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PubMed2001

Observer experience and Cup:Disc ratio assessment.

BACKGROUND: The validity of the Cup:Disc (C:D) ratio as a clinical measure depends on the level of agreement among observers. In this study, we investigated the effect of observer experience on interobserver and intraobserver agreement in C:D ratio estimation. METHODS: Nine 3rd-year (Yr3) and nine 4th-year (Yr4) optometry students and nine optometrists (Opt), determined C:D ratios from 26 optic disc photographs viewed monoscopically and stereoscopically. Observer agreement was investigated using weighted kappa (Kw) analysis. RESULTS: Interobserver agreement was higher (p < 0.01) among optometrists than among 4th-year students and higher (p < 0.01) among 4th-year than among 3rd-year students (mean Kw: Opt = 0.61; Yr4 = 0.51; Yr3 = 0.39). Stereoscopic estimates of C:D ratios were higher (p < 0.0001) than monoscopic estimates, and interobserver agreement was higher (p < 0.001) when evaluating the vertical rather than the horizontal C:D ratio. Intraobserver agreement (mean Kw: Opt = 0.67; Yr4 = 0.66; Yr3 = 0.62) did not vary significantly (p = 0.78) with experience. CONCLUSIONS: The extent to which an observer reproducibly assesses the C:D ratio from optic disc photographs (intraobserver agreement) does not increase with experience. However, the agreement between different observers in assessing the C:D ratio (interobserver agreement) increases with experience.

Clinical Competence↗
PubMed2001

Comparing optical systems, and the concept of the converter system.

The purpose of this article was to present a complete and general method for comparing the first-order optical character of optical systems. The method provides a common basis for quantifying the difference between systems of all kinds including thin lenses, ophthalmic prisms, eyes before and after accommodation, eyes before and after refractive surgery, etc. Systems may be astigmatic or stigmatic, coaxial or noncoaxial. In special cases, the method reduces to being equivalent in essence to ostensibly incommensurate comparisons implicit or explicit in current optometric and ophthalmological usage (difference in power for refractions, corneas, and thin lenses, difference in prismatic power for prisms, ratio of magnifications for afocal telescopes, etc.). The method uses the concept of a converter system that when placed in front of or behind one system, converts its first-order optical character to the equivalent of a second system. Equations are presented for the ray transferences of the anterior and posterior converter systems for pair-wise comparisons in general. For any two systems, the transferences of the converter systems always exist and are unique. Numerical examples are presented; they illustrate converter systems that may be thin in special cases but thick otherwise. The transference of a converter system embodies and quantifies the optical difference between systems or characterizes the change from one state of a system (presurgical or preaccommodative, for example) to another (postsurgical or postaccommodative). The method provides a rational and uniform methodology for research and clinical applications in many areas of optometry and ophthalmology.

Accommodation, Ocular↗
PubMed2003

Interexaminer difference and the effect of training on the phenol red thread test results in Hong Kong-Chinese.

PURPOSE: This study evaluated interexaminer agreement in the measurement of tear volume using the phenol red thread (PRT) test on Hong Kong-Chinese subjects. The effect of an intensive training session on interexaminer agreement was also investigated. METHODS: Three postgraduate students without an optometry background were introduced to the use of the PRT test. After a general introduction (including a demonstration and some practice among themselves), the examiners collecting the first set of data from 38 subjects. They were then given an intensive 30-min training that involved strict standardization of instructions/procedures and practice. PRT values were collected from 27 subjects (four subjects participated in both phases of the study) after the intensive training. RESULTS: Significant differences were found among the examiners before and after the intensive training, which was mainly due to examiner 1, who consistently obtained relatively lower mean PRT values in both testing sessions. The intraclass correlation values estimated for all examiners were 0.35 and 0.58 before and after the training session, respectively. The 95% limits of agreement after the training session ranged from -14.8 to 8.0 mm/15 s between examiners 1 and 3, who showed the largest difference, and from -8.8 to 9.3 mm/15 s between examiners 2 and 3, who showed the smallest difference. The latter pair also showed the most significant increase in agreement after the intensive training (intraclass correlation value increase from 0.29 to 0.65), although no significant differences in the PRT results were found between the two examiners before and after training. CONCLUSIONS: Our results suggest that the interexaminer agreement of PRT results is influenced by both examiner- and training-specific factors. Intensive training is important for ensuring the highest consistency among examiners. The moderate interexaminer agreement suggests that clinicians should seek a substantial difference in tear volume when making decisions regarding interventions for their Hong Kong-Chinese patients.

Adult↗
PubMed2005

Four different types of client attitudes towards purchasing spectacles in optometric practice.

BACKGROUND: Unmet expectations are a major cause of client dissatisfaction, yet very little is known about the expectations and health values that clients in optometry practice hold about having an eye examination and purchasing spectacles. This study identified different attitudes and behaviours held by presbyope clients in optometric practices. METHOD: A total of 158 presbyope clients, recruited from 14 practices, completed a questionnaire which was developed from the theory of planned behaviour. The questionnaire examined attitudes towards spectacles and visiting the optician, motivation to visit the optician, perceptions of barriers to attending the opticians, information requirements, and preferences for shared decision-making. Responses were analysed using principal components analysis. RESULTS AND CONCLUSIONS: Four factors were identified, which were labelled style, vision, avoiding and seeking. Style is concerned with the importance of appearing fashionable or stylish, and desiring approval from others. Vision relates to clients' attitudes towards obtaining clear vision and to maintaining healthy eyesight. Avoiding describes the perceived difficulties associated with visiting the optician and purchasing new spectacles. Seeking corresponds to the desire for information on the technical details of lenses. Practitioners could use these characteristics to tailor information to meet the needs and address the expectations of individual clients. This may make the information provided more personally relevant, and could enhance client satisfaction.

Adult↗
PubMed2005

Twenty years of NZOVRF-supported scientific inquiry.

For many years, Alan Bott travelled from his optometric practice in Paeroa to supervise the contact lens laboratories and clinics at The University of Auckland. He was one of the founders of the New Zealand Optometric Vision Research Foundation (NZOVRF) working closely with Eugene Hirst and Dr Leon Garner (now Professor Emeritus Garner) to raise nearly $500,000 for the Foundation from 1985 to 1988. Alan passed away in 1999 as a result of prostate cancer. He is remembered fondly by all who knew him. Since its inception 20 years ago, the NZOVRF has supported research that has advanced our knowledge and understanding in many areas of optometry and vision science. Even a brief discussion of each of the 39 studies that the foundation has supported would result in a very long report, so I shall confine my remarks to an area that has been of great interest and controversy, especially concerning whether myopia and other refractive anomalies occur as a result of hereditary or environmental influences or both.

Biomedical Research↗
PubMed2005

Diversity in optometric education within and across China: challenges for harmonization.

The development of optometric education and the establishment of formal tertiary educational programs in the Chinese mainland, Hong Kong and Taiwan are described. The various types of degree and diploma programs from medical and technological universities are differentiated. The definition of optometry, as it is understood by the regulatory bodies and the populace, is discussed. There is more diversity in optometric programs within and across Greater China than among some nations. However, due to cultural and linguistic similarities, interactions and interchanges among institutions/associations at regular intervals are of immense value in harmonizing the differences in educational programs and professional practices. Exchange programs, conferences and seminars further enhance the educational standards by exchanging technical knowledge and good clinical practices.

China↗
PubMed1994

Mean response and oscillations of accommodation with colour and contrast.

The mean level and microfluctuations of accommodation were objectively recorded, in natural viewing conditions, by infrared optometry on steady presentation of various combinations of achromatic and coloured Snellen E on achromatic or coloured fields, with or without a luminance contrast. In addition to the absolute mean power spectrum of the microfluctuations, the HF/LF ratio of the high (HF, 0.5-6 Hz) and low (LF, 0-0.5 Hz) frequency activity of this phenomenon, which provides a sensitive objective description of the control, was analysed. In the case of maximum luminance contrast, for any monochrome situation, the HF/LF ratio decreases when changing from an achromatic-only contrast to a saturated coloured situation. At the same time, the relative shifts of the mean level of accommodation, which compensate ocular chromatism under coloured conditions, increase with colour saturation. In the case of an isoluminant chromatic contrast, the decrease in the HF/LF ratio was significant. This result confirms the inefficiency of chromatic contrast to control accommodation. Furthermore, this study confirms that both LF and HF absolute activity of the microfluctuations of accommodation are usually related to the stimulus characteristics. Their antagonistic behaviour is an argument for considering the HF/LF ratio.

Accommodation, Ocular↗
PubMed2005

Optometric and ophthalmic contact in elderly hip fracture patients with visual impairment.

AIM: To describe previous contact with optometry and ophthalmic services in a group of elderly patients with and without visual impairment (VI) who had fallen and sustained a fractured neck of femur. METHOD: A cross sectional study of 537 patients aged 65 and over who had undergone hip fracture surgery in four Scottish centres (Glasgow, Ayr, Dundee and Fife). All patients had an in-depth optometric history, ophthalmic history and examination. RESULTS: Three hundred and ninety-three (79%) patients reported optometric contact in the 3 years preceding surgery and 107 (21%) patients had not seen an optometrist for more than 3 years. In the latter group, 64 had VI, which was due to uncorrected refractive error in 17 (27%) and untreated cataract in 20 (31%). VI (best binocular visual acuity of 6/18 or less) was found in 239 (46%) patients. A past ophthalmic history was present in 257 (50%) patients. Only 39 (16%) patients with VI were under ophthalmic care at the time of the study. CONCLUSIONS: There was significantly poor optometric and ophthalmic contact in patients who had VI and had fallen and sustained hip fracture. A proportion of the VI (66%) was due to uncorrected refractive error and untreated cataract. Public health providers should be made aware of the fact that current optometric and ophthalmic care pathways are not accessed by this group of elderly patients with VI and at risk of falling.

Accidental Falls↗
PubMed2006

Error classification in community optometric practice - a pilot project.

OBJECTIVE: A pilot study was conducted to undertake a baseline assessment of errors reported in community optometric practice. The feasibility and acceptability of a method for recording staff-reported errors in optometric community practice was investigated. DESIGN: An anonymous self-reporting system was introduced in order to collect information regarding errors/untoward events in community optometric practice. SETTING: UK community optometric practice. MAIN OUTCOME MEASURES: Classification of errors according to a previously published study pertaining to general medical practice in the same geographical area. RESULTS: Thirty-six notebooks were distributed to 10 participating community optometric practices. At the end of the 1 month study period the note books were returned and the 439 entries made were classified into seven categories: optical prescriptions (18.2%), communication (35.5%), administrative (15%), appointments (2.3%), equipment (11.9%), clinical (10.3%) and other (6.9%). CONCLUSION: A previously developed classification of errors in general medical practice was found to be equally applicable to community optometric practice. This study forms the basis of providing an acceptable and practical methodology, which can be applied by Primary Care Trusts (PCTs) when developing their risk management strategy to include optometry.

Appointments and Schedules↗
PubMed2006

Improvements in performance following optometric vision therapy in a child with dyspraxia.

SS, an 8-year-old boy with dyspraxia, presented for behavioural optometry assessment. He had been diagnosed with a subtle form of dyspraxia by his paediatric occupational therapist, based on poor proprioception, delayed bilateral integration and poor visual perception. A full visual assessment was carried out. SS was given a programme of reflex inhibition exercises for 3 months. Then, a programme of optometric vision therapy (OVT) exercises was prescribed at home and in practice for a period of 8 months. SS was assessed using a battery of occupational therapy Sensory Integration and Praxis Tests (SIPT) before optometric intervention, and after OVT. There were significant improvements in fusional reserves, accommodative facility and oculomotor control of pursuit and saccadic eye movements. His reading level had changed by 4 years in 11 months. The SIPT results showed improvements in the visual and motor/visual perception subtests, confirming the significant changes in visual perceptual performance. Consideration is given to treatment modalities for dyspraxia, and the studies confirming their effectivity of approach. This case study provides evidence supporting the use of OVT eye exercises in dyspraxia, ocular motility, accommodative dysfunction, learning difficulties and sports performance. The need for further research and inter-professional working is discussed.

Apraxias↗
PubMed2006

Defining myopia using refractive error and uncorrected logMAR visual acuity >0.3 from 1334 Singapore school children ages 7-9 years.

AIM: To determine the association of spherical equivalent (SE) with low uncorrected visual acuity (VA) along with a proposed definition for myopia using logMAR VA >0.3 as the criteria. METHODS: 1334 Chinese schoolchildren (mean age 7.8; range 7-9 years) were enrolled in the study after those who had hyperopia > or =+2.00 dioptres (D) and astigmatism > = -2.00 D were excluded. Uncorrected logMAR VA was measured for both eyes. Cycloplegia autorefraction was achieved by the instillation of three drops of 1% cyclopentolate 5 minutes apart. The average of five successful consecutive refraction and keratometry readings were obtained with calibrated Canon RK5 autokeratorefractometers by well trained optometry students, at least 30 minutes after the instillation of the third drop of cyclopentolate. SE cut-off points (-0.25 D, -0.5D, -0.75 D, -1.0 D) were evaluated. RESULTS: Using different SE cut-off points, the myopia prevalence rates of this sample of schoolchildren varied from 45.8% (SE at least -0.25 D) to 30.7% (SE at least -1.0 D). The cut-off point of > or =-0.75 D had a sensitivity and specificity of 91.8% (95% CI, 89.2 to 94.4) and 93.7% (95% CI, 92.1 to 95.3), respectively, to predict low vision defined as uncorrected logMAR VA > 0.3 (either eye). The next best cut-off point of -0.5D had a higher sensitivity (93.3%), but lower specificity (87.9%). CONCLUSIONS: The cut-off points of -0.75D and -0.5D in SE refraction are appropriate for the prediction of uncorrected logMAR VA worse than 0.3, which is the criterion for the US common state adult driver licensing standard.

Child↗
PubMedDate not supplied

Local survey of optometrists about dilated funduscopic examinations for patients with diabetes: making use of phone book yellow-page listings.

The risk of blindness from retinopathy and macular edema is significantly greater in people with diabetes than in the general public. Annual dilated funduscopic examinations are recommended for early detection and treatment before these problems become serious and threaten vision. Yet national health survey data indicate that only about half of patients with diabetes obtain an annual dilated funduscopic examination. This study surveyed optometrists listed in the NYNEX Yellow Pages (for the Bronx, NY) to assess their knowledge, attitudes, and practices related to dilated funduscopic examinations for patients with diabetes. Over half of the optometry practices in the survey indicated that dilated funduscopic examinations were available at a relatively modest cost. However, the optometrists reported that less than one fourth of the patients they saw with diabetes had knowledge about the purpose of an annual dilated examination. Optometrists are readily available through yellow-page listings. Their role as primary eye care providers in retinopathy screening may increase with managed care.

Diabetic Retinopathy↗
PubMed2003

A validity study of expert judgment procedures for setting cutoff scores on high-stakes credentialing examinations using cluster analysis.

This study compares an expert judgment process--minimal performance levels (MPL) using the Nedelsky and Ebel procedures--for setting cutoff scores for pass/fail on licensure examinations with an empirical approach--cluster analysis. Data from all three components of the Canadian Standard Assessment in Optometry (CSAO) examinations (knowledge, clinical judgment, and clinical skills) from 243 candidates were obtained. Results indicate that for the written components of the exams employing the Nedelsky method of MPL setting, there was a mean agreement of pass/fail of 81% with the cluster analysis approach on pass/fail categorization. For the performance exams using the Ebel method, the mean agreement of pass/fail with the cluster analysis was 93%. Thus the subjective approaches to setting cutoff scores (i.e., expert judgment methods) converge with the objective method (i.e., cluster analysis) of classifying test takers in the same categories.

Canada↗
PubMed1976

Effects of training in design on magnitude of the Müller-Lyer illusion.

The Müller-Lyer illusion was measured for 10 design and 10 optometry students. The illusion was smaller for design students and they improved significantly with practice. The results are discussed in relation to size-constancy, according to which part of the figure corresponding to a distant object is overestimated and to the aptitude of design students to draw according to their retinal image.

Adult↗
PubMed1976

Comprehensive vision care: a model.

This paper suggests a model for the practice of vision care in which the optometrist and ophthalmologist are each used to maximum advantage. It is demonstrated how the present antagonism between the two fields can be removed with a resultant enhancement of the practice of both optometry and ophthalmology. The natural outcome of the new relationship will be better vision care for the public.

Delivery of Health Care↗
PubMed1976

Optometric manpower development and utilization: a look toward the future.

This paper attempts to discuss in detail the rise in demand for optometric services and the manpower problems of the future. A proposal for the rational future development of optometric manpower has been made. Hopefully optometry will be able to consider its future development and scope of practice, and the types of changes to be made as the profession prepares for its increasing role in providing quality vision care to all Americans.

Humans↗
PubMed1986

Visits to selected health care practitioners: United States, 1980.

This report, based on data from the 1980 National Medical Care Utilization and Expenditure Survey, presents statistical estimates on visits to different types of practitioners by the noninstitutionalized civilian population of the United States. The report does not include dental visits, telephone visits, emergency room visits, or visits in which a physician was also seen. The practitioners whose visits are reported vary from the highly independent practitioners with doctorate degrees (opticians, chiropractors, podiatrists, and many psychologists); to the nurses, paramedics, social workers, and counselors who often provide services less independently; to the physical therapists and the laboratory, radiology, and other technicians who largely provide services under physician prescriptions or on teams headed by physicians. In general it was found that the most independent practitioners (optometrists, chiropractors, and podiatrists) tended most to provide services in their own facilities and to be paid directly by the patients or their families. Persons who visited technicians and physical therapists almost invariably saw a physician at least once during the year. Physicians were visited by 70.8 percent of the population. Persons seeing physicians averaged 4.5 visits to them during the year. There were nearly twice as many physician visits--by the survey's definition--than there were visits to all of the other types of practitioners reported on here. Nearly three-fourths of the physician visits took place in the doctors' offices, and about one-twentieth in doctors' clinics. The patient or the patient's family paid 40 percent of the charges for physician visits, and insurance and prepayment plans paid another 30 percent. Each of the remaining practitioner types is compared with all others and with physicians in terms of particular features of their practices. Following are some of the more notable findings for the respective practitioners: Nurses made more visits to the home than any other practitioner type. They also accounted for more clinic visits. More than half of the nurse visits for specific problems involved respiratory or circulatory diseases. Visits to nurses were the least expensive kind of visits reported. Most people who saw optometrists saw them only once or twice during the year. Optometry visits usually took place in the optometrist's office and usually involved eye examinations for glasses. The average visit was expensive, partly because it often included the cost of the eyeglasses. People who saw chiropractors tended to see them often during the year. Visits were usually in the chiropractor's office or clinic. The problems presented to chiropractors most often involved musculoskeletal diseases or injuries.(ABSTRACT TRUNCATED AT 400 WORDS)

Allied Health Personnel↗