WASHINGTON (AP) - Your 9-year-old's eyes hurt during homework? Your teen's a
slow reader plagued with headaches? They may have a common yet often missed
vision problem: Eyes that don't turn together properly to read.
As many as one of every 20 students have some degree of what eye doctors
call "convergence insufficiency," or CI, where eye muscles must work harder to
focus up-close. And those standard vision screenings administered by schools and
pediatricians won't catch it -- they stress distance vision.
When symptoms such as eye strain, headaches, double vision or reading
problems trigger the right diagnosis, doctors prescribe any of a hodgepodge of
exercises designed to strengthen eye coordination. Now a major government study
finally offers evidence for the best approach: Eye training performed in a
doctor's office for 12 weeks.
The right treatment can make a profound difference, says Adele Andrews of
Rydal, Pa., whose son Thomas participated in the study when he was 10 -- and
improved enough to at last start reading for fun.
His mother knew something wasn't right early on: Reading seemed to require a
physical struggle of Thomas that his three older siblings never experienced.
"He always wanted to buy books but he wouldn't read them. He wanted to but
it was too hard for him," she recalls.
Then homework began and "I don't even want to tell you how bad it was,"
Andrews adds. "He would get frustrated. He wouldn't do it. ... I tried bribery,
I tried everything. It got to the point where it was just a battle."
Why? To bring print or other close-in work into focus, both eyes must turn
slightly inward, or converge. As its name implies, convergence insufficiency
means the eyes aren't doing that properly. Words may appear blurry or double, or
disappear as readers lose their place. How much extra effort eye muscles must
exert to compensate and bring that image into focus determines whether someone
has obvious symptoms and how bad they are.
Complaints are rare in very young children because pictures and large type
don't require as much convergence. Parents tend to start noticing a problem once
homework and deeper reading begins. Some people complain only in the teen or
college years, perhaps when their workload outpaces their ability to compensate.
Others find they can read with one eye closed and do fine.
Nor does everyone experience obvious symptoms. How many compensate enough
that CI truly doesn't matter -- and how many quietly try to avoid reading? No
one knows.
Dr. Mitchell Scheiman of the Pennsylvania College of Optometry at Salus
University is suspicious when a child's "behavior is, 'I don't want to read, I
don't like reading, I can't concentrate." His advice then: "Just rule it out."
Diagnosis requires seeing an ophthalmologist or optometrist trained to treat
children who can measure convergence with some simple tests such as moving a
pencil steadily closer to the nose until the person sees double.
But which treatment works best: The most commonly prescribed "pencil
push-ups," practicing that pencil-to-nose test at home? At-home computer eye
games? Or more varied eye exercises, including computer-based ones, performed in
a doctor's office with at-home techniques for reinforcement?
A study funded by the National Eye Institute aimed to find out, by randomly
assigning 221 9- to 17-year-olds to one of those approaches or to a control
group given "dummy" exercises at the doctor's office.
Three months later, nearly three-quarters of the office-treated patients had
greatly improved -- compared with no more than 43 percent of home-treated
patients, Scheiman and colleagues report in this month's Archives of
Ophthalmology. The study will continue tracking patients for a year, to ensure
the benefit lasts.
At roughly $75 a visit, office treatment is clearly more expensive. Why
would it work better? First, they got more intense treatment. The NEI's Dr.
Brian Brooks says a combination of more varied in-office exercises may hold a
child's attention better -- along with a doctor acting like a personal trainer,
ensuring the youngster does each technique properly and doesn't slack off.
What's not clear is the more intricate in-office techniques could be adapted
for home use and work just as well, he cautions.
But Andrews witnessed the difference between the two techniques as they're
practiced today. Thomas was originally assigned to pencil push-ups but improved
only slightly. After his 12 study weeks were over, researchers switched him to
office-based treatment -- and his mother saw a rapid lessening of the homework
battles.
Today at 13, Thomas has "become pretty serious about his schoolwork," says a
relieved Andrews. "He's going to do OK."
EDITOR's NOTE -- Lauran Neergaard covers health and medical issues for The
Associated Press in Washington.
Copyright 2008 Associated Press. All rights reserved. This material may not be
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