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PubMed1989

Photographic method for Brückner and Hirschberg testing.

An apparatus for strabismus detection was designed to allow photographing fundus and corneal reflexes for Brückner and Hirschberg testing, respectively. Photographs of adult subjects with simulated strabismic deviations were viewed by two groups of observers, optometry students and optometry faculty. In general there was no significant difference in testing results between the two groups. Subject error produced unreliable Brückner results. However, Hirschberg testing was effective approximately 80% of the time in detecting a deviating eye in strabismus of magnitudes of about 5 delta. Anisometropia in Brückner testing was also investigated. Magnitudes of 2.00 D or greater significantly affected results. Clinical application of the photographic Hirschberg test may have potential value as a screening method. The photographic Brückner test is not recommended for adults; its reliability in children requires investigation.

Equipment Design↗
PubMed1998

Effect of patient personality profile and verbal presentation on successful rigid contact lens adaptation, satisfaction and compliance.

BACKGROUND: Rigid gas permeable (RGP) lenses have numerous benefits, including quality of vision, ocular health, and reduction of myopic progression in young people. Nevertheless, RGP lens use is not increasing in the United States. It is possible that certain patient personality characteristics and/or how a practitioner presents RGP lenses to a new patient may affect satisfaction and success. The purpose of this study was to evaluate the effect of individual patient's personality and the practitioner's method of presenting RGP lenses to new patients on their ability to adapt to these lenses. METHODS: Forty-nine subjects, all noncontact lens wearers, were entered into this 1-month study, which was conducted at both the University of Missouri-St. Louis School of Optometry and the Pacific University College of Optometry. All subjects initially completed standardized questionnaires pertaining to locus of control, openness to new experiences, and motivation/expectations. After diagnostic fitting with a RGP lens material, the subjects were placed into one of the following three groups: (1) Fear-Arousing Non-Enthused; (2) Neutral Content Non-Enthused; or (3) Neutral Content Enthused. They observed one of three video presentations on RGP lens wear. Subjects submitted daily questionnaires providing their evaluation of such factors as comfort, wearing time, and handling. RESULTS: The results showed that there was a significant difference (chi(2) = 6.99; p < 0.05) among the different groups in the number of dropouts: 6/19 with the Fear-Arousing Non-Enthused group, 2/17 with the Neutral Content Non-Enthused group, and 0/13 with the Neutral Content Enthused group. There was also a significant difference (ANOVA F = 4.1, p < 0.05) among the groups on compliance, with the Neutral Content Enthused group demonstrating greater compliance. In terms of satisfaction, there was no significant difference among presentation groups. CONCLUSION: It was concluded that the method of presentation is important for successful RGP contact lens wear. If presented with genuine interest and a positive and realistic attitude, patients are more likely to succeed in RGP lens wear during the initial critical period.

Adaptation, Physiological↗
PubMed1999

Short-term repeatability of hand-held keratometry measurements.

PURPOSE: The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study is a multi-center, observational investigation of ocular component and refractive error development in schoolchildren. Anterior corneal curvature is one of several ocular components which influence refractive status of the eye, and the CLEERE Study uses the Alcon Auto-Keratometer to measure corneal curvature. This report assesses the repeatability of this hand-held instrument. Previous studies have demonstrated the validity of the Alcon Auto-Keratometer; however, none have assessed its repeatability. METHODS: Sixty children were recruited from clinics affiliated with the Southern California College of Optometry and the University of Houston College of Optometry. Two sets of five hand-held keratometry measurements were obtained on the right eye of each child by one investigator at each site using the Alcon Auto-Keratometer. The two sets of measurements were performed at least 10 minutes apart. RESULTS: The mean differences between the two occasions were not significantly different from zero for either the flat or steep corneal curvature measurements regardless of the number of readings taken. The largest improvement in repeatability, primarily for the steep meridian, occurred when the first two readings were averaged. The addition of readings 3, 4, and 5 to the average did not substantially improve repeatability for either meridian. The 95% limits of agreement between the average of two readings on two occasions for the flat and steep meridians were +/-0.28 and +/-0.39 D, respectively. The 95% limits of agreement after two readings were +/-0.28, +/-0.20, and +/-0.24 D for the M, J0, and J45 vectors, respectively. CONCLUSION: The Alcon hand-held keratometer provides a repeatable measure of corneal curvature as demonstrated by short-term repeat agreement within +/-0.50 D. This level of repeatability can be achieved only by manually averaging two consecutive measurements.

Adolescent↗
PubMed2002

Ocular and systemic findings and their correlation with hemodynamically significant carotid artery stenosis: a retrospective study.

BACKGROUND: Optometrists often encounter patients with ocular signs and/or symptoms suggestive of carotid artery disease, but criteria for eye care practitioners concerning when to order carotid studies are not well established. A retrospective study in an optometry clinic was performed to determine if certain ocular findings and associated systemic risk factors were associated with hemodynamically significant carotid artery stenosis (HSCAS). METHODS: A retrospective analysis was performed on all patients examined in the optometry clinic at the Sepulveda Ambulatory Care Center from January 1, 1998 through December 31, 1999 to identify all patients who had carotid studies ordered. Charts were then reviewed to determine the ocular finding that prompted the carotid study. Statistical analysis using an odds-ratio was performed to determine whether any ocular sign/symptom or systemic risk factor was associated with HSCAS. RESULTS: Of 3822 patients, 48 (1.26%) had carotid studies ordered. Eight (17%) had HSCAS of >50% and symptomatic patients were 1.6 times more likely to have HSCAS than asymptomatic patients. Patients with HSCAS were 1.8 times more likely to have retinal vascular occlusions, 1.9 times more likely to have normotensive glaucoma, 2.4 times more likely to have peripheral retinal hemorrhages, and 2.6 times more likely to be smokers, although none of these factors were found to be a statistically significant indicator of HSCAS. However, the number of systemic diseases tended to be greater for the HSCAS patients compared with the non-HSCAS patients (HSCAS median = 3.5 and the non-HSCAS median = 2, p = 0.049). CONCLUSION: Although no single ocular or systemic risk factor was found to be a statistically significant indicator of HSCAS, the number of systemic disease risk factors tended to be greater for the HSCAS patients compared with the non-HSCAS patients (p = 0.049). An extensive literature review was also performed to help establish guidelines for when to order carotid studies on the basis of ocular signs and/or symptoms as well as the presence of additive associated systemic risk factors.

Aged↗
PubMed2004

Community-based study of the association of high myopia in children with ocular and systemic disease.

PURPOSE: High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. METHODS: Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. RESULTS: High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. CONCLUSIONS: There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia > or =5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.

Abnormalities, Multiple↗
PubMed2006

Legislative issues facing pediatric ophthalmology in 2006.

PURPOSE OF REVIEW: There has been a surge in legislative activity concerning children's vision in recent years. This review will summarize and compare newly enacted state statutes and review legislation that has been introduced at both the state and federal level. Detailed reference sites are provided and may be a useful resource for those involved in legislative advocacy. RECENT FINDINGS: The legislative arena has often mirrored the disparate views of ophthalmology and optometry regarding the most appropriate methods for identifying vision problems in young children. While state legislation mandating comprehensive eye examinations for all asymptomatic and risk free children was passed in Kentucky in 2000, no other state since has successfully enacted and implemented similar legislation. In contrast, numerous states, have enacted mandatory preschool vision screening legislation. Federal legislation, introduced separately by ophthalmology and optometry, would provide funds for uninsured children's eye exams, but the two bills have important differences in eligibility requirements. Issues such as eye safety and retinoblastoma detection have also been addressed through the legislative process. SUMMARY: There has been a myriad of state and federal legislative activity in the area of children's vision. The momentum is likely to continue as additional states file new legislation.

Child↗
PubMedDate not supplied

Near esophoria is associated with high myopia.

BACKGROUND: A retrospective study was undertaken to examine the hypothesis that esophoria is associated with higher amounts of myopia. METHODS: One hundred and forty-four subjects were selected from the files of optometry clinics at the Department of Optometry, National University of Malaysia, from the years 1995 to 1998 inclusive. These subjects were matched in terms of age group, sex, race and near phoria group. Near phorias were determined by Maddox wing technique and were classified into three groups: more than six prism dioptres exophoria, zero to six prism dioptres exophoria and any esophorias. RESULTS: One way analysis of variance revealed that there were significant differences in mean myopias between the three phoria groups (ANOVA, F(2,141) = 5.34, p < 0.01). Further analysis with the Student-Newman-Keuls test showed that the amount of myopia is significantly higher in the esophoric group than in the other two groups. CONCLUSIONS: The results support the hypothesis that near esophoria is associated with high myopia. This study suggests that near phoria might be an important factor in myopia development.

Journal Article↗
PubMedDate not supplied

Optometric therapeutic competency standards 2000.

BACKGROUND: Competency standards for entry-level to the profession of optometry in Australia were first developed in 1993 and then revised in 1997. The competencies require that optometrists entering the profession have the skills to use ocular diagnostic drugs but did not consider the prescription of topical therapeutic ocular drugs by optometrists. Following the introduction of legislation in the Australian state of Victoria that permitted optometrists to be licensed by the relevant state registration board to prescribe topical therapeutic ocular medication, Optometrists Association Australia (OAA) was asked to develop therapeutic competency standards that could be used in the assessment of the suitability of optometrists for such licensing. METHODS: Expert members of the profession and representatives from optometry schools, registration boards in Australia and New Zealand, state divisions of OAA and the New Zealand Association of Optometrists (NZAO) were consulted in the process of developing these standards. RESULTS: Nine new performance criteria with associated indicators, within Units 3 and 5 of the revised entry-level standards, were developed. Additions were made to the indicators for 25 of the previously developed performance criteria (within all six original units of competency). The modified therapeutic competency standards were adopted on behalf of the profession by the National Council of OAA in March 2000. DISCUSSION: These therapeutic competency standards may be used as a basis for licensing authorities to develop an assessment process to determine suitability of optometrists for licensing to prescribe topical therapeutic ocular medications. At this stage, the therapeutic competencies cannot be regarded as entry-level competencies in Australia but as second-tier competencies. However, it is anticipated that the therapeutic competencies will come to be regarded as entry-level over the coming years.

Journal Article↗
PubMed2002

Purtscher's retinopathy.

BACKGROUND: Purtscher's retinopathy (a.k.a. angiopathia retinae traumatica) is a traumatic angiopathy, most commonly caused by head and chest trauma. The most-prevalent bilateral retinal signs include white ischemic infarcts (cotton-wool spots or Purtscher-flecken) and hemorrhages (dot and blot, pre-retinal, or flame). The prognosis for patients with decreased vision is unpredictable. CASE REPORT: A 19-year-old man came to the Louis Stokes Cleveland Veterans Administration Optometry Clinic for a consultation to rule out ocular anomalies associated with a motor vehicle accident. The patient was diagnosed with Purtscher's retinopathy in the right eye due to cotton-wool spots observed during fundus examination, an air embolism discovered on chest X-ray, and a history of head/chest trauma. All signs and symptoms had resolved by 1-month follow-up examination. The patient's visual acuity resolved to 20/30 in the right eye. CONCLUSIONS: Purtscher's retinopathy is a traumatic angiopathy with an uncertain pathophysiology. A case report and review are presented, and the role of optometry in its management is discussed.

Adult↗
PubMed2000

Migraine aura without headache: prevalence and risk factors in a primary eye care population.

BACKGROUND: Although migraine headache has received substantial attention in the scientific literature, migraine aura without headache (MAWOH) has not been investigated frequently. A general population survey study estimated the lifetime prevalence of MAWOH to be 1% in males and 3% in females. Anecdotal evidence has suggested that MAWOH is encountered by primary eye care practitioners more frequently than these rates suggest. This study is the first investigation of this condition in a primary eye care population. METHODS: A written questionnaire was used to survey 1,000 patients, ages 18 years and older, presenting for a comprehensive eye examination in the Primary Care Optometry Service of the School of Optometry, University of Alabama at Birmingham. Cases were identified by the presence of visual sensations consistent with MAWOH. RESULTS: Of the primary eye care population surveyed, 6.5% reported experiencing visual sensations consistent with MAWOH. The prevalence in males was 2.9% and in females, 8.6%. A multivariate analysis revealed that female gender (odds ratio [OR] = 2.3), history of migraine headaches (OR = 3.2), and history of childhood motion sickness (OR = 2.7) were significantly related to MAWOH. CONCLUSIONS: The prevalence of MAWOH is higher in an adult primary eye care population than previously reported in a general population study.

Alabama↗
PubMed2002

[The state of diopter and visual acuity in central serous chorioretinopathy].

PURPOSE: To investigate the state of diopter and best corrected visual acuity in active central serous chorioretinopathy (CSC). METHODS: Twenty-three unilateral active CSC patients (23 eyes) were observed with Integrated Optometry Apparatus. The period of follow-up was from 3 - 12 months (mean, 7.2 months). RESULTS: Of the 23 patients, 15 eyes (65.2%) of active CSC and 5 fellow eyes (21.7%) showed hyperopic state. There were significant differences in hyperopic state between the active eyes and fellow eyes (P < 0.01). After follow-up, there were only 5 eyes of CSC (21.7%) showed slight hyperopia. There were significant differences in hyperopic state between before and after follow-up of the eyes of CSC (P < 0.01) Among the eyes of the best corrected visual acuities were increased 3 row or above, 90.9% eyes of the best corrected visual acuities were resumed to 1.0. CONCLUSION: Most of the active CSC demonstrated temporary hyperopic state due to the neuroretinal detachment of macula. The best corrected visual acuities with the Integrated Optometry Apparatus in active CSC are useful in evaluating the final visual acuities of the eyes.

Adult↗
PubMed1989

Analysis of a community vision screening program.

For 3 consecutive years a community vision screening program has been conducted on-site at the Walker Eye Clinic of the Indiana University (IU) School of Optometry. A group of 490 screened patients, including 86 who returned for comprehensive evaluation, was retrospectively studied for a variety of characteristics. It was determined that the typical participant was likely to be an adult female who learned of the screening program through the written media. She was likely to have had a previous vision examination but it probably took place 3 or more years earlier. She usually failed the vision screening for reasons of reduced visual acuity, a problem with binocularity or asthenopia. If she returned to the Walker Eye Clinic for a comprehensive examination, she was likely to do so within 5 months and would be found to have been accurately identified as being in need of vision care. The organization and implementation of this vision screening program are described, and its value as an educational tool for students of optometry and its technician program is discussed.

Adolescent↗
PubMed1984

The relationship of contrast sensitivity functions to sports vision.

Contrast sensitivity, a more recent test of visual function, has never been studied in its relationship to sports vision. The hypothesis that contrast sensitivity functions among college varsity level baseball players significantly differs from that of a random sample of optometry students was tested using Arden grating plates. A statistically significant difference was found at the 98 percent confidence level, demonstrating that in this study, a sample of college varsity level baseball players have higher level contrast sensitivity functions than those of a randomly selected sample of Southern California College of Optometry students.

Adolescent↗
PubMed1984

The replacement of the chair, stand and phoropter by subjective autorefraction--a candid evaluation.

With all the competition from outside of professional optometry, it is imperative that the doctor of optometry offer the patient a service that is superior. Keep in mind that I am no better than or different from other doctors, but my patients see me that way. That is an important ingredient in a successful practice. My experience demonstrates that the Humphrey Over-refraction System can function with great efficiency as the primary and indeed the only subjective refraction device in a busy solo practice. It can also take a mediocre practice and help to put it on the map. Some may not have confidence in automation. Others may feel that the methods described herein are maverick or financially risky. If you are skeptical, whatever the reason, you will obviously stick with traditional refractive methods. If, on the other hand, you are dissatisfied with traditional methods and the fruits of your labor, automation is a solid alternative as long as sound management guidelines are followed.

Computers↗
PubMed1995

Retinal nerve fiber layer defects and microtalc retinopathy secondary to free-basing "crack" cocaine.

BACKGROUND: There have been several reports in the literature documenting ocular manifestations of cocaine abuse. None have discussed the potential retinal complications stemming from cocaine inhalation. METHODS: Approximately 60 patients with a history of free-basing "crack" cocaine were examined at the Optometry Clinic. Threshold visual field testing and fundus photographs were obtained and later reviewed. RESULTS: Microtalc retinopathy and associated retinal nerve fiber layer "rake" or "slit" defects were detected exclusively in patients who had free-based "crack" cocaine. Some of these patients manifested visual field changes that mimic glaucoma. Several cases are presented that demonstrate the findings typical of those observed in the patients examined at the Optometry Clinic. CONCLUSIONS: Microtalc retinopathy and associated glaucoma-like retinal nerve fiber layer defects indicate the presence of permanent microvascular changes in the eyes, as well as the lungs, brain, and probably other peripheral organs. Optometrists should be aware of these new findings in order to properly manage patients who free-base "crack" cocaine.

Adult↗
PubMed1995

Variation in ophthalmic testing prior to cataract surgery. Results of a national survey of optometrists. Cataract Patient Outcome Research Team.

OBJECTIVE: To assess variation in optometrists' use of ophthalmic tests in the evaluation of patients being considered for cataract surgery who have no history of other eye disease. DESIGN/PARTICIPANTS: National survey of a systematic sample of practicing members of the American Optometric Association (St Louis, Mo), who had referred at least one patient to an ophthalmologist for consideration of cataract surgery in 1991. RESULTS: Ninety-two of 130 eligible responding optometrists reported that they routinely performed preoperative testing on patients being considered for cataract surgery. Of these 92 optometrists, 91 (99%) frequently or always performed refraction, and 82 (89%) frequently or always performed a dilated fundus examination in their evaluation of patients being considered for cataract surgery who had no history of other eye disease. None of these 92 optometrists reported using B-scan ultrasonography or electroretinograms frequently or always, and few used A-scan ultrasonography or visual evoked responses frequently or always. A substantial percentage frequently or always used formal visual field testing (47%), formal color vision testing (40%), fundus photography (24%), potential acuity measurement (25%), glare testing (23%), contrast sensitivity testing (19%), and specular microscopy (14%), while 11% to 81% of optometrists never performed these tests on such patients. More recent graduation from optometry school was associated with a decreased frequency of use of potential acuity measurement and contrast sensitivity testing and with an increased use of dilated fundus examinations. CONCLUSION: There is a substantial variation in optometrists self-reported use of a number of ophthalmic tests in the preoperative evaluation of patients being considered for cataract surgery who have no history of other eye disease.

Adult↗
PubMed1996

Detection of sight-threatening diabetic eye disease.

Blindness due to diabetes mellitus is potentially preventable in the majority of patient. Early detection of sight-threatening changes is associated with a better outcome, indicating the need to screen for retinopathy. At least 50% of diabetic patients do not attend a hospital, so that diabetologists and ophthalmologists are unable to screen the diabetic population comprehensively. Although in theory all patients has access to general practitioners, these may lack training or confidence to screen for retinopathy. Hospital based or community optometrists using direct ophthalmoscopy or slit lamps and technicians performing fundus photography are alternatives which may be more effective. Further studies are required to examine the effectiveness of optometry screening. Initial studies using fundus photography raised concerns about the sensitivity of the technique, but these have been partially addressed by improvements in methodology and technology. As well as technicological effectiveness, factors affecting patient uptake of screening services still need to be addressed.

Blindness↗
PubMed1995

A hand-held keratometer.

Using model eyes the sensitivity to orientation of an Alcon hand-held autokeratometer was assessed after calibration with steel balls. It was concluded that the keratometer should be used in a vertical position (6:00/12:00) in order for axis references to be accurate. Corneal curvature of optometry students was measured using the autokeratometer and a Bausch and Lomb keratometer. The results showed that the autokeratometer was similar to the Bausch and Lomb keratometer in measuring the vertical and horizontal principal meridians, and the axis of the vertical principal meridian. This hand-held keratometer is useful for screening purposes and measuring corneas of infants.

Adult↗