Optometric quality assurance.

Quality Assurance, (QA), is an expanding hospital-based system of optimizing cost-effective eye care. It seeks to minimize patient care problems. Drawing from military experience with QA under the JCAH, a QA checklist and a patient satisfaction survey are presented as tools to improve QA programs for other optometrists.

Plus lens, prism, and bifocal effects on myopia progression in military students, Part II.

Military academies routinely lose a percentage of their pilot-qualified students to myopia during the 4-year academic program. This study investigated the progression of myopia during such a program and evaluated the usefulness of reading glasses to prevent myopia progression and subsequent acuity loss. A group of students at the United States Naval Academy comprised three randomly divided groups: a placebo group (no. 1 pink tint), a plus with prism group (+1.25 D with 2 delta base-in each eye), and a bifocal group (+1.50 D near addition). All the lens powers were relative to the experimental subject's distance refraction and were for use full-time when reading. The pre- and post-test refractive errors at distance were determined using 1% tropicamide HCl. At the end of 4 years, the tropicamide refraction showed approximately -0.25 D of myopic shift in all groups. There were no significant differences between the myopic shifts in the controls and experimental groups.

Optical prophylaxis for environmental myopia: an epidemiological assessment of short-term effects.

The biologically plausible concept that relief of accommodation may reduce myopic progression, although not confirmed and not universally accepted, has nevertheless strongly influenced the practice of preventive optometry. Yet, no quantitative estimates of the strength of this postulated effect were found in the literature. From a cohort study of 120 young (18 to 20 years of age) male military students with low initial refractive error (less than or equal to +/- 1D, spherical equivalent), estimates were made of the short-term (5 months) effect of two forms of optical treatment to prevent school-related myopia. The cumulative incidence of clinically significant (greater than 0.25 D, spherical equivalent) myopic progression was less [standardized morbidity ratio (SMR) = 0.45] among those prescribed monofocal convex lenses (+1.25 D over far Rx) and prisms (2 delta base-in OU) and even more reduced (SMR = 0.32) among those prescribed bifocals (+1.5 D near adds) compared with those receiving sham treatment (no. 1 pink tint). Placebo-treated patients were more than twice [rate ratio (RR) = 2.2, 1.5] as likely as the monofocal group, and more than three times (RR = 3.2, 1.7) as likely as the bifocal patients, to suffer myopic progression during the period of follow-up. Etiologic fractions (EF, increase in myopic progression if treatment were eliminated) of 37 and 47% and preventive fractions (PF, decrease in myopic progression attributable to the treatment) of 27 and 32% were estimated for the monofocal and bifocal treatments, respectively. These findings suggest that while both modes of therapy are efficacious, the bifocal form is 20% (32/27 = 1.2) more preventive.

Plus lenses, prisms, and bifocal effects on myopia progression in military students.

Students of the Naval Academy Preparatory School (NAPS) class of 1978 to 1979 were randomly divided into three groups, one-third of the class receiving their correlation for distant vision with a no. 1 pink tint to be used for reading (the placebo group); one-third of the class receiving +1.25 D added to their distance correction with 2 delta base-in each eye, in glasses to be used for reading; and one-third of the class receiving bifocals, incorporating their distance correction with a +1.50 D near addition. The refractive error at distance for all 232 students was determined under cycloplegia. At the end of 5 months, a repeat cycloplegic refraction showed nonsignificant myopic shifts (Wilcoxon test) of -0.08 +/- 0.29 D in the placebo group, -0.07 +/- 0.25 D in the plus-with-prism group, and -0.06 +/- 0.18 D in the bifocal group. This research note is preliminary to a followup at academic graduation of these same students from the Naval Academy in 1983.