CI: The Private Eye Goes Public – Part 1


As concerned parents we all want the best for our children. This is particularly true when it deals with a health related issue. If you have a sick child with a disorder that needs a doctors attention, you expect that your doctor will make the correct diagnosis and provide treatment or advise you where to obtain treatment that will successfully resolve your child’s problem.

Certainly in cases involving life and death there is no tolerance for error. We will not accept a “go home, give him a couple aspirin and call me back in a couple months if it’s not better” approach for a child with raging pneumonia. Yet for other medical matters of children’s health care, particularly certain types of  eye disorders this could be the  response you hear from your eye doctor.

What? How could a child in the year 2010  be suffering from a significant eye disorder in the US and yet have a  high probability that the  disorder will not be  recognized and properly managed by a large percentage of eye doctors?

This is exactly what we will be investigating in this series – CI: The Private Eye Goes Public. The topical acronym “CI” does not stand for “criminal investigation”, rather it refers to the name of the eye disorder in question. This eye disorder is not rare. As a matter  fact research shows this vision disorder is found in 1 out of 12 children. It is found in a category of disorders involving the successful neuromuscular control of the two eyes, thus referred to as a dysfunction of binocular vision. It has a medical ICD-9-CM diagnosis code (378.83). The symptoms of this binocular vision disorder can range from mild to severe, but usually deteriorates over time. The common symptoms usually occur when the child attempts to sustain a near-centered visual task, such as reading, computers and/or paper pencil tasks. The child with this condition usually suffers from fatigue, frontal headaches, loss of concentration, periodic blurry and doubling (overlapping) of words when  reading . It is common for the child with the condition to have stress related side-effects that result in emotional upset and/or avoidance behaviors associated with the near-centered visual work.

The name of this common binocular vision disorder in children is called Convergence Insufficiency. Affecting as much as 8% of the pediatric population, CI is more common than glaucoma in children. It is more common than amblyopia in children.

The actual prevalence of Glaucoma in children is 1 in 43,575. The prevalence of Amblyopia in children is 1 in 50. The prevalence of Convergence Insufficiency is 1 in 12!

CI has been the focus of a massive research effort  for over 10 years by the Convergence Insufficiency Treatment Trial study group. This NEI research was funded by the Federal Government (NIH) to the tune of over $6.1 million to study this condition in multicenter sites including the Mayo Clinic, Bascom Palmer and 6 Colleges of Optometry around the US.  The results of these landmark studies has been to identify the treatments that work and those that don’t work for the treatment of this common eye disorder that affects 1 in 12 children.

In this series, I will join with Dr. Leonard Press to help address the issues and answer the questions about why patients with Convergence Insufficiency are often marginalized even when the NEI research clearly spells out the importance of diagnosis and outlines the appropriate treatment protocols. Likewise, the American Optometric Association has established clearly defined Clinical Practice Guidelines entitled: Care of the Patient with Accommodative and Vergence Dysfunction.

Yet the questions persist about why some doctors overlook the patient with CI:

  • Could it be lack of training?
  • Could it be the lack of a viable delivery system for treatment in the doctor’s office or referral network?
  • Could it be that the doctor doesn’t care?
  • Could it be that the eyecare professions don’t emphasize it in the journals or the doctor’s continuing education?
  • Could it be because some organizations like the AAP, AAO and the AAPOS trivialize CI by lumping it in with LD and dyslexia thereby giving CI (and the treatment for CI) a misleading and  “controversial bias”?

As a result of this investigational reporting… CI: The Private Eye Goes Public we will be exploring these questions and providing answers. In the mean time,  if you are a parent (or know of a parent) who has a story to tell of a child who is or was suffering (but finally found help) from Convergence Insufficiency, would you please share your story with us in the comment section below? It could be very useful for other parents to read as well as for your humble correspondents, Dr. Press and Dr. Fortenbacher, who will continue to launch this investigative report on why your child with Convergence Insufficiency may be overlooked by your doctor.

We await your comments!

Dan L. Fortenbacher, O.D, FCOVD

22 thoughts on “CI: The Private Eye Goes Public – Part 1

  1. Pingback: CI: The Private Eye Goes Public – Part 1 | Lynn Hellerstein, Author of See It Say It Do It

  2. I cannot thank my eye doctor enough for all that his vision therapy program has done for both my son and me. The transformation that has taken place in both of us is profound and absolutely life changing! I am writing our story in hopes that it will be given to any person diagnosed as needing vision therapy. I hope that our story will help them decide to pursue the treatment.

    I know that they are skeptical and I thought that hearing our story from the perspective of a college educated mother who herself experienced vision therapy with her son might shed some light on very unfamiliar territory. I want them to understand the varying degrees of these vision problems and their implications behaviorally. I want them to know that no matter what the severity, pursuing vision therapy treatment will help. Unlike psychology, which is subjective, vision therapy is measured and you will see the results, in black and white, printed out for you from the Visagraph. The computer will show you what your eyes are doing while you read and evaluate your comprehension. The Gardner Test will further evaluate your visual abilities, including things like visual memory and visual discrimination.

    The following two paragraphs describe what I mean about varying degrees of vision problems and their implications behaviorally and academically for that matter. The Visagraph showed that my eyes jumped 110 times, 70 is the norm for adults, and that I had poor tracking. My symptoms were that I lost my place while reading. When I got to the end of the line I had trouble getting to the next line of text and would often skip lines. As a child, I went to a reading tutor who taught me to put a piece of paper under the line of text that I was reading so that I could not skip lines. I read slow and hated doing it. I could not remember half of what I read so I learned to become an excellent listener and take great notes. I watched every book that I ever had to read in high school. I rented the super old version of the movie, you know the one that they would show you in class after you read the book and took the test. I avoided reading. I could do it, I just wasn’t very good at it. My brother had to read the movie Dances with Wolves to me because I could not keep up with the subtitles. I could not do a puzzle for the life of me and I was gifted a C in high school geometry. I simply did not understand it but I tried, I went to after school tutoring, so my teacher passed me. I graduated from college with a 3.24 grade point average and a degree in both management and marketing. I did not know that I had a problem and I thought that I was smart. When the Gardner Test was administered and scored I could not believe how poorly I had done. I mean embarrassingly low scores, no pathetic. My visual memory score fell in the negative 1 percentile and many other scores were in the 3rd and 11th percentile. When I told my grandmother who was a teacher, she asked how I ever got through school. I told her that it was certainly not by reading the books. I compensated by listening really well. I was the master at taking notes.

    In contrast, my son’s Visagraph results showed that his eyes were jumping 400+ times when 100 was the norm for children, and that he too had tracking problems. When he looked at print on paper, it literally moved around the page. It did not sit still. Because this is how he had always seen, he did not know that others did not see things the same way and I had never thought to ask what it was that he was seeing. Below is the rest of our story and how we found our miracle – Vision Therapy. All I can say is that this treatment is worth every penny. I know that it can be expensive if insurance does not cover any of it but I hope that you will consider this. It is not any more than you would spend on braces for your child and it is so much more important. This treatment can mean the difference in being “learning disabled” and being at the top of your class. That was certainly the case with my son. There is not a person alive that would not benefit from vision therapy, but some people will not be successful without it.

    I had this little guy that was struggling. He seemed so very angry at a very young age. I could not figure out why at ages 3, 4 and 5 that he was so angry. His behavior was out of control and punishment did not affect him at all. He did not seem to care. He would not look you in the eyes and he avoided doing any type of schoolwork like flashcards, coloring or writing. He would not even play hand held video games. He would say that he was not smart and that he wanted to switch brains with me and with his little brother. He just seemed frustrated/angry all the time. You had to threaten him in order to get him to do anything. I was sure that when school started that I would be in the principal’s office every day.

    At age 3, I took him to a psychologist. She labeled him ADHD/ODD/Pervasive Developmental Disorder (Autism category) and many other things. She suggested that we go to developmental preschool, which was free through our school district, and see her again when he was 5, just before entering Kindergarten. He received speech and occupational therapy through the school and it helped a little. The summer before Kindergarten, I went back to see the doctor as instructed. I was hopeful but was shattered by the doctor’s analysis. She said that he had all of the things listed above and that he was going to be in a self contained special ed class and need an Aid to get through school. I was mortified! She continued to tell me that therapy would not work, that I could spend millions of dollars and would just be wasting my time and money. The only thing that would help in her opinion was medication, “a magic pill”. My reply was with a question with which the answer disturbed me immensely. “You said that he has numerous disorders, yes? You would not give someone with ADD/ADHD the same medication as you would someone with Autism or ODD, correct?” She replied that she would give my son ADHD medication and based on his reaction that would tell her if he definitively had ADHD. It was her theory that you rule out possible disorders based on chemically altering a child and observing their behavior. In other words, she wanted to use my 5 year old as her lab rat to rule out possible disorders.

    I now refer to this doctor as Dr. Rx. I said that I did not believe in medicating a five year old and that I would go waste my time and money on therapy. How dare she portray the bleakest of futures for my son! I refuse to let that happen. I will show her, nothing motivates me more than being told that I can’t. I dedicated the summer to private therapy. I was determined to prove Dr. Rx wrong and fix my son before he ever had a chance to fail in school.

    I went to the pediatrician to tell her of the experience that I had with Dr. Rx from their referral and asked if they knew of a psychologist that believed in therapy and not medication. Even the pediatrician made the comment that it was ok to explore therapy as long as it was not affecting the other kids at school. Again, another pro-medicator. There are tons of them out there. She gave me another referral and I went to check out. I happened to push over one of those free Arizona kids magazines onto the check out ladies desk. She looked at me disgusted, so I immediately picked it up. It was all about summer camps around the valley. I took it home and began my summer of therapy. I decided that the things that one needs to be successful in life are to read, write, speak and hear. Inside the magazine I found an ad for a handwriting summer camp. I thought to myself how cool, exactly what I need, so I gave them a call. The owner answered. I told her that my son was entering Kindergarten in August and he was still fisting the pencil. I told her our story and said that I was not sure if he could just take the class or if he would need more help than just that. She said that she was an OT that specialized in handwriting and would evaluate him. They offered private OT as well as the classes so we would see where he would best fit. She evaluated my son and thought that he had convergence insufficiency. She said that when you look at something on a piece of paper, your eyes come together to look at the point (converge) and when you look up, your eye separate back out to normal. She said that she was not seeing that with him and she wanted us to see a behavioral optometrist for screening.

    I had never heard of such a thing. I came home and started researching all this stuff: Behavioral Optometrist, Vision Therapy, Convergence Insufficiency. I discovered that I also had a form of this so I made an appointment for us both to be screened. Turns out that yes, we both needed vision therapy. How can this be? I had been to an optometrist every year and worn glasses since I was in the sixth grade. I have never had an eye exam as thorough as the one I received from my COVD certified Optometrist. He not only asked me to read an eye chart to evaluate my eyesight, he went further and evaluated my vision at close range. This further probe evaluates the skills needed for reading and schoolwork. Since Dr. Rx said that therapy did not work, I decided that I would go through it with my 5 year old son and see for myself. OMG – it was the most amazing thing that we have ever experienced! With every single visit, I noticed a considerable difference in my son’s behavior. After 4 units in five short months, he was cured. He never talks about not being smart anymore. In fact it is all about how brilliant he is. Vision Therapy was able to solve his problem before he was ever unsuccessful in school and disliked it. Before it ever had a chance to affect his self esteem. We were very fortunate to have found this when we did and I am eternally grateful! Prior to vision therapy, my son did not know his ABC’s and just yesterday he brought home an all-star student award from his school and he gets to go to an NBA basketball game as a reward. Only the top three kids academically and behaviorally were chosen from each classroom. This is no easy feat, as my son goes to a college prep elementary school where they are doing 1st grade work in Kindergarten. His success brings me to tears – happy tears!

    Speaking from someone who has experienced vision therapy. It makes everything in your or your child’s life easier. Things that I could never do before now come so easily. My speed and comprehension in reading have more than doubled! I am able to process information more quickly, therefore I think faster and react faster. My peripheral vision has also increased. I am so fascinated and awed by the transformation that has taken place in both myself and my son, that I want to be trained as a vision therapist. I have an overpowering need to help others and save them from the struggle I, and more so, my son experienced. I need to save all the children from medication! I want to use my marketing background to spread the word. Vision therapy is the cure for learning related issues and most behavioral issues. The change that has taken place in both of us is so profound and so powerful that it feels like I have the “cure for cancer” and I want to shout it from the rooftops!! How can people not know about this?

    Please share our story with potential clients. I want them to know that if they are skeptical or hesitant at all, please know that they have made a wonderful decision to pursue vision therapy. It is worth every penny that you will spend on it and then some!! It makes everything in your or your child’s life easier!

    For all of the parents out there who have children that have been diagnosed with some form of Autism Spectrum Disorder and have been sold false hope time and time again, this is the treatment for you. THIS ONE WILL WORK! It can change your family forever in a way that you never thought possible. It will change your life and that of your child’s forever in the most positive way imaginable. Your retina is actually made up of brain tissue. Your eyes are actually an extension of your brain (80% of learning is done through the visual system) and by changing how your child’s visual system behaves, you will open up and change their brain forever. Visual skills are learned and your child has an underdeveloped system. Learning to use your eyes is like learning to ride a bike, once you get it, you never forget. If you are still skeptical, I beg you to give it a shot. Do it to prove me wrong if you must, but just do it, I dare you! Give it one last shot, take one more leap of faith, it certainly won’t hurt. The very worst that can happen is that nothing changes. I bet that you will be pleasantly surprised, no make that ecstatic about the results. Please share your stories and experiences, both good and bad, with me at visiontherapyadvocate@gmail.com. I will be your biggest cheerleader and I wish you and your family the best of luck!

    Sincerely,
    Stephanie Leary

    • Thank you Stephanie for your heartwarming story. Your personal experience, as well as your son’s, tells what it is like for many patients who have had the Dr. Rx recommendation and fall throught the proverbial cracks in the health care/vision care system. Thankfully you and your son were able to be correctly diagnosed and obtain the proper treatment.

      Thanks for being a great advocate for patients with binocular vision problems!
      Dr. Fortenbacher

  3. Pingback: CI:The Private Eye Goes Public -Part 3…who’s looking out for the kids? « The VisionHelp Blog

  4. Pingback: CI: The Private Eye Goes Public – Part 4 « The VisionHelp Blog

  5. Pingback: Convergence Insufficiency: The Private Eye Goes Public #4 | Lynn Hellerstein, Author of See It Say It Do It

  6. My daughter was diagnosed with CI last year when she was 6 and was very successfully treated by Dr. Hillier in San Diego. But the process of figuring out what was wrong with her eyes and what to do about it took much longer. When my daughter started to read in Kindergarten, I noticed she could only read for a few minutes at a time. She also frequently lost her place and missed small words, substituting “a” for “the” and vice versa, or left out words altogether when reading. I attributed this to her being a new reader. However, over the next year and a half, it seemed that although her ability to read improved (and I worked with her on reading every day after school and over the summer), she was still making the same mistakes and was still only able to read for a few minutes at a time. Although she was usually a very happy kid and liked just about everything, she said she hated reading and avoided the small amount of homework she had like the plague.

    By the fall of first grade, I began to get worried and asked her teacher if she thought something was wrong, perhaps with my daughter’s eyes. She dismissed this, and said her vision was fine–after all, she knew all her letters and sounds perfectly. I knew she had 20/20 vision, but it just seemed like something wasn’t right. I then called her school’s office and asked if the nurse or the school had any way of testing her eyes, or if not, if they could recommend an eye doctor for her to see. They said they would call back with a recommendation, but they never did. I again expressed my concern about my daughter’s lack of progress in reading to her teacher, and I was left with the impression that her teacher felt, “your daughter just isn’t as smart as you think she is.”

    Of course, in hindsight, I should have taken her to a pediatric eye doctor on my own. Instead, I figured that if it wasn’t her eyes, maybe it was the school and we switched to a private school starting in January of first grade. I did not mention any concern about her eyes to the new school. Within a week, her new school called me to recommend I take my daughter to a pediatric opthamologist, because her reading teacher suspected she had Convergence Insufficiency. Interestingly, her reading teacher said it was my daughter’s writing that tipped her off to the CI more than her reading (although she also pointed out my daughter often covered one eye when reading). My daughter had a great deal of difficulty writing in a straight line, would often start sentences somewhere in the middle of a page instead of on the left side, and seemed unable to complete worksheets.

    We took her to an eye doctor in Albuquerque, and he diagnosed her with CI. Prior to seeing the doctor (I had to wait about 6 weeks), I had done a lot of research on my own about CI and had read about the CITT study and about vision therapy as a proven effective treatment for CI. The eye doctor confirmed my daughter had CI and prescribed prism eyeglasses. I inquired about VT. He said 6 was too young to start, and although his office did VT, they didn’t start on kids that young. He seemed unwilling to discuss VT as an option. I then called the local university hospital and got an appointment with the head pediatric opthamologist and their orthotics person. The eye doctor there agreed my daughter had CI, but said it was “very mild” and that most kids her age “don’t like to read” and opined that it was very normal and I shouldn’t worry about it. My daughter was given two at-home exercises that even I couldn’t figure out how to do, and the doctor completely dismissed (even scoffed at) office vision therapy as an effective or necessary treatment for her CI. She seemed totally unaware of the CITT study as well.

    There was no way I was going to accept that there was nothing I could do for my daughter or that her behavior was normal–it was very clear to me there was a significant problem. I realized I would have to find an optometrist who could perform VT on a young child on my own. After researching further, I decided I wanted her to see an optometrist with an FCOVD certification, and found Dr. Hillier at the San Diego Center for Vision Care. Since I have family in San Diego and it is an easy nonstop flight from Albuquerque, I decided I would take my daughter there for an evaluation and if necessary, travel with her to San Diego for treatment. Dr. Hillier agreed she had CI, and interestingly, he was the only doctor who tested her convergence twice. Once before reading and once after reading for a couple minutes. Although she had CI even before reading, Dr. Hillier found that after reading for just a minute or two, my daughter was unable to make her eyes converge closer than about 14-16 inches. It was fascinating, because I watched the whole exam, and you could clearly see one of her eyes wander off to the side when she tried to focus on something. No wonder she refused to read–she struggled very hard to make her eyes converge to read, and then the words must have gone blurry when the one eye drifted off. We immediately began VT at the San Diego Center for Vision Care, and we were very dilligent about doing the nightly home exercises in addition to the office visits.

    It was a lot of work, but it also was like a miracle, because within 6-8 weeks my daughter picked up a book and began reading. She was as shocked as I was that she could read fluently for a long period of time. I asked her what the difference was, and she said, “I don’t know, it’s just easier to focus on the words.” We continued therapy over the course of the summer, and my daughter went from hating to read to loving it. Her writing has significantly improved as well, and her 2nd grade teacher said she is doing a wonderful job in school. I am very grateful for VT (and Dr. Hillier and the staff at the San Diego Center for Vision Care!) It has made a world of difference to my daughter. I just wish that more schools were aware of the symptoms and prevalence of CI, and that more opthamologists would recommend VT as an effective treatment for CI. If I had accepted their dismissive and negative opinion of vision therapy, my daughter wouldn’t be the happy, successful student and reader that she is.

    • Thank you Paige for your inspirational story. Only through a mother’s determination to not take “no” for an answer, did you finally find a doctor who was able to identify and provide the correct treatment. Yes, Dr. Hillier is one of the best in the US and has successfully treated thousands of patients like your daughter with Convergence Insufficiency. What’s more amazing to me is that you were advised by others doctors to simply wait because she was too young! There could not have been a better time to address this condition in your 6 year old daughter. Treating this now before she developed inappropriate avoidance adaptations was essential!

      Thanks to your story, hopefully more parents will not accept the “wait and see” approach to the visual health and function of a child with early diagnosed convergence insufficiency. There is a proven treatment…office based vision therapy (in conjunction with home based activities). You are right, to find a doctor who is experienced and Board Certified in developmental vision and vision therapy, parents should look for a Fellow of the Optometrists in Vision Development with the doctor locator at htttp://www.covd.org

  7. Pingback: Early intervention critically important in children’s vision problems « COVD Blog

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  9. Paige is a great example of a proactive mom! And while her story is inspiring, it is unrealistic to think that every parent of a child that stuggles with CI can afford to go to those lengths. There has to be a way to get treatment without putting families in finacial jeopardy–especially in these economically difficult times!

    Here is my story…

    I have two boys that have struggled with reading for years. My oldest is 11. I knew something wasn’t right even when he was about 4. I would spend countless hours and energy trying to help him read and do his math! I could not fathom why he wasn’t “getting it” and why I had to keep reteaching him concepts. I was constantly asking his teachers what I could do to help him, but they could never seem to give me any suggestions. For years I was told that my son had a learning disorder. Only, they could never tell me what that was… He ended up in resource, his self esteem plummeted and he hated school. Every day was a battle to get him to school and to help him with homework. He was having anxiety issues. We decided it was time do something drastic! We knew our son had potential and that his test results were not a reflection of what he was capable of. We decided to pull him out of school and do homeschool. He made significant improvements in a year both acedemically and emotionally, so we put him back in a charter school, only we held him back a grade. He seemed to be doing fine with his self esteem, but I knew he was still struggling.

    And then our youngest son was diagnosed with Amplyopia while this was going on… We went though patching for over a year. His vision improved in his lazy eye, but he wasn’t learning to read. We thought adventually he would catch on. He wasn’t displaying the same issues that our other son was. He was doing well in math and he liked school. So, most of our energy was focused on finding out what our other son’s “disability” was.

    This last Summer at a play date with my boys’ friends from school, I got to talking with their mom on the topic of how our boys have struggled with reading. She told me that her boys were diagnosed with CI a year ago and of the success her boys had with vision therapy. She referred me to their eye doctor. Sure enough, my 11-year-old son was diagnosed with Convergence Insuffiency. My 8-year old son with Ocular Motor Dysfuction (which is in conjunction with Amplyopia).

    We started doing vision therapy for both of them. They have each had nine sessions, but due to our lack of funds, we have had to put them on hold. We have spent thousands of dollars between tutoring and therapy already and we are only 1/4 of the way through with their treatment. It is killing me! I was just starting to see improvements! It is frustrating to have a diagnosis and a solution but not to have the funds to follow through.

    The school system does not have the resources available to help my boys! They just want to put my 11-year-old back in resource. That is not what he needs! I just don’t know what my options are for getting help.

    I am now homeschooling my 8-year-old. The school wanted to hold him back because he was still at a primer level at the end of second grade. After the mistakes we made with our oldest son, we didn’t feel that would be the best thing for him! His teacher from last year has been wonderful helping with tutoring over the Summer and she says that he has already improved a grade level in reading!

    We are optimistic and hopeful for our boys! But, so discouraged at the same time. We have hit a road block. Any suggestions on how we can get financial help with vision therapy? We would be so grateful!

    Tamra
    spencertamra@yahoo.com

    • Thank you Tamra for sharing this heartfelt story about your 2 boys. Financial issues can often be resolved when the matter is brought to the attention of the doctor’s office. For example, I am aware of many doctor’s who provide office based vision therapy around the US and have special programs, such as scholarships to help those with a financial hardship. This is true for all of the VisionHelp doctors. The best thing is to bring it to the attention of the doctor.

  10. Pingback: Early intervention for CI | Vision Therapy of Vermont

  11. I was undiagnosed for convergence insufficiency for about 3-4 years. Finally a doctor found the correct diagnosis and has recommended me only pencil push up exercise as he believes it is the only ‘effective’ treatment. I have really suffered for last 3-4 years. Dr has told me treatment will be effective but may take time (2-4 months maybe 6 or 12)

    • Thank you Aditya for your comment regarding your current diagnosis of Convergence Insufficiency as well as the recommended treatment. Unfortunately, even though your doctor has suggested “pencil push-ups” to treat your condition, it is important to note that this mode of treatment is no more effective than taking sugar pills for Convergence Insufficiency. The only reason why some doctors recommend this treatment is because this is what they learned from text books. However, this form of treatment, even though taught decades ago and remains in some text books, was never based on research. In fact now the most recent double-blind, multi-center CITT study published in October 2008 in Archives of Ophthalmology proved that pencil push-ups for Convergence Insufficiency is ineffective treatment. My recommendation is that you consult with a Doctor who is experienced in treating CI. To find a doctor, go to http://www.cord.org and click on the Doctor Locator to find a doctor nearest you.

  12. our son was diagnosed with Accommodation Convergence Insufficiency at age 8, was prescribed special glasses (therapy glasses) for a year. In the meantime, he was labeled by a teacher as he must have ADD but of course we were in denial. (side note: I have 2 degrees in child development and taught for 11 years). At the age of 9, our son started Vision Therapy twice a week for 6 months. by the way, he always screened 20/20 at his vision screening. I took him to a Developmental Optometrist because he was reading to me one night and I became aware that words were being omitted, while others being injected where they didn’t belong. He was struggling in comprehension at school and getting him to read was like committing an act of God. However, in other academic areas, math in particular, he preformed at advanced gifted levels. It must be noted that prior to VT, he could not pass the examine that would qualify him for the Gifted Talented program. Two weeks after he completed VT, he took the test for 5th grade (I had discouraged him, but her insisted he wanted to try one last time). He qualified. He said he could finally read it and that he actually understood it this time. This diagnosis, and in turn the VT, changed his life. Prior to he thought he was dumb and acted the clown so that everyone would laugh at him because he was funny, not because he couldn’t read…his words.

    • Thank you Angela for taking the time to share your son’s story. I’m so glad you found a Developmental Optometrist who made the correct diagnosis and could provide the vision therapy treatment that your son needed. Thanks to you sharing, my hope is that other parents whose children struggle with Convergence Insufficiency, will read this and not be discouraged by the ADD/ADHD labels placed on their child, but will seek out the help you have described.

  13. My son has been diagnosed with Convergence Insufficiency and we are currently looking for treatment. There is only one office near us, within 75 miles, that offers vision therapy. They do not accept any type of insurance and it is expensive. We are going to go ahead with treatment because I’m hopeful that it will make a difference with my son. He is in the First Grade, and although there is obviously something going on with his eyes, he loves to read. He is reading on a 4th Grade level. But, he stops frequently and looses his place while reading and is suffering in other areas. His scores in reading on the last academic test were unexplainable. Like I said, he can read on a 4th Grade level, but he scored very low on the academic test. We thought he just had a hard time staying focused and paying attention, afterall, when a school does academic testing it lasts for several days. Ofcourse he has been misdiagnosed with ADHD/ADD and the possibility of Autism has not been ruled out. We, thankfully, have not tried medication for his inability to pay attention. What about parents who can not afford this treatment? The office that we are taking him to must be paid upfront and then, if your insurance covers the treatment, you can submit to them and get reimbursed. My son has a primary and secondary insurance. The primary insurance is Tri-Care and they do not cover this treatment at all. The secondary covers, but they do not do reimbursement and you have to use a provider in network. There are no providers in network that provide vision therapy. When I contacted Tri-Care, I was told they do not cover the therapy at all but would pay for the evaluation, 80% of the Maximum allowable cost. The maximum they allow is less than $80.00. The cost for the evaulation is $359.00. Something has been found that works and it will only be given to those children whose parents can afford it. If this works, why are insurance companies not recognizing it?

    • Thank you for your heartfelt comment. Your question centers around one main theme. Why do some insurance companies exclude coverage for vision therapy? This is a complex issue and it is not based on if the treatment is effective or not. In fact, double blind research has clearly shown that office-based optometric vision therapy is effective in the treatment of convergence insufficiency.http://convergenceinsufficiency.net/uploads/CITT_Arch_2008.pdf Furthermore, research shows that the successful treatment of convergence insufficiency will lead to an improvement in reading, learning and attention and concentration: http://www.ncbi.nlm.nih.gov/pubmed/22080400. Therefore, we have the evidence that shows the treatment is effective both in correcting the condition and that by doing so will result in favorable outcomes in reading, learning and other behaviors.
      But, the unfortunate reality is that the problem here is not with the doctors who are providing the treatment, but rather with the quality of the health insurance that you describe. In our experience, most health insurances do recognize and pay a portion of the treatment. There is a wide range as some will pay nearly the entire costs of care and others will reimburse only a fraction of the costs. The issue of poor reimbursement is an issue that should be taken up with the health insurance company.
      As far as how can those who have financial hardship find access to care? The answer to this can be found in many doctors offices who provide, to those with financial hardship, vision therapy scholarship programs that lower the cost of care. Also, there many other benevolent sources such as Lions Club Foundations or the new Vision Leads Foundation http://visionleadsfoundation.com/

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