Healthy People 2010--vision objectives for the nation.

BACKGROUND: In January 2000, the U.S. Department of Health and Human Services released new national health goals and objectives in a report entitled Healthy People 2010. This national report includes specific objectives for improving the vision of people in the United States during the 2000-2010 decade through prevention, early detection, treatment, and rehabilitation. The vision objectives, along with other health objectives, are designed to help the nation achieve two major outcomes: (1) increase the quality and years of healthy life and (2) eliminate health disparities among different groups. These health objectives will strongly influence many health care programs and the provision of health care through laws, regulations, reimbursements, and clinical guidelines enacted by federal and state agencies. PURPOSE: The purpose of this article is to inform optometrists about the new Healthy People 2010 vision objectives. METHODS: A summary of the Healthy People process for developing the objectives--and the specific vision objectives--is provided. These objectives address many important areas, including: regular dilated eye examinations; vision screening for preschool children; uncorrected visual impairment due to refractive errors; blindness and visual impairment in children and adolescents; visual impairment due to diabetic retinopathy, glaucoma, and cataracts; occupational eye injury; the use of personal protective eye wear in recreational activities and hazardous situations around the home; and the use of vision rehabilitation services and adaptive devices by people with visual impairments. CONCLUSION: These new national health goals and objectives will impact optometrists. Therefore, it is important that optometrists understand these objectives and actively work to help implement them at the national, state, and local levels. By doing this, they can help provide the services needed to reduce visual impairments and improve the vision of people in their communities.

Short-term repeatability of hand-held keratometry measurements.

PURPOSE: The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study is a multi-center, observational investigation of ocular component and refractive error development in schoolchildren. Anterior corneal curvature is one of several ocular components which influence refractive status of the eye, and the CLEERE Study uses the Alcon Auto-Keratometer to measure corneal curvature. This report assesses the repeatability of this hand-held instrument. Previous studies have demonstrated the validity of the Alcon Auto-Keratometer; however, none have assessed its repeatability. METHODS: Sixty children were recruited from clinics affiliated with the Southern California College of Optometry and the University of Houston College of Optometry. Two sets of five hand-held keratometry measurements were obtained on the right eye of each child by one investigator at each site using the Alcon Auto-Keratometer. The two sets of measurements were performed at least 10 minutes apart. RESULTS: The mean differences between the two occasions were not significantly different from zero for either the flat or steep corneal curvature measurements regardless of the number of readings taken. The largest improvement in repeatability, primarily for the steep meridian, occurred when the first two readings were averaged. The addition of readings 3, 4, and 5 to the average did not substantially improve repeatability for either meridian. The 95% limits of agreement between the average of two readings on two occasions for the flat and steep meridians were +/-0.28 and +/-0.39 D, respectively. The 95% limits of agreement after two readings were +/-0.28, +/-0.20, and +/-0.24 D for the M, J0, and J45 vectors, respectively. CONCLUSION: The Alcon hand-held keratometer provides a repeatable measure of corneal curvature as demonstrated by short-term repeat agreement within +/-0.50 D. This level of repeatability can be achieved only by manually averaging two consecutive measurements.

Cycloplegia in African-American children.

PURPOSE: The selection of a cycloplegic agent depends on the desired outcome, the characteristics of the patient receiving the drug, and the associated risks. The Orinda Longitudinal Study of Myopia (OLSM) has used 1% tropicamide to assess the ocular components and cycloplegic refractions in a large cohort of predominantly Caucasian children. Although tropicamide has provided adequate cycloplegia and mydriasis for the OLSM cohort, conventional clinical wisdom and scientific investigations have suggested that tropicamide might not produce adequate cycloplegia and mydriasis for subjects with darker iris pigmentation. In this study one drop of 1% tropicamide followed by one drop of 1% cyclopentolate was used to determine their effectiveness in producing adequate cycloplegia and mydriasis for cycloplegic refraction and ocular component measurements in a group of African-American children. METHODS: Nineteen children [age range 5.5 to 15.6 years, mean 8.4 years +/- (SD) 2.5 years] were tested at Family HealthCare of Alabama, Eutaw, AL. Their accommodative responses were measured using a Canon R-1 autorefractor prior to and at 30, 45, and 60 min after instillation of one drop of 0.5% proparacaine, 1% tropicamide (Mydriacyl), and 1% cyclopentolate (Cyclogyl) in both eyes. A target of 20/155 letters in a 4x4 grid positioned behind a +6.50 diopter (D) Badal lens provided accommodative stimuli of 1.00 D, 2.00 D, and 4.00 D. RESULTS: All results are presented as mean +/-1 SD. Pupils, measured from video frames, dilated rapidly and maximally at 30 min after instillation of eye drops (7.3+/-0.5 mm) Predilation, the mean accommodative responses were 0.17+/-0.29 D for the 1.00 D stimulus, 1.01+/-0.40 D for the 2.00 D stimulus, and 2.77+/-0.74 for the 4.00 D stimulus. At 30 min after drop instillation, the responses were 0.07+/-0.14 D for the 1.00 D stimulus, 0.36+/-0.35 D for the 2.00 D stimulus, and 0.77+/-0.61 for the 4.00 D stimulus. Results were very similar at 45 and 60 min after drop instillation. CONCLUSIONS: Combining 1% tropicamide and 1% cyclopentolate was very effective in providing both cycloplegia and mydriasis adequate for ocular biometry and cycloplegic refractions 30 min after drop instillation in African-American children.

Evaluating the value of low-vision services.

BACKGROUND: Low-vision care is a widely accepted and valued service provided by many optometrists. As in other areas of health care, evaluation of the outcome of low-vision care is increasingly necessary so it can be properly positioned in the health care delivery system. METHODS: This article reviews the literature relating to the prevalence of low vision, its impact on affected individuals, and how low-vision intervention affects those with visual impairments. This review considers the ways in which the impact of low-vision care has been evaluated. RESULTS: The existing literature demonstrates that low-vision intervention can be highly valued by low-vision patients and can have a significant impact on an individual's daily life and activities. Evaluating this impact is a significant challenge-particularly if the goal is to gauge the outcome of low vision care as broadly as possible. CONCLUSIONS: Evaluation of health-related quality of life is a desirable option for evaluation of outcomes, and the application of quality of life instruments to the visually impaired population is necessary. There remain unresolved issues of optometric research that need to be addressed.

Healthy People 2000--health promotion and disease prevention, a new opportunity for optometrists.

The Healthy People 2000 objectives represent a major opportunity for optometry to expand its scope of practice, enhance its quality of patient care, and become involved in making policies and programs that will directly affect the services and patient care it provides. If optometrists take advantage of this opportunity they will: 1. Increase the visibility of optometry and enhance our image as the primary eye and vision care provider. 2. Increase the number of patients seen by optometrists. 3. Expand the number of organizations, policy makers and third party providers who understand the services optometrists provide and their importance in achieving the Healthy People 2000 objectives. 4. Increase the number of referrals from nontraditional sources. 5. Enhance the overall health of their patients. 6. Be recognized as the leader of health promotion and disease prevention activities involving eye and vision care. The question is, "Will optometrists become involved and use this opportunity?" We must look back from the perspective of the year 2000 and be able to answer this question with a definite YES!

Why should optometric research be designated as a priority for the profession?

Research is the discovery of new information, ideas or theories that increases our knowledge and understanding of ourselves and our environment. Optometric research focuses on the health, functioning and performance of people with emphasis on their eyes and vision. The goal of optometric research is to enable optometrists to provide high quality eye and vision care for their patients.

Detection of diabetic retinopathy by optometrists.

Optometrists examined 25 eyes with varying severity of diabetic retinopathy. No history or clinical information was provided to the optometrists who performed fundus examinations on dilated eyes using direct or indirect ophthalmoscopes. Color stereoscopic fundus photographs were independently graded and used as the standard. Optometrists made a correct diagnosis of whether retinopathy was present in 77% of the eyes (95% confidence interval (CI): 73%, 82%). They made a correct diagnosis of the type and degree of diabetic retinopathy in 57% of the eyes (95% CI: 39%, 75%). This diagnosis rate exceeded the rate reported for physician examiners (39%) and equaled that of general ophthalmologists (52%) in the only other similar study. Sensitivity for diagnosis of diabetic retinopathy in eyes of diabetic patients using only ophthalmoscopy was 74% (95% CI: 67%, 81%), while specificity for diagnosis of the absence of retinopathy was 84% (95% CI: 73%, 96%). 100% of these optometrists would have referred the eye with preproliferative retinopathy. 53% would have referred the eye classified as proliferative retinopathy without high risk characteristics, and 79% would have referred the eye with macular edema.

Muscular and intraocular pressure responses among ocular-hypertensive subjects: is there a rationale for biofeedback?

Several animal and human investigations have indicated that intraocular pressure (IOP) levels may be associated with extreme drug-induced changes in the extraocular muscles. Further, recent data suggest that, among individuals with normal IOP level, moderate increases in facial muscle (EMG) activity around the eye while the eye is open are associated with increases in IOP. To investigate further the relationship between facial EMG activity and IOP levels and to examine a group of individuals with elevated IOP levels, subjects were recruited from outpatients at an optometry clinic. Three groups of subjects were selected: a group of ocular hypertensive subjects who showed elevated pressures at the optometry clinic and upon the day of testing, a group of labile ocular hypertensive subjects who evinced elevated pressures during their visit to the optometry clinic but lower pressures on the day of testing, and a group of normal IOP subjects who showed normal pressures both during their optometry clinic visit and on the day of testing. To investigate anxiety differences, subjects were administered the State-Trait Anxiety Inventory, but subsequent analysis revealed no group differences. To evaluate the role of stress upon muscle (EMG) functioning around the eye, subjects were subjected to imagery and standardized mental arithmetic stressors; analyses of these results also revealed no significant group differences. Finally, subjects were given EMG biofeedback for muscle activity around the eye while IOP was assessed during five alternating periods in which they made decreases and increases in EMG activity. Results revealed significant group, period, and group by period interaction effects. The pattern of results is interpreted as implicating EMG activity in IOP fluctuations; the implications of these data for potential biofeedback and stress management treatments are discussed.

5-year followup of the effect on optometrists of continuing education about hypertension.

All 319 participants of an intensive continuing education course on optometric hypertension screening at the University of Alabama at Birmingham were surveyed 5 years after completion of the course. Almost 85 percent of 211 responding optometrists reported that they were continuing to screen for hypertension in their practices. They estimated that 24 percent of their patients had hypertension and that of these 11 percent were previously undetected. The criteria used by these optometrists for tentative diagnosis and referral were consistent with currently accepted guidelines. Hypertension screening by optometrists is cost-effective, and this survey suggests that continuing education courses providing intensive didactic and clinical instruction may be an effective method for changing clinicians' behavior. For most optometrists who participated in this continuing education program, the program appears to have positively changed their clinical behavior.

Simplified fitting procedures for toric soft contact lenses.

This pilot study assessed a simplified procedure for fitting toric soft contact lenses without the use of a diagnostic fitting set. The sample consisted of 12 patients (21 eyes) who has astigmatic refractive effects of -0.75 D.C. to -2.50 D.C. and who ranged in age from 21-38 years. Patients were fit using a standard protocol. Using the criteria of success as defined in this paper, 17 of the 21 eyes were successfully fit with Hydromarc toric soft contact lenses.

Modeling HTL of industrial workers using multiple regression and path analytic techniques.

This study compared path analytic with multiple regression analyses of hearing threshold levels (HTLs) on 258 adult textile workers evenly divided into low- and high-noise exposure groups. Demographic variables common in HTL studies were examined, with the addition of iris color, as well as selected two-way interactions. Variables of interest were similarly distributed in both groups. The results indicated that (1) different statistical procedures can lead to different conclusions even with the same HTL data for the same Ss; (2) conflicting conclusions may be artifacts of the analytic methodologies employed for data analysis; (3) a well-formulated theory under which path analytic techniques are employed may clarify somewhat the way a variable affects HTL values through its correlational connections with other antecedent variables included in the theoretical model; (4) multicollinearity among independent variables on which HTL is regressed usually presents a problem in unraveling exactly how each variable influences noise-induced hearing loss; and (5) because of the contradictory nature of its direct and indirect effects on HTL, iris color provides little, if any, explanatory assistance for modeling HTL.

Iris color and hearing loss.

This study investigated the relation between iris color and hearing loss in 261 adult textile workers exposed to either a low-noise environment (below 85 dB) or a high-noise environment (above 102 dB). The subjects included 48% white males, 28% white females, 15% black males, and 9% black females. No relation was found between iris color and hearing loss in the control or low-noise group. A significant relation between iris color and hearing loss or hearing threshold levels was found for workers in the high-noise environment. Other variables, however, were found to predict susceptibility to hearing loss better than iris color alone.

Screening for rubella in schools of optometry.

Rubella can cause birth defects in fetuses of pregnant women who are susceptible to this disease. Because national immunization efforts have been relatively successful, most cases of rubella occur in young adults. The School of Optometry and Jefferson County Department of Health in Alabama, and the Division of Optometry in Northeastern Oklahoma, cooperated to provide a voluntary serologic rubella screening for their students. About 9% were seronegative and were immunized against rubella. To eliminate the risk of future optometrists transmitting rubella to susceptible patients, we recommend that optometry students be screened for rubella antibodies and be provided immunization if found to be seronegative.

A survey of the graduates of the University of Alabama School of Optometry. Screening for hypertension.

Systemic hypertension is a major health problem in the United States. Almost 16 million people with this disease are estimated to be untreated or inadequately treated. Optometry graduates of the University of Alabama in Birmingham School of Optometry have always received clinical and didactic training in the routine assessment of blood pressure. This study reports the results of a survey of these graduates to determine the number who screened for high blood pressure following graduation, their criteria for referral, their management of hypertensive patients, and their patient characteristics. Over 90% of the optometrists surveyed screened for high blood pressure, and they screened 57% of their patients. Twenty percent of these patients were found to have high blood pressure. These results indicate that optometrists are an important and significant resource in the detection of hypertension in many high risk groups.

In vivo aqueous humor oxygen tension--as estimated from measurements on bare stroma.

Aqueous humor oxygen tension of the in vivo rabbit eye was estimated by a relatively atraumatic procedure. The anterior corneal surface of the eye was first scraped free of its epithelial layer. A polarographic oxygen electrode was then used to measure the oxygen tension at the bare stromal surface. Aqueous humor oxygen tension can be estimated from this measured steady-state stromal surface oxygen tension by correcting the measured oxygen tension for the tension drop across the stroma and endothelium. When animals breathed room air (155 mm Hg oxygen tension), the oxygen tension of the aqueous humor was 13 mm Hg; this rose to 150 mm Hg when the inspired oxygen tension was 713 mm Hg.