Guidelines for an occupational vision program.

The need for and development of an effective occupational vision program is discussed. The role of the optometrist as an occupational vision consultant is outlined and specific guidelines for the provision of in-plant and in-office vision services are provided. Requirements of the OSHAct are summarized and specific problem areas related to industrial safety eyewear are also discussed.     

School of optometry at Tel Aviv University

The following article describes the program for the study of optometry to begin at Israel's Tel Aviv University in the 1987/1988 academic year. Details of the proposed structure, facilities and curriculum are presented. In addition, background is provided as to the current vision care system in Israel, and how the absence of a school of optometry has influenced its condition.     

Analysis of a community vision screening program

For 3 consecutive years a community vision screening program has been conducted on-site at the Walker Eye Clinic of the Indiana University (IU) School of Optometry. A group of 490 screened patients, including 86 who returned for comprehensive evaluation, was retrospectively studied for a variety of characteristics. It was determined that the typical participant was likely to be an adult female who learned of the screening program through the written media. She was likely to have had a previous vision examination but it probably took place 3 or more years earlier. She usually failed the vision screening for reasons of reduced visual acuity, a problem with binocularity or asthenopia. If she returned to the Walker Eye Clinic for a comprehensive examination, she was likely to do so within 5 months and would be found to have been accurately identified as being in need of vision care. The organization and implementation of this vision screening program are described, and its value as an educational tool for students of optometry and its technician program is discussed.     

Working with school nurses: improving children's vision and building relationships

The 45,000-plus school nurses in the U.S. have an astonishing array of responsibilities, and serve as important gatekeepers to the health care of millions of children. By building relationships with local school nurses, doctors of optometry can play an important part in improving children's vision care, and build their practices as well. We take a look at the challenges school nurses face, and an AOA program designed to reach out to them and improve the quality of vision screenings.     

不同年龄及不同进展程度的近视患者3种验光方法的选择时机

目的　探讨不同进展程度及不同年龄的近视患者选择小瞳验光、复方托吡卡胺散瞳后验光及阿托品散瞳后验光的时机。方法　将年龄7～18岁的304例近视患者按复诊的戴镜视力或初诊的裸眼视力分为3组:0.1～0.3组、0.4～0.6组、0.7～0.9组。所有患者根据不同年龄段（7～9岁、10～12岁、13～15岁、16～18岁）分别进行小瞳验光、复方托吡卡胺散瞳后验光及阿托品散瞳后验光,记录各组患者屈光度。结果　视力下降至0.1～0.3时,不同年龄段患者三种验光方式所得屈光度比较,差异无统计学意义（P>0.05）。结果显示各年龄段近视患者采用小瞳验光、复方托吡卡胺散瞳后验光、阿托品散瞳后验光的屈光度变化不明显。视力下降至0.4～0.6时,7～12岁近视患者复方托吡卡胺散瞳后验光、阿托品散瞳后验光都比小瞳验光所得屈光度低,而阿托品散瞳后验光所得屈光度降低更显著;13～18岁近视患者复方托吡卡胺散瞳后验光、阿托品散瞳后验光所得屈光度均低于小瞳验光所得屈光度,但其降低的差异随着年龄增长更加不明显。视力下降至0.7～0.9时,各年龄段近视患者小瞳验光、复方托吡卡胺散瞳后验光、阿托品散瞳后验光所得屈光度差异均有统计学意义（均为P＜0.05）。各年龄段近视患者小瞳验光、复方托吡卡胺散瞳后验光、阿托品散瞳后验光所得屈光度之间两两比较,差异均有统计学意义 （均为P＜0.05）。结果显示与小瞳验光所得结果相比,复方托吡卡胺散瞳后验光和阿托品散瞳后验光所得屈光度均降低,而阿托品散瞳后验光结果降低更显著。结论　视力下降至0.1～0.3的不同年龄患者可采用小瞳验光。视力下降至0.4～0.6的12岁以上近视患者可采用复方托吡卡胺散瞳后验光。视力下降至0.4～0.6的12岁以下近视患者和视力下降至0.7～0.9的各年龄段患者均需采用阿托品散瞳后验光。     

VX120多功能眼检查仪的客观验光与主观验光结果的一致性分析

目的比较使用VX120多功能眼检查仪检测的客观验光与主观验光结果的一致性。 方法收集2018年3月至2018年4月在首都医科大学附属北京同仁医院就诊拟行屈光矫正术的患者71例(142只眼)。采用CANON全自动验光仪和VX120多功能眼检查仪分别进行客观验光检查,包括球镜光度(S)、柱镜光度(C)、等效球镜光度(SE)、水平和垂直方向的柱镜光度(J0)及45°柱镜光度(J45);再结合综合验光仪进行主观验光检查校正。采用Rosner-Glynn-Lee法对双眼检查数据进行校正,采用配对秩和检验对不同设备的测量值进行组间比较;对无统计学意义的数据再采用组内相关系数和Bland-Altman 95%一致性界限法衡量其一致性。 结果VX120多功能眼检查仪在明视模式和暗视模式下所测S的中位水平分别为-5.63(-7.25,-4.25)和-5.75 (-7.00, -4.25); VX120在明视模式和暗视模式所测C的中位水平分别为-0.75 (-1.50,-0.50)和-0.75 (-1.50,-0.50);VX120在明视模式和暗视模式下所测SE的中位水平分别为-6.19(-8.09,-4.63)和-6.20 (-7.84,-4.53);VX120在明视模式和暗视模式下所测J0的中位水平分别为-0.02(-0.22,0.21)和0.03(-0.15,0.30);VX120在明视和暗视模式下所测J45的中位水平分别为0.04(-0.22,0.34)和0.04(-0.22,0.34)。主观验光所测S的中位数为-5.50(-7.00,-4.25),C的中位数为-0.50 (-1.00,-0.25),SE的中位数为-6.02 (-7.50, -4.50),J0的中位数为0.00 (-0.21,0.10),J45的中位数为0.00 (-0.21,0.10)。CANON全自动验光仪所测S的中位水平为-5.62 (-7.37,-4.50),C的中位水平为-0.62 (-1.12,0.00),J0的中位水平为0.00(-0.20,0.03),J45的中位水平为0.00(-0.10, 0.08)。主观验光与VX120在明视模式下验光所测的J0和J45,差异无统计学意义(Z＝-0.11,1.64;P>0.05)。两者所测J0和J45的组内相关系数分别为0.92(95%CI＝0.88,0.96)和0.93(95%CI＝0.89,0.97),一致性较好。Bland-Altman 95%一致性分析显示,数据点多分布在95%可信区间内,两者一致性较好。主观验光与VX120在暗视模式验光所测的S和J45,差异无统计学意义(Z＝1.71,-0.24;P>0.05);两者所测的S和J45的组内相关系数分别为0.99(95%CI＝0.98, 1.00)和0.90 (95%CI＝0.86,0.94),一致性较好。Bland-Altman 95%一致性分析显示,数据点多分布在95%可信区间内,两者一致性较好。 结论VX120多功能眼检查仪在暗视模式和明视模式下检测的客观验光结果与主观验光结果的差异在临床可接受范围内,且可为主观验光提供参考依据。     

Merton C. Flom, OD, PhD--a paradigm of optometric leadership.

Dr. Merton Flom serves as the quintessential model for demonstrating what it takes to be an outstanding scientist, clinician, and educator. Professor Flom's career as a clinician, vision scientist, and visionary in optometry is well known to most faculty in optometric institutions, but many in the profession may not be aware of his enormous contributions. This profile captures Dr. Flom's professional and personal views about optometry, vision research, and education.     

Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding.

BACKGROUND: A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. METHODS: The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. RESULTS: Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. CONCLUSIONS: Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.     

An interdisciplinary course for optometry students specializing in vision training.

The practice of primary-care optometry often necessitates interaction with professionals from varied backgrounds. This is especially true in the area of vision training, in which close coordination between professionals in schools, agencies, and clinics is necessary. Too often a communcation problem prevents beneficial interdisciplinary liaison. One way of ensuring that optometrists acquire communication and interaction skills is to provide seminars and courses in schools and colleges of optometry. The program described in this paper has helped optometry students refine their communication and referral skills.     

World optometry: the challenges of leadership for the new millennium.

The World Council of Optometry has developed a mission and organizational strategies to improve the delivery of eye and vision care around the world, as well as to advance the profession of optometry. Its growth over the past several years is a tribute to the early pioneers in international optometry who unselfishly volunteered their time and expertise to improving the profession and eye and vision care. It also underscores the continued spirit of global volunteerism that energizes the recent leaders who have sustained this growth. Over the past decades, optometry has seen the steady growth of its educational infrastructure, scope of practice, and professional image. It has faced adversity and seized opportunities. Throughout, the overarching raison d'être has been optometry's responsiveness to the public health needs of society. The future growth of optometry within the global health community will depend on expanding this professional growth at an international level, and forging durable strategic alliances that address the significant prevention of blindness imperatives of our generation.     

A comprehensive eye/vision program

As an essential element of the comprehensive rehabilitation efforts at Northport VA Medical Center, and as a service whose demand is projected to increase substantially with the expanding proportion of aging veterans, eye/vision care has become increasingly important. As a result, the administration of the Medical Center decided to heed the suggestions of Congress and the Director of Optometry in VA Central Office and reorganize the delivery of eye/vision services so the ever-increasing demand could be met more rationally, efficiently and effectively. In this paper, the Northport VA Medical Center's Comprehensive Eye/Vision Program, including the residency program in rehabilitative optometry, will be described and the benefits of the reorganization will be discussed.     

Citation patterns in the optometric and ophthalmologic clinical binocular vision literature.

PURPOSE: The purpose of this study is to compare citation patterns in the clinical binocular vision literature of optometry and ophthalmology. METHODS: The author conducted citation analysis of two current clinical binocular vision textbooks from optometry and two from ophthalmology and of articles published in the years 2000 to 2004 in optometry and ophthalmology journals. Topical parameters for inclusion of sources were diagnosis and management of nonstrabismic binocular vision disorders, diagnosis and management of nonpresbyopic ocular accommodation disorders, and procedures for examining such conditions. These topical parameters were chosen because they are areas in which the diagnostic procedures and treatment options available to members of the two professions are not delineated by their respective scopes of practice. RESULTS: The most frequently cited journals in the optometric publications were optometry journals (63% of citations in the optometry textbooks and 58% in the optometry journal articles). The most frequently cited journals in the ophthalmology publications were ophthalmology journals (79% of citations in the ophthalmology textbooks and 49% in the ophthalmology journal articles). Each discipline also cited a greater variety of journals from within its own field than was cited by the other discipline. The journal with the highest total number of citations was Optometry and Vision Science (280) followed by Ophthalmic and Physiological Optics (73), American Journal of Ophthalmology (68), Investigative Ophthalmology and Visual Science (62), and Optometry (61). CONCLUSIONS: Optometry and ophthalmology sources show more citations to materials from their own discipline than from their fellow discipline in the area of nonstrabismic binocular vision disorders and nonpresbyopic accommodative disorders. Reasons may include lack of awareness of the literature of the other discipline, bias toward the literature of one's own discipline, or bias against the literature of another discipline. It is also likely that the diagnostic and management strategies of the two professions are significantly different, although scope of practice would not constrain the range of strategies for the conditions chosen as the topical matter for consideration in this study. The journals found to be most frequently cited in this study should help to identify the core journals in this area of clinical binocular vision.     

Optometry residency in low vision rehabilitation: a cooperative program

A cooperative Optometry Residency in Low Vision Rehabilitation has been established by the Optometry Sections at Hines Veterans Administration Hospital, Westside Veterans Administration Medical Center and the Illinois College of Optometry. The objective of this program is to train optometrists to function within, develop and direct clinical low vision programs in multidisciplinary settings. This optometry residency is unique in that it provides experience in delivering clinical low vision services in both inpatient and outpatient settings for patients of all ages during all stages of the clinical course of their disease, treatment and rehabilitation. Clinical rotations include the Optometry Section at the Central Blind Rehabilitation Center, the Chicago VICTORS Program, the Low Vision Clinic and affiliated Low Vision Clinics of the Illinois College of Optometry.     

可调节度数眼镜验光与传统验光法在社区老年人眼保健中的应用比较

背景 中国老年人屈光不正矫正需求巨大,亟待寻求适宜的新型屈光不正矫正技术. 目的 探讨可调节度数眼镜作为验光和矫正视力的方法应用于社区老年人初级眼保健筛查的可行性. 方法 采取前瞻性横断面研究方法,在上海市普陀区白玉社区6个居委会55岁以上老年人初级眼保健筛查现场用ETDRS LogMAR视力表检查视力,纳入任一眼日常生活视力＜0.5的受检者作为调查对象,进行自主可调节度数眼镜（Eyejusters眼镜）验光和矫正视力检查,并由专业视光医师行传统电脑自动验光和主觉验光法矫正视力,与Eyejusters眼镜验光和矫正视力结果进行比较.对纳入的受检者进行眼科检查,确定影响视力的原因;对自主调节验光矫正视力低于主觉验光最佳矫正视力（BCVA）2行及以上的影响因素进行分析.结果 参加社区日常生活视力检查者727人,日常生活视力任一眼＜0.5者338人,其中自愿验光者294人,占87.0％,平均年龄（70.4±177;8.6）岁,女性占64.3％.日常生活视力较好眼≥0.5者145人,占49.3％,经自主调节验光和主觉验光矫正视力后,人数分别增至230人（占78.2％）和258人（占87.8％）.日常生活视力＜0.5的443眼中,自主调节验光矫正视力≥主觉验光矫正视力的眼数为233眼（占52.6％）,低于1行的眼数为82眼（占18.5％）,低于2行及以上的眼数为128眼（占28.9％）.Logistic回归分析发现,自主调节验光矫正视力低于主觉验光2行及以上的影响因素为相对高的球镜和柱镜度数的绝对值,OR值分别为1.11 （95％ CI：1.02 ～1.20）和1.34（95％ CI：1.02 ～ 1.77）.自主调节验光矫正视力作为视力损伤判定指标的受试者工作特征（ROC）曲线下面积为0.941 （95％ CI：0.907 ～0.965）,最佳阳性界值为＜0.5,灵敏度为94.4％ （95％ CI：81.3％ ～99.2％）,特异度为88.4％ （95％ CI：83.8％ ～92.0％）.在自主可调节眼镜屈光范围内（自动电脑验光SE为-5.50～＋4.50 D）自主调节验光与主觉验光所得SE的Spearman相关系数为0.68（95％CI：0.59～0.76）,Bland-Altman分析发现,两者95％一致性界限为-3.4～＋2.6 D,相差幅度±0.50 D以内者占18.1％,相差±1.00 D以内者占47.0％,相差在±1.50D以内者占68.5％. 结论 老年人采用可调节度数眼镜矫正视力的结果可作为定性判定未矫正屈光不正简便、易行的指标,但可调节度数眼镜尚不宜作为验光工具定量检测屈光度.     

Vision care benefits and optometric services in HMOs

General eye care, although not a required basic health service of federally qualified health maintenance organizations (HMOs), is being offered in virtually all HMOs. Reasons for including vision care benefits and optometric services are presented. Data from the Group Health Association of America and the Department of Health and Human Services demonstrates that HMOs are in fact providing vision care benefits and optometric services. The growth of the independent practice association (IPA) model is significant for optometry as it threatens to limit the scope of optometric practice. New professional problems arise as participating optometrists are constrained from performing the full range of optometric services. In recent years optometry has expanded its scope of licensure and practice to incorporate both diagnostic and therapeutic drugs in its management of visual problems. Managed care and alternate delivery systems, however, may restrict the advances that optometry has made in the legislative arena.     

Optometric education in Nigeria

A 3-year optometry program was established at the University of Benin, Nigeria in 1973. The program is considered from the standpoint of curriculum, faculty, clinical instruction, and grading. Some background is given about Nigeria itself. Present eye care facilities are reviewed as well as the increasing requirements of a developing nation. The need of strong support from established optometry schools is indicated.     

The evolution of optometric education in America.

BACKGROUND: The first American optometry law was passed in Minnesota 100 years ago. That law--and the others that followed--determined the minimal educational requirements to practice optometry. Legislating the practice of optometry was the first step in changing optometric education, from a short course in refraction to an accredited university program. As the practice of optometry has changed and evolved over the past 100 years, so has the optometry school education. PURPOSE: This article chronicles the changes that have occurred in optometric education during this evolutionary period.     

视觉健康管理背景下眼视光教育的探索与实践

世界卫生组织及我国"健康中国"战略都将视觉健康管理提升到前所未有的高度,多方位、全周期保障民众视觉健康,增强人们视觉保健的意识是我国实现健康中国的战略重点.而人才培养是行业发展的命脉与基石,因此眼视光人才教育的探索与建设又是重中之重.本文以天津医科大学眼视光专业为例,就当今社会视觉健康管理的背景下,如何切实有效地开展眼...     

学龄前儿童电脑验光和检影验光的对比研究

目的:比较电脑验光和检影验光在学龄前儿童客观屈光检查中的应用价值。方法:门诊屈光不正的学龄前儿童98例196眼,年龄3～6岁,使用10g/L阿托品眼膏涂眼,2次/d,连用4d,第5d停药后分别使用电脑验光和检影验光,结果进行统计学分析比较。结果:比较电脑验光和检影验光的结果显示远视球镜均值电脑验光法(2.70±2.75D)所测结果低于检影验光法(2.99±2.09D),行配对t检验,两种方法结果比较差异有统计学意义(P<0.05);近视球镜均值电脑验光法(-2.74±1.25D)所测结果高于检影验光法(-2.35±2.18D),结果比较差异有统计学意义(P<0.05);散光轴向两种方法比较差异无统计学意义(P>0.05),而散光度数值均值比较差异有统计学意义(P<0.05)。结论:电脑验光和检影验光法在学龄前儿童散瞳验光应用中各有利弊,临床工作中需结合使用。     

Improvements in performance following optometric vision therapy in a child with dyspraxia

SS, an 8-year-old boy with dyspraxia, presented for behavioural optometry assessment. He had been diagnosed with a subtle form of dyspraxia by his paediatric occupational therapist, based on poor proprioception, delayed bilateral integration and poor visual perception. A full visual assessment was carried out. SS was given a programme of reflex inhibition exercises for 3 months. Then, a programme of optometric vision therapy (OVT) exercises was prescribed at home and in practice for a period of 8 months. SS was assessed using a battery of occupational therapy Sensory Integration and Praxis Tests (SIPT) before optometric intervention, and after OVT. There were significant improvements in fusional reserves, accommodative facility and oculomotor control of pursuit and saccadic eye movements. His reading level had changed by 4 years in 11 months. The SIPT results showed improvements in the visual and motor/visual perception subtests, confirming the significant changes in visual perceptual performance. Consideration is given to treatment modalities for dyspraxia, and the studies confirming their effectivity of approach. This case study provides evidence supporting the use of OVT eye exercises in dyspraxia, ocular motility, accommodative dysfunction, learning difficulties and sports performance. The need for further research and inter-professional working is discussed.