Saturday, May 24, 2008

Lasting Effects of Pediatric Traumatic Brain Injury

The number one cause of death and disability in children and teenagers is traumatic brain injury. Despite this fact, this clinical scourge receives limited research investigation. Given the remarkable recovery often seen after focal childhood brain injuries (infarction, hemorrhage, surgical excision), there is a common misconception that the younger brain is always more resilient. However, increasing evidence suggests that this assumption is incorrect. First, TBI represents a diffuse type of brain injury, and both clinical and laboratory studies suggest that the immature brain is less capable of recovering from such damage. Second, there appear to be developmental windows wherein diffuse injury can result in lost potential; at time this loss may only be detectable at a later stage of brain maturation. In addition to understanding these complex concepts of TBI sustained during development, consideration will also be given to relating these concepts to chronic sequelae of pediatric TBI, including cell death and regional brain atrophy, cognitive and behavioral deficits, and altered trajectories of brain maturation.

Computerized cognitive rehabilitative training of a traumatic brain injury patient: a seven year followup case study

This outcome study documents the return of functioning in cognitive abilities of an individual seven years post-injury. Executive, interpersonal, and social skills are also discussed.

Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome

The results support the idea that MTBI can have sustained consequences, and that the subjectively experienced symptoms and difficulties in everyday situations are related to objectively measurable parameters in neurocognitive function.

The effect of anisometropia on binocular visual function.

In addition to amblyopia, the potential effect of anisometropia on binocular vision should be considered while prescribing spectacles in young children during the sensitive period.


Dyslexia may be a development disturbance in which there are alterations in visual-spatial and visual-motor processing, while obsessive-compulsive disorder (OCD) is a psychiatric disease in which there are alterations in memory, executive function, and visual-spatial processing. Our hypothesis is that these disturbances may be, at least partially, the result of a crossed eye and hand preference. In the present study 16 controls, 20 OCD (DSM-IV criteria) and 13 dyslexic adults (Brazilian Dyslexia Association criteria) were included. All had a neurological examination, the Yale-Brown scale for obsessive-compulsive symptoms application and the Zazzó evaluation for laterality, abridged by Granjon. Results showed a right hand preference for 100% of controls, 84.6% of dyslexics, and 75% of OCD patients and a right eye preference for 73.3% of controls, 69.2% of dyslexics, and 35% of OCD patients. The left eye preference was significantly higher in OCD when compared with the two other groups (p = 0.01) and the left hand preference of OCD patients (25%) was also significant when compared to Brazilian population (4%) or British population (4.5%). It is possible that this crossed preference may be partially the reason for visual-spatial and constructive disturbances observed in OCD.

Neural underpinnings of dyslexia as a disorder of visuo-spatial attention

For nearly 100 years, the underlying cause of dyslexia has been a matter of much debate, with widely varying viewpoints that have ranged from considering dyslexia as largely a learning disability to claims that it is essentially a perceptual defect occurring early along the visual pathway. This paper reviews some of this literature with particular reference to the studies that have implicated a defect in the afferent visual pathways in the aetiology of the disorder, then goes on to outline a neural theory of how functionally distinct parallel pathways in vision interact with each other in the process of reading and suggests how a defect in these pathways can lead to reading difficulties. Central to the proposed scheme is the suggestion that a fast-track pathway, arising from the magnocellular cells in the retina and acting through an attentional mechanism, has a gating function in spotlighting the individual letters of a text in a sequential fashion. That such gating occurs at the level of the primary visual cortex is supported by recent physiological evidence concerning attentional mechanisms.

Music-reading deficiencies and the brain

This paper reviews the literature on brain damage and music-reading for the past 25 years. Acquired patterns of selective loss and sparing are described, including both the association and dissociation of music and text reading, and association and dissociation among components of music reading. As well, we suggest that developmental music - reading deficiencies may be isolated in a form analogous to developmental dyslexia for text or congenital amusia for auditory music processing. Finally, we propose that the results of brain damage studies can contribute to the development of a model of normal music reading.

Verbal and non-verbal intelligence: dyslexic-dysgraphic students and normal students

...This research suggesting that the nonverbal skills of students with dyslexia-dysgraphia may compensate the shortage of students’ verbal intelligence, if this can be well handled by appropriate educational methods....

Role of orthoptic treatment in the management of intermittent exotropia

30 patients of intermittent ACDS were studied prospectively for a period of 8 weeks to 1 year to evaluate the role of orthoptics in the management of these cases. In patients with convergence insufficiency and a maximum deviation of 25 PD or less the orthoptic treatment was found to be effective in offering symptomatic relief and improving binocular functional status. A reduction in the maximum angle of deviation by 4 PD to 8 PD was observed in 4 patients. Even though the basic angle of deviation remained unchanged in most of the patients, significant functional and symptomatic improvement was obtained ...

Uncorrected refractive error: the major and most easily avoidable cause of vision loss

In the late 1990s, two papers from very different parts of the world, Australia and India, highlighted the fact that uncorrected refractive error was a significant cause of blindness and the major cause of impaired vision.1,2 Since then, the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB), both separately and in their joint initiative, VISION 2020: The Right to Sight, have worked very hard to put uncorrected refractive error on the blindness prevention agenda and to develop strategies for the elimination of this most simple avoidable cause of vision loss. They have been joined in these efforts by international non-governmental development organisations with expertise or programmes in this field, such as the International Centre for Eyecare Education (ICEE), Sightsavers International (SSI), Christian Blind Mission (CBM), Helen Keller International (HKI), and the World Council of Optometry (WCO).

Can the Bruckner test be used as a rapid screening test to detect significant refractive errors in children?

Brückner test can be used to rapidly screen the children for significant refractive errors. The potential benefits from such use may be maximized if programs use the test with lower crescent measurement cutoffs, a crescent measurement ruler and a distance fixation target.

Acquired Vertical Accommodative Vergence

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 unknown.

Dynamic Fusional Vergence Eye Movements in Congenital Esotropia

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.

Hand-eye correlation: Sensorimotor learning of movement/color pairs

People can learn sensorimotor contingencies between hand movements and color perception (Richters & Eskew, 2007) which produce changes in subsequent color judgments that are dependent on the hand movements. These experiments include a pre-test, a learning phase, and a post-test. In the learning phase, we correlated leftward hand movements (using a joystick) and presentation of a high-contrast red spot, and rightward hand movements and a green spot. In each learning trial, observers heard five color names (e.g., "red", "red", "green", "red", "green"), and then produced that sequence of colors on the screen by moving the joystick to the appropriate sides. We found that 45 minutes of learning trials produced a shift in color judgments in the post-test: observers compared near-threshold colors of the spots, which varied around white, by judging if the second spot was "redder" or "greener" than the first spot (cf. Bompass & O'Regan, 2006). However, this effect could be linguistic rather than sensory -- a pairing between hand-movements and the words "red" and "green," which influenced the color judgments later. The present study substituted the words "left" and "right" for the color name words used previously in the learning phase. This linguistic change had no effect on the results, showing that the change in color judgments is not just a shift in color naming. Instead, the effect is caused by learning a new sensorimotor contingency between a color percept and a hand movement, and then compensating for that contingency. We also examine detection thresholds from red and green spots, paired with leftward and rightward hand movements, to see if the effect can be obtained at threshold and to test whether the effect is best characterized as a shift in criterion or sensitivity. Both explanations will be discussed along with related experiments.

Perceptual grouping and inverse fMRI activity patterns in human visual cortex

We used functional magnetic resonance imaging (fMRI) to measure activity in human visual cortex, including a higher object processing area, the lateral occipital complex (LOC), and primary visual cortex (V1), in response to a perceptually bistable stimulus whose elements were perceived as either grouped into a shape or randomly arranged. We found activity increases in the LOC and simultaneous reductions of activity in V1 when the elements were perceived as a coherent shape. Consistent with a number of inferential models of visual processing, our results suggest that feedback from higher visual areas to lower visual areas serves to reduce activity during perceptual grouping. The implications of these findings with respect to these models are discussed.

Neuropsychiatry of Learning Disabilities

The author reviews almost all aspects regarding learning disturbances, disabilities, classification, up date terminology, the neurobiological basis of learning disabilities, the Genetics of learning disabilities, brain measurements, neurobiological basis of neuropsychiatric comorbidity, associated neuropsychiatric disturbances, medical comorbidity, common pitfalls in the neuropsychiatric assessment of patients with developmental disabilities, neuropsychiatric assessment, expanded neurological examination, general physical examination, laboratory studies, neuropsychological testing, neuropsychological testing, and treatment among others aspects. In conclusion: In this review an attempt has been made to look at learning disabilities as a spectrum of syndromes of developmental deficits. Current terminologies have been defined. The neurobiological nature of learning disabilities has been presented with a review of advances in genetics and imaging studies, with particular emphasis on functional neuroimaging. Neuropsychiatric disorders, their neurobiological basis and medical comorbidities have been reviewed as well.

Comments: Does not mention learning related vision problems....very sad. DM

A 77 year old man with diplopia

A 77-year-old male presented with constant vertical diplopia 7 months after a right cataract extraction. His symptoms started 1 month after his cataract extraction with initial mild diplopia and gradual progression to the stage where he now has constant diplopia.
Past Medical History: None Past Ocular History: Bilateral cataract extractions (OS 5 months prior to OD) by clear corneal incision phacoemulsification procedures performed under inferior peribulbar anaesthetic using a mixture of 2% lignocaine and 0.5% bupivacaine administered by an experienced anaesthetist. Current Medications: None

Comments: Can you make the diagnosis? DM

7 year old girl with a left face turn and binocular diplopia

A 7 year old girl presented to Wills Eye Hospital after her mother noted that she was holding her chin up and turning her face to the left. On further questioning, the patient also noted double vision when looking up and left. The patient denied a history sinus infections or upper respiratory infections. She also denied pain or trauma.

Comments: Can you make the diagnosis? DM

A 19-month-old girl with nystagmus, paradoxical pupillary response and low vision

A 19-month-old girl presented to the ophthalmology clinic at Children’s Hospital, Boston with bilateral horizontal nystagmus, first noticed at 3 months of age. Her parents stated that lately, the nystagmus was less noticeable; however, they became concerned because the patient did not seem to see things far away. Her parents also reported that she did not seem bothered by light. She had normal brain magnetic resonance imaging. Her past medical history was unremarkable and she had normal development. There was no difficulty with pregnancy, but the patient was delivered by C-section because of failure to progress. She had no known drug allergies and she was not taking any medication.

Comments: This case report features video and differential diagnosis. DM

Intraocular Lens (IOL) Implants in Children

...The major advantage of an IOL is that it provides permanent continuous correction of the aphakia. This may be important in preventing amblyopia, and encouraging normal visual development. Although glasses are necessary to obtain the best vision, uncorrected pseudophakic vision is probably better than uncorrected aphakic vision....

Absence of stimulus-driven synchronization effects on sensory perception in autism: Evidence for local underconnectivity?

It is speculated that the differences in sensory perceptual capacities in the presence of synchronized conditioning stimuli in autism are due to local under-connectivity in cortex at the minicolumnar organizational level, and that the above-average TOJ thresholds in autism could be attributed to structural differences that have been observed in the frontostrial system of this population.

Cognitive subtypes of dyslexia

The purpose of this study was to determine cognitive subtypes of dyslexia. Read the full study by clicking on the title above.

Duration of antidepressant use during pregnancy and risk of major congenital malformations do not support an association between duration of antidepressant use during the first trimester of pregnancy and major congenital malformations in the offspring of women with psychiatric disorders. These findings should help clinicians decide whether to continue antidepressant therapy during pregnancy....

Friday, May 23, 2008

Longitudinal assessment of visual development in non-syndromic craniosynostosis

...abnormalities of visual function are not frequent in infants with non syndromic craniosynostosis who underwent surgical correction. Approximately half of the patients had some visual abnormalities before surgery, that subsequently improved, showing a delayed visual maturation rather than persistent abnormalities....

Prospective investigation of complementary and alternative medicine use and subsequent hospitalizations

...While there were limitations to these analyses, this investigation utilized an objective measure of health to investigate the potential health effects of CAM therapies and found a modest reduction in the overall risk of hospitalization associated with self-administration of two or more CAM therapies. In contrast, use of practitioner-assisted CAM was not associated with a protective effect....

Comments: the CAM Tx used included: acupuncture, chiropractic services, homeopathy, spiritual/religious healing, energy healing, folk remedies, massage therapies, self-help group, biofeedback, hypnosis, exercise/movement therapy, psychotherapy, and art/music therapy. Wow! What a mixture!! The full text of the article can be found here. DM

Fad treatments for Autism

...“Developmental disabilities like autism are a magnet for all kinds of unsupported or disproved therapies, and it has gotten worse as more children have been diagnosed with autism,” said James Mulick, professor of pediatrics and psychology at Ohio State University .”...

Therapeutic Vest Will Help Children With Autism, ADHD, Anxiety

...Children with autism and ADHD may soon get anxiety relief from a novel “deep-pressure” vest developed by Brian Mullen at the University of Massachusetts Amherst. The vest, which can also be used for adults with mental illness, delivers a “portable hug” called deep pressure touch stimulation (DPTS)....

About Intellectual Disability

...Intellectual disability is characterized both by a significantly below-average score on a test of mental ability or intelligence and by limitations in the ability to function in areas of daily life, such as communication, self-care, and getting along in social situations and school activities. Intellectual disability is sometimes referred to as a cognitive disability or mental retardation....

Comments: I work with children and adults with ID all the time. Here's what the CDC says about it. DM

Caribbean Council for the Blind to set up school of optometry

...Come September, interested persons would be able to commence reading for a degree in optometry at the University of Guyana (UG) if the Caribbean Council for the Blind (CCB) has its way....

Comments: I wonder if they need a Professor of Pediatrics/Binocular Vision? DM

Exam-boosting drug tests 'loom'

...Schools and universities may soon need to test students sitting exams for brain improving drugs, experts say. ...The Academy of Medical Sciences said drugs for diseases such as Alzheimer's were being used by healthy people to boost alertness and memory. ...

Sleep-Deprived Brains Show Lapse in Visual Processing

...Seemingly normal function could give false sense of competence...Using MRI to measure blood flow in the brains of volunteers, the researchers found that even after sleep deprivation, participants had periods of near-normal brain function in which they were able to complete tasks quickly. However, periods of slow response and severe declines in visual processing were mixed in with these periods of normalcy....

Comments: How much sleep do your patients get before you do vision information processing testing? It may make a difference. DM

Doctors of Optometry, Parents, Educators and Legislators Applaud New Illinois Law Requiring Comprehensive Eye Exams for Children Starting School

...According to the Illinois Optometric Association, the new state law requires comprehensive eye exams for children entering kindergarten orenrolling for the first time in public, private, or parochial elementaryschools in Illinois. Since comprehensive eye exams are the best way todiagnose eye and vision problems in children early, before they interfere witha child's ability to learn, doctors of optometry agree that the new law is acrucial step in ensuring that Illinois students perform to the best of theirability in the classroom...."We know that healthy vision is essential for learning," said CharlotteNielsen, O.D., president of the Illinois Optometric Association and a Grayslake optometrist. "All Illinois children deserve the tools they need tofulfill their potential, and our students will benefit from this law. Wethank Sen. Demuzio and Rep. Tracy for their leadership on children's eyehealth."...

Comments: It is past time for all states to require mandatory eye examinations for children in school. It is also time for ophthalomogy to join with us in this endeavor. DM

Eye movements may detect autism

From AOA First Look...

Researchers say eye-tracking technology may detect autism in children under age one.
UPI (5/22) reported that "[e]ye tracker technology that measures eye direction of babies that may detect autism in children under age one is on horizon," according to a study presented at the International Meeting for Autism Research. Researchers from McMaster University in Canada are "using eye tracker technology" that "can distinguish between a group of siblings with autism from a group with no autism -- at nine months and 12 months."

Early autism study website

Colds and Zinc

Duration and severity of symptoms and levels of plasma interleukin-1 receptor antagonist, soluble tumor necrosis factor receptor, and adhesion molecules in patients with common cold treated with zinc acetate....Administration of zinc lozenges was associated with reduced duration and severity of cold symptoms. We related the improvement in cold symptoms to the antioxidant and anti-inflammatory properties of zinc.

Comments: Working with children....we are constantly being sneezed upon...and you know you are going to come down with something nasty eventually....well, pop a tablet containing zinc....and it looks as if you won't have to suffer for too long!! DM

Tuesday, May 20, 2008

Outstanding Pediatric Optometrist Recognized for Artistic Talent

Ok, Ok.....I'm laying it on a bit thick here...but if you want to see how I did during a year long competion within my camera the title above.

Amblyopia Studies at the Illinois College of Optometry

There are at least 6 amblyopia studies going on at the Illinois College of Optometry. If you have patients in the Chicago-land area who could benefit from participating in one or more of these studies, you might want to contact Dr. Yi Pang at today!!

Overcoming Measles Myth

...The measles vaccine was first approved in 1963. Before that, the disease struck hundreds of thousands of people per year. Approximately 500 deaths were recorded in 1958, Zucker said.
Today, widespread vaccination of infants with a combination measles,
mumps, and rubella vaccine has drastically cut infection rates. At least 72 cases of measles have been reported in the U.S. this year. The CDC had confirmed 64 of those cases as of April 25, most of which were linked to people who contracted measles overseas....All of the cases in the recent outbreaks were in children or adults who had incomplete vaccinations or no vaccinations at all against measles, officials said. "The perception that measles is not a serious disease still persists. So overcoming that belief was a challenge," said Wooten. While families in San Diego voluntarily cooperated with quarantine requests, some continued to go out in public instead of staying completely isolated at home, she said....

Watch Out for Pool Parasites

...Last year, the CDC got a record number of reported outbreaks of recreational water illnesses, which are spread by swallowing, breathing, or having contact with germs in the water of swimming pools, spas, lakes, rivers, or oceans.....

Comments: Many of the children I see spend the better part of their day in the pool during the summer. Make sure you tell parents of the problems their children could encounter because of the various "bugs" (let alone chemicals) in the water. And...remind the parents that a red eye is God's way of saying call your optometrist and make an appointment today! DM

MBA Student Survey

I received this email from students completing an MBA course...

My name is Matt Hyon and I am a UCLA student working on a group class project for an Entrepreneurship class at UCLA's Anderson School of Business. Four classmates and I have decided to do market research to study the feasibility of starting a business to produce a new
Optometric practice management software product. We have created a 5-10 minute survey that we are hoping you will help us by completing; we are willing to share the results of our work, which will lead to a presentation in front of a small group of Venture Capitalists on the
last day of class.

The survey is here:

Thank you for your time,
Matt Hyon
Fully Employed MBA Class of 2008

The survey is quick to do .... and who knows, perhaps they will develop the perfect computer software for us!! DM

Impact of ADHD and Its Treatment on Substance Abuse

Impact of ADHD and Its Treatment on Substance Abuse

Join Dr. Timothy Wilens in an in-depth CME activity as he discusses emerging data on the impact of ADHD and its treatment on substance use disorder, especially as related to adolescents and adults.

Comments: This is a one hour PodCast on the topic. Very interesting. DM

Optometrist says OTC eyeglasses are not suitable for everyone.

From AOA First Look...

On its website, Washington, D.C. NBC affiliate WRC-TV (5/19) reported that "[e]ach year, more and more folks -- especially those over the age of 40 -- turn to reading glasses." Because "good reading glasses can be expensive, many people choose over-the-counter (OTC) glasses sold at drugstores instead of prescription lenses." According to Andrea Thau, O.D., of the American Optometric Association in Manhattan, "Over-the-counter glasses are not suitable for everyone." Dr. Thau pointed out, "Many people have differences in prescription between their two eyes, many people have a stigmatism, which these glasses don't correct for, and other patients have trouble with eye coordination issues, which the glasses do not address." By purchasing reading glasses over the counter, "people also run the risk of not choosing the lenses that are best for their eyes." The wrong eyeglass prescription "can cause eye strain, headaches, and decreased visual efficiency," Dr. Thau noted. She explained that the "only way to know whether or not they are the right prescription for you is to have your eyes examined,...undergo a comprehensive eye exam," and "consult a doctor before purchasing any pair of glasses."

Comments: I hate to admit this, but like so many of my patients I tried OTC readig glasses. They were absolutely awful. The optics were....well, most questionable. They made me feel queasy. I now have a very nice pair of high quality PALs I well as several pairs of Eschenbach readers. The Eschenbach readers are very high quality and can be reasonably priced for your patients. DM

AOA UV expert offers tips to protect eyes from the sun.

From AOA First Look...

The Indianapolis Star (5/20, Rudavsky) reports that "[w]hen it comes to protecting yourself from sun, it's not just your skin that you need to worry about. It's also your eyes." According to Christopher Browning, O.D., an optometrist with VisionQuest Eyecare in Indianapolis, "Ultraviolet radiation from the sun can cause cataracts and macular degeneration years after exposure." Therefore, "it's critical to protect both yours and your children's eyes from these dangerous rays as soon as possible." Dr. Browning, who is also "an American Optometric Association UV Protection and Eye Care expert," offers various tips to protect eyes from the sun, including wearing sunglasses even when the weather is cold, ensuring that "sunglasses block out 99 to 100 percent of UV-A and UV-B radiation, and screen out 75 to 90 percent of the visible light," and getting annual eye exams.
Sunglasses protect eyes from permanent damage.
ACED Magazine (5/19, Mathews) reported that the adage "'you get what you pay for,' doesn't add up when it comes to sunglasses." Sunglasses are not just "a fashion statement," but are "a way to block harmful" ultraviolent (UV) "rays that can cause permanent damage to eyes in the form of cataracts, pterygium, and possibly retinal degeneration." Price and style do not "correlate [to] the amount of UV protection" sunglasses offer. That is because the "government doesn't regulate or classify the different types of sunglasses which are available." Therefore, consumers should do some research to "find the most reputable companies that manufacture sunglasses, because they almost always block both UVA and UVB rays." In particular, "[c]hildren should wear sunglasses" to "protect [their] eyes from the sun's harmful rays," and prevent long-term damage.

LASIK in Children With Hyperopic Anisometropic Amblyopia

...LASIK seems to be an effective and safe procedure for the management of hyperopic anisometropic amblyopia in select cases. Visual acuity improved in the amblyopic eyes and was associated with decreased anisometropia. The refractive response to hyperopic LASIK in children appears to be similar to that of adults with comparable refractive errors...

Comments: Every time I see one of these articles on refractive surgery and children, I keep thinking about what could happen to their corneas 10,20,50 years down the road. This is not a pleasant thought. DM

Phakic Refractive Lens: Two-year Results

This study evaluated...the surgical outcome and adverse events associated with correction of myopia and hyperopia with a phakic refractive lens (PRL),.... The study concluded that: Safety and efficacy indexes were high at 2-year follow-up. The distance between the PRL and crystalline lens decreased by 59% during the first year but seemed to stabilize thereafter. The PRL rotated in only a few eyes after the first year.

Comments: I haven't read the complete study yet, but I'm wondering if patients with these PRLs also exhibit the same unwanted side affects that we see with IOLs? DM

Discovery Of Cell Linked To Learning And Memory

...Queensland Brain Institute (QBI) neuroscientists at The University of Queensland have discovered a fundamental component of the process that regulates memory formation...

Researchers Create Genetically Modified Human Embryo; Could Lead To 'Designer' Infants, Critics Say

...Researchers from Cornell University have created what is believed to be the first genetically modified human embryo, the New York Times reports. The research was released last fall at an American Society for Reproductive Medicine meeting but did not receive widespread attention until Sunday, when London's Sunday Times published an article about the research after it was mentioned in a British government review of similar technology, according to the Times. Researchers said the study was an attempt to learn how early cells and diseases develop in order to correct genes which cause diseases such as cystic fibrosis, hemophilia and cancer. The embryo was destroyed after five days....

Comments: Designer infants? How about one with no major refractive error, nor strabismus or amblyopia! Well, until then....let's all sign up for the AOA's InfantSee program. We can help these children and their families right now! Go to for more information. DM

Students Focus On Vision

..."Vision is important in childhood learning, and vision care is critical to the academic development of Ohio's children," said Karla Zadnik, OD, PhD, Associate Dean of The Ohio State University College of Optometry....Realeyes connects classrooms with eye doctors in the community. Now in its seventh year, Realeyes has been presented to over 300,000 students in schools throughout Ohio. The Ohio Optometric Association, through a grant from the Ohio Department of Health Save Our Sight fund, created three age-appropriate, standardized classroom presentations. An online curriculum is available for high school students at All curricula are offered at no charge to schools. Funds are generated through donations collected at license and registration renewal by the Ohio Bureau of Motor Vehicles.

Comments: Dr. Zadnik is an awesome lady with many accomplishments to her credit and has published outstanding ground breaking research...this Ohio Optometric Association program is an outstanding example of how all optometrists (clinical and research oriented) can come together to improve the lives of chidren. Congratulations to all! DM

New Formula Connects Optical Quality With Visual Acuity With Potential To Provide Automatic Eyeglasses Prescriptions

...For the first time, a study combines measurements of abnormalities in the eye with models for assessing how well an individual can see, meaning it may be possible to program a machine to automatically produce prescriptions for corrective lenses. ...

Comments: Fear not! Those of us who work with children know that no matter how wonderful the refractive determination instrumentation may be...a doc with a retinoscope will be a vital part of the examination process for some time to come.... DM

A Quarter Can Prevent A Child From Going Blind

...You can't buy many newspapers for a quarter anymore, but with that same twenty-five cents you can buy a year's supply of vitamin A for a child in need. Affecting up to 140 million children every year, vitamin A deficiencies that go untreated can result in the child going blind before age 6, however vitamin A, given to a child twice a year for four years, can prevent blindness forever. ...
... "We are beginning to see that molecular genetics research is creating exciting new links between research in animal models and clinical disorders. The paper by Carolyn Yrigollen and colleagues suggests that two neurohormones that have been linked to affiliative behavior in animals, prolactin and oxytocin, are linked to deficits in affiliative behaviors associated with autism." ...

New European Study Showed OROS(R) Methylphenidate Tablets Significantly Improved Symptoms In Adults With ADHD

...Adults with attention deficit hyperactivity disorder (ADHD) treated in an investigational study with OROS® methylphenidate tablets experienced significantly greater improvements in their ADHD symptoms compared to patients taking placebo, according to findings from a trial published in Biological Psychiatry....

Monday, May 19, 2008

How much do babies see and when do they see it?

...Is it true that newborns are in a perceptual state of confusion not making sense of the sensory bombardment they face immediately after entering the world? Well, actually not. The visual apparatus in humans is used from birth as an important part of the infant’s interaction with the environment. It is a developing sensory modality that at birth is ready to function without prior experience. Eliciting visual behavior in the neonate appears to be positive evidence of central nervous system function.2 The full-term, and some premature infants, responses to appropriate stimuli can be demonstrated in the delivery room by observing fixation on a contrasting object....

Myopia: Can Its Progression Be Controlled?

Myopia is considered to be a leading cause of visual impairment. Furthermore, the prevalence of myopia in young adolescents has increased substantially over the past few decades. Although myopia was identified more than two thousands years ago, a consistently effective approach to myopia control for all patients still eludes clinicians. Among all the treatments mentioned in this review, the most promising ones are muscarinic receptor antagonists, including atropine and pirenzipine. Bifocal and progressive lenses can be effective in the control of myopia and have greater effectiveness for subjects with nearpoint esophoria and a high lag of accommodation. The treatment outcomes of gas permeable contact lenses have been confirmed to be effective but with questionable overall clinical effect. Other treatments including the under correction of myopia have been shown to be ineffective while traditional Chinese interventions for myopia prevention need further study to access their efficacy.

Optometric vision therapy improves the quality of life for our patients

The COVD Quality of Life Outcomes Assessment was an effective way to measure quality of life changes after vision therapy ... Vision therapy resulted in a decrease in subjects’ symptoms.

Comments: We know this is's always nice to have research to back it up! DM


PCO Expands Focus to Respond to Emerging Health Care Demands

ELKINS PARK, PA--- Over the past nine decades, the Pennsylvania College of Optometry (PCO) has undergone a series of transformations – changing campuses, strengthening curriculums and developing new programs. The College now has completed a process to significantly enhance its institutional structure. On July 1, 2008, PCO will officially make the transition from a college to a university.

Since 1919, the Pennsylvania College of Optometry has created a legacy of excellence in optometry. Over the past 25 years, the College has broadened its focus to include other disciplines and currently offers a total of seven graduate and two professional degrees. In addition to the Pennsylvania College of Optometry, PCO today is comprised of the PCO School of Audiology, four programs in Graduate Studies in Vision Impairment and a Physician Assistant program, each reflecting the values and the commitment to excellence upon which PCO was founded. Through its Center for International Studies, the College brings students and practicing optometrists to Philadelphia through its optometric programs in 17 countries around the world. A dynamic learning community and a multi-purpose institution, the College now will be better served by the internal structure of a university.

An institution’s name reflects its identity and conveys its past while charting its future course. With its new status, the institution will adopt the name Salus University. Salus, a Latin word for health and well-being, was unanimously adopted by the Board of Trustees as an expression of the institution’s dedication to the preservation of the health and well-being of the communities its graduates serve.

“The university’s name supports the institution’s vision of an academic community that emphasizes a holistic approach to education, prevention, treatment and rehabilitation, and includes a commitment to interdisciplinary learning,” according to Salus University President Thomas L. Lewis, O.D., Ph.D. “Our faculty, students, staff and Board of Trustees realize that, as this institution grows and becomes more complex, the name Salus will offer direction, underscoring the value of inter-disciplinary education and early clinical experience that are the hallmarks of our innovative curriculum.”

The mission of the institution remains the same as it has been since 1919: to educate health care professionals and educators, conduct research and provide patient care and rehabilitative services that advance the welfare of the public worldwide. Salus University provides students with uncommon opportunities to gain clinical experience and real-world understanding in their fields, and ensures that its students understand cutting-edge technology in order to perform effectively in their chosen professions.

While the mission of the institution and its commitment to excellence in education has not changed, the expansion of its programs is the result of careful planning and an examination of the health, scientific and political changes in society. As the need for more - and more highly specialized - health professionals continues to increase, Salus University will continue to respond to the demand with relevant programs.

Salus University is located in Elkins Park, PA. For more information about the University, please visit

History of the Pennsylvania College of Optometry
The Pennsylvania College of Optometry was established in Philadelphia in 1919 and the history of the College is the history of modern optometry. PCO was the nation’s first nonprofit, independent college of optometry and has continued to be a leader in the fields of education, research and new approaches to the management of vision problems. The College has spearheaded innovations in many areas. In 1975, PCO was the first college of optometry to develop a comprehensive, off-campus externship program. In 1978, PCO opened The Eye Institute, making it the first optometry college to develop a comprehensive interdisciplinary clinical facility for education and patient care. In 1998, PCO moved its campus to Elkins Park, at the intersection of Routes 73 and 611. As an innovator in the field of optometry, PCO has always been committed to going beyond standard procedures and advancing the profession through continuing education courses and innovative curricula.

In addition to the Doctor of Optometry (O.D.) program, PCO offers programs in Graduate Studies that include Low Vision Rehabilitation, Orientation and Mobility, Vision Rehabilitation Teaching and Education of Children and Youth with Visual and Multiple Impairments. The College’s Center for International Studies offers a Bachelor of Science and Master of Science degree to international optometry students and practitioners, as well as outstanding special educational programs and initiatives in 17 countries.

Setting a New Standard
Just as PCO set the standard for the practice of optometry, the College has led the way in establishing the Doctor of Audiology degree as the entry level degree for the profession. The College created AuDonline, a Doctor of Audiology distance education program designed specifically for licensed, practicing audiologists. The establishment of the residential four-year Doctor of Audiology program in 2003 at the PCO School of Audiology emphasized a groundbreaking biomedical curriculum with early experiential learning. The College provides students with a solid scientific understanding of hearing while developing the students’ clinical skills for professional practice at the state of the art Pennsylvania Ear Institute, located on the Elkins Park campus. The School of Audiology program represents a new model for the professional education of audiologists, with graduates who are positioned to take advantage of audiology’s expanding scope of practice and are uniquely qualified to become private practitioners.

Responding to Demand
The introduction of a Physician Assistant Program in August 2007 began a new era for the institution. Graduates of this program receive a Master of Medical Science degree, and the focus of the program is on evidence-based medicine and clinical problem solving. Physician Assistant students at PCO gain valuable cross-disciplinary experience through classes with Optometry and Audiology students and faculty.

The proud legacy of the Pennsylvania College of Optometry now becomes the cornerstone of Salus University. The institution’s commitment to excellence and innovation, coupled with a tradition of public service and responsible stewardship will continue to flourish.

Contact: Beth Drost215.884.6499

Taking Care of Caregivers

How often do we work with children and adults with a disability and we find that it is the mom, dad or other care giver that needs special attention.

...More than 50 million people in the United States are caregivers. Their help saves the health care system more than $300 billion a year. That's why a new clinical trial focuses on educating the caregiver. ...For the study, caregivers will have one-on-one time with a nurse and receive a home care guide book. Some of the advice: 1) take time to rest -- devote at least 30 minutes a day to yourself; 2) Be open in your conversations with the patient -- talk about life and death; 3) Watch for signs of depression and 4) Let the sick person make as many decisions as possible....

Comments: I often make recommendations to moms/dads that they need to let the kid just be a kid every now and can over "therapy" a child....and I will then suggest they contact appropriate respite care so that they can let themselves be husbands/wives and friends as well. A worn out care giver will be less likely to follow your primary care practitioners we need to take care of the whole family.

Other articles on similar topics include:

Care for Caregivers
Daycare Solutions -- In-Depth Doctor's Interview
Behind Closed Doors: Elder Rage (Part 3 of 3) -- Full-Length Expert's Interview
In Safe Hands? Part 3: Tort Reform: The Solution or the Punishment? -- Full-Length Interview
Caregiving may be Hazardous to Your Health
Caregivers Need Care Too
Help For Caregivers


Autism: Information for Professionals

Do you work with children and adults with autism? Check out

Federal Resources
Professional Organizations for Practitioners
Additional Resources of Interest

for appropriate information..... DM

Vaccines & Autism: What's New?

Get the information you need by clicking on the resourses below:

What research is CDC doing related to vaccines and ASDs?

What are other Federal Agencies doing related to vaccines and ASDs?
Additional information on vaccines and ASDs

Do vaccines cause or worsen mitochondrial disease?

CDC on Vaccines

This is a website that you should recommend to every parent. It contains a great deal of information to help parents decide any issues surrounding having their children vaccinated. DM

Skipping Vaccines

This story notes that:..."If you aren't vaccinating your child, you are making a mistake and putting them at risk for having a serious illness," Mike Jordan, M.D., a pediatrician at East Lake Pediatrics and Morton Plant Mease Hospital in Trinity, Fla., told Ivanhoe. Dr. Jordan is concerned about the growing number of parents opting out. He says many diseases that kids are vaccinated for are rare because of vaccinations. "It's estimated, for instance, that if we stopped vaccinating against measles, there would be about 2.7 million deaths per year as a result of that," he says....

Comment: Bottom-line? Recommend that all children get vaccinated when appropriate. DM

Eye Scans of the Future

...Through scans like these, soon Dr. Ansari believes doctors will be able to see the first signs of diabetes, Alzheimer's and Parkinson's. Clinical trials are starting in the next month, so some of these eye scans could be available across the country in the next few years....

Comments: Using non-invasive means to help diagnose disease would be a great benefit to us working with children. DM

How will I ever get my child to wear glasses?

...How will I ever get my child to wear glasses? Many parents worry about this, especially those with a baby or toddler. However, there is no need for concern. Most children wear their glasses proudly. At this young age, anything to make them different, or set them apart from the other children is welcomed. Attention seeking toddlers will more than likely jump at the chance to wear something special on their faces. What parent should instead be concerned with is whether or not their child will lose or break their glasses. Talk to your eye doctor about getting durable frames and scratch resistant lenses....

Comments: This is a blog that is "A community for parents to discuss the benefits of music, education, development, and entertainment for babies, infants, toddlers, and young children. Juno Baby is a critically acclaimed producer of DVDs, CDs, trendy apparel, and plush. To learn more about joining the Juno Baby Family, please visit our parent website at" Take a look around. You may find it interesting and a good place to send your parents. DM

Getting little girls to wear patches/glasses

Having trouble getting your patients to wear their patches or glasses. This website may help. Just a reminder, this blog does not necessarly support or recommend any particular products or services mentioned...this is for your information only. BTW I do not have any commercial interest in these products.... DM

The Eyes Have It: A Conversation with Neuroscientist Michael Stryker About How the Brain Learns to See

...One of the great wonders of vision is that we learn to see with our eyes still closed. The waves of activity that connect the retina to the visual cortex in the third trimester of pregnancy are the womb’s version of a shakedown cruise. ...

Comments: OK.....anyone up for a little pre-natal optometric vision therap!! DM

Are there inequities in the utilization of childhood eye care services in relation to socioeconomic status?

...The differences in the trends between socioeconomic groups in eye conditions and utilization of services suggest inequitable access to services. Our data highlight the limitations of community-based pre-school vision screening, which fails to abolish this inequity. ...

Comments: All children should have appropriate access to eye and vision care. Since a child's eyes change rapidly, a yearly comprehensive eye examination should be mandatory for all children no matter what their socio-economic level may be. DM

Prevalence and risk factors for common vision problems in children

...Although strabismus has decreased in the UK, it and amblyopia remain common problems. Children from less advantaged backgrounds are more at risk of hypermetropia and to a lesser extent of amblyopia and convergent strabismus. Children's eye care services may need to take account of this socioeconomic gradient in prevalence to avoid inequity in access to care. ...

Comments: The bottom line on all of this is to have these children examined early (search InfantSee on this blog) and often while they are growing up! More information about this can be found at DM

Computer vision syndrome becoming more widespread

From the AOA First Look...

The Houston Chronicle (5/17, Goldstein) reported, "With more than 143 million Americans working on a computer each day,...some are blaming all that screen time for dry, irritated eyes and computer vision syndrome." Eye-care experts say that children are also at risk, because "kids spend up to three hours per day on a computer doing homework, talking with friends, and playing games." Dr. Richard Yee, of the Hermann Eye Center and a clinical professor at the University of Texas Health Science Center, and Dr. Regina Sun of the Berkeley Eye Center in Pearland, "both tie computer time to eye strain, or computer vision syndrome." According to Drs. Yee and Sun, "simple precautions, like taking short breaks, and forcing blinking more often, can help ease the irritation." Dr. Sun noted, "Each time we blink, we replenish our tear film that" lies "over the cornea. When we don't blink as often, there is more exposure time to the air and the tear can evaporate," which "can dry out our corneas, and cause blurred vision, irritation, [and] eye fatigue."

New consent guidance for doctors

...The General Medical Council is calling for a fresh approach in the way doctors seek patient consent for treatment. ...For the first time it sets out the need to share information on side effects and risks, and outlines good practice for patients with dementia. ...

Comments: How do you obtain consent from your "special populations" patients? DM

Researchers develop first transgenic monkey model of Huntington's disease

Experts see model as tool to better understand the disease, develop more effective therapies, and lead the way to similar models for other genetic diseases. Scientists have developed the first genetically altered monkey model that replicates some symptoms observed in patients with Huntington's disease, according to a new study funded by the National Institutes of Health. Researchers are now able to better understand this complex, devastating and incurable genetic disorder affecting the brain. This advance, reported in the May 18 advance of online publication edition of Nature, could lead to major breakthroughs in the effort to develop new treatments for a range of neurological diseases.

Comments: I'm interested in genetics and the various diseases caused by our DNA. Fragile X syndrome for example was the first human disease caused by a repeated nucleotide sequence. I believe the etiology of Huntingtons is similar. DM