Thursday, May 28, 2009

Fixing My Gaze: A Scientist's Journey Into Seeing in Three Dimensions

Comments: Read this review. Buy this book. DM

Reviews Written by
David H. Peterzell "Ph.D., Ph.D." (San Diego, CA United States)

Fixing My Gaze: A Scientist's Journey Into Seeing in Three Dimensions
by Susan R. BarryEdition: Hardcover

Great Story, Great Science, Instills Hope, May 24, 2009

I ordered this new book just after meeting the inspirational Dr. Barry at this year's meeting of the Vision Sciences Society. The book arrived this last Friday and I spent the day reading it. I confess to be blown away by her story, as well as the scientific and clinical implications of her work. Add me to the list of people who loved the book! Sue Barry's astonishing development of stereopsis at age 48 changed - profoundly - the way that many scientists (me included) view visual development and plasticity. Somehow we had tuned out, en masse, one hundred years of successes using vision therapy (including the extensive the work of Frederick Brock). The stuff of vision therapy was ignored, relegated to the fringes of sensible vision care. Instead, several generations of us took the Nobel Prize winning research of Hubel and Wiesel as gospel truth, going beyond the data by wrongly concluding (perhaps unlike the Nobel laureates) that stereopsis could only develop during a critical period during infancy. It took Barry, a well-established neuroscientist and keen observer, to bring us to our senses. And yet now, having read her new book, I see that the story is much deeper and profound than I thought. First off, she's a very entertaining storyteller in her own right. The human drama escalated as she went through frightening surgeries as a child (including an encounter with a deceptive anesthesiologist); as she experienced shock and disappointment at being exposed as stereoblind; as she had her vision problems dismissed by one ophthalmologist as a psychiatric disorder; as she experienced steropsis bursting out at her for the first time; as she gained steam and knowledge, recognizing the scientific, clinical, and human implications of her story; as she brought celebrity neuroscientists on board. And so it is a story of empowerment for Barry the patient, Barry the scientist, Barry the teacher, and Barry the instiller of hope. I believe that Susan Barry has demonstrated for many of us that stereopsis is, indeed, important. I, for instance, was trained to believe that binocular vision and any advantage it afforded us wasn't that big a deal. Sure, I loved stereo viewers and all that... But as an undergrad at Berkeley in the early `80s, I recall a visit by Bela Julesz, of cyclopean vision fame. Two of my academic heroes, Russ and Karen De Valois rose to challenge Julesz, eventually (as I recall) suggesting that two eyes really aren't that much better than one. As I read Barry's book, as well as her descriptions of the consequences of her visual deficit, I realized that my early academic training (as a I had encoded it) was quite wrong. The book makes it clear that lack of stereopsis, and having two eyes that don't fuse images properly, has profound consequences for people like Barry (e.g., her driving, her energy level, and her sense of efficacy). Moreover, it is fair to say that Barry is an extraordinary observer of stereoscopic experience, and that she uses her newfound, developing perceptual ability to achieve scientific and clinical insights that are elusive to us who grew up with normal stereopsis. One of the epiphanies for me was when I read and grasped the following paragraph: "Just as I could not imagine a world in stereo depth, an individual with normal normal stereopsis cannot experience the worldview of a person who has always lacked steropsis. This may be surprising because you can eliminate clues from stereopsis simply by closing one eye. What's more, many people do not notice a great difference when viewing the world with one eye or two. When a normal binocular viewer closes one eye, however, he or she still uses a lifetime of past visual experiences to re-create the missing stereo information." People interested in stereopsis will find excellent coverage of the basic issues and the key scientific figures past and present (e.g., Wheatstone, Hering, Helmholtz, Eileen Birch, Shin Shimojo, Denis Levi, Uri Polat, Chris Tyler). It is nice, if not surprising, to learn that the already positive, cool Oliver Sacks played a positive, cool role in Susan Barry's story. If you have strabismus or some other disorder of binocular vision, you will find what you need here. You will find out how to find an appropriate vision therapist. You will find extensive, understandable information about the theory and science of binocular vision. More importantly, you will learn in marvelous detail about the experiences and practices that can in some instances lead to acquiring stereopsis late in life. My guess is that vision therapy patients will use this book as a guide for years to come. One last thing: I recommend listening to two NPR interviews (2006, 2009) featuring Sue Barry, as well as other key scientific figures in the story, including Sacks, Hubel, Levi, and, briefly, the heroic Theresa Ruggiero. The NPR programs are available online and go quite well with the book. Two thumbs up! (one with uncrossed disparity; one with crossed disparity).


...Younger children with anisometropic refractive error have a lower prevalence and depth of amblyopia than do older children. By age 4, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding, or even preventing, the development of amblyopia ...

Comments: Unfortunately, Sean P. Donahue MD PhD , still doesn't seem to get it...the earlier a COMPREHENSIVE eye examination is given, the better the outcomes for all children. Sean....full exams NOT VISION SCREENINGs are needed. The first full exam should be between 6-12 months (I've mentioned InfantSee a million times....check it out!) and then before Kindergarten and every 1-2 years after that. DM


...A majority of the patients interviewed would trade a portion of their life expectancy in return for being rid of strabismus and its associated effects. These results were validated by significant associations with diplopia, asthenopia, and disability ...

Comments: Optometric vision therapy for adults works....see StereoSue and Fixing My Gaze: A Scientist's Journey Into Seeing in Three Dimensions . Let's help these individual overcome all these significatn associations thru optometric vision therapy! DM

Does Assessing Eye Alignment along with Refractive Error or Visual Acuity Increase Sensitivity for Detection of Strabismus in Preschool Vision Screen

...The most efficient and low-cost ways to achieve a statistically significant increase in sensitivity for detection of strabismus were by combining the unilateral cover test with the autorefractor (Retinomax) administered by eye care professionals and by combining Stereo Smile II with SureSight administered by trained lay screeners. The decision of whether to include a test of alignment should be based on the screening program’s goals (e.g., targeted visual conditions) and resources....

Comments: How many children are still missed? Vision screenings are not adequate. Billions for banks....nothing for our children. Comprehensive eye exams for all kids are a smart investment in that child's future. Have a comprehensive eye exam at 6-12 months (see InfantSee), then Kindergarten, then as often as needed (once a year to every two years). DM

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....

Comments: Very interesting. The full text available by clicking on title. DM

Dynamic Fusional Vergence Eye Movements in Congenital Esotropia

...This study adds further evidence that patients with history of congenital esotropia 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....

Comment: PDF of article available by clicking on title above. DM

Wednesday, May 27, 2009

Free is my Life Blog

The Free is my Life Blog tells the story of how optometrists in Michigan provide free eye care for little ones as part of the American Optometric Association's InfantSee program.

Eat Fish, Boost Brain Power

...Eating fish may be as good for your brain as a healthy dose of sunshine.
Researchers have found that higher levels of vitamin D -- acquired from the sun and also found in oily fish -- are associated with improved cognitive function in middle-aged and older men....

Shaken Baby Syndrome: A Common Variant of Non-Accidental Head Injury in Infants

Background: Recent cases of child abuse reported in the
media have underlined the importance of unambiguous
diagnosis and appropriate action. Failure to recognize
abuse may have severe consequences. Abuse of infants
often leaves few external signs of injury and therefore merits
special diligence, especially in the case of non-accidental
head injury, which has high morbidity and mortality.
Methods: Selective literature review including an overview
over national and international recommendations.
Results: Shaken baby syndrome is a common manifestation
of non-accidental head injury in infancy. In Germany,
there are an estimated 100 to 200 cases annually. The
characteristic findings are diffuse encephalopathy and
subdural and retinal hemorrhage in the absence of an
adequate explanation. The mortality can be as high as 30%,
and up to 70% of survivors suffer long-term impairment.
Assessment of suspected child abuse requires meticulous
documentation in order to preserve evidence as well as
radiological, ophthalmological, laboratory, and forensic
Conclusions: The correct diagnosis of shaken baby syndrome
requires understanding of the underlying pathophysiology.
Assessment of suspected child abuse necessitates
painstaking clinical examination with careful documentation
of the findings. A multidisciplinary approach is indicated.
Continuation, expansion, and evaluation of existing preventive
measures in Germany is required.

Comments: Full text pdf available by clicking on title above. DM

Parents Are Drugging Kids For An Academic Edge!

...According to a recent article in the New Yorker, college students are taking neurological drugs like Adderall and Ritalin to help them party hard -- while giving them an academic edge. What's even worse is that this trend isn't just occurring in colleges. Parents are giving their young kids Ritalin to help them gain a competitive advantage over their peers, even when they're not suffering from ADD or ADHD...

Comment: VERY BAD IDEA! If you are a parent doing this...stop it immediately. These medicines have numerous unwanted side effects. DM

Study Confirms Effectiveness Of Innovative Prism Glasses For Hemianopia Patients

In a study of specially designed peripheral prism glasses for hemianopia patients (blinded in half the visual field in both eyes), scientists found that two-thirds of patients continued to wear the glasses at the end of the study period and beyond, indicating a high level of success. They also found that the brains of patients had not fully remapped to adjust for the prisms, which means that improved training in their use could further enhance the benefits, says principal investigator, Dr. Eli Peli, a senior scientist at Schepens Eye Research Institute and inventor of the glasses.The study, published in the May 2009 issue of Optometry and Vision Science, not only reaffirms previous clinical studies, but also adds a deeper understanding of the neurological processes at play when a patient uses prisms for this purpose, adds Peli....

Comments: I haven't used the Peli lenses just yet....but have at least one patient I'm probably going to try them on...DM

Top 10 Tips To Save Your Vision

Here are the top 10 tips safeguard your vision:

Wear sunglasses --
Don't smoke --
Eat right --
Baseline eye exam --
Eye protection --
Family History --
Early intervention --
Know your eye care provider --
Contact lens care --
Be aware of eye fatigue --

Comments: This list was put together by an ophthalmology as you might expect it's a bit slanted. I would also recommend all of the above, but unlike our OMD colleagues I believe that the baseline examination/early intervention should start somewhere between 6-12 months of age (See the AOA InfantSee Program) with children being seen once a year starting in Kindergarten and continuing until they graduate High School.

Knowing your eyecare practitioner is also a good idea. Did you know that optometrists are primary eye care providers who provide the majority of eye care for the people of the United States? Did you know that our ophthalmology colleagues are surgeons? You do realize that optometrists can provide the majority of eyecare services you need and are very cost effective? Would you go to a surgeon if you didn't need something cut?

Oh yes, eye fatigue...up until recently most of my ophthalmologist colleagues didn't really do much about "eye fatigue". Did you know that there are several binocular vision dysfunctions that result in eye fatigue and that National Institutes of Health National Eye Institute sponsored clinical trials have shown that optometric vision therapy is the most effective treatment for improving ones quality of life...including eye fatigue?

Bottom line? All of the above 10 tips make sense....see an optometrist. DM

UCLA Discovery May Explain Why Autism Strikes Boys Four Times More Than Girls

...UCLA scientists have discovered a variant of a gene called CACNA1G that may increase a child's risk of developing autism, particularly in boys. The journal Molecular Psychiatry publishes the findings in its May 19 advance online edition. ...

Sunday, May 24, 2009

COVD asks AOA to be a part of the Board Certification Process

The College of Optometrists in Vision Development (COVD) is an international organization established in 1970 for the primary purpose of conducting Board Certification through our International Examination and Certification Board (IECB). Over 90% of COVD’s members are American optometrists and the majority are also members of AOA.

Comments: Learn more by clicking on the title above. DM

AOA President Addresses 2009 ICO Class

I had the pleasure of being present when, Dr. Peter Kehoe gave the Keynote address at the Illinois College of Optometry last week. I was a fairly new ICO faculty member at ICO and had an opportunity to "teach" the AOA President back then. Now I "learn" from every day.

He is a dedicated doctor who always puts his patients first. He is husband and father, who always puts his family first. He is a member of several organizations...he always puts his profession first.

Few of us can do this....Pete has done this successfully.

Here are some comments that Pete made on his blog:

Last weekend I had the honor of delivering the commencement address to the ICO Class of 2009. What an awesome experience and one that 25 years earlier at my graduation – was not a thought in my mind.

This years graduating class is the best educated in our profession and they can be proud of their education and training. Patients for years ahead will benefit from the care provided by these great doctors.

I delivered 5 points to them for consideration:

First and foremost, be an independent doctor of Optometry no matter what setting you choose to practice.

Second: Use the power of your exam room by becoming a doctor driven dispenser and educating your patients about a lifetime of healthy vision at EVERY opportunity.

#3 Get involved in your local society

#4: join your state and national associations whatever mode of practice you choose. This is where the deep roots of optometry are planted.

And fifth and last…include your personal and extended family in all you do …and MAKE IT FUN.

Thank you ICO for allowing me the opportunity to deliver my message and best of luck to ALL 2009 graduates. The Future of Optometry is in Your Hands……GRAB HOLD!