Prenatal cocaine and neuromotor outcome at four months: effect of duration of exposure.

The effect of prenatal cocaine exposure on the motor development of full-term infants was examined in a prospective study, controlling for maternal characteristics and exposure to other substances. Intrauterine cocaine exposure was determined at birth by maternal self-report and was verified by hair analysis. At 4 months, 120 cocaine-exposed (COC) and 186 non-cocaine-exposed (NON-COC) infants were assessed by blinded examiners using a standard evaluation of neuromotor function, the Movement Assessment of Infants (MAI). Relative to NON-COC infants, COC infants had significantly higher full-scale MAI total risk scores after adjusting for covariates (p = .05). Infants exposed through the third trimester of pregnancy (n = 48) had higher MAI scores for both total risk (p = .02) and Volitional Movement (p = .01), and when compared with infants exposed only within the first two trimesters (n = 72), they had significantly more deficits in Volitional Movement (p = .03). Although MAI scores for the majority of exposed infants were within the normal range, infants exposed through the third trimester were at significantly increased risk for motor dysfunction (relative risk = 1.6; 95% confidence interval = 1.1, 2.8). Intrauterine cocaine exposure had an adverse effect on infant motor development after the neonatal period; this association was related to the timing and duration of gestational exposure. Further study is needed to evaluate the long-term clinical implications of neuromotor abnormalities in prenatally exposed infants.

The association of change in maternal marital status between births and adverse pregnancy outcomes in the second birth.

The relationships between change in marital status between two consecutive births and adverse pregnancy outcomes at the second birth were investigated using linked Washington State 1980-93 white singleton birth certificates. Women who were married at the first birth had lower low birthweight (LBW) and small-size-for-gestational-age (SGA) rates at that birth than single women, and women married at the second birth had lower LBW, SGA and preterm delivery rates at that birth regardless of marital status at the first birth. Adjusted relative risks (RR) of LBW and SGA were significantly increased for initially married women who were single at the second birth compared with those who remained married (RR = 1.4 and 1.3, respectively). Risks of LBW and SGA were significantly decreased among initially single women who married by the second birth, compared with those remaining single (RR = 0.7 for LBW and 0.8 for SGA). We conclude that the largely unstudied subgroup of previously married women is at increased risk for adverse pregnancy outcomes. Public health policy and programmes directed at high-risk mothers and infants should be aware of the specific physical and emotional needs of this group of child-bearing women.

Older Alabamians System of Information and Services (OASIS): a model Title VII chapter 2 low vision rehabilitation program.

BACKGROUND: Little attention has been paid in the ophthalmic literature to programmatic issues of low vision rehabilitation services delivery. The Older Alabamians System of Information and Services (Project OASIS) is a model low vision rehabilitation program functioning within the state of Alabama. This program is funded through Title VII, chapter 2 of the Rehabilitation Act, Independent Living Services for Older Blind Individuals. The program provides a comprehensive array of independent living services, including optometric low vision evaluation and low vision devices, to persons who are older and blind. Through intergency agreements between various state agencies and private entities, OASIS is able to maximize limited resources and reduce service redundancies. METHODS: Components of the OASIS consortium are reviewed along with outcomes of participants in fiscal year 1993-94. RESULTS: In fiscal year 1993-94 1,114 persons were entered into Project OASIS. Over half (569/1,114) of individuals accepted into the program received traditional optometric low vision rehabilitation services. More than 80% (586/717) of persons were able to achieve their independent living goals. CONCLUSIONS: Through a consortium effort between aging and rehabilitative services, minimal resources have been maximized to allow older visually impaired adults to benefit from comprehensive low vision rehabilitation services.

Care plan assessment of visual status and evaluated vision among nursing home residents.

OBJECTIVE: To compare the comprehensive care plan assessment (Minimum Data Set, MDS) of vision with the clinically evaluated visual status of nursing home residents to determine the accuracy of the vision care plan. DESIGN: Descriptive study. SETTING: One publicly funded and four privately owned long-term care nursing facilities. PARTICIPANTS: 151 nursing home residents undergoing vision examination at the nursing home request. Mean age of 81, range 34 to 97 years. MAIN OUTCOME MEASURE: The charted MDS assessment for vision patterns was compared with the MDS plan which would have been formulated based on direct clinical vision examination. Determinations were made based on the three areas required by MDS: visual acuity (VA), peripheral vision, and presence of prosthetic visual devices. CONCLUSIONS: The MDS care plan for vision and actual visual status agreed in only 34% (52/151) of persons. The Vision (VA) subsection overestimated VA in 41% and underestimated VA in 11%. Concordance for VA was extremely poor (kappa 0.176). In no participants did the MDS indicate a visual field defect, whereas 16.5% (25/151) did show visual field restriction on examination. Care plan assessments also failed to note the use of visual prosthetic devices in 17% (26/151). These results indicate that MDS care plan assessment for vision is often inaccurate and may result in the lack of appropriate vision care being triggered through resident assessment protocols (RAP).

A statistical analysis of Modified Clinical Technique vision screening of preschoolers by optometry students.

Fourth year optometry students screened 745 preschoolers using a slightly altered Modified Clinical Technique (MCT) under the supervision of a faculty doctor. Children who failed the MCT were randomly selected and then matched by age, sex, and ethnic origin to children who had passed the screening battery. The 61 screening failures and 45 matched controls were later given full eye examinations with cycloplegia by University of Alabama at Birmingham faculty doctors who were unaware of the screening results. The positive predictive value (PPV) (0.52) and negative predictive value (NPV) (0.78) of the MCT were calculated directly from the 2 x 2 contingency table crossing screening results and a standard diagnosis. Sensitivity [0.50, k(1,0) = 0.29], specificity [0.79, k(0,0) = 0.30], efficiency [0.70, k(0.5,0) = 0.29] of the MCT, and the prevalence (0.30) of children failing the standard diagnosis were estimated using statistics appropriate to the prospective sampling design. The reproducibility of the diagnosis, estimated by analyzing multiple, independent diagnosis of each study child by seven doctors was moderate (kappa D 0.58). Statistics summarizing the agreement between the MCT and the diagnosis by the individual study doctor are similar to those obtained with comparison to the standard diagnosis. The characteristics of the MCT may be generalized only to similar populations that are screened by clinicians with similar experience, using the same tests.

Analysis of an older adult vision screening project.

BACKGROUND: The purpose of this study was to determine how a variety of reasonable vision screening criteria affected the results of vision screening previously performed on a community-dwelling older adult population. METHODS: The records of 201 previously performed vision screening evaluations of adults over the age of 65 were reanalyzed to determine failure rates using new theoretical criteria. Those criteria included screening by history alone, visual acuity alone, history in combination with visual acuity and a multiple test format with both 20/40 and 20/60 acuity criteria. RESULTS: Theoretical screening that would have taken place using visual acuity of less than 20/60 failed the fewest individuals; however, even using this minimal criteria 46 percent of those screened would have failed. Using a multiple test format the failure rate rises to almost 90 percent. The combination of historical criteria and visual acuity failed almost an identical population as would be failed by using an elaborate multiple test format. CONCLUSIONS: The prevalence of ocular abnormalities in this older adult populations was so high that vision screening done with even minimal criteria can be expected to fail very high numbers. Similar failure rates and composition can be achieved by using historical criteria in combination with visual acuity as are achieved using a more elaborate multiple-test format. Given the high prevalence of eye abnormalities in the older adult population the public health value of screening for the need for eye examination is questionable.

The perceived needs of practicing optometrists in geriatric continuing education.

BACKGROUND: A survey of American Optometric Association members in the states of Kentucky and Illinois was undertaken to determine the perceived need areas for continuing education in the field of optometric geriatrics and gerontology. METHOD: The membership was surveyed on which of a 23 possible courses were of the most interest and need. A total of 332 questionnaires were returned and analyzed. The respondents were largely younger practitioners (mean age 41) who had not taken a specific course in geriatrics during optometry school (56 percent). RESULTS: A large majority (79 percent) indicated that they would attend courses with geriatric content at regional and state continuing education. Courses with heavy optometric content were preferred over those with more general gerontology content. The most desired courses were in geriatric pharmacology and ocular disease. Coursework in medical epidemiology and systemic conditions affecting the older adult were the most needed in the area of general gerontology.

Results of community-based vision screenings of older adults in the Birmingham, Alabama metropolitan area.

BACKGROUND: Two-hundred one adults age 65 and older underwent vision screening at community senior centers and nutrition sites in the Birmingham, Alabama metropolitan area. METHODS: Using a multiple-test format recommended by the American Optometric Association, 89 percent of those screened failed. Reduction in visual acuity associated with anterior segment abnormalities was the most common reason for failure. Almost half (48 percent) of the overall population had less than 20/50 distance acuity in both eyes. Median visual acuity for the population was 20/50. Median visual acuity decreased with age from 20/40 at age 65 to 20/80 for those over the age of 85, while only 8 percent were legally blind. RESULTS: Results show that a large percentage of older adults have reduced vision without being legally blind and will fail vision screening. CONCLUSIONS: Given the high failure rate, the value of this type of vision screening is questionable.

Ocular metastatic disease.

Metastasis to the eye represents by far the most common form of intraocular and orbital cancer. This form of malignant disease may present with a variety of signs and symptoms including pain, vision loss, visual field defect, and proptosis. This varied clinical presentation is described, and available treatment modalities are discussed.

Identification of neurodevelopmental abnormality at four and eight months by the movement assessment of infants.

The predictive validity of infant neuromotor evaluation by the Movement Assessment of Infants (MAI) was investigated in low-birthweight infants. Motor performance at four and eight months was examined in relation to neurodevelopmental outcome at 18 months of age. Correlations were equally strong between total MAI risk scores at four and eight months and performance on the Bayley Scales. Muscle tone observations were more discriminating at four months, and automatic reactions and volitional movement were most predictive at eight months. The MAI was highly sensitive to neurodevelopmental abnormality at four and eight months and more sensitive than the Bayley Motor Scale; both assessment tools had lower specificity at eight months. The high false-positive rate is attributed to transient neuromotor abnormalities and immaturity of motor function in low-birthweight infants with normal outcome.

In-office laboratory testing for diabetes mellitus.

New technology has made accurate blood glucose determination a possibility within all optometric practices. This paper reviews the technology, methodology, and potential sources of error in office glucose testing.

A retrospective analysis of primary eye cancer at the University of Alabama at Birmingham 1958-1988. Part I: Eye and orbital cancer.

Records of 99 patients with 100 primary eye cancers seen at the University of Alabama Hospital for the years 1958-1988 were reviewed. Three ocular cancers were found to predominate: 1) choroidal melanoma, 2) retinoblastoma, and 3) squamous cell carcinoma. Epidemiologic distribution of the population is presented and compared to that of tumors commonly seen in general ophthalmic practice.

A retrospective analysis of primary eye cancer at the University of Alabama 1958-1988. Part 2: Eyelid tumors.

Records of 117 patients with eyelid tumors on file at the University of Alabama at Birmingham were reviewed. Basal cell carcinoma was the single most common tumor, followed by squamous cell carcinoma, cutaneous melanoma, meibomian gland carcinoma and sebaceous gland carcinoma. A high percentage of patients with eyelid tumors were found to have secondary skin and non-skin tumors (41 percent).

Cataract surgery and postoperative follow-up.

Cataract surgery has undergone enormous change in the last 20 years. This paper discusses the basic methodologies, advances in microsurgical technique, and major trends involving four methods of cataract extraction: planned extracapsular cataract extraction, phacoemulsification, pars plana lensectomy, and intracapsular cataract extraction. Surgical methodology is also reviewed in relation to common, immediate postoperative complications.

Neuroanatomy of the cavernous sinus and clinical correlations.

The cavernous sinus has been described for over three centuries. Controversy still exists over the exact nature of the region and its neuroanatomy. Current points of controversy include the dural wall relations, the nature of the venous system, and the nervous system pathways. The clinical implications of current anatomical thinking are discussed.

Optometric care of the homebound and institutionalized older adult.

The older adult population is one of the fastest growing segments of the United States population. The number of older adults requiring services in nontraditional settings is expanding rapidly. This paper explores the background, realities, and methods of delivery of optometric services in two nontraditional settings: the home and the long-term care nursing facility.

Metastatic tumor formation: processes within the visual system.

Metastatic cancer is the most common form of neoplasm affecting the eyes and orbit. Six cases of metastatic cancers with origination or dissemination within the visual system are presented. Typical and atypical characteristics of metastatic cancer of the visual system are discussed.

Association of antibody titer and chorioretinal scarring in toxoplasmosis retinochoroiditis.

Thirty subjects with clinically diagnosed toxoplasmosis retinal lesions, and 30 control subjects matched for age, sex, and race, were evaluated for the presence of IgG antitoxoplasmosis antibodies by enzyme-linked immunosorbent assay (ELISA) methodology. Positive titer was found in 56% of subjects and 20% of controls. Positivity of titer was not correlated to location of lesion, laterality, presence of satellites, sex, or race. Increasing age in both subjects and controls was weakly correlated to positive titer. Study results indicate that a relative overdiagnosis of toxoplasmosis occurs if positive antibody titer is accepted as criteria for positive diagnosis. Currently employed criteria based on physical findings appear to be of little value in predicting positive titer.