Friday, November 6, 2009

Amblyopia Therapy in Children Identified by Photoscreening

Comments: Usually I make comments after segments of the paper are noted here. But this paper is so wrong in so many ways that I couldn't stop myself from making comments now.

First of all they note that only 20% of children every get screened...and yet they promote screening as a way to help diagnosis amblyopia. The best way to diagnose the presence of amblyopia is a comprehensive eye examination. The best way is to participate in the AOA's InfantSee program and examine all children early. The best way is full examination for all children in school. It's the very least we should be able to do for our children.

Secondly, even though one of the authors, Sean Donahue, is a part of the PEDIG series of studies and should know better, they write false statements like:
"However, treatment must be delivered within the critical period of visual development."
We know that treatment can be done AT ANY AGE! It is sad that the authors of this paper, and Sean Donahue in particular, did not catch this obvious falsehood. Why are they continuing to publish these misguided myths about amblyopia?

Thirdly, they wanted to know if amblyopia can be treated successfully after the children are screened. Well, duh! We have several PEDIG studies that already show this.

Fourth, they treated the children with 'standard' therapy...that did not include vision therapy. They often considered 20/40 successful, when better VA can often be achieved with additional "perceptual learning" (aka VT). It is obvious they did not bother to look at the recent research in cortical plasticity....that's a shame!

Fiftht, even though 900+ kids were referred only 125 took part in the therapy.

This is a paper that needed additional work before it was published. It should be read with a most critical eye.... DM

The success rate of amblyopia treatment in children identified through our photoscreening
program is high. This study supports the role of photoscreening programs in the prevention of amblyopia-related vision loss. Such early screening may translate to true visual acuity improvement

Thursday, November 5, 2009

Changes In Brain Chemicals Mark Shifts In Infant Learning

...When do you first leave the nest? Early in development infants of many species experience important transitions-such as learning when to leave the protective presence of their mother to start exploring the wider world. Neuroscientists have now pinpointed molecular events occurring in the brain during that turning point....

Improving Cognitive Skills With Music

...Regularly playing a musical instrument changes the anatomy and function of the brain and may be used in therapy to improve cognitive skills. ...

Traumatic Brain Injury-Vision Loss Severely Impacts Veterans' Quality Of Life;Who Is That Stranger On My Couch? Hallucinations In Low-vision Patient

...a Veterans Administration study that indicates that Iraq and Afghanistan veterans with vision loss from traumatic brain injury have significantly poorer quality of life than comparable civilian patients, ...

More People Rely On Alternative Medicine

... The National Center for Complimentary and Alternative Medicine (NCCAM) shows 38 percent of adults and 12 percent of kids are now using alternative therapies to treat pain. In fact, Americans are now reportedly spending $34 billion a year on CAM...

Attention-Deficit/Hyperactivity Problems Associated With Low Folate Levels In Pregnant Women

...It has long been suggested that healthy folate (the natural form of folic acid) levels in expectant mothers goes hand in hand with healthy nervous system development in their children. A study published in an upcoming issue of The Journal of Child Psychology and Psychiatry finds that low maternal folate levels is linked to the development of attention-deficit/hyperactivity problems in children at age seven to nine years....
...Retinopathy of prematurity (ROP) is a clinically multifactorial process characterized by the aberrant vascularization of the retina that has potentially devastating effects on vision in preterm infants. Despite an appreciation for the postnatal risk factors that contribute to the development of ROP, this condition continues to be a major cause of childhood blindness. Studies using the mouse model of oxygen-induced retinopathy (OIR) have identified new therapeutic targets that may be used to guide treatment and determine which babies are at highest risk for ROP development. Such factors include the hypoxia-driven proteins vascular endothelial growth factor (VEGF) and erythropoietin (EPO) as well as the maternally derived factors insulin-like growth factor-1 (IGF-1) and omega-3 polyunsaturated fatty acids (PUFAs). Each has been demonstrated to have phase-specific effects on the pathogenesis of ROP. Through an understanding of the contribution of the IGF-1 pathway to the development of ROP in particular, a new algorithm has been developed (WINROPTM) that uses postnatal weight gain to identify infants at highest risk for ROP in an attempt to target therapy and resources more effectively. ...

Treating mild iodine deficiency boosts brain power

...At the end of the study, children in iodine group showed an overall improvement on two standard cognitive tests that gauge problem-solving abilities. And they outperformed children who received the placebo....

Clinical significance of neurological abnormalities in psychosis

...The neurological deficits in sensory and motor function in schizophrenia have been described using a confusing variety of terms, reflecting their uncertain relevance and significance to psychosis. In this article we explore the nature of neurological abnormalities in psychosis, describe their assessment and suggest their potential relevance for clinician and patient. We propose that the assessment of neurological abnormalities and extrapyramidal side-effects should figure in the assessment of any patient with psychosis, particularly at illness onset. Furthermore, we suggest that neurological abnormalities can inform prognostic predictions and help to identify patients with more complex future care needs. ...

Smoking in pregnancy tied to bad behavior in kids

...Although previous studies have demonstrated significant risks for school-aged boys, this is the first time an association has been shown between smoking during pregnancy and problems for girls and for boys as young as 3, the researchers point out....

H1N1 and ocular consequences

Comment: One of my colleagues sent this to me so I thought I'd pass it along! DM

Since concerns of H1N1 have become widespread across the US, many have rushed to obtain the H1N1 vaccine. While the adverse effects of this vaccine are relatively mild, they can have ophthalmic consequences. The following case demonstrates one such occurrence:

A 25 year old female with history of bilateral corneal transplants for keratoconus (OD in 2009, OS in 2004) received the live attenuated H1N1 vaccine intranasally. The following morning she awoke with bilateral corneal rejection OD more severe than OS. While the left eye has responded well to topical steroid drops, the right remains edematous despite injecting both sub-tenons with triamcinolone and oral prednisone.

Corneal transplant rejection following vaccination has been described previously with influenza vaccine1,2,3, however in these cases the time from vaccination to rejection has ranged from two to eight weeks. The fast onset of corneal transplant rejection in this patient may likely be related to the close proximity of the inoculation site (nares) to the eye. However, this may also represent a more robust immune reaction to a relatively new and understood vaccine.

Where does this matter in
refractive surgery? Increased immune response, and therefore inflammation, can be associated with regression, diffuse lamellar keratitis, transient light sensitivity, and, in severe cases, corneal melting.

As the H1N1 vaccine becomes more available, our patients will be more likely to obtain it, particularly without alerting their ophthalmologist. In discussing laser refractive surgery with our patients in these upcoming months, we must take care to warn our patients about receiving the H1N1 vaccine prior to refractive surgery. If the vaccine is administered to the patient around the time of refractive surgery, we may want to consider a more frequent and prolonged course of topical steroid therapy.

By David A. Goldman MD and Jonathan Etter MD

Clinical Tests Begin On Medication To Correct Fragile X Defect

Scientists are beginning a clinical trial of a potential medication designed to correct a central neurochemical defect underlying Fragile X syndrome, the most common inherited cause of intellectual disability. There has to date been no medication that could alter the disorder's neurologic abnormalities. The study will evaluate safety, tolerability and optimal dosage in healthy volunteers.

Tuesday, November 3, 2009

Infant Eye Exams

The Importance of Infant Eye Exams

One underserved patient population could clearly benefit from optometric care: infants!
When you examine infants, you change lives.

Andrea P. Thau, O.D.

Some fundamental concepts about vision make it truly unique. One such fundamental is that vision is a learned skill that develops over time. Unlike hearing, which is fully developed at birth, vision is rudimentary. When born, babies are routinely given an auditory evoked potential test, which is effective at detecting hearing loss. Vision can be tested at this time, but a visual evoked potential test cannot detect all vision problems. The visual system undergoes profound developmental changes in the first years of life—especially during infancy and toddlerhood. ...

Comments: Not only does the Review of Optometry have a whole new web also has a great article by my friend and colleague Dr. Andrea on the title for the full article. DM

Visual function in patients followed at a Veterans Affairs polytrauma network site: an electronic medical record review.

...Visual symptoms were self-reported by 76% of patients with polytrauma and 75% of the patients with TBI. Problems with reading (polytrauma 60% and TBI 50%) and accommodation (polytrauma 30% and TBI 47%) were frequently found on eye examinations. Spectacles were the treatment most frequently prescribed (polytrauma 62% and TBI 78%). ...

Comments: TBI patients have many vision problems. The VA is a great place to diagnose and treat these dysfunctions. Read this excellent paper by my colleagues Joan and Tom Stelmack et al. immediately! DM