Convergence insufficiency and “tracking problems”…How hard can it be to spot these kids?

Sometimes the vision problems that involve poor eye coordination seem to be missed or mistaken during a regular eye examination. Parents who have such a child with a previously undetected binocular or oculomotor problem  are often surprised and ask,  “Why was this not spotted before?”  After many years of seeing hundreds if not thousands of these children and with the plethora of research and body of knowledge readily available, it is becoming more and more difficult for me to explain to a parent why the previous eye doctor, whether ophthalmologist or optometrist did not see this.  After all,  how can a child with complaints of words overlapping while reading and trouble concentrating on a reading tasks not raise a red flag to test for problems in  eye coordination??

To show how easy it is to test for this condition, take a look at the video below to see our patient Josh before and after his vision therapy treatment. While there are about 17 clinical tests typically performed by the doctors who specialize in Developmental Vision to make the correct diagnosis, there are 2 easy chair-side tests that nearly anyone can perform that will often show if a child has convergence insufficiency (CI) and/or oculomotor dysfunction (tracking problems).

  • The first test is a simple “tracking” test where Josh is asked to follow a bead on a stick. Notice at first he starts out pretty good, but as I begin to ask him questions and he has to think, in less than a minute he begins to show signs of significant fatigue, loss of fixation and furrowed brow showing stress.
  • In the second clip Josh is wearing red-green glasses (over his own glasses). He is then asked to look at a “penlight” as it is brought closer to his nose. This test is described and published by the American Optometric Association. Read more by clicking here. Notice that in this second clip that Josh reports double (two lights -one red, one green) at about 20 inches. What’s normal on this test? Double at 2-4 inches. To see the research and normative data …click here

Just as so many other children are affected (research shows 1 in 12) by this vision problem known as Convergence Insufficiency (CI), Josh also struggled. The impact on him was that he had double vision and loss of interest for reading. It also made it difficult for him to play baseball or most any ball sport. As a result Josh lacked confidence at school and on the playground. Now after successful completion of his office-based optometric vision therapy Josh no longer sees double when reading, his comprehension and reading speed has significantly improved and he is gaining skill and confidence in sports. Now that he has good binocular vision, Josh no longer struggles and is a happy kid!

Dan L. Fortenbacher, O.D., FCOVD

2 thoughts on “Convergence insufficiency and “tracking problems”…How hard can it be to spot these kids?

  1. Very well done, Dr. Fortenbacher. There’s a nice, concise YouTube video from our colleague, D.r Lynn Hellerstein, that complements what you’re saying:
    Yesterday, I spoke to a group of 50 OTs and Educators. I am very blunt now when I lecture, and the beauty of it is, these professionals get it. They have the chance to experience first-hand what we’re talking about. And to a person, they walk away realizing that one misses more by not looking than by not seeing. The ophthalmologists you refer to can almost be excused, because this area isn’t their field. They simply don’t know enough to realize what they don’t know when it comes to vision based learning problems. The optometrists who don’t know most likely were influenced early in their education, or careers, to adopt the ophthalmologic model that thses issues are somehow “brain problems, not eye problems”. Keep up the great work, and ultimately the truth will prevail.

    • Thank you Dr. Press for sharing the very nice video of Dr. Hellerstein. She does a wonderful job communicating this message as well.

      I think you said it best when you said, “one misses more by not looking than by not seeing”. This is so true and yet a sad state of affairs when those doctors who are entrusted to care for the visual welfare of the public fail to even look. Patient’s deserve better!

      Thank you!

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