Visual Diagnosis and Care of the Patient with Special Needs: Syndromes

1

Visual Diagnosis and

Care of the Patient with

Special Needs

SyndromesGenetic AnomaliesBrain Injury

Dominick M Maino OD MEd FAAO FCOVD-A

Professor

PediatricsBinocular Vision Service

Illinois College of Optometry

Illinois Eye Institute 3241 S Michigan Ave Chicago Il 60616

312-949-7280 (Voice) 312-949-7358 (fax)

dmainoicoedu MainosMemoscom

wwwicoedu LyonsFamilyEyeCarecom

Taub M Bartuccio M Maino D (Eds)

Visual Diagnosis and Care of the Patient

with Special Needs Lippincott Williams amp

Wilkins New York NY2012

Steel G Maino D The Life Cycle Approach to Care for Patients with

Special Needs

Taub M Reddell AS Cerebral Palsy

Woodhouse M Maino D Down Syndrome

Berrry-Kravis E Maino D Fragile X

Coulter RA Autism

Schnell PH Maino D Jespersen R Psychiatric Illness and Associated

Oculo-visual Anomalies

Bartuccio M Browing RT Howell AC ADHD

Ciuffreda K Kapoor N Acquired Brain Injury

Maino D Donati R Pang Viola S Barry S Neuroplasticity

Lran BS Mayer DL Vision Impairment and Brain Damage

Children with Special Needs

bullLearning Disability

bullADHD

bullCerebral Palsy

bullDown Syndrome

bullFragile X Syndrome

Children with Special Needs

bullAutism

bullMental RetardationIntellectual Disability

bullAcquiredTraumatic Brain Injury

bullMental IllnessPsychiatric Illness

Learning Disabilities

ReadingDyslexia

Dyscalculia

Dysgraphia

2


ReadingDyslexia

Reading disabilities common

Dyslexia rare


ReadingDyslexia Language Based

Vision Based

Combination of LanguageVision


Dyscalculia (Math Disability)

3 and 6 of the population

Neurological Dyscalculia Deficits in working amp short term memory

Congenitalhereditary (Gerstmann syndrome Dyscalculia + Dysgraphia)


Dysgraphia Working memory (orthographic coding)

Motor planning

Attentional issues


ADHDADD Etiology

Brain Functioning

Heredity

Exposure to Toxic Substances

Brain Trauma Tumors Strokes or Disease

Functional Vision Problems


ADHDADD Not Caused By

Diet

Hormones

Vestibular dysfunction

Poor parenting

Television

3


ADHDADD Treatment

Medication

Psychotherapy

Education or Training

A combination of treatments

Oculomotor therapyVision Therapy

Cerebral Palsy

bull What is it

bull What is itrsquos etiology

bull What is itrsquos prevalenceincidence

bull How is it classified

bull What are itrsquos visual characteristics

Cerebral Palsy

bull Cerebral Palsy is a persistent but not

unchanging disorder of movement and

posture appearing in the early years of life

due to traumatic or inflammatory brain

damage

bull Affects virtually all motor systems

bull Can be acquired

Cerebral Palsy Etiology

Something goes awry just before during or

just after birth

Prenatal

Neonatal

Postnatal

Cerebral Palsy IncidencePrevalence

bull 764000+ children and adults

bull 500000 children under age of 18

bull 2-3 children out of 1000 (as low as 23 per 1000 to 36

per 1000)

bull 10000 babies born each year

bull 8000 - 10000 babies and infants are

diagnosed per year

4


bull Around 1200 to 1500 preschool-aged

children are diagnosed per year

bull births 10 of cases are acquired

(trauma)

bull Normal life spans 40 live to age 40

many living into their senior years


bull 75 of CP occurs during pregnancy 5 during childbirth

andor 15 after birth up to age 3

bull 80 the etiology is unknown

bull The number of new cases have increased 25 during the

past decade (1990rsquos)

bull Average lifetime cost per person of $921000 (in 2003

dollars)

Cerebral Palsy Classifications

bull Spastic - 61 to 769

bull DyskineticAthetoid - 10-15

bull Ataxic - lt5

bull Mixed

Cerebral Palsy Visual Characteristics

Wesson M Maino D Oculovisual findings in children with Down syndrome Cerebral

Palsy and mental retardation without specific etiology In Maino D (ed)

Diagnosis and management of special populations 1995 St Louis Mo Mosby-

Yearbook Inc17-54

bull Binocular acuity could be evaluated in

45 of individuals below age 13

bull For CP patients VAs are generally

decreased when compared to those

measured for individuals with Down

Syndrome

bull Much higher incidence of ocular disease

and neurological dysfunction

Cerebral Palsy Refractive Characteristics

Scheiman MM Optometric findings in children with cerebral palsy Am J Optom Physiol

Opt 198461321-333

bull 60 significant refractive error

bull Hyperopia (gt+150) 3X more common among

CP children than in non-affected individuals

bull Other studies (Black Breakey et al Duckman

LoCasio) support increased refractive error

being present

Cerebral Palsy Refractive Characteristic

bull Hyperopia present 3Xs

more than when compared

to myopia

bull Wesson amp Maino note bull many more hyperopes than myopes

bull average amount of significant myopia is greater

5

Cerebral Palsy Binocular

Characteristics

bull Prevalence of strabismus exceeds that of

general population by a factor of 10

bull Slightly more esotropia than exotropia

bull Dyskinetic Strabismus bull slow tonic deviation similar to vergence

bull change from ET to XT bull usually associated with athetoid classification

Cerebral Palsy InteractionTips

bull Positioning

bull Right tools (objective)

bull No sudden movement

bull No loud unexpected noises

bull Speak smoothly soothingly softlyhellipif

appropriate sing to the patient

bull Smile smile SMILE

Cerebral Palsy

Barca L Cappelli FR Di Giulio P Staccioli S Castelli E Outpatient assessment of

neurovisual functions in children with Cerebral Palsy Res Dev Disabil 2010 Mar-

Apr31(2)488-95 Epub 2009 Dec 5

hellipOverall 73 patients had impairments hellipthe majority of which presenting difficulties on both visuoperceptual and visuospatial tasks (79) hellip

Cerebral Palsy

bull Saunders KJ Little JA McClelland JF Jackson AJ Profile of refractive errors in cerebral palsy

impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome Invest

Ophthalmol Vis Sci 2010 Jun51(6)2885-90 Epub 2010 Jan 27

hellip A significantly higher prevalence and magnitude of refractive error was found in the CP group hellip Higher spherical refractive errors were significantly associated with the nonspastic CP hellip The presence and magnitude of astigmatism were greater when intellectual impairment was more severe hellip High refractive errors are common in CP pointing to impairment of the emmetropization process hellip

Cerebral Palsy

McClelland JF Parkes J Hill N Jackson AJ Saunders KJ

Accommodative dysfunction in children with cerebral palsy a population-based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Brain injury such as that present in CP has a significant impact on accommodative function These findings have implications for the optometric care of children with CP and inform our understanding of the impact of early brain injury on visual development

Cerebral Palsy

Ross LM Heron G Mackie R McWilliam R Dutton GN Reduced accommodative function in dyskinetic cerebral palsy a novel

management strategy Dev Med Child Neurol 2000 Oct42(10)701-3 Links

hellipThe near-vision symptoms were completely removed and reading dramatically improved with the provision of varifocal spectacles Varifocal lenses provide an optimal correction for far intermediate (ie for computer screens) and near distances (ie for reading) Managing this type of patient with varifocal spectacles has not been

previously reported It is clearly very important to prescribe an optimal spectacle correction to provide clear vision to

optimize learning

6

Down Syndrome

Children with Down syndrome have been included in regular academic

classrooms in schools across the country In some instances they are

integrated into specific courses while in other situations students are

fully included in the regular classroom for all subjects The degree of

mainstreaming is based in the abilities of the individual but the trend is

for full inclusion in the social and educational life of the community

From httpwwwndssorgaboutdsaboutdshtmlDown

Down Syndrome

bull What is it



bull What are itrsquos physicalvisual characteristics

Down Syndrome

bullLangdon Down 1866

bullldquoMongolismrdquo no longer used

bullMost common genetic anomaly

bullVariable levels of ability amp disability

Down Syndrome

From 1979 to 2003 the prevalence of

Down syndrome increased by 311

from 90 to 118 per 10000 live births

In 2002 prevalence among children and

adolescents aged 0 to 19 was 1 in 971 or

approximately 83400 children and

adolescents living with Down syndrome

in the Unites States

Down Syndrome PrevalenceIncidence

bull 1 in 12 for older mothers (gt=49yrs of age)

bull Most babies with Down syndrome born to

younger mothers (80 born to moms younger than 35)

bull Most frequently encounter ldquoviablerdquo genetic

anomaly

bull Most frequently encounter ldquospecialrdquo patient

bull Prevalence increasing (improved survival rates)

httpwwwnichdnihgovpublicationspubsdownsyndromecfm

7

You will see individual with Down

Syndrome in Your Office Down Syndrome Etiology

bull Genetics bull 95 demonstrate non-disjunction of one chromosome during meiosis (Trisomy 21)

bull 2-4 mosaicism bull 3-4 Robertsonian translocation of the long arm of chromosome 21 to another chromosome usually 14

bull risk of having a second child with Trisomy 21 or mosaic Down syndrome is 1 in 100 The risk is higher if one parent is a carrier of a translocated cell

Down Syndrome Etiology

bull Genetics Trisomy 21

Down Syndrome Refractive Error

Many more hyperopes than

myopes but those with myopia

tended to have higher

magnitudes

Up to 49 may exhibit some

astigmatism

Down Syndrome Binocular

Characteristics

23-44 have strabismus

(Wesson amp Maino) Down syndrome and

strabismus shows a constant unilateral

esotropia of less than 20 PD at near (Greatly reduced number show ET at distance)

Itrsquos suggested that the etiology is a high

ACA ratio rather that of a basic ET

Whatrsquos New in Down Syndrome

Al-Bagdady M Stewart RE Watts P Murphy PJ Woodhouse JM Bifocals

and Downs syndrome correction or treatment Ophthalmic Physiol

Opt 2009 Jul29(4)416-21 Epub 2009 May 11

Accommodation is reduced in approximately 75 of

children with Downs syndrome (DS) Bifocals have

been shown to be beneficial and they are currently

prescribed regularly hellip Bifocals are an effective

correction for the reduced accommodation in children

with DS and also act to improve accommodation with

a success rate of 65 hellip

8


Haugen OH Hovding G Eide GE Biometric measurements of the eyes in teenagers and

young adults with Down syndromeActa Ophthalmol Scand 2001 Dec79(6)616-25

Thinning of the corneal stroma may

account for the steeper cornea and the

high frequency of astigmatism in Down

syndrome due to lower corneal rigidity

It may also be of etiological importance

to the increased incidence of

keratoconus in Down syndrome

Haugen OH Hovding G Lundstrom IRefractive development in children

with Downs syndrome a population based longitudinal study Br J Ophthalmol

2001 Jun85(6)714-9

hellipAccommodation weakness may be of

aetiological importance to the high

frequency of refractive errors

encountered in patients with Downs syndrome

Stewart RE Woodhouse JM Cregg M Pakeman VH Association

between accommodative accuracy hypermetropia and strabismus

in children with Downs syndrome Optom Vis Sci 2007

Feb84(2)149-55

hellipThis study demonstrates the marked

association between under-

accommodation hypermetropia and

strabismus in children with Downs

syndrome hellip

Haugen OH Hovding GStrabismus and binocular function in children with

Down syndrome A population-based longitudinal studyActa Ophthalmol

Scand 2001 Apr79(2)133-9

hellipThe majority of the Down syndrome

children with strabismus have an

acquired esotropia and hence a

potential for binocularity

Hypermetropia and accommodation

weakness are probably important

factors in esotropia helliphellip

Stewart RE Woodhouse MJ Trojanowska LD In focus

the use of bifocal spectacles with children with Downs

syndromeOphthalmic Physiol Opt 2005 Nov25(6)514-22

helliphellipBased on the results of this

study eye examinations of children

with Downs syndrome should

routinely include a measure of

accommodation at near and bifocal

spectacles should be considered for

those who show under-

accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome

Most frequently encountered inherited form of

mental retardation (X-linked MR)

Often misdiagnosed in the past

ldquoNewrdquo syndrome that has caught the

imagination of researchers around the world

1st human disease shown to be caused by a

repeated nucleotide sequence

Fragile X Syndrome

X-linked MR 1600 in affected males

12500-4000 males 17000-8000 females

female carriers 1130-250 population

male carrier 1250-800

10 of undiagnosed ID in males

3 of previously undiagnosed ID in females

Fragile X Syndrome Characteristics

bull Large prominent ears

bull Long narrow face

bull Macro-orchidism

(80 affected men)

Other hypotonia seizures

recurrent otitis

media




bull Macro-orchidism (80

affected men)


recurrent otitis media





affected men)



10


bull First demonstrated genetic etiology of

learning disability

bull Variable mental retardation

bull Math language delay

bull Sensory integration problems

bull Attentional deficits

bull Psychiatric illnesses (shy)


Gaze Avoidance

How do you conduct an

examination on an individual

that wonrsquot look at you

Fragile X Syndrome Diagnosis

Genetics

bull Triplet nucleotide repeated sequence bullcytosine guanine guanine (CGG) bull0-50 CGG repeats normal 50-200 premutation gt 200 full syndrome

bull Fragile site on X chromosome (band

q273)

Fragile X Syndrome Ocular Findings

bull Strabismus (33-50)

bull Nystagmus

bull Refractive error

bull Accommodative dysfunctions

bull Oculomotor anomalies

bull Ocular Health

bull Perceptual dysfunction

Whatrsquos New in Fragile X Syndrome

bull Hatton DD Buckley E Lachiewicz A Roberts J Ocular status of boys with fragile X syndrome a

prospective study J AAPOS 1998 Oct2(5)298-302

hellipobserve a higher prevalence of strabismus than

that found in the general population (8 vs 05

to 1hellip 17 of the sample did have significant

refractive errors In addition to evaluating the

ocular motility of children with fragile X

syndrome cycloplegic refraction should also be

performed to determine whether refractive

problems are present

11


Block SS Brusca-Vega R Pizzi WJ Berry-Kravis E Maino DM Treitman TMCognitive and visual processing skills and their relationship to mutation size in full and premutation female fragile X carriersOptom Vis Sci 2000 Nov77(11)592-9

hellipfull mutation female carriers performed more poorly in visual-motor processing and analysis-synthesis on the Woodcock-Johnson Psycho-Educational Battery-Revised The Developmental Test of Visual Motor Integration and on five of the seven subtests of the Test of Visual-Perceptual Skills Regression analyses revealed significant negative correlations between mutation size and cognitive ability hellip


Effect of CX516 an AMPA-modulating compound on cognition

and behavior in fragile X syndrome a controlled trial Berry-

Kravis E Krause SE Block SS Guter S Wuu J Leurgans S

Decle P Potanos K Cook E Salt J Maino D Weinberg D Lara

R Jardini T Cogswell J Johnson SA Hagerman R J Child

Adolesc Psychopharmacol 2006 Oct16(5)525-40PMID

17069542

Cognitive and visual processing skills and their relationship to

mutation size in full and premutation female fragile X carriers

Block SS Brusca-Vega R Pizzi WJ Berry-Kravis E Maino DM

Treitman TM Optom Vis Sci 2000 Nov77(11)592-9PMID

11138833


The fragile X female a case report of the visual visual perceptual

and ocular health findings Amin VR Maino DM J Am Optom

Assoc 1995 May66(5)

Optometric findings in the fragile X syndrome Maino DM Wesson

M Schlange D Cibis G Maino JH Optom Vis Sci 1991

Aug68(8)

Mental retardation syndromes with associated ocular defects Maino

DM Maino JH Maino SA

J Am Optom Assoc 1990 Sep61(9)707-16

Ocular anomalies in fragile X syndrome Maino DM Schlange D

Maino JH Caden B J Am Optom Assoc 1990 Apr61(4)316-23

Fragile X-associated tremorataxia syndrome

(FXTAS)

reported in 33-40 of men older than 50 years and less

frequently (4-8) in older women with premutations in the

fragile X mental retardation (FMR1) gene

Clinical features (FXTAS) incontinence impotence cerebellar

ataxia peripheral neuropathy autonomic dysfunctionorthostatic

hypotension severe intention tremor and other signs of

neurodegeneration (brain atrophy memory loss and dementia

anxiety depression and irritability) Premature ovarian failure

in 25 of women with premutations this represents a 30-fold

increase compared with the general population

Autism

Factors such as younger age of diagnosis broadening of diagnostic criteria improvements in the availability

of services and better awareness of the disorder have all been attributed to the change in autism

prevalence However recent epidemiological studies indicated that while these factors do account for a

portion of the change they cannot account for all of the increase alone

Autism

Do Parents cause their children to be autistic There are autistic children born to parents who do not fit the autistic parent personality pattern

Parents who do fit the description of the supposedly pathogenic parent have normal non-autistic

children

Frequently siblings of autistic children are normal

Autistic children are behaviorally unusual from the moment of birth

There is a consistent ratio of three or four boys to one girl

Virtually all cases of twins reported in the literature have been identical with both twins

afflicted

Autism can occur or be closely simulated in children with known organic brain damage

The symptomatology is highly unique and specific

There is an absence of gradations of infantile autism which would

create blends from normal to severely afflicted

12

Autism Etiology

Yeast infections

Intolerance to specific food substances

(Gluten intolerance (Leaky Gut SyndromeCasein intolerance causing

intestinal permeability and allowing improperly digested peptides to enter

the bloodstream and cross the blood-brain barrier which may mimic

neurotransmitters and result in the scrambling of sensory input Ive also

heard Leaky Gut Syndrome described as lack of the beneficial bacteria

that aids digestion and that the resulting matter in the bloodstream invokes

an unnecessary immune reaction)

Phenolsulphertransferase (PST) deficiency--theory that some with autism are

low on sulphate or an enzyme that uses this called phenol-

sulphotransferase-P This means that they will be unable to get rid of amines

and phenolic compounds once they no longer have any use for them These

then stay in their body and may cause adverse effects even in the brain

Autism Etiology

Brain injury Constitutional vulnerability

Developmental aphasia Deficits in the reticular

activating system An unfortunate interplay

between psychogenic and

neurodevelopmental factors Structural

cerebellar changes Genetic causes Viral

causes Immunological ties Vaccines

Seizures

Autism Etiology

My Goodness Maino DM Viola SG Donati R The

Etiology of Autism Optom Vis

Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism

Impairment in social interactions

Impairment in communication

Restricted repertoire of activities

Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder

Autism US FDA Statement

Childhood

Disintegrative

Disorder

IOM Report No Link Between Vaccines and Autism

By Michelle Meadows

There is no link between autism and the

measles-mumps-rubella (MMR) vaccine or the

vaccine preservative thimerosal according to a

report released by the Institute of Medicines

(IOM) Immunization Safety Review

Committee

httpwwwfdagovfdacfeatures2004504_iomhtml

Autism

Childhood

Disintegrative

Disorder

Thompson WW Price C Goodson B Shay DK Benson P Hinrichsen

VL et al Early thimerosal exposure and neuropsychological outcomes at 7

to 10 years N Engl J Med 2007 Sep 27357(13)1281-92

Our study does not support

a causal association between early

exposure to mercury from thimerosal-containing vaccines and immune

globulins and deficits in neuropsychological functioning at the age of 7 to

10 years

Autism

Childhood

Disintegrative

Disorder

Andrew Wakefield (born 1956) is a British former

surgeon and researcher best known for his discredited

work regarding the MMR vaccine and its claimed connection

with autism and inflammatory bowel disease Wakefield was the lead author

of a 1998 study published in The Lancet which reported bowel symptoms in

twelve children diagnosed with autism spectrum disorders to which the authors

suggested a possible link with the MMR vaccine Though stating We did not

prove an association between measles mumps and rubella vaccine and the

syndrome described the paper tabulated parental allegations and adopted these

allegations as fact for the purpose of calculating a temporal link between receipt

of the vaccine and the first onset of what were described as behavioural

symptomsldquo

Summary

Autism

Mental Retardation without Specific Etiology

Most frequently encountered form of Intellectual

Disability

4000 known Online Mendelian Inheritance

in Man

httpwwwncbinlmnihgovomim

25 of the etiologies are unknown

14

Mental Retardation Classification

Classification IQ

MildEducable Mentally Handicapped 50-70

ModerateTrainable Mentally Handicapped 35-55

Severe 20-40

Profound below 20

AcquiredTraumatic Brain Injury

Neuroplasticity Maino D Neuroplasticity Teaching an Old Brain New Tricks Rev Optom

2009 46(1)62-6466-70

(httpwwwrevoptomcomcontinuing_educationtabviewtestlessonid106025)


Neuroplasticity amp Rehabilitation

Use it or lose it If you do not drive specific brain functions functional

loss will occur

Use it and improve it Therapy that drives cortical function enhances that

particular function

Specificity The therapy you choose determines the resultant plasticity and

function

Repetition matters Plasticity that results in functional change requires

repetition

Intensity matters Induction of plasticity requires the appropriate amount

of intensity


Neuroplasticity amp Rehabilitation Time matters Different forms of plasticity take place at different times

during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also possible in an

adult brain

Transference Neuroplasticity and the change in function that results from

one therapy can augment the attainment of similar behaviors

Interference Plasticity in response to one experience can interfere with the

acquisition of other behaviors

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for

rehabilitation after brain damage J Speech Lang Hear Res 2008 Feb51(1)S225-39


Post Trauma Vision Syndrome SymptomsSigns

Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity

Attention or concentration difficulties


bull Staring behavior (low blink rate)

bull Spatial disorientation

bull Losing place when reading

bull Canrsquot find beginning of next line when

reading

bull Comprehension problems when reading

bull Visual memory problems

15


bull Pulls away from objects when they are

brought close to them

bull Exotropia or high exophoria

bull Accommodative insufficiency

bull Convergence insufficiency

bull Poor fixations and pursuits

bull Unstable peripheral vision


bullAssociated neuromotor

difficulties with balance

coordination and posture

bullPerceived movement of

stationary objects


Visual Midline Shift Syndrome

bullDizziness or nausea

bullSpatial disorientation

bullConsistently stays to one side of

hallway or room

bullBumps into objects when walking



bull Poor walking or posture leans back on

heels forward or to one side when

walking standing or seated in a chair

bull Perception of the floor being tilted

bull Associated neuromotor difficulties with

balance coordination and posture


References

TBI a Major Cause of Disability

by Marc B Taub OD FAAO FCOVD

Clinical Oculomotor Training in Traumatic Brain

Injury by Kenneth J Ciuffreda OD PhD FAAO

FCOVD-A Diana P Ludlam BS COVT Neera

Kapoor OD MS FAAO


References

bull Myopia and Accommodative Insufficiency

Associated with Moderate Head Trauma

by Steve Leslie B Optom FACBO FCOVD

bull Neuro-Optometry and the United States Legal

System

by Theodore S Kadet OD FCOVD R E

Bodkin JD MBA Attorney-at-Law

16


References

bull Oculo-Visual Evaluation of the Patient with

Traumatic Brain Injury

by Maria Mandese OD

bull Traumatic Brain Injury and Binasal Occlusion

by Alissa Proctor OD

httpwwwcovdorgHomeOVDJournalOVD401tabid263Defaultaspx

Questions Contact

Dominick M Maino OD MEd FAAOFCOVD-A

Professor PediatricBinocular Vision Service

Illinois Eye Institute Illinois College of Optometry

3241 S Michigan Ave Chicago Il 60616

312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

2


ReadingDyslexia

Reading disabilities common

Dyslexia rare


ReadingDyslexia Language Based

Vision Based

Combination of LanguageVision


Dyscalculia (Math Disability)

3 and 6 of the population

Neurological Dyscalculia Deficits in working amp short term memory

Congenitalhereditary (Gerstmann syndrome Dyscalculia + Dysgraphia)


Dysgraphia Working memory (orthographic coding)

Motor planning

Attentional issues


ADHDADD Etiology

Brain Functioning

Heredity

Exposure to Toxic Substances

Brain Trauma Tumors Strokes or Disease

Functional Vision Problems


ADHDADD Not Caused By

Diet

Hormones

Vestibular dysfunction

Poor parenting

Television

3


ADHDADD Treatment

Medication

Psychotherapy




Cerebral Palsy

bull What is it





Cerebral Palsy





damage





just after birth

Prenatal

Neonatal

Postnatal





per 1000)



diagnosed per year

4





(trauma)










dollars)




bull Ataxic - lt5

bull Mixed





Yearbook Inc17-54






Syndrome





Opt 198461321-333






being present




to myopia



5


Characteristics







bull Positioning







Cerebral Palsy



Apr31(2)488-95 Epub 2009 Dec 5


Cerebral Palsy





Cerebral Palsy




Cerebral Palsy





optimize learning

6

Down Syndrome








Down Syndrome

bull What is it




Down Syndrome





Down Syndrome














anomaly




7












magnitudes


astigmatism


Characteristics










Opt 2009 Jul29(4)416-21 Epub 2009 May 11








8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

3


ADHDADD Treatment

Medication

Psychotherapy




Cerebral Palsy

bull What is it





Cerebral Palsy





damage





just after birth

Prenatal

Neonatal

Postnatal





per 1000)



diagnosed per year

4





(trauma)










dollars)




bull Ataxic - lt5

bull Mixed





Yearbook Inc17-54






Syndrome





Opt 198461321-333






being present




to myopia



5


Characteristics







bull Positioning







Cerebral Palsy



Apr31(2)488-95 Epub 2009 Dec 5


Cerebral Palsy





Cerebral Palsy




Cerebral Palsy





optimize learning

6

Down Syndrome








Down Syndrome

bull What is it




Down Syndrome





Down Syndrome














anomaly




7












magnitudes


astigmatism


Characteristics










Opt 2009 Jul29(4)416-21 Epub 2009 May 11








8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

4





(trauma)










dollars)




bull Ataxic - lt5

bull Mixed





Yearbook Inc17-54






Syndrome





Opt 198461321-333






being present




to myopia



5


Characteristics







bull Positioning







Cerebral Palsy



Apr31(2)488-95 Epub 2009 Dec 5


Cerebral Palsy





Cerebral Palsy




Cerebral Palsy





optimize learning

6

Down Syndrome








Down Syndrome

bull What is it




Down Syndrome





Down Syndrome














anomaly




7












magnitudes


astigmatism


Characteristics










Opt 2009 Jul29(4)416-21 Epub 2009 May 11








8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

5


Characteristics







bull Positioning







Cerebral Palsy



Apr31(2)488-95 Epub 2009 Dec 5


Cerebral Palsy





Cerebral Palsy




Cerebral Palsy





optimize learning

6

Down Syndrome








Down Syndrome

bull What is it




Down Syndrome





Down Syndrome














anomaly




7












magnitudes


astigmatism


Characteristics










Opt 2009 Jul29(4)416-21 Epub 2009 May 11








8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

6

Down Syndrome








Down Syndrome

bull What is it




Down Syndrome





Down Syndrome














anomaly




7












magnitudes


astigmatism


Characteristics










Opt 2009 Jul29(4)416-21 Epub 2009 May 11








8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

7












magnitudes


astigmatism


Characteristics










Opt 2009 Jul29(4)416-21 Epub 2009 May 11








8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

8













2001 Jun85(6)714-9








Feb84(2)149-55





syndrome hellip



Scand 2001 Apr79(2)133-9


















accommodation

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

9

Fragile X Syndrome

bull What is it




Fragile X Syndrome








Fragile X Syndrome


12500-4000 males 17000-8000 females









(80 affected men)


recurrent otitis

media





affected men)







affected men)



10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

10



learning disability







Gaze Avoidance





Genetics



q273)



bull Nystagmus




bull Ocular Health













11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

11











17069542





11138833




Assoc 1995 May66(5)



Aug68(8)







(FXTAS)











Autism





Autism



children





afflicted





12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

12

Autism Etiology

Yeast infections














Autism Etiology








Seizures

Autism Etiology



Dev 2009(40)3150-156

Autism Etiology

What the research

showshellip

Autism




Autism

Autism

Asperger

Syndrome

Rett Syndrome

Childhood

Disintegrative

Disorder

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

13

Autism

Childhood

Disintegrative

Disorder


Childhood

Disintegrative

Disorder


By Michelle Meadows






Committee


Autism

Childhood

Disintegrative

Disorder








10 years

Autism

Childhood

Disintegrative

Disorder












symptomsldquo

Summary

Autism



Disability


in Man



14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

14


Classification IQ



Severe 20-40

Profound below 20



2009 46(1)62-6466-70





loss will occur


particular function


function


repetition


of intensity



during therapy



adult brain









Double vision

Headaches

Blurred vision

Dizziness or nausea

Light sensitivity







reading



15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

15














stationary objects






hallway or room











References






Kapoor OD MS FAAO


References





System



16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

16


References



by Maria Mandese OD




Questions Contact





312-949-7280 (phone) 312-949-7660 (fax)

dmainoicoedu


MainosMemoscom

Visual Diagnosis and Care of the Patient with Special Needs: Syndromes

Health & Medicine

Transcript of Visual Diagnosis and Care of the Patient with Special Needs: Syndromes