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PubMed1998

Vision and driving: selective effect of optical blur on different driving tasks.

A test of static (high-contrast) visual acuity is the most prevalent vision test used to screen driver license applicants worldwide, even though research has largely failed to provide convincing empirical evidence for its role in traffic accidents. The purpose of this research was to evaluate the effect of visual acuity degradation on different components of the driving task. Participants were 24 young licensed drivers (15 men, 9 women) with normal vision. Driving performance was measured while participants wore modified swimmer's goggles to which blurring lenses were affixed in amounts necessary to produce binocular visual acuity levels of 20/20, 20/40 (the prevalent acuity standard for driving), 20/100, and 20/200. Driving performance was measured using the closed-road method of Wood and Troutbeck (1994). Acuity degradation produced significant decrements in road sign recognition and road hazard avoidance as well as significant increments in total driving time. Participants' abilities to estimate whether clearances between pairs of traffic cones were sufficiently wide to permit safe passage of the vehicle and to slalom through a series of traffic cones were relatively unaffected by acuity degradation. Thus the latter tasks appear to be mediated by aspects of central and peripheral vision that are relatively unaffected by optical blur. Potential applications of this type of research include the development of procedures for defining empirically justifiable vision standards for driver licensure.

Adult↗
PubMed2006

Field evaluation of the Welch Allyn SureSight vision screener: incorporating the vision in preschoolers study recommendations.

INTRODUCTION: The prospective Vision in Preschoolers (VIP) study evaluated 11 methods of screening and proposed referral criteria for the Welch Allyn SureSight(trade mark) Vision Screener with 90% and 94% specificity. The SureSight had a higher sensitivity than most other screening techniques when these criteria were applied. We evaluated the usefulness of these criteria in a field study of healthy preschool children. METHODS: The SureSight software was altered to recommend referral using the VIP referral criteria with 90% specificity. Lions Club volunteers screened preschool children throughout Tennessee. Referred children underwent comprehensive eye examinations with cycloplegic refraction. Examination failure criteria were based upon published standards. Reanalysis using the 94% specificity criteria was then performed. Outcomes included referral rate and positive predictive value. RESULTS: The SureSight was used to screen 4,733 children, and screening was successful in 99.7% of children. The referral rate using the 90% specificity criteria was 12.2%. Most children (73%) were referred for suspected astigmatism. The positive predictive value was 30%. Using the 94% specificity criteria from the VIP study decreased the referral rate to 7.9% and substantially decreased over referral for suspected astigmatism; however, several anisometropes went undetected. Higher specificity was achieved by raising astigmatism referral criteria to 2.2 diopters while leaving the anisometropia criteria unchanged. CONCLUSIONS: The SureSight can be used successfully for preschool screening in the field provided that criteria with high specificity are incorporated into the instrument's software program. Higher rates of positive predictive value can be achieved without jeopardizing sensitivity by raising astigmatism referral criteria to 2.2 diopters.

Amblyopia↗
PubMed1982

Improved color vision testing.

Pseudoisochromatic color vision testing plates have traditionally provided the clinician with screening-type information regarding the color with screening-type information regarding the color vision of patients. The introduction of a variable-color filter, through which the patient views these plates during testing, produces quantifiable results while exploiting the clinical advantages of the color plates. Thus, this approach allows the quick classification and quantification of color vision defects in a clinical setting. The results of this study on 153 subjects show that a variable-color filter combined with a series of traditional pseudoisochromatic plates can be successfully used on patients in a typical ophthalmology clinic to identify normal persons, protanopes, and deuteranopes. The results of the new test correlated well with those of standard tests.

Adult↗
PubMed2004

Preschool visual acuity screening with HOTV and Lea symbols: testability and between-test agreement.

PURPOSE: To compare the performance of 3- to 5-year-old children on visual acuity screening with HOTV letters vs. Lea symbols as optotypes. METHODS: Subjects included 1253 Head Start children who were aged either 3 or 4 years on September 1 of the school year of testing. The sample over-represented children who had not passed a Head Start screening. Binocular pretesting at 1 m demonstrated the child's ability to identify the optotypes verbally or by matching optotypes on a lap card. Acuity was tested monocularly at 3 m using crowded single lines of optotypes. Lines tested were based on age at the beginning of the school year (September 1) with 3-year-old children tested with lines 10/100, 10/32, 10/25, and 10/20 and 4-year-old children tested with 10/100, 10/25, 10/20, and 10/16. RESULTS: Overall, 99% of children were able to complete the binocular pretest for each test successfully, and there was no difference between the tests (p = 0.83). Children's ability to complete the pretest increased slightly with age. HOTV test scores were slightly worse than Lea symbols test scores (p = 0.047), primarily because more children were unable to pass the monocular 10/100 card for the HOTV test than for the Lea symbols test (2.6% vs. 1.3%). The percentage of identical results on HOTV vs. Lea overall was 67.3% and increased significantly with age. When the results were different, 3-year-old children, but not 4- and 5-year-old children, tended to have worse results on the HOTV letter test. CONCLUSIONS: The vision of nearly all 3- to 5-year-old children can be screened using either HOTV letters or Lea symbols. HOTV letters may be slightly more difficult than Lea symbols for 3- to 5-year-old children, with the largest difference between acuity results on the two tests occurring in 3-year-old children.

Aging↗
PubMed1988

Predictions of outcomes from cataract surgery in elderly persons.

To determine how well visual outcomes of cataract surgery can be predicted from acuity estimations by visual instruments and an ophthalmologist, the authors compared predictions of postsurgical visual acuity with the measured acuity at 4 months in 82 elderly persons. Comparisons were made between the potential acuity meter (PAM), laser interferometer (LI), and an ophthalmologist, who predicted the final vision before surgery using screening visual information, including PAM, LI data, and results of the patient's examination. Neither instrument alone was successful in predicting postsurgical acuity +/- 1 contiguous Snellen chart line (bivariate correlation [r] = 0.03 for PAM and 0.07 for LI). The ophthalmologist was the most accurate predictor of acuity within 1 line (r = 0.41, p less than or equal to 0.001). These results indicate that the PAM and LI did not independently predict postsurgical vision in elderly cataract patients, but results of a clinical examination markedly improved the accuracy of predictions.

Aged↗
PubMed1994

[Changes in visual function caused by work at a data display terminal].

Working at video display terminals (VDTs) is particularly demanding in terms of orthopaedic and visual functions. This study was initiated to examine whether, and if so how, VDT work can influence the visual system. It was designed as a 5-year-prospective study based on the matched-pairs technique. The subjects were examined at the beginning and after 5 years of VDT work. The study group consisted of 102 people working at VDTs, and these were paired with 102 other office workers who did not use VDTs. The legally prescribed screening examinations of visual acuity (distance and near vision, phorias, stereopsis, and colour vision) were carried out. We also checked the anterior segments by examination with the slit-lamp and the fundus by ophthalmoscopy. Break-up time, Schirmer-I test, perimetry and tonometry were included in our range of examinations. We found a significant difference in asthenopia and daily hours of VDT work between VDT workers working less than 6 h daily and those working more than 6 h daily. In the study group pre-existing exophoria seemed to increase, but no statistical significance was found on testing. Nor was there any significant difference between the study group and the control group in the parameters examined in the course of the screening examination. In our investigation of monocular VDT workers (n = 3) we could not find any visual problems.

Adult↗
PubMed2005

Digital mammography: a world without film?

OBJECTIVES: eDiaMoND is a next generation Internet ("Grid") multidisciplinary research project funded by the UK e-Science Programme with the following objectives; the development of a next generation Internet enabled prototype to demonstrate the potential benefits of a national infrastructure to support digital mammography; the exploration of potential benefits for digital mammography systems, with particular emphasis being placed on selected applications, namely, screening, training, computer-aided detection and appropriate support for epidemiological studies. METHODS: EDiaMoND has worked in conjunction with selected clinical partners to enable the collection of valuable mammography information and the design of applications based upon extensive requirements gathering exercises. The clinical partners validated both the immediate needs and assisted with defining future needs of such an architecture to support the UK Health Service. RESULTS: The project has succeeded in invoking the interest of clinical partners and representatives of the UK NHS Breast Screening Programme in our vision of a world without film, albeit a long way off. The project has also succeeded in identifying the barriers to adopting this approach with the current limitations within the NHS, and has developed a blueprint for working towards this strategy. CONCLUSIONS: A UK national digital mammography archive has the potential to provide major benefits for the UK. For example, such an archive could: ensure that previous mammograms are always available, and could link up seamlessly the screening, assessment and symptomatic clinics; it could provide a huge teaching and training resource; it could be a huge resource for epidemiological studies.

Archives↗
PubMed1987

Neuro-ophthalmic presentation of cone dysfunction syndromes in the adult.

Cone dysfunction syndromes are probably part of the spectrum of cone-rod degenerations and can present with widely varying clinical pictures. Thus, although the age of onset is usually before the third decade, patients can present at any age, and, although family history is usually positive, in typical cases it may be quite negative. Patients can have initially very subtle, bizarre, or poorly described visual complaints so that numerous examiners may label them "functional" or "malingering." They can present with the classic symptoms of hemeralopia, poor acuity, and reduced color vision, but these complaints may be absent. Visual acuity and color vision can be normal or severely reduced and the fundi may show classic changes such as bulls-eye maculopathy, macular choroidal atrophy, pigment clumping in the maculae, mild peripheral pigmentary changes, or a fundus flavimaculata-like change. The patients here reported were considered as having normal fundi by several competent ophthalmologists as a rule, however. Visual fields can vary from normal to ring scotomas, central scotomas, and other interesting types of defects, even simulating a hemianopia. Although involvement is usually symmetrical between the two eyes, this is not always the case, and one of our patients had a strictly uniocular cone dystrophy. Cone dysfunction can be considered in a patient of any age even with normal acuity, good color vision, and a normal ophthalmoscopic examination. A high index of suspicion should prompt specific questioning about hemeralopia, or reduced visual function in brightly illuminated situations, and better vision in twilight or under dim illumination. Patients may falsely describe hemeralopia as "glare" or "photophobia." Careful testing of color vision, a meticulous tangent screen examination, and specifically looking for diffuse narrowing of retinal arterioles in a patient with an otherwise normal fundus appearance will usually suffice to prompt the clinician to order electroretinography, which is the definitive diagnostic criterion for the cone dystrophies. It is important to consider this diagnosis before embarking on an otherwise fruitless and expensive neuroimaging investigation.

Adult↗
PubMed1993

The four-meter confrontation visual field test.

Confrontation visual fields have limited value in testing paracentral vision. We have used a four-meter confrontation test for several years at the Mayo Clinic for screening of the central field. This test can identify paracentral scotomas and macular sparing in a homonymous hemianopia. The optics of this technique parallel those of the two-meter tangent screen examination in which a scotoma is greatly enlarged by doubling the test distance. Although in common usage by some neuro-ophthalmologists, this simple technique is useful as an office screening device for evaluating paracentral vision.

Adult↗
PubMed2004

[Astigmatism analysis on 983 astigmatic eyes between six to seven years children].

PURPOSE: To analysis astigmatism from six to seven years old children. METHODS: To statistical analysis on 983 eyes with astigmatism of > or = 0.5 diopter, which are detected from six or seven-year-old children poor vision acuity examination. RESULTS: In astigmatism from six to seven years old children the ratio of compound hyperopic astigmatism (AsH) is 62.97%, mixed astigmatism 23.19%; and the ratio of astigmatism with rule is 90.34%, astigatism against the rule 0.14%, oblique astigmatism 9.25%. Grade of astigmatism: the ratio of astigmatism of 0.50 D to 1.00 D is 37.03%, 1.25 D to 2.00 D 34.49%, 2.25 D to 3.00 D 18.62%, 3.25 D to 4.00 D 7.83%, 4.25 D or higher 2.03%. The ratio of binocular astigmatism is up to 80.61%, and the rest with monocular astigmatism is 19.39%. CONCLUSION: Compound hyperopic astigmatism (ASM) is more in six to seven years old children's ASM. The rate of astigmatism with the rule is main in distribution of astigmatism.

Astigmatism↗
PubMed2000

Practical color vision tests for air traffic control applicants: en route center and terminal facilities.

BACKGROUND: Two practical color vision tests were developed and validated for use in screening Air Traffic Control Specialist (ATCS) applicants for work at en route center or terminal facilities. The development of the tests involved careful reproduction/simulation of color-coded materials from the most demanding, safety-critical color task performed in each type of facility. METHODS: The tests were evaluated using 106 subjects with normal color vision and 85 with color vision deficiency. The en route center test, named the Flight Progress Strips Test (FPST), required the identification of critical red/black coding in computer printing and handwriting on flight progress strips. The terminal option test, named the Aviation Lights Test (ALT), simulated red/green/white aircraft lights that must be identified in night ATC tower operations. Color-coding is a non-redundant source of safety-critical information in both tasks. RESULTS: The FPST was validated by direct comparison of responses to strip reproductions with responses to the original flight progress strips and a set of strips selected independently. Validity was high; Kappa = 0.91 with original strips as the validation criterion and 0.86 with different strips. The light point stimuli of the ALT were validated physically with a spectroradiometer. The reliabilities of the FPST and ALT were estimated with Chronbach's alpha as 0.93 and 0.98, respectively. CONCLUSIONS: The high job-relevance, validity, and reliability of these tests increases the effectiveness and fairness of ATCS color vision testing.

Adolescent↗
PubMed2001

[On-screen work and visual fatigue and its course after ophthalmologic management].

INTRODUCTION: The number of staff subjected to significant amounts of on-screen work with visual complaints is currently increasing. OBJECTIVE: This epidemiological study aimed to observe the influence of changes in working conditions and an ophthalmological treatment on vision and eye complaints due to on-screen work. MATERIALS AND METHODS: This comparative study included a transversal initial study on the visual symptoms and function as well as a longitudinal follow-up of the efficacy of the recommendations given by the company medical officer. The studied subjects were be exposed to screen irradiation for at least 4 hours a day during the study. The control group was selected according to the age, sex, and education level of the investigated group. RESULTS: We examined 814 subjects under investigation and 325 control subjects. The subjective signs of visual fatigue with on-screen work (burning or stinging eyes, diplopia or blurred vision after work, tearing, globe heaviness and fatigue, and headaches, the latter particularly in female subjects) were significantly more frequent in the exposed group than in the control group. A statistically significant correlation was found with the following factors: poor working conditions, frequent keyboard data entry, far vision optic correction, far vision significantly more often corrected to less than 10/10 at least in one eye, and, finally, near vision exophoria more than 7 diopters. We re-examined 465 exposed and 139 control subjects 1 and 2 years after consultation with the company medical officer. Following the recommendations proved to be effective in 50.5% of the employees. Improving vision by changing the optical correction showed the strongest statistical relation with the decrease in visual fatigue complaints. Organizational and material improvements also led to positive effects on functional discomfort. DISCUSSION: The far vision of those exposed to screen irradiation was significantly worse than in those who were not exposed. The people from the exposed group had vision correction significantly more often. The probable relation between progressive myopia and on-screen work is not excluded, but further investigation is needed. The proposed measures were effective for preventing visual fatigue. However, 49.5% of the study group had persistent visual symptoms, probably because of not following the recommendations, not having an ergonomic correction, or because modifications of blinking, tear film, and the ocular surface were ot taken into account. CONCLUSION: The coordination between the occupational medicine and ophthalmology departments during this study has significantly reduced visual fatigue. Nevertheless, there is still a considerable number of people from the exposed group with persistent symptoms.

Adult↗
PubMed1998

Influence of screen and copy holder positions on head posture, muscle activity and user judgement.

A study was conducted on eight subjects, in order to investigate the influence of head posture with regards to the screen and copy holder position, the activity of cervical muscles and the subjective judgement given by the subjects. A total of eleven different positions (exercises) of screen and copy holder were investigated. Four different screen positions were examined in the upright (middle) sitting posture and three different screen positions were investigated in the backward sitting posture. In addition, four different positions of the copy holder were examined in the upright sitting posture. Head posture and muscle activity were continuously measured in each exercise for a duration of 5 min. At the end of each exercise, the subjects were asked how they judged the position of the screen and/or the copy holder in comparison with other positions. The results show that preference is to be given to a screen position in which the vision axis is horizontal or inclined slightly downwards. The copy holder should be arranged at one side of the screen.

Adult↗
PubMed1984

Preventive care and overall use of services. Are they related?

The relationship between the use of services of children constantly enrolled in a prepaid group practice medical plan for six years and the completeness of their preventive care were examined. Children who were consistently low users of services were more likely to be lacking one or more components of standard preventive care, particularly general health assessments in older children and vision, hearing, and tuberculosis screening in younger children. Teenage children who were low users were at some risk of not receiving their tetanus-diphtheria immunization on time. The relationship between low use of services and incomplete preventive care persisted after controlling for the severity of morbidity, although children with more severe morbidity were somewhat less likely to be missing preventive care. Health facilities and practitioners should pay special attention to assessing the need for standard preventive care in children who are infrequent users of services.

Adolescent↗
PubMed2006

Separating brain regions involved in internally guided and visual feedback control of moving effectors: an event-related fMRI study.

Online visual information of moving effectors plays important roles in visually guided movements. The present study used event-related functional resonance imaging to temporally separate neural activity associated with internally guided and visual feedback control of moving effectors. Using a cursor controlled by a computer mouse, participants traced curved lines on a screen. During this movement, vision of the moving cursor was occluded after tracing had begun and then was restored after variable intervals. The results showed that when visual feedback was unavailable, bilateral activation was significantly greater in the basal ganglia, thalamus, premotor cortex and mesial motor areas, peaking at the presupplementary motor area (pre-SMA). In contrast, when visual feedback was available, significantly greater activation was observed bilaterally in the posterior parietal cortex (PPC) and cerebellum and in the middle and inferior frontal gyri and occipito-temporal cortex in the right hemisphere. Pre-SMA activity was significantly negatively correlated with tracing error when visual feedback was unavailable. In contrast, right PPC activation showed a significant positive correlation with tracing error after visual feedback became available. These findings suggest that the pre-SMA is involved in internally guided movements in the absence of visual feedback, and that the PPC is related to visual feedback control by evaluating online visuomotor error. The current study clarifies the different functional roles of fronto-parietal and cerebellum circuits subserving visually guided movements regarding visual feedback control of effectors.

Adult↗