Friday, January 18, 2013

Amblyopia Treatment for Adults - Is It Possible?

Amblyopia Treatment for Adults - Is It Possible?

We field inquiries literally from all over the world regarding amblyopia treatment for adults.  The question is always the same:  Am I too old to get treatment for my lazy eye?  And our answer is always the same:  People of all ages can be treated for amblyopia.
Why is there so much confusion over the issue?  There are actually two issues to consider here:
  1. Can amblyopia (lazy eye) be treated at all? [YES]
  2. Is there an age cut-off for treatment? [YES]
Comments: One of my colleagues has an outstanding blog that takes a closer look at amblyopia and its treatment. Click on the title above to learn more. DM

National Academies of Practice Call for Abstracts

Call for Abstracts for Poster Session

The National Academies of Practice (NAP) are calling for abstracts for the Poster Session at the 2013 Annual Meeting  Forum, April 5-7, in Alexandria, VA.  The Poster Session will be held during the Welcome Reception, the evening of Friday, April 5.

Abstract content should reflect inter-professional healthcare subjects: practice, education, research or policy. Selection criteria include:

  • Relevance/significance of the topic to inter-professional practice, education or research
  • Author’s review and knowledge of existing literature and other relevant needs assessment
  • Clarity of purpose, objectives
  • Methods are appropriate for project and clearly explained
  • Accurate interpretation of results, which includes lesions learned, potential contributions and/or recommendations for practice, education or research
  • Effective presentation - clear cohesive writing
  • Selected presentations may be invited to submit a paper to the NAP E-Journal:  Journal of Interprofessional Healthcare (JIH).

Abstract submissions are due by Monday, February 4, 2013. Notification regarding decisions will be sent to all submitters by February 15.  Notifications will be sent to the contact person for each poster submission. If the poster has more than one author, the contact person is asked to share the information with the other author(s). Information on the formatting of posters will be provided upon acceptance. All selected poster presenters are required to register, pay applicable registration fees, and attend the Forum.

Submission Guidelines
Abstracts must be free of commercial bias or promotion, should be no more than 500 words in length and written in English, and must be submitted online. You are encouraged to compose the text of your abstract on your own word processing software before beginning the online submission process, so that you can easily copy and paste the complete text. Please note that the abstract submission form supports text only. Do not use bolding, centering, underlines, columns, bullets, or scientific symbols. Do not include graphs or tables. Please use the following headings, as appropriate:
  • Abstract Title
  • Author Name(s)
  • Institution
  • Background/Introduction
  • Purpose: objectives or hypothesis
  • Methods/Design
  • Results/outcomes
  • Conclusions/Lessons Learned
Submitting Your Abstract

The submission process is simple and starts on the Home Page at

On the Event Details page click on the button at the bottom of this page “Register for this Event”. If you are not already logged in, you will be directed to a login page. As a member of NAP, you are already a registered user. Your “Primary E-Mail Address” is the one used by NAP to send you communications, like 5 Things.

If you have not logged in to the website before, your “Password” will be Password1. If you have forgotten the password you previously created, please use the “Forgot your password?” link. Please do not use the New Visitor Registration which will create a duplicate record for you.

At the Event Registration Page, the following information will be already displayed from your record: First Name, Last Name, and Badge Name. If any of this information is incorrect, please update these fields.

Then, COPY the previously written text of your abstract and PASTE it into the “Abstract Text” field. When you are satisfied with your text, click the “Next” button at the bottom of the page.

On the ‘Confirm & Submit Registration’ page, you will have the ability to add another email address to receive a copy of your submission confirmation. You must click the “Register Now” button to submit your abstract.

If you have questions about the submission process please contact Heather Outhuse at [email protected] or call 703-299-0105.

National Academies Of Practice (NAP),PO Box 644930 Pittsburgh PA 15264, Phone Number:(703) 299-0105, Fax Number: (703) 299-9233, Email Address: [email protected], Website :

Influenza vaccination rates remain lower than expected

Influenza vaccination rates remain lower than expected

.....fewer than 45% of influenza-negative children aged 6 months and older were fully vaccinated against influenza. The study findings also indicated that single-season influenza hospitalization rates were 0.4 to 1.0 per 1,000 children aged younger than 5 years; hospitalization rates were highest for infants aged younger than 6 months.....
Comments: This past week I asked all my patients in my private office if they had gotten their flu shots. Less than 5% had received the shot. This is ludicrous! Get your fly shot. Get it now! Make sure all your family members get theirs as well. People still die from flu related complications. Protect yourself and those around you. DM

Thursday, January 17, 2013

Profile of anisometropia and aniso-astigmatism in children: prevalence and association with age, ocular biometric measures and refractive status

Profile of anisometropia and aniso-astigmatism in children: prevalence and association with age, ocular biometric measures and refractive status

...In this population there is a high prevalence of axial anisometropia and corneal/axial aniso-astigmatism, associated with hyperopia but whether these relations are causal is unclear. Further work is required to clarify the developmental mechanism behind these associations.....

Wednesday, January 16, 2013

Binocular coordination of saccades during reading in strabismic children

Binocular coordination of saccades during reading in strabismic children

.....In strabismic children binocular saccade coordination is deficient and could be responsible for impaired reading capabilities. Binocular vision plays an important role in improving binocular saccade yoking.....

Tuesday, January 15, 2013

Strabismus Surgery: The Discussion Continues

A colleague of mine (I believe this to be Dr. EA Pennock, a pediatric ophthalmologist (OMD)) responded to one of my earlier posts and then to the one noted below. Please read his comments and then my response:

Dr. Maino, I enjoyed reading your blog and you bring up many good points. However, this page in particular has many unfounded claims and untruths. In the spirit of congeniality I'd like to make a few comments. First, surgery is often NOT the first option for treatment of strabismus. I am an ophthalmologist who specializes in pediatrics and strabismus. If there is a non-surgical option for my patients I always recommend it first. I've even had some parents of accommodative esotropes question me as to why I prescribe glasses instead of just straightening their child's eyes ("can't you just do surgery and be done with it?"). I won't operate when it's not appropriate. In fact, I can't think of any of my esteemed colleagues across the nation who would jump right into strabismus surgery if there were viable non-surgical options. "Strabismus surgery has well [sic] many well-known risks and complications". ANY surgery has well-known risks and complications. These are spelled out to all on Another risk of strabismus surgery? Increased risk of learning disabilities and attention deficit hyperactivity disorder (ADHD) because of exposure to anesthesia.


Dear Dr. Pennock, I would like to respond to your comments (also in the spirit of congeniality).

Saying something has unfounded claims and untruths does not prove it so. If you have published data to support what you say, I would love to see it (no sarcasm here, I really would love to see it). I should also point out that my Canadian colleague had references for many of her statements about strabismus surgery.

I am thrilled that you try non-surgical approaches before surgical intervention. Those patients with accommodative esotropia must wear an appropriate pair of glasses with an add (and maybe even prism). Then if there is a residual strabismus still present, optometric vision therapy should be instituted to improve accommodative (focus) function, oculomotor abilities and (hopefully) fusion. Only then should surgery be considered. I have looked for the data to ascertain how often non-surgical interventions are used by my OMD colleagues and haven't found the information just yet. Do you have one or more papers I could review?

Although as you note, ANY surgery has well-known risks and complications, unfortunately these are not often known by our patients...and may not even be known by our non-eye colleagues.

Strabismus surgery is an option, but only after all non-strabismic interventions have been tried. This should include optometric vision therapy.

I refer to my ophthalmological colleagues for surgical intervention when appropriate. Dr. Peenock, when was the last time you referred to an optometrists for non-surgical intervention? Click here to find some doctors who might be able to improve your surgical outcomes.

Our professions have a great deal to do to improve the care of our patients with strabismus. We also have numerous research studies to conduct in this area for better evidence based treatment options. The first step is recognizing the benefits and problems associated with our current treatment approaches. The next step is to work together to improve outcomes.

I deeply appreciate your comments and hope to be able to continue this conversation in person some day. It is obvious that you care about what you do. It is obvious you want the very best for all your patients. We have this in common. From this common ground, let us begin building a relationship between our professions to break down barriers.

See reviews and articles below for information on strabismus surgery outcomes.

Cochrane Reviews for strabismus surgery:

No reliable conclusions could be reached regarding which technique (adjustable or non-adjustable sutures) produces a more accurate long-term ocular alignment following strabismus surgery or in which specific situations one technique is of greater benefit than the other. High quality RCTs are needed to obtain clinically valid results and to clarify these issues. ......

See: Haridas A, Sundaram V. Adjustable versus non-adjustable sutures for strabismus. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004240. DOI: 10.1002/14651858.CD004240.pub2
The majority of published literature on the use of botulinum toxin in the treatment of strabismus consists of retrospective studies, cohort studies or case reviews. Although these provide useful descriptive information, clarification is required as to the effective use of botulinum toxin as an independent treatment modality. Four RCTs on the therapeutic use of botulinum toxin in strabismus have shown varying responses ranging from a lack of evidence for prophylactic effect of botulinum toxin in acute sixth nerve palsy, to poor response in patients with horizontal strabismus without binocular vision, to no difference in response in patients that required retreatment for acquired esotropia or infantile esotropia. It was not possible to establish dose effect information. Complication rates for use of Botox™ or Dysport™ ranged from 24% to 55.54%.

See: Rowe FJ, Noonan CP. Botulinum toxin for the treatment of strabismus. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD006499. DOI: 10.1002/
The main body of literature on interventions for IE are either retrospective studies or prospective cohort studies. It has not been possible through this review to resolve the controversies regarding type of surgery, non-surgical intervention and age of intervention. There is clearly a need for good quality trials to be conducted in these areas to improve the evidence base for the management of IE.
See: Elliott S, Shafiq A. Interventions for infantile esotropia. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004917. DOI: 10.1002/14651858.CD004917.pub2
From PubMed:
Br J Ophthalmol. 2012 Oct;96(10):1291-5. Epub 2012 Aug 11.Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study.
After surgery 65% had fair to poor outcomes and 20% of the subjects remained XT or the XT recurred
BMC Ophthalmol. 2012 Jan 18;12:1. doi: 10.1186/1471-2415-12-1.The improving outcomes in intermittent exotropia study: outcomes at 2 years after diagnosis in an observational cohort.
....8% ...of those treated surgically required second procedures for overcorrection within 6 months of the initial procedure and at 6-month follow-up 21% ... were overcorrected ....
J AAPOS. 2011 Dec;15(6):527-31. doi: 10.1016/j.jaapos.2011.08.007.Postoperative outcomes of patients initially overcorrected for intermittent exotropia.Pineles SL, Deitz LW, Velez FG.
....(49%) were orthotropic to <8 ...="..." 8="8" after="after" b="b" diopters="diopters" exotropia="exotropia" eyes="eyes" means="means" of="of" omment:="omment:" still="still" surgery="surgery" the="the" turned="turned"> (41%)
had recurrence of exotropia >8(Δ), and ... (10%) had monofixational esotropia <10 div="div">
These are only a few examples of why strabismus surgery should not be considered before other forms of intervention are tried. Patients should know surgical outcomes if the data is available. DM


Monday, January 14, 2013

Stick and Find: Awesome!

Stick and Find: Awesome!

Find your keys, your luggage and even your kids!

This was too good not to let you know that it exists! I haven't tried it yet....but will shortly once it becomes available. Keep your computer logged into MainosMemos for more info!

Sunday, January 13, 2013

American Academy of Optometry OVS Information

American Academy of Optometry OVS Information

Reminder: Continue Your Access to OVS on the iPad
Eye Image
Your subscription to Optometry and Vision Science for the iPad® is a benefit of your subscription to Optometry and Vision Science in addition to your online subscription via the journal’s website,

To continue accessing the full-text issues via your iPad, you will be required to sign-in using a Username and private Password you create starting with the January 1st issue of Optometry and Vision Science for the iPad. If you already have a Username and Password for Optometry and Vision Science’s website or another LWW iPad app, you should use the same Username and Password. Otherwise, you will need to create an account using your Subscriber ID.

Simply, download the app for free, if you haven’t already. If you have already downloaded the app, please download the update when prompted. Then, download the most recent issue and walk through the prompts provided in the app to create an account. For further assistance, contact LWW Customer Service: call 1.800.638.3030 (United States), + (Europe), or +1.301.223.2300 (Rest of World). You can also email [email protected].

Easy Steps to Sign into Your Account for Optometry and Vision Science for the iPad.
  1. You must download the app or update your previously downloaded Optometry and Vision Science app before completing the next steps.
  2. Once you download the app for the first time or download the newest release, open the Optometry and Vision Science app from the icon on your iPad home screen.
  3. You will see the message “If you have already set up your account for Optometry and Vision Science for your iPad, simply tap “Sign In” above and enter your Username and email address. Otherwise, “create an account”.
  4. Create an account if you haven’t already.
  5. Use your Subscriber ID to create your account and establish your own password.
  6. Follow all remaining prompts.
  7. Tap the “Sign In” button.
  8. You are now ready to download issues starting with the January 1st issue of Optometry and Vision Science and for the duration of your active subscription to Optometry and Vision Science.

Comment:If you are not a member or Fellow of the AAO here is a great reason to join now! DM

Why you should have your children's eye examined immediately!

  • 1 in 10 children is at risk from undiagnosed vision problems
  • 1 in 30 children will be affected by amblyopia - often referred to as lazy eye - a leading cause of vision loss in people younger than 45 years
  • 1 in 25 will develop strabismus - more commonly known as crossed-eyes - a risk factor for amblyopia
  • 1 in 33 will show significant refractive error such as near-sightedness, far-sightedness and astigmatism
  • 1 in 100 will exhibit evidence of eye disease - e.g. glaucoma
  • 1 in 20,000 children have retinoblastoma (intraocular cancer) the seventh most common pediatric cancer
Schedule your InfantSee appointment at Lyons Family Eye Care today! DM