Friday, April 11, 2008

Rise in Autism May be Partly Explained by Diagnostic Changes

The increasing prevalence of autism may, at least in part, be a result of a broadening definition of the disorder, researchers here found.

Comment: I was just lecturing yesterday on this topic to my students....and I've come to a very similar conclusion. DM

Researchers in Singapore say babies who are breastfed may be less likely to become nearsighted children.

...Breastfeeding has been linked with brain development, which could affect young children's vision, say the researchers. They note that before weaning, breast milk is a main source of many nutrients, including docosahexaenoic acid (DHA), which is important in the development of the brain and eyes....

Omega-3 intake during last months of pregnancy boosts an infant’s cognitive and motor development

A study supervised by Université Laval researchers Gina Muckle and Éric Dewailly reveals that omega-3 intake during the last months of pregnancy boosts an infant’s sensory, cognitive, and motor development. The details of this finding are published in a recent edition of the Journal of Pediatrics.

Kids have many undiagnosed and untreated Eye Problems

The New York Daily News (4/11, Black) reports that eye problems are not uncommon in children. Estimates indicate that "one in 20 preschoolers, and one in four school-age children have some type of eye problem," including strabismus (crossed eyes), amblyopia (lazy eye), or myopia (nearsightedness). Babies can receive "a free eye screening through a program called InfantSEE," which is "sponsored by the American Optometric Association and Johnson & Johnson Vision Care, Inc." According to eye-care specialists, preschool children should undergo "a comprehensive eye exam between age three and three-and-a-half," during which the "doctor will screen for strabismus and also for amblyopia, which is the leading cause of visual loss in children." At the same time, a "preschooler's vision will be screened to see if" he or "she needs glasses." Parents should encourage consumption of "dark green vegetables and vitamin-fortified milk," discourage "play with sharp toys or objects," and "buy [their] child sunglasses to protect...eyes against UV exposure." In addition, parents should "invest in a good reading lamp," and have children "take breaks once in a while" to avoid focus problems caused by heavy computer use.

Hidden Costs of Autism

It’s a disorder that seems to have an impact on the entire family. A new study finds the average household with children with autism not only spends thousands of dollars more in expenses, but also makes less money overall.

Wine may protect against dementia

There may be constituents in wine that protect against dementia. This is shown in research from the Sahlgrenska Academy at University of Gothenburg in Sweden. The findings are based on 1,458 women who were included in the so-called Population Study of Women from 1968. When they were examined by physicians they were asked to report how often they drank wine, beer, and liquor by selecting from seven categories on a scale from ‘never’ to ‘daily.’

Comment: I know this has little to do with children's vision...but I need to show my wife why drinking a bit of wine from time to time is a good idea...now where did I put that wine bottle openner? DM

Vision Affects how Children Learn Math Skills

Two articles just published in Optometry & Vision Development by renowned scientist/researcher, Dr. Burkhart Fischer and his colleagues strongly suggest that vision problems may affect how children acquire math skills. Both of these articles abstracts are noted below....free and full access to the complete texts of the articles can be obtained by clicking the title above.... DM


Subitizing and Visual Counting in Children with Problems in Acquiring Basic Arithmetic Skills
Burkhart Fischer, Dipl. Phys., Christine Gebhardt, Dipl. Phys., and Klaus Hartnegg, Dipl. Phys.
Center of Neuroscience, Optomotor Laboratory, University of Freiburg, Freiburg, Federal Republic of Germany


ABSTRACT
The ability of recognizing a number of briefly presented items without actually counting is called subitizing (from lat. subito = suddenly). Adult subjects can subitize 3 to 4 items. For greater numbers the subjects begin a counting process relying on the visual memory of the test pattern, which needs increasingly more time as the number of items increases. The development of accuracy and speed of subitizing and visual counting was measured for subjects up to the age of 17 years. Furthermore, this study tests the hypothesis that children with difficulties in acquiring basic arithmetic skills exhibit developmental deficits in subitizing and/or counting. The study does not intend to investigate theories on the nature of dyscalculia even though most test children can be classified as dyscalculic.
Methods: Two-hundred-nineteen control subjects and 156 test subjects with problems in arithmetic skills in the age range of 7 to 17 years were given a visual counting task in which 1 to 9 items were presented for 100 ms. The subjects had to press a digit key on a numerical keyboard to indicate the number of items they had seen. Percentages of correct responses and response times were recorded.
Results: The analysis shows systematic differences between control and test children increasing with age. The percentage of test children performing below the 16-percentile of the age matched controls was estimated to be between 40% and 78% (increasing with age).
Conclusions: We concluded that the deficit in a basic visual capacity may contribute to the problems encountered by children with anomalies in acquiring basic arithmetic skills.



Effects of Daily Practice on Subitizing, Visual Counting,and Basic Arithmetic Skills
Burkhart Fischer, Dipl. Phys., Andrea Köngeter, Dipl. Biol., and Klaus Hartnegg, Dipl. Phys.
Center of Neuroscience, Optomotor Laboratory, University of Freiburg, Freiburg, Federal Republic of Germany



ABSTRACT
Background: The ability of subitizing and counting undergoes a long lasting development until
the age of 17 years. Large proportions of children with problems in acquiring basic arithmetic skills exhibit developmental deficits in the correctness and speed of this special visual capacity. The first study described in this paper tests the possibility that subitizing and visual counting can be improved by daily practice. The second study described in this paper shows that basic arithmetic skill were significantly improved in a trained as compared to an untrained
control group.

Methods: Altogether, 74 subjects (age 7 to 13 y) participated in the first study. They were given a special task for daily practice during a period of 21 days. Corresponding to the state of the subject under training the difficulty of the task was adapted. For the second study 21 children (aged 7.5 to 9 y), were recruited from a local school. All children had problems in basic mathematics and failed the test of subitizing. The training group (N=10) was given the
required training, while the waiting group (N=11) had to wait. A standard test of basic mathematics (DEMAT) was used to measure basic arithmetic skills before and after the training.
Results: The analysis of the pre-post training data revealed that subitizing and counting were significantly improved in about 85% of the subjects: they reached the normal range of the control subjects (N=133) of the same age. The second study shows that basic arithmetic skills were significantly improved in a trained as compared to an untrained control group.
Conclusion: Since the result of the second study of this paper shows a transfer from improvements in subitizing to improvements of basic arithmetic skills one may conclude that the basic visual capacity of subitizing and visual number counting contributes to the problem encountered by children with dyscalculia.


In the interest of full disclosure, it should be noted that I am the editor of Optometry & Vision Development, the official journal of the College of Optometrists in Vision Development. DM

Topiramate Associated Bilateral Acute Angle Closure Glaucoma And Myopia

Abstract
Topiramate, an oral sulphamate medication, is primarily licensed for treating epilepsy, though it is increasingly being used for treating migraine 1 . Studies have also established its role in treating cocaine addiction 2 . Topiramate is thought to potentiate the activity of GABA ( -aminobutyric acid) neurotransmitter by blocking the glutamate receptors 3 . It also has a weak carbonic anhydrase inhibitory activity. We describe a case of acute myopia and angle closure glaucoma secondary to topiramate, used for the treatment of migraine.

Comment: Many of my patients take Topomax. It's use is spreading for many disorders and diseases. Always assess refractive error and IOP on these patients. DM

Thursday, April 10, 2008

Directory of Open Access Journals

This link allows you access to hundreds of open access journals in numerous categories. Have fun! DM

Bentham Open Access Journals

I'm always looking for new avenues to knowledge....and I just found Bentham Open Access Journals.

Bentham notes that:

All articles are made freely and permanently accessible online immediately upon publication.
All articles are available for you to read, download, copy, distribute, deposit in digital repositories and use (with attribution) in any way you wish. No permission is required for distribution, copying or commercial use of published articles.
All submitted articles undergo a fast but rigorous peer-review procedure, followed by prompt submission of an article for publication.
Authors publishing with Bentham Open retain the copyright to their work.
Authors can publish research, reviews and short communication articles.
Bentham Open offers affordable article processing fees, ranking amongst the lowest as compared to those of other open access journal publishers.
Publishing in an open access journal caters to an extensive audience allowing anyone with an interest in your work to read it and there by translate it into increased usage and impact.
All articles are deposited in at least one major international open digital repository (such as PubMed Central).
All articles are indexed by Google and Google Scholar which offers additional massive world wide web exposure.

Journals of interest to optometrists may include: The Open Aging Journal, The Open AIDS Journal, The Open Allergy Journal, The Open Behavioral Science Journal, The Open Neurology Journal, The Open Ophthalmology Journal, The Open Optics Journal, The Open Sports Medicine Journal, and many, many more....

There is one catch.....the author has to pay to see his/her article in print....and the costs range from $600 to $800!

Wednesday, April 9, 2008

Notes from Ireland




I recently had the pleasure of meeting Ms. Eva Doyle, (above left), who is the Head of the Optometry Department at the Dublin Institute of Technology during my visit and lecture at the institute. [You might be wondering why Eva is wearing a bright green cap. I gave this to her...the green is for Ireland (of course) and it is an official Illinois College of Optometry cap, my academic institution.] The optometry program opened a new eye clinic, the National Optometry Centre (below) not long ago as well.
The reception I received from the faculty, students, staff and attending optometrists was absolutely incredible. I would recommend that all optometrists take a moment to stop by and say hello the next time they are in Dublin! BTW the Guinness and Hennessy are great as well!

Acquired Vertical Accommodative Vergence

From an Open Access journal. Click on the title above to download full article. DM

Abstract:
Vertical accommodative vergence is an unusual synkinesis in which vertical vergence is modulated together with accommodation. It results from a supranuclear miswiring of the network normally conveying accommodative convergence. So far, it is unknown whether this condition is congenital or acquired. We identified an otherwise healthy girl who gradually developed vertical accommodative vergence between five to 13 years of age. Change of accommodation by 3 diopters induced a vertical vergence of 10 degrees. This observation proves that the miswiring responsible for vertical accommodative vergence must not necessarily be congenital, but can be acquired. The cause and the mechanism leading to vertical accommodative vergence are yet unknow

Dynamic Fusional Vergence Eye Movements in Congenital Esotropia

This paper is a part of the Bentham Open Access Journal program. If you click the title above you will have access to the full article. DM

Dynamic Fusional Vergence Eye Movements in Congenital Esotropia
pp.9-14 (6) Authors: Yair Morad, Horace Lee, Carol Westall, Stephen P. Kraft, Carole Panton, Ruth Sapir-Pichhadze, Moshe Eizenman doi: 10.2174/1874364100802010009


Abstract:
-->
Abstract:
Purpose: To evaluate whether a selected group of 9 children with history of congenital esotropia is capable of producing vergence eye responses to fusional disparity stimuli.
Methods: Nine children with history of congenital esotropia and 5 age-matched children with normal binocular vision were examined. Using a full-field target, ve
rgence responses to base out 3 prism diopters placed in front of both eyes were recorded.

Results: In five patients, the initial response was a saccade generated by the dominant eye, followed by a disconjugate movement of one or both eyes. In two patients with long standing uncorrected strabismus, the responses were almost purely saccadic, while in two other patients, in whom early surgery resulted in fusional abilities, smooth vergence movements were recorded.

Conclusion: This study adds further evidence that patients with history of congenital esotropia patients are capable of producing vergence eye movements in response to fusional disparity. The responses usually start with a saccade followed by a vergence response. The preference for initial saccadic or vergence response is correlated with sensorial tests of stereopsis and motor fusion and may be related to the size of the suppression scotoma in the deviating eye, the duration of misalignment, or both.

Vets’ group: Link between TBI, blindness needs more attention

...many vision-impaired soldiers are not quickly diagnosed because, like post-traumatic stress disorder or mild traumatic brain injuries, these eye injuries are not always readily apparent. And some physicians don’t seem to know what to look for; if they’re looking for an injury to the eye itself, they may miss the brain injury, ...

Comment: Our injured soldiers should have a comprehensive assessment of the medical and functional disorders associated with traumatic brain injury. Many times optometric vision therapy can help our injured soldiers improve their quality of life. DM

Working Memory Has Limited 'Slots'

A new study by researchers at UC Davis shows how our very short-term "working memory," which allows the brain to stitch together sensory information, operates. The system retains a limited number of high-resolution images for a few seconds, rather than a wider range of fuzzier impressions. ...

Comment: Working memory allows us to function appropriately within our visual world. Eye movements are a part of this process....faulty eye movements may contribute to problems in visual information processing... we can improve oculomotor function with optometric vision therapy. DM

Majority Of Sports-Related Eye Injuries Are Preventable With Protective Eyewear

...thousands of sports-related eye injuries occur in the United States. The arrival of spring brings more outdoor sports and with them, the increased danger of eye injuries. The American Optometric Association (AOA) urges even casual athletes to protect their sight-and that of teammates-by keeping street eyewear off the playing field and wearing proper protective eyewear instead. Conventional frames and lenses do not meet the minimum requirements for impact resistance in most sports...

Comment: All kids and adults playing sports should have protective eyeware. Save your loved one from serious injury. Ask your optometrist about what is currently available today! DM

The Analysis Of Frontal Lobe Microstructure May Provide Insight Into The Biological Causes Of Autism

...This unique study analyzing frontal cortex microstructure is aimed at identifying the underlying cellular and molecular defects in the autistic brain. "An extensive study of this type has never been attempted in autism," explained Dr. Sophia Colamarino, Vice President of Research for Autism Speaks. "This could give us the very first window into brain development in autism, something about which we know virtually nothing." ...

Tuesday, April 8, 2008

Optometry in Ireland

Things I learned while in Ireland....

The Dublin Institute of Technology offers the only Optometry program in the Republic of Ireland. It is a 4-year undergraduate full-time degree program. This program provides the education and training required for Optometrists and is approved by Bord na Radharcmhastóirí (the Opticians Board) . Graduates must also satisfy the Association of Optometrists Ireland as to their clinical competence. The training of optometrists includes a period of at least 6 months of Supervised Optometric Practice with a practising optometrist. At present this takes place at the beginning of the fourth year of the course.

Further Information Eva Doyle, Head of Department of Optometry
DIT Kevin Street, Dublin 8, Republic of Ireland
Email: Eva.Doyle@dit.ie
Telephone: +353 1 402 4751 Fax: +353 1 402 4915

I will have more information about optometry in the Emerald Isle over the next few weeks. My optometric hosts (Ms. Eva Doyle and Mr. John McGann) were most accommodating....and the optometrists, students, and faculty of the Optometry Department most welcoming.

Retinoblastoma

In continuing coverage from previous editions of First Look, Medscape (3/25, Chustecka) reports that a "new approach to the treatment of retinoblastoma" may "save children from having an eye removed," according to a study presented last week at the Society of Interventional Radiology 33rd Annual Scientific Meeting....

The effect of amblyopia on fine motor skills in children

Fine motor skills were reduced in children with amblyopia, particularly those with strabismus, compared with control subjects. The deficits in motor performance were greatest on manual dexterity tasks requiring speed and accuracy.

Comment: This is why amblyopia is MORE than just visual acuity reduction. It affects many systems. Optometric vision therapy is designed to address these issues and to remediate motor, accomodative, visual perceptual, and spatial problems associated with amblyopia. DM

StyleMark recalls children's sunglasses.

In its Health Highlights section, HealthDay (4/3) reported that nearly "144,000 'Main Street Drag' children's sunglasses distributed by StyleMark, Inc. of Ormond Beach, Fla. are being recalled due to excessive levels of lead paint in lettering on the sunglasses' frames." The sunglasses, which are made in China, "have dark blue or dark metallic red fronts, and gray checkered sides," with the "[s]tyle number DI25K711...printed on the left temple." According to the Consumer Product Safety Association, the "sunglasses were sold at Walgreen's, Academy Sports, and CVS stores across the United States from October 2007, through March 2008." Consumers should "call StyleMark at 866-928-1913 to find out how to return the sunglasses, and receive a free replacement pair."

Program improves post-LASIK binocular vision disorders

Patients with post-LASIK binocular vision disorders can benefit from an Internet-based vision therapy program, according to a physician speaking here. "Patients can experience a complete resolution of their symptoms," Ella G. Faktorovich, MD, said here during a paper presentation at the American Society of Cataract and Refractive Surgery annual meeting.

Comment: I've had several post-LASIK patients that developed binocular vision problems including strabismus after the refractive surgery. Online programs should not be used without the guidance of an optometrist who specializes in binocular vision. Members of the College of Optometrists in Vision Development and the Optometric Extention Program Foundation should probably be consulted before starting any online programs. DM

Dyslexia affects brain according to language

Dyslexia affects different parts of children's brains depending on whether they are raised reading English or Chinese....Millions of children worldwide are affected by dyslexia, a language-based learning disability [not always ... see comments...] that can include problems in reading, spelling, writing and pronouncing words...

Comment: I'm surprised that researchers are surprised about this....the Chinese language is very different from what we use in English....different brain pathways may certainly be used depending upon the language. It should be noted that not all "dyslexia" is language based...there are those who are primarily visually based, mixed patterns....and those with learning related vision problems. There are few children with true dyslexia....but many with reading problems. DM

Parents follow pediatrician advice on administering MMR vaccinations

News stories about an allegedly harmful link between the mumps, measles and rubella vaccine and the onset of autism had little effect on whether U.S. parents immunized their children, according to a review of immunization records and news stories. Parents’ decisions were more likely influenced by recommendations from their child’s pediatrician, the researchers said.

Comments: As far as we know the benefits of vaccines far out weight any risks. Get you kids vaccinated. Protect them, you and all your neighbors. DM

Baby sleep 'link' to weight risk

Researchers found infants sleeping less than 12 hours a day and watching more than two hours of television had a 16% chance of becoming overweight.

Comments: Little ones need to be "doing" lots of motor activities....not watching TV. DM

2.5m children on drugs in US

Antipsychotic drugs for children have taken off in the US on the back of a willingness to diagnose those with behavioural problems as having manic depression. Even children barely out of babyhood are getting a diagnosis of bipolar disorder, the modern term for the condition. The chief symptoms are mood swings, which, however, are common in children of any age.

Comment: Are we too ready to medicate our kids? Probably. As with all medications always ask you doctor why the medication is being suggested and what are the alternatives. Medicine can help many children....but should not always be the first approach. DM

Monday, April 7, 2008

A Place to Praise/Critque Your Doctor

Angie's list, an online repository of customer-service ratings for plumbers, electricians, home contractors, and the like, sees physicians in the same light ....

[This] list pays no [attention] to the ... debate over whether [doctors] are service providers or professionals, whether those flocking to their offices are consumers, patrons or patients.

For $7 a month, consumers can log-in and grade physicians, hospitals, pharmacists, health insurers, and others. They can submit reports on anyone from their primary care physician to the entire staff of a hospital. Angle's list has 600,000 users nationally.

Comment: This is "word of mouth" advertising for the internet age. The feedback from this list should be required reading for all doctors....how do your patients "critique" you?

DM

Sunday, April 6, 2008

InfantSee Video

The American Optometric Association's InfantSee program can stamp out amblyopia within our lifetime IF we as doctors of optometry participate and get the word out to our patients. View this video, sign up, participate.

Other InfantSee videos:
Live Interview on Fox TV,
Infant Eye Examinations

DM

Myopia and Personality

In a recent study... The long-held view that myopic persons are introverted and conscientious may reflect intelligence-related stereotypes rather than real correlations. Furthermore, the predictive characteristic of intellect, subsumed in Openness, appeared to be representative of a previously reported link between intellective abilities (IQ) and myopia rather than personality and myopia.

Comment: I agree....I'm a myope who is not only intelligent but also quite out going!!

Brain's visual system can focus on few objects at a time,

In the Basics column in the New York Times (4/1, F2), Natalie Angier explained the phenomenon of "change blindness," that is, "the frequent inability of our visual system to detect alterations to something staring us straight in the face." Angier pointed out that the "mechanisms that succeed in seizing our sightline fall into two basic classes: bottom up and top down." Bottom-up stimuli are "something in our visual field that is the optical equivalent of a shout," and "seem to head straight for the brainstem." In comparison, top-down stimuli require "a decision by the viewer that an item, even in the absence of flapping parts or strobe lights, is nonetheless a sight to behold." According to researchers, "the results of change blindness studies and other experiments strongly suggest that the visual system can focus on only one or very few objects at a time, and that anything lying outside a given moment's cone of interest gets short shrift." In other words, it seems that the brain "is a master at filling gaps and making do, of compiling a cohesive portrait of reality based on a flickering view."

Health of nation's children varies by state

HealthDay (4/2, Reinberg) reported that according to the Every Child Matters Education Fund, where American children "are born and raised plays a major role in their chances of getting and staying healthy, and living to adulthood." The group ranks each state's ability to care for its younger residents in a report titled Geography Matters: Child Well-Being in the States. By examining "10 commonly recognized measurements of child well-being," the authors found that "children in the lowest-ranking state, Louisiana, are twice as likely to die in their first year of life, compared with children in the highest ranking state, Vermont." Additionally, "children in Louisiana are more likely to live in poverty with no health insurance than children in Vermont." The report also indicated that "[c]hildren in bottom 10 states," including Arizona, South Dakota, and South Carolina, "are 6.7 times more likely to die from abuse and neglect." The publication attributes these trends to the fact that "the bottom states tend to see government's role in social issues as limited." The "states also generally have lower taxes, so they invest less in children's programs."

Health of nation's children varies by state

HealthDay (4/2, Reinberg) reported that according to the Every Child Matters Education Fund, where American children "are born and raised plays a major role in their chances of getting and staying healthy, and living to adulthood." The group ranks each state's ability to care for its younger residents in a report titled Geography Matters: Child Well-Being in the States. By examining "10 commonly recognized measurements of child well-being," the authors found that "children in the lowest-ranking state, Louisiana, are twice as likely to die in their first year of life, compared with children in the highest ranking state, Vermont." Additionally, "children in Louisiana are more likely to live in poverty with no health insurance than children in Vermont." The report also indicated that "[c]hildren in bottom 10 states," including Arizona, South Dakota, and South Carolina, "are 6.7 times more likely to die from abuse and neglect." The publication attributes these trends to the fact that "the bottom states tend to see government's role in social issues as limited." The "states also generally have lower taxes, so they invest less in children's programs."