Saturday, August 9, 2008

Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment.

... We conclude that early diagnosis of strabismus in combination with general population screening at the age of 4 to detect amblyopia caused by anisometropia or microstrabismus seems to be efficacious for the cure of most cases. The major factor in treatment failure was found to be inadequate adherence to the treatment regimen....

Comments: You do not wait until 4yrs of age. You participate in InfantSee and get those children in between 6-12 months of age....and watch them carefully!! The major factor in treatment failure is not inadequate adherence to the treatment regimen....don't blame the is that we (docs) have not found the treatment regimen that works well for all!! DM

Prevalence and causes of amblyopia in an adult population.

...Amblyopia was diagnosed in 118 participants, or 3.2% of the population using a visual acuity criterion of 20/30 or less and 2.9% using a visual acuity criterion of 20/40 or less. Using a two-line visual acuity difference between the eyes, the amblyopia prevalence was 2.6% and 2.5%, respectively, for the above criteria. The underlying amblyogenic causes assessed were anisometropia (50%), strabismus (19%), mixed strabismus and anisometropia (27%), and visual deprivation (4%). The visual acuity of the amblyopic eye was 20/200 or worse (19%), 20/80 to 20/160 (19%), 20/40 to 20/63 (52%), and 20/30 (11%). No statistically significant associations were found between amblyopia and gender or eye affected. The most frequent pattern of strabismus was esotropia, whereas hypermetropia was the most frequent refractive error in amblyopic eyes. The mean age at diagnosis was earlier for strabismic and mixed amblyopia (7.4 years) than for anisometropic amblyopia (12.7 years)....

Study suggests children with autism may make limited eye contact.

From AOA First Look:

The Oregonian (8/6, Rojas-Burke) reported, "Within three months of birth, babies show a strong preference for eye contact," and "spend more time looking at eyes than any other part of a person's face or body." In children with autism, however, "this behavior falters early," and "contribute[s] to the difficulties they have relating to others," experts say.

According to a study published in the Aug. issue of the Archives of General Psychiatry, "eye-mapping technology" may have "prove[n] that children with autism don't make eye contact like normally developing children do," HealthDay (8/6, Gordon) reported. For the study, Ami Klin, Ph.D., of the Yale University School of Medicine, and colleagues, "compared 15 children with autism to 36 typically developing children, and to another 15 children who were developmentally delayed, but not autistic. All of the children were two years old." The youngsters "were shown 10 videos of adults looking directly into the camera,...mimicking caregiving, and playing with the child. While the videos were running, the researchers used eye tracking to assess the child's visual fixation patterns." The investigators found that children with autism "looked at the eyes about 30 percent of the time, compared to nearly 55 percent for both of the other groups." Specifically, "[c]hildren with autism spent almost 40 percent of the time looking at the mouth area, while children in the other groups only spent about 24 percent of the time looking at this area."

New camera reproduces human vision.

From AOA's First Look:

The Chicago Tribune (8/7, Manier) reports, "Drawing inspiration from the simple design of the human eye, Illinois engineers have invented a new kind of eye-like camera." While "[b]ionic eyes based on the design are not yet on the horizon,...other teams are studying how to get digital signals into the brain's vision centers, and the new camera could be useful in such efforts."

The U.K.'s Daily Mail (8/7, Dolan) points out that the new camera "can reproduce human vision," according to research published in the journal Nature. The camera, developed by researchers from Illinois University and Northwestern University, Illinois, has "a curved detection surface" that "copies the effect of light from a subject hitting a curved human retina, which turns it into images by sending messages along the optic nerve to the brain." According to its inventors, this "is a vast improvement on the flat sensors used in digital cameras at the moment." The curved detection surface allows "the device [to] capture sharper images without distortion," and provides "a better field of view, as the human eye does."

New Scientist (8/7, Kleiner) explains that the researchers "built their hemispherical electronic eye by first using conventional photolithography to build silicon photodiodes 500 micrometers square and one micrometer thick. These were then wired into a flexible 16-by-16 array using chromium and gold." Next, the team "created a one-cm-wide hemisphere out of a stretchy plastic, and stretched it into a flat surface. That stretched surface, or 'drumhead,' was then pressed against the photodiode array." Under the effect of van der Waals forces, "[t]he silicon squares stuck to the stretched plastic,...which was then allowed to spring back to its original hemispherical shape." Then, "[a]s the array took its new form, the photodiodes packed together tightly, and the connecting wires arced away from the surface." This "reformed array was then glued to a curved glass surface, and a conventional lens [was] attached." The camera resembles "a human eye in construction, with light entering the lens from the front, and passing to the curved 'retina' containing the matrix of photodiodes behind." Scientific American (8/6, Minkel) also covered the story in its 60-Second Science blog.

Promising Treatment for Alzheimer’s

-- New results support the practice of using antibodies to treat Alzheimer’s disease. The nine-month tests show better outcomes in cognitive performance and daily functioning in patients treated with IGIV compared to placebo treated patients.

IGIV is an intravenous immunoglobulin called Gammagard. Gammagard contains a broad spectrum of antibodies and is an immunoglobulin replacement therapy for patients with immunodeficiency disorders.

Measles fears prompt MMR campaign

...An epidemic of measles - which can be fatal - could potentially affect up to 100,000 young people ....The MMR vaccine protects against measles, mumps and rubella....

The evidence on MMR is absolutely clear - there is no link between the vaccine and autism
Professor David Salisbury, Department of Health

Experts say it is perfectly safe, but vaccination rates dipped following controversy about its safety.....A study which raised the possibility that MMR was linked to autism has since been dismissed by the vast majority of research, but levels of public confidence in the jab have still not fully recovered.

Gender differences in early accommodation and vergence development.

...The apparent earlier maturity of the male accommodative responses may be due to refractive error differences but could also reflect gender-specific male preference for blur cues while females show earlier preference for disparity, which may underpin the earlier emerging, disparity dependent, stereopsis and full vergence found in females in other studies.....

Too Little 'Tummy Time' for Infants May Risk Development Delays

...Infants who spend too much waking time on their back may have an increased risk of delayed motor development, a survey of pediatric therapists suggests....

Comments: Developmental optometrists have been saying this for years!! DM

Can anyone hear that picture?

....The rare form of synaesthesia - a condition where senses intermingle - came to light after a student reported "hearing sounds" from a screensaver....Those affected performed better in tests of recognising visual patterns than those without the condition....A more common form of the condition is being able to perceive numbers or letters as colours.

Friday, August 8, 2008

Practice Management Tip: How not to do it!

This post is not about research, but rather a recent experience I had.

I called my hospital's billing department to settle an account balance. When I called the first time, no human picked up the phone....instead there were 4 options available to me.

I usually like to choose the option that lets me talk to a human....well, that wasn't going to happen....but I could leave a message to have someone call me back. I decided I'd call back 20 minutes later.

When I called back, no human answered. I again listened to all my of the options concerned being able to pay by credit card. I hit this number....and the message, "Please leave your name, phone number, account number and credit card number and we will .....". I almost started to do this when I realized that leaving my credit card number in a voice mail message just did not seem too secure to I hung up and called back about 20 minutes later.

When I called back no human answered....I did not wish to leave a message for a call I called back again 20 minutes later.

....well, you guessed it....when I called back no human answered the phone. This time I did leave a message so they could call me back.

In a couple of hours, the hospital billing department called me back. They were very professional and all went well. I decided that I wanted to talk to a supervisor to tell them about my experience....and that I did not understand how anyone would leave their credit card number in a voice mail message. The lady I was talking to told me her supervisor had left for the day (it was about 2:30PM Friday afternoon) I asked to talk to the supervisor's supervisor....unfortunately she/he also had left for the day.

Well, thinking that the hospital could benefit from my comments, I then called the hospital's Chief Financial Officer (I figured that if the lower level supervisors were not available....that the person at the top would be....). I was wrong. I was put into her/his voice human contact again...

I left a voice mail describing pretty much what I've written above....I also left my phone number. If they call me back I'm thinking that I should just let it go into my home voice mail.....

BTW my bill was for $9.89. Do you think if my bill was for $989,000.00 that they would have acted differently?

I would like to suggest that when if comes to our patients paying us....that we should make it as easy as possible, with human contact involved (at least someone should say "thank you"), and in a secure environment....

Well, that's just one doc's/patient's opinion. I'd like to hear yours...

Dominick M. Maino, OD, MEd, FAAO, FCOVD-A

Wednesday, August 6, 2008

Italian-American Renaissance 2008 Free Art Exhibition

Italian-American Renaissance 2008 Free Art Exhibition

Featuring Chicago-land's Best Known Contemporary Italian-American Artists

Gala Opening & Artists' Reception

Chandelier Room

Thursday August 7th 7:00 PM

Italian Cultural Center at Casa Italia
1621 N. 39th Ave. Stone Park, IL 60165

Dominic Candeloro, Exhibition Coordinator

Almost 100 Works of art on display including: Painting, Sculpture, Photography, & More

John Bucci, Anthony Panzica, Anna Pagnucci , Horacio Baggio, Mario Spampinato, Thomas Palazzolo, Dominick M. Maino, Julia delNegro Oehmke, Nick Bernero, Rita Dianni-Kaleel, Christopher Burlini, Bridgette Baggio, Vanessa Baggio, Leemarie Gaimari Bonk, Robert Buono, Claudia Pontarelli-Hallissey, Richard Bertucco, Nuccia Lucini,


A New Look At How Memory And Spatial Cognition Are Related

...Path integration, or the ability of the brain to compute the distance and direction of a traveled path, is an important aspect of spatial cognition an ability long-thought to be dependent on the medial temporal lobe structures of the brain....

Comprehensive Eye Exams Particularly Important For Classroom Success

The American Optometric Association (AOA) reminds parents that good vision is critical for many classroom tasks - from reading books or seeing a blackboard to viewing a computer screen. Without healthy vision, students can face unnecessary challenges not only in the classroom, but also to their mental, physical, social and emotional well being....

Shire Re-Launches, A Virtual Road Map Providing Information, Tools And Practical Tips About Attention Deficit Hyperactivity Disorder

...ADHD is a common psychiatric disorder that can impact the lives of many people, including patients, caregivers, friends and co-workers. It has certainly impacted my own life both personally and professionally," said Michele Novotni, Ph.D., internationally recognized ADHD expert, former president and CEO of the national Attention Deficit Disorder Association (ADDA), psychologist and consultant in the development of

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 improve. ...

Fox/Business News Website article...

Vision exercises benefit everyone, not just sports professionals, optometrist says.

From AOA First Look..

The U.K.'s Independent (8/5, Usborne) reports that in the past ten years, eye care "has become as crucial a part of elite sport as psychology." First taking hold in the U.S. with professional baseball teams, sports vision was "soon pitched across the pond" to various hockey, soccer, and rally teams in the U.K. But, according to optometrist David Ruston, O.D., of Johnson & Johnson Vision Care, "you don't have to be a pro to benefit from eye exercises." Even weekend warriors can improve their sports vision. Because the "eye loves to jump from one thing to another,...look to the other side of the room or out the window every 20 minutes." To help train eyes to "dart around readily in space," go into a "darkened room, flick a [flash light] around, and attempt to follow it." To "exercise all six muscles that move the eyeball inside the socket," stand before "a mirror, and move your head around while maintaining eye contact." And, by "sit[ting] at your desk and keep[ing] your focus on something ahead of you," while simultaneously "increas[ing] your awareness of what is happening" in your immediate vicinity, you can improve peripheral vision.

Surgeons use phakic intraocular lenses to treat amblyopia in children.

From AOA First Look...

The AP (8/5, Neergaard) reports that last week, a seven-year-old California girl "became one of a small number of U.S. children to try an experimental surgery to prevent virtual blindness from lazy eye diagnosed too late, or too severe, for standard treatment." In a "new approach," surgeons implanted a phakic intraocular lens (IOL) into her eye. Experts estimate that "[u]p to five percent of children have amblyopia,...where one eye is so much stronger than the other that the brain learns to ignore the weaker eye. Untreated, the proper neural connections for vision don't form, eventually rendering that eye useless." Amblyopia sometimes results when there is "a big difference in focusing power" between the two eyes, as was the case with the California child, who "had near-perfect vision in one eye," but was severely nearsighted in the other. While IOLs are not "officially approved for use in children," experimental implantation is legal. Now, "surgeons are starting to try the approach for hard-to-treat amblyopia. In a French study of a dozen children, all had improved vision after the surgery, and half recovered normal binocular vision."
Surgeons remove cataracts from eyes of four-month-old infant. The U.K's
Express & Star (8/4) reported that surgeons at Britain's Birmingham Children's Hospital recently removed cataracts and inserted contact lenses in the eyes of a four-month-old infant. Hospital staff told the parents that they "had dealt with only 115 similar cases in" the last "15 years." According to the baby's mother, the operation was "pretty straightforward." She explained, "It's just a slit in the corner of the eye, and then they suck the cataract out, just the same as in an older person." The parents "have been taught how to take the contact lenses out, cleanse them overnight, and put them back in." When the child is older, "doctors will decide if he needs future treatment." Meanwhile, the baby is expected to develop normally.

Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study.

...Among Hispanic/Latino and African American children in Los Angeles County, strabismus prevalence increases with age, but amblyopia prevalence appears stable by 3 years of age. Amblyopia is usually caused by abnormal refractive error. These findings may help to optimize the timing and modality of preschool vision screening programs...

Eye movements and binocular function in low birthweight teenagers.

...Premature birth with VLBW affects binocular visual functions negatively in adolescence, whereas birth small for date at term does not appear to be a risk factor for impaired eye movements and binocular function....

Binocular adaptation to near addition lenses in emmetropic adults.

...The results showed that +2D lenses initiate an increase in exophoria and convergence driven accommodation. The degree of the initial induced phoria was dependant upon the magnitude of the AV/A ratio. Vergence adaptation occurred after 3 min of near fixation and reduced the exophoria and convergence driven accommodation. The magnitude of vergence adaptation was dependant upon the size of the induced phoria and hence the AV/A ratio. The completeness of adaptation was seen to vary inversely with induced exophoria and thus the AV/A ratio....

Outpatient evaluation of vision and ocular motricity in 123 children with cerebral palsy.

Visual and oculomotor tests are of significant importance in children with CP and provide relevant information for creating a rehabilitation programme aimed at the individual as a whole.

Prevalence and risk factors for common vision problems in children: data from the ALSPAC study.

...Data were available for 7825 seven-year-old children. 2.3% had manifest strabismus, 3.6% had past/present amblyopia, and 4.8% were hypermetropic. Children from the lowest occupational social class background were 1.82 times more likely to be hypermetropic than children from the highest social class. Amblyopia (p = 0.089) and convergent strabismus (p = 0.066) also tended to increase as social class decreased. ... Although strabismus has decreased in the UK, it and amblyopia remain common problems. Children from less advantaged backgrounds were more at risk of hypermetropia and to a lesser extent of amblyopia and convergent strabismus. Children's eye-care services may need to take account of this socio-economic gradient in prevalence to avoid inequity in access to care.

Comments: A full comprehensive examination is need for every child. DM

Clinical investigation of surgery for intermittent exotropia.

...CONCLUSIONS: (1) Strabismus surgery can help to preserve or restore the binocular vision for intermittent exotropia; (2) Receiving the surgery at young ages may develop better postoperative binocular vision; (3) The postoperative synoptophore exercise can help to restore the binocular vision....

Comments: Why would you put your pt through surgery and its associated risks without conductihng optometric vision therapy first which has been shown to be highly effective in convergence insufficiency? DM

Observation on therapeutic effect of acupuncture combined with western medicine on paralytic strabismus

...Acupuncture combined with western medicine has obvious therapeutic effect, which is better than that of simple acupuncture or simple western medicine....

AOA reminds parents good vision is critical for children's classroom success, overall well-being.

From AOA First Look...

With the new school year about to start, Medical News Today (8/6) reports that the "American Optometric Association (AOA) reminds parents that good vision is critical for many classroom tasks." Children who do not have "healthy vision...can face unnecessary challenges not only in the classroom, but also to their mental, physical, social, and emotional well being." Some youngsters who "suffer from undetected vision problems...may even be misdiagnosed as having a learning disorder." In fact, "[s]tudies indicate that 60 percent of children identified as 'problem learners' actually suffer from undetected vision problems. According to the AOA's American Eye-Q® survey, only 39 percent of adults understand that behavioral problems can be an indication of vision problems." Optometrist Leonard Press, O.D., AOA's vision and learning specialist, pointed out that "10 million school children in America have vision conditions that can negatively affect learning." Therefore, "[a] comprehensive eye examination for students is one of the most important 'to-dos' as children head back to school."

In-Hospital Falls of Newborn Infants: Data From a Multihospital Health Care System

If the incidence of a neonatal in-hospital fall in this study is representative, then 600 to 700 such falls occur annually in the United States. Relatively few scenarios explain the majority of falls. Author speculate that the prevalence of this error could be reduced significantly by enacting programs aimed at eliminating or monitoring the most common circumstances under which these falls occur.

How HIPAA affects checks that bounce

...As long as the collection agencies have a business associate agreement with the billing company they can't contact a patient directly if his check bounces. Since HIPAA allows the use and disclosure of protected health information for treatment, payment, and operation purposes, they're allowed to contact the patient directly regarding a bounced check or delegate that task to the billing company. ...

Monday, August 4, 2008

Researchers say children with low outdoor activity may have two- to three-fold higher risk of myopia.

From AOA First Look (even though I already reported on's worth noted again....get your kids outside and running around!! DM)

The U.K.'s Telegraph (8/2, Smith) reported that "[c]hildren with low outdoor and high near-work activity," that is, reading, working on the computer, or watching television, "had two to three-fold higher risk of myopia than the children who spent the most time outside," according to a study published in the journal Ophthalmology. Kathryn A. Rose, M.D., of Australia's Sydney University, and colleagues, "used data from the Sydney Myopia Study of more than 4,000 Australian school children to assess whether outdoor activity might be significant in controlling myopia." The researchers defined "[a] high level of outdoor more than 2.8 hours a day, while less than 1.6 hours was classed as a low level of outdoor activity." Dr. Rose theorized that in response to "the intensity of light outside," the "retina releases dopamine which inhibits eye growth, affecting the shape of the eye." In addition, "the pupils of the eyes constrict in intense outdoor light, which increases the visual depth of field, the distance at which objects can be clearly seen."

COVD Launches Public Awareness Campaign

The College of Optometrists in Vision Development's (COVD) "August is Children's Vision and Learning Month" campaign is working to raise awareness about the important connection between vision and learning. According to the COVD, current research shows that vision problems afflict millions of American children and thereby impact their ability to learn: - One in four school-age children have vision problems, according to the American Foundation in Vision Awareness; - 18 million children will not have had eye examinations by a vision care professional prior to entering school; - 60 percent of students identified as "problem learners" have undetected vision problems, according to the American Optometric Association. "Vision disorders are one of the leading impediments to successful learning in children," said Dr. Drusilla Grant, Immediate Past President of the COVD. "Many vision problems go undetected because a child is told he or she has 20/20 vision and healthy eyes. This can be misleading because their visual skills like tracking, eye teaming, and focusing may not have been evaluated and this is really where the problem lies." The COVD is urging parents and teachers to make a comprehensive eye examination part of their preparations for the new school year and to look for the following indications that vision problems may be contributing to learning challenges of their children and students: frequent loss of place when reading, poor reading comprehension, sloppy handwriting, confusing similar looking words, failure to recognize the same word in sequential sentences, complaints of eyes hurting or headaches after reading, avoidance of close work (such as reading) and attention problems. For more information visit