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PubMed1986

Refractive error and the reading process: a literature analysis.

The literature analysis of refractive error and reading performance includes only those studies which adhere to the rudaments of scientific investigation. The relative strengths and weaknesses of each study are described and conclusions are drawn where possible. Hyperopia and anisometropia appear to be related to poor reading progress and their correction seems to result in improved performance. Reduced distance visual acuity and myopia are not generally associated with reading difficulties. There is little evidence relating astigmatism and reading, but studies have not been adequately designed to draw conclusions. Implications for school vision screening are discussed.

Astigmatism↗
PubMed1995

Clinicolegal aspects of practice guidelines for pediatric eye and vision examination.

BACKGROUND: The American Optometric Association (AOA) recently joined a growing trend in the health care professions by adopting clinical practice guidelines. The goals of practice guidelines are to improve quality of care and to provide a more objective measure of standard of care for the legal system and the health insurance industry. Practice guidelines may eventually reduce the number and cost of malpractice actions. Historically, the standard of care for pediatric eye and vision examination has been the subject of controversy. Issues of disagreement include the amount of ocular health testing that should be performed and the determination of appropriate emphasis on functional vision. This paper summarizes the precedents that have established a legal standard of care for pediatric eye and vision examination. METHODS: A review of malpractice claims relevant to pediatric optometry was conducted. Public health policy, legal, and malpractice literature was also consulted for current views on practice guidelines. The recent AOA Optometric Clinical Practice Guidelines for Pediatric Eye and Vision Examination were compared to this review. RESULTS: Standards of care for pediatric eye examination should minimally include assessment of visual acuity, refractive error, binocular vision, functional vision, and eye health assessment including dilated funds examination with a binocular indirect ophthalmoscope. These standards are commensurate with the AOA Guidelines. CONCLUSIONS: The AOA Optometric Clinical Practice Guidelines for Pediatric Eye and Vision Examination is compared to the current standard of care for pediatric optometry. It is concluded that the Guidelines are appropriate. Optometrists should integrate these practices into patient care, and the optometric profession should seek to obtain wide spread acceptance of the Guidelines.

Adolescent↗
PubMedDate not supplied

[Energy characteristics of vision with the use of electronic displays].

When developing diagnostic apparatuses to assess visual power characteristics by means of electronic displays, much attention should be paid to metrological aspects. To meet the metrological requirements for sensitivity, measurement range and errors, etc. allows one to detect the changes concerned in visual characteristics and visual disorders at different stages of pathological development. To estimate visual frequency-contrast sensitivity and colour discrimination ability, the number of reproduced brightness gradations for each display primary colour R, G or B should be at least 256 and the discrete raster format of test image, 512 x 512 elements. Recommendations are given on display operation modes with the aim of enhancing the accuracy of estimating visual characteristics.

Color Perception↗
PubMed1995

Epidemiology of ametropia of U.S. Army recruits.

All people attempting to enlist in the U.S. Army must undergo a physical examination that requires a rudimentary vision screening. Those who pass the physical, upon reporting to basic training, are again evaluated and any treatment necessary to allow the recruits to function during their initial indoctrination is provided. Those who fail to see 20/20 O.D. and O.S. with their current spectacles fail the screening and are evaluated by an optometrist. If their condition is not disqualifying, appropriate correction is prescribed. We reviewed the records of all the recruits in a 1-month period who either required spectacles to see 20/20 or failed the screening at the 43rd AG BN (reception). Epidemiological evaluation revealed most to be either simple myopes or myopic astigmats. Hyperopia and hyperopic astigmatism accounted for the next most common diagnosis. Other conditions included anisometropia, antimetropia, amblyopia, keratoconus, and nystagmus. Examinations of these recruits were very limited, with dilated fundus evaluations being performed only when there was a high probability of a disqualifying condition. Therefore, it is unknown what retinal disease or degeneration may be present other than what would be visible with direct ophthalmoscopy.

Adolescent↗
PubMed1994

Tank crew vision.

Army optometrists stationed at The Armor Center, Fort Knox, identify the vision conservation needs and the functional visual requirements of each member of the tank crew. This article contains recommendations for vision conservation and for enhancement of visual function of the tank crewmen.

Humans↗
PubMed1994

Identifying potential dropouts through school health records.

This study of the records of 255 ninth grade, inner-city Midwestern high school students shows that students who drop out of school are several times as likely to have incomplete health information in the school health record as students who stay in school. A cluster of five variables--vision screening, scoliosis screening, visits to the health office, age and attendance--were found to provide 85% or better accuracy in estimating actual drop-out rates. Missing or incomplete data in combination with attendance data thus become powerful predictors of potential dropouts.

Adolescent↗
PubMed1994

Assessing the health status of children entering foster care.

OBJECTIVE: Most research on health problems of children in foster care has been cross-sectional, resulting in overselection of children who have been in care long-term and underrepresentation of children who are in care for a short time. METHODOLOGY: This paper reports on the health of a large cohort of children who had complete health examinations at the time of entry into foster care in a middle-size city during a 2-year period. RESULTS: Results indicate that > 90% of the children had an abnormality in at least one body system, 25% failed the vision screen, and 15% failed the hearing screen. The children were also lighter and shorter than the norm. Mental health screening revealed that 75% had a family history of mental illness or drug or alcohol abuse. Of children older than 3 years of age, 15% admitted to or were suspect for suicidal ideation and 7% for homicidal ideation. Of the children younger than 5 years of age, 23% had abnormal or suspect results on developmental screening examinations. At the time of entry into foster care, 12% of the children required an antibiotic. More than half needed urgent or nonurgent referrals for medical services and, for children > 3 years of age, more than half needed urgent or nonurgent referrals for dental and mental health services. Just 12% of the children required only routine follow-up care. CONCLUSIONS: The high prevalence and broad range of health needs of children at the time they enter foster care necessitate the design and implementation of better models of health care delivery for children in foster care.

Adolescent↗
PubMed1993

Prospective assessment of stereoscopic visual status and USAF pilot training attrition.

The role of stereopsis (i.e., the use of binocular cues for depth perception) in military aviation is undetermined. Pilots possessing adequate near stereopsis but having deficient distant stereopsis are thought to have microtropias. Historical reviews of microtropia and research concerning the role of depth perception in military aviation are described. A historical prospective study of student pilots entering U.S. Air Force Undergraduate Pilot Training (UPT) from Oct 1990 through Sep 1991 (FY 90-91) compares UPT attrition rates according to their preselection stereoscopic status (microtropia vs. normal). Univariate and multiple logistic regression analyses do not show significant differences in attrition rates between the two groups, implying that distant stereopsis is not critical to successful completion of UPT. The U.S. Air Force decided in Oct 91 to eliminate near stereoscopic vision screening while retaining distant stereoacuity testing as a criterion for candidates to qualify medically for UPT. Valid rationale for this decision includes simplified and uniform administration of stereoacuity testing, minimizing spurious results, the continued validity of stereopsis testing as a cross-check of other areas of visual function, the uncertain role of stereopsis in critical areas of flight operations, and the large applicant pool competing for a limited number of pilot training positions.

Aerospace Medicine↗
PubMed1996

Association between eye and hand dominance and hitting, fielding and pitching skill among players of the Southern Baseball League.

BACKGROUND: The relationship between eye dominance and batting skill in baseball has been investigated, but conflicting results have been obtained. In addition, little attention has been given to the relationship, if any, between eye dominance and fielding and pitching skill. METHODS: A vision screening of 215 professional baseball players in the Southern Baseball League was performed and the eye dominance of these players was determined by a sighting test. Handedness for batting, fielding, and pitching was determined by history. RESULTS: The screening revealed that 66 percent of players were right-eye dominant and that, of 92 players who met the criteria established to qualify for the league batting championship, 60 percent had matched dominance of eye and hand. When official league batting averages were obtained for these 92 players, it was found that there was no statistically significant difference between batters with matched dominance (.278 mean batting average). For the 149 fielders in the league, no statistically significant differences based on eye dominance were found for fielding average (.893 matched dominance, .864 crossed dominance); for the 89 pitchers, a similar result was obtained. Pitchers were also evaluated with respect to eye dominance and earned run average, but no significant difference was found (3.91 matched dominance, 4.03 crossed dominance). CONCLUSIONS: Results indicate that there is no association between eye dominance, and hitting, fielding, or pitching skill in baseball.

Baseball↗
PubMed1998

Clinical application of the new civil airman vision standards and certification procedures.

INTRODUCTION: The final rule revising the civil airman medical standards became effective September 16, 1996. The purpose of this study was to review changes in the vision standards and procedures and how they relate to the clinical optometrist. METHODS: Revision of Airman Medical Standards and Certification Procedures and Duration of Medical Certificates; Final Rule, (14 CFR, Parts 61 and 67) and the Guide for Aviation Medical Examiners, published by the Federal Aviation Administration's Office of Aviation Medicine, were reviewed, and those parts pertaining to the clinical optometrist were summarized. DISCUSSION: The uncorrected distance visual acuity standards for first- and second-class airmen have been deleted. New equivalent near-vision standards were established for all classes of airmen. A major change--for pilots > or = 50 years of age--was the addition of an intermediate vision requirement of 20/40 or better at 32 inches for both first- and second-class medical certificate holders. Although the third-class medical certificate is still valid for 24 months after the date of examination for those > or = 40 years of age, the certificate is now valid for 36 months for those < 40 years of age. CONCLUSION: The new vision standards primarily affect the elderly pilot. Ophthalmic considerations in the application of the new vision standards are reviewed.

Adult↗
PubMed1998

Assessing the likely effectiveness of screening older people for impaired vision in primary care.

Screening for visual impairment is frequently included in multiphasic screening assessments for older people, although evidence for the effectiveness of screening from randomized trials is lacking. This paper uses previously developed criteria for assessing the likely effectiveness of community screening programmes to review the non-trial evidence around visual screening. Unreported or undiagnosed visual impairment is common among older people and is associated with considerable morbidity. Testing for visual acuity is easy and quick, but may not accurately reflect the level of functional disability caused by the visual problem in everyday living. Effective therapeutic interventions exist for most symptomatic patients, but the effects of treating unreported visual impairment detected by screening have not been evaluated. Existing barriers to effective treatment for older people with symptomatic visual problems include financial costs to the patient, and an inability of ophthalmic services to meet demand. These same factors may be barriers to the uptake of treatment following screening. Further work is needed to assess the needs of older people with unreported visual problems, and to clarify barriers to effective screening.

Aged↗
PubMed1987

Screening of colour vision defects in diabetic patients.

The colour vision of 50 diabetic patients was examined with two screening tests, Standard Pseudoisochromatic Plates part 2 (SPP 2) and Farnsworth Panel D 15 (Panel D 15) test and with two diagnostic tests, Nagel anomaloscope and Farnsworth-Munsell 100-hue test. The performance of the diabetic patients in colour vision tests was compared to their performance in colour dependent urine and blood glucose tests. Fourteen of the patients failed the glucose tests, and they failed both of the screening tests as well. The diagnostic tests showed that all of them had a blue-yellow defect and 10 of them also had a red-green defect. The rest of the patients, 36, read the glucose tests correctly, but 17 of them failed the SPP 2 screening test, and 5 failed the Panel D 15 screening test. In diagnostic tests there were 15 patients with normal colour vision, one patient with a red-green defect, 13 patients with a blue-yellow defect, and 7 patients with both a red-green and a blue-yellow defect. The colour vision defect in diabetic patients is most often a blue-yellow defect or a combined blue-yellow and red-green defect. Therefore, the usual pseudoisochromatic plates, e.g. the Ishihara test, are not sufficient in screening because they screen only red-green defects. The screening tests should contain both a red-green and a blue-yellow part.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

BVAT distance vs. near stereopsis screening of strabismus, strabismic amblyopia and refractive amblyopia; a prospective study of 68 patients.

PURPOSE: Although there have been studies in the past of the difference between distance and near stereopsis in intermittent exotropia, no such comparisons have been studied and/or reported for other forms of strabismus, nor for strabismic functional amblyopia, or for refractive functional amblyopia. METHODS: The study was prospective: Sixty-eight consecutive patients, ages 6-76 years, with either childhood onset strabismus and no amblyopia, childhood onset strabismus and amblyopia, or refractive amblyopia and no strabismus, had their stereopsis measured. Distance stereopsis was determined on the Mentor BVAT with Random Dot E Test (global stereopsis) and the Circle Test (contour stereopsis). Near stereopsis was determined with the Circle Test of the Randot Stereotest. The data were tabulated and analyzed statistically. RESULTS: Of the 26 strabismus/no amblyopia cases, 14 (54%) appreciated distance stereopsis. Of these, 12/14 were intermittent, and other 2 who were constant had deviations of 8 PD or less. Only 4 of the 14 appreciated global stereopsis at distance (mean = 90 sec. of arc), but all 14 appreciated contour stereopsis at distance (mean = 125 sec. of arc). Of all 26, 21 (81%) had near stereopsis (mean = 137 sec. of arc). For the 21 strabismic amblyopes, only one appreciated global stereopsis at distance (120 sec of arc), and 2 (10%) contour stereopsis at distance (mean = 210 sec. of arc). These two and 4 others (total 29%) had near stereopsis (mean = 162 sec. of arc). For the 21 refractive amblyopes, 3 appreciated global stereopsis at distance (mean = 220 sec. of arc), 11 in all, (52%) contour stereopsis at distance (mean = 121 sec. of arc) and 20 (95%) had near stereopsis (mean = 78 sec. of arc). The percentages of patients in all categories capable of appreciating distance stereopsis were "statistically significantly" (P<.05) or clinically/medically significantly different from (less than) the percentages having near stereopsis. CONCLUSIONS: distance stereopsis is more likely to be reduced or absent than near stereopsis in strabismus, strabismic amblyopia and refractive amblyopia and thus appears to be more sensitive to, and better screening for, binocular vision disorders and a stronger and better outcome standard for treatment of binocular vision disorders than near stereopsis.

Adolescent↗
PubMed1990

[Refractive errors, strabismus and amblyopia in pre-school screening--experiences using a vision test in kindergarten].

UNLABELLED: Within the framework of mass screenings conducted by the Public Health service section for juveniles, 254 children were examined jointly on a voluntary basis in 5 different kindergartens. The examined children represented in each case 88% of the respective kindergarten groups. The examination programme included, among others, the R5 apparatus (visual acuity in respect of remote objects with and without + 1.5 D), Lang- and DeKa Stereo Test, Cover-and-Uncover Test with remote and near fixation, heterostatic retinoscopy (in 205 children only), ophthalmoscopic fixation test. In addition, the acceptance for U8 and the degree of care in respect of ophthalmological control and treatment were investigated. RESULTS: Strabismus or significant uncorrected errors of refraction were discovered by the on-target tests of covering and uncovering, fixation and retinoscopy in 26 of 205 completely examined children (12.7%). This had not been satisfactorily covered by single tests such as R5-Visus test with the criteria much less than 1.0 (grade 5) or much less than 0.7 (grade 4), respectively stereo tests. The combination of "R5-Test Visus much less than 1.0" and "DeKa Stereo Test not fully identified" attained a sensitivity of 81% with a positive predictive value of only 28%. This combination, therefore, results in too many healthy children being referred to the ophthalmologist. "R5-Test Visus much less than 0.7" and "DeKa Stereo Test not fully identified" attained a sensitivity of 75% with a positive predictive value of 44%. This combination is recommended as long as the R5 or R11 apparatuses are used. The phoria and stereo tests contained in the R5 apparatus are unsuitable for kindergarten screening.(ABSTRACT TRUNCATED AT 250 WORDS)

Amblyopia↗