CI: The Private Eye Goes Public – Part 1

As concerned parents we all want the best for our children. This is particularly true when it deals with a health related issue. If you have a sick child with a disorder that needs a doctors attention, you expect that your doctor will make the correct diagnosis and provide treatment or advise you where to obtain treatment that will successfully resolve your child’s problem.

Certainly in cases involving life and death there is no tolerance for error. We will not accept a “go home, give him a couple aspirin and call me back in a couple months if it’s not better” approach for a child with raging pneumonia. Yet for other medical matters of children’s health care, particularly certain types of  eye disorders this could be the  response you hear from your eye doctor.

What? How could a child in the year 2010  be suffering from a significant eye disorder in the US and yet have a  high probability that the  disorder will not be  recognized and properly managed by a large percentage of eye doctors?

This is exactly what we will be investigating in this series – CI: The Private Eye Goes Public. The topical acronym “CI” does not stand for “criminal investigation”, rather it refers to the name of the eye disorder in question. This eye disorder is not rare. As a matter  fact research shows this vision disorder is found in 1 out of 12 children. It is found in a category of disorders involving the successful neuromuscular control of the two eyes, thus referred to as a dysfunction of binocular vision. It has a medical ICD-9-CM diagnosis code (378.83). The symptoms of this binocular vision disorder can range from mild to severe, but usually deteriorates over time. The common symptoms usually occur when the child attempts to sustain a near-centered visual task, such as reading, computers and/or paper pencil tasks. The child with this condition usually suffers from fatigue, frontal headaches, loss of concentration, periodic blurry and doubling (overlapping) of words when  reading . It is common for the child with the condition to have stress related side-effects that result in emotional upset and/or avoidance behaviors associated with the near-centered visual work.

The name of this common binocular vision disorder in children is called Convergence Insufficiency. Affecting as much as 8% of the pediatric population, CI is more common than glaucoma in children. It is more common than amblyopia in children.

The actual prevalence of Glaucoma in children is 1 in 43,575. The prevalence of Amblyopia in children is 1 in 50. The prevalence of Convergence Insufficiency is 1 in 12!

CI has been the focus of a massive research effort  for over 10 years by the Convergence Insufficiency Treatment Trialstudy group. This NEI research was funded by the Federal Government (NIH) to the tune of over $6.1 million to study this condition in multicenter sites including the Mayo Clinic, Bascom Palmer and 6 Colleges of Optometry around the US.  The results of these landmark studies has been to identify the treatments that work and those that don’t work for the treatment of this common eye disorder that affects 1 in 12 children.

In this series, I will join with Dr. Leonard Press to help address the issues and answer the questions about why patients with Convergence Insufficiency are often marginalized even when the NEI research clearly spells out the importance of diagnosis and outlines the appropriate treatment protocols. Likewise, the American Optometric Association has established clearly defined Clinical Practice Guidelines entitled: Care of the Patient with Accommodative and Vergence Dysfunction.

Yet the questions persist about why some doctors overlook the patient with CI:

  • Could it be lack of training?
  • Could it be the lack of a viable delivery system for treatment in the doctor’s office or referral network?
  • Could it be that the doctor doesn’t care?
  • Could it be that the eyecare professions don’t emphasize it in the journals or the doctor’s continuing education?
  • Could it be because some organizations like the AAP, AAO and the AAPOS trivialize CI by lumping it in with LD and dyslexia thereby giving CI (and the treatment for CI) a misleading and  “controversial bias”?

As a result of this investigational reporting… CI: The Private Eye Goes Public we will be exploring these questions and providing answers. In the mean time,  if you are a parent (or know of a parent) who has a story to tell of a child who is or was suffering (but finally found help) from Convergence Insufficiency, would you please share your story with us in the comment section below? It could be very useful for other parents to read as well as for your humble correspondents, Dr. Press and Dr. Fortenbacher, who will continue to launch this investigative report on why your child with Convergence Insufficiency may be overlooked by your doctor.

We await your comments!

Dan L. Fortenbacher, O.D, FCOVD