Friday, December 10, 2010

Monocular and binocular reading performance in children with microstrabismic amblyopia

....In this study, the average binocular maximum reading speed of children with microstrabismic amblyopia was significantly reduced when compared to normal sighted, age matched controls  indicating a functionally relevant reading impairment. ......  reading speed is known to be closely related to visual function....Also in children with unilateral microstrabismic amblyopia, functional discrepancies in reading performance could be reliably elucidated between the amblyopic eyes and the normal sighted fellow eyes. Even relatively mild forms of microstrabismic amblyopia with no persistent acuity deficit lead to an impairment of monocular reading ability.....reading impairment may be significantly influenced by ....abnormal contour interaction, ....; abnormal eye  movements,...and positional uncertainty.....Nevertheless, binocular confusion, deficits in quality of binocular coordination of saccades, or the presence of suppression scotomata centred around the fixation point of the squinting eye may explain the significantly impaired binocular MRS of the amblyopic group..... The binocular visual acuity and reading acuity of the amblyopic group were
both comparable with the control group. However, the binocular MRS was significantly reduced in the amblyopic group, indicating functional reading impairment in comparison with normal sighted controls....

Comments: Full article available by clicking on the title above. DM

Letter-recognition and reading speed in peripheral vision benefit from perceptual learning

....We found that the visual-span profiles can be expanded (bits of information transmitted increased by 6 bits) through training with a letter-recognition task, and that there is an accompanying increase (41%) in the  maximum reading speed. These improvements transferred, ... from the trained to an untrained retinal location, and were retained, ..., for at least three months following training. Our results are consistent with the view that the visual span is a bottleneck on reading speed, but a bottleneck that can be increased with practice....

Comments: OK so let me get this straight...the American Academy of Pediatrics and the American Academy of Ophthalmology say vision has nothing to do with reading.....but wait! From the research I've been certainly looks like there is a vision and reading link doesn't it! BTW developmental optometrists have been doing just this kind of "perceptual learning" therapy...aka optometric vision therapy...for decades. DM

Reading impairment and visual processing deficits in schizophrenia

....The degree of deficit correlated significantly with independent measures of magnocellular dysfunction.
Reading impairment in schizophrenia reaches the level of dyslexia and is associated with
compromised magnocellular processing as hypothesized....

Comments: The full article is available by clicking on the title above. DM

Early Attention Problems and Children’s Reading Achievement: A Longitudinal Investigation

....Attention problems predicted reading achievement even after controlling for prior reading
achievement, IQ, and other behavioral difficulties. Inattentive first graders with normal reading
scores after kindergarten were at risk for poor reading outcomes....

Comments: Full article is available by clicking the title above. DM

The case for the visual span as a sensory bottleneck in reading

.....The visual span for reading is the number of letters, arranged horizontally as in text, that can be
recognized reliably without moving the eyes. The visual-span hypothesis states that the size of the
visual span is an important factor that limits reading speed. ....We found that the size of the visual span and reading speed showed the same qualitative dependence on character size and contrast, reached maximum values at the same critical points, and exhibited high correlations at the level of individual subjects..... Our results confirm the visual-span hypothesis and provide a theoretical framework for understanding the impact of stimulus attributes, such as contrast and character size, on reading speed. Evidence for the visual span as a determinant of reading speed implies the existence of a bottom–up, sensory limitation on reading, distinct from attentional, motor, or linguistic influences.....

Comments: You can read the whole paper online by clicking the title above....well, I guess someone sholdtell some of our medical and education colleagues that vision does have something to do with reading afterall! DM

Most Low Birth Weight Babies Become Productive Adults

....Most survivors of extremely low birth weight grow up to become productive adults ....Extremely low birth weight is defined as less than about 2.2 pounds. About one in 200 babies is born at that size.....while these survivors were somewhat less productive as adults, on average, than normal-weight subjects, the productivity deficits were not very large. ...."Our findings suggest that the long-term economic impact of being born at extremely low birth weight is pretty modest for typical survivors," .....

How The Brain's Architecture Makes Our View Of The World Unique

...environment depends on the size of the visual part of our brain. ...the primary visual cortex - the area at the back of the brain responsible for processing what we see in the world around us - is known to differ in size by up to three times from one individual to the next....

Taking An Active Role In Learning Enhances Memory

....Having active control over a learning situation is very powerful and we're beginning to understand why," said University of Illinois psychology and Beckman Institute professor Neal Cohen, who led the study with postdoctoral researcher Joel Voss. "Whole swaths of the brain not only turn on, but also get functionally connected when you're actively exploring the world." ....

Comments: This was published in Nature Neuroscience. DM

Major Step Toward First Biological Test For Autism

...Researchers at Harvard-affiliated McLean Hospital and the University of Utah have developed the best biologically based test for autism to date. The test was able to detect the disorder in individuals with high-functioning autism with 94 percent accuracy. The study was published online in Autism Research....

Medicaid-funded ADHD Treatment For Children Misses The Mark

...."Findings from this study identify several areas for quality improvement for ADHD care within the managed care Medicaid program studied. These areas are alignment of the child's clinical severity with provider type, frequency of follow-up visits, stimulant medication use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatments, and stimulant medication refill prescription persistence. The enduring symptoms, impairment, and poor academic achievement of the children who remain in care and those untreated underscores the public health significance of improving the quality of care for publicly insured children with ADHD."....

Comments: I haven't read the full article just yet....but what do you want to bet few to none of these children had a comprehensive developmental/behavioural/functional examination or vision information processing assessment by an optometrist. DM

Capturing Children and Young People's Perspectives to Identify the Content for a Novel Vision-Related Quality of Life Instrument

...a child-centered approach to identifying the content for a self-report vision-related QoL questionnaire is feasible. ... approach is critical to accurately capturing children and young peoples' subjective perspectives on the impact of living with impaired vision....

Your Brain : How It Learns New Stuff!

...Medical researchers have found a so-called "missing link" that explains the interaction between brain state and the neural triggers responsible for learning. ...

Research Support for MFBF Amblyopia Optometric Vision Therapy/

Thursday, December 9, 2010

Vision Revision For ADHD Diagnosis

...It may be common, but the stats are still staggering. Last year, 4.5 million U.S. kids were diagnosed with attention deficit hyperactivity disorder or ADHD. That’s more than seven percent of all children in the U.S. But a new study shows more than one million of those kids may be misdiagnosed....

Exercises help 3D syndrome

....In a presentation at this year's American Academy of Optometry meeting in San Francisco last week, Dr Dominick Maino of Chicago described how convergence and accommodation exercises had alleviated some of the symptoms of nausea, headache and blur experienced by susceptible patients. ...

Comments: It's always nice to get noticed.... I wish folks would use the term "therapy" instead of "exercises".... when we help folks with 3 D Vision Syndrome we re-educate the brain so that the eyes can do what they need to do to enjoy the 3D experience....exercise is what I need to do more of....but often do not! DM

Vision therapy for ADHD

...Children with undetected vision problems can exhibit symptoms similar to ADD.  Studies show that approximately 20% of school-aged children suffer from eye teaming or focusing deficits, which make remaining on task for long periods of time difficult.  Like those with ADD, children with vision-based learning problems are highly distractible, have short attention spans, make careless errors, fail to complete assignments, and are often fidgety and off task.  However, their inability to remain on task is caused by the discomfort of using their eyes for long periods of time at close ranges, not true deficits in attention.  Unfortunately, parents and teachers are not trained to recognize the difference and these children are often misdiagnosed.....

Validity of the VERA visual skills screening.

....VERA has fairly good sensitivity and very good specificity in detecting visual skills problems. Given that the majority of visual skill deficits currently go undetected, VERA can be considered a reasonably effective method of in-school visual skills screening.....

Comments: Watch for a companion article to this by Dr. Gallaway in the next issue of Optometry & Vision Development. DM

Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function?

...The results found ... poorer accommodative and vergence function with the use of contact lenses in comparison to glasses. ....The higher accommodative lags found in this study with SCL could indicate that prolonged use of SCL in near tasks may provoke a continuous hyperopic retinal defocus, a risk factor for the onset and progression of myopia, as indicated in numerous studies...

Comments: I could never understand why anyone would want to stick a piece of plastic in their eye anyway! My apologies to all my doc friends who fit CLs!! DM (;-}>

Association between assisted reproductive technology and advanced retinopathy of prematurity

.....ART is associated with severe ROP requiring treatment in this cohort. This is the first report that demonstrates a statistically significant association between ART and severe ROP requiring treatment in infants in the US.....

Comments: Get access to this article free by clicking the title above. DM

Neuro-Optometric Rehabilitation Continuing Education

Neuro-Optometric Rehabilitation Continuing Education

Integrating a Neuro-Visual-Postural Model of Service for Neurologically Affected Persons

Presented by William V. Padula, OD & Raquel Munitz, MS, COVT
Padula Institute of Vision Rehabilitation

Saturday & Sunday, February 26 & 27, 2011  8:00 am – 4:00 pm each day

12 CE Credits*    $300.00 includes Continental Breakfast and lunch, both days

Western University Campus, Pomona, CA
For additional information and to pre-register go to

Me & Mommy TECH at CES

As I mentioned earlier, I am going to be speaking at the Consumer Electronics Show in Las Vegas this January. If you click the title above you will see who else is speaking during the MommyTech track. DM

Indiana Journal of Optometry

Read these articles in IJO



Clincal Diagnosis and Management of Streff Syndrome: A Case Report

Abstract: Streff syndrome is a controversial clinical entity associated with multiple thoughts on treatment and  etiology. Some authors suggest that this could be a common clinical presentation that is often misdiagnosed or ignored. Patients with these symptoms may undergo unnecessary medical or psychological testing. Presenting symptoms may include blurred vision, headaches, difficulty with reading, tunnel vision, and trouble judging distances. Because the symptoms can be significant and greatly affect activities of daily living, eye care providers should be familiar with the signs and symptoms of Streff syndrome and know how to initiate treatment or referral. A typical case of Streff syndrome with treatment and background of the syndrome is presented here.

Comments:  Read full pape by clicking on the title above. DM

Assessing the Vision Readiness of Indiana School Children – An Analysis of P.L. 140-1986


Background. Vision screening of school children is a widely accepted procedure to detect vision problems that can interfere with learning. The Indiana Department of Education requires the annual vision screening with the Modified Clinical Technique (MCT) of all children upon their enrollment in either kindergarten or the first grade.
Methods. Indiana University School of Optometry conducted an analysis of the Indiana State Department of Health’s statewide school screening data on 36,967 Grade 1 children from 139 of the 294 Indiana school corporations that submitted data for the 2000-2001 school year to examine differences in referral rate by screening method, the socioeconomic status of children(SES) screened, and academic performance.
Results. Significant differences were seen when comparing the mean referral rates of school corporations that conduct the MCT compared to those school corporations that do not conduct the MCT (p = 0.001) and in the rate of referral by median family income of the children screened (p = 0.050). A median family income of $46,500 was identified as the level at which the income-specific difference in referral rates ceased to be significant (p = 0.074). A weak non-significant trend (p= 0.116) was seen comparing the percentage of Grade 1 children referred in 2000-2001 to their percentages of passing both the English/Language Arts and Mathematics components of the 2002-2003 ISTEP+ exam by SES.
Discussion/Conclusion. Schools using the highly sensitive and specific MCT identified more visually at-risk children than schools using alternative, less sensitive vision charts techniques, and the percentage of Grade 1 children referred to an eye care provider was higher for school corporations with lower median family incomes. Although statistically insignificant, the results trend support that students who fail the vision screening in Grade 1 tend to be more at-risk for poorer academic performance on standardized testing in Grade 3.

Comments: Read the full text of the article by clicking on the title above. I do not believe that "Vision screening of school children is a widely accepted procedure to detect vision problems that can interfere with learning". Put "vision screening" in the upper left search box and you will see why this is so. DM

Monday, December 6, 2010

Relationship between Binocular Vision, Visual Acuity, and Fine Motor Skills.

....Both sensory and motor fusion and good VA in both eyes are of benefit in the performance of fine motor skills tasks, with the presence of some binocular vision being beneficial compared with no fusion on certain sensorimotor tasks. This evidence supports the need to maximize fusion and VA outcomes.....

Comments: Vision screenings do not test for sensory and motor fusion....only full eye exams can do this. Stop the madness...only full comprehensive eye exams are appropriate for our children. DM

Evidence-based medicine: the value of vision screening.

This paper answers a couple of questions about the value of vision screening. The questions were:

(1) Is vision valuable (an inherent good)?; 
(1) yes

(2) Is screening effective (finding amblyopia)?; 
(2) based on literature, not definitively so;

(3) What are the costs of screening?; 
(3) relatively inexpensive

(4) Is treatment effective?; and 
(4) yes, for compliant care

(5) Is amblyopia detection beneficial?
(5) economic productive values are likely very high, with returns of investment on the order of 10:1, while human value returns need further elucidation. 

Comments: Again and again we learn that based on the literature there is not enough supportive data for vision screening to be continued. It is a looser!! Stop this nonsense. Vision screening is a waste of time and money. Every child deserves a full comprehensive eye examination! DM

Assessment of a modification of Brückner's test as a screening modality for anisometropia and strabismus

Click on title for pdf of article. DMpdf

The perception of strabismus by children and adults

.....Adults and children rated a squinting right eye as worse compared to a left one. Children perceived esotropia as more disturbing than exotropia. Neither age, nor gender, nor the fact that the respondents have friends or family members with a squint, had an impact on this ranking. Almost all adults would correct all forms of strabismus, and think that surgery should be covered by compulsory health insurance....

Comments: Surgery? What about optometric vision therapy? Full text available. DM

Refractive Status and Prevalence of Refractive Errors in Suburban School-age Children

....The distribution of refractive status changes gradually from positively-skewed to negatively-skewed distributions as age increases, with 9-year-old being the critical age for the changes. Environmental factors and study intensity influence the occurrence and development of myopia.....

Change in vision disorders among Hong Kong preschoolers in ten years

....A significant increase in myopia has been noted in Hong Kong preschoolers. Visual screening programs may need to be tailored to correspond to the local population and be adjusted accordingly from time to time....

UIW receives $11.5 million gift for School of Optometry

.... The University of the Incarnate Word has received a major gift of $11.5 million from Sandra and Stanley Rosenberg. The generous gift is significant as it is one of the largest gifts in the country ever given by a Jewish family to a Catholic institution of higher learning. 
To mark this auspicious occasion, the university has named the Sandra and Stanley Rosenberg School of Optometry in their honor. The naming of this professional school will make it the only named school of optometry in the United States.....

Best Careers 2011: Optometrist

....Money: .... the top earners make more than $166,400. The annual median wage in 2009 was $96,140 . ...

Comment: Optometry is a great career. Check out the Illinois College of Optometry for more info. DM

Optometrists Song

Scientists May Have Discovered How To Help Stem Cells In The Brain Regenerate Myelin

From AOA FirstLook:

The Financial Times (12/6, Bolger) reports that, according to a paper in Nature Neuroscience, scientists in the UK have made a breakthrough which could eventually help patients with multiple sclerosis repair damaged nerve fibers. The UK's Daily Mail (12/6, Borland) explains that the "incurable disease...causes loss of mobility, sight problems, tiredness, and excruciating pain." It's "caused by damage to myelin, the substance that surrounds all nerves in the brain and spinal cord. This impairs the way messages are transmitted from the brain to the rest of the body."

At present, "treatments involve suppressing the immune system to stop it damaging the myelin and the myelin-forming cells," the UK's Guardian (12/6, Jha) reports. "But they don't regenerate damaged myelin." The authors of the current study, however, "found a way to activate the 'RXR pathway,' a crucial cell development route that turns brain and spinal cord stem cells into myelin-making cells, in rats and mice."

The "scientists believe this will help in identifying drugs to encourage myelin repair in MS patients," BBC News (12/6) reports. "However, much more work is needed -- both to test if the mechanism works in people with MS and to see what drugs might be needed to promote the effect." Still, "Simon Gillespie, chief executive of the MS Society, which part-funded the research, said: 'For people with MS this is one of the most exciting developments in recent years.'" Gillespie added, "It's hard to put into words how revolutionary this discovery could be and how critical it is to continue research into MS." The UK's Press Association (12/6) and the UK's Independent (12/6, Laurance) also cover the breakthrough.

Eye Movement Problems Common Cause of Reading Difficulties in Stroke Patients

...Visual problems can affect up to two thirds of stroke patients, but can sometimes go undetected if patients do not recognise them as an after-effect of the condition or if they are unable to communicate the problem to their medical team or families....damage to the nerve supply that controls eye movement is also a common problem after a stroke. Impaired eye movement can impact on the ability to follow a moving object or read words on a page....

Comments: So let me see if I understand this correctly....eye movement problems can cause reading dysfunction in adult stroke patients but according to many of my ophthalmogical colleagues (and some other researchers) this couldn't possibly happen in children with reading problems but not a stroke. DM

Smoking May Thin the Brain

....Many brain imaging studies have reported that tobacco smoking is associated with large-scale and wide-spread structural brain abnormalities.....

Children with Autism have Mitochondrial Dysfunction

...Children with autism are much more likely to have deficits in their ability to produce cellular energy than typically developing children. ... cumulative damage and oxidative stress in mitochondria, the energy producer of the cell, could influence the onset and severity of autism,....