The AOA Committee on Basic and Applied Research sent a questionnaire to all Oregon optometrists requesting information on their attitudes toward 1) research areas to be emphasized in the schools, 2) funding sources for research, and 3) optimum ways of reporting research results. The majority of the O.D.s responding felt that new equipment and techniques, contact lenses, and vision training should be given first priority as research areas, and felt that 5% or more of their AOA dues should be devoted to research. The Journal of the AOA was reported to be the most helpful of all the optometric journals in presenting research information and the vast majority of O.D.s responding selected a complete article with an abstract as the most appropriate report style.
Quality of life has become an important issue in evaluating clinical research outcomes, and in relationship to cost containment and managed care issues.
The literature on quality of life was reviewed to give the practicing optometrist an overview of the issue.
Quality of life embraces a wide range of physical and psychological characteristics that describe a person's functional ability. There is no agreed upon definition of quality of life. This lack of agreement has led most researchers to adopt a multidimensional approach toward assessing quality of life since no single parameter has ever proven to be adequate.
Quality of life measurement is an important issue in health care research and policy. In the future, awareness of quality of life issues will be of increasing importance for the optometrist.
This study was designed to evaluate the effect of Paremyd, a combination of 1.0 percent hydroxyamphetamine hydrobromide and 0.25 percent tropicamide, on pupil size during binocular indirect ophthalmoscopy (BIO) upon 164 subjects of various skin pigmentation, iris color, and age.
Pupillary dilation and ease of performing BIO were measured after 30 minutes following instillation of a single drop of either Paremyd or tropicamide (1.0 or 0.5 percent) to an eye. Subjects were assigned to one of three groups; either Paremyd OU, or Paremyd OS and tropicamide (either 0.5 or 1.0 percent) OD, or Paremyd OD and tropicamide OS. Pupillary dilation was measured during BIO performed at a set illumination using a near point card.
Results indicate that Paremyd is a significantly more effective dilator than either concentration of tropicamide alone. BIO was rated good to excellent for all dilating agents. As could be expected (based upon data from previous experiments), there was a small, but significant, negative correlation between dilation and age, skin pigmentation, and iris pigmentation.
Paremyd, because of its superior effect upon dilation without side effects, can be the preferred agent used for routine single-drop dilation in all patients, independent of age, iris color, or skin color.
Paremyd, consisting of a combination of 1.0 percent hydroxyamphetamine and 0.25 percent tropicamide, is a commercially available eyedrop used clinically for diagnostic mydriasis. This study sought to determine if one drop of Paremyd is equally effective and tolerable as the traditional combination of one drop each of 2.5 percent phenylephrine and 0.5 percent tropicamide.
A prospective, double-masked, randomized, cross-over study was conducted in 60 normal volunteers ranging from age 20 to 35 years (mean 24.3 years). Twenty-two subjects (36.7 percent) were male, and 32 subjects (53.3 percent) had brown irides. Pupil diameter, amplitude of accommodation, distance and near visual acuity, and subjective comfort of eyedrop instillation were assessed for 8 hours following drug instillation.
Significantly more subjects (p < 0.05) experienced adverse ocular symptoms with the tropicamide plus phenylephrine (TP) combination than with Paremyd (P). There was no statistically significant (p > 0.05) difference in mydriatic response between TP and P. During the first hour, however, TP and P demonstrated significant (p = 0.001) differences in cycloplegic effect.
Paremyd appears to be as effective a mydriatic as TP, but with greater comfort on instillation. Paremyd has less effect on accommodation.
Apraclonidine 1.0% has been shown to reverse the potential intraocular pressure (IOP) increase after pupil dilation IOP increases in patients with chronic open-angle glaucoma. However, it is only approved for preventing IOP spikes after laser surgery. The purpose of this study is to determine the effectiveness of 0.5% apraclonidine in reversing IOP increases after pupillary dilation in patients with chronic open-angle glaucoma.
Twenty-two patients with chronic open-angle glaucoma were found to have an increase in post-dilation IOP of at least 4 mmHg from pre-dilated levels (baseline) in both eyes. IOP was measured 1 hour after dilation, after which two drops of 0.5% apraclonidine were instilled in one eye and the IOP was remeasured 15 minutes later in both eyes. Instillation of 0.5% apraclonidine in one eye was continued every 15 minutes and IOP was measured 15 minutes after each instillation, until the pressure returned to baseline levels.
The IOP of the initially treated eye of all 22 patients returned to within levels clinically insignificant from baseline IOP within 90 minutes. By comparison, the IOP of the control group (untreated eye) remained elevated. Once the initial treatment eye returned to baseline levels, the control group was then treated with 0.5% apraclonidine, resulting in a lowering effect of the IOP in similar fashion to the initial treated group.
Apraclonidine 0.5% appears to be effective in reduction of post-dilated IOP increases in patients with chronic open-angle glaucoma.
Dapiprazole 0.5 percent (REV-EYES) eyedrops have recently become commercially available in the U.S. to reverse the diagnostic mydriasis produced by various concentrations and combinations of tropicamide and phenylephrine. Although a previous study has shown that dapiprazole increased accommodative amplitude after the administration of tropicamide, no attempt was made to control for differences in pupil size.
In the present single masked study, the accommodative amplitudes of forty-eight age-matched subjects previously dilated with 0.5% tropicamide were measured through a 3 millimeter artificial pupil following random instillation of dapiprazole in one eye and a placebo drop in the other eye.
Area under the curve analysis determined that the magnitude of accommodative response to dapiprazole was significant at p < 0.001 (paired t-test). The McNemar test also showed that the accommodative amplitude was greater in eyes treated with dapiprazole at all observation points (p < 0.005), beginning at 15 mins after the instillation of the test drug.
The results demonstrate that dapiprazole accelerates the return of accommodation independent of pupil size.
The AcuVision 1000 Trainer is an instrument designed to assess and train eye-hand coordination in athletes. Variable environmental conditions are encountered when sports-vision screenings are performed. The effect of these factors on scores attained on sports-vision testing equipment is an important consideration when results for different populations are compared.
This study investigated the effect of different lighting levels on subject performance. Twenty-five subjects performed three trials at each of three lighting levels (day-light, dim room, and dark. The presentation order of lighting level was counterbalanced and subjects were randomly assigned to the various presentation orders.
The results indicate a statistically significant difference in performance at the various levels. High lighting levels decreased scores significantly, whereas there was no significant difference between the two lower levels.
This study emphasizes the effect lighting can have on performance, and illustrates the need to properly control environmental factors through well-defined testing protocols for the use of the AcuVision 1000.
Visuoscopy is an indispensable test in the evaluation of the monocular fixation pattern. Unfortunately, the instrumentation needed to accurately perform the test is often costly. A procedure describing how the Welch-Allyn "11500 ophthalmoscope may be inexpensively modified for the routine performance of visuoscopy is presented.
The Ober2 Model B-1200 system uses infrared reflections to record and analyze eye movements made during reading. The system's ability to analyze data from normal subjects and the reliability of the data produced by subjects who read standard paragraphs were investigated.
Forty-two optometry students and 20 junior high school students, all self-assessed normal readers, read five different Taylor test paragraphs during each of two sessions. Ober2 Model B-1200 analysis was attempted for each paragraph; when analysis was successful, grade-equivalent scores based on fixations, span of recognition, regressions, fixation duration, and reading rate were determined.
The Ober2 Model B-1200 system was unsuccessful in analyzing data from 30% of the paragraph presentations; manual calibration procedures allowed no additional data analysis. Using mean grade-equivalent data from 16 optometry student subjects for whom all 10 paragraphs could be analyzed, significant differences were found between results for two of the test paragraphs. Split-half inter-session reliability coefficients for grade-equivalent data ranged from 0.84 to 0.95. No intra-session learning or fatigue effects on reading data were found.
Although the Ober2 Model B-1200 potentially can provide valuable information on eye movements made during reading, problems exist with respect to its ability to analyze data. The analysis failures significantly limited the value of this system.
Clinical use of an innovative fundus camera system which takes extra wide-angle pictures is described. Advantages and limitations of the system are reviewed. Photographic patient examples are demonstrated.
Data on DPA side effects were gathered from six schools and colleges of optometry for a reporting period from February 1 to April 30, 1979. These data indicate a low incidence of mild and transient side effects caused by several of the DPAs.
Today's optometry students and practitioners alike are often unaware of the richness of optometric history. The use of ophthalmic pharmaceutical agents and the designation of primary care practitioners are often taken for granted. This article utilizes some of the early research conducted by Harrington, Hofsteter, Prentice, Hirsch, Wick, Fitch, and Gregg, and describes the advent of drug legislation and the expanded role of optometry within the health care system.
Accommodative spasm (AS) is rarely reported in the literature. We studied 17 patients with accommodative spasm. Most patients were clinically emmetropic. Ten patients also manifested a spasm of the near reflex (SNR). The probable etiology of the accommodative disorder for most patients was psychogenic as revealed by case histories and visual field analysis. Treatment consisted primarily of plus reading lenses and, in some instances, orthoptic training. Some patients also underwent psychological counseling. Follow-up ranged from 2 months to 30 months. Although visual symptoms improved for most patients, only four patients had complete resolution of the spasm.
The history surrounding the development of codes of ethics and other official statements of desired professional conduct adopted by the American Optometric Association reveals the interesting struggle optometry faced in establishing itself as a leading primary health care profession.
Information regarding the events and documents reported in this paper were obtained through research of the historical literature and achieves at the International Library, Archives and Museum of Optometry located at the American Optometry Association's offices at 243 N. Lindbergh Boulevard, St. Louis, MO.
Forces outside as well as within the profession were found to have influenced the drafting and redrafting of the official ethical and professional conduct statements that were meant to guide the professional behavior of the membership of the AOA.
Ethical codes and other statements of desired conduct have been essential to the establishment of the profession of optometry. As optometry has grown and matured as a provider of primary eye and vision care services, so have its ethical emphases.
Henry Armaignac, a French ophthalmologist in the early twentieth century, criticized the Monoyer optometric scale, which was used to measure visual acuity.
This article discusses the "optometric scale" for visual acuity letter sizes proposed by Armaignac in a 1906 publication.
Armaignac pointed out the flaws of the Monoyer visual acuity chart commonly used in France at the time and suggested an improvement in the progression of letter sizes on the chart.
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).
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.
This paper describes the impact of modern technology on extraction of lens procedures. National estimates are presented on inpatient hospital utilization based on data collected through the National Hospital Discharge Survey. Trend data are shown for numbers, rates and average lengths of stay for patients with the procedure for 1965-1984. The trend data demonstrate changes in the procedure brought about by the effect of brought about by the effect of the introduction of Medicare and the introduction of the intraocular lens implant. Data on insertion of intraocular lens prosthesis are also presented for 1979-1984.
For 26 years the CCOC served professional optometry as its institutional-practice reviewer.
The council used nine standards for accrediting clinical institutions.
The benefits of the accreditation process were many, with improved patient care as its cornerstone.
During its 26 year existence, the Council on Clinical Optometric Care (CCOC) had a major influence on the quality of optometric care.
The Optometric Manpower Resources Project, funded under government contract since June of 1971, has completed its 1973 national census of licensed optometric manpower in the United States. The first article in this series of three reported on the distribution of optometrists by census region and the current ratios of practicing optometrists to civilian population. The second article reported on the principal forms of employment of active optometrists, the number of years in practice and practice size. This third article reports on the age and sex distributions of licensed optometrists, their racial/ethnic composition, their pattern of specialization, and the schools/colleges of optometry from which they graduated. The data indicate that almost 50% of active optometrists were over 50 years of age. Approximately 90% of male optometrists and only 58.5% of female optometrists were active. The data also indicate that one-third of all optometrists active in 1973 graduated from four schools/colleges of optometry.
The Optometric Manpower Resources Project, funded under government contract since June of 1971, has completed its 1973 national census of licensed optometric manpower in the United States. The first article in this series of three reported on the distribution of optometrists by census region and the current ratio of practicing optometrists to civilian population. This second article reports on the principal forms of employment of active optometrists, the distribution of number of years in practice and practice size. The data indicate that there has been a shift away from self-employment (88% in 1968, 77% in 1973) into more varied forms of salaried employment, especially among those in practice fewer than ten years. Practice size is shown to peak at between fifteen and twenty-four years in practice with a median of approximately 5,400 patients.
Optometry residency programs have existed since the mid 1970s. Most residencies today are funded and conducted by the Veterans Administration, and all hospital based residencies are located at a VA Medical Center. To compile a profile of VA optometry residents, identify their perceptions of VA residencies and determine trends within this group which are significantly affecting our profession, a survey was sent to all former and current VA residents whose addresses could be obtained. Results, a discussion and implications for our profession are included.
The 1979 revision of the ANSI Z80.1 Ophthalmic Lens Standards resulted in rather significant changes affecting three areas of ophthalmic lens requirements: 1) central refractive characteristics, 2) prismatic characterstics, and 3) factors relating to the magnification properties of lenses. Based primarily on what an optical laboratory could consistently produce, the ANSI Ophthalmic Lens Sub-committee decided to widen some of the tolerances over those expressed in previous revisions. This paper attempts to show how these new tolerances relate to certain aspects of patient sensitivity to errors induced by ophthalmic lenses conforming with the new revision.
Since April, 1972, the American National Standard Requirements for First-Quality Prescription Ophthalmic Lenses, Z80.1-1972, has been in the process of revision. The American National Standards Institute procedures are explained as well as details of the new revised standard. In addition, an explanation of the AOA position on the revision is given. Finally, what this standard means to the practicing optometrists is discussed.
