Saturday, April 19, 2008
Comment: There is seldom a day that goes by that I do not use Epocrates. If you are not familar with this program, it provides information about pts medications right on your PDA. Now I will also receive info concerning ADHD each time I sync my PDA. Awesome! DM
Physicians and parents may access an online tool that generates statistics, based on the factors the researchers listed in their article, at http://www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/. By specifying the baby's sex, weight, and information related to each of the variables listed above, physicians and family members can generate composite statistics on infant outcomes, based on the experiences of extremely low birthweight infants in the NICHD Neonatal Research Network study. The Web tool is not a substitute for a physician's careful assessment, but physicians and families may find the statistics it generates useful when considering the most appropriate care to provide an infant.
"Every individual is different, and no single tool can precisely predict a given baby's chances of survival or disability," said Duane Alexander, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH Institute that supports the Neonatal Research Network. "However, the researchers' findings, and the tool they developed, provide important information that physicians and family members can consult to help them make the most informed treatment decisions possible.".......................
Comment: Be a bit careful on this one. As far as I know, although it seems as if "everything" these days is a possible cause for autism or is associated with autism....rocking is not. It is not the rocking so much as a repetitive behavior that you need to watch for....besides, I was a great "Rocker" as a kid and I think I turned out OK!! DM
Friday, April 18, 2008
Of course, all of this is JIMMHO. DM
Thursday, April 17, 2008
The Normal Optic Nerve Head in Pediatric African Americans Using the Heidelberg Retina Tomograph II
Illinois College of Optometry, Chicago, IllinoisResults of this study contribute to the development of a data base of normal ONH parameters in the pediatric population. A knowledge of the differences and/or normal variations in ONH morphology based on age, refractive error, gender and race could assist in the diagnosis of optic nerve pathologies including optic nerve hypoplasia, megalopapilla and glaucoma.
Comment: To be presented at ARVO . DM
Comments: Very interesting place to browse around. DM
Clinical judgement of near pupil responses provides a useful indicator of focusing ability in children with cerebral palsy.
Accommodation is often reduced in cerebral palsy (CP). Knowledge about accommodative facility is valuable when investigating a child's visual needs and developing strategies for education. .... A total of 9.8% of pupil responses were judged absent, 25.6% reduced, and 64.6% normal. Participants with reduced or absent pupil responses demonstrated significantly poorer levels of accommodation with DR .... Sensitivity and specificity of NPR in identifying participants with reduced accommodation were 83% .... NPR provides a rapid, useful indicator of accommodative function in children with CP.
Comment: As the authors note, accommodation is typically poor in children with cerebral palsy. Using NPR to assess accommodation may be one of several good ways to determine the accommodative abilility of children with CP. I also use MEM, NRA/PRA, flipper facility (BTW Dr. Robert Duckman (see reference below) showed sometime ago that you can not only use flippers with kids who have CP, but that you can also alter accommodative function with optometric vision therapy) and other available tools depending upon the cognitive level of the child. I usually prescribe multi-focal lenses for children AND adults with CP 99.99% of the time!
Duckman RH. Accommodation in cerebral palsy: function and remediation.
J Am Optom Assoc. 1984 Apr;55(4):281-3.
Accommodation function, in a population of severely involved cerebral palsied children, is significantly lowered or absent. This observation suggests that lowered amplitudes and accommodation facility could be part of the cerebral palsy syndrome and untrainable . This paper looks at the accommodative function and the results of vision training on such a population.DM
Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort s
B . LARROQUE. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study . The Lancet , Volume 371 , Issue 9615 , Pages 813 - 820
Comments: Optometric intervention (along with OT, PT, Speech/Lang, etc) for any learning related vision problems may be appropriate for this population.
Comments: Although I posted info about this earlier, I cannot emphasize enough....that early intervention is better than later...and screening is just NOT enough. Too many children do not get the appropriate diagnosis and treatment. The American Optometric Association and their InfantSee program has it right! Get your children in for a complete evaluation by an AOA member participating optometrist. There is not cost associated with the evaluation (for kids 6-12 months of age) and we can stamp out lazy eye in our lifetimes!!
Also, it is past due that our opthalmological colleagues stop beating the "vision screening" drum...it just rings hollow ... and to join with optometry to meet the eye and vision care needs of infants through out America! (Sorry about getting up on my soap box....but as you can see, I am passionate about this issue!!) DM
Comment: As editor of Optometry & Vision Development, the official journal of the College of Optometrists in Vision Development, there are some days I think having "ghost" authors wouldn't be so bad!! (;-()> OTOH....I'm usually very happy with the authors who submit their work! DM
Comment: Even though I tell most of my pre-refractive surgery patients that the vast majority of those who have LASIK/LASEK are very happy, that this is a surgical procedure....and it does not work well for all. There can be unwanted side affects....a very dry eye and/or the development of binocular vision problems....This article has a great diagram associated with it. Please click on the title to read the whole story.
Go to http://www.fda.gov/cdrh/lasik/risks.htm for the FDA's sight on refractive surgery. DM
On its website, Northern Ireland's University of Ulster (4/16) reported that researchers from Ulster's Vision Science Research Group "have discovered that many primary school-age children in Northern Ireland who need glasses to correct astigmatism -- a condition that causes blurred vision -- have never had a pair of" eyeglasses. The investigators "tested the eye health of more than 1,000 Northern Ireland school children in a study funded by the U.K. College of Optometrists and supported by the Northern Ireland Optometric Society," and "found that 24 percent of children sampled had significant levels of astigmatism." Of that group of six- and seven-year-old children, nearly three-quarters "did not have a pair of" eyeglasses, "nor had [they] ever worn any." Dr. Kathryn Saunders stated, "This may impact not only on their learning, but, if left uncorrected, may mean they enter adulthood with permanent uncorrectable vision loss." Dr. Saunders recommended that "all children have a full sight test by an optometrist...before starting school."
Comment: Having just gotten back from the Republic of Ireland and talking to optometrists, DIT Optometry school faculty and students, I know the talent is there to provide outstanding eye and vision care for children. I heard that the state does not support optometrists examining children younger than 12 in the Republic of Ireland....if children in the Republic are similar to children in Northern Ireland....then optometrists within in ALL of Ireland should be examining kids!!! Just my most personal and humble opinion, of course. DM
The performance of children (and sometimes adults) with visual impairments (VI) on a range of tasks that reflect learning, memory and mental imagery is considered in this article. Sometimes the evidence suggests that there are impairments in performance in comparison with typically developing children with vision, and sometimes some advantages emerge. The author’s aim is to describe some of her own and others’ findings and explore what they tell us about the cognitive characteristics of such children, so that progress with practical interventions can be advanced through understanding. The article starts by focusing on social-cognitive development and in particular considers the potential benefits of language in that development. This is followed by a review of some studies of learning and memory performance which provide a coherent picture of development without vision and finally ends with a consideration of spatial mental imagery.
Comment: The full text of this article is available. Click on the title above. DM
Comment: When conducting our case history, we should probably ask a few more questions when a premature birth is noted. DM
Best known as the dance of love, the tango is now being studied as a treatment for depression.
University of New England psychology researcher Rosa Pinniger says she hopes to prove the passionate two-person dance is an effective alternative therapy for depression by carrying out a six-week trial.
Horizontal eye movements are thought to cause the two hemispheres of the brain to interact more with one another, and communication between brain hemispheres is important for retrieving certain types of memories.Previous studies have suggested that horizontal eye movements improve how well people recall specific words they have just seen. ...
Comments: I'm doing optometric vision therapy saccades to improve my memory right now! DM
Wednesday, April 16, 2008
Comment: I am at that stage of my life where....the first thing I do when I wake up in the morning is to check my drivers license so I can remember who I am! I think I might go out to the store for some blueberries soonest! DM
Columbia University Begins Search For Causes Of Autism International Effort Considered Groundbreaking
LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment
LASIK-induced dry eye and neurotrophic epitheliopathy are common complications of LASIK surgery. Optimization of the ocular surface prior to surgery decreases the incidence and severity of postoperative symptoms of the condition.
Comment: 99.999% of my post LASIK patients seem to complain to dry eye (well, maybe the percentage is a bit lower than that!) and we can often help them.....what is not as well known is that post LASIK patients may also develop binocular vision problems including strabismus and diplopia! A complete binocular vision work up should be done on every potential LASIK patient prior to surgery. DM
The lower prevalence of myopia in Sydney was associated with increased hours of outdoor activities. We hypothesize that another factor contributing to the differences in the prevalence of myopia may be the early educational pressures found in Singapore but not in Sydney.
Comment: I was recently in Sidney and can verify that that is one "outdoors" city! It is about time that my ophthalmology colleagues note that the environment (outdoors vs indoors) and excessive nearpoint activity (i.e. reading) can affect myopia development. This means that at least some of myopia is functionally acquired (not all determined by genetics) and that we should be able to find mechanisms to slow down and perhaps even reverse myopia development. DM
Very early photoscreening yields better visual outcomes in amblyopia treatment compared with later photoscreening in preschool-aged children.
Comment: Screenings have never been enough. They just miss too many children. The American Optometric Association has it right! The AOAs InfantSee program wants all children 6-12 months of age to have complete evaluations by an optometrist. This major public health program has the real potential to stamp out lazy eye (amblyopia) in our lifetimes!! Schedule an InfantSee appointment today. DM
Tuesday, April 15, 2008
In continuing coverage from previous editions of First Look (the AOA Newsletter), Optician Online (4/12) reported that the delivery of the chemotherapy drug melphalan "directly into the ophthalmic artery" may offer "a new way to treat retinoblastoma." Pierre Gobin, M.D., of New York's Weill Cornell Medical Center, and colleagues, conducted trials of the new technique "on 18 children at U.S. hospitals." Of that group, "16 had their tumor cured, and 14 kept their eye." Of the saved eyes, nine retained "vision, and in four cases, vision" improved.
In continuing coverage from previous editions of First Look, Optician Online (4/12) reported that infants "born in autumn or winter months" may "have a greater chance of severe myopia than those born in the summer months," according to a study published in the Apr. issue of Ophthalmology. Yossie Mandel, M.D., M.H.A., and colleagues, examined data on over 276,000 "candidates for the Israeli military service who were medically assessed between 2000 and 2004." The "participants were born in Israel," and were "exposed to the same seasonal light variations." After adjusting for "other known myopia risk factors, such as gender, education level, and father's country of origin," the authors theorized that "light exposure before and just after birth generated biological signals that influenced the development of the eye's ability to focus and refract light properly."
The International News Network (4/14) reports that "many children who are seven years of age or older appear to respond to treatment for amblyopia," according to a study published in the Archives of Ophthalmology. Mitchell M. Scheiman, O.D., FCOVD, of the Jaeb Center for Health Research in Tampa, Florida, and colleagues, "enrolled 507 patients with amblyopia from 49 locations. All the participants were provided with optimal optical correction, and then randomly assigned to the amblyopia treatment group, or a 'control' group." Participants "in the active treatment group were prescribed two to six hours per day of patching, along with instructions to perform near visual activities while their good eye was covered." The researchers then followed participants "every six weeks for up to 24 weeks." The authors found that "[a]mong children seven to 12 years old, more than half (53 percent) of those in the treatment group improved, compared with 25 percent of the children in the control group." But, "good response was less likely among 13- to 17-year-olds -- 25 percent in the treatment group, versus 23 percent in the control group."
Comment: Children and adults of any age can benefit from optometric vision therapy. The final result may be more variable....but improvement in visual acuity and other measures of amblyopia is often noted. DM
Study links prenatal omega-3 fatty acids to increased visual acuity, cognitive development in babies.
In continuing coverage from previous editions of First Look, the UPI (4/15) reports that "[o]mega-3 fatty acids in the last months of pregnancy" may "increase a baby's cognitive and motor skills," according to a study published in the Journal of Pediatrics. By testing 109 babies at six and 11 months of age, researchers from the U.S. and Canada found that the infants' "visual acuity, as well as cognitive and motor development, [was] closely linked to" the concentration of docosahexaenoic acid in umbilical cord blood at birth.
Early screening for amblyopia may yield better treatment outcomes, researchers say.
In continuing coverage from previous editions of First Look, MedPage Today (4/14, Smith) reported that "[s]creening infants and toddlers for amblyopia" may yield "better treatment outcomes than waiting until they are in the preschool years," according to a study published in the Apr. issue of the journal Archives of Ophthalmology. Robert Arnold, M.D., of Alaska's Ophthalmic Associates, and colleagues, "undertook a retrospective analysis of data from the Alaska Blind Child Discovery program, a charitable research effort to offer vision screening to children in both urban and rural areas of Alaska." The researchers analyzed data from "a 10-year period from Feb. 1, 1996, through Feb. 28, 2006," during which "lay screeners evaluated 21,367 children, about half of them younger than 48 months," and 6.9 percent of whom "were referred for a complete eye examination and treatment." The investigators found that youngsters "screened before the age of two" through a technique called photoscreening, "and found to have amblyopia,...had significantly better visual acuity at age six (P=0.04) than children screened later."
In its Health column, Florida's Bradenton Herald (4/15) reported that "[c]omputer vision syndrome is becoming more frequent, according to the American Optometric Association (AOA), which says that prolonged use of electronic devices such as computers...can leave users with problems like dry eye, eye strain, neck and/or backache, light sensitivity, and fatigue." The AOA found that "78 percent of Americans do not have their monitors set below eye level, the correct height for computer usage; 73 percent of Americans do not take breaks as often as they should (at least every 20 minutes); and one out of 10 never take a break." Only 11 percent of Americans use "[s]pecially designed glasses...to help reduce glare from screens," the AOA said. The same column also offered a link to the Food and Drug Administration's checklist to help readers decide whether LASIK surgery is right for them.
My presentations/lectures/research are noted below. Many of these were in collaboration with my one or more of my outstanding colleagues....
Please note...if you click on the presentation titles below it will take you to the search page of the AAO. Type in "Maino D" in the author area and you will find my presentation abstracts.
New Resources from IDHD
The Go Vote Public Service Announcement was developed by the National Technical Assistance Center for Voting and Cognitive Access. The National TA Center is managed and implemented by self-advocacy leaders, working in partnership with Self-Advocates Becoming Empowered, Portland State University, Oklahoma Disability Law Center, TheArcLink, and the University of Illinois - Chicago. To view the PSA please visit: www.govoter.org/ and click on "PSA"
The new State of the States in Developmental Disabilities is here. Copies are available through the Project Headquarters at the University of Colorado https://www.cusys.edu/ColemanInstitute/stateofthestates/ContactUs.html or through AAIDD http://bookstore.aaidd.org/BookDetail.aspx?bid=73
April is Autism Awareness Month. The following resources are available from the National Center on Physical Activity and Disability (NCPAD)
Focus on Secondary Condition Prevention: Walking Program to Reduce Secondary Conditions in Adolescents with Autism
Health Promotion: Autism and Nutrition
Videos: Autism and Considerations in Recreation and Physical Activity Settings
The report from the pre-conference on aging at AAIDD is available. State of the Science in Aging with Developmental Disabilities: Charting Lifespan Trajectories and Supportive Environments for Healthy Community Living
Funding and Service Recommendations for Transitioning Older Adults: An Examination of Illinois’ Money Management Participants This report from the Illinois RCSC Rebalancing Grant, quantifies the actual expenses faced by older residents living in the community and applies it to those living in a nursing home seeking reintegration to community living. Furthermore, it hopes to identify a floor of income required to sustain community residency. The analysis should be helpful in formulating system changes for programs including eligibility standards and policies.