Accommodation in mild traumatic brain injury

Visual dysfunction following blast-related traumatic brain injury from the battlefield.

......Blast-related TBI is strongly associated with visual dysfunction within 1 year after injury and the odds of disorder appears to increase with severity of brain injury. Comprehensive vision examinations following TBI in theatre may be necessary.....

DEM Test, Visagraph Eye Movement Recordings, and Reading Ability in Children

"...DEM outcomes can identify children whose Visagraph recorded eye movement patterns show slow reading rates. However, when reading ability is accounted for, DEM outcomes are a poor predictor of reading rate. Visagraph outcomes of duration of fixation and reading rate relate to standardized reading achievement scores; however, DEM results do not...."


Comments: I have not read the full paper just yet, but it appears that from this study you need to interpret the DEM carefully when reading level achievement scores vary. DM

Why the Snellen Chart Fails with Certain Vision Problems

....You’re probably familiar with the eye chart used by most schools for vision screenings. It’s called the Snellen chart, and despite its widespread usage, it tends to miss significant vision problems.


The Snellen Chart has given us the term “20/20” vision. This refers to acuity, which the American Optometric Association defines as the “clarity or sharpness of vision.” Unfortunately, acuity does not include a wide range of other vision issues that can result in a learning problem....

Comments: To read more click on title above. DM

My Articles in PubMed

I (and one or more collaborating colleagues) have had several articles published and indexed in PubMed over the years. If you are interested in a small sample of what I've written over the decades, click on the title above. DM

Treatment of amblyopia (lazy eye) caused by strabismus (squint) with patching and/or optical treatment (glasses or penalisation)

".....These trials suggest there may be benefit to adding near activities to prescribed occlusion regime......"

Comments: Active optometric vision therapy, not just "near activities"  should be done when working with these patients for maximum results. DM

Cochrane Reviews:Vision screening for amblyopia in childhood

"............ The review found that there is currently not enough evidence to determine whether or not screening programmes reduce the proportion of older children and adults with amblyopia............."

Comments: Screenings are inadequate. Full, comprehensive eye examinations are need for all our children. DM

How to Become a Vision Therapist

....By becoming a vision therapist, you will be responsible for helping a patient with dysfunctional vision...

 How to Get Certified As a Vision Therapist


Comment: Read both of these for  information on becoming an optometric vision therapist and how to become certified as a vision therapist. DM

Efficiency of occlusion therapy for management of amblyopia in older children

"..... Occlusion therapy yields favorable results in strabismic and/or anisometropic amblyopia, even when initiated for the first time after 6 years of age. After 12 years of age, .... children .... still respond to occlusion of the dominant eye......"

Reading difficulty after stroke: ocular and non ocular causes.

.....Patients complaining of reading difficulty were mostly found to have visual impairment relating to low vision, eye movement or visual field loss. ......

Vision Problems Can Rob Movie-Goers of 3-D

Colleague, friend and joint AOA spokesmen on the topic of 3D Vision Syndrome, Dr. Len Press and I were recently quoted in this article:

.....As people crowd into theaters for the latest wave of 3-D movies, everyone seems to be oohing and ahhing over the visual feast provided by Hollywood's improved 3-D technology.
Well, almost everyone.
"There will be at least one person in the crowd who says, 'What are you talking about? I didn't see anything flying out at me.' Or maybe they will say, 'That movie actually made me a little nauseated,'" said Dr. Dominick Maino, a professor at the Illinois College of Optometry and the Illinois Eye Institute.
From 3 million to 9 million people in the United States have vision problems that keep them from enjoying such 3-D movies as Avatar and Toy Story 3, estimates the American Optometric Association. And as many as 56 percent of people between 18 and 38 years of age suffer from symptoms related to depth-perception problems.
These problems have to do with binocular vision, the ability to align both eyes on a target and combine the visual images from the two eyes into a single, three-dimensional perception.....

Comments: Read more about it by clicking on the title above. DM

Identification of binocular vision dysfunction (vertical heterophoria) in traumatic brain injury patients and effects of individualized prismatic spectacle lenses in the treatment of postconcussive symptoms: a retrospective analysis.

"....Vertical heterophoria was identified in a group of TBI patients with postconcussive symptoms and treatment of the vertical heterophoria with individualized prismatic spectacle lenses resulted in a 71.8% decrease in subjective symptom burden......"

Study examines long-term outcomes of acquired nonaccommodative esotropia

This article notes that:  "....Of these 174 children, 127 underwent strabismus surgery (73.3%) at a mean age of 10.9 years after diagnosis. Twenty-nine (22.8%) required a second surgery, and five (3.9%) underwent a third; three-fourths of the surgeries resulted in a horizontal alignment within 10 ΔD and some stereopsis...."


Comments: So this means about 1/3 of the children needed a second strabismus surgery.....and about 4% needed yet another surgery.....with 25% of the population studied not achieving horizontal alignment within 10PD!!! This does not seem to support the use of surgery for strabismus too often....perhaps as a LAST resort. Every ophthalmologist that offers strabismus surgery should reccommend none surgical intervention before surgery. If you or your child has strabismus, please read Fixing My Gaze by Susan Barry, PhD and go to http://www.covd.org for more information. DM