Pub Date : 2015-10-01DOI: 10.31707/vdr2015.1.3.p214
M. Scheiman, G. Mitchell, S. Cotter, M. Kulp, C. Chase, E. Borsting, Eugene Arnold, Carolyn A. Denton, R. Hertle
OBJECTIVE To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic convergence insufficiency (CI). METHODS CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention. CONCLUSION The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.
{"title":"Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART): Design and Methods.","authors":"M. Scheiman, G. Mitchell, S. Cotter, M. Kulp, C. Chase, E. Borsting, Eugene Arnold, Carolyn A. Denton, R. Hertle","doi":"10.31707/vdr2015.1.3.p214","DOIUrl":"https://doi.org/10.31707/vdr2015.1.3.p214","url":null,"abstract":"OBJECTIVE\u0000To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic convergence insufficiency (CI).\u0000\u0000\u0000METHODS\u0000CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention.\u0000\u0000\u0000CONCLUSION\u0000The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.","PeriodicalId":91423,"journal":{"name":"Vision development and rehabilitation","volume":"1 3 1","pages":"214-228"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69666063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.31707/vdr2021.7.1.p35
Background: Apart from vision correction, there appears to be a need for a method of increasing the success of balance exercises by using more sensitive methods of detecting postural sway. Methods: Reference to relevant articles from a wide range of sources were used to examine how the well-established theoretical basis for motion parallax phenomena, and the examples of rifle and pistol shooting, can be used to explain the practical application of those principles to balance exercises. Results: An approach to balance enhancement exercises has been developed and a step by step set of instructions have been prepared that enable fall-risk patients to make motion parallax observations which detect small degrees of postural sway, and so allow for appropriate minor corrections to be achieved so that balance is maintained. Conclusions: These instructions provide a mechanism whereby balance can be maintained during balance improvement exercises with associated reduced need for major postural sway corrections which would otherwise risk over-correction and loss of balance. Improved performance during balance exercises may have the potential to promote the development and consolidation of the sensory integration required for maintaining balance outside the remedial balance exercise setting. Apart from helping to build confidence during a variety of balance exercises, these methods of balance control also appear to have relevance as supportive adjuncts to some strength and endurance exercises which are used to improve balance maintenance.
{"title":"Fall Avoidance: Motion Parallax Cues and Balance Control Therapy","authors":"","doi":"10.31707/vdr2021.7.1.p35","DOIUrl":"https://doi.org/10.31707/vdr2021.7.1.p35","url":null,"abstract":"Background: Apart from vision correction, there appears to be a need for a method of increasing the success of balance exercises by using more sensitive methods of detecting postural sway. Methods: Reference to relevant articles from a wide range of sources were used to examine how the well-established theoretical basis for motion parallax phenomena, and the examples of rifle and pistol shooting, can be used to explain the practical application of those principles to balance exercises. Results: An approach to balance enhancement exercises has been developed and a step by step set of instructions have been prepared that enable fall-risk patients to make motion parallax observations which detect small degrees of postural sway, and so allow for appropriate minor corrections to be achieved so that balance is maintained. Conclusions: These instructions provide a mechanism whereby balance can be maintained during balance improvement exercises with associated reduced need for major postural sway corrections which would otherwise risk over-correction and loss of balance. Improved performance during balance exercises may have the potential to promote the development and consolidation of the sensory integration required for maintaining balance outside the remedial balance exercise setting. Apart from helping to build confidence during a variety of balance exercises, these methods of balance control also appear to have relevance as supportive adjuncts to some strength and endurance exercises which are used to improve balance maintenance.","PeriodicalId":91423,"journal":{"name":"Vision development and rehabilitation","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90169402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.31707/vdr2021.7.1.p43
A focus of both basic and clinical research on concussion/mild traumatic brain injury has been to ascertain which test, or combination of tests, is best for its detection. In the present retrospective analysis, three potential clinical tests were evaluated to determine which one, or combination, best differentiated between visually-symptomatic concussed (n=52) versus asymptomatic non-concussed (n=24) patients. The three tests were: distance horizontal vergence facility, peripheral visual motion, and critical flicker fusion. Each test was found to differentiate the two groups. The peripheral visual motion test was the best, with a sensitivity of 93.8% and a specificity of 83.3%. When this test was combined with the distance horizontal vergence facility test, specificity remained the same whereas sensitivity increased to 94.4%. Addition of the critical flicker fusion test did not affect these values. Thus, of the three, the combination of the peripheral visual motion and distance horizontal vergence facility tests has a high probability of assisting in concussion detection and diagnosis.
{"title":"Assessment of Three Clinical Tests for Evaluation of Concussion/Mild Traumatic Brain Injury","authors":"","doi":"10.31707/vdr2021.7.1.p43","DOIUrl":"https://doi.org/10.31707/vdr2021.7.1.p43","url":null,"abstract":"A focus of both basic and clinical research on concussion/mild traumatic brain injury has been to ascertain which test, or combination of tests, is best for its detection. In the present retrospective analysis, three potential clinical tests were evaluated to determine which one, or combination, best differentiated between visually-symptomatic concussed (n=52) versus asymptomatic non-concussed (n=24) patients. The three tests were: distance horizontal vergence facility, peripheral visual motion, and critical flicker fusion. Each test was found to differentiate the two groups. The peripheral visual motion test was the best, with a sensitivity of 93.8% and a specificity of 83.3%. When this test was combined with the distance horizontal vergence facility test, specificity remained the same whereas sensitivity increased to 94.4%. Addition of the critical flicker fusion test did not affect these values. Thus, of the three, the combination of the peripheral visual motion and distance horizontal vergence facility tests has a high probability of assisting in concussion detection and diagnosis.","PeriodicalId":91423,"journal":{"name":"Vision development and rehabilitation","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75464163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessment of eye movements is one of the most important procedures in the optometric armamentarium. Since abnormal eye movements are found in a wide range of vision-based (e.g., amblyopia) and non-vision-based (e.g., multiple sclerosis) diagnoses, which in many cases are remediable, it is crucial that they be tested in a careful, informative manner, with their functional consequences considered. In this paper, some of our thoughts on this important clinical process are presented.
{"title":"Some Thoughts on Clinical Eye Movement Testing","authors":"","doi":"10.31707/vdr2021.7.1.p7","DOIUrl":"https://doi.org/10.31707/vdr2021.7.1.p7","url":null,"abstract":"Assessment of eye movements is one of the most important procedures in the optometric armamentarium. Since abnormal eye movements are found in a wide range of vision-based (e.g., amblyopia) and non-vision-based (e.g., multiple sclerosis) diagnoses, which in many cases are remediable, it is crucial that they be tested in a careful, informative manner, with their functional consequences considered. In this paper, some of our thoughts on this important clinical process are presented.","PeriodicalId":91423,"journal":{"name":"Vision development and rehabilitation","volume":"146 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80991690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.31707/vdr2021.7.1.p17
Background: This is a two-part paper, in which fixational eye movements are reviewed in part one, and a new clinical test of fixational eye movement accuracy and stability is introduced in part two. Part two also contains a partial validation study and normative results for this new test. The study was designed to explore the following questions: 1. Is there a significant difference in clinically measurable fixation stability and accuracy between symptomatic individuals who have sustained mTBI versus visually normal individuals who have not sustained TBI? 2a. Could the Macular Integrity Tester (MIT) be useful as a diagnostic instrument for differentiating fixation stability and accuracy with mTBI patients versus those without TBI? 2b. If so, could introduction of a standardized test protocol (AP-FAST) allow for more reliable and descriptive quantification of monocular fixation behavior? Methods: To answer the first question posed in our study, data were compared between non-mTBIs and mTBI patients using two different fixation testing methods. One of the methods employed the eyetracker EyeLink II comparing optometry students to mTBI patients. Fixation accuracy and stability were measured with a custom fixation pattern program. Fixation results were compared for both groups. To answer question 2a, we compared fixation behavior for both groups using the MIT diagnostically by having each subject rate accuracy and stability of his/her own fixation posture. To address question 2b, a 15-point rating system protocol was created to help describe and quantify monocular fixation behavior via Haidinger’s brush perception. Two groups of test subjects: mTBI patients versus visually normal subjects were compared using the AP-FAST grid and fixation behavior survey. Results: Regarding question one, there was a significant and clinically relevant difference in monocular fixation stability and accuracy between the visual normal subject group and mTBI patient group, with normals demonstrating better accuracy and stability. Regarding questions 2a and 2b, the mTBI patient group had poorer mean ability (statistically significant) to perceive, localize, and center the Haidinger’s brush than those in the non-TBI group. Based on our results, we propose that the newly developed AP-FAST is useful for helping describe, standardize and quantify how the Haidinger’s brush entoptic phenomenon is perceived monocularly by both mTBI and nonmTBI subjects.
{"title":"Introduction of a New Test for Standardizing and Quantifying Monocular Fixation: The Aalen-Pacific Fixation Accuracy & Stability Test (AP-FAST)","authors":"","doi":"10.31707/vdr2021.7.1.p17","DOIUrl":"https://doi.org/10.31707/vdr2021.7.1.p17","url":null,"abstract":"Background: This is a two-part paper, in which fixational eye movements are reviewed in part one, and a new clinical test of fixational eye movement accuracy and stability is introduced in part two. Part two also contains a partial validation study and normative results for this new test. The study was designed to explore the following questions: 1. Is there a significant difference in clinically measurable fixation stability and accuracy between symptomatic individuals who have sustained mTBI versus visually normal individuals who have not sustained TBI? 2a. Could the Macular Integrity Tester (MIT) be useful as a diagnostic instrument for differentiating fixation stability and accuracy with mTBI patients versus those without TBI? 2b. If so, could introduction of a standardized test protocol (AP-FAST) allow for more reliable and descriptive quantification of monocular fixation behavior? Methods: To answer the first question posed in our study, data were compared between non-mTBIs and mTBI patients using two different fixation testing methods. One of the methods employed the eyetracker EyeLink II comparing optometry students to mTBI patients. Fixation accuracy and stability were measured with a custom fixation pattern program. Fixation results were compared for both groups. To answer question 2a, we compared fixation behavior for both groups using the MIT diagnostically by having each subject rate accuracy and stability of his/her own fixation posture. To address question 2b, a 15-point rating system protocol was created to help describe and quantify monocular fixation behavior via Haidinger’s brush perception. Two groups of test subjects: mTBI patients versus visually normal subjects were compared using the AP-FAST grid and fixation behavior survey. Results: Regarding question one, there was a significant and clinically relevant difference in monocular fixation stability and accuracy between the visual normal subject group and mTBI patient group, with normals demonstrating better accuracy and stability. Regarding questions 2a and 2b, the mTBI patient group had poorer mean ability (statistically significant) to perceive, localize, and center the Haidinger’s brush than those in the non-TBI group. Based on our results, we propose that the newly developed AP-FAST is useful for helping describe, standardize and quantify how the Haidinger’s brush entoptic phenomenon is perceived monocularly by both mTBI and nonmTBI subjects.","PeriodicalId":91423,"journal":{"name":"Vision development and rehabilitation","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73578617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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