Ocular morbidity in a sample of 150 treated leprosy patients.
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Diagnostic Techniques, Ophthalmological↗
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Results for “Vision Screening”
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Blindness and low vision in leprosy patients in Sichuan Province, China.
The acuity of vision of 2145 leprosy patients was examined. Twenty-six patients had bilateral blindness and 80 had diminution of vision bilaterally, according to WHO's standard. The vision disability rate was 4.94%. In addition, 136 patients (6.34%) had blindness or low vision involving one eye. The causes of blindness and low vision were leukoma and corneal ulcer.
Adult↗
Ophthaproblem. Glaucomatous damage.
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Chronic Disease↗
Intraocular pressure asymmetry is not a clinically-significant feature when using the PULSAIR non-contact tonometer.
This report describes the results of a retrospective analysis of intraocular pressure (i.o.p.) values recorded from the right (R) and left (L) eyes of middle-aged and elderly at-risk but assumed non-glaucomatous subjects. The tensions had been measured using the Keeler PULSAIR non-contact tonometer (NCT) in the course of routine optometric practice when individuals attended for a sight test. These bilateral IOP data were collated on the basis of each subject's gender, (male/female), age (40-59 years/60+ years) and the time of the tonometry assessment (a.m./p.m.). Wherever possible material was equi-partitioned across these three bipartite variables producing balanced data groupings. Pair-wise testing of R versus L absolute values of pneumo-applanation pressures across any of the balanced data groupings failed to reveal a statistically-significant difference between the paired IOP distributions. There was a consistent but small relative IOP asymmetry (L > R) in these data. Further analysis indicated that this asymmetry only attained borderline statistical significance with respect to subject's age: neither gender nor the time of assessment were statistically significant features, and there were no statistically-significant interactions between any of the three variables. In conclusion, provided that the manufacturer's operating instructions are adhered to, IOP asymmetry is not a clinically-significant feature when using the PULSAIR NCT on a clinical population at risk of developing glaucoma.
Adult↗
The diurnal variation of intraocular pressure in non-glaucomatous subjects: relevance in a clinical context.
Although it has been recognised for a century that an individual's intraocular pressure (i.o.p.) varies over a 24 hr period, the implications for the clinician of this physiological characteristic remain uncertain. While financial constraints nowadays prohibit in-patient assessment of suspect ocular hypertensive cases, the U.K. has witnessed a concurrent increase in the monitoring of at-risk subjects at local centres, including optometric practices. Consequently a description of the pattern of variation of IOP in the at-risk population during normal consulting hours, assessed using a popular model of pneumo-applanation tonometer, could assist the clinician in establishing management and referral protocols. This report describes the results of a single-centre study based on the retrospective analysis of the records of over 1,500 age-matched male and female at-risk but assumed non-glaucomatous subjects. Statistical analysis of the collated data indicated that subject age group was not a major variable: however gender and the time of IOP assessment were both significant features. For recordings between the hours of 09.00 and 18.00 human non-glaucomatous males and females registered an IOP peak in the late morning, succeeded by a lowered value from mid-afternoon. For both male age groups (40-59 and 60+ years) the afternoon mean IOP values were significantly lower than the male morning values and significantly different to the female morning and afternoon means. On the basis of these results it is suggested that male subjects who record borderline or high pressures at an afternoon appointment should be reassessed the following (mid-)morning; also that subsequent reviews of such cases should be scheduled for morning visits. By adopting this approach the likelihood of recording an elevated IOP value is increased and true-positive cases of raised IOP identified. However, during normal consulting hours the present evidence suggests that this temporal precaution need not be observed in female subjects.
Adult↗
Toward optimal health: the experts respond to the aging eye. Interview by Jodi Godfrey Meisler.
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Aging↗
Performance of red-green color deficient subjects on the Farnsworth Lantern (FALANT).
BACKGROUND: The Farnsworth Lantern (Falant) is an occupational color vision test intended to identify people with significant red-green color deficiency who are unable to name aviation, marine or railway signal lights correctly. The colors shown are white, green and red selected to be within protan and deutan isochromatic zones. HYPOTHESIS: The Falant grades the severity of color deficiency and identifies subjects with different types of deficiency. METHOD: 270 color deficiency subjects (diagnosed with the Neitz anomaloscope) were examined. A subset of 108 subjects also completed the Farnsworth D15 and the Farnsworth-Munsell 100 hue test. RESULTS: All dichromats and 75% of anomalous trichromats failed the Falant. The mean error score of dichromats was greater than that anomalous trichromats, but errors were made in a similar number of qualitative color naming categories. The range of Falant error scores was continuous with no demarkation between the criteria for pass and fail. It was not possible to identify anomalous trichromats likely to pass the Falant from the size of the anomaloscope matching range or from the results of Farnsworth-Munsell tests. CONCLUSIONS: People with severe red-green color deficiency fail the Falant, but neither the type nor the severity of color deficiency can be determined either from the qualitative results or from the error score.
Aviation↗
Cracking the crock: how to deal with factitious eye disease.
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Diagnosis, Differential↗
Self-reported assessment of visual function in a population-based study: the SEE project. Salisbury Eye Evaluation.
PURPOSE: To report on the usefulness of the Activities of Daily Vision Scale (ADVS) questionnaire for assessing visual functioning, a population-based sample of elderly Americans. METHODS: The ADVS questionnaire was administered to a population-based sample of 2520 community-dwelling individuals 65 to 84 years of age in Salisbury, MD. Items and subscales were evaluated for internal consistency, item discrimination, and content validity. Published subscale groupings and item associations in our population were compared for coherence using correlation, factor, and cluster analyses. Whole-sample and race- and gender-specific analyses were conducted. External validity was explored by regressing ADVS scores on standard psychophysical vision measures. RESULTS: ADVS scores were skewed to high visual functioning levels; approximately 60% of the population had function scores of 95 or better (of a possible 100). The overall, night driving, and near vision scales were internally consistent and had strong item-subscale associations; the day driving and glare subscales were not acceptable regarding these properties. The far vision subscale was acceptably scalable but only weakly differentiated from the other subscales. Overall, night driving, near vision, and far vision scores were all statistically and independently associated with multiple psychophysical vision measures. Findings were consistent across race and gender subgroups. CONCLUSIONS: As assessed by the ADVS, reported visual functioning is high in our representative older population. The overall scale and selected subscales effectively distinguish persons along a spectrum of ability. They correlate with measures of visual impairment in a reasonable way and thus hold promise for risk factor investigations. The published day driving and glare subscales should be examined for relevance and consistency before being applied in population-based settings. Methods specific to population-based settings should be investigated for their ability to better elicit additional visual function dimensions and early visual disability.
Activities of Daily Living↗
A screening approach to the surveillance of patients with diabetes for the presence of vision-threatening retinopathy.
OBJECTIVE: To provide scientifically based screening rules for the primary care setting designed to identify, through evaluation of a prescribed and limited portion of the posterior fundus, those patients with diabetes who have retinopathy severe enough to need referral to eye care specialists. DESIGN: Retrospective analysis of the Early Treatment Diabetic Retinopathy Study (ETDRS) photographic data base. PARTICIPANTS: The fundus photographic grading data from 3711 patients with diabetes enrolled in the ETDRS. METHODS: Multivariate regression techniques were used to identify retinopathy lesions in photographic fields 1, 2, 3, or a combination thereof that predict proliferative diabetic retinopathy (PDR) or clinically significant macular edema (CSME) within the seven standard fields. These were used to construct a family of screening rules with optimal combined sensitivity and specificity on which to base referrals to eye care specialists. MAIN OUTCOME MEASURES: Presence of moderate to severe nonproliferative diabetic retinopathy (NPDR), PDR, or CSME in graded fundus photographs. RESULTS: Hemorrhages and microaneurysms (h/ma) temporal to the macula (photographic field 3), as severe as or more severe than ETDRS standard photograph 1 (h/ma 3 > or = 3), identified 87% to 89% of eyes with PDR and 92% to 93% of eyes with moderately severe to severe NPDR, which are at high risk for developing PDR. Extrapolating the results using retinopathy prevalence data from epidemiologic studies for the general older onset diabetic population, the calculated sensitivity for detecting PDR on a single examination is 87%, the specificity 80%; for moderate NPDR or worse, the sensitivity is 81 %, specificity 93%. Applying the presence of h/ma 3 > or = 3 as a screening rule to the older onset population, 26.5% of patients would be referred and 73.5% would not be referred. Any hard exudate within one disc diameter of the macular center detects CSME with sensitivity 94%, specificity 54%. Hard exudate of moderate or worse severity anywhere in the macular region (field 2) predicts CSME with sensitivity 89%, specificity 58%. CONCLUSIONS: Screening protocols based on assessing retinopathy lesion severity in the posterior fundus have the potential to identify most diabetic patients with vision-threatening retinopathy. If the protocols can be implemented effectively in a primary care setting, patients requiring referral for specialty care could be reliably identified, and the total number of patients needing specialty referral could be substantially reduced from current guidelines.
Diabetes Mellitus↗
Infant vision testing by a behavioral method.
A behavioral method of screening binocular infant vision called forced choice preferential looking (FPL) has been developed. Clinical trials of the FPL test for young infants are reported here. The test aids nonspecialized personnel in early identification of bilateral ocular abnormalities and anomalies of binocular cooperation (strabismus). It is not possible to screen for monocular eye disease or amblyopia with this test. Modifications of the FPL test may offer new ways of assessing other aspects of visual function early in life.
Age Factors↗
Community screening for visual impairment in the elderly.
BACKGROUND: While the aims of multicomponent screening of older people are broad, any benefit arising from the inclusion of a vision component in the assessment will necessarily be dependent on improving vision. OBJECTIVES: To assess the effects on vision of mass screening of older people for visual impairment. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, in The Cochrane Library (Issue 1, 2006), NRR (Issue 1, 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), PubMed (on 8th March; last 90 days), SciSearch and reference lists of relevant trial reports and review articles. We contacted investigators to identify additional published and unpublished trials. SELECTION CRITERIA: We included randomised trials of visual or multicomponent screening for identifying vision impairment in people aged 65 years or over in a community setting. DATA COLLECTION AND ANALYSIS: Both authors independently extracted data and assessed trial quality. MAIN RESULTS: Visual outcome data were available for 3494 people in five trials of multicomponent assessment. Length of follow up ranged from two to four years. All the trials used self-reported measures for visual impairment, both as screening tools and as outcome measures. In four of the trials people reporting visual problems were referred to either eye services or a physician. In one trial people reporting visual problems received information about resources in the community designed to assist those with poor vision. The proportions of participants in the intervention and control groups who reported visual problems at the time of outcome assessment were 0.26 and 0.23 respectively (risk ratio for visual impairment 1.03, 95% confidence interval (CI) 0.92 to 1.15). Visual outcome data were also available for 1807 people aged 75 years and over in a cluster randomised trial in which physicians' general practices were randomised to two different screening strategies; universal or targeted. Three to five years after screening, the risk ratio for visual acuity less than 6/18 in either eye comparing universal with targeted screening was 1.07 (95% CI 0.84 to 1.36, P = 0.58). The mean composite score of the National Eye Institute 25 item visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group, a difference of 0.4 (95% CI -1.7 to 2.5, P = 0.69). AUTHORS' CONCLUSIONS: There is no evidence that community-based screening of asymptomatic older people results in improvements in vision.
Aged↗
[Diabetic retinopathy--screening is a requirement. Don't wait until vision becomes impaired].
Diabetic retinopathy is the most common systemic disease capable of leading to blindness. Laser treatment of diabetic retinopathy is standardized; in most cases it can prevent blindness, provided the diagnosis is made in good time. Since impairment of vision is a late complication, systemic screening examinations are of particular importance if we are to reliably determine the optimal time for treatment. Advances in vitreoretinal surgery make possible the treatment of such late manifestations as vitreous hemorrhage and tractive retinal detachment. Provided that stage-oriented and timely treatment is forthcoming, these formerly hopeless cases should become a rare exception. The currently sole confirmed medical treatment is optimal control of blood sugar--based on the HBA1c value--and of blood pressure. The clinical efficacy of inhibitors of angiotensin converting enzyme or protein kinase C is presently undergoing investigation.
Adolescent↗
Screening for depression in low-vision elderly.
OBJECTIVE: To determine the sensitivity and specificity of the Geriatric Depression Scale (GDS) in older low-vision patients, and to compare GDS scores with the diagnosis of major depression in statistical models examining the interrelationships of vision, depression and disability. DESIGN: Cross-sectional survey. PARTICIPANTS: Community-residing older persons attending the low-vision clinic of Wills Eye Hospital, Philadelphia, PA, USA. MEASUREMENTS: Geriatric Depression Scale, DSM-III-R Checklist for Depression, Community Disability Scale and Snellen Visual Acuity. RESULTS: The sensitivity and specificity of the GDS (GDS = 11) were 63% and 77%, respectively. A receiver operating characteristic curve showed that the GDS's ability to discriminate patients with and without major depression was no better than chance. Although the GDS was limited as a screen for major depression, it was useful in statistical models examining the interrelationships of vision, depression and disability. CONCLUSION: Depressive symptoms are common among elderly patients with impaired vision attending a low-vision clinic. Although the GDS is unable to discriminate patients with and without major depression in this population, it is valuable as a continuous measure of depressive symptomatology to examine the interrelationships of vision, depression and disability.
Aged↗
Nutrition and health promotion in older adults.
During recent decades, the concept of health promotion has become a legitimate part of health care because of the aging of the postwar baby boom generation. As this population ages, the potential strain on health care systems will increase because the greatest use of health care services occurs during the last years of life. In older adults there are many correctable health factors that can be assessed through screening protocols. Hypertension, cholesterol, hearing, vision, diabetes, and cancer screening are well integrated into health promotion programs; nutrition promotion programs are not as well integrated. Reluctance to develop health promotion programs for older adults exists because of a perception that they would not follow such plans or change their lifestyles. However, longitudinal studies have shown that health promotion activities extend the number of years of health in older people although the relationship weakens in older age. Changes in diet and exercise patterns are most effective in the prevention of nutrition-related conditions when they are instituted early in life, but positive effects can occur at any age. If nutritional interventions are instituted early, a substantial reduction in health care expenditures may result from a decrease in the incidence or the delayed onset of these conditions. Changes in behaviors (reducing salt and fat intake) were positively associated with a belief that consuming a healthful diet would contribute to better health. The use of a variety of adult education theories and models will enhance behavior changes that lead to more healthful habits and enable a health educator to be successful in effecting change.
Aged↗
Recognition performance of subjects with color-vision deficiencies on a polychromatic sonar screen for ship navigation.
To facilitate differentiation between objects that are approaching, stationary, and moving away, these objects are represented in different colors on the screens of sonar locating devices used in ship navigation. Yellow represents stationary objects, and represents approaching objects, and green represents those objects moving away. A total of 46 subjects with normal color vision and 184 individuals with color-vision deficiencies, among them 29 deuteranopic, 100 deuteranomalous, 21 protanopic and 34 protanomalous individuals, were investigated for their ability to identify different signals. Ten different objects were presented for a period of 64 s each. As a minimal requirement it was established that 50% of the respective experimental group be capable of recognizing the objects within half of this time. Whereas 73.3% of the subjects with normal color vision could meet this requirement, none of the subjects in the different groups with color-vision deficiencies could do so. Only 16.1% of the deuteranopic subjects, 33.1% of the deuteranomalous individuals, 16.2% of the protanopic subjects, and 37.6% of the protanomalous individuals detected all objects within 32 s. No appreciable difference in the ability to recognize signals occurred among the different groups of subjects with color-vision deficiencies.
Color Perception↗
[Experience in the early detection of strabismus in child day care centers. Value in the prevention of amblyopia in young children].
A screening for early detection of strabismus in infants and young children attending day care centers in the town of Lyons was conducted during one year (1986): 838 children (3 month to 3 year old) were screened. A defective vision was found in 17 children (2%). Such early screening of strabismus, easy to realize and well accepted by the parents, is of great interest since it allows early detection and treatment with a maximum chance of complete recovery before starting primary school.
Amblyopia↗
Medical students and congenital colour vision deficiency: unnoticed problems and the case for screening.
The results are given of a questionnaire study to determine the range of difficulties that doctors notice in their work due to congenital colour vision deficiency (CCVD). The study is primarily qualitative. A questionnaire was sent to 40 self-selected doctors, 35 of whom were general practitioners (GPs). All were administered a number of colour vision tests to assess the type and severity of their deficiency. Many difficulties and some ways of overcoming them were reported. Those with a mild deficiency reported fewer difficulties and this relationship was significant. Twenty-three of the doctors also reported difficulties as medical students and their answers are given verbatim. The results are discussed in relation to other studies and data on colour vision. The reasons for and against screening medical students for this deficiency are considered and it is concluded that there is a strong case for screening.
Color Perception Tests↗