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Types of optometric testing emphasized in different practice modes.

BACKGROUND: In order to determine if tests performed in an examination vary with practice settings, we surveyed all 5,200 California licensed optometrists and asked them to identify their primary mode of practice and the percentage of time and/or frequency that certain test procedures were done in an eye examination. METHODS: We restricted our analysis to three practice modes: private, corporate, and nonprofit/health maintenance organization (NP/HMO). We received a 66.4 percent response rate. To determine any trends in emphasis of testing by the three practice modes and to establish relationships between the three, we compared each mode of practice to the other. The combinations were private vs. corporate, corporate vs. NP/HMO, and private vs. NP/HMO. The three combinations were compared to the frequency of performing case history, stereo acuity testing, binocular vision testing, biomicroscopy, dilated fundus examination, tonometry and perimetry. RESULTS AND CONCLUSIONS: We found the following relationships in the frequency/emphasis of testing as statistically significant: 1) For stereopsis testing: private practices performed it more often than corporate; 2) For binocular vision testing: private practices performed it more than did either corporate or NP/HMO, corporate performed it more than NP/HMO; 3) For tonometry: corporate performed it slightly more than NP/HMO; 4) For dilation: NP/HMO performed it more than both private and corporate; and 5) For perimetry: private performed it more than both corporate and NP/HMO.

Data Collection↗

The Houston Vision Assessment Test (HVAT): an assessment of validity. The Cataract Outcome Study Group.

PURPOSE: Cataract surgery is one of the most successful procedures in medicine, and outcome is typically measured by a single factor - improvement in visual acuity. Health-related functional outcome testing, which quantifies the patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. METHOD: A functional outcome test (the Houston Vision Assessment Test - HVAT, copyrighted 1990, 1992) was evaluated in a cataract population of 149 patients from seven study centers. Test results were correlated with objective ophthalmic endpoints. The HVAT divides an estimated total impairment into subcomponents of Visual Impairment (correctable by cataract surgery) and non-visual Physical Impairments (co-morbidities not affected by cataract surgery). RESULTS: In this prospective study, the average Visual Impairment score improved by 19 points (65%) following cataract extraction (the mean HVAT Visual Impairment score was 29 points before surgery and 10 points at 5 months post-surgery, a change of 65%). Physical Impairment remained unchanged by surgery. Visual acuity was a poor predictor of Visual Impairment. CONCLUSIONS: The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: http://www.DHAC.com. The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

Adult↗

Computer analysis of Farnsworth-Munsell 100-hue test.

Color vision abnormalities indicated by the Farnsworth-Munsell 100-hue Color Vision Tests (FM-100) were analyzed by computer to better characterize and group congenital and acquired color vision disorders and to help establish statistically significant diagnostic criteria. Standard evaluation of the FM-100 is by axis and error score calculations. A method has been established for computer-averaging many tests from patients with the same color abnormalities determined by history, standard FM-100 and Nagel anomaloscope. The computer calculated an average error score and standard deviation for each of the 85 color caps. Every time a new patient was evaluated for color vision abnormality, his score was compared with averaged tests with common diagnoses, by calculating distance scores. The averaged test with the lowest distance score consistently tended to coincide with the diagnosis. An analysis of 130 FM-100 color tests found technician-calculated error scores to be incorrect, although usually minor, in 40% of the tests. The computer-calculated axes agreed well with the technician's estimates. The distance scores predicted the diagnosis accurately 89% of the time. Many errors were due to the small number of protanopes averaged and inability to distinguish trichromats from dichromats.

Color Perception Tests↗

Evaluation of colour vision, mesopic vision, visual evoked potentials and lightness discrimination in adult amblyopes.

This is a study conducted on thirty adult strabismic and anisometropic amblyopes using colour vision tests, the lightness discrimination test, mesopic vision and visual evoked responses, in order to determine the probable site of the amblyopic defect. The results showed that, in its progressed stages, amblyopia is associated with eccentric fixation, abnormal hue discrimination, disturbed lightness discrimination and mesopic vision, and attenuation of the amplitude of the pattern visual evoked response. It is suggested that these abnormalities result from a defect involving the extrastriate higher visual association areas 18 & 19 of Brodmann.

Adult↗

Electrophysiological and psychophysical testing of vision in glaucoma.

Electrophysiological testing in patients with early glaucoma and in glaucoma suspects reveals defects of central or foveal vision. Most studies suggest that glaucomatous eyes are best separated from normal eyes by use of stimuli with a spatial frequency below the peak of the human contrast sensitivity curve and a relatively high temporal frequency. The stimulus-dependent abnormalities in glaucoma are generally consistent with contrast sensitivity data The stimulus-dependent visual changes are related to the physiology of parallel processing in the primate retinogeniculate pathway.

Aged↗

A quantitative scoring technique for panel tests of color vision.

Panel tests of color vision (eg FM100-Hue test) lack a common quantitative method for the scoring of cap arrangements. We describe a scoring method applicable to all panel tests that makes use of a novel technique to analyze test cap data, namely the calculation of a moment of inertia from the Color Difference Vectors (CDVs) of any arrangement pattern. Using the Farnsworth D-15 panel, as an example, we specify how to determine CDVs and demonstrate the benefits of calculating a moment of inertia for the analysis of these vectors. Moment of inertia analysis yields three factors which quantify cap arrangements: the first is the confusion angle which identifies the type of color defect; the second is the Confusion index (C-index) which quantifies the degree of color loss relative to a perfect arrangement of caps; and the third is the Selectivity index (S-index) which quantifies the amount of polarity or lack of randomness in a cap arrangement. A retrospective study on the result of 53 normal and 66 congenitally color defective observers is reported and provides normative data. We show that the technique differentiates between different types of color defect and provides useful clinical information regarding a loss of color vision. Likewise, a similar observation is made on a smaller sample of FM100-Hue results. A BASIC computer program is provided for anyone wishing to use the technique.

Adolescent↗