As you should know by now, the American Optometric Association is very concerned about those who suffer eye strain, blurred vision, diplopia (see double), headaches, nausea and more after watching 3D Movies, 3D Television, or while playing 3D Video Games. The AOA has been kind enough to ask me to be its spokesperson on this topic to various media around the country (no pressure there!! (;-}>). COVD applauds the AOA on its concern for the public and on its support of the many areas COVDers are most knowledgable. I wrote a bit more about my media experience at MainosMemos. DM
Archive for April, 2010
One of the most common measurements of “how well a person sees” is visual acuity. For older children and adults, optometrists typically use a letter chart to determine the smallest letters the patient is able to recognize. Just about everyone is familiar with this concept of 20/20 visual acuity. But how can you measure visual acuity in an infant? Obviously the baby is not going to be reading the letters on a chart 20 feet away.
Another way to measure visual acuity uses black and white stripes. As the stripes become skinnier and more closely packed together, it becomes more difficult to resolve the stripes. They begin to blend together and look like a uniform grey space. Vision scientists studied this phenomenon in infants and developed a method called “Forced Preferential Looking” that is now used to measure visual acuity in babies.
Babies love to look at interesting things; human faces, toys, and complex patterns. If you show a baby a card with black and white stripes on one side and grey space on the other, they usually prefer to look at the stripes because it is more interesting than the empty grey space. This assumes that the baby can tell the difference between the stripes and the grey space. If the stripes are too close together and the baby cannot resolve the stripes, both sides of the card will look the same and the baby will no longer have a preference to look at the stripes.
This is the science behind the use of Teller Acuity Cards. The optometrist will show the baby a card with big fat stripes on one side and grey space on the other and watch to see if the baby “prefers” to look at the stripes. Here is a great photo of these cards in action. If the baby does prefer the stripes, then the baby is shown another card with slightly skinnier stripes. This procedure is continued until the baby no longer shows a preference for looking at stripes versus the grey field. The stripe width of the last card where the baby seemed to have a preference is converted to a visual acuity measurement.
Although the stripe width is typically converted to an acuity measurement such as 20/20 or 20/100, these measurements are not equivalent.
There has been a considerable amount of research using this technique to help us interpret the results. This method seems to work best for babies from 6 to 12 months of age. We know what visual acuity measurements to expect for babies at different ages and this will allow the doctor consider whether your baby sees well or may have a visual problem. Of course, the earlier a problem is detected, the earlier treatment can be initiated. So be sure to take your baby to see an optometrist during the first year of life!
Optometry & Vision Development volume 41 #2 is just now being finalized. It’s shaping up to be another magnificent issue that will feature editorials by Dr. Dominick Maino (DMM Scope of Practice Data Series: Ophthalmology). Did you know the AMA is telling others all about your profession, but not quite always telling the truth….but wait there’s more! They also want to tell you about Nursing, Podiatry, Pharmacy and many other professions as well. Read this satirical editorial. It will make you laugh, cry and get very angry at the hubris of organized medicine.
Susan Barry, PhD (aka Stereo-Sue) writes, Optometric Vision Therapy: More Than Meets the Eye….an editorial you do not want to miss! Her book, Fixing My Gaze:A Scientist’s Journey into Seeing in Three Dimensions, is a top seller on Amazon. Find out why when you read this editorial.
Our articles will include Frequency and Types of Pediatric Symptoms in a Clinical Population by Dr. WC Maples (and you know what an outstanding author he is!!) and From Braille to Quilting: A Neuro-Optometric Rehabilitation Case Report by Dr. Kauser Sharieff who is both a Fellow of the College of Optometrists in Vision Development and the Neuro-Optometric Rehabilitation Association.
OVD volume 41 #2 does not ignore the practice management side either! There will be articles on Social Digital Media – a New and Powerful Way to Educate Your Patients about Optometric Vision Therapy, Staff Problems: Proficiency or Attitude, Doctor-Staff Relations: Don’t Underestimate the Power of “Hello , and Dispelling Two Pernicious Myths about Optometric Vision Therapy.
Of course there are Letters to the Editor, Literature Reviews, and the NewsMakers columns as well. Watch very carefully for future announcements regarding the publication of this OVD issue!
I was fortunate enough to be asked by the American Optometric Association to be featured on the AOA’s digital TV program (I Want My AOA TV) in their Member’s Spotlight segment. This segment discusses 3 D Movie Vision Syndrome where movie goers get more than their monies worth…unfortunately what they typically get includes headache, eye strain, diplopia (seeing double)….and NO 3 D!!
Before you go to a 3 D movie, it might be an excellent idea to have a comprehensive vision examination by a COVD optometrist. Go to http://www.AOA.org and http://www.COVD.org (College of Optometrists in Vision Development) to find a doctor who can help … click on their “Doctor’s Locator” tab. Other questions? Email me at firstname.lastname@example.org, conduct a search by typing “3 D” in the search box in the upper right of this blog, or check out http://www.NW.optometry.net and http://www.ICO.edu.
Questions? Just let me know.
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
”Eye movement is a predictor of academic success”. This month marks the 10 year anniversary when the Harvard University Graduate School of Education made this announcement. The research clearly shows that there is important association between effective eye movement control and academic success.
Ever since this breaking news a decade ago, further evidence of the association between eye movement and academic success continues to be recognized. For example, in Volume 27 Issue 8 of the Journal of Brain Development in 2005 the titled research is, the Voluntary Control of Saccadic and Smooth-Pursuit Eye Movement in Children with Learning Disorders.
While the testing of eye movement is relatively easy, the clinical presentation of poor eye movement control can often be missed and misunderstood. For example the testing of smooth-pursuit eye movement control can be easily performed with a bead on a stick or the tip of a pencil or pen. The examiner simply asks the child to look at the target (held about 10 inches from the nose) and follow it with their eyes as the target is slowly moved horizontally, vertically (on the midline) and in a rotation. The child should be able watch the moving target with minimal head movement. Furthermore, the child who is years and older, should be able to “visually track” the target with a minimal amount of distraction such as asking simple questions (cognitive loading).
With the advent of web-based professional networking sites, like Sovoto, a platform now exists to help doctors and other professionals who work with children to see an example of a child with oculomotor dysfunction. To see an example of a child with oculomotor difficulty that was associated with his reading difficulty click here.
The American Optometric Association has published the symptoms of eye movement disorders in the Optometric Clinical Practice Guideline (CPG) Care of the Patient with Learning Related Vision Problems. They are:
- Moving head excessively when reading
- Skipping lines when reading
- Omitting words and transposing when reading
- Losing place easily when reading
- Requiring a finger or marker to keep place when reading
- Experiencing confusion on return sweep phase when reading
- Experiencing illusionary text movement
- Having deficient ball playing skills
More importantly, once identified, the child who is diagnosed with a problem in eye movement, such as smooth-pursuits, can be treated with vision therapy. Specifically office-based optometric vision therapy provided by a vision therapist (supervised by the doctor), can effectively treat disorders of voluntary eye movement. The results can often be a dramatic improvement in the child’s reading efficiency.
To see the same patient after 24 sessions of office-based vision therapy click here. His reading efficiency and fluency has improved and he is enjoying reading!
Dan L. Fortenbacher, O.D.,FCOVD
Part 2 — Hockey
Dr. M: Let’s talk about hockey. I know that is one of your favorite sports and that you actually worked with the 1980 gold medal Olympic Team.
Dr. S: Yes, I had the pleasure of actually evaluating potential members of that team. That evaluation was one additional piece of information used by Herb Brooks in selecting the players for the Olympic Team.
Dr. M: So you should have gotten a gold medal too!
Dr. S: At least I can say I had a small part in winning the gold medal.
Dr. M: Let’s start with the goalie. It seems to me that it is similar to baseball. The puck is traveling at very high speed and the goalie has to make split second decisions about where and when to make his move.
Dr. S: Absolutely, the puck might be traveling at close to 100 mph. Like a pitcher in baseball, the offensive player is going to try to deceive the goalie, to make it more difficult for the goalie to track the puck. But in hockey, the puck can be coming from anywhere on the ice, and the net is much bigger than the strike zone. There are more variables that have to be processed to make the save—velocity, distance, angle. Don’t forget the goalie is also wearing a mask that reduces peripheral vision very significantly.
Dr. M: Not to mention they have to make their move wearing 50 pounds of gear! How do they make ANY saves?
Dr. S: It is amazing. The best goalies are successful 92% of the time. That’s one reason why hockey players fight so hard for the puck. The offense knows they are going to need MANY shots on goal to score.
Dr. M: What is the most important visual skill for hockey goalies?
Dr. S: Visual motor reaction time; this refers to the amount of time that elapses between the initiation of a visual stimulus (such as a light going on) and the completion of the motor response to that stimulus (such as hitting the light with your hand). Athletes with faster response times to very simple visual-motor tasks will be at an advantage when they are asked to react to very complex tasks such as making a save.
This poster was recently presented by COVD Fellow Dr. Dominick Maino during the International Congress of Behavioral Optometry/Neuro-Optometric Rehabilitation Association 2010 joint meeting in California.
The College of Optometrists in Vision Development has made a concerted effort to get the word out about binocular vision dysfunction and optometric vision therapy. Not only has the public responded in a most favorable fashion, but organizations such as the American Optometric Association have also been supportive of helping its members to diagnosis and manage these disorders as well.
Dominick M. Maino, OD, MED, FAAO, FCOVD-A said that: “The AOA was kind enough to use some of my activities to highlight the need for comprehensive eye examinatons that include the assessment of the binocular vision system. The story quoted me saying….”Any where from 3 million to 9 million or more individuals will have binocular vision dysfunction that will stop them from enjoying 3-D movies,”…. “Watching 3-D movies can unmask issues such as lazy eye or convergence insufficiency…Dr. Maino stressed that optometric vision therapy can help with these problems and that it’s quite effective even for adults. The goal is to improve eye coordination, focusing and eye movement to help with the appreciation of the 3-D experience,” …..“We need to re-educate the brain to achieve single, clear, comfortable, two-eyed vision so that everyone can appreciate these new technologies.” They noted that I also pointed out that the human organism was not designed to act in a virtual 3-D environment. This can cause a cognitive dissonance in which what someone knows to be true (the image is at the distance of the movie screen) and sees to be true (the distance they actually perceive the image to be) are in conflict.
The article also suggested that patients not only contact the AOA and consult Dr. Maino’s blog (Mainos Memos), but to also go to the COVD website for additional information and to find doctors who can help.
Dr. Arnold Sherman is a Fellow of COVD and a Diplomate of the American Academy of Optometry. He has served as a consultant to the NY Jets, the NY Rangers, and the US Olympic Committee. He has worked with athletes of all ages, from little leaguers through the professionals. He maintains a private practice in Merrick NY and is a member of the clinical faculty at SUNY Optometry.
Part 1 — Baseball
Dr. M: Thanks for sitting down with me to answer my questions about vision and sports. Sitting here in Bryant Park, I can feel spring! That means baseball, lacrosse, and tennis! And of course your favorite, hockey playoffs are starting. Let’s talk about elite athletes first. How would you describe the visual requirements to succeed in these sports?
Dr. S: All these sports are different and they all require different visual skills. But let’s look at what they have in common first. Baseball, hockey, lacrosse, and tennis all require the athlete to respond to a moving target. Vision is the signal that directs the muscles of the body; the eyes LEAD the body. Vision utilizes the eyes for input, the brain for integrating information from the other senses, and the action system of the body for output.
Dr. M: Can we get specific? How does that apply to these sports?
Dr. S: Let’s start with baseball. Vision provides the batter with information as to “WHERE” and “WHEN.” Where is the ball going to be and when do I swing? A fastball traveling at 90 mph reaches the bat in 400 milliseconds—less than a half second! It takes 150 milliseconds to initiate the swing and make contact with the ball. Therefore, the hitter has at most 250 milliseconds to decide whether or not to swing. Vision has to be razor sharp. Superior size, strength bat speed and agility cannot make up for inefficient processing of “where” and “when” to respond.
Dr. M: Even the most successful major league hitters are only successful about 35% of the time. Can improvements in vision have big impact?
Dr. S: In baseball and other sports, most performances that fail are not due to the wrong physical movement but the movement being performed at the incorrect time or in the incorrect place. In baseball, fine tuning the visual time machine can result in raising a batting average to the next level. Joe Mauer (catcher for the Minnesota Twins) is a perfect example. He never swings at the first pitch. He’s not afraid to stand at the plate with 2 strikes because he has gathered visual information from seeing several pitches and that helps him get to the right place at the right time when the right pitch is delivered.
Dr. M: What is the most important visual skill for baseball players?
Dr. S: One of the most important skills is binocularity. You need both eyes following the ball in order to make accurate judgements about “when” and “where.” You need to turn your head toward the pitcher enough to get both eyes working together. Once you have your head posture figured out, you may need to make adjustments to the rest of your body, because, remember, the EYES LEAD THE BODY.