When students don’t see, they don’t learn
By Dan Allen
Dantallen@gmail.com
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Thirty-five hundred students who attend public elementary schools in the community school district that includes Hunts Point and Longwood have been classified as learning disabled. But for many of them, a hard-to-diagnose vision problem may account for some or all of their poor performance in school.
Even when the problem is found, Bronx students have limited access to treatment, ophtamologists say.
Convergence insufficiency, or CI, a condition of eye muscle weakness, makes it hard for both eyes to focus, or converge, on a single point at short distances.
Symptoms like eyestrain, blurred or double vision, headaches and fatigue affect students, especially when they read, write or look at a computer screen.
“How much can you get done in school if you constantly have to force yourself to focus? That’s just common sense,” said Dr. Judith E. Gurland, an ophthalmologist at Bronx-Lebanon Hospital Center’s eye clinic.
“It does not come up as frequently as it’s there. It’s not on people’s radar. If the first stop is an ophthalmologist and they miss it, it’s a big problem,” said Gurland, who uses a plush Cookie Monster toy to test children’s ability to converge.
CI can get worse when students have a cold or don’t get enough sleep. In addition, said Gurland medications prescribed for attention deficit disorder (ADD) can magnify the symptoms of CI. More rarely, she said, students are diagnosed with ADD when the real cause of their problem is that they can’t see clearly. In those cases, the medication makes things worse.
Various studies put the number of adults and children with convergence insufficiency at anywhere from 2.5 percent to 13 percent of the population of the United States.
It is the fifth most common vision problem among New York City students, according to Dr. Gina Cardone, a consulting optometrist for the Department of Health, who facilitates the vision screening of pre-k and first graders citywide.
Basic eye exams are not enough to catch CI. A person can test 20/20 and still suffer symptoms.
And because the ability to converge decreases with age, students who show no symptoms of CI may develop them as they grow into their teenage years.
Doctors disagree on the best treatment for CI, sometimes prescribing glasses with prismatic lenses that force the eyes to adjust and in some cases recommending surgery.
Then there’s vision therapy. Like any muscle, those surrounding the eye can be strengthened with exercise. With a daily workout for the eyes, many doctors believe that patients can surmount CI.
But for some Bronxites, treatment for CI could be hard to obtain. Most insurance plans do not cover vision therapy, and cost of courses offered by optometrists can reach into the thousands of dollars.
Dr. Gregory Rios, the only ophthalmologist with a full-time practice in Hunts Point, agrees that vision therapy is not readily available in the South Bronx. He said he refers patients with convergence insufficiency to the SUNY School of Optometry in Manhattan.
Additionally, vision therapy requires commitment to complete the proper exercises every day, a difficulty for busy parents and children.
“The biggest problem in New York is that parents are dealing with so many other things. It’s hard to attend to,” said Elizabeth Bogen, director of vision screening for the health department.
Even for the 20 percent of students who fail school vision screenings, further treatment is not always a given.
“We can only encourage parents to take their children for a full eye exam,” said Bogen, who recommends that all preschoolers see an eye doctor for a full check-up, even though it’
s not required by law.
As a result of CI, younger children may avoid reading; older students may show the lack of concentration associated with a behavioral disorder.
“The children don’t know that there’s anything wrong,” said Cardone.
Without knowing a patient’s detailed medical history, it could be hard to differentiate the symptoms of CI from other neurological problems that shorten attention span.
Because he sees so many patients, Rios, who has practiced at the Urban Health Plan clinic on Southern Boulevard for 11 years, cannot conduct these in-depth interviews.
“I’m not House,” said Rios, referring to the television character known for an uncanny ability to diagnose rare conditions with limited information.