Parents of school-age children who have struggled in reading and learning are often looking for answers to many questions. A common concern might be, “Why did my bright child continue to have difficulty with reading fluency and/or paying attention in the classroom this year, even with extra help?”
To provide some direction, two years ago the VisionHelp Group interviewed educational specialist, Wendy Rosen, author of the book, The Hidden Link Between Vision and Learning, Why Millions of Learning Disabled Children are Misdiagnosed and produced videos. Here is one example entitled: Misdiagnosing Learning Disabilities
In the video, Wendy mentions the diagnosis, “Convergence Insufficiency”, a binocular vision dysfunction usually associated with a reduced convergence ability and commonly identified with the Red/Green Penlight Near Point of Convergence (NPC) test. This test which can be done in about 30 seconds is one tool in the eye care provider’s binocular vision assessment tool kit.
But not so fast, as outlined in my recent VisionHelp Blog post and also featured as the Elsevier’s Practice Update Story of the Week, there is new Harvard Medical School research published in the American Journal of Ophthalmology entitled: Receded Near Point of Convergence is Not Diagnostic of Convergence Insufficiency. What they found was that while the majority of post-concussed patients (89%) had a reduced near point of convergence, what they also found was these patients had a high incidence of poor visual tracking (oculomotor dysfunction), eye focusing problems (accommodative dysfunction) and poor eye teaming and focusing flexibility (binocular vergence/accommodative dysfunction)
The conclusions by the JAO Harvard researchers was that, “Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.” In other words, these complex visual problems should be addressed with a comprehensive evaluation process followed by a comprehensive model of treatment to meet the patient’s individual visual needs.
So why bother doing a Near Point of Convergence Test on school-age children, especially those who have not been concussed? Because a reduced NPC is one important measure found with Convergence Insufficiency. Furthermore, research shows that those children with vision-based reading and learning problems also have a high frequency of oculomotor, accommodative and binocular vergence/accommodative problems!
Therefore, the importance of assessing binocular vision, plus additional sensorimotor areas, is critical to assessing those children with reading and learning problems. When the initial testing diagnosis identifies a reduced near point of convergence, it is essential to have a comprehensive sensorimotor and visual perceptual evaluation so that an accurate diagnosis can be made.
Once identified, as outlined by the American Optometric Association CPG-18, the best approach to treatment involves as comprehensive model of office-based vision therapy working one-on-one with a skilled vision therapist (typically 45-60 minutes 1-2 times per week in-office with assigned home support activities) in conjunction with lenses, prisms, and/or therapeutic tints prescribed and supervised by an experienced Doctor of Optometry in developmental vision and rehabilitation. Furthermore, it’s important to clarify that home-based models of treatment with periodic office-monitoring visits have been found by clinical trial research to be no better than a placebo in treating these conditions.
For more information check out the VisionHelp Vision and Learning Project.
Dan L. Fortenbacher, O.D., FCOVD