About Amanda Zeller Manley, O.D., F.C.O.V.D.

Developmental Optometrist based in Bethesda/Chevy Chase, Maryland (greater Washington DC metro area).

Exciting New Research on Amblyopia (Lazy Eye) Treatment

—Amanda Zeller Manley, OD, FCOVD

R.M., a 28-year-old man, was getting headaches more and more frequently when using a screen. As someone who spent most of his workday on the computer, this was a problem. A previous eye doctor told him he was out of luck, too old to fix his problem. R.M. had amblyopia, and his new eye doctor had referred him to me.

skeffington symposium

Dr. Jeffrey Kraskin

Last weekend was the 61st Annual Kraskin Invitational Skeffington Symposium (KISS), held in Bethesda, MD. One of the most exciting presentations was given by Dr. Paul Harris, a prolific author, developmental optometrist and professor at Southern College of Optometry. He reported that a group of scientists and clinicians are preparing a publication with new clinical guidelines on the treatment of amblyopia.

 

The old paradigm for amblyopia treatment is something most people are familiar with to some degree– patching. I think most adults can think back and remember a child at school wearing a stick-on eye patch, and probably getting teased about it. While patching can temporarily improve visual acuity (how many letters you can read off the eye chart), it does nothing to improve the other visual problems present in amblyopia, such as difficulties with eye strain, visual crowding, contrast sensitivity, and using the eyes as a team (among others).

Newer research has shown that not only is patching not the best method of treating amblyopia, it’s not even necessary except during active therapeutic activities. Instead, treating the entire visual system –as a system— produces superior results that last. The key is that amblyopia is not a “lazy eye”, but rather a problem in how the brain uses the two eyes.

It’s interesting that using whole system, or binocular vision, techniques is described as “NEW“, when Developmental Optometry has been doing this clinically for a hundred years.

Developmental optometrists had been using binocular vision perceptual learning techniques for decades before the concept hit the mainstream in research. In the last 25 years, perceptual learning as it relates to vision therapy has been discussed more and more in the fields of psychology and vision science. Many computer games have been developed that capitalize on perceptual learning to develop true and lasting visual skills. However, I and my developmental optometry colleagues have found that working in 3D space (rather than a flat 2D screen) generates a knowledge of “Where am I?” and “Where is it?” that more easily translates into real-world visual scenarios.

Another important acknowledgement in the current scientific literature is that there is no cutoff age for improvement of visual skills and development of binocular 3D vision. Instead, using a binocular vision approach to therapy in conjunction with appropriate compensation of refractive error (glasses or contact lenses), yields excellent results. This mirrors what we have seen clinically. Adult patients frequently reach normal or near-normal levels of visual performance, and in nearly all cases see significant improvements in quality of life.

Publishing new treatment guidelines, taking into account all of the data supporting established developmental optometry clinical therapies, will bring amblyopia remediation out of the dark ages and provide hope to so many patients who have been told, “It’s too late for you.”

As for R.M., as he completed vision therapy, he no longer experienced headaches and eye strain. He was more productive at work, and very happy that his efforts had paid off. He wasn’t too old, after all!

For the nerds, some additional papers on perceptual learning, adult amblyopia, and vision:

Improving vision in adult amblyopia by perceptual learning

Perceptual Learning Improves Stereoacuity in Amblyopia

Binocular visual training to promote recovery from monocular deprivation

Amblyopia and Binocular Vision

Perceptual learning, aging, and improved visual performance in early stages of visual processing

Applying perceptual learning to achieve practical changes in vision

School is out soon, but learning never ends!

The science of brain plasticity is abundant with new ideas! Dr. Green and I just returned from the NORA (Neuro-Optometric Rehabilitation Association) conference in Denver. We spent four full days learning about the vision repercussions of whiplash, concussion, stroke, and other neurological injuries. There is so much more for us to learn, but we were able to bring home some great new ideas to help all of our patients in the therapy room.

We learned new ways to interpret the information from the VEP (Visual-Evoked Potential), a specialized

form of EEG that actually measures the brainwaves created by visual input. It tells us how much visual signal is getting through, and how strong that signal is. We’ve also learned that it can give us information about what the brain is doing when it’s waiting for the visual signal, and how we can change that with specialized lenses.

The VEP is appropriate for any neurological insult; strabismus, amblyopia, and some other vision disorders. If you’d like more information or would like to know if you are a candidate, please email me or call (301) 951-0320.

Another great new learning opportunity is on the horizon. In June, I will be attending a workshop outside of Chicago where I will be learning about Syntonic Phototherapy. This is a technique in which specific wavelengths of light are used to change the person’s nervous system response and can greatly augment vision therapy. You may be familiar with how Seasonal  Affective Disorder is treated with a special light; this is a similar concept but much more specifically tailored to the individual.

School is out soon, but learning never ends!

Vision Problems Masquerade as Learning Disabilities

It is important to understand that while our eyes take in visual information, that information is sent to the brain where it is processed. If the information that is sent to the brain is faulty, it can make learning very difficult.

While learning disability websites list a variety of accommodations that can help children with Visual Information Processing Disorders, it is important for parents and educators to understand that these are signs that a correctable vision problem is playing a role in a child’s learning challenges.

Many individuals with learning disabilities also have ADHD (Attention Deficit Hyperactivity Disorder). One of the signs that a vision problem may be contributing to one’s learning challenges is a short attention span when it comes to reading and near work. This behavior could easily be mistaken for ADHD.

A study published in the November 2013 issue of the Journal of Attention Disorders states that “attention and internalizing problems improved significantly following treatment for     Convergence Insufficiency.” Convergence insufficiency is an eye coordination disorder which can make reading difficult and cause symptoms such as eye strain, double vision, loss of concentration, and frequent loss of place when reading and working up close, all which play a negative role in learning.

The National Eye Institute of the National Institutes of Health recently funded a 5-year, 8 million dollar study called the Convergence Insufficiency Treatment Trial – Attention and Reading Study (CITT-ART).  This will be a national multi-center clinical trial that involves optometry, ophthalmology, psychiatry, and education in evaluating how this eye-teaming problem impacts a child’s attention and reading performance.

These studies are very exciting because we are sure they will prove what we have seen in our patients over the years: Vision problems, including eye coordination and eye movement disorders, can and do impact the ability to read and pay attention. We are able to help children and adults.

For more information visit our website: http://www.VisionTherapyDC.com

Halloween Eye Safety

October is Eye Injury Prevention Month, so let’s take a minute to consider a couple of common sense eye safely tips this Halloween.

Is this how you want your costume to turn out?

nasty eye

Horrible eye infection from wearing a non-prescribed decorative contact lens. Ouch!

Using flea-market, beauty shop, or internet purchased contact lenses without a proper fitting is setting yourself up for an ugly eye that lasts well past Halloween night. The FDA is cracking down on unlicensed vendors and educating the public about poorly-fitted lenses. Don’t go blind! Most optometrists can properly fit decorative lenses at a reasonable price.

This costume looks cool, but it would be easy to get hit by a car or fall down the steps when your vision is impaired by this mask. Wigs or scarves should be kept out of kids’ eyes, too.

Just like wearing a blindfold.

Choose makeup instead, especially for young children. Check that it’s approved for use around the eyes, or better yet, avoid the eye area.

Does your child play soccer or football?

kid soccer headerWhen your daughter is on the soccer field heading a ball, she may help win the game, but she may actually be hurting her brain. While most parents know that their child is at risk of a head injury when playing football, a lot of people don’t know that head injuries can occur even with a helmet from the impact. Also, soccer is also one of the top sports that can also result in head injuries.

A recent study found that 85% of concussions go undiagnosed. Another study found that nearly 63 percent of varsity soccer players had symptoms of a concussion at some point, but only about 19 percent actually knew it. The reason this can happen is because you do not have to lose consciousness to have a concussion, so most players will experience a blow to the head and get right back into the game. However, repeated blows to the head can accumulate and cause just as much damage as a concussion.

When someone has a head injury they typically have vision problems that can be small boy footballtemporary or permanent. When a vision problem is causing or contributing to a problem with reading, balance or movement, the recovery process will move very slowly until the visual component is treated.

Visual rehabilitation is vital, as soon as possible. There are a variety of symptoms which are involved in Post Trauma Vision Syndrome, including:

  • Blurred vision, especially when reading
  • Headaches
  • Double vision
  • Pain in the eye or eyes
  • Poor reading comprehension
  • Sensitivity to light
  • Loses place when reading
  • See a complete checklist of symptoms

boy footballIt should also be noted that sometimes symptoms of a concussion might not even appear for days, even weeks after the accident. Some symptoms may last only seconds, while others linger much longer, months and even years. Additionally, some symptoms might disappear after time, such as eye pain or headaches, and yet other symptoms remain, i.e., blurred or doubled vision. Keep in mind, that when someone is experiencing any of the above symptoms they could also have difficulty with reading and learning, as well as physical activities.

Head injury patients with resulting vision problems are very similar to patients we see at our office who have vision problems that interfere with reading and learning. Vision therapy is very effective at eliminating blurry and/or double vision, focusing problems, poor concentration, and reduced comprehension, to name a few, when they are due to a vision problem.

If you or your child have had a blow to the head, or suspect Post Trauma Vision Syndrome, call us today at 301-951-0320 to schedule a vision evaluation and get on the road to recovery.

April is National Autism Awareness Month

April is National Autism Awareness Month, and there has been a lot of information in the news about the rising rates of autism spectrum disorders. The CDC now estimates that as many as 1 in 68 children are now being diagnosed with ASD. This is particularly frightening as it’s not well understood what  is behind this abrupt rise.

While such research is ongoing, it’s important to consider what we as parents and providers can do right now to improve the quality of life of those with ASD. The College of Optometrists in Vision Development (COVD) has issued a press release discussing the impact of vision in ASD:

“While the search to find the exact cause for ASD is ongoing, the visual link to autistic behaviors provides some answers and help to improve quality of life,” states COVD President, Dr. Ida Chung, O.D., FCOVD.

 

There has recently been a lot of research involving the role of vision in autism spectrum and other disorders, which you can read about here and here. There’s also a piece about eye movements in ASD in the Huffington Post.
autism
In our practice, every day we see children with ASD who exhibit visual processing deficits that interfere with school, play, and social interactions. Fortunately, most of these visual anomalies can be improved through vision therapy.
“Visual processing problems are common in individuals with autism spectrum disorders. They can result in lack of eye contact, staring at objects, or using side vision… Suspect a visual processing problem if you see an autistic child tilt his head and look out of the corner of his eye… a child with poor vision processing may fear the escalator.”– Temple Grandin in The Way I See it: A Personal Look at Autism & Asperger’s
One of the most promising autism therapies available is DIR/Floortime, an approach which influences the style of the vision therapy we offer at the Vision & Conceptual Development Center. In fact, my colleague Dr. Mehrnaz Azimi Green holds an Intermediate Certificate as a DIR/Floortime provider. We first engage the child based on his individual interests, and adapt our therapy techniques based on those interests. We find this tailored approach to be successful with both neurotypical children and those with ASD or other special needs.
We also provide education to other professionals regarding the role of vision in autism spectrum disorders. To keep up-to-date with our speaking schedule, please join our mailing list (we send an e-newsletter about once a month), or visit our Facebook page.
The slides from our most recent lecture, prepared for Parent University, can be accessed here.