Saturday, January 3, 2009

Combined sensory impairment (deaf-blindness) in five percent of adults with intellectual disabilities.

Meuwese-Jongejeugd A, van Splunder J, Vink M, Stilma JS, van Zanten B, Verschuure H, Bernsen R, Evenhuis H.Combined sensory impairment (deaf-blindness) in five percent of adults with intellectual disabilities.
Am J Ment Retard. 2008 Jul;113(4):254-62.

.....Results show that the risk of combined sensory impairment in this population is considerably increased compared with the general population. Part of the underlying conditions are treatable or can be rehabilitated. .....

Maino at the Review of Optometry

Click on the title above and see the many articles I've written for the Review of Optometry. DM

Less Patching Time Needed for Amblyopia

...Children with amblyopia only require occlusion therapy (patching) for three to four hours daily, not the “maximal” dose of 12 hours a day traditionally prescribed, or even six hours daily, ......No doubt, these findings are good news to amblyopic patients (and the prescribing O.D.). “Depending on the depth of amblyopia, patching for six and/or 12 hours may just not be feasible,” says Dominick Maino, O.D., M.Ed., a professor in the Pediatric/Binocular Vision Service in the Illinois Eye Institute, a part of Illinois College of Optometry, and editor of Optometry and Vision Development. ...Dr. Maino says he usually recommends two hours of patching with one hour of active home hand-eye therapy and one hour of passive activity, such as watching television, eating or playing video games.

Comments: Want to know more? Contact me at DM

Friday, January 2, 2009

An Open Letter to David K Wallace, MD, MPH (and other disbelievers and holders of outdated and biased opinions and beliefs)

Dear Dr. Wallace,

I recently read your editorial1 in the Archives of Ophthalmology concerning the paper by the Convergence Insufficiency Treatment Trial Study Group entitled, Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. At the very beginning of your editorial you noted that the typical symptoms associated with convergence insufficiency (CI) include “difficulty with reading, eye strain or discomfort with near work (asthenopia) and headache.”

Optometrists have for decades noted how learning related eye and vision problems can affect various academic areas such as reading. Many of our ophthalmological colleagues however, have claimed and continue to claim that the eyes have little to do with reading. I want to thank you for your support in acknowledging that how the vision system functions can have a significant and adverse impact on reading...

For the rest of this editorial you need to click on the title above....DM

Computerized Saccadic Eye Movement Therapy to Improve Oculomotor Control during Reading and Reading Rate in Adult Japanese Readers


Background: This study is aimed at determining whether reading rate and oculomotor control during reading, could be improved in adults with home-based computerized saccadic eye movement therapy.

Methods: Sixteen Japanese foreign students in the U.S. served as subjects and were randomly divided into two groups; a computerized eye movement training (CEMT) group and a control group. Subjects in the CEMT group received 5 weeks of home-based computerized saccadic eye movement training while subjects in the control group received no comparable training or intervention, other than diagnostic evaluations.

Results: CEMT group demonstrated significant improvement in all Visagraph II measurement parameters after intervention, except for duration of fixation and reading comprehension. Subjects in the control group demonstrated no significant pre-post differences.

Conclusions: These results suggest that CEMT, without supplementary reading instruction or educational intervention, can improve reading oculomotor performance with adult Japanese readers.

Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading


Background: Saccade control is a complex function of our brain and relies on the coordination of several subcortical, cortical, and functional areas. In the past it has been difficult to use data from saccade analysis as an additional diagnostic tool for insight into any particular patient’s oculo-visual problem. With the development of technological advances and optomotor research there is now a better understanding of visually guided saccadic reactions. This article describes the development of saccade control, diagnostic data from dyslexic subjects, and the effect of daily saccadic and fixation practice and its transfer to reading skills.

Methods: All subjects were recruited from local schools. Several standard tests (reading, spelling, intelligence) were used for inclusion/exclusion of the subjects participating in the various studies. Eye movements were recorded by infrared light reflection methods. Prosaccades with overlap conditions and antisaccades with gap conditions were required in 200 trials for each task. Variables characterizing pro- and antisaccade performance were extracted for each subject. Mean values and standard deviations comparing the experimental and control subjects were calculated in each of the 4 age groups in an age range of 7 to 17 years. ANOVAs or t-test were used for statistical evaluations.

Results: The data from 114 normal control subjects show a developmental progression lasting until adult age. Among the 3230 subjects in the dyslexic group 20 to 70% (depending on age) failed the criterion of the age matched controls when looking at anti-saccade performance. Pro-saccade performance did not differentiate between the groups. Daily practice conducted by 182 dyslexic subjects improved their antisaccade performance in approximately 80% of the cases. For training subjects, it was noted that successful training transferred to the act of reading by reducing the percentage of reading errors in the experimental group (N=10) by 50% and by 20% for the control group (N=11).

Conclusion: This study suggests that deficits in antisaccade control but not in prosaccade control contribute systematically to the problems of subjects with specific deficits in acquiring reading skills and that appropriate training can reduce the percentage of reading errors.

Optometry and Vision Development Volume 39, No. 4, 2008

Optometry and Vision Development Volume 39, No. 4, 2008 is now available:

An Open Letter to David K Wallace, MD, MPH
by Dominick M. Maino, OD, MEd, FAAO, FCOVD-A, Editor

Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading
by Burkhart Fischer, Dipl Phys; Klaus Hartnegg, Dipl Phys

Computerized Saccadic Eye Movement Therapy to Improve Oculomotor Control during Reading and Reading Rate in Adult Japanese Readers
by Tomohito Okumura, MScOptom, MEd, FCOVD, FAAO, et. al.

COVD 2008 Papers and Posters

Literature Review
Current Eye & Vision Science Literature
by David A. Goss, OD, PhD, FAAO, FCOVD-A

Book Review
The Special Education Battlefield
Review by Janice McMahon, OD

Behaviors, Beliefs and Emotions
Review by Sanford M. Gross, MA, OD

Practice Management
Evaluating Yourself as a CEO
by Mark R. Wright, OD, FCOVD

Make Classroom Visits to Generate Teacher Referrals
by Thomas Lecoq

Medical Debt and Personal Disaster
by Richard Rizzardi

COVD 38th Annual Meeting
President’s Speech – Who is COVD?

by Carol L. Scott, OD, FCOVD

Annual Meeting Photos


COVD extends our appreciation to the advertisers that continue to make OVD possible


Three Rivers Optical

Ambliopia iNet




Expansion Consultants

Vision Assessment Corporation

The Fresnel Prism and Lens Co.

Visual Edge

Stereo Optical

Refractive errors and schizophrenia.

Caspi et al noted that "There was a negative association between refractive errors and later hospitalization for schizophrenia. Future male schizophrenia patients were two times less likely to have refractive errors compared with never-hospitalized individuals, controlling for intelligence, years of education and socioeconomic status"

Comments: Be mentally well! DM

Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial.

Scheiman and the PEDIG group have done more to help us understand amblyopia than any research done this study they note that "Atropine and patching achieve similar results among older children with unilateral amblyopia."...and although this is very important...even more noteworthy is that they continue to find that you can treat amblyopia on "older children". They continue to show that neuroplasticity continues through out our lifetimes and that treatment is probably possible at any age. Do not only diagnose those amblyopes ... but offer to treat them...NO MATTER what the age may be. DM

Amblyopia characterization, treatment, and prophylaxis

Simos notes in this review that: "Amblyopia has a 1.6-3.6% prevalence, ...and is more complex than simply visual acuity loss and the better eye has ... deficits. Functional limitations appear more extensive and loss of vision in the better eye of amblyopes more prevalent than previously thought. ....Successful treatment can be achieved in at most 63-83% of patients. Treatment outcome is a function of initial visual acuity and type of amblyopia, and a reciprocal product of treatment efficacy, duration, and compliance. Age at treatment onset is not predictive of outcome in many studies but detection under versus over 2-3 years of age may be. ..."

Comments: So let me get this straight...amblyopia is more complex that just the decreased visual acuity and amblyopia affects the better seeing eye as well! Sounds like what optometrists have been saying for decades. Amblyopia is a BINOCULAR vision problem and a "brain" dysfunction. We need to do therapy not only to improve the visual acuity....but to improve binocularity and cortical function as well. DM

Optic disc area and retinal area in amblyopia.

This study found that "...there was a 20 percent increase in the retinal receptor areas of hyperopic amblyopic eyes as compared to hyperopic eyes without amblyopia despite reduced retinal areas in the amblyopic eyes. Dysplastic and/or asymmetric optic discs were present in 163 of 293 (56 percent) amblyopic patients, 47 of 84 (56 percent) strabismic, and 10 of 77 (13 percent) normal patients. ... The increase in the receptor area may be an explanation for diminished acuity and impaired visual function in amblyopic eyes."

Comments: Once again we see a structural change in neuro tissue when amblyopia is present. Once again I wonder if optometric vision therapy can alter not only function but structure. DM

Long-term application of computer-based pleoptics in home therapy: selected results of a prospective multicenter study.

This study noted that....Recalculated relatively to the duration of the therapy periods, the computer training combined with occlusion was found to be about twice as effective as the preceding occlusion alone. ... The results of combined computer training and occlusion show an additional increase of the same amount as the preceding occlusion alone, which yielded at its end no further advantage to the development of visual acuity in the selected sample of our 55 therapy-resistant patients.....

Comments: I haven't read the whole paper just yet, but the abstract gives two impressions. One is that using the computer is 2X as effective as when it is not used and that VAs increased the same amount no matter if you used the computer or if you just used occlusion. Wouldn't you want to do the therapy in as fast and efficienct method as possible? Doesn't that mean therapy with the computer should be recommended? I'll try to get back to you once I've read the complete paper. DM

Prolonged perceptual learning of positional acuity in adult amblyopia: perceptual template retuning dynamics.

Li, Klein, and Levi showed that the mature (adult) amblyopic brain is surprisingly malleable, and point to more intensive treatment methods for amblyopia. I suggest these more intensive treatment modalities be what we do during optometric vision therapy! DM

Occipital lobe's cortical thinning in ametropic amblyopia.

...The changes in cortical thickness of several occipital regions in amblyopic patients may be important in the diagnosis and treatment of this disease....

Comments: This paper noted "cortical thicknesses of the lingual and pericalcarine areas of the left hemisphere and of the cuneus, lateraloccipital and lingual areas in the right hemisphere in the amblyopic group were significantly thinner than those of the control group". I just completed a paper on neuroplasticity for the Review of Optometry to be printed in Jan 2009 that noted that various forms of therapy could not only alter function BUT ALSO structure of the brain. If we do optometric vision therapy on these brains would they show functional and structural changes? Where can I get me a FMRI quick! DM

Comprehensive vision care in urban communities: the pediatric outreach program.

...Comprehensive eye examinations were performed on 4,298 children ages birth to approximately 5 years . Of the children examined, Approximately 6.5% had risk factors for isometropic amblyopia, and 2.3% had risk factors for anisometropic amblyopia. Approximately 1% of the children had strabismus. Less than 1% of the children examined were identified with ocular pathology. Spectacles were dispensed to 16.6% of the children examined.

Comments: Yes, I know this was a clinical population. Yes, I know that this was an at-risk group. But for this group of young children approximately 714 needed glasses, 378 were at risk for amblyopia and 43 had strabismus. Now tell me again why our Ophthalmological colleagues do not want young children to have comprehensive eye and vision examinations?

A bit of bragging is due....this study was conducted by Drs. Val Kattouf, Jan Scharre and a couple of other ICO colleagues of mine! Congrats to all. DM

Thursday, January 1, 2009

Occlusion properties of prosthetic contact lenses for the treatment of amblyopia

...Sufficient vision penalization can be achieved to make occlusion with prosthetic contact lenses a viable therapy for amblyopia. The degree of penalization can be varied and different iris print patterns and pupil sizes, using peripheral fusion, can be preserved with some lenses. Prosthetic contact lenses can be more cosmetically appealing and more tolerable than other amblyopia treatment modalities. These factors may improve compliance in occlusion therapy....

Monday, December 29, 2008

Teach Your Baby to Read part 2

Comment: Ms. Reich quickly responded to my email about research supporting her product. I hope her colleagues will do so as well. DM

Hi Dominick,

I have been reading your blog and was pleased to see you talked about our program recently. I have forwarded your request to our founder, Dr. James O'Neil, and to our chief engineer, Rich Tirendi, so they can respond appropriately to your research question. I am attaching our media kit to this e-mail which tells you more about our organization and who we are.

I would be happy to answer any other questions you might have.

Happy New Year!


Elizabeth Reich
Chief Executive Officer
VisionQuest 20/20
564 W. 9th Place
Suite #3
Mesa, AZ 85201

Phone: 602-903-4460
Cell: 602-321-4800

Faculty Position in Pediatric Optometry & Vision Therapy

Looking for work in California?

Brain Waves Shed Light on Autism

...Unique brain wave patterns, spotted for the first time in autistic children, may help explain why they have so much trouble communicating....Using an imaging helmet that resembles a big salon hair dryer, researchers discovered what they believe are "signatures of autism" that show a delay in processing individual sounds....

Autism News Beat

Autism News Beat An evidence-based resource for journalists

Comments: This is a blog that responds to the autism hype...finally someone questioning what should be questioned....DM

How chromosomes meet in the dark -- Switch that turns on X chromosome matchmaking

...A research group lead by scientists at the University of Warwick has discovered the trigger that pulls together X chromosomes in female cells at a crucial stage of embryo development. Their discovery could also provide new insights into how other similar chromosomes spontaneously recognize each other and are bound together at key parts of analogous cell processes. This is an important mechanism as the binding togetgher of too many of too few of a particular chromosome can cause a number of medical conditions such as Down's Syndrome or Turner's Syndrome....

Acting Out Dreams May Be Marker of Neurodegenerative Disease

...Patients who frequently kick or cry out in their sleep may be at an increased risk of developing a neurodegenerative disease, particularly Parkinson's disease or Lewy body dementia....

Treatment Approved by the FDA for Hypotrichosis of Eyelashes

Allergan, Inc. (NYSE: AGN) today announced the U.S. Food and Drug Administration (FDA) has approved LATISSE (bimatoprost ophthalmic solution) 0.03% as a novel treatment for hypotrichosis of the eyelashes. Eyelash hypotrichosis is another name for having inadequate or not enough eyelashes. LATISSE is the first and only science-based treatment approved by the FDA to enhance eyelash prominence as measured by increases in length, thickness and darkness of eyelashes.

Comments: What! Using a GLC drug for better looking eyelashes....why that sounds almost as unbelievable as using a poison injected into your head to reduce wrinkles! Who in their right minds would do that? DM

Study explores how neural vision systems react to rewarding objects.

From AOAs FirstLook:

HealthDay (12/24, Dotinga) reported that, according to a study published in the Dec. 26 issue of the journal Neuron, "neural vision systems get turned on by expensive or 'rewarding' objects, even before people realize they're excited." In addition, "even the parts of the brain that handle the very beginning of the vision-processing system can tell whether something is valuable and should be flagged." For the study, researchers from the University of California-San Diego used functional magnetic resonance imaging to study "the brains of 14 college students" who were playing a game in which they had to choose rewarding targets. The investigators found that the participants' "brains reacted differently to targets that had been monetarily rewarding in the past," and also discovered "that the brains of the subjects seemed to remember which targets were more rewarding, even if the subjects themselves actually forgot."

Our unconscious brain makes the best decisions possible

... the human brain—once thought to be a seriously flawed decision maker—is actually hard-wired to allow us to make the best decisions possible with the information we are given. The findings are published in today's issue of the journal Neuron....

Brain starvation as we age appears to trigger Alzheimer's

...A slow, chronic starvation of the brain as we age appears to be one of the major triggers of a biochemical process that causes some forms of Alzheimer's disease....has found when the brain doesn't get enough sugar glucose -- as might occur when cardiovascular disease restricts blood flow in arteries to the brain -- a process is launched that ultimately produces the sticky clumps of protein that appear to be a cause of Alzheimer's....The altered protein, called eIF2alpha, increases the production of an enzyme that, in turn, flips a switch to produce the sticky protein clumps. Vassar worked with human and mice brains in his research....

Pollution at home often lurks unrecognized

...Many people may be surprised by the number of chemicals they are exposed to through everyday household products, a small study finds, suggesting, researchers say, that consumers need to learn more about sources of indoor pollution....

Teach Your Baby to Read (NOT !!!!!)

This is a video program that supposedly teaches your little one to read. I doubt it. Babies should not be learning to read. Babies should not be watching videos. Babes should be moving and exploring their world. I would strongly suggest you look for any research that supports this...what you will find is lots of research supporting your child actively engaging in his/her environment using motor activities to learn about the world. DM

HEADLINES 1 43 pm x70 Computer game determines children's vision problems

...The computer game Eye Spy helps medical professionals pinpoint vision problems like refractive error and amblyopia....

More Information
For more information
More Information

Elizabeth Reich
Chief Executive Officer
VisionQuest 20/20
Mesa, AZ
(602) 903-4460

Children wear glasses with red and blue lenses while playing the game, which is a treasure hunt. The different-colored lenses ensure each eye is screened individually.

Estimates show the game would cost about $5 per child. Professional eye exams can cost up to $75 per child....

Comments: I have not seen any research that suggests that this is a viable vision screening option. Beware. Vision screenings are just that...screenings miss many many children missed at $5 each would be worth a comprehensive eye examination for a child? (BTW I will contact Ms. Reich to see what research had been done to support this software.) DM