Kids’ eye problems often emerge in homework battle

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Posted on 27th October 2008 by gjohnson in Uncategorized

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Date: 10/27/2008

By LAURAN NEERGAARD
AP Medical Writer


WASHINGTON (AP) _ Your 9-year-old’s eyes hurt during homework? Your teen’s a slow reader plagued with headaches? They may have a common yet often missed vision problem: Eyes that don’t turn together properly to read.

As many as one of every 20 students have some degree of what eye doctors call “convergence insufficiency,” or CI, where eye muscles must work harder to focus up-close. And those standard vision screenings administered by schools and pediatricians won’t catch it — they stress distance vision.

When symptoms such as eye strain, headaches, double vision or reading problems trigger the right diagnosis, doctors prescribe any of a hodgepodge of exercises designed to strengthen eye coordination. Now a major government study finally offers evidence for the best approach: Eye training performed in a doctor’s office for 12 weeks.

The right treatment can make a profound difference, says Adele Andrews of Rydal, Pa., whose son Thomas participated in the study when he was 10 — and improved enough to at last start reading for fun.

His mother knew something wasn’t right early on: Reading seemed to require a physical struggle of Thomas that his three older siblings never experienced.

“He always wanted to buy books but he wouldn’t read them. He wanted to but it was too hard for him,” she recalls.

Then homework began and “I don’t even want to tell you how bad it was,” Andrews adds. “He would get frustrated. He wouldn’t do it. … I tried bribery, I tried everything. It got to the point where it was just a battle.”

Why? To bring print or other close-in work into focus, both eyes must turn slightly inward, or converge. As its name implies, convergence insufficiency means the eyes aren’t doing that properly. Words may appear blurry or double, or disappear as readers lose their place. How much extra effort eye muscles must exert to compensate and bring that image into focus determines whether someone has obvious symptoms and how bad they are.

Complaints are rare in very young children because pictures and large type don’t require as much convergence. Parents tend to start noticing a problem once homework and deeper reading begins. Some people complain only in the teen or college years, perhaps when their workload outpaces their ability to compensate. Others find they can read with one eye closed and do fine.

Nor does everyone experience obvious symptoms. How many compensate enough that CI truly doesn’t matter — and how many quietly try to avoid reading? No one knows.

Dr. Mitchell Scheiman of the Pennsylvania College of Optometry at Salus University is suspicious when a child’s “behavior is, ‘I don’t want to read, I don’t like reading, I can’t concentrate.” His advice then: “Just rule it out.”

Diagnosis requires seeing an ophthalmologist or optometrist trained to treat children who can measure convergence with some simple tests such as moving a pencil steadily closer to the nose until the person sees double.

But which treatment works best: The most commonly prescribed “pencil push-ups,” practicing that pencil-to-nose test at home? At-home computer eye games? Or more varied eye exercises, including computer-based ones, performed in a doctor’s office with at-home techniques for reinforcement?

A study funded by the National Eye Institute aimed to find out, by randomly assigning 221 9- to 17-year-olds to one of those approaches or to a control group given “dummy” exercises at the doctor’s office.

Three months later, nearly three-quarters of the office-treated patients had greatly improved — compared with no more than 43 percent of home-treated patients, Scheiman and colleagues report in this month’s Archives of Ophthalmology. The study will continue tracking patients for a year, to ensure the benefit lasts.

At roughly $75 a visit, office treatment is clearly more expensive. Why would it work better? First, they got more intense treatment. The NEI’s Dr. Brian Brooks says a combination of more varied in-office exercises may hold a child’s attention better — along with a doctor acting like a personal trainer, ensuring the youngster does each technique properly and doesn’t slack off.

What’s not clear is the more intricate in-office techniques could be adapted for home use and work just as well, he cautions.

But Andrews witnessed the difference between the two techniques as they’re practiced today. Thomas was originally assigned to pencil push-ups but improved only slightly. After his 12 study weeks were over, researchers switched him to office-based treatment — and his mother saw a rapid lessening of the homework battles.

Today at 13, Thomas has “become pretty serious about his schoolwork,” says a relieved Andrews. “He’s going to do OK.”

___

EDITOR’s NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Copyright 2008 The Associated Press.

EPA tightens health standard for airborne lead

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Posted on 24th October 2008 by gjohnson in Uncategorized

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Date: 10/16/2008 7:30 PM

By DINA CAPPIELLO
Associated Press Writer


WASHINGTON (AP) _ Three decades after removing lead from gasoline, the Environmental Protection Agency is slashing the amount of the toxic metal that will be allowed in the nation’s air by 90 percent.

EPA officials, under a federal court order to set a new standard by midnight Wednesday, said the limit would better protect public health, especially for children. They can inhale lead particles released from smelters, mines and waste incinerators and ingest it after it settles on surfaces.

Exposure to even low levels of lead early in life can affect learning, IQ and memory in children. Lead can cause cardiovascular, blood pressure and kidney problems in adults.

“Our nation’s air is cleaner today than just a generation ago, and last night I built upon this progress by signing the strongest air quality standards for lead in our nation’s history,” the EPA chief, Stephen Johnson, said Thursday. “Thanks to this stronger standard, EPA will protect my children from remaining sources of airborne lead.”

The new limit, 0.15 micrograms per cubic meter, is the first update since 1978, when the government helped phase out leaded gasoline. It is 10 times lower than the old standard, 1.5 micrograms per cubic meter.

The EPA estimates that 18 counties in a dozen states will violate the new standard. That means state and local governments must find ways to further reduce lead emissions.

The new limit is in the lower end of a range recommended in May by the agency’s independent scientific advisory panel. By contrast, the Bush administration did not follow its own staff’s advice or its science advisers when it set health standards for smog and soot that were less stringent than recommendations.

The EPA also said it would require lead to be measured in 101 cities and near sources that release at least 1 ton of lead per year.

A representative for the Association of Battery Recyclers said the new standard would be difficult to meet. Several members of the group, which represents 14 facilities that recycle lead from car batteries, met two weeks ago with White House and EPA officials to seek a less stringent standard.

“We have put in the best controls and we are going to still have compliance problems,” said Robert Steinwurtzel, a lawyer for the group. “We explained to them our concerns that if the standard was promulgated at lower end of EPA’s range it would threaten viability of industry.”

Environmentalists hailed the move but said the agency could have done more to monitor emissions and ensure the standard is met.

“We commend EPA for taking a giant step in the right direction, but they need to greatly expand the lead monitoring network if they hope to enforce this standard,” said Dr. Gina Solomon, a senior scientist with the Natural Resource Defense Council.

The EPA will designate areas that fail to meet the new standard by October 2011. Based on air quality data from collected from 2005-2007, 18 counties in Alabama, Colorado, Florida, Illinois, Indiana, Minnesota, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Texas would fail to meet the standard.

The EPA said the cost of the reductions would be between $150 million to $2.8 billion, but the standard would produce economic benefits of $3.7 billion to $6.9 billion. In calculating the benefits, the agency assumed that children would be smarter and earn more money as a result of less lead in the air.

The government was under a court order to review the standard after a 2004 lawsuit by the Missouri Coalition for the Environment on behalf of two former residents of Herculaneum, Mo., the home of the last lead smelter in the U.S. The smelter repeatedly has violated the older health standard for lead in recent years. Blood taken from children in the area in 2002 showed elevated concentrations of the toxic metal.

The Doe Run Co., which operates the Herculaneum smelter, said the facility is now in compliance with the current standard. Dan Vornberg, the company’s vice president for environmental affairs, said the new standard “will have a significant impact on our operations” and will require exploring options such as new technologies and process adjustments.

The suit charged that the EPA had failed to review the lead standard every five years as law requires. Since 1990, more than 6,000 studies have examined the effects of lead on health and the environment, according to the agency.

“They still have to enforce it,” said Kathleen Logan Smith, executive director of the coalition. “But it is there. It is a start.”

___

On the Net:

EPA lead site: www.epa.gov/air/lead

Doe Run. Co.: http://www.doerun.com/

Copyright 2008 The Associated Press.

www.lead-info.com