Optometry 360 - Edition 2

Issue No. o2  •   July 2021    

OPTOMETRY

ALO's Official Magazine

360

OPTOMETRY Coverpage Credit:
OUTSIDE INDIA
PAINT THE DARK
Prospects of O.D. and
Ph.D. in USA Meghana Yelamanchi
Light painting artist
PERSPECTIVE
COLUMN

Why did Batman do it?
Do You Know What Tricked Your Mind?

Contents

3-13 FAQs 16 Do You Know What
Tricked Your Mind?

Doctor of Optometry

20 22 24
Why Did Batman Do It? Amblyopia and
Management Vision Beyond 20/20

31 Innovations

33-36 38

Clinical Photographs

42 53 64
ALO Highlights
Fun Column
58Alumni Corner

Editor's
Note

SANDHYA SHEKAR

Another month, another magazine! It seems like it was only yesterday we launched the first edition of Optometry 360 and
we are already on the second one. I guess time flies when you're busy. Team ALO has been working diligently to craft the
second edition of Optometry 360 in addition to keeping the community active. Some of the chief highlights of the last two

months have been that the first edition of Optometry 360 enjoyed a tremendous reception and we received over 2000
views, online. We thank each one of you for making this a grand success and also appreciate your congratulatory wishes

and feedback. Our Broaden your Horizon web education series and Divergent Knowledge series received an
overwhelming response of over 1500 views. The official ALO website was viewed by over 50,000 people in the last few

months.

In this edition, we bring to you varied optometry and eye care related content contributed by optometrists, both in house
and from other optometry institutes. Peruse through our Perspective Column to know more about this. As our erudite
alumni are involved in every field of optometric vocation, in nearly every location around the world, we bring to you the
extensive clinical and research landscape of optometry and vision science outside India. This edition extensively

elucidates the application and preparation aspects of pursuing higher degrees in USA, in the next few pages. This edition
also showcases the art and photographic talents of our alumni and other professionals. Team ALO congratulates the
alumni who have received awards and accolades for their work and contributions.

We appreciate your participation and encourage you to further contribute to our magazine. Please read through the new
guidelines to understand how to pitch to us. Team ALO eagerly awaits to work with all of you.

OPTOMETRY 360 |  2

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Doctor of Optometry in USA

What is Doctor of Optometry?

Doctor of Optometry is a 4-year professional doctorate degree in the U.S. In simple terms, this is the degree
you need if you want to practice as an optometrist in the U.S.
Unlike in India, anyone with a bachelor degree in optometry cannot practice as an optometrist in the US as
bachelor’s degree is termed pre-optometry. After bachelors you pursue a doctorate to practice as an
optometrist and hence O.D is a professional doctorate degree.
According to the American Optometric Association, Doctors of Optometry (O.D.s) are independent primary
health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries,
and disorders of the visual system, the eye, and associated structures as well as identify related systemic
conditions affecting the eye. Doctors of Optometry prescribe medications, low vision rehabilitation, vision
therapy, spectacle lenses, contact lenses and perform certain surgical procedures. If you are passionate to
treat and manage ocular diseases, the scope of practice in India is currently limited.

What is the program structure of the O.D. program? Which universities in USA offer this degree?

They are three O.D. programs, the traditional 4-year program
and an accelerated 2.5 or 3-year program. Not all the universities offer a 2 or 3-
year program.

Association of Schools and Collages of Optometry (ASCO) is the academic
leadership organization that has information about accredited schools and
colleges of optometry in the United States. There are 23 optometry schools
that offer the traditional O.D. program (4 years) and 4 optometry schools
that offer the accelerated O.D. program (2.5-3 years).

Please follow this link to ASCO’s official website to get more information on the list of optometry schools,
optometry admission test and centers.
https://optometriceducation.org/about-asco/asco-member-schools-and-colleges/

What are the minimum requirements for the admission process?

a. Application Process:

For the 4-year program, the admission cycles begin in June and
end by March-April.

The accelerated program begins sooner and ends before
January.

You need to have a bachelor degree in science with necessary
prerequisites and a good GPA. Second, you need a score of
310 or above on the Optometry Admission Test (OAT). Once you have these, you can start the application
process through OptomCas (OptomCAS is the Optometry Centralized Application Service). The universities
then short list candidates and invite them for an interview. After the interview process, the admission
committee selects the best students and offers them an admission.

OPTOMETRY 360 | 4

b. Exams to be given (OAT), preparation process and study materials:

OAT test score is mandatory for the O.D. program.
The OAT is an optometry admission test like EAMCET in India.
It is a 5-hour test comprising 4 section survey of the Natural
Sciences (includes biology, chemistry, organic chemistry),
Physics, Reading Comprehension, and Quantitative Reasoning.
To be competitive one needs to get a score of 310 or above on
all the four sections. This exam can only be given in USA.
The cost of the exam is about $490. You can take the test
multiple times, but you need to wait at least 90 days before retaking the OAT.
Kaplan study material is typically good to prepare for the test. If you remember your 11th and 12th
grade concepts well, you may need at least 60-90 days of preparation before the exam. For more
details about the OAT visit https://www.ada.org/en/oat. GRE can be taken in lieu of OAT for the
accelerated program. However, OAT score increases your chances of getting accepted.

c. Prerequisites:

To apply for the O.D. degree, most universities require a bachelor degree in science including
prerequisites such as english, general biology with labs, microbiology with labs, physics with labs,
algebra or calculus, general chemistry with lab, organic chemistry with lab, statistics, psychology,
liberal arts/ humanities. Applicants must have completed 90
semester hours or 135 quarter hours prior to applying for this degree.
There are some universities that do not require a bachelor’s
degree but applicant's holding a bachelor's degree are usually given
preference over other applicants with similar academic credentials.
International applicants must demonstrate English language
proficiency by submitting IELTS (International English Language
Testing System) Academic or TOEFL
For those wishing to pursue an accelerated O.D. program, a minimum
of 40-60 hours of shadowing an optometry practice in the USA is needed.
Clinical experience from a renowned eye hospital in India is a bonus

d. Minimum GPA in bachelors:

3.5 or higher
World Education Service (WES) course evaluation is required.
Transcripts from India should be converted and validated to apply to
universities in the US. World education services is a good place to
send and get the transcripts converted. Check https://www.wes.org/
for more information.

e. Does clinical experience, clinical internships, work experience etc. boost the admission process?

Yes, it adds on to your experience. However, shadowing in the USA strengthens the application.

OPTOMETRY 360 | 5

f. How many board exams do you have to give during this program and how long are these exams?

You must pass 3 national board exams to be able to practice in the US.
The first exam is 16 hours long, is theoretical and is spread over 2 days (8 hours each).
The second exam is 8 hours long and mostly compromises clinical cases.
The third exam which is mostly practical of the clinical procedures is about 4 hours long.

What are the career opportunities after graduation?

Some students plan to pursue a residency program in their area of interest
while some choose to work in hospitals or eye clinics or even start their private
practice. One can also pursue a degree in MS. And Ph.D. during or after the
O.D. Degree if they wish to have a clinical practice and also pursue research
actively.

What is your advice for prospective students who aspire to become licensed optometrists in USA?

The career as an optometrist in the US is extremely rewarding and satisfying. There are a lot of jobs for
optometrists across the US. Optometry is one of the few careers that gives you a great work life balance. If
you are willing to work hard and invest in this career, you will have a lot of options once you graduate. The
entire admission process is overwhelming but remember everything is possible if you work hard towards
achieving your goal. You can work in a hospital setting, or in a private practice or in a retail chain or set up
your own practice and the best part is you can choose what mode of practice and specialty you want your
practice to be.

What financial advice would you give to the prospective students?

Think of it as an investment. If you are smart and hardworking you can surely
pay off your loans and be successful. If you have a friend or family in the US
who has a green card or is a citizen of the US, it would be best if they can be
your guarantor for a loan in the US as the interest rates are extremely high in
India. If you are an US citizen, you may be eligible for local federal grants.

Can one practice in India with this O.D. degree?

This O.D. degree will not be given the same importance in India. We have not seen or heard of anyone
who went back to India after graduation. We personally think that it would take some time and lot of
effort from the optometrists to fight the system in India to reach a place where we would have the same
scope of practice that we now have in the US.

Where all can one practice optometry with an O.D. degree from USA?

O.D. degree is recognized around the world, but you will still
have to pass the local boards and licensure exams. For example, an
O.D. degree from the US is recognized in Canada, but you will have to take the
Canada board certification exams and the local licensure exam to be
able to practice in Canada.

OPTOMETRY 360 |  6

At Optometry School

a. How to prepare for the O.D. course load?

The O.D. program is very different from the bachelor’s degree in
optometry. There is a lot of emphasis on core subjects and basics.
Also, ophthalmic procedures like laser treatments are taught in
the program. All colleges have full library access to books,
articles, literature etc. and the professors provide guidance
for preparing for the exams. The 4-year optometry course is
intense and is only for hard working and determined individuals.
The first 2 years of optometry school are the hardest and if you
do well then, the next 2 years can get easier, but each year has its
own challenges. It can sometimes takes a whole semester to get acclimatized to the method of studying
in USA. It is quite different from India where you can study in the last few weeks/days before exams and
clear your finals with a good score. But here, you have exams throughout the semester, and you need to
do well in all the tests to get a good GPA. The first 2 years of optometry school demand long waking and
working hours as you have 2-3 exams every week. For the 2 and 3-year degrees, the course work is intense
in the first year. Be prepared to jump in and keep up the momentum. The 4-year program allows a little
more breathing space.

b. What are the total credits required over 4 years?

O.D. program have 8 -9 semesters depending on your university with 21-23 credits each semester. You do
not have a choice to pick the courses. You are given the courses each semester and are expected to
complete them. Most of the universities require 70% or above as a cut off for passing.

c. How is this different from the optometry program in India?

The course work in the O.D. program goes a lot more in depth in
comparison to the bachelor degree in India. Some courses like
optics are similar but courses like ocular diseases, treatment and
management, pharmacology, binocular vision are taught intensively.

d. Clinical experience (internship and externships):

Each university has its own pattern when it comes to internships and externships. 4th year of O.D.
program is divided into six clinical rotations. These rotations lay the foundation for clinical work and also
provides opportunities to learn to run a successful private practice.

Few schools also offer community eye care service programs. Most universities have mobile eye clinics
where students are encouraged to participate in community eye care.

e. How can we manage our finances and prepare for a huge financial commitment? Are there any
scholarships/funds?

There are no scholarships/funds available to international students.
The cost of O.D. program is around 250,000 USD. Do not get discouraged
by the huge amount. There are many loan options available in India and
USA for international applicants. In USA, you need a US citizen co-signer
to obtain a student loan if you are not a citizen or a permanent resident.
Few private banks in USA also offer student loans without co-signer but
will need additional information from the applicant. There are financial advisors in each college who will
guide you and give the right information.

OPTOMETRY 360 |  7

What are the chances of getting a job in the US and what is the process of getting a work visa?

There are always jobs for optometrists in the US if you clear your national boards and get an O.D. degree.
The biggest concern however is the work visa for international students.

There is no guarantee that you would get your work visa because
of the lottery system in the US. You come to the US on F1 visa
(student visa) to study optometry. Once you finish your course,
you are given 1 year to work on your student visa. This is called
Optional Practical Training (OPT) which allows students on F-1
visa to take temporary employment as an optometrist. During the
one year you need to find a company to sponsor your H-1B visa
(work Visa). If your visa gets picked, you can stay and work legally,
else you will have to leave the country in 90 days. If your visa
doesn’t get picked you could go back to a university to continue
further education. Optometry degree, unlike a research degree does not fall under the STEM program in
the US and hence we are only given 1 year of OPT. If, however, your H-1 gets picked you get the work visa
for 3 years which can again be extended for another 3 years. Before the end of these 6 years, you need to
apply for the Green Card (Permanent residency). If your green card process reaches the stage where you
get your EAD (Employment Authorization Document) you no longer need a work visa and you can
work legally in America. If your green card process does not begin before the end of the 6 years, you will
have to leave the US. However, if your green card process begins, you can apply for an extension of your
H-1 until you obtain your EAD.

Team ALO thanks Drs. Aarthi Jude, Daniel Prakash and Dr. to be Pallavi Chereker for their valuable
contributions.

Contributors' details :
Dr. Daniel Prakash Ethakoti

Private Practice
St Louis, Missouri, USA

Dr. Aarthi Jude
Hospital Based Practice,

Arizona, USA

Pallavi Cherekar
O.D. student,

New England College of
Optometry, Boston,USA

OPTOMETRY 360 |  8

P h .D.

IN
USA

Are you passionately curious and spend your time pondering over the whys and hows? Do
you explore to find an answer to your questions? A career in research maybe your calling.
Research in the States is categorized into either optometry or vision sciences. In fact, most of
the universities will announce their research degrees (MS. And Ph.D.) under vision sciences.
So, let’s first understand what is vision sciences and how is it different from optometry. Vision
science is multidisciplinary. It includes the study of biochemistry, biophysics, engineering,
epidemiology, molecular biology, cell biology, neuroscience, optics, ophthalmology,
optometry, pathology, physiology, psychology, statistics, and other disciplines that relates to
the eye and its problems. Optometry research or clinical vision research as the name
suggests is usually related to clinical care or ocular diseases and management. In our
conversation with professionals who pursued their Ph.D. in the US, we asked them to answer
some of the frequently asked questions that every student or a graduate mulls over.

How integral is GPA for securing a Ph.D. admission? Is it good to have some work experience before
applying or is it better to apply before graduating from the bachelor's degree?

It is difficult to judge a student purely based on grades. While GPA is
something the admission committee keenly looks at, it is however not
the only pre-requisite. Having a good GPA definitely helps with the
process especially when the student doesn’t have publications or other
achievements to showcase. But, do not be discouraged if you have an
average GPA. Other factors that help compensate an average GPA are
publications, conference presentations, work experience etc.

Similarly, work experience is not a pre-requisite for the graduate program. Many students came to the US
immediately after graduation. But, a career in research after graduation might come in handy as you
might have a few publications, presentation experiences and also have some idea about what goes into
conducting a research study. A master’s degree in research can also boost your application. It is a good
practice to peruse through university websites during the third year of under graduation to plan and
prepare in advance.

Is there a blueprint the student can follow to navigate through the decision and admission process?

If you want to pursue a career in research, you should be able to make
this decision by at least towards the end of your second year or by
beginning of third year. The capstone project in 3rd/4th year will give
you an understanding of conducting a research study and also aid in
decision making. The next step is to decide the country you choose to
pursue the MS. Or Ph.D. in. Decide when you want to pursue it; just
after internship or after gaining a few years of work experience. This
will help you plan your applications accordingly. If you wish to work for
a couple of years, then try to build your CV and career in the areas of
your interest.
Talk to your seniors, mentors, alumni, etc. to know more about universities. Peruse through various
university websites to understand their research, faculty, admission requirements, etc. Shortlist a few
universities based on your areas of interest and store all the key details in a word document with weblinks
for future references. The standard admission requirements include grade sheets with GPA, letters of
recommendation, statement of purpose, personal statement, and proof of financial stability (if offered an
admission). Most universities abroad will require an aptitude test like TOEFL, IELTS, and GRE etc. Planning
in advance will help you take these tests before the application deadlines of your shortlisted universities.
If you are stuck or need guidance with the admission process, don’t hesitate to contact the graduate
program coordinator of the university. They are of extreme help.

For those who wish to work before pursuing a research program, you may want to garner skills in the
areas of data collection, analysis, scientific writing, paper or poster presentations, publications etc. This
will help portray your research interest and skill set and you can emphasize in your college essays that
you wish to use this opportunity of graduate education to improve your skills further. This will connect
with your bigger picture.

Is Ph.D. always funded?

Yes, Ph.D. programs in the US are usually funded, with a few exceptions however. The funds are paid to
the student who work in the university as teaching or research assistants.

OPTOMETRY 360 |  10

What are some tips for choosing a research supervisor?

It is imperative to choose research interest(s) before choosing a supervisor. This will
also help you shortlist the universities and the faculty you wish to work with. There will
be times when you might not find your area of research in the University of your choice.
Hence it is always helpful to have at least 3 areas of interest. Once you shortlist the
faculty who are working in the areas you are interested in, read about their past and
present research, publications, grants and other activities. Reach out to them with your
interests. If you already have a research idea, include that in your email. This will help
build a good rapport with a potential supervisor. You can also reach out to the students who are currently
working with your potential supervisor. Their contact details will be listed on the website. The best part
about studying in the US is that a student doesn’t have to pick a supervisor in the beginning of the course.
The first 6- months to 1- year are usually packed with core courses and will provide ample opportunities to
meet and talk to several faculty members . This will also allow you to explore or develop your research
ideas.

Is GRE, TOFEL, and IELTS necessary for a Ph.D. in the US?

GRE is usually necessary for the graduate program. Some universities might waive it under certain
circumstances on a case to case basis. Most universities accept either IELTS or TOFEL for English
proficiency. Go through the admission guidelines for specifications.

What is important? Choosing a good university or a good supervisor?

It is imperative to choose a good supervisor as the student will spend a good 4-5 years with the supervisor.
Also, having someone experienced in your field of interest will help you bounce research ideas with, write
a paper or a publication and will also help in networking.

What are some additional skills that can come handy when pursuing a Ph.D.?

Basic computer proficiency such as web browsing, Microsoft office (Excel, Power point, and Word), and
plotting data is a mandatory requirement. Other skills such as coding, or using software like Matlab, C, C+,
R, Python, CAD, 3D modelling, RefWorks, Zotero, Endnote etc. come in handy during data analysis and
representation.

What are some areas of research that are booming now?

There is no such thing as “booming” in research as there are at least 50 areas where research is ongoing in
optometry and vision sciences. Visit several university websites to know more about the areas that are
being researched currently. However, there has been an increased volume of research in the areas of
myopia control, contact lenses, machine learning, virtual reality and artificial intelligence etc. in the last
decade.

What are some key points to be added in the college essay or the statement of purpose (SOP)?

Earlier, SOP was the only document that communicated about a student.
However, with Zoom, Skype and other online platforms, most universities
arrange face-to face interviews with a panel of faculty from your area(s) of
interest. Nevertheless, SOP is crucial as it highlights your interests,
experiences and future goals in addition to serving as an epitome for your
vocabulary and writing skills.

OPTOMETRY 360 |  11

Consider this as an opportunity to show them your best side and elucidate what sets you apart from the
other potential candidates. Try to include the following in your SOP:

What motivated you to pursue a Ph.D.?
Your current skill set, research and clinical experience, other work experiences and interests you have
that would make you a suitable candidate for a Ph.D.
Why did you choose this university and what are your larger goals?
Try to maintain brevity and clarity and keep this under 2-pages.

People say Ph.D. is also not enough these days. Is this true?

This question highlights the ‘herd mentality’ prevailing in our society. Remember why you
are applying to a graduate program. Remember that it interests you, excites you and inspires
you. Do not choose this career if you just wish to prefix the title "doctor" to your name or because
the courses are fully funded. Choose the career of research only if you wish to be a researcher,
educator or want to actively pursue research throughout. There will be tough times and
it might be difficult to see the light at the end of tunnel due to unprecedented circumstances.
If you are not self-motivated, you might find it difficult to keep up and march ahead. When you realize
that research is not your forte, it would be better to follow your instincts and withdraw your application or
from the program. This will save you from a lot of trouble and will also give an opportunity to another
student who might actually be interested in pursuing a research career to contribute to the community.
The natural course after a Ph.D. is post-doctoral research or fellow position which is an extension of the
graduate program. In your graduate program, you are fully dependent on your primary investigator (PI)
but during your post-doc, you gradually become autonomous and communicate with your PI only for
their expert opinion. While Ph.D. is time bound, post-doc isn’t.
The next transition from being a post-doc is to become a faculty if you wish to continue your career in
academics. There are many faculty members who have taken up positions immediately after their Ph.D.
and are very productive and successful. You can also apply to industrial research after pursuing a Ph.D.
This gives a huge scope for understanding innovations.

How does a Ph.D. help?

Ph.D. is a training that shapes graduate students to be a good researcher. As of today,
the world follows a protocol for research and that guideline in research is a Ph.D.
You can be a good researcher, but you would need a degree in advanced skills.
Ph.D. is a journey that provides the foundation for future research endeavours and
advanced skills that will help you move up the ladder. Having a degree in Ph.D.
tells the world that you have undergone that journey. Some jobs also have a
requirement of Ph.D. as their minimum criteria. This degree will help you
in your greater goal as a researcher.

What is the scope of research opportunities in India if one wishes to return?

There is no doubt that we need our researchers to return to India and develop the infrastructure here.
There are a lot of grants awarded by the Government of India to encourage those who choose to return
after completing their Ph.D. There are several industrial grants, in addition. The likely hood of the approval
of your grant however depends on the host institution.

OPTOMETRY 360 |  12

What is your advice for students/graduates who are planning to pursue a Ph.D.?
My principal advice to any potential graduate student is to understand what research is. Patient care or
clinical practice gives you instant gratification, results, satisfaction, feedback etc. Research on the other
hand is rather a slow and a lengthy process, sometimes frustrating even. There are no instant results. But,
the end result is definitely worthy as you see a better version of yourself with an improved skillset. If you
are impatient and are keen to get instant results, you may want to reconsider this career path. Research is
not straight forward. It will make you think and grow. It is a maze and every day is a step towards the final
goal. Research demands a lot of patience, motivation, determination and encouragement.
Research is just a professional aspect in one’s life. There might be other things going on in your life that
might take up time, energy and may slow down your professional commitments. Hence, it is better to be
mindful and be aware of the expectations of this research journey. Like any other field, there are
challenges in continuing to be a researcher. But the results and the contributions are what makes it
worth. Research is a constant learning journey.
How can I work in the US after pursuing a Ph.D.?
After completing Ph.D., the system permits the student to avail Optional Practical Training (OPT) to work
for a year on their student visa. The student can extend this to a maximum of 24-months after the first
year as a MS. Or Ph.D. in vision sciences qualifies as a Science Technology Engineering and Mathematics
(STEM) degree. Before the end of this 24-months period, one must find a job that can grant them a work
visa. The student can also plan to go back to India or move to another country after this time period.

Team ALO thanks the professionals for making a valuable contribution to this article

OPTOMETRY 360 |  13

PERSPECTIVE
COLUMN

TIPS FOR CONTRIBUTING TO

THE PERSPECTIVE COLUMN

Optometry 360 aims to cater to both practicing optometrists and students, both from LVPEI and from
other optometry schools and institutes. We envisage to bring to you the best practices and interesting
stories from different institutes across the country. Hence we are excited to extend this invitation to
contribute to the optometry fraternity. One such section where everyone can contribute is the
“Perspective Column.” Perspective column is a mix of scientific and science writing. While they both
could mean the same, there is a slight nuance between them. Scientific writing is an objective
communication of science related best practices and research shared by clinicians and researchers.
Science writing, although does the same, engages the readers and keeps them enthused with your
passion for the subject. While the former doesn’t encourage subjective beliefs, wishes and hopes, the
latter encourages you to share your beliefs and hopes to explain the motivation of your science or
practice. We want to bring the best of both these features in our column. Hence we invite optometry
or related articles elucidating a scientific revelation, a concept or a topic sporadically discussed,
evidence based best practice, story of a new invention/discovery or anything that keeps our audience
engaged, in your own words. We have four such articles in our current edition.
If you wish to contribute to this section, please send us your pitch. Our team of editors will walk you
through the process and help you in bettering the article when necessary. Here are some guidelines for
pitching to us:

Originality: Please ensure that you send us your own work. We want to hear your story in your own
words. You may use information or research to corroborate your results or understanding but make
sure to rephrase them
Plagiarism: We take plagiarism very seriously. If you have used information from text books,
scientific articles or a website, please cite their references appropriately in Vancouver style. To
ensure that the plagiarism is under 10%, please run your article on any of the online plagiarism
check software. We will also run a check at our end once we receive your articles. We reserve the
right to reject any article we deem unfit
Images and photographs: Feel free to add photographs, graphs, flow charts to articulate your
concepts. If you plan to use photographs taken by you or your team, please add a watermark. If you
choose to use an online image, cite the reference below the image in a small font with the web link
Grammar: Grammar is of utmost importance. There are several free grammar check platforms
available online. Use them to check your basic tenses, spellings and punctuations. Our editing team
will also work with you by providing valuable inputs, suggestions and corrections wherever
necessary. The attractiveness of correct grammar cannot be overstated
Practice the art of brevity: The briefest construct of words that explicitly states a thought is long
enough - Herbert Brün. Try saying a lot in under 1200 words (references excluded)
Time: Please allow at least 2-3 days to hear back from the team. If you don’t hear back from us
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OPTOMETRY 360 |  15

DO YOU KNOW WHAT TRICKED YOUR MIND?

Eight cognition-based techniques that influence our mind

Srikanth M, M.Optom, PGDHRM
Consultant Optometrist
Teaching Faculty

Bausch & Lomb School of Optometry
Brien Holden Institute of Optometry and Vision Sciences

L V Prasad Eye Institute (LVPEI)

Imagine you are listening to your favorite music and your friends come to visit you. The way you
receive them will most likely be pleasant and joyous. Now imagine you are listening to loud and irritating
noises. If the same friends came by, you would probably react differently this time. Here, music is an
external factor; its perception is a personal factor that affects your behavior, the personality factor. The
Social (external) and cognitive (individual) factors affect personality (demeanor).

Our mind is often full of thoughts related to the past and future that affect our contemporary living.
These thoughts bring the race between positive and negative reviews, and the current environmental
factors fuel it. Negative reviews are distractive, and often we realize their impact more than the positive
reviews. These reviews cause emotional imbalance and start affecting our behavior.

Each of us, be it a learner, clinician, educator, researcher, manager, entrepreneur, bonded with
relations are tricked by cognitive psychology skills. We become prey to it and they affect our thoughts
and decisions.

Following are the nine cognition-based techniques or theories that might help you connect with your
situation and hopefully enhance your meta-cognition skills. They might help you find solutions after
analyzing your life situations and would help you lead a successful life.

Priming: There are three individuals in a society, Dohra,
Anuj, and Nirvath. Dohra gives an opinion on Nirvath to
Anuj before introducing Nirvath to him. Later, Anuj
interacts with Nirvath with Dohra's impression. What
Dohra did to Anuj is called priming. Priming is a
phenomenon whereby exposure to one stimulus (here,
Dohra influenced Anuj) influences a response to a
subsequent stimulus (Anuj to Nirvath) without conscious
guidance or intention.

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Perspective column

Forced perspective: In a gathering, Anuj proposes an idea X to Nirvath

Dohra offers and highlights idea Y in the conversation and talks
positively about Y, speculating that X is inferior without talking
low about it. Forced perspective is a technique employed in an
optical illusion; a few apply this technique to trick your mind.
(Here, idea Y).

Helicopter technique metaphor: In the above conversation, while
Dohra and Anuj discuss X and Y, Nirvath joins and supports Anuj’s
statement (X). Suddenly, Dohra talks about a movie he watched
recently to divert the topic. The helicoptering technique is a
method to divert the focus of the ongoing conversation. Many use
this technique to shift the attention out of the conversation or to
avoid conflicts and altercations.

Dohra brings them under the umbrella, C.
Bringing under one umbrella: Anuj and Nirvath have ideas A and
B and express them to Dohra.

Here, the ideas A and B appear as a subset of C. In the bigger
picture, concept C is evident and the ideas A and B become tiny,
though they are supportive of C.

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Perspective column

2D (Defer, Dilute) to Distract: Anuj and Nirvath plan to execute ideas X and Z. Dohra manipulates to
defer the execution and dilutes it by adding challenges that take time to overcome. This technique is a
diplomatic way of distracting the implementation of ideas, thus causing a delay.

Doppelgängers phenomenon: Dohra brings Amrish, Gopa, Apeksha, Mahant, and Kairav into the
society with the same background as himself to support his actions and decisions.

Bandwagon effect: "Whenever you find yourself on the side of the majority, it is time to pause and
reflect"- Mark Twain. We tend to follow what the majority observes in society, thinking that the majority is
following the right path. Values and principles that we adopt shall drive us to our destiny, not what the
majority follows.

Sama, daama bheda dandopaya: It is one of the ancient followed strategies in finding a solution to a
problem. The first step (sama) is the alliance. If conflicts arise between two individuals or groups, resolve
them with a discussion. The second step is compensation by gifts or offerings (daama or dana). The third
uses logic, tricking the mind (bheda) and the fourth is force (danda) or armaments.
Dysrationalia: Dysrationalia is a concept in educational psychology. We think and behave without logical
reasoning despite having the intelligence to develop the right decisions and statements. For example,
Anuj could have used his rationale to understand Nirvath, but got tricked by priming.

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Perspective column

How do you understand and deal with these techniques?
Spend some time for yourself. Use your rationale and analyze what is happening with you. If you

realize that someone is influencing you positively with these techniques, be thankful to them. If not, focus
on self-actualization; the rest will fall in place.

Self-actualization: One should be aware of oneself. When we know our positives, negatives, capabilities,
skills, and values, we will manage ourselves well and bring in many opportunities to grow, flourish and
become peaceful human beings by living life to the fullest potential. Yoga and meditation help us know
about ourselves. Understanding Maslow’s hierarchy of needs will also help us realize what we want in life
and our determination and self-discipline will drive us towards what we want to achieve.

Morality,
creativity,
spontaneity,
problem-solving,
lack of prejudice,
acceptance of facts
Self-esteem, confidence, achievement,
respect of others and respect by others

Friendship, family, sexual intimacy

Security of body, of employment, of resources, of morality, of
the family, of health, of property

Breathing, food, water, sex, sleep, homeostasis,excretion

References:
1. Weingarten E, Chen Q, McAdams M, Yi J, Hepler J, Albarracín D (May 2016). "From primed concepts to action: A meta-analysis of
the behavioral effects of incidentally presented words". Psychological Bulletin. 142 (5): 472–97. doi:10.1037/bul0000030. PMC
5783538. PMID 26689090.
2. Bargh JA, Chartrand TL (2000). "Studying the Mind in the Middle: A Practical Guide to Priming and Automaticity Research". In Reis
H, Judd C (eds.). Handbook of Research Methods in Social Psychology. New York, NY: Cambridge University Press. pp. 1–39.
3. Dysrationalia: Stanovich, Keith E. (October 1993). "Dysrationalia: a new specific learning disability". Journal of Learning Disabilities.
26 (8): 501–515. doi:10.1177/002221949302600803. PMID 8245696.
4. Bandwagon effect: https://www.inc.com/sam-mcroberts/7-cognitive-biases-that-are-holding-you-back.html
5. https://psychology.wikia.org/wiki/Maslow%27s_hierarchy_of_needs

OPTOMETRY 360 |  19

Perspective column

Dr. PremNandhini Satgunam
Consultant Optometrist; Scientist
Specialisation: Binocular Vision and Orthoptics
L V Prasad Eye Institute, Hyderabad

Noel is this cute little cuddly 2-year old Scottish boy whose video
posted by his mum went viral on social media in 2016. (1) He wins
people’s heart when he answers “innocently” to his mom “Batman
did it”, after scribbling on the mirror with his mum’s lipstick. Soon
after, TV channels interview him and he is an instant celebrity in
many parts of the world.
if it was not for Batman, if it was “I cannot see”, and if he had come
to an eye clinic, only to find out he “can see”, we would label this
child as a malingerer. Such children don’t become celebrities, but
instead in many cases may end up losing face in front of their
parents. I vividly remember few children seen by colleagues or me
at different stages of my career who fall in this diagnosis bracket.
This essay is to reflect on my learnings through these cases and
how my perspective has changed over time.

Chocolate box
Soon after I became a faculty at Elite School of Optometry, Sankara Nethralaya (SN), my first case of
examining a child (12/m) detected as a malingerer happened to come from Andhra Pradesh. The medical
records from main SN noted that the child has normal VEPs but is not reading beyond 6/60 and N36. A
worried dad & a supportive uncle along with the child were referred to Dr.E. Vaithilingam (EV) to our
college clinic. Dr. EV asked me to do the workup.
As I kept taking the history, and realizing that this maybe a case of functional vision loss and malingering,
I asked the dad and uncle to be seated outside. I started talking with the child, I found out that he does
not like his new school. He was happy in his old school. We became friends, I asked him to read my name
from my ID card, it was about N8 font size, and he read it from 60 cm with ease, unlike N36 with difficulty
at 20cm. I asked him if I can get his school changed, and give a spectacle with a small power, will it help
him to see better. We made a deal. He would read the full chart in front of his dad and uncle. Dr.EV also
joined after I briefed him about the case.

OPTOMETRY 360 |  20

Perspective column

Dr. EV and I explained to the dad that emotional stress can reduce a child’s vision and after some
counseling also told them it may be a good idea to change his school back. They sort of got the hint, and I
brought them in and the child read. The dad cried, since for the past 1 month they have been hopping
around different places and have spent so much for different scans and tests. They left our hospital and
came back within 10 minutes with a box of chocolate for us. This was the first time I was getting a gift
from a patient. Dr. EV told me “see how important it is to understand the patient fully.”

Crying stones
In 2017, newspapers in Andhra Pradesh reported of a 12-year old girl crying out stones instead of tears. (2)
It was a medical mystery and apparently this phenomenon has been reported before in Yemen as well! At
least for the girl from Andhra Pradesh, who was taken to LVPEI, Vijayawada the mystery was solved when
it was found that the girl packed little stones into her eyes and could maneuver to cry it out. She did this
to get attention of her parents. Her parents apparently were more focused on her brother and she was left
with her grandparents’.

True lies
As a part of research work (3) and trying to solve the cases of spasm of near reflex (SNR), I realized that
many patients with true spasm of near reflex were getting misdiagnosed as malingerers on the medical
records stating “variable response, not cooperative etc.” I remember another child with his dad who came
to our binocular vision and orthoptics clinic at LVPEI, Hyderabad, reporting the child who could see earlier
is not seeing now. The father appeared restless and angry. Upon finding SNR, and explaining the
condition and after the child read 20/20 with cycloplegic eye drops, the father looked remorseful. He
regretted for being angry with his son, since the earlier doctor had mentioned that the child could read if
he wants to, he is just faking poor vision!

Why is there variable response in these patients with spasm of near reflex (or accommodative spasm or
pseudomyopia)? We observed (4) that the accommodation vacillates, and there are epochs when the
refractive error goes to zero, giving some clarity and the patient picks up few letters but then again, the
refractive error swings into myopic refractive error and now they cannot see the same letters. It baffles the
patient and tests our patience, when they are very slow to read the letters. This fluctuation in
accommodative response is what we see as vacillating retinoscopic reflex. This is also the reason for the
varying or fluctuating visual acuity.

Wisdom spoke
I was invited to give a talk on accommodative spasm in a conference organized by Narayana Nethralaya
in 2018.(5) Prof. Lea Hyvarinen was a chief guest at this event. I was mentioning to her about patients with
spasm and how many are labeled as malingerers. She then mentioned to me that in all these years of her
experience she has never come across a child who is malingering. I just looked at her shocked and asked
“how is that possible?”, we have seen a lot of them. Then in her infinite wisdom she patiently answered
“there is always a problem for the child, no one lies”. That wisdom hit me, it was an eye-opener!

We may get a Sherlock Holmes kind of pleasure, when we trick a child to read with plano combination
lenses and not reading when we remove the trial frame. While it doesn’t take too long to expose them to
the parent, as eye care professionals we need to pause for a minute and think “why is the child doing it?”
That may uncover many layers of their troubles. If we can understand that, we can help the child (and the
parent) in dignified ways, beyond just prescribing -0.12DS spectacles!

References:
1. https://www.youtube.com/watch?v=oo5uPLA16sc
2. https://www.thehindu.com/news/national/andhra-pradesh/doctors-call-thebluff-of-teenage-girls-tears-of-stone/article20120867.ece
3. https://www.jaapos.org/article/S1091-8531(21)00142-7/fulltext
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425728/
5. https://www.youtube.com/watch?v=TdFcblCu5oQ

OPTOMETRY 360 |  21

Management of Amblyopia in
Adults - Never Too Late to Treat

- Md. Oliullah Abdal

Amblyopia is a neuro developmental disorder that is characterised by
visual impairment unilaterally and less commonly bilaterally along
with compromised binocular visual function, which is not explained
with structural abnormality (1). The most common treatment for
amblyopia is patching of the good eye to force the amblyopic eye to
improve. Treatment is effective if done at an early age (up to 13 years),
however, its effectiveness decreases in older children and adults. With
a prevalence rate of 2-5% globally, amblyopia will carry on in adults if
the treatment doesn’t begin during childhood. Moreover, for adult
amblyopia there is no accepted treatment to improve visual acuity till
the recent past, however, studies show otherwise (2, 3).

Any condition that interferes with the focusing of the eyes in Md. Oliullah Abdal
childhood can cause the eye to become amblyopic. It could be a Optometrist
difference in the refractive error of the two eyes, misalignment of the
eyes or any media opacity. In many cases, the diagnosis can be missed Founder director of Bynocs™
in childhood resulting in a permanent disability. Therefore it is
important to get eyes checked during childhood. Amblyopia has

traditionally been considered as a monocular disorder causing a binocular dysfunction. Patching or
penalization of the good eye has been the gold standard of treatment for many years. This forces the
brain to focus on the image received from the affected eye (4). But this treatment has its limitations.

Here are some:

Patients are non-compliant to patching
Prolonged treatment which can go on for months/ years
15%- 50% of patients may be left with residual amblyopia
20%-50% may have recurrent amblyopia (5)
This monocular treatment may lead to never developing higher binocular vision function of
stereopsis
Ineffective in adults

The current concept is that amblyopia is a binocular dysfunction and it is caused because of the
suppression by the ocular dominance columns in the dominant eye over the non-dominant eye at the
level of the cerebral cortex(6).
Many therapy modules now offer treatment for amblyopia in the form of games. Treatment is based on
the principle of dichoptic therapy (Understating Dichoptic Principle for Amblyopia Management)
where both the eyes are made to view images with different levels of contrast.

Dichoptic therapy is emerging as a very effective tool in the management of amblyopia.(6) Contrast
adjusted images are presented to both eyes, with the dominant eye getting an image of lesser contrast
than the non-dominant eye. This contrast differentiation removes the inter ocular suppression in the
ocular dominance columns and results in the visual gain of the amblyopic eye. The patient is made to
play games on patented software with both the eyes open and wearing special anaglyphic glasses.

OPTOMETRY 360 | 22

Perspective column

There are a variety of virtual software games for better engagement and it is recommended to play
these games for 30-40 minutes a day at least 5 times a week. The initial improvement is usually seen
within 2 weeks and a good result can be expected between 6-8 weeks in certain cases.
One needs to remember that dichoptic therapy works best in patients with bifoveal fixation and with
complete correction of refractive error. Several studies have shown 2-6 lines of improvement in visual
acuity after dichoptic therapy among adult patients with amblyopia. (7,8,9)
Here are some case studies showing improvements in visual acuity and stereopsis after dichoptic
therapy:

Case 1: A 63 year old male with hyperopia and
anisometropic amblyopia with a best corrected visual
acuity (BCVA) of 1.00 & 0.00 logMAR in his right and left
eyes respectively, enrolled for dichoptic therapy program
at Wellington eye hospital, Dublin, Ireland. At the end of
30 active therapy sessions, his BCVA improved to 0.20
logMAR in the right eye. He not only improved his BCVA in
the right eye but also improved his stereopsis up to 60 arc
sec from a state of left eye suppression.

Dychoptic principle explained

Case 2: A 55 year old male with high hyperopia and
isoametropic amblyopia with a best corrected visual acuity
(BCVA) of 0.30 logMAR in both eyes, enrolled for the
dichoptic therapy program at Wellington Eye Clinic, Dublin,
Ireland. He had undergone refractive lens exchange to
correct his high hyperopia. At the end of 30 active sessions,
his BCVA improved to 0.00 logMAR in both eyes. His
stereopsis improved to 40 arc sec from 400 arc sec

A viideo game for amblyopic patients

References

1. Chen, A. M., & Cotter, S. A. (2016). The amblyopia treatment studies: implications for clinical practice. Advances in ophthalmology and optometry, 1(1), 287.
2. Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA, Crouch ER Jr, Cruz OA, Davitt BV, Donahue S, Holmes JM, Lyon DW, Repka MX, Sala NA, Silbert DI, Suh DW, Tamkins SM; Pediatric
Eye Disease Investigator Group. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005 Apr;123(4):437-47. doi: 10.1001/archopht.123.4.437. PMID: 15824215.
3. Flynn JT, Schiffman J, Feuer W, Corona A. The therapy of amblyopia: an analysis of the results of amblyopia therapy utilizing the pooled data of published studies. Trans Am Ophthalmol Soc.
1998;96:431–453.
4. Chen AM, Cotter SA. The Amblyopia Treatment Studies: Implications for Clinical Practice. Adv Ophthalmol Optom. 2016 Aug;1(1):287-305. doi: 10.1016/j.yaoo.2016.03.007. PMID: 28435934; PMCID:
PMC5396957.
5. Holmes JM, Beck RW, Kraker RT, Astle WF, Birch EE, Cole SR, Cotter SA, Donahue S, Everett DF, Hertle RW, Keech RV, Paysse E, Quinn GF, Repka MX, Scheiman MM; Pediatric Eye Disease Investigator
Group.
Risk of amblyopia recurrence after cessation of treatment. J AAPOS. 2004 Oct;8(5):420-8. doi: 10.1016/S1091853104001612. PMID: 15492733.
6. Hess, RF, Thompson, B & Baker, DH. Binocular vision in amblyopia: structure, suppression and plasticity. Ophthalmic Physiol Opt 2014; 34: 146– 162. doi: 10.1111/opo.12123
7. Žiak P, Holm A, Halička J, Mojžiš P, Piñero DP. Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: preliminary results. BMC Ophthalmol.
2017 Jun 28;17(1):105. doi: 10.1186/s12886-017-0501-8. PMID: 28659140; PMCID: PMC5490155.
8. Vedamurthy I, Nahum M, Huang SJ, Zheng F, Bayliss J, Bavelier D, Levi DM. A dichoptic custom-made action video game as a treatment for adult amblyopia. Vision Res. 2015 Sep;114:173-87. doi:
10.1016/j.visres.2015.04.008. Epub 2015 Apr 24. PMID: 25917239; PMCID: PMC4549206.
9. Campana G, Camilleri R, Pavan A, Veronese A, Lo Giudice G. Improving visual functions in adult amblyopia with combined perceptual training and transcranial random noise stimulation (tRNS): a pilot
study. Front Psychol. 2014 Dec 9;5:1402. doi: 10.3389/fpsyg.2014.01402. PMID: 25538653; PMCID: PMC4260493.

OPTOMETRY 360 |  23

Vision Beyond 20/20 - My Model of Vision
An Insight into Behavioral Optometry

There are over 1.2 million nerve fibers that exit through each eye (jonas, 1992) and they contribute to
almost 70 % of all the sensory nerves in the entire body. This is why the visual cortex receives majority of
the information.
Our visual system is composed of 2 major sub-systems:
1. Focal or central visual process (Parvocellular Pathway).
2. Peripheral or ambient visual process (Magnocellular Pathway).

Central visual system is derived primarily through the macula, which is located on the retina at the
central, or the posterior pole of the eye. The macula is densely packed with cone cells in the foveal
region. The primary functions of the cone cells are colour detection and detailed resolution. This is also
called the Parvocellular pathway (p-pathway). P- Pathway helps us see things in detail with better
resolution and also helps us with recognition.

The peripheral area of retina is highly composed of rod cells. The rods occupy greater area than the
cones throughout the retina. The rod cells are important for scotopic vision and they are also more
sensitive to movements/motion than the cone cells. This is also called Magnocellular pathway (M-
pathway). It is the M-pathway or the ambient visual process which links up with and becomes the part of
sensorimotor feedback loop at the level of midbrain. M- Pathway helps us with peripheral awareness of
our surroundings and also facilitates reading surroundings, visual attention and saccadic eye
movements.

We have all been taught that the eye is like a camera as the light passes through the lens to produce an
inverted image on the retina, the light-sensitive film at the back of the eye. Retina is connected to the
brain and turns the inverted image the right way up and through some magical process, we see!

At optometry school, my model of vision was My very first patient, an 8-year old boy, visited
developed to provide an explanation for myopia, my clinic with a complaint of difficulty in
hypermetropia, astigmatism, and presbyopia. This reading. His best corrected visual acuity (BCVA)
model of vision was basic and sufficiently adequate was 20/20 (OU) for distance and N6 (OU) for
for a typical optometrist to perform refraction and near. Anterior segment and posterior segment
provide a spectacle prescription when needed. A were unremarkable. The boy was struggling
decade ago, when I started my professional journey with reading, writing and learning for 4 years
as practicing vision therapy optometrist and began and he was diagnosed with attention deficit
expanding my knowledge in the field of disorder (by another practitioner). However,
developmental/behavioural optometry, my model of after his functional visual evaluation, I started
vision evolved and my understanding about vision working on his functional visual skills. After 30
changed. It inclined towards understanding the sessions of vision therapy for improving his
patients’ functional difficulties which allowed me to oculomotor skills, normalizing accommodation
plan and provide appropriate therapy. and vergence amplitudes, his parents reported
a drastic improvement in his reading, tracking,
and writing.

Another patient, a 4-year-old boy, who was diagnosed as a child with global developmental delay with
nystagmus presented to us with complaints of poor vision in both the eyes with poor motor control and
was unable to stand or walk (Pandey, December -2020). I decided to work with him on improving his
visual fixation and eye movements, followed by helping with the boy’s primitive reflexes by providing
visual-vestibular rehabilitation therapies. These therapies finally resulted in improved body balance and
a much better body posture and the boy began standing and walking for the first time in his life. This
changed my understanding of vision and I could clearly see that vision is more than reading the 20/20
line on a vision chart and also justifies that there is a difference between “vision” and “eye sight”.

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My present understanding of vision and the model I believe is very much motivated from Dr Skeffington’s
four circles theory of vision. In the mid-twentieth century, Dr A.M. Skeffington, the founding father of
modern developmental / behavioural optometry realised that “vision” plays a much larger part in
individuals’ lives than simply being able to read a letter chart and then postulated and developed his four-
circle concept.
Dr. Skeffington highlighted that vision is an emergent process as it is actually a cluster of interrelated sub
senses that works together to create the visual world we experience. He conceptualized vision as
emerging from four intimately related and integrated processes or system components as explained
below:

The relationship of the magnocellular/parvocellular systems with Skeffington’s 4 circles (Shayler, the
use of models to help our understanding of vision, 2015)

A. Antigravity: “Where am I?”
B. Centring: “Where is it?”
C. Identification: “What is it?”
D. Speech-Auditory: “How can I communicate it?”

The most important and the major concept in his model was that the understanding of vision requires
more than looking at isolated processes or individual structure-function pieces. Skeffington moved the
field away from the camera-like understanding of eye toward the framework for multiple, distributed,
parallel, and reintegrated processing.
In postulating vision as an emergent process, Dr. Skeffington used terminology distinct from the more
familiar visual subcomponents of convergence and accommodation. Let’s understand his ideas of four
circles below:

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Perspective column

A. The Antigravity Process: “WHERE AM I?”
Vision provides us the idea of our reference in space and also allows us to organize things and materials
spatially and for this we must first know where we are in space. Vision also plays a vital and active role in
controlling our body posture, movements, locomotion, and manipulation function and this particular
role is called visual proprioception (Shayler, the use of models to help our understanding of vision, 2015).
The very important role of vision in counterbalancing gravitational forces and visually guided movement
of our body is also evident and reflected in our clinical tests of gross motor skills of standing and walking
balance.
Therefore, the antigravity system depends on many neurological processes which evolves and comes into
action and follows the below mentioned sequence:

Visual system input that aids in the determination of vertical and horizontal frames of reference and
the perception of self-motion that comes from optic flow patterns across the retina.
Vestibular system input through the otolith and semi-circular canal systems of the inner ear gives
information about head position relative to gravity and changes in acceleration and deceleration.
Proprioception system input from the stretch receptors in the muscles that give information on body
position.

(A) Bosu Ball- visuo-vestibular training combining with SVI- rotator module.
(B) Balance board training with visual fixation for improving balance (Pandey, december -2020), a part of
visuo-vestibular training. These are some of the vision therapy activities we perform which relates to the
circle of Anti-gravity process: Where Am I?

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B. The Centring Process: “WHERE IS IT?”
The centring process refers to the coordinated movements of eyes, head and body to investigate and
explore the environment surrounding the person and is a response crucial to the development and
survival of the individual and species (holland, 2008). This particular process of centring describes ocular
motility that can be fragmented and described as fixation, saccades, pursuits, and vergence.
Fixation: It is the ability of the eye to keep a steady image of object in space on the fovea. Fixation also
serves as a measure of global attention and a patient with reduced attention span may can have difficulty
maintaining visual fixation on a task. An accurate fixation is also very important and serves as a
prerequisite for accurate saccades & pursuits.
Saccades: Saccades, also called fast eye movements shifts our centre of focus between two or three
successive points of fixation in the same direction. Saccades can be further classified into involuntary
saccades and voluntary saccades. Involuntary saccades are mostly reflexive in nature and gets stimulated
because of sudden changes in the environment for example bright light or sudden sound whereas
voluntary saccades are purposefully induced by an individual for example reading is a voluntary saccades.
Pursuits: Pursuits are the smooth eye movements used to track moving objects in space.
Vergence: Vergence can be subdivided into five subclasses:

Tonic vergence: normal vergence tone of the neuromuscular system. (Penelope S. Suter)
Fusional vergence: disparity driven vergence when images fall on non-corresponding retinal points.
Voluntary vergence: vergence under voluntary control.
Accommodative vergence: vergence stimulated by changes in accommodation.
Proximal vergence: vergence stimulated by the nearness of an object.
All of the various components of vergence must be integrated so that binocular fusion is effortless. This
frees attention from the act of vergence, allowing attention to be allocated toward other aspects of visual
information processing (Penelope S. Suter).

(a)VTS-4 (b) Saccadic fixator. (c) Four corner saccadic chart – Sanet Vision Integrator

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Perspective column

(d) Sanet Vision Integrator- Rotator module – Pursuit training

(e) Eye port fixation training – to develop vergence

(f) Space fixator

(g) Mac- Donald charts – to improve peripheral awareness
These are some of the vision therapy activities we perform which relates to the circle of centring- Where is it?

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C. The Identification Process: “WHAT IS IT?”

Identification, or recognition of an object, occurs through the recognition of objects through their specific
attributes such as shape, colour, size, and texture. Multiple processes are involved, including attention,
prior experience with the object, and storage of information, conversion to memory, memory retrieval,
association, generalization, and classification. Object vision normally has as its basis stable visual fixation,
aided by the ability to attain and maintain a clear image through visual process of focusing or
accommodation.

(a)Perceptual Therapy- Pegboard (b) Visuo motor module - SVI

(c) Perceptual therapy- Directionality training (d) Parquetry blocks

These are some of the therapies we perform which relates to the 3rd circle – The Identification Process:
What is it?

D. Speech – Auditory: Analysis and Communication:

Identification of an object is incomplete until a person is able to label and communicate that which is
seen. The communication may be internal, in the generation of visual images or more in the form of
auditory analysis to tell ourselves what we are seeing, or speech in terms of conveying what is seen.

AB
(a) Computer Tachistoscope- Audio- Visual Format to train visual auditory integration. This particular
vision therapy activity relates to the 4th circle – Speech -Auditory- Analysis and Communication
(b) Computerised parquetry blocks – visual verbal format

OPTOMETRY 360 |  29

Perspective column

Now, I can conclude that Dr. Skeffington’s theory on four circles of visual process is very closely standing
up with the modern concept of neurological processes of the magnocellular and parvocellular pathways. I
can very well relate that antigravity and centring circles are primarily related to the magnocellular
processing and are closely associated with visual attention, whereas identification and speech/auditory
circles are primarily related to parvocellular pathway mechanism and associated with cognition.
So based on the above theory postulated by Dr Skeffington and my newly evolved understanding of
vision, I can now clearly state that there is a difference between eye sight and vision. Where eye sight is
more quantitative in nature (20/20) and can be measured using a vision chart whereas “vision” is an
emergent process which integrates with all other senses together to give an amazing experience of the
world surrounding us which cannot be measured by any one single test.
“Vision is a dynamic interactive process of motor and sensory function, mediated by the eyes for the
purpose of simultaneous organization of posture, movement and spatial orientation, for manipulation
of the environment and to its highest degree, of perception and thought.” – William V Padula

Rabindra Kumar Pandey is the Optometric Director and Proprietor of Caring Vision Therapy and
Neuro-Vision Rehabilitation Centre in Chennai, India. He completed his bachelor of optometry
and vision science from NSHM school of Optometry, Durgapur/ Kolkata and post-graduation in
clinical optometry (M.Optom) from Chitkara School of Health sciences- Chitkara University,
Punjab. He is currently pursuing his Ph.D. from CT University, Punjab. He has been an
international member of The College of Optometrists in London, U.K, international clinical
associate member of College of Optometrists in Vision Development (COVD), Neuro Optometric
Rehabilitation Association (NORA), American Academy of Optometry (AAO) and the College of
Syntonic Optometry (CSO) and is currently pursuing his fellowship at COVD and AAO.

References:
1. holland, k. (2008, march). www.optometry.co.uk. Retrieved from www.optometry.co.uk.
2. jonas, j. B. (1992). human optic nerve fiber count and optic disc size. investigative opthalmology and visual science .
3. Pandey, R. K. (december -2020). a journey towards 1st step of life- a case report on vision therapy for a patient with
global developmental delay and nystagmus. vision development and rehabilitation , 295-303.
4. Penelope S. Suter, L. H. Vision Rehabilitation- multidisciplinary care of the patient following brain injury. CRC press.
5. Shayler, G. (2015). the use of models to help our understanding of vision. optometry and visual performance , 138-
150.
6. Shayler, G. (2015). the use of models to help our understanding of vision. optometry and visual performances .

OPTOMETRY 360 |  30

LATEST

SCI BUZZ > INNOVATIONS INDUSTRY >

USING STEM CELLS TO RESTORE SIGHT
IN ACID ATTACK VICTIMS

ultivated Limbal Epithelial Transplantation (CLET) is a new stem cell treatment for
C
restoring sight in acid attack victims. It’s a pioneering therapy which uses stem cells to repair

surface of the eye. Small biopsy from the eye is taken and is used to grow the stem cells. Scar

SMART CONTACT tissue is removed from the injured area and then resurfaced with the grown stem cells. Dr.
LENS ALTERS Sajjad Ahmad, Ophthalmic surgeon at Moorfields Eye Hospital, London when talking with
COLOUR IN Optometry today magazine, shared that he sees patients with severe eye injuries due to
RESPONSE TO chemical assaults. He observed that many of the patients affected by acid attacks were in
MOISTURE AND their 20s and 30s.
This is treatment may seem to cost significantly high, but the results are astonishing. Please
PRESSURE CHANGES follow the link to read more on CLET: (https://www.aop.org.uk/ot/science-and-
vision/technology/2020/01/26/using-stem-cells-to-restore-sight-in-acid-attack-victims)

Chinese researchers developed a smart
contact lens which reacts to changes

in eye pressure and moisture levels by

changing its colour. These contact

lenses provide a suitable platform for

point of care of diagnosis of eye

diseases. These contact lenses have

structured colored contact lens sensor

with a tunable color, making it suitable

to use as an instrument free detection

of pathologically relevant signals of eye

diseases. FACEBOOK AND ESSILORLUXOTTICA PARTNER
This smart contact lens is made from FOR SMART GLASSES PROJECT
biocompatible hydrogel made from
polymer material, poly (2-hydroxyethyl

methacrylate, pHEMA), with periodic RayBan is all set to launch new generation smart glasses in collaboration with Facebook

nano structural spacing which makes it and EssilorLuxottica.

sensitive to moisture and pressure During the Facebook connect virtual conference, Mark Zuckerberg announced their multi-

changes. This might be useful to detect year collaboration with EssilorLuxottica to combine technology with fashion to create smart

conditions like xerophthalmia and glasses that consumers will truly love wearing. Andrew Bosworth, Vice-president, Facebook

ocular hypertension. Reality Labs, mentioned that, “With EssilorLuxottica we have an equally ambitious partner

For more details: who’ll lend their expertise and world-class brand catalogue to the first truly fashionable smart

https://www.aop.org.uk/ot/science-and- glasses.”

vision/technology/2020/02/22/smart- Mr. Basilico, Chief Wearable’s Officer at Luxottica, added that this collaborative efforts of

contact-lens-alters-colour-in-response- making a smart glass can reset expectations around wearables.

to-moisture-and-pressure-changes More details on the product name, software capabilities and pricing will be shared closer to

the 2021 launch.

OPTOMETRY 360 | 31

KELLOGGS’ TO ROLL OUT CEREAL BOXES WITH WORLD-FIRST
TECHNOLOGY FOR BLIND AND VISUALLY IMPAIRED

C ereal brand Kellogg’s recently announced world’s first technology, NaviLens technology, to be added to all of its cereal boxes to
make them accessible to the blind and visually impaired. With NaviLens technology, new boxes will allow a smartphone to easily
detect a unique code and playback the labelling information to the shopper with sight loss. Most critical information on food
packaging such as ingredients, allergies, contents can often be difficult to read for the blind or partially sighted.
Shoppers do not have to know where the scan code is located. This technology includes high contrasting colored squares on a
black background, which allows smartphone to pick the code area from a 3-meter distance. When the shopper points the device in
the direction of the cereal box, it alerts the phone and the shopper can choose to playback the details such as ingredients,
allergens, recycling information etc. aloud.
Royal National Institute of Blind people(RNIB) showed 97 % of the participants agreed that they would like to see this feature
available on grocery packaging in the future. Follow this link to read more, https://disabilityhorizons.com/2021/07/kelloggs-to-roll-
out-cereal-boxes-with-world-first-technology-for-blind-and-visually-impaired-people/

SCIENTISTS USE VR TO SIMULATE GLAUCOMA

D r. Peter Jones and his research group (Crabb Lab) from City University, London investigated the potential of a virtual and
augmented reality device to simulate the visual changes that are caused by glaucoma. This study explored the possibility of using
head mounted displays to illustrate the visual changes. In this study, 22 participants without glaucoma wore the head mounted
displays while performing a variety of tasks in virtual or augmented reality scenarios. Sensors within the head mounted displays
tracked the position of the participant’s eyes and generated a blurred area of vision that obstructed the portion of their visual field
wherever they looked. This study reported that participants’ performance slowed down when a simulated visual impairment was
presented. Digital medicine journal when talking about this article highlighted that using head mounted displays to simulate sight
loss could aid policymakers in better assessing the impact of visual impairment in patients. Dr. Peter’s research group is now
working on implementing and exploring the use of sight-loss simulators in designing more accessible buildings and transport
system.
Please follow this link to read more: https://www.aop.org.uk/ot/science-and vision/technology/2020/03/12/scientists-use-vr-to-
simulate-glaucoma

OPTOMETRY 360 |  32

Picture credit:
M.Prashanth Goud
Faculty Optometrist,

BHIOVS- LVPEI

CLINICAL
PHOTOGRAPHS

Iron foreign body resembling a fish diving in the ocean

Sankara Eye Hospital

Navya
Consultant Optometrist
Sankara Eye Institute, Bangalore

Symblepheron

Iron foreign body resembling a fish diving in the ocean

Sankara Eye Hospital

Goldmine in the eye

Nishat Tamanna

Ocular Toxoplasmosis. Nishat Tamanna
Camera: 3netra Classic Research Optometrist

Radical Health-Tech

Orthokeratology lens fit

Harnish Khudkhudia

Harnish Khudkhudia
B.Optom student
Nagar School of Optometry, Ahmedabad

Montage of disc edema with blurring of margins along with hemorrhages in all four quadrants
suggestive of Central Retinal Artery Occlusion(CRAO) with Central Retinal Vein Occlusion(CRVO)

LVPEI

Neelima Manchikanti
Optometrist
Neoretina Eye Institute, Hyderabad

This image of birefringence
pattern seen in an ophthalmic
lense was captured using a Moto
E3 phone in the dispensing lab.
This was also published as a case
report in the Indian Journal of
Ophthalmology.

Manchikanti N, Maseedupalli S. Birefringence
in ophthalmic lenses. Indian J Ophthalmol
Case Rep 2021;1:455

Vidhi Bavishi
Consultant Optometrist
Shiv Jyoti Eye Hospital, Gujrat

THAULNENTT

SAMPATH KONDA
Product Application Specialist
Carl Zeiss India

"Life is all about how we all, humans, animals and other
beings CONVERGE and live in UNION"

SHWETHA SINGH
Student
Sankara Eye Institute, Ludhiana

With a keen of a kid,
I stepped in this world.
To sustain or not was never a query
knowledge didn’t seem this perfect.
Hurdles came, jumped off easily
problems popped up,
but got solved with ease.
Cultures threaded together,

hearts twirled up.
Greenery, flowers and paintings
elevated the soul from ground.

Practice became habit
for I gained confidence.
Doubts never underlined irrelevant
platforms opened up for questions.
Always thought why this?
Couldn't search for a better option.
Being in this place turned to be dream.
For I fell in love being an "OPTOM"

Anjali Suresh
Optometrist
The Eye Foundation, Bangalore

When the Eye Speaks
People take care of artificial eye i.e. phone camera which is just 20 megapixels.

Ever thought of taking care of me? I'm 576 megapixels.

When your artificial eye gets a scratch you rush to the service centre,
but, when I get infected or have an irritation, you don’t rush to the care

centre.

I may not have any beauty mode on me,
but what is real and natural I perceive that only

Whenever I see blur, I try to adjust with my structure, rather than changing the
filter.

Your artificial eye may provide better versions every day
but remember, I'm your only vision.

You always keep your eye on your artificial eye,
but know that I am your original eye.

Always remember that your artificial eye is with you only for a certain time,
but I will be with you for your life time.

At some point, your phone will have no space,
but our heart is the only place, where there is always space.

I may not have the save option for your pictures,
but will always have the best moments of your life in captures.

Uma Maheshwari
Intern

Aditya jyothi Institute of optometry, Mumbai

Theme for talent hunt for next edition: Sight

CForunner

CROSSWORD

1 2 3
4
5
6 7

8
9

10 DOWN

ACROSS 1. I give shape to the eye.
2. Generally I'm hidden, but if you check for
4. I cause problems if am too low or too high. me, I will manifest
Who am I? 3. Left to right or right to left, I am the same.
6. I am called lazy, who am I? 5. I am fitted into this so that people can
7. If I breakup with you, you will see nothing, wear me.
What am I?
8. I make people see clear. Who am I?
9. Growth of anything is appreciated but not
for me. Who am I?
10. My life span is only one day.Who am I?

Answers:

Crossword answers for last edition:
1.Neovascularization 2. Refractive Index 3. Monocular Estimated Method 4. Eye Lash 5. Hyperopia 6. Optic Chiasm 7.Myopia 8. Physiological
Suppression 9. Sclera 10.Cyclopean Eye.

Word Search

Can you find eye-related words in the puzzle below?

Look for the words listed below.

D XK H YT R EI ADL FA R RA MAE P
U DS L BP L AU SEL EI N PS H LD H

GR E ENF I L T E RQ

N MH I TN U TS LWE NC S LX L SW O

B VE V NC U EP MUV EE A AC J AO T

L GL C WG K RO CRC LDU YD E NR N
MLJ M NGN O BUE DKODF TII P SCT R DRX
O S R L E F

C YA I MD OBR XEO DAD CA MHF U

K UF R WZ MAP IVN HE O SL E CB N
QHI P NNR E EXT OEAMB OLP S PNI E LTL
P N S A R E

PRISM LENSOMETER MINUSLENS
PINHOLE PLUSLENS TRIALFRAME
RED FILTER TRIALBOX MADDOXROD
JCC OCCLUDER GREENFILTER

Answers:

1.Semi Rimless
2. Asymmetrical
3. Pupillometer
4.Near Addition
5. Segment
6.Base Curve
7.Lens Material
8. Polycarbonate
9. Multifocals
10. Edges
11.Nylon Cord
12.Vertex Distance

WORD SCRAMBLE

Unscramble the words

RSMSIMELISE
SAILMYECMART
LIEOPRLUPMET
NROITEIDADAN

NMEEGST
EVAUCBERS
AAITELENSLMR
RCOPBNOYAALTE
ASLLUTCOMIF

GEDES
ORCOLNDYN
RTTDCIEEENXAVS

Your eye is the fastest contracting muscle in
the body, contracting in less than 1/100th of

a second.

Your iris (the coloured part of your
eye) has 256 unique

characteristics; your fingerprint
has just 40.

Source: versanthealth.com

1. What word laonodksbtahcekwsaamrde?upside
down

2. The more there 3. A mbaurrsetlyoofuwpautteirnwitefigohr sit6t0o
What What pounds?
is, the less you see. pounds.
am I? weigh 40

4. No sooner spoken than broken. What is it?

ANSWERS
1.Swims
2.Darkness
3.A hole
4.Silence

OPTOMETRY 360 | 46

MEME
CORNER

meM corner
e

FUNtastics

OPTOMETRY 360 | 49