Gender differences in the utilisation of optometric services in Victoria

Medicare and population data demonstrate clear gender differences in utilisation of health services. There are three broad hypotheses that may explain different utilisation rates of health services by gender: differences in access, differences in incidence and differences in attitudes in seeking health care between the genders. Men are 28 per cent less likely than women to see an optometrist in Victoria. Both women's and men's utilisation of optometric services in Victoria increase with age but there are clear gender differences apparent at every stage of life after childhood. These utilisation rates between genders are tested against incidence rates between genders for eye conditions. There are few noted gender differences apparent in the incidence or prevalence of ocular conditions. The data on the incidence of health conditions often has limitations, either in measurement tools or in differences in incidence between genders. These limitations are not as evident in eye care incidence data. Access and incidence differences do not adequately explain the differences in optometric service utilisation rates. This promotes the hypothesis that attitudinal differences in seeking health care between men and women are significant.     

Pharmacological considerations in older adults

The older adult population--those age 65 years and over--continues to increase in numbers and will comprise a large segment of optometric practices in the future. As the prevalence of ocular and systemic disease escalates with age, older adults will utilize more pharmaceutical agents than their younger counterparts. The increase in chronic systemic disease, ocular disease, and polymedicine which accompanies aging contributes to the higher incidence of adverse reactions present in this age group. The optometrist who is knowledgeable in the adverse reactions associated with the common ocular and systemic drugs utilized by geriatric patients will provide both better optometric care and systemic health care screening to his or her patients. This paper discusses the factors contributing to adverse reactions in the elderly and some of the common ocular and systemic medications and their associated side effects which are utilized by the older population.     

Prevalence and severity of symptomatic dry eyes in Hispanics.

PURPOSE: Past studies have not addressed the prevalence of dry eyes in the growing US Hispanic population. 463 Hispanic patients were screened in an optometric practice located in Southern California. METHODS: A single symptom variable of self-assessed ocular dryness was used to categorize patients. RESULTS: Of the patients 43.6% had some symptoms of dryness. Twenty-five percent had clinically relevant (mild, moderate or severe) scores that may merit treatment. The findings were 16.4% classified as mild (dryness score 2), 6.2% were moderate (dryness score 3) and 2.3% were severe (dryness score 4). Age was a significant predictor of dryness level. As age increased, severity of dryness increased (p <.001). The mean age for None or Trace were significantly lower than for Mild and Moderate (p <.05). Gender was not a useful as a second predictor of self-reported dryness. CONCLUSION: Southern Californian Hispanics seen in a optometric practice have a higher prevalence for dry eye symptoms than most other previously studied ethnic populations not selective for age.     

Behçet's disease: medical and optometric review

Behçet's disease is an uncommon disease complex, presumed to have an autoimmune basis and has a world-wide albeit variable prevalence. The principle diagnostic features are ocular inflammation and both oral and genital ulceration. However retinal vasculitis and a number of additional systemic complications including arthritis, pathergy, cardiovascular and neurological abnormalities may be associated with Behçet's disease. The ocular examination may provide cues to the diagnosis of previously unrecognised disease. Medical and optometric management suggestions are outlined. (Clin Exp Optom 1995; 78: 5: 163–167)     

Ocular allergy: causes and therapeutic options

Ocular allergic eye conditions are among the most common anterior eye problems encountered in optometric practice. There are six common forms of ocular allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunc‐tivitis, atopic keratoconjunctivitis, contact lens associated papillary conjunctivitis and contact ocular allergy. Here, we review the current understanding of the pathophysiol‐ogy underlying ocular allergic conditions and describe the different causes and forms of allergic eye disease and different treatment options.     

Management of patients undergoing hydroxychloroquine (Plaquenil) therapy

The quinolines, hydroxychloroquine (Plaquenil) and chloroquine are used primarily for their anti‐inflammatory effects in the treatment of auto‐immune conditions such as rheumatoid arthritis. Another common use of these drugs is the prophylaxis and suppression of malaria. The use of quinolines may cause several ocular side‐effects. The most significant complication is irreversible macular damage resulting in both visual acuity and visual field loss. However, the Royal College of Ophthalmologists, UK (RCO) recently recommended against the monitoring of patients receiving quinoline therapy as it was deemed to be too costly, given the low incidence of retinal complications. In this article, we present a case of hydroxychloroquine retinopathy, describe the ocular changes associated with quinoline therapy and recommend an optometric review schedule for patients who are currently taking these drugs. Furthermore, we recommend a proactive approach toward medical practitioners prescribing these drugs for optometric‐based monitoring of these patients.     

Some ocular manifestations of systemic drug abuse.

Optometrists are increasingly likely to see patients who use illicit drugs, which may cause ocular signs which mimic other problems. This paper reviews pharmacologic effects on the eye of depressants, hallucinogens, inhalants, marijuana, opiates, and stimulants including amphetamines and cocaine. Drug abusers suffer from AIDS, CMV retinitis, fungal and bacterial endophthalmitis, quinine poisoning and talc retinopathy. The ocular signs and symptoms of these diseases are discussed. The most common presenting complaints in an optometric setting are emphasized.     

Community-based study of the association of high myopia in children with ocular and systemic disease.

PURPOSE: High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. METHODS: Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. RESULTS: High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. CONCLUSIONS: There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia > or =5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.     

The unwanted ocular effects from topical ophthalmic drugs. Their occurrence, avoidance and reversal

Unwanted effects may occur when drugs are applied topically on the eye or when they are administered by other routes. The unwanted effects may be ocular, systemic or both. This paper discusses unwanted ocular effects which may arise when certain optometric drugs are applied directly on the eye. Among the effects described are allergic reactions, infections, pigmentary changes, and the production of aqueous "floaters." Changes in intraocular pressure and appropriate first aid measures to counter an acute rise in IOP are also discussed. Not discussed are the adverse ocular effects which are associated with topical application of the potent anticholinesterases nor those which can arise when certain drugs e.g. corticosteroids are applied to the eye for therapeutic purposes.     

Eye disease in kidney transplantation: Clinical challenges in a unique patient population

Eye disease is common among kidney transplant recipients, and their management is challenging. Chronic kidney disease is associated with ocular complications, both independently and in the context of various systemic disorders. In addition, chronic immunosuppression predisposes kidney transplant recipients to an array of long-term ocular issues. This may be broadly categorized into infections, malignancies, and other immunosuppression-specific side effects. The interdependence of kidney disease, transplant pharmacotherapy, and ocular health, therefore, requires a multispecialty approach. Although the kidney transplant population has grown along with the burden of associated oculopathies, systematic guidelines targeting this patient group are lacking. This evidenced-based narrative review summarizes the pertinent issues that may present in the ophthalmic and optometric clinical settings, with emphasis on collaborative management and directions for future research.     

Epidemiology of strabismus

In a survey of around 60000 optometric eye examinations, each with orthoptic assessment, 5% of patients were found to have a binocular vision anomaly. The frequency of each anomaly was found and an estimate was made of its prevalence in the general population. The prevalence rates are generally similar to other studies but are given in more detail. Of 3075 binocular anomalies 74% had concomitant strabismus, 10% were paretic, 8% had decompensated heterophoria and 6% convergence insufficiency.     

School vision screening, ages 5–16 years: the evidence-base for content, provision and efficacy

The optometric profession in the UK has a major role in the detection, assessment and management of ocular anomalies in children between 5 and 16 years of age. The role complements a variety of associated screening services provided across several health care sectors. The review examines the evidence-base for the content, provision and efficacy of these screening services in terms of the prevalence of anomalies such as refractive error, amblyopia, binocular vision and colour vision and considers the consequences of their curtailment. Vision screening must focus on pre-school children if the aim of the screening is to detect and treat conditions that may lead to amblyopia, whereas if the aim is to detect and correct significant refractive errors (not likely to lead to amblyopia) then it would be expedient for the optometric profession to act as the major provider of refractive (and colour vision) screening at 5-6 years of age. Myopia is the refractive error most likely to develop during primary school presenting typically between 8 and 12 years of age, thus screening at entry to secondary school is warranted. Given the inevitable restriction on resources for health care, establishing screening at 5 and 11 years of age, with exclusion of any subsequent screening, is the preferred option.     

Is there a need for binocular vision evaluation in low vision?

The purpose of this study was to determine the need for a binocular vision evaluation in the management of low vision patients. Thirty subjects were selected with visual acuities of at least 6/60 in each eye. Twenty-three had age-related macular degeneration as the primary ocular pathology and seven had various other ocular conditions. The binocular vision evaluation comprised: detailed history and symptoms with an emphasis on the occurrence of near vision problems; modified binocular vision assessment which included cover test at near, ocular movements, convergence, Bagolini glasses, horizontal vergence reserves and prismatic measurement of any observed anomaly. History and symptoms revealed horizontal and vertical diplopia, jumbling of print, asthenopia, intermittent blurring and print being too small. Binocular vision assessment revealed exophoria at near, manifest horizontal deviations, convergence insufficiency, and vertical muscle imbalance. These anomalies occurred either singly or in combination. The results indicate that there is a need for binocular vision evaluation in low vision in order to reveal near vision disorders that may be partly attributable to binocular vision anomaly and not solely due to ocular pathology. This information should facilitate the implementation of the appropriate course of optometric management for these patients.     

Increased scope of practice: a survey of Missouri doctors of optometry

This study attempts to assess the effects on the Missouri optometric community resultant from the recent expansion in the scope of practice to include the management of ocular disease with pharmaceutical agents. A majority of those responding reported they felt comfortable in providing such services. They also reported an increase in income and patient retention. Improved relations with ophthalmologists and a greater willingness to comanage patients were perceived by some as other benefits. Over half of the respondents have received referrals from primary care physicians for therapeutic services.     

VEP验光技术研究及法医学应用

目的:通过VEP验光结果与电脑验光结果的比较,评价VEP验光技术在眼外伤法医学鉴定中的应用价值。方法:通过对50例86眼不同程度的屈光不正依次行电脑验光和VEP验光,将两种方法所得的结果进行比较分析。结果:VEP验光与电脑验光结果比较无显著性差异。两者差值约有66.1%在0～0.25D之间;约有51.2%的电脑验光结果高于VEP验光结果。结论:在眼损伤的法医学鉴定中,VEP验光技术可以作为一种客观评价受检者屈光不正程度的验光手段。     

Functional improvement after vision rehabilitation in low monocular vision after myopic macular degeneration and retinal detachment

PURPOSE: We present a case of a 62 year-old woman, with a single eye functional vision (VA of 0.16) who improved her vision after following a vision rehabilitation program, which included optical and non-optical devices for daily performance. CONCLUSIONS: A correct optometric evaluation and a training program are key factors to improve quality of life in low vision patients, whose ocular pathology allows no other treatment.     

A CLOSER LOOK AT DIAGNOSTIC DRUGS FOR OPTOMETRIC USE*

Much attention is presently being given to the subject of optometric use of pharmaceutical agents. While there are a great many ocular drugs available, only a few readily lend themselves to being incorporated into the optometric examination procedure. This article reviews certain local anaesthetics, mydriatics, cycloplegics, and miotics that are of special interest to optometry. These agents are discussed with particular reference to the disadvantages as well as the advantages associated with their usage.     

Importance of the lipid layer in providing tear stability

Therapeutic contact lenses are a rewarding area of optometric practice. Within Sunderland Eye Infirmary a diversity of ocular conditions present, creating a wide range of challenges. A variety of case histories will be discussed.
A prosthetic scleral shell was made for a chemical burn injury which presented with symblepharon. A traumatic cataract (caused by a flying contact lens lid) was extracted and an aphakic hydrogel contact lens with an opaque iris print and clear pupil was required to maintain vision and decrease symptoms of glare. Two cases of perforating injury resulting in opaque corneas are shown. In one case the lens was ordered from a trial set, the other prosthetic contact lens was hand-painted to match a photograph sent to the manufacturer. A hydrogel occlusive pupil contact lens was used to cover a dense white inoperable cataract caused by recurrent chronic uveitis in rheumatoid arthritis. This type of contact lens is also used for diplopia therapy.