Saturday, April 27, 2013

10 Things We Know About Autism That We Didn't Know a Year Ago

10 Things We Know About Autism That We Didn't Know a Year Ago

1. High-quality early intervention for autism spectrum disorder (ASD) can do more than improve behaviors, it can improve brain function.

2. Being nonverbal at age 4 does NOT mean children with autism will never speak. Research shows that most will, in fact, learn to use words, and nearly half will learn to speak fluently. 

3. Though autism tends to be life long, some children with ASD make so much progress that they no longer meet the diagnostic criteria for autism. High quality early-intervention may be key.

4. Many younger siblings of children with ASD have developmental delays and symptoms that fall short of an autism diagnosis, but still warrant early intervention.

5. Research confirms what parents have been saying about wandering and bolting by children with autism: It's common, it's scary, and it doesn't result from careless parenting. 

6. Prenatal folic acid, taken in the weeks before and after a woman becomes pregnant, may reduce the risk of autism.

7. One of the best ways to promote social skills in grade-schoolers with autism is to teach their classmates how to befriend a person with developmental disabilities.

8. Researchers can detect presymptom markers of autism as early as 6 months -- a discovery that may lead to earlier intervention to improve outcomes. 

9. The first medicines for treating autism's core symptoms are showing promise in early clinical trials. 

10. Investors and product developers respond to a call to develop products and services to address the unmet needs of the autism community. 

Comments: Click the title above to read the complete article. DM

Friday, April 26, 2013

Dichoptic training enables the adult amblyopic brain to learn


....Adults with amblyopia, a common visual cortex disorder caused primarily by binocular disruption during an early critical period, do not respond to conventional therapy involving occlusion of one eye. But it is now clear that the adult human visual cortex has a significant degree of plasticity, .... One possibility is an inhibitory signal from the contralateral eye that suppresses cortical inputs from the amblyopic eye. .... Here we provide direct evidence that alleviating suppression of the amblyopic eye through dichoptic stimulus presentation induces greater levels of plasticity than forced use of the amblyopic eye alone. This indicates that suppression is a key gating mechanism that prevents the amblyopic brain from learning to see.....

Comments: The research continues to show that adults with amblyopia have a treatable condition AND that amblyopia is not just related to decreased visual acuity in one eye. Amblyopia is a two-eyed-brain problem! When are my colleagues going to realize that you should not treat amblyopia by patching alone?

 The current research tends to support the sequence of therapeutic approaches for amblyopia as noted below:

The [...] indicate my opinion, methodologies, and approaches to care not necessarily support by research at this time. I have no financial interest in any of the products, computer programs or services mentioned unless otherwise noted.
1.) Rx the most appropriate pair of glasses. The patient should wear these full time for 1-3 months.
2. Return for follow-up 1-3 months after Rx wear. Continue to wear the Rx as acuity improves.
3.) Change the Rx as needed.

[Since amblyopes often have poor accommodative systems (focusing), I will frequently prescribe a multifocal lens (bifocal) to improve accommodative function. Hyperopic amblyopes frequently cannot accept the full amount of correction initially. I will cut the distance to an amount I believe the patient can accept, and then add this power to the multifocal/bifocal.]

4.) When improvement in visual acuity reaches a plateau, start to patch the better seeing eye. You usually DO NOT have to patch all day. The research supports from 2-6 hours of patching the better eye per day depending upon the beginning acuity level. 

5.) Once the improvement in visual acuity has once again reached a plateau, start hand-eye activities at home. 

[I will add several different hand-eye activities. Neuroplasticity works best when attention, arousal, and novelty is used as part of the therapy program. Change the therapy fairly often. I typically use the Amblyopia iNet computer program at this stage. Other computer programs I use include Perceptual Visual Tracking Program, ADR iNet (Dynamic Reader), Track and Read, and any number of similar programs. I usually suggest one hour of patching with active therapy and one hour doing normal activities, 5-6 days/week minimum.] 

6.) Continue with the at home activities until visual acuity improvement stops. 

7.) Start in office optometric vision therapy that emphasizes the development of binocular vision (heavy on the anti-suppression). 

[There are 4 phases of optometric vision therapy. These are monocular, biocular, binocular, and integration/stabilization. Individual doctors may start at the monocular phase and then work all the way thru each of the other phases. Other doctors may start at other phases of therapy. I often begin monocularly. The biocular phase is where much of the anti-suppression therapy occurs. The binocular phase is where vergence abilities are improved significantly. The integration/stabilization phase makes the patient use all binocular vision skills (oculomotor, hand-eye, accommodation, vergence) simultaneously. Each phase may work on hand-eye, oculomotor, focusing, vergence, stereopsis and more. Each phase may emphasize one area over another area; for instance, once the monocular phase is completed, hand-eye and oculomotor skills are often greatly improved. The integration/stabilization phase (as well as other phases) may also include cognitive processing, use of distractors, auditory support, various aspects of rhythm/timing, visual-perceptual tasks and other activities to improve habituation of the visual skill.] 

8.) Continue until all visual skills normalize (not only visual acuity, but also hand-eye, accommodation (focusing), binocularity, stereopsis (3D). 

9.) Continue therapy through the integration and stabilization phase. (Integrate all visual skills simultaneously and make sure these skills have been stabilized). 

10.) Discontinue in-office therapy when all skills have been normalized. 

11.) Put the patient on an at home maintenance therapy program. 

[I often continue to use the computer programs noted above for this at home phase of the program.] 

12.) Follow-up in 3 months. 

13.) If visual acuity and all other binocular skills are normal, follow at 6 months and/or annually. 

Research also notes that if you abruptly stop therapy, the visual acuity tends to regress. An at home maintenance program ensures little to no regression. We do not yet know how long the therapy effects last, but research and clinical experience suggests that it lasts for some time. 

There is some research to support the use of specifically designed lenses to improve the treatment of amblyopia. (Bobier W., Shaw P.J. A consideration of binocular parameters in the spectacle correction of anisometropic amblyopia: A Case Report. Optom Vis Dev 2012;43(2):67-71). Please note that I do not currently have a financial interest in this lens. I may have such an interest at some point in the future. 

The take home from this blog discussion of amblyopia is that treatment has only begun once visual acuity improves. In order to keep the visual acuity at an appropriate level and to have that last for some time, binocular vision therapy is needed along with maintenance therapy and appropriate follow-up. Please note that your doctor's approach to treating amblyopia may differ from what is written here. This does not necessarily mean that his/her approach is wrong. The therapeutic approach noted here however, tends to use the latest evidence based science to support the therapy recommended. See a few references below.  DM 

Li J, et al. The role of suppression in amblyopia. Invest. Ophthalmol. Vis. Sci. 2011;52:4169-4176. [PubMed]

To L, et al. A game platform for treatment of amblyopia. IEEE Trans. Neural Syst. Rehabil. Eng. 2011;19:280-289. [PubMed] 

Agrawal R, Conner IP, Odom JV, Schwartz TL, Mendola JD. Relating binocular and monocular vision in strabismic and anisometropic amblyopia. Arch. Ophthalmol. 2006;124:844-850. [PubMed] 

Hess RF, Mansouri B, Thompson B. A new binocular approach to the treatment of amblyopia in adults well beyond the critical period of visual development. Restor. Neurol. Neurosci. 2010;28:793-802. [PubMed] 

Hess RF, Mansouri B, Thompson B. A binocular approach to treating amblyopia: antisuppression therapy. Optom. Vis. Sci. 2010;87:697-704. [PubMed] 

Webber AL, Wood J. Amblyopia: prevalence, natural history, functional effects and treatment. Clin. Exp. Optom. 2005;88:365-375. [PubMed] 

Levi  D. Perceptual learning in adults with amblyopia: A reevaluation of criticalperiods in human vision. Developmental Psychobiology. Special Issue: Critical Periods Re-examined: Evidence from Human Sensory Development. 2005;46(3):222-232 (full pdf) 



Reliability and Validity of an Automated Computerized Visual Acuity and Stereoacuity Test in Children Using an Interactive Video Game

Reliability and Validity of an Automated Computerized Visual Acuity and Stereoacuity Test in Children Using an Interactive Video Game

.......The automated computerized distance visual acuity test had high test-retest reliability ... and acceptable validity as compared with the Snellen visual acuity chart ... automated computerized distance stereoacuity test had high test-retest reliability ... and acceptable validity as compared with the Distance Randot Stereotest ....

We're superhuman, we just can't spell

"We're superhuman, we just can't spell." Using the affordances of an online social network to motivate learning through literacy in dyslexic sixth-form students.

.....Facebook motivated learning through literacy and enabled students to view themselves as independent learners. Those that view themselves as successful learners tend to be more successful than those who do not. ....

Barden, Owen. 2012. "If we were cavemen we’d be fine’: Facebook as a catalyst for critical literacy learning by dyslexic sixth-form students.” Literacy 46 (3):123-132.

Comments: I found out about this paper via NeuroNet Learning. The original thesis can be read by clicking the title above. The paper reference is above as well. It's interesting to note that "visual attention" as a problem for those with "dyslexia" was stated in the NeuroNet Learning article.

Developmental optometry has been interested in this aspect of reading dysfunction for some time. Research by Solan and others have strongly suggested importance of the role of visual attention in the reading process. Several of Solan's articles are listed below. (Dr. Harold Solan recently passed away. His outstanding work continues to be as relevant today as ever.)

Visual and Auditory Processing in Reading Disability: A matter of cognitive dissonance. Solan, H. J Optom Vis Dev. 204;35(1):16-21. (full article)

Silent Word Reading Fluency & Temporal Vision ProcessingDifferences Between Good and Poor Reader. Solan H.A., Shelley-Tremblay J., Larson S., Mounts, J. J Behav Optom 2006; 17(6):149-57.  (Full article)
Is there a common linkage among reading comprehension, visual attention, and magnocellular processing? Solan HA, Shelley-Tremblay JF, Hansen PC, Larson S. J Learn Disabil. 2007 May-Jun;40(3):270-8.
M-cell deficit and reading disability: a preliminary study of the effects of temporal vision-processing therapy. Solan HA, Shelley-Tremblay J, Hansen PC, Silverman ME, Larson S, Ficarra A.
Optometry. 2004 Oct;75(10):640-50.
J Learn Disabil. 2001 Mar-Apr;34(2):107-18.
Effect of attention therapy on reading comprehension. Solan HA, Shelley-Tremblay J, Ficarra A, Silverman M, Larson S. J Learn Disabil. 2003 Nov-Dec;36(6):556-63.
Coherent motion threshold measurements for M-cell deficit differ for above- and below-average readers. Solan HA, Hansen PC, Shelley-Tremblay J, Ficarra A. Optometry. 2003 Nov;74(11):727-34.

Thursday, April 25, 2013

Stiff Person Syndrome with CI/XT

Stiff Person Syndrome with CI/XT

Comments: I have a few concerns about how some of the tests were conducted (tilted prism bar while measuring the deviation for example), but I also realize that this was for the blog and that he had already done the testing. A very interesting case. I'm curious if optometric vision therapy could help this lady. Dr. Manley does mention "exercises" briefly. DM

Tuesday, April 23, 2013

Acupuncture Improves Memory, Test Performance, And Reduces Anxiety

Acupuncture Improves Memory, Test Performance, And Reduces Anxiety

A new study shows that acupuncture improves memory, test performance, and reduces anxiety. The study will appear in an upcoming edition of The Journal of Acupuncture and Meridian Studies. .....Dr. Jason Bussell, PhD, conducted an experiment with 90 undergraduate students. Half the students received acupuncture and half did not; and the placebo effect was controlled. Then all the students took a computerized test of Working Memory- the Automated Operation Span Task. Tests of Working Memory have been associated with predicting performance with such diverse abilities as reading comprehension, arithmetic calculation, note taking, language comprehension, playing bridge, learning a computer language, learning to spell, following directions, building vocabulary, writing, complex learning, and reasoning ability. So Working Memory is a good measure of mental aptitude.....

Sunday, April 21, 2013

Traumatic Brain Injury Signs Are Often Misinterpreted Or Ignored

Traumatic Brain Injury Signs Are Often Misinterpreted Or Ignored

...Given an estimated 225,000 Californians living with traumatic brain injury (TBI), it's hard to understand how the signs of TBIs can be missed, misinterpreted or simply ignored. And yet, they are. The most common TBIs are concussions, nearly 3.8 million of which are caused by sports and recreation activities in the United States annually, as reported by the Centers for Disease Control and Prevention. Norma Vescovo, founder and Chief Executive Officer (CEO) of the Independent Living Center of Southern California, Inc. (ILCSC), has seen an increase in the number of TBIs, including concussions or mild TBIs, at ILCSC and fully understands why TBIs are often missed. ....
Initially, individuals may experience any one of a number of symptoms, including confusion, concentration difficulties, dizziness or, most commonly, memory loss, all of which are also experienced by people who don't have a TBI. ....

Errors in strabismus surgery

Errors in strabismus surgery

....173 strabismus surgeons ...self-reported having operated on the wrong eye or muscle or performed the wrong procedure at least once. .... The most common factors contributing to errors were confusion between the type of deviation (esotropia/exotropia) and/or the surgical procedure ..., globe torsion ...leading primarily to inadvertent operation on the inferior rectus rather than the intended medial rectus muscle, and inattention and/or distraction ..... Running more than 1 operating room ... and failing to mark eye muscles preoperatively... were associated with an increased likelihood of error.....

Comments: When you add in theapproximat 33% fail rate for strabismus surgery outcomes, should surgery be your first choice for strabismus? Go to,, and for more information. Also type in "strabismus sugery" in the search box above for more information. DM