Monday, December 31, 2012

Visual Sensitivity Improved By Control Of Brain Activity; May Have Implications For Stroke Patients

Visual Sensitivity Improved By Control Of Brain Activity; May Have Implications For Stroke Patients

....Training human volunteers to control their own brain activity in precise areas of the brain can enhance fundamental aspects of their visual sensitivity.... This non-invasive 'neurofeedback' approach could one day be used to improve brain function in patients with abnormal patterns of activity, for example stroke patients. ....Researchers at the Wellcome Trust Centre for Neuroimaging at UCL used non-invasive, real-time brain imaging that enabled participants to watch their own brain activity on a screen, a technique known as neurofeedback. During the training phase, they were asked to try and increase activity in the area of the brain that processes visual information, the visual cortex, by imagining images and observing how their brains responded. ....

Comments: Functional optometrists already do this....it's called Optometric Vision Therapy! Go to http://www.COVD.org to find a doc who can help! DM

Sunday, December 30, 2012

Fragile X Study

The Carolina Institute for Developmental Disabilities (CIDD) at the University of North Carolina at Chapel Hill would like to inform you of an exciting new research opportunity available to families with infants who have a child diagnosed with fragile X.

This multi-center study involves the collaboration of two sites which are part of an NIH-funded network (University of North Carolina at Chapel Hill, and Washington University in St. Louis, MO). At UNC, the lead investigator is Heather Cody Hazlett, PhD., she is well known in the field of developmental disabilities, and is currently assisting and leading four studies within the field of developmental disabilities. Currently, we are searching for 30 participants in the United States who meet the following criteria:

  • Are between 0-6 months of age (parents who are expecting may also be eligible)
  • Have diagnosis of  fragile X
Once a family is enrolled in this study, they will travel to Chapel Hill, NC for a comprehensive series of developmental, non-invasive assessments completed on the infant at the 6, 12 and 24 month time periods.  Also, during this trip the infant will receive an MRI scan while they sleep.  Between trips to Chapel Hill there will be phone conversations, genetic and environmental data collection.

There is no cost for family participation.  All travel and lodging costs are reimbursed by the study, and any services the study provides are at no charge to the family.  Families will receive feedback on the assessments and each MRI scan. I would like to speak with you further about participating in this research.  Please do not hesitate to contact me either by email or phone for more information.

Participating in this study is not the only way to get involved!  If this does not sound like something you are currently interested in, please consider sharing this information with your friends and family who may be interested in participating.

Please contact:


Heidi Bryant
Heidi.bryant@cidd.unc.edu   https://www.fragilexregistry.org/
Carolina Institute for Developmental Disabilities   
UNC-Chapel Hill, CB# 3367                          

Chapel Hill, NC  27599-3367            
             
Phone: (919) 966-5278
Toll-Free: (800) 793-5715
Fax: (919)843- 3825

Saturday, December 29, 2012

3D Vision Syndrome & 3D Movies: A PSA from COVD

3D Vision Syndrome & 3D Movies Do you or your children have problems seeing the 3D in 3D movies, video-games, and academic programs. Watch this video to learn more about this.

  >

 
This public service announcement is brought to you courtesy of the College of Optometrists in Vision Development.

Friday, December 28, 2012

OMD Comment on "The Number of Placebo Controlled, Double Blind, Prospective, and Randomized Strabismus Surgery Outcome Clinical Trials: None!"


One of my ophthalmological colleagues (Dr. EA Pennock) commented on my editorial, " The Number of Placebo Controlled, Double Blind, Prospective, and Randomized Strabismus Surgery Outcome Clinical Trials: None!".

This is a bit long, but should be informative. I have not edited his commentary in anyway. Please read and note my [comments]:

One can't ignore the studies regarding anesthesia and the potential for future cognitive impairment. This is a work in progress and the pediatric specialties are following closely. Like anything in medicine (and you should be well-versed since you received an "Excellence in Medicine" award) you have to consider the risk-vs.-benefit ratio.
[While the risk involved in strabismus surgery is small, you are right that it cannot be ignored. Is the benefit always worth the risk when 1/3 of those who have had the surgery need a second surgery and 1/3 of those a third surgery? Do not misunderstand me here, I have recommended surgical intervention for those with strabismus, but only after I have conducted vision therapy to improve all the foundation visual skills. DM]  

If I have a young patient with a 40 PD decompensated exotropia who is in danger of developing irreversible amblyopia 
[Research clearly shows that this dated and worn out concept of irreversible amblyopia is not only no longer true, it never was true. As an expert in this area I assume you are aware of this. Please do a PubMed search for a review article by Dennis Levi, OD, PhD. Actually, just click here for several of Dr. Levi's studies in this area. Note that he and his colleagues conduct “perceptual learning” which is really vision therapy by another name. DM] 

and loss of stereoacuity, 30-40 minutes of anesthesia for strabismus surgery is not going to prevent him or her from getting into Harvard.
[You might be right if it only took one surgery...but what about the cumulative effect of 3 surgeries? What about other surgeries the child may have for one reason or another over their lifetimes? DM] 

NB vision therapy and patching will not touch a 40 XT]. People need to be properly educated, look at all of the facts, and not over-react.
[I agree, you should really look at all the facts. Start with amblyopia for one! DM]

"The Number of Placebo Controlled, Double Blind, Prospective, and Randomized Strabismus Surgery Outcome Clinical Trials: None!" Not entirely false
[Thanks for acknowledging the truth present in my editorial, I really appreciate it! [DM]

but there have been many published outcome trials
[This does not appear to be true according to Cochrane's Reviews (see below) where I sought most of the information in my editorial. There are not only few clinical trials but most according to Cochrane are of poor quality or show poor outcomes. DM]

Search PubMed. As far as placebo-controlled and double-blinded--that's just ludicrous and not really feasible.
[Isn't that interesting? This is the same thing optometrists said when you told us we needed clinical trials when it came to vision therapy. Somehow we managed with the many CITT studies. So are you admitting you cannot do "good" clinical trials in the area of strabismus surgery? DM] 

The patients will know whether they had surgery. The blinded examiners will also be able to figure out who had surgery and who did not. The only way to blind/mask it is to take one cohort and put them under anesthesia, make an incision, and go through the motions i.e. sham surgery. Another option would be to operate on a cohort of patients without strabismus--to compare outcomes. I'm certain that both scenarios are unethical and any IRB (institutional review board) would not be amused. 

Speaking of which, I have yet to come across a well-designed and executed vision therapy study without multiple confounding variables. The CITT does not count, though it is legitimate
[I am thrilled that you think this study is legitimate...but I'm puzzled why you say it does not count? Does it not count because you say so or do you have some science to back up your comment about this "legitimate" clinical trial? DM]

Its results are often inappropriately extrapolated for all vision therapy. The CITT addressed only a specific problem, namely convergence insufficiency.
[The few clinical trials concerning strabismus surgery are also inappropriately extrapolated for all surgical interventions one can use with strabismus. There are also multiple ways one can go about conducting the surgery, right? I have been told by your colleagues that strabismus surgery is as much "art" as it is "science". Is this true? DM]   

It did not look at dyslexia
[Find articles about reading and vision by clicking here. DM],

headaches 
[Headaches are often associated with uncorrected refractive errors (Headaches Associated With Refractive Errors: Myth or Reality? , The Correlation Between Migraine Headache and Refractive Errors) and binocular vision dysfunction (Is all Asthenopia the Same? , Asthenopia in Schoolchildren, Orthoptic and Ophthalmological Findings and Treatment) You should also be aware that one of the symptoms eliminated after vision therapy is headaches as noted in the CITT study, right? DM], 

cortical blindness 
[Are you familiar of any of the research in the area of vision rehabilitation? I'm giving a presentation during the Pediatric Cortical Visual Impairment Conference this year at the Children's Hospital in Omaha, NE this April. Although I was only going to discuss vision therapy for those with cortical blindness in a limited fashion, I'm sure the other presenters will do so in more detail. I hope to see you there. DM],

reading comprehension, 
[Besides the articles concerning vision and reading noted above, a colleague of mine recently published, Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls, and found that ... there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination...in addition to a comprehensive binocular vision evaluation.... DM]

esotropia,
[Throwing in everything except the kitchen sink is an old, tired argument methodology that ophthalmology uses to confuse the issues. Shame on you for digging this one up to support your statements about strabismus surgery. Dyslexia, headaches, etc. are not relevant to this discussion at all. If you stick to the point, you might make a better, more believable statement. DM] 

and so forth.
[Here is a listing of hundreds of articles concerning vision therapy. Happy reading! 
Summary 1
Completed in July, 2009, this paper presents over 350 abstracts from 77 journals.

Summary 2

Completed in October, 2010, this paper presents 35 additional abstracts.
Maybe, once you review these hundreds of articles, you might be changing your opinion on at least some of your feelings regarding vision therapy. DM]

Moreover it only looked at convergence/orthoptic exercises,
[You should know that clinical trials tend to be narrowly focused. You do understand how clinical trials are conducted, right? DM] 

not syntonics, 
[The use of light for therapy is well founded in several areas of medical care. Click here for more information on syntonics. DM]

yoked prism, 
[The use of yoked prisms has been invaluable in the case of brain injury (Vision Disturbances Following Traumatic Brain Injury), improving asthenopia (The use of yoked base-up and base-in prism for reducing eye strain at the computer .), and can improve vision function and reduce symptoms. Click here.]

 low powered reading glasses, 
[Although not a direct comparison, whoever thought a sub-clinical dose of aspirin could have an effect that reduces your chance of heart attack? This is an area where we do need additional studies but take a look at Behavioral effects of low plus lenses,     and using low plus to reduce myopia (Decrease in Rate of Myopia Progression with a Contact Lens Designed to Reduce Relative Peripheral Hyperopia: One-Year Results).

 pinhole glasses, 
[We agree on this one. Most ODs and OMDs, would agree this is a scam. But both professions have members that promote interventions that need to be carefully evaluated like when the ophthalmologist, Dr. Bates says "palming" can slow down myopia development. DM]

flashing lights, 
[Not sure what you mean by "flashing lights". DM]

and the myriad other exercises that often cost patients thousands of dollars out-of-pocket.
[It's a good thing you never charge for your services, right? You do charge every time you repeat a strabismus surgery, don't you? Fees should not be an issue here, but a discussion for another day. Once again you are reaching beyond the topic to muddle the issues involved. DM]

Orthoptic exercises and surgery can both have excellent results in the hands of a skilled therapist and surgeon, respectively.
[Optometric Vision Therapy and surgery can both have excellent results in the hands of a skilled optometrist, surgeon, and therapist... no argument here! You do have to be open to all avenues of therapy, however, and not closed minded and prejudicial. DM]

 I hope this cleared up some misconceptions.
[I hope I helped to clear up some of your misconceptions as well. DM]

EA Pennock, MD 

Dear Dr. Pennock:
I do appreciate the time you took to respond to my concerns regarding strabismus surgery (even the sarcasm). I believe we both want what is best for our patients. I also believe that we both want to see a great deal more science behind our treatment paradigms.

My concern is that your colleagues seldom acknowledge the short comings of strabismus surgery, while bashing optometric vision therapy without taking the time to review the current research in this area.

My concern is that your colleagues often demand of optometry a level of evidence not demanded of themselves.

My concern is when ophthalmology bans optometrists from their meetings because of professional pettiness and a meanness of spirit, our patients are the ones who suffer.

Several of my awesome colleagues have addressed many of these issues as well. Please see:

 
 I would also suggesting reading:

MDs Talk about Vision Therapy
MDs discuss Vision Therapy as an effective medical treatment. 

Vision Therapy: Information for Health Care and Other Allied Professionals
A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association 


Foundations of Binocular Vision: A Clinical Perspective by Scott Steinman, Barbara Steinman and Ralph Garzia

Anomalies Of Binocular Vision: Diagnosis And Management,  by Robert P. Rutstein OD MS and Kent M. Daum OD MS PhD

 Binocular Anomalies: Diagnosis and Vision Therapy by John R. Griffin MOpt OD MSEd, J. David Grisham OD MS FAAO

You should also see the comments and other presentations by Susan Barry, PhD. Read Fixing My Gaze, read her Psychology Today blog, and check out her YouTube channel as well.
 
I should also mention the American Optometric Association's Clinical Guidelines ....

Finally, Cochrane had other reviews of strabismus intervention used by OMDs that I might not have mentioned in the editorial:

Cochrane's Reviews on Strabismus Treatment
 ......The one included study in this review compared surgery on one eye to surgery on both eyes for the basic type of X(T) and found that surgery on one eye was more effective. There are many studies of X(T) in the current literature but the methods used do not allow reliable interpretation of the results. Furthermore there is a worrying lack of evidence regarding the natural history of X(T) and poor validation of measures of severity. There is a clear need for further randomised studies to provide more reliable evidence for the management of this condition......

 The review did not find any randomised trials that compared treatment to another treatment or to no treatment. 

Let's not forget about the use of ....

...This review found four randomised controlled trials that compared botulinum toxin to another treatment or to no treatment. The results showed no prophylactic use for botulinum toxin in sixth nerve palsy, poor effect in adult horizontal strabismus without binocular use of the eyes, and no difference in response for retreatment of infantile esotropia or acute onset esotropia. It was not possible to determine dose effect because of the different types and doses of botulinum toxin used in each trial. Complications from the use of botulinum toxin (Botox™ or Dysport™) included transient ptosis and vertical deviation and combined rates for these complications ranged from 24% to 55.54%. This review identified a need for more randomised controlled trials to provide further reliable evidence on the effective use of botulinum toxin for the treatment of strabismus....

Please take a moment to study the many resources I have provided.

I suppose that we could continue to argue any number of points......  

I would suggest, however, that we come together as individuals and as learned professions. I suggest that we put aside our political differences and territorial behaviors; stop the pettiness and work together for the benefit of our patients, as equals. 

I know optometry has been and is willing to do this. Can you say the same for ophthalmology? DM
 


Thursday, December 27, 2012

Ophthalmic manifestations of children with Down syndrome in Port Harcourt, Nigeria

Ophthalmic manifestations of children with Down syndrome in Port Harcourt, Nigeria

.....Refractive errors were prevalent ....., whereas the prevalence of ocular diseases was low when compared to age-matched control participants. This study highlights the need for ophthalmic care in children with DS. Routine eye care such as the use of spectacles when necessary is recommended for people with DS at all ages to improve their educational and social needs as well as overall quality of life.....

Comments: It did not appear as if they assessed accommodative function in their population. The incidence of focusing dysfunctions in those with Down Syndrome is so high that you should typically assume that a plus add is needed for near tasks. (See Woodhouse M. Maino D. Down Syndrome. In Taub M, Bartuccio M, Maino D. (Eds) VisualDiagnosis and Care of the Patient with Special Needs; Lippincott Williams & Wilkins. New York, NY;2012:31-40. for a review of the vision problems associated with those who have Down Syndrome)

Wednesday, December 26, 2012

Prevalence of Amblyopia and Refractive Errors in an Unscreened Population of Children

Prevalence of Amblyopia and Refractive Errors in an Unscreened Population of Children

....Refractive errors ranged from 84.2% in children aged up to 2 years to 75.5% in those aged 10 to 12 years. Refractive error showed a myopic shift with age; myopia prevalence increased from 2.2% in those aged 6 to 7 years to 6.3% in those aged 10 to 12 years. Of the examined children, 77 (16.3%) had refractive errors, with visual loss; of these, 60 (78%) did not use corrections. The prevalence of amblyopia was 3.1%, and refractive error attributed to the amblyopia in 9 of 13 (69%) children.....

Comments: Children do not need to be screened. The outcomes of vision screening have been shown to be poor. Our children need full, comprehensive eye examinations at least once a year until high school. DM

Tuesday, December 25, 2012

Christ is Born! Merry Christmas!



 Merry Christmas and Happy New Year
Peace. Love. Family. Friends. Faith.
2013 Here We Come!

Sunday, December 23, 2012

The Effect of Sensory Uncertainty Due to Amblyopia (Lazy Eye) on the Planning and Execution of Visually-Guided 3D Reaching Movements

The Effect of Sensory Uncertainty Due to Amblyopia (Lazy Eye) on the Planning and Execution of Visually-Guided 3D Reaching Movements

Sensory uncertainty due to amblyopia leads to reduced precision of the motor plan. The ability to implement online corrections depends on the severity of the visual deficit, viewing condition, and the axis of the reaching movement. ...., patients with severe amblyopia were not able to use online control as effectively to amend the limb trajectory especially along the depth axis, which could be due to their abnormal stereopsis...

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

Saturday, December 22, 2012

Visual Outcome in Isoametropic Amblyopic Children With High Hyperopia and the Effect of Therapy on Retinal Thickness

Visual Outcome in Isoametropic Amblyopic Children With High Hyperopia and the Effect of Therapy on Retinal Thickness

.....Visual acuity of isoametropic amblyopia improved satisfactorily with spectacle correction and vision therapy. Treatment duration had the greatest impact on VA improvement. Age at first correction also influenced VA improvement but was not a good clinical predictor. Foveal thinning occurring with treatment was not correlated with visual improvement......

Friday, December 21, 2012

Perceptual Learning Reduces Crowding in Amblyopia and in the Normal Periphery

Perceptual Learning Reduces Crowding in Amblyopia and in the Normal Periphery

...Amblyopia is a developmental visual disorder of cortical origin, characterized by crowding and poor acuity in central vision of the affected eye. Crowding refers to the adverse effects of surrounding items on object identification, common only in normal peripheral but not central vision. ...., perceptual learning reduced the deleterious effects of crowding in amblyopia and in the normal periphery. The results support the effectiveness of plasticity-based approaches for improving vision in adult amblyopes and suggest experience-dependent effects on the cortical substrates of crowding.....

Comments: Full article available by clicking title above. DM

Thursday, December 20, 2012

Recovery of stereo acuity in adults with amblyopia

Recovery of stereo acuity in adults with amblyopia

...Plastic neural mechanisms can be harnessed to develop new treatment tools for treating amblyopia in adulthood......Monocular improvements in visual performance promoted the independent recovery of stereoscopic visual function in adults with amblyopia.....It is possible to recover normal levels of stereo function in amblyopic subjects with mature visual systems, challenging the long held dogma that the critical period for visual development and the window for treating amblyopia are one and the same....
 
Comments: The bottomline is that amblyopia can be treated at any age. Full article available by clicking on the title above. DM

Wednesday, December 19, 2012

Damari Appointed Dean of Michigan College of Optometry at Ferris State University


Damari Appointed Dean of Michigan College of Optometry 
at Ferris State University


BIG RAPIDS, Mich.—David Damari, OD, FCOVD, FAAAO, has been appointed dean of the Michigan College of Optometry at Ferris State University, effective March 28, 2013. Fritz Erickson, provost and vice president for academic affairs made the announcement on Dec. 14, 2012.

Damari was most recently chair for the Department of Assessment and professor at Southern College of Optometry in Memphis, Tenn. Since 1995, he has been a consultant on visual disabilities, advising national and state testing organizations on candidates who have requested special testing accommodations under the Americans with Disabilities Act, including the National Board of Medical Examiners, National Board of Examiners in Optometry, CFA Institute, Graduate Management Admissions Council, National Board of Osteopathic Medical Examiners, National Conference of Bar Examiners, Law School Admissions Council, and State Bar Examiners including Minnesota, Texas and Virginia. His previous administrative experience also included serving as chair of the Department of Optometry at Southern College of Optometry. Prior to his career at Southern College of Optometry, Damari operated a private solo practice in New York and was an assistant clinical professor at the State University of New York College of Optometry.
Damari's present professional service includes president for the College of Optometrists in Vision Development and co-chair at the Summer Institute for Faculty Development for the Association of Schools and Colleges of Optometry. He also serves in numerous roles for the Association of Schools and Colleges of Optometry. Damari was awarded the Southern College of Optometry President's Special Recognition Award and the Fredrick W. Brock Memorial award for Outstanding Performance in Vision Training. Damari earned a Doctor of Optometry degree from State University of New York College of Optometry, and he was a 2002 fellow-in-resident for the National Board of Examiners in Optometry in Bethesda, Md.

His latest publication includes a chapter (Disabilities and the Education System) in the book, Visual Diagnosis and Care of the Patient with Special needs.
"Damari has passion for the profession of optometry and a keen awareness of the changes that will occur in health care and health care education over the new few decades," Erickson said. "We look forward to the leadership that he will provide for the Michigan College of Optometry at Ferris."
Comments: I've been a friend and colleague of Dr. Damari for many years. He is an incredible person who will lead MCO into this new millenium with a great deal of passion and commitment. Congratulations David! DM