Wednesday, December 3, 2014

Vision and learning Ted Talk

Here is a new (and excellent) Ted Talk by Dr. Vicky Vandervort on how treatable vision problems can cause learning problems, including a great explanation and demonstration of the most common eye movement problem that interferes with learning: convergence insufficiency.

The video also includes a demonstration of a real patient's eyes as they move inefficiently across a page in an attempt to read.

As explained in the video, many well meaning professionals, including many eye doctors, are not aware of an do not test for eye movement disorders, leaving patients without any help. Developmental optometrists (like Dr. Randhawa) diagnose and treat eye movement problems that interfere with learning.  To find one near you visit

Saturday, November 29, 2014

Eye make-up and discomfort

Eye make-up is very popular and millions of women around the world use it.  Some eye cosmetics, like eyeliner, is applied very close to the surface of the eye where it can cause eye disease and ocular discomfort.  What impact does eye make-up on ocular discomfort?  That is the question investigated in a study published in the November 2012 issue of the journal Ophthalmic & Physiological Optics.  

The authors of the study took surveyed 1360 women aged 20-34 and found that over 80% of them used eye cosmetics regularly and over half used at least three different eye cosmetics regularly.  Mascara was the most common type used.

The survey results lead the authors to conclude that the use of multiple eye cosmetics is extensive and
associated with the perception of ocular discomfort. The results suggest that taking a break from eye make-up might make your eyes feel better.  However, the use of makeup could be the cause of diseases such as dry eye, tear gland dysfunction or blepharitis (inflammation of the eyelid where the eyelashes grow).

However, if you love your make-up and can't do without it, see your optometrist to determine if any of those other eye issues are the cause of your discomfort.  It may be possible to treat the other conditions while keeping you in your make-up.


Eye cosmetic usage and associated ocular comfort
Alison Ng, Katharine Evans, Rachel North and Christine Purslow
School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
Citation information: Ng A, Evans K, North R & Purslow C. Eye cosmetic usage and associated ocular comfort. Ophthalmic Physiol Opt 2012, 32,
501–507. doi: 10.1111/j.1475-1313.2012.00944.x

Wednesday, October 15, 2014

The reason for childhood eye exams

Childhood is the critical time to look after a child's health.  Untreated childhood vision problems are associated with poor social, economic and academic outcomes.  Most vision problems are treatable and are diagnosed during an eye exam with your optometrist. Don't let childhood vision problems grow up to be adult issues.

A 2011 study published in the journal,Pediatrics, found that in addition to refractive errors that can be corrected with glasses such as myopia and astigmatism, ocular disorders like strabismus (eye-turn, cross eyes) and amblyopia (lazy eye) that occur in infants, toddlers, and children may present lifelong problems for the child. Strabismus and amblyopia require more intense treatment such as vision therapy or surgery.

Children who become adults with these conditions must adapt and compensate for them. Moreover, vision problems that were present in childhood may continue to plague the patient into adulthood, affecting overall health, self-perception, educational attainment, job choices, and a number of other social factors.

Basically, people with these disorders find it very difficult to do things that people with healthy vision take for granted, like effortlessly understanding visual learning. The fact that 80% of classroom learning happens through our visual system means a child with lazy eye, for example, is at a significant disadvantage in school.

Here is a nice childhood vision infographic by Doctors of Optometry Canada.

Vision and Learning

In honour of Children's vision month, here is a nice infographic from Doctors of Optometry Canada .  To learn more about vision and learning click here.

Saturday, August 30, 2014

Aeroplan promotion - September to October, 2014

We have a huge Aeroplan promotion that runs from September to October 2014.  Here are the highlights:

  1. 1000 Bonus Miles for New patients!
  2. 500 Bonus Miles with the purchase of premium personalized lenses
  3. Up To 600 Bonus Miles on Select Contact Lenses!

1000 Bonus Miles for New patients!

New Patients! Earn 1000 Bonus Miles with a completed eye exam
Bonus mile offer only applies to Aeroplan Members who are NEW patients of FYidoctors (and participating Vision Source locations) and who have completed an eye examination.

One-time bonus offer per Aeroplan Member for NEW patients of FYidoctors (and participating Vision Source locations) only.

Members are considered NEW if they have never been to an FYidoctors (or participating Vision Source locations) location.

If you are not sure if you have been to an FYidoctors location (or participating Vision Source location) before, please visit and search by optometrist or city/province.

Aeroplan Members cannot receive 500 bonus miles for other members in the event the member pays for another member’s exam(s).

Aeroplan Card must be presented at time of payment to receive your Aeroplan Miles.
Bonus miles will be credited to Aeroplan Members’ accounts within one week of payment.

Some restrictions may apply. Please see our clinic for complete details.  Bonus Miles offer cannot be combined with the Free Eyeglasses promotion.

500 Bonus Miles with the purchase of premium personalized lenses

Qualifying lens products include TruClear SD and TruClear XD lenses. Patients can choose either single vision or progressive designs. For information on materials and prescription range availability, click here.

Please call or visit our clinic for more details.

Bonus Miles are awarded PER lens pair purchase. For example, one pair of lenses gets you 500 Bonus Miles; two pairs of lenses gets you 1000 Bonus Miles.

Aeroplan member may purchase as many pairs as they like.

Aeroplan Card must be presented at time of payment to receive your Aeroplan Miles.
Bonus miles will be credited to Aeroplan Members’ accounts within one week of payment.
Some restrictions may apply. Please visit our clinic for complete details.

Do You Wear Contact Lenses? Earn Up To 600 Bonus Miles on Select Contact Lenses!

Earn 250 Miles on any 4 box purchase of eligible Alcon products.
Earn 600 Miles on any 8 box purchase of eligible Alcon products.

Eligible Products:

-          DACP (Sphere, Multi Focal and Toric) – 90 packs
-          Dailies Total One – 90 packs
-          Air Optix Aqua (Sphere, Multi Focal and Toric)
-          Night and Day

Non eligible contact lens products:

-          All 30 pack purchases
-          All Freshlook products

Aeroplan Card must be presented at time of payment to receive your Aeroplan Miles.

Aeroplan Card must be presented at time of payment to receive your Aeroplan Miles.

Bonus miles will be credited to Aeroplan Members’ accounts within one week of payment.

Some restrictions may apply. Please visit this clinic for more information.


Aeroplan® and the Aeroplan® logo are registered trademarks of Aimia Canada Inc.

Sunday, August 24, 2014

Eyewear trends for fall 2014

The website, is an excellent source for info on eyewear trends.  They have a excellent post on trends for Fall 2014.  Click here to visit  Here is a taste of Fall 2014:

Friday, August 1, 2014

Vision therapy for saccades improves reading

Dr. Dominick Maino has an excellent post on the blog of the College of Optometrists in Vision Development about a new study published in the journal Clinical Pediatrics by a group of researchers including one from the Illinois College of Optometry that shows that vision training (vision therapy) for saccadic eye movements improves reading in children. Read more

Saturday, July 5, 2014

Do clouds block UV rays?

According to the Doctors of Optometry Facebook page, UV rays are so strong, up to 90% of rays can penetrate through the clouds. They can also reflect off surfaces such as sand, snow and water. No matter the day, always protect your eyes from invisible UV rays.

A significant amount of UV rays can actually enter your eyes even you are wearing UV blocking eyeglasses.  That's because those glasses block the UV rays that come at them from the front but UV rays can reflect of the back of the lens (the side of the lens that is closest to your eye) and into your eyes.  To stop that, you should wear advanced UV protection lenses with an ESPF (eye-sun-protection factor) of 25 or higher.

Learn more here.

Sunday, June 22, 2014

How to be visible at night to older drivers

A new study says that it takes longer for older drivers to notice pedestrians at night. And pedestrians are more visible to them if they wear reflective strips on their movable joints like such as shoulders, elbows, wrists, waist, knees and ankle. Eye doctors can test seniors to ensure that they are safe driving at night. Learn more.

Wednesday, June 4, 2014

Eye movement dysfunctions, their treatment and reading related problems in patients with mild traumatic brain injury (mTBI)

We have large vision therapy practice at our Vancouver vision and eye clinic where one category of patients that we treat come to us with traumatic brain injuries that have caused vision problems in the patients, including reading difficulties.  

Reading is a complex task involving a number of functions, abilities and visual skills.  Reading has oculomotor, sensory, cognitive, and attentional components, and all of these must be integrated. If any one of them is affected by a brain injury, they reading is likely to be negatively affected as well.   For example, accurate eye movements are essential for efficient reading. This means that if a traumatic brain injury (TBI) has affected the normal control of eye movements, then reading will likely be adversely impacted.

How can doctors fix these problems?  That was the issue investigated by the authors of a study published in 2007 in the Journal of Behavioral Optometry.  The researchers looked at three studies done by their research group which involved versional oculomotor dysfunctions, their related reading problems, and treatment in a group of patients with mild TBI whose injury affected their vision and reading ability.

Let's take a second to make sure we understand a few of those scientific terms.  A "version" is an eye movement involving both eyes moving together as a team in the same direction.  A "versional oculomotor dysfunction" is a problem in the way the eyes move together as a team.

The results have shown that in a large clinical sample (160 patients), approximately 90% had one or more oculomotor deficits, such as convergence insufficiency or abnormal saccadic tracking- a saccade is a fast movement of the eye like the moments the eye does when tracking words on a printed page.  Deficits in these areas have the potential to interfere with reading performance.  

Out of the 160 patients examined, thirty-three of them completed a program of vision therapy. Of the patients who received vision therapy, an impressive ninety percent of them experienced improvement in at least one related sign and one related symptom. 

The researchers also laboratory-tested 9 of the study subjects who had  eye-movement-related reading problems and found that all of them improved their overall reading performance and versional eye tracking ability after vision therapy.

There are a number of conclusions to draw from this study:
  1. eye movement dysfunctions are common in individuals with mild TBI;
  2. vision therapy can effectively treat eye movement dysfunctions;
  3. the positive vision therapy findings demonstrate that the adult brain can be changed and molded (re-wired) with vision therapy and this shows the presence of considerable neuroplasticity in adults with mild traumatic brain injury;
  4. optometric vision therapy should be used to treat  visually symptomatic patients with TBI who have eye-movement-based reading problems.

More information

To learn more about vision therapy and brain injuries, visit:
Another excellent resource is the website of NORA, the Neuro-Optometric Rehabilitation Association.


Related Articles
Traumatic brain injury often results in convergence insufficiency 
Dec 11, 2012

Brain injuries and vision problems
Nov 04, 2012

Eye movement dysfunctions, their treatment and reading relateed problems in patients with traumatic brain injury
Dec 28, 2012

Vision problems after car accident are caused by brain injury 
Nov 07, 2012

- See more at:

Image courtesy of Victor Habbick /

Monday, June 2, 2014

Binocular vision and older adults

Binocular vision, refers to the way that the two eyes work together as a team.  Deficiencies in this ability  is one of the major categories of vision disorder that is effectively treated with vision therapy. Recent research has sought to determine the prevalence of binocular vision disorders in adults aged 60 or over and has found that the prevalence of binocular vision disorders increases as we age.

The results of a study from researchers at Canada's University of Waterloo found that as many as 27% of adults in their sixties have a binocular vision or eye movement disorder and 38% of adults over the age of 80 have such a vision disorder. That's compared to the general population in which 20% of people have a binocular vision disorder.

Binocular vision disorders can cause problems in reading, driving, motion sickness and depth perception. The latter problem is of particular concern among the elderly, as people with reduced depth perception are at greater risk of falls.

According to the press release issued by the University of Waterloo to publicize the results of the study, vision therapy and eye-glasses are effective treatments for binocular vision disorders:

Although the study suggests that the rate of binocular vision disorders in older adults is higher than expected, there is good news. Many binocular vision disorders are treatable with glasses, vision therapy, or in some cases surgery. 
Related Articles

January 23, 2014

Sunday, June 1, 2014

Demodex mites in eyelashes - treatment in Vancouver

What is demodex?

Demodex is an eight-legged mite that lives in hair folicles and sebaceous glands. Some species of demodex commonly infect humans. You can catch demodex through contact with the mite or from or dust containing eggs.

Demodex and dry, irritated eyes

The two types of Demodex that infect humans are D. brevis and D. folliculorum.  D. brevis is about 0.2 mm long and tends to live inside the eye lash’s sebaceous glands and in meibomian glands. Meibomian glands are critical for proper tear production and when these glands don't work properly, dry eye disease often results. That's why D. brevis can be associated with meibomian gland disease and deficient tear quality.  

D. folliculorum buries itself face down near the root of the eyelash and it is associated with anterior blepharitis, which is inflamed, irritated and itchy eyelids.

Treatment options for demodex infestation

There are a number of options for treating demodex infestation.  One of the most effective treatments that we use in our Vancouver optometry clinic involves a series of in-office procedures involving the use of anesthetic, tea tree oil, antibiotics and topical steroids.

If I have demodex, what about the rest of my family?

Doctors frequently observe that if one family member has an infestation, other family members are frequently also infected due to close contact.  It is a good idea to make appointments for family members if you are diagnosed with a demodex infection.

Thursday, May 22, 2014

Surgery for intermittent exotropia

How effective is surgery for intermittent exotropia? The authors of one study noted that 62% of intermittent exotropia surgery patients achieved only a fair or poor outcome and that 60% of the patients required at least one re-operation."

See: Pineles SL, Ela-Dalman N, Zvansky AG, Yu F, Rosenbaum AL.Long-term results of the surgical management of intermittent exotropia. J AAPOS. 2010 Aug;14(4):298-304

Monday, May 19, 2014

Babiators - sunglasses for children

We see a lot of kids at our Vancouver eye clinic. One important aspect of children's eye care is protecting young eyes from the sun. The eyes of children are much more vulnerable to damage from UV rays. The lenses in their eyes do not block as much UV radiation as in adults. Follow the same precautions as you would for an adult, but be sure to choose sunglasses that fit their smaller faces, have impact-resistant lenses, and have lenses large enough to shield the entire eye.

According to a new report issued by The Vision Council in May 2012, parents protect own eyes from the sun better than they protect their kids eyes. The report shows that while 73% of adults do wear sunglasses, only 58% of them make their children wear sunglasses.

Parents may hold back on sunglasses for their kids because of cost or because kids are rough and forgetful with their eye wear resulting in lost or broken sunglasses. To fix this problem, we have begun carrying Babiators kids' sunglasses. The photo above is Dr. Randhawa's daughter wearing her new Babiators in the park. Babiators have a great guarantee to replace lost or broken sunglasses within one year, as long as you register your new pair of Babiators online.

Here is the guarantee straight from their website:

Babiators are durable — made to withstand whatever adventure your child dreams up. We know life can be a bit unpredictable, so should you lose or break your Babiators within one year of purchase, we'll send you a replacement pair — free. Simply register for your Lost & Found Guarantee within 30 days of purchase, and you're all set.register here

UV exposure over time causes eye disease and vision loss

The Vision Council report suggests that too many people still do not understand the serious damage that UV exposure can have on your eyes. Even fewer realize that it is cumulative exposure over time – which happens on both sunny and cloudy days – that leads to vision threatening diseases. One such disease, macular degeneration, leads to permanent vision loss and their is no cure.

The solution is to wear sunglasses and regular eye glasses with proper UV protection. Kids need this more than adults because the lens of a child’s eye is not as good as blocking UV rays as the lens of an adult eye. 

What cataracts and macular degeneration look like

Wearing sunglasses is a serious preventative health measure. Here is what macular degeneration can do to your vision:

UV damage also causes cataracts. Here is what cataracts can do to your vision:

Monday, May 5, 2014

Cataract surgery - risks and complications

Cataract Surgery Complications, Dr. M.K. Randhawa
At our Vancouver eye clinic, we manage a large number of patients with cataracts.  That includes referring them for surgery where appropriate, preparing them for surgery with medication that will make it easier for them to deal with common side effects of the surgery such as dry eye and also managing their post-operative care.

One of the most important things that eye doctors do for cataract surgery patients is explain the procedure as well as it's risks and complications. A new study published in the Canadian Journal of Ophthalmology found that some type of complication during the surgery were found in 10.35% of patients and complications arising after the procedure affected 26.63% of patients. That's a lot of patients and it highlights the need to have effective care for the patient after the surgery.

The most common complication during surgery was posterior capsule rupture (2.83%), whereas the most common postoperative complications were corneal edema (15.42%) and ocular hypertension (7.34%). These are described below.

Posterior capsule rupture

The lens of the eye is held in place by a thin membrane called the capsule. The purpose of cataract surgery is to remove the lens of the eye because it has become cloudy, causing bad vision, and then to replace it with a clear artificial lens.  Surgeons want to keep the capsule in place to hold the new artificial lens implant. If the capsule is perforated during the surgery, it is called a capsule rupture, which can lead to various complications. 

Corneal edema

The cornea is the clear dome covering the colored part of the eye.  The cornea lets light into the eye and focuses it, producing clear vision.  Sometimes the cornea swells after surgery.  This is called corneal edema and it causes cloudy vision. Other names for corneal edema after cataract surgery include “pseudophakic corneal edema,” “pseudophakic bullous keratopathy,” and “aphakic bullous keratopathy.”

Patients with corneal edema usually notice blurred vision or halos around lights. At the beginning, blurriness is often worse in the morning, but improves over the course of the day.
Ocular Hypertension

Ocular hypertension is increased pressure inside the eye.  High intra-ocular pressure can damage the optic nerve and cause permanent vision loss if not treated.


Canadian Journal of Ophthalmology. Journal Canadien d'Ophtalmologie
Factors Affecting Cataract Surgery Complications and Their Effect on the Postoperative Outcome
Can J Ophthalmol 2014 Feb 01;49(1)72-79, N González, JM Quintana, A Bilbao, S Vidal, N Fernández de Larrea, V Díaz, J Gracia

Sunday, April 20, 2014

Strabismus - depression and anxiety

depression and anxiety are prevalent in patients with strabismus - Dr. M.K. Randhawa, optometrist, Vancouver, BC
Sometimes eye health is also mental health.  A new study from The British Journal of Ophthalmology looked at the psychological and social well-being of 220 patients with strabismus.

In patients with Strabismus, the two eyes do not line up together properly to look at the same object.  In some people with strabismus the condition can be very obvious to any onlooker who will immediately notice that the eyes are clearly misaligned, crossed or turned outward or turned inward.

Strabismus is often called "crossed eyes" when the eyes are turned inward towards the nose or "wall eyes" when the eyes are turned out towards the wall.  However, it is important to be aware that in some cases strabismus is only obvious to an eye doctor but still must be taken seriously and treated. Alternative names for strabismus include, crossed eyes, esotropiaexotropia, hypotropia, hypertropia, squint, walleye, misalignment of the eyes, comitant strabismus, noncomitant strabismus.

The authors of the new study found that 11% of strabismus patients experienced clinical depression and 24% experienced clinical anxiety. Negative beliefs about the condition were chiefly responsible for these numbers, even more so that clinical factors such as double vision.

The study rings true given our experience treating many patients with strabismus in our Vancouver eye clinic.

The study highlights the need for doctors to pay attention to the psychological and social aspects of strabismus when treating patients, as these factors are significantly correlated to the patient's well-being.


The British Journal of Ophthalmology
Factors Associated With Quality of Life and Mood in Adults With Strabismus

Br J Ophthalmol 2014 Jan 03;[EPub Ahead of Print], HB McBain, KA Mackenzie, C Au, J Hancox, DG Ezra, GG Adams, SP Newman 

Friday, April 18, 2014

Strabismus and body balance - vision therapy and the eye-brain connection

Strabismus and body balance - the eye brain connection, cerebellum dysfunctions may contribute to strabismus, esotropia and exotropia.  Vision therapy may help rehabilitate the malfunction.
An important new study appeared in the journal Vision Research. It confirms the approach that we take to strabismus (eye turns, cross eyes) treatment in our Vancouver eye clinic, where we employ non-invasive optometric vision therapy. Vision therapy is based on the concept of neuroplacitity - the ability of the brain to reorganize itself though a program of rehabilitative therapy and fix problems that arise from the failure of the brain and eyes to communicate properly. One such problem is strabismus, a condition where the eye turns in or out (called esotropia or exotropia). These eye turns are usually not caused by problems with the muscle itself. The problem is in the eye-brain connection that controls eye movement. The new study confirms this approach to treating strabismus.

This study investigated how the information from eye-muscles muscles affects postural stability in adults with binocular vision disorders and demonstrated that those with binocular vision disorders showed significantly worse balance control than those without binocular vision disorder, even when they were only using only one eye. The study showed that inaccurate signals related to the eye muscles impact body balance and that this effect can last into adulthood even where subjects had surgery as children to make the eyes appear straight. The second part of their study shows that specific therapeutic tasks can allow patients with strabismus to develop better body balance.

The study adds to the growing body of research that suggests that strabismus is a whole-body problem that results in impairments, adaptations and compensations on many levels throughout the body, which often last into adulthood.  The researchers suggest that a dysfunction in a part of the brain called the cerebellum may contribute to strabismus. The cerebellum plays an important role in eye movement coordination and alignment. Recent studies have shown that the cerebellum is also involved in cognitive functions including attention. Based on this, the researchers thought that the attentional effort required for the mental task in their study resulted in activation of the cerebellum which decreased inhibition from the strabismic eye, which in turn lead to greater postural control.

Here is a passage form a commentary by Dr. Leonard J Press OD, FAAO, FCOVD and Dr. Joseph D Napolitano MD on why this research is so exiting:

Why is this research exciting? It counteracts the notion that strabismus is an isolated eye muscle problem that has little bearing other than cosmesis. The appearance of the eyes is only one feature of strabismus, better appreciated as a difficulty in multimodal coordination. This presents new opportunities to conceive of the synergy between extra-ocular muscle (EOM) surgery and optometric vision therapy, somewhat analogous to the synergy between orthopedic surgery and physical therapy.
When conceived in this fashion, the cognitive and attentional resources employed in optometric vision therapy help the brain to coordinate both eyes through activities mediated through the cerebellum. Even when [eye muscle] surgery or optometric vision therapy do not achieve bi-foveal alignment or random dot stereopsis, very meaningful gains can be realized in improved head to toe motor control.
The role of vision therapy features prominently in this study.  Here is what the authors say:
These findings emphasize the role of the eye-muscle signals in postural control and suggest that suitable vision therapy can be the appropriate way to improve body balance/motor functions in people with binocular vision disorders.


Vision Research
Impaired Body Balance Control in Adults With StrabismusVision Res 2014 May 01;98(-)35-45, A Przekoracka-Krawczyk, P Nawrot, M Czaińska, KP Michalak

Related Articles

Strabismus surgery rates in decline because of non-surgical procedures
Apr 23, 2013

Alternatives to strabismus surgery
Oct 28, 2012

Another risk of strabismus surgery?
Mar 07, 2012

Non-surgical treatment alternatives to strabismus surgery
Jan 23, 2013

Wednesday, March 26, 2014

Saturday, March 15, 2014

ADHD and vision problems, misdiagnosis and over-diagnosis of ADHD

adhd and vision disorders
We have written many articles on a common medical mistake. Children are often misdiagnosed with attention deficit / hyperactivity disorder (ADHD) when they actually have a treatable vision disorder that has many symptoms in common with ADHD. Convergence insufficiency is one vision disorder whose symptoms mimic ADHD symptoms and is often missed by doctors who are not eye specialists and even by many eye doctors themselves if they do not routinely test for developmental vision disorders.

A new study published in the Journal of AAPOS : The Official Publication of the American Association for Pediatric Ophthalmology and Strabismus/American Association for Pediatric Ophthalmology and Strabismus, found that children with vision disorders are more then twice as likely as the general population to be diagnosed with ADHD.

The study looked at a cohort of visually impaired children between the ages of 4 and 17. In this group, researchers found that 22.9% of the kids had a parent-reported diagnosis of ADHD. That was 2.3 times greater than the national average, which is 9.5%.

The fact that a an ADHD diagnosis is twice as common in people with vision problems suggests that may people with vision problems are being misdiagnosed with ADHD. In fact ADHD diagnoses have increased “by 33% between 1997-1999 and 2006-2008.” These statistics are worrisome and suggest a possible over-diagnosis of this condition (see Feldman HM, Reiff MI. Attention Deficit-Hyperactivity Disorder in Children and Adolescents. N Engl J Med. 2014;370:838-846)

Related articles:

ADHD diagnoses skyrocket - are children being inappropriately diagnosed? Vision problems can cause the same symptoms.

Convergence insufficiency symptoms - doctors need to pay attention to performance related symptoms such as reading performance, attention and ADHD-like symptoms

Vision therapy for visual attention skills significantly improves reading comprehension

Another risk of strabismus surgery? Increased risk of learning disabilities and attention deficit hyperactivity disorder (ADHD) because of exposure to anesthesia.

New research on the connection between convergence insufficiency and ADHD


Journal of AAPOS : The Official Publication of the American Association for Pediatric Ophthalmology and Strabismus/American Association for Pediatric Ophthalmology and Strabismus

Prevalence of Attention-Deficit/Hyperactivity Disorder Among Children With Vision Impairment
J AAPOS 2014 Feb 01;18(1)10-14, DK Decarlo, E Bowman, C Monroe, R Kline, G McGwin, C Owsley

Sunday, February 23, 2014

Congratulations to the 2014 BC Optometrist of the Year: Dr. M.K. Randhawa!

In a ceremony earlier today, the British Columbia Association of Optometrists named Dr. M.K. Randhawa, its 2014 Optometrist of the Year!

Dr. M.K. Randhawa, Optometrist of the year

Visual system plasticity

Visual system plasticity
There has been considerable evidence that the plasticity of the human visual system persists beyond a so-called "critical period" in early childhood.  The most famous example of this is the case of neuroscientist Susan Barry, who achieved 3D vision for the first time in her life at the age of 47 through optometric vision therapy.  Her book about that experience, Fixing My Gaze was Amazon's fourth most popular science book of 2009. What vision therapy did for Susan Barry was an example of how visual rehabilitation is possible well into adulthood because od the plasticity of the visual system.  

As another example, the National Eye Institute funded a study that showed that amblyopia can be treated in young adults, well beyond the critical period of early childhood which was previously thought to be the limit beyond which no change was possible. 

A new study published in the Proceedings of the National Academy of Sciences of the United States of America examined a small number of patients who experienced early-onset (it began before age 1 year), extended-duration ( it lasted 8–17 years) severe visual impairment due to cataracts in both eyes. When the cataracts were removed and the corrective lenses implanted, the patients displayed considerable improvement in contrast sensitivity, which is a measure of vision ability.  The study adds to the body of evidence that improvement in visual function can be achieved well beyond early childhood.   The authors comment on the results as follows:

These results reveal that the visual system can retain considerable plasticity, even after early blindness that extends beyond critical periods.

However, it is still true that the earlier that vision problems are caught and treated, the easier it is and the better are the results.  That's why it is recommended that children have an eye exam at six months of age and then every year thereafter.  We still want to catch vision problems as early as possible. 


Development of Pattern Vision Following Early and Extended Blindness Proc. Natl. Acad. Sci. U.S.A 2014 Feb 04;111(5)2035-2039, A Kalia, LA Lesmes, M Dorr, T Gandhi, G Chatterjee, S Ganesh, PJ Bex, P Sinha

Friday, February 21, 2014

Amblyopia treatment

amblyopia treatment
A large focus of what we do at our Vancouver eye clinic is the treatment of amblyopia using optometric vision therapy.

Developmental optometrists have long used active forms of therapy to rehabilitate the lazy eye that does not see well in amblyopic patients. The advantages of therapy over patching are that therapy is much more enjoyable for children than wearing an eye patch.  Moreover, therapy develops the binocularity (i.e. binocular vision or the two eyes working together as a team) of the visual system.

While optometrists have been doing this for a very long time, only recently have eye surgeons and the wider medical community come on-board with this approach. Dr. Leonard Press has found this passage in a new book on Vision Development by Dr. Daw, Professor Emeritus of Ophthalmology and Neuroscience at Yale University, where Dr. Daw acknowledges that vision therapists have been using effective active forms of therapy for a long time.

“Use of perceptual learning and video games has helped by increasing activity and attention as the therapy is done. Many of the principles have been employed by pediatric vision therapists for some time, but the publicity generated by “Stereo Sue” and others has helped to broadcast them.”
As stated in this passage, much credit goes to Dr. Susan Barry (known as "Stereo Sue") and her book Fixing My Gaze for increasing awareness of vision therapy techniques.  Dr. Barry is a neuroscientist, who was born with strabismus (an eye turn) and had lived all her life without stereo vision, meaning that she could not see in three dimensions. Her case was also the subject of an article in the New Yorker by Oliver Sacks.

She had three surgeries to "correct" the eye turn cosmetically but she still could not see properly and the eye was still turned, although less than before. She had lived this way for over 40 years until she met optometrist Dr. Theresa Ruggiero. Dr. Ruggiero treated Susan with vision therapy which corrected the eye turn and allowed her see in three dimensions for the first time in her life.

Thanks to vision therapy and the work of developmental optometrists, amblyopia is now widely regarded as a binocular problem, not a monocular problem upon which the old treatment of eye patching was based.  Here is one quotation from a study that makes the point:

amblyopia is an intrinsically binocular problem and not the monocular problem on which current patching treatment is predicated. Thought of in this way, the binocular problem involving suppression should be tackled at the very outset if one is to achieve a good binocular outcome as opposed to hoping binocular vision will be regained simply as a consequence of acuity recovery in the amblyopic eye, which is the current approach and which is often not found to be the case.
Hess, Robert F.; Mansouri, Behzad; Thompson, Benjamin, A Binocular Approach to Treating Amblyopia: Antisuppression Therapy. Optometry & Vision Science:September 2010 - Volume 87 - Issue 9 - pp 697-704

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Evidence that patching alone is not enough for amblyopia treatment
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Patching alone is not good enough for amblyopia ... - See for Life
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More evidence that patching alone is not enough for amblyopia treatment ...
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The ultimate amblyopia infographic - See for Life
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Advance treatment for amblyopia (lazy eye) - it's not patching
Friday, September 20, 2013

Active therapy is more effective for amblyopia
Nov 20, 2011

Take your kids to see "Thor": doctor's orders!
Thursday, October 25, 2012

Video Game therapy, optometric vision therapy are more effective than patching alone in treating amblyopia
Sunday, November 20, 2011

Is your child at risk for a vision disorder? Take this interactive quiz to find out. Wednesday, February 8, 2012

Vancouver Parents: Amblyopia treatment in a nutshell!
Monday, July 1, 2013

Thursday, February 20, 2014

Vision therapy for vergence and accommodation

Vision therapy success - Dr. M.K. Randhawa
A new case report was published in the latest issue of the Journal Optometry & Visual Performance, which supports the effectiveness of in-office vision therapy for the treatment of vergence and accommodation dysfunctions.

Vergence is the simultaneous movement of both eyes in opposite directions to obtain or maintain single binocular vision.

Accommodation  is the process by which the eye changes its focusing power to maintain a clear focus on an object as its distance from the eye varies.

The case report discussed a patient who was 10-years and 10 months old and underwent 16 visits for vision-based therapy along with home reinforcement (vision therapy homework). The authors used several methods to measure accomodation and vergence before and after therapy, including the Convergence Insufficiency Symptom Survey (CISS), near point of convergence (NPC), positive fusional vergence range at near (PFV), accommodative amplitude, and accommodative facility. The measures taken showed decreased symptom severity following therapy.

The in-office vision therapy program used in the study was identical to that used in the well known Convergence Insufficiency Treatment Trial studies and produced measurable changes in vergence and accommodation in the case subject, who also had convergence insufficiency.

The results not only demonstrate the efficacy of vision therapy but also provide an illustration of the plasticity of the oculomotor system, which is not fully developed at 10 years of age and responds well to interventions like vision therapy.


Optometry & Visual Performance
Objective Assessment of Vergence and Accommodation After Vision Therapy for Convergence Insufficiency in a Child: A Case Report Optometry and visual performance 2014 Feb 04;2(1)7-12, M Scheiman, KJ Ciuffreda, P Thiagarajan, B Tannen, DP Ludlam

Monday, February 17, 2014

Cosmetic contact lenses sold on the internet attract bacteria

cosmetic contact lenses and bacteria infection danger
A new study published in the journal, Contact Lens Anterior Eye looked into whether surface pigments on cosmetic contact lenses lead to increased adherence of bacteria.

The researchers bought 15 brands of cosmetic contact lenses over the Internet. To determine whether the lenses had surface pigments, the researchers did a standard rub-off test to confirm whether the pigments were on the surface or embedded.  Most of the brands failed (13 out of 15) the rub-off test meaning that the pigments were on the surface and these brands showed significantly higher bacterial adherence.

The conclusion is that purchasers of cosmetic contact lenses risk bacterial infections unless they make healthy choices for their contact lens wear.  Consult your eye doctor before buying contact lenses over the Internet.


Contact Lens & Anterior Eye: The Journal of the British Contact Lens Association
Microbial Adherence to Cosmetic Contact Lenses Cont Lens Anterior Eye 2014 Jan 16;[EPub Ahead of Print], KY Chan, P Cho, M Boost

Sunday, February 9, 2014

Stereo vision (depth perception) in preschool children - what if my child can't see 3D?

Depth perception in preschool kids by Dr. M.K. Randhawa
One of the easiest ways to diagnose a vision disorder in a very young child is to test his or her stereo acuity or depth perception.  Poor 3D vision is often caused by a vision disorder, some of which may be serious disorders that are best treated in early childhood.  Poor 3D vision may even be the sing of life threatening diseases such as tumours, as in this famous story from Ontario.

A new study published in the journal Optometry & Vision Science examined the a large population of pre-school children and tested their depth perception using the Stereo Smile II test.  The researchers then looked at the association of poor 3D vision with vision disorders.

The study found that children with vision disorders had significantly worse median stereoacuity than that of children without vision disorders. Children with the most severe vision disorders had worse stereoacuity than that of children with milder disorders.

The researchers also found that testability was excellent at all ages of the children included in the study. The results support the validity of the Stereo Smile II for assessing random-dot stereoacuity in preschool children.  The results also point to the need to take children who have poor stereo vision to a developmental optometrist to be evaluated and treated for developmental vision disorders that may be the cause of the poor stereo vision.

For more information visit our 3D vision web page at

Stereo vision, vision therapy and the TED talks

Stereo vision and treatment of depth perception problems with optometric vision therapy has been the subject of TED talk featuring neuroscientist Dr. Susan Barry:

Related articles on children and depth perception

What is 3D Vision Syndrome? 

Don't like 3D movies? You may have 3D Vision Syndrome

Take your kids to see "Thor": doctor's orders!

Life threatening disease found in girls eye - lack of 3D vision was the clue

Fixing My Gaze - Can you imagine not having 3D vision?

TED - ideas worth spreading - Susan Barry on how vision therapy gave her 3D vision


Stereoacuity and Vision Disorders in Preschool Children
Optom Vis Sci 2014 Jan 23;[EPub Ahead of Print], EB Ciner, G-S Ying, MT Kulp, MG Maguire, GE Quinn, E Graham, D Orel-Bixler, LA Cyert, B Moore, J Huang

Sunday, January 26, 2014

Older adults and the loss of depth perception

Here is a graphic we made on older adults and the loss of depth perception.  Please share it to raise awareness.

Saturday, January 25, 2014

What is accomodative esotropia?

At our Vancouver eye clinic, we treat many patients with various types of strabismus.  One of them is accomodative esotropia.  Here is an excellent presentation by Professor Dominick Maino on accomodative esotropia:

Thursday, January 23, 2014

Eyes and aging - anisometropia 3D vision, binocular vision and increased fall risk

Eyes and ageing - depth perception and fall risk

A new study published in the journal, Optometry & Vision Science, has confirmed what many eye doctors with elderly patients already know: changes in the eyes as we age can degrade our ability to see depth (stereopsis) and in three dimensions (3D vision). That can contribute to blurry vision, eye strain and eye fatigue, and an increased risk of falls. Falls in the elderly are troubling because they can be the cause of brain injuries, broken bones or worse.

The new study looked at the incidence of a condition called anisometropia in elderly patients. Anisometropia is a condition in which the two eyes have unequal refractive power. That means that the focusing ability of the two eyes is unequal. Each eye is in a different state of myopia (nearsightedness) and hyperopia (farsightedness). The condition is characterized by blurry vision, double visoin, eye strain, eye fatigue, loss of depth perception. When anisometropia happens in children and infants, it can impair the development of normal binocular vision, which can lead to many learning and other problems.

Anisometropia is common in elderly people and it grows exponentially with age. The study found that significant anisometropia is at least 10 times more common in those older than 75 years than it is in children.  This is an alarming statistic and must be taken seriously by eye doctors.  At our Vancouver optometry clinic, we see large number of elderly patients because of our low vision practice and so we are always on the look-out for anisometropia.

The study's authors pointed out that the prevalence of anisometropia in US children is between 2 and 4% whereas data for those near 80 years old shows that 32% have 1.00 D or more anisometropia.

Related article:

When seniors loose depth perception and need to see a developmental optometrist
Thursday, June 28, 2012


Longitudinal Increase in Anisometropia in Older Adults

Haegerstrom-Portnoy, Gunilla; Schneck, Marilyn E.; Lott, Lori A
Optometry & Vision Science:
January 2014 - Volume 91 - Issue 1 - p 60-67