Saturday, October 31, 2009

Tailored Therapy for Neurological Injuries

Many physical therapy programs for neurological injury aid in the restoration of one particular function at a time. Researchers at Georgetown University Medical Center have begun the development of a new tailored physical therapy program designed to restore a variety of everyday functions instead of just one.

Statins show dramatic drug and cell dependent effects in the brain

...Besides their tremendous value in treating high cholesterol and lowering the risk of heart disease, statins have also been reported to potentially lower the risks of other diseases, such as dementia. However, a study in the October Journal of Lipid Research finds that similar statin drugs can have profoundly different effects on brain cells -both beneficial and detrimental. These findings reinforce the idea that great care should be taken when deciding on the dosage and type of statin given to individuals, particularly the elderly....

Visual impairment in the hearing impaired students

Background : Ocular problems are more common in children with hearing problems than in normal children. Neglected visual impairment could aggravate educational and social disability.
Aim : To detect and treat visual impairment, if any, in hearing-impaired children.
Setting and Design : Observational, clinical case series of hearing-impaired children in schools providing special education.
Materials and Methods : Hearing-impaired children in selected schools underwent detailed visual acuity testing, refraction, external ocular examination and fundoscopy. Ocular motility testing was also performed. Teachers were sensitized and trained to help in the assessment of visual acuity using Snellen's E charts. Refractive errors and squint were treated as per standard practice.
Statistical Analysis : Excel software was used for data entry and SSPS for analysis.
Results : The study involved 901 hearing-impaired students between four and 21 years of age, from 14 special education schools. A quarter of them (216/901, 24%) had ocular problems. Refractive errors were the most common morbidity 167(18.5%), but only 10 children were using appropriate spectacle correction at presentation. Fifty children had visual acuity less than 20/80 at presentation; after providing refractive correction, this number reduced to three children, all of whom were provided low-vision aids. Other common conditions included strabismus in 12 (1.3%) children, and retinal pigmentary dystrophy in five (0.6%) children.
Conclusion : Ocular problems are common in hearing-impaired children. Screening for ocular problems should be made mandatory in hearing-impaired children, as they use their visual sense to compensate for the poor auditory sense.

Comments: For full text of the article click the title above. DM

Mixed Results for Pediatric Eye Surgery

...all lens types implanted for pediatric cataract are eventually plagued by a higher-than-expected rate of posterior capsule opacification, necessitating Nd:YAG laser treatment....The problem is treating people who still have 70 years ahead of them..."

Comments: Be careful. Very careful. Long term results of refractive surgery for adults are unknown yet alone for children who have decades ahead of them. DM

41% of Americans Haven't Had and Eye Exam

41% of Americans haven't had and eye exam in the last 1-3 yrs. This video recommends a "vision screening"? How ridiculous! They said that early exams for children are important...unfortunately they suggest your pediatrician and school nurse can do this....of course they CANNOT! Go see you optometrist today. Check out American Optometric Association or the College of Optometrists in Vision Development to find a good doc for yourself and your children. DM

Thursday, October 29, 2009

Optimal compliance for amblyopia therapy: occlusion with a translucent tape on the lens

...The translucent tape optimizes compliance and yields better vision by lengthening the duration of occlusion therapy and reducing the number of treatment failures due to noncompliance....

Comments: I've used this method for many years....and as the research works pretty well. Click on title for full text article. DM

Brain function and gaze-fixation during facial emotion processing in fragile-X and autism

Click title for full text article.

Looking But Not Seeing: Atypical Visual Scanning and Recognition of Faces in 2 and 4-Year-Old Children with Autism Spectrum Disorder.

...This study illustrates that face processing in ASD may be affected early and become further compromised with age. We propose that deficits in face processing likely impact the effectiveness of toddlers with ASD as social partners and thus should be targeted for intervention....

Journal of Behavioral Optometry TBI Issues

Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation
Optometric vision therapy and rehabilitation have been used to successfully treat a wide range of visual disorders for over 80 years. However, it was not until the past few decades that the scientific basis supporting its efficacy was beginning to be understood. This review article discusses current neuroplasticity concepts, the supporting research, their therapeutic applications in other disciplines, and their implications to optometry. It can be hypothesized that vision therapy techniques strengthen synaptic connections through Hebbian learning and induce cortical reorganization to maximize visual efficiency. This can provide a theoretical basis for the efficacy of vision therapy, while neuroimaging can provide an objective basis.

Oculomotor Dysfunctions, Their Remediation, and Reading-Related Problems in Mild Traumatic Brain Injury
Reading is a complex task involving a wide range of functions and abilities that are both vision and non-vision-based. Accurate eye movements are essential for efficient reading. Hence, if oculomotor control is impaired by traumatic brain injury (TBI), reading will likely be adversely affected.

Traumatic Brain Injury: A New Challenge for Optometry, Neuro-Optometric Rehabilitation and Our Nation
Traumatic Brain Injury (TBI) may result in the need for life-long care. In times of combat TBI comprises at least 14-20% of surviving casualties, who need more acute and long-term healthcare resources. The Department of Defense and Department of Veterans Affairs have been meeting this challenge since 1992 with the Defense and Veterans Brain Injury Center (DVBIC). More recently, the Veterans Health Administration has developed a Polytrauma System of Care so that veterans receive the right care, in the right place, at the right time.

Military Optometry in the Care of Traumatic Brain Injury Patients

The medical care system for soldiers and Marines who incur traumatic brain injury in Iraq and Afghanistan is presented. After initial immediate care is provided, they are sent to a staging area for further treatment and then to a tertiary care hospital in Germany. Finally, they are assigned to an army or navy medical care facility in the United States. All suspected traumatic brain injured patients are screened to determine the level of severity of injury. They are then assigned to either an Army Hospital, or a Department of Veterans Affairs health care facility for further treatment and rehabilitation. The author notes his impressions that in terms of vision, there are often changes in refraction, impaired accommodation and binocular functioning.

Additional articles can be found at:

Relationship between accommodative and vergence dysfunctions and academic achievement for primary school children

...The purpose of this study was to investigate the prevalence and types of non-strabismic accommodative and/or vergence dysfunctions in primary school children, and to determine the relationship of these dysfunctions to academic achievement. A total of 1031 parents and their children aged 9-13 years responded to the College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. Of these, 258 children whose visual symptom scores were ≥20 were identified for further evaluation. Comprehensive eye and vision examinations were provided to the children who met the eligibility criteria (114 of 258): eligible symptomatic children were those without amblyopia, strabismus, ocular and systemic pathology, and contact lens wear. Children were also excluded if they had visual acuity poorer than 20/25 in either eye or vertical phoria >1 prism diopter. The results showed that 82 of 114 (71.9%) of criteria-eligible symptomatic primary school children had non-strabismic accommodative and/or vergence dysfunctions. In addition, a significant relationship was found between these dysfunctions and academic scores in every academic area (reading, mathematics, social science and science) in the total sample. Therefore, accommodative and vergence functions should be tested for all school children who have visual symptoms and/or academic difficulties. Additional study is needed to determine if improvements of accommodative and vergence functions also improve academic achievement....

Gene Therapy Can Restore Eyesight In People With A Genetically-Inherited Sight Disorder, Especially Children

...The authors say: "All 12 patients given gene therapy in one eye showed improvement in retinal function. The effect was stable during follow-up. The results support our hypothesis that the response to subretinal gene therapy depends on the extent of retinal degeneration and, therefore, the age of the patient."

They add: "The most noteworthy result was the ability of children to navigate an obstacle course independently and accurately, even in dim light...The visual recovery noted in the children confirms the hypothesis that efficacy will be improved if treatment is applied before retinal degeneration has progressed. Assessment of whether the treatment alters the natural progression of the retinal degeneration will be possible in follow-up studies."

They conclude: "The success of this gene therapy study in children provides the foundation for gene therapy approaches to the treatment of other forms of LCA and of additional early onset retinal diseases."...

Understanding Music's Healing Power

...Research has shown music therapy to be an effective method of treatment for people with neurological disorders and heart conditions, but the scientific community doesn't yet have a clear explanation of why and how music affects the body....

Younger children with influenza A (H1N1) may have longer viral shedding than older children, adults

...Further analysis by real-time PCR determined that the median duration of viral shedding was six days (range 1 to 13 days) after the onset of fever. Further analysis by culture determined that the median duration that viable H1N1 was detected was five days (range 1 to 7 days) after the onset of fever....

Comments: So how long should we keep our kids at home? DM


The AOA is making available to members, free upon request, a Convergence Insufficiency (CI) Toolkit. The primary purpose of the toolkit is to help primary care optometrists screen for convergence insufficiency. The recent CITT publications has elevated awareness about functional vision problems to a new level. A number of COVD members were involved in this project. The toolkit was originally conceived by Dr. Bill Leadingham. The project became a priority for this year’s Pediatrics/Binocular Vision Committee of the AOA, comprised of Drs. Gary Williams, Sandy Block, Bill Reynolds and Glen Steele, and chaired by Dr. Leonard Press.

Dr. Mary Beth Rhomberg, of the AOA’s Clinical Care Center helped put the finishing touches on the project. There will be a laminated insert accompanying background information on this in the October 26 issue of the AOA News.

You can preview this information at:


More information about the toolkit is available at:

Sunday, October 25, 2009

Prevalence and Severity of Hypertensive Retinopathy in Children

The National High Blood Pressure Education Program (NHBPEP) report recommends a retinal exam seeking evidence of target organ damage in hypertensive children. This study aimed to determine the prevalence and severity of hypertensive retinopathy among hypertensive children, evaluated by pediatric ophthalmologists in the "real world" clinical setting using direct ophthalmoscopy. The authors retrospectively reviewed the medical records of the 83 children diagnosed with hypertension by a pediatric nephrologist between 1999 and 2006. Of the 35 children examined by an ophthalmologist within 12 months of the diagnosis of hypertension, only 3 (8.6%; 95% CI, 1.8%-23.1%) were diagnosed with hypertensive retinopathy. Despite the fact that those selected for retinal examination were likely at higher risk for retinopathy, the prevalence of retinopathy was low, and only mild abnormalities were detected. Given the lack of evidence linking mild retinal abnormalities with adverse outcomes, the NHBPEP recommendation for retinal examinations in hypertensive children should be reconsidered.

Dietary restrictions may do more harm than good for children with autism

...New data do not support the relationship between autism and gastrointestinal dysfunction that some have hypothesized...Data from the retrospective study that spanned between 1976 and 1997 indicated that there were no significant differences in overall GI symptom prevalence as defined by three of five diagnostic categories — including diarrhea; abdominal bloating, discomfort or irritability; and gastroesophageal reflux or vomiting — between a matched control group and 121 patients aged younger than 21....

Separate measles, mumps, rubella vaccine formulations discontinued

...A representative from Merck announced that the company plans to discontinue production of monovalent measles, mumps, rubella vaccine formulations during the Advisory Committee on Immunization Practice’s meeting yesterday....

6th International Congress of Behavioral Optometry

6th International Congress of Behavioral Optometry

We are excited to announce the opening of registration for our once-every-four-year event, the 6th International Congress of Behavioral Optometry, which is taking place on 6-Apr-2010 8:00 AM PDT - 11-Apr-2010 1:30 PM PDT at the Doubletree Hotel Ontario Airport, 222 North Vineyard Avenue, Ontario, CA 91764 USA.

V.S. Ramachandran will be the Keynote speaker. Nat Flax, with a special introductory lecture by Don Getz, will be our Kraskin Memorial presenter. Featured speakers include: Sue Barry, Dan Barry, Steve Cool and Elizabeth Quinlan. The meeting is in association with NORA and Western University of the Health Sciences new College of Optometry. Nearly 50 additional speakers will be part of this fantastic meeting.

Early registration closes January 1, 2010, so, we'd like to offer you the opportunity to reserve your spot at a reduced early bird rate! To RSVP, click here .

We look forward to hearing from you!

Thank you,

Phone: 1-949-250-8070, Email: [email protected]

6th International Congress of Behavioral Optometry