Saturday, October 25, 2008

Prevalence and risk factors for common vision problems in children

Prevalence and risk factors for common vision problems in children: data from the ALSPAC studyC Williams1, K Northstone2, M Howard3, I Harvey4, R A Harrad5, J M Sparrow5

Objective: To estimate the distribution and predictors of some common visual problems (strabismus, amblyopia, hypermetropia) within a population-based cohort of children at the age of 7 years.

Methods: Children participating in a birth cohort study were examined by orthoptists who carried out cover/uncover, alternate cover, visual acuity and non-cycloplegic refraction tests. Prospectively collected data on potential risk factors were available from the study.
Results: Data were available for 7825 seven-year-old children. 2.3% (95% CI 2.0% to 2.7%) had manifest strabismus, 3.6% (95% CI 3.3% to 4.1%) had past/present amblyopia, and 4.8% (95% CI 4.4% to 5.3%) were hypermetropic. Children from the lowest occupational social class background were 1.82 (95% CI 1.03% to 3.23%) times more likely to be hypermetropic than children from the highest social class. Amblyopia (p = 0.089) and convergent strabismus (p = 0.066) also tended to increase as social class decreased.

Conclusions: Although strabismus has decreased in the UK, it and amblyopia remain common problems. Children from less advantaged backgrounds were 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 socio-economic gradient in prevalence to avoid inequity in access to care.

Common visual problems of childhood in the UK include refractive errors, amblyopia and strabismus.1 Contemporary population-based data are not available on the prevalence or distribution of these problems in children in the UK. In the 1960s, 5.3% of 7 year-old schoolchildren in Cardiff had a manifest strabismus.2 Among 11-year-old children in the 1970 UK birth cohort, 5.9% had presumed myopia, 1.5% presumed hypermetropia, and 1.5% presumed amblyopia. While vision defects overall were more common in deprived children, there was no clear association between factors associated with amblyopia and social class.3
Up-to-date, population-specific prevalence data are necessary for planning the quantity and delivery of ophthalmic and optometric services, particularly as expansions in community-based eye care have been recommended.
4 We therefore present results from an ongoing birth cohort study to estimate some of these data in children. The relevant conditions that could be reliably identified were hypermetropia, strabismus and amblyopia. We also looked at potentially important risk factors identified from the literature.3 5 6

Prevalence of General Dysfunctions in Binocular Vision

Prevalence of General Dysfunctions in Binocular Vision .
Montés-Micó Robert. Annals of Ophthalmology, Volume 33, Number 3, September 2001 , pp. 205-208(4)

A 1-year clinical trial to determine the prevalence of general dysfunctions in binocular vision in a nonpresbyopic population was conducted in 1679 subjects aged 18 to 38 years. A thorough eye examination included binocular vision testing. A high prevalence of binocular vision dysfunctions was found. Of the subjects, 56.2% presented symptoms of binocular dysfunctions, 61.4% with accommodation disorders and 38.6% vergence disorders. Accommodation insufficiency was most prevalent among those with symptoms (11.4%).


Friday, October 24, 2008

Much More about CI and In Office Optometric Vision Therapy

Study Finds Best Treatment For Common Childhood Eye Problem
Medical News Today (press release) - UK
Convergence insufficiency, which is common among children, is a condition in which patients cannot accurately point their eyes together, so they see double ...
See all stories on this topic
Alzheimer's study; Convergence insufficiency - New York,NY,USA
It's called CI for convergence insufficiency. Kids who have it usually complain of tired eyes, headaches and blurred or double vision when they read. ...
See all stories on this topic
Best treatment determined for childhood eye problem
HULIQ (press release) - Hickory,NC,USA
Mayo Clinic researchers, as part of a nine-site study, helped discover the best of three currently-used treatments for convergence insufficiency in children ...
See all stories on this topic
Home therapy for vision problem might not be sufficient - IL, USA
Convergence insufficiency, or CI, is a muscle coordination problem that affects one 1 of every 20 children. It can cause problems with reading and writing. ...
See all stories on this topic

Google Blogs Alert for: "convergence insufficiency"

Study: Office-based therapy effective for treating convergence ...
A large study has found that combining 12 weeks of office-based therapy with home reinforcement is more effective for treating children with convergence insufficiency than two home-based therapies and an office-based placebo therapy ... RSS Daily Feed -
New Research Gives Hope to Children with Common ReadingRelated ...
(Vision News and Information) On Monday the National Institute of Health released a study showing that there is a more effective treatment for children who have a common readingrelated vision disorder Convergence insufficiency CI is an ...
News PRNN -
Study Finds Best Treatment for Common Childhood Eye Problem
A new study finds that a combination of in-office therapy and at-home treatment is the best solution to convergence insufficiency,...
All Muscle Mag Fitness News Feeds -
More Effective Treatment Identified for Common Childhood Vision ...
By Mamma
Scientists have found a more effective treatment for a common childhood eye muscle coordination problem called convergence insufficiency (CI). For words on a page to appear in focus a child’s eyes must turn inward, or converge. ... -
Study Finds Best Treatment For Common Childhood Eye Problem
By News
... at Nova Southeastern University (NSU) have found. The team, led by Stacey Coulter, OD, worked with researchers across the country to determine which treatment works best for a condition known as convergence insufficiency. [...]
Professional Medical Billing... -

Part-time occlusion therapy for amblyopia in older children

All grades of part-time occlusion are comparable to full-time occlusion in effectiveness of treatment for mild to moderate amblyopia in children between 7-12 years of age unlike in severe amblyopia, where six hours and full-time occlusion were more effective than two hours occlusion therapy.

More COVD Photos

If you attended the COVD meeting in Palm Springs last know how much fun we had...if you didn't go... click on the title and be envious....very envious...DM

Convergence Insufficiency - Best Treatment Determined For Childhood Eye Problem

Mayo Clinic researchers, as part of a nine-site study, helped discover the best of three currently-used treatments for convergence insufficiency in children. Convergence refers to the natural ability of the eyes to focus and align while viewing objects up close. Children with convergence insufficiency tend to have blurred or double vision or headaches and corresponding issues in reading and concentrating, which ultimately impact learning.

Comments: Several News media folks have picked up on this is very important! DM

Blindsight: How Brain Sees What You Do Not See

Blindsight is a phenomenon in which patients with damage in the primary visual cortex of the brain can tell where an object is although they claim they cannot see it. A research team led by Prof. Tadashi Isa and Dr. Masatoshi Yoshida of the National Institute for Physiological Sciences, Japan, provides compelling evidence that blindsight occurs because visual information is conveyed bypassing the primary visual cortex. Japan Science and Technology Agency supported this study. The team reports their finding in the Journal of Neuroscience on Oct 15, 2008.

More Effective Treatment Identified For Common Childhood Vision Disorder

Scientists have found a more effective treatment for a common childhood eye muscle coordination problem called convergence insufficiency (CI). For words on a page to appear in focus a child's eyes must turn inward, or converge. In CI, the eyes do not converge easily, and as a result, additional muscular effort must be used to make the eyes turn in.

Comments: This NEI funded clinical trial confirms that the BEST way to treat convergence insufficiency is with in office Optometric Vision Therapy. If you have a binocular vision problem, you should find an optometrists who does OVT. Go to to find a doctor near you. DM

Study Finds Best Treatment For Common Childhood Eye Problem

A combination of in-office therapy and at-home treatment is the best solution for a common childhood eye problem, optometrists at Nova Southeastern University (NSU) have found. The team, led by Stacey Coulter, O.D., worked with researchers across the country to determine which treatment works best for a condition known as convergence insufficiency.

Comments: I know Dr. Coulter....she always does good work! She and I are working on a theme issue for Optometry & Vision Development...the theme is Autism. Watch for it! DM

Research Shows A Walk In The Park Improves Attention In Children With ADHD

For children with Attention Deficit Hyperactivity Disorder (ADHD) tasks that require concentration such as doing homework or taking a test can be very difficult. A simple, inexpensive remedy may be a "dose of nature."

Peripheral prism glasses & hemianopia

Hemianopia patients may receive long-term benefits from the use of carefully fitted peripheral prism glasses. Stroke survivors and others afflicted by homonymous visual field defects (HVFDs) that stem from lesions in the postchiasmal visual pathways have more evidence about a prominent optical aid used to help them detect obstacles on the side of the loss. Such patients, who are 0.8% of the general population older than 49 years, are often left with impaired mobility.

Viewing too much TV harmful for children

Watching too much TV can have negative influence on the physical and mental development of the child, according to a report.

15 negative effects of watching television were found in youngsters such as autism, obesity, premature puberty, dementia etc. after analyzing 35 scientific studies.

Research links vision problems to soldiers diagnosed with TBIs.

Ivanhoe Broadcast News (10/23) reported, "Military studies show that up to 340,000" of the American men and women who have served in Iraq and Afghanistan "suffer from mild traumatic brain injury (TBI)." Preliminary studies "reveal that as many as 70 percent of severely-wounded soldiers treated for TBIs also complain of double vision, difficulties reading, and blindness. Another study found that "26 percent of soldiers who had been injured in blasts had severe visual impairment, including blindness." Ivanhoe added, "This year, the Veterans Health Administration is spending $40 million to add 55 outpatient vision-rehabilitation clinics nationwide, and to increase staff at existing facilities."

Wednesday, October 22, 2008

Sutured Protective Occluder for Severe Amblyopia: What were they thinking?

Comment: Remember the article I posted here about the ophthalmlogists' study concerning suturing a patch on a child's eye instead of patching, using atropine, or some other form of therapy for amblyopia....Here is a picture of the poor child with a patch SUTURED to his eye!! How could this get by any Institutional Review Board? Why did the Arch Ophthalmolgy publish this paper? What were they thinking?
What were Drs. Arnold, Limstrom and Ms. Armitage thinking? Was there no one involved in this sad project that bothered to stop and think that perhaps this was NOT a good idea? Shame of them all. It is obvious that the Institutional Review Board involved in this project needs to remove all members of its board. It is obvious that the editors of the Arch Ophthalmol need to be replaced immediately. They have all lost their ability to distinguish between research and torture! DM

Sutured Protective Occluder for Severe Amblyopia
Robert W. Arnold, MD; Mary Diane Armitage, CO; Scott A. Limstrom, MD

Objective: To investigate the feasibility, acceptability, efficacy, and cost of a newly developed translucent shield that can be fixed by sutures to the orbital rim for a month of amblyopia therapy.

Conclusion:Sew-on occluder shields are an alternative when adherence to the use of other types of patching (often referred to as compliance with patching) is not satisfactory.

Arch Ophthalmol. 2008;126(7):891-895

Sunday, October 19, 2008

Important Comment by Pat Wyman

Comment: I took Pat Wyman comments from the "comments" section of this blog and am posting it here because it really says it all when we talk about why we do this kind of research. Our ophthalmology colleagues may not want to accept the facts...but in office optometric vision therapy works quite well....the clinical trials have been done (with more on the way)...with your ophthalmological colleagues...accept this well done that all of our patients can benefit. DM (See Pat's comments below)

This is a study I have been following for a long time as a learning and reading specialist.

My daughter suffered from convergence insufficiency, along with other visual problems in the first grade.Once she had vision therapy, all her visual problems were corrected, and she was able to fulfill her dream of becoming a Pediatrician.

Today, she can tell her patients how much vision therapy helped her see the words on the page more clearly, read faster, and eliminate how tired she felt when she read. I am deeply grateful to COVD, OEP and PAVE for the help and training they've given me over the years, so I could testify on vision screening legislation to help all children read better, as well as teach this information to teachers and write about it my books.

My daughter is able to help her patients when parents say their children have reading problems - most likely undiagnosed in school and very often undetected even during a well child exam in Pediatrician's office.

Thank you for sharing this article and I am more than happy to place it on my blog,


Pat Wyman
Best selling author, Learning vs. TestingFounder,

University Instructor of Continuing Education