Holding the phone too close?

Children with learning difficulties and differences seem to exist in a world of alphabet soup in their journey to succeed in school. ADD, ADHD, ASD, SLD, and APD are all acronyms that we come across frequently in the pursuit of answers, not to mention nebulous and frequently misunderstood terms like dyslexia, dysgraphia, and dyscalculia.  

In hopes that I can simplify the issue rather than add to the soup, I’d like to suggest considering one acronym higher on the list: CI. 

CI, or convergence insufficiency, is a developmental visual disorder that affects the clarity, consistency, and comfort of vision when focusing on things in our near visual space – reading, writing, using computers – most of what we do day-to-day. Though convergence insufficiency as a condition was first defined in the 1800s, there’s a reason your grandparents likely wouldn’t have heard of it.  

Take a moment to imagine yourself in a day in the life of one of your grandparents when they were kids. How much time did they likely spend looking at something within arms’ reach versus far away? Now compare that to kids, and even adults, these days. We’ve doubled, if not tripled or quadrupled, the amount of time we spend looking “up close” thanks to the universality of screens in our lives.  

But with the benefits of improved technology also comes consequences. 

For most people with “normally” developed vision, looking far away is relatively passive. The car is in neutral, so to speak – idling – when we view things farther than arm’s reach (think looking at the teacher at the front of the room, watching TV, etc). 

But when we look up close, we’re hitting the gas. And some people have more gas, and everyone’s car (and vision) gets different gas mileage. This is where convergence insufficiency comes in – a kid who gets less gas mileage out of their car is going to run out of gas sooner. 

Unfortunately, no kid is going to come up to their parent and say, “I think I have convergence insufficiency.” They might think they have ADHD. One study reports childrenwith CI are three times more likely to also have ADHD, and conversely, children with ADHD are three times more likely to have CI. They may also say, “I don’t like reading” or “school is hard.” 

So what are these signs? How can we help our children? 

The signs are fairly predictable when we understand what CI physically is. When we look in the distance, the lines of sight of the two eyes are roughly parallel. But as we shift our gaze to near, the eyes must cross inward toward the nose to converge the lines of sight on the same target. In some kids with CI, they can do this successfully, but with monumental effort compared to their classmates. Prolonged near work like reading is a true struggle for them. This results in fatigue, headaches, and eventually avoidance of near work, as it has become associated with pain and failure.  

Similarly, some kids simply won’t be able to fully align their eyes. When asked, they may report experiencing double or blurry vision when reading but may just as commonly report odd symptoms such as words floating, swimming, or jumping on the page. 

Luckily, unlike many conditions in the alphabet soup, CI is completely treatable.  

We take for granted that most of us see fairly effortlessly, especially when we are younger, but we weren’t born this way; we learned to do this. And for those who don’t naturally learn the most efficient way to do this, because this is an act of “sensory-motor coordination,” we can still be trained to do this properly, just as someone can be trained to ride a bike, say a tongue-twister, or run with better form.  

This is where developmental optometry comes in. 

Sometimes referred to as “behavioral optometrists” or “neuro-optometrists” depending on their training and approaches, developmental optometrists have additional post-doctoral training and experience in the learned aspects of vision, especially in rehabilitating them. Your typical eye exam consists of measuring the visual acuity of the eyes, testing for glasses to improve visual acuity, and checking for eye diseases. In a developmental evaluation, you will also be tested to assess your abilities to visually track from place to place, change the focus of your eyes, and adjust your eye teaming capabilities. This is also followed by testing visual perceptual abilities – the cognitive abilities that allow us to understand and use what we see, such as visual memory, visual-motor integration, and many other skills. 

Identifying areas that can be affecting academic performance and addressing them by teaching individuals to use their vision more efficiently and effectively can be life-altering.  

Not to mention, CI is not the only acronym a developmental vision evaluation will test for – BVD (Binocular Vision Dysfunction), OMD (Ocular Motor Dysfunction), AI (Accommodative Insufficiency), CE (Convergence Excess), and many others are possibilities.  

And if you’ve made it this far, you might have already realized that visual issues like these can affect performance when testing for things like ADHD and dyslexia. This reason alone should put seeing a developmental optometrist at the top of your list if your child is having learning difficulties, as it informs the entire process of identifying and tackling these difficulties head on.  

It is important to begin with visual testing because most other testing uses the visual system. If you are already having trouble seeing, you will by default have trouble seeing the psychoeducational tests and it can muddy the result. 

So if you or your child has any learning difficulties, make it a priority to see a developmental optometrist as soon as possible. 

Your closest developmental optometrist can be identified by using the Locate a Doctor tool provided by OVDRA, the professional organization that most developmental optometrists belong to at locate.covd.org. 

Dr. Jesse Willingham is a developmental optometrist and binocular vision expert at Brighter Outlook Vision in Charleston.