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Results for “Vision Screening”

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At least 1,207 records · Page 67Linked to original sources
PubMed2003

Impact of cataract surgery on self-reported visual difficulties: comparison with a no-surgery reference group.

PURPOSE: To examine the impact of cataract surgery on older adults' self-reported visual difficulties and compare them with those of patients with cataract who declined surgery over the same period. SETTING: Twelve area practices. METHODS: This was a consecutive chart review over a 6-month period. Primary inclusion criteria were 55 years or older, cataract in 1 or both eyes with 20/40 visual acuity or worse (best corrected, distance), and no previous cataract surgery in either eye. The Activities of Daily Vision Scale (ADVS) and visual acuity, contrast sensitivity, and disability glare tests were administered at baseline and at a 1-year follow-up visit. RESULTS: This study comprised 245 patients, 156 of whom elected to have cataract surgery and 89 of whom declined. Those electing surgery were more likely to be white, female, and have worse visual acuity and no ocular comorbidities. At baseline, ADVS subscale scores ranged from 53 to 76 in the surgery group and from 72 to 89 in the no-surgery group. In the surgery group, subscale scores improved by 15 to 21 points on average at the 1-year follow-up; scores were unchanged or worse in the no-surgery group over this period. This difference between the groups remained statistically significant after adjustment for group baseline differences in demographics, vision, and ADVS score. In the surgery group, visual acuity improvement in the first eye was an independent predictor of increases in the ADVS overall score and night driving and glare disability subscales; contrast sensitivity was an independent predictor of improvement in the night driving subscale. A reduction in disability glare in the second eye was independently linked to increases in the overall ADVS score and the night driving, near vision, and glare disability subscales. CONCLUSIONS: Baseline findings suggest that cataract patients who have surgery have more difficulty in visual tasks than those who decline surgery. After surgery, patients reported less difficulty with visual tasks. In the no-surgery group, no change was reported. Improvements in visual acuity and contrast sensitivity and reductions in disability glare after surgery were independently linked to improvements in ADVS scores.

Activities of Daily Living↗
PubMed1997

The ABCs of visual acuity assessment.

An accurate visual acuity assessment is an important part of the ophthalmic examination. Each patient needs his or her vision assessed whether an adult, a baby, or a child. The purpose of this article is to review some of the testing methods used to assess vision in the less than 20/200 adult, the preverbal infant, and the uncooperative or timid child. Several "pearls and pitfalls" will be mentioned to help you obtain the best visual acuity assessment on all types of patients.

Adult↗
PubMed1998

Driving with a visual impairment.

Driving is a highly prized activity for individuals of all ages. The decision to continue driving after a decrease in central acuity or visual field can be a source of anxiety for the individual and his or her family, as well as the ophthalmic practitioner. Although a great deal of research has been done concerning vision and driving, much controversy still surrounds this subject. This article reviews the literature concerning visual impairment and driving and makes suggestions for what should be considered when determining who should and should not continue to drive.

Automobile Driver Examination↗
PubMed2004

Patients' perspectives on noncompliance with diabetic retinopathy standard of care guidelines.

BACKGROUND: Periodic dilated eye examinations are recommended by the American Optometric Association, American Academy of Ophthalmology, and American Diabetes Association to detect sight-threatening conditions in diabetic patients. However, many patients with diabetes do not receive this recommended eye care and there is limited research to explain why. The objective of this study was to determine reasons some diabetic patients do not receive a dilated eye examination at least every year. METHODS: A chart review identified patients at The Ohio State University College of Optometry who had not been examined for more than a year, but less than two years. A telephone interview was attempted for all subjects. RESULTS: Of 100 eligible subjects, 43 completed the telephone interview. The reasons patients with diabetes did not return for a recommended dilated eye examination included transfer of care to another eye doctor, limited personal mobility due to poor overall health, last examination at a homeless clinic, self-reported lack of insurance, and self-reported apathy. CONCLUSIONS: Strategies to improve compliance of patients with diabetes should include reaching patients of low socioeconomic status and those institutionalized for poor overall health. Improved compliance may also come by encouraging patients to use medical insurance for eye examinations and using patient recall systems.

Adolescent↗
PubMed2004

Improved clinical outcomes for fee-for-service physician practices participating in a diabetes care collaborative.

BACKGROUND: The Rockwood Clinic in Spokane, Washington, participated in the Washington State Diabetes Collaborative, which promoted spread of the Chronic Care Model. Eleven participating providers managed care for 698 patients with diabetes, while 19 non-participating providers had 1,300 patients. IMPLEMENTING THE CHRONIC CARE MODEL: Rockwood upgraded its clinical information system to allow for creation of a patient registry to track clinical measures and generate performance reports. Components included a referral mechanism to facilitate more frequent use of diabetes educators, monthly reports, and sharing of results and updated clinical information from consulting specialists. Rockwood created a self-management tool kit and implemented patient goal setting and group visits. OUTCOME MEASURES: Seven of the 12 patient outcomes were significantly better for participating providers (p < .05). Two favorable outcomes, eye examinations and blood pressure < 130/85 mm Hg, were significantly associated with greater participation levels at p < .05. DISCUSSION: Implementing the Chronic Care Model to improve care, using quality improvement staff and administrative support, required fundamental changes in the system of care delivery. These changes were designed to refocus diabetes care efforts at Rockwood on prevention rather than acute care episodes.

Blood Pressure Determination↗
PubMed2001

Visual function in children with hemiplegia in the first years of life.

The aim of this study was to evaluate the incidence of visual function abnormalities in children with infantile hemiplegia, and the relation between visual abnormalities and type of lesion, as shown by brain MRI. Visual function was tested (grating acuity, visual field size, binocular optokinetic nystagmus [OKN], and ocular movements) in a group of 47 children with congenital or early acquired hemiplegic cerebral palsy (mean age 25 months, range 8 to 52 months). The cohort was subdivided into four groups according to MRI findings: brain malformations (n=5), abnormalities of the periventricular white matter (n=20), cortical-subcortical lesions (n=16), and non-progressive postnatal brain injuries (n=6). More than 80% of the children showed abnormal results in at least one visual test: acuity was the least impaired function, while visual field and OKN were abnormal in more than 50% of the cohort. No specific correlation could be identified between the type and timing of the lesions and visual function. Unlike adults with stroke, visual field defects were not always related to contralateral damage in the optic radiations or in the visual cortex. These results indicate that visual abnormalities are common in children with hemiplegia, and that they cannot always be predicted by MRI. All children with hemiplegia need a detailed assessment of visual function.

Age Factors↗
PubMed2001

Visual and visuospatial development in young children with Williams syndrome.

This study investigated the relation between sensory visual problems and the severity of visuospatial difficulties in a large group of young children with Williams' syndrome (WS). A questionnaire describing visual and associated problems was completed by the families of 108 children with WS and detailed follow-up assessments were conducted, including visual, spatial, motor, visuocognitive, and linguistic tests of 73 of these children (mean age 7 years 3 months; 40 males, 73 females). Children with WS showed a much higher incidence of common paediatric sensory vision problems (strabismus, visual acuity loss, amblyopia, reduced stereopsis) than normally developing children. It was found that delays with respect to age normative values increased with age on all tests. No significant correlation was found between the presence of a visual deficit and the severity of the visuospatial problems, suggesting that the difficulties children with WS have in understanding spatial arrangements are not simply a result of their earlier sensory visual problems. Results confirm the dissociation between visuospatial and language abilities in children with WS, and support the neurobiological model of a split between ventral and dorsal stream processing of visual information with a generalized deficit in dorsal stream processing in young children with WS.

Amblyopia↗
PubMed2004

Do routine eye exams improve vision?

We use a longitudinal national sample of Medicare claims linked to the National Long-Term Care Survey (NLTCS) to assess the productivity of routine eye examinations. Although such exams are widely recommended by professional organizations for certain populations, there is limited empirical evidence on the productivity of such care. We measure two outcomes, the ability to continue reading, and no onset of blindness or low vision, accounting for potential endogeneity of frequency of eye exams. Using instrumental variables, we find a statistically significant and beneficial effect of routine eye exams for both outcomes. Marginal effects for reading ability are large, but decline in the number of years with eye exams. Effects for blindness/low vision are smaller for the general elderly population, but larger for persons with diabetes. Instrumental variables provide a useful approach for assessing the productivity of particular interventions, particularly in situations in which randomized controlled trials are expensive or perhaps unethical and difficult to conduct over a lengthy time period.

Cost-Benefit Analysis↗
PubMed1999

Disc hemorrhage and peripapillary atrophy in apparently healthy subjects.

PURPOSE: We estimated the prevalence of disc hemorrhage and peripapillary atrophy in apparently healthy subjects. METHODS: We reviewed consecutive plain color fundus photographs of 12,140 eyes of 6,070 subjects (male/female=4,079/1,991) who visited a health consultation center. RESULTS: We analyzed 11,934 eyes of 5,967 subjects with good quality of photographs. Disc hemorrhage was found in 36 eyes of 35 subjects (0.6%). The prevalence of disc hemorrhage was significantly greater in women 60 years of age or older (Fisher's exact test, p=0.0004). The prevalence of peripapillary atrophy (zone Beta, zone Alpha), and suspected glaucomatous excavation in eyes with disc hemorrhage was 66.7%, 86.1% and 25.0%, respectively, and significantly greater than that (29.1%, 52.9% and 1.7%) in eyes without disc hemorrhage (Fisher's exact test, p<0.0001). CONCLUSIONS: Disc hemorrhage is more frequent in women over 60 years of age and is significantly associated with peripapillary atrophy in otherwise apparently healthy Japanese people.

Adult↗
PubMed1998

The changing pattern of glaucoma referrals by optometrists.

PURPOSE: To identify any change in optometric referral patterns for suspect glaucoma over a 5 year period. METHOD: A retrospective analysis was carried out of referrals for suspect glaucoma to a hospital glaucoma clinic from 1988 and 1993. RESULTS: There was a significant decrease in the positive referral rate with time from 56% in 1988 to 37% in 1993 (p = 0.02). Intraocular pressures (IOPs) of all patients prior to referral and at presentation to the glaucoma clinic were significantly higher in 1988 (25.1 and 25.6 mmHg respectively) than in 1993 (22.4 and 23.0 mmHg respectively, p < 0.0005). However, the presenting IOPs of eyes with glaucoma were similar in the cohorts (27.5 vs 26.4 mmHg, p = 0.33). Prior to referral, optometrists performed visual fields on 28% of patients in 1988 and on 48% in 1993 (p 0.01), giving an estimate of the cup/disc ratio in 15% of patients in 1988 and 41% in 1993 (p = 0.0004). CONCLUSIONS: The increased false positive referral rate appears to be associated with the increasing use of visual field analysers by optometrists and a willingness to refer at lower IOPs. Increased false positive referrals result in increased waiting times for hospital assessment.

England↗
PubMed2003

Community refinement of glaucoma referrals.

AIM: To describe a Manchester-based glaucoma referral refinement scheme designed to reduce the number of false-positive referrals to the hospital eye service. To report on the first years results of this scheme and its financial costs to the NHS. METHODS: Patients with suspected glaucoma, instead of being referred to their GP and then on to the hospital eye service, were referred to a group of specially trained community optometrists working to an agreed set of referral criteria. Those patients who did not meet the referral criteria were returned to the referring optometrist, while those who met the referral criteria were referred directly to Manchester Royal Eye Hospital. The patient's GP was informed in all cases. RESULTS: The number of suspect glaucoma cases referred to the Manchester Royal Eye Hospital was reduced by 40%. This figure is close to the percentage of false-positive referrals measured at Manchester Royal Eye Hospital prior to the onset of this study. The information accompanying referral has been improved and the scheme produces a small financial cost saving to the NHS of approximately 17 pounds sterling per patient. CONCLUSION: Community refinement of suspect glaucoma offers some important benefits over the current referral pathway.

Community Health Services↗
PubMed2003

Evaluating a new logMAR chart designed to improve visual acuity assessment in population-based surveys.

AIMS: This study aimed to evaluate a new chart designed to improve the collection of visual acuity data in population-based surveys. The Reduced logMAR E chart (RLME) employs three letters per line, 'tumbling E' optotypes, and conforms to accepted contemporary design principles. METHODS: The performance of the chart was assessed within a population-based glaucoma survey in Thailand. Performance indices were test-retest variability (TRV) and agreement with acuity data measured using the ETDRS logMAR chart which acted as the 'gold standard'. RESULTS: The 95% confidence limits for TRV of RLME acuity data were +/-0.15 logMAR. This figure is consistent with published data on the TRV of acuities measured using five-letter-per-line logMAR charts. The mean difference between RLME and ETDRS acuity data was 0.00 logMAR (95% confidence intervals of +/-0.05 logMAR) indicating that RLME acuities agreed well with those of the ETDRS chart. The chart and its method of use was readily accepted by the local ancillary staff who required only minimal training before acuity measurement could be delegated to them. CONCLUSIONS: The study demonstrated that the RLME chart is capable of accurate and repeatable acuity measurements. Certain aspects of the design of the RLME chart may be particularly pertinent to the measurement of vision in population-based surveys.

Aged↗