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Dominick M. Maino, O.D., M.Ed., 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 312-949-7280 (Voice) 312-949-7358 (fax) [email_address] MainosMemos.blogspot.com www.ico.edu nw.optometry.net
Learning Disabilities Reading/Dyslexia Reading disabilities common Dyslexia rare
Learning Disabilities Reading/Dyslexia Language Based Vision Based Combination of Language/Vision
Learning Disabilities Dyscalculia (Math Disability) 3 and 6% of the population Neurological Dyscalculia Deficits in working & short term memory Congenital/hereditary (Gerstmann syndrome: Dyscalculia + Dysgraphia)
Learning Disabilities Dysgraphia Working memory (orthographic coding) Motor planning Attentional issues
Wesson M, Maino D. Oculovisual findings in children with Down syndrome, Cerebral Palsy, and mental retardation without specific etiology. In Maino, D. (ed) Diagnosis and management of special populations. 1995. St. Louis, Mo. , Mosby-Yearbook Inc.:17-54.
Binocular acuity could be evaluated in 45% of individuals below age 13
For CP patients VAs are generally decreased when compared to those measured for individuals with Down Syndrome
Much higher incidence of ocular disease and neurological dysfunction
Saunders KJ, Little JA, McClelland JF, Jackson AJ. Profile of refractive errors in cerebral palsy: impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome. Invest Ophthalmol Vis Sci. 2010 Jun;51(6):2885-90. Epub 2010 Jan 27.
. … A significantly higher prevalence and magnitude of refractive error was found in the CP group ….. Higher spherical refractive errors were significantly associated with the nonspastic CP …. The presence and magnitude of astigmatism were greater when intellectual impairment was more severe , …. High refractive errors are common in CP, pointing to impairment of the emmetropization process. ….
McClelland JF , Parkes J , Hill N , Jackson AJ , Saunders KJ .
Accommodative dysfunction in children with cerebral palsy: a population-based study. Invest Ophthalmol Vis Sci. 2006 May;47(5):1824-30.
Brain injury such as that present in CP has a significant impact on accommodative function . These findings have implications for the optometric care of children with CP and inform our understanding of the impact of early brain injury on visual development.
Ross LM , Heron G , Mackie R , McWilliam R , Dutton GN .
Reduced accommodative function in dyskinetic cerebral palsy: a novel management strategy. Dev Med Child Neurol. 2000 Oct;42(10):701-3. Links
… . The near-vision symptoms were completely removed and reading dramatically improved with the provision of varifocal spectacles. Varifocal lenses provide an optimal correction for far, intermediate (i.e. for computer screens), and near distances (i.e. for reading). Managing this type of patient with varifocal spectacles has not been previously reported . It is clearly very important to prescribe an optimal spectacle correction to provide clear vision to
Down Syndrome Children with Down syndrome have been included in regular academic classrooms in schools across the country. In some instances they are integrated into specific courses, while in other situations students are fully included in the regular classroom for all subjects. The degree of mainstreaming is based in the abilities of the individual; but the trend is for full inclusion in the social and educational life of the community. From: http://www.ndss.org/aboutds/aboutds.html#Down
Down syndrome is the most commonly occurring genetic condition . One in every 800 to 1,000 live births is a child with Down syndrome, representing approximately 5,000+ births per year in the United States alone. Today, Down syndrome affects more than 350,000 people in the United States.
Al-Bagdady M , Stewart RE , Watts P , Murphy PJ , Woodhouse JM . Bifocals and Down's syndrome: correction or treatment? Ophthalmic Physiol Opt. 2009 Jul;29(4):416-21. Epub 2009 May 11.
Accommodation is reduced in approximately 75% of children with Down's syndrome (DS ). Bifocals have been shown to be beneficial and they are currently prescribed regularly .. … Bifocals are an effective correction for the reduced accommodation in children with DS and also act to improve accommodation with a success rate of 65% . ….
Haugen OH, Hovding G, Eide GE. Biometric measurements of the eyes in teenagers and young adults with Down syndrome.Acta Ophthalmol Scand. 2001 Dec;79(6):616-25.
CONCLUSIONS: Thinning of the corneal stroma may account for the steeper cornea and the high frequency of astigmatism in Down syndrome due to lower corneal rigidity. It may also be of etiological importance to the increased incidence of keratoconus in Down syndrome.
Haugen OH, Hovding G.Strabismus and binocular function in children with Down syndrome. A population-based, longitudinal study.Acta Ophthalmol Scand. 2001 Apr;79(2):133-9.
… The majority of the Down syndrome children with strabismus have an acquired esotropia and hence a potential for binocularity. Hypermetropia and accommodation weakness are probably important factors in esotropia …….
Stewart RE , Margaret Woodhouse J , Trojanowska LD . In focus: the use of bifocal spectacles with children with Down's syndrome.Ophthalmic Physiol Opt. 2005 Nov;25(6):514-22
…… .Based on the results of this study, eye examinations of children with Down's syndrome should routinely include a measure of accommodation at near, and bifocal spectacles should be considered for those who show under-accommodation.
Hatton DD, Buckley E, Lachiewicz A, Roberts J. Ocular status of boys with fragile X syndrome: a prospective study. J AAPOS. 1998 Oct;2(5):298-302.
… observe a higher prevalence of strabismus than that found in the general population (8% vs 0.5% to 1…. , 17% of the sample did have significant refractive errors. In addition to evaluating the ocular motility of children with fragile X syndrome, cycloplegic refraction should also be performed to determine whether refractive problems are present .
Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM, Treitman TM.Cognitive and visual processing skills and their relationship to mutation size in full and premutation female fragile X carriers.Optom Vis Sci. 2000 Nov;77(11):592-9.
… . full mutation female carriers performed more poorly in visual-motor processing and analysis-synthesis on the Woodcock-Johnson Psycho-Educational Battery-Revised, The Developmental Test of Visual Motor Integration , and on five of the seven subtests of the Test of Visual-Perceptual Skills. Regression analyses revealed significant negative correlations between mutation size and cognitive ability . …
Effect of CX516, an AMPA-modulating compound, on cognition and behavior in fragile X syndrome: a controlled trial. Berry-Kravis E, Krause SE, Block SS, Guter S, Wuu J, Leurgans S, Decle P, Potanos K, Cook E, Salt J, Maino D, Weinberg D, Lara R, Jardini T, Cogswell J, Johnson SA, Hagerman R. J Child Adolesc Psychopharmacol. 2006 Oct;16(5):525-40.PMID: 17069542
Cognitive and visual processing skills and their relationship to mutation size in full and premutation female fragile X carriers. Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM, Treitman TM. Optom Vis Sci. 2000 Nov;77(11):592-9.PMID: 11138833
The fragile X female: a case report of the visual, visual perceptual, and ocular health findings. Amin VR, Maino DM. J Am Optom Assoc. 1995 May;66(5):
Optometric findings in the fragile X syndrome. Maino DM, Wesson M, Schlange D, Cibis G, Maino JH. Optom Vis Sci. 1991 Aug;68(8):
Mental retardation syndromes with associated ocular defects. Maino DM, Maino JH, Maino SA.
J Am Optom Assoc. 1990 Sep;61(9):707-16.
Ocular anomalies in fragile X syndrome. Maino DM, Schlange D, Maino JH, Caden B. J Am Optom Assoc. 1990 Apr;61(4):316-23
Autism The incidence of autism has increased from 1 in 10,000 in the 1970s to 1 in 110 today, an increase of over 6,000 %. …
Autism Do Parents cause their children to be autistic ? There are autistic children born to parents who do not fit the autistic parent personality pattern. Parents who do fit the description of the supposedly pathogenic parent have normal, non-autistic children. Frequently siblings of autistic children are normal. Autistic children are behaviorally unusual "from the moment of birth." *** There is a consistent ratio of three or four boys to one girl. Virtually all cases of twins reported in the literature have been identical, with both twins afflicted. *** Autism can occur or be closely simulated in children with known organic brain damage. *** The symptomatology is highly unique and specific. There is an absence of gradations of infantile autism which would create "blends" from normal to severely afflicted.
Autism Etiology Yeast infections Intolerance to specific food substances ( Gluten intolerance (" Leaky Gut Syndrome "/ Casein intolerance causing intestinal permeability and allowing improperly digested peptides to enter the bloodstream and cross the blood-brain barrier which may mimic neurotransmitters and result in the scrambling of sensory input. I've also heard "Leaky Gut Syndrome" described as lack of the beneficial bacteria that aids digestion, and that the resulting matter in the bloodstream invokes an unnecessary immune reaction) Phenolsulphertransferase (PST) deficiency--theory that some with autism are low on sulphate or an enzyme that uses this, called phenol-sulphotransferase-P. This means that they will be unable to get rid of amines and phenolic compounds once they no longer have any use for them. These then stay in their body and may cause adverse effects, even in the brain.
Autism Etiology Brain injury, Constitutional vulnerability Developmental aphasia , Deficits in the reticular activating system, An unfortunate interplay between psychogenic and neurodevelopmental factors, Structural cerebellar changes, Genetic causes, Viral causes, Immunological ties, Vaccines, Seizures
Autism Etiology My Goodness! Maino DM, Viola, SG, Donati R. The Etiology of Autism. Optom Vis Dev 2009:(40)3:150-156.
Autism US FDA Statement Childhood Disintegrative Disorder IOM Report: No Link Between Vaccines and Autism By Michelle Meadows There is no link between autism and the measles-mumps-rubella (MMR ) vaccine or the vaccine preservative thimerosal , according to a report released by the Institute of Medicine's (IOM) Immunization Safety Review Committee. http://www.fda.gov/fdac/features/2004/504_iom.html
Autism Childhood Disintegrative Disorder Thompson WW , Price C , Goodson B , Shay DK , Benson P , Hinrichsen VL , et al. Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. N Engl J Med. 2007 Sep 27;357(13):1281-92 Our study does not support a causal association between early exposure to mercury from thimerosal-containing vaccines and immune globulins and deficits in neuropsychological functioning at the age of 7 to 10 years.
Autism Childhood Disintegrative Disorder Andrew Wakefield (born 1956) is a British former surgeon and researcher best known for his discredited work regarding the MMR vaccine and its claimed connection with autism and inflammatory bowel disease. Wakefield was the lead author of a 1998 study, published in The Lancet , which reported bowel symptoms in twelve children diagnosed with autism spectrum disorders, to which the authors suggested a possible link with the MMR vaccine. Though stating "We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described," the paper tabulated parental allegations, and adopted these allegations as fact for the purpose of calculating a temporal link between receipt of the vaccine and the first onset of what were described as "behavioural symptoms “ .