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Not Autistic or Hyperactive. Just Seeing Double at Times - New York Times
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Not Autistic or Hyperactive. Just Seeing Double at Times
Dr. Atul Gawande on Paying for a Health Care Overhaul
By LAURA NOVAK Published: September 11, 2007
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As an infant, Raea Gragg was withdrawn and could not make eye contact. By preschool she needed to smell and squeeze every object she saw. Enlarge This Image
Thor Swift for The New York Times
Raea Gragg, 9, needed therapy to help her eyes work together.
“She touched faces and would bring everything to mouth,” said her mother, Kara Gragg, of Lafayette, Calif. “She would go up to people, sniff them and touch their cheeks.”
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Specialists conducted a battery of tests. The possible diagnoses mounted: autism spectrum disorder, neurofibromatosis, attention-deficit hyperactivity disorder, anxiety disorder.
A behavioral pediatrician prescribed three drugs for attention deficit and depression. The only constant was 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 a school reading specialist suggested another. And this time the optometrist did what no one else had: he put his finger on Raea’s nose and moved it in and out. Her eyes jumped all over the place. Within minutes he had the diagnosis: convergence insufficiency, in which the patient sees 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 selfesteem and inability to concentrate. Doctors and teachers often attribute the behavior to attention disorders or seek other medical explanations. Mrs. Gragg said her pediatrician had never heard of convergence insufficiency. Dr. David Granet, a professor of ophthalmology and pediatrics at the University of California, San Diego, said: “Everyone is familiar with A.D.H.D. and A.D.D., but not with eye problems, especially not with convergence insufficiency. But we don’t want to send http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
Page 1 of 3
Not Autistic or Hyperactive. Just Seeing Double at Times - New York Times
12/8/09 1:20 PM
eye problems, especially not with convergence insufficiency. But we don’t want to send kids 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 10 percent also had diagnoses of attention deficit or hyperactivity — three times that of the general population. The reverse also proved true: examining the hospital records of 1,700 children with A.D.H.D., Dr. Granet and colleagues found that 16 percent also had convergence 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 not step 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. “Doctors should look at it when there’s a history of poor school performance.”
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Dr. Stuart Dankner, a pediatric ophthalmologist in Baltimore and an assistant clinical professor at Johns Hopkins, said that children should be tested for convergence difficulty, but cautioned that it was not the cause of most attention and reading problems.
Tips to lower your cholesterol.
Dr. Dankner recommended an overall assessment by a psychologist or education specialist. “An eye exam should be done as an adjunct,” he said, “because even if the child 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 well as 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, the National Eye Institute will announce the results of a $6 million randomized clinical trial measuring 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 special glasses 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 mother said. “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 a patient sees double because the eyes cannot work together at close range, misidentified the specialty of the doctor who diagnosed and treated the problem in Raea Gragg. The
http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
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Page 2 of 3
Not Autistic or Hyperactive. Just Seeing Double at Times - New York Times
12/8/09 1:20 PM
the specialty of the doctor who diagnosed and treated the problem in Raea Gragg. The doctor, Carl Hirsch, who was not identified in the article, is an optometrist, not an ophthalmologist. Sign in to Recommend
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Tips To find reference information about the words used in this article, double-click on any word, phrase or name. A new window will open with a dictionary definition or encyclopedia entry. Past Coverage Not Autistic or Hyperactive. Just Seeing Double at Times (September 11, 2007) REALLY? (July 4, 2006) Assemblyman Takes Aim At City Rules on 3rd Graders (April 20, 2004) Video-Game Killing Builds Visual Skills, Researchers Report (May 29, 2003) Related Searches Reading and Writing Skills Eyes and Eyesight Medicine and Health Attention Deficit Hyperactivity Disorder
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Welcome to TimesPeople
TimesPeople Lets You Share and Discover the Best of NYTimes.com Recommend1:20 PM
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12/8/09 1:20 PM
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Not Autistic or Hyperactive. Just Seeing Double at Times
Dr. Atul Gawande on Paying for a Health Care Overhaul
By LAURA NOVAK Published: September 11, 2007
A Workout in a Shoe SIGN IN TO RECOMMEND
Correction Appended
As an infant, Raea Gragg was withdrawn and could not make eye contact. By preschool she needed to smell and squeeze every object she saw. Enlarge This Image
Thor Swift for The New York Times
Raea Gragg, 9, needed therapy to help her eyes work together.
“She touched faces and would bring everything to mouth,” said her mother, Kara Gragg, of Lafayette, Calif. “She would go up to people, sniff them and touch their cheeks.”
E-MAIL SEND TO PHONE PRINT
December 8, 2009, 10:31 AM December 7, 2009
When New Fathers Get Depressed December 7, 2009
Spotting Depression in Adolescents December 7, 2009
A Makeover for Food Labels December 7, 2009
REPRINTS SHARE
Sophisticated Shopper Deals by E-Mail Sign up for shopping deals from NYTimes.com's premier advertisers. See Sample
[email protected] Change E-mail Address | Privacy Policy
Specialists conducted a battery of tests. The possible diagnoses mounted: autism spectrum disorder, neurofibromatosis, attention-deficit hyperactivity disorder, anxiety disorder.
A behavioral pediatrician prescribed three drugs for attention deficit and depression. The only constant was 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 a school reading specialist suggested another. And this time the optometrist did what no one else had: he put his finger on Raea’s nose and moved it in and out. Her eyes jumped all over the place. Within minutes he had the diagnosis: convergence insufficiency, in which the patient sees 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 selfesteem and inability to concentrate. Doctors and teachers often attribute the behavior to attention disorders or seek other medical explanations. Mrs. Gragg said her pediatrician had never heard of convergence insufficiency. Dr. David Granet, a professor of ophthalmology and pediatrics at the University of California, San Diego, said: “Everyone is familiar with A.D.H.D. and A.D.D., but not with eye problems, especially not with convergence insufficiency. But we don’t want to send http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
Page 1 of 3
Not Autistic or Hyperactive. Just Seeing Double at Times - New York Times
12/8/09 1:20 PM
eye problems, especially not with convergence insufficiency. But we don’t want to send kids 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 10 percent also had diagnoses of attention deficit or hyperactivity — three times that of the general population. The reverse also proved true: examining the hospital records of 1,700 children with A.D.H.D., Dr. Granet and colleagues found that 16 percent also had convergence 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 not step 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. “Doctors should look at it when there’s a history of poor school performance.”
Health & Fitness Tools BMI Calculator What's your score? » Calorie Calculator for Goal Weight What's your limit? »
Dr. Stuart Dankner, a pediatric ophthalmologist in Baltimore and an assistant clinical professor at Johns Hopkins, said that children should be tested for convergence difficulty, but cautioned that it was not the cause of most attention and reading problems.
Tips to lower your cholesterol.
Dr. Dankner recommended an overall assessment by a psychologist or education specialist. “An eye exam should be done as an adjunct,” he said, “because even if the child 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 well as 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, the National Eye Institute will announce the results of a $6 million randomized clinical trial measuring 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 special glasses 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 mother said. “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 a patient sees double because the eyes cannot work together at close range, misidentified the specialty of the doctor who diagnosed and treated the problem in Raea Gragg. The
http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
LEARN MORE »
MOST POPULAR - HEALTH E-MAILED
BLOGGED
1. Mind: Postpartum Depression Strikes Fathers, Too 2. Well: Firm Body, No Workout Required? 3. 18 and Under: Hard Questions to Ask After a Cry for Help 4. Patient Money: Knowing What’s Worth Paying For in Vitamins 5. Personal Health: Shedding Light on a Tremor Disorder 6. Recipes for Health: Breakfasts Rich With Grains 7. Recipes for Health: Steel-Cut Oatmeal With Fruit 8. Fitness: Becoming Your Own Massage Therapist 9. Well: 10 Video Games to Cross Off Your Child’s Gift List 10. Well: How Safe Is Your Chicken Dinner? Go to Complete List »
Page 2 of 3
Not Autistic or Hyperactive. Just Seeing Double at Times - New York Times
12/8/09 1:20 PM
the specialty of the doctor who diagnosed and treated the problem in Raea Gragg. The doctor, Carl Hirsch, who was not identified in the article, is an optometrist, not an ophthalmologist. Sign in to Recommend
More Articles in Health »
Subscribe to Times Reader 2.0 and get $100 off a Samsung GoTM netbook
Ads by Google
what's this?
ADHD Teen Boarding School Enrollments Accepted Year Round. Student Loans up to 100%. OCRS.com/Arizona-Boarding-School
ADVERTISEMENTS
Fix Child Behavior Get kids with ADD/ADHD to behave. Trusted parenting tool that works! www.TheTotalTransformation.com/ADHD
Kidspace Pediatric Occupational Therapy Assessment & Treatment in SF www.kidspacetherapy.com
Tips To find reference information about the words used in this article, double-click on any word, phrase or name. A new window will open with a dictionary definition or encyclopedia entry. Past Coverage Not Autistic or Hyperactive. Just Seeing Double at Times (September 11, 2007) REALLY? (July 4, 2006) Assemblyman Takes Aim At City Rules on 3rd Graders (April 20, 2004) Video-Game Killing Builds Visual Skills, Researchers Report (May 29, 2003) Related Searches Reading and Writing Skills Eyes and Eyesight Medicine and Health Attention Deficit Hyperactivity Disorder
INSIDE NYTIMES.COM T MAGAZINE»
HEALTH »
OPINION »
SPORTS »
OPINION »
BOOKS »
Room for Debate: The Food Stamp Economy
See the New Look of T Magazine Home
World
U.S.
As more people receive aid, should the rules be aimed at promoting better nutrition?
Well: Firm Body, No Workout Required? N.Y. / Region
Business
Technology
Copyright 2007 The New York Times Company
Science
Privacy Policy
Health Search
http://www.nytimes.com/2007/09/11/health/11visi.html?_r=1&oref=slogin
Still Counting the Ways to Infiltrate Daily Lives
For Volleyball Coach, the Streak Is Beside the Point
Sports Corrections
Opinion
Arts
RSS
Style First Look
Op-Ed: Coverage Without Borders Travel Help
Jobs
Real Estate
Contact Us
Ken Auletta depicts Google as a behemoth that can be both naïve and arrogant in its dealings with the world.
Automobiles
Work for Us
Back to Top
Site Map
Page 3 of 3
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