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At least 991 records · Page 55Linked to original sources
PubMed2003

Experience and training as determinants of grading reliability when assessing the severity of contact lens complications.

PURPOSE: A study was conducted to investigate the influence of experience and training on grading reliability when assessing the severity of contact lens complications. METHODS: Twenty-three optometry students who were unfamiliar with the use of grading scales each used the Efron Grading Tutor computer program to ascertain grading reliability at an 'initial' experimental session and a 'final' session 3 weeks later. Twelve subjects (the 'trained' group) were given a tutorial on grading techniques and were asked to complete two grading exercises between the initial and final sessions. The other 11 subjects (the 'untrained' group) received no such training between the two sessions. Differences in grading reliability between the initial and final grading sessions were evaluated. RESULTS: Grading reliability was superior (lower) for the combined subject cohort at the final session (mean +/- standard deviation 0.33 +/- 0.12) compared with the initial session (0.46 +/- 0.25) (p = 0.004). However, there was no difference in the improvement in grading reliability between the two groups. CONCLUSIONS: Grading reliability improves statistically with some experience, although perhaps not to a clinically meaningful extent. No added benefit can be derived from supplemental training.

Clinical Competence↗
PubMed1999

Treatment of photosensitive epilepsy using coloured glasses.

A recently introduced optometric technique, colorimetry, enables the perceptual effects of ophthalmic tints to be evaluated subjectively, optimized, and then prescribed in tinted spectacles. The new technique is beneficial in reducing visual stress in patients with dyslexia and migraine. We describe an open trial designed to ascertain: (1) whether the colorimetry assessment, as it is now given, is safe for the investigation of photosensitive patients in optometry clinics where colorimetry equipment is most readily available, but where EEG control is not practical; (2) what proportion of patients with photosensitive epilepsy is likely to benefit to the extent already described in individual cases; (3) whether a tint selected by colorimetry could be shown to reduce the incidence of paroxysmal epileptiform EEG activity in response to flicker and patterns, thereby validating the subjective methods and corroborating the reported seizure reduction. Twenty-four females and nine males (aged 12-43 years) took part. All the patients had suffered visually-provoked seizures, had exhibited a photoparoxysmal response on at least one previous EEG recording, and had received a diagnosis of photosensitive epilepsy. Twenty-two were currently experiencing seizures. A further EEG was recorded in all except seven cases: a routine resting record, followed by hyperventilation. Colorimetry was performed after hyperventilation and before photic stimulation. Twenty-three (70%) reported beneficial effects during colorimetry and were prescribed glasses. There was a preponderance of lenses with a rose or purple colour, in contrast to patients with dyslexia. Seventeen of the 23 patients were available at follow-up, an average of 2.4 years later. Thirteen (57%) reported benefits, and said they were still using the lenses. In six of the 13 the benefits were pronounced, including a reduction of dizziness from fluorescent lighting, elimination of aura when using computer screens etc. Only in three cases was there a reduction in seizures that could reasonably be attributed to the use of lenses; in two of these cases no medications were prescribed, and in the third the medications remained unchanged for four years, two before and two after the introduction of the glasses. In an additional four cases a reduction in seizures was observed but medication had been changed. There was a modest reduction in EEG photosensitivity with the coloured lenses but also to an equivalent or lesser extent with grey in all of the eight patients examined in this way. One patient had seizures during colorimetry, but the seizures were not accompanied by scalp EEG changes.

Adolescent↗
PubMed2003

The association between cataract and mortality among older adults.

CONTEXT: Previous research has suggested that persons with cataract have an increased risk of death. OBJECTIVE: To compare the mortality experience of patients with cataract who elect surgery, patients with cataract who do not elect surgery, and patients without cataract independent of potentially confounding risk factors. DESIGN: Cohort study. SETTING: Ophthalmology and optometry clinics affiliated with the Callahan Eye Foundation Hospital in Birmingham, Alabama. PATIENTS: 384 persons with and without cataract. MAIN OUTCOME MEASURE: Mortality. RESULTS: Of the 384 study subjects, 286 had cataract, of whom 200 elected to have cataract surgery. Patients with cataract who did and did not elect surgery had significantly higher mortality compared to those without cataract (crude mortality rate ratio (MRR) 3.9 (95% confidence interval (CI) 1.5-9.8) and 7.3 (95% CI 2.8-19.1), respectively). After adjustment for age, gender, race, education, chronic medical conditions, smoking, drinking, depression, and cognitive status, the no-surgery cataract group had an elevated mortality rate (MRR 3.2 (95% 1.2-9.0)), compared to the no-cataract group, with a borderline elevation in MR for the surgery group (MRR 2.0 (95% 0.8-5.9). Limiting the study population to non-diabetics or those without concurrent eye conditions (glaucoma, maculopathy, retinopathy) did not materially influence the adjusted MRRs although the precision of the estimates was reduced. CONCLUSIONS: The results suggest that older persons with cataract, in particular those who decline surgery, have an increased risk of death, supporting the hypothesis that age-related cataract reflects systemic as well as localized ocular disease.

Aged↗
PubMed2001

Statistical analysis when dealing with astigmatism: assessment of different spherocylindrical notations.

Ophthalmic epidemiological studies frequently deal with ocular refractive errors, which are commonly expressed in the form sphere/cylinder x axis. However, this representation has been shown not to be the most suitable one for performing statistical analysis. Although alternative analytical and graphic methods to represent this kind of data have been developed, these formalisms have often gone unnoticed by researchers, despite their usefulness and versatility. Besides, there has been no discussion of how each of them fits in with a particular type of study. In this paper, several mathematical representations of dioptric power are revisited in a comprehensive way. The aim is to encourage researchers in ophthalmology and optometry to use these formalisms in their epidemiological studies, thus profiting from their exactitude and simplicity. Consequently, the emphasis is not on complicated mathematical derivations but on how to use these representations. Their potential and suitability in different applications is analyzed in detail. In addition, some examples are presented to illustrate the mathematical methods considered.

Astigmatism↗
PubMed1990

Potential jurors' opinions on the effects of hypnosis on eyewitness identification: a brief communication.

The present study examined a selected group of potential jurors' opinions on the effects of hypnosis on eyewitness identification and testimony. A group of 78 undergraduate psychology and optometry students completed a 2-part multiple choice questionnaire. The first part assessed Ss' knowledge of several issues concerning eyewitness testimony. The second part of the questionnaire contained 11 items which assessed Ss' beliefs and expectations concerning the effects of hypnosis on eyewitness identification and testimony. It was found that Ss' opinions on the effects of hypnosis on eyewitness testimony and identification were at odds with current empirical findings. These results, in accord with the previous literature, suggest that it is imperative that the courts be informed of the use of hypnosis during police work and that adequate precautions be taken to avoid a potential source of miscarriage of justice.

Adult↗
PubMed1997

Visual electrodiagnostic findings in mild traumatic brain injury.

Patients with traumatic brain injury (TBI) frequently exhibit varied forms of visual system dysfunction including: binocular, oculomotor, accommodative, refractive error shift, visual field loss, and visual perceptual deficits. A 5-year collaborative study between optometry and ophthalmology was initiated to follow documented mild TBI patients utilizing diagnostic methods to assess the quantity and quality of visual system deficits and recovery. A group of patients with mild TBI receiving optometric rehabilitation were compared with a group of age-matched, gender-matched, and headsize-matched TBI patients not receiving such treatment. Eighteen patients diagnosed with mild TBI underwent a treatment regimen of optometric rehabilitation (group I); 32 patients diagnosed with mild TBI did not receive optometric rehabilitation (group II). Pattern visually evoked cortical potential (VECP) testing and electroretinography (ERG) evaluation were utilized initially, repeated 6-12 months later and then 12-18 months after baseline. All TBI patients' VECP and ERG results were compared to age-matched, headsize-matched controls. Once the ERG had been used to exclude retinal involvement, identification of visual pathway dysfunction was possible with the VECP. Full-field ERG results in all groups were not remarkable and not sensitive for patients with mild TBI. Initial testing results revealed that 72% of those TBI patients in group I demonstrated VECP waveform abnormalities and 81% of those patients in group II showed waveform dysfunction. In the testing performed 12-18 months later, 38% of group I TBI patients, after receiving a treatment regimen of optometric rehabilitation, showed VECP waveform abnormalities; 78% of group II TBI patients demonstrated waveform abnormalities. VECP evaluation in patients with mild TBI can provide a useful and reliable tool for objective assessment of visual system deficit and recovery. Significant differences in visual system recovery were shown when comparing group I and group II.

Adolescent↗
PubMedDate not supplied

Postnatal refractive development in the Brown Norway rat: limitations of standard refractive and ocular component dimension measurement techniques.

PURPOSE: The genetic tractability of the rat and its larger eye size as compared to the mouse make it an attractive model for studies of ocular development and emmetropisation. This study aimed to provide normative data in the strain of rat being used for the rat genome sequencing project whilst also evaluating standard measurement techniques. METHODS: Ocular refraction (retinoscopy, Hartinger coincidence optometry) and ocular component dimensions (keratometry, A-scan ultrasonography, calliper measures, eye weight) were measured at intervals from eye-opening to adulthood. RESULTS: There was no convincing evidence of visually guided emmetropisation during normal development. Key measurement techniques such as high-resolution A-scan ultrasonography, which work effectively in several other animal species, were unusable or inaccurate in the rat. CONCLUSIONS: This study found no evidence of emmetropisation during normal development in rat. As in mice, technical difficulties prevent accurate measurement of ocular refraction and vitreous chamber depth and may complicate tests of emmetropisation to imposed blur.

Aging↗
PubMedDate not supplied

A real-time video pattern generator for use in ophthalmology.

An automated real-time microcomputer-based video pattern generator for use in optometry and ophthalmology is presented. The system can generate various vision pattern tests including a static and dynamic random dot stereogram that can be used to test depth perception. The patterns are generated in real time, which provides the ability to generate programmable images with objects that can move at different speeds. This feature is very useful in testing depth perception among infants and non-communicative people by correlating the movement of the eye with the movement of the object. The system also can generate other patterns such as checkerboards, vertical and horizontal bars, and provide the ability to sweep the size of the checkers and bars. These patterns are also useful for testing visual acuity. The system hardware is based on the TMS34010 graphics processor and hardware circuits and is connected to a host computer through a RS-232C serial communication port. Both control and application programs are written in assembly language. The system is fast, versatile and flexible with affordable cost.

Computer Graphics↗
PubMed1999

Telemedicine screening of glaucoma.

OBJECTIVES: Glaucoma is a major cause of blindness. More than 80,000 Americans suffer permanent vision loss from the disease. Widespread screening is fundamental in limiting the incidence of glaucoma-associated blindness. This pilot study explored the use of stereo digital images taken at a primary care center for telemedicine review by an off-site specialist as a means of screening for glaucoma. MATERIALS AND METHODS: Thirty-two diabetic patients were screened at a family medicine clinic. None had previously been diagnosed with glaucoma. A senior optometry student took stereoscopic digital and 35-mm optic disc photographs with a nonmydriatic retinal camera. The digital images were forwarded to a remote ophthalmologist for review. The conventional color stereo slide pairs of the same eyes were subsequently reviewed for comparison. Agreement on signs of glaucomatous disc changes between the two imaging systems was analyzed. RESULTS: Twenty-six of 32 eyes' digital and 35-mm photographs were analyzed. Six of 32 eyes (18.8%) could not be compared due to lack of matching 35-mm slides or digital images. Out of 26 eyes, lamina cribosa visibility was undeterminable in 8 eyes' digital images and 3 other eyes' 35-mm slides. Agreement among digital images and 35-mm slides of the remaining eyes was: 100%-vertical elongation, barring of vessels, bayoneting of vessels, and drance hemorrhage; 96.2%-focus notching of rim and rim pallor; 93.3%-lamina cribosa visability; 92. 3%-overpass cupping; 88.5%-focal enlargement; 84.6%-parapapillary halo; 80%-nerve fiber visibility; 65.4%-parapapillary atrophy. Parapapillary halo (p = 0.046) and nerve fiber layer visibility (p = 0.18) were detected on some 35-mm slides but not seen on matching digital views. CONCLUSION: Evaluations of cup-to-disc ratio (C/D) using both methods were in general agreement. However, some digital images were noted as too dark for assessing fine glaucomatous disc changes. Stereo digital images taken with a nonmydriatic camera by nonophthalmic photographers is a promising alternative for glaucoma screening in primary care settings. Telemedicine offers efficient communications with off-site glaucoma specialists. A larger study population is necessary to determine the overall effectiveness of using stereo digital imagery and teleophthalmology for glaucoma screening.

Adult↗
PubMed1999

A store-forward ophthalmic telemedicine case report from deployed U. S. Army forces in Kuwait.

This telemedicine test was developed to determine the relative ease with which an off-the-shelf ophthalmic telemedicine package could be successfully applied from within a remote theatre of operations. The project was conducted at the Camp Doha Health Clinic, located just outside Kuwait City, during the period from April 12(th) through April 23(rd), 1998. The deployed signal unit had contracted for a direct T-1 commercial satellite link (via MCI), which allowed for direct internet connectivity using a PCMCIA network card. Digital images were sent via this connection to 140 e-mail sites throughout the world, including an unsolicited image to each of 134 Army optometry officers for their review, analysis, and diagnosis. Return responses to this unsolicited survey were 53 out of 134, for a 39.7% response rate. Half of the respondents were able to view the image with ease and clarity, rendering an accurate clinical diagnosis. The other half of the respondents either did not have the software to display an image on their clinical desktop PC, or did not know how to use their provided software. This project clearly indicates that an off-the-shelf ophthalmic digital system can be successfully used from a remote deployed site. However, the consulting clinicians require up-to-date training, and their computer packages should have as wide a capability base as possible.

Humans↗
PubMed1994

Motor vehicle collision injuries and sensory impairments of older drivers.

To determine whether ocular disease, impaired vision, or diminished hearing might increase the risk of motor vehicle collision injuries in older drivers, we conducted a population-based case-control study at a large Health Maintenance Organization (HMO). All study subjects were HMO members who were licensed drivers age 65 or over. Cases were drivers treated for injuries sustained in a police-reported collision that occurred in 1987 or 1988. Controls were drivers who experienced no such injury during the study years and were matched to cases by age, sex, and county of residence. We found no clear evidence that ocular diseases or impaired visual acuity, as customarily recorded in the medical record, increased the risk of an injury collision. Although there was no significant association between impaired hearing and injury collision, we found that subjects who used hearing aids while driving had about twice the risk of others (adjusted RR 2.1; 95% CI 1.2-3.8). We conclude that mild reductions in static visual acuity have little effect on the risk of injury collisions for older drivers. Moreover, the types of vision tests needed to identify elderly drivers at increased risk are not those that are generally administered during routine optometry examinations or at the time of licence renewal. Further research is needed to verify a possible increase in risk among elderly drivers using hearing aids.

Accidents, Traffic↗
PubMed2000

Older adults, diabetes mellitus and visual acuity: a community-based case-control study.

MAIN OBJECTIVES: to screen for impaired distance visual acuity in older adults living at home, both with and without diabetes mellitus to determine whether diabetes increases the likelihood of visual impairment and to identify associated factors. DESIGN: case-control study. SETTINGS: three districts of Wales: North Clwyd, Powys and South Glamorgan, with assessments in subjects' homes. SUBJECTS: 385 with diabetes mellitus and 385 age- and sex-matched controls. MAIN OUTCOME MEASURES: visual acuity measures, short form (SF)-36 quality of life scores RESULTS: we observed impairment of visual acuity in 40% of those with diabetes mellitus and 31% of controls. Diabetes was associated with an increased risk of visual impairment [odds ratio 1.50 (95% confidence interval 1.09-2.05), P = 0.013]. The pinhole test identified uncorrected refractive error in 11% of the 63 patients with diabetes and 12% of the 49 controls who wore glasses, and in 51% of the 91 patients and 84% of the 69 controls who did not wear glasses (P < 0.001). Increasing age (P < 0.001) and female sex (P = 0.014) were significantly associated with visual impairment in both groups, whilst history of foot ulceration (P = 0.001), duration of diabetes (P = 0.018) and treatment with insulin (P < 0.001) were significantly associated with visual impairment in subjects with diabetes. We observed a significant association between impaired visual acuity and five domains of the SF-36 (physical and social functioning, mental health, vitality, and health perceptions; P < 0.01 in each case). CONCLUSION: older adults living at home have a high prevalence of uncorrected visual impairment. Diabetes mellitus is associated with significantly increased risk of visual loss. This impairment is associated with detriments in health-related quality of life. We recommend earlier use of optometry services and assessment of visual acuity by clinicians.

Aged↗
PubMed2004

Falls prevention in residential care homes: a randomised controlled trial.

OBJECTIVE: to determine the effect of risk factor modification and balance exercise on falls rates in residential care homes. DESIGN: cluster randomised controlled trial. PARTICIPANTS: 196 residents (aged 60 years or over) in 20 residential care homes were enrolled (38% response rate). Homes were randomly allocated to intervention and control arms. A total of 102 residents were consigned to the intervention arm and 94 to the control arm. INTERVENTION: a multifactorial falls prevention programme including 3 months gait and balance training, medication review, podiatry and optometry. MAIN OUTCOME MEASURES: number of falls/recurrent falls per person, number of medications per person, and change in Tinetti gait and balance measure. RESULTS: in the intervention group there was a mean of 2.2 falls per resident per year compared with 4.0 in the control group; this failed to reach statistical significance (P = 0.2) once the intra-cluster correlation (ICC, 0.10) had been accounted for. Several risk factors were reduced in the intervention arm. CONCLUSIONS: falls risk factor reduction is possible in residents of care homes. A modest reduction in falls rates was demonstrated but this failed to reach statistical significance.

Accidental Falls↗
PubMed1993

Diet and endometrial cancer: a case-control study.

A case-control study of 168 cases with endometrial cancer and 334 controls was conducted in Birmingham, Alabama, between June 1985 and December 1988. Cases were identified at the University of Alabama Hospital and in a private practice; controls were selected from among women who attended the University optometry clinic. A food frequency questionnaire that evaluated the intake of 55 nutrients and 116 foods was obtained for 103 cases and 236 controls. Logistic regression was used to evaluate the effect of diet on endometrial cancer after adjustment for total calories, age, race, education, obesity, smoking status, age at menarche, number of pregnancies, age at menopause, diabetes, hypertension, and use of exogenous estrogens. High intake of certain micronutrients was associated with a decreased risk of endometrial cancer: the odds ratio for subjects in the upper tertile versus those in the lower tertile was 0.4 for both carotene and nitrate (95% confidence interval (CI) 0.2-0.8 and 0.2-0.9, respectively). There also was an inverse association between endometrial cancer and protein consumption (trend test; p = 0.002), and a moderate direct association with cholesterol intake (OR = 1.9, 95% CI 0.9-3.7) when terms for both these macronutrients were included in a logistic model. Total intake of animal and vegetable fat were not associated with endometrial cancer. More frequent consumption of several vegetables and certain dairy products was associated with a statistically significant decreased risk of endometrial cancer. These results suggest that diet plays an important role in the etiology of endometrial cancer.

Carotenoids↗
PubMed2002

Performance and repeatability of the NEI-VFQ-25 in patients with dry eye.

PURPOSE: The use of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) has increased as a method of assessing patients' impressions of their vision-specific quality of life. The purpose of this study was to assess the performance and test-retest repeatability of the 25-question format of the NEI-VFQ in patients with dry eye. METHODS: The self-administered NEI-VFQ-25 was administered to 75 patients with dry eye on two occasions in a university-based optometry practice. Dry eye severity was assessed with use of the European criteria for dry eye. The weighted kappa statistic (kappa(w)) was used to evaluate test-retest repeatability of the NEI-VFQ-25 individual test questions, and the 95% limits of agreement and the intraclass correlation coefficients were calculated for the overall VFQ and subscale scores. RESULTS: With use of the European dry eye criteria, 21.9% of participants were classified with moderate to severe dry eye. For the sample, the ocular pain subscale score was lower (indicating more ocular pain) than published normative values. Repeatability of individual NEI-VFQ-25 questions ranged from moderate to substantial (kappa(w) values: 0.42 [pain and discomfort] to 0.90 [stay home because of vision]). The intervisit mean (+/- standard deviation) difference in the overall VFQ score was -0.66 +/- 4.26 (95% limits of agreement: -9.02, 7.69), and the intraclass correlation coefficient for the ocular pain subscale was 0.57. CONCLUSION: Patients with dry eye have lower ocular pain subscale scores. The repeatability of the overall NEI-VFQ score and the subscale scores was moderate to high, and it may be influenced by the number of questions in each subscale.

Adult↗
PubMed1976

Application of biofeedback and behavior modification techniques in visual training.

A review of the biofeedback literature was made and proposals for use in optometry advanced. To this end electromyograph units can be connected to an apparatus which gives a reward when a patient performs proper eye movements. By this means, patients who undergo visual training become conscious of their eye movements. As a reinforcement, they are rewarded by music or the motion of toys when they give the right answer. Application of the system in cases of strabismus, limitation of gaze, convergence insufficiency or excess, ptosis, and other cases are discussed. Methodological and financial advantages of incorporation of biofeedback reinforcement into visual training are enumerated.

Behavior Therapy↗
PubMed1976

Eye movements during reading: case reports.

Since the time of Javal, it has been well established that normal reading eye movement patterns have 3 principal components: (1) small saccades that move the eyes from word to word, (2) large saccades that return the eyes to the beginning of the next line, and (3) fixation pauses between each saccade for information processing. We discuss the vision analysis results and show the quantitative reading eye movement records, measured with the infrared photoelectric method, of 5 patients examined in the Neuro-optometry Clinic. The reading records showed a wide variety of behavior: 1 patient performed normal reading movements, 1 "slow reader" manifested an excessive number of fixations as well as extended fixational durations, another "slow" reader only exhibited an excessive number of fixations, a patient with dyslexia performed backward reading movements, and 1 patient exhibited nystagmus superimposed upon the reading pattern.

Adult↗
PubMed1977

Phoria, vergence, and fixation disparity in oculomotor problems.

Measures of horizontal phoria, vergence, and fixation disparity were obtained for 2 samples: 28 optometry students without symptoms and 32 orthoptic patients with symptoms associated with binocular oculomotor difficulties. Discriminant analysis was used to determine which tests or group of tests best discriminated between the 2 samples. Analysis was done for both samples and for exophoric and esophoric subsamples. Sheard's criterion was the best discriminator for the exophoric group, and amount of heterophoria was the best discriminator for the esophoric group. Fixation disparity was the next best discriminator for both groups.

Accommodation, Ocular↗