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PubMed1993

Effective strategies and programs to increase minority participation in the health professions for the 21st century.

Efforts in the 1960s and early 1970s aggressively met the national health care challenge to increase minority enrollment in health professions schools. These efforts resulted from an academic and community-based collaboration supported by public and private funding. This review was undertaken to inventory the strategies and programs of that period and to highlight effective strategies. A literature review of minority program studies was conducted to catalog specific strategies and programmatic activities. Criteria used to evaluate effectiveness were also assessed. Publication of any studies and evaluations of these programs are limited; longitudinal studies are scarce. Evaluative criteria of that time combined quantitative and qualitative measures that were not applied uniformly and consistently. The inventory of programmatic activity ranged from career awareness days to establishment of health career "magnet" schools. The review found that three strategies--awareness development, enrichment/reinforcement, and prematriculation--were effectively applied in programs across all areas of the health professions studied, that is, MODVOPP (medicine, optometry, dentistry, veterinary science, osteopathy, podiatry, and pharmacy), nursing, and allied health. Today these strategies continue to be effectively applied, but the hostile social climate and dwindling funding threaten the progress made. Revitalization of past efforts is imperative.

Education↗
PubMed1993

Traumatic cataract.

Cataract formation is commonly observed as a result of direct penetration of the crystalline lens by a foreign object or by blunt trauma to the globe or adnexa, creating a "shock wave" within the eye. Partial or total damage to the zonules may also occur, resulting in subluxation or total displacement of the crystalline lens. The primary care doctor of optometry plays an important role in evaluating patients with cataract, both immediately and long after the injury has occurred. Many of these patients can be managed conservatively by careful observation, while others will require surgical intervention.

Cataract↗
PubMed1993

State board requirements for CPR certification for licensure in independent health professions.

CPR certification requirements for licensure were obtained from 50 states and the District of Columbia for the fields of medicine, osteopathy, podiatry, chiropractic, dentistry, and optometry. It was found that none of the states required CPR certification for initial medical, osteopathic or chiropractic licensure or license renewal, while 4 percent required certification for initial podiatric licensure and license renewal. For initial licensure in dentistry, 25 percent of the boards required CPR certification while 29 percent required CPR certification to renew dental licensure. For initial optometric licensure with diagnostic pharmaceutical agents, 44 percent of the states required CPR certification.

Cardiopulmonary Resuscitation↗
PubMed1995

Reversal of tropicamide mydriasis with single instillations of pilocarpine can induce substantial pseudo-myopia in young adults.

Pupillary dilation for diagnostic purpose has become an increasingly common procedure in UK optometry in recent years and the consensus seems currently to militate against the routine use of miotics; an eye that is judged safe to dilate is thought to be at minimal risk during the natural recovery phase to normal pupil size. Nevertheless, the optometrist does, on occasion, need to consider whether there might be some advantage in minimising the sometimes debilitating effects of cycloplegia and mydriasis produced in young adults by tropicamide. In this context we compare the effects of single instillations of two miotic agents: the alpha-adrenoceptor antagonist thymoxamine HCl (0.5%), and the parasympathomimetic pilocarpine HCl (1 and 2%). Tropicamide was used to induce mydriasis in a group of 12 volunteer student subjects aged 20-26 years (7 males, 5 female; mean 21.67 years) selected to provide low (L; n = 4), medium (M; n = 4) and high (H; n = 4) iris pigment levels. Measurements of pupil diameter (Brocca pupillometer), Snellen visual acuity and accommodative amplitude (near point rule) were made every 3 min over a 90 min recording period for 4 trials: (1) a control condition whereby a miotic was not employed; (2) thymoxamine HCl 0.5% was instilled after 30 min; (3) and (4) pilocarpine 1% and 2% was instilled after 30 min, respectively. Tropicamide induced a mean increase in pupil area from 25 to 50 mm2 after 22 min which was generally sustained over the 90 min period and was enhanced for the lower pigment groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Accommodation, Ocular↗
PubMed1995

A new protocol for the optometric management of patients with reading difficulties.

Research by Evans et al. (Ophthal. Physiol. Opt. 15, 481-487, 1995) has demonstrated a correlation between visual processing and ocular motor factors in people with specific reading difficulties (dyslexia). In addition, research by Wilkins et al. (Ophthal. Physiol. Opt. 14, 365-370, 1994) has shown that some people with dyslexia will benefit from a reduction of perceptual symptoms of discomfort and distortion if they use individually prescribed coloured filters. Three examples of the dyslexic patients who attend at the Institute of Optometry clearly demonstrate the importance of full investigation of ocular function, including the assessment of the effect of colour on visual perception. All three patients presented with similar symptoms of asthenopia when reading. Symptoms were alleviated for the first patient by use of orthoptic treatment of an exotropia with intermittent suppression. With the second patient, ocular motor functions were found to be within acceptable limits and relief of symptoms was obtained by the prescribing of lenses of a specific chromaticity. For the third patient, both orthoptic intervention and the use of specifically tinted lenses were necessary to relieve the visual difficulties that were being experienced. By taking advantage of recent research and developments in optometric instrumentation, it is possible for some of those with dyslexia to receive considerable benefit from optometric intervention.

Adolescent↗
PubMed1995

Clinical implications of intra- and inter-reader agreement in four different automated visual fields.

BACKGROUND: This study was designed and conducted to examine the degree of inter- and intra-reader agreement when four readers evaluate visual fields in patients known to have glaucoma and patients known to not have glaucoma. METHODS: Fifty-three patients known to have glaucoma and 60 patients known not to have glaucoma were selected randomly from a population at the University of Alabama at Birmingham School of Optometry. Four visual fields were performed on each patient, non-dilated, with the proper correction in place. The fields were performed on three different instruments by technicians who were unaware of the diagnostic status of the patient. Four independent (blinded) clinicians read the visual fields and judged them as: "glaucoma field defect," "no glaucoma field defect," and "poor reliability-cannot judge." RESULTS: Statistical analysis revealed that a single reader's interpretation of four different types of visual fields are very different from, are poorer than, and are more consistent than are the four readers' interpretations of a single type of visual field. The analysis also shows that the readers consistently underestimated the number of glaucoma patients with one instrument and overestimated the number with another. CONCLUSIONS: This results suggest that a single visual field will discriminate patients with glaucoma with an accuracy in the 70 to 75 percent range. For one of the instruments, the shorter protocol was almost as effective in discriminating glaucomatous fields as the longer protocol. This study also suggests that repeating the visual fields or analysis of a single field by two readers improves reliability.

Aged↗
PubMed1995

Comparing threshold visual fields between the Dicon TKS 4000 automated perimeter and the Humphrey Field Analyzer.

BACKGROUND: The automated perimeter is becoming the instrument of choice in the analysis of the visual field. There are a number of different perimeters in use and it can be difficult to compare results from different instruments. The purpose of this study was to compare visual field threshold measurements determined by the Humphrey Field Analyzer and the Dicon TKS 4000. METHODS: This study provided a statistical comparison of field test results from the Dicon TKS 4000 Automated Perimeter (program number 9) and the Humphrey Field Analyzer (30-2 threshold using FastPac). Central 30 degree, 76 point full threshold fields were performed on 20 non-dilated optometry students (age range 21 to 32 years, mean age 25.1 years) using both instruments. For the purpose of statistical analysis, the visual field was divided into 24 sectors, each measuring 10 degrees by 10 degrees. The mean threshold value of each group of points was compared between instruments. RESULTS: A difference was found between instruments (significant at P&0.0001) for 19 of 24 sectors. In addition, the Humphrey Field Analyzer threshold values were consistently higher (average difference 2.47 dB) than the Dicon values. Each subject was tested twice on each instrument; both instruments showed high test-retest correlations: 0.970 for the Humphrey and 0.971 for the Dicon. Test administration times were comparable (average 435.2 seconds for the Humphrey Field Analyzer and 430.2 seconds for the Dicon), although the Dicon averaged 41.5 fewer presentations tested per examination. Fixation losses were higher with the Dicon instrument. CONCLUSIONS: A practitioner may be reluctant to directly compare test results between the two instruments since they produce threshold values of statistically significant differences. The Dicon TKS 4000 was subjectively preferred over the Humphrey Field Analyzer by most subjects.

Adult↗
PubMed1977

Non-contact and Mackay-Marg tonometry: comparison in patients ages 7 to 85 years.

In a sample of 212 eyes of patients referred to an ocular pathology clinic, measures of intraocular pressure (IOP) using the non-contact tonometer (NCT) and the Mackay-Marg tonometer were highly correlated (+0.91), the NCT MEASURES BEING LOWER BY AN AVERAGE OF 6.5 MM Hg. In a general optometry clinic, the mean IOP as measured with the NCT on 987 eyes of patients, ages 7 to 85 years, was 15.7 mm Hg (S.D.=3.5 mm Hg). Stability of IOP was age, found for this sample, is unexpected if IOP is proportional to systemic blood pressure which rises with age. Several hypotheses propose to explain the apparent inconsistency.

Adolescent↗
PubMed1996

Prevalence of vision and ocular disease conditions in a clinical pediatric population.

BACKGROUND: The purpose of this study was to fill a significant void in the ophthalmic literature by performing a large scale, comprehensive, prospective study of the prevalence of vision disorders and ocular pathology in a clinical pediatric population using well-defined diagnostic criteria. METHODS: A prospective study was performed on 2,023 consecutive patients between the ages of 6 months and 18 years presenting for an initial comprehensive examination at the Eye Institute of The Pennsylvania College of Optometry. There were 373 subjects between 6 months and 5 years, 11 months of age, and 1,650 subjects between 6 years and 18 years of age. RESULTS: The most important finding from this study is that other than refractive anomalies, the most common conditions optometrists are likely to encounter in a pediatric population are binocular vision and accommodative disorders. The prevalence of accommodative and binocular (strabismic and non-strabismic) vision disorders is 9.7 times greater than the prevalence of ocular disease in children 6 months to 5 years of age, and 8.5 times greater than the prevalence of ocular disease in children 6 to 18 years of age. CONCLUSIONS: The data from this study has great significance for clinicians, optometric educational institutions, health care planners, and administrators. This data suggests that other than refractive anomalies, the most prevalent conditions in the clinical pediatric population are binocular and accommodative disorders. Clinicians should use a minimum data base that includes assessments of accommodation and binocular vision that will allow them to detect conditions with the highest prevalence.

Adolescent↗
PubMed1996

Comparison of the effectiveness of a nondilated versus dilated fundus examination in the pediatric population.

BACKGROUND: A study was performed to compare the clinical effectiveness of a nondilated fundus examination to a dilated fundus examination. METHODS: The population consisted of 90 pediatric patients aged 5 to 16 years. Subjects were randomly selected from patients presenting for a routine eye examination at the Eye Institute of the Pennsylvania College of Optometry. Direct ophthalmoscopy was performed on the subjects before pupillary dilation while direct and binocular indirect ophthalmoscopy were performed post-dilation. RESULTS: Twenty-three patients (25.5 percent) had one or more posterior pole anomalies not detected by the nondilated pupil examination. A total of 30 posterior pole anomalies were not detected by the nondilated pupil examination. Forty-six patients (51 percent) had one or more peripheral anomalies not detected by the nondilated pupil examination. Sixty-nine total peripheral anomalies were not detected by the nondilated pupil examination. CONCLUSIONS: A dilated fundus examination provides a more effective clinical method for evaluating intraocular health in a pediatric population.

Adolescent↗
PubMed1997

A study of racial differences in age at onset and progression of presbyopia.

BACKGROUND: This study investigated reported differences in age at onset and progression of presbyopia between black and white patients. METHODS: The records of 692 primary care patients (242 black and 450 white), ages 35 to 55 years, who received eye examinations at the University of Alabama at Birmingham School of Optometry (December 1, 1992 and May 31, 1993), were reviewed retrospectively. Regression models were used to compare age at onset and progression of presbyopia of study subjects with respect to race. Also, the effect of socioeconomic status (SES) was assessed for a subset of 373 subjects. RESULTS: No significant differences in the age at onset or progression of presbyopia were detected between black and white patients (p > 0.05). Similarly, there were no significant differences in age at onset and progression of presbyopia with respect to socioeconomic status. CONCLUSIONS: Contrary to previous studies, the onset and progression of presbyopia of black and white patients in this study population did not differ significantly. This result suggests other factors may play a role in previously reported variation of presbyopia in black and white patients. Similarly, variations in income status did not significantly impact the onset and progression of presbyopia. Further study is needed to corroborate or refute these findings.

Adult↗
PubMed1997

The effect of an artificially elevated intraocular pressure on the central corneal curvature.

Twenty-three optometry students with normal corneal condition were recruited. The intraocular pressure and central corneal curvature of the right eye were measured in a sitting and a 30 degrees head-down posture. The mean (standard deviation) IOPs before and during posture change were 15.6 (2.4) mmHg and 22.1 (2.3) mmHg respectively. This 6.5 mmHg mean rise in IOP was found to be statistically significant which is similar to the results from previous studies. The mean changes in radius of corneal curvature and the orientation of the axis of the vertical principal meridian were 0.02 mm (SD 0.025 mm) and 2.4 degrees (SD 10.4 degrees) respectively. No significant variation was demonstrated on these keratometric results due to the 30 degrees head-down posture. The maximum change in radius of curvature was only 0.055 mm for one subject. Perhaps this amount of pressure rise was not sufficient enough to distort the corneal surface centrally. Another possibility could be an even distribution of the elevated pressure around the cornea, or the distribution of pressure is not even but could not be revealed by a conventional keratometer.

Adult↗
PubMed1997

Variation during autorefraction: influence of two different target types.

An investigation was performed on seven subjects of varying ages in order to determine the influence of two different target types on autorefractor results. A single autorefractor capable of presenting two different targets was used. Multivariate statistical methods which only recently have become available in optometry are used to illustrate graphically the results obtained and formal hypothesis tests further demonstrate that most of the eyes in the sample display similar variation or behaviour with both targets. The mean refractive state likewise is not significantly different for both targets for five of the seven eyes at a 99% confidence level. Departures from multivariate normality (such as resulting from outliers) are shown to be of great importance in order to reach appropriate decisions with respect to target influence on autorefractor measurements and an example is provided to illustrate this point. In the absence of departures from normality it is believed that this study exhibits only weak evidence for differences in variation or mean refractive state with the different target types.

Adolescent↗
PubMed1997

Prevalence of vision problems in an indigent urban population.

BACKGROUND: Low-income individuals may encounter difficulties in gaining access to routine health care. Certain clinics operate to serve indigent people. The University of Missouri-St. Louis, School of Optometry, in conjunction with New Life Evangelistic Center, offers routine eye care in such a clinic. METHODS: A retrospective epidemiologic analysis of 2 years of eye clinic records from the center was performed to determine the prevalence of vision anomalies in the study population and the benefit of the availability of this care. RESULTS: The mean patient age was 37.8 years, with a high percentage of the patients being black males. Ninety-five percent of the patients required a change in spectacle prescription, improving acuities from an average of 20/70 O.D. and 20/70(-3) O.S. to 20/25(+1) O.D. and 20/25 O.S. This result indicates a statistically significant improvement in exit visual acuities as compared with entrance visual acuities (p < 0.0001). The mean spherical refractive error was -0.77 +/- 2.50 D O.D. and -0.77 +/- 2.45 D O.S. The mean cylinder in each eye was -1.00 +/- 0.75 D. Most cylinders were oriented with-the-rule Ocular disease was present in 11.9% of the patients; systemic disease in 10.4% of patients. Referrals to other health care practitioners were made in 5.9% of cases. CONCLUSIONS: This study demonstrates that indigent patients receive a useful and needed service from clinics that provide routine eye care to this population.

Adolescent↗
PubMed1996

Ocular anomalies of individuals with mental illness and dual diagnosis.

BACKGROUND: Oculo-visual findings commonly associated with persons diagnosed as having mental illness and/or dual diagnosis (i.e. mental illness with mental retardation) have not been fully investigated. This study determines the most common eye and vision anomalies associated with these disorders and discusses the similarities and differences between these two unique populations. METHODS: Data were obtained by the random selection of 88 patient records from the Illinois Eye Institute/Easter Seal Society of Metropolitan Chicago Eye Care and Treatment Program (Illinois College of Optometry). Results from the most recent oculo-visual evaluation were reviewed. Commonly accepted methods of assessing the eyes and vision of patients with disabilities were used. RESULTS: Individuals with mental illness frequently exhibited uncorrected refractive error, strabismus, blepharitis, pigmentary retinopathy, and cataracts. Those with mental retardation and mental illness (dual diagnosis) demonstrated similar findings with the exception of cataracts. A statistically significant amount of compound astigmatism was seen in those with mental illness. CONCLUSIONS: Many of the ocular anomalies found among the mentally ill and those with dual diagnosis were common to both groups but occurred with different frequencies. Appropriate spectacle correction and individually designed therapy programs should play an important role in the developmental and intellectual habilitation of these patients.

Adolescent↗
PubMed1997

Demographic characteristics of the vision-disabled elderly.

PURPOSE: To profile certain demographic features of the low-vision population in Ontario, Canada. METHODS: Sixty-six optometrists or optometry centers, 8 ophthalmologists, and 23 Canadian National Institute for the Blind rehabilitation worker teams were recruited to the study. They were required to report on their low-vision examinations during a 3-year period. RESULTS: Reports from 4744 low-vision examinations were received. Of the patients examined, 71% were over age 65 (subsequently called seniors or elderly), and 55% were over age 75. Ninety percent of all the patients lived in households and 10% lived in institutions. Seniors made up 71% of the patients living in households and 88% of the patients living in institutions. Most of the seniors were women (65%), and 57% had functional limitations in addition to low vision, most commonly limitations in mobility, hearing, or agility. Age-related maculopathy was the primary diagnosis in 75% of seniors, and the most common secondary diagnosis was cataract (46%). The main objective for most elderly low-vision patients was to gain improvement in personal reading (75%). CONCLUSIONS: The vast majority of low-vision patients were elderly, the largest number being 75 to 84 years old. When older senior low-vision patients (> or = 85 years) were compared with younger seniors (65 to 74 years), the older seniors were more likely to be women, more likely to have additional functional limitations, more likely to live in an institution, and more likely to have age-related maculopathy and cataract. Whether some elderly low-vision patients may be helped by cataract surgery needs to be determined.

Adolescent↗
PubMed1998

Total navy recruit health: making our sailors fit for the fleet.

Naval Hospital Great Lakes, Branch Medical Clinic, Recruit Training Command is the Navy's only recruit inprocessing point in the country. The clinic will medically inprocess approximately 54,000 new Navy recruits this year. In fiscal year 1995, the clinic inprocessed approximately 44,000 recruits, 35,000 males and 9,000 females. The Navy Medical Department is very concerned about total Navy recruit health. This includes a check on the present state of health of all sailors and teaching sailors how to stay healthy and take care of themselves during their naval careers. Navy medicine is also an integral part of the recruit training experience. Recruit training at Great Lakes is 9 weeks in duration. This article will describe the Navy's recruit medical inprocessing procedure to include the Sailor's Health Inventory Program, the Navy/Air Force Medical Entrance Test, immunizations, optometry, audiology, wellness education, gynecological examinations, medical assessment, and laboratory tests.

Female↗
PubMed1998

Retinal manifestations of idiopathic myelofibrosis, a hematologic disorder.

BACKGROUND: Idiopathic myelofibrosis (IMF) is a bone marrow and hematologic disorder. Retinal and systemic manifestations are observed and result from inefficient blood cell production and blood cell irregularities. CASE REPORT: A review of IMF as a disease process is presented by way of case report. A 70-year-old woman came to us with specific systemic symptoms. Further ocular investigation revealed bilateral retinal hemorrhages. The hemorrhages were consistent with the results of subsequently ordered blood tests. An understanding of the underlying systemic condition and recognition of the retinal manifestations of IMF aid in the diagnosis. Recognizing differential diagnoses is important as well because IMF produces retinal findings similar to other blood disorders with comparable blood counts and morphologies. There are certain systemic signs the optometrist may look for to assist in the recognition of IMF as opposed to the other diseases. CONCLUSION: This is an important disease process to recognize, since the systemic and retinal manifestations are within optometry's scope to co-manage.

Aged↗