Eye Exercises Help Patients Work Out Vision Problems, Optometrist Says

A young patient undergoes vision therapy at the University Eye Institute at the University of Houston. (Credit: University of

Houston)

Science Daily (Apr. 9, 2009) — You've probably been there. In a doctor's office, being advised to do what you dread – exercise. You get that feeling in your gut, acknowledging that, indeed, you should exercise but probably won't. Now imagine that the doctor is your optometrist.

Don't clean your glasses. You read that right. Eye exercises are used to treat a variety of vision disorders, according to Dr. Janice Wensveen, clinical associate professor at the University of Houston's College of Optometry.

Patient reactions to this quite common prescription range between surprise and relief, she said, but doing the therapy can improve their performance at school and work.

"They're curious, especially when we tell them, instead of putting a Band-Aid on it like we do with glasses or contact lenses, we're actually going to solve your problem. You're going to be cured, and that's something we don't very often do," she said.

The standard at-home prescription is known as "pencil push-up therapy," said Wensveen, who practices at the University Eye Institute's Vision Therapy Clinic in the Family Practice Service.

"Patients visually follow a small letter on a pencil as they moved the pencil closer to the nose. The goal is to be able to keep the letter clear and single until it touches your nose."

Not surprisingly, she said, many patients don't follow through once they're out the door.

"You can imagine that, in the doctor's office, it sounds great, and you can do it. You think, 'Wow, this can help me?' But you get home, and you do it. You think, 'This is really dumb.' You do it once, and you never do it again," she said.

In fact, a study released in the fall by the National Eye Institute (NEI) found that office-based treatment for patients with a common eye muscle coordination disorder, along with at-home reinforcement, is more effective than home-based programs in isolation. The research, reported in the Archives of Ophthalmology, involved more than 200 young people with a condition known as convergence insufficiency, which Wensveen said likely affects between 5 percent and 20 percent of the population, depending on the definition used and the age group studied.

"As the name implies, it's somebody who can't cross their eyes, and you might think that's a weird thing to have to be able to do. But, if you just consider the geometry of looking up close, your two eyes do have to turn in so that they're both pointing at the thing that you want to see," Wensveen said.

Left unattended, Wensveen said, convergence insufficiency can affect a student's performance in school, because reading can become very frustrating.

"These are the kids who would rather do anything but sit down and do their work," she said. "And I think that's why kids especially who have convergence insufficiency are sometimes mislabeled as having attention deficit hyperactivity disorder, because they just don't want to sit down."

While most eye care professionals treat convergence insufficiency using only home-based therapy, the NEI results indicated approximately 75 percent of patients treated both in the office and at home reported fewer and less severe symptoms related to reading and other close-up work. Symptoms of convergence insufficiency include loss of place and concentration while reading, reading slowly, eyestrain, headaches, blurry vision and double vision.

"Studies would suggest there is a possible relationship between convergence insufficiency and ADHD, in that about 10 percent of patients with convergence insufficiency had a history of ADHD at initial presentation or in follow-up exams," said Dr. Nick Holdeman, executive director of the University Eye Institute. "While the research does not support a direct relationship between the two diagnoses, it is recommended that evaluation

of convergence insufficiency should be undertaken in children diagnosed with ADHD."

Wensveen said the research results underscore that patients, or the parents of patients, advised to conduct eye exercises should seriously consider in-office vision therapy to get the results they desire.

"It's like using a physical trainer or a physical therapist. We will work with you to ensure that you do make progress toward being able to use your eyes comfortably and efficiently," she said.

Adapted from materials provided by University of Houston, via EurekAlert!, a service of AAAS.

Vaccine For Ear InfectionsPediatricians Reduce Ear Infections By Vaccinating

Children

September 1, 2007 — Infectious disease experts have completed clinical trials on a vaccine designed to eliminate chronic ear infections. The vaccine works on 7 pneumococcal bacterial strains that cause ear infections. Tests with 177,000 kids show around a 20% reduction in the number of children who experienced regular problems with ear infections.

Almost every child in America will have an ear infection by the age of two. It's one of the most common infections in babies and today, a simple shot may be the answer parents have been waiting for.

Pediatrician Katherine Poehling from Wake Forest University Medical Center not only treats sick kids, but knows first-hand what it's like to have a child suffering from an ear infection.

"You go home at night. They are just a little bit fussy, you put them down, and they are screaming all night," Poehling said.

She sees the benefits of the PCV-7 vaccine every day. It protects against seven strains of pneumococcal bacteria ... one of the most common causes of ear infections.

"It's a routine shot in the arm or actually, more commonly in the leg."

Babies receive four doses of the vaccine at age two months, four months, six months and again at 12 months. "The good news is we did find that children who are prone to frequent ear infections, which we define as three or four separate episodes in a year, are having a reduction," Poehling explains.

Since the vaccine got the okay by the FDA in 2000, ear infections in children have decreased nationally by 20-percent.

"While I may not personally see that my children have missed an ear infection, knowing that, in all likelihood, they had about one fewer ear infection is a good thing to know," Poehling said.

The PCV-7 vaccine was first used to fight meningitis and serious blood infections in children. Now it's helping elderly patients avoid these infections as well.

BACKGROUND: A new vaccine has been developed that can help reduce the number of infants and toddlers who develop frequent ear infections. It has been available since 2000, but a new study demonstrates its effectiveness against seven especially virulent strains of the bacteria that cause such infections.

WHAT THEY FOUND: A team of researchers at Wake Forest University Baptist Medical Center tracked some 27,000 children in New York, and 150,000 children in Tennessee from birth to age two -- all born after a vaccine was approved by the FDA to help protect children from potentially deadly strains of meningitis and other pneumococcal (a type of bacteria) diseases such as ear infections. The children received four doses of the vaccine: at two months, four months, six months, and between 12-15 months. The researchers found that number of children who developed frequent ear infections declined by 16% in Tennessee and 25% in New York after receiving the vaccine. They also found declines in the incidence of serious

cases of pneumococcal meningitis on both children and adults. Most children develop at least one ear infection by their second birthday, and 25 to 30 percent will experience frequent infections. Of those, one in every 15 to 25 will need to have ear tubes implanted by age two. Before the vaccine was introduced, about one-third of ear infections were caused by the pneumococcal bacteria. However, there are 90 known strains of the bacteria; the vaccine only protects against seven of them.

ABOUT EAR INFECTIONS: There are three main parts to the human ear: outer, middle and inner ear. The outer ear is the part you can see and opens into the ear canal leading to the middle ear. The middle ear is a closed, air-filled chamber, separated from the outer ear by the ear drum, and ventilated by the Eustachian tube. Sometimes the pressure in the middle ear becomes higher or lower than that in the outer ear, causing hearing loss, severe pain, and the accumulation of fluid in the middle ear. The inner ear contains the hearing nerve that leads to the brain. It detects sound vibrations and turns them into electrical nerve impulses, which the brain then interprets as sound. Chronic middle ear fluid is a condition known as otitis media with effusion (OME).When this condition becomes persistent, and antibiotics aren't effective, it is often treated with surgical insertion of ear ventilation tubes. More than 700,000 children undergo this procedure each year. But the tubes often fall out within four to seven months, and the patients have a recurrence of the condition.

HOW VACCINES WORK: Whenever a disease-causing micro-organism enters the body, the immune system mounts a defense, producing proteins to fight off the foreign substance. Vaccines stimulate the body's immune system by introducing a weakened form of a particular germ or virus, making the body think it is being invaded by a foreign organism. If a person who has been vaccinated is exposed later to the virus, he or she will be protected because the body already has the necessary antibodies to ward off infection