Saturday, April 19, 2008

Illinois Oral Therapeutic Course

Illinois recently passed its optometric oral therapeutics bill.....and today and tomorrow, I am being exposed to an incredible opportunity to learn all about oral meds and their use in eye care (much of this was already taught in OD school and for the diagnostic and therapeutic (topical) courses). We have approximately 500+ ODs taking the 2 day course at ICO given by Dr. Bruce Onofrey (an OD and Pharmacist...and ICO grad) . Immediately after the course we also get to take a 2 hr test. Hopefully by dinner time Sunday I will have successfully passed my examination and can add one more service to the many I provide my patients. DM

Misdiagnosis of ADHD opens family’s eyes

This is a Chicago Parent Magazine article on how ADHD was mistaken for learning related vision problems. It features 2 of my colleagues in Arlington Heights Il.

Epocrates Mobile Resource Center:ADHS

...ADHD Resource Center: Epocrates has introduced a new Mobile Resource Center dedicated to ADHD, hosted by contributing editor Dr. Adelaide Robb, Associate Professor of Child and Adolescent Psychiatry and Pediatrics at Children’s National Medical Center in Washington, DC. This free resource provides a timely, intelligent summary of the most important clinical news and research in ADHD. Other centers available for download include: infection management and fibromyalgia. Future center releases include: diabetes, epilepsy, allergy & asthma and IBS. ...

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


............Based on observations of more than 4,000 infants, researchers in an NIH newborn research network have identified several factors that influence an extremely low birth weight infant's chances for survival and disability. The findings offer new information to physicians and families considering the most appropriate treatment options for this category of infants.

Physicians and parents may access an online tool that generates statistics, based on the factors the researchers listed in their article, at 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.".......................

Rocking Toddlers

Rocking is very common in toddlers. Often children do it to soothe themselves when they're tired or upset; some do it when they're bored. Keep an eye on it, though, as repetitive behaviors like rocking back and forth can sometimes be seen in autism.

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

Google Scholar My Articles

I've looked at Google Scholar in the past....and it did a fairly good job of finding interesting articles on topics I wanted to take a closer look at....this time I searched "me" and discovered that Google Scholar even found articles I had written that normally would not have showed up in PubMed or a similar database. It's about time the "tyranny" of some of these databases (and I say this with utmost respect) was significantly reduced. All too often if you wanted to find an article not listed in databases like PubMed you were out of luck. Give Google Scholar a chance by adding it to your tools when you are doing a literature search.

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

The Normal Optic Nerve Head in Pediatric African Americans Using the Heidelberg Retina Tomograph II

R. A. Trachimowicz, Y. Pang, D. D. Castells, G. W. Goodfellow and D. M. Maino

Illinois College of Optometry, Chicago, Illinois

Results 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

As Autism Diagnoses Grow, So Do Number Of Fad Treatments

...There's no cure for autism, and many parents are willing to believe anything if they come to think it could help their child.”...Some of the newer, more popular fad treatments for autism involve special diets or nutritional supplements. Megadoses of Vitamins C and B6 are popular, as well as supplements with fatty acids like omega-3s...

The Free Library: amblyopia

I've discovered a website that provides FREE articles you can use on your website. There are a few rules you have to follow....but over all....if you need content for your website, check out The Free Library. If you click on the title above, most o the articles found will be about amblyopia. DM

Daroff-Dell'Osso Ocular Motility Laboratory

Measurement of Eye Movements to Study Neurological, Visual, and Vestibular Disorders; Ocular Motor System Function and Dysfunction

Areas of Specialization: Systems and Computational Neurobiology, Ocular Motor Oscillations (Nystagmus and Saccadic), Ocular Motor System Models, Nystagmus Therapies, Vision and Balance, Vestibular Function, Version-Vergence Interaction, Eye-Head Interactions, and Retinal Electrophysiology of Visual Disorders

Measurement techniques: Infrared Reflection, Magnetic Search Coil, and High-Speed Digital Video Systems to record eye movements in the horizontal, vertical and torsional planes of humans, canines, and mice; Motion platform and rotating chairs to study balance.

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.

Kathryn J Saunders PhD MCOptom, Julie F McClelland PhD MCOptom, Patrick M Richardson MCOptom, Mike Stevenson (2008) Clinical judgement of near pupil responses provides a useful indicator of focusing ability in children with cerebral palsy Developmental Medicine & Child Neurology 50 (1) , 33–37 doi:10.1111/j.1469-8749.2007.02012.x

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

...In children who are born very preterm, cognitive and neuromotor impairments at 5 years of age increase with decreasing gestational age. Many of these children need a high level of specialised care. Prevention of the learning disabilities associated with cognitive deficiencies in this group is an important goal for modern perinatal care for children who are born very preterm and for their families....

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.

Early Screening for Amblyopia Improves Results

...Screening infants and toddlers for amblyopia yields better treatment outcomes than waiting until they are in the pre-school years, researchers said here....Children screened before the age of two and found to have amblyopia -- reduced vision in one eye -- had significantly better visual acuity at age six (P=0.04) than children screened later...

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" 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

Fewer Medical Journal Articles Planted by Phantom Authors

...The day of using skilled writers with dubious agendas to secretly turn out journal articles for ostensibly independent researchers may be largely past, according to insiders. After a spate of scandals involving high-profile ghost-authored papers published in the 1990s and early 2000s, accusations of more recent wrong-doing are hard to come by....

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

LASIK is a surgical procedure. It has its downsides.

...That’s the only way I can explain why I willingly let a doctor cut my corneas with a laser: vanity. Little did I know when I chose Lasik surgery that I would not end up satisfied like the friends and acquaintances who raved about their post-glasses existence...

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 for the FDA's sight on refractive surgery. DM

Children in Northern Ireland Lack Optometric Care

Many children with astigmatism in Northern Ireland may lack eyeglasses, researchers say.
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

Psychological characteristics of children with visual impairments: learning, memory and imagery

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

Gestational age not only factor in outcome of severely premature healthy babies

...Published in the April 17, 2008 issue of the New England Journal of Medicine, the study titled “Intensive Care for Extreme Prematurity: Moving Beyond Gestational Age” found four other factors that are of comparable importance: female sex, treatment of the mother with antenatal corticosteroids, singleton birth and higher birth weight. ...

Comment: When conducting our case history, we should probably ask a few more questions when a premature birth is noted. DM

Tango your way out of Depression

I love to dance...but my dad was the award winning ballroom dancing....however...the next time I get depressed...who knows!! 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.

Moving Your Eyes Improves Memory

...If you’re looking for a quick memory fix, move your eyes from side-to-side for 30 seconds...
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

Video on how to examine a very Special Population

As you know I frequently examine a group of patients who are often called "special". I recently came across another "special" group that I only typically see once a year....and then not for an eye examination. Click here to learn more about how to examine this special population. DM

Blueberries May Hold The Key To Eradicating Forgetfulness

...[a research team] have found that phytochemical-rich foods, such as blueberries, are effective at reversing age-related deficits in memory, according to a study soon to be published in the science journal Free Radical Biology and Medicine. The researchers working at the Schools of Food Biosciences and Psychology in Reading and the Institute of Biomedical and Clinical Sciences at the Peninsula Medical School in Exeter supplemented a regular diet with blueberries over a 12-week period, and found that improvements in spatial working memory tasks emerged within three weeks and continued throughout the period of the study.

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

.............The Simons Simplex Collection (SSC) is a coordinated effort to create a database of information about cases where there is only one family member with autism. This group, which represents the great majority of autism spectrum disorders, may lead us to new insights regarding the underlying mechanisms of autism............

Kids With Autism May Have Gene That Causes Muscle Weakness

Some kids with autism may have a genetic defect that affects the muscles, according to research that will be presented at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago, April 12 - 19, 2008

LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment

Many eye doctors know that

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

Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney

This article concludes that:

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

Preverbal Photoscreening for Amblyogenic Factors and Outcomes in Amblyopia Treatment

According to this article:

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

New technique to treat retinoblastoma may help save eyes, vision.

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.

Study links autumn, winter births to greater chance of severe myopia.

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."

Study indicates amblyopia treatable in older children

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

Prenatal omega-3 fatty acids to increased visual acuity, cognitive development in infants

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 yield better treatment outcomes

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."

AOA offers tips to prevent computer vision syndrome.

The American Optometric Association notes that:

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 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.

AAO Research & Lecture Presentations

The American Academy of Optometry and I have a long history. I have often presented research and/or lectures during the annual meeting. This year, unfortunately, I will not be doing so because, fortunately, I have been invited to lecture in Oslo, Norway.

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.





Maino, Dominick M.Explosive Topics in Optometric Education: LAYING THE GROUND RULES1998





Maino, Dominick M.Diagnosis and Management of Special Populations 2001

Maino, Dominick M.To BV or Not to BV: VT in the Primary Care Office2001

Maino, Dominick M.To BV or Not to BV: VT in the Primary Care Office2004

Maino, Dominick M.Diagnosis and Management of Special Populations 2004


Maino, Dominick M.To BV or Not to BV: VT in the Primary Care Office2007

Maino, Dominick M.Diagnosis and Management of Special Populations 2007
075030Maino, Dominick M.VATER SYNDROME2007


Institue on Disability & Human Development Resources

Please find below new resources from the Institute on Disability and Human Development, University of Illinois at Chicago. Further information on the Institute can be found at

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: 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 or through AAIDD

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.