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PubMed2005

Color vision tests for aviation: comparison of the anomaloscope and three lantern types.

INTRODUCTION: A comparison of the results obtained with the Nagel anomaloscope and the Holmes-Wright Type A, Spectrolux, and Beyne aviation color vision lanterns was undertaken. The Joint Aviation Requirements (JAR) specify pass/fail limits for these four secondary color vision tests and the Ishihara screening test. The results for individuals on all five tests were studied. METHODS: The color vision of 55 color-vision deficient and 24 color-vision normal subjects, mostly applicant pilots, was assessed using a battery of tests, including the Ishihara plates, the Nagel anomaloscope, and three lanterns. The testing methods and characteristics of the lanterns and anomaloscope were compared. RESULTS: Of the color-deficient applicants, only deuteranomalous trichromats passed more than one of the four secondary JAR tests, but a pass on one test did not reliably predict a pass on another test. Three out of nine protanomalous trichromats passed the Nagel anomaloscope but failed all three lantern tests. Of the normal trichromats, 12 failed the anomaloscope and 12 failed the Beyne lantern. DISCUSSION: Variability in pass/fail results can be attributed to many factors apart from loss of chromatic sensitivity. Some normal trichromats can fail both the Ishihara screening and the secondary tests. The approved secondary test varies between countries and the outcome of regulatory assessment depends on the color vision test used. Since the flight safety consequences of the current situation cannot be ignored, the development of a less variable technique for color vision assessment that is accepted internationally, allied with a better understanding of color vision requirements, is needed.

Aerospace Medicine↗
PubMed1996

Visual predictors of reading performance in kindergarten and first grade children.

PURPOSE: A masked investigation of the relation between performance on various vision tests and reading was conducted with 90 kindergartners (mean age 5.73 years) and 91 first graders (mean age 6.76 years) from a middle class, suburban, elementary school near Cleveland, Ohio. METHODS: Vision testing included the Modified Clinical Technique (MCT), +/- 2.00 D flipper lenses with red/green suppression check for accommodative facility, and Randot for stereoacuity. Reading performance was independently evaluated with the Metropolitan Achievement Test 6 Reading Test and teachers' assessments. RESULTS: The results revealed that accommodative facility was predictive of successful reading performance in 7-year-olds (p = 0.0431), first graders (p = 0.0125), and in the entire subject group when age (p = 0.0254) or grade (p = 0.0224) was controlled. Failure on the MCT was significantly associated with decreased reading skill in 5-year-olds (p = 0.0431). In addition, stereoacuity worse than 100 sec arc (p = 0.0316), MCT failure plus stereoacuity worse than 50 sec arc (p = 0.0316), and accommodative facility (p 0.0155) were predictive of whether children of average intelligence would show successful or unsuccessful reading ability. CONCLUSIONS: Thus, visual performance was significantly related to reading performance even in children of average intelligence when IQ was partially controlled. Also, the predictive value of the MCT for reading achievement could be improved by the addition of a referral criterion for stereoacuity. This would make the results of MCT screening more readily applicable to educators.

Accommodation, Ocular↗
PubMed2005

Use of general medical services among Medicaid patients with severe and persistent mental illness.

OBJECTIVE: The aim of this study was to examine patterns of use of general medical services among persons with a severe and persistent mental illness enrolled in Medicaid from 1996 to 1998. METHODS: A total of 669 persons with a severe and persistent mental illness were identified by using statewide clinical criteria. A three-year database of Medicaid claims was developed to examine service use. The main outcome measures were use of outpatient services for a general medical problem, use of dental and vision services, and use of screening tests for women. Service use was examined by primary psychiatric diagnosis (schizophrenic, affective, paranoid, and anxiety disorders), and analyses controlled for the presence of a chronic medical condition, age, race, and sex. RESULTS: This study found high levels of service use for outpatient services but very low levels for primary and preventive services. Although 78 percent of persons with a schizophrenic disorder had an office-based visit during the three-year period, all persons with an anxiety disorder had such a visit. Sixty-nine percent of persons with a schizophrenic disorder had at least one emergency department visit, whereas 83 percent of those with an anxiety disorder had such a visit. Dental and vision visits and the use of mammograms and pap tests followed the same pattern; persons with a schizophrenic disorder had fewer visits and had less overall use than the other diagnostic groups. The use patterns across the four groups were significantly different in outpatient service use, dental and vision service use, and screening tests for women. Compared with persons with a schizophrenic disorder, those with an anxiety disorder were more likely to have had an office-based visit and to have received vision services, those with a paranoid disorder were more likely to have used dental services or received a mammogram, and those with an affective disorder were more likely to have had a pap test. CONCLUSION: Although this group of Medicaid patients with severe and persistent mental illness had access to providers, they received an unacceptably low level of preventive care. Use of health services for general medical problems differed somewhat by primary psychiatric illness.

Adult↗
PubMed2002

[Results of surgical management of abducens paralysis].

BACKGROUND: The pre- and postsurgical results after mono- and bilateral transposition surgery for abducens nerve palsy are reported. PATIENTS AND METHODS: In 13 eyes from 11 patients with 6th nerve paralysis, transposition surgery modified after Kaufmann was performed after a median duration of 13 months (range 6-28 months). The actual angle of strabismus, the capability of abduction and the field of binocular single vision with the tangent screen according to Harms were measured prior to surgery, immediately after surgery (1-3 weeks) and in the later postsurgical period (9-12 months). RESULTS: Of the patients 7 achieved fusion with binocular single vision, 5 of these patients had to accept an ocular torticollis of 10 degrees (range 5-15 degrees) and 4 patients had a tendency to exclusion. Of the 11 patients, 9 were treated successfully with one single surgical procedure 2 of which had bilateral abducens nerve palsy and 2 patients needed 2 further operations. The median preoperative convergent angle in the primary position was reduced from 28 degrees (range 16 degrees-60 degrees) to a median angle of 0 degree, sometimes only latent (range D 7 degrees-C 4 degrees) in the late postoperative period. The median postoperative abduction over the midline was 10 degrees (range 3 degrees-25 degrees). CONCLUSIONS: Bilateral 6th nerve paralysis was treated effectively with simultaneous transposition surgery in both eyes. In most cases an additional weakening of the medial rectus muscle was not necessary. An initial overcorrection with exotropia in the early postoperative period is desired and is a predictive factor for a good late postoperative result.

Abducens Nerve Diseases↗
PubMed1985

The value of sight-screening, a comparative study of the Rodenstock sight-screener and a clinical eye examination of 109 adult employees in a hospital.

A rodenstock sight-screener has been used in examinations of more than 20 000 employees in trade and industry by an organisation sponsored by Danish optical companies. In a following report it was stated, that a great deal of these people, because of reduced sight-function, would benefit from further examination by optician or ophthalmologist with prescription of glasses. On that background we undertook an examination of 109 adults working in our hospital. First they were tested with the Rodenstock sight-screener and afterwards they underwent orthoptic and clinical ophthalmological examinations in a blind design. The sight-screening included examination of vision for near and far, stereopsis, phoria, dark adaption and visual fields. We found some difference between our results and those published earlier. Furthermore we found bad clinical accordance. In conclusion, many people will be worried by this kind of sight-screening procedure and only few will benefit from it.

Adolescent↗
PubMed2005

Screening compliance and visual outcome in diabetes.

PURPOSE: To study the relationship between screening compliance and visual outcome in a screening programme for diabetic eye disease. METHODS: A retrospective case control study. The screening compliance of all the diabetes patients (n = 22) listed at the Icelandic National Registry for the Blind (visual acuity <0.3) was compared to a matched group of 44 non-blind diabetes patients (visual acuity > or =0.3) who participated in the same screening programme for diabetic retinopathy. Glycaemic control (HbA1c), office blood pressure and cholesterol levels were assessed. RESULTS: The study group had a significantly lower level of compliance with the screening programme (27% +/- 38% [mean +/- SD] versus 77% +/- 26% [mean +/- SD]; p < 0.0001). Macular oedema or proliferative diabetic retinopathy was found in 60% (13/22) of the study group when entering the screening programme, compared to 7% (3/44) in the control group. Blood pressure (except diastolic BP among type 1 diabetes mellitus), blood glucose and cholesterol levels were identical. The prevalence of blindness and low vision amongst diabetes patients in Iceland is about 0.5%. CONCLUSIONS: There was a significant relationship between screening compliance and visual outcome in diabetes patients in our screening programme.

Adult↗
PubMedDate not supplied

Evaluation of an updated HRR color vision test.

The HRR pseudoisochromatic plate (pip) test was originally designed as a screening and diagnostic test for color vision deficiencies. The original HRR test is now long out of print. We evaluate here the new 4th edition of the HRR test, produced in 2002 by Richmond Products. The 2002 edition was compared to the original 1955 edition for a group of subjects with normal color vision and a group who had been previously diagnosed as having color vision deficiencies. The color deficient subjects spanned the range of severity among people with red-green deficiencies except for one individual who had a mild congenital tritan deficiency. The new test compared favorably with the original and in at least two areas, outperformed it. Among subjects with deutan defects the classification of severity correlated better with the anomaloscope results than the original; all the subjects who were classified as dichromats on the anomaloscope were rated as "severe" on the new HRR, while those diagnosed as anomalous trichromats were rated as mild or medium on the new test. Among those with moderate and severe defects the new test was highly accurate in correctly categorizing subjects as protan or deutan. In addition, a mild tritan subject made a tritan error on the new test whereas he was misdiagnosed as normal on the original.

Adult↗
PubMed1997

Chromatic-contrast threshold impairment in diabetes.

A prospective study was carried out to investigate acquired colour-vision deficits in diabetics using an automated, computer-controlled, cathode-ray-tube based test of chromatic contrast. Chromatic-contrast thresholds estimates were measured along both a red/ green (constant S-cone) confusion axis and a tritan (constant M/L-cone) confusion axis for 305 eyes of 305 diabetics. The diabetic data were partitioned into groups based on a clinical categorisation of retinopathy. The diabetic data were compared with both age-matched and 'lens-equated' control data obtained from a bank of 347 normal subjects. Further analysis of differences between diabetic-status groups was performed. Associations between chromatic contrast threshold estimates and age, duration of disease, and severity of both macular oedema and ischaemia were investigated. The diabetic group was found to have significantly reduced chromatic-contrast threshold estimates when compared with normal controls, even in the absence of retinopathy. This reduction in chromatic contrast was predominantly tritanopic in nature. Interestingly, no reduction in red/green chromatic-contrast threshold estimate was found in diabetics without retinopathy. The tritan deficit seen in diabetics without retinopathy was strongly correlated with duration of disease, but when adjustments were made to account for the effects of duration-dependent lens yellowing, the tritan deficit was no longer apparent. A correlation between both the severity of macular oedema and severity of ischaemia with chromatic-contrast loss was established. Acquired reductions in both red/green and tritan chromatic-contrast threshold estimates seen in diabetics are strongly correlated with the severity of retinopathy. The results provide evidence that the specific tritan deficits seen in diabetics can be explained by the effects of lens yellowing rather than by selective damage of the blue cone system as has been hypothesised by other groups. The results provide support for the potential use of automated CRT-based tests of colour vision in diabetic retinopathy screening protocols.

Adolescent↗
PubMed2004

Pseudo-false positive eye/vision photoscreening due to accommodative insufficiency. A serendipitous benefit for poor readers?

BACKGROUND: Children whose eyes and vision are otherwise normal and who should screen negatively as normals, but who fail to compensate for their normal mild hyperopia (i.e. by normally accommodating, or rather actually failing to accommodate) will generate hyperopic crescents in a photoscreen test that can be interpreted as "positive" (for pathology) because high and asymmetric levels of hyperopia are common risk factors for amblyopia. This would therefore usually be considered a "false positive" and no further care would be offered. However, this failure to compensate, may in fact be a pathological disorder, accommodative insufficiency, making this apparently "false positive" situation actually a actually a "false-positive-false- negative positive test", or more simply a "false- false positive test". METHODS: The Alaska Blind Child Discovery Project photoscreened just under 16,000 children referring 6% as "positive", of which, after examination, the false positive rate was just 6% of those referred (0.4% of the total number screened). RESULTS: Ten (42%) of the 24 false positives had evidence of accommodative insufficiency inspite of only average (for age) amounts of cycloplegic hyperopia and a lag of accommodation on dynamic retinoscopy. Eight of the 10 were boys of kindergarten age. Most of these subsequently benefitted from prescription and use of reading glasses of low plus sphere correction. CONCLUSION: About 0.15% of photoscreened children, or 2.5% of those screening positive, and 42% (10/24) found initially on exam to be falsely positive, yielding hyperopic interpretations despite low and usually acceptably normal for age amounts of hyperopia, are in fact suffering from a pathological accommodative insufficiency. Identification of such false- false positives by a combination of photoscreening and dynamic retinoscopy may be used to determine which students might be helped with enforced reading glasses. Confirmatory exams on photoscreen positive-hyperopia cases should include an assessment of accommodation to identify these children.

Accommodation, Ocular↗
PubMed1992

Color vision deficits and Rorschach performance in aged persons.

Forty-two community residing older adults (M age = 69.28) (32 color normal, 10 color deficient) were administered the Rorschach and measures of both verbal and nonverbal intelligence in order to explore the effect of color vision deficiencies on affective responsivity. Among the sample of older persons screened for both visual and auditory acuity, when controls for intelligence and numbers of responses were made, greater affective constriction was found in the protocols of color vision deficient persons, relative to color normal individuals. These data suggest that Rorschach indicators of affective constriction may be biased in the case of individuals who have experienced color vision decrements. Consequently, first screening for color vision decrements when assessing older persons' personality dynamics may be desirable.

Aged↗
PubMed2006

The Pediatric Vision Screener III: detection of strabismus in children.

OBJECTIVE: To evaluate the clinical performance of the Pediatric Vision Screener (PVS) in children in a pediatric ophthalmology office setting. METHODS: Seventy-seven subjects between 2 and 18 years of age received gold-standard orthoptic examinations and were classified as at risk for amblyopia if strabismus or anisometropia (>1.50 diopters) was present. Strabismus was subclassified as variable or constant. The subjects were then tested with the PVS, which produced a pass or refer recommendation based on a binocularity score. The PVS also produced a yield score to indicate the subject's interest in the target. Sensitivity and specificity for amblyopia risk detection were calculated. RESULTS: Binocularity as determined by the PVS was greater than 65% for all controls and less than 20% for all subjects with constant strabismus. Binocularity ranged from 0% to 52% in subjects with variable strabismus. All subjects with anisometropia and no strabismus had binocularity scores less than 10%. CONCLUSIONS: The PVS identified strabismus, when present, in all subjects and identified 3 subjects with anisometropia as well. The PVS shows potential to address a lack of screening instrumentation appropriate for use with preschool-aged children.

Adolescent↗
PubMedDate not supplied

Visual screening in a school for hearing-impaired children.

Hearing-impaired children use vision to compensate for impaired auditory information. This fact, and the relatively high incidence of visual defect among the deaf population, render regular visual screening essential. The Royal School for Deaf Children, Margate, caters for children with a wide range of needs; screening involving a single-assessment structure for all pupils is felt to be inappropriate. This paper describes the implementation of a 'tiered' screening system, and the factors affecting allotment of pupils to particular 'tiers'. The screening structure is illustrated by a case study, and generalization of the system to other educational settings is discussed.

Adolescent↗
PubMed2002

A longitudinal study of visual acuity and visual rehabilitation needs in an urban Swedish population followed from the ages of 70 to 97 years of age.

PURPOSE: To investigate the longitudinal change in visual acuity (VA) in the oldest members of the elderly population, to estimate future numbers of people with visual impairments, and to estimate needs for and the effects of visual rehabilitation. METHODS: In the Gerontological and Geriatric Population Studies in Gothenburg, Sweden (H 70), subjects underwent repeated eye examinations at the ages of 70, 82, 88, 95 and 97 years. Logistic regression analysis was used to estimate the probability of independent living as a function of distance VA at different ages. RESULTS: Rates of normal VA (>or= 0.8) declined from 86% of the study group at age 70 to 7% of the study group at age 95 (0% at age 97). The incidence of VA <or= 0.1 increased from 1.4% at age 70 to 27% (all women) at age 97. The deterioration was faster at higher ages. No statistically significant difference in best-corrected distance VA between genders was found. A substantial improvement was achieved by correcting refractive errors. There was a statistically significant correlation between distance VA and the probability of independent living at all ages except age 97. At ages 95 and 97, about 50% of the study group were able to read newspaper print with best-corrected glasses. CONCLUSIONS: The number of old people with impaired vision will increase. People aged 80 years and older should have regular eye-screening in order to preserve vision and present conditions of living. Cataract surgery and low vision rehabilitation should be offered when the subject can still benefit from it, preferably during their 80s at the latest.

Activities of Daily Living↗
PubMed1990

[Case finding of amblyopia in young children using the TNO-depth-vision-test].

To evaluate the policy in amblyopia detection by pre-school health care workers we studied the prevalence of amblyopia that had not previously been detected among 1975 children at the ages of 4 years 6 months to 5 years 10 months. Seventy-eight (3.9%) of the children had insufficient stereo-acuity, though no form of ocular abnormality had been noted in the past. Twenty-one (1%) of the children had a previously undetected amblyopia. After 1 1/2 years 74% of the children with amblyopia had a visual acuity of 0.9 or more, while most of the children--at the time of referral--were 4 1/2 years or older. Amblyopia can be identified earlier by (a) a proper transfer of information from pre-school health care workers to the school doctor; (b) taking into consideration low vision if assessment of vision was not successful in the first examination, and (c) performing at least the TNO-stereotest when in doubt.

Amblyopia↗
PubMed1999

Screening for glaucoma with frequency-doubling technology and Damato campimetry.

OBJECTIVE: To assess frequency-doubling technology (FDT) perimetry (Humphrey Systems, San Leandro, Calif) and Damato campimetry (Precision Vision, Villa Park, Ill) for detecting glaucoma in a public glaucoma screening. METHODS: A 2-day public glaucoma screening was held at 2 different institutions. Each subject underwent 2 visual field screening tests (Damato campimetry and FDT perimetry in screening mode), an ophthalmologic examination, and Humphrey perimetry (24-2 FASTPAC) for each eye. Eyes were divided into 4 categories: normal, ocular hypertensive, glaucoma suspect, and definite glaucoma. The sensitivity and specificity of FDT perimetry and Damato campimetry for detecting glaucoma were estimated with receiver operating characteristic curves. RESULTS: Among 240 subjects who underwent FDT, the number identified as normal, ocular hypertensive, glaucoma suspect, and definite glaucoma was 151, 28, 35, and 26, respectively; among 175 subjects who underwent Damato campimetry, the numbers for the same groups were 118, 19, 19, and 19, respectively. The areas under the receiver operating characteristic curve for FDT perimetry and Damato campimetry were 0.925 and 0.883, respectively. The optimal sensitivity and specificity for FDT perimetry were 92% and 93%, while those for Damato campimetry were 53% and 90%, respectively. The average test time was 1 minute and 3 minutes per eye for FDT perimetry and Damato campimetry, respectively. CONCLUSION: Frequency-doubling technology perimetry was superior to Damato campimetry in this screening for glaucoma.

California↗
PubMedDate not supplied

[Indications for eye examination of HIV patients--screening parameters for cytomegalovirus retinitis].

BACKGROUND: To reduce the burden of frequent visits at the physician we have checked (I) for which ocular manifestations in HIV-infection screening of asymptomatic patients is worthwhile and (II) which parameters may indicate patients at risk for CMV-retinitis. PATIENTS AND METHODS: The clinical data of 215 HIV-infected patients were analyzed retrospectively. Only those ocular manifestations were considered suitable for screening that (a) endanger vision, (b) are treatable, (c) can be diagnosed sufficiently early and (d) are common. Furthermore (1) CDC-stage, (2) CD4+ count, (3) HIV-retinopathy, (4) CMV-uria and (5) CMV-antibodies were checked for their usefulness in indicating patients at risk for CMV-retinitis. RESULTS: Ophthalmological screening of asymptomatic HIV-patients should focus on cytomegalovirus (CMV)-retinitis because early diagnosis of this common blinding disease improves the visual outcome. 85 of 215 HIV-infected patients had a CD4+ count less than 50 cells/microliters 25% of these patients developed CMV-retinitis (21/85). The risk for CMV-retinitis rose to 38% (13/34) when the low CD4+ count was accompanied by CMV-uria. The proportion of patients with CMV-retinitis did not increase when HIV-retinopathy had been diagnosed earlier (12/48 = 25%). CMV-serology and CDC-classification were not helpful in screening for CMV-retinitis. CONCLUSIONS: We recommend the following ophthalmological screening scheme for HIV-patients without ocular symptoms: (1) patients with a CD4+ count < 100 cells/microliters should be checked every third month and (2) those with a CD4+ count < 50 cells/microliters and CMV-uria every sixth week.

AIDS-Related Opportunistic Infections↗
PubMed1983

Chromograms of color normals and multiple sclerosis patients.

The Gunkel chromograph was tested on 81 volunteers with normal color vision as indicated by screening with Ishihara plates and the panel D-15. Most of these color normals located their neutral area superior to the geometric center of the chromogram. A minority located their neutral area at the geometric center. Recognition of this variation may prevent misdiagnosis of chromographs of patients suspected of having color vision defects. All 29 eyes with history and VEP findings consistent with optic nerve demyelinization had enlargement of the neutral area, even though visual acuity could be corrected to 20/20.

Adolescent↗