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The author reviews the development of contact lenses in the period 1930 to 1950. Based on personal knowledge and involvement the author describes the ideas, the problems, and the people who combined to advance this aspect of optometry.
An examination of proposed changes in the Medicare regulations indicates that there is a wide divergence of views and many unrealistic arguments advanced by both optometry and ophthalmology. Current financial considerations make it unlikely that any changes will be made if they raise costs.
Eighty-nine optometry students were divided into an asymptomatic group and a symptomatic group on the basis of a case history. A forced vergence fixation disparity (FD) curve was generated for each subject using a Disparometer (Vision Analysis, Columbus, Ohio). Slopes were calculated for each curve. In addition, each curve was labeled steep or flat based on a previously determined cutoff point of -0.96 min/delta (Sheedy, 1980). Steep curves did not correlate well with symptomatic patients, whereas flat curves did not correlate well with asymptomatic patients. An independent t-test found no significant difference between the two groups.
The need for optometric vision care for handicapped people is discussed. The high incidence of functional vision problems among the disabled population is presented. A vision clinic operated jointly by the New England College of Optometry and the Cotting School, a school for physically disabled children, is described. Suggestions for achieving successful involvement with the vision care of disabled people are presented.
During the 1987 Academy Meeting, a joint Optometric Education/Public Health and Occupational Optometry Symposium was held on The Delivery of Optometric Care in Nontraditional Settings. Papers were presented on prison systems, long-term care facilities, schools for the mental/physically handicapped, home eye care services, migrant work program, and juvenile detention facilities. This paper is an overview of care delivered in nontraditional settings, including important health care and demographic considerations, brief summation of the nontraditional populations presented, the impact on optometric education, and implications for optometric manpower needs.
Information on the geriatric patient is needed in the curricula of all health professional programs. During the 1988 Academy Meeting a Symposium on the Graying of America: Optometric Considerations, was held. The following paper will: (1) summarize a recent survey of geriatric education in the United States schools and colleges of optometry, (2) describe two continuing education projects on gerontology conducted for practicing optometrists, and (3) discuss two recently completed projects involving the training of optometric faculty.
The profession of optometry has been very successful in providing optical corrections for spherocylindrical refractive errors. In this paper, I examine one attempt to improve retinal image quality beyond that afforded by a standard refractive correction. Ocular chromatic aberration is one of the factors that prevent retinal image quality from reaching the upper limit set by the wave nature of light. It can be subdivided into three primary aberrations (wavelength-dependent differences in imaging plane, image position, and image size). We have been able to measure all three of these using psychophysical techniques. Although attempts to provide an optical correction for wavelength-dependent refractive errors have been optically successful, they have failed to improve vision. Several possible explanations are given for this failure.
This paper describes Dr. Hofstetter's early family life and the influences which shaped his attitudes to his friends, his work, and his profession. It chronicles his early experiences as a young professor of optometry and later as a highly successful administrator.
In 1991, the American Optometric Association (AOA) and the Association of Schools and Colleges of Optometry (ASCO) committed to the joint sponsorship of a national Summit on Optometric Education. The decision began a 3-year effort which will have an impact on both the academic and political arms of the profession for years to come. The purpose of this discussion is to consider the specific parameters and the process involved in a nationally based strategic planning process for optometric education. The planning process began with The Georgetown Conference in April 1992 and will continue through a series of 6 focus conferences ending in November 1993.
Collectively, the American Optometric Association (AOA) and the Association of Schools and Colleges (ASCO) have felt a growing need to develop a strategic plan that would ensure that the financial and other resource needs of the educational establishment can and will be met. Only when this is accomplished can the profession of optometry continue to be able to meet the needs of the public. An initial Georgetown Conference--Summit on Optometric Education was held in March 1992. It was followed later in 1992 by a Conference on the Scope of Optometric Practice and a Curriculum Conference. Scheduled for 1993 were four additional conferences which dealt with Optometric Students, Optometric Research, Graduate Education, Residencies and Fellowships, and the Financing of Optometric Education. Critical questions have been addressed and recommendations have been made. Additional efforts are underway to reach the stated objectives of the initial conference.
BACKGROUND: The Missouri State Highway Patrol (MSHP) required that its vision standards be updated in order to comply with the Americans with Disabilities Act (ADA). This act prohibits employers from using qualification standards to screen out people with disabilities, including vision, unless they are job-related and necessary. METHODS: Since 1992 the author and a team of optometry students have screened all MSHP applicants using the American Optometric Association (AOA)'s Vision Standards for Police Officers with the addition of grating contrast sensitivity. RESULTS: The mean age of this group was 24.8 years and most (87%) were male. Thirty percent wore spectacles, contact lenses, or had refractive modification. Ninety-seven percent of the applicants were able to pass all aspects of the enhanced vision screening. CONCLUSION: The initiation of optometric screening to ensure that all future troopers meet the recommended vision standards for police officers should ensure uniformity of these standards for the MSHP.
Optometric records which have evolved in private practice must be reconsidered when included in a comprehensive care environment. These hospital, health maintenance organization (HMO), preferred provider organization, and similarly linked systems require a higher degree of communication among specialties than do self-standing practices. Furthermore, the administrative requirements of such a system require more standardization, cost sensitivity, medicolegal compliance, and other elements pecular to a comprehensive facility. The expended scope of care provided by optometrists within a hospital requires familiarity with a new range of procedures, languages, and reports. Information from laboratories, radiology, and other areas must be incorporated into the optometric record. Continuity of care is more complex. Opportunities for strong interprofessional synergies within the organization arise directly from proactivity in optometric record keeping. New legal hot spots arise from questions of records ownership, access, and privacy. Billing procedures are becoming extremely important, with significant effects on quality assurance audits, coding, doctor "profiling" against fraud, and abuse; these priorities can interfere with clinical priorities. Driven primarily by the concerns and resources of large third-party payers, technology is making rapid changes in the form of optometric record keeping in comprehensive systems. Electronic data management will change the face of medical records, although administrative data will be digitized much more quickly than clinical notes. Comprehensive care environments will be the "test beds" for these technologies. Optometry is in a good position to show its contribution to the health care team through leadership in the implementation of new record keeping models.
In 1901, when optometry first achieved legal status, optometric education in the United States was inadequate. Two-week courses in refraction, correspondence courses, and 2 year apprenticeships were common. Over the next 2 decades, progress was made through the closing of a number of schools and the development of some creditable ones, but across the country optometric education remained unacceptably uneven. There were various calls for improvement, and in 1921 the American Optometric Association (AOA) formed a Council on Optometric Education. In 1921, funds were appropriated by the AOA to fund a nationwide conference on optometric education, which was held in January, 1992. Among other things, this conference resulted in the classification of all schools, closing some in the process; the adoption of minimum entrance requirements; the adoption of subject matter syllabi; and the recommendation of the end of apprenticeship and correspondence courses. Optometric education was forever changed.
BACKGROUND: Occasionally, co-management involving both optometry and ophthalmology is needed to optimize treatment outcome for the strabismic patient. METHODS: JB, a 47-month-old consecutive esotrope presented to our clinic. Two previous attempts to surgically correct her exotropia had failed and the parents sought another treatment approach. We recommended optometric vision therapy (VT) to improve sensorimotor fusion before any further surgery. After 31 VT sessions (bi-weekly for a time, then weekly), before a third scheduled surgery, sensorimotor fusion was good in the amblyoscope, but unstable with neutralizing prism in free-space. We recommended surgery be postponed, but the family proceeded. Esotropia recurred with constant suppression. After additional VT, JB developed stable sensorimotor fusion and random dot stereopsis in free-space with neutralizing prism. A fourth surgery was then performed resulting in esophoria at all distances with good sensory fusion. RESULTS: Twenty-one months postoperatively, JB remains nonstrabismic with good sensory fusion. CONCLUSIONS: Clinicians should understand the roles and limitations of available treatment options. Surgery reduces the magnitude of the deviation, whereas optometric VT provides the unique role of establishing normal sensory processing.
Dioptric power expressed in the familiar three-component form of sphere, cylinder, and axis is unsuited to mathematical and statistical treatments; there is a particular class of power that cannot be represented in the familiar form; and it is possible that sphere, cylinder, and axis will prove inadequate in future clinical and research applications in optometry and ophthalmology. Dioptric power expressed as the four-component dioptric power matrix, however, overcomes these shortcomings. The intention in this paper is to provide a definitive statement on the nature, function, and mathematical representation of dioptric power in terms of the matrix and within the limitations of paraxial or linear optics. The approach is universal in the sense that its point of departure is not power of the familiar form (that is, of thin systems) but of systems in general (thick or thin). Familiar types of power are then seen within the context of power in general. Dioptric power is defined, for systems that may be thick and astigmatic, in terms of the ray transfer matrix. A functional definition is presented for dioptric power and its components: it defines the additive contribution of incident position to emergent direction of a ray passing through the system. For systems that are thin (or thin-equivalent) it becomes possible to describe an alternative and more familiar function; for such systems dioptric power can be regarded as the increase in reduced surface curvature of a wavefront brought about by the system as the wavefront passes through it. The curvital and torsional components of the power are explored in some detail. Dioptric power, at its most general, defines a four-dimensional inner product space called dioptric power space. The familiar types of power define a three-dimensional subspace called symmetric dioptric power space. For completeness a one-dimensional antisymmetric power space is also defined: it is orthogonal in four dimensions to symmetric dioptric power space. Various bases are defined for the spaces as are coordinate vectors with respect to them. Vectorial representations of power in the literature apply only to thin systems and are not obviously generalizable to systems in general. They are shown to be merely different coordinate representations of the same subspace, the space of symmetric powers. Some of the uses and disadvantages of the different representations are described. None of the coordinate vectors fully represent, by themselves, the essential character of dioptric power. Their use is limited to applications, such as finding a mean, where addition and scalar multiplication are involved. The full character of power is represented by the dioptric power matrix; it is in this form that power is appropriate for all mathematical relationships.
Velocardiofacial syndrome (VCFS) is a congenital genetically determined condition with skeletal, heart, and facial anomalies. Almost all children have learning problems, despite an often normal or above average IQ. We have examined 10 children with a prior diagnosis of VCFS. All were mildly to moderately hyperopic. Most had poor accommodation, and convergence was clinically poor. About 30% had tortuous retinal vessels. VCFS may be detected in the optometry clinic, and optometric management may ameliorate the learning problems in some cases.
PURPOSE: To determine the type and frequency of chief complaints reported by parents of pediatric patients younger than 8 years of age in an optometry clinic. There have been many reports on prevalence of pediatric eye and vision disorders; however, the frequency of presenting complaints has not been carefully investigated. METHODS: 578 patient charts were retrospectively evaluated to determine the entering chief complaint, representing a 28-month time period between January 1993 and April 1995. The subjects were classified by age, and the chief complaint was placed in one of eight categories. RESULTS: The most frequently reported (30.1%) entering complaint for all subjects was the need for a routine vision examination. Each age category, however, had a unique distribution of complaints. Infants (1 to 11 months of age, n = 24) and young school age children (6 to 7-11 years of age, N = 233) most frequently reported complaints in the "other" category, at rates of 37.5% and 38.2%, respectively. Toddlers (12 to 36 months of age, N = 61) most commonly presented with complaints of an observed eye turn (39.3%), and preschoolers (3 to 5-11 years of age, N = 260) presented mainly for routine vision examinations (48.9%). CONCLUSIONS: There was a large percentage of patients presenting for routine vision care, which may represent an encouraging trend in public education efforts concerning children's vision care needs. The relative frequency of chief complaints in each age category prepares the eye care practitioner to address common parental concerns. This information can help to improve vision care education and services for the pediatric population.
PURPOSE: To determine agreement among optometrists regarding assessment of optic nerve C/D ratios and perceived glaucomatous damage and to separately analyze these results on the basis of residency training, practice setting, and glaucoma patient experience. METHODS: Fifty-six optometrists from various modes of professional practice evaluated 33 stereoscopic optic nerve photographs. Observers were asked to estimate the vertical cup-to-disk (C/D) ratio and determine the glaucomatous status of the optic nerve. The mean vertical C/D ratio, percentage perceived as glaucomatous, and levels of interobserver and intraobserver agreement (kappa) are reported. RESULTS: Estimated C/D ratios differ significantly on the basis of training (p = 0.02) practice setting (p = 0.001), glaucoma patient experience (p = 0.001). Glaucomatous damage interpretation was significantly different (p = 0.006) based upon an optometrist's practice setting. Interobserver agreement regarding C/D ratios is significantly higher among optometrists who have completed a residency (kappaw = 0.59) and practice in clinical settings (optometry school/medical center/hospital) (kappaw = 0.59) compared with non-residency-trained optometrists (kappaw = 0.52) and those practicing in commercial settings (kappaw = 0.54). Interobserver agreement of glaucomatous damage is significantly higher among optometrists who have completed a residency (kappa = 0.50) compared with non-residency-trained optometrists (kappa = 0.42). CONCLUSIONS: Intraobserver agreement is higher than interobserver agreement among optometrists when C/D ratios are estimated and the glaucomatous status of the optic nerve is assessed. Optic nerve evaluation among optometrists is significantly influenced by residency training, practice setting, and glaucoma patient encounters.