Friday, March 7, 2008

Mental fitness--exercises for the brain

Just as physical exercise maintains body tone, strength, and endurance, mental exercising has positive conditioning effects for people of all ages. This article describes a complete "mental workout"--daily

The Stroop Test

The Stroop Task is a psychological test of our mental (attentional) vitality and flexibility. The task takes advantage of our ability to read words more quickly and automatically than we can name colors. ... The cognitive mechanism involved in this task is called directed attention, you have to manage your attention, inhibit or stop one response in order to say or do something else.

Brain Plasticity: How learning changes your brain

Brain Plasticity: How learning changes your brain

Neuroplasticity occurs in the brain:
1- At the beginning of life: when the immature brain organizes itself.
2- In case of brain injury: to compensate for lost functions or maximize remaining functions.
3- Through adulthood: whenever something new is learned and memorized

Comment: It's amazing how functional optometry for decades has been saying you can change the way the brain works by altering the environment thru optometric vision everyone is hopping onto the we can the change the brain bandwagon! DM

Keeping Your Brain Fit

A recent article in US News & World Report suggests those of us who are chronologically enhanced can improve our brains using these software tools...

Larson C. Keeping your brain fit. US News & World Report. 2008;144(4):41-49

Brain Fitness Program


Brain Age

Big Brain Academy

My Brain Trainer

Radica Brain Games and Brain Games 2:

Therapy Shown To Improve Brain Activity

Vision Restoration Therapy Shown To Improve Brain Activity In Brain Injured Patients: Columbia University Medical Center researchers have demonstrated using functional magnetic resonance imaging (fMRI), that brain activity was increased in stroke and traumatic brain injury survivors who underwent Vision Restoration Therapy (VRT), a rehabilitative treatment that helps these patients recover lost vision.

Comment: Optomtrists have been working with those with brain injury for decades using optometric vision therapy to improve patient abilities. Go to and for more info. DM

Stereoacuity in Intermittent Exotropia

Variability of Stereoacuity in Intermittent Exotropia: 50% of children with IXT showed significant changes in stereoacuity over the course of a single day, therefore an apparent change in distance stereoacuity between visits should be interpreted with caution.

Treatment of Nasolacrimal Duct Obstruction

Primary Treatment of Nasolacrimal Duct Obstruction with Probing in Children Younger than 4 Years: In children 6 to <36>

Rehabilitation of Pseudophakic Amblyopia using Active Vision Therapy

Rehabilitation and Management of Pseudophakic Amblyopia in Cases of Unilateral Congenital Cataract by Active Vision Therapy

We studied the benefit of active vision therapy in 910 pseudophakic amblyopic children and young adults suffering from unilateral congenital cataract. It was concluded that noninvasive active vision therapy helps improve visual acuity in the majority of subjects.

Binasal Occlusion

Where to find information on binasal occlussion.

Several years ago I published the following articles:
Maino D. Binasal occlusion for the child with Cerebral Palsy. J Ill Optom Assoc 1986;44 (1):12,18. Maino D, Hechtman M, Meltzer P, Weinstein N. Binasal occlusion. Optom Mon 1985;May,208-9.

Childhood Immunizations are Life-saving

The CDC says it is standing by its view that childhood immunizations are life-saving, despite a federal court ruling that linked the autism-like symptoms of a Georgia girl to vaccines.
The Georgia case was "a very special situation in a child who was genetically predisposed" to develop neurological symptoms under stress, according to Julie Gerberding, M.D., the agency's director.

Comment: There is still not clear cut evidence as to what causes autism. It could be many different etiologies....or something we have not yet discovered. DM

Computer Vision Syndrome. CVS

The New York State Optometric Association (NYSOA) alerted New Yorkers who use computers daily that they could suffer from “computer vision syndrome,” leaving them vulnerable to problems like dry eye, eyestrain, neck and/or backache, light sensitivity and fatigue.

Comment: Optometric Vision Therapy and or special computer glasses as perscribed by your optometrist can eliminated many of the problems associated with CVS.

Thursday, March 6, 2008

Congenital ocular motor apraxia

Congenital ocular motor apraxia is an uncommon disorder of ocular motility. Even so, ophthalmologists (and optometrists) should be aware of the developmental delay and the other associated conditions, in order to grant the patients the multidisciplinary assistance they often require.

Scientists Link Down Syndrome and Alzheimer's

... (A) new study shows that the mutant genes that cause Alzheimer's also lead to the creation of Down Syndrome cells during the normal process of cell division....

Tourette's Syndrome: What It Is and How It's Treated

Tourette's syndrome (too-RETTS SIN-drome) is a disorder that causes tics. Tics are sudden, brief movements (like muscle spasms) or sounds (like words or grunts) that a person repeats over and over. They are hard to control, can be mild to severe, and come and go over time. Common tics are eye blinking and shoulder shrugging. Tics can get worse with stress or if you talk about them.

Amblyopic reading is crowded

Researchers, Dennis Levi, Shuang Song, and Denis G. Pelli noted that the entire amblyopic reading deficit is accounted for by crowding...published in the Journal of Vision Volume 7, Number 2, 2007.

The convergence insufficiency treatment trial: design, methods, and baseline data

Objective: This report describes the design and methodology of the Convergence Insufficiency Treatment Trial (CITT), the first large-scale, placebo-controlled, randomized clinical trial evaluating treatments for convergence insufficiency (CI) in children. We also report the clinical and demographic characteristics of patients. Methods: We prospectively randomized children 9 to 17 years of age to one of four treatment groups: 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, 4) office-based placebo therapy. Outcome data on the Convergence Insufficiency Symptom Survey (CISS) score (primary outcome), near point of convergence (NPC), and positive fusional vergence were collected after 12 weeks of active treatment and again at 6 and 12 months posttreatment. Results: The CITT enrolled 221 children with symptomatic CI with a mean age of 12.0 years (SD = +2.3). The clinical profile of the cohort at baseline was 9Delta exophoria at near (+/- 4.4) and 2Delta exophoria (+/-2.8) at distance, CISS score = 30 (+/-9.0), NPC = 14 cm (+/- 7.5), and near positive fusional vergence break = 13 Delta (+/- 4.6). There were no statistically significant nor clinically relevant differences between treatment groups with respect to baseline characteristics (p > 0.05).Conclusion: Hallmark features of the study design include formal definitions of conditions and outcomes, standardized diagnostic and treatment protocols, a placebo treatment arm, masked outcome examinations, and the CISS score outcome measure. The baseline data reported herein define the clinical profile of those enrolled into the CITT.

From:Ophthalmic Epidemiol. 2008 Jan-Feb;15(1):24-36.

New Medical Terms/Jargon

404 moment
The point in a ward round when-despite all efforts to look through the notes or access electronic systems-a particular result cannot be located. (From the world wide web error message "404 document not found.")

The pleasantly decorated and furnished palatial offices of trust management or the dean.

The flurry of pointless emails and paperwork that emanate from the adminosphere.

The (usually vain) attempt to answer the question, "How long have I got, doc?"

A session of mutual recrimination during which a multidisciplinary team attempts to apportion blame for some particularly egregious error.

McCain Cites 'Strong Evidence' of Link Between Vaccines and Autism

Sen. John McCain, the presumptive Republican candidate for president, has given credibility to "strong evidence" of a link between autism and thimerosal in childhood vaccines. He cited "divided scientific opinion" on the matter.

Comment: It just goes to show you that politicians should not make speeches on subjects they know little about. (and I like McCain!!). I have reviewed the research....and their appears to be several possible links between multiple etiologies and autism. No one knows just yet what causes autism.

14% of Households have a Special Needs Child that needs Health Care

Approximately 14 percent of U.S. children have special healthcare needs, survey indicates.
The UPI (3/6) reports that according to a survey released by the Health Resources and Services Administration, some "10.2 million U.S. children," or about 14 percent of them, "have special healthcare needs," and "[m]ore than one-fifth of U.S. households with children have at least one child with special needs." Of the reported special-needs cases, approximately "94 percent have a regular source of care when they are sick." In addition, the survey indicated that "families are struggling with the demands of caring for a special-needs child, with 12 percent of families requiring mental healthcare or counseling related to the child's medical, behavioral, or other health conditions."

Comment: All of these children require eye care as well. Many have strabismus, amblyopia, and other functional vision problems.

Study suggests new technique may treat amblyopia.

In continuing coverage from yesterday's edition of First Look, AHN (3/5, Arceo) reported that a "study suggests promise of a simple, non-surgical treatment for amblyopia or 'lazy eye,' which is considered mostly irreversible after age eight [Comment: Current research suggests that amblyopia can be treated at any age. It is unfortunate that this myth of an age limit for treating amblyopia is still mentioned even by those who should know better. DM]." Researchers "at a Beijing hospital found that 28 out of 30 patients underwent good results after a ten-day treatment course." Lead author Zhong-Lin Lu, Ph.D., "said that after the training, patients started using both eyes, some got 20/20 vision, and that by clinical standards, they are completely normal." Still, Dennis Levi, O.D., dean of optometry at the University of California in Berkeley, "said that though this therapy shows promise, it has not been established in a clinical setting to be effective."

Computer Vision Syndrome

American Optometric Association says computer vision syndrome becoming more prevalent in Americans.

The Baltimore Sun (3/6, 1C, Cohn) reports, "Doctors say there is too much staring and not enough blinking [among Americans], and it is resulting in an annoying condition the American Optometric Association (AOA) terms 'computer vision syndrome.'" This "syndrome is not one defined disorder, but a collection of symptoms that is affecting people young and old who work, study, and play in front of a screen." Indeed, "[i]ndustry officials believe it's more widespread than repetitive motion injuries, such as carpal-tunnel syndrome." According to Martin Novey, O.D., "I ask about it as part of my [patients'] history when I do an exam now." In addition, the AOA states that "82 percent of respondents in a recent nationwide survey say they frequently use a computer or hand-held device, and 42 percent frequently use them for three or more hours a day." Moreover, the Journal of the American Optometric Association points out that most people fail to "blink or take enough breaks, their lights are too bright and their computer screens are positioned incorrectly," with the result that about "three-quarters of the computer users report eye problems."

Comment: CVS had make your eyes feel dry and fatigued and you may experience blur and seeing double. We at Northwest Optometric Associates can diagnose and treat this disorder. DM

Dr. Maino Quoted in EyeCare Business

Brands are as equally hot as they were before, but there has been a new turn—in addition to a well-known name, high-quality, durability, and fashion are also wow factors," says Dominick Maino, OD, MEd, professor at the Illinois Eye Institute and doctor at Northwest Optometric Associates in Harwood Heights, Ill. "You usually get all those qualities in a designer brand, so that has helped maintain their popularity." ...

...Dominick Maino, OD, MEd, FAAO, FCOVD-A, a professor at the Illinois Eye Institute and a doctor at Northwest Optometric Associates, says he takes time to sit down with a child to tell them not to put up with a bully. "Kids are sometimes picked on for wearing glasses, especially if they are the first one on the block to be wearing them," he says. Maino teaches kids how to stand up to a bully with role-playing, where he pretends to be the bully. "I explain to the child I'm working with, that if a bully is picking on them for wearing glasses it's because of the bully's own problems," he says. "Then I give the child a stack of my business cards and tell him or her that if the bully is bothering them to say: 'If you have a problem with me wearing glasses, call my doctor and he'll explain it to you!' Then, I tell them to hand over a business card and walk away."In the two decades that Dr. Maino has been using this technique he's gotten just one call from a bully. Most bullies give up—most likely because an authority (a doctor) is now involved, though indirectly. Dr. Maino is right in line with what KidsHealth tells parents to teach their children: when a bully is taunting you show them it doesn't bother you by not reacting, or by using humor, and then simply walk away.

Comment: We always want the very best frames and lenses for our patients and so do many parents! DM

Wednesday, March 5, 2008

Cell Phone That Reads To The Blind And Dyslexic

K-NFB Reading Technology, Inc., a company combining the research and development efforts of the National Federation of the Blind and Kurzweil Technologies, Inc., unveils an exciting product line that will revolutionize access to print for anyone who has difficulty seeing or reading print, including the blind and learning disabled.

Researchers Can Now Determine When A Human Was Born By Looking Into The Eyes Of The Dead

Using the radiocarbon dating method and special proteins in the lens of the eye, researchers at the University of Copenhagen and Aarhus can now establish, with relatively high precision, when a person was born. This provides a useful tool for forensic scientists who can use it to establish the date of birth of an unidentified body and could also have further consequences for health science research.

Why Does The World Appear Stable While Our Eyes Move?

Whenever we shift our gaze, attention is directed to a new target. This shift in attention causes a brief compression of visual space, according to a study published February 15 in the open-access journal PLoS Computational Biology. The team of researchers from the University of Münster, Germany, describes a model of brain function in which eye movement signals are used to boost the neural representation of objects located at the future eye position. This boost comes at the expense of a temporary loss of spatial accuracy. This research shows a direct correlation between visual perception and eye movement control.

Breakthrough In Study Of Childhood Cataracts

The international team of researchers was able to identify the location and defect in the coding region of the gene through analysis of genetic material (DNA) from members of a large Swiss family, the majority of whom suffered from autosomal dominant juvenile cataract. The corresponding protein belongs to a family of monocarboxylate transporters which move small molecules across cell mem-branes. Surprisingly, this genetic defect may also lead to the condition of renal glucosuria, a non-pathological kidney defect with elevated levels of glucose in the urine, but not in blood.

3-D movie viewer may spot eye problems

Taking your kids to see Spy Kids 3-D may serve as a diagnostic experience. If a child wearing 3-D glasses (of paper and colored plastic film) can't see three-dimensional objects on the screen, he or she may be suffering from a vision disorder. So says Robert Lederman, a Jerusalem optometrist who has looked into the matter. A fellow of the College of Optometrists in Vision Development, Lederman says that five to seven percent of children cannot see 3-D at a distance, and a greater percentage struggle with seeing 3-D up close. 'In order for someone to experience 3-D effects, their eyes need to work together properly. If the movie does not look three-dimensional through the special glasses, or if it appears three-dimensional but the viewer experiences eyestrain or headaches, a vision problem might be present.'

The importance of seeing in 3-D extends beyond the movie theater, he continues. 'Any activity requiring depth perception or hand-eye coordination such as riding a bike, climbing stairs or even pouring milk on cereal can be affected if a child has problems seeing 3-D. This can have a profound negative impact on a child's ability to learn.'

Comment: Optometric Vision Therapy can improve your 3D vision. DM

InfantSee Program: Have Your Little Ones Eyes Examined Now!

2007 InfantSEE(R) Data Magnifies The Need For Early Eye And Vision Screenings For Infants, According To American Optometric Association

Eye assessments from one in nine infants have shown an overall need for concern, according to new data collected by the American Optometric Association (AOA) via 10,000 InfantSEE(R) assessments conducted during 2006 and 2007. The overall need for concern has increased from one in 14 last year and clearly reveals a growing need for early vision examination in infants.The data also showed that the two groups at greatest risk for abnormal prescription status were those born prematurely and those from ethnic minority backgrounds.InfantSEE(R), a public health program developed by the AOA in partnership with The Vision Care Institute of Johnson & Johnson Vision Care, Inc., was designed to provide professional eye care for infants nationwide at no cost regardless of family income. The program launched in 2005 with support from former President Jimmy Carter, honorary national chair and spokesman. To date an estimated 125,000 to 150,000 babies have had their eye health and vision assessed.

Comments: Infants from 6-12 months can participate in this free public health program. Go to InfantSee's website for more information. Northwest Optometric Associates participates in this program.

Children With Lazy Eye Need Only Wear Patches A Few Hours A Day

A child with amblyopia (lazy eye) does not have to wear a patch all day; three to four hours daily for a total of twelve weeks is all that is usually needed to improve vision, according to an article published in the British Medical Journal (BMJ). The writers say that wearing a patch all day long for several years is too much.

Comment: It is now known that children may be patched for as little as 2 hours/day IF active hand-eye home therapy is given. Amblyopia does not only include problems with the clarity of vision (visual acuity) but also accommodation (focusing), visual spatial relationships, binocularity and more. Do not stop treating amblyopia until all the associated problems are also corrected. DM

Children's Vision Screening Is Failing

Vision screenings do not catch a significant number of eye problems. Always have your children scheduled for a comprehensive eye examination at least once a year by a pediatric optometrist.

"Lazy Eye" Treatment Shows Promise In Adults

New evidence from a laboratory study and a pilot clinical trial confirms the promise of a simple treatment for amblyopia, or "lazy eye," according to researchers from the U.S. and China.The treatment was effective on 20-year-old subjects. Amblyopia was considered mostly irreversible after age eight.

[Comment: This is NOT true. There has been ample evidence that amblyopia is treatable at any age, but many eye doctors have confused the concept of "critical period" and when neuroplasticity no longer ocurrs. It seems that adults have plenty of time to be treated for lazy eye. DM]

...[amblyopia] affects about nine million people in the U.S. alone.Results from the laboratory study will be published online the week of Mar. 3 in PNAS Early Edition.Patients seeking treatment will need to wait for eye doctors to adopt the non-surgical procedure in their clinics, said Zhong-Lin Lu, the University of Southern California neuroscientist who led the research group.

Comment: Members of the College of Optometrist in Vision Developmemt have been treating adults with amblyopia for some time have the doctors at Northwest Optometric Associates. DM

Prolonged recovery of memory functioning after mild traumatic brain injury in adolescent athletes

Individuals who sustained in-season concussions demonstrated impairments in reaction time, processing speed, and had delayed memory functioning. Although reaction time and processing speed deficits returned to baseline levels by ~ 6 days postinjury, participants continued to show memory impairments up to 7 days postinjury. Memory impairments were found to resolve by Day 10, however. The results of the present study suggest that high school athletes demonstrate prolonged memory dysfunction compared with college athletes, and should therefore be treated more conservatively.

Comment: It has been found that even mild head injury can result in longterm dysfunction. although this study suggests fairly complete recovery of function, this need not be the case for all individuals.

Tuesday, March 4, 2008

Alport syndrome: a review

Alport syndrome, a hereditary nephritis accompanied by high-tone sensorineural deafness and distinctive ocular signs was first noted in the literature during the early 1900s. This disease is caused by a genetic defect in Type IV collagen which makes up basement membranes in many body systems. The patient will usually have bilateral anterior lenticonus causing varied refractive errors. You may also note yellow-white to silver flecks within the macular and midperipheral regions of the retina. The treatment of the visual problems is an important but secondary concern due to the seriousness of the systemic disease. Dual sensory loss, however, creates an urgent need for appropriate vision care. Due to the high risk for developmental delay and decreased social integration, early intervention should be considered in the treatment plan. Coping strategies for the patient (and the family) need to be addressed because of the chronicity of this syndrome. The primary care optometrist will be challenged by the individual with Alport syndrome since a balance between oculo-visual, developmental/psycho-educational and systemic care is required. A multi-disciplinary approach by the healthcare management team will enhance the quality of life and positive outcomes for these patients.

Cognitive and Visual Processing Skills and Their Relationship to Mutation Size in Full and Premutation Female Fragile X Carriers.

Block, Sandra S. OD, MEd, FAAO; Brusca-Vega, Rita EdD; Pizzi, William J. PhD; Berry-Kravis, Elizabeth MD, PhD; Maino, Dominick M. OD, MEd, FAAO; Treitman, Theresa M. Cognitive and Visual Processing Skills and Their Relationship to Mutation Size in Full and Premutation Female Fragile X Carriers. Optometry & Vision Science. 77(11):592-599, November 2000.

Background: The fragile X gene contains an unstable trinucleotide (CGG) repeat that expands as it is passed from female carriers to the affected offspring. Obligate female carriers may have a premutation or full mutation genotype.

Methods: In this study, fragile X premutation and full mutation female carriers were compared on three tasks of visual processing and cognitive skills.

Results: In each case, there were significant differences between premutation and full mutation carriers on a number of the subtests or the full test scores. Specifically, full mutation female carriers performed more poorly in visual-motor processing and analysis-synthesis on the Woodcock-Johnson Psycho-Educational Battery-Revised, The Developmental Test of Visual Motor Integration, and on five of the seven subtests of the Test of Visual-Perceptual Skills. Regression analyses revealed significant negative correlations between mutation size and cognitive ability.

Conclusions: These findings have implications in educational planning decisions for full mutation carriers who may present with specific cognitive deficits.

Memory Tied to Low School Scores

Poor working memory, rather than low intelligence, could be the reason why some children are underachievers at school. Working memory is the ability to retain and manipulate information. An example would be doing math without the aid of pen and paper or a calculator. Students need working memory for a variety of school-related tasks, such as following teachers' instructions or remembering sentences they've been asked to write down. Using a new tool that they developed, a team at Durham University surveyed more than 3,000 children of different ages and found that 10 percent of them suffered from poor working memory, which seriously impairs their ability to learn. The study authors also found that poor working memory in students is rarely identified by teachers, who often believe children with this problem are inattentive or have low intelligence. If poor working memory -- believed to be genetic -- isn't identified and addressed in children, it can affect their long-term academic success and prevent them from achieving their potential, the researchers said.

Monday, March 3, 2008

Vision Therapy Improves Strabismus Surgery Outcomes

Edwin C Figueira MS, Stephen Hing FRANZCO. Intermittent exotropia: comparison of treatments Clinical & Experimental Ophthalmology. 2006; 34 (3); 245–251

Noted that: Surgery with preoperative orthoptic/occlusion (optometric vision therapy) therapy had the highest success rates. Surgery with orthoptic/occlusion therapy was more effective in reducing exodeviation (compared with surgery only.

Comment: Surgery can be done at almost any age for strabismus....but if surgery is an option, you may want to conduct optometric vision therapy first to improve your chance of successful outcomes.

The scientific basis and efficacy of Optometric Vision Therapy

The scientific basis for, and efficacy of, optometric vision therapy in such patients are discussed. Using bio-engineering models of the oculomotor system as the conceptual framework, emphasis is focused on studies that used objective recording techniques to directly assess therapeutically related changes in oculomotor responsivity. Research clearly supports the validity of optometric vision therapy. Furthermore, the results are consistent with the tenets of general motor learning.

Comments: Optometric Vision Therapy is evidenced based treatment for a variety of visual disorders. DM

Abilify Approved for Children With Bipolar Disorder

The U.S. Food and Drug Administration has approved Abilify (aripiprazole) to treat manic and mixed episodes in children aged 10 to 17 with bipolar 1 disorder, makers Otsuka Pharmaceutical Co. and Bristol-Myers Squibb Inc. said Friday. The drug has been approved for this and other uses in adults for several years. The new approval was based on results from a four-week study involving children in this age group. The trial demonstrated the drug's effectiveness compared to a placebo, the drug companies said in a statement. Abilify was first approved in November 2002, and nearly 15 million prescriptions had been written through December 2007, the statement said.

Comment: There are many unwanted side effects with this drug. The more common side effects include headache, blurred vision and fatugue. DM

Mathematics and Learning Disabilities

Increased attention is being paid to students who demonstrate difficulty in learning and applying mathematics concepts. The purpose of this special series was to address issues related to students and mathematics learning disabilities (LD). We identify Response to Intervention (RtI) as it relates to early mathematics instruction and a multi-tiered service delivery system. Further, because RtI has focused primarily on young children and the prevention of LD, we present information about older students who have been identified as having mathematics LD and provide strategies for helping them access the general education curriculum. Six papers on various mathematics topics, grade levels, and service delivery will be provided in this special series. Authors report findings on research efforts and offer implications for practice.

Comment: Although I see many children with LD....most have reading problems. We should not ignore those with difficulty in math. DM