In recent years, there has been substantial scientific research into the efficacy of vision therapy for the treatment of a wide variety of vision disorders such as convergence insufficiency, strabismus and amblyopia, among others. However, a controversy remains in the medical field about the effectiveness of vision therapy treatments. You want to do right by your patients, so you are reasonably skeptical, but you also are prudent enough to keep up on scientific advances.
There are many reasons why a child might need vision therapy:
- Convergence insufficiency (or CI)
- ADHD or ADD symptoms
- Low achievement in school
- Low self-esteem
And so forth. Our job as doctors is to ensure that each of our patients is well taken care of, and that we constantly seek out the best way to improve the lives of our patients.
Vision Therapy Effectiveness Proven in Randomized Clinical Trials
The truth is that much of the hesitancy about vision therapy is being evaporated through the use of controlled experiments. The Convergence Insufficiency Treatment Trial (CITT) effectively demonstrated that in-office vision therapy works better than a placebo treatment for the treatment of convergence insufficiency. This is not the only RCT to demonstrate vision therapy’s efficacy, but is one of the most widely published.
Strabismus Correction Surgery Unproven
Contrast the above with strabismus surgery. To date, there have been no RCTs on strabismus surgery outcomes. While there have been non-randomized studies, they do not sufficiently support strabismus correction surgery as a viable way to restore stereopsis in strabismus sufferers.
Would you trust a children’s medicine which had no placebo-controlled studies, and which had only a marginal success rate in the few non-randomized trials you could find?
This lack of research would almost certainly disqualify the medicine from use in your practice, yet strabismus correction surgery is considered by many pediatricians and physicians as the “best” way to correct strabismus. When there are RCTs which support vision therapy as a valuable tool in correcting vision disorders, and no such RCTs in support of strabismus correction surgery, the choice is clear: Vision therapy has been clinically proven to treat vision disorders.
Prism Glasses Are a Poor Solution for Convergence Insufficiency
Base-in prism glasses are often prescribed to help those with convergence issues. However, one study, “Convergence insufficiency and its current treatment” by Judith B. Lavrich demonstrated that the use of these glasses is not ideal except in patients with presbyopia: “Base-in prism glasses should be reserved for reduction of symptoms in the presbyopic population.” For children, Dr. Lavrich maintains that intensive vision therapy is the best solution to convergence insufficiency issues.
Children with ADHD Need More than Just Medicine
Adderall, Ritalin and other ADHD medications are prescribed so much throughout the United States as to create shortages of the drug, driving up costs for the families who have children so diagnosed with the disorder. The prevailing belief is that ADHD is simply being found more throughout the country as awareness of the disorder. However, what if people are lying on the ADHD self-surveys that you use to diagnose the disorder? Or, what if there is another reason that they are having these issues?
Studies Have Shown a Link between Convergence Insufficiency and ADHD Diagnoses
One study by Dr. David Granet, “The Relationship between Convergence Insufficiency and ADHD,” demonstrates that there is a 15.9% incidence of convergence insufficiency (CI) in those who have already been diagnosed with ADHD, compared to a 3.3% incidence of convergence insufficiency in the general population. A child who has been diagnosed with ADHD is therefore nearly five times more likely to be suffering from convergence insufficiency.
Convergence Insufficiency Sufferers Score High on Academic Behavior Surveys
A high ABS score is used as one of many tools to diagnose ADHD. However, one study shows that ABS scores are higher in convergence insufficiency sufferers than the general population, even when there is no parental report of ADHD. A mean score of 11.7 was present in convergence insufficiency sufferers without parental report of ADHD, as opposed to 8.7 for those with normal binocular vision.
Because of this, convergence insufficiency deserves to be suspected whenever a high ABS score would point to possible or probable ADHD, and a full vision screening with a developmental optometrist should be recommended.
Maybe the Child Needs Both
Even if the child is diagnosed with ADHD and Adderall or Ritalin has a positive effect, children who have symptoms of convergence insufficiency with parental report of ADHD scored higher on the ABS than children with parental report of ADHD without convergence insufficiency. As such, it is possible that the child needs both medication and vision therapy to treat what are really two problems with overlapping symptoms: ADHD and convergence insufficiency. A full vision screening will determine the presence of convergence insufficiency, and ensures that all areas of the child’s health are addressed.
Let us help. Dr. Tod Davis has over 30 years of experience as a developmental optometrist and vision therapy expert. By testing for occurrence of convergence insufficiency, we can better manage the symptoms of ADHD together. Call us today to learn more about convergence insufficiency, ADHD, and how we can help your practice.