Not Autistic or Hyperactive. Just Seeing Double at Times

Not Autistic or Hyperactive. Just Seeing Double at Times



Published: September 11, 2007

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As an infant, Raea Gragg was withdrawn and could not make eye contact.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.



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.”

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 self-esteem 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 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.”

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.

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 doctor, Carl Hirsch, who was not identified in the article, is an optometrist, not an ophthalmologist.

3D Movies May Cause or Reveal Vision Issues



Submitted by Denise Reynolds RD on 2010-07-14

The technology for 3D movies has come a long way since the first American color feature Bwana Devil in 1952. However, one issue hasn’t changed over the years – eye-related health issues can be a problem for some viewers.

Stephen Glasser, a Washington optometrist, says that more people may discover eye problems as 3D movies become more mainstream. According to the National Association of Theatre Owners, almost 10% of US movie screens are now capable of projecting in 3D, up from 1.5% in 2007. There are approximately 20 3D movies set to release in 2010.

Television is also going 3D. ESPN has launched a 3D channel, which broadcast 18 of the World Cup soccer matches, and Discovery plans their own channel in early 2011.

To generate a three-dimensional effect, a special projector displays two identical images on the screen, but from slightly different angles making one appear close and the other to appear far away. Special polarized glasses are worn that force one of the images to enter the left eye and the other to enter the right. The two images travel to the visual cortex, the area of the brain primarily responsible for processing vision. This creates the illusion of three dimensions.

Early 3D movies used color to set the images apart, and viewers wore paper glasses with one lens colored red and the other colored blue. These tended to give viewers headaches, eyestrain, and nausea.

Today’s 3D with digital technology gives crisper, clearer images and fewer problems, however there is still a risk of visual fatigue and “simulator sickness”, a type of nausea that also plagues users of flight simulators, head-mounted virtual reality displays and other 3D applications.

In Italy, the ministry of health has other concerns about 3D movies – specifically the cleanliness of the borrowed glasses. They confiscated 7000 pairs of 3D glasses from cinemas, stating that they were not properly disinfected between screenings and lacked tags that proved that they do not cause vision problems. When seeing a 3D movie here in the States, it is best to carry an antibacterial spray or wipe – just in case.

3D can have some advantages – some patients actually discover health problems because they are unable to see the images clearly. About 2 to 3 percent of people have an eye condition where only one of the eyes turns inward to track a close object. The condition is called vergence accommodation conflict. Other conditions that cause 3D movies to fall flat include lazy eye (amblyopia), strabismus, keratoconus, or poor vision in one eye due to cataracts, glaucoma or retinal problems.

Treatments for eye conditions that cause 3D vision viewing include surgery for cataracts or glasses/contacts to correct poor vision in one eye. There is also vision therapy for those with convergence insufficiency, where the patient spends an hour once a week doing eye-strengthening exercises