2/8/2010 Remote treatment of intermittent central suppression - - PDF document

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2/8/2010 1

Remote treatment of intermittent central suppression improves quality of life measures

Eric S. Hussey, OD, FCOVD

25 W. Nora, Suite 101 Spokane, WA 99205 spacegoggle@comcast.net

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2/8/2010 2

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Borish Near Card Enlarged Modified Diamond Target

Polaroid Overlays

D R K C V O Z H S N S Z H V D N R K C O R C O S V Z N D H K D S V N K H O C Z R D R K C V O Z H S N S Z H V D N R K C O R C O S V Z N D H K D S V N K H O C Z R

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VZNDH M R H O C Z S

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Seen by left eye Seen by right eye

Seattle Seattle Spokane Spokane

Curlew Curlew

Canada Canada Idaho Idaho

~8 mi. ~8 mi.

Brewster Brewster

Oregon Oregon

• Mt. St. Helens
• Mt. St. Helens

Pacific Pacific Ocean Ocean Pacific Pacific Ocean Ocean Tri Tri-

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Cities

OEP # Pratt/Haynes Norms 4 21m 14A 15A 14B 15B Vertical fixation disparity/associated phoria Lateral fixation disparity/asociated phoria Monocular negative relative acommodation blur/recovery Cylinder Description Distance Retinoscopy Pratt Near Cylinder 18d Near fd Unfused Crossed Cylinder Lateral Phoria through 14A Fused Crossed Cylinder Lateral Phoria through 14B Target is standard non-polarized near card ICS Diagnosis Point Target is polarized (modified) Borish Near Card p.e. =2/3  Calculated from +3.25/+2.75 +1.25 .37 7 exo 3.5 +1.00 .37 6 exo 3.3

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Binocular positive relative acommodation /

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ICS

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ICS 20

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15B 17A/B 16A/B 21 Base-out to Break / Recovery Base-in to Break / Recovery Unfused Crossed Cylinder Lateral Phoria through - Move to Distance with AO Vectographic Chart 7A 12 (&3) fd Video ICS diagnosis with diamond Binocular positive relative acommodation blur/recovery Binocular negative relative acommodation blur/recovery

• 3.50/-2.62

1.00 +0.50 .37 6 exo 3.3 20/12 2.8/2.9 19/9 4.7/4 +2.37/+1.87 .50/.37 Best VA Distance Correction - “Binocular Vertical fixation disparity/associated phoria Lateral fixation disparity/asociated phoria ICS Use all distance targets Clockdial is great for kids MEM Near retinoscopy through 7A +0.62 .18

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No losses No losses Stereopsis Distance Vectographic Chart Rings 88% (4th Row)

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Myron - QOL Scores 20 25 30 35 40 45 5 10 15 Diagnosis Dx + 4 mo. Dx + 8 mo. Dx + 18 mo. 3.5 4.0 4.5 5.0 Post- Therapy 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 0.5 1.0 1.5 2.0 2.5 3.0 Pre-Therapy Length of ICS Suppression Periods, Seconds

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7 8 9 10 Post- Therapy 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 Pre-Therapy Length of “Binocular” Periods During ICS Cycle, Seconds 70 80 90 100 110 P 10 20 30 40 50 60 70 80 90 100 110 10 20 30 40 50 60 Pre-Therapy Post- Therapy COVD QOL Score - Full Checklist 40 50 60 Post- Therapy 10 20 30 40 50 60 10 20 30 Pre-Therapy COVD QOL Score - 16 Reading Questions

Blurred vision at near/reading Double vision Headaches with near work Words run together reading Burning, itching, watering eyes Fall asleep reading See worse end of day

x x x x x x x

See worse end of day Skip/repeat lines when reading Dizziness/nausea with reading Head tilt/close an eye reading Avoid near work/reading Miss/omit small words reading Reading comprehension down Hold reading too close Short attention span reading Difficulty finishing assignments

x x x x x x x x x x

Blurred vision at near/reading Double vision Headaches with near work Words run together reading Burning, itching, watering eyes Fall asleep reading See worse end of day

x x x x x x x

See worse end of day Skip/repeat lines when reading Dizziness/nausea with reading Head tilt/close an eye reading Avoid near work/reading Miss/omit small words reading Reading comprehension down Hold reading too close Short attention span reading Difficulty finishing assignments

x x x x x x x x x x

1 Blur at near 2 Double Vision 3 Headaches with near work 4 Words run together reading 5 Eyes burn/sting/water 6 falls asleep reading 7 Vision worse end of day 8 skip/repeat lines reading 16 read comprehension down over time 22 avoids sports 23 poor hand-eye/handwriting - difficulty with hand tools 17 poor sports performance 20 difficulty completing assignments on time 21 says "I can't" 19 trouble keeping attention on reading 18 holds reading too close 8 skip/repeat lines reading 10 tilts head/closes eye reading 15 misaligns digits/columns 13 omits words reading 9 dizziness/nausea with near work 12 avoids near work/reading 14 writes uphill/downhill 11 difficulty copying from board 23 poor hand-eye/handwriting - difficulty with hand tools 24 can't estimate distances 25 clumsy/knocks things over on desk/table 26 difficulty with time management 27 difficulty with money concepts/make change 28 loses papers & belongings 29 car sickness, motion sickness 30 poor memory

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1 Blur at near 2 Double Vision 3 Headaches with near work 4 Words run together reading 5 Eyes burn/sting/water 7 Vision worse end of day 8 skip/repeat lines reading 16 read comprehension down over time 22 avoids sports 17 poor sports performance 20 difficulty completing assignments on time 21 says "I can't" 19 trouble keeping attention on reading 18 holds reading too close

p<0.001

5 Eyes burn/sting/water 6 falls asleep reading 10 tilts head/closes eye reading 15 misaligns digits/columns 13 omits words reading 9 dizziness/nausea with near work 12 avoids near work/reading 14 writes uphill/downhill 11 difficulty copying from board 22 avoids sports 23 poor hand-eye/handwriting - difficulty with hand tools 24 can't estimate distances 25 clumsy/knocks things over on desk/table 26 difficulty with time management 27 difficulty with money concepts/make change 28 loses papers & belongings 29 car sickness, motion sickness 30 poor memory 3 Headaches with near work 4 Words run together reading 5 Eyes burn/sting/water 6 falls asleep reading 7 Vision worse end of day 8 skip/repeat lines reading 10 tilts head/closes eye reading 16 read comprehension down over time 13 omits words reading 14 writes uphill/downhill 20 difficulty completing assignments on time 19 trouble keeping attention on reading 18 holds reading too close

p<0.001 p<0.01

1 Blur at near 2 Double Vision 15 misaligns digits/columns 9 dizziness/nausea with near work 12 avoids near work/reading 11 difficulty copying from board 22 avoids sports 23 poor hand-eye/handwriting - difficulty with hand tools 17 poor sports performance 24 can't estimate distances 21 says "I can't" 25 clumsy/knocks things over on desk/table 26 difficulty with time management 27 difficulty with money concepts/make change 28 loses papers & belongings 29 car sickness, motion sickness 30 poor memory 1 Blur at near 2 Double Vision 3 Headaches with near work 4 Words run together reading 5 Eyes burn/sting/water 6 falls asleep reading 7 Vision worse end of day 8 skip/repeat lines reading 10 tilts head/closes eye reading 16 read comprehension down over time 15 misaligns digits/columns 13 omits words reading 12 avoids near work/reading 14 writes uphill/downhill 20 difficulty completing assignments on time 24 can't estimate distances 21 says "I can't" 19 trouble keeping attention on reading 18 holds reading too close

p<0.001 p<0.01 p<0.05

9 dizziness/nausea with near work 11 difficulty copying from board 22 avoids sports 23 poor hand-eye/handwriting - difficulty with hand tools 17 poor sports performance 25 clumsy/knocks things over on desk/table 26 difficulty with time management 27 difficulty with money concepts/make change 28 loses papers & belongings 29 car sickness, motion sickness 30 poor memory

All the rest improved, but p>0.05

7 8 9 10 TABE Reading Test Grade Level p << 0.001

JobCorps average age, 19.7 yrs

1 2 3 4 5 6 7 Diagnosis Re-Examination

5th grade level ~ 11 yrs. old

7 8 9 10 11 12 Post- Therapy 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 Pre-Therapy TABE Reading Scores

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7 8 9 10 Increase in “Binocular” Periods, Seconds 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

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Decrease in Suppression Periods, Seconds On Off On Off Control is all in the “off” portion - active inhibition Fig 1

Cortical Inhibition

On Off 7 8 9 10 Increase in “Binocular” Periods, Seconds 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

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Decrease in Suppression Periods, Seconds 7 8 9 10 Increase in “Binocular” Periods, Seconds 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

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Decrease in Suppression Periods, Seconds On Off On Off Control is all in the “off” portion - active inhibition Fig 1

Cortical Inhibition

On Off On Off Control is in some internal timing, so on/off is a cycle of pre-determined length decrease in “off” = increase in “on” Fig 2

Internal Gating

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7 8 9 10 Increase in “Binocular” Periods, Seconds 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

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Decrease in Suppression Periods, Seconds On Off Changes are in “On” portion of cycle - Increasing “Binocular” Periods Fig 3 On Off 7 8 9 10 Increase in “Binocular” Periods, Seconds

Makes sense - a motion stimulus, applied to neurology, should make Makes sense - a motion stimulus, applied to neurology, should make

1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

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Decrease in Suppression Periods, Seconds

gy, motion synapses more robust, increasing binocular periods which will decrease suppression periods gy, motion synapses more robust, increasing binocular periods which will decrease suppression periods