1. Do you test for learning-related vision problems?
2. Do you provide an in-office vision therapy program when indicated, or
Will you refer me to someone who does?
If the answer is no to either one or both of these questions, visit COVD’s Web site, www.covd.org , to find a developmental optometrist near you.

In closing, the President of COVD, Dr. Carol Scott, a developmental optometrist from Springfield, Missouri, says, “In celebration of August being National Children’s Vision & Learning month, I invite you to visit our Web site and learn more about the vital role vision plays in our children’s education.”

About COVD
The College of Optometrists in Vision Development (COVD) is an international, non-profit optometric membership organization that provides education, evaluation and board certification programs in behavioral and developmental vision care, vision therapy and visual rehabilitation. The organization is comprised of doctors of optometry, vision therapists and other vision specialists. For more information on learning-related vision problems, vision therapy and COVD, please visit www.covd.org or call 888.268.3770.
CONTACT: Pamela R. Happ, CAE COVD Executive Director 888 268 3770 tel Email: phapp@covd.org Web site: www.covd.org
SOURCE College of Optometrists in Vision Development (COVD)

by Susan R. Barry, Ph.D.

Dr Susan Barry, Professor of Neurobiology

As another school year is brought to a close, we need to ask again why so many children struggle in their classes. Sometimes the answer is right in the front of our face.

When I was in second grade, I did miserably on a standardized achievement test. The school principal told my parents that I was, “a dim bulb,” and I was placed in a class with other “problem” children. But the principal was unaware of the connection between vision and reading. I was cross-eyed and, in the previous five years, my eyes had been surgically rearranged in their sockets three times. I had 20/20 eyesight with each eye, but even after the operations, my two eyes still did not point to the same place at the same time. In fact, when trying to read, I saw letters with my right eye that were to the left of those I saw with my left eye. No wonder I had trouble pinpointing the letters on the page and did not like to read.

Poor eye coordination affects more than the four percent of children who are cross-eyed or walleyed. An additional five percent of children (about one per classroom) have a condition called “convergence insufficiency.” Although their eyes look straight and they may coordinate them well for far viewing, they do not use them well when they look near. When they try to read, the letters appear blurry or doubled. Since a young child may not know that this is abnormal, he may not report what he sees to his teachers or parents. Sadly, this condition is not picked up by the standard school eye exam which tests only how well one eye sees at a distance of twenty feet. As a result, the child may be diagnosed with a learning disability, or if he misbehaves in frustration, with ADHD.

Even if a child’s vision disorder is diagnosed, it can be surprisingly difficult to obtain the proper treatment. According to a recent National Eye Institute study, the best treatment for convergence insufficiency is optometric vision therapy. Yet, ophthalmologists and pediatricians are not generally trained in vision therapy and don’t always refer the patients to the developmental/behavioral optometrists who are. Medical insurance companies may not cover the treatments making the vision therapy difficult to afford.

If we really want to help our children to learn, then we need to provide them with a thorough binocular vision exam before or at the time they enter kindergarten. Such testing could provide huge savings as children struggling with reading in school may then get the early intervention they need. Detecting vision problems early and seeking the right treatment can change a child’s vision and transform a child’s life.

Note: I wrote about this issue in a recent Op-Ed published in the Los Angeles Times and in my book, Fixing My Gaze.  Another good website to learn about the connection between vision and reading is here.

From Psychology Today

New York Times recently wrote an article about a child who was misdiagnosed with Autism/ADHD, when in fact she had a Convergence Insufficiency. This disorder is one of the easiest binocular disorders to treat with Vision Therapy.

As an infant, Raea Gragg was withdrawn and could not make eye contact. By preschool she needed to smell and squeeze every object she saw.

“She touched faces and would bring everything to mouth,” said her mother, Kara Gragg, of Lafayette, Calif. “She would go up to people, sniff them and touch their cheeks.”

Specialists conducted a battery of tests. The possible diagnoses mounted: autism spectrum disorder, neurofibromatosis, attention-deficit hyperactivity disorder, anxiety disorder.

A behavioral pediatrician prescribed three drugs for attention deficit and depression. The only constant was that Raea, now 9, did anything she could to avoid reading and writing.

Though she had already had two eye exams, finding her vision was 20/20, this year a school reading specialist suggested another. And this time the optometrist did what no one else had: he put his finger on Raea’s nose and moved it in and out. Her eyes jumped all over the place.

Within minutes he had the diagnosis: convergence insufficiency, in which the patient sees double because the eyes cannot work together at close range.

Experts estimate that 5 percent of school-age children have convergence insufficiency. They can suffer headaches, dizziness and nausea, which can lead to irritability, low self-esteem and inability to concentrate.

Read more at NY TImes

Dear Abby wrote a recent column on this prevalent problem.

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. When studying, 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. IN MINNESOTA

By Harley Flego (Parent)

How could my daughter, a bright, articulate, 7-year old who could paint ‘Starry Night’ by Van Gogh, speak two languages and sing with perfect pitch not be able to read? I just didn’t understand.

Chelsea did well in preschool and kindergarten. There was no sign of anything wrong. The eye doctor and the pediatrician both said that she had ‘a small drifting lazy eye’, but not to worry because her ‘vision’ was good. Little did I know that what they called ‘vision’ was only ‘eye-sight’.

In 1st grade, Chelsea did well until after Christmas vacation, when her schoolwork seemed more intensive. It was painful to watch and hear her read. Chelsea became very frustrated and started to hate school. She didn’t want to get up in the morning.

She couldn’t comprehend anything she read. (Even sentences she had read just seconds before.) She traced lines with her finger to keep her place and put words together that were meant to be apart. She held her books very close to her eyes and was constantly fidgeting in her seat. She lacked confidence. She procrastinated with homework because it took 3 hours to do. It became a frustration nightmare for my husband and myself.

I wrote a note of concern to Chelsea’s teacher and asked to meet with her. We felt something was very wrong with Chelsea, but we couldn’t pinpoint what is it was. The teacher couldn’t either. Things weren’t clicking. Maybe she has ADD or ADHD? She exhibited some of the symptoms, but something about the ADD label just didn’t sit right with me.

My gut instincts kept me from physically getting her tested. I hated the fact that I might label my child and I refused to believe that my wonderful child had ADD. Still, I was extremely concerned that she was falling behind the rest of the class while I kept waiting for an answer. But, I held steadfast to my intuition and prayed for Divine intervention. It was the only thing I had to hold onto at that moment. I didn’t know how or where the answer would come from. I just knew in my heart that it would.

Amazingly enough, while Chelsea’s teacher was going through her files, she came across an article from 4 years ago. The article was entitled; 20/20 Vision May Not Be Good Enough. The article stressed the distinction between sight and vision. It also explained why some children who had perfect vision were having such trouble in school.

The article spoke about the Vision Development Center in King of Prussia, Pennsylvania. A wonderful place where the doctors test the eyes to make sure they work together properly and can possibly rule out ADD and ADHD. It’s kind of a one-stop shop; they have eye doctors, psychologists, vision therapists, occupational therapists, and they sometimes make house calls for children with disabilities.

They work with people of all ages.

We scheduled an appointment immediately and had Chelsea tested at the Vision Development Center. My husband and I were devastated to learn the extent of Chelsea learning disabilities but at least we had an answer and a place to start. The doctor told us that Chelsea needed to be in a remedial program.

She was diagnosed with several vision problems, not ADD or ADHD, and these vision problems were leading to serious learning disabilities.

We explained to Chelsea that her eyes weren’t working together. We told her that her one eye wanted to do ballet and the other eye wanted to play soccer. She seemed to understand. We told her that the vision therapy program would take away her headaches and blurry vision and help her to read better. She had been so frustrated, that frankly, she seemed relieved and eager to start her sessions. The therapists used games and she wore funny glasses. They made it fun for her to retrain her eyes. We were both relieved to know we could fight this battle and win.

Three months have passed and my husband and I are astounded at Chelsea’s progress. She no longer has headaches, blurry vision or double vision when she reads. She is like a different child. She likes school and tells us she loves her new teacher in second grade.

The National PTA adopted a resolution in June of 1999 that school nurses should test for more than just 20/20 vision, yet rarely do they. I was a lucky parent. With the help of a wonderful and caring teacher, we found our answer.

Vision problems can manifest themselves as learning disabilities and sometimes have the same symptoms as ADHD. Children with the vision disorder, Convergence Insufficiency, an inability to focus at close range, may be misdiagnosed as having ADHD.

According to David B. Garnet, MD in an ‘April 2000’ article in Science Daily entitled: Ophthalmologists Discover Relationship Between Eye Condition and Attention Deficit Hyperactivity Disorder; “We showed that children with the disorder, Convergence Insufficiency are three times as likely to be diagnosed with ADHD than children without the disorder. This is the first time such a relationship has been identified between these two disorders.” Not so; The Doctors at the Vision Development Center have known about this for years.

For more information, additional locations, or to make an appointment at the Vision Development Center to have your child evaluated, phone 610-783-1331.

By Eleanor Skale Lowenstein (parent)

I suspected that my daughter Shari was a perfectionist when she was around 5 years old.  Not that perfectionism is necessarily a bad thing; I just didn’t like watching the frustration level arise in her every time she sat at the kitchen table and tried to write or do a craft project.  Sometimes her frustration would escalate to the point that she would hit her forehead a couple of times with her fist, and cry out “I can’t get it right!” Interestingly, these were self-initiated projects, with no external pressure to perform. As a parent, I was concerned for her physical and emotional well being. I hated seeing her so upset.  Reassuring her that her work was all right never had any effect; she insisted that it wasn’t.

Because I suspected a possible visual problem with her older sister, Joanna, I made an appointment at the Vision Development Center. My friend, who was a specialist in education, had recommended them.  While I was there, both children had routine visual screenings.  I had been correct to suspect a problem with Joanna’s vision, and she underwent vision therapy for a short period of time and later had eye surgery to complete the correction.

The surprise was that Shari also had a problem.  Although she didn’t have significant physiological vision problems, her visual-perceptual abilities were only at the 10th percentile. Now I could understand.  She had a conception in her mind about what she wanted to produce, and she couldn’t produce it!  That would be exceedingly frustrating, indeed.

She underwent therapy and her perception improved to the 40th percentile, which was considered sufficient for her to function successfully. I also noticed that, thankfully, Shari no longer got frustrated when doing close, detailed work and no longer hit herself on the head.

Well, my little girl has grown up.  To my surprise, a few art and design courses taken in college and an enjoyment of doing crafts has led to her having her own business.  She has been creating hand painted glassware, gift items and baby clothes, which she sells to stores and directly to consumers. (You can check this out at her website: www.shariz.com, if interested.)

The best thing is that she is happy.  She left the frustration behind at the Vision Development Center.

At the Vision Development Center we take pride in our reputation for seeing each child as a unique individual with special talents and gifts.  We work with many children who face a variety of challenges from Developmental Delays to Learning Disabilities, ADD/ADHD etc.  All of these children have expressed how much they enjoy their time here because they are appreciated for their individuality and not viewed as a “diagnosis”.  Unfortunately, all too often this is not a common experience for many of them in their daily lives.  It is truly a joy to see these children explore and expand their abilities as they develop the skills whose absence had made efficient learning and adequate attention so difficult for them.

For more information, additional locations, or to make an appointment at the Vision Development Center to have your child evaluated, phone 610-783-1331

By Kathy Caruso (parent)

My oldest daughter, Anya was adopted from Russia when she was almost 6 years old. She is a great kid who came with a few challenges. She had been diagnosed with a language delay in Russia, and although, she learned to speak English very quickly, she often mixed up words and couldn’t learn to read at all.

By age 9 she still could not read. I believed that she had a vision problem because sometimes her eyes didn’t look straight. Since, I had a vision problem as a child, which was fixed by vision therapy (VT), I tried to find someone to provide Anya with Vision Therapy.

Finally we discovered the Vision Development Center. Anya began Vision Therapy and within the first month to 6 weeks jumped from a kindergarten level to the first grade reading level. Anya was finally able to read!

By the time she finished the treatment regimen, she was reading on the 2^nd grade level. She went from hating school to loving it. Her teachers said she could now focus better.

Anya’s sister Zoya, who was also adopted from Russia, has also benefited from Vision Therapy at the Vision Development Center. At age 3 ½ her eyes crossed and she held everything upside down. She even watched TV upside down.

We wasted no time and started Vision Therapy when she turned 4. Today she has just turned 6 and is one of the best readers in her Kindergarten class. She is reading on the first grade level.

Anya, in addition, had learning disabilities. Her memory was very poor and she could not remember any math facts. She processed information so slowly, that at age10, her performance was that of a 4-year-old.

So, we began PACE (an intense 12-week, one-on-one processing and cognitive enhancement program) which was perfect for the summer months. She loved this program and we could see results immediately. Her reading improved even more, and she could now memorize math facts.

By the end of the PACE program, Anya was in a new school, which placed her according to her tested ability. She tested at the high 4^th grade level in math, 3^rd grade in reading and at the 5^th grade level on every other subject. She had started the previous year at the kindergarten level!

Anya’s IQ was also tested before and after PACE. She gained about 20 IQ points after completing the PACE program.

I believe that the lives of both of my children have been changed for the better as a result of vision therapy. In addition, my oldest daughter benefited from the PACE program, which is also available at the Vision Development Center in King of Prussia.

I don’t know what would have happened to my two girls without Vision Therapy. We had tried everything else to help Anya, but Vision Therapy and PACE worked the best. As a teacher and a psychotherapist, I do not hesitate to recommend Vision Therapy or PACE for children who are having learning difficulties.

_____________________________________________________________

For more information, or to make an appointment, phone 610-783-1331.

Executive function and attention. The ability to make effective decisions requires integrative and sustained attention. The ability to search memory, to link current sensation to immediate context and connect this experience to past memories, is the quintessential attentional task.^[3] Planning and working memory are essential components of executive function.^[1,2] The capacity to do what we intend requires sustain attention, even in an environment of distractions and through phases of weakening interest or mounting fatigue.^[29]

The cognitive aspects of executive function are primarily located in the anterior frontal cortex, whereas spatial organization occurs more dorsally; verbal memory and organization are localized more internally. Anticipatory, or expectant waiting, aspects of executive function are managed in the cingulate gyrus. The ability to interpret visual experience — an important component in executive learning — is processed in the posterior visual cortex.

For information about how our PACE program is specifically designed to increase attention and executive function visit out PACE site here.