Friday, April 25, 2008

Study breaks ground in revealing how neurons generate movement

...When the eye tracks a bird’s flight across the sky, the visual experience is normally smooth, without interruption. But underlying this behavior is a complex coordination of neurons that has remained mysterious to scientists. Now, UCSF researchers have broken ground in understanding how the brain generates this tracking motion, a finding that offers a window, they say, into how neurons orchestrate all of the body’s movements. ...

80 percent of Americans claim docs need better bedside manners

........As the 2008 national presidential election heats up, one topic remains a voter hot button and a constant debate issue - the health care crisis in America. Political affiliations aside, there is one aspect everyone can agree on - the importance of access to quality health care. But what defines ‘quality’ health care today" According to a new survey conducted by Kelton Research for the Arnold P. Gold Foundation, a vast majority of Americans wish their doctors demonstrated the ‘care’ in the term heath care. The survey unveiled that nearly eight out of ten polled (78 percent) complain that today’s doctors need better bedside manners and less than half of survey respondents could describe their doctor’s recent conduct as attentive (49 percent), communicative (44 percent) or compassionate (32 percent) at their last medical visit. ...

Comment: In the latest edition of the COVD newsletter, Dr. Dan Fortenbacher notes we have an epidemic of "empathy insufficiency" among some docs. I agree. The #1 complaint from the patients I see from other docs that their former doctors' bedside manner was awful. Be good. Be sympathetic and empathetic. Let's listen to our patients. DM

FDA Okays Lisdexamfetamine Dimesylate (Vyvanse) for Adults with ADHD

Do you work with adults with ADHD?

Patients randomized to active treatment reduced ADHD rating scale scores by 16.2 to 18.6 points. Patients treated with lisdexamfetamine dimesylate also improved scores on the Clinical Global Impressions-Improvement (CGI-I) scale by 57% to 61%, the company said. The most common adverse events were decreased appetite, difficulty falling asleep, and dry mouth.

Comment: All drugs have potential adverse affects...and just as I suggest for children....I will also recommend for adults....use drugs usually as one of your last forms of treatment. It's been noted, for instance, that ADHD behaviors can be associated with vision problems...rule out other causes of the attention problems other appropriate methodologies of treatment...then consider drugs. Drugs can help many patients.....knowing when to use/recommend them is the sign of a good doc! DM

Skin Contact With Mothers Palliates Preemies' Pain

...In a single-blind, randomized, crossover trial, infants born at 28 to 31 weeks of gestation getting kangaroo mother care [Skin-to-skin comforting by the mother ]recovered to baseline pain levels following a heel lance significantly faster than those who were left swaddled in an incubator (123 versus 193 seconds, P<0.0000).>

Comment: Mom's touch heals and makes us feel better! No argument from me. DM

Health Advice on the Internet

From AOA First Look:

HealthDay (4/24, Thompson) reported that while "[t]he Internet offers a dizzying amount of health information," this "information can lead to overload -- or worse." Don Powell, Ph.D., president and CEO of the American Institute for Preventive Medicine, said, "We ask people when they look on the Web that they make sure the site is accredited," because that is "a good way to establish trustworthiness." Jim King, M.D., a family practice doctor in Selmer, Tenn., and president of the American Academy of Family Physicians, noted that "websites published by companies or individuals can contain some good advice, but health consumers need to be more discerning when using those sites." Dr. King added that "[t]he ads supporting a site can be a hint to possible bias."

Comment: The health info from this blog is the best and most accurate I can find....and if you've been reading this blog for any length of already are quite aware of whatever bias I may have! DM

Sports-related injuries among children.

From AOA First Look:

The Chicago Tribune (4/24, Ahmed, Napolitano) reported that according to estimates released by the U.S. Consumer Product Safety Commission (CPSC), over "65,000 children younger than 15 received treatment in an" emergency department (ED) "for skateboarding-related injuries in 2006." Researchers, "extrapolating from a sample of 100 hospitals across the nation, estimate that nearly 240,000 children under age 15 were treated for bike-related accidents, the highest number for any sport." Moreover, "[i]n that age group, football resulted in almost 221,000 injuries, baseball almost 85,000, and operating unpowered scooters slightly more than 37,500." Gary Smith, M.D., Dr.P.H., director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, said, "Injury is arguably the most compelling public health problem facing youth in this country, because it is the leading cause of death and acquired disability from ages one through 44 years."

Comment: Always recommend polycarbonate or TriVex lenses....and other forms of protective eyeware for your young or athletically inclined patients... DM

Thursday, April 24, 2008

Young Adults Play Solar Roulette Despite Awareness of Dangers

...Suntans and indoor tanning beds show no sign of losing popularity among young adults even though the message about the cancer hazards has gotten though, researchers here said.More than 80% of beach-going Chicagoans 18 to 30 years old surveyed in 2007 said people look better with suntans, up from 69% and 58% in surveys conducted in 1994 and 1988, respectively, reported June K. Robinson, M.D., of Northwestern, and colleagues, in the April issue of Archives of Dermatology.Although 87 of 100 respondents in 2007 said they knew about the link between skin cancer and tanning -- compared with 38% in 1994 and 42% in 1988 -- there has also been no decline in use of indoor tanning beds, the researchers said....

Comment: Don't foget to tell all your patients about the eye complications that can happen if you do not wear protective sun eyeware....every child should have sun glasses!

More kid friendly products for kids needed!

From AOA First Look...

Doctors want medical device industry to design more products for children.

The AP (4/24, Perrone) reports, "With growing support from lawmakers, doctors are prodding the medical device industry to design a new class of kid-friendly equipment." But, "[t]he profit potential is limited because....experimental kid-sized devices" can "be sold without full federal approval only if they're used to treat rare diseases." Furthermore, "compared to adults, kids are healthier, and therefore a much smaller market to begin with." Being that "companies like Medtronic and Boston Scientific Corp. [are] already under scrutiny for pacemakers, stents and other adult devices, they may be more reluctant to start testing in kids." While doctors often "work around the" lack of kid-sized devices "by jury-rigging adult-sized devices to" treat younger patients, "they acknowledge that such ingenuity has limits and that the risks to patients are often high."

Necrotizing scleritis after strabismus surgery

...This is a case report of a 88-year-old woman developed necrotizing scleritis after eye muscle surgery. The scleritis completely resolved after initiation of systemic corticosteroids. Postoperative necrotizing scleritis is a rare complication that occurs at the site of previous ocular surgery. ...

Comment: No surgery is 100% safe. Unwanted affects can happen.

Bilateral brown syndrome in monozygotic twins

...Most cases of Most cases of Brown syndrome are sporadic and unilateral. We believe this to be the first reported occurrence in monozygotic twins. . ...

Vision Problems Affect How Children Learn Math Skills

In the most recent issue of Optometry & Vision Development, two articles were
published by German scientist and researcher,
Dr. Burkhart Fischer and his team
which found that children with vision problems have a hard time learning basic
mathematical skills and that if the appropriate vision therapy is given, math skills

Dr. Fischer’s work has been featured on several German television news programs
which reported on his research in the area of deficits in vision and eye movement
control, as well as his success using vision therapy and its ability to improve reading.
It has been pointed out, that his results show the importance of brain research in the
field of deficits in vision function, academic performance and eye movements.
Unfortunately many individuals do not know about the importance of eye movements
as an integral part of vision and learning. Children with learning problems at school
can profit from these new methods of diagnosing and treating these learning related
vision problems.

Dr. Fischer notes that, “My research shows that vision function and eye movement
control can affect a child’s development even into young adulthood. It is important for
children to have a comprehensive assessment for the presence of learning related
vision disorders in order to know why they may be having difficulties in reading and
spelling skills, as well as obtaining basic arithmetic ability at school.”

He goes on to state, “Teachers, doctors, psychologists, therapists, and parents must
be informed about these new facts in order to be able to help children overcome their
deficits. It may make little sense to teach reading or math skills to someone who has
deficits in basic sensory, visual and/or optomotor processing.”

Dr. Burkart Fischer and his team conduct their research at the Center of
Optomotor Laboratory, University of Freiburg, Freiburg, Federal
Republic of Germany.

Dr. Fischer’s articles are available free of charge by going to
Optometry & Vision Development is the official journal of the College of Optometrists
in Vision Development.

For more information, please contact:
Pamela Happ, CAE, Executive Director
College of Optometrists in Vision Development
215 West Garfield Road, Suite 210 Aurora, OH 44202
P 330-995-0718 888-268-3770 F 330-995-0719
[email protected]

Comment: In the interest of full disclosure it should be known that I am the editor of the journal, Optometry & Vision Development (OVD) and am absolutely thrilled that Dr. Fischer and his team has chosen COVD's journal to submit their work for publication. Watch for another article by Dr. Fischer and his colleagues hopefully to be published in OVD on Saccade Control in Dyslexia: Development, Deficits, Training and Transfer to Reading, once it completes the peer review and editorial process. Questions? Please feel free to contact Ms. Pamela Happ or myself.

The articles recently published include:

Subitizing and Visual Counting in Children with Problems in Acquiring Basic Arithmetic Skills

Effects of Daily Practice on Subitizing, Visual Counting, and Basic Arithmetic Skills


Wednesday, April 23, 2008

Oculomotor abnormalities in a patient with fragile X-associated tremor/ataxia syndrome

... This is a case report of a case report of an 80-year-old man with Fragile X-associated tremor/ataxia syndrome (FXTAS) and acquired diplopia, strabismus, and other oculomotor abnormalities. This is the first case report of ocular abnormalities in a patient with FXTAS. ..

Comments: As some of you know, I've done a bit of work with folks who have Fragile X syndrome. Inviduals with Fra X tend to show many oculomotor anomalies including strabismus and nystagmus depending upon the popultation studied. This case report shows that those with FXTAS also may be at risk for oculomotor anomlies as well....(see some of my references below). DM

Berry-Kravis E, Krause SE, Block SS, Guter S. Wuu J, Leurgans S, Decle P, Potanos E, Cook E, Salt J, Maino D, et al Effect of the AMPAKINE® COMPOUND CX516 on cognition and behavior in Fragile X syndrome. J Child Adolesc Psychopharmacol 2006; (5): 525-540

Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM, Treitman T. Cognitive and visual processing skills and their relationship to mutation size in full and permutation female fragile x carriers.. Optom Vis Sci 2000;77 (11):592-599.

Maino D, Wesson M, Schlange D, Cibis G, Maino J. Optometric findings in the fragile X syndrome. Optom Vis Sci 1991;68:634-40.

Amin V, Maino D. The Fragile X female: Visual, visual perceptual, and ocular health anomalies. J Am Optom Assoc 1995;66(5):290-95.

Maino D, Schlange D, Maino J, Caden B. Ocular anomalies in fragile X syndrome. J Am Optom Assoc 1990;61:316-23.

Dibler LB, Maino DM. Martin-Bell phenotype, Fragile X syndrome, and the very low birth weight child: The differential diagnosis. J Optom Vis Dev 1994;233-246.

Martinez S, Maino D. A comprehensive review of the Fragile X syndrome: oculo-visual, developmental, and physical characteristics. J Behav Optom 1993; 4: 59-64.

Maino D, King R. Oculo-visual dysfunction in the Fragile X syndrome. In Hagerman R, McKenzie P (eds).1992 International Fragile X Conference Proceedings. Spectra Publishing Co., Dillon, CO, 1992:71-8.

Neuroplasticity At The Learning And The Brain Conference

...The brain is "plastic," according to recent findings in neuroscience, and that concept can help teachers and educators improve learning. Brain plasticity is the focus of a gathering of nearly 800 educators, from across the U.S. and other countries, to be held in Massachusetts at the end of this month...

Comments: Many functional/behavioral/developmental optometrists must be just shaking their heads and saying, "It's about time others recognize what we've known for decades!" It's wonderful that the science is finally catching up to the clinician (THANK YOU to all scientists!!) the clinician needs to quote/reference the science to support how we approach patient care thru the use of altering the environment with lenses, prisms and optometric vision therapy to change brain function at all ages. DM

Good Rhythm And Intelligence Go Hand In Hand

...People who score high on intelligence tests are also good at keeping time, new Swedish research shows. The team that carried out the study also suspect that accuracy in timing is important to the brain processes responsible for problem solving and reasoning. ...

Comments: Don't only watch "Dancing with the Stars"...get out on the dance floor!! Go to a concert! Play a musical instrument! Sing! Who might be able to boost your "smarts"...well, at least your "fun quotient" anyway!! DM

Software for kids with Special Needs

Autism/PDD And Special Needs Children Can Take Advantage Of Newly Released Mac Educational Programs By BloomingKids Software

...Many of the programs offer internal testing and reporting capabilities. All of the programs use colorful animations, pictures and music to help children to learn with enthusiasm and attention. Each exercise in the program rewards and encourages. Every correct answer earns positive reinforcement. For more information, visit to view online demos of each program...

Comments: I have not used these programs so I know little about them. If you do use them, please post a comment here. DM

Medication Improves Driving Ability ADHD Patients

........People with ADHD are often prescribed methylphenidate (brand name Ritalin) to counteract hyperactive behavior and attention dysfunction that may negatively affect their driving ability. Although little was known about the influence methylphenidate had on driving ability, a number of studies using driving simulators did indicate that the medication had a positive effect on driving ability.....

Comments: Note that Ritalin does help many individuals with ADHD, but, like all medications can have serious side effects such as dependency, psychosis, aggressive behavior (all rare) and/or nervousness, headache, dizziness (more common) just to name a few.

Tuesday, April 22, 2008

Optometry & Vision Development now open access!

The Board of the College of Optometrists in Vision Development has agreed to provide the journal, Optometry & Vision Development, as an open access journal.

This means you will have immediate access to all the articles and other included information once it is published on the COVD website. Go there right now. Find the article you need. Share them with patients and friends. Link our journal page to your website (please take a moment to inform the editor you are going to do this).

All reproduction of articles for non-educational purposes still needs the permission of the editor (email me, Dominick M. Maino, OD, MEd, FAAO, FCOVD-A, at [email protected] ). DM

Up Coming Meetings of Note

Upcoming Meetings

Neuro-Optometric Rehabilitation Association Annual Meeting San Antonio, TX
April 10-13, 2008 For information: (866) 222-3887

College of Syntonic Optometry 76th Annual Conference on Light & Vision
Phoenix, Arizona May 1-4, 2008
For information:

COVD 38th Annual Meeting
College of Optometrists in Vision Development
October 14-18, 2008
Palm Springs, California
For information:

COVD 39th Annual Meeting
College of Optometrists in Vision Development
October 13-17, 2009
Denver, Colorado
For information:

College of Optometrists in Vision Development Blogs

College of Optometrists in Vision Development Blogs....

Vision Developments (public blog)

Around the World: The COVD International Blog

Diamonds & Pearls: Tips to Improve Your Patient Care Today

The Lighthouse: A Community of Leaders in Vision Development

VisionU: The State of the Science of Vision

VT Economics: Tips from Experts to Build Practice Excellence

Statements: The COVD State Coordinators Blog

Finding a Cure for Empathy Insufficiency

Dr. Dan Fortenbacher, President of the College of Optometrists in Vision Development, notes in the latest Visions newsletter that...

...Interestingly enough medicine is now beginning to recognize empathy’s importance
in healing. This “empathetic aptitude” is now being described as an increasingly
important skill for physicians in the care of their patients. Daniel Pink, author of A Whole
New Mind …Why Right Brainers Will Rule the Future, states “several leaders in the medical
field are urging that the profession shift its overarching approach from ‘detached concern
to empathy’. The detached scientific model is not inappropriate, they say. It is insufficient.”
Therefore, we are beginning to see the emergence of a new condition, otherwise known as “empathy insufficiency.”...

Comments: Let us all start a therapy program to "cure" empathy insufficiency if we need too. What I typically that those who need therapy for this condition the most....are the last to admit it!! DM

20% of first-graders nearsighted

...CNATAIPEI, Taiwan -- The results of a survey of Taiwanese students' eyesight in 2006 show that 19.6 percent of first-graders suffer from myopia, according to a statement released by the Department of Health (DOH) yesterday...

Comment: Asians, in general, seem to develop myopia early. In any case, children should be examined first between 6-12 months of age, and then at 2 years, 4, years and then every year while in school. JIMMHO of course. DM

AHA Recommends ECG Before Starting Stimulant Therapy for ADHD

.........In a statement released in Circulation, Journal of the American Heart Association, the AHA said assessment of children with ADHD should include a detailed patient and family history, a physical exam, and a baseline ECG, .....Published studies suggest that ADHD is more common among children with congenital heart defects than it is in the general population, occurring in as many as 40% of children who have had surgery to repair congenital defects, Dr. Vetter said. ........

Comment: Also note that other conditions, such as convergence insufficiency is also associated with ADHD and sometimes misdiagnosed as ADHD. DM

Researchers design "bionic eye" to restore basic level of vision to patients with retinitis pigmentosa.

From AOA First Look...

The BBC (4/21) reported, "A 'bionic eye' may hold the key to returning sight to people left blind by" retinitis pigmentosa. As "part of a clinical study," a "team at London's Moorfields Eye Hospital" has "carried out the treatment on the U.K.'s first patients." Developed by the U.S. company Second Sight, the artificial eye, known as Argus II, is "connected to a camera on a pair" of eyeglasses. It is designed to "restore a basic level of vision."
Guardian (4/22, Sample, Williams) adds that eye-care specialists "have fitted 'bionic eyes' to two men in their fifties to partially restore their eyesight." The men are the first patients in the U.K. "to have the artificial retinas fitted, in three-hour operations." Both men were totally "blind, but will now be able to walk around unaided, and identify simple objects. If the trial is successful, the £15,000 retinas could be approved for general use within three years." The two men "are among 15 patients given the artificial retinas as part of a three-year trial in the U.S., Mexico, and Europe."
According to the U.K.'s
Telegraph (4/21, Smith), "Surgeons implanted an electronic device into the back of the eye to allow the patients to distinguish objects as pictures made up of spots of light." The 'bionic eye' "works with a tiny camera mounted in a pair of glasses, which transmits a wireless signal via a small processor on a belt into a receiver, and a panel of electrodes placed in the back of the eye." Previous "trials in America have shown patients can see light, shapes, and movement." Indeed, these patients "were able to navigate without their stick or guide dog, and distinguish between objects on a table." Such results suggest that the "device could help blind people to lead independent lives."
Consultant ophthalmic surgeon Lyndon da Cruz, M.D., who carried out the operations at Moorfields, said that "[i]f the device worked, it could help people suffering from severe blindness of any cause, provided their optic nerve was still functioning," Britain's
Independent (4/22, Laurance) notes. Nevertheless, Dr. da Cruz cautioned that the device "would not be suitable for people suffering from macular degeneration, the commonest cause of blindness which destroys the center of the retina, because these patients retain peripheral vision, and that would still be better than anything the device could deliver."
The U.K.'s
Times Online (4/22, Rose) quotes Mark Humayun, M.D., professor of ophthalmology and biomedical engineering at the Doheny Eye Institute in Los Angeles, California, which developed the technology, as saying, "The camera is very, very small, and very low power, so it can go inside your eye, and couple your eye movement to where the camera is." Dr. Humayun added, "With the kind of missing information the brain can fill in, this field is really blossoming. In the next four to five years, I hope...that we see technology that's much more advanced." Britain's Press Association (4/22) also covers the story.

Light as Therapy for Sleep Disorders and Depression in Older Adults

Proper lighting is necessary for vision and to carry out one’s daily activities. This aspect of light-light for vision - is well known by the general public and health professionals. What is less well appreciated is the large and growing body of scientific literature on light as a therapeutic agent. Indeed, although much has been documented over the past decades about its therapeutic uses, light is rarely prescribed by physicians and other healthcare providers. In part, this is because much is yet to be understood ...

Comments: Some optometrists us light as a form of therapy as well (syntonics). Unfortunately, optometric use has not been supported by the least not yet. These and similar studies do support the use of light for many systemic anomalies however. DM

Monday, April 21, 2008

Sports Vision in the UK

...Woodward first took notice of Calder's work during a presentation in which she showed him a picture of Lawrence Dallaglio in his underwear, and asked why, when so much weightlifting work was being done, no one was honing the muscles that controlled Dallaglio's eyesight. "Nothing," Calder pointed out, "can happen on a sports pitch until the eyes have done their work." Calder specialises not only in improving hand-eye coordination but also in developing peripheral vision. When Woodward talked about playing "heads-up rugby", as he was so prone to doing, it was Calder who worked on the players' ability to absorb, and react to, the visual information around them. ...More specifically, she worked on visual anticipation with Bryan Habana, whom she rates as the most gifted athlete she has been associated with, and he has said that he intercepts more passes as a consequence. If that was one extreme - Habana's scores in her tests were near superhuman - then Steve Thompson sits at the other. Calder's work to improve Thompson's depth perception vastly improved his lineout throwing, giving him confidence that Woodward pinpointed as vital in the World Cup success.

Prozac Might Help Cure Amblyopia

From my friend & colleague's blog (Dr. Bonilla-Warford at Bright Eyes Family Vision Care):

We’ve know for quite some time that amblyopia can be improved in older children and adults. It may take more work, but it can be done with the proper vision therapy.
Now there is evidence, at least in rats, that Prozac (fluoxetine) may actually assist in the developing the neural connections in the brain to improve visual acuity reduced due to amblyopia.

But remember two things: First, People are not rats and, at best, it will be some time before fluoxetine is studied in people. Second, whether fluoxetine is helpful or not, vision therapy is crucial in developing the all visual skills in people with amblyopia.
Read the whole article

Vision therapy project

Schools Bring in Vision Therapy to help students with learning related vision problems:

Alannah Wellborn works with students who can have 20/20 vision, but that doesn't rule out vision-related learning disabilities.Wellborn directs the Vision Therapy Project, a nonprofit organization in Casper that works with students who have issues with their vision, though not in the way you might think....The Vision Therapy Project will use $335,000 to work in seven Casper-area schools this fall. The funds will pay for full-time vision specialists and occupational therapists to help students develop skills to correct their vision problems."Which in turn, should really help their academics," Wellborn said.....The students who worked with Wellborn in the program showed significant improvement by the end of the year, Waddell said."

Comment: This project will (hopefully) show the relationship between vision function and academic performance in a real world way. Individuals, such as Dr. Hal Solan in his aritcles in the Journal of Learning Disabilities, show this relationship...articles in Optometry & Vision Development, also show how learning related vision problems can be improved thru optometric vision therapy...and result in improved academic and achievement/cognitive performance, as well as the individual's reading ability and quality of life.... DM

Researchers link infantile esotropia and developmental delays.

From AOA First Look:

Medical News Today (4/19) reported that "[b]abies with an eye-alignment disorder called infantile esotropia have delays in motor development milestones, but development 'catches up' after corrective surgery," according to a study in the Apr. issue of the Journal of AAPOS (American Association for Pediatric Ophthalmology and Strabismus). James R. Drover, Ph.D., of the Retina Foundation of Southwest Texas, Dallas, and colleagues, "assessed developmental milestones in 161 infants with infantile esotropia, or crossed eyes." Next, "the researchers had parents complete an infant development questionnaire before and/or after corrective surgery" that "assessed fine-motor skills (sensorimotor development)," and "large-muscle skills (gross motor development)." The investigators also examined a control "group of children with normal eye alignment." Prior to surgery, the babies "with esotropia had delays in both" sensorimotor and gross motor milestones. But, after surgery, the babies "had no delays in developmental milestones." Indeed, they "had a faster rate of sensorimotor development, suggesting that correcting their binocular vision helped their development to 'catch up' to that of normal infants."

AOA recommends wearing protective eyewear while playing sports.

HealthDay (4/19, McKeever) reported that wearing protective eyewear is the best way to "prevent injuries to [the] eyes while playing sports," according to the American Optometric Association (AOA). Approximately 13,500 of the nearly "600,000 documented sports-related injuries [that] are reported annually in the" U.S. "result in permanent loss of sight," and "[e]ven non-contact sports such as tennis, golf, and fishing pose a moderate to high risk of eye injury because of flying objects, such as balls, racquets, and hooks." AOA optometrist and sports vision specialist Paul Berman, O.D., stated, "Thousands of children and adults unnecessarily suffer sports-related eye injuries each year." Dr. Berman added, "Every thirteen minutes, an emergency room in the United States treats a sports-related eye injury, and nearly all could be prevented by using the proper protective eyewear." An AOA cautionary advisory pointed out that "[e]veryday prescription eyewear or sunglasses probably won't" protect eyes, because "most conventional frames and lenses fail to meet minimal impact requirements for most sports." But, "[s]ports-protective tested to meet rigid standards, and some have been independently verified and received the AOA Seal of Acceptance."

The age-dependent effect of anisometropia magnitude on anisometropic amblyopia severity

They conclude that:

Children with higher magnitudes of anisometropia had higher prevalence and greater depth of amblyopia. Older children had an increased risk of amblyopia compared with younger children for moderate levels of anisometropia. Low magnitude anisometropia in young children may not predispose to amblyopia; these findings have implications for vision screening criteria at various ages.

Comment: While it is not a suprise that higher amounts of anisometropia puts an individual at greater risk for amblyopia...what I do find as curious is that low magnitudes of anisometropia may change the screening criteria. Practically any anisometropia should be followed closely and warrants a full, comprehensive examination. The "potential" for the development of amblyopia is still present....and unfortunately, you may give parents a false sense of security to indicate otherwise.

This problem is easily solved if all parents are encouraged to participate in the AOA's InfantSee program. A comprehensive evaluation and NOT a screening is the best way to eliminate amblyopia as a significant public health problem. DM

Sunday, April 20, 2008


...the increase in the incidence of convergence insufficiency in the older patients taking medicines was disproportionately high....

Comment: First off, I'm thrilled that the researchers looked at CI in adults. Secondly...could it be that adults who take more meds because they tend to be more CI because of the decreased ability to control oculomotor ability when you are sick/fatigued/etc? DM

Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group.

These findings suggest that CI (defined as high suspect and definite) is frequent (13%) among fifth and sixth grade children. In addition, there is a high percentage of CI children with an associated AI.

Comment: Children should have a complete work-up for CI and other binocular vision problems. DM

Websites that offer info on Convergence Insufficiency Excellent Excellent study Excellent Bad advice on treatment...optometric vision therapy YES....pencil push ups (only) NO! The rest of the info good Gives the personal touch Old information. Stresses "eye muscles" not how the brain is involved. Not a good reference. Not bad. Limited by ophthalmology viewpoint. OK. Cute graphics. ADHD and CI. ADHD can be confused with CI CI and reading Good Good

Convergence Insufficiency ORG

Great info from Convergence Insufficiency Org

Convergence Insufficiency (CI) is the leading cause of eyestrain, blurred vision, double vision (diplopia), and/or headaches.1
Convergence insufficiency disorder can interfere with the ability to read, learn, and work at near (close distances).
Patients should be made aware that convergence insufficiency is a fairly common condition and that treatment is very effective.
Treatments range from passive (prism lenses) to active (office-based vision therapy/orthoptics).
According to a recent survey, home-based pencil pushups therapy (PPT) is the most commonly prescribed treatment
5, but studies show that compliance (patient cooperation) is poor and that this treatment does not eliminate symptoms.3, 6
Eye surgery is rarely recommended.
1, 2
The basic eye exam by a pediatrician is not adequate for the detection of convergence insufficiency (as well as other visual conditions).
A person can pass the 20/20 eye chart test and still have convergence insufficiency.
Convergence Insufficiency can be treated at any age.
1, 2, 4

Comment: Go to this site for good info on CI. DM

Public rating of hospitals, docs and healthcare providers

Public reporting of performance isn’t working [Ann Intern Med 2008;148:111-23 [PubMed abstract] Publicly rating the performance of hospitals, doctors, and other healthcare providers should, in theory, motivate them to improve their quality of service, attract more patients, and treat them better. But a systematic review of 45 studies has found little evidence that it works. The results were a mixed bag except for fairly consistent evidence that publishing performance data stimulates quality improvement activity in hospitals, and probably influences patients’ choice of health plan. Whether the reports help make hospitals or doctors more effective is still unclear, and few data are available on the effect of public reporting on patient safety. Public reporting is expensive and this review suggests it may not be paying off. Perhaps the underlying theory is wrong, says an editorial (p 160). Or perhaps the information in the reports is simply too inaccessible for people to use when choosing where to go for treatment. Patients may also define quality differently from the academics who devise and publish performance reports. The idea behind public reporting is probably sound, says the editorial. It’s the execution that needs work.

Comments: Some appropriate type of assessment system should be developed....unfortunately many patients will only look at the outcomes and not how the outcomes were determined which could afftect what those measurements REALLY mean and their importance. DM