Saturday, May 21, 2011

Autism 101 and Resources

...As part of the PBS NewsHour's Autism Now series, here's a look at the basics on autism: what it is, how it is treated and key resources. ....

OPTOMETRIC VISION THERAPY: Diagnosis, Treatment Time, Coding/Billing

Trends in Concussion Incidence in High School Sports

.....Although the collision sports of football and boys’ lacrosse had the highest number of concussions and football the highest concussion rate, concussion occurred in all other sports and was observed in girls’ sports at rates similar to or higher than those of boys’ sports. The increase over time in all sports may reflect actual increased occurrence or greater coding sensitivity with widely disseminated guidance on concussion detection and treatment. The high-participation collision sports of football and boys’ lacrosse warrant continued vigilance, but the findings suggest that focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk....

3D Vision....There's an App for That! It's called Optometric Vision Therapy

.....Can a piece of string actually be the latest in technology? In his editorial, Brock String Debuts at 2011 Consumer Electronics Show, Dr. Dominick M. Maino, Professor of Pediatrics/Binocular Vision at the Illinois College of Optometry, and OVD Editor, tells how a simple piece of string can be used to diagnose and treat binocular vision problems that interfere with enjoying 3D entertainment and classroom learning. In the editorial Dr. Maino states, "3D. There's an app for that. It's called Optometric Vision Therapy," which means many of those with problems appreciating the 3D experience can be helped by vision therapy. He also noted, "Unlike that other eye-care profession that tells consumers not to view 3D if it makes them uncomfortable; we are not the Doomsday docs of 3D. We want 3D to succeed so that all can enjoy an improved vocational, recreational and educational experience."....

What's It Like to be an Optometry Student? Check this Out Now!

Friday, May 20, 2011

Breast Milk Does A Body And Behavioral Development Good In Infants

......The benefits of breastfeeding are fairly well known. For example breastfed babies have lower rates of infections, and mothers who breastfeed have a reduced risk of breast cancer. However in a new study, breast feeding may now influence behavior patterns of infants as they mature. Babies who are breastfed are less likely to grow into children with behavior problems by the time they reach the age of five than those who receive formula milk......

New Journals on PubMed

The following new journals from Medknow Publications have been added to PubMed Central.

Journal of Research in Medical Sciences
ISSN 1735-1995 (print); 1735-7136 (electronic)

Archive includes volume 15 (2010) to current
Note: There is no embargo delay for this journal

Research in Pharmaceutical Sciences
ISSN 1735-5362 (print); 1735-9414 (electronic)

Archive includes volume 4 (2009) to current
Note: There is no embargo delay for this journal

Dental Research Journal
ISSN 1735-3327 (print); 2008-0255 (electronic)

Archive includes volume 6 (2009) to current
Note: There is no embargo delay for this journal

Iranian Journal of Nursing and Midwifery Research
ISSN 1735-9066 (print); 2228-5504 (electronic)

Archive includes volume 15 (2010) to current
Note: There is no embargo delay for this journal

International Journal of Preventive Medicine
ISSN 2008-7802 (print); 2008-8213 (electronic)

Archive includes volume 1 (2010) to current
Note: There is no embargo delay for this journal

Indian Journal of Endocrinology and Metabolism
ISSN 2230-8210 (print); 2230-9500 (electronic)

Archive includes volume 14 (2010) to current
Note: There is no embargo delay for this journal

Journal of Anaesthesiology Clinical Pharmacology
ISSN 0970-9185 (print)

Archive includes volume 26 (2010) to current
Note: There is no embargo delay for this journal

Journal of Ayurveda and Integrative Medicine
ISSN 0975-9476 (print); 0976-2809 (electronic)

Archive includes volume 1 (2010) to current
Note: There is no embargo delay for this journal

Pharmacognosy Research
ISSN 0976-4836 (print); 0974-8490 (electronic)

Archive includes volume 2 (2010) to current
Note: There is no embargo delay for this journal

Thursday, May 19, 2011

Discomfort, delirium, and PONV in infants and young children undergoing strabismus surgery

Stowman AM, Bothun ED, Belani KG. Discomfort, delirium, and PONV in infants and young children undergoing strabismus surgery. Minn Med. 2011 Mar;94(3):39-41.


This article presents the results of a retrospective analysis of anesthesia care and perioperative outcomes in children up to 2 years of age who underwent strabismus surgery during a five-year period at the University of Minnesota Amplatz Children's Hospital. We reviewed the charts of 74 children to determine perioperative outcomes--namely discomfort, emergence agitation/delirium, and postoperative nausea and vomiting (PONV).We found that although PONV was not an issue in this age group, as it was with older children, discomfort and emergence agitation/delirium do need to be considered during their care.

AOATV Update for May!

ICO's Presenations at ARVO

The Illinois College of Optometry presented these posters at the recent The Association for Research n Vision and Ophthalmology (ARVO) meeting.

a. Program#/Poster#: 4702/D746 Abstract Title: Saccadic and Fixation Control in Relationship to Birth Order Presentation Start/End Time: Wednesday, May 04, 2011, 1:45 PM - 3:30 PM Session Number: 459 Session Title: Eye Movements and Nystagmus / Location: Hall B/C Reviewing Code: 198 eye movements - EY Author Block: Christine L. Allison, Darrell Schlange. Pediatric Optometry & Binocular Vision, Illinois College of Optometry, Chicago, IL. Keywords: 521 eye movements; 578 learning; 752 visual development Abstract Body: Purpose: The purpose of this ongoing study is to evaluate the relationship that birth order may have in regards to saccadic and fixation eye-movement abilities. It is theorized that first children and children with no siblings may exhibit better saccades and fixation control prior to entering Kindergarten due to their play activities and reading experiences.

Methods: 61 children were examined the summer prior to entering Kindergarten. The age range of these children was 4 to 6 years. Each child was given a full comprehensive eye examination including tests of accommodation and vergence, as well as a full ocular health evaluation. The children also received an analysis of their saccades and fixations as recorded with the Visagraph Visual Skills protocol. The parents completed a survey regarding the number and ages of siblings, prior school history, and the amount of time the children spent on specific tasks such as being read to by an adult, playing near vision games, and participating in outdoor activities.

Results: Children who were first in birth order exhibited better fixation control with fewer off-target drifts (F 17.699, p = 0.023) and more efficient horizontal saccades (F 12.379, p = 0.031). These observations were also noted in the children that were read to more often and performed more near vision games.

Conclusions: The type of activities that first born children are encouraged to perform may lead to better eye movement skills by the time they enter elementary school. This may result in early school success and earlier reading when compared to children later in the birth order. These children will also be re-examined in their later school years to determine if these observations remain with age. CommercialRelationships: Christine L. Allison, None; Darrell Schlange, None

b. Program#/Poster#: 5722/D827 Abstract Title: Assessment of Visual Function with Therapeutic Tinted Contact Lenses in Patients with Albinism Presentation Start/End Time: Thursday, May 05, 2011, 8:30 AM -10:15 AM Session Number: 523 Session Title: Binocular Vision and Stereopsis, Development, Fields, Fixation, and Adaptation / Location: Hall B/C Reviewing Code: 264 low vision - VI Author Block: Faheemah Saeed, Darrel G. Schlange. Illinois College of Optometry, Chicago, IL. Keywords: 583 low vision; 477 contact lens; 616 nystagmus Abstract Body: Purpose: To determine visual function in patients with Albinism with three forms of vision correction (spectacle correction, un-tinted contact lenses and tinted contact lenses).

Methods: 3 subjects (6 eyes) were fit with soft toric contact lenses that were then custom tinted to create an artificial iris. Four dependent variables that were measured include visual acuity, contrast sensitivity, effect of glare, and nystagmus eye movement recordings. Patients’ subjective evaluation of their visual comfort and clarity, and their perception of change in glare and light sensitivity was also evaluated by means of a short questionnaire. The EDTRS chart was used to measure visual acuity. The CSV-1000HGT (halogen glare test) and 1000E (Contrast Sensitivity chart) were used to measure the contrast sensitivity function and effect of glare. Nystagmus fixation characteristics and waveforms were studied with the ISCAN (RK 826PCI) that uses a video based dark pupil-to-cornea reflection method.

Results: Preliminary results of this ongoing study are being reported. Visual acuity was significantly improved in all eyes with tinted contact lens wear (Mean improvement = 1.4 LogMAR, X2 = 11.565, p = 0.03). Contrast sensitivity measurements, under normal testing conditions as well as with glare, showed improvement in all eyes. ISCAN trials with 3 runs in each of 5 positions of gaze showed decreased nystagmus amplitude and frequency with tinted contact lenses. Patients subjectively reported reduced sensitivity to light and decreased glare with tinted contact lenses.

Conclusions: The results obtained thus far show significantly improved visual acuity in patients with albinism with the use of custom tinted contact lenses. Contrast sensitivity, glare reduction, nystagmus amplitude and frequency were also improved. CommercialRelationships: Faheemah Saeed, None; Darrel G. Schlange, None Support: 2010 Illinois Society for Prevention of Blindness Research Grant

c. Program#/Poster#: 1540/D1109 Abstract Title: Rate of Increase in Lens Thickness Decreases With Age Presentation Start/End Time: Monday, May 02, 2011, 8:30 AM -10:15 AM Session Number: 233 Session Title: Cell Biology and Biophysical Properties of the Lens / Location: Hall B/C Reviewing Code: 258 lens: all topics except epidemiology - LE Author Block: Elizabeth A. Knighton1, Rebecca K. Zoltoski1, Daniel K. Roberts1,2A, Jacob T. Wilensky2B, Jer R. Kuszak3. 1Illinois College of Optometry, Chicago, IL; ADepartment of Epidemiology and Biostatistics, BOphthalmology, 2University of Illinois at Chicago, Chicago, IL; 3Ophthalmology, Rush University Medical Center, Chicago, IL. Keywords: 413 aging; 551 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) Abstract Body: Purpose: We create dynamic computer models to recreate anatomical relationships at the fiber level in the lens during growth and accommodation. To do this accurately, in addition to studying the lens ultrastructure, gross lens dimensions are necessary to increase the accuracy of the model. As we age, it is expected that the rate of growth will decrease, especially after the age of 50.

Methods: A-scan ultrasounds (PalmScanTM AP2000 or Accutone) were collected on 305 subjects between the ages of 22 and 93. The younger subjects were looking at a non-accommodating distance target using minus lenses to fully relax their accommodation. The older subjects were asked to fixate at distance. Linear regression (Systat v11) of age and LT (mm) of the right eye was used to assess the increase in LT (± SEM) across age (μm/year).

Results: During the ages assessed, the accommodative ability of the lens is decreasing, while lens growth continues. An increase in LT of 30 ± 1 μm/year was noted across the seven decades of life measured. To assess the differences in growth across age, the data was first divided into two age groups (50, n=223). Below the age of 50, the LT increased 59 ± 5 μm/year (LT = 0.059 (±0.005) * age + 1.902 (± 0.157), R = 0.532, p < 0.001). While above the age of 50, the increase per year dramatically dropped to 14 ± 3 μm/year (LT = 0.014 (±0.003) * age + 4.014 (±0.202), R = 0.297, p < 0.001). In younger subjects, the increase in LT was much greater than the reported values of 13 - 29 μm/year between the ages of 20 and 60 using various methods.

Conclusions: The rate of lens growth may be faster in younger subjects than once thought, but that in a short span of time, the rate slows dramatically. Unfortunately, this type of analysis does not provide information on the influence of the addition of fibers and compaction to the lens dimensions. Further analysis of more lenses, particularly in the earlier decades of life, as well as using other techniques, is warranted to provide accurate growth rate assessment for lens aging. CommercialRelationships: Elizabeth A. Knighton, None; Rebecca K. Zoltoski, None; Daniel K. Roberts, None; Jacob T. Wilensky, None; Jer R. Kuszak, None Support: NIH Grant K23EY018183, MEBTC Fellowship, and ICO RRC

d. Program#/Poster#: 2800/D649 Abstract Title: Case-Control Study of Long Anterior Lens Zonule (LAZ) Trait in First-Degree Relatives of African-American Probands Presentation Start/End Time: Tuesday, May 03, 2011, 8:30 AM -10:15 AM Session Number: 317 Session Title: Cataract, Methodology, Education Location: Hall B/C Reviewing Code: 208 genetic epidemiology - CL Author Block: Daniel K. Roberts1,2A, Radha Ayyagari3, Bridget J. McCarthy2A, Hui Xie2A, Jacob T. Wilensky2B, Faye Davis2A. 1Clinical Education, Illinois College of Optometry, Chicago, IL; AEpidemiology and Biostatistics, BOphthalmology and Visual Science, 2University of Illinois at Chicago, Chicago, IL; 3Ophthalmology, University of California San Diego, La Jolla, CA. Keywords: 538 genetics; 421 anterior segment; 463 clinical (human) or epidemiologic studies: prevalence/incidence Abstract Body: Purpose: The long anterior zonule (LAZ) trait is characterized by zonular fibers that insert more central than usual on the anterior lens capsule. LAZ may cause a unique type of intraocular pigment dispersion, and there is question whether there is association with open- and narrow-angle forms of glaucoma. Although LAZ can be familial in conjunction with a complex phenotype of LAZ and late-onset retinal degeneration (L-ORD) resulting from a C1QTNF5/CTRP5 mutation in white families, the trait does not appear to have genetic homogeneity. This study evaluated familial aggregation apart from a L-ORD association.

Methods: African-American LAZ, probable LAZ, and control probands (matched on race, age) and first-degree relatives had a complete eye exam, including ocular/medical history, EOM testing, color vision testing, pupil testing, refraction, Goldmann tonometry, gonioscopy, dilated fundus exam, and threshold visual fields. Testing was done as part of a larger investigation to study ocular and medical parameters associated with LAZ, and the analysis included 37 first-degree relatives (2 parents, 15 siblings, 20 children) belonging to 25 LAZ probands (mean age=68.8 + 9.0 yrs), 21 first-degree relatives (14 siblings, 7 children) belonging to 11 probable LAZ probands (69.2 + 8.6 yrs), and 36 first-degree relatives (14 siblings, and 22 children) belonging to 22 control probands (66.7 + 9.3 yrs). Logistic regression was used to compare LAZ prevalence among case/control relatives.

Results: LAZ were detected in 10 of 37 (27.0%) LAZ relatives, 4 of 21 (19.0%) probable LAZ relatives, and 2 of 36 (5.6%) control relatives. Based on these data, the LAZ trait was 6.3 times more likely (OR=6.3; 95% CI=1.3 to 31.2; P=0.02) to occur among first-degree relatives of LAZ probands than of controls. Combining the definite and probable LAZ families, the LAZ trait was 5.4 times more likely (OR=5.4; 95% CI=1.2 to 25.4; P=0.03) to occur among relatives of LAZ probands than of controls.

Conclusions: The LAZ trait was significantly more likely to be detected in first-degree relatives of African-American LAZ probands than among relatives of comparable controls. This is consistent with the possibility of a genetic etiology for the trait among African-Americans who do not have the L-ORD phenotype. CommercialRelationships: Daniel K. Roberts, None; Radha Ayyagari, None; Bridget J. McCarthy, None; Hui Xie, None; Jacob T. Wilensky, None; Faye Davis, None Support: NIH Grant K23EY018183

e. Program#/Poster#: 834/D982 Abstract Title: Effect Of Low Accommodative Demand On Higher Order Aberrations Of The Lens Presentation Start/End Time: Sunday, May 01, 2011, 11:15 AM - 1:00 PM Session Number: 132 Session Title: Crystalline Lens, Presbyopia, Accommodation and Its Restoration Location: Hall B/C Reviewing Code: 101 accommodation and presbyopia, in vivo and in vitro -VI Author Block: Rebecca K. Zoltoski1A, Jennifer Harthan1B, Kyle Klute1, Marc Landes1, Jer R. Kuszak2. ADidactic Education, BCornea Center for Clinical Excellence, 1Illinois College of Optometry, Chicago, IL; 2Ophthalmology, Rush University Medical Center, Chicago, IL. Keywords: 404 accommodation; 623 aberrations Abstract Body: Purpose: During dynamic focusing, the shape, as well as the internal ultrastructure of the lens is changed. Our lab is investigating changes in the ultrastructure, specifically at the sutures, of the lens during accommodation. We have hypothesized that unique structural features and organization of fiber cells enables them to interface at the sutures resulting in a change in surface curvature of the lens, allowing near focus to occur. We are currently using slit lamp and sequential ray tracing analysis of the patterns associated with the sutures to provide additional insight into the importance of the ultrastructure of the lens in the accommodative process. To further support our hypothesis, we are investigating changes in higher order aberrations in various states of accommodation. Preliminary observations are being reported here.

Methods: Wavefront analysis and accommodative response using the iTrace (Tracey Technology, Houston, TX) was collected on normal subjects, between the ages of 20-35 (n=26). Data were collected from the right eye as the subject viewed a lighted distance, then near target (40 cm) with their normal correction using their left eye. Accommodation was stimulated using minus lenses in 2.5 D increments until the subject could no longer clearly view the target. Data were preliminarily analyzed using SPSS to measure correlations between zernike polynomials for the internal optics (mostly lens) of the eye and accommodative response. We focused mainly on those indicative of suture patterns (trefoil, tetrafoil, pentafoil, hexafoil, and heptafoil). Correlation coefficients and p values are presented.

Results: When analyzed as raw data (n=74), there was a correlation between accommodative response and trefoil (C6 : 0.234, p=0.045), tetrafoil (C10 : -0.234, p=0.045 and C22 : 0.232, p=.047) and pentafoil (C15 : -0.226, p=0.050). From these preliminary results, further analysis of combined Zernike polynomials is needed. In addition, higher level of accommodation are needed, so if using this type of system, the impact of convergence on the aberrations needs to be reduced.

Conclusions: There are changes in higher order aberrations that may be indicative of a role for the lens fiber interactions at the sutures during accommodation. Further research investigating these patterns during growth and aging, as well as during accommodation is needed. A potential use of these patterns in detecting early problems with vision may be useful in a clinical setting. CommercialRelationships: Rebecca K. Zoltoski, None; Jennifer Harthan, None; Kyle Klute, None; Marc Landes, None; Jer R. Kuszak, None Support: NIH Grant EY021015-01 and ICO RRC

f. Program#/Poster#: 3866/D999 Abstract Title: Changes In Aberrations Of The Eye In Patients With Dry Eye Syndrome Presentation Start/End Time: Tuesday, May 03, 2011, 3:45 PM - 5:30 PM Session Number: 377 Session Title: Dry Eye Disease II Location: Hall B/C Reviewing Code: 186 dry eye disease - CO Author Block: Jennifer S. Harthan1A, Rebecca K. Zoltoski1B. ACornea/Contact Lenses, BDidactic Education, 1Illinois College Of Optometry, Chicago, IL. Keywords: 486 cornea: tears/tear film/dry eye; 623 aberrations Abstract Body: Purpose: Dry Eye Syndrome (DES) is a disease of the tears and ocular surface that is multi-factorial; resulting in a wide range of symptoms and signs with potentially damaging effects. A break-up in the tear film may induce an increase in higher order aberrations (HOA), thereby decreasing the quality of the retinal image. We hypothesize that treated patients with varying levels of DES will have an improvement in their HOA over time. For this study, patients with varying levels of DES had HOA measurements with wavefront analysis while instilling non-preserved artificial tears (OPTIVETM by Allergan) during sequential time frames.

Methods: A complete dry eye work up and wavefront analysis using the iTrace (Tracey Technologies) were collected on 22 patients (19 with DES and 3 controls) who had no other eye related problems. Aberrometry (total and corneal topography) was measured prior to and at 1, 5, 10, 15, 30, and 60 mins after the tears were administered. The patients then used the drops 4x/day for 1 week, after which the above measurements were repeated. HOA at each time point was compared using an ANOVA for repeated measures (Systat, 2008) with comparisons between the two groups. Data are presented as HOA ± SEM.

Results: The Optive drop significantly increased HOA across the time period studied (p<0.001). In post-hoc comparisons, the only significant time period was at 1 min after the drop. (p<0.001). There was no difference between the groups, but this was probably due to the small sample size.

Conclusions: There are improvements in HOA over a period of time that demonstrate the importance of treating dry eye syndrome to maintain retinal image quality. Further investigation will help us better understand how higher order aberrations change in relation to tear film stability and the health of the cornea in dry eye patients. Further analysis by assessing the severity of the DES and the individual components of the HOA is needed to determine when this type of treatment will benefit the patient most. CommercialRelationships: Jennifer S. Harthan, None; Rebecca K. Zoltoski, None Support: None

g. Program#/Poster#: 1895/D853 Abstract Title: Test-retest Repeatability For Contrast Sensitivity In Children and Young Adults Presentation Start/End Time: Monday, May 02, 2011, 1:45 PM - 3:30 PM Session Number: 266 Session Title: Spatial and Temporal Vision, Function and Task Performance in Aging and Low Vision Location: Hall B/C Reviewing Code: 438 visual perception - VI Author Block: Susan Kelly, Yi Pang, Chandra Engs, Lauren Foley, Nellie Salami, Audra Sexton. Illinois College of Optometry, Chicago, IL. Keywords: 468 clinical research methodology; 478 contrast sensitivity Abstract Body: Purpose: Contrast sensitivity (CS) testing has become an important tool used to assess patient vision. Currently two letter CS tests,the Pelli-Robson and the Mars chart are often used to assess CS. Both these charts measure patient sensitivity to peak spatial frequencies. These tests are not only quickly administered but have validity and good test-retest repeatability. There are chart-based CS tests that measure sensitivity to contrast across the full range of spatial frequencies that are also rapid but their accuracy and reliability have been less well examined. The present study measured the test-retest repeatability for the Vector Vision CSV-1000E system in visually normal children and young adults.

Methods: Twenty-one visually normal adults (mean age=27.96 yrs, range = 22-38) and 16 children (mean age= 7.7 yrs, range =5-12) were tested on the the Vector Vision 1000E chart on two separate visits (average inter-visit duration = 15 wks for adults and 2 wks for children). All subjects were free of ocular pathology, had best-corrected visual acuity of 20/20 or better and wore their habitual correction if needed. The testing procedure followed that recommended by the manufacturer. The chart self-calibrates to a mean luminance of 85 cd/m2 and testing was conducted at 8 feet.

Results: Data were converted to log CS scores for all data analysis. Test-retest repeatability was determined with a Bland-Altman analysis. Both the 95% limits of agreement (and their 95% confidence intervals) and the correlation of repeatability (COR) were calculated. The average test-retest difference was -0.07 log CS for adults and -0.014 for children. The negative values indicate performance improved on the second administration of the test. The 95% limits of agreement (LoA) ranged from + 0.425 to+0.757 for adults and +0.482 to +0.91 for children.

Conclusions: Both children and adults completed the test in under 3 minutes. Although the average test-retest difference in logCS between visits is small, it is 3 times that which has been reported for the Pelli-Robson or the Mars chart in adults. The LoA reported for the Pelli-Robson test in visual normals and clinical populations ranges from + 0.14 to +0.2. This is in contrast with the LoA measured in the present study which are 2 to 4 times greater. These values are also larger than those reported for a healthy, older population using the Vector Vision test (Pomerance and Evans, '94). It is possible that test-retest variability varies with the subject's understanding of the instructions; variability in CS estimates will occur if they guess the location of the pattern after they no longer see it. CommercialRelationships: Susan Kelly, M&S Technologies,Inc. (C); Yi Pang, M&S Technologies Inc. (C); Chandra Engs, None; Lauren Foley, None; Nellie Salami, None; Audra Sexton, None Support: Illinois College of Optometry Research Resource Committee

h. Program#/Poster#: 778/D828 Abstract Title: Graft Microfolds, Graft Thickness, and Ocular Aberrations after Descemet-Stripping Endothelial Keratoplasty for Fuchs Endothelial Dystrophy Presentation Start/End Time: Sunday, May 01, 2011, 11:15 AM - 1:00 PM Session Number: 130 Session Title: Lamellar Keratoplasty Location: Hall B/C Reviewing Code: 173 corneal transplantation: penetrating and lamellar keratoplasty - CO Author Block: Cherie B. Nau1,2, Jay W. McLaren2, Keith H. Baratz2, Sanjay V. Patel2. 1Illinois College of Optometry, Chicago, IL; 2Department of Ophthalmology, Mayo Clinic, Rochester, MN. Keywords: 623 aberrations; 737 transplantation; 462 clinical (human) or epidemiologic studies: outcomes/complications Abstract Body: Purpose: Visual acuity often remains less than 20/20 after Descemet-stripping endothelial keratoplasty (DSEK), possibly because of aberrations induced by an irregular posterior graft surface. Confocal images of DSEK grafts often show stromal microfolds. In this study we examined the relationships between graft microfolds, graft thickness, and aberrations after DSEK.

Methods: Twenty-three corneas of 17 patients at 2 years after DSEK for Fuchs dystrophy, and 36 corneas of 18 normal untreated subjects, were examined by using a ConfoScan 4 confocal microscope with the z-ring adapter. Central graft microfolds, which appeared as dark striations, were counted in a standard area of each image in the donor tissue. The total number of folds (sum of the number of folds per frame weighted for the distance between consecutive frames) was calculated between the interface and the endothelium after DSEK, or between the endothelium and 160 μm anterior to the endothelium in untreated corneas. Central graft thickness was the distance between images of the interface and endothelium in eyes after DSEK. Wavefront aberrations were determined from Hartmann-shack aberrometry over a 4 mm optical zone, and best-corrected visual acuity (BCVA) was measured by using the ETDRS protocol. Correlations between visual parameters, the total number of microfolds, and graft thickness, were assessed by using generalized estimating equation models.

Results: After DSEK, the total number of microfolds was correlated with total high-order aberrations (HOAs, r=0.52, p<0.001), trefoil (r=0.65, p<0.001) and graft thickness (r=0.43, p=0.01). Graft thickness was also correlated with total HOAs (r=0.76, p<0.001), coma (r=0.58, p<0.001), and trefoil (r=0.79, p<0.001). BCVA after DSEK was weakly correlated with trefoil (r=0.22, p=0.04). The total number of microfolds in DSEK grafts (350 ±137 folds-μm) was higher than in normal corneas (200 ± 144 folds-μm, p<0.001). In normal corneas, posterior stromal microfolds were not correlated with total HOAs (r= -0.19, p=0.17) or with BCVA (r= -0.10, p=0.29).

Conclusions: Although increased HOAs after DSEK are associated with an increased number of graft microfolds and thicker grafts, there is a weak association between HOAs and BCVA. Microfolds also appear in normal corneas, and might be an artifact of pressure exerted by the z-ring during confocal microscopy. Nevertheless, in normal corneas, there were fewer microfolds than in DSEK grafts, and microfolds were not associated with HOAs. CommercialRelationships: Cherie B. Nau, None; Jay W. McLaren, None; Keith H. Baratz, None; Sanjay V. Patel, None Support: Research to Prevent Blindness; Mayo Foundation

i. Program#/Poster#: 2072 Abstract Title: Circadian Variation Of Aqueous Humor Dynamics: Effects On Episcleral Venous Pressure And Uveoscleral Outflow Presentation Start/End Time: Monday, May 02, 2011, 4:45 PM - 5:00 PM Session Number: 271 Session Title: Intraocular Pressure/Physiology Location: Room 114 Reviewing Code: 130 aqueous humor dynamics - PH Author Block: Arthur J. Sit1, Mehrdad Malihi1, Cherie B. Nau2, Jay W. McLaren1. 1Ophthalmology, Mayo Clinic, Rochester, MN; 2Illinois College of Optometry, Chicago, IL. Keywords: 629 outflow: ciliary muscle; 630 outflow: trabecular meshwork; 567 intraocular pressure Abstract Body: Purpose: Aqueous humor flow decreases during sleep, while IOP in the physiologic positions (sitting during day; supine at night) increases. Previous work suggests that outflow facility decreases slightly at night, but not enough to explain this pattern. However, the contribution of episcleral venous pressure (EVP) and uveoscleral outflow to the nocturnal change in IOP are unknown, due of the lack of objective methods to measure EVP. In this study we used a new method to assess circadian changes in EVP, and combined with measurements of aqueous humor flow and IOP, we examined circadian changes in uveoscleral outflow.

Methods: Twenty-six eyes of 13 healthy subjects (age 47-76; mean 59 years) were studied in the mid-diurnal and mid-nocturnal periods. IOP was measured by pneumatonometry, aqueous humor flow rate was determined by fluorophotometry, and outflow facility was measured by Shiøtz tonography. EVP was measured by using a custom computerized venomanometer that applies an inflatable chamber to an episcleral vein and objectively determines the pressure required to collapse the vein. Uveoscleral outflow was calculated by using the modified Goldmann equation. IOP (sitting and supine), aqueous humor flow rate, outflow facility, EVP, and uveoscleral outflow rate during the day were compared to the same parameters at night by using paired t-tests.

Results: At night, aqueous humor flow rate decreased by almost 50%, sitting IOP was slightly lower, and supine IOP was unchanged. EVP was not different at night than during the day, but outflow facility and uveoscleral outflow both decreased significantly at night.

Conclusions: Decreased aqueous humor flow at night is compensated by decreased outflow facility and uveoscleral flow to maintain a high IOP. EVP remains unchanged, which suggests active regulation. The lack of uveoscleral outflow at night is consistent with the concept of a uveolymphatic drainage system that is pressure-insensitive, but dependent on eye movements. CommercialRelationships: Arthur J. Sit, None; Mehrdad Malihi, None; Cherie B. Nau, None; Jay W. McLaren, None Support: American Glaucoma Society Clinician-Scientist Grant, Mayo Foundation for Medical Education and Research (Hoeft Career Development Award), Research to Prevent Blindness (Schaub Special Scholar Award)

j. 579/A319 Abstract Title: Examining Recalcitrant Diabetic Macular Edema with Optos Wide-Field Fluorescein Angiography Presentation Start/End Time: Sunday, May 01, 2011, 11:15 AM - 1:00 PM Session Number: 122 Session Title: Diabetic Retinopathy I (Macular Edema) Location: Hall B/C Reviewing Code: 176 diabetic macular edema: clinical research - RE Author Block: Ravi D. Patel1, Seenu M. Hariprasad1, Leonard V. Messner2, Bruce Teitelbaum2, Kimberly Michel2. 1Section of Ophthalmology and Visual Science, Department of Surgery, University of Chicago, Chicago, IL; 2Illinois College of Optometry, Illinois Eye Institute, Chicago, IL. Keywords: 498 diabetes; 584 macula/fovea; 505 edema Abstract Body: Purpose: In this study we have 2 main objectives: i) to study the peripheral angiographic features of patients with recalcitrant diabetic macular edema (DME) and peripheral retinal nonperfusion in non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) and ii) to demonstrate the diagnostic value of wide-field fluorescein angiography in elucidating the role of subtle peripheral pathology in diabetic retinopathy.

Methods: This is a retrospective observational case series of approximately 50 eyes of 100 patients who have been diagnosed with DME for at least 2 years at a single academic institution. Protocols were approved by the institutional review board at the study site, and consent was obtained from each patient. A retrospective review of all Optos wide-field fluorescein angiograms and spectral domain OCT (SD-OCT) was performed at baseline (1 clinic visit). Three study cohorts were enrolled. Cohort 1 (control) subjects were diagnosed with NPDR without DME or peripheral ischemia. Cohort 2 subjects were diagnosed with NPDR with DME or peripheral ischemia. Cohort 3 subjects diagnosed with PDR and DME with or without previous pan retinal photocoagulation (PRP).

Results: Our preliminary data demonstrates an increased incidence of peripheral nonperfusion on Optos wide-field fluorescein angiography with recalcitrant DME (on SD-OCT) in all non-control cohorts. Further statistical analysis is to follow. Also, the diagnostic value of the wide-field fluorescein angiogram was demonstrated by detecting subtle peripheral neovascularization that was not found on clinical exam.

Conclusions: Wide-field fluorescein angiography is an excellent diagnostic instrument that provides a reproducible method to detect subtle peripheral neovascularization in diabetic retinopathy. Areas of untreated retinal nonperfusion may generate biochemical mediators that promote ischemia with or without neovascularization and recalcitrant DME. Targeted retinal photocoagulation will show improvement or resolution of recalcitrant DME. CommercialRelationships: Ravi D. Patel, None; Seenu M. Hariprasad, Optos, Inc (C); Leonard V. Messner, None; Bruce Teitelbaum, None; Kimberly Michel, None Support: None

Free infant vision assessment at Imagination Station

....Moms and dads always are taking their newborns to the doctors for well-baby checkups, immunizations, and, of course, whenever baby becomes ill.

And though taking their bundles of joy to an optometrist probably is not on most parents' radar until it's time for the youngsters to enroll in school or after a school exam suggests they see an eye doctor, visiting an optometrist should be a priority early on too.

Every infant's eyes should be assessed by an optometrist when the child is between six and 12 months old,...

Comments: Go to for more information. DM

Sporadic Mutations Identified In Children With Autism Spectrum Disorders

....The researchers found 21 newly occurring mutations, 11 of which altered proteins. Proteins altered by genetic mutations may hold clues to the biological pathways involved in the development of the disease. The abnormal proteins or the pathways they affect could draw interest as targets in the design of preventive or treatment drugs. ....

How OMDs still get it wrong...

My friend and colleague, Dr. Len Press, certianly got this one right! Read his blog immediately about how our OMD colleagues just seem to miss the boat in so many areas. Amblyopia CAN be treated at any age. Neuroplasticity exists within the human organism forever. The most effective treatment for binocular vision disorders is IN OFFICE Optometric Vision Therapy...(this according to NEI sponsored clinical trials)...and yes, vision does have something to do with reading and academic performance...( see the latest AOA Journal...Chen AH, Bleything W, Lim YY. Relating vision status to academic achievement among year-2 school children in MalaysiaOptometry. 2011 May;82(5):267-73.
BACKGROUND: Vision affects daily activities, but of particular importance is the impact upon the learning process. Many studies have been conducted to establish the relationship between vision problems and academic performance. The results are varied, however, and suggest additional research is needed with particular care given to study design.
METHODS: This study included 1,103 year-2 school children enrolled in 7 public schools in the Klang Valley region of Malaysia. There were an equal proportion of males (50.6%) and females (49.4%). The testing battery was designed to assess visual acuity, ocular muscle balance, visual analysis skills, visual-spatial skills, and visual-motor integration skills.
RESULTS: Children with average and above-average achievement showed a different visual performance profile from those children with low academic achievement. They had a statistically significant better pass rate in physical aspects (visual acuity), physiological aspects (ocular motor balance), and perceptual aspects (visual-motor integration/visual-spatial and visual-analysis skills).
CONCLUSION: Children with low academic achievement are more likely to exhibit problems in visual acuity, ocular motor balance, visual-motor integration and most all components of visual analysis skills. This finding supports the concept that visual performance is key to learning and therefore of chief concern as to school achievement.) DM

An Invitation to Enroll in the COVD Fellowship Program

Do you have what it takes to be a Fellow of the College of Optomrtrist in Vision Development? Click on the title above to find out. DM

What's In A Simple Line Drawing? Quite A Lot, Our Brains Say

....."Our results suggest that our brains can recreate whole detailed scenes from just a few lines, ..... ...."The representations in our brain for categorizing these scenes seem to be a bit more abstract than some may have thought - we don't need features such as texture and color to tell a beach from a street scene," .... .....

ICO and the National Boards: Time to brag a bit!

The National Board of Examiners in Optometry noted that the national pass rate average for 1st time takers of this year's board was 77.7%. The Illinois College of Optometry pass rate, however was 90.1%.  The national pass rate (first time takers) dropped 14.4% from last year. This was probably due to the many changes made to the National Board this year. I am certainly biased when it comes to ICO, but I feel justified in saying that the ICO faculty, students, and adminstration have worked very hard to ensure our students perform at the highest possible level on national boards....and yet again, it appears that the programs we have in place a working very, very well! Congratulations to all!! DM


The following journal from Nature Publishing Group has been added to PMC:


ISSN: 0893-133X (print) 1740-634X (electronic)

Archive: volume 35 (2010) and 36 (2011). Current content is forthcoming, with no delay for select articles and a 12-month embargo for all remaining


Optometrist Receives Top Navy Award

...Lt. Kyle Dohm, an optometrist serving at Branch Health Clinic (BHC) Atsugi, has been named as the recipient of the U.S. Navy 2010 Stanley H. Freed Junior Optometrist of the Year Award, based on an announcement made by the U.S. Naval Hospital (USNH) in Yokosuka, Japan....

Comments: I just thought this was awesome for a colleague to be recognized! DM

Diagnosing Strabismus: A Hirschberg Simulation

Crazy Glasses

Wednesday, May 18, 2011

'Best' places to live with autism all in major metro areas

....Based on the results of the online survey, Autism Speaks listed the best places for families with an autistic child to live. Parents in 10 major metropolitan areas —New York, Los Angeles, Chicago, Cleveland, Philadelphia, Boston, northern New Jersey, Minneapolis/St. Paul, Seattle and Milwaukee — tended to report better access to services.....

Thinking Outside the Light-Box: Vision Therapy Support Group

Do you have a child with visual impairment...check out this Facebook page. DM

Effect of pupil size on uncorrected visual acuity in astigmatic eyes

.Both the amount of astigmatism and the pupil size can affect UCVA in astigmatic eyes. It is suggested that not only the amount of astigmatism but also the pupil size should be taken into consideration for acquiring better visual performance in astigmatic eyes....

Comment: Read free PDF by clicking on title above. DM

ICO Capstone 2011

As President of the ICO Alumni Council, I had the pleasure to present the first every Illinos College of Optometry Alumni Association Scholarship Award during the 2011 ICO Capstone Program. More than 53 awards were given to very deserving soon to be colleagues, doctors, and ICO alumni. These awards totaled more than $200,000 in value! Thanks to all for their support of this marvelous activity. Want to know who recieved recognition? Click here.

Mom shares story of daughter overcoming vision struggles

....Jillian Benoit is a smart, vibrant sixth-grader at Longfellow Middle School. She plays clarinet in the band. She is interested in drama, and she likes to read....These are things that would have more difficult without the intervention of her parents and visual therapy.....The journey from parenting a child legally blind in one eye through therapies, both productive and nonproductive, is documented in the book “Jillian’s Story: How Vision Therapy Changed My Daughter’s Life.”....It is a book which has caught the attention of vision care specialists around the country and led to the mother/author, Robin Benoit (pronounced Ben-wah), being invited to address the American Optometric Association’s School Readiness Summit in Washington, D.C....

Neurology International

The following new journal from PAGEPress has been added to PubMed Central.

Neurology International
ISSN: 2035-8377 (Electronic)


Archive includes 1 (2009)] to the current issue
Note: There is no embargo delay for this journal

International Journal of Therapeutic Massage & Bodywork

The following journal has been added to PMC:
International Journal of Therapeutic Massage & Bodywork

ISSN: 1916-257X (electronic)


Archive includes volume 1 (2008) to the current issue.
There is no embargo delay for this journal

Your Eyes Are Buggy!

Diversity of bacteria at healthy human conjunctiva

....The first DNA sequencing-based survey of bacterial population at the conjunctiva have revealed unexpectedly diverse microbial community. All analyzed samples contained ubiquitous (“core”) genera that included commensal, environmental and opportunistic pathogenic bacteria.....

Tuesday, May 17, 2011

Click Here so you can LIKE Optometry Giving Sight!

Visual Function at 35 and 40 Weeks' Postmenstrual Age in Low-Risk Preterm Infants

....this paper provides..... data for visual function at 35 and 40 weeks' postmenstrual age in low-risk preterm infants. The results suggest that early extrauterine experience may accelerate the maturation of aspects of visual function related to ocular stability and tracking but does not seem to affect other aspects that may be more cortically mediated. ....

Comments: For the full text/PDF click the title above. DM

Improving Infant Eye and Vision Care: InfantSee

....."Early eye and vision assessments are essential to a child's healthy development and I encourage all Ohio families with young children to take advantage of the InfantSEE® program," said Representative Pat Tiberi (R-Columbus). "I also commend Ohio's optometrists for providing their time and service, as well as the American Optometric Association and the Vision Care Institute, for providing access to free eye health assessments to help provide children the best start in life".....

Comments: Go to for more information. DM

School-Based Vision Therapy

...To my knowledge, no public school anywhere in the country, or in any English-speaking country for that matter, offers vision therapy under the purview of the school. They offer speech therapy for speech problems and occupational or physical therapy for motor problems, but not vision therapy for vision problems. Yet, if the developmental optometrists are correct, and I believe they are, the vision problems addressed by vision therapy affect learning far more than either speech or motor problems. Still, we have no vision therapy in public schools....

Health-Care Providers Are Prescribing Nontraditional Medicine

......collected information from more than 23,000 U.S. households from the 2007 National Health Interview Survey. They found that nearly 3 percent (representing more than 6.3 million Americans) used MBT due to provider referral and that these Americans were sicker and used the health care system more than people who self-referred for Mind-Body-Therapy.....

Politics, Research and Optometry

We often think that we seldom have an opportunity to make a real difference when it comes to electing public officials. After all what does my one vote really do?

I was lucky enough to meet John Arena early in his campaign. My wife and I sat down with him for almost an hour over a Sunday brunch and had an opportunity to get to know him. I then helped out with his campaign a bit in the social media area and later as a supporter asking all my friends and family to support his bid for Alderman of the 45th Ward in Chicago.

After a very hard fought campaign, John was declared the winner by 30 votes!

30 votes.

These 30 votes could have been the votes I helped to get for him by asking all I knew to support his campaign.  In the end what matters is YOUR vote and participation in this uniquely American process. Even in Chicago, which never seems ready for reform....we may have a chance at a new beginning because of 30 votes.

Chicago has a new Mayor and several new members of the City Council. Life just became very interesting in my home town.

How does this apply to optometry and the topics I frequently bring to your attention in this blog? Our lawmakers often determine what research is supported and what is not supported by allocating dollars for this research. Our lawmakers legislate what optometry can and cannot well as determine our very existence as a profession.

Will one single Chicago Alderman make a difference? Did a backwoodsman who grew up in Illinois make a difference? Did a kid who used to broadcast football games from Dixon, Illinois make a difference? Did that fellow who learned politics in Chicago and now sits in the White House make a difference?

Yes, and it all started with your involvement. Get involved. Pay attention....and VOTE! DM

Monday, May 16, 2011

Optometric Vision Therapy: Base Out LifeSaver Cards

Optometric Vision Therapy
Base Out LifeSaver Cards

This video has been placed in the public domain and may be freely distributed for non-commerical purposes only and should be used under the guidance of your family optometrist. Questions? Contact Dr. Dominick Maino at Copyright 2011 Dominick M. Maino

Intermittent exotropia: comparison of treatments

...Surgery with preoperative orthoptic/occlusion therapy had the highest success rates. Surgery with orthopticocclusion therapy was more effective in reducing exodeviation (prism dioptres per millimetre of horizontal rectus surgery), compared with surgery only...

Comments: Now here's why I usually recommend that my patients have optometric vision therapy BEFORE they consider strabismus surgery. The end result and outcomes are better if you do optometric vision therapy first!! Get this free PDF by clicking on the title above. DM

Pictures of Me Over the Years

AOANews Story about being inducted into the National Academies of Practice

For more information on the National Academies of Practice, click here.

Sunday, May 15, 2011


Hidden Roadblocks: What Parents Need To Know About Vision and Learning

.....As a mother trying to determine why her child was struggling with reading and learning, Robin Benoit found it very difficult to locate answers.  According to Jillian's fourth grade teacher, even though Jillian was very bright, her academic performance was lagging behind.  She had poor handwriting, left many of her class assignments unfinished, skipped words when she read out loud, would daydream during silent reading, and was consistently going to the restroom during math.  
Jillian had been diagnosed with amblyopia (also known as lazy eye) but despite following the treatment prescribed by the ophthalmologist she continued to struggle with reading, spelling, and math. Her mom started searching the internet for information regarding vision and learning.  Her pediatrician and ophthalmologist were not supportive when Mrs. Benoit thought she found the answer to her daughter's problem.  But she followed her heart and continued pushing forward to help Jillian. This push led Mrs. Benoit to optometric vision therapydevelopmental optometrist who was able to help Jillian. and a
The results from optometric vision therapy changed Jillian's life, making it possible for her to learn and do many things she'd never done more by clicking on title....