ORLANDO, Fla. — Posters presented here at the 107th annual American Optometric Association Congress included some notable research that addressed a multidisciplinary approach to autism, low vision management and Intacs (Addition Technology, Des Plaines, Ill.) for keratoconus.
Optometry and autistic patients
Based on the results of a case study, Researchers at Nova Southeastern University, Ft. Lauderdale, concluded that shared information between the disciplines of optometry and speech increased understanding of the patient’s performance and aided in planning treatment strategies for an autistic patient. Nimali S. Patel, OD, Tanya K. Mahaphon, OD, FAAO, and Brian Humphrey, MA, CCC-SLP, reported on a 13-year-old autistic boy who came in for a comprehensive eye exam.
The patient had been diagnosed with autism at age 4. He had visual signs and symptoms typically found in autistic patients, including ocular motor dysfunction and visual memory and laterality/directionality deficits. Autistic patients also typically exhibit gaze avoidance, crossing of the eyes, rubbing of the eyes and sensitivity to light.
The patient, who already participated in occupational therapy, physical therapy and speech-language therapy, was started on a combined office- and home-based vision therapy program. The program addressed fixation and eye tracking skills, visual memory, auditory and visual integration, gross motor skills and overall sensory integration.
The researchers said in an abstract titled, “Making eye contact: A multidisciplinary approach to the management of autism,” that because “many signs and symptoms of autism include gaze avoidance, hand flapping or waving in front of eyes and extreme sensitivity to light, optometrists can aid in early detection and intervention of autism by ruling out visual conditions that mimic autism. Once autism is diagnosed, the optometrist’s role is to provide clear, single, comfortable binocular vision and enhance visual perception and oculomotor skills by providing lenses, yoked prism or vision therapy.”
Low vision management
Optometrists at the Center for the Partially Sighted, in collaboration with the Southern California College of Optometry, Fullerton, Calif., presented a case study that showed how low vision devices along with rehabilitative services can be used to maximize the visual potential of a patient with severe degenerative myopia.
In “Degenerative myopia and low vision management,” Katherine Witmeyer, OD, and Tina MacDonald, OD, FAAO, CDE, presented data on a 40-year-old Hispanic man who had a previous diagnosis of high myopia and vision that was worsening over the years. The patient had a best-corrected visual acuity of –26.00 DS 5/25 and –35.00 DS 1/100. His uncorrected distance visual acuity was hand motion in both eyes at 1 ft. Uncorrected near visual acuity measured 5 M at 4 cm in the right eye and 8 M at 4 cm in the left eye. The patient was unable to have visual field testing due to his poor vision, poor fixation and high refractive error.
Recommendations for the patient included single vision minus-curve biconcave design distance glasses with CPF 450 (Corning Photochromic Filters, Corning, Corning, N.Y.) matched tint for general use and glare reduction; 8 x 20 Specwell monocular telescope (Specwell Corp., Tokyo, Japan) giving 10/60+ acuity; 11x Optelec illuminated hand magnifier for large print (Optelec USA Inc., Chelmsford, Mass.) (approximately 1-m text); and referral for orientation and mobility training with a white cane through the Center’s Rehabilitation Department.
“The case report demonstrates the significance of low vision management with devices and services for patients with severe vision loss. These few devices, coupled with orientation and mobility training, have improved [the patient’s] independence. Ideally, [the patient] should enter an intensive training program focusing on non-visual forms of learning and communication,” the optometrists said in the poster presentation.
Intacs for keratoconus
Kristopher May, OD, of the Eye Center at Southern College of Optometry, Memphis, reported on successful Intacs implantation in a man with bilateral keratoconus in “Intacs corneal implants to treat keratoconus and higher-order aberrations.”
A 43-year-old white male with longtime bilateral keratoconus came in with decreasing best-corrected visual acuity with glasses or contact lenses. He complained of intolerance to gas-permeable lenses and was previously told by both an optometrist and an ophthalmologist that his only remaining option was a corneal transplant.
This patient, who elected to undergo bilateral Intacs implantation, had a more aspheric post-Intacs cornea with keratoconus and improved visual acuity as well as decreased higher-order aberration compared to before the implantation.
Intacs are approved by the Food and Drug Administration for treating myopia from 1 to 3 D and astigmatism of up to 1 D and received approval in August for use in treating keratoconus.
An ideal patient for Intacs has a mild to moderate cone and is experiencing decreased contact lens tolerance or decreased visual acuity through spectacles or contacts. Advanced cones may have scarring that slows or limits visual improvement. Ideal corneal thickness is at least 400 µm. Intacs position is then determined by topography, keratometry, pachymetry and cycloplegic refraction.
The outcome for the patient in this study showed postoperative visual acuity of 20/15 uncorrected in both eyes.
For Your Information:
- Nimali S. Patel, OD, can be reached at Nova Southeastern University, 3200 South University Dr., Ft. Lauderdale, FL 33328-2018; (973) 207-3369; e-mail: email@example.com. Dr. Patel has no direct financial interest in the products mentioned in this article, nor is Dr. Patel a paid consultant for any companies mentioned.
- Katherine Witmeyer, OD, can be reached at the Center for the Partially Sighted, 12301 Wilshire Blvd., Los Angeles, CA 90025; (310) 458-3501; e-mail: firstname.lastname@example.org.
- Kristopher May, OD, can be reached at the Eye Center at Southern College of Optemetry, 1225 Madison Ave., Memphis, TN 38104-2222; (901) 722-3250; fax: (662) 622-5590; e-mail: email@example.com; Web site: www.sco.edu/eyecenter.