Saturday, May 3, 2008

3-D Dragon Illusion

...This is a wonderful optical illusion. This little dragon is made out of paper - you simply cut it out and stick it together, and stand it on a table or window ledge. But when you move around, the dragon's head seems to follow you around the room.

How does it work? If we move around when viewing a solid object, our brain knows how the object we are looking at should behave. However the dragon gives us the wrong clues, because we mis-interpret what its shape is. We assume that the nose of the dragon is pointing out towards us, but in fact the dragon's head is concave....

Comments: I was talking to one of my students in ICO's mail room the other day and she had this awesome 3D dragon she was showing off....what's unique is that it is really only 2D! Have you ever had a hard time explaining to your strabismus patients what's it like to see in 3D....this is perfect for that explanation! More cool stuff can be seen at I have no finacial interest in any of this stuff. But wish I did! DM

Friday, May 2, 2008

CDC Alarmed Over U.S. Measles Surge

.....Dr. Schuchat said the rise in measles in the U.S. is related to large-scale outbreaks in Europe and Israel. Of the 64 cases formally reported to the CDC, 54 were regarded as "importation-associated," she said. ....But the surge is also linked to lack of immunization, Dr. Schuchat said. Although the vast majority of Americans are immunized against measles, only one of the 64 patients had full immunization. ...

Comments: Have your children vaccinated. Remind the families that you work with to have vaccinations. Remind your college aged kids to watch out for any outbreaks of diseases in the dorms they live in. DM

U.S. House approves Genetic Information Nondiscrimination Act.

From AOA First Look:

ABC World News (5/1, story 10, 0:20, Gibson) reported that on Thursday, the U.S. House voted 414 to 1 to approve HR 493, legislation that would ban employers and insurance companies from discriminating against "people whose genetic testing shows they are more likely to contract disease." President Bush has said he will sign the bill, NBC Nightly News (5/1, story 12, 0:30, Williams) added.
The measure, called the Genetic Information Nondiscrimination Act (GINA), was already approved by the U.S. Senate last week with a vote of 95 to 0, the
New York Times (5/2, A1, Harmon) points out on its front page. The bill is likely to encourage more people "to take advantage of genetic testing, and to participate in genetic research." The Times notes that "[w]hile the intent of the law is to prohibit discrimination by insurance companies based on genetic tests, the bill does allow the companies urge patients take them." The goal of the provision is "not to deny coverage, but to help find the best, and least expensive, therapy for a patient."
Bloomberg (5/2, Marcus) adds, "Genetic tests can help predict someone's likelihood of getting cancer and other diseases, and are used by researchers seeking new treatments."
Even so, Rep. Ron Paul (R-Texas) voted against the bill because he said that the federal government has had a "poor record in protecting privacy," and that he did not believe "intrusive federal legislation" was "the best way to address concerns about the misuse of genetic information," the
AP (5/2, Holland) notes.
Congressional Quarterly (5/2, Wayne) reports that the "House adopted a resolution (H Con Res 340) correcting a technical glitch," and the "Senate must follow suit before the bill can be sent to the White House." The San Francisco Chronicle (5/2, A2, Coile) and Modern Healthcare (5/1, DoBias) also covered the story.

Comments: Since I work with many children and adults who have genetic anomalies, I whole heartly support appropriate protections and am a strong advocate of privacy in all areas of health care. DM
Also in the News

National health insurance best way to ensure care for all Americans

...The need for meaningful health care reform remains one of the hottest topics in the public as we approach our national election. An important new study, in the ... Annals of Internal Medicine, reveals a growing consensus among practicing physicians that our broken health care system would be best fixed by legislation establishing national health insurance (NHI)....

Comments: No matter what side of this issue you may be on, one of the main questions next to assess is quality. What quality of care can you expect from a government run program? How cost effective, yet compassionate and caring health care would you expect? What are you willing to pay or to give up to get this health care? If you look at most government run health care programs, I would be very cautious. DM

Birth Control for Brain Injuries?

...Traumatic brain injuries are a major cause of death and disability. Preventing brain cell death after an injury is crucial to survival and recovery. Several ‘neuroprotective drugs’ have shown promise in preventing nerve cell death in animal models of traumatic brain injury, but now researchers have discovered a hormone -- progesterone -- may produce the same results. Progesterone is a female hormone commonly used in oral contraceptive pills. ...

Comments: More and more of us (optometrists) are becoming interested in TBI. This study may help us help our patients. DM

Kids use Senses one at a Time

...In two separate studies, European researchers ran kids through tests involving two senses at a time to see if they could integrate the two, similar to the way adults do. The children generally used one or the other to get the job done, but not both. ...

Comment: Vision is learned has been a mantra of functional optometry for decades. We are born with the capability, but before we have functionality we must learn how to use our capabilities appropriately. This includes all of our five senses. DM

Thursday, May 1, 2008

Amblyopia Treatment

From AOA First Look...

Researchers develop promising treatment for amblyopia.

Medscape (4/30, Libov) reported that according to a new study on amblyopia presented at a meeting on vision research, "binocular connections remain intact -- a finding that could pave the way for a new type of treatment that would be an alternative to eye patching, the current standard of care." Lead author Bahzad Mansouri, a postdoctoral student at McGill University in Montreal, Canada, and colleagues, "tested eight amblyopic and eight normal subjects" during an experiment. The researchers used "a dichoptic motion task to assess dorsal function, and a dichoptic form task to assess ventral function," which allowed them "to separate the signal and noise between the two eyes, and to directly evaluate how well the organs combined the information." After "comparable information was presented to each eye, amblyopic eyes made only a minor contribution to binocular performance." But, "by reducing the information content to the fellow eye, the researchers were able to create a condition under which the two eyes equally combined the information." The authors hope "to conduct a trial comparing the new treatment with the traditional one," and based on those results, develop new treatments for amblyopia.

Eye & Vision Videos

Videos about....

Computer Vision Syndrome

Risks of Refractive Surgery

Choosing Sunglasses

Wednesday, April 30, 2008

Components of placebo effect

Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome

Factors contributing to the placebo effect can be progressively combined in a manner resembling a graded dose escalation of component parts. Non-specific effects can produce statistically and clinically significant outcomes and the patient-practitioner relationship is the most robust component.

Comments: Others have been critical of the "placebo effect" in medicine. It is interesting to note that this effect can be as important in the treatment of a patient as "real" medicine. The most important of these placebo effects is the doctor/patient relationship. DM

The role of a homoeopathic preparation compared with conventional therapy in the treatment of injuries

Traumeel is as effective as conventional medicines in the management of mild to moderate injuries in this population. Traumeel was safe in use and judged by physicians to be better tolerated than conventional medicines. This study contributes to the case for a broad clinical effectiveness of Traumeel in the treatment of acute injuries and trauma.

Comment: Homoeopathy has gotten some bad reviews it is interesting that this particular study notes that "Traumeel" can be an effective treatment.

BTW a 300 mg tablet of Traumeel may contain:

Belladonna 4X 75 mg
Arnica montana radix 3X 40 mg
Aconitum napellus 3X 30 mg
Chamomilla 3X 24 mg
Symphytum officinale 8X 24 mg
Calendula officinalis 2X 15 mg
Hamamelis virginina 2X 15 mg
Millefolium 2X 15 mg
Hepar sulphuris calcareum 8X 15 mg
Mercurius solubilis 8X 15 mg
Hypericum perforatum 3X 8 mg
Bellis perennis 2X 6 mg
Echinacea augustifolia 2X 6 mg
Echinacea purpurea 2X 6 mg


Tuesday, April 29, 2008

Images of Ireland

This blog is mostly about the latest research involving children....but I also have a blog that looks at the art scene in Chicago....and my photography. Go to to see some of my latest photos from Ireland....DM

Variability of Control in Intermittent Exotropia

...In 17 patients who were assessed for interobserver variability, the agreement between observers was high. (Greater than or equal to a 2-point difference on the scale was used to indicate a change.) There was a high level (24%) of minute-to-minute variability. Of the 13 patients studied over 1 day, 6 (46%) showed a change in fusional control of the exotropia. Two of these were at distance fixation only, 3 at near only, and 1 at near and distance.In 17 patients who were assessed for interobserver variability, the agreement between observers was high. (Greater than or equal to a 2-point difference on the scale was used to indicate a change.) There was a high level (24%) of minute-to-minute variability. Of the 13 patients studied over 1 day, 6 (46%) showed a change in fusional control of the exotropia. Two of these were at distance fixation only, 3 at near only, and 1 at near and distance...

Comments: I always tell my students that what we measure during any diagnostic evaluation is only a brief snapshot of whatever condition we are trying to diagnose. Most, if not all, vary over time and circumstance. We can use this data to make a diagnosis, but always be prepared to update that diagnosis as needed. DM

Tiger Woods' Secret Reverse-Lasik Surgery Revealed

...Five days after successful knee surgery, golfing champion Tiger Woods underwent reverse-Lasik surgery at an Orlando clinic and is said to be in pretty-good condition. "While his knee recovers, Tiger thought this would be a perfect time to undo the Lasik," said Dr. Isaac Myopia in a blurry videotaped interview from his Lake Buena Vista hotel room. "Within minutes of the surgery, Woods' vision went from 20/20 to 10/50," the doctor added."Although his vision was basically perfect after having Lasik in 1999, Tiger missed the way he looked in glasses and wanted this done before summer," said Dr. Myopia....

Comment: This story was noted at I think Tiger looks good in spectacles myself! They might even let him get his game back!! DM

Soft Contact Lenses Do Not Increase Myopia Progression in Children

...According to the multi-site wearing trial study, which tracked the myopic progression of 484 children ages 8-11 randomly assigned to wear glasses or contact lenses, there is no clinically meaningful difference between the two forms of vision correction for the treatment of nearsightedness, a vision problem experienced by approximately one-third of the population.The new research further dispels a long held myth that soft contact lenses increase myopia progression more than other vision correction options....

Comments: I didn't know that soft CLs were ever thought to increase myopic progression. I did "know" that spectacle and soft CL wear were very similar when it came to myopia progression. Now we have a clinical trial verifying what I "knew". Cool!! DM

An Infant's Future Mental Abilities And Susceptibility To Mental Illness Can Be Permanently Altered By Dietary Changes In Early Life

Remarkable new research into the way environmental factors affect the development of the brain has opened up the possibility that an infant's future mental abilities and susceptibility to mental illness can be permanently altered by dietary changes in early life.

Comments: If it sounds to good to be true..... Keep an open, but skeptical mind. DM

Simplicity Of Working Memory Study Could Help With ADD And Other Attention Difficulties

...University of Missouri researchers found that the average person can keep just three or four things in their "working memory" or conscious mind at one time. This finding may lead to better ways to assess and help people with attention-deficit and focus difficulties, improve classroom performance and enhance test scores....

Comments: Sounds like what optometrists do during standard optometric vision therapy for learning related vision problems. DM

The Eye-Patch Kids, DVD

The Eye-Patch Kids DVD is designed to take the pressure off the parents and to put it on the puppets. Throughout the DVD, we encourage your child to put on their eye patches so they can be cool like the puppets.

Comments: No financial interest in the product mentioned. It does sound like a good way to get your patients to wear a patch. DM

FDA Approves VYVANSE(TM) (lisdexamfetamine Dimesylate), The First And Only Once-Daily Prodrug Stimulant To Treat ADHD In Adults

VYVANSE, introduced in July 2007 for the treatment of ADHD in children aged 6 to 12 years, is now the first and only once-daily prodrug stimulant approved to treat adults with ADHD. In its first eight months of availability, more than one million VYVANSE prescriptions have been filled.

Comments: According to Epocartes, Vyanse has a high abuse potential and can result in psychosis, mania and agressive behavior as well as stroke and sudden death (rarely). More commonly seen are dry mouth, dizziness, pyrexia, and visual name just a few. All drugs have unwanted side affects. When we use them wisely, they serve our patients well, but we must know about the potential for harm as well. DM

Sensory Integration Treatment Reduces Autistic Mannerisms

A new study from Temple University researchers, presented this month at the American Occupational Therapy Association's 2008 conference, found that children with autistic spectrum disorders who underwent sensory integration therapy exhibited fewer autistic mannerisms compared to children who received standard treatments.

Interventions for strabismic amblyopia

Combining occlusion and refractive correction with near activities may be more effective than occlusion and refractive correction alone. Further study of the role of near activities is necessary before a more definitive conclusion can be made.

Comment: Optometrists for decades have been using optometric vision therapy to improve amblyopia in conjunction with occlusion and spectacle correction. It is important that a review of the literature (this paper) also shows active therapy (i.e. near activities) is an important part of the overal program for amblyopia as well. DM

Higher Order Aberrations in Children With Amblyopia

Higher order aberrations are similar in amblyopic eyes due to strabismus or anisometropia and normal fellow eyes. Unlike lower order aberrations such as sphere and cylinder, higher order aberrations are unlikely to play a role in the development of amblyopia.

Monday, April 28, 2008

Panexa Does It All!!

...PANEXA is a prescription drug that should only be taken by patients experiencing one of the following disorders: metabolism, binocular vision, digestion (solid and liquid), circulation, menstruation, cognition, osculation, extremes of emotion. For patients with coronary heart condition (CHC) or two separate feet (2SF), the dosage of PANEXA should be doubled to ensure that twice the number of pills are being consumed. PANEXA can also be utilized to decrease the risk of death caused by not taking PANEXA, being beaten to death by oscelots, or death relating from complications arising from seeing too much of the color lavender. Epileptic patients should take care to ensure tight, careful grips on containers of PANEXA, in order to secure their contents in the event of a seizure, caused by PANEXA or otherwise....

Comment: Hopefully as you read this you notice a few very strange things....this drug is for everything! is even for "binocular vision" which I thought was a good thing to have!! Yep, it's a hoax....but maybe it will get all of us to be a bit more skeptical when we hear about all these new wonder drugs.... DM

AOA offers tips to prevent computer vision syndrome.

From AOA First Look:

In continuing coverage from previous editions of First Look, Rhode Island's Providence Journal (4/27) reported that according to the American Optometric Association (AOA), "[c]omputer vision syndrome is becoming more frequent." Indeed, "prolonged use of electronic devices, such as computers and PDAs, can leave users with problems like dry eye, eye strain, neck or backache, light sensitivity, and fatigue." The AOA said that "78 percent of Americans do not have their monitors set below eye level, the correct height for computer usage; 73 percent of Americans do not take breaks as often as they should (at least every 20 minutes); and one out of 10 never take a break" from the computer. And, although "[s]pecially designed glasses exist to help reduce glare from screens,...only 11 percent of Americans use them," the AOA found.

Leber Syndrome

From AOA First Look:

Studies suggest gene therapy may restore vision in patients with Leber's syndrome.

The CBS Evening News (4/27, lead story, 0:15, Mitchell) reported that there is a "possible breakthrough in gene therapy" for the blind, according to two studies published in the New England Journal of Medicine.
In a front-page article,
USA Today (4/28, 1A, Szabo) reports, "For the first time, doctors have used gene therapy to restore vision in patients with a rare and usually incurable form of blindness" called Leber's syndrome. Lead author of the U.S. study, Albert Maguire, M.D., of the University of Pennsylvania School of Medicine, stated that while "cataract surgery and medication can restore sight in patients with other eye ailments, doctors have never before been able to restore vision to patients with this kind of hereditary degenerative disease."
During the unprecedented research, scientists "used gene therapy to increase light sensitivity, and improve vision in patients who were virtually blind, a finding that offers new hope to hundreds of thousands of patients with inherited forms of vision impairment," the
Los Angeles Times (4/28, Maugh II) adds. Robin R. Ali, Ph.D., of University College London, who led the British study, pointed out that the "experiments, so far meant only to prove the safety of the technique, produced 'real clinical benefit,' and 'made a real difference in patients' lives.'" Morton F. Goldberg, M.D., of John Hopkins University's Wilmer Eye Institute, who was not involved in the studies, noted, "In the field of retinal dystrophies, this is, I believe, the most important therapeutic discovery" in the last forty years.
According to the
Washington Post (4/28, A5, Weiss), "The experiments involve[d] patients with Leber's congenital amaurosis, a rare disease caused by a defect in a single gene that is crucial to the retina's ability to convert light into signals to the brain." Children with Leber's "have impaired vision from birth, and are typically blind by age 30." Both research teams used "adeno-associated viruses, popular among gene-therapy researchers because of their ability to deliver new genes to cells." Specifically, the researchers utilized "genetic engineering techniques to load the viruses with healthy versions of the rpe65 gene, the gene that is faulty in people with Leber's." Next, the authors "injected tens of billions of the viruses into the tiny space behind the retina" of one eye in each patient.
In the U.S. study, Dr. Maguire and colleagues found that "one patient, a 26-year-old man, went from very poor vision -- worse than 20/2000 -- to 20/710, meaning he could now read some rows of an eye chart," the
Wall Street Journal (4/28, A4, Winstein) adds. Ali and colleagues discovered, however, that the "three British patients didn't achieve improvements on an eye chart, but did do better on certain other measures of vision." Still, the Journal notes that even though the results are preliminary, they "showed a modest improvement in vision," despite the fact that "the patients studied were older than 18, and their eyes' sensors had largely deteriorated."
Further elaborating on the results,
Bloomberg (4/28, Cortez) reports that in the British study, "one 18-year-old patient had significantly improved night vision, and was able to navigate a darkened street with ease after the surgery." But, the other two participants "didn't have a marked improvement, perhaps because their disease was more severe, the researchers said." For the U.S. study, subjects "reported improved vision in dimly lit areas starting two weeks after the operation, and were three times more sensitive to light." The patients "also had less nystagmus, an involuntary eye movement."
AP (4/28, Nano) points out that according to the researchers, "There were no serious side effects reported in either group," even though a U.S. patient "developed a hole in his retina, which didn't affect his eyesight." Furthermore, the authors stated that "there was no evidence that the altered virus used to ferry the gene into the retina's cells had traveled outside the eye to other areas of the body."
The researchers plan to conduct additional tests, which "will involve treating children, whose eyes have deteriorated less, and who have a better chance of improving,"
Reuters (4/28, Beasley, Hirschler) notes.
AFP (4/28), the BBC (4/27), the Philadelphia Inquirer (4/27, Avril), and Minnesota's Star Tribune (4/28) also covers the story.

FDA advisers: Clearer LASIK warnings needed

...The vast majority of people undergoing laser eye surgery benefit and are happy, but a small fraction, perhaps fewer than 1 percent, suffer serious, life-changing side effects: worse vision, painful dry eye, glare, inability to drive at night.... go to FDA Advisers Find LASIK Safe But Oversold for more information.

Comments: They may also develop diplopia, strabismus and other binocular vision disorders. DM

Normative pediatric visual acuity using single surrounded HOTV optotypes

These results represent the first normative data reported for HOTV optotypes using the ATS protocol on the Electronic Visual Acuity Tester. These data may play an important role in clinical practice, screening, and clinical research.

Comment: Just a reminder that amblyopia is more than just visual acuity...and these other areas should be investigated as well. DM

Long-term follow-up of visual functions in prematurely born children

Repeated ophthalmologic follow-up of prematurely born children should be performed in those with treated ROP and/or neurological conditions. For a third group without such problems, at least one follow-up is recommended. Such an examination also provides a good opportunity to identify neurological problems that warrant further ophthalmologic follow-up.

Comments: Optometrists can also provide follow up care for premature children. I would also suggest that all children be seen at least once a year for a comprehensive evaluation...especially if they were premature. There may be functional/development issues noted besides ocular pathology. DM

Generic Drugs

Each year more and more prescription medications become available in a lower cost generic form. This provides greater options for physicians who want to prescribe their patients effective and safe medications that won’t break the bank. A study published in Archives of Internal Medicine shows that patients who received therapeutically equivalent generic medication also had 62% greater odds of achieving adequate medication adherence compared to patients receiving non-preferred brands.1 To ensure that your patients receive a lower cost generic medication, write the prescription for the generic medication or allow for substitution when the prescription is written for the brand-name medication. Currently Available Generic Medications: This list contains the available generic medication options for a few of the most commonly seen conditions. To access a listing, please visit