Ernest V. Loewenstein, PhD, OD
Professor of Optometry; New England College of Optometry 

Dr. Coulter was the Behavioral Scholar in Residence at NECO from April 2 through 6, 2014.  Dr. Coulter is a faculty member at Nova Southeastern University where she divides her time between academic and clinical duties.  Dr. Coulter’s special clinical interest is in the optometric treatment of children with autism; she is director of the Nova Southeastern University’s Vision and Autism Service.

The Behavioral Scholar in Residence is an annual program at NECO in which a distinguished behavioral optometrist is invited to visit the College for a period of five days to bring a new perspective to the students and faculty. The duties include presentations to the students, participation in a symposium on a subject of interest to the Scholar, and a CE lecture to the general optometric community and to such outside professionals as may be interested in the subject.

Dr. Coulter is a graduate of Pennsylvania College of Optometry (now Salus University).  She did a residency in Pediatric Optometry and Vision Therapy at PCO. She also holds a Master of Science in Exceptional Student Education from Nova Southeastern University.  Dr. Coulter is a fellow of COVD, and a diplomate in binocular vision, perception and pediatric optometry.  She has served as chair of the Binocular Vision, Perception and Pediatric Optometry sections of the American Academy of Optometry and the Florida Optometric Association Children’s Vision Committee.

Dr. Coulter participated in a symposium organized by Dr. Richard Laudon of NECO, titled “Autism, Its Impact on Families and Society.” Other participants included internist, an occupational therapist, and a young woman with personal experience of living on the autism spectrum.  Each participant brought a personal story of their experience with the implications of autism to the individual and family.

On Sunday April 6, Dr. Coulter presented a CE program of two lectures titled “Is Your Practice Ready to Care for the Patient with Autism?” and “Providing Vision Therapy to Patients with Autism Spectrum Disorder.”  The first lecture covered a description of some aspects of autism, how the ocular and refractive conditions differ between autism and non-autism, and suggestions for structuring the eye examination for patients on the autism spectrum.  The second lecture provided information garnered from Dr. Coulter’s experience in the University Vision and Autism clinic on the practical aspects of vision therapy with children on the spectrum, including some videos of how children act in the training room.

This successful visit by Dr. Coulter was enhanced by her presentations to students in the first three years (fourth year students are mostly at remote clinics).  The presentations were made in the regularly scheduled class times through the generosity of the respective instructors in giving up some of their limited lecture time. Students responded with interest and many questions, including inquiries about how they could the training necessary to offer such service in their future practice.

Leong DF, Master CL, Messner LV, Pang Y, et al.

Clin Pediatr (Phila). 2014 May 1. [Epub ahead of print]

http://www.ncbi.nlm.nih.gov/pubmed/24790022

Reviewed by Marc B. Taub, OD, MS

It goes without question that without the ability to read, learning would be rather difficult. Efficient reading impacts fluency and therefore reading comprehension. School teachers and reading specialists work tirelessly with children every day to improve their reading skills; what if training saccadic eye movements could provide a possible solution? In this pilot study, the impact of saccadic training on early reading fluency is investigated.  

Seventy-six children from a private urban school in grades kindergarten through third grade participated in the study.  All children underwent a school vision screening and had a binocular near point visual acuity of 20/20.  Subjects, 56 in the treatment group and 20 in the control group, were evaluated with either the Reading Fluency Assessment:  Wechsler Individual Achievement Test Third Addition (WIAT) (grades one to three) or the King-Devick test (kindergarten). The WIAT Reading Fluency subtest consists of two timed, grade-level specific reading passages. The total number of words read, number of errors made and total time are recorded. The treatment consisted of the KD remediation software which is a similar format to the KD test. Randomized numbers are presented at variable speeds from left to right; the participants read the numbers as quickly as possible. The control group was presented numbers positioned in the center of the screen. The training consisted of 20 minute sessions, three days a week for six weeks.  The total training time was six hours for both the treatment and control groups.  The WIAT and KD tests were completed after the treatment was completed and one year post treatment in 25 participants. 

Subjects in the treatment group had significantly higher reading scores post-treatment (P<0.001) and in comparison to the control group (P<0.005). The one year post-treatment scores for all grades were higher but only grade one was significant (P=0.037). For the KD test, which was done with kindergartners only the treatment group showed significant improvement post-treatment (P<0.001) and in comparison to the control group (P=0.0435).  The post-treatment one year scores also showed significant improvement (P<0.005).    

This study shows that remediation of saccadic eye movements is not only possible but a reality. Remediation was also demonstrated to have a long impact. There are indeed questions about this study.  Will the gains made translate into a true improvement in reading? Will these changes in tests results translate to the classroom? While the students took part in a vision screening program, what did that entail?  Were there children that had convergence, accommodative or even tracking issues included in the study unknowingly?  Also, in looking at the training regimen, would these children show greater improvement with a true program of optometric vision therapy? While limited in scope, the results lend credence to the concept of improvement in reading fluency with a program of vision training.    

Resident Winner

Take Time to Smell the Prisms: A Case Report on a Deliberate Set of Examinations and the Application of Yoked Prism in the Treatment of Visual Midline Shift Syndrome

Christopher H. Caldwell, OD
San Antonio Uniformed Services in Health Education Consortium, Fort Sam    
Houston, Texas

Resident Runner-Up

Prevalence of Accommodative and Non-strabismic Binocular Anomalies in the Pediatric Population of the Inter American University School of Optometry Eye Institute

Stefania M. Paniccia, OD, MS
Inter American University School of Optometry
Bayamon, Puerto Rico

Student Winner

“The Day the World Tilted:” A Case Study on Visual Vertigo and Anomalous Spatial Perception

Katie Davis, OD-Illinois College of Optometry

The resident winner receives a Clinical Curriculum Course from OEP valued at $2000 and the resident runner-up and student winner both receive a package of equipment and books from Goodlite and OEP!

By Dr. Patricia Fink; Burlington, Ontario

Dr. Glen (Bubba) Steele’s seminar “The Importance of Vision in Overall Development” was exceptionally well received at the office of Dr. Patricia Fink’s in Burlington, Ontario.  There were 26 optometrists in attendance from all over the province, most that are practising in-office vision therapy and a few that are passionate about infant vision (and had their minds expanded by the seminar, partly from the discussions with the VTODs and lecturer).

Dr. Steele was excellent in explaining how to appreciate the retinoscopy reflex and to show us how to look for more than with or against motion.  To be able to appreciate when a patient can attend by the colour of the reflex at near and to compare this reflex between the two eyes...well, Jennifer Braniff (Vision Therapist) had the best quote with “I want one of those (spot retinoscopes) in the VT room.”  Being able to perform accommodative facility testing while observing the reflex was astounding...to see the lead or lag of accommodation and to really “see” when the patient achieved “neutrality” and to “know” they were accommodating accurately and the response was objectively accurate...WOW.

Cheng D, Woo GC, Drobe B, Schmid KL.

JAMA Ophthalmology 2014;132(3):258-64

http://www.ncbi.nlm.nih.gov/pubmed/24435660

Reviewed by Dr. Marc Taub; Memphis, Tennessee

Eye care providers are constantly bombarded with questions from parents related to the progression of their children’s myopia. They demand to know how high the prescription will reach, will the children need new glasses every year, and what can be done to stop the myopia from getting worse. They do not want their children wearing Coke-bottle glasses! There are numerous theories concerning the cause of myopia progression and just as many treatments. Eye care providers have studied hard contact lenses, orthokeratology, under-minusing with glasses, bifocal glasses with high add powers, and multifocal contact lenses. Some studies show positive gains with each of these treatments, while others show the opposite. In this study, the authors examined the progression of myopia comparing bifocal glasses to bifocal glasses with prism. 

I am thrilled to be able to bring to you an interview with an amazing optometrist and humanitarian. Dr. Johnson-Brown is a successful clinician and President of the National Optometric Association.  She serves as a mentor to many optometrists and gives so much back to her community in Chicago.  I am honored to be able to bring her words directly to you.