12/8/09 1:20 PMNot Autistic or Hyperactive. Just Seeing Double at Times - New York TimesPage 1 of 3http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
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Thor Swift for The New YorkTimes
Not Autistic or Hyperactive. Just Seeing Double atTimes
By LAURA NOVAKPublished: September 11, 2007
A s an infant, RaeaGragg was withdrawn and could not mak e eye
contact. By preschool she needed to smell and squeeze every object
she saw.“She touchedfaces andw ould bring
everything to mouth,” said hermother, Kara Gragg, of Lafayette,Calif. “She would go up to people,sniff them and touch their cheeks.”Specialists conducted a battery of
tests. The possible diagnosesmounted:autism spectrumdisorder, neurof ibromatosis,
attention-def icit hyperactivity disorder, anxiety disorder. A behavioral pediatrician prescribed three drugs for attention deficit anddepression.The only constantw as that Raea, now 9, did anything she could to avoid reading and
writing.Though she had already had two eye exams, finding her vision was 20/20, this year aschool reading specialist suggested another. And this time the optometrist did what noone else had: he put his finger on Raea’s nose and moved it in and out. Her eyes jumpedall over the place. Within minutes he had the diagnosis: convergence insufficiency, in which the patientsees double because the eyes cannot work together at close range.Experts estimate that 5 percent of school-age children have convergence insufficiency.They can suffer headaches, dizziness and nausea, which can lead to irritability, low self-esteem and inability to concentrate.Doctors and teachers often attribute the behavior to attention disorders or seek othermedical explanations. Mrs. Gragg said her pediatrician had never heard of convergenceinsufficiency.Dr. David Granet, a professor of ophthalmology and pediatrics at theUniversity of California, San Diego, said: “Everyone is familiar with A.D.H.D.and A.D.D., but not with
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12/8/09 1:20 PMNot Autistic or Hyperactive. Just Seeing Double at Times - New York TimesPage 2 of 3http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
eye problems, especially not with convergence insufficiency. But we don’t want to sendkids for remedial reading and education efforts if they have an eye problem. This should be part of the protocol for eye doctors.”In 2005, Dr. Granet studied 266 patients with convergence insufficiency. Nearly 10percent also had diagnoses of attention deficit or hyperactivity — three times that of thegeneral population. The reverse also proved true: examining the hospital records of 1,700children with A.D.H.D., Dr. Granet and colleagues found that 16 percent also hadconvergence insufficiency, three times the normal rate.“When five of the symptoms of A.D.H.D. overlap with C.I.,” he said, “how can you notstep back and say, Wait a minute?”Dr. Eric Borsting, an optometrist and professor at the Southern California College of Optometry who has also studied the links between vision and attention problems,agreed. “We know that kids with C.I. are more likely to have problems like loss of concentration when reading and trouble remembering what they read,” he said. “Doctorsshould look at it when there’s a history of poor school performance.”Dr. Stuart Dankner, a pediatric ophthalmologist in Baltimore and an assistant clinicalprofessor at Johns Hopkins, said that children should be tested for convergencedifficulty, but cautioned that it was not the cause of most attention and readingproblems.Dr. Dankner recommended an overall assessment by a psychologist or educationspecialist. “An eye exam should be done as an adjunct,” he said, “because even if thechild has convergence difficulty, they will usually also have other problems that need to be addressed.”Doctors recommend a dilated eye exam and a check of eye teaming and focusing skills.Testing includes using a pen or finger to test for the “near point of convergence,” as wellas a phoropter, which uses lenses and prisms to test the eyes’ ability to work together.There is no consensus on how to treat convergence insufficiency. Next spring, theNational Eye Institute will announce the results of a $6 million randomized clinical trialmeasuring the benefits of vision therapy in a doctor’s office versus home-based therapy.For Raea Gragg, the treatment was relatively simple. For nine months she wore specialglasses that use prisms to help the eyes converge inward. She then had three months of vision therapy. She has just entered fourth grade and is reading at grade level.“Raea didn’t know how to describe it because that’s all she’s ever known,” her mothersaid. “She felt like she had been telling us all along that she couldn’t see, but nobody listened.”
Correction: October 4, 2007
An article in Science Times on Sept. 11 about convergence insufficiency, in which apatient sees double because the eyes cannot work together at close range, misidentified
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