ICBO: A Coming Together of International Behavioral Optometry

Journal: 
Author: 
Marc B. Taub, OD, MS
Title: 
ICBO: A Coming Together of International Behavioral Optometry
Abstract: 

 In September of 2014, the 7th Quadrennial Meeting of the International Congress of Behavioural Optometry (ICBO) will be held in Birmingham, UK. I have been waiting four years since the meeting in Pomona, California ended; I can’t explain how excited I am! Yes, it is just another optometry meeting in that there are speakers, a poster session, and a vendor fair, but it is so much more. Let me explain with the use of David Letterman’s famous Top Ten List! Let’s call this the Top Ten Reasons you should go to ICBO next year!

 

Point/Counterpoint 4 Vision Therapy at Home

Journal: 
Author: 
Mark Menezes, BSc(Hons) Optom
Gregory Kitchener, OD
Title: 
Point/Counterpoint 4 Vision Therapy at Home
Abstract: 

POINT: 

Optometric vision training/therapy (VT) comprises therapeutic optometric procedures that are used to modify visual function.1 Office-based VT typically involves one to three visits to the office each week. The question is whether these in-office visits are sufficient on their own or whether practice at home is a necessary part of a VT program.

 

 

 

 

Birnbaum advocated seeing patients twice a week in- office, as he found this produced better results in a shorter period of time. In his experience, the benefits of this modality of treatment became more readily visible to both patients and parents, resulting in better compliance. Birnbaum felt that home practice was a foundation of therapy and reinforcement of skills learnt between in-office sessions.2 Peachey talks of seeing patients in-office either once or twice a week, supported whenever possible by home practice of 15-30 minutes daily. A VT program without home practice would be considered a compromise.

COUNTERPOINT:

 The assignment of specific VT procedures to be completed as “homework” is frequently included in descriptions of VT.1-6 The primary rationale for this inclusion seems to be that if repetition is a necessary element of the therapy, more repetition through homework is better. Naturally enough, this follows a line of thought in the field of education where acceptance of homework as an element of school programs is nearly universal. Our personal experience with required homework in our formal schooling may have established a model that we glibly adapt to our VT programs.

 

 

 

 

 

 

While optometrists did not originate the concept of homework, if we are going to exploit the practice, we should understand it. Although little research is available on the role of homework in VT, there is some research on perceptual learning, and there is significant literature on the efficacy of homework in educational programs. 

Optometric Management of Persistent Diplopia Status Post Scleral Buckle Surgery: Two Case Studies

Journal: 
Author: 
Yutaka Maki, OD, MS
M.H. Esther Han, OD
Title: 
Optometric Management of Persistent Diplopia Status Post Scleral Buckle Surgery: Two Case Studies
Abstract: 

 Background: A scleral buckling procedure repairs retinal detachments by indenting the sclera under the retinal breaks. One of the complications is diplopia, which typically subsides once the muscle heals. Persistent diplopia lasting longer than three to six months is reported in 0.5% - 25% of patients.

Case Reports: The cases presented demonstrate the use of optometric vision therapy and/or prisms as effective treatment options for patients experiencing persistent diplopia and manifesting different magnitudes and directions of deviation.

Conclusion: It is important to know when prisms and/or optometric vision therapy is indicated for patients with persistent diplopia secondary to scleral buckle surgery. Given the non-comitancy of the resultant deviations, optometric vision therapy activities modified to expand fusional reserves in all positions of gaze will help to minimize the diplopia and the final amount of prism prescribed for the patient. The two case reports suggest that patients with smaller vertical deviations could respond to passive optical treatment with compensatory prisms, while patients with larger vertical deviations may benefit from both optometric vision therapy and prism.

 

Keywords: diplopia, optometric vision therapy, prism, retinal detachment, scleral buckling, strabismus 

Counterpoint: Questioning the Value of VT “Homework”

Journal: 
Author: 
Gregory Kitchener, OD
Title: 
Counterpoint: Questioning the Value of VT “Homework”
Abstract: 

 The assignment of specific VT procedures to be completed as “homework” is frequently included in descriptions of VT.1-6 The primary rationale for this inclusion seems to be that if repetition is a necessary element of the therapy, more repetition through homework is better. Naturally enough, this follows a line of thought in the field of education where acceptance of homework as an element of school programs is nearly universal. Our personal experience with required homework in our formal schooling may have established a model that we glibly adapt to our VT programs.

 

While optometrists did not originate the concept of homework, if we are going to exploit the practice, we should understand it. Although little research is available on the role of homework in VT, there is some research on perceptual learning, and there is significant literature on the efficacy of homework in educational programs. 

A Vision in Narrative Medicine

Journal: 
Author: 
Michelle Glass, BA
Helen Bennett, PhD
Title: 
A Vision in Narrative Medicine
Abstract: 

 Background: Narrative medicine (NM) is more than just an approach to medicine; it is an approach to human contact. The field developed mostly during the 1990s and has emerged from a variety of similar concepts such as patient-centered care, literature and medicine, and relationship-centered care. The method by which NM is practiced and the fields where it is applied vary greatly across the country. Despite the inherent differences, the overall goal of the field remains the same, to use narrative skills to communicate more effectively. Currently, NM has developed extensive roots in oncology, neurology, primary care, nursing, psychology, and even the social sciences.

Methods: Survey request flyers (n=300) were distributed to three optometry offices and one ophthalmology office in the greater Cincinnati, OH area. Links to the anonymous online survey were also posted on studentdoctor.net as well as ODwire.org and emailed to the faculty of Southern College of Optometry. Twelve patients and a total of 29 optometrists and ophthalmologists responded.

Results: Approximately 70% of both doctors and patients felt they had a good relationship with each other, while 22% of patients that did feel close to their optometrist/ophthalmologist believed that better communication would improve the doctor-patient relationship. Sixty-seven percent of optometrists and ophthalmologists reported experiencing trouble communicating with patients, and 89% percent of participating doctors reported that they would be interested in learning new communication techniques.

Conclusion: There is room for improved communication between doctors and their patients in the field of optometry and ophthalmology. This improved communication may be possible through the use of NM. Narrative medicine has the potential for tangible benefits in optometry and ophthalmology such as increased patient trust, compliance to treatment, and more meaningful doctor-patient relationships. Narrative medicine in optometry and ophthamology has the potential for tangible benefits, such as increased patient trust.


Keywords: communication, doctor-patient relationships, narrative medicine, survey 

The Effect of Orthokeratology on Accommodative and Convergence Function: A Clinic Based Pilot Study

Journal: 
Author: 
Paul Brand, BAppSc(Optom), GradCertOcTher
Title: 
The Effect of Orthokeratology on Accommodative and Convergence Function: A Clinic Based Pilot Study
Abstract: 

 Background: Orthokeratology is a successful treatment for patients with myopia. There has been little research on its effects on accommodation and convergence.

Methods: Eleven subjects presenting for orthokeratology had accommodative and convergence function assessed pre- and post-treatment. Based on the results, patients were categorised as normal or embedded. The pre- and post-treatment results were compared.

Results: This pilot study found that of the 11 subjects, 10 (90.1%) demonstrated an improved accommodative convergence profile after treatment (p=0.003). The subject who demonstrated no change was the only one that had a normal profile before treatment. No subject displayed a worse accommodative convergence profile post-treatment.

Conclusion: This suggests that orthokeratology has a positive effect on accommodation and convergence function. More research with larger sample sizes is required to confirm this result.

 

Keywords: accommodation, myopia, myopia control, orthokeratology 

Everyone Needs a Work Spouse or Two!

Journal: 
Author: 
Marc B. Taub, OD, MS
Title: 
Everyone Needs a Work Spouse or Two!
Abstract: 

 Hi, my name is Marc, and I cheat on my wife. No, no, no, not in a bad way, I promise. I have a work wife. Actually, I have two work wives, and my wife knows about each of them. What, you may ask, is a work wife? Well, it is a co-worker, usually of the opposite sex, with whom one shares a special relationship, having bonds similar to those of  a marriage. You may be wondering how these relationships developed.

Visual Attentional Deficits in Reading Disability

Journal: 
Author: 
Vandana Rajaram, OD, PhD
Vasudevan Lakshminarayanan, PhD
Title: 
Visual Attentional Deficits in Reading Disability
Abstract: 

 Background: Dyslexia, also referred to as specific reading disability, is a condition where an individual demonstrates a level of reading that is significantly below what may be expected for his age or intelligence. Although the phonological deficit theory of dyslexia is widely accepted, there is accumulating evidence suggesting that at least a subset of dyslexic subjects demonstrate distinct visual attentional deficits. However, it is unclear if the magnitude of visual attention at attended and unattended locations is equivalent in poor and normal readers. The aim of the present study was to examine differences in the magnitude of attentional facilitation (benefits) and inhibition (costs) in response to an abrupt onset spatial cue in children with reading disabilities in comparison to controls.

Methods: A group of impaired readers (n=15), ages nine to 12 years, reading at a level at least 1.5 years below grade level and with average mathematics scores, were included in this study. The control group included an age-matched sample of normal readers (n=20). An adaptation of the covert orienting paradigm was used to investigate differences in magnitude of visual spatial attention between groups.

Results: Poor readers demonstrated smaller costs (t=2.07, p<0.02) at unattended locations in comparison to their normal counterparts. Additionally, poor readers were significantly slower (F(1,32) = 14.17, p<0.001) in moving spatial attention in response to an abrupt onset peripheral cue when compared to controls.

Conclusion: The poor readers in the current study were slower in shifting spatial attention in comparison to their normal counterparts. They also demonstrated smaller costs at unattended locations, providing indirect evidence for a diffuse attentional field in this group. Consistent with many studies in the literature, we have presented evidence for spatial attentional deficits in impaired readers, the implications of which are discussed within the context of some of the current models of attention.

 

Keywords: costs and benefits, dyslexia, spatial attention, specific reading disability 

Visual Sequential Memory and the Effect of Luminance Contrast

Journal: 
Author: 
Jason S. Ng, OD, PhD
Title: 
Visual Sequential Memory and the Effect of Luminance Contrast
Abstract: 

 Background: Standard visual acuity using reverse contrast (white-on-black) has been shown to be significantly better than standard contrast (black-on-white). We examined whether differences in luminance contrast would have any effect on a visual sequential memory task.

Methods: Forty-two subjects (23 males, 19 females) performed two tests of visual sequential memory specifically designed for this study. Each test had 16 questions. One test was presented in standard contrast and another was presented in reverse contrast. All of the test stimuli were well above visual acuity thresholds. Subjects were free from ocular pathologies, had visual acuities of 0.1 logMAR or better, and the majority (81%) were completely naïve to the standard clinical test of visual sequential memory, which is given in standard contrast. The raw scores (number correct) of each test were compared using an unpaired t-test.

Results: A significant order effect was observed, and thus, subjects’ scores on the first test performed was the outcome measure analyzed. The mean scores were 11.6 [95% CI: 10.8-12.4] and 12.9 [95% CI: 11.9-13.9] for the standard and reverse contrast tests, respectively. Subjects performed significantly (p < 0.05) better (8.3% improvement) when the test was presented in reverse contrast versus standard contrast.

Conclusions: Reverse contrast presentation of stimuli yields a statistically significant improvement in visual sequential memory. The findings could play an important clinical role in the determination of optimal print contrast for some patients.

 

Keywords: contrast, memory, polarity, visual memory, visual perceptual processing, visual sequential memory