Saturday, May 10, 2008

Parents Active for Vision Education

Parents Active for Vision Education is an awesome website for parents by parents. Go to for the latest information on
The Hidden Disability -

Undetected Vision Problems

Friday, May 9, 2008


This blog is supposed to be about children and the latest in eye/vision care research, but some times we need to consider what we adults might like on the title above and make (as my friend George says) the Nectar of the Gods! DM

AOA Journal

The AOA journal, Optometry, has several articles that are "must read".

I always read Dr. Freeman's editorials of course (since I'm an editor I know how important it is to read these things!)....

I also find Dr. Byron Newman's Health Notes most informative. He is a real eclectic pursuer of knowledge!

Dr. Gurwood constantly keeps us up to date with current research (It's mostly about path stuff...but that's can come to Mainos Memos for the pediatric vision research updates!)

Now for the REALLY, REALLY good stuff...

Powers, Grisham and Riles' article, Saccadic tracking skills of poor readers in high school notes that poor high school readers are at risk for exhibiting poor tracking skills...


...Jamara, Potaznick and Matjucha in their article, Low vision rehavilitation for a target shooting marksman with visual field loss and diplopia, conclude that low vision rehabilitation and sports vision (not to mention some knowledge of how the binnocular vision system works) is important to improve function. In any case....I would have to assume that if some one is shooting a gun.....I do not want them to be diplopic!! Good job gentlemen!

and finally...

...Drs. Han, Craig, Rutner, Kapoor, Ciufredda and Suchoff wrote, Medicatios prescribed to brain injury patients: A retrospective analysis, noted that antidepressants, anticonvulsants, analgesics and HTN meds were most often Rx'ed. Many of these patients are talking multidrugs that could also result in unwanted visual side affects...

...Dr. Robert Donati and I just gave a presenation at ARVO that looked at meds taken by those with developmental disablities and the dually diagnosed (mental retardation and mental illness) so I'm very interested in reading this paper much more closely... DM

Off to Montana!

I am soon to be off to beautiful Missoula, Montana to give 6 hours of continuing education lectures (Diagnosis and Management of Special Populations, To BV or Not to BV: VT in the Primary Care Office, Working with Special Populations) during the Montana Optometric Association's annual meeting May 14-17th. If you need some CE hours you should consider coming to Montana! Hope to see you there! DM

Dyscalculia Forum

Did you know that 4-6 % of the population has dyscalculia? Find out more today by visiting the Dyscalculia Forum...

Origins of Neuroblastoma Potentially Uncovered

...In a large genome-wide study, alleles at chromosome band 6p22 were associated with up to a two-fold risk of having neuroblastoma....Children with neuroblastoma who were homozygous for these risk alleles were more likely to have metastatic disease (P=0.02) and disease relapse (P=0.01). ...

VEP maturation and visual acuity in infants and preschool children

...the expected maturation of flash, reversal and onset VEPs, and demonstrate their correlation to normal development of visual acuity. Maturation of VEP latencies is associated with development of visual acuity. ...

Computer vision syndrome related to improper work habits, poor workstation conditions.

From AOA First Look:

In continuing coverage from previous editions of First Look, New York's Ithaca Journal (5/8, Hibma) reported, "While most of us can't get by without using a computer for work, it's the very thing that's causing office workers to experience...eye strain." In particular, "[w]here the monitor is placed is important for the eyes." This March, "[t]he New York State Optometric Association (NYSOA) put out a warning for New Yorkers...about 'computer vision syndrome' -- a condition for frequent computer users that leaves them susceptible to eyestrain, light sensitivity, fatigue, and neck and back pain." This condition, according to the NYSOA, "is related to poor workstation conditions, prior vision problems, and improper work habits." The "NYSOA gives suggestions to prevent or reduce eye and vision problems, such as checking for glare, reducing the lighting to match the computer, and to keep blinking." Eye-care experts also recommend "get[ting] an eye exam regularly."

Comments: Changing the work environment AND using optometric vision therapy can decrease or eliminate the signs and symptoms of CVS. DM

Chemicals in Plastic Shown to Cause Reproductive and Neurological Disorders

...children's brains and reproductive organs may be having their development harmed by an estrogen-like chemical that is present in plastic according to a federal health agency report. BPA is an ingredient in polycarbonate plastic. BPA is also one of the most widely used synthetic chemicals today. It has been shown to seep from hard plastic beverage containers (such as baby bottles) and even from liners in cans that contain food and infant formula...

Comments: The baby bottle controversy has been in the media for a while. The NIH is also looking at this. The thing to remember is that much of the research done in this area has been with rats....where you typically give them enormous doses of the BPA. Use caution...also use common sense. DM

Mothers' High Normal Blood Sugar Levels Place Infants at Risk for Birth Problems

Pregnant women with blood sugar levels in the higher range of normal — but not high enough to be considered diabetes — are more likely than women with lower blood sugar levels to give birth to babies at risk for many of the same problems seen in babies born to women with diabetes during pregnancy, according to a study funded in large part by the National Institutes of Health....

Comments: Those of us who work with families and their young children need to keep up with the latest medical research that affects the well being of those we serve. Moms & dads should know what risks are associated with elevated though normal blood sugar levels. DM

Thursday, May 8, 2008

Genetic aspects of strabismus

...There is evidence for a pattern consistent with an autosomal dominant form of strabismus in most families. ...

Comment: Remember, just because there is a genetic component to the strabismus, that this does not mean you can't positively alter the function of the visual system by using optometric vision therapy. DM

Uncorrected refractive error: the major and most easily avoidable cause of vision loss

...The world must make every effort to meet the goals of VISION 2020 and eliminate uncorrected refractive error within the next 13 years. A tall order? Not really. ICEE has estimated (based on its own data from Africa, Timor-Leste, and Sri Lanka, as well as on data from the LV Prasad Eye Institute in India) that it will cost US $1,500 million to give 300 million people access to an eye examination by a trained local eye care person and a pair of spectacles....

Comments: We tend to forget the power of a simple pair of glasses. We buy blue ones to go with blue outfits....and green ones to go with our shoes. But in reality, glasses are medical devices...and we can work miracles just by prescribing them appropriately for our patients and the wider world community. DM

You can create a placebo when doing VT research

Kulp MT, Borsting E, Mitchell GL, Scheiman M, Cotter S, Cooper J, Rouse M, London R, Wensveen J. THE CONVERGENCE INSUFFICIENCY TREATMENT TRIAL (CITT) INVESTIGATOR GROUP. Feasibility of Using Placebo Vision Therapy in a Multicenter Clinical Trial.Optom Vis Sci. 2008 Apr;85(4):255-261.

The CITT placebo therapy program was effective in maintaining subject masking in this multicenter clinical trial.

Comments: Over the past decade or so, the docs noted above (and many others) have been instrumental in bringing the science of optometric vision therapy to the clinician. Clinicians know what works....these good docs tell us the how, why, when, what and where....Thanks for all you do!! DM

Safest Spot for Baby's Car Seat

Study Shows Placing Car Seat in Center of Back Seat Cuts Risk of Injury in Crash

...the study showed that children under age 3 seated in the center of the back seat had nearly half the risk of injury in motor vehicle crashes than children seated in either of the other positions....

Comments: Please always use a care seat....and always remind the parents of the children you see to do so as well! DM


The first analysis of the genome sequence of the duck-billed platypus was published today by an international team of scientists, revealing clues about how genomes were organized during the early evolution of mammals. The research was supported in part by the National Human Genome Research Institute (NHGRI), part of the National Institutes of Health (NIH).

Comments: I know this may have little to do with children's eye and vision care issues...but I'm into genetics...and the phrase "duckbilled platypus" said aloud always makes me laugh!! DM


From AOA's First Look:

Optometrist, allergy group discuss allergies and eye health.

The North American Press Syndicate (5/7) reported that the Asthma and Allergy Foundation of America (AAFA) has created "a free educational brochure titled, Eye Health and Allergies," which contains "information on how eye allergies occur, common signs and symptoms, and practical advice on how to treat and prevent eye allergies." According to Susan Resnick, O.D., F.A.A.O., a New York-based optometrist, "[a]llergy sufferers who wear contact lenses that you use for two weeks or more may experience discomfort and symptoms such as ocular itching, tearing, and redness, because allergens and other irritants can build up on the lenses over time," and "[c]hemical disinfectants and preservatives used in some contact lens care systems also can cause ocular distress." In order to "minimize these symptoms, contact lens wearers can limit their wearing time during allergy season, but Dr. Resnick says there is no need to discontinue contact lens wear during the allergy season."

Comments: Over the past few weeks I've diagnosed and treated more allergic conjuntivitis than I have in months. We've had a wet winter (lots of snow) and the spring has seen a fair amount of is all paying off with beautiful green grass and lots of ' stuff ' for us to sneeze at.

I usually Rx Pataday for children when the kids have symptoms (no matter how mild the signs) or when the signs are there (no matter the symptoms). DM

Let's help keep kids from abusing medication

Article highlights:

Talk to young patients about the dangers of drug misuse.
Educate parents about the problem of drug abuse from medications in the home.
Teach parents the signs of drug misuse and when to suspect it.
Make sure parents know how to keep medications safe.
Write scripts for the length of time the patient will need to use the medication.

Comments: Children know what drugs are "in". All they have to do is listen to the news to find out the latest celebrity Rx'd high (i.e. Oxycontin has certainly been in the news...). During your Hx do you ask about drugs....even those Rx'd by a doctor? DM

Wednesday, May 7, 2008

Watch out for the sun this summer!

From AOA First Look...

AOA warns that prolonged exposure to sun's UV rays may lead to variety of vision disorders.

Medical News Today (5/6) reported that the "American Optometric Association (AOA) warns that prolonged exposure to the sun's" ultraviolet rays (UV) "and short wavelength light (violet and blue light) without proper protection may cause eye conditions that can lead to a variety of vision disorders." For example, "[o]verexposure to UV rays has been linked to age-related cataracts, pterygium, photokeratitis, and corneal degenerative changes," which "can cause blurred vision, irritation, redness, tearing, temporary vision loss, and in some instances, blindness." Moreover, "[t]he AOA cautions that the effects of sunlight exposure are cumulative; therefore, individuals whose work or recreational activities involve lengthy exposure to sunlight are at the greatest risk." But, according to Gregory Good, O.D., Ph.D., member of AOA's Commission on Ophthalmic Standards, "Protection can be achieved by simple, safe, and inexpensive methods such as wearing a brimmed hat, and using eyewear that properly absorbs UV radiation."

Tuesday, May 6, 2008

Evidence-Based Amblyopia Treatment: Results of PEDIG Studies

Results have shown that spectacles alone are a powerful treatment for amblyopia; patching is superior to spectacles alone; initiating fewer hours of prescribed patching seems to be as effective as traditional treatment; patching is effective in older children, particularly if they have not previously been treated; atropine is as effective as patching after six months; and weekend atropine is equally effective as daily atropine.

Comment: Start using this knowledge in how you treat your patients. DM

Refractive Surgery in ChildrenIs It Ready for Prime Time?

...Refractive surgery in children to reduce amblyopiogenic levels of refractive error is proving to be relatively stable. Best corrected and uncorrected visual acuity has also been shown to improve following the excimer laser procedures. Refractive surgery also appears to be effective for pure accommodative esotropia. Randomized clinical trials are needed to fully establish safety and efficacy. Other refractive procedures, such as clear lens extraction and phakic intraocular lenses, may also prove to be valid treatment options for these conditions in the future....

Comments: Refractive Surgery in Children, Is It Ready for Prime Time? The short answer is, NO! At the moment there are just too many unknowns. These children will have 70-80 years to act as an experiment for refractive surgery. Will their corneas be affected? How will this affect emmetropization? How will this affect the functional aspects of vision? We've already seen adults develop diplopia and other binocular vision problems because of refractive surgery. How about dry eye? All of these can become major problems for these children. At this point only extreme cases should be considered for refractive surgery....we just do not know what is going to happen 10, 20, 50 years down the road... DM

Down Synfrome and Bifocal Use

...Dr Maggie Woodhouse, who is leading the Bifocal Study funded by The Health Foundation says the findings are highly significant and unexpected: "Our study provides further evidence in support of more wide-spread use of bifocal lenses for this group of young people. "We found that before bifocal wear, Down's syndrome children have a focusing problem not because they cannot focus but because they do not focus. More specifically, the children accommodate much more accurately through their bifocals than do the control children through their ordinary lenses. Surprisingly, the children with bifocals also accommodate more accurately when looking over the top of their bifocals through the 'distance' part of the lens. This suggests that the bifocals are 'teaching' the children to use their own focusing ability. ...

Comments: What Dr. Woodhouse is saying is that accommodation function is "trainable". This means optometric vision therapy may be used to improve accommodative function in children with Down Syndrome. Others have shown this to be true for children with cerebral palsy. It is time for our ophthalmological colleagues to realize that just because you have the ability to do something, you may not have the Dr. Woodhouse notes, [it's]"...not because they cannot focus but because they do not focus..." This is also true for non-Down Syndrome children who may have focusing's "not becasue they cannot focus but because they do not focus.."....the abilitiy but NOT the functionality. The functionality we can change thru therapy. I haven't had a chance to read this study....I'm interested in learning how they measure accommodative ability in kids with Down Syndrome.

We should also note that individuals with Down Syndrome tend to age faster than those without Down Syndrome....which means they may need a bifocal earlier....say at age 30 as oppose to 40 years of age....DM

American children take anti-psychotic medicines at about six times the rate of children in the United Kingdom

...In both countries, the issue isn't simply how many children are getting these drugs, said Dr. David Fassler, a University of Vermont psychiatry professor. "The more important question is whether or not the right kids are getting the most appropriate and effective treatment possible," he said. Fassler wasn't involved in the study.... Dr. William Cooper, a Vanderbilt pediatrician, said the study shows the drugs are being used "without full understanding about the risks."...

Monday, May 5, 2008

Pediatric Eye Disease Investigator Group Amblyopia Treatment Review

...Ninety percent continue to use patching as their first method of treatment in moderate amblyopia. Over 50% will patch four hours/day or more to begin treatment and 83% will use near exercises to augment the patching. Two thirds will begin patching six or more hours/day in patients with severe amblyopia. Those that use atropine, use it daily rather than on weekends. Most felt that amblyopia could be treated to age 12 years and some thought it could be treated to 14 years.

...Most ophthalmologists and orthoptists taking the survey have not significantly changed their approach to amblyopia treatment in light of the recent PEDIG studies.

Comments: I've read that it can take up to ten years for research to "filter" down to clinical practice.... It's a shame that health care professionals do not keep up with the research. Actually, if you know of anyone like this, please have them sign up for this blog immediately!! DM

Should We Rx Full Plus for Accommodative Esotropes?

According to an article in the Br J Ophthalmol. Published Online First: 11 April 2008. doi:10.1136/bjo.2007.126417...YES! The authors found that:

Children with fully accommodative esotropia who are given the full hypermetropic correction demonstrate smaller, more controllable angles of deviation than those who are undercorrected by as little as only one dioptre. This supports the practice of providing the maximum hypermetropic correction for childhood esotropes.

Another very important clinical fact to remember is that FIRST you must ensure that the child WEARS the glasses. This may make it mandatory that you cut the plus at distance. I would also add that you should consider giving the child a multi-focal prescription (a bifocal) as well. Many times the cycloplegic does not uncover all of the plus in the system and an add (bifocal) will help maintain alignment much more readily. In terms of patient/parent management, please tell them that it is not uncommon for a child with an accommodative esotropia "plus prescription" to change over a short period of time, perhaps even multiple times, and that when the prescription changes, this could be a GOOD sign that the visual system is adapting appropriately. DM

Manifest Strabismus Following Pseudostrabismus Diagnosis

...The prevalence of strabismus was higher in patients diagnosed with pseudostrabismus than was reported for the general pediatric population. Therefore, patients diagnosed with pseudostrabismus might be considered "at risk". With pseudostrabismus, management should reflect this increased risk of true strabismus....

Children more vulnerable to harmful effects of lead

......extreme lead exposure can cause a variety of neurological disorders, such as lack of muscular coordination, convulsions and coma, lower lead levels have been associated with measurable deficits in children’s mental development and behavioral problems. These include hyperactivity, or ADHD, lowered performance on intelligence tests, and deficits in fine motor function, hand-eye coordination and reaction time. Chronic lead exposure in adults can result in increased blood pressure, decreased fertility, cataracts, nerve disorders, muscle and joint pain as well as problems with memory or concentration....

Illinois Therapeutic Law

Earlier I had noted that:

Illinois recently passed its optometric oral therapeutics bill.....and today and tomorrow, I am being exposed to an incredible opportunity to learn all about oral meds and their use in eye care (much of this was already taught in OD school and for the diagnostic and therapeutic (topical) courses). We have approximately 500+ ODs taking the 2 day course at ICO given by Dr. Bruce Onofrey (an OD and Pharmacist...and ICO grad) . Immediately after the course we also get to take a 2 hr test. Hopefully by dinner time Sunday I will have successfully passed my examination and can add one more service to the many I provide my patients.

Well, I jut got the good news....I passed my Oral Therapeutics course and as soon as my controlled license is mailed to me I will be able to prescribe oral medications for my patients as is noted within the Illinois Optometric Practice Act. Hurrah! DM