Saturday, October 2, 2010

Diagnosing Extraocular Muscle Dysfunction in Clinic: Comparing Computerized Hess Analysis, Park’s 3-Step Test and a Novel 3-Step Test

Quaid P, Hamilton-Wright AH. Diagnosing extraocular muscle dysfunction in clinic: comparing computerized Hess analysis, Park’s 3-step test and a novel 3-step test. Optom Vis Dev 2010;41(3):143-157.

Background: Determining the primary underacting
or overacting extraocular muscle (EOM)
or muscle pair in ocular mis-alignment cases can
frequently be challenging to eye care practitioners,
especially if the mis-alignment is bilateral or
longstanding. The purpose of this study was to
compare the results of a commercially available
computerized Hess Lancaster test to a proposed novel
3-step test and to the commonly used Park’s 3-step
Methods: Ten patients with recent onset or
longstanding EOM dysfunction were seen at the
primary author’s private optometric office for a
binocular vision evaluation. In addition to a complete
eye examination and binocular vision work-up, which
included Park’s 3-step test, all patients were examined
using both a commercially available computerized
Hess Lancaster test and the proposed novel 3-step
method. No mechanical restriction cases were
included in the patient sample.
Results: In all 10 cases, which comprised of
both longstanding and recent onset deviations,
the dysfunction indicated using the novel 3-step
method agreed well with the EOM(s) identified using
computerized Hess-Lancaster testing. Park’s 3-step
test did not prove useful in any of the presented
longstanding or recent onset cases.
Conclusions: Results attained using established
computerized Hess Lancaster testing agreed well
with results attained using a novel 3-step test. In
the absence of Hess Lancaster testing, the proposed
3-step test appears to be a viable alternative in arriving
at a potential diagnosis of the primary underacting
and overacting EOM(s). Park’s 3-step did not prove
useful in any of the presented cases as they were
either bilateral or had no significant vertical deviation
or change in vertical deviation in dextroversion or
levoversion. The proposed novel 3-step test appears
preferable over Park’s 3-step test as it also detects
bilateral and/or longstanding deviations that have
undergone a spread of comitance.

COVD: Recapitulating 40 Years of Excellence

Press L. COVD: recapitulating 40 years of excellence. Optom Vis Dev2010;41(3):137-142.

This year during the week of October 11, COVD will be celebrating our 40th year anniversary. It is fitting that our Annual Meeting this year in Puerto Rico provides an international flavor that attests to the global reach of our organization, mirroring our Cancun experience in 2003....

Do Gifted Children Choose Their Gifts?

Press L. Do gifted children choose their gifts? Optom Vis Dev 2010;41(3):133-

....“Go ahead and ask him”, her mom said. I couldn’t imagine what was on her mind at that point. “Well…” she demurred, “I’m a good artist and I really like to draw. And I draw some things in the same steps each time.” Her mother suggested that she draw me a horse as an illustration of her point. I turned over my examination sheet, handed her my pen, and invited Brigid to draw. She hastily sketched a horse’s head, narrating what she was doing as she went from one spot to the next .... When she was done she apologized that it was not up to her usual standards because she was rushing, but I was struck by its simplistic beauty. I was even more struck by what Brigid asked me next. Perhaps “floored” is a better word. “So if I do some things here to learn how to use my eyes better for reading, will I still be able to draw like I do?”.....

Comments: This editorial reminds us to remember what is important to our patients besides improving after doing optometric vision therapy. DM


Maino D. Words. Optom Vis Dev 2010;41(3):130-132

....Words are important. Words hold even more importance when you use them to identify or name objects, activities and ideas. This concept goes back thousands of years to biblical times, i.e. “He brought them to the man to see what he would name them; and whatever the man called each living creature, that was its name.” We control our world because we have named all within it. When you name a thing, you own it. Your world view is altered when you give all within that world a name or hen you adopt a name as your own even though the words you use may have been first given by others.....

This is an editorial I recently wrote for Optometry & Vision Development. The bottom line is optometrists who word in pediatrics, binocular vision, vision rehab, optometric vision therapy....need to rethink the language we use to describe what we do and who we are. DM

Nine-year Results of a Volunteer Lay Network Photoscreening Program of 147 809 Children Using a PhotoScreener in Iowa

....A retrospective review of results 147 809 children who were screened between May 1, 2000 and April 30, 2009 using a photoscreening program were assessed for the number of screenings, referral rate, positive predictive value (PPV), follow-up rate, and associated costs per year are described. The overall PPV of the MTI PhotoScreener was 94.2%. The cost of screening per child was$US9 .....

Comments: Lots of problems with this study including its retrospective design and high photo unreadable rate for children less than 12 years of age...although amblyopia or lazy eye can be treated at any age...the younger the better and this paper seems to say that the if you are younger than 12 the unreadable rate of the screener is high. Even though this particular study had a good positive predictive value...other studies have noted that most vision screening data is so poor that they couldn't even evaluate the value of vision screening. It has been noted that: "Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available." ... which means that vision screenings are so horrible that the research cannot tell us if they are worth doing or not! Read this particular article by clicking here. I suppose if you are only concerned with the cost using the MTI Photoscreener might be a good thing. If you want to make sure every child sees properly please schedule a comprehensive vision examination today. To read the article cited above click on the title. DM

Friday, October 1, 2010

Kids with ADHD more likely to have missing DNA

....Children with attention deficit hyperactivity disorder are twice as likely to have missing or extra chromosomes than other children ....British researchers compared the genomes of 366 white British children from 5 to 17 years old with attention deficit hyperactivity, or ADHD, to those of more than 1,000 similar children without the disorder. The scientists focused on a sequence of genes linked to brain development that has previously been connected to conditions like autism and schizophrenia....

Visual control in children with developmental dyslexia


PURPOSE: To assess binocular control in children with dyslexia.
METHODS: Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests.
RESULTS: In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed.
CONCLUSION: The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.

Keywords: Dyslexia/physiopathology; Attention; Vision, binocular/physiology; Visual perception; Ocular motility disorders; Learning disorders


OBJETIVO: Avaliar o controle binocular em crianças com dislexia.
MÉTODOS: Estudo transversal do qual participaram 26 crianças, nas quais foram aplicadas uma série de exames oftalmológicos e visuais.
RESULTADOS: Nas crianças com dislexia observou-se controle menor na convergência voluntária e na estabilidade da fixação binocular.
CONCLUSÃO: Os resultados apóiam a hipótese de que na dislexia do desenvolvimento podem ocorrer déficits que envolvem a via visual magnocelular e uma parte da rede cortical posterior da atenção.

Descritores: Dislexia/fisiopatologia; Atenção; Visão binocular/fisiologia; Percepção visual; Transtornos da motilidade ocular; Transtornos de aprendizagem

Comments: Full article in English and Spanish available by clicking title above. DM

Extensive Video Game Experience Readies Brain For More Challenging Hand-Eye Tasks

This study notes an improvement in visiomotor tasks after playing video games...while other papers have noted that individuals skilled in video game-playing have a more efficient brain network for controlling movement that includes the prefrontal, premotor, primary sensorimotor and parietal cortices....

Hard-Wired For Chocolate And Hybrid Cars? How Genetics Affect Consumer Choice

... people seem to inherit the following tendencies: to choose a compromise option and avoid extremes; select sure gains over gambles; prefer an easy but non-rewarding task over an enjoyable challenging one; look for the best option available; and prefer utilitarian, clearly needed options (like batteries) over more indulgent ones (gourmet chocolate). They also found that likings for specific products seemed to be genetically related: chocolate, mustard, hybrid cars, science fiction movies, and jazz....The researchers also found that some tendencies did not seem to be heritable - for example, a preference for a smaller versus larger product variety or likings for ketchup and tattoos. ....

Acute Pain Is Eased With The Touch Of A Hand

...There may be a very good reason that people naturally clutch their hand after receiving an injury. A new report ... shows that self-touch offers significant relief for acute pain under experimental conditions. The researchers suggest that the relief comes from a change in the brain's representation of the rest of the body. ...

Do gaze cues in complex scenes capture and direct the attention of high functioning adolescents with ASD? Evidence from eye-tracking.

...Visual fixation patterns whilst viewing complex photographic scenes containing one person were studied in 24 high-functioning adolescents with Autism Spectrum Disorders (ASD) and 24 matched typically developing adolescents. Over two different scene presentation durations both groups spent a large, strikingly similar proportion of their viewing time fixating the person's face. However, time-course analyses revealed differences between groups in priorities of attention to the region of the face containing the eyes. It was also noted that although individuals with ASD were rapidly cued by the gaze direction of the person in the scene, this was not followed by an immediate increase in total fixation duration at the location of gaze, which was the case for typically developing individuals....

Development of neural correlates of empathy from childhood to early adulthood: an fMRI study in boys and adult men.

...Although empathy is rooted early in life, the ability to understand and share the emotions of others continues to develop after childhood. ....This study is the first to show developmental changes in the neural mechanisms supporting empathy. Our findings may have important implications for the development of novel therapeutic interventions in clinical conditions characterized by empathy deficits, such as autism spectrum disorder....

General Health-Related Quality of Life in Preschool Children with Strabismus or Amblyopia

....Of the 4218 children aged ≥25 months, 121 (2.9%) were diagnosed with strabismus. Significant differences were found in all 3 composite scores between children with and without strabismus, ..... A total of 3318 children were aged ≥30 months, and 71 children (2.1%) had amblyopia. There were no significant differences in any PedsQL scores between children with and without amblyopia....Strabismus was associated with significantly worse quality of life in preschool children. difference was found with children with amblyopia....

Comments: Click on title above for abstract. DM

Visual Tricks to Looking Thinner

Since I am a "short, round Italian" I am always looking for ways to appear thinner.... AOAConnect had this info on how to achieve just that. (Of course, I could just loose a few poinds!!) Click on the title above for more info. DM

Visual Acuity Norms in Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study

...Visual acuity test performance in normal preschool children improves with age. We propose new age-specific thresholds for defining abnormal monocular VA using HOTV optotypes in children between 2 and 5 years of age, for use in screening, clinical practice and research....

Comments: Full article available by clicking on title. DM

Waking Up Brains After Stroke

....It strikes 800 thousand people every year and is the leading cause of long-term disability in the U.S. Ninety-five-percent of stroke survivors struggle to move their arms or hands after an attack. Now researchers are hoping to wake up hands by stimulating sleepy brain cells....

Comments: Don't forget that individuals with acauired and traumatic brain injury often have many vision problems that can interfer with their quality of life. See story and video by clicking on title above. Go to for more information. DM

Anxious & Unfocused: Adult ADHD

...One of every 10 kids in the U.S. has ADHD, attention-deficit hyperactivity-disorder. But experts say some of the parents should take a closer look at their own behaviors. ...

Comments: Just a reminder...just as children with ADHD can also have vision problems that can make ADHD worse...or can be mistaken for attentional problems....adults can have these same vision problems as well. If you are an adult with ADHD, please have a comprehensive functional vision assessment. Go to to find a doc who can help. Also...type in adult adhd in the search box to the upper left and see additional info on the topic. DM

Thursday, September 30, 2010

Was this Your Last Patient?

Children’s reading trouble could be linked to vision problem

Comments: Canadian optometrists understand the importance of evaluating every child for vision related learning problems. My friend and colleague, Dr. Patrick Quaid was quoted in this story. For the full article click the title above. DM

Everyone thought Skyla Lutz had a reading problem.
She’s in Grade 3 and had been stuck at a kindergarten level of reading for years. Her mother was getting worried about her. But it turned out all that was wrong with Skyla was her vision.....And Waterloo Region school board officials are beginning to see that in 80 per cent of cases where children are struggling with reading, there’s an underlying vision problem.

“There are many, many children struggling at school needlessly because of undiagnosed vision issues,” said [Dr.]Quaid, who teaches at University of Waterloo’s optometry school and has a practice in Guelph.

[Dr.] Quaid said if parents know their children are struggling with reading, they should ask the child’s optometrist about their binocular vision status in order to rule out these vision problems. Not every optometrist can treat these issues, but they can refer to a specialist.

It’s also important for parents to take their children to an optometrist before they start school, which is the recommendation of the Canadian Pediatric Association. But only an estimated 14 per cent of students have an eye exam before they start Grade 1. According to the Ontario Association of Optometrists, children should have their eyes examined at six months old, three years old and then every year, or as recommended.

Comments 2: Dr. Patrick Quaid just had an article published in Optometry & Vision Development. See Quaid P, Hamilton-Wright AH. Diagnosing extraocular muscle dysfunction in clinic: comparing computerized Hess analysis, Park’s 3-step test and a novel 3-step test. Optom Vis Dev 2010;41(3):143-157. by going to . DM

Tuesday, September 28, 2010

3-D Movie Effects Can be Affected by Vision Problems

...Improved 3-D film-making technology has people packing into theaters to enjoy the latest releases of 3-D blockbuster movies. However, not everyone is able to enjoy the special 3-D effects....

Optometry/Ophthalmology Coding Guide

Comment: Not sure what version this is or if it is appropriate for all ODs/MDs in every state, but I thought it would be a good potential resource. Please evaluated this closely before using it to make any decisions. DM

APHA Annual Meeting Advance Registration Deadline

American Public Health Association Annual Meeting Advance Registration Deadline This Friday

This Friday, October 1, marks the end of Advance Registration for the APHA Annual Meeting and Exposition in Denver, Colorado, November 6-10, 2010.

Discounted registration pricing is in effect until Friday at which point the on-site fees will be in effect. To view the registration fees visit

No Cost Infant Eye Evaluations

...Due to the overwhelming number of children with eye and vision problems across the United States, South Carolina optometrists are devoting appointments to no-cost, comprehensive eye and vision assessments for infants between six to 12 months of age through InfantSEE®. ...

Comments: All the states have optometrists who are InfantSee volunteers. To find a doc near you just click on the title above. DM

Monday, September 27, 2010

USA Today website on 3D and Vision Problems

3-D movies hampered by vision problems for some

....."There will be at least one person in the crowd who says, 'What are you talking about? I didn't see anything flying out at me.' Or maybe they will say, 'That movie actually made me a little nauseated,' " said Dominick Maino, a professor at the Illinois College of Optometry and the Illinois Eye Institute.....

My friend and colleague, Dr. Len Press was alos quoted: "However, people who are having problems with their binocular vision will either not be able to perceive the illusion of 3-D, or they will find that the movies or TV shows actually give them "visual hangover," said Leonard Press, a spokesman for the American Optometric Association and optometric director of the Vision and Learning Center in Fair Lawn, N.J....An association poll found that headaches, blurred vision and dizziness are the most common side effects from 3-D movies for people who have binocular vision difficulties. "After the movie, they're a bit dizzy, and it takes them awhile to get back to normal," Press said."

USA Today's website has Dennis Thompson's article about 3D Vision Syndrome which quotes me and Dr. Len Press discussing this prevalent problem. Click on the title above to read the story....DM

Study breaks down divorce rates by occupation

....Dancers and choreographers registered the highest divorce rates (43.1 percent), followed by bartenders (38.4 percent) and massage therapists (38.2 percent). Also in the top 10 were casino workers, telephone operators, nurses and home health aides. ...reporting low marital breakup rates were optometrists (4 percent), clergy (5.6 percent) and podiatrists (6.8 percent). ....

Not only is Optometry a great profession...but if you are married to one you are more likely to stay married according to this Washington Post article. (My thanks to AOA President Dori Carlson and Facebook for cluing me in on this article.) DM

Why does Autism show up more in males than females?

....ASD is a neurological disorder that affects brain functioning, resulting in challenges with communication and social interaction, unusual patterns of behavior, and often, intellectual deficits. ASD affects one in every 120 children and a startling one in 70 boys....

LA Times: Study follows new siblings of kids with autism

Take a look at this LA Times Q and A about autism... DM

Stress can control our genes

...Stress has become one of the major disease states in the developed world. ....Researchers ... have just shown that external factors can stress our cells through the control of our genes. "We found that stress-activating factors can control our genes by turning on certain genes that were supposed to be silenced. It is very important that some genes are on and others are off in order to ensure normal foetal development and correct function of our cells later in life" says Dr. Klaus Hansen. ... found that exposing human cells to a stress-activating compound turned on silenced genes. Even brief changes in gene activation can be disastrous during foetal development ..... But altered gene activity can also have consequences in the adult body. "For example, one could imagine that prolonged stress causes nerve cells in the brain to produce hormones and other signalling molecules they do not normally produce and this can disturb normal brain function" .....

Free vision tests to help with reading troubles

My friend and colleague, Dr. Brad Haberhmel is offering a vision screening to screen for learning related eye and vision the title above to learn more. DM

Bad study habits or does your child need vision therapy?

...Travis Hardee tested into Mountain Pointe's special program for gifted students, but struggled with Honors English. He procrastinated completing assignments and complained that reading made him fall asleep....

3-D Movies Clue Some Viewers To Vision Problem

...the American Optometric Association (AOA) estimates that 3 to 9 million Americans have vision problems which may preclude them from fully enjoying a 3-D movie...