Thursday, December 31, 2009

Oculomotor function in frontotemporal lobar degeneration, related disorders and Alzheimer’s disease

Frontotemporal lobar degeneration (FTLD) often overlaps clinically with corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP), both of which have prominent eyemovement abnormalities.To investigate
the ability of oculomotor performance to differentiate between FTLD, Alzheimer’s disease, CBS and PSP, saccades and smooth pursuit were measured in three FTLD subtypes, including 24 individuals with frontotemporal dementia (FTD), 19 with semantic dementia (SD) and six with progressive non-fluent aphasia (PA), as
compared to 28 individuals with Alzheimer’s disease, 15 with CBS, 10 with PSP and 27 control subjects. Different combinations of oculomotor abnormalities were identified in all clinical syndromes except for SD, which had oculomotor performance that was indistinguishable from age-matched controls.Only PSP patients displayed abnormalities in saccade velocity, whereas abnormalities in saccade gain were observed in PSP`CBS`Alzheimer’s disease subjects. All patient groups except those with SD were impaired on the anti-saccade task, however only the FTLD subjects and not Alzheimer’s disease, CBS or PSP groups, were able to spontaneously self-correct anti-saccade errors as well as controls. Receiver operating characteristic
statistics demonstrated that oculomotor findings were superior to neuropsychological tests in differentiating PSP from other disorders, and comparable to neuropsychological tests in differentiating the other patient groups.These data suggest that oculomotor assessmentmay aid in the diagnosis of FTLD and related disorders.

Effectiveness of screening systematic review

Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication.

Comments: I don't get it...this paper says there is NO evidence that consistently supports vision screening....why isn't optometry and InfantSee shouting this from the roof tops?DM

How parents choose to use CAM: a systematic review of theoretical models

Conclusion: The SBM modified for CAM use, which incorporates both psychological and pragmatic determinants, was identified as the best conceptual model of CAM use. This model provides a valuable framework for future research, and could be used to explain child CAM use. An understanding of the decision making process is crucial in promoting shared decision making between healthcare practitioners and parents and could inform service delivery, guidance and

Preserved motor learning after stroke is related to the degree of proprioceptive deficit

These results support the importance of central sensory processing for motor learning. The confirmation of central sensory processing dependent motor learning in humans is discussed in the context of our prior report of preserved motor learning when sensation is disrupted peripherally.

Developmental dyscalculia: compensatory mechanisms in left intraparietal regions in response to nonsymbolic magnitudes

Overall, findings are suggestive of (a) less consistent neural activity in right (intra)parietal regions upon processing nonsymbolic number magnitudes; and (b) compensatory neural activity in left (intra)parietal regions in developmental dyscalculia.

Attention Deficit Hyperactivity Disorder comorbid oppositional defiant disorder and its predominately inattentive type: evidence for an association wi

Background: There are three childhood disruptive behavior disorders (DBDs), attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). The most common comorbid disorder in ADHD is ODD. DSM-IV describes three ADHD subtypes: predominantly inattentive type
(ADHD-IA), predominantly hyperactive-impulsive type (ADHD-HI), and combined type (ADHD-C). Prior work suggests that specific candidate genes are associated with specific subtypes of ADHD in China. Our previous association studies between ADHD and functional polymorphisms of COMT and MAOA, consistently showed
the low transcriptional activity alleles were preferentially transmitted to ADHD-IA boys. Thus, the goal of the present study is to test the hypothesis that COMT Val158Met and MAOA-uVNTR jointly contribute to the ODD phenotype among Chinese ADHD boys.
Methods: 171 Chinese boys between 6 and 17.5 years old (mean = 10.3, SD = 2.6) with complete COMT val158met and MAOA-uVNTR genotyping information were studied. We used logistic regression with genotypes as independent variables and the binary phenotype as the dependent variable. We used p < 0.05 as the level of nominal statistical significance. Bonferroni correction procedures were used to adjust for multiple comparisons.
Results: Our results highlight the potential etiologic role of COMT in the ADHD with comorbid ODD and its predominately inattentive type in male Chinese subjects. ADHD with comorbid ODD was associated with homozygosity of the high-activity Val allele, while the predominantly inattentive ADHD subtype was associated with the low-activity Met allele. We found no evidence of association between the MAOA-uVNTR variant and ADHD with comorbid ODD or the ADHD-IA subtype.
Conclusion: Our study of attention deficit hyperactivity disorder comorbid oppositional defiant disorder and its predominately inattentive type highlights the potential etiologic role of COMT for ADHD children in China. But we failed to observe an interaction between COMT and MAOA, which suggests that epistasis between COMT and MAOA genes does not influence the phenotype of ADHD-IA with comorbid ODD in a clinical sample of Chinese male subjects. To confirm our findings further studies with a larger number of subjects and healthy controls are needed.

The relationship between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women

These results suggest that a higher dietary intake of n-3 fatty acids is associated with a decreased presence of DES in women. These findings are consistent with anecdotal clinical observations and postulated biological mechanisms.

The relationship between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women

These results suggest that a higher dietary intake of n-3 fatty acids is associated with a decreased presence of DES in women. These findings are consistent with anecdotal clinical observations and postulated biological mechanisms.

Lutein, zeaxanthin, macular pigment, and visual function in adult cystic fibrosis patients

Adults with CF have dramatically low serum and macular concentrations of carotenoids (lutein and zeaxanthin), but their ocular status and visual function are surprisingly good. The clinical implications of low plasma concentrations of carotenoids in CF are yet to be clarified.

Cognitive function and psychological well-being: findings from a population-based cohort

Background: depression is associated with poor cognitive function, though little is known about the relationship between psychological well-being and cognitive function.
Objective: to investigate whether psychological well-being is associated with levels of cognitive function.
Design: nationally representative population-based cohort study.
Setting and participants: 11,234 non-institutionalised adults aged 50 years and over of the English Longitudinal Study of Ageing in 2002.
Methods: psychological well-being was measured using the CASP-19, and cognitive function was assessed using neuropsychological tests of time orientation, immediate and delayed verbal memory, prospective memory, verbal fluency, numerical
ability, cognitive speed and attention. The relation of psychological well-being to cognitive function was modelled using linear regression.
Results: on a global cognitive score combining all cognitive tests, those in the fifth quintile of psychological well-being scored an average of 0.30 SD units higher than those in the lowest quintile (95% CI 0.24–0.35) after adjustment for depressive
symptoms and sociodemographics. This association remained after additional adjustment for physical health and health behaviours. The same pattern of association was observed for men and women, and across all cognitive domains.
Conclusions: in a large population of community living adults, higher levels of psychological well-being were associated with better cognitive function.

Myopia Progression in Children Wearing Spectacles vs. Switching to Contact Lenses

COMET children switching from glasses to CLs experienced a small, statistically significant but clinically inconsequential increase in myopia progression.

Detecting Alzheimer’s Through the eye?

According to recent data from the Alzheimer’s Association, every 71 seconds someone develops Alzheimer’s disease, the seventh leading cause of death in the United States; but a new laser eye scanning device is providing hope of diagnosing the degenerative condition early.

Engineers at Neuroptix Corporation in Acton, Mass., are developing a non-invasive laser eye scanning device to detect the presence of beta-amyloid (BA) plaque in the eye -- a protein widely associated with the disease. The device is based on the discovery that these plaques form on the lens of the eye, in addition to the brain.

Behind the Unproven H1N1 Flu Vaccine

Public health officials have been warning for some time that nothing about the flu is predictable. But here's something that is: When it comes to a new strain of the flu like H1N1, which has already stoked global fears of a massive pandemic, there's almost certain to be some overreaction. That's what happened this week when the public was hit with a double-play of scary news: A new estimate showed that that up to 90,000 Americans could die of H1N1 in the upcoming season; and a simultaneous report that the government was taking some unprecedented steps to get a vaccine ready in time. But the fatality numbers are more complicated — and less alarming — than they seem; and the vaccine report is less a reason for alarm than a sign of smart epidemiological planning. Read more:,8599,1918743,00.html#ixzz0bFbOrxSb

American Medical Association may investigate journal editors

The American Medical Association is seeking an investigation of claims that editors of its leading medical journal threatened a whistle-blower who pointed out a researcher's conflict of interest.

Editors of the Journal of the American Medical Association deny threatening a professor who raised concerns about a study author's undisclosed financial link to a drug company when JAMA published the study last year. JAMA, like most leading medical journals, has a policy of noting scientists' industry connections.

According to the Wall Street Journal, JAMA editors threatened to ban the professor from their journal and ruin his medical school's reputation if he didn't stop talking to reporters.

Odds of abuse associated with retinal hemorrhages in children suspected of child abuse

....Seventy-four percent of children were younger than 6 months old. Forty-five percent of cases were definite abuse and 37% were definite accident. The prevalence of retinal hemorrhages was 32%. Across all subjects, the presence of retinal hemorrhage was highly associated with definite or probable abuse versus definite or probable accident (age-adjusted odds ratio 5.4 [95% CI, 2.1-13.6]). The odds ratio in children younger than 6 months (n = 81) was 11.7 (95% CI, 2.9-66.8). Retinal hemorrhage severity was higher in abuse versus accident (p < 0.0001) and correlated positively with abuse (Spearman r = 0.406, p < 0.0001). Scores above 8 (n = 13) were only present in abused children....Retinal hemorrhages are highly associated with abusive head trauma, particularly in children younger than 6 months of age. Increasing retinal hemorrhage severity is correlated with increasing likelihood of abuse.....

Diplopia and Fluoroquinolones

...A total of 171 case reports of diplopia associated with fluoroquinolones were reported, including 76 men, 91 women, and 4 case reports in which the gender was not specified. The median age was 51.6 years. Dosage varied between the different fluoroquinolone drugs, with the median dosage within the range recommended in the package insert for each different fluoroquinolone. Median time from beginning of therapy to appearance of the ADR was 9.6 days (range 1 day to 5 months). Seventeen subjects also had concomitant tendinitis, 49 patients were 60 years or older, 1 patient had renal cysts, and 4 patients were taking systemic anti-inflammatory steroids. There were 53 positive dechallenge and 5 positive rechallenge case reports....

Top-Read Clinical Articles of 2009 in Ophthal/Pediatric Ophthalmology

1. Infantile Hemangiomas and Retinopathy of Prematurity Pediatrics 03/04/2009

2. Recognizing the signs of retinoblastoma Practice Nursing 09/02/2009

3. Osteopontin and 'melanoma inhibitory activity': comparison of 2 serological tumor markers in metastatic uveal melanoma patients Ophthalmologica 03/06/2009

4. Whole–body 18FDG PET–CT Imaging of Systemic Sarcoidosis: Ophthalmic Oncology and Uveitis Ocular Immunology and Inflammation 05/11/2009

5. Orbital sarcoma in HIV positive patient: A diagnostic dilemma Diagnostic Cytopathology 07/08/2009

6. Malignant Transformation of Congenital Hypertrophy of the Retinal Pigment Epithelium Ophthalmology 09/23/2009

7. Cerebral Arteriopathy in Children With Neurofibromatosis Type 1 Pediatrics 09/15/2009

8. Analysis of ototoxicity in young children receiving carboplatin in the context of conservative management of unilateral or bilateral retinoblastoma Pediatric Blood & Cancer 01/27/2009

9. Decreased Catalase Expression and Increased Susceptibility to Oxidative Stress in Primary Cultured Corneal Fibroblasts from Patients with Granular Corneal Dystrophy Type II American Journal of Pathology 06/05/2009

10. Natural history and outcome of optic pathway gliomas in children Pediatric Blood & Cancer 07/23/2009

11. Oncogenic GNAQ mutations are not correlated with disease–free survival in uveal melanoma British Journal of Cancer 08/05/2009

12. Ifosfamide or trofosfamide in patients with intraocular lymphoma Journal of Neuro-Oncology 12/30/2008

13. Relapses of optic pathway tumors after first–line chemotherapy Pediatric Blood & Cancer 01/22/2009

14. Spontaneous Subperiosteal Hematoma of the Orbit Journal of Pediatric Ophthalmology & Strabismus 06/01/2009

15. Peripheral Exudative Hemorrhagic Chorioretinopathy Simulating Choroidal Melanoma in 173 Eyes Ophthalmology 03/24/2009

16. How to Handle Benign Optic Glioma of Childhood: A Short Overview Neuro-Ophthalmology 06/18/2009

17. Pterygium and Associated Ocular Surface Squamous Neoplasia Archives of Ophthalmology 01/16/2009

18. Leucocoria in a boy with Kawasaki disease: a diagnostic challenge Singapore Medical Journal 08/17/2009

19. Episodic Src activation in uveal melanoma revealed by kinase activity profiling
British Journal of Cancer 07/01/2009

20. Cytomegalovirus retinitis mimicking intraocular lymphoma Clinical Ophthalmology 01/09/2009

21. Clinical Course and Prognosis of Trochlear Nerve Schwannomas Ophthalmology 08/26/2009

22. A Phase I Study of Periocular Topotecan in Children with Intraocular Retinoblastoma Investigative Ophthalmology and Visual Science 04/14/2009

23. Intravitreal Administration of the Anti–Tumor Necrosis Factor Agent Infliximab for Neovascular Age–related Macular Degeneration American Journal of Ophthalmology 05/07/2009

24. Is CT Still Useful in the Study Protocol of Retinoblastoma American Journal of Neuroradiology 07/20/2009

25. Darier Disease Mimicking Basal Cell Carcinoma of the Eyelid Ophthalmic Plastic and Reconstructive Surgery 04/10/2009

26. Orbital Metastasis: Clinical Features, Management and Outcome
Orbit - The International Journal on Orbital Disorders, Oculoplastic and Lacrimal Surgery 06/22/2009

27. Cryo–assisted anterior approach for surgery of retroocular orbital tumours avoids the need for lateral or transcranial orbitotomy in most cases
Acta Ophthalmologica 09/08/2009

28. Familial retinoblastoma in developing countries
Pediatric Blood & Cancer 05/15/2009

29. Eye–conserving treatment in massive congenital orbital teratoma
Clinical and Experimental Ophthalmology 05/12/2009

30. Invasive thymoma with intraorbital metastases
Journal of Cancer Research and Therapeutics 03/31/2009

31. Toxocariasis mimicking liver, lung, and spinal cord metastases from retinoblastoma
The Pediatric Infectious Disease Journal 03/10/2009

32. The skull beneath the skin: Cancer survival and awareness of death
Psycho-Oncology 03/10/2004

33. Orbital lymphoma: Role of radiation
Indian Journal of Ophthalmology 02/18/2009

34. Salvage external beam radiotherapy after failed primary chemotherapy for bilateral retinoblastoma: rate of eye and vision preservation
British Journal of Ophthalmology 04/17/2009

35. Eye Cancer Related Glaucoma: Current Concepts
Survey of Ophthalmology 02/17/2009

36. Nondiagnostic Conjunctival Map Biopsies for Sebaceous Carcinoma
Archives of Ophthalmology 08/12/2009

37. Expression of –Crystallin in Retinoblastoma
Archives of Ophthalmology 02/11/2009

38. Intralesional injection of OK–432 in pediatric orbital lymphangioma
Journal of American Association for Pediatric Ophthalmology and Strabismus 04/08/2009

39. Eyelid Contracture may Indicate Recurrent Basal Cell Carcinoma, even after Mohs Micrographic Surgery Orbit - The International Journal on Orbital Disorders, Oculoplastic and Lacrimal Surgery 02/23/2009

40. Inadvertent Evisceration of Eyes Containing Uveal Melanoma Archives of Ophthalmology 02/10/2009

41. Retinoblastoma and Hirschsprung Disease With a 13q14 to 22 Deletion Journal of Pediatric Ophthalmology & Strabismus 12/30/2008

42. Combined Hamartoma of the Retina and Retinal Pigment Epithelium in 77 Consecutive Patients: Visual Outcome Based on Macular versus Extramacular Tumor Location Ophthalmology 12/31/2008

43. Preceding orbital granulocytic sarcoma in an adult patient with acute myelogenous leukemia with t(8;21): a case study and review of the literature
Cancer Genetics and Cytogenetics 08/12/2008

44. Orbital solitary fibrous tumor. Another rare case from Africa
International Ophthalmology 09/09/2009

45. Benign Hamartoma Masquerading as a Deep Orbital Hemangioma Journal of Pediatric Ophthalmology & Strabismus 07/30/2009

46. Schwannoma of the Lower Eyelid in a 13–Year–Old Girl Ophthalmic Plastic and Reconstructive Surgery 03/18/2009

47. Topical Interferon Alpha 2b Eye Drops for Treatment of Ocular Surface Squamous Neoplasia: A Dose Comparison Study British Journal of Ophthalmology 06/08/2009

48. SPECT–CT Images of an Ocular Coralline Hydroxyapatite Implant Visible on Bone Scintigraphy Clinical Nuclear Medicine 02/05/2007

49. Recurrent melanotic neuroectodermal tumor in the orbit successfully treated with resection followed by pediculated periosteal flaps Pediatric Blood & Cancer 06/05/2008

50. Ectopic Meningioma Anterior to the Lacrimal Gland Fossa Ophthalmic Plastic and Reconstructive Surgery 03/18/2009

Monday, December 28, 2009


...Exodeviations or divergent squint occurs as a result of certain obstacles to development or maintenance of binocular vision and/ or due to defective action of the medial rectus muscles. Small exophorias are found in high frequency in the normal population and 60-70% of normal newborn infants have a transient exodeviation that resolves by 4-6 months of age (1-3). Intermittent exotropia is an exodeviation intermittently controlled by fusional mechanisms. Unlike a pure phoria, intermittent exotropia spontaneously breaks down into a manifest exotropia.............

Comments: This was written by a surgeon (which doesn't automatically make it bad) but it does explain why he has a misguided view of orthoptics/vision therapy. I know I am biased as an optometrist....but I would not try surgery first. I would recommend optometric vision therapy first....especially after the NEI supported clinical trials in the area of convergence insufficiency. You can do surgery at any time. DM

Impact of computer use on children's vision

Today, millions of children use computers on a daily basis. Extensive viewing of the computer screen can lead to eye discomfort, fatigue, blurred vision and headaches, dry eyes and other symptoms of eyestrain. These symptoms may be caused by poor lighting, glare, an improper work station set-up, vision problems of which the person was not previously aware, or a combination of these factors. Children can experience many of the same symptoms related to computer use as adults. However, some unique aspects of how children use computers may make them more susceptible than adults to the development of these problems. In this study, the most common eye symptoms related to computer use in childhood, the possible causes and ways to avoid them are reviewed.