Dizziness and Headaches in Kids....maybe they just need a full eye examination and not an MRI!

Once again, Dr. Len Press (a good friend and colleague) has an interesting post on his blog. He says that....."....The IOVS paper and the Pediatric Neurology paper have an author in common, an MD based in the Department of Otorhinolaryngolgy and Ophthalmology at the Robert Debre Hospital in Paris. But enough name dropping – let’s get to the meat of this paper, which is that a significant number of children with seemingly inexplicable complaints of dizziness and headaches would be sent for an MRI when what they really need is a more in-depth vision evaluation. ...."

Comments: Click on the title to read the full blog posting. DM

Watch This COVD Meeting Video by Clicking Here

From AOA FirstLook!

Injuries From Playing Interactive Video Games Appear To Be On The Rise

HealthDay (10/4, Reinberg) reported, "Sports injuries are commonplace, but injuries from playing interactive video games such as Nintendo Wii are now on the rise," researchers found after examining data collected between 2004 and 2009. "Compared with traditional video games, those playing interactive video games were more likely to injure their shoulder, ankle or foot," whereas the "65 reported seizures, the eight reported cases of eye pain or visual disturbance, and 23 of the 24 cases of neck injuries were all among those playing traditional video games." Investigators also noted that "injuries to bystanders occurred in both traditional and interactive video games, but happened significantly more often with interactive games." BBC News (10/4) also covered the study.

Comments: Click on the title for more info. DM

The effect of visual impairment on quality of life of children aged 3e16 years

...Children with VI had significantly lower quality of life scores than the comparison group .... Consideration of the effects of this reduced QoL must be made. Further studies are needed to establish the benefit to QoL of different habilitation strategies....

Comments: The full article is available by clicking on the title above. DM

Optometrists, Children and Contact Lenses

OPTOMETRISTS SHARE ATTITUDES AND PRACTICES IN FITTING CHILDREN IN CONTACT LENSES

Study offers practitioners’ insights on appropriate age to introduce a child to soft contact lenses and factors that influence their decision to prescribe contacts for children

ST. LOUIS (October 5, 2010) – More than half of optometrists feel it is appropriate to introduce a child to soft contact lenses between the ages of 10-12, with daily disposable contact lenses being the most frequently prescribed contacts for this age group, according to a new American Optometric Association (AOA) study.

At ages 8-9 (51 percent) and 10-12 (71 percent), optometrists most often fit children in glasses as the primary method of vision correction and prescribe contact lenses as a secondary correction. However, data from the survey of 576 optometrists from across the country shows a gradual shift in optometrist’s approach to vision correction as children get older, with 21 percent noting that they are more likely to fit 10-12 year olds in contact lenses than they were a year ago. One-in-five (20 percent) respondents say they begin prescribing contact lenses as the principal form of vision correction for children ages 10-12; nearly half (49 percent) prescribe contact lenses first for 13-14 year olds, and two-thirds (66 percent) recommend contact lenses as the main form of vision correction for 15-17 year olds.

“Studies in children’s vision correction confirm that contacts provide collateral benefits to children beyond simply correcting their vision, including significantly improving how they feel about their physical appearance, acceptance among friends, and ability to play sports, so it’s no surprise that optometrists and parents are becoming even more comfortable with the decision to recommend contact lenses to children when vision correction is required,” says Christine W. Sindt, OD, FAAO, Associate Professor of Clinical Ophthalmology, Department of Ophthalmology and Vision Sciences, University of Iowa, and Chair of the Contact Lens and Cornea Section of AOA.

The Children & Contact Lenses study was conducted by the AOA Research and Information Center in conjunction with the Sports Vision Section and Contact Lens and Cornea Sections of AOA, with support from VISTAKON®, Division of Johnson & Johnson Vision Care, Inc. The study was designed to gauge current trends in prescribing contact lenses to children ages 8-17 and to understand factors that influence optometrists’ decisions to fit a child in contacts. On average, respondents indicated that children up to the age of 17 account for about 41 percent of their total contact lens patient population.

Of doctors who say they are now more likely to fit children in contact lenses, 30 percent attribute their change in fitting behavior to daily disposable lenses; 23 percent cite “improved contact lens materials,” 19 percent say they are more likely to fit childen with contact lenses because of requests from the child and/or parent, and 10 percent say that “recent research/studies” on the subject and children’s participation in activities/sports have influenced their decision.

Nearly all (96 percent) respondents say that a child’s interest and motivation to wear contact lenses is the most important factor to consider in fitting a child with contacts. Also very important to doctors are a child’s maturity level (93 percent), the child’s ability to take care of contact lenses by themselves (89 percent), and the child’s personal hygiene habits (89 percent). While only a very small percentage of doctors say they are less likely to fit contact lenses in children, poor hygiene and maturity levels seen in younger children were most often cited as reasons.

“Studies demonstrate that children who need refractive error correction are capable of wearing and caring for soft contact lenses,” adds. Dr. Sindt. “Optometrists will typically evaluate a child’s maturity and level of parental support in deciding whether a child is ready for contact lenses.”

Other findings from the survey:

• The majority (74 percent) of optometrists surveyed say that gender does not influence their decision to fit a child in contact lenses, while one in four (26 percent) say they are more likely to fit younger children when they are girls.
• One-hundred percent of respondents cite the visual acuity (i.e., clearness of vision) achieved with a contact lens as important, and virtually all respondents rate ease of handling (99 percent), oxygen permeability (99 percent), comfort (98 percent), and replacement schedule (96 percent) as properties that influence their decision to fit a child in contact lenses. Three-fourths (75 percent), say contact lenses that offer ultraviolet protection influence their decision to prescribe contacts for children.
• While daily disposable contact lenses are the most frequently prescribed lenses for children 12 years and under, doctors tend to prescribe reusable contact lenses (i.e., two-week and monthly replacement) more often than daily disposables for children ages 13-14 and 15-17.
• Two out of five (39 percent) optometrists say that parents requesting their child be fitted in contact lenses do so because the child refuses to wear his or her glasses; 36 percent say parents note that the child’s current vision correction interferes with sports and 16 percent say parents want their child in contact lenses because the current form of vision correction interferes with daily activities.
• Seven in ten (71 percent) doctors said overnight wear of contact lenses is not appropriate for children under the age of 18

To view the Executive Summary of the survey, visit www.aoa.org/childrenandcontactlenses.

About the American Optometric Association (AOA):
The American Optometric Association represents approximately 36,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists serve patients in nearly 6,500 communities across the country, and in 3,500 of those communities are the only eye doctors.

American Optometric Association doctors of optometry are highly qualified, trained doctors on the frontline of eye and vision care who examine, diagnose, treat and manage diseases and disorders of the eye. In addition to providing eye and vision care, optometrists play a major role in a patient’s overall health and well-being by detecting systemic diseases such as diabetes and hypertension.

Prior to optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor’s degree. Required undergraduate coursework for pre-optometry students is extensive and covers a wide variety of advanced health, science and mathematics. Optometry school consists of four years of post-graduate, doctoral study concentrating on both the eye and systemic health. In addition to their formal training, doctors of optometry must undergo annual continuing education to stay current on the latest standards of care. For more information, visit www.aoa.org.

VISTAKON® is a trademark of Johnson & Johnson Vision Care, Inc.

COVD & Special Olympics Sign A Memorandum of Understanding

SPECIAL OLYMPICS LIONS CLUBS INTERNATIONAL OPENING EYES DEMONSTRATION PROGRAM at COVD Meeting in Puerto Rico Next Week!!

Next week at the College of Optometrists in Vision Development meeting and Special Olympics are signing a memorandum of understanding at this meeting. As part of the arrangement a demonstration program with Special Olympics athletes will be part of this year’s COVD meeting. The Special Olympics population has a high rate of severe functional vision problems and since COVD members are experts with this population it makes sense to work together to help raise the level of care given to Special Olympians.

COVD and Special Olympics need quite volunteer clinicians because we have been asked to assess 75 athletes in a very short period of time. This is much more than a screening program as glasses will actually be prescribed for the athletes who need them. We will provide a high level of care, but need quite a bit of help to do so. If you plan on coming to the COVD meeting....plan on participating in this very unique COVD and Special Olympics joint venture.

Wii Fit And Brain Damage Rehab

..Wii Fit, combined with sophisticated new software, is giving people their lives back, not just brain-injured soldiers but also thousands of others who suffer brain injuries in car, motorcycle and other accidents.....“You don’t even see this damage with an MRI. It’s called diffuse axonal injury,” said Dr. Allen Cohen of the SUNY College of Optometry. “Their world may feel like it’s moving, the floor may feel like it’s tilted. They can’t focus. Visually the words may double, split apart, run together.”.....The idea is to integrate balance, vision, hearing and eye-hand coordination in a way her brain used to without even thinking....“But it has to be done everyday so that we give very, very specific, organized home therapy procedures,” Cohen said....

Comments: By way of complete disclosure, I do not have any financial interest in the product mentioned here...but I do know the good folks at Home Therapy Solutions and Dr. Al Cohen very well. Click on the title above to see a video on the topic.

Eyestrain self-test for adults

Eyestrain self-test for children

Getting the Word Out About 3 D Movies, Television and Video Games

The American Optometric Association, with Dr. Len Press and myself as primary spokespersons, have had a major impact on getting the word out to 3D movie-goers about the importance of single, clear, comfortable, pathology free, two-eyed/binocular vision. Between May and September of 2010 there were a total of 1,682 media hits (500 online, 15 print, 60 television, 1,100 radio and 7 Reuters) for a total of 229,591,440 impressions.

The American Optometric Association has led the way in making sure that the 3D movie-going, television-watching, and video game playing public know what to look for if eye problems exist while participating in 3D activities and that a comprehensive eye and vision examination by an optometrist should be sought if any problems arise.

Optometry is also the only profession to offer National Eye Institute research supported treatments for those with problems with binocular vision function....this treatment is known as optometric vision therapy. For more information contact the American Optometric Association , watch this video, and/or to seek out an optometrist certifed in the diagnossis and treatment of eye problems associated with 3D Vision Syndrome go to the College of Optometrists in Vision Development website.

Vision Dysfunctions Secondary to a Motor Vehicle Accident: A Case Report

Tong D, Zink C. Vision dysfunctions secondary to motor vehicle accident: a case report. Optom Vis Dev 2010;41(3)158-168.

ABSTRACT
Background: Traumatic brain injury (TBI) is a
common consequence of motor vehicle accidents.
One in every five cases of TBI has a motor vehicle
involved in its etiology. Patients with TBI have been
found to have a high prevalence of vision symptoms
and dysfunctions. This case report discusses a patient
who sustained a TBI from a motor vehicle accident
and received neuro-optometric rehabilitation from a
developmental optometrist and Integrative Manual
TherapyTM with a physical therapist.
Case Summary: A 28-year-old Caucasian male
was evaluated. For vision problems that started after
he acquired a TBI during a car accident 11 years
previous. He had numerous symptoms including
reading difficulties, ocular pain, headaches, and
difficulties with depth perception. The evaluation
revealed binocular vision, accommodative, and
oculomotor dysfunctions, as well as reduced
peripheral visual awareness and visualization anomalies.
Treatment included weekly office-based
optometric vision therapy (OVT), home-based
syntonics, primitive reflex integration, and single
vision lenses with base-in prism. He also received
Integrative Manual Therapy which began five months
prior to the initiation of optometric intervention.
At both a 1-month post OVT progress evaluation
and by a telephone follow up 15 months post-OVT,
the patient reported significant improvement in
symptoms.
Conclusion: Patients with TBI secondary to
motor vehicle accidents experience many detrimental
quality of life changing vision symptoms. This case
illustrates that improvement of symptoms and quality
of life of a TBI patient are possible even 11 years after
the initial injury.

Understanding Children Who Struggle in School

My friend and colleague, Dr. Len Press, "just finished reading a marvelous new book by Deborah P. Waber, PhD, a neuropsychologist in the Learning Disabilities Program in the Department of Neurology at Harvard Medical School.

Dr. Waber lifts the rug that has covered many of the dark secrets in the learning disabilities field. The first secret is that despite volumes of work, scholars are still unable to reach consensus about what a learning disability is, how to know if someone has it, and what to do about. This comes as no surprise to the large number of parents who are frustrated with our current educational system....."

Comments: Read all his comments by clicking on the title above. DM

Diagnosing Extraocular Muscle Dysfunction in Clinic: Comparing Computerized Hess Analysis, Park’s 3-Step Test and a Novel 3-Step Test

Quaid P, Hamilton-Wright AH. Diagnosing extraocular muscle dysfunction in clinic: comparing computerized Hess analysis, Park’s 3-step test and a novel 3-step test. Optom Vis Dev 2010;41(3):143-157.

ABSTRACT
Background: Determining the primary underacting
or overacting extraocular muscle (EOM)
or muscle pair in ocular mis-alignment cases can
frequently be challenging to eye care practitioners,
especially if the mis-alignment is bilateral or
longstanding. The purpose of this study was to
compare the results of a commercially available
computerized Hess Lancaster test to a proposed novel
3-step test and to the commonly used Park’s 3-step
test.
Methods: Ten patients with recent onset or
longstanding EOM dysfunction were seen at the
primary author’s private optometric office for a
binocular vision evaluation. In addition to a complete
eye examination and binocular vision work-up, which
included Park’s 3-step test, all patients were examined
using both a commercially available computerized
Hess Lancaster test and the proposed novel 3-step
method. No mechanical restriction cases were
included in the patient sample.
Results: In all 10 cases, which comprised of
both longstanding and recent onset deviations,
the dysfunction indicated using the novel 3-step
method agreed well with the EOM(s) identified using
computerized Hess-Lancaster testing. Park’s 3-step
test did not prove useful in any of the presented
longstanding or recent onset cases.
Conclusions: Results attained using established
computerized Hess Lancaster testing agreed well
with results attained using a novel 3-step test. In
the absence of Hess Lancaster testing, the proposed
3-step test appears to be a viable alternative in arriving
at a potential diagnosis of the primary underacting
and overacting EOM(s). Park’s 3-step did not prove
useful in any of the presented cases as they were
either bilateral or had no significant vertical deviation
or change in vertical deviation in dextroversion or
levoversion. The proposed novel 3-step test appears
preferable over Park’s 3-step test as it also detects
bilateral and/or longstanding deviations that have
undergone a spread of comitance.

COVD: Recapitulating 40 Years of Excellence

Press L. COVD: recapitulating 40 years of excellence. Optom Vis Dev2010;41(3):137-142.

This year during the week of October 11, COVD will be celebrating our 40th year anniversary. It is fitting that our Annual Meeting this year in Puerto Rico provides an international flavor that attests to the global reach of our organization, mirroring our Cancun experience in 2003....

Do Gifted Children Choose Their Gifts?

Press L. Do gifted children choose their gifts? Optom Vis Dev 2010;41(3):133-
136.

....“Go ahead and ask him”, her mom said. I couldn’t imagine what was on her mind at that point. “Well…” she demurred, “I’m a good artist and I really like to draw. And I draw some things in the same steps each time.” Her mother suggested that she draw me a horse as an illustration of her point. I turned over my examination sheet, handed her my pen, and invited Brigid to draw. She hastily sketched a horse’s head, narrating what she was doing as she went from one spot to the next .... When she was done she apologized that it was not up to her usual standards because she was rushing, but I was struck by its simplistic beauty. I was even more struck by what Brigid asked me next. Perhaps “floored” is a better word. “So if I do some things here to learn how to use my eyes better for reading, will I still be able to draw like I do?”.....

Comments: This editorial reminds us to remember what is important to our patients besides improving after doing optometric vision therapy. DM

Words

Maino D. Words. Optom Vis Dev 2010;41(3):130-132

....Words are important. Words hold even more importance when you use them to identify or name objects, activities and ideas. This concept goes back thousands of years to biblical times, i.e. “He brought them to the man to see what he would name them; and whatever the man called each living creature, that was its name.” We control our world because we have named all within it. When you name a thing, you own it. Your world view is altered when you give all within that world a name or hen you adopt a name as your own even though the words you use may have been first given by others.....

This is an editorial I recently wrote for Optometry & Vision Development. The bottom line is optometrists who word in pediatrics, binocular vision, vision rehab, optometric vision therapy....need to rethink the language we use to describe what we do and who we are. DM

Nine-year Results of a Volunteer Lay Network Photoscreening Program of 147 809 Children Using a PhotoScreener in Iowa

....A retrospective review of results 147 809 children who were screened between May 1, 2000 and April 30, 2009 using a photoscreening program were assessed for the number of screenings, referral rate, positive predictive value (PPV), follow-up rate, and associated costs per year are described. The overall PPV of the MTI PhotoScreener was 94.2%. The cost of screening per child was$US9 .....

Comments: Lots of problems with this study including its retrospective design and high photo unreadable rate for children less than 12 years of age...although amblyopia or lazy eye can be treated at any age...the younger the better and this paper seems to say that the if you are younger than 12 the unreadable rate of the screener is high. Even though this particular study had a good positive predictive value...other studies have noted that most vision screening data is so poor that they couldn't even evaluate the value of vision screening. It has been noted that: "Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available." ... which means that vision screenings are so horrible that the research cannot tell us if they are worth doing or not! Read this particular article by clicking here. I suppose if you are only concerned with the cost using the MTI Photoscreener might be a good thing. If you want to make sure every child sees properly please schedule a comprehensive vision examination today. To read the article cited above click on the title. DM

Kids with ADHD more likely to have missing DNA

....Children with attention deficit hyperactivity disorder are twice as likely to have missing or extra chromosomes than other children ....British researchers compared the genomes of 366 white British children from 5 to 17 years old with attention deficit hyperactivity, or ADHD, to those of more than 1,000 similar children without the disorder. The scientists focused on a sequence of genes linked to brain development that has previously been connected to conditions like autism and schizophrenia....

Visual control in children with developmental dyslexia

ABSTRACT

PURPOSE: To assess binocular control in children with dyslexia.
METHODS: Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests.
RESULTS: In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed.
CONCLUSION: The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.

Keywords: Dyslexia/physiopathology; Attention; Vision, binocular/physiology; Visual perception; Ocular motility disorders; Learning disorders

RESUMO

OBJETIVO: Avaliar o controle binocular em crianças com dislexia.
MÉTODOS: Estudo transversal do qual participaram 26 crianças, nas quais foram aplicadas uma série de exames oftalmológicos e visuais.
RESULTADOS: Nas crianças com dislexia observou-se controle menor na convergência voluntária e na estabilidade da fixação binocular.
CONCLUSÃO: Os resultados apóiam a hipótese de que na dislexia do desenvolvimento podem ocorrer déficits que envolvem a via visual magnocelular e uma parte da rede cortical posterior da atenção.

Descritores: Dislexia/fisiopatologia; Atenção; Visão binocular/fisiologia; Percepção visual; Transtornos da motilidade ocular; Transtornos de aprendizagem

Comments: Full article in English and Spanish available by clicking title above. DM

Extensive Video Game Experience Readies Brain For More Challenging Hand-Eye Tasks

This study notes an improvement in visiomotor tasks after playing video games...while other papers have noted that individuals skilled in video game-playing have a more efficient brain network for controlling movement that includes the prefrontal, premotor, primary sensorimotor and parietal cortices....

Hard-Wired For Chocolate And Hybrid Cars? How Genetics Affect Consumer Choice

... people seem to inherit the following tendencies: to choose a compromise option and avoid extremes; select sure gains over gambles; prefer an easy but non-rewarding task over an enjoyable challenging one; look for the best option available; and prefer utilitarian, clearly needed options (like batteries) over more indulgent ones (gourmet chocolate). They also found that likings for specific products seemed to be genetically related: chocolate, mustard, hybrid cars, science fiction movies, and jazz....The researchers also found that some tendencies did not seem to be heritable - for example, a preference for a smaller versus larger product variety or likings for ketchup and tattoos. ....

Acute Pain Is Eased With The Touch Of A Hand

...There may be a very good reason that people naturally clutch their hand after receiving an injury. A new report ... shows that self-touch offers significant relief for acute pain under experimental conditions. The researchers suggest that the relief comes from a change in the brain's representation of the rest of the body. ...

Do gaze cues in complex scenes capture and direct the attention of high functioning adolescents with ASD? Evidence from eye-tracking.

...Visual fixation patterns whilst viewing complex photographic scenes containing one person were studied in 24 high-functioning adolescents with Autism Spectrum Disorders (ASD) and 24 matched typically developing adolescents. Over two different scene presentation durations both groups spent a large, strikingly similar proportion of their viewing time fixating the person's face. However, time-course analyses revealed differences between groups in priorities of attention to the region of the face containing the eyes. It was also noted that although individuals with ASD were rapidly cued by the gaze direction of the person in the scene, this was not followed by an immediate increase in total fixation duration at the location of gaze, which was the case for typically developing individuals....

Development of neural correlates of empathy from childhood to early adulthood: an fMRI study in boys and adult men.

...Although empathy is rooted early in life, the ability to understand and share the emotions of others continues to develop after childhood. ....This study is the first to show developmental changes in the neural mechanisms supporting empathy. Our findings may have important implications for the development of novel therapeutic interventions in clinical conditions characterized by empathy deficits, such as autism spectrum disorder....

General Health-Related Quality of Life in Preschool Children with Strabismus or Amblyopia

....Of the 4218 children aged ≥25 months, 121 (2.9%) were diagnosed with strabismus. Significant differences were found in all 3 composite scores between children with and without strabismus, ..... A total of 3318 children were aged ≥30 months, and 71 children (2.1%) had amblyopia. There were no significant differences in any PedsQL scores between children with and without amblyopia....Strabismus was associated with significantly worse quality of life in preschool children. ...no difference was found with children with amblyopia....

Comments: Click on title above for abstract. DM

Visual Tricks to Looking Thinner

Since I am a "short, round Italian" I am always looking for ways to appear thinner.... AOAConnect had this info on how to achieve just that. (Of course, I could just loose a few poinds!!) Click on the title above for more info. DM

Visual Acuity Norms in Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study

...Visual acuity test performance in normal preschool children improves with age. We propose new age-specific thresholds for defining abnormal monocular VA using HOTV optotypes in children between 2 and 5 years of age, for use in screening, clinical practice and research....

Comments: Full article available by clicking on title. DM

Waking Up Brains After Stroke

....It strikes 800 thousand people every year and is the leading cause of long-term disability in the U.S. Ninety-five-percent of stroke survivors struggle to move their arms or hands after an attack. Now researchers are hoping to wake up hands by stimulating sleepy brain cells....

Comments: Don't forget that individuals with acauired and traumatic brain injury often have many vision problems that can interfer with their quality of life. See story and video by clicking on title above. Go to http://www.nora.cc/ for more information. DM

Anxious & Unfocused: Adult ADHD

...One of every 10 kids in the U.S. has ADHD, attention-deficit hyperactivity-disorder. But experts say some of the parents should take a closer look at their own behaviors. ...

Comments: Just a reminder...just as children with ADHD can also have vision problems that can make ADHD worse...or can be mistaken for attentional problems....adults can have these same vision problems as well. If you are an adult with ADHD, please have a comprehensive functional vision assessment. Go to http://www.covd.org to find a doc who can help. Also...type in adult adhd in the search box to the upper left and see additional info on the topic. DM