3D Vision Syndrome: Vision Institute of Canada Handout
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    3D Vision Syndrome: Vision Institute of Canada Handout 3D Vision Syndrome: Vision Institute of Canada Handout Document Transcript

    • 11/4/2011Disclosure Statement: Nothing to disclose” Please silence all mobile devices. Unauthorized recording of this session is prohibited.Dominick M. Maino, OD, MEd, FAAO, FCOVD-A FAAO, FCOVD- AOA National Spokesperson on 3 D Vision Syndrome Lecture Rules: AOA Classroom 3D Project Team Member Professor, 1.) Yes, you may ask questions. Pediatrics/Binocular Vision Service 2.) But only if I know the answer! Illinois College of Optometry Illinois E I tit t Illi i Eye Institute 3.) My answer is always right! ) y y g 3241 S. Michigan Ave. Chicago, Il. 60616 312-949- 312-949-7280 (Voice) 312-949-7358 (fax) 312-949- 4.) An updated version of this presentation can be found at dmaino@ico.edu www.slideshare.net/DMAINO/ MainosMemos.blogspot.com www.ico.edu nw.optometry.net 1
    • 11/4/2011Photo credit: http://science.howstuffworks.com/3-d-glasses2.htm Virtual 3 D: Why Now? 3 D Tipping Point A 3D TV Tipping Point? http://www.cnbc.com/id/41591929/A_3D_TV_Tipping_Point htt // /id/41591929/A 3D TV Ti i P i t Stereoscopic 3D Technologies Reach Tipping Point on PC Market – JPR. http://www.xbitlabs.com/news/video/display/20100526234951_Stereoscopic_3D_Technologies _Reach_Tipping_Point_on_PC_Market_JPR.html 10/114 ESPN: 3D Is at the Tipping Point 3D Printing Technology Nearing Tipping Point Will you one day print yourself a new bowl or even a new house using 3D printing + technology? 3D printers are nearing a tipping point according to one expert cited in a TechWeb article. Sharp’s New Cell phone Video May Be a Tipping Point for 3D http://www.bnet.com/blog/gadget-guy/sharp-8217s-new-cellphone-video-may- htt // b t /bl / d t / h 8217 ll h id be-a-tipping-point-for-3d/315 3-D reaches a tipping point in Europe http://www.variety.com/article/VR1118004886 Dr. Karl Kapp: "the tipping point for 3D will be in the healthcare industry“ 3D Medical Education http://medical-animation-studio.com/ 2
    • 11/4/2011Many activities including: http://www.youtube.com/watch?v=9 U4AoDWPEQ0 The Public Health Implications ofSymposia, 3D Users Experience Tech Summit, The 3Ds of3D Viewing, AOA YouTube Videos Virtual 3D3D in the Classroom: See Well, Learn Well Michael Duenas, OD The Visual System and Virtual 3D Jim Sheedy, O.D., Ph.D. 3D: The User Experience Story Philip J. Corriveau Exploring a New Dimension Chris Haws Do You Know if the Kids are OK? Maureen Powers, PhD Improving Binocular Vision- Creating a Better 3D Audience 3D Vision Syndrome Dominick M. Maino, OD, MEd, FAAO, The Public Health Implications of FCOVD-A Virtual 3D - Michael Duenas (http://www.youtube.com/watch?feature=player_embedded&v=howdZm-d7Z0) Public Health Model3D Movies Have a New Dimension: Protecting Eye Health 1850 Snellen Eye Chart Snellen eye chart has a 27% sensitivity (OMG!!) High rate of FALSE Negatives. Children that are referred because they fail the eye chart …. Have a distance VA problem p Pediatrician screening? School nurse screening? Only 3 states have mandatory vision screening. Only a small percentage of children ever get the care they need 25% of school children have one or more vision problems Undiagnosed untreated vision disorders are very prevalent Cost of untreated vision problems staggering All BV are treatable and preventable: Great Public Health Model 3
    • 11/4/2011The Visual System and Virtual 3D - Jim Sheedy, O.D., Ph.D. 3D: The User Experience Story - Philip J. Corriveau (http://www.youtube.com/watch?v=ZLpwCC5yxlo&feature=related) (http://www.youtube.com/watch?v=1IiHNit3RPM&feature=related) Exploring a New Dimension- Chris Haws Brock String Debuts at the Consumer Electronics Show Kids@Play Summit at CES 2011 Dominick M. Maino, OD, MEd, FAAO, FCOVD-A (http://www.youtube.com/watch?v=4qZw98mkIhI&feature=related ) (http://mainosmemos.blogspot.com/2011/04/dr-dominick-maino-at-consumer.html) 20/114 Binocular Vision Available from: AOA 3D@Home Dysfunction as a 3deyehealth.org Medical & MainosMemos Public Health Issue 4
    • 11/4/2011 For the 3D Movie, Television, Video- gaming and 3D in the Classroom Improving Binocular Vision - Creating a Better Audience Techno-Industrial Complex….not having binocular vision is the 800lbs Cyclops in the room! Maybe Mike, from "Monsters, Inc.," looks so sad because he realizes 3- D doesnt do you any good if you dont have binocular vision.).... Improving 3D Television Technology Improving 3D Movie but Not Creating Technology but a Better 3D Viewing Audience Not Creating a Better 3D Viewing Audience1920’s Image Credit : Baird Television Today 1953 Image Credit: Mystic Cinema Today Image Credit: Joystiq Improving Classroom Technology but Improving 3D Gaming Have Not Created Technology but a Better 3D Viewing Student Not Creating a Better Gamer Image Credit: Daily Motion 3D Image Credit: Nintendo 30/128 Image Credit: American Optometric Association Image Credit: mkrstovic.edublogs.org 5
    • 11/4/2011History of 3D 3 D Stereo Scopes 1844 Scottish inventor and writer David Brewster introduced the Stereoscope 1862 USA jurist, author, j , , inventor Oliver Wendell Holmes makes it possible for all to enjoy 3D! 3D in the Classroom: See Well, Learn Well 3D Timeline 30/114 Some of the first 3D Movies included: Bwana Devil (1952 ) starring Robert Stack http://www.youtube.com/watch ?v=4oGl_KqTw-M&NR=1 House of Wax (1953) starring Vincent Price 13 Ghosts (1960) http://www.youtube.com/watch?v=Zdwq3jdvZD I 6
    • 11/4/2011 The Mask (1961) 3D Television Stereoscopic television was first demonstrated by John Logie Baird in 1928http://www.youtube.com/watch?v=xGTApr_SAts Stereo TV Stereo Receiver3D Television 3D EducationStereoscopic television was first demonstrated by JohnLogie Baird in 1928 VRMagic Digital BIO 40/128 http://www.youtube.com/watch?v=O5ZSXPMlumc 3D Education 3D Education VRMagic Digital BIO http://www.3dmedicaleducation.co.uk/index.php/anatomy/lumbar_ vertebrae/ 40/114 7
    • 11/4/20113D Video-games 3D Tech - NASA Uses Video Games for Visualization & Engineering http://www.youtube.com/watch?v=v-mFx6blZK8 NASA Video Game Brain Training for ADHD http://www.youtube.com/watch?v=S26Kk- ueWjQ&feature=related Mario Brothers 3D http://www.youtube.com/ watch?v=0U0ZDjnQiXQ 3D in the Classroom: See Well, Learn Well Passive Passive 3D glasses technology 3D glasses technology Linearly polarized glasses Two images are projected superimposed onto the same Circularly polarized glasses Use a silver screen so that polarization is preserved. Light that is left-circularly polarized Can’t tilt head is extinguished by the right-handed analyzer, while right-circularly polarized light is extinguished by the left-handed analyzer. The viewer can tilt their head and still maintain left/right separation. 8
    • 11/4/2011 RealD Cinema system uses an Circularly polarized glasses electronically driven circular polarizer Infitec glasses Infitec (interference filter technology.) Filters divide the visible color spectrum into six narrow bands "super-anaglyph” 3D glasses technology Active Dolby 3D theatres Active Complementary color LCD shutter glasses anaglyphs (use red and cyan) A liquid crystal glasses stop q y g p or allow light in thru synchronization with the images seen on the screen Red eye shutterglasses The Red Eye Method reduces the ghosting 50/114 Active 3D Glasses Active 3D Glasses small LCD screens this method of 3D cuts refresh rate in halfwhen voltage applied lens goes dark synced with screen showing 3D Known to cause headaches content then alternates image viewed each eye different angle of view creates 3D effect http://www.3d-tvbuyingguide.com/3dtv/3d-glasses.html 9
    • 11/4/2011 Active 3D Glasses Autostereoscopic displays Auto 3D 3D Personal Display Spectacles Almont Green 3D Photography two small screens in the glasses (http://almontgreen.wordpress.com/) display separate images to each eye. Does not require a television http://www.trendhunter.com/trends/head-mounter-3d Lenticular printing 3D Printing used to produce images with an illusion of depth, or the ability to change or move as the image is viewed from different angles Autostereoscopic displays Auto 3D Remember we want 6 y/olds Nintendo 3DS using Nintendo 3DS! Nintendo 3DS is hazardous to the eyes of children (Nope!) 3D Vision as Public Health Modelhttp://www.digitaltrends.com/gaming/nintendo-3ds-is-hazardous-to-kids-eyes/ 60/128 10
    • 11/4/2011 How Does Nintendo 3D Vision Syndrome 3DS Work? two separate What constitutes a syndrome? outputs at slightly different angles g one for your left A group of symptoms that eye and the other collectively indicate or characterize a for your right disease, psychological disorder, or http://kombo.com other abnormal condition /features/How_th e_3DS_Works/ So is the 3D Vision Syndrome The 3D’s of 3D Viewing: Really a Syndrome? Discomfort, Dizziness and Lack of Depth Yes. Discomfort: The symptoms and signs consistently Since 3D viewing is based include: headaches, nausea, dizziness, a on the eyes converging in vision induced sense of motion, front of or beyond the diplopia, blurred vision and eyestrain; screen, viewing 3D images as well as a disconnect between can potentially create accommodation and vergence. eyestrain and headaches The 3D’s of 3D Viewing: The 3D’s of 3D Viewing:Discomfort, Dizziness and Lack of Depth Discomfort, Dizziness and Lack of DepthDizziness: Lack of Depth:3D technology can A viewer lacking binocularexaggerate visually vision, simply won’t see 3D. i i i l ’t 3Dinduced motion sickness While this doesn’t pose any…causing consumers to feel problem viewing the screen,dizzy or nauseous during or it serves as a “visionafter viewing 3D content. screening” that something is abnormal with the viewer’s binocular vision. Photo credit: Photobucket 11
    • 11/4/2011Symptoms of 3D Vision Syndromeasthenopia, headaches, blurred vision, Symptoms of 3D Vision Syndromeeyestrain, diplopia, dizziness/nausea and …a happy, actively engaged users of 3Dvision induced motion sickness …..or …. content? Image credit: squidoo.com/3d-Image Credit: American Optometric Association animated-gif Image Credit: American Optometric Association3D Vision Syndrome …… is comprised of a group of symptoms andphysical signs that collectively indicate orcharacterize a functional vision and/or eye So….is thishealth disorder that manifests when viewingsimulated 3D technology These signs and technology. really a publicsymptoms include but are not limited toheadaches, blurred vision, eyestrain, doublevision, dizziness/nausea, decreased depth health issue?perception and vision induced motionsickness. 70/128 Scope of The Problem According to Statistics Canada, the population of Canada, as of January 1, Amblyopia 2% (6,239,043 US) Strabismus 2-5% (15,597,609 US 2011, is estimated to be 34,278,400. Accommodation 2.5-9.2% (28,699,600 US) Eye Coordination (CI 7%) Amblyopia 2% (686,568) Up to 25% (77 988 195 US) (77,988,195 Strabismus 2-5% (1,713,920) 2 5% Vertical Misalignment 7-52% Accommodation 2.5-9.2% (3,085,056) (162,215,135 US) Eye Coordination (CI 7%) US Census Bureau: U.S. 311,952,183 Up to 25% (8,569,600) World 6,954,459,463 Vertical Misalignment 7-52% AOA Clinical Guidelines: http://www.aoa.org/x4813.xml US Census: http://www.census.gov/main/www/popclock.html (17,842,768) 12
    • 11/4/2011 Chicago is only a bit Toronto, has a population of 2.48 more than an hour million people (5.5 plane ride from million in the GTA - Toronto…so Toronto so if you Greater Toronto Area) don’t want to care for these folks…. How to Dx an Individual with How to Dx an Individual with 3D Vision Syndrome 3D Vision Syndrome Examination SequenceComprehensive Case HxVisual Efficiency/Strabismus/AmblyopiaVi l Effi i /St bi /A bl iSpecial Testing (Visagraph, TOVA, etc) Salient Findings How to Tx an Individual with How to Tx an Individual with 3D Vision Syndrome 3D Vision SyndromeWe really don’t Use what we do knowknow the b tk th bestmethodology/approach. Rx/Prism Optometric Vision Therapy 13
    • 11/4/2011 These are your patient’s eyes…. 3D Vision Syndrome Single Subject Design Research Study Patient #1 Symptoms: blurred vision, bl d i iThese are double vision,your patient’s nausea, headache,eyes dizziness whileOn 3D! watching 3D movie 80/128 3D Vision Syndrome 3D Vision Syndrome Patient #1 Patient #1 27 y/o white female Initial Findings College educated VA’s CLS RE/LE 20/20 Athletic trainer OR RE -.25, LE PL Acceptable Fit , p MR RE -4.25-50X175 20/15,Hx of reading problems since 5th grade LE -4.00-.50X175 20/15 Remedial reading class in college Pursuits/Saccades +4 Seasonal allergies CT 18 XOP @ near Nephrectomy 2nd Degree Fusion Variable 3D Vision Syndrome 3D Vision Syndrome Patient #1 Patient #1 Initial Findings Initial Findings Random Dot 100” (?) Accommodative Facility diplopia NPC 2/6/4” MEM variable After 5 attempts pain noted Ocular health mild allergic conjunctivitis PFV/NFV @ near could not do/diplopia - Lens amplitudes could not do NRA +2.00 diplopia PRA -1.00 14
    • 11/4/2011 3D Vision Syndrome 3D Vision Syndrome Patient #1 Patient #1 Diagnosis Plan Convergence insufficiency Obtain past records Accommodative dysfunctions y Start Optometric Vision Therapy p py Headache Diplopia Allergic conjunctivitis 3D Vision Syndrome Patient #1 Optometric Vision TherapyPrevious Eye Examination (10/09) “No Binocular Testing Done!” Evidence Based MedicineHx “General Exam”, health “good”, Aided VAs General Exam good20/20 RE/LE, SLE unremarkable, Non-dilatedfundus evaluation unremarkable, Ret -4.00 SphRE/LE, MR -4.00-50X175 RE, -4.00-.50X180 LE, CT2XO dist/Ortho near, BI 20/8, BO 24/12 near Dx Myopia, AstigmatismRandomized clinical trial of treatments for symptomatic convergence Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, Hopkinsinsufficiency in children. Arch Ophthalmol. 2008 Oct;126(10):1336-49. KB, Bartuccio M, Chung I; the Convergence Insufficiency Treatment TrialConvergence Insufficiency Treatment Trial Study Group. Study Group. Treatment of Accommodative Dysfunction in Children: Results from a Randomized Clinical Trial. Optom Vis Sci. 2011CONCLUSIONS: Nov;88(11):1343-1352.Twelve weeks of OBVAT results in a significantlygreater improvement in symptoms and clinical CONCLUSIONS: Visionmeasures of near point of convergence andpos t ve us o a vergence and greaterpositive fusional ve ge ce a d a g eate therapy/orthoptics is effective inpercentage of patients reaching the improving accommodativepredetermined criteria of success compared with amplitude and accommodativeHBPP, HBCVAT+, and OBPT. Application toClinical Practice Office-based vergence facility in school-aged childrenaccommodative therapy is an effective treatment with symptomatic CI andfor children with symptomatic convergenceinsufficiency. accommodative dysfunction. 90/128 15
    • 11/4/2011 Long-term effectiveness of treatments for symptomatic convergence Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M, Borsting E, insufficiency in children. Optom Vis Sci. 2009 Sep;86(9):1096-103. London R, Wensveen J. A randomized clinical trial of vision Convergence Insufficiency Treatment Trial Study Group. therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. Optom Vis Sci. 2005 CONCLUSIONS: Most children aged 9 to Jul;82(7):583-95. 17 years who were asymptomatic after DISCUSSION: In this study, vision therapy/orthoptics was the a 12-week treatment program of g only treatment that produced clinically significant OBVAT for convergence insufficiency improvements in the near point of convergence maintained their improvements in and positive fusional vergence. …… symptoms and signs for at least 1 year after discontinuing treatment. …. Pencil Push ups do not work very well! Ciuffreda KJ. The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders. Optometry. 2002 Dec;73(12):735-62. BACKGROUND: For nearly 75 years, optometric vision therapy has been an important mode of therapy for both children and adults who manifested a range of Maino D. The number of placebo controlled, nonstrabismic accommodative and vergence disorders. METHODS: double blind, prospective, and randomized In this article the scientific basis for, and efficacy of, optometric vision article, for of strabismus surgery outcome clinical trials: therapy in such patients will be discussed. Using bio-engineering models of the oculomotor system as the conceptual framework, emphasis will be None! Optom Vis Dev 2011;42(3):134-136. focused on studies that used objective recording techniques to directly assess therapeutically related changes in oculomotor responsivity. RESULTS AND CONCLUSIONS: http://www.covd.org/Portals/0/OVD/42-3/Editorials/OVD%2042- The findings clearly support the validity of 3%20Journal_Editorial_Maino_web.pdf optometric vision therapy. Furthermore, the results are consistent with the tenets of general motor learning. 3D Vision Syndrome Patient #1 Use principles of neuro-plasticity therapy: Optometric Vision TherapyPhase 1 Phase 2 Phase 3 Phase 4Mono Biocular Binocular IntegrationOculo-O l add anti- dd ti add dd Stabilization St bili tiMotor, suppression vergenceHE, Acc 3 month post OVT maintenance Tx and Maino D. Neuroplasticity: Teaching an Old final progress evaluation Brain New Tricks. Rev Optom 2009. 46(1):62- 64,66-70 16
    • 11/4/2011 3D Vision Syndrome 3D Vision Syndrome Patient #1 Optometric Vision Therapy Patient #1 Optometric Vision TherapyOVT #1HC Saccades OVT #2HC Rock Reviewed HVT R i dHTS (saccades, pursuits, Vision Builderaccommodation (saccadesBrockstring Franzblau Red RockHVT BrockstringSent Home all of the above 3D Vision Syndrome Patient #1 Optometric 3D Vision Syndrome Vision Therapy Patient #1 Optometric Vision OVT #3 Therapy Reviewed HVT OVT #4 Minus lens dips Mi l di Reviewed HVT HC accom rock Vision Builder Vision Builder Randot vergence (binoc reading) Eccentric Circles Quoits Quoits 100/128 Photo credit VisionHelpBlog 3D Vision Syndrome 3D Vision Syndrome Patient #1 Optometric Patient #1 Optometric Vision Therapy Vision Therapy OVT #5 OVT #6 Reviewed HVT +/- Flippers (mono) Review HVT Eccentric Circles E t i Ci l ECC HTS autoslide vergence Vectogram Jump Jump vergences (vectos) Vergence Brockstring (bug on a string) HVT Lifesaver Cards ECC BO/Brockstring, HTS jump vergences 17
    • 11/4/2011 3D Vision Syndrome 3D Vision Syndrome Patient #1 Optometric Vision Therapy Patient #1 Optometric Vision Therapy Progress evaluation #1 OVT #7 20/15 BVA, RE/LE NPC TN no pain CL OR RE +1.00-.50X180 BI 12/9 near Clown vectograms (push BI) 20/20 BO > 45 LE +1.25 20/20 Amps 7 D RE/LE Chicago Skyline (jump) MR RE -3.25-.25X175 20/20 3 25 25X175 Facility F ilit 8 CPM RE, 11 CPM LE, 10 RE LE LE -3.250.75X005 20/20 CPM OU Pursuits +4 Saccades +3 CT 2EP (near) MEM +.75 each eye W4D 4 at all distances Random dot 20 ‘ During evaluation no diplopia, pain, suppression stable findings Symptoms improving, not all resolved 3D Vision Syndrome 3D Vision SyndromePatient #1 Optometric Vision Therapy Patient #1 Optometric Vision Therapy OVT #8 Progress Evaluation #2 Clown vectograms (push 1 month later BI) with +/-1.00 Majority of symptoms resolved Tranaglyph BC 601 BVA 20/20 RE, LE Slight + CL OR Amps 8.33 RE/LE NRA +2.50 Brockstring B k t i CT ortho/2 EXO PRA -2.25 NPC TN Facility 6 RE, 7LE, 8 OU CPM no Aperture Rule After 5 trials TN suppression NPC with RL 7/10 cm MEM +.50 RE, LE Vergence dist BI x/14/10 BO Switch to HVT only due to X/30/25 RTO 6 mos CEE, intermittently do Near BI 16/12 BO 35/25 HVT change in work schedule W4D 4 all distancesSaw 3D movie…no problems! Random Dot 25’ Pur/Sac +4 Started Here: Ended Here: Convergence insufficiency, Accommodative dysfunctions, Headache, Diplopia, VA’s CLS RE/LE 20/20 Majority of symptoms Blurred vision, Double vision, Nausea, Dizziness OR RE -.25, LE PL Acceptable Fit resolved MR RE -4.25-50X175 20/15, BVA 20/20 RE, LE LE -4.00-.50X175 20/15 Slight + CL OR Pursuits/Saccades +4 Pur/Sac +4 All resolved in 8 OVT visits and HVT CT 18 XOP @ near CT ortho/2 EXO, NPC TN NPC 2/6/4” After 5 trials TN After 5 attempts pain noted NPC with RL 7/10 cm Last Progress Evaluation on 7/10 PFV/NFV @ near could not Vergence dist BI x/14/10 do/diplopia BO X/30/25 W4D Fusion Variable Near BI 16/12 BO 35/25 On 8/1/10 the patient texted me and Random Dot 100” (?) W4D 4 all distances, Random - Lens amplitudes could not Random Dot 25’ said, “Just saw a 3D movie. It didn’t do Amps 8.33 RE/LE hurt! It was an awesome experience!” NRA +2.00 diplopia NRA +2.50, PRA -2.25 PRA -1.00 Facility 6 RE, 7LE, 8 OU CPM no suppression MEM +.50 RE, LE 18
    • 11/4/2011 Computer Programs Used in Optometric Vision Therapy 3D as a Public Information and Marketing Tool 3D in the News-Print Media-Internet Computer AidedHome Therapy Solutions Vision Therapy In Your Office-3D Pictures-Newsletters Website/Blog/Facebook/SOVOTO/LinkedIn Media Awareness! 110/128 3D in the News ABC Chicago http://abclocal.go.com/wls/s tory?section=news/health&i d=7298893 NBC News Broadcast http://www.wlbz2.com/news/local/story.aspx?st oryid=145741&catid=9 AOA TV Diagnosis Maino D. Brock String Debuts at 2011 Consumer Electronics Show. Optom Vis Dev 2011;42(1):6-9. http://www.iwantmyaoatv.com/ 19
    • 11/4/2011 Blogs Print /Digital MediaMainosMemos.blogspot.com Radio 120/128http://prescription3dglasses.com/ http://prescription3dglasses.com/ 20
    • 11/4/2011 Pacific Eye Clinic Beaverton Opens 3D Performance Eye Clinic The 3D’s of 3D Viewing:Discomfort, Dizziness and Lack of Depth The 4th D of 3D Viewing Discomfort The fourth “D” of 3D Viewing should be Dizziness to call your…. Lack of Depth Doctor of Optometry 3D Resources 3D in the Classroom: AOA See Well, Learn Well http://www.aoa.org American Academy of Optometry http://www.aaopt.org 3D Eye Health.org http://www.3deyehealth.org/ COVD http://www.covd.org OEPF http://www.oepf.org Optometrists Network http://www.vision3d.com/ Berezin Stereo Photography Products http://www.berezin.com/3d/ 21
    • 11/4/2011 Questions?Chris Haws Dominick M. Maino, O.D., M.Ed., 3D@Home F.A.A.O., F.C.O.V.D- F.A.A.O., F.C.O.V.D-A. Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949- 312-949-7280 (Voice) 312-949-7358 (fax) 312-949- dmaino@ico.edu MainosMemos.blogspot.com www.ico.edu nw.optometry.net 22