The neuro-ophthalmology of head trauma

"....Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Concussion, a form of mild TBI, might be associated with long-term neurological symptoms. The effects of TBI and concussion are not restricted to cognition and balance. TBI can also affect multiple aspects of vision; mild TBI frequently leads to disruptions in visual functioning, while moderate or severe TBI often causes structural lesions. In patients with mild TBI, there might be abnormalities in saccades, pursuit, convergence, accommodation, and vestibulo-ocular reflex. Moderate and severe TBI might additionally lead to ocular motor palsies, optic neuropathies, and orbital pathologies. Vision-based testing is vital in the management of all forms of TBI and provides a sensitive approach for sideline or post-injury concussion screening. One sideline test, the King-Devick test, uses rapid number naming and has been tested in multiple athlete cohorts....."

How Curiosity Changes the Brain and Enhances Learning

".....The findings yielded three major conclusions regarding curiosity and changes in the brain: First, those who are highly curious put forth the effort to seek out the answers to a particular question are better at learning the information. Although, a seemingly obvious finding, this led researchers to discover that the more an individual’s curiosity is aroused the more likely he/she is able to learn unrelated information; i.e., information they may not have been interested in the first place.

A second finding shows that once curiosity is stimulated in the brain there is increased activity in the areas related to reward. The brain’s reward circuit relies on dopamine which acts as a “chemical messenger that relays messages between neurons.” Curiosity is an intrinsic motivator that triggers the brain’s reward circuit in a similar manner that would be observed with extrinsic motivators, according to the researchers.

And lastly, along with stimulating the brain’s reward circuit, curiosity also increased activity in the brain’s hippocampus -an area that helps to form new memories. The increased interactions between these two areas in the brain lead to increased learning and retention....."

Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children.

"....Hyperopia (farsightedness) in infancy requires accommodative effort to bring images into focus. Prolonged accommodative effort has been associated with an increased risk of strabismus (eye misalignment). Strabismus makes it difficult for the eyes to work together and may result in symptoms of asthenopia (eye strain) and intermittent diplopia (double vision), and makes near work tasks difficult to complete. Untreated strabismus may result in the development of amblyopia (lazy eye). The prescription of spectacles to correct hyperopic refractive error is believed to prevent the development of strabismus........Although children who were allocated to the spectacle group were less likely to develop strabismus and less likely to have visual acuity worse than 20/30 children allocated to no spectacles, these effects may have been chance findings, or due to bias. Due to the high risk of bias and poor reporting of included trials, the true effect of spectacle correction for hyperopia on strabismus is still uncertain....."

Comments: This was an assessment by Cochrane Reviews. Cochrane takes a very detailed assessment of current evidence that supports the diagnosis and treatment of numerous disorders. They use extensive statistics to assess the research and to determine the validity of its conclusions. Because there is seldom a perfect research project that results in a perfect research publication, you often get the impression that Cochrane dislikes 99.99% of all research published. 

What I usually recommend is to evaluated the research, the assessment of that research and what my patients need to solve their problems. This paper starts out noting that uncorrected hyperopia can lead to strabismus, amblyopia and a whole host of other symptoms that interfere with ones quality of life.

Although you should always use the best available evidence based clinical approach, you should not be bound by this research, it's often restrictive results and its possible non-appropriate application for any one individual patient. 

As always use this research and your own clinical experience to determine what is best for each individual you see. A great example of this was those who stated that amblyopia could not be treated after a certain age because of a misunderstanding of the available research in this area. Functional optometrists had many clinical experiences and published numerous papers from case reports to multipatient studies at different evidence levels that supported treating those with amblyopia at any age. Unlike many of our medical colleagues we actually helped these patients as opposed to those who told their patients that "nothing could be done".

Use research as a guide in patient care and not as a pair of handcuffs binding your approach to improve your patients' quality of life. DM

Fitting glasses just part of comprehensive eye care

Fitting glasses just part of comprehensive eye care

Illinois College of Optometry alumni featured in Chicago Tribune Career Builder story.

"....Optometry involves far more than giving eye exams and fitting people for glasses and contact lenses.

...Deborah Zelinsky, an optometrist at Northbrook's Mind-Eye Connection, is part of a highly trained team of vision experts serving patients with a wide variety of needs....

...Geoffrey Goodfellow, an associate professor at Chicago's Illinois College of Optometry, said an optometrist is the primary health care professional for vision care. Optometrists examine, diagnose, treat and manage eye diseases, injuries and disorders of the eye and associated structures related to vision....

Comments: Both Dr. Zelinsky and Dr. Goodfellow are not only alumni of the Illinois College of Optometry, but also members of the College of Optometrists in Vision Development as well. Congratulations to both!

To read the full story, click on the link above! DM

Don't Buy Contact Lenses from Any Store or Website If It Doesn't Require a Prescription

Selling lenses without a prescription is illegal and can put consumers' eye health at risk, warns the American Optometric Association.

Some Halloween enthusiasts may wear decorative contact lenses, which can change a person's eye color or create the effect of a character like a cat, zombie, or vampire, as part of their costume. However, if these lenses are bought without a prescription from an eye doctor, they could lead to serious health issues and potentially damage your eyesight.

Eyes Gone Bad from Evil Halloween Contact Lenses!

All contact lenses are classified as medical devices by the U.S. Food and Drug Administration (FDA) and require a valid prescription, whether they correct your vision or are worn simply for a special occasion, like Halloween, proms or weddings. "Even though these are non-corrective lenses, they still pose the same potential health and safety risks as other contact lenses," says Glenda Secor, O.D., chair of the AOA's Contact Lens and Cornea Section.

However, some decorative lenses are sold illegally through flea markets, the Internet, beauty salons, convenience stores, and even national retailers. The AOA warns that you should never buy lenses from these sources. "When purchased over-the-counter, decorative contact lenses can put people at risk for bacterial infections, allergic reactions, or even significant damage to the eye's ability to function, with the potential for irreversible sight loss. Sadly, numerous cases of serious harm have been documented," adds Dr. Secor.

According to the AOA's 2013 American Eye-Q® consumer survey, 17 percent of Americans have worn decorative contact lenses that don't provide vision correction as part of a costume or for other cosmetic purposes. Of those individuals, 24 percent purchased them without a prescription from a source other than an eye doctor—a great concern to doctors of optometry.

 "Don't buy contacts from any store or website that doesn't require an eye doctor's prescription," adds Dr. Secor.  "In other words, if you can walk in off the street, or log-on to a website and buy them without verification of your prescription, the lenses are not being sold legally."

It's important to have a medical eye and vision examination from your optometrist to be sure you are a good candidate for contact lenses and your cornea can safely tolerate the lenses. Your eye doctor will also make sure your lenses fit properly and teach you how to safely care for your lenses.

"One of the safest things consumers can do is visit an eye doctor for a consultation," says Dr. Secor. "This way they can obtain the proper prescription and lens material, and ensure a healthy contact lens fit, reducing the risk of infection or other serious side effects."

The AOA offers the following recommendations for all contact lens wearers:

• Wear contact lenses only if they are fitted and prescribed by an optometrist.
• Do not purchase contact lenses from gas stations, video stores, websites, or any other place not authorized by law to dispense contact lenses.
• Make sure contact lenses are properly cleaned and disinfected as instructed by your eye-care professional.
• Make sure you wash your hands before handling and cleaning your contact lenses.
• Never swap or share contact lenses with anyone.
• Never sleep while wearing contact lenses unless they are extended-wear lenses specifically designed for that purpose.

Information on violations should be well documented and reported to the FTC as quickly as possible with a request for FTC investigation and action. Violations can be reported to the FTC electronically directly through the FTC Web site.

If a patient has been harmed or injured due to the illegal sales of contact lenses (corrective or decorative) AOA urges that doctors report the incident to the Food and Drug Administration (FDA) through the FDA's website.

Eye care practitioners should also send an e-mail copy of any complaint filed regarding the FCLCA to the AOA at: [email protected] so the association can maintain an accurate record of all complaints filed with the FTC and FDA.

Click here for more information about the risks associated with decorative contact lenses, or to find additional resources about contact lens hygiene and safety.

Bifocals in children with Down syndrome

Bifocals in children with Down syndrome


"...[Introduction]...the aim of this study was to investigate the impact of bifocals on the educational 
attainment of children and young adults with DS who have reduced accommodation and monitor 
their performance longitudinally. ...

[Key Findings]...Accommodation accuracy was found to improve with bifocals.... bifocals do have an impact on the children‘s visual and school performance....there was a statistically significant overall improvement in word recognition tests and in some visual perceptual skills. .... This improvement in reading performance and visual perceptual tasks is expected to transfer into improvements in academic attainments...... the children were readily using the bifocals and adapted to them quicker than expected. In fact, they appeared to adapt to them more readily than the SV glasses, wearing them for the majority of their waking time. ..... On average the children performed the WI test faster with bifocals at both the main visits and after bifocal provision. Faster performance was also seen with the Dolch and the number writing test in the monthly probes.....

.[Conclusion]...This was also one of the few studies that assessed reading, printing and perceptual skills together with measures of literacy administered every month. To conclude, this thesis provides evidence of improved near visual acuity, accommodative accuracy and improved performance and rate of performance on tests of literacy with bifocals. Indirect measures of compliance also showed improved compliance with bifocal lenses compared to single vision lenses. Thus the clinical standard of care must change for individuals with DS. The clinical standard of care should include the measurement of accommodation and that clinicians be more ready to prescribe bifocals to children and young adults with DS who present with reduced 
accommodation. More studies are required to understand the long term impact of bifocals in 
individuals with DS and in similar populations....."

Comments: This is a dissertation by Krithika Nandakumar a PhD candidate at the University of Waterloo, in Canada. It appears to be a well designed and thought out study.

If these findings are in fact accurate and the outcomes are reliable, why does the medical/scientific community accept the fact that bifocals can do all these wonderful things in children with Down Syndrome and then scoff at the improved outcomes (similar to those noted above) noted for children without Down Syndrome when functional optometrists use bifocals and/or vision therapy to improve accommodative function in their patients?

Could it be that functional optometry has been right all along and the non-OD community is embarrassed for their shortsightedness in so many areas (pun intended!)? 

Functional optometrists were right when we said amblyopia could be treated at any age.

Functional optometrists were right when we said in office vision therapy is an effective mode of treatment for binocular vision disorders.

Functional optometrists were right when we said the environment affects the development of refractive error.

Are functional optometrists also right when we say that learning related vision problems can affect academic performance and with vision therapy we can improve school performance? 

Stay tuned for the outcomes of the Office-based Vision Therapy for Improving Reading and Attention in Children With Convergence Insufficiency (CITT-ART) clinical trials. I'm betting we are right about this too!!! DM