Infants' and Children's Vision Coalition

Did you know there is an Infants' and Children's Vision Coalition? This coalition includes the

American Academy of Optometry Association (AAO)
Vision Awareness Network (VAN)
American Optometric Association (AOA)
College of Optometrists in Vision Development (COVD)
Eye Care Council (See To Learn)
Optometric Extension Program Foundation (OEPF)
Association of Schools and Colleges of Optometry (ASCO)
American Optometric Student Association (AOSA)

Stop by and take a look today. DM

Chocolate, tea and wine help memory

... Oxford researchers, together with colleagues in Norway, examined the effect that [chocolate, tea and wine] had on memory and thinking among more than 2,000 people aged between 70 and 74. They found that wine had the most pronounced single effect, while those who regularly consumed all three in modest amounts performed best in a series of brain tests....

Comments: Hurrah!!! I love all three. Wait! did they say something about "moderation". (Bummer!!) I knew that my colleagues in Norway were up to something when I was there a few weeks ago!

Did I miss the part about single Malt Scotch being good for you too (McCallan 25 year)? DM

A Randomized Trial of Near Versus Distance Activities While Patching for Amblyopia in Children Aged 3 to Less Than 7 Years

...Performing common near activities does not improve visual acuity outcome when treating anisometropic, strabismic, or combined amblyopia with 2 hours of daily patching. Children with severe amblyopia may respond to 2 hours of daily patching....

Comments: This was a 4-week pilot randomized trial in which 64 children (age 3 to <7) performed near activities to improve visual acuity. These near activities included:

Arts and crafts, Blocks/marbles/dominoes, Board games/puzzles/card games, Cars up close, Computer/video game, Counting up close, Dolls/action figures up close, Homework, Lite-Brite, Playing with toys up close, Sorting/stringing beads, Stacking coins, Tying shoes, Writing/reading/activity books

Does anyone see a single therapeutic activity specificaly designed to improve amblyopia?

I'd take the results of this study with caution. Let's see what the full blown study says....perhaps they will change it appropriately. DM

ERADICATELAZYEYE.ORG

Rachel Pietrini Klein, Ortoptist (Retired) is on a mission.

Her website ERADICATELAZYEYE.ORG is dedicated to a mission that should be near and dear to all of our hearts. Please take a moment to visit this site. DM

Use of the Transcendental Meditation technique to reduce symptoms of Attention Deficit Hyperactivity Disorder (ADHD) by reducing stress and anxiety: A

...In a pilot study, researchers found that lessons in transcendental meditation, or TM, appeared to calm the anxiety of children with ADHD, and improve their behavior and ability to think and concentrate....

Making early childhood count

...An ongoing flow of high-quality information about the state of early child development, its determinants and longterm development outcomes is essential .... The importance of developing measures of early child development at a population level should be selfevident if we believe that “what gets counted, counts.” With counting comes a focus on issues, public dialogue and resources. Thus, monitoring early child development — across a population, over time and with the ability to examine geographic trends — is a key activity in support of the success of a modern developed society....

Abnormal optic disc and retinal vessels in children with surgically treated hydrocephalus

...Hydrocephalus is associated with subnormal optic disc and rim areas and an abnormal vascular pattern, indicating a pre/perinatal disturbance of the development of these structures. A promising finding is that the frequency of optic atrophy in the present study was lower than previously reported, most likely reflecting improved perinatal care and better regulation of the intracranial pressure...

The effectiveness of progressive addition lenses on the progression of myopia in Chinese children

....Compared with SV lenses, myopia progression was found to be retarded by PALs to some extent in Chinese children without moderately or highly myopic parents, especially for subjects with near esophoria or females. ...

Amblyopia Studies at ICO

If you are in the Chicago-land area and have one or more patients that might be enrolled in any of these studies, please contact Yi Pang, PhD, OD at ypang@ico.edu .

The Studies...

There are a total of 5 amblyopia studies covering patients from 3 years of age to infinity. [I'm not sure how old infinity is....but I want to live to be that old! DM]

Benefit for patients:
• A pair of glasses with polycarbonate material
• Patches
• Paid up to $100 for some of studies.

Dr. Kelly Frantz and Dr. Yi also have a study on optic nerve hypoplasia. If you see a patient with unilateral or bilateral small optic nerve head, please refer to them.

We really appreciate your support!

For more information please contact:

Yi Pang, Ph.D., O.D., FAAO.
Assistant Professor
Illinois College of Optometry / Illinois Eye Institute
3241 S. Michigan Ave
Chicago, IL 60616
Phone: 312-949-7287
Fax: 312-949-7363
Email: ypang@ico.edu

AAO Call for Courses

Just a reminder that:

The submission window for Lectures & Workshops at Academy 2009 Orlando is now open!
Click here to submit your courses.

The deadline for submission is February 2, 2009.

Guidelines can be found here.

Academy 2009 Orlando will take place November 11-14, 2009, at Marriott's Orlando World Center.

The AAO is trying to get as many NEW lectures and topics involved as possible. Which means you younger whipper-snappers may have a better chance of getting a course accepted than those of us who have done this before!! (This of course won't stop me from submitting a course or two for consideration, however.)

There are many reasons to submit a course to the AAO....it looks great on your CV....our Schools and Colleges of Optometry's Deans/Assoc Deans/Chair-folk/President and others thinks it's cool...it builds your case for merit/promotion...but most of all...it's one of the best places to give back to your profession and to share your clinical/research knowledge and insights.

Questions? See all the help on the new and improved AAO site....or just ask me! DM

Combined sensory impairment (deaf-blindness) in five percent of adults with intellectual disabilities.

Meuwese-Jongejeugd A, van Splunder J, Vink M, Stilma JS, van Zanten B, Verschuure H, Bernsen R, Evenhuis H.Combined sensory impairment (deaf-blindness) in five percent of adults with intellectual disabilities. Am J Ment Retard. 2008 Jul;113(4):254-62.

.....Results show that the risk of combined sensory impairment in this population is considerably increased compared with the general population. Part of the underlying conditions are treatable or can be rehabilitated. .....

Maino at the Review of Optometry

Click on the title above and see the many articles I've written for the Review of Optometry. DM

Less Patching Time Needed for Amblyopia

...Children with amblyopia only require occlusion therapy (patching) for three to four hours daily, not the “maximal” dose of 12 hours a day traditionally prescribed, or even six hours daily, ......No doubt, these findings are good news to amblyopic patients (and the prescribing O.D.). “Depending on the depth of amblyopia, patching for six and/or 12 hours may just not be feasible,” says Dominick Maino, O.D., M.Ed., a professor in the Pediatric/Binocular Vision Service in the Illinois Eye Institute, a part of Illinois College of Optometry, and editor of Optometry and Vision Development. ...Dr. Maino says he usually recommends two hours of patching with one hour of active home hand-eye therapy and one hour of passive activity, such as watching television, eating or playing video games.

Comments: Want to know more? Contact me at http://www.nw.optometry.net. DM

An Open Letter to David K Wallace, MD, MPH (and other disbelievers and holders of outdated and biased opinions and beliefs)

Dear Dr. Wallace,

I recently read your editorial1 in the Archives of Ophthalmology concerning the paper by the Convergence Insufficiency Treatment Trial Study Group entitled, Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. At the very beginning of your editorial you noted that the typical symptoms associated with convergence insufficiency (CI) include “difficulty with reading, eye strain or discomfort with near work (asthenopia) and headache.”

Optometrists have for decades noted how learning related eye and vision problems can affect various academic areas such as reading. Many of our ophthalmological colleagues however, have claimed and continue to claim that the eyes have little to do with reading. I want to thank you for your support in acknowledging that how the vision system functions can have a significant and adverse impact on reading...

For the rest of this editorial you need to click on the title above....DM

Computerized Saccadic Eye Movement Therapy to Improve Oculomotor Control during Reading and Reading Rate in Adult Japanese Readers

ABSTRACT

Background: This study is aimed at determining whether reading rate and oculomotor control during reading, could be improved in adults with home-based computerized saccadic eye movement therapy.

Methods: Sixteen Japanese foreign students in the U.S. served as subjects and were randomly divided into two groups; a computerized eye movement training (CEMT) group and a control group. Subjects in the CEMT group received 5 weeks of home-based computerized saccadic eye movement training while subjects in the control group received no comparable training or intervention, other than diagnostic evaluations.

Results: CEMT group demonstrated significant improvement in all Visagraph II measurement parameters after intervention, except for duration of fixation and reading comprehension. Subjects in the control group demonstrated no significant pre-post differences.

Conclusions: These results suggest that CEMT, without supplementary reading instruction or educational intervention, can improve reading oculomotor performance with adult Japanese readers.

Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading

ABSTRACT

Background: Saccade control is a complex function of our brain and relies on the coordination of several subcortical, cortical, and functional areas. In the past it has been difficult to use data from saccade analysis as an additional diagnostic tool for insight into any particular patient’s oculo-visual problem. With the development of technological advances and optomotor research there is now a better understanding of visually guided saccadic reactions. This article describes the development of saccade control, diagnostic data from dyslexic subjects, and the effect of daily saccadic and fixation practice and its transfer to reading skills.

Methods: All subjects were recruited from local schools. Several standard tests (reading, spelling, intelligence) were used for inclusion/exclusion of the subjects participating in the various studies. Eye movements were recorded by infrared light reflection methods. Prosaccades with overlap conditions and antisaccades with gap conditions were required in 200 trials for each task. Variables characterizing pro- and antisaccade performance were extracted for each subject. Mean values and standard deviations comparing the experimental and control subjects were calculated in each of the 4 age groups in an age range of 7 to 17 years. ANOVAs or t-test were used for statistical evaluations.

Results: The data from 114 normal control subjects show a developmental progression lasting until adult age. Among the 3230 subjects in the dyslexic group 20 to 70% (depending on age) failed the criterion of the age matched controls when looking at anti-saccade performance. Pro-saccade performance did not differentiate between the groups. Daily practice conducted by 182 dyslexic subjects improved their antisaccade performance in approximately 80% of the cases. For training subjects, it was noted that successful training transferred to the act of reading by reducing the percentage of reading errors in the experimental group (N=10) by 50% and by 20% for the control group (N=11).

Conclusion: This study suggests that deficits in antisaccade control but not in prosaccade control contribute systematically to the problems of subjects with specific deficits in acquiring reading skills and that appropriate training can reduce the percentage of reading errors.

Optometry and Vision Development Volume 39, No. 4, 2008

Optometry and Vision Development Volume 39, No. 4, 2008 is now available:

Editorial
An Open Letter to David K Wallace, MD, MPH
by Dominick M. Maino, OD, MEd, FAAO, FCOVD-A, Editor

Articles
Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading
by Burkhart Fischer, Dipl Phys; Klaus Hartnegg, Dipl Phys

Computerized Saccadic Eye Movement Therapy to Improve Oculomotor Control during Reading and Reading Rate in Adult Japanese Readers
by Tomohito Okumura, MScOptom, MEd, FCOVD, FAAO, et. al.

COVD 2008 Papers and Posters

Literature Review
Current Eye & Vision Science Literature
by David A. Goss, OD, PhD, FAAO, FCOVD-A

Book Review
The Special Education Battlefield
Review by Janice McMahon, OD

Behaviors, Beliefs and Emotions
Review by Sanford M. Gross, MA, OD

Practice Management
Evaluating Yourself as a CEO
by Mark R. Wright, OD, FCOVD

Make Classroom Visits to Generate Teacher Referrals
by Thomas Lecoq

Medical Debt and Personal Disaster
by Richard Rizzardi

COVD 38th Annual Meeting
President’s Speech – Who is COVD?
by Carol L. Scott, OD, FCOVD

Annual Meeting Photos

Advertisers

COVD extends our appreciation to the advertisers that continue to make OVD possible

AIT	Three Rivers Optical
Ambliopia iNet	TransFirst
Bernell	VectorVision
Expansion Consultants	Vision Assessment Corporation
The Fresnel Prism and Lens Co.	Visual Edge
Stereo Optical

Refractive errors and schizophrenia.

Caspi et al noted that "There was a negative association between refractive errors and later hospitalization for schizophrenia. Future male schizophrenia patients were two times less likely to have refractive errors compared with never-hospitalized individuals, controlling for intelligence, years of education and socioeconomic status"

Comments: Be myopic...be mentally well! DM

Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial.

Scheiman and the PEDIG group have done more to help us understand amblyopia than any research done previously....in this study they note that "Atropine and patching achieve similar results among older children with unilateral amblyopia."...and although this is very important...even more noteworthy is that they continue to find that you can treat amblyopia on "older children". They continue to show that neuroplasticity continues through out our lifetimes and that treatment is probably possible at any age. Do not only diagnose those amblyopes ... but offer to treat them...NO MATTER what the age may be. DM

Amblyopia characterization, treatment, and prophylaxis

Simos notes in this review that: "Amblyopia has a 1.6-3.6% prevalence, ...and is more complex than simply visual acuity loss and the better eye has ... deficits. Functional limitations appear more extensive and loss of vision in the better eye of amblyopes more prevalent than previously thought. ....Successful treatment can be achieved in at most 63-83% of patients. Treatment outcome is a function of initial visual acuity and type of amblyopia, and a reciprocal product of treatment efficacy, duration, and compliance. Age at treatment onset is not predictive of outcome in many studies but detection under versus over 2-3 years of age may be. ..."

Comments: So let me get this straight...amblyopia is more complex that just the decreased visual acuity and amblyopia affects the better seeing eye as well! Sounds like what optometrists have been saying for decades. Amblyopia is a BINOCULAR vision problem and a "brain" dysfunction. We need to do therapy not only to improve the visual acuity....but to improve binocularity and cortical function as well. DM

Optic disc area and retinal area in amblyopia.

This study found that "...there was a 20 percent increase in the retinal receptor areas of hyperopic amblyopic eyes as compared to hyperopic eyes without amblyopia despite reduced retinal areas in the amblyopic eyes. Dysplastic and/or asymmetric optic discs were present in 163 of 293 (56 percent) amblyopic patients, 47 of 84 (56 percent) strabismic, and 10 of 77 (13 percent) normal patients. ... The increase in the receptor area may be an explanation for diminished acuity and impaired visual function in amblyopic eyes."

Comments: Once again we see a structural change in neuro tissue when amblyopia is present. Once again I wonder if optometric vision therapy can alter not only function but structure. DM

Long-term application of computer-based pleoptics in home therapy: selected results of a prospective multicenter study.

This study noted that....Recalculated relatively to the duration of the therapy periods, the computer training combined with occlusion was found to be about twice as effective as the preceding occlusion alone. ... The results of combined computer training and occlusion show an additional increase of the same amount as the preceding occlusion alone, which yielded at its end no further advantage to the development of visual acuity in the selected sample of our 55 therapy-resistant patients.....

Comments: I haven't read the whole paper just yet, but the abstract gives two impressions. One is that using the computer is 2X as effective as when it is not used and that VAs increased the same amount no matter if you used the computer or if you just used occlusion. Wouldn't you want to do the therapy in as fast and efficienct method as possible? Doesn't that mean therapy with the computer should be recommended? I'll try to get back to you once I've read the complete paper. DM

Prolonged perceptual learning of positional acuity in adult amblyopia: perceptual template retuning dynamics.

Li, Klein, and Levi showed that the mature (adult) amblyopic brain is surprisingly malleable, and point to more intensive treatment methods for amblyopia. I suggest these more intensive treatment modalities be what we do during optometric vision therapy! DM

Occipital lobe's cortical thinning in ametropic amblyopia.

...The changes in cortical thickness of several occipital regions in amblyopic patients may be important in the diagnosis and treatment of this disease....

Comments: This paper noted "cortical thicknesses of the lingual and pericalcarine areas of the left hemisphere and of the cuneus, lateraloccipital and lingual areas in the right hemisphere in the amblyopic group were significantly thinner than those of the control group". I just completed a paper on neuroplasticity for the Review of Optometry to be printed in Jan 2009 that noted that various forms of therapy could not only alter function BUT ALSO structure of the brain. If we do optometric vision therapy on these brains would they show functional and structural changes? Where can I get me a FMRI quick! DM

Comprehensive vision care in urban communities: the pediatric outreach program.

...Comprehensive eye examinations were performed on 4,298 children ages birth to approximately 5 years . Of the children examined, Approximately 6.5% had risk factors for isometropic amblyopia, and 2.3% had risk factors for anisometropic amblyopia. Approximately 1% of the children had strabismus. Less than 1% of the children examined were identified with ocular pathology. Spectacles were dispensed to 16.6% of the children examined.

Comments: Yes, I know this was a clinical population. Yes, I know that this was an at-risk group. But for this group of young children approximately 714 needed glasses, 378 were at risk for amblyopia and 43 had strabismus. Now tell me again why our Ophthalmological colleagues do not want young children to have comprehensive eye and vision examinations?

A bit of bragging is due....this study was conducted by Drs. Val Kattouf, Jan Scharre and a couple of other ICO colleagues of mine! Congrats to all. DM

Occlusion properties of prosthetic contact lenses for the treatment of amblyopia

...Sufficient vision penalization can be achieved to make occlusion with prosthetic contact lenses a viable therapy for amblyopia. The degree of penalization can be varied and different iris print patterns and pupil sizes, using peripheral fusion, can be preserved with some lenses. Prosthetic contact lenses can be more cosmetically appealing and more tolerable than other amblyopia treatment modalities. These factors may improve compliance in occlusion therapy....