American Academy of Optometry Updates

The Latest Program

Neuroplasticity: A Paradigm Sea Change (My lecture handout)
Lecture to be given Thursday Nov 12th at 11AM
Course #BV-05 in room Crystal J!


Illinois College of Optometry Alumni Reception

Binocular Vision Section Presentations

Optometric Education Section Presentations

CITT Study Chair, Dr. Mitch Schieman Discusses the CITT Study

Dr. Mitch Schieman, Chair of the CITT National Institutes of Health National Eye Institute clinical trial discusses this ground breaking research. Click on the title above for access to this video. DM

Amblyopia Therapy in Children Identified by Photoscreening

Comments: Usually I make comments after segments of the paper are noted here. But this paper is so wrong in so many ways that I couldn't stop myself from making comments now.

First of all they note that only 20% of children every get screened...and yet they promote screening as a way to help diagnosis amblyopia. The best way to diagnose the presence of amblyopia is a comprehensive eye examination. The best way is to participate in the AOA's InfantSee program and examine all children early. The best way is full examination for all children in school. It's the very least we should be able to do for our children.

Secondly, even though one of the authors, Sean Donahue, is a part of the PEDIG series of studies and should know better, they write false statements like:
"However, treatment must be delivered within the critical period of visual development."
We know that treatment can be done AT ANY AGE! It is sad that the authors of this paper, and Sean Donahue in particular, did not catch this obvious falsehood. Why are they continuing to publish these misguided myths about amblyopia?

Thirdly, they wanted to know if amblyopia can be treated successfully after the children are screened. Well, duh! We have several PEDIG studies that already show this.

Fourth, they treated the children with 'standard' therapy...that did not include vision therapy. They often considered 20/40 successful, when better VA can often be achieved with additional "perceptual learning" (aka VT). It is obvious they did not bother to look at the recent research in cortical plasticity....that's a shame!

Fiftht, even though 900+ kids were referred only 125 took part in the therapy.

This is a paper that needed additional work before it was published. It should be read with a most critical eye.... DM

The success rate of amblyopia treatment in children identified through our photoscreening
program is high. This study supports the role of photoscreening programs in the prevention of amblyopia-related vision loss. Such early screening may translate to true visual acuity improvement.

Changes In Brain Chemicals Mark Shifts In Infant Learning

...When do you first leave the nest? Early in development infants of many species experience important transitions-such as learning when to leave the protective presence of their mother to start exploring the wider world. Neuroscientists have now pinpointed molecular events occurring in the brain during that turning point....

Improving Cognitive Skills With Music

...Regularly playing a musical instrument changes the anatomy and function of the brain and may be used in therapy to improve cognitive skills. ...

Traumatic Brain Injury-Vision Loss Severely Impacts Veterans' Quality Of Life;Who Is That Stranger On My Couch? Hallucinations In Low-vision Patient

...a Veterans Administration study that indicates that Iraq and Afghanistan veterans with vision loss from traumatic brain injury have significantly poorer quality of life than comparable civilian patients, ...

More People Rely On Alternative Medicine

... The National Center for Complimentary and Alternative Medicine (NCCAM) shows 38 percent of adults and 12 percent of kids are now using alternative therapies to treat pain. In fact, Americans are now reportedly spending $34 billion a year on CAM...

Attention-Deficit/Hyperactivity Problems Associated With Low Folate Levels In Pregnant Women

...It has long been suggested that healthy folate (the natural form of folic acid) levels in expectant mothers goes hand in hand with healthy nervous system development in their children. A study published in an upcoming issue of The Journal of Child Psychology and Psychiatry finds that low maternal folate levels is linked to the development of attention-deficit/hyperactivity problems in children at age seven to nine years....

...Retinopathy of prematurity (ROP) is a clinically multifactorial process characterized by the aberrant vascularization of the retina that has potentially devastating effects on vision in preterm infants. Despite an appreciation for the postnatal risk factors that contribute to the development of ROP, this condition continues to be a major cause of childhood blindness. Studies using the mouse model of oxygen-induced retinopathy (OIR) have identified new therapeutic targets that may be used to guide treatment and determine which babies are at highest risk for ROP development. Such factors include the hypoxia-driven proteins vascular endothelial growth factor (VEGF) and erythropoietin (EPO) as well as the maternally derived factors insulin-like growth factor-1 (IGF-1) and omega-3 polyunsaturated fatty acids (PUFAs). Each has been demonstrated to have phase-specific effects on the pathogenesis of ROP. Through an understanding of the contribution of the IGF-1 pathway to the development of ROP in particular, a new algorithm has been developed (WINROPTM) that uses postnatal weight gain to identify infants at highest risk for ROP in an attempt to target therapy and resources more effectively. ...

Treating mild iodine deficiency boosts brain power

...At the end of the study, children in iodine group showed an overall improvement on two standard cognitive tests that gauge problem-solving abilities. And they outperformed children who received the placebo....

Clinical significance of neurological abnormalities in psychosis

...The neurological deficits in sensory and motor function in schizophrenia have been described using a confusing variety of terms, reflecting their uncertain relevance and significance to psychosis. In this article we explore the nature of neurological abnormalities in psychosis, describe their assessment and suggest their potential relevance for clinician and patient. We propose that the assessment of neurological abnormalities and extrapyramidal side-effects should figure in the assessment of any patient with psychosis, particularly at illness onset. Furthermore, we suggest that neurological abnormalities can inform prognostic predictions and help to identify patients with more complex future care needs. ...

Smoking in pregnancy tied to bad behavior in kids

...Although previous studies have demonstrated significant risks for school-aged boys, this is the first time an association has been shown between smoking during pregnancy and problems for girls and for boys as young as 3, the researchers point out....

H1N1 and ocular consequences

Comment: One of my colleagues sent this to me so I thought I'd pass it along! DM

Since concerns of H1N1 have become widespread across the US, many have rushed to obtain the H1N1 vaccine. While the adverse effects of this vaccine are relatively mild, they can have ophthalmic consequences. The following case demonstrates one such occurrence:

A 25 year old female with history of bilateral corneal transplants for keratoconus (OD in 2009, OS in 2004) received the live attenuated H1N1 vaccine intranasally. The following morning she awoke with bilateral corneal rejection OD more severe than OS. While the left eye has responded well to topical steroid drops, the right remains edematous despite injecting both sub-tenons with triamcinolone and oral prednisone.

Corneal transplant rejection following vaccination has been described previously with influenza vaccine1,2,3, however in these cases the time from vaccination to rejection has ranged from two to eight weeks. The fast onset of corneal transplant rejection in this patient may likely be related to the close proximity of the inoculation site (nares) to the eye. However, this may also represent a more robust immune reaction to a relatively new and understood vaccine.

Where does this matter in refractive surgery? Increased immune response, and therefore inflammation, can be associated with regression, diffuse lamellar keratitis, transient light sensitivity, and, in severe cases, corneal melting.

As the H1N1 vaccine becomes more available, our patients will be more likely to obtain it, particularly without alerting their ophthalmologist. In discussing laser refractive surgery with our patients in these upcoming months, we must take care to warn our patients about receiving the H1N1 vaccine prior to refractive surgery. If the vaccine is administered to the patient around the time of refractive surgery, we may want to consider a more frequent and prolonged course of topical steroid therapy.

By David A. Goldman MD and Jonathan Etter MD

Clinical Tests Begin On Medication To Correct Fragile X Defect

Scientists are beginning a clinical trial of a potential medication designed to correct a central neurochemical defect underlying Fragile X syndrome, the most common inherited cause of intellectual disability. There has to date been no medication that could alter the disorder's neurologic abnormalities. The study will evaluate safety, tolerability and optimal dosage in healthy volunteers.

Infant Eye Exams

The Importance of Infant Eye Exams

One underserved patient population could clearly benefit from optometric care: infants!
When you examine infants, you change lives.

Andrea P. Thau, O.D.

Some fundamental concepts about vision make it truly unique. One such fundamental is that vision is a learned skill that develops over time. Unlike hearing, which is fully developed at birth, vision is rudimentary. When born, babies are routinely given an auditory evoked potential test, which is effective at detecting hearing loss. Vision can be tested at this time, but a visual evoked potential test cannot detect all vision problems. The visual system undergoes profound developmental changes in the first years of life—especially during infancy and toddlerhood. ...

Comments: Not only does the Review of Optometry have a whole new web design....it also has a great article by my friend and colleague Dr. Andrea Thau....click on the title for the full article. DM

Visual function in patients followed at a Veterans Affairs polytrauma network site: an electronic medical record review.

...Visual symptoms were self-reported by 76% of patients with polytrauma and 75% of the patients with TBI. Problems with reading (polytrauma 60% and TBI 50%) and accommodation (polytrauma 30% and TBI 47%) were frequently found on eye examinations. Spectacles were the treatment most frequently prescribed (polytrauma 62% and TBI 78%). ...

Comments: TBI patients have many vision problems. The VA is a great place to diagnose and treat these dysfunctions. Read this excellent paper by my colleagues Joan and Tom Stelmack et al. immediately! DM

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

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 shows...it 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:
http://www.oepf.org/jbo/index.php?pid=search&searchtype=simple&searchquery=traumatic+brain+injury

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

AOA ISSUES CONVERGENCE INSUFFICIENCY TOOLKIT

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:

http://www.aoanewsorg/x9667.xml

http://www.youtube.com/aoaweb#p/u/0/DEBeTNro55w

More information about the toolkit is available at: http://www.aoa.org/CI-Toolkit.xml

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: icbo@oep.org 6th International Congress of Behavioral Optometry