The document discusses diagnosing and treating learning related vision problems. It addresses what doctors should do to diagnose LRVP, the current research on the topic, and appropriate therapy procedures. It provides information on the prevalence of various binocular vision disorders from multiple studies and articles. It also discusses tools that can be used to measure symptoms, such as the COVD Quality of Life Outcomes Assessment, as well as common subjective complaints reported by patients with binocular vision disorders.
3D Vision Syndrome: Solving Patient Problems-Creating a Better 3D Viewing Con...Dominick Maino
This document discusses 3D vision syndrome, its diagnosis, and treatment through optometric vision therapy. It begins by outlining the common symptoms experienced by millions who view 3D content. Proper diagnosis is important, but treatment through vision therapy is needed to improve patients' quality of life. The document then provides details on diagnosing individuals with 3D vision syndrome through a comprehensive eye exam and discusses a case study of a patient who was successfully treated with 8 visits of vision therapy over several months to resolve her symptoms.
1. The document discusses pediatric cortical visual impairment (PCVI), also known as pediatric cerebral visual impairment.
2. It describes the diagnostic criteria used in optometry, ophthalmology, occupational therapy, and education for the visually impaired to diagnose PCVI.
3. The document discusses management and treatment techniques used across these disciplines to address PCVI and develop a multidisciplinary approach.
Neuroplasticity and Vision Therapy for Adults; A Case SeriesDominick Maino
This poster was presented at the American Optometric Association's Annual meeting in Boston, MA 06/2016
The bottom line:
The visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.
The 3D Vision Syndrome (3DVS) has all
the required qualifications for a new but not yet officially recognized syndrome. A syndrome is comprised of a group of symptoms that collectively indicate or characterize a disease, psychological problem, other abnormal condition or, in this case, a functional vision disorder. 3DVS symptoms include headaches, blurred vision, eyestrain,
diplopia, dizziness/nausea and motion sickness
after watching a 3D movie, television or video game.
This is the first report of an individual with 3DVS who has undergone optometric vision therapy (OVT). This poster will be presented at the American Academy of Optometry meeting in San Francisco this November. Please come to learn more about it!
This document summarizes a conference on evaluating and treating pediatric cerebral visual impairment (PCVI). The conference aims to bring professionals together to define PCVI, determine visual function in children with PCVI, and discuss therapeutic strategies. PCVI was previously referred to as cortical or cerebral visual impairment but a unified definition is needed. Evaluating visual function and functional vision is important for children with PCVI who often have ocular, visual pathway, visual processing and oculomotor issues. Treatment should begin with addressing any correctable visual issues and promoting visual development.
AOA "There's More to 3D than Meets the Eye"Dominick Maino
The American Optometric Association did an awesome job in making a potentially hard to understand topic...easier to understand. If you have problems with viewing 3D, please review this PowerPoint presentation.
This document summarizes key topics from a conference on pediatric cerebral visual impairment (PCVI). The conference aimed to define PCVI, determine methods to assess vision function in children with PCVI, and discuss therapeutic strategies. PCVI was defined as visual impairment due to brain injury, and assessment of both vision skills and functional vision was recommended. Treatment should begin by addressing eye health and vision issues, and various therapies can help improve eye movements, coordination, and visual stimulation. Environmental factors, medications, and other disabilities can impact evaluation and treatment of children with PCVI.
This document provides a summary of research and developments at the Eye Institute at the University of California, Irvine. It discusses Dr. Kenney's research into diabetic retinopathy at the cellular level to find safer treatments. It also discusses Dr. Lerner's stem cell research for age-related macular degeneration using a patient's own stem cells. Additionally, it highlights the role of the Institute's researchers in clinical trials that helped bring the drug Lucentis to market for treating wet macular degeneration.
3D Vision Syndrome: Solving Patient Problems-Creating a Better 3D Viewing Con...Dominick Maino
This document discusses 3D vision syndrome, its diagnosis, and treatment through optometric vision therapy. It begins by outlining the common symptoms experienced by millions who view 3D content. Proper diagnosis is important, but treatment through vision therapy is needed to improve patients' quality of life. The document then provides details on diagnosing individuals with 3D vision syndrome through a comprehensive eye exam and discusses a case study of a patient who was successfully treated with 8 visits of vision therapy over several months to resolve her symptoms.
1. The document discusses pediatric cortical visual impairment (PCVI), also known as pediatric cerebral visual impairment.
2. It describes the diagnostic criteria used in optometry, ophthalmology, occupational therapy, and education for the visually impaired to diagnose PCVI.
3. The document discusses management and treatment techniques used across these disciplines to address PCVI and develop a multidisciplinary approach.
Neuroplasticity and Vision Therapy for Adults; A Case SeriesDominick Maino
This poster was presented at the American Optometric Association's Annual meeting in Boston, MA 06/2016
The bottom line:
The visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.
The 3D Vision Syndrome (3DVS) has all
the required qualifications for a new but not yet officially recognized syndrome. A syndrome is comprised of a group of symptoms that collectively indicate or characterize a disease, psychological problem, other abnormal condition or, in this case, a functional vision disorder. 3DVS symptoms include headaches, blurred vision, eyestrain,
diplopia, dizziness/nausea and motion sickness
after watching a 3D movie, television or video game.
This is the first report of an individual with 3DVS who has undergone optometric vision therapy (OVT). This poster will be presented at the American Academy of Optometry meeting in San Francisco this November. Please come to learn more about it!
This document summarizes a conference on evaluating and treating pediatric cerebral visual impairment (PCVI). The conference aims to bring professionals together to define PCVI, determine visual function in children with PCVI, and discuss therapeutic strategies. PCVI was previously referred to as cortical or cerebral visual impairment but a unified definition is needed. Evaluating visual function and functional vision is important for children with PCVI who often have ocular, visual pathway, visual processing and oculomotor issues. Treatment should begin with addressing any correctable visual issues and promoting visual development.
AOA "There's More to 3D than Meets the Eye"Dominick Maino
The American Optometric Association did an awesome job in making a potentially hard to understand topic...easier to understand. If you have problems with viewing 3D, please review this PowerPoint presentation.
This document summarizes key topics from a conference on pediatric cerebral visual impairment (PCVI). The conference aimed to define PCVI, determine methods to assess vision function in children with PCVI, and discuss therapeutic strategies. PCVI was defined as visual impairment due to brain injury, and assessment of both vision skills and functional vision was recommended. Treatment should begin by addressing eye health and vision issues, and various therapies can help improve eye movements, coordination, and visual stimulation. Environmental factors, medications, and other disabilities can impact evaluation and treatment of children with PCVI.
This document provides a summary of research and developments at the Eye Institute at the University of California, Irvine. It discusses Dr. Kenney's research into diabetic retinopathy at the cellular level to find safer treatments. It also discusses Dr. Lerner's stem cell research for age-related macular degeneration using a patient's own stem cells. Additionally, it highlights the role of the Institute's researchers in clinical trials that helped bring the drug Lucentis to market for treating wet macular degeneration.
This document presents the final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. The trial compared early retinal ablative treatment to conventional management for infants with high-risk prethreshold retinopathy of prematurity (ROP). The study found that early treatment significantly reduced unfavorable outcomes, with a reduction in unfavorable visual acuity from 19.8% to 14.3% and unfavorable structural outcomes from 15.6% to 9.0%. The results support retinal ablative therapy for type I ROP and a "wait and watch" approach for type II ROP.
Vinchon M Sdh In Infants Can It Occur Spontaneously Childs Nerv Sys 2010[1]alisonegypt
This study examines cases of subdural hematoma (SDH) in infants that were considered to have occurred spontaneously rather than from nonaccidental trauma. The study identified 16 cases of spontaneous SDH in infants (SSDHI) from a prospective database that met criteria for lack of trauma history or suspicious findings. Most SSDHI cases involved males and had predisposing factors like macrocephaly, arachnoidomegaly, or obstetric complications. The study aims to better characterize SSDHI and identify risk factors to differentiate it from cases of traumatic SDH caused by nonaccidental injury.
This document discusses the epidemiology of childhood blindness globally and in developing countries like Nepal. It finds that the most common causes of childhood blindness worldwide are retinopathy of prematurity, cataracts, and corneal opacity. In high-income countries, the leading causes are cerebral visual impairment, optic nerve hypoplasia, and inherited retinal disorders. The document also examines prevalence data and determinants of childhood blindness in different regions of Nepal. Reducing avoidable childhood blindness requires improved eye health education, maternal/neonatal healthcare, and national ophthalmic infrastructure.
This document provides an overview of pediatric cortical visual impairment (PCVI). It begins with definitions of PCVI and discusses its history. Key aspects of vision function are then reviewed, including clarity of vision, oculomotor ability, accommodation, binocularity, and eye health. Functional vision anomalies that can overlay PCVI are also described. The presentation concludes with discussing diagnostic approaches and treatment strategies for PCVI, including using vision therapy principles of neuroplasticity.
Vision deficits are common following mild and moderate traumatic brain injuries. A high-yield vision screening should include a case history, tests of extraocular motility, accommodation, and vergence. Referral for further vision testing is recommended if the patient reports bothersome vision symptoms, has visual acuity poorer than 20/40, abnormal color vision, pupil abnormalities, or inability to fixate, make accurate saccades, or pursue targets. A comprehensive vision evaluation can diagnose specific deficits and guide rehabilitation.
Adult congenital heart disease and the surgical patientsxbenavides
This document discusses adult congenital heart disease and surgical patients. It notes that as surgical techniques have improved, more patients with congenital heart diseases are surviving into adulthood. This results in an increasing population of adults requiring long-term follow-up and potential further interventions. It also discusses some of the challenges in managing these adult patients and classifying their various congenital conditions.
This document discusses pediatric cortical visual impairment (PCVI). It begins by defining PCVI and exploring its history. PCVI is caused by injury to the brain rather than the eyes. The document then examines diagnostic approaches for PCVI, including assessing visual acuity, refractive error, oculomotor function, and more. It also discusses functional vision anomalies that can occur with PCVI like amblyopia. The document concludes by outlining treatment approaches for PCVI like using glasses, vision therapy, and modifying the home environment to encourage visual stimulation.
Vitiligo - critical review of medical treatments by Prof. R. SchwartzVR Foundation
Prof. Robert Schwartz
Vitiligo: Critical review of medical treatments
Presentation from the World Vitiligo Symposium 2011. Sponsored by the VR Foundation.
Prescribing for refractive errors - presentation at www.eyenirvaan.comEyenirvaan
This document discusses prescribing for refractive errors such as myopia, pseudomyopia, hypermetropia, astigmatism, and presbyopia. For myopia, optimal correction is recommended with slight undercorrection in some cases. Pseudomyopia is differentiated from true myopia and treated with cycloplegic drops and exercises. Hypermetropia in children under 7 may not require correction if asymptomatic, while adults generally need full correction. Astigmatism is usually fully corrected but some undercorrection is acceptable. Presbyopia is assessed using near tests and treated with reading additions based on age.
This document provides information on examining the 12 cranial nerves, with a focus on testing the functions of nerves 1-7. It describes how to test smell (cranial nerve 1), visual acuity and fields (cranial nerve 2), eye movements and diplopia (cranial nerves 3, 4, 6), sensation and motor function of the face (cranial nerves 5 and 7). Formal testing of each nerve is outlined, including bedside assessments of smell, vision, eye movements, facial expression, and jaw strength.
1. The visual pathway begins in the retina and passes through the optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiations, and visual cortex.
2. Lesions in different parts of the visual pathway cause specific visual field defects such as hemianopia. For example, a lesion in the optic chiasm causes bitemporal hemianopia.
3. Pupillary reflexes can localize lesions, such as Wernicke's hemianopic pupil indicating an optic tract lesion.
(1) Accommodation is the mechanism by which the eye changes refractive power by altering the shape of the lens to focus on objects at different distances.
(2) Theories of accommodation include the relaxation theory of Helmholtz which proposes that contraction of the ciliary muscle relaxes the suspensory ligaments of the lens allowing it to take on a more spherical shape.
(3) Accommodative anomalies include decreased accommodation seen in presbyopia and other conditions, as well as increased accommodation seen in conditions like accommodative excess or spasm.
This document discusses various anomalies of accommodation that can occur, including accommodative fatigue, presbyopia, insufficiency of accommodation, inertia of accommodation, paralysis of accommodation, and spasm of accommodation. It describes the symptoms, causes, assessments, and management approaches for each condition. The key message is that anomalies of accommodation are common and their management is an important part of optometric practice.
Accommodation anomalies can occur due to various causes and present with different symptoms. Assessment involves dynamic retinoscopy and measuring accommodation amplitudes. Accommodative fatigue can result from overuse and be treated by correcting refractive errors and discussing visual hygiene. Presbyopia is age-related and treated with near vision correction. Other failures of accommodation include insufficiency, paralysis, spasm, and sustained accommodation, each with different etiologies, signs, and treatments.
Lenses of slit lamp biomicroscope & indirect ophthalmoscope.Ayat AbuJazar
This document discusses different lenses used for ophthalmic examination, including Volk double aspheric lenses, Goldmann three mirror lenses, and indirect ophthalmoscope lenses. Volk lenses come in 60D, 78D, and 90D powers and are used for slit lamp biomicroscopy. The 60D provides high magnification of the posterior pole, while the 78D is for general diagnosis and the 90D is for small pupils. Goldmann three mirror lenses provide a 3D view of the anterior chamber and fundus and require a coupling agent. Indirect lenses act as condensing lenses, with higher powered lenses providing less magnification but wider field of view.
Duane's retraction syndrome involves congenital miswiring of the medial and lateral rectus muscles, causing limited eye movement. There are typically four types based on the pattern of limited adduction and/or abduction. Treatment may involve glasses, prisms, botulinum toxin injections, or surgery such as recession of the medial or lateral rectus muscles to improve eye alignment and positioning. Brown syndrome similarly involves a congenital or acquired restriction of eye elevation in adduction, believed to be caused by an abnormality of the superior oblique tendon. It is characterized by limited elevation in adduction and downshoot, and may cause a vertical eye misalignment.
The document summarizes several theories of accommodation, including Helmholtz's relaxation theory, Schachar's theory, and the catenary theory. It also discusses clinical assessment of accommodation and various anomalies such as insufficiency, excess, spasm, and infacility. Treatment options mentioned include spectacle correction, vision therapy exercises to stimulate or relax accommodation, and in rare cases, cycloplegic drugs.
Diagnosing Learning Related Vision ProblemsDominick Maino
This document summarizes information on diagnosing and treating learning related vision problems. It discusses what optometrists should do to diagnose these issues, including conducting a comprehensive eye exam, visual efficiency exam, and vision information processing exam. It outlines the common tests that should be performed in each exam, such as visual acuity tests, oculomotor exams, stereopsis tests, and vergence and accommodative testing. It also discusses common binocular vision disorders like convergence insufficiency and accommodative disorders. Finally, it reviews research on the efficacy of optometric vision therapy and treatments for conditions like amblyopia and refractive errors.
Read this article by my friend and colleague, Dr. Patrick Quaid. Binocular vision (BV) dysfunction, a term generally used to describe problems with teaming and co-ordination of one’s eyes, is often a significant challenge to detect and treat in the eyecare arena. BV disorders are more frequently encountered than glaucoma, macular degeneration and diabetic retinopathy ombined. Surely a condition that occurs 8.5 – 9.7 times more ofen than all ocular disease in children aged six months to 18 years1 combined deserves greater attention.....
This document provides information on Down syndrome including:
- Down syndrome is a genetic condition caused by trisomy 21 and has a prevalence of 1 in 800-1000 live births.
- Physical characteristics include refractive errors like hyperopia and astigmatism as well as binocular vision issues like strabismus.
- Recent studies have found that bifocals can effectively treat the reduced accommodation often seen in individuals with Down syndrome.
This document presents the final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. The trial compared early retinal ablative treatment to conventional management for infants with high-risk prethreshold retinopathy of prematurity (ROP). The study found that early treatment significantly reduced unfavorable outcomes, with a reduction in unfavorable visual acuity from 19.8% to 14.3% and unfavorable structural outcomes from 15.6% to 9.0%. The results support retinal ablative therapy for type I ROP and a "wait and watch" approach for type II ROP.
Vinchon M Sdh In Infants Can It Occur Spontaneously Childs Nerv Sys 2010[1]alisonegypt
This study examines cases of subdural hematoma (SDH) in infants that were considered to have occurred spontaneously rather than from nonaccidental trauma. The study identified 16 cases of spontaneous SDH in infants (SSDHI) from a prospective database that met criteria for lack of trauma history or suspicious findings. Most SSDHI cases involved males and had predisposing factors like macrocephaly, arachnoidomegaly, or obstetric complications. The study aims to better characterize SSDHI and identify risk factors to differentiate it from cases of traumatic SDH caused by nonaccidental injury.
This document discusses the epidemiology of childhood blindness globally and in developing countries like Nepal. It finds that the most common causes of childhood blindness worldwide are retinopathy of prematurity, cataracts, and corneal opacity. In high-income countries, the leading causes are cerebral visual impairment, optic nerve hypoplasia, and inherited retinal disorders. The document also examines prevalence data and determinants of childhood blindness in different regions of Nepal. Reducing avoidable childhood blindness requires improved eye health education, maternal/neonatal healthcare, and national ophthalmic infrastructure.
This document provides an overview of pediatric cortical visual impairment (PCVI). It begins with definitions of PCVI and discusses its history. Key aspects of vision function are then reviewed, including clarity of vision, oculomotor ability, accommodation, binocularity, and eye health. Functional vision anomalies that can overlay PCVI are also described. The presentation concludes with discussing diagnostic approaches and treatment strategies for PCVI, including using vision therapy principles of neuroplasticity.
Vision deficits are common following mild and moderate traumatic brain injuries. A high-yield vision screening should include a case history, tests of extraocular motility, accommodation, and vergence. Referral for further vision testing is recommended if the patient reports bothersome vision symptoms, has visual acuity poorer than 20/40, abnormal color vision, pupil abnormalities, or inability to fixate, make accurate saccades, or pursue targets. A comprehensive vision evaluation can diagnose specific deficits and guide rehabilitation.
Adult congenital heart disease and the surgical patientsxbenavides
This document discusses adult congenital heart disease and surgical patients. It notes that as surgical techniques have improved, more patients with congenital heart diseases are surviving into adulthood. This results in an increasing population of adults requiring long-term follow-up and potential further interventions. It also discusses some of the challenges in managing these adult patients and classifying their various congenital conditions.
This document discusses pediatric cortical visual impairment (PCVI). It begins by defining PCVI and exploring its history. PCVI is caused by injury to the brain rather than the eyes. The document then examines diagnostic approaches for PCVI, including assessing visual acuity, refractive error, oculomotor function, and more. It also discusses functional vision anomalies that can occur with PCVI like amblyopia. The document concludes by outlining treatment approaches for PCVI like using glasses, vision therapy, and modifying the home environment to encourage visual stimulation.
Vitiligo - critical review of medical treatments by Prof. R. SchwartzVR Foundation
Prof. Robert Schwartz
Vitiligo: Critical review of medical treatments
Presentation from the World Vitiligo Symposium 2011. Sponsored by the VR Foundation.
Prescribing for refractive errors - presentation at www.eyenirvaan.comEyenirvaan
This document discusses prescribing for refractive errors such as myopia, pseudomyopia, hypermetropia, astigmatism, and presbyopia. For myopia, optimal correction is recommended with slight undercorrection in some cases. Pseudomyopia is differentiated from true myopia and treated with cycloplegic drops and exercises. Hypermetropia in children under 7 may not require correction if asymptomatic, while adults generally need full correction. Astigmatism is usually fully corrected but some undercorrection is acceptable. Presbyopia is assessed using near tests and treated with reading additions based on age.
This document provides information on examining the 12 cranial nerves, with a focus on testing the functions of nerves 1-7. It describes how to test smell (cranial nerve 1), visual acuity and fields (cranial nerve 2), eye movements and diplopia (cranial nerves 3, 4, 6), sensation and motor function of the face (cranial nerves 5 and 7). Formal testing of each nerve is outlined, including bedside assessments of smell, vision, eye movements, facial expression, and jaw strength.
1. The visual pathway begins in the retina and passes through the optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiations, and visual cortex.
2. Lesions in different parts of the visual pathway cause specific visual field defects such as hemianopia. For example, a lesion in the optic chiasm causes bitemporal hemianopia.
3. Pupillary reflexes can localize lesions, such as Wernicke's hemianopic pupil indicating an optic tract lesion.
(1) Accommodation is the mechanism by which the eye changes refractive power by altering the shape of the lens to focus on objects at different distances.
(2) Theories of accommodation include the relaxation theory of Helmholtz which proposes that contraction of the ciliary muscle relaxes the suspensory ligaments of the lens allowing it to take on a more spherical shape.
(3) Accommodative anomalies include decreased accommodation seen in presbyopia and other conditions, as well as increased accommodation seen in conditions like accommodative excess or spasm.
This document discusses various anomalies of accommodation that can occur, including accommodative fatigue, presbyopia, insufficiency of accommodation, inertia of accommodation, paralysis of accommodation, and spasm of accommodation. It describes the symptoms, causes, assessments, and management approaches for each condition. The key message is that anomalies of accommodation are common and their management is an important part of optometric practice.
Accommodation anomalies can occur due to various causes and present with different symptoms. Assessment involves dynamic retinoscopy and measuring accommodation amplitudes. Accommodative fatigue can result from overuse and be treated by correcting refractive errors and discussing visual hygiene. Presbyopia is age-related and treated with near vision correction. Other failures of accommodation include insufficiency, paralysis, spasm, and sustained accommodation, each with different etiologies, signs, and treatments.
Lenses of slit lamp biomicroscope & indirect ophthalmoscope.Ayat AbuJazar
This document discusses different lenses used for ophthalmic examination, including Volk double aspheric lenses, Goldmann three mirror lenses, and indirect ophthalmoscope lenses. Volk lenses come in 60D, 78D, and 90D powers and are used for slit lamp biomicroscopy. The 60D provides high magnification of the posterior pole, while the 78D is for general diagnosis and the 90D is for small pupils. Goldmann three mirror lenses provide a 3D view of the anterior chamber and fundus and require a coupling agent. Indirect lenses act as condensing lenses, with higher powered lenses providing less magnification but wider field of view.
Duane's retraction syndrome involves congenital miswiring of the medial and lateral rectus muscles, causing limited eye movement. There are typically four types based on the pattern of limited adduction and/or abduction. Treatment may involve glasses, prisms, botulinum toxin injections, or surgery such as recession of the medial or lateral rectus muscles to improve eye alignment and positioning. Brown syndrome similarly involves a congenital or acquired restriction of eye elevation in adduction, believed to be caused by an abnormality of the superior oblique tendon. It is characterized by limited elevation in adduction and downshoot, and may cause a vertical eye misalignment.
The document summarizes several theories of accommodation, including Helmholtz's relaxation theory, Schachar's theory, and the catenary theory. It also discusses clinical assessment of accommodation and various anomalies such as insufficiency, excess, spasm, and infacility. Treatment options mentioned include spectacle correction, vision therapy exercises to stimulate or relax accommodation, and in rare cases, cycloplegic drugs.
Diagnosing Learning Related Vision ProblemsDominick Maino
This document summarizes information on diagnosing and treating learning related vision problems. It discusses what optometrists should do to diagnose these issues, including conducting a comprehensive eye exam, visual efficiency exam, and vision information processing exam. It outlines the common tests that should be performed in each exam, such as visual acuity tests, oculomotor exams, stereopsis tests, and vergence and accommodative testing. It also discusses common binocular vision disorders like convergence insufficiency and accommodative disorders. Finally, it reviews research on the efficacy of optometric vision therapy and treatments for conditions like amblyopia and refractive errors.
Read this article by my friend and colleague, Dr. Patrick Quaid. Binocular vision (BV) dysfunction, a term generally used to describe problems with teaming and co-ordination of one’s eyes, is often a significant challenge to detect and treat in the eyecare arena. BV disorders are more frequently encountered than glaucoma, macular degeneration and diabetic retinopathy ombined. Surely a condition that occurs 8.5 – 9.7 times more ofen than all ocular disease in children aged six months to 18 years1 combined deserves greater attention.....
This document provides information on Down syndrome including:
- Down syndrome is a genetic condition caused by trisomy 21 and has a prevalence of 1 in 800-1000 live births.
- Physical characteristics include refractive errors like hyperopia and astigmatism as well as binocular vision issues like strabismus.
- Recent studies have found that bifocals can effectively treat the reduced accommodation often seen in individuals with Down syndrome.
This document provides information on Fragile X syndrome including:
- It is the most common inherited cause of intellectual disability and is an X-linked condition.
- The prevalence is 1 in 4000 males and 1 in 4000-6000 females who have the full mutation.
- Physical characteristics can include prominent ears, long narrow face, enlarged testes in males, and sensory or behavioral issues.
This document discusses binocular vision disorders and their treatment. It begins with an executive summary noting the high prevalence of binocular vision problems. It then discusses various binocular vision syndromes like convergence insufficiency and excess, their signs and symptoms. Treatment options discussed include lenses, prisms, and vision therapy. The document provides evidence from research studies supporting the effectiveness of vision therapy and optical treatment for conditions like amblyopia and convergence insufficiency.
This document discusses binocular vision disorders and their treatment. It begins with an executive summary noting the high prevalence of binocular vision problems. It then discusses various binocular vision syndromes like convergence insufficiency and excess, their signs and symptoms. Treatment options discussed include lenses, prisms, and vision therapy. The document provides evidence from research studies supporting the effectiveness of vision therapy and optical treatment for various binocular vision disorders and amblyopia.
This document summarizes classical notions of refractive error distributions and factors that affect those distributions. It begins by describing how the distribution of refractive errors shifts from birth towards emmetropia during childhood through a process called emmetropization. It then discusses how the prevalence of myopia increases dramatically between ages 5-15, with onset typically between 7-14 years of age. Finally, it reviews several key factors that influence refractive error distributions, including age, ethnicity, geographical location, and genetic factors.
When you or your child has an eye turn all too often the first recommendation for intervention is surgery. You should know the outcomes, risks and complications associated with this surgical procedure and alternative ways to manage these problems.
A single etiology for autism or for any of the
disorders on the autistic spectrum has yet to be determined. In the past, suspected causes of these disorders included parentally induced autism, brain
injury/anomalies, constitutional vulnerability, and developmental aphasia, as well as deficits in the reticular activating system, and an unfortunate interplay between psychogenic and neurodevelopmental factors. Other suspected etiologies are structural cerebellar changes, genetics, viral infections, and immunological
abnormalities, with various teratogens, seizures and vaccines also being investigated. Until we know the multiple etiologies of those within the Autism
Spectrum; as researchers, health care providers, educators and optometrists, we must offer all within the autistic continuum the very best, most current and accessible care available based upon the latest known science.
A single etiology for autism or for any of the
disorders on the autistic spectrum has yet to be determined. In the past, suspected causes of these disorders included parentally induced autism, brain
injury/anomalies, constitutional vulnerability, and developmental aphasia, as well as deficits in the reticular activating system, and an unfortunate interplay between psychogenic and neurodevelopmental factors.Other suspected etiologies are structural cerebellar changes, genetics, viral infections, and immunological abnormalities, with various teratogens, seizures and
vaccines also being investigated. Until we know the multiple etiologies of those within the Autism Spectrum; as researchers, health care providers, educators and optometrists, we must offer all within
the autistic continuum the very best, most current and accessible care available based upon the latest known science.
Epidemiology is the study of disease distribution and control in human populations. Visual impairment is a functional limitation of the eye(s) due to disorder or disease, which can result in disability or handicap. Studying the epidemiology of eye disease aims to promote healthy eyes, prevent blindness and low vision. The magnitude of visual impairment is measured through prevalence and incidence rates of eye diseases and causes of blindness. Prevalence is the number of existing cases at a time, while incidence is the number of new cases in a period, usually one year. Cataract is the leading cause of blindness in India, responsible for 62.6% of cases, while refractive error and glaucoma also contribute significantly.
April 2019 . Cataracts secondary to intraocular diseases are complicated cata...Vinitkumar MJ
DEMOGRAPHIC PROFILES AND AETIOLOGY OF COMPLICATED CATARACTS: A HOSPITAL BASED STUDY.
Aim: To study demographic profiles and aetiology of complicated cataracts in patients presenting to the Out-Patient Department of B. P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS).
PDF Handout: D Maino: Visual Diagnosis and Care of the Patient with Special N...Dominick Maino
This is a copy of my handout of the lecture given in class today. (Copyright 2016). You may download and use this for any non-commercial educational purpose.
Visual Diagnosis and Care of Patients with Special Needs: SyndromesDominick Maino
This document discusses visual diagnosis and care of patients with special needs, including those with syndromes/genetic anomalies/brain injury. It covers several conditions commonly seen in children with special needs such as cerebral palsy, Down syndrome, fragile X syndrome, autism, ADHD, acquired brain injury, and various learning disabilities. For each condition, it discusses etiology, prevalence/incidence, physical and visual characteristics. It emphasizes the importance of comprehensive eye exams and vision therapy for patients with special needs.
This document discusses binocular vision (BV) disorders and their treatment. It begins with an introduction noting the prevalence of BV disorders like convergence insufficiency and accommodative disorders. It then provides details on examining for and diagnosing common BV syndromes. The document reviews evidence from research studies supporting the use of vision therapy and other optometric treatments. It discusses treating amblyopia at all ages and lists various treatment modalities like lenses, prisms, and vision therapy techniques.
Birth Defects: Care, preventing and counsellingPiLNAfrica
Birth Defects was written for healthcare workers who look after individuals with birth defects, their families, and women who are at increased risk of giving birth to an infant with a birth defect. This book is being used in the Genetics Education Programme which trains healthcare workers in genetic counselling in South Africa. It covers: modes of inheritance, medical genetic counselling, birth defects due to chromosomal abnormalities, single gene defects, teratogens, multifactorial inheritance
This document provides an overview of myopia, including its definition, global epidemiology, risk factors, management options, and the importance of controlling axial length growth. It discusses that myopia prevalence is increasing globally and poses lifelong risks. Risk factors for increased myopia progression include younger age, family history, near work, ethnicity, and binocular vision issues. The document reviews behavioral, optical, and pharmacological management strategies and their effectiveness, noting that controlling axial length growth through approaches like orthokeratology and atropine is key to managing myopia progression.
Similar to Diagnosing learning related vision problems (20)
Aging Oxidative Stress and Dietary OxidantsDominick Maino
This book review summarizes the text "Aging: Oxidative Stress and Dietary Antioxidants" which discusses how oxidative stress impacts the aging process and various age-related diseases. It contains 29 chapters authored by 82 contributors exploring topics like the role of antioxidants in reducing frailty, supporting cardiovascular health and preventing Alzheimer's disease. The review highlights how certain foods, herbs, spices and supplements can potentially slow aging by decreasing oxidative stress and inflammation. While technical at times, the book's diagrams and photographs help explain complex topics for readers without extensive scientific backgrounds. The reviewer recommends it for anyone wanting to better understand senior health and the science behind antioxidants.
06 17 current research that you should incorporate into yourDominick Maino
This course presents the best research posters from the 2017 American Optometric Association conference, featuring 5 presentations on topics ranging from concussive effects in veterans to myopia in children to management of central serous retinopathy and choroideremia. The document provides background on the poster selection process and encourages optometrists to submit their own case reports and clinical research for consideration in future poster sessions. It concludes with a question and answer period following the 5 presentations.
06 17 current research that you should incorporate into yourDominick Maino
This document summarizes a course featuring the best poster presentations from the 2017 AOA conference. It discusses 5 poster presentations that were selected to be highlighted covering topics like concussive effects in veterans, myopia in children in China, corneal edema, central serous retinopathy, and low vision rehabilitation for choroideremia. The document provides details on the abstract review process and encourages clinicians to submit case reports and research to the 2018 poster session.
Cerebral Palsy is a motor disability appearing in early life due to brain damage. It has a prevalence of 1-4 per 1000 live births. Etiologies include prenatal, perinatal and postnatal insults. It is classified as spastic, dyskinetic or ataxic. Visual characteristics include refractive errors like hyperopia, strabismus in over 10% of cases, and reduced accommodation. Down Syndrome is a genetic condition caused by trisomy 21. Its prevalence is about 1 in 700 live births. Physical characteristics include low muscle tone, a flat facial profile, and health issues such as congenital heart defects and hearing loss.
My students and I wrote several translations of how to conduct an eye examination (mostly my students since my language skills are not very good!). I know there are many ways, and perhaps better ways to ask these questions, but this could be a starting point. Feel free to adapt this to your needs and to make this even better. Please share when you do.
My students and I wrote several translations of how to conduct an eye examination (mostly my students since my language skills are not very good!). I know there are many ways, and perhaps better ways to ask these questions, but this could be a starting point. Feel free to adapt this to your needs and to make this even better. Please share when you do.
Let me know what you think. (dmaino@ico.edu).
Current Clinical Case Reorts & Research You Should Incorporate into Your Mode...Dominick Maino
Dominick Maino, OD, MEd, FAAO, FCOVD-A
Moderator
Featuring the Best of AOA's 2016 Poster Presentations
Saturday, July 2nd 8-10AM
Five of the very best, clinically relevant posters were chosen to be given during the American Optometric Association meeting in Boston in 2016. These posters were chosen by the AOA Poster Committee (Dr. Dominick M. Maino, Chair).
Writing the Perfect Poster Abstract in 20 Minutes or LessDominick Maino
One of the easiest ways to begin your publishing career is to present a poster during one of the many annual meetings held by professional optometry. These meetings include but are not limited to the College of Optometrists in Vision Development, American Academy of Optometry and the American Optometric Association. This presentation reviews the step by step process involved in writing an abstract that will be accepted for presentation by these and other organizations most of the time. Once the abstract is written, you are one third of the way to making a significant contribution to the optometric literature. The other two thirds include, creating the poster and writing the final paper to be submitted to an appropriate journal for publication (the last two topics will be addressed at other meetings and/or within future VDR articles). You are encouraged to bring information for a case report and/or case series that you wish to use for a poster in the future.
This course presents the latest information concerning cortical visual impairment, its etiology, diagnosis and treatment. Various topics reviewed include cortical vs cerebral visual impairment, ventral/dorsal visual streams, visual acuity, and contrast sensitivity. Also discussed are various retinoscopy techniques, overlapping functional vision disorders, and visual stimulation/therapy for these disorders.
Course Objectives
At the end of this course, the participant will:
Be able to identify cortical vs cerebral visual impairment
Be able to access various vision functions such as visual acuity, contrast sensitivity, oculomotor and accommodative disorders
Be able to treat the diagnosed vision problems with all the tools available to the optometrist (spectacles, low vision devices, vision rehabilitative techniques)
Be aware of and use outside resources to supplement and add to any therapeutic interventions recommended
A,B,V's of School Performance: Academics, Behavior and VisionDominick Maino
This presentation is geared towards teachers and professional teaching staff, but can also be adapted for parents and others. It reviews the three O's of eye care (Optometry, Ophthalmology, Optician), the optometric examination, learning related vision problems and more.
Evidence Based Practice: Pediatrics, Binocular Vision and Patients with Speci...Dominick Maino
This document discusses evidence-based clinical practice in pediatrics and optometry, specifically for patients with special needs. It covers different perspectives of clinicians and researchers, as well as patients' views. It questions whether evidence is needed for everything, given limitations of randomized controlled trials and systematic reviews. The document also discusses levels of scientific evidence and grades of evidence in evaluating research studies and forming clinical recommendations.
060915 current research that you should incorporate into yourDominick Maino
Current Research that You Should Incorporate into Your Mode of Practice Now!
Dominick Maino, OD, MEd, FAAO, FCOVD‐A
Moderator
Featuring the Best of AOA's 2015 Poster Presentations
Jun‐27‐2015 8:00AM ‐ 10:00AM
Optic Nerve Head Drusen: A Myriad of Presentations
Jennifer L. Jones, Sylvia E. Sparrow, Christina Grosshans
Validation Study of New LCD‐Based Contrast Sensitivity Testing Method
Sarah Henderson, Jeung H Kim, Paul Harris
Bilateral Cystoid Macular Edema in Retinitis Pigmentosa and its Management
Lindsay T. Gibney
An ODE to Optic Disc Edema
Kelli Theisen
Is Binocular Balancing with Subjective Refraction a thing of the Past?
David Geffen
Optometry's Meeting 2015
Seattle, Washington
Maino D. Agenda Driven Research. Vis Dev Rehab 2015; 1(1):7-11.
Read the editorial.....
Conclusion
It is time for all to put aside our agendas,
our biases, our preconceived notions. It is time
to work together to determine best practices
even if it is contrary to prevailing opinion. The
world is not flat. Amblyopia can be treated at
any age. And optometric vision therapy is an
appropriate treatment modality for disorders of
he binocular vision system.
Dr. Dominick Maino Quoted in AOAFocus Article: Wearable WonderDominick Maino
".....Dominick M Maino, O.D., M.Ed., FAAO, FCOVD-A, professor of pediatrics and binocular vision at the Illinois College of Optometry and private practitioner at Lyons Family Eye Care in Chicago, imagines a world in which people with dementia wear unobtrusive GPS devices that allow family members to easily track them if they leave the safety of their homes. Or, he imagines Google Contacts, which are being designed to monitor blood glucose levels, working seamlessly with insulin pumps, so one's blood sugar never veers out of healthy range. The possibilities are endless. Already, engineers are developing bracelets for the hearing impaired that can translate hand movements into words. For optometrists such as Dr. Maino, who see a great number of patients with disabilities, such technology could be quite useful.
"In the not-too-distant future—probably in my lifetime—both in terms of prevention and monitoring of health, we will probably all be wearing one or more devices that talk to each other," Dr. Maino says. "But right now, much of this is in the development stage or just vaporware."...."
This document describes a case study of a 4-year-old female patient named SS who has Pallister-Killian Mosaic Syndrome (PKMS). PKMS is a rare genetic disorder characterized by multiple birth defects and developmental delays. The patient presented with eye rubbing and was found to have cortical visual impairment, as well as hyperopia and astigmatism. A visual evoked response test showed a cortical response to light but variability, consistent with cortical visual impairment. The treatment plan is for the patient to wear glasses full time, use eye drops for allergic conjunctivitis, repeat the visual evoked response test in a year, and begin vision rehabilitation therapy.
This document discusses vision function and functional vision anomalies in pediatric cortical visual impairment (PCVI). It begins with a history and definition of PCVI, describing how it was originally applied to adults with brain injuries and later to children. It then discusses diagnostic approaches for PCVI, including case history, visual acuity tests, refractive error tests, vision function assessments, and the use of special diagnostic tools. The document also discusses therapeutic strategies for treating PCVI, including refractive correction, vision therapy, use of lenses/devices, and considering how environmental factors and medications can affect evaluation and treatment.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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1. Diagnosing and Treating
Diagnosing and Treating Learning Related Vision Problems
Learning Related Vision Problems
What do Doctors do (or should do) to
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
diagnose LRVP?
Professor Where’s the research?
Illinois Eye Institute
Illinois College of Optometry What Therapy Procedures Should I
Private Practice Use?
Harwood Heights, Il.
What’s New?
BV Dx & Tx in the News!!
3 4
3 D Movie Stars…Can’t See 3D!
5 6
2. 3-D TV and Movies Look to Attract Viewers But Not Healthbeat Report: The 3-D Dilemma
Everyone Can 'See' What All the Hype is About
7 8
3 D Classroom!
Non-strabismic BV disorders
…Studies have shown that the measurable Prevalence
educational benefits of presenting teaching Prevalence of General Dysfunctions in Binocular Vision . Montés-
Micó Robert. Annals of Ophthalmology, Volume 33, Number 3,
materials in 3D are significant, generating a September 2001 , pp. 205-208(4). (Spain)
threefold improvement in comprehension and
retention over the more traditional non - 3D …in 1679 subjects aged 18 to 38 years. …. A high
prevalence of binocular vision dysfunctions was
style of presentation. And students respond found. … 56.2% presented symptoms of binocular
well to the immersive and engaging qualities of dysfunctions, 61.4% with accommodation
the 3D effect … disorders and 38.6% vergence disorders.
Accommodation insufficiency was most prevalent
AOA/3D@Home among those with symptoms (11.4%). …
www.3Dhealth.org 9 10
BV disorders BV disorders
Prevalence Prevalence
Prevalence and risk factors for common vision
Pickwell's Binocular Vision Anomalies By Bruce
problems in children (in the UK)
J. W. Evans, David Pickwell
Between 1 in 5 to 1 in 10 individuals have …for 7825 seven-year-old children.
BV problems. 30-60 million people 2.3% had manifest strabismus,
3.6% had …amblyopia….
11 12
3. Non-strabismic BV disorders BV disorders
Prevalence
General binocular disorders: prevalence in a clinic population. Ophthalmic & Prevalence: Additional Articles
Physiological Optics. 21(1):70-74, January 2001.Lara, Francisco 2; Cacho, Pilar 1; Garcia,
Angel 1; Megias, Ramon 2 Prevalence of general binocular dysfunctions in a
….W
We examined 265 symptomatic patients …., 59
i d t ti ti t population of university students.
students
patients (22.3%) had some form of accommodative
or binocular dysfunction …. The frequency of
binocular dysfunctions was 12.9%, and 9.4% for 32.3% of the subjects showed general
accommodative anomalies. Convergence excess
(4.5%) was more prevalent than convergence binocular dysfunctions
insufficiency (0.8%) and accommodative excess
(6.4%) more prevalent than accommodative
13 14
insufficiency (3%).
BV disorders BV disorders
Prevalence: Additional Articles Prevalence: Additional Articles
Stereoacuity levels and vision problems
in hild
i children from 7 to 11 years
f t Prevalence of amblyopia in
ametropias in a clinical set-up
…prevalence of defective stereoscopic vision was
found to be between 2.1 and 3.2 per cent (5.97%)
…Out of 970 ametropic eye patients a total of 56
patients have amblyopia….
15 16
Non-strabismic BV disorders
What Does the
Prevalence
• Convergence Insufficiency: 1.3% to 37% of
Doctor Do to
the population; most report 3-5%
• Convergence Excess: ~6% Diagnose Learning
• Accommodative disorders: 3-5%
AOA: Care of the Patient with Accommodative and Vergence Dysfunction
Related Vision
http://www.aoa.org/documents/CPG-18.pdf
17
Problems? 18
4. Can We Measure Symptoms Can We Measure Symptoms
Test-retest reliability of the college of optometrists in Evaluating Changes in Quality of Life After
vision development quality of life outcomes Vision Therapy Using the COVD Quality of
assessment. MAPLES W. C. , et al. Life Outcomes Assessment Kelly M. Daugherty,
OD, et. al.
The COVD Quality of Life Outcomes Assessment is
a reliable tool to measure changes in symptoms on The COVD – QOL Questionnaire in a socially at-
the basis of optometric intervention-specifically, risk population of youth Willard B. Bleything,
vision therapy OD, MS, FAAO, FCOVD, Sandra L. Landis, OD,
FCOVD
19 20
Subjective Complaints of
Can We Measure Symptoms
Patients with BV Disorders
Validity of the convergence insufficiency
symptom survey: a confirmatory study.
• Blur
Rouse M, Borsting E, Mitchell GL, et al.
, g , ,
• Headache
d h
• Aesthenopia
…The CISS continues to be a valid
• Diplopia
instrument for quantifying
• These complaints are usually
symptoms in 9 to <18-year-old associated with near work
children… 21 22
Subjective Complaints of Subjective Complaints of
Patients with BV Disorders Patients with BV Disorders
• Blur
• Blur
•H d h
Headache • H d h
Headache
• Aesthenopia • Aesthenopia
• Diplopia • Diplopia
• These complaints are usually associated • These complaints are usually
with near work associated with near work
23 24
5. Subjective Complaints of
Examination Sequence
Patients with BV Disorders
Comprehensive Eye/Vision Examination
• Blur
• Headache
H d h
Visual Efficiency Examination
• Aesthenopia
• Diplopia
• These complaints are usually Vision Information Processing Examination
associated with near work
25 26
Examination Sequence Examination Sequence
Comprehensive Eye/Vision Examination Visual Efficiency Evaluation
HX
History (Sy pto s e ated
(Symptoms related to near wo , school,
ea work, sc oo ,
sports, BV dysfucntions, etc.)
Visual Acuity VA
Oculomotor/Entrance Tests Oculomotor System
Sensory Fusion System
Refraction Motor Fusion/Vergence System
Accommodative System
Eye Health 27 28
Visual Visual
Efficiency Efficiency
Examination Examination
29 30
6. Examination Sequence
Vision Information Processing Examination
Laterality/Directionality
Visual Information Processing Non-motor
VIP
Visual Information Processing Motor
Oculomotor
Auditory Information Processing
Misc.
31 32
Master
VIP Problem List
33 34
Visual Efficiency Examination:
Basic Tests
History
Master
Problem List Must be
M b geared towards the child or
d d h hild
adult with likely binocular vision
dysfunction, learning related vision
problems or work/recreational
related functional vision anomalies.
35 36
7. Visual Efficiency Examination: Visual Efficiency Examination:
Basic Tests Basic Tests
• Visual acuity
– May find reduced Refraction
acuity at
it t
near or complaints of
Control Lens
blur at near
(intermittent
problems)
37 38
Visual Efficiency Examination: Visual Efficiency Examination:
Basic Tests Basic Tests
Oculomotor System Developmental Eye Movement Test
DEM J . TASSINARI
Pursuits, S
P i Saccades
d Developmental Eye Movement
Test: reliability and
symptomatology .
Developmental Eye Movement Test Journal of the American
Optometric Association ,2005;
DEM Volume 76 ,
Issue 7 , Pages 387 - 399
Visagraph/Readalyzer
39 40
Visual Efficiency Examination: Visual Efficiency Examination:
Basic Tests Basic Tests
• Cover test • Nearpoint of convergence
– Repeat several times
–Distance and near
– See what happens with
–Repeat during the fatique
exam to see if – Red lens sensitive for CI
fatigue changes
A prospective study of different test targets for
your result the near point of convergence
Yi Pang, Helen Gabriel, Kelly A. Frantz and Faheemah Saeed
41 42
8. Visual Efficiency Examination:
Basic Tests Other tests
Heterophoria 2 Degree Fusion
In Phoropter
Prism Bar Suppression
S i
– Worth 4 Dot
Risley Prism/Madox Rod
43 44
Accommodative
Basic tests amplitude Basic tests
Stereopsis – Either push-up, push
away methods or
Look for reduced steropsis
minus lens
Less th
L than 70 seconds of arc
d f
method
– Minimum amplitude
= 15 - (0.25) age The minus lens method
– So a 20 year old exhibited the best
repeatability...
should have at least
Repeatability intra-examiner and agreement in
10 diopters of amplitude of accommodation measurements
accommodation Antona B, Barra F, Barrio A, Gonzalez E, Sanchez I.
45 43
Basic tests Basic tests
• Accommodative facility NRA
– Perform monocularly and
binocularly Negative Relative
with suppression control (+/-2 00)
(+/ 2.00) Accommodation
• ~10 cycles per minute is diagnostic
PRA
For children with reading problems: Positive Relative
Binocular accommodative facility
values were significantly lower (p <
Accommodative function in
school children with reading
Accommodation
difficulties. Palomo-Alvarez C,
0.05) in the poor readers (4.9 cpm +/- Puell MC.
3.1) than controls (6.3 cpm +/- 2.9)
47 48
9. Basic tests
Other Tests
• Vergences • Dynamic Retinoscopy
– Use either prism bars or –Monocular
Risley prisms Estimation Method
– Sheard’s criteria
–Expected Values:
• Need twice your phoria in
reserve –+0.50 to +0.75 D
• Example: a 10 pd exophore
at near needs 20 pd BO
49 50
reserves
Other Tests Other Tests
• Fixation Disparity • Fixation Disparity
Testing Testing
– Wesson Card – Wesson Card
– Bernell Fixation – Bernell Fixation
Disparity (Associated Disparity (Associated
Phoria) Phoria)
– Disparometer – Disparometer
51 52
Other Tests Other Tests
• Fixation Disparity
Testing
– Wesson Card
– Bernell Fixation
Disparity (Associated
Phoria)
– Disparometer
53 54
10. 55 56
Common BV Syndromes Convergence Insufficiency
• Convergence Insufficiency • Signs:
– Most common syndrome – An exodeviation at near
• Can even be an intermittent exotropia at near
– Symptoms: aesthenopia, – Receded NPC value
headaches, blur, diplopia, loss • NPC larger than 10 cm
of concentration – Reduced BO vergences at near
• associated with near work • Often fail to meet Sheard’s criterion
• often occur near the end of the
day 57 58
Convergence Excess Convergence Excess
• Symptoms: Diplopia, headaches, • Signs
aesthenopia – Dynamic Retinoscopy
– almost always near related
• May be the most significant test
• Signs:
• Typically a high lag of accommodation
– Esophoria at near
• Use detailed accommodative target or you may miss • Lag may be +1.00 to +2.00 DS at 40
the esophoria cm
– Vergences • Lags greater than +2.50 D at 40 cm
• BI vergences at near may not compensate should suggest uncorrected hyperopia 60
59
11. Binocular Vision Dysfunction Accommodative Disorders
• Symptoms: aesthenopia, headaches, blurred • Symptoms: blur,
vision (Binocular Vision/Visual Discomfort Dx) headache,
– Associated with reading or near work aesthenopia,
aesthenopia fatigue
• Signs: when reading,
– Phorias: Normal at distance and near difficulty changing
– Reduced BI and BO vergences at distance
focus from one
and/or near distance to another
61 62
Accommodative Disorders Other BV Disorders
• Signs • Divergence Excess
– Accommodative Insufficiency: – Prevalence of ~0.5 to 4%
• Reduced amplitude of accommodation – Exophoria greater at distance than near
• Minimum Accommodation: 15 - (0.25) (age) – Frequently first discovered in grade school
– Accommodative Infacility
• Divergence Insufficiency
• Failure of monocular facility testing
• Expected value: 11 cpm
– Very rare!
– Esophoria greater at distance than near
– Be careful to rule out lateral rectus palsy!
63 64
Strabismus & Amblyopia Exotropia
3-6% of the population
CI, Intermittent XT @ near
Tx
T appropriate at all ages
i ll
May do out of office VT DE, Intermittent XT @ distance
and achieve success!
65 66
12. Accommodative Esotropia Accommodative Esotropia
First seen in 2-4 year
olds
Uncorrected hyperopia
From:
http://www.strabismus.org/
esotropia_eye_turns_in.ht
High ACA ml
67 68
Diplopia & Head Turns/Tilts Amblyopia
Paresis or paralysis? Pathological until proven otherwise
Infants/Toddlers
Duane’s Retraction
Syndrome Young Children
Busy Adults
69 70
Efficacy of Optometric
Amblyopia
Vision Therapy
Pathological until Efficacy of vision therapy as assessed by the
Anisometropia
p COVD quality of life checklist. Maples WC,
p
proven otherwise Bither MM.
Infants/Toddlers Bilateral Refractive Error
The COVD-QOL can be used to measure
Young Children changes in symptoms, and to objectively
Strabismus (Constant) demonstrate quality of life changes that are
No disease present achieved through optometric vision therapy.
Busy Adults
71 72
13. Efficacy of Optometric Efficacy of Optometric
Vision Therapy Vision Therapy
Ciuffreda KJ. The scientific basis for and Scheimann M et al. A randomized clinical trial of vision therapy/orthoptics versus
pencil pushups for the treatment of convergence insufficiency in young adults.
efficacy of optometric vision therapy in Optom Vis Sci. 2005 Jul;82(7):583-95.
non-strabismic accommodative and …vision therapy/orthoptics was the
ii h / h i h
vergence disorders. Optometry. only treatment that produced
2002;73(12):735-62 clinically significant improvements
in the near point of convergence
and positive fusional vergence.
73 74
Efficacy of Optometric
Vision Therapy Treatment for BV Disorders
A Randomized Clinical Trial of Treatments for Symptomatic Convergence Evidence Based Medicine
Insufficiency in Children Mitchell Scheiman, OD, FCOVD, CITT Study Chair
Office Based Vergence/Accommodation Therapy Cotter S et al Treatment of strabismic amblyopia with
al.
was significantly more effective than Home Based refractive correction. Am J Ophthalmol. 2007
Jun;143(6):1060-3.
Pencil Pushups, Home Based Computer Vergence/
Accommodation Therapy with PP+, and Office These results support the suggestion …that strabismic
Based Placebo Therapy in improving both the amblyopia can improve and even resolve with spectacle
symptoms and clinical signs associated with correction alone.
symptomatic CI in children
75 76
Treatment for BV Disorders Refractive Error
Myopia: Can Its Progression Be Controlled? Yi Pang, PhD, OD, Dominick M. Maino,
Scheimann M et al. Randomized trial of treatment of amblyopia in OD, MEd, FAAO Guoming Zhang, MD, PhD, Fan Lu, MD, OD
children aged 7 to 17 years. Arch Ophthalmol. 2005 Apr;123(4):437-
47.
…. muscarinic receptor antagonists, including
usca c ecepto a tago sts, c ud g
Amblyopia improves with optical correction alone in about one
fourth of patients aged 7 to 17 years, although most patients who atropine and pirenzepine. Bifocal and
are initially treated with optical correction alone will require progressive lenses can be effective in the
additional treatment for amblyopia. For patients aged 7 to 12 years,
prescribing 2 to 6 hours per day of patching with near visual control of myopia and have greater
activities and atropine can improve visual acuity even if the
amblyopia has been previously treated. For patients 13 to 17 years,
effectiveness for subjects with nearpoint
prescribing patching 2 to 6 hours per day with near visual activities esophoria and a high lag of accommodation.
may improve visual acuity when amblyopia has not been previously
treated 77 78
14. New Amblyopia Treatments?
Refractive Error
Two-year multicenter, randomized, double-masked,
placebo-controlled, parallel safety and efficacy study of Thompson B, Mansouri B, Koski L, Hess
2% pirenzepine ophthalmic gel in children with myopia. RF. Brain plasticity in the adult:
R. Michael Siatkowski MD, Susan A. Cotter OD, MS . Et
modulation of function in amblyopia with
al.
rTMS. Curr Biol. 2008 Jul 2;18(14):1067-
Pirenzepine ophthalmic gel 2% was effective compared with 71.
placebo in slowing the progression of myopia over a 2-year
treatment period and demonstrated a clinically acceptable
safety profile. ( J AAPOS 2008;12:332-339) Watch for studies on “Perceptual Learning”!
79 80
Video-Game
Li RW, Ngo C, Nguyen J, Levi DM (2011)
Play Induces Plasticity in the Visual Learning Related Vision Problems
System of Adults with Amblyopia. PLoS Biol
9(8): e1001135. doi:10.1371/journal.pbio.1001135 All vision problems affect learning,
usually as a secondary contributing
…..video-game play may provide factor.
f t
important principles for treating
New research suggests that the
amblyopia, and perhaps other cortical
Magnocellular pathway may show a
dysfunctions. direct vision link.
81 82
Learning Related Vision Problems Learning Related Vision Problems
Repeatability of the VMI Supplemental Developmental Test of Visual
Perception Marjean Taylor Kulp, OD, MS, FAAO and Michael J. Subitizing and Visual Counting in Children with
Earley, OD, PhD, FAAO Problems in Acquiring Basic Arithmetic Skills
Burkhart Fischer, Dipl. Phys., Christine Gebhardt, Dipl.
Visual perceptual ability has been found to be related
to academic achievement. Therefore, the screening of Phys., and Klaus Hartnegg, Dipl. Phys.
h d l i l h
perceptual skills in children should provide valuable information. …
The VMI Supplemental Developmental Test of Visual Perception We concluded that the deficit in a basic visual capacity
(VP) test 1) has been shown to be related to academic performance, 2) may contribute to the problems encountered by children
has an objective scoring system and 3) can be administered and scored
quickly and easily. Therefore, the VP test may have the potential to be with anomalies in acquiring basic arithmetic skills.
used as a stand-alone screening test of motor-reduced visual
perception. However, its repeatability as a stand-alone screening test Fischer B, Gebhardt C, Hartnegg K. Subitizing and Visual Counting in Children
has not been evaluated. No consistent learning effect appeared to be with Problems in Acquiring Basic Arithmetic Skills. Optom Vis Dev
present upon retest. 2008:39(1):24-29.
• It give repeatable results.
83 84
15. Learning Related
Learning Related Vision Problems
Vision Problems
Effects of Daily Practice on Subitizing, Visual Solan H et al. M-cell deficit and reading
Counting, and Basic Arithmetic Skills Burkhart disability: a preliminary study of the effects of
Fischer, Dipl. Phys., Christine Gebhardt, Dipl. Phys.,
and Klaus Hartnegg, Dipl. Phys. temporal vision-processing therapy.
Since the result of the second study of this paper shows a Optometry. 2004 Oct;75(10):640-50.
transfer from improvements in subitizing to
improvements of basic arithmetic skills one may This research supports the value of rendering temporal vision therapy to children
conclude that the basic visual capacity of subitizing and identified as moderately reading disabled (RD). The diagnostic procedures and
visual number counting contributes to the problem the dynamic therapeutic techniques discussed in this article have not been
encountered by children with dyscalculia. previously used for the specific purpose of ameliorating an M-cell deficit.
Improved temporal visual-processing skills and enhanced visual motion
Fischer B, Gebhardt C, Hartnegg K. Subitizing and Visual Counting in Children discrimination appear to have a salutary effect on magnocellular processing and
with Problems in Acquiring Basic Arithmetic Skills. Optom Vis Dev reading comprehension in RD children with M-cell deficits.
2008:39(1):24-29.
85 86
Learning Related Learning Related
Vision Problems Vision Problems
Solan H et al. Is there a common linkage among reading
The Effects of HTS Vision Therapy Conducted in a School Setting
comprehension, visual attention, and magnocellular on Reading Skills in Third and Fourth Grade Students David Goss,
processing? J Learn Disabil. 2007 May-Jun;40(3):270-8. O.D., Ph.D., FAAO, FCOVD-A, et. al.
Solan H et al. Role of visual attention in cognitive control of oculomotor A Study of the Effectiveness of Cognitive Skill Therapy Delivered in
readiness in students with reading disabilities. Learn Disabil. 2001 Mar- a Video Game Format Don Helms, O.D., and Sara M. Sawtelle, Ph.D.
Apr;34(2):107-18.
Training Direction-Discrimination Sensitivity Remediates a Wide
Eye movement therapy improved eye movements Spectrum of Reading Skills Teri Lawton, Ph.D.
and also resulted in significant gains in reading
comprehension. Optom Vis Dev. 2007;38(1)
87 88
Learning Related Learning Related
Vision Problems Vision Problems
Vision, Visual-Information Processing, and Academic A randomized prospective masked and matched
Performance Among Seventh-Grade Schoolchildren: A comparative study of orthoptic treatment versus
More Significant Relationship Than We Thought? Sarina conventional reading tutoring treatment for reading
Goldstand, Kenneth C. Koslowe and Shula Parush American Journal of Occupational disabilities in 62 children.
Therapy July/August 2005 vol. 59 no. 4 377-389
Atzmon D, Nemet P, et al.
Effect of attention therapy on reading comprehension.
Binocular Vision & Eye Muscle Surgery Quarterly, 8(2):p.
Solan HA, Shelley-Tremblay J, Ficarra A, Silverman M,
91-106, 1993.
Larson S. J Learn Disabil. 2003 Nov-Dec;36(6):556-63.
89 90
16. Orthoptic treatment, to increase convergence Optometric Vision Therapy are
amplitudes to 60 D, is as effective as NOT!
conventional in-school reading tutoring
treatment of reading disabilities. An advantage of
orthoptic treatment was that subjective reading and asthenopic
symptoms (excessive tearing, itching, burning, visual fatigue, and
headache) virtually disappeared after orthoptics. We recommend
orthoptic treatment as: 1) an effective alternate
primary treatment; 2) adjunctive treatment for those
who do not respond well to standard treatment; and
3) as primary treatment in any case with asthenopic
symptoms of /or convergence inadequacy.
Eye Exercisers!
91 92
Vision Therapy is…..! Treatment for BV Disorders
• Treatment modalities
– Lenses
– Prisms
– Vision therapy
• Traditional therapy
Brain Therapy • Computer therapy
Neuro-therapy
Neuro-plasticity Therapy
93 94
Lenses as Treatment
Best Rx (clarity, comfort, function)
Lenses as Treatment
Refractive Error Amblyopia Binocularity Interference Rx if….
Concern Concerns with
Learning
• Best Rx (clarity, comfort, function)
Myopia >5.00D Under correct Depends >5.00D (any age)
eso/Fully o child’s
on c d s >3.00D @>1yr
• Accommodative disorders
correct exo
age – Can prescribe reading only Rx or an add
Hyperopia >2.00D Under correct >2.50D >2.00D • Exodeviations
exo/Fully
correct eso – Overminusing (DE)
Astigmatism >1.25D Depends >1.25D – Not usually a first choice! Give add
on VA
Anisometropia >1.00D Monitor >1.00D >1.00D
95 96
BV/Stereo
17. Bifocals for Kids Bifocals for Kids
Bifocal Seg Height Bifocal Seg Height
3-5 Years
Infants/Toddlers Bottom 1/3 of Pupil
Pre-schoolers
Bi-sect pupil
97 98
Bifocals for Kids Bifocals for Myopia Progression
Bifocal Seg Height Gwiazda JE, Hyman L, Norton TT, Hussein ME, Marsh-Tootle W, Manny R,
Wang Y, Everett D; COMET Grouup.
Accommodation and related risk factors associated with myopia progression and
their interaction with treatment in COMET children.
Invest Ophthalmol Vis Sci 2004 Jul;45(7):2143-51.
Sci. Jul;45(7):2143-51
> 5yrs ….Children with large lags of accommodation and
Bottom of Pupil near esophoria …are prescribed …bifocals to
improve visual performance. Results of this study
suggest that such children, if myopic, may have an
additional benefit of slowed progression of
myopia…..
99 100
Polycarbonate Lenses
Prism as Treatment
• Can be used with CI, CE, DI, DE, Vertical
Deviations
• Prescribe the least amount of prism needed
– Determine the associated phoria with a Wesson
Card or Bernell Box
• Fresnel Prism trial, then Rx
101 102
18. Optometric Vision Therapy as Treatment Vision Therapy as Treatment
• The approach of choice for CI, Fusional • Traditional therapy
Vergence Dysfunctions, accommodative – Hand-eye, Vergence and Accommodative
disorders,
disorders and Amblyopia procedures
– High chance of success with these disorders • Computer Therapy
– Results are typically long lasting – Can attack hand-eye, vergence, accommodative
– Often can treat these disorders using primarily and oculomotor problems (Vision information
home VT with in-office check-ups processing anomalies?)
103 104
Vision Therapy for Amblyopia
Period of Sensitivity
• Prescribe Rx vs
• Implement occlusion
therapy
Period of Plasticity
• Active vision therapy
• Monitor
• Change Rx/Tx as needed
105 106
Atropine
Atropine
Pediatric Eye Disease Investigator Group. Repka MX, Cotter SA, Beck RW, Kraker RT,
The course of moderate amblyopia (20/100) Birch EE, Everett DF, Hertle RW, Holmes
treated with atropine in children: JM, Quinn GE, Sala NA, Scheiman MM,
experience of the amblyopia treatment Stager DR Sr, Wallace DK; A randomized
trial of atropine regimens for treatment of
study. moderate amblyopia in children.
Am J Ophthalmol. 2003 Oct;136(4):630-9. Ophthalmology. 2004 Nov;111(11):2076-
85.
107 108
19. Atropine
Occlusion Therapy
Age (yrs) Per Day Schedule Minimum Exam
Frequency
1 4 60min periods 1 day on/1 day off Weekly
Weekend atropine provides an 2 3 30min periods 2 day on/1 day off Every 2 wks
improvement in VA of a magnitude 3 3 30min periods 3 day on/1 day off Every 3 wks
similar to that of the improvement
4 2 60min periods 4 day on/1 day off Every 4 wks
provided by daily atropine in treating
moderate amblyopia in children 3 to 7 5 2 60min periods 5 day on/1 day off Every 5 wks
years old. 6 2 60min periods 6 day on/1 day off Every 6 wks
109 110
Amblyopia Therapy Active Vision Therapy
What do we know about Hand-eye
amblyopia?
Oculomotor
–MMore than d
h decreased VAd
– Visual-Spatial affects
Accommodation
– Accommodation
– Hand-eye Have child “Do Stuff”
– Stereopsis Interact with environment
111 112
Vision Therapy as Treatment
Roberts CJ, Adams GG.Contact lenses in the management of
high anisometropic amblyopia. EYE. 2004;18(1):109-10 Phases of Therapy
High anisometropic amblyopia is
g p y p • Monocular (HE, OM, ACC)
challenging to treat. …contact • Biocular (HE, OM, ACC, Anti-suppression)
lenses improved visual acuity in • Binocular (Vergence, Acc)
myopic anisometropia of up to 9 • Integration/Stabilization
diopters. Do it all at the same time!
113 114
20. Vision Therapy as Treatment Vision Therapy as Treatment
Phases of Therapy Phases of Therapy
• Monocular (HE, OM, ACC) • Monocular (HE, OM, ACC)
• Biocular (HE, OM, ACC, Anti-suppression) • Biocular (HE, OM, ACC, Anti-suppression)
• Binocular (Vergence, Acc) • Binocular (Vergence, Acc)
• Integration/Stabilization • Integration/Stabilization
Do it all at the same time! Do it all at the same time!
115 116
Vision Therapy as Treatment Vision Therapy as Treatment
Phases of Therapy Phases of Therapy
• Monocular (HE, OM, ACC) • Monocular (HE, OM, ACC)
• Biocular (HE, OM, ACC, Anti-suppression) • Biocular (HE, OM, ACC, Anti-suppression)
• Binocular (Vergence, Acc) • Binocular (Vergence, Acc)
• Integration/Stabilization • Integration/Stabilization
Do it all at the same time! Do it all at the same time!
117 118
Traditional Therapy Procedures Traditional Therapy Procedures
• Hand-Eye Procedures • Vergence procedures
– mazes – Brock String
– dot to dot – Lifesaver card BI and BO
– cutting – Anaglyph Series (BC920, others)
– coloring • Accommodative Procedures
– filling in O’s – Minus lens dips
– Bunt Ball – Flippers
– Hart Chart
119 120
21. Vergence Procedures Vergence Procedures
Brock String Life Saver Cards
Simple
Inexpensive BO and BI
d
Easy
Good fusion
Effective
Anti-suppression
Inexpensive
Effective
Brock String
121 122
Vergence Procedures Vergence Procedures
Aperture Rule
Fusion Cards
“Flying W”
Random dot
targets Stereoscopes
BC 920, BC 50 Vectograms
Eccentric Circles
Anaglyph
series Vectograms
Aperture Rule
Aperture Rule
123 124
Accommodative Procedures Accommodative Procedures
Rock Card Hart Chart
Flippers the old
standby
Anti-suppression
125 126
22. Vision Therapy Videos Vision Therapy Videos
http://www.youtube.com/watch?v=HtzEHSie-90 http://www.youtube.com/watch?v=fX8mqtgdzgs
127 128
Vision Therapy Videos Vision Therapy Videos
http://www.youtube.com/watch?v=Ui3KTZOdzbo
http://www.youtube.com/watch?v=RTy3o8DwON8 http://www.youtube.com/watch?v=wcVX684r3xQ
129 130
Computer Vision Therapy
Computer Vision Therapy
• Can attack vergence, accommodative, and
oculomotor problems
• Computer based vision therapy program
• Most programs are set up to record patient’s
• Patient can use at home, work, wherever
performance each session
they have access to computer
– Removes the problem of compliance!
• Trains eye movements, vergences,
• Different products on the market
accommodation, and perceptual skills
– Home Therapy System
– Computer Aided Vision Therapy
131 132
23. Why use Computer Aided VT? How do you incorporate
Computer Aided Vision
• “Patients who cannot make a time Therapy in your program?
commitment
• Patient compliance problems • Diagnose the patient!!!
• Insurance or Third Party Problems • Assign a therapy protocol
• It’s Fun! • Computer aided VT in the office
• Schedule follow-up appointments
• Evaluate the patient’s progress/Follow-up
133 134
Computer Aided VT Resources Computer Aided VT Resources
Computer Orthoptics HTS (Home Therapy System)
http://www.homevisiontherapy.com/
135 136
Computer Aided VT Resources Computer Aided VT Resources
137 138
24. Computer Aided VT Resources Computer Aided VT Resources
Computerized Aided Vision Therapy
Gary Vogel, OD, FAAO
http://www.cavt.net/software.html
Available from Bernell 800-348-2225
http://www.bernell.com/
139 140
Computerized Aided Computerized Aided
Vision Therapy Vision Therapy
Module 1 Track and Read Module 2: Visual Therapy
Visual information processing skills
Visual attention/fixation test
Visual reaction time test Left-right warm-ups Directional reactions
Directional questions Random targets
Short term visual memory test
Directional grids Tachistoscopic arrows
Eye tracking test
Satellite commando game
141 142
Computerized Aided Computerized Aided
Vision Therapy Vision Therapy
Module 2: Visual Therapy Module 2: Visual Therapy
Visual Skills Therapy
py Therapy Procedures
py
Visual attention/fixation Tracking with Numbers
Tic-Tac-Toe rotations Spatial Sequencing
Span of recognition Random eye movements
Spatial Patters BPDQ Grids Short term visual memory
Circles, Boxes, Triangles Geo Boards Large angle eye movements
Rotating patterns
143 144
25. Computerized Aided Computerized Aided
Vision Therapy Vision Therapy
Module 2: Visual Therapy Module 2: Visual Therapy
Visual Figure Ground Skills Visual Closure Skills Therapy
Circles & boxes Lines & rectangles
Target counting Character searching Closing on center Closing patterns
Letter locator Dot to dot Letters/numbers dot to dot
Shapes Hidden patterns Closing words Tracking with sequences/words
Verbal saccades Tracking with stories
145 146
Computerized Aided
Vision Therapy Vision Builder
Module 3: Computer Vergences
Ju p vergences (s g e/doub e ta gets)
Jump ve ge ces (single/double targets)
Smooth vergences Pursuit vergences
Life saver drills
Anti-suppression games
147 148
Brainware Safari Brainware Safari
Helms D, Sawtelle SM. A study of the effectiveness of
cognitive therapy delivered in a video game format. Optom
; ( )
Vis Dev 2007;38(1):19-26.
Students in the study group showed an average of 4 years and 3
months improvement on tests of cognitive skills, compared to
4 months improvement for the control group and showed an
average of 1 year and 11 months improvement on tests of
achievement compared to 1 month for the control group.
http://www.brainwareforyou.com/
http://www.brainwareforyou.com/
149 150
26. Conclusions VT Equipment
• Easy to incorporate VT for BV disorders Use the tools
into your activities discussed
• Monitor the output to check for compliance
and tricks!
You do not need a
• Remember that the key is in diagnosing
patients and follow-up whole room of
VT “stuff”
151 152
WWW Sites for BV/VT BV Organizations
Gemstonevision.Org COVD http://www.covd.org/
OEP http://www.oepf.org//
949-250-8070
AAO BV Section
http://www.aaopt.org/section/bv/index.asp
153 154
301-984-1441
BV Organizations Patient WWW Sites
PAVE/Parents Active 3 D Pictures
for Vision Education http://www.vision3d.com/optical/
http://www.pavevision.org/
htt // ii / index.shtml#stereogram
i d ht l# t
Neuro-Optometric
How Does Binocular Vision Work?
Rehabilitation Association
http://www.vision3d.com/stereo.html
http://www.nora.cc/
155 156
27. Position Statement on VT
Patient WWW Sites
AOA, AAO, COVD many others:
Position Statement on
• http://www.chil
dren-special- Optometric Vision Therapy
needs.org/visio
d / ii
“The American Optometric Association
n_therapy/what affirms its long standing position that
_is_vision_ther optometric vision therapy is effective in the
apy.html treatment of physiological, neuromuscular and
perceptual dysfunctions of the vision
system……..”
157 158
MainosMemos, Facebook, LinkedIn, ICO
My Private Office
159 160
Social/
Professional
Connections
161 162
28. Questions? Contact:
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor, Pediatric/Binocular Vision Service
Illinois Eye Institute/Illinois College of Optometry
3241 S. Michigan Ave. Chicago, Il. 60610
312-949-7280 voice 312-949-7668 fax
Private Practice 708-867-7838
dmaino@ico.edu MainosMemos.blogspot.com
www.nw.optometry.net www.ico.edu