Eye Muscle Disorders
Nystagmus

Macro image of human eye

A condition in which there are rapid involuntary movements of the eyes in any direction. Blurred vision may result.  Research on results of dietary treatment are needed.

Strabismus

A young man that looks very confused and cross eyed with his eyes looking upward towards his forehead.

Sometimes called “crossed eyes” in young children, this condition is the lack of coordination between the eyes, with one or both eyes turning in, out, up or down.

Research on results of dietary treatment are needed.

Convergence Insufficiency

Close up portrait young, girl with glasses reading book, having difficulty to see text, vision problems, isolated grey wall background. Face expression. Education concept eyesight issue in childrenThe two eyes do not work well together in focussing on nearby objects or text. It is a leading cause of eyestrain, blurred vision, double vision (diplopia), and headaches.

Research on results of dietary treatment are needed.

ADHD Connection

In a study published in the Journal of Neural Transmission, back in 1979, Dr. Feingold wrote that it “is perhaps the failure to integrate all the signs presented by the various clinical patterns with hyperkinesis … that eye muscle involvement manifested as either nystagmus or strabismus has not been emphasized as part of the hyperkinetic syndrome.”

The Studies

The studies listed below are organized by date, with the most recent date first.  Some of the full texts will need a password because they are kept in a locked file to protect their copyright.  For educational purposes only, we are allowed to share the password with you if you write to us.

If you are trying to find a particular author, see the Index below which lists all the primary authors alphabetically with their publication dates.

Author Index
  1. Barnhardt 2012
  2. Borsting 2012
  3. Feingold 1979
  4. Granet 2005
  5. Habek 2011
  6. Merkin-Zaborsky 2001
  7. Neuman 1978
  8. Praputpittaya 2003
Borsting 2012: Convergence insufficiency symptoms related to ADHD

Improvement in academic behaviors after successful treatment of convergence insufficiency. Borsting E et al. Optometry and Vision Sciences, 2012, Jan, 89(1), 12-8.

“To determine whether treatment of symptomatic convergence insufficiency (CI) has an effect on Academic Behavior Survey (ABS) scores…. The ABS was administered at baseline and after 12 weeks of treatment to the parents of 218 children aged 9 to 17 years with symptomatic CI, who were enrolled in the Convergence Insufficiency Treatment Trial and randomized into (1) home-based pencil push-ups; (2) home-based computer vergence/accommodative therapy and pencil push-ups; (3) office-based vergence/ accommodative therapy with home reinforcement; and (4) office-based placebo therapy with home reinforcement. …A successful or improved outcome after CI treatment was associated with a reduction in the frequency of adverse academic behaviors and parental concern associated with reading and school work as reported by parents.”
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Note: Dietary treatment was not used here, but these studies are included to show that ADHD can be related to convergence insufficiency and symptoms can improve upon treatment.

 

Barnhardt 2012: Convergence insufficiency can occur with ADHD

Symptoms in Children with Convergence Insufficiency: Before and After Treatment,
Barnhardt C, Cotter SA, Mitchell GL, Scheiman M, & Kulp MT, CITT Study Group. Optometry and Vision Science, 2012, Oct 89(10, 1512-20.

” … In a randomized clinical trial, the convergence insufficiency symptom survey was administered pre- and posttreatment to 221 children … Children with parent-reported ADHD were more symptomatic … than those without parent-reported ADHD because of a higher performance-related score …  A significant and equal improvement (p<0.01) for the performance-related and eye-related symptoms was found in treatment responders. ”
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Habek 2011: Case study of nystagmus with celiac disease, treated by gluten-free diet

Downbeat nystagmus, ataxia and spastic tetraparesis due to coeliac disease. Habek M, Hojsak I, Barun B, & Brinar W. 2011.  Neurological Sciences, Oct, 32(5), 911-4.

“A 25-year-old female presented to a university neurology clinic with a 1-month history of progressive ataxia, downbeat nystagmus and spastic tetraparesis. . . .a diagnosis of cerebellar ataxia due to coeliac disease was done. The patient was treated with strict gluten-free diet and intravenous administration of immunoglobulins. Although there are many controversies about neurological manifestations of coeliac disease, this case pointed to strong association between these two disorders. . . . ”
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Granet 2005: Children with ADHD and convergence insufficiency can be helped by treating vision

The relationship between convergence insufficiency and ADHD.Granet DB, Gomi CF, Ventura R, Miller-Scholte A.  Strabismus. 2005 Dec;13(4):163-8.

“Children being evaluated for attention deficit hyperactivity disorder (ADHD) often have an eye exam as part of their evaluation. The symptoms of convergence insufficiency (CI) can make it difficult for a student to concentrate on extended reading and overlap with those of ADHD. …We reviewed 266 charts of patients with CI. Twenty-six patients (9.8%) were diagnosed with ADHD at some time in their clinical course. Of the patients with ADHD and CI, 20 (76.9%) were on medication for ADHD at the time of diagnosis for CI while 6 (23.1%) were either not on medication or the medication was discontinued several months before the diagnosis of CI. .. We report an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8-3.3%). We also note a seeming three-fold greater incidence of CI in the ADHD population. This may simply represent an association and not be a causative relationship. Until further studies are performed, however, patients diagnosed with ADHD should be evaluated to identify the small subset that may have CI — a condition that responds well to treatment at home.”
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Praputpittaya 2003; Rat study showing MSG causes dose-dependent vision problem

Visual performance in monosodium glutamate-treated rats. Praputpittaya C, Wililak A. Nutr Neurosci. 2003 Oct;6(5):301-7.

” The purpose of this study was to examine the effect of monosodium glutamate on the visual performance in rats. . . . In conclusion, glutamate treatment was shown to cause dose-dependent deficit in visual performance and this may reflect impairment of visual organs and brain function.”
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See more studies on MSG.

Merkin-Zaborsky 2001: Thiamine (Vitamin B1) & nystagmus or eye muscle weakness

Thiamine-responsive acute neurological disorders in nonalcoholic patients,  Merkin-Zaborsky H1, Ifergane G, Frisher S, Valdman S, Herishanu Y, Wirguin I., European Neurology, 2001;45(1):34-7.

Wernicke’s encephalopathy (WE) (abnormal eye movement, abnormal walking, mental confusion) is most commonly associated with alcoholism, although other causes have also been implicated. In the years 1994-1997, 9 patients with no history of alcohol abuse presented with acute signs of ophthalmoplegia or nystagmus and ataxia which resolved within 48 h after intravenous thiamine. There were 7 women and 2 men aged 17-57 (7 below the age of 30). Precipitating events included vomiting 2, drastic weight-reducing diet 2, renal colic in a postpartum woman 1, colonic surgery 2 and chronic hemodialysis 1. In 2 patients there was no obvious precipitating event but their history was suggestive of a genetic predisposition. Mental changes were slight or absent in all patients and all of them made good functional recovery. These cases suggest that the diagnosis of WE should be considered more often in nonalcoholics in various clinical settings.

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Feingold 1979: Case studies of diet for nystagmus

Dietary Management of Nystagmus, B.F. Feingold, Journal of Neural Transmission, 1979, Vol. 45 (2), pp. 107-115.

Case reports of response of congenital nystagmus to a diet eliminating synthetic food colors, flavors, BHA, BHT, and salicylates. “…proposal that a variety of neurologic and neuromuscular disturbances … may be induced by identical chemicals, depending upon the individual’s genetic profile and the interaction with other environmental factors.”
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Neuman 1978: Yellow 5 & allergy; fibrinolytic pathway

The danger of “yellow dyes” (tartrazine) to allergic subjects, Neuman I, Elian R, Nahum H, Shaked P, Creter D. Clinical Allergy. 1978 Jan;8(1):65-8.

” Oral administration of 50 mg tartrazine to 122 patients with a variety of allergic disorders caused the following reactions: general weakness, heatwaves, palpitations, blurred vision, rhinorrhoea, feeling of suffocation, pruritus and urticaria. There was activation of the fibrinolytic pathway . . .”
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The Diet Connection

Dr. Feingold studied seven children with eye disturbances including nystagmus and strabismus. The history of the first two were published in Dr. Feingold’s paper, Dietary Management of Nystagmus (1979). Both had behavioral problems as well as eye problems – one was throwing tantrums and the other was restless and talkative.

Since Dr. Feingold’s work in the 1970s, very little has been studied on the link between vision problems and diet, although research does show that children with an ADHD diagnosis are more likely to have vision problems.   One of the problems many of these children have is called “cognitive insufficiency,”  which is a condition where the two eyes do not work together well.  Other research reported that Yellow 5 can cause a variety of symptoms including blurred vision (Neuman, 1978), and that MSG (noted in our Foodlists) causes dose-dependent vision deficits in rats (Praputpittaya, 2003) .

Child #1

After ten months on the diet, the first child had a marked improvement in nystagmus control and his vision was continuing to improve – from 20/300 (both eyes together) to 20/50. In June 1977, still on the diet after a year and a half, he was doing well at school without the low vision aids, he was able to participate in sports, and had no difficulty seeing the blackboard. At that time, he was given several foods containing synthetic colors, flavors, and salicylates, and observed. No change was seen for the first two days; then his vision regressed to 20/200 in each eye separately and 20/100 together, with near vision at 20/80. Going back on the diet, it took 21 days to restore his vision to what it was before the challenge test. In his case, it was also determined that foods containing benzoates, especially cranberries, were a problem.

Child #2

This child had been diagnosed as having very marked nystagmus, in spite of surgery and treatment with patches over one eye at a time. The child was doing very well academically, but was overly talkative and restless; she still had enuresis (bed wetting) at age 5 1/2.

One week after starting the diet, her enuresis cleared. Her eyes didn’t improve much until also eliminating white potatoes and bananas. Five months later, the eye doctor confirmed a marked improvement in perception as well as complete control of the nystagmus. At that time, the child was challenged for 5 days with a number of items containing the additives as well as salicylates. Her behavior changed – she became more talkative, more active, and fought with her siblings – but although her vision became worse, there was no return of the nystagmus.

Our View

Unfortunately, there has been very little published on the connection between diet and eye problems since Dr. Feingold’s study. Thus, with hesitation, we must say that if you or your children have eye muscle disorders, the Feingold diet is worth a try, and that it may be necessary to also eliminate the benzoates (listed in our Handbook) as well as possibly white potatoes and bananas. Whether adults as well as children can be helped is not known at this time.

Among the slim pickings we have found on this subject in the research, Neuman (1978) reported that Yellow #5 caused a variety of symptoms including blurred vision, and Praputpittaya (2003) reported that MSG (noted in our Foodlists) caused dose-dependent vision deficits in rats.

Convergence Insufficiency

A child might have 20/20 vision and be able to see clearly, but that doesn’t mean that his eyes are able to work together smoothly, especially at close range. This difficulty in focussing on nearby things is called “convergence insufficiency” or CI, and it is three times more common in children with ADHD than in other children.

Dr. David Granet, a professor of opthamology at the University of California, has found that nearly 10% of children with CI had been diagnosed as having ADHD, and that 16% of children with an ADHD diagnosis had the vision problem. This also raises the possibility that children with this disorder are being misdiagnosed as having ADHD. Some of the children had also been diagnosed with anxiety disorder or depression. If you wear reading glasses, and take them off and spend any length of time trying to read under pressure without them, you might experience some anxiety yourself.

Convergence insufficiency and other vision disorders can be successfully treated with special glasses and vision therapy provided by specialists such as behavioral optometrists, who are knowledgeable in this area. As far as we know, there is no strong connection with diet.