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Back to school may mean struggling with reading problems

By Zack Steele

If you’re like me, you loaded your kids up on the bus last Wednesday and said hello to another school year. At my house, this means getting up earlier and balancing homework with soccer, cheerleading and everything else that a second-grader does for extracurricular activities.

I thought I would delve into an eye condition that affects children in school, and is one that makes learning difficult. A child can have this condition and still have 20/20 vision. The condition is called convergence insufficiency, or CI.

Convergence insufficiency is present in one out of every 10 children, suggesting that in a typical classroom one or two children may have this condition. Studies have demonstrated that children with this problem are likely to experience performance-related symptoms (e.g. loss of place, loss of concentration, re-reading the same line, reading slowly, trouble remembering what was read or feeling sleepy) as well as eye-related symptoms (e.g. blur, headache, double vision or eye strain).

In addition, The Convergence Insufficiency Treatment Trial studied parent concern about school performance in children with convergence insufficiency. The study looked at parents’ perceptions of the frequency of problem behaviors that their child may exhibit when reading or performing schoolwork. The survey was administered to the parents of 221 children between the ages of 9 and 17 with symptomatic convergence insufficiency prior to enrolling into the Convergence Insufficiency Treatment Trial and to 49 children with normal vision. Parents of children with CI reported a higher frequency of behaviors that may interfere with their children’s completion of school work and academic progress. In addition, parents of children with CI reportedly “worry” more about their children’s school performance.

The symptoms of CI can make it difficult for a child to concentrate on extended reading and may overlap with those of ADHD. The recent CITT study showed that 45 percent of the children with CI reported attention problems. Other studies have demonstrated similar results. One study found a three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general U.S. population (1.8–3.3 percent). They also reported a three-fold greater incidence of convergence insufficiency in the ADHD population. The authors concluded that until further studies are performed, patients diagnosed with ADHD should be evaluated to identify the whether they may have CI.

The bad news is vision screening doesn’t find these problems. If your child was screened in school, they likely measured their visual acuity. A child can have normal 20/20 vision and still have this problem. I have a huge problem with vision screenings creating the feeling that an eye exam isn’t needed, but that’s a column for another day.

The good news is CI is 100 percent treatable. With vision therapy, CI can be practically eliminated. I’m amazed at how well children and adults improve after therapy.

The take-home message is, if your child is struggling with reading comprehension and grades, make sure an eye exam is included in the battery of testing to determine what is wrong.

Dr. Zack Steele is a 2003 graduate of the UAB School of Optometry. His practice, Trussville Vision Care, is located on Chalkville Mountain Road in downtown Trussville.

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