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Saturday / June 15.
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Children’s Vision for Health

The over prescribing of controversial Attention Deficit Hyperactivity Disorder (ADHD) drug Ritalin to incorrectly diagnosed children, may soon be rendered a thing of the past. As word spreads about the new Vision-2-Lean Program, which uses specialised computer and optical devices to treat children with convergence insufficiency (CI), often mistaken for ADHD, families are experiencing dramatic results.

Sydney optometrist Russel Lazarus is excited. Russel has treated about 400 children with learning difficulties, many even diagnosed as ADHD/ADD, with a 95 per cent success rate.

Russel is a practitioner of a system of unobtrusive treatments known as the Vision-2-Learn Program, developed by American eye specialist Professor Geoffrey Cooper. The program has revealed up to one quarter of children who are diagnosed with ADHD and prescribed the drug Ritalin, actually have a visual condition referred to as convergence insufficiency (CI).

Approximately 100 of the 400 children he has seen with learning difficulties have suffered from this common eye condition. Using a fun and simple computer program, the problem is easily treatable and life-changing.

If every child in the country had these tests, I think we would cut down on the number of Ritalin-taking kids diagnosed as ADHD/ADD, by as much as a quarter

According to Russel, every child in Australia should have their eyes tested at pre-school age – a simple series of tests which can quickly determine whether a child has any degree of visual deficiency, which might not be picked up under normal circumstances or mistaken for intellectual problems.

“If every child in the country had these tests, I think we would cut down on the number of Ritalin-taking kids diagnosed as ADHD/ADD, by as much as a quarter,” says Russel. “This research actually comes from eye specialists in America, not optometrists, who now say that every child diagnosed with ADHD should be automatically checked for convergence insufficiency. That’s coming from the medical professionals.”

Convergence insufficiency is an eye muscle disorder in which the eyes do not look at near objects easily, but display a strong tendency to drift outward when reading or doing close work (exophoria at near). If the eyes drift outward, the person is likely to encounter double vision. In a bid to prevent this from occurring, the individual exerts extra effort, inducing the eyes to turn back in (converge). This extra effort can lead to a number of frustrating symptoms which interfere with the ability to read and work comfortably when performing close work.


People who have convergence insufficiency may complain of the following difficulties when doing close work (i.e. reading, computer work, deskwork, playing handheld video games, craftwork):

  • eyestrain (especially with or after reading)
  • headaches
  • inability to concentrate
  • short attention span
  • frequent loss of place
  • squinting, rubbing, closing or covering an eye
  • blurred vision
  • sleepiness (especially while reading)
  • trouble remembering what was read
  • words appearing to move, jump, swim or float on the page
  • problems with motion sickness and/or vertigo
  • double vision

After graduating from university in 1990, Russel practised as a behavioural optometrist for several years, but increasingly became frustrated with established treatments.

“As part of my work I was doing therapy for these children and in doing that course, I found that it was a little outdated,” recalls Russel. “I thought there would probably be a better way of doing therapy for these kids instead of the old fashioned method, using the proto lenses and the string with beads on it.

“It didn’t quite gel with what I was practising, so I contacted a colleague in the U.S. I’d previously met, who suggested there must be a better way. He mentioned a new computerised program that was having amazing results, so I flew over there in 2002 to learn more. I did a course with the College of Optometrists in Vision Development, under the University of New York’s Professor Geoffrey Cooper, who developed the computerised eye exercises,” says Russel.

Fun treatment

Russel touts the element of fun, as being one of the main reasons behind the program’s success.

“The kids use three-dimensional glasses, are given scores and are rewarded with gold stars. It has just totally transformed the way we provide vision therapy.

I was amazed at its success and couldn’t believe how advanced the system was,” says Russel. “There are nine levels that the children are taken through, so they know what level they are on and how many stars they need in order to get to the next level. They’re playing a fun game and in doing so, it’s also aligning their eye muscles.”

Russel believes of all the visual problems he treats in children, the number one complaint is convergence insufficiency.

“When the muscles aren’t strong enough, you experience symptoms such as tiredness, headaches, lack of concentration, reading and comprehension problems. These symptoms become more evident when kids aren’t performing in school or aren’t getting the grades they should be.”

“The biggest mistake in making a diagnosis from these symptoms has been ADHD/ADD. In the past six months, we have seen more than 400 children who are a product of this program. We probably have a 95 per cent success rate because it’s fun. Children enjoy playing it and only need to spend eight minutes a day on the program. Parents don’t even have to be involved,” says Russel.

When determining whether or not a patient has a visual problem which may be contributing to other behavioural problems, Russel says the first step is to complete a vision test.

“Following this, we do a computerised test of convergence and an accommodation test, which is focusing. We also do tests on reading fluency. That way we can assess how the eye moves according to how the child reads,” explains Russel. “Once the test interprets the word and comprehension speeds we can make an assessment as to whether there is a visual component to what is going on.”

Research indicates that about 80 per cent of what the brain processes, is derived through vision. Consequently, a visual problem can have a marked effect on a whole range of different areas.

Studies into childhood vision conducted by the University of NSW, shows that one in four children has a visual problem pertaining to a multitude of disorders, including convergence, long-sightedness or accommodation. However, the majority tend to revolve around convergence problems.

Simple Fix

According to Russel, the problem is fairly simple to rectify. “Doing this program works in a similar way to going to the gym. After repeatedly performing these exercises, the eye’s muscles are working properly again and the kids can then get on with their lives and not have to worry about it any more.”

The Vision-2-Learn Program has proven to be so successful in the U.S., that six of its major universities are about to hold a major treatment trial, titled the Convergence Insufficiency Treatment Trial (CITT), to be carried out by eye surgeons and optometrists.

“I am very excited about the results we are getting with this program,” says Russel. When Professor Cooper lends his name to something, there’s a reason behind it. There’s a ton of research that he’s done on this program.”

The upcoming trial will possibly confirm that the way to treat convergence insufficiency is through the use of computerised eye exercises, believes Russel.

“In the past, the old system for kids tended to be somewhat boring, so they never enjoyed it and the exercises were never completed. Research shows that because they were never completed, there was not a great deal of success.

“We’ve had children improve their reading speed by up to four times as fast, while comprehension has almost doubled. We’ve seen young people who have been told to drop out of school at 14 or 15 due to disruptive behaviour, now represent model students. Two of these people are now studying medicine at university.”

Russel suggests every parent has his or her child’s eyes checked regularly. “It’s amazing how much children benefit in all ways once you get the eyes right. They should be checked in preschool, and then every two years during school.”

However, Russel explains that this is not always so simple.

“Sometimes when a child gets tested, they may be assured that they have 20/20 vision, and everything is fine, when there may in fact be other problems lurking beneath the surface,” explains Russel. “There is a big push by COVD in America to make sure that all children have their vision, convergence, accommodation and eye tracking checked.”

Routine eye exercises replace Ritalin

Jan Capra was so impressed with the results of Russel Lazarus’s vision therapy for her nine-year-old daughter Angela, that she telephoned Sydney’s Daily Telegraph Newspaper, so that others in the same position could also benefit from it.

That call resulted in not only a story about the wonders of the therapy and how much it had helped Angela, but left Russel inundated with enquiries.

“About five years ago, Angela was diagnosed with ADHD,” Jan recalls. “She was disruptive at school and found it difficult to concentrate and focus, prompting concern from worried teachers.”

Jan says she and husband Angelo had several meetings with their daughter’s teachers, who convinced them to see a behavioural child specialist who diagnosed Angela with ADHD.

“He prescribed Ritalin, but that was out of the question,” says Jan. “We were not prepared to give her a mind-altering drug which could have other side effects, such a liver damage”.

Jan, a dietician, decided to alter her daughter’s diet, cutting out foods with chemicals and preservatives. It did help, but not completely. Angela was still having problems concentrating and focusing.

“Eventually, we took Angela to an optometrist who tested her eyes and told us everything was alright. She had 20/20 vision.”

It was Jan’s sister who set the wheels in motion, by finding a program that would eventually allow Angela to have a normal life. She began researching ADHD/ADD on the Internet and discovered a U.S. website about convergence insufficiency and how its symptoms were often mistaken for ADHD.

“From there, we discovered this new vision therapy technique and discovered that Russel Lazarus was a practitioner,” says Jan.

“We first saw him less than a year ago and in the first ten minutes he diagnosed Angela as needing reading glasses. Russel suggested she use the glasses only when she felt it necessary,” says Jan. “After further tests, he diagnosed her with CI and gave her these computer exercises. It’s amazing how much it’s helped her to read and focus. It’s calmed her down and she’s a different girl now. She’s not easily upset or frustrated and her grades have improved markedly.”

Jan says her daughter still sees Russel regularly and she highly recommends that other parents go down this path before accepting a diagnosis of ADHD or ADD.

“I think everyone should do whatever they can for their kids before giving their kids Ritalin,” she says.

Russel says there are about 150 optometrists around Australia currently using the system. Each year he

travels interstate, educating other optometrists about its benefits.

For more information on the HTS program and other computerised VT programs go to www.visiontherapy.com.au or phone (AUS) 1-800-755-441.