American Academy of Optometry Meeting: Be There!

There are thousands of reasons to attend this years American Academy of Optometry meeting in Orlando. I hope that one of them is that the AAO was kind enough to allow me to present a lecture on Neuro-plasticity that is relevant for optometrists. It seems as if optometry and ophthalmology are the only 2 professions in the world who have not yet applied the concepts of neuro-plasticity to patient care....hopefull, my presentation and others on this topic will rectify that problem!! Click on the title above to learn more. DM

Vision Screening: Have your voice heard!

AHRQ is offering an opportunity for public comment on the U.S. Preventive Services Task Force draft recommendation on vision screening in children ages 1 to 5 years. To provide comments, please go to http://www.ahrq.gov/clinic/uspstf/uspstf_form/ and follow the directions for submitting comments. The public comment period is open until October 23, 2009. This public comment is part of an effort to increase the transparency of the methods and processes of the Task Force.

Additional information about the evidence-based recommendations of the Task Force and AHRQ’s work to improve the delivery of effective clinical preventive services is available at: www.preventiveservices.ahrq.gov.
You are subscribed to AHRQ Prevention Program Updates for Agency for Healthcare Research and Quality (AHRQ). This information has recently been updated, and is now available.

Comments: Please, if you do this, let AHRQ know that vision screenings are inadequate for America's children. Comprehensive examinations are a must. Tell them that the research on vision screening is so poor that the authors of at least one study couldn't determine if vision screenings do what they are supposed to do or not!

http://www.biomedcentral.com/1471-2415/9/1/3
Effectiveness of screening preschool children for amblyopia: a systematic review
Their conclusion was "Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication. DM

Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007

Here is the full text of the article.
http://pediatrics.aappublications.org/cgi/reprint/peds.2009-1522v1

Abstract
OBJECTIVES: The reported increasing prevalence of autism spectrum
disorder (ASD) and attendant health and family impact make monitoring
of ASD prevalence a public health priority.

METHODS: The prevalence of parent-reported diagnosis of ASD among
US children aged 3 to 17 years was estimated from the 2007 National
Survey of Children’s Health (sample size: 78 037). A child was considered
to have ASD if a parent/guardian reported that a doctor or other
health care provider had ever said that the child had ASD and that the
child currently had the condition. The point-prevalence for ASD was
calculated for those children meeting both criteria. We examined sociodemographic
factors associated with current ASD and with a past
(but not current) ASD diagnosis. The health care experiences for children
in both ASD groups were explored.

RESULTS: The weighted current ASD point-prevalence was 110 per
10,000. We estimate that 673,000 US children have ASD. Odds of having
ASD were 4 times as large for boys than girls. Non-Hispanic (NH) black
and multiracial children had lower odds of ASD than NH white children.
Nearly 40% of those ever diagnosed with ASD did not currently have the
condition; NH black children were more likely than NH white children to
not have current ASD. Children in both ASD groups were less likely than
children without ASD to receive care within a medical home.

CONCLUSIONS: The observed point-prevalence is higher than previous
US estimates. More inclusive survey questions, increased population
awareness, and improved screening and identification by providers
may partly explain this finding. Pediatrics 2009;124:000DM

Comments: Be very careful how you interpret this research. I believe the design flaws inherent in such research has a tendency to over predict the outcome. DM

2 government studies find autism disorders in 1 in 100 U.S. children

Two new government studies indicate about 1 in 100 American children have autism disorders — higher than a previous U.S. estimate of 1 in 150.
Greater awareness, broader definitions and spotting autism in younger children may explain some of the increase, federal health officials said.
“The concern here is that buried in these numbers is a true increase,” said Dr. Thomas Insel, director of the National Institute of Mental Health. “We’re going to have to think very hard about what we’re going to do for the 1 in 100.”

Long term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia.

Garoufalis P, Georgievski Z, Koklanis K. Long term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia. Binocul Vis Strabismus Q. 2007;22(1):49-56.

Visual acuity was relatively stable over a mean followup period of 6.6 years. The treatment outcome and the success of amblyopia treatment were found to be irrelevant to long term stability of visual acuity. These findings suggest that amblyopia treatment mostly results in a lasting improvement in visual acuity, and that both unsuccessfully and successfully treated individuals maintain their visual acuity improvement achieved during treatment.

Long-term visual function outcomes of congenital cataract surgery with intraocular lens implantation in children under 5 years of age

Hussin HM, Markham R. Long-term visual function outcomes of congenital cataract surgery with intraocular lens implantation in children under 5 years of age.Eur J Ophthalmol. 2009 Sep-Oct;19(5):754-61.

Mean final best-corrected visual acuity for the bilateral group was 0.57 logMAR (range 0.18 -1.06) and for the unilateral group 0.91 logMAR (range 0.18 -1.40). Nystagmus was recorded in 10 children (56%) of the bilateral group and 5 children (23%) of the unilateral group. Strabismus was recorded in 14 children (78%) of the bilateral group and 19 children (86%) of the unilateral group. Glaucoma was diagnosed in one child. There was a significant myopic shift in the unilateral group.

Reasonably good postoperative visual acuity was achieved in the bilateral cataracts group, but relatively poor acuity in the unilateral cataract group. Poor stereopsis was recorded in both groups. One child developed glaucoma. None of the children developed retinal detachment. The expected myopic shift in the unilateral group compared with the bilateral group was demonstrated. Elective primary capsulotomy and elective anterior vitrectomy are mandatory to keep a clear visual axis.

Clinical Findings and Surgical Results of Duane Retraction Syndrome

Altinas AG, Arifoglu HB, Arikan M, Simsek S Clinical Findings and Surgical Results of Duane Retraction Syndrome J Pediatr Ophthalmol Strabismus. 2009 Oct 2:1-7. doi: 10.3928/01913913-20090918-02.



PURPOSE:To evaluate clinical properties and surgical outcomes of Duane retraction syndrome (DRS). METHODS:Twenty-one patients with DRS were evaluated. Surgery was indicated for correction of strabismus, abnormal head position, upshoot-downshoot, and globe retraction. Six patients had undergone surgery. In 5 cases, the lateral rectus muscle was recessed from 4.0 to 7.0 mm combined with "Y-splitting" according to deviation in primary position and degree of globe retraction. In case of a significantly positive forced duction test on the medial rectus muscle intraoperatively, simultaneous recession of the ipsilateral medial rectus muscle was performed in addition to lateral rectus surgery. RESULTS:Type I DRS was diagnosed in 83.33% of cases. All 6 cases that underwent surgery had type I DRS. After surgery, all patients showed elimination of upshoot-down-shoot. Two cases had minimally improved abduction from the midline. Case 1 underwent a second operation and it was observed that the middle split part disappeared and muscular fibers proliferated to the original insertion. To protect against refusion of the middle split part of the muscle due to proliferation, nonabsorbable separation sutures were placed around the split parts of the upper and lower halves without scleral fixation. Separation sutures were placed on both parts of the muscle to protect refusion in the other cases. CONCLUSION:Y-splitting combined with recession of one or both horizontal recti is an effective procedure in patients with DRS and associated horizontal deviation. Prophylactic separation sutures as part of Y-splitting may protect against recurrence. Copyright 2009, SLACK Incorporated.

Data indicate more than one million premature babies die within first month of life

From AOA First Look:

USA Today (10/5, Szabo) reports, "More than one million babies die each year" within a month of birth "because they're born too soon, according to the first" study to evaluate "the global burden of premature births." Each year, according to the March of Dimes, "about 13 million babies" -- approximately "10 percent of all newborns -- are born prematurely," being born before 37 weeks of gestation.
According to the Washington Post (10/5, Brown), "rates and causes of preterm birth vary widely by region." For instance, "Africa has the highest rate (11.9 percent), followed by North America (10.6 percent) and Asia (9.1 percent). Latin America and the Caribbean are midrange (8.1 percent), and Australia and New Zealand (6.4 percent) and Europe (6.2 percent) are the lowest." Although "little is known about the causes of prematurity in the developing world," its been said that "malnutrition, coexisting illnesses, such as malaria and anemia, and inadequate prenatal care are likely factors." As for the US, "where the rate of preterm birth has increased 36 percent in the last quarter-century," the surge of "older women having babies and reproductive techniques" that make "multiples more likely are probably contributing to the trend."
Cesarean sections, "which are now the most common surgical procedure for women," have also been implicated, the Los Angeles Times (10/4, Maugh) "Booster Shots" blog reported. "Poor nutrition and low bodyweight; pre-existing medical conditions, such as diabetes and high blood pressure," as well as "alcohol and tobacco use and secondhand smoke" are also being blamed for the increase.
What's more, "sophisticated neonatal intensive-care units" have produced "headlines about miracle babies" that lead, the AP (10/5) notes, "to a false sense that modern medicine conquers prematurity -- without acknowledging lifelong problems including cerebral palsy, blindness, and learning disabilities that often plague survivors."
At present, "there is no reliable way to prevent or delay preterm birth," HealthDay (10/4, Preidt) pointed out. Accordingly, "the annual cost of caring for preterm babies and their associated health problems is more than $26 billion a year," the authors noted in their study, titled Global and Regional Toll of Preterm Birth, which used data "from the recently published Bulletin of the World Health Organization." AFP (10/5) also covers the story.

CDC says H1N1 "widespread" in 27 states.

From AOA First Look:

NBC Nightly News (10/2, story 7, 0:20, Williams) reported that the "latest numbers out from the Center for Disease Control indicate what we have been saying here night after night: swine flu is spreading rapidly over the country. The CDC reporting there's widespread flu activity in 27 states now."
Physicians debate safety concerns of swine flu vaccine. ABC World News (10/4, story 8, 2:15, Harris) reported that as the swine flu vaccine becomes available to Americans in a record-setting influenza vaccination campaign, "the most challenging part...may be convincing enough Americans to actually get vaccinated." In fact, data indicate that around 40 percent of parents who are hesitant to have their children vaccinated. Dr. Ira Rubin, a pediatrician, stated, "We don't know how well this works. We don't know how long it'll last. We have a lot of unknowns." Meanwhile, Dr. William Schaffner, of the Vanderbilt University School of Medicine, said that "we're very secure about how it was produced and how it was tested."
On the CBS Evening News (10/4, story 5, 1:30, Mitchell), medical correspondent Jon LaPook, MD, reported that there were "no shortcuts" in manufacturing the swine flu vaccine, according to his sources at the CDC. Some people, Dr. LaPook said, "think this is some kind of an experimental, brand-new vaccine. And it isn't." It "is being made the exact same way that the regular seasonal flu vaccine is." Getting the vaccine, therefore, is "a no-brainer for health professionals," he added.
Bloomberg News (10/4, Randall) reported that CDC director Dr. Thomas Frieden stated that the swine flu vaccine is being made "with the same ingredients, dose and manufacturing process as the seasonal influenza vaccine given to 100 million Americans each year."
The St. Petersburg Times (10/5, Martin) attributes some Americans' hesitation over the vaccine to the spread of "myths," including that "you can actually get the flu from the flu shot." Frieden said, however, that "there's no way" a person can acquire the flu from the vaccine.
Polls find US public ambivalent about H1N1 vaccine. AFP (10/4, Santini) reported, "US health authorities on Friday announced plans for a massive vaccination campaign intended to protect millions of Americans" from H1N1 influenza, with the "first distribution of 600,000 vaccine doses set for Tuesday, two weeks ahead of schedule." The US "expects to quickly dispense some six- or seven-million doses and hopes to administer 250-million doses by the end of the year. ... The first vaccine doses are being made available in the form of nasal sprays that take effect in about eight days."
According to the Washington Post (10/4, Stein), however, several surveys suggest the American "public is decidedly ambivalent." For example, a poll of 1,042 adults released Friday by the Harvard School of Public Health "found that only 40 percent were sure they would receive the vaccine"; only about 50 percent "were certain their children would"; and only "13 percent" thought the vaccine was "safe for pregnant women." Other recent polls showed "similar results."
Healthcare workers object to mandatory flu shots. The CBS Evening News (10/4, story 4, 2:10, Mitchell) reported that some healthcare workers have taken issue with mandatory vaccinations imposed by their employers, as well as by the government of New York on all of the state's healthcare workers. Dr. Richard Daines, New York State commissioner of health, said it was "kind of intolerable that patients should come to the hospital and not know that the healthcare workers are vaccinated." Meanwhile, Carole Blueweiss, a New York physical therapist, said the mandate was "outrageous...it feels criminal and it feels anti-American."

AOA Clinical Practice Guidelines Pediatrics/BV/VIP

Pediatric Eye and Vision Examination

(CPG2) 1994 2nd Edition 2002 Reviewed 2007

Care of Patient with Amblyopia (CPG4)

1994 Revised 1998 Reviewed 2004

Care of the Patient with Strabismus: Esotropia and Exotropia (CPG12)

1995 Revised 1999 Reviewed 2004

Care of the Patient with Accommodative and Vergence Dysfunction (CPG18)

1998 Revised 2008

Care of the Patient with Learning Related Vision Problems (CPG20)

2000 Revised 2008

Ask the Optometric Expert: Infant Eye Examinations

Information about Infant Eye Examinations

Keratoconus associated with the Pierre Robin Sequence

...A 30-year-old female with known Pierre Robin sequence presented to the emergency department of the Royal Victorian Eye and Ear Hospital, Melbourne, with acute unilateral hydrops as her first presentation of bilateral keratoconus. Initial management consisted of eye patching, hypertonic saline and cycloplegia. However, the long-term prognosis for visual rehabilitation remained poor in this patient because of the presence of a central corneal opacity and inability to comply with contact lenses. She was not an appropriate candidate for keratoplasty due to severe mental retardation. This report highlights an association of keratoconus in patients with the Pierre Robin sequence....

New Methods for the Assessment of Accommodative Convergence

...The authors introduced a new objective method for measuring horizontal eye movements based on the first Purkinje image with the use of infrared charge-coupled device (CCD) cameras and compared stimulus accommodative convergence to accommodation (AC/A) ratios as determined by a standard gradient method....

Vaccination for influenza A (H1N1) expected to begin next week

... CDC officials expect 6 to 7 million doses of the vaccine will be out by next week. The first 600,000 doses will be available by Tuesday. ...

Flu Vaccine may Protect Against Heart Attacks

...Researchers say greater efforts are needed to encourage people with heart disease and diabetes (which increases the risk of heart attacks) to have the flu shot, especially with the looming double-whammy of the H1N1 influenza (swine flu) pandemic and seasonal flu outbreaks.

The cardiac complications of influenza infection, such as myocarditis, are well known, but the role of influenza as a trigger of heart attacks is less clear. It has been suggested that influenza might cause acute and severe inflammation, which in some patients may destabilize atherosclerotic plaques and cause clots in coronary arteries leading to heart attacks....

Research indicates most babies born this century in rich countries may live to 100.

From AOA FirstLook:

The AP (10/2, Cheng) reports, "Most babies born in rich countries this century will eventually make it to their 100th birthday," according to research published in The Lancet. Researchers say "that since the 20th century, people in developed countries are living about three decades longer than in the past," and that "trend shows little sign of slowing down." For the study, researchers "examined studies published globally in 2004-2005 on numerous issues related to aging."
The study showed that "without any further improvement in longevity, three-quarters of babies will mark their 75th birthdays," Bloomberg News (10/2, Hallam) reports. The researchers noted that "better healthcare for the elderly, particularly in the US, has extended lives by making illnesses...manageable over time and allowing earlier detection and intervention."
WebMD (10/1, Hitti) reported that the researchers speculated that "societies will stop looking at life as consisting of three phases -- childhood, adulthood, and old age -- and start dividing 'old age' into a 'third age (young old)' and a 'fourth age (oldest old).'" They added, however, that "it remains to be seen if obesity, which has also been rising, will put the brakes on rising life expectancies."

CDC warns against forgoing H1N1 vaccine.

From AOAFirstLook:

ABC World News (10/1, story 8, 1:45, Gibson) reported, "Federal health officials are expressing new concern about pregnant women and the H1N1 swine flu, releasing what they call, quote, 'upsetting numbers.' The CDC says at least 28 pregnant women have died from H1N1."
In a front-page story, the New York Times (10/2, A1, McNeil) reports that the CDC announced Thursday that "swine flu is now widespread across the entire country," with the CDC director of immunization and respiratory disease Dr. Anne Schuchat saying there is "significant flu activity in virtually all states," which is "quite unusual for this time of year." The Times also notes that, "as anecdotal reports and at least one poll showed that many Americans are nervous about the vaccine, officials emphasized that the new shots were nearly identical to seasonal ones, and said they were doing what they could to debunk myths about the vaccine."
The Washington Post (10/2, Brown) notes that Dr. Schuchat warned pregnant women in particular, noting that "100 pregnant women infected with the virus were hospitalized in intensive care units in the first four months of the outbreak, and 28 have died." Schuchat said, "What we are seeing is quite striking. ... The obstetric caregivers here, and the ones that we're speaking with [around the country], have rarely seen this kind of thing in practice."
McClatchy (10/2, Pugh) reports, "Because of their high-risk designation, pregnant women with respiratory illnesses and flu-like symptoms should be treated with anti-viral medications in addition to receiving both flu vaccinations, which now are becoming available nationwide."
Regarding "anecdotal reports and polling" that "suggest widespread hesitancy about getting" vaccinated, "Schuchat said the public should not fear the flu shot," CQ HealthBeat (10/2, Reichard) reports. She said that "it is being produced in exactly the same way as seasonal flu vaccine," adding, "As a public health worker I'm really looking forward to getting that vaccine."

Economics and Attitudes Regarding Spectacles in Daily Life: A European Perspective

...Respondents in France bought mostly expensive spectacles while Italians acquired the least expensive eyeglasses. The spectacle frequency of replacement rate is inversely related to prices. About half of all respondents expressed a willingness to pay, at least partially, for freedom from spectacles. ...

Scientists Develop Nasal Spray That Improves Memory

...Good news for procrastinating students: a nasal spray developed by a team of German scientists promises to give late night cram sessions a major boost, if a good night's sleep follows. In a research report...scientists show that a molecule from the body's immune system (interleukin-6) when administered through the nose helps the brain retain emotional and procedural memories during REM sleep.....

Antidepressant And Placebo Are Equally Effective In Child Pain Relief

...Many pharmaceutical products are prescribed for off-label use in children due to the lack of clinical trials testing the efficacy of the drugs in children and adolescents. Therefore, the pediatric gastroenterologist frequently has to make treatment decisions without the evidence of how drugs work in children," said Miguel Saps, MD, of Children's Memorial Hospital and lead author of the study. "The high placebo effect we identified in this study suggests that further studies of the use of certain antidepressants in children with functional bowel disorders are needed. While several trials have demonstrated a beneficial effect of antidepressants, including amitriptyline, for the treatment of irritable bowel syndrome (IBS) in adults, more research is needed to determine how effective this drug is, if at all, in children."...