The doctors at North Suburban Vision Consultants prides themselves on being on the cutting edge of eye and vision care.  We have been administering an eye movement test to all patients between the ages of 6-18 as part of their annual eye health examination.  This test, the King-Devick test, has been proven to be a valuable tool for detecting a concussion and deciding if a player should be removed from play.  The Mayo Clinic endorsed this test recently and it is the first time in the long and rich history of the Mayo Clinic that it has aligned themselves with a commercial product.  The reason they feel so compelled to back this test is the rash of scientific evidence supporting the King-Devick's use in concussion detection. 

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I examined twin boys yesterday, 4 years old and the mother expressed concern over one of the boys color vision. Sure enough on Ishihara testing he was diagnosed with Red/Green color blindness.



The twin brother was also diagnosed with Red/Green color deficiency and the mother was very surprised. "He doesn't seem to have nearly as much difficulty as his brother".  We say that we are testing aspects of visual perception through a comprehensive eye examination including depth perception and color perception.   When I probed further at the differences between the boys, the mother admitted that the boy she had concerns about is considerably further behind with his general skills.  The other twin is compensating for his innate color difficulty with his advance perceptual skills to mask his problem.

Meanwhile the original  twin may be coming back for further visual perception testing.  I bet visual figure ground, discrimination and closure will be difficult for him.

Dr. Eiden was recently asked to write a guest blog article for the National Keratoconus Foundation describing today's contemporary approach to contact lens management of patients with keratoconus. Please click the below link to this interesting article:

http://discoveryeye.org/blog/the-a-b-cs-of-contact-lens-fitting-for-keratoconus/

Today we have so many options for the vision correction and management of keratoconus and other causes of irregular corneas. NSVC is at the forefront of all technologies related to these diseases and conditions.

Shatterproof Protective Eyewear May Prevent Golf-Related Eye Injuries
“Research Report,” the Wall Street Journal  (4/15, Lukits, Subscription
Publication) reports that according to a study  published in the journal Eye, the use
of shatterproof protective eyewear while playing golf may prevent terrible and
potentially sight-robbing eye injuries, including ruptured eyeballs and orbital
wall fractures. After analyzing injuries sustained by 22 patients on golf courses
and eight patients on driving ranges, researchers concluded that wearing
protective eyewear that won’t shatter would help dissipate some of the energy
from flying golf balls.

Protective eyewear typical is comprised of a well constructed frame and lenses fabricated from shatter resistant polycarbonate material. The impact resistance of polycarbonate also has the benefit of having ultraviolet (UV) absorption. In addition to the risk of injury from golf ball impact, those who spend great amounts of time on the golf course typically are exposed to the harmful UV rays of the sun which have been linked to higher risk of macular degeneration and possibly cataracts.

What would an 8 year old say if he had the language capabilities of a 17 year old with the same visual inefficiencies?

Samuel, age 8, completed his program of office based vision therapy on April 4, 2014.  His mother wrote "Samuel is reading significantly more for pleasure at home and enjoying reading.  His academic reading comprehension is improving."

Claire, age 17, completed her of office based vision therapy on March 25, 2014.  She and Samuel had similar diagnoses.  Here is what Claire wrote: "I am able to read without getting headaches for longer and I no longer have shaking within my eyes after longer periods of concentration.  My grades have improved and reading is much easier."

Neither of these patients were in vision therapy for reading.  They were in vision therapy to improve the efficiency of the visual system.  This was done by performing activities that improve the visual centers of the brain using the principles of perceptual learning.

What does vision have to do with reading? If you have 10 minutes, this VisionHelp Video will help explain.

Julien is a gifted child.  He is 10 years old and has been home-schooled for most of his school career because his parents felt that the educational system could not accommodate the discrepancy between his intelligence and his chronologic age.  He is studying college level physics and mathematics.  In October, 2012 Julien suffered a concussion when he fell and hit his head on a cement stair, he was first seen in our office in October, 2013.

After he was stabilized and back to everyday life his mother noticed that his reading skills had regressed.  He was no longer able to complete texts anywhere close to his abilities before the fall.  He was as intelligent as ever but his performance was suffering.  Julien's concussion resulted in classic Post Traumatic Vision Syndrome (PTVS) and as part of the syndrome he developed a significant eye teaming disorder named Convergence Insufficiency (CI).  A program of office based optometric vision therapy was commenced.  Fast forward to the end of January 2014, 24 sessions but only 3 months after his initial visit and HE'S BACK!!! 

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Amblyopia is the medical term for a lazy eye.  Amblyopia is defined as a developmental disorder of spatial vision.  The treatment of choice for most eye care practitioners is using an opaque patch to block the vision from the better seeing eye in order to force the lazy eye to improve function.  This is going to change.



The problem to this approach is beautifully explained in a series of blogs on this wonderful site.  With a lazy eye there is a deficiency in the brain's ability to use both eyes together as a team.  Patch an eye and you may get lucky in addressing the one-eye deficiencies but what have you done to help the brain learn to coordinate the use of both eyes as a team?  Nothing.  These are facts that optometrists have known for decades which is why many use a binocular vision approach to improving lazy eye outcomes.

Now studies are being published to back up this notion.

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How common is Attention Deficit Hyperactive Disorder (ADHD)?  The number of children medicated have soared from 600,000 in 1990 to 3.5 million this year.  The pharmaceutical companies profits off of these medications is $9 Billion.  Do you really believe that the number of children who have ADHD has quintupled in less than 25 years?  These numbers are from a December, 2013 article on The New York Times website titled "The Selling of Attention Deficit Disorder".



So what is the big deal about giving these medications to our children?  They work don't they?  I will be the first to tell you that I believe there is such a thing as ADHD that is best served by powerful medications that alter brain chemistry.  These medications are not harmless as the drug companies may want you to believe.  Side effects include, loss of appetite, mood swings, sleeping problems, possible cardiovascular and psychiatric problems including suicidal thoughts.

The skyrocketing in the numbers leads me to believe there are other factors here.  The problem is there are conditions, outside of a chemical imbalance etiology, that can lead to symptoms that mimic ADHD.  Are behavioral problems best treated with behavioral therapy, medication, or a combination of both?  One of the known conditions with symptoms that can mimic ADHD is a visual condition known as Convergence Insufficiency (CI).  A qualified developmental optometrist can diagnose CI and offer treatment options that may lead to a decrease in symptoms which can save your child from risking the side effects listed above.  Please do not take your child off of any medication before consulting with the appropriate professionals.  North Suburban Vision Consultants can help diagnose or rule out this important condition.

Do NOT clean your contact lenses with water!

[caption id="attachment_507" align="alignright" width="251"] Amoeba: single cell organisms


A recent article in the Huffington post tells the story of a woman, named Erin, who is going blind because she developed an infection that is attacking her cornea. What's worse is that her rare amoeba infection was not properly diagnosed when she went to the emergency room and the steroid that was prescribed there actually masked her real condition.  You may have seen her story featured on the TV program, The Doctors.

When the pain continued, Erin sought the advice of an optometrist, who said that the steroid was actually feeding the amoeba, making it stronger.  "The pain was excruciating," said Erin, who is pregnant.

Acanthamoeba keratitis is an infection of the eye that typically occurs in healthy people, and can enter the body in several ways including the use of contact lenses and can result in permanent visual impairment or blindness.

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Julia came to our office after being told by her primary care pediatric ophthalmologist that she needed orthoptics.  The advice was to specifically seek out an orthoptist but that proved to be very difficult.  Our office provides optometric vision therapy which is an advanced version of orthoptics, you can think of it as orthoptics on steroids.  Her family found our office through an internet search.

Julia is 12 years old and was suffering from double vision, headaches and eye strain.  Her visual process was so inefficient that she used to close her eyes to block out the visual confusion so that she could listen to someone speak.  She was diagnosed with amblyopia (lazy eye), accommodative dysfunction (focusing problem) and severe convergence insufficiency (eye teaming problem). After the evaluation I consulted with the pediatric ophthalmologist who was politely skeptic about the role optometric vision therapy could play in Julia's case.

After 6 months of office based optometric vision therapy Julia's headaches are much less frequent, she does not experience double vision and she finds school and sports much easier to handle.  She returned to her pediatric ophthalmologist for an exam and the note back to me read "Dr. Press: Julia is clearly better. I recommend that she continue vision therapy with you. Thank you for your assistance." For the full note, follow this link, Julia OMD Note, a new bright spot.

 



More children need to be helped with the effective communication and collaboration between primary care eye doctors and developmental optometrists.  This is a great start in the Chicago area!

 

Chicago Low Vision Optometrist and Diplomate

[caption id="attachment_486" align="alignright" width="70"] Dr. Barron


Dr. Carol Barron is our senior low vision specialist and has rare credentials from American Academy of Optometry that make her uniquely qualified in her field.  She is one of approximately 50 low vision Diplomates in the United States who are recognized for their academic and practical achievement in treating diseases like age related macular degeneration, diabetic retinopathy,  glaucoma, blurred vision or reduced peripheral vision.

She tells us what warning signs to watch out for and shares some links to find out more about low vision rehabilitation.

She has some favorite free-time activities and follows the Bulls, Bears, Blackhawks and Wildcats.  And, as you will find out below, she has wanted to be an eye doctor since she was in middle school.

1) Tell me a little about your practice and what you specialize in.

"My practice has a specialty in low vision rehabilitation."

2) Where did you get your education?

"I am a graduate of the University of Illinois in Champaign, and a graduate of the State University of New York, the College of Optometry which is in New York City.  I graduated from the State University of New York, the College of Optometry in 1981."

3) What additional training do you have?

"I worked as a Clinical Professor at the State University of New York, and was Department Chair of the Primary Care Department for 5 years before moving to Chicago. During that time I was able to both work beside and learn from the other senior faculty members at the Optometry College."

4) What is your biggest professional achievement?

"My biggest professional achievement is to have earned the title of Diplomate in Low Vision Rehabilitation from the American Academy of Optometry.  This title is bestowed upon an optometrist who writes a number of peer reviewed papers, and passes both a rigorous clinical, and a written evaluation in the area of low vision rehabilitation. Currently there are approximately 50 Low Vision Diplomates in the area of Low Vision Rehabilitation in the United States."

5) What are the early warning signs and how can these diseases/conditions be prevented?

"The early warning signs for the most common causes of vision loss (age related macular degeneration, diabetic retinopathy, and glaucoma) are blurred vision, or reduced peripheral vision. The conditions can not always be prevented as genetic risk factors make these diseases unfortunately too common. However, routine evaluations by the eye care doctor can assist in early detection, and appropriate eye care management."

6) Can you recommend any online resources for people to learn more?

American Academy of Optometry at www.aaopt.org

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Case Study: Dry Ice Accident and A RevitalEyes Contact Lens

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[caption id="attachment_458" align="alignnone" width="150"] Measurement of corneal shape for contact lens fitting


A recent study surveying behavior and outcomes associated with the use of daily disposable, single use contact lenses not only shows that people tend to abuse even the best systems presented to them, but that there are significant consequences of such abuse.

The study by Dumbleton KA, Richter D, Woods CA, et al. named "A multi-country assessment of compliance with daily disposable contact lens wear." published this in this month's issue of the journal Contact Lens and Anterior Eye looked at re-use rates of patients who were prescribed daily disposable, single use contact lenses. Patients from a number of countries were surveyed for this study. The overall rate for non-compliance to single use of daily disposable contact lenses was almost 10%. The countries with the highest rates of such non-compliance were Australia at 18% and the US at 12%! the primary reason given for re-use was "to save money". Most notably over 25% of people reported sleeping overnight in these daily disposable contact lenses despite the fact that none of these lenses were developed or approved for overnight wear! A key finding from this survey study was that re-use of daily disposable single use contact lenses was associated with significantly reduced comfort of contact lens wear.

The purpose of single use daily disposable contact lenses is to address issues found with re-usable contact lenses, specifically reduced contact lens wearing comfort, inconvenience of lens disinfection and care systems, and complications associated with overnight wear of contact lenses. Re-use of these lenses simply defeats the purpose. Realizing that economics is a reality, patients should consider the overall cost of daily disposable contact lenses. For sure they are far less expensive per lens vs. re-usable contacts, however if worn every day they can be more costly. However we should keep in mind the savings associated with not needed contact lens solutions.

Discuss with your eye doctor the advantages and issues associated with daily disposable contact lenses and make an informed decision if they are right for you. At our practice our goal is to provide our patients with the healthiest contact lens option and the optimal contact lens vision correction available. Today new designs of daily disposable contact lenses often meet these criteria. Ultimately our patients have to decide if the value proposition is there for them.

For more information on the most advanced contact lens designs available including new daily disposable technologies please contact us at:  This email address is being protected from spambots. You need JavaScript enabled to view it.

[caption id="attachment_446" align="alignright" width="270"] Dr. Shana Brafman - Dry Eye Disease Specialist


What is Dry Eye Disease?

Dry eye disease (DED) was defined by the Dry Eye Workshop (DEWS) study group in 2007 as “a multi-factorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by tear film hyperosmolarity and inflammation of the ocular surface.”

Another, more simple, definition from 2009 described it as “a disease caused by conditions that either increase evaporation of the tear film or decrease tear production with resulting increase in tear film osmolarity (hyperosmolarity) leading to inflammation in the eye, damage, and symptoms.” DED is a common condition: 23 million patients in the United States report frequent Dry Eye symptoms, and more than 50% of contact lens wearers report DED symptoms.

At the onset, most patients notice a foreign body sensation, contact lens intolerance or have a shorter contact lens wearing tolerance.  That's a sign that you need an appointment for a Dry Eye workup, and once under control, we will fit the patient with new contacts in most cases.

Diagnosing Dry Eye Disease

Today, therapeutic options are abundant for the treatment of patients with DED and ocular surface disease (OSD). The ability to differentially diagnose not only the presence of Dry Eye Disease but to determine the causative factors (especially evaporative vs aqueousdeficient disease) can significantly increase our success rates with regard to managing this disease. Fortunately, technologies geared toward appropriate DED diagnosis have developed along with treatment modalities. In this post, I will review one of the most advanced and useful technologies currently available for the diagnosis of DED.

The RPS InflammaDry Detector (Rapid Pathogen Screening) is designed to detect matrix mettaloproteinase 9 (MMP-9), an inflammatory marker that is known to be elevated in patients with DED. MMP-9 is a cytokine produced by epithelial cells experiencing inflammation. It is the only test of this kind on the market and has a sensitivity of 85% and specificity of 94%. The test is easy to administer and no anesthetic is required.

A patient’s tear sample is taken from the inferior palpebral conjunctiva. Once the tears are collected, the applicator is dipped into a solution for 10 to 15 seconds. This solution is able to detect MMP-9 within the tears. A red line appears on the applicator if the tears are positive for MMP-9. A blue line will appear for negative results, and no lines will appear if the test is invalid.

The test can be administered in office and takes about 10 minutes from start to finish for results. Positive results indicate beginning anti-inflammatory therapy to improve the patient’s ocular comfort and health while reducing DED symptoms. Currently, the device is awaiting final FDA approval.

We all work hard, staying up with the latest technology options that can help diagnose and treat our patients suffering from Dry Eye Disease. I have had many patients tell me they aren't able to wear contacts due to their dryness issues. With proper testing and treatment of DED, I've been able to help these patients become part time and full time contact lens wearers. One of the newest tests to the market is the RPS InflammaDry Detector.  North Suburban Vision Consultants is an Accredited TearLab Dry Eye Center.

To find out more about the treatment of Dry Eye Disease, please read the article by Dr. Barry Eiden, Dr. Robert Davis and me in the May 2013 issue of Advanced Ocular Care at: http://eyetubeod.com/2013/05/latest-technologies-in-the-diagnosis-of-ded-and-osd#sthash.SIaJmCo4.dpuf

If you are suffering from these symptoms, I would recommend making an appointment with us today.  Or call (847) 412-0311.

[caption id="attachment_432" align="alignright" width="175"] Dr. Daniel Press


Chicago optometrist specializing in pediatric vision, corneal reshaping and binocular vision.

Dr. Press is the newest member of our team.  He joined us in August of 2012 after spending 6 years practicing in the premier vision therapy practice in New Jersey.  Dr. Press often takes an integrated approach, sometimes working with occupational therapists, medical doctors, reading and educational specialists and others  to improve the patient's quality of life and getting them back to work or in the classroom.

We recently asked him to tell us a little about himself, including his education, some great online resources for parents & other caregivers and what he likes to do in his spare time.

Tell us a little about your practice and what you specialize in.

"My specialty is in pediatrics, binocular vision, visual perception and myopia control.  I enjoy seeing patients of all ages but have a passion for helping children reach their fullest visual potential."

Where did you get your education?

"Undergraduate: Rutgers Optometry Degree: Pennsylvania College of Optometry"

What additional training do you have?

"Earned fellowship in the College of Optometrists in Vision Development (COVD).  Obtained certification to fit multiple designs of corneal reshaping treatment lenses."

What is your biggest professional achievement?

"Being elected to serve on the board of directors for COVD."

What are the early warning signs for these kinds of vision problems in children and how can these diseases/conditions be prevented?

"Warning signs for visual problems in children: Avoidance of reading or doing close work, any physical complaints in or after school (headaches, eyestrain, blurred vision, etc..), can read individual words but when presented in sentence/paragraph form they have trouble.  Prevention is best achieved by early visual evaluations."

Can you recommend any online resources for people to learn more?

Certainly. The College of Optometrists in Vision Development has a Vision Conditions option in the upper right corner of their Home page:  www.covd.org,   The VisionHelp site features resources and information on common vision problems, a Glossary of Common Vision Problems and information on vision and learning, autism, ADHD, injuries and strokes  www.visionhelp.org and I also recommend the American Optometric Association's website at www.aoa.org.

What did you want to grow up to be when you were little?

"Veterinarian"

What do you like to do in your spare time?

"Spend time with my family (wife, children and dog), play golf, watch football. Our dog Jackson is a Lab/Border Collie mix that we rescued at a shelter."

What are your favorite TV shows, music, teams, etc?

"I enjoy most live sporting events, TV shows: The Office, Parks and Rec, CNBC's Squawk Box.  Music: Green Day, Nirvana, Pearl Jam. Teams: Won’t be popular but Philadelphia everything. Eagles, Phillies, Flyers, 76ers."

Click here to read Dr. Press' bio.

Dr. Press sees patients at both our Deerfield and Park Ridge locations.  You can request an appointment or call 847 412-0311 to schedule a consultation.  Please wear a Cubs, Sox, Bears, Blackhawks or Bulls jersey for your appointment. :-)

 

Researchers at the University of Waterloo in Canada recently published results of a study of a new contact lens design that shows great promise in controlling progression of myopia (nearsightedness). This study tells us about the initial study results of testing of this contact lens design on chickens.

http://whatcounts.jobson.com/dm?id=9B223ABF4F78A4026EF60F6C9C7E873B

Today we have a number of highly effective ways to control myopia progression in young people which include: corneal reshaping treatments, use of atropine eye drops and specially designed multifocal contact lenses. We know that the prevalence of nearsightedness is growing at alarming rates. In the United States rates are approaching 50% and in parts of Asia they have exceeded 80%. Myopia is the major cause of vision loss in the world today and is associated with a number of eye diseases that can result in vision loss. Our ability to control how advanced myopia gets will allow us save vision and improve function for so many people over the years to come.

For more information on myopia, contact lenses, eye diseases and other eye care topics please visit our website at www.nsvc.com.

 

On May 5th 2013 the results of the Age Related Eye Disease 2 Study (AREDS 2) were announced online in the Journal of the American Medical Association and at the prestigious ARVO eye meeting . The impact on our management of Age Related Macular Degeneration (ARMD) are profound.




The objective of AREDS 2 was to determine if the addition of dietary carotinoids (Zeaxanthin and Lutein) along with Omega 3's to the original AREDS suggested supplement formula would further reduce the progression to advanced forms of ARMD. The results confirmed that the addition of these nutrients did in fact slow progression of ARMD to advanced disease. Analysis indicated that there was approximately 9% reduction in the progression rates to advanced ARMD in the study groups that had Zeaxanthin and Lutein in their formulations vs. those that did not. This study however did not find that consumption of Omega-3 in the formulations reduced progression rates. This is in contrast to the ocular benefits of Omega-3 in numerous other studies and further analysis is required to better understand the role of Omega-3. Finally, the elimination of beta carotene from the formulation was found to provide a dramatic 18% reduction in the risk of progression to advanced ARMD! Most importantly the presence of beta carotene in the formulation when used by smokers was associated with higher rate of developing lung cancer. As such, the elimination of beta carotene is suggested for all formulations.

Macula Pigment Optical Density (MPOD) measurements are clinically available and indicate the density of the key protective macula pigments (Zeaxanthin and Lutein) in the eye . Use of systems like the "Quantify" MPOD instrument and others like it allow for quick, easy and non-invasive quantification of MPOD levels during regular eye examinations. A large body of scientific evidence is available that indicates low MPOD as a key risk factor for the development of ARMD. Most importantly MPOD levels can be improved in most patients with appropriate supplementation of Zeaxantin and Lutein.

 

The results of the AREDS 2 study are welcome and support ongoing comprehensive management of patients with ARMD and those at risk to develop ARMD. Regular and frequent eye examinations that include thorough history, physical examination of the eye, MPOD testing and access to other advanced technologies should they be indicated (such as retinal imaging, macula OCT testing, genetic risk testing for ARMD, and home based Hyper-acuity perimetry) are key to management of this very serious disease.

The National Keratoconus Institute (NKCI) was formed to provide patients who suffer from the corneal disease keratoconus and other related diseases that induce corneal irregularity and vision loss access to the most advanced eye care services available. Over 8,000 corneal transplants are performed in the United States annually to treat keratoconus. These transplants are the final option for those who suffer from advanced forms of keratoconus. There are numerous reasons why corneal transplants should be considered only when all other options have been exhausted and most experts in the field share the opinion that reducing the number of transplants by earlier detection and management is an important goal. Today we have numerous methods to prevent progression of keratoconus and in some cases reduce the severity of the disease. The National Keratoconus Institute is dedicated to allowing patients to have earlier diagnosis made and intervention to prevent cases from progressing to the point of need for a transplant. Though the establishment of "centers of excellence" and collaborative efforts in research and technology development, NKCI will allow more patients with diseases such as keratoconus to have access to state of the art diagnostic and treatment technologies and outcomes analysis to improve our quality of care.

Dr. S. Barry Eiden is president and medical director of the National Keratoconus Institute. He along with an esteemed group of experts in the field (both optometry and ophthalmology) are dedicated to the goals of NKCI. The first of a planned number of NKCI Centers of Excellence in keratoconus care saw their first referral cases this week at the initial referral center located in the greater Chicago area. Dr. Eiden, based on extensive experience in the management of patients with keratoconus and related diseases in his clinical practice and research efforts, realized that many patients with keratoconus are being cared for by eye care practitioners who only occasionally see patients with these diseases and may lack the access to advanced diagnostic and treatment technologies that these people need. By establishing NKCI referral and consultation centers in key locations throughout the United States and creating referral networks with local eye care providers, these doctors can allow their patients to have the highest level of care available. In addition, NKCI is devoted to advancing education of both eye care providers and patients. Ultimately this will result in a raising of the bar of care for people suffering from keratoconus and related diseases.

We will continually update you on the development of NKCI on this practice blog and ultimately establish an NKCI blog exclusively posting about keratoconus and related corneal diseases and condition. Be on the look out!




 

Your child's vision may be negatively impacting how they feel about school.

We all know that academic demands seem to have skyrocketed over the last few decades.  Kids are expected to read earlier, for longer periods of time and with increasingly smaller text.  If your child has a fairly common eye teaming disorder (convergence insufficiency) it may make meeting these demands difficult and downright cruel!




A study published in 2012 showed that academic behaviors improved after successful treatment of convergence insufficiency (CI).  What is that successful treatment?  In a 2008 study published in the Archives of Ophthalmology, office based vision therapy is the most effective treatment for symptomatic CI.

If your child is struggling in school or has negative feelings about reading and school work, then receiving an evaluation by a doctor skilled in detecting CI should be on your list.  The most difficult part of being a parent is knowing if the examination your child received even checked for this condition.

The questions you should ask your doctor are:

1) Does my child have exophoria at near great than at distance?

2) What is his/her near point of convergence?

3) What was my child's positive fusional vergence?

4) What was his/her score on the convergence insufficiency symptom survey?

If your doctor cannot answer at least 3 of those questions, my recommendation would be to ask for a referral to a doctor that can.