Availability of eye care services in Missouri nursing homes.

PURPOSE: Residents of nursing homes do not have the same access to health care as do other elderly persons. Some sources have indicated that only 20% of nursing home residents in the United States ever receive eye care services in the nursing home. We sought to determine the availability of eye care services in Missouri nursing homes. METHOD: A survey was mailed to all licensed nursing homes in the State of Missouri (1,199). The survey inquired about the type of nursing facility, their location, and types of medical care and eye care provided at their institution. Information was also requested regarding the number of patients eligible for Medicare, Medicaid, and other third-party coverage. A 6-week period was allowed for responses. RESULTS: A response rate of 26.86% was obtained. Larger facilities were more likely to provide services than smaller facilities, and skilled nursing facilities were more likely to provide services than residential care facilities. Overall, 73% of the responding facilities provided some type of eye care services, as compared with 81% providing medical care. However, only 21% of nursing facilities have any type of regular schedule for provision of these services. Approximately 40% of the nursing homes without eye care services were interested in adding those services within a year, while half of those were not interested in adding them for their patients. CONCLUSIONS: Eye care services are available for many Missouri nursing home patients, but there is a lack of understanding as to how those services can be used. This can have considerable impact in meeting the health care needs of these patients, as well as enhancing the quality of life.

Prevalence of vision problems in an indigent urban population.

BACKGROUND: Low-income individuals may encounter difficulties in gaining access to routine health care. Certain clinics operate to serve indigent people. The University of Missouri-St. Louis, School of Optometry, in conjunction with New Life Evangelistic Center, offers routine eye care in such a clinic. METHODS: A retrospective epidemiologic analysis of 2 years of eye clinic records from the center was performed to determine the prevalence of vision anomalies in the study population and the benefit of the availability of this care. RESULTS: The mean patient age was 37.8 years, with a high percentage of the patients being black males. Ninety-five percent of the patients required a change in spectacle prescription, improving acuities from an average of 20/70 O.D. and 20/70(-3) O.S. to 20/25(+1) O.D. and 20/25 O.S. This result indicates a statistically significant improvement in exit visual acuities as compared with entrance visual acuities (p < 0.0001). The mean spherical refractive error was -0.77 +/- 2.50 D O.D. and -0.77 +/- 2.45 D O.S. The mean cylinder in each eye was -1.00 +/- 0.75 D. Most cylinders were oriented with-the-rule Ocular disease was present in 11.9% of the patients; systemic disease in 10.4% of patients. Referrals to other health care practitioners were made in 5.9% of cases. CONCLUSIONS: This study demonstrates that indigent patients receive a useful and needed service from clinics that provide routine eye care to this population.

Routine optometric care in nursing homes: a retrospective study.

Residents of nursing homes do not have the same access to health care as do others. A retrospective study of the records of optometric examinations at three nursing homes with demographics presumably similar to those of most nursing homes in the United States was performed in order to determine the prevalence of vision anomalies in this population and to determine if optometric intervention was beneficial. Sixty-five percent of the patients received an immediate benefit from the optometric examination in either treatment or referral to another health care provider for an undetected or poorly controlled health problem. We concluded that this type of service was needed by the patients in the nursing homes and was professionally rewarding to the optometrist providing it.

Clinical evaluation of five portable tonometers.

BACKGROUND: Intraocular pressure (IOP) measurements obtained with five commercially available portable tonometers (Keeler Pulsair 2000, Tomey Pro-Ton, Tono-Pen XL, Perkins, and Shiotz) were compared to IOPs measured with a Goldmann tonometer in order to predict whether instrument accuracy justified substitution of a portable instrument for the Goldmann in all or specific circumstances. METHODS: A total of 31 patients (59 eyes) were assessed. The order of techniques was random except that in each case Goldmann tonometry was performed first and Shiotz tonometry was performed last. Examiners were masked to all other IOP measurements. Correlation and regression analyses were used to predict Goldmann IOP from the other portable tonometer readings. In addition, the difference in pressure readings was compared to mean pressure readings. RESULTS: Comparisons of means, correlations, regression equations, and box plots of difference scores were performed to determine which techniques were more accurate. The results varied slightly depending on the method used. All IOPs obtained with portable tonometers showed significant correlation and regression equations compared to the Goldmann IOPs. The correlation ranged from (r = 0.75) for the Keeler Pulsair to (r = 0.66) for the Schiotz. Three tonometers (Tono-Pen, Schiotz, and the Pro-Ton) showed a small significant underestimation of the Goldmann IOPs. CONCLUSIONS: All portable tonometers were able to accurately predict Goldmann IOPs. While three of the tonometers were found to underestimate Goldmann IOP on average, these results can be corrected by either adding the underestimation or by using the best fitting regression equation.

A comparison of TPA/DPA certification and access to care in North Carolina, Missouri, and Illinois.

BACKGROUND: The changing scope of optometric practice has had a large impact on the profession. Optometry has gone from a drugless profession to a profession that can use diagnostic pharmaceutical agents (DPAs) in every state and therapeutic pharmaceutical agents (TPAs) in 46 states. The intent of this study was to determine the influence that these legal variables exert on the scope of practice for optometrists in different states. METHODS: Optometrists in three states with varying statutes regulating the scope of practice were surveyed to determine if there were practice differences related to these state laws. RESULTS: In states with TPA usage, more optometrists accepted Medicare assignment and had hospital and nursing home privileges. Optometrists with TPA certification had, as a group, graduated more recently. Travel times for patients with conditions requiring treatment with therapeutic drugs were shorter in the states with TPA legislation. CONCLUSIONS: Access to care is enhanced for citizens of a state with optometric usage of therapeutic pharmaceutical agents.

Epidemiology of ametropia of U.S. Army recruits.

All people attempting to enlist in the U.S. Army must undergo a physical examination that requires a rudimentary vision screening. Those who pass the physical, upon reporting to basic training, are again evaluated and any treatment necessary to allow the recruits to function during their initial indoctrination is provided. Those who fail to see 20/20 O.D. and O.S. with their current spectacles fail the screening and are evaluated by an optometrist. If their condition is not disqualifying, appropriate correction is prescribed. We reviewed the records of all the recruits in a 1-month period who either required spectacles to see 20/20 or failed the screening at the 43rd AG BN (reception). Epidemiological evaluation revealed most to be either simple myopes or myopic astigmats. Hyperopia and hyperopic astigmatism accounted for the next most common diagnosis. Other conditions included anisometropia, antimetropia, amblyopia, keratoconus, and nystagmus. Examinations of these recruits were very limited, with dilated fundus evaluations being performed only when there was a high probability of a disqualifying condition. Therefore, it is unknown what retinal disease or degeneration may be present other than what would be visible with direct ophthalmoscopy.

The effect of the M43 and M17 protective masks on stereoacuity.

The purpose of this study was to evaluate the effects of the M17 and M43 protective masks on stereoacuity. Twelve subjects were tested on the Keystone diagnostic series stereopsis test at nearpoint and the Howard-Dolman apparatus at 40 cm and 6 m. Stereopsis was evaluated without a mask and with the M43 and M17 masks. Stereoacuity was decreased at near point with both masks and was not significantly affected at the 6-m distance.

U.S. Army Reserve optometry mobilization in support of Operations Desert Shield and Desert Storm.

Reserve participation contributed significantly to the successful optometric support of the U.S. Army in Operations Desert Shield and Desert Storm. This survey profiles the experiences of reserve optometry officers during these operations. Many doctors suffered personal and financial hardship, the latter being particularly common for those in private practice settings. Readiness may be impaired as many responses indicated that a considerable number plan to separate from the reserve in order to avoid future activation.

Compromises in the visual field with the M43 aviation mask.

This study evaluated peripheral vision through the M43 protective mask currently worn by aviators in the AH-64 Apache helicopter. A Humphrey Visual Field Analyzer was used to measure the sensitivity of a subject's visual field with and without the mask. The results were analyzed using Dicon's Fieldview software. The monocular visual field was reduced for each eye when wearing the mask, especially superiorly and nasally. The overall size of the visual field was not reduced when both eyes were open; however, the quality of the visual field was reduced. The area of binocular vision (central binocular vision fusion field subserving stereopsis) was restricted to the central 30 degrees.

Prevalence of refractive errors on a VOSH mission to Nicaragua.

BACKGROUND: Optometric services in many parts of the world are unavailable with a resultant lack of information on the epidemiology of visual problems in those countries as well. METHODS: A retrospective analysis was conducted on the records of 3,281 patients seen on a VOSH mission to Nicaragua. RESULTS: The mean spherical correction for each eye was a low hyperopic correction. For eyes having an astigmatism the mean cylinder correction was -1.00 and was usually oriented against the rule. CONCLUSION: There was a lower incidence of myopia in this population than for many others that have been studied. There was also a need for a presbyopic correction at an earlier age than for Mid-European populations. A very large number of spectacles must be donated in order to get a sufficient supply for a successful VOSH mission.

A comparison of the visual field restrictions with the M17 series protective mask and the MCU-2/P chemical-biological mask.

The U.S. Air Force and U.S. Navy recently adopted the MCU-2/P Chemical-Biological Mask to replace the M17 series of protective masks. Visual field plots were generated on a patient wearing each of these respirators. Although both resulted in a decrease of the visual fields, the magnitude of restrictions was far less with the MCU-2/P Chemical-Biological Mask.

State board requirements for CPR certification for licensure in independent health professions.

CPR certification requirements for licensure were obtained from 50 states and the District of Columbia for the fields of medicine, osteopathy, podiatry, chiropractic, dentistry, and optometry. It was found that none of the states required CPR certification for initial medical, osteopathic or chiropractic licensure or license renewal, while 4 percent required certification for initial podiatric licensure and license renewal. For initial licensure in dentistry, 25 percent of the boards required CPR certification while 29 percent required CPR certification to renew dental licensure. For initial optometric licensure with diagnostic pharmaceutical agents, 44 percent of the states required CPR certification.

Epidemiological evidence that access to routine optometric care benefits nursing home residents.

Public perception is that nursing home residents receive less than adequate health care. To confirm or refute this view we provided routine optometric services to 47 residents in a nursing home who had ready access to primary medical care. Average refractive error, intraocular pressure, visual acuity, and the prevalence of ocular disease were analyzed. Despite the fact that routine primary medical care was provided in-house and ophthalmologic care was provided on a consultation basis, our study revealed a need for further medical intervention. Seven percent of the patients received a legend prescription for drugs for ocular conditions, whereas 11% received an over-the-counter preparation. Although 11% were already under ophthalmological care, we requested consults from ophthalmology for another 11%. An additional patient was referred to an internist. This study shows that even in nursing homes where residents have access to in-house medical management, routine vision care provided by optometrists can disclose undetected medical problems and improve the quality of life.

Visual field restrictions with the M17 series protective mask.

The restrictions on the central and peripheral visual fields, resultant from wearing a M17 series mask, were measured on a subject with normal field of vision. The results showed a decrease in visual field in all meridians, with the nasal area being the most dramatically restricted.

State boards of optometry requirements of CPR certification for optometric licensure.

Cardiopulmonary resuscitation (CPR) certification requirements for optometric licensure were obtained from 49 states, the District of Columbia and Puerto Rico. It was found that 17 percent of the states required CPR certification for optometric licensure while 11 percent required certification to maintain licensure. For initial Diagnostic Pharmaceutical Agents (DPA) licensing 44 percent of the boards required CPR certification while less than 25 percent required maintaining that certification to sustain DPA licensure. Of those states having Therapeutic Pharmaceutical Agents (TPA) legislation, 36 percent required CPR certification for initial licensure but only 8 percent of them required maintenance of certification for license renewal. Optometry can take the lead in health care by requiring CPR certification for all forms of licensure and license renewal.