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PubMed2002

Vision readiness in Operation Restore Hope.

Ensuring that our forces are vision ready for their mission is essential on today's battlefield. Vision readiness considers optical readiness (appropriate correcting eyewear) and visual readiness (adequate job-required visual acuity). A study of vision readiness among deploying personnel for Operation Restore Hope in Bosnia from December 1995 to September 1997 was conducted at Fort Benning, Georgia. Of the 10,063 personnel screened, 3,554 (35.3%) were not optically ready for deployment and 406 (4.0%) were not visually ready for deployment. Analyses indicated a statistically significant difference between the active duty and reserve components in optical and visual readiness. A more effective vision readiness process should be implemented before deployment to ensure that all personnel are deployment ready. Optometry personnel, commanders, and deploying soldiers, sailors, airmen, and marines must take a more active role in ensuring that our forces have the appropriate visual acuity and optical devices to deploy.

Contact Lenses↗
PubMed1975

Fixation disparity and learning disabilities.

This study was conducted at the Massachusetts College of Optometry in 1974 to determine if there is a relationship between binocularity and learning disabilities. A fixation disparity test was administered to 53 learning disabled and 61 normal children in a blind study. The results indicated no statistically significant differences in binocularity between the two groups as measured by the fixation disparity technique.

Adolescent↗
PubMed2002

Clinical testing of accommodative facility: part III. Masked assessment of the relation between visual symptoms and binocular test results in school children and adults.

BACKGROUND: Accommodative facility is commonly assessed using +/- 2.00 lenses at 40 cm. Significant differences have been demonstrated on binocular facility testing between symptomatic and asymptomatic children; studies on adults have not replicated these results. We evaluate the relation between symptoms and binocular amplitude-scaled facility (equivalent stimulus for each subject based on individual amplitude). METHODS: Optometry students (N = 98) and school children IN= 152) participated in a vision screening. A 9-question standardized questionnaire quantified symptoms. Binocular accommodative facility was assessed using random presentation of standard and amplitude-scaled facility, without knowledge of symptom level. Subjects with abnormal binocular vision were excluded from data analysis. RESULTS: For children, both amplitude-scaled (p = 0.0004). and standard accommodative facility (p = 0.0055) significantly differentiated symptomatic from asymptomatic responses. For adults, amplitude-scaled responses were significantly different (p= 0.0228) between symptomatic and asymptomatic subjects; standard testing results were not (p = 0.2013). CONCLUSION: Binocular amplitude-scaled facility testing (test distance 45%, lens power range 30% of push-up amplitude) identifies symptomatic adults at high significance level. And both children and adults perform similarly on amplitude-scaled testing. These results suggest that amplitude-scaled binocular accommodative facility should be the test of choice for evaluation of patients between the age of 8 years and the onset of presbyopia. Patients who perform less than 10 cycles per minute are likely to be symptomatic.

Accommodation, Ocular↗
PubMed2002

Prevalence of ametropia in Ugandan soldiers.

A U.S. Army Optometry team was dispatched as part of the Africa Crisis Initiative to Uganda to provide vision care to a battalion-size task force of the Ugandan Army. Their mission was to ensure vision readiness of the unit and to promote humanitarian good will. Of the 692 soldiers refracted, 117 required spectacle correction to be vision ready. One hundred one records were available to be examined. The distribution of ametropia among this population is consistent with other studies of Third World countries.

Eyeglasses↗
PubMed2002

Spectacle fitting with ear, nose and face deformities or abnormalities.

Spectacle frame selection and dispensing remain significant components of optometry. Occasionally, we encounter patients who are unable to wear conventional spectacles due to abnormalities or deformities following injury and/or surgery to their nose, ears or head. In these cases, spectacle frame fitting may be more complex and customized frame adjustments may be required to account for the anatomical variations. A patient with a microtia (hypoplastic pinna) was fitted with a tailored spectacle frame. The details are presented together with a summary of different frames and modifications available for ears, nose and face abnormalities.

Adolescent↗
PubMed1992

A review of common ophthalmic antibacterial and corticosteroid-antibacterial combination drugs.

The use of antibacterial agents and corticosteroid-antibacterial combinations are essential to the practice of primary care optometry. In this paper we review common antibacterial drugs available for the treatment of ocular infection or prophylaxis, and offer some clinical guidelines for their use. Corticosteroid-antibacterial combination drugs, used primarily to suppress ocular inflammation, are also discussed, and the distinctions between common drugs are described.

Anti-Bacterial Agents↗
PubMed1992

Variability of fixation disparity and accommodation when viewing a CRT visual display unit.

Fixation disparity and accommodation were measured while subjects viewed a target on a cathode ray tube at a 50 cm viewing distance. The psychophysical method of sequential testing was used. For measuring fixation disparity a series of brief dichoptic nonius targets was presented and the direction of perceived misalignment was reported by the subject. From these responses the psychometric function of fixation disparity can be derived which gives not only the mean fixation disparity but also the range of fluctuation during the period of measurement. During a 5 min period, this range was +/- 1.5 min arc averaged over subjects, when expressed as the range in which instantaneous fixation disparity fell with a probability of 68%. Repeated measurements on 5 days within 2 weeks gave a larger range of +/- 2 min arc. However, individual results can differ considerably from these average values. Repeated measurements and the analysis of the psychometric function can provide a more complete description of individual binocular status than is obtained with a single adjustment of continuously visible nonius targets. Laser optometry revealed that, compared to the stimulus distance of 50 cm, accommodation lagged behind in the range 1-2 D. The two display modes of bright characters on dark background and vice versa gave very similar results.

Accommodation, Ocular↗
PubMed1992

Dapiprazole: will it affect the standard of care for pupillary dilation?

One of the most controversial clinical issues in optometry is the use of "routine" pupillary dilation. Many optometrists are still reluctant to employ routine dilation because of concerns regarding patient inconvenience, angle-closure glaucoma, or systemic side effects. Dapiprazole, a new alpha-adrenergic blocking agent, is now available to reverse the effects of tropicamide- or phenylephrine-induced mydriasis. This article discusses the advantages, clinical uses, limitations, and legal aspects of this mydriatic antagonist in optometric practice.

Adrenergic alpha-Antagonists↗
PubMed1992

QROC curves and kappa functions: new methods for evaluating the quality of clinical decisions.

The application of statistical methods for measuring the ability of clinical judgements and tests to discriminate between normal and diseased patients is increasing in optometry and ophthalmology. This paper presents two new methods for assessing the quality of such diagnostic decisions. Both are based on measurement of the kappa coefficient of association and offer theoretical and practical advantages over traditional methods. The paper first introduces the family of kappa coefficients with examples of their calculation and application. The use of weighted kappa values for measuring test sensitivity and specificity is explained, and it is shown how the results may be plotted in the form of the QROC curve which enables different aspects of test discriminability to be represented graphically. Kappa functions are then proposed as an alternative method for representing and predicting test performance, having the advantage of identifying optimal test criteria in addition to providing measures of discriminability. The clinical application of the new methods is illustrated using data for the detection of glaucoma from measurements of intraocular pressure.

Eye Diseases↗
PubMed2004

The Correction of Myopia Evaluation Trial: lessons from the study design.

The Correction of Myopia Evaluation Trial (COMET), a multicentre clinical trial based in 4 schools of optometry in the United States, evaluated the effect of progressive addition lenses versus single vision lenses on myopia progression in an ethnically diverse group of 469 myopic children aged 6 to 11 years. Completion of the clinical trial phase of the study provides an opportunity to evaluate aspects of the study design that contribute to its success. This article describes aspects of the study design that were influential in ensuring the smooth conduct of COMET. These include a dedicated team of investigators, an organisational structure with strong leadership and an independent Co-ordinating Centre, regular communication among investigators, flexible and creative approaches to recruitment and retention, sensitivity to concerns for child safety and child participation, and methods for enhancing and monitoring data reliability. The experience with COMET has provided a number of valuable lessons for all aspects of the study design that should benefit the development and implementation of future clinical trials, particularly those done in similar populations of children. The use of a carefully designed protocol using standard methods by dedicated members of the study team is essential in ensuring achievement of the study aims.

Disease Progression↗
PubMed1992

Epidemiology of essential hypertension and diabetes mellitus.

Essential hypertension and diabetes mellitus are highly prevalent and potentially lethal chronic diseases in the US population. Both have ocular complications that can result in permanent vision loss. Ten risk factors for hypertension and six risk factors for diabetes are discussed to help practicing doctors of optometry screen, refer, educate, monitor and co-manage patients who have one or both of these diseases.

Chronic Disease↗
PubMed2000

Meibomian gland status and prevalence of giant papillary conjunctivitis in contact lens wearers.

PURPOSE: The purpose of this study was to determine the clinical prevalence of Meibomian gland dysfunction (MGD) and giant papillary conjunctivitis (GPC) in an active contact lens wearing population. METHODS: One examiner observed 105 consecutive adapted contact lens patients over a 3-month period at a stateside USAF Regional Hospital Optometry Clinic. All eyes were graded for MGD and for GPC as described in the literature. RESULTS: Twenty-three patients were identified as having MGD. No patients had Meibomianitis and no patients in the study had GPC. CONCLUSION: Although a relationship between MGD and GPC has found its way into the ophthalmic literature, this study population reveals no relationship existent between these conditions in healthy and successful contact lens-wearing patients.

Adolescent↗
PubMed2000

Hypovolemic ischemic optic neuropathy.

BACKGROUND: Ischemic optic neuropathy refers to an acute event of ischemia, or decreased blood flow, to the optic nerve resulting in varying degrees of vision loss and visual field defects. Typically this disease affects the elderly population who experience systemic diseases that compromise the blood flow efficiency of the optic nerve head (e.g., giant-cell arteritis, hypertension, diabetes, etc.). However, cases of blood loss to the optic nerve, secondary to traumatic injuries or surgeries, have also been shown to result in ischemic optic neuropathy, regardless of age. It seems that in these cases, the resulting anemia and hypotension play contributing roles in the development of ischemic optic neuropathy. METHODS: A 41-year-old black man came to us with optic nerve head pallor O.S., count-fingers vision O.S., positive afferent pupillary defect O.S., and a central scotoma O.S. after being hospitalized and treated for a stab wound to his left neck that severed his left carotid artery at the bifurcation. RESULTS: This patient had been seen in the Optometry Clinic two years before the stab-wound incident. At that time, he had 20/20 vision in his left eye and no remarkable neurological deficits. His ocular presentation after the traumatic hypovolemic event was probably a direct result of the hypoperfusion to the left optic nerve head. This patient was diagnosed with a hypovolemic, or blood loss-related, ischemic optic neuropathy (O.S.). CONCLUSIONS: Patients who experience large amounts of blood loss due to trauma, surgery, internal bleeding, etc. and report vision loss should be screened for possible optic nerve ischemia. As eye care providers, when we are presented with patients who have optic nerve head atrophy, we should inquire about events that may have precipitated blood loss, potentially triggering ischemic optic neuropathy.

Adult↗
PubMed1992

Rotary Diamond Chart--a new visual field screening device.

The Rotary Diamond Chart (RDC) is presented as a new clinical method suitable for screening general optometry patients for visual field defects. A pilot study was conducted using both the rotary diamond chart and a central 76-point threshold-related screening test (Allergan-Humphrey) on 21 consecutive clinical patients. Full-threshold field testing was then completed on those subjects failing either screening test. The RDC detected five of six visual field defects including one very subtle defect which was not detected by the automated screening test. The sensitivity of the RDC visual field screening assessment was 83.33 percent with a specificity of 100 percent. These results suggest that the RDC is an effective clinical visual field screening test. It is easy for the clinician to use and for the patient to understand.

Adult↗
PubMed1992

Calculation and least-squares estimation of surface curvature and dioptric power from meridional measurements.

The calculation or estimation of dioptric power or surface curvature from meridional measurements is an important problem with applications in a number of areas. By phrasing the problem in terms of matrices and applying new results in the mathematics of matrices one is able to reformulate the problem into a standard form that is well known in mathematics and statistics. As a result the solution can be written down directly. The method copes with any number of measurements along any number of meridians, including repeated measurements along the same meridian, and is more general than methods previously proposed. It gives least-squares and best estimates of the true surface curvature or dioptric power. Being phrased in standard statistical terms the method lends itself readily to extension to related types of problems such as least-squares estimation under certain types of constraints. Matrix methods employed in this paper are likely to find wider application in optometry and the vision sciences.

Mathematics↗
PubMed2005

[The treatment of retinal apoptosis by Caspase 3 inhibitor Ac-DEVD-CHO in experimental myopia].

OBJECTIVE: To investigate the mechanism of retinal apoptosis in chick experimental myopia and the therapy of Caspase 3 inhibitor Ac-DEVD-CHO. METHODS: Chick myopia was induced by lid-suture. After Ac-DEVD-CHO had been injected into vitreous, myopia was confirmed by optometry. Subsequently, chick eyeballs removed were measured its extro-dimensions, and the change of fundus were observed. Retinal apoptotic cells were determined by electron microscopy, TUNEL technique and flow cytometry. Retinal Caspase 3 proteins and its activities were measured by immunohistochemistry, flow cytometry and a colorimetric method using Ac-DEVD-pNA as a substrate. RESULTS: Ocular diopters and extro-diameters in all sutured eyes remarkly increased in comparison with its control eyes at 12 weeks after lid-suture. Lacquer crack lesions were found in 41 of 90 sutured eyes (45.56%). Apoptotic cells were observed in retinal outer and inner nuclear layer of the sutured eyes, and its apoptotic rate was significantly more than in control eyes (P < 0.05). Moreover, the expression of retinal Caspase 3 proteins and its activities were increased. After Ac-DEVD-CHO was injected into vitreous, the decrease of retinal apoptotic rate, Caspase 3 proteins and its activities was found. The treated effect of Ac-DEVD-CHO was in a dose dependent manner. CONCLUSIONS: Caspase 3 plays an important role in retinal apoptosis of chick myopia. Ac-DEVD-CHO can effectively ameliorate retinal apoptosis by blocked the effect of Caspase 3.

Animals↗
PubMed2005

[Multiple factor analysis of visual function in hypermetropic children].

OBJECTIVE: To investigate the characteristics of hypermetropic children whose visual acuity (VA) is declined or accompanied by esotropia. METHODS: One hundred and ninety children were given optometry, strabismus degree and binocular vision measurement. RESULTS: Declined VA appeared in 170 children, while esotropia occurred in 173. Sixty-one got binocular single vision, 17 had fusion function, and 11 had stereoaculty. Spherical equivalent had a linear relationship with VA (P < 0.01), but not with the strabismus degree (P > 0.05). The influence factors of binocular vision were age of discovery, VA and the strabismus degree, while the stereoaculty was influenced by the strabismus degree, spherical equivalent and VA. CONCLUSION: Low VA and strabismus are the most common complaint in children. Ametropia and strabismus do great harm to juvenile binocular vision, and stereoaculty is damaged seriously. We suggest an early examination of visual function in children.

Adolescent↗
PubMed2006

Enforcement of commercial violations by health professional regulatory boards: a research note.

This article explores the nature of disciplinary decisions of health professional regulatory boards in response to commercial violations by licensees. Decisions of the Virginia Boards of Dentistry, Medicine and Optometry are analyzed to assess the extent to which disciplinary decisions appear to protect the economic interests of professionals versus the health, safety and welfare of the public. Sanctions imposed on commercial and non-commercial violations are compared. Given the criticism that regulatory boards are more concerned with commercial practices rather than quality of care practices, it was expected that board disciplinary actions would reflect this concern. The results indicate that there is no significant difference in the severity of sanctions imposed on both types of violations. Commercial violations, when compared with non-commercial violations, are not sanctioned more harshly by regulatory boards. The implications for self-interest theories of professional regulation and policies governing commercial practices of health professionals are discussed.

Commerce↗