NSU College of Optometry investigators awarded NIH grant to study convergence insufficiency

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The National Eye Institute of the National Institutes of Health has awarded up to $556,532 to investigators at Nova Southeastern University's College of Optometry to study the relationship between the vision condition, convergence insufficiency, and reading performance and attention.

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[Michael Molamphy]

Stupid waste of money. We already know the answer.

 

[Steven Nelson]

Stupid waste of money. We already know the answer.

That's really not the point. What is worthy of more study is the relationship between convergence insufficiency and ADHD. A study done in CA back in the late 90s showed that kids with a prior diagnosis of ADHD had an incidence of CI over 3 times the norm.

What I think would be some good that can come from it is to figure out whether they're related in their neural mechanisms. In other words, is the same thing that causes CI causing ADHD or vice versa. Plus I think it's good to have these studies in the forefront of the MD community as many of the meds they prescribe for ADHD can induce or exacerbate CI symptoms.

In addition to that, it's difficult to realize the full benefit of ADHD treatment without addressing the visual disorders affecting their sensory input and comprehension. For these kids, if they're having to work too hard to get the info in, they'll take the path of least resistance and teachers and parents are super quick to blame ADHD because "meds" are a simple fix and really, that's NOBODY'S fault.

What makes it tricky is that I personally believe the statistics are WAY off because most ODs and virtually NO OMDs check for these things in kids and literally never in adults. I know that when you're a hammer, everything looks like a nail, but when I did peds, I tested for this as part of my normal pediatric protocol and found it to be a lot more prevalent than literature indicates.

This was part of the talk I gave to the MD residents a month or so ago.

 

[James Jordan]

blondes have more fun, what about CI's ? Do they get any benefit or is it all gloom for them....especially if they have brown hair and brown eyes

 

[Steven Nelson]

blondes have more fun, what about CI's ? Do they get any benefit or is it all gloom for them....especially if they have brown hair and brown eyes

Oh yeah. Decreased attention span, decreased comprehension, poor grades, stigma, fatigue, behavioral disorder...it's just LOADS of fun.

 

[James Jordan]

sounds like gloom. I'd like to know of famous people that somehow managed to overcome untreated CI vs how many become plumbers. Maybe one day after meaningful use we can look that up.

 

[Steven Nelson]

sounds like gloom. I'd like to know of famous people that somehow managed to overcome untreated CI vs how many become plumbers. Maybe one day after meaningful use we can look that up.

Not gloom, just something that needs to be addressed. The upside is that the CI is easily treated.

 

[James Jordan]

When does one "treat" a CI? Is it when there are symptoms or findings or just a willing patient?

I wonder because what if we had 2 patients:

1) CI with "Decreased attention span, decreased comprehension, poor grades, stigma, fatigue, behavioral disorder"

2) no CI with "Decreased attention span, decreased comprehension, poor grades, stigma, fatigue, behavioral disorder"

How can we determine whether the CI is the issue in #1 or did we just miss some eye/vision problem in #2?

 

[Steven Nelson]

When does one "treat" a CI? Is it when there are symptoms or findings or just a willing patient?

I wonder because what if we had 2 patients:

1) CI with "Decreased attention span, decreased comprehension, poor grades, stigma, fatigue, behavioral disorder"

2) no CI with "Decreased attention span, decreased comprehension, poor grades, stigma, fatigue, behavioral disorder"

How can we determine whether the CI is the issue in #1 or did we just miss some eye/vision problem in #2?

Well, I would certainly avoiding treating a CI that isn't there.

Excepting that, all that I'm saying is that there's a possible link between AD(H)D and CI AND that you need to address CI, when present of course, to reap the full benefit of ADHD treatment. Not every symptomatic case is CI and one of the biggest problems with the criteria is that there are so many areas of overlap in the metrics. For example, when you compare the Convergence Insufficiency Symptom Survey with the DSM-IV criteria for ADHD, there are 5 of 9 symptoms that overlap (metrics 1, 2, 4, 6 and 8 listed below).

–Often does not give close attention to details or makes careless mistakes in schoolwork, work or other activities.
–Often has trouble keeping attention on tasks or play activities.
–Often does not follow instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions.
–Often avoids, dislikes or doesn’t want to do things that take a lot of mental effort for long periods of time such as schoolwork or homework.
–Is often easily distracted.​

How many things do those metrics above describe? Dr. Maria Lymberis(who was treasurer of the American Psychiatric Association at the time these comments were made some time after the study done by David Granet in 2005) said the following:

“I wouldn’t be surprised at all if a relationship between the two disorders is eventually proven to exist. It’s not exactly a new idea. The brain is not one uniform thing. It is many centers with many different highly specialized functions. So, if you’re having a problem even in a relatively minor part of the circuitry, it can affect your overall performance.”​

It's that potential roadblock in the neural pathways that needs to be addressed and we have a role in that. Your comment about whether you're just looking for someone "willing" implies that it's a scam. Is that what you're thinking?

 

[James Jordan]

I'm not implying scam but I feel some OD's might have convinced themselves that CI needs to be treated.

If a patient has some amt of CI that you feel could be remedied with treatment, do you overcome objections by suggesting that their CI might be the cause of their behavior? Thus you have "willed" them to follow your recommendations even though they had no complaint?

Is male behaviour more likely to have a CI component?

How do you know behaviour is related to CI?

I don't know who to believe since I think a lot of society wants behaviours to be treated when we can't find a better outlet for them.

 

[Steven Nelson]

I'm not implying scam but I feel some OD's might have convinced themselves that CI needs to be treated.

If a patient has some amt of CI that you feel could be remedied with treatment, do you overcome objections by suggesting that their CI might be the cause of their behavior? Thus you have "willed" them to follow your recommendations even though they had no complaint?

Is male behaviour more likely to have a CI component?

How do you know behaviour is related to CI?

I don't know who to believe since I think a lot of society wants behaviours to be treated when we can't find a better outlet for them.

I think you have to look at the overall presentation. CI DOES have some objective findings, so it's not like you're just guessing. How much of the symptomology is CI and how much is the other is really the question, isn't it? I have to wonder if CI isn't just a peripheral symptom of ADHD.

One of the biggest flys in the ointment is that many of the meds prescribed for ADHD can induce CI and most MDs don't get evaluations first, so sometimes it really IS a guess. Not whether there's CI or even whether to treat it, but rather which came first?


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[Michael Molamphy]

The National Eye Institute of the National Institutes of Health has awarded up to $556,532 to investigators at Nova Southeastern University's College of Optometry to study the relationship between the vision condition, convergence insufficiency, and reading performance and attention.

Continue reading...

After extensive study, blowing over 1/2 million$$ the researchers will reveal astounding results that CI can interfere with reading and learning. Darn it, I should have known. Then they will suggest that more studies are needed. Perhaps they can apply for a full $1 M study grant to study the study and endlessly study the issue.

 

[James Jordan]

I'll have to look that up...ADHD meds causing CI (or worsening?). That's interesting. Is that true for adults as well...ADHD meds causing CI for them?

I think you have to look at the overall presentation. CI DOES have some objective findings, so it's not like you're just guessing. How much of the symptomology is CI and how much is the other is really the question, isn't it? I have to wonder if CI isn't just a peripheral symptom of ADHD.

One of the biggest flys in the ointment is that many of the meds prescribed for ADHD can induce CI and most MDs don't get evaluations first, so sometimes it really IS a guess. Not whether there's CI or even whether to treat it, but rather which came first?


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[Steven Nelson]

After extensive study, blowing over 1/2 million$$ the researchers will reveal astounding results that CI can interfere with reading and learning. Darn it, I should have known. Then they will suggest that more studies are needed. Perhaps they can apply for a full $1 M study grant to study the study and endlessly study the issue.

You think that's the point of the study? To determine that CI interferes with reading?

Is anyone actually reading the link before they post? What they're studying is the link between CI and ADHD and how they combine to interfere with learning to help design more effective treatment for reading disorders.

 

[Steven Nelson]

I'll have to look that up...ADHD meds causing CI (or worsening?). That's interesting. Is that true for adults as well...ADHD meds causing CI for them?

It's true for both, but it manifests more for kids because they read for "comprehension" on a scale that most adults don't do for extended periods unless they're in educational programs.

We really need to jump on this because it's an area we can totally own AND work cooperatively with medicine making HUGE differences for these kids. This is a life changer for most of them.

 

[Brittney McWilliams]

It's true for both, but it manifests more for kids because they read for "comprehension" on a scale that most adults don't do for extended periods unless they're in educational programs.

We really need to jump on this because it's an area we can totally own AND work cooperatively with medicine making HUGE differences for these kids. This is a life changer for most of them.

Agreed. I see a large amount of peds and it seems that half of them are on ADHD meds. I ask every patient and parent if they were told of any visual side effects of their medications. I think I've had 1 parent in the past 2 years that had any idea what I was talking about.

Many of these kids never even had a vision exam before starting these meds! I can't wrap my head around it no matter how many times a day I see it.


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[Steven Nelson]

Agreed. I see a large amount of peds and it seems that half of them are on ADHD meds. I ask every patient and parent if they were told of any visual side effects of their medications. I think I've had 1 parent in the past 2 years that had any idea what I was talking about.

Many of these kids never even had a vision exam before starting these meds! I can't wrap my head around it no matter how many times a day I see it.


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Half of the pediatricians in my lecture said it never even occurred to get their eyes checked for this. They have them read a chart, if they see 20/30 or better, they just assume it's not the eyes.