Pre-participation Vision Screening and Comprehensive Eye Care in National Collegiate Athletic Association Athletes.

SIGNIFICANCE: Pre-participation physical evaluation and its vision screenings have been the mainstay of medical clearance for competitive play for decades. The ability of screening to address athlete's sports-specific vision needs is unknown. METHODS: Fifty-eight intercollegiate football players consented to participate in a comprehensive, sports-specific eye examination in addition to the standard pre-participation vision screening. Sensitivity, specificity, and positive and negative predictive values were determined for screening's ability to detect athletes whose vision might improve with correction, athletes who had significant ocular findings that impact safety, and either of the two conditions together. The effect no recent eye examination added to pre-participation vision screening results was evaluated for change in screening yield. Descriptive statistics of the cohort and associations with no recent comprehensive eye examination were generated. RESULTS: The pre-participation vision screening was able to identify three athletes not meeting visual acuity requirements for medical clearance to play without a comprehensive assessment. A failed screening was poorly able to identify athletes who might benefit from improved acuity (sensitivity, 9.1%; specificity, 100%), have sports-specific significant ocular findings (sensitivity, 10.5%; specificity, 97.3%), or have either together (sensitivity, 7.5%; specificity, 100%). Sixty percent (33/55) of athletes reported never having a comprehensive examination or one within the last 10 years. Fifty-eight percent (34/58) had improved best-corrected visual acuity after comprehensive examination, and 81% (47/58) had improved acuity or a sports-specific significant finding. CONCLUSIONS: The pre-participation vision screening was largely able to identify athletes meeting the minimum visual acuity requirement for athlete clearance. It poorly identified those who might benefit from improved vision with refractive correction and those in whom sport-specific significant eye findings were noted. Comprehensive eye care had a clear benefit for the majority of athletes tested. This benefit needs to be balanced with the potential added costs and time constraints to players and athletic department staff.

Objective Vision-related Indications for Clear and Tinted Football Helmet Visors.

SIGNIFICANCE: Football helmet visors are popular among players and may increase safety. However, they may also be costly or impractical, or impair the evaluation of head and neck injury. Determining an objective list of vision-related clinical conditions may help meet risk-benefit ratios while increasing access to care to athletes with special needs. PURPOSE: The purpose of this study was to determine an objective list of vision-related conditions that may benefit from clear and tinted football helmet visor use in athletes. METHODS: After comprehensive dilated eye examinations on 58 Division I collegiate football players at the University of Alabama at Birmingham between February 2017 and June 2018, an expert panel in vision care, sports medicine, and football equipment convened to determine vision-related conditions most important for clear or tinted football helmet visor use. RESULTS: In August 2018, the list drafted by the expert vision and sports medical panel in which a clear football helmet visor might be justified included conditions associated with retinal detachment and unilateral or binocular vision loss as well as high refractive error, refractive surgery, corneal compromise, and other conditions, which would necessitate additional eye protection. Of the 58 players examined, 3 (5%) were determined to have eye conditions that would require a clear visor as deemed by the expert panel, and 3 (5%) were determined to have eye conditions for which a clear visor was recommended. No players met indications for a tinted visor including congenital eye conditions that limit useful vision in daylight or bright-light environments, acquired conditions that may increase light sensitivity, and light-induced systemic conditions. CONCLUSIONS: This objective list of eye and vision-related systemic conditions is intended to mitigate the risk of long-term eye damage and/or vision deprivation. Clear and especially tinted football helmet visors require the sports medicine team to evaluate factors that will maximize the vision, head, and neck health of the athlete while increasing accessibility to sports for individuals with unique abilities.

Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion.

OBJECTIVE: The main objective of this study was to assess whether objective vestibular, oculomotor, and balance functions were impaired in children with a current diagnosis of concussion with vestibular and/or ocular symptoms. SETTING: Data were collected in a vestibular/ocular clinical laboratory. Patient participants were recruited from a concussion clinic in a children's hospital. PARTICIPANTS: Thirty-three children aged 8 to 17 years with a current diagnosis of concussion and vestibular and/or ocular symptoms and 30 children without concussion. DESIGN: Cross-sectional single-visit study. MAIN OUTCOME MEASURES: Eye-tracking rotary chair oculomotor and vestibular measures, vestibular evoked potentials, and static posturography. RESULTS: There were no statistically significant differences on any clinical measure between children with concussion and children without concussion. Younger children without concussion performed significantly worse on several rotary chair and balance measures compared with older children without concussion. CONCLUSIONS: No vestibular, oculomotor, or balance measures were significantly different between children with concussion and children without concussion, suggesting these measures may not be useful in the evaluation of a child with concussion and vestibular and/or oculomotor symptoms. Future research should investigate age effects and other vestibular and oculomotor tests to identify objective findings that better relate to vestibular and/or ocular symptoms in children with concussion.

Vision Screening among Children with Autism Spectrum Disorder.

SIGNIFICANCE: Vision problems occur at higher rates in children with autism spectrum disorder (ASD) than in the general population. Some professional organizations recommend that children with neurodevelopmental disorders need comprehensive assessment by eye care professionals rather than vision screening. METHODS: Data from the 2011 to 2012 National Survey of Children's Health (NSCH) were accessed. Logistic regression was used to evaluate differences between vision screening rates in eye care professionals' offices and other screening locations among children with and without ASD. RESULTS: Overall, 82.21% (95% confidence interval [CI], 78.35 to 86.06%) of children with ASD were reported to have had a vision screening as defined by the NSCH criteria. Among children younger than 5 years with ASD, 8.87% (95% CI, 1.27 to 16.5%) had a vision screening at a pediatrician's office, 41.1% (95% CI, 20.54 to 61.70%) were screened at school, and 37.62% (95% CI, 9.80 to 55.45%) were examined by an eye care professionals. Among children with ASD older than 5 years, 24.84% (95% CI, 18.42 to 31.26%) were screened at school, 22.24% (95% CI, 17.26 to 27.21%) were screened at the pediatricians' office, and 50.15% (95% CI, 44.22 to 56.08%) were examined by eye care professionals. Based on estimates from NSCH, no children in the U.S. population younger than 5 years with ASD screened in a pediatrician's office were also seen by an eye care provider. CONCLUSIONS: If the public health goal is to have all children with ASD assessed in an eye care professional's office, data from the NSCH indicate that we as a nation are falling far short of that target.

Peripheral Vestibular and Balance Function in Athletes With and Without Concussion.

BACKGROUND AND PURPOSE: According to the most recent consensus statement on management of sport-related concussion (SRC), athletes with suspected SRC should receive a comprehensive neurological examination. However, which measures to include in such an examination are not defined. Our objectives were to (1) evaluate test-retest reliability and normative data on vestibular and balance tests in athletes without SRC; (2) compare athletes with and without SRC on the subtests; and (3) identify subtests for concussion testing protocols. METHODS: Healthy athletes (n = 87, mean age 20.6 years; standard deviation = 1.8 years; 39 female and 48 male) and athletes with SRC (n = 28, mean age 20.7 years; standard deviation = 1.9 years; 11 female and 17 male) were tested using rotary chair, cervical vestibular-evoked myogenic potential (c-VEMP), and the Sensory Organization Test (SOT). A subset (n = 43) were tested twice. We analyzed reliability of the tests, and compared results between athletes with and without SRC. RESULTS: Reliability ranged from poor to strong. There was no significant difference between athletes with and without SRC for tests of peripheral vestibular function (ie, rotary chair and c-VEMP). Athletes with SRC had significantly worse scores (P < 0.05) on vestibular-ocular reflex (VOR) cancellation gain, subjective visual vertical and horizontal variance, and all conditions of the SOT. DISCUSSION AND CONCLUSION: SRC did not affect medium frequency VOR or saccular function. SRC did affect the ability to use vestibular inputs for perception of vertical and postural control, as well as ability to cancel the VOR.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A274).

Visuo-oculomotor Function and Reaction Times in Athletes with and without Concussion.

SIGNIFICANCE: Oculomotor tests in concussion commonly show impairment in smooth pursuit and saccadic function. Honing in on the systems likely to be affected by concussion will streamline use of oculomotor function as a supplemental diagnostic and prognostic tool, as well as improve our understanding of the pathophysiology of concussion. PURPOSE: This study investigates oculomotor function between concussed and healthy collegiate athletes and determines measurement test-retest reliability of those tools. METHODS: Eighty-seven healthy athletes were recruited from a U.S. Division 1 sports university and completed a 30-minute vestibular ocular testing battery in an enclosed rotary chair system equipped with 100-Hz eye-tracking goggles. Forty-three individuals completed the battery twice. Twenty-eight individuals with a current diagnosis of concussion also completed the battery. All participants were aged 18 to 24 years. Bivariate statistical tests examined differences in scores across groups, and intraclass coefficients were computed to test reliability. RESULTS: Concussed individuals had significantly longer saccadic, visual, and dual-task reaction times and reduced saccadic accuracy. There was no difference in optokinetic reflex gain, but few concussed individuals tolerated the task. Reaction time latencies and optokinetic gain show moderate test-retest reliability. Smooth pursuit tasks and saccadic accuracies showed poor test-retest reliability. CONCLUSIONS: Saccadic latency was the most sensitive oculomotor function to change after concussion and was reliable over time. Saccadic accuracy was significantly lower in the concussed group but had poor retest reliability. Optokinetic gain may warrant more investigation because of its high test-retest reliability and symptom provocation in concussion, despite not showing a significant difference between groups.

Rehabilitation Referral for Patients With Irreversible Vision Impairment Seen in a Public Safety-Net Eye Clinic.

Importance: The prevalence of irreversible vision impairment in the United States is expected to increase by 2050. Vision rehabilitation is the primary treatment option. Clinical trials have established its efficacy in improving quality of life. Yet studies indicate that patients experience many barriers to accessing low-vision care. Objectives: To examine the rate of referral for low-vision rehabilitation services by resident and attending ophthalmologists for adults with irreversible vision impairment and to assess the knowledge, attitudes, and beliefs of patients about vision rehabilitation. Design, Setting, and Participants: Cross-sectional study with enrollment from June 20, 2016, to January 31, 2017, of 143 adults 18 years or older seen in a publicly funded, comprehensive eye clinic in Jefferson County, Alabama, and having 1 or both eyes with irreversible vision impairment (visual acuity was defined as 20/60 or worse) per the electronic health record. Exposures: Demographic characteristics; patient questionnaire on knowledge, attitudes, and beliefs about vision rehabilitation; general cognitive status (Short Orientation-Memory-Concentration test); depressive symptoms (Patient Health Questionnaire-9); health literacy (Rapid Estimate of Adult Literacy in Medicine, Revised [REALM-R]); and self-reported difficulty in everyday activities. Main Outcomes and Measures: Proportion of patients with irreversible vision impairment who were referred by ophthalmologists to low-vision rehabilitation services per the electronic health record. Results: Of 143 patients enrolled with irreversible vision impairment in 1 or both eyes, the mean (SD) age was 55.4 (11.1) years and 68 (47.6%) were women. Most patients were African American (123 [86.0%]), uninsured (88 [61.5%]), and unemployed (92 [64.3%]); on average, they had normal cognitive status, minor depressive symptoms, and limited health literacy. As noted in the electronic health record, the rate of referral for low-vision rehabilitation services was 11.4% for patients with irreversible bilateral vision impairment (4 of 35 patients) and 1.9% for those with unilateral impairment (2 of 108). Most patients with bilateral (31 of 34 [91.2%]) and unilateral (90 of 97 [92.8%]) impairment indicated that they were bothered by their vision impairment, and most reported difficulty with reading (33 of 34 patients [97.1%] who were bilaterally impaired vs 85 of 104 [81.7%] who were unilaterally impaired). Conclusions and Relevance: Results of this study suggest a need to better educate ophthalmologists and residents in ophthalmology about referrals to low-vision rehabilitation services for patients with irreversible vision impairment.

Academic Difficulty and Vision Symptoms in Children with Concussion.

PURPOSE: Academic difficulty is reported in children with prolonged post-concussive symptoms. Despite growing evidence that vestibular-ocular and vision-specific dysfunction are common in children after concussion, vision is rarely mentioned in return-to-learn protocols. The purpose of this project was to evaluate a cohort of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with those reporting academic difficulty. METHODS: Data were obtained from the Children's of Alabama Concussion Clinic REDCap dataset from the period January 2007 to October 2013. From this dataset of 1033 concussion events, a cohort of 276 children aged 5 to 18 years with three or more concussion-related symptoms present for 10 days or more was identified. A cross-sectional cohort study was undertaken to evaluate the association of concussion symptoms, SCAT2 scores, and demographic and concussion severity markers to reported educational difficulty among children with prolonged post-concussive symptoms. Univariate and multivariate logistic regression techniques were used to model the association of reported educational difficulty to self-reported vision abnormalities. RESULTS: Mean age was 13.8 years. Median time since the concussive event was 21 days, with 33% (95/276) reporting their concussion more than 30 days before data collection. Academic difficulty was reported by 29% (79/270) and vision abnormalities in 46% (128/274). After model reduction, vision symptoms (OR 2.17, 95% CI 1.02, 4.62), hearing disturbance (OR 2.39, 95% CI 1.06, 5.36), and concentration difficulty (OR 21.62, 95% CI 9.50, 44.47) remained associated with academic difficulty. For those with symptoms 30 days or more after concussion, only vision (OR 3.15, 95% CI 1.06, 9.38) and concentration difficulty (OR 15.33, 95% CI 4.99, 47.05) remained statistically significant. CONCLUSIONS: Vision problems were commonly reported in children with concussions and were independently associated with those reporting academic difficulty. Comprehensive vision assessment should be considered in children reporting academic difficulty and in the development of return-to-learn protocols.

King-Devick and Pre-season Visual Function in Adolescent Athletes.

PURPOSE: The King-Devick test (KD) has been studied as a remove-from-play sideline test in college-age athletes and older; however, studies in younger athletes are limited. A cross-sectional study of the KD and other vision correlates was completed on school-aged athletes during pre-season physicals for a variety of sports to determine the repeatability of the KD. The study also evaluated how convergence, alignment, or pupil function contributed to a slower King-Devick baseline reading. METHODS: Seven hundred eighty-five athletes underwent vision screenings in a hospital or school setting by trained/certified staff as part of pre-season physicals. Six hundred nineteen had KD testing completed per the manufacturer's suggested protocol and repeated. Other baseline vision testing included visual acuity, Modified Thorington testing for alignment, convergence testing, and pupil function using the NeurOptics (NPI-200) NPi. RESULTS: The mean fastest, error-minimized KD time for all participants was 43.9 seconds(s) (SD ± 11.6, range 24-120). Median KD time got faster (+) with age (p < 0.0001). The inter-class correlation coefficient for all scores was 0.92. The absolute mean time difference for any two tests was 3.5 s (SD ± 2.5, range 0-23). There was no association between the best KD time and reduced NPC (p = 0.63), Modified Thorington measure of alignment (p = 0.55), or NPi pupil function (p = 0.79). The Bland Altman repeated measure limits of agreement was ±6.5 seconds for those in the 10th to12th grades, and ±10.2 seconds for those in the 6th to 9th grades. CONCLUSIONS: King-Devick score in junior high and high school athletes is variable but gets faster and more repeatable with increasing age. The KD does not correlate significantly with reduced convergence, alignment, or pupil function. Based on grouped data, a slowing of 10 seconds for younger athletes and 6 seconds for older athletes on a second administration represents a true difference in testing speed. Within-player variability should be considered when removal-from-play decisions are influenced by KD results.

Nystagmus in pediatric patients: interventions and patient-focused perspectives.

Nystagmus refers to involuntary, typically conjugate, often rhythmic oscillations of the eyes. The most common cause of nystagmus in children is infantile nystagmus syndrome (INS). INS presents within the first few months of life and is sometimes accompanied by an ocular condition associated with sensory impairment. Because this condition affects a person throughout life, it is important to understand the options available to manage it. This review focuses on the underlying nystagmus etiology, psychosocial and functional effects of nystagmus, as well as current principles of management, including optical, pharmacological, surgical, and rehabilitative options. Currently, the neural mechanisms underlying INS are not fully understood. Treatment options are designed to increase foveation duration or correct anomalous head postures; however, evidence is limited to mainly pre- and post-study designs with few objective comparisons of treatment strategies. Management of INS should be individualized. The decision on which treatment is best suited for a particular patient lies with the patient and his/her physician.

Smoking deception and age-related macular degeneration.

PURPOSE: Smoking has been identified as a major modifiable risk factor for age-related macular degeneration (AMD). Smoking deception or failing to self-report as a smoker is a recognized concern among studies of smoking-related disease. To date, no studies have evaluated the rates of smoking deception in macular degeneration. METHODS: Data from the 2005 to 2008 National Health and Nutrition Examination Survey were used to produce estimates of smoking deception among three ethnic groups within the US population. Comparisons of self-reported rates of cigarette use, any nicotine product use, and serum cotinine levels were used to produce estimates of potential smoking deception among adults older than 40 years with any-level macular degeneration and those at risk of late-stage disease. RESULTS: Any-level AMD was found to be present in 6.7% (95% confidence interval [CI] = 5.6% to 7.8%) of this cohort. Excluding those with late AMD, 9.7% (95% CI = 8.3% to 11.0%) were at risk of developing late-stage disease. Among individuals with any level of macular degeneration, 5.4% (95% CI = 2.1% to 8.6%) were potential smoking deceivers. A similar rate was seen among those at risk of late-stage disease at 5.0% (95% CI = 2.3% to 7.6%). CONCLUSIONS: The rate of possible smoking deception seems higher for macular degeneration and those at risk of late-stage AMD than is generally reported in the US population. While the deception rate is low at the individual level, as many as 450,000 adults in the US population at risk of late-stage AMD may misclassify their smoking status.

Medical decision-making capacity and cataract surgery.

BACKGROUND: Medical decision making has evolved from a paternalistic, "doctor knows best system" to one of shared decision making between health care providers and patients. Shared decision making involves informed consent related to the proposed health care options and medical decision-making capacity by patients. Adults aged 90 and older are the fastest growing segment of the US population. Dementia prevalence increases dramatically among this group. Dementia may affect the ability of patients to participate in shared decision making. CASE REPORT: The case of a 91-year-old female rehabilitation inpatient with mild cognitive impairment, cataracts, and macular degeneration is presented. The case highlights key issues of informed decision making and medical decision-making capacity related to cataract surgery. Video examples of the assessment of cognitive and medical decision-making capacity are presented.

A cross-sectional analysis of U.S. contact lens user demographics.

PURPOSE: Large population studies carried out in the United States, while addressing refractive error prevalence, have published little addressing the modes of refractive correction. As such, there are little data in the biomedical literature concerning the characteristics of the contact lens wearing population in the United States. The purpose of this project was to develop estimates of the demographic characteristics of a cross section of contact lens wearers in the United States based on those who wore contact lenses on the day of their National Health and Nutrition Examination Survey (NHANES) examination. METHODS: The NHANES is a nationally representative sample of the U.S. population. As part of NHANES, the type of refractive correction used is collected during a mobile medical clinic examination along with demographic variables. Data files from the 2005-2006 and 2007-2008 NHANES were obtained from the National Center for Health Statistics. Demographic characteristics of the U.S. population using contacts during the medical clinic examination were derived. Associations between demographic variables and contact lens use were explored in age-stratified univariate and multivariate analyses taking into account the complex sampling frame. RESULTS: In univariate analysis, age (p < 0.001) and the availability of health insurance (p = 0.007) have negative associations with contact lens use, while female gender (p < 0.001), higher socioeconomic status (p < 0.001), and higher educational attainment (p < 0.001) are associated with increased contact lens use. In multivariate analysis, age (p < 0.001), socioeconomic status (p < 0.001), the interaction of age with gender (p < 0.001), and the interaction of socioeconomic status with education (p = 0.002) are associated with contact lens use. CONCLUSIONS: Four demographic variables, age, socioeconomic status, age-gender interaction, and socioeconomic status-education interaction, defined those likely to be using contact lens on any given day in the United States. Together, these four variables identify almost 9 of 10 contact lens users.

Visual acuity's association with levels of leisure-time physical activity in community-dwelling older adults.

Little is known about the effect of reduced vision on physical activity in older adults. This study evaluates the association of visual acuity level, self-reported vision, and ocular disease conditions with leisure-time physical activity and calculated caloric expenditure. A cross-sectional study of 911 subjects 65 yr and older from the University of Alabama at Birmingham Study of Aging (SOA) cohort was conducted evaluating the association of vision-related variables to weekly kilocalorie expenditure calculated from the 17-item Leisure Time Physical Activity Questionnaire. Ordinal logistic regression was used to evaluate possible associations while controlling for potential confounders. In multivariate analyses, each lower step in visual acuity below 20/50 was significantly associated with reduced odds of having a higher level of physical activity, OR 0.81, 95% CI 0.67, 0.97. Reduced visual acuity appears to be independently associated with lower levels of physical activity among community-dwelling adults.

The 97.5th and 99.5th percentile of vertical cup disc ratio in the United States.

PURPOSE: The International Society of Geographical and Epidemiological Ophthalmology (ISGEO) suggests a case definition for the prevalence studies of glaucoma based on the 97.5th and 99.5th percentile of vertical optic cup distribution among the evaluated population. Although multiple studies evaluating the prevalence of glaucoma have been undertaken in the last 20 years, case definitions have varied, and data on the underlying population distribution are sparse. This study evaluates the population distribution of 97.5th and 99.5th percentile of vertical cup disc ratio (VCDR) and VCDR asymmetry (VCDRA) in the US population and its association with demographic characteristics, self-reported glaucoma, and visual field. METHODS: The National Health and Nutrition Examination Survey (NHANES) is a nationally representative sample of the US population, which during the years 2005 to 2008 collected frequency doubling technology screening fields and digital fundus photography. Accounting for the complex design of the NHANES population, estimates of the 97.5th and 99.5th percentile of VCDR and VCDRA were calculated, and national estimates of glaucoma prevalence were generated. Associations between disc characteristics, demographic variables, and self-reported glaucoma were explored. RESULTS: Approximately 2.11% (95% confidence interval, 1.55 to 2.67) of the US population older than 40 years has glaucoma based on ISGEO criteria. A much larger 5.13% (95% confidence interval, 4.43 to 5.85) of the US population older than 40 years self-reports having glaucoma. Based on the estimates from NHANES, 6.89% of the population has a VCDR or VCDRA >97.5th percentile in either eye or OU. For the at-risk population with VCDR/VCDRA above the 97.5th percentile, <20% reported having glaucoma, whereas for those at the 99.5th percentile, <50% reported having glaucoma. CONCLUSIONS: The prevalence of glaucoma from NHANES based on ISGEO criteria produces similar population estimated to other population-based studies. Self-reported glaucoma is ∼2.4 times more common than what the prevalence estimates suggest.

The nursing home minimum data set for vision and its association with visual acuity and contrast sensitivity.

OBJECTIVES: To evaluate the association between the Minimum Data Set's (MDS) Vision Patterns section and near and distance visual acuity and contrast sensitivity in nursing home residents. DESIGN: Cross-sectional study. SETTING: Seventeen nursing homes in the Birmingham, Alabama, area. PARTICIPANTS: Three hundred seventy-one nursing home residents aged 55 and older with Mini-Mental State Examination scores of 13 or greater. MEASUREMENTS: The MDS 2.0 assessment for vision from the date closest to acuity and contrast sensitivity assessment were obtained from the resident's medical record. Acuity and contrast sensitivity were measured using the ETDRS chart and Pelli-Robson chart, respectively. RESULTS: The MDS rating of visual status was associated with distance and near visual acuity and contrast sensitivity. The MDS performed poorly in distinguishing residents with mild visual impairment from those with moderate visual impairment. For residents who were rated on the MDS as having adequate vision, 45.9% had distance acuity worse than 20/40 in the better eye, 72.8% had near acuity worse than 20/40 in the better eye, and 85.8% had contrast sensitivity less than 1.50. CONCLUSION: The MDS 2.0 assessment for vision in nursing home residents is positively associated with visual acuity and contrast sensitivity but does not adequately distinguish between individuals with mild and moderate visual impairment and classifies many as having adequate vision who have visual impairment. The validity of the MDS 2.0 as a mechanism for triggering comprehensive eye care for nursing home residents is questionable.

Association between the Nursing Home Minimum Data Set for Vision and Vision-Targeted Health-Related Quality of Life in Nursing Home Residents As Assessed by Certified Nursing Assistants.

PURPOSE: The purpose of this study was to evaluate the association between the federally mandated Minimum Data Set (MDS) Vision Patterns assessment for nursing home residents in the United States and an assessment of their vision-targeted quality of life as assessed by certified nursing assistants (CNAs). METHODS: Participants were 371 residents over the age of 55 from 17 nursing homes in the Birmingham, Alabama metropolitan area and the CNAs directly assigned to their care. CNAs assessed the vision-targeted quality of life of residents in their charge using the Nursing Home Vision-Targeted Health-Related Quality of Life (NHVQoL) questionnaire. MDS assessment categories assigned to each resident by the MDS nurse coordinator ("adequate", "impaired", "moderately impaired", "highly impaired", "severely impaired") were obtained from the medical record. Visual acuity was measured using logMAR charts by trained research staff. RESULTS: CNA rated NHVQoL subscale scores decreased as the MDS rating indicated more vision impairment (all P's for trend < 0.05). Almost all mean scores were in the 80s and 90s for those in the adequate, impaired, and moderately impaired categories. For those with MDS ratings of severely or highly impaired, NHVQoL subscale scores (except ocular symptoms) were dramatically lower (P ≤ 0.001) than those rated as moderately impaired. CONCLUSIONS: Ratings by CNAs on the vision-targeted quality of life of nursing home residents under their care is in general agreement with the MDS category assigned by the nurse coordinator. However, CNA ratings are largely homogeneous in the adequate vision to moderately impaired categories.

Anti-inflammatory drug use and age-related macular degeneration.

PURPOSE: Basic research has shown that early processes in the development of age-related macular degeneration (ARMD) are related to inflammation. The purpose of this manuscript is to evaluate the association of ARMD and the use of anti-inflammatory medications. METHODS: A nested case control study was carried out among male patients at the Veteran's Medical Center in Birmingham, Alabama (BVAMC). Cases were 614 patients with incident ARMD diagnosed between 1997 and 2001 by International Classification of Disease, Ninth Revision code. Controls (4526) were individuals with no diagnosis of ARMD by International Classification of Disease, Ninth Revision coding and matched on age. Formulary records of all medications dispensed through the Veteran's Administration Medical Center were accessed. All oral or injectable drugs with anti-inflammatory properties were considered anti-inflammatory medications for study purposes. Topical ophthalmic and dermatologic preparations were not considered anti-inflammatory. RESULTS: Among veterans with a diagnosis of ARMD 24% (150/614) patients had filled a prescription for any of the anti-inflammatory medications compared with 60% (3051/4526) individuals in the control population. Individuals who had filled a prescription for anti-inflammatory drugs had an 85% reduced odds of having a diagnosis of ARMD (odds ratio 0.15, 95% confidence interval 0.12-0.18). CONCLUSIONS: The results of this study suggest that veterans who had filled a prescription for anti-inflammatory medications had a reduced risk of ARMD. Further studies are needed to confirm this result.

Atypical fixation preference with anisometropia.

PURPOSE: To describe a child with hyperopia and anisometropia who manifests strabismus and amblyopia in the much less hyperopic eye. CASE REPORT: A 6-year-old child presented with a history of strabismus and refractive error since infancy, which has been treated with glasses and patching. The present examination revealed 3 D of hyperopic anisometropia, intermittent exotropia, and amblyopia. The strabismus and amblyopia occur in the less hyperopic eye. Ocular health assessment including optical coherence tomography was normal. After patching therapy, the vision improved in the amblyopic eye. CONCLUSION: Amblyopia and strabismus need not always occur in the more ametropic eye when accompanied by anisometropia.