Entry-level competency standards for optometry 2022.

The Entry-level Competency Standards for Optometry in Australia identify the required knowledge, skills and attributes for an optometrist to practise safely and competently. The 2022 competencies are the sixth generation of entry-level competency standards. To ensure the standards reflect contemporary practice and the expectations placed on optometrists, a full revision of the standards was commenced in late 2019. A steering committee was appointed by Optometry Australia to oversee the development of the Entry-level Competency Standards for Optometry. The development was informed by a review of best-practice design for health professional competency standards undertaken by Paul Hager on behalf of the Optometry Council of Australia and New Zealand (OCANZ) in 2019. To identify the changes required, workshops were held with optometrists and representatives from stakeholder organisations leading to the formation of draft Entry-level Competency Standards for Optometry in early 2020. The impacts of the COVID-19 pandemic meant development halted in March 2020, and resumed in late 2021. Consultation on the Entry-Level Competency Standards for Optometry 2022 was undertaken in two rounds with the first being targeted stakeholder consultation, followed by public consultation. Following consultation, feedback was considered by the steering committee and amendments were made to produce the final Entry-level Competency Standards for Optometry 2022. This document outlines the development process and the major changes in the updated standards. The major changes include a redesigning of the Domains, a reduction in the level of detail and a strengthening of the expectations around cultural responsiveness and culturally safe care. The revised standards capture the current entry requirements for the optometric profession as of 2022. The updated Entry-level Competency Standards for Optometry 2022 were endorsed by the national board of Optometry Australia and accepted by the Optometry Board of Australia in February 2023.

Infection control guidelines for optometrists 2016.

BACKGROUND: This paper provides an updated version of the paper: Infection control guidelines for optometrists 2007. METHODS: Information from peer-reviewed journal articles, guidelines from professional societies, and government health department and other websites and instructions from equipment manufacturers were considered in determining infection risk factors in optometric practice. They were used to revise the recommendations on disinfection, sterilisation and reprocessing procedures for instrumentation and other equipment used in optometric practice as well as personal infection control measures to be undertaken by staff. RESULTS AND CONCLUSIONS: Optometrists and optometric practice staff should adopt measures to minimise the risk of transmission of infection. These include appropriate hand-washing, staff vaccinations, single use instruments/equipment, appropriate disposal of waste, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for individuals who are known to be infected or immuno-suppressed. Information provided to patients regarding infection control procedures in topical drug administration, contact lens wear and use of eye make-up are additional considerations for optometrists.

Optometry Australia Scope of Practice Survey 2015.

BACKGROUND: This paper presents results from the inaugural Scope of Practice Survey of Optometry Australia members conducted in October 2015. The survey gathered information related to confidence in detecting and diagnosing key ocular conditions, grading diabetic retinopathy, prescribing scheduled medicines, access to equipment, confidence using equipment, incidence of patients requiring therapeutic management, referral practices and services provided. METHODS: The survey was developed, piloted, modified and administered to members of Optometry Australia (excluding student and retired members), who had a current email address. Results were collated and analysed using Microsoft Excel. RESULTS: Of the 587 optometrists in clinical practice who responded, 254 (43 per cent) had therapeutic endorsement of registration. The majority of respondents practised in a major city or surrounding suburbs (63 per cent). Independent practice was the most frequently cited practice type (58 per cent). The estimated average number of patients seen in a week was 48; there was a steady decrease in the number of patients per week with increasing age, from 53 for optometrists in their 20s to 27 for optometrists aged over 70. There was very high confidence (over 93 per cent) in ability to grade diabetic retinopathy and diagnose a range of ocular conditions. Confidence in performance of more advanced techniques was higher for endorsed than non-endorsed optometrists. Approximately 12 per cent of patients required a Schedule 4 therapeutic prescription. The most frequently recommended over-the-counter medications were for dry eye for both endorsed and non-endorsed optometrists. The most frequently prescribed Schedule 4 medications were anti-inflammatories. The most challenging conditions to prescribe for were glaucoma, microbial keratitis and uveitis. Approximately one in six therapeutically endorsed optometrists reported unexpected side effects of medications they had prescribed. CONCLUSION: Information from the survey will guide Optometry Australia in the design of continuing professional development programs and other materials.

Optometric supply and demand in Australia: 2011-2036.

BACKGROUND: The effective size of the optometric workforce is dependent on graduate numbers, retention rates and immigration and is influenced by age, gender and working hours of optometrists. This paper presents modelling results of the relationship between the projected Australian optometric workforce and projected demand for optometric services for the period 2011 to 2036. Nine hypothetical optometric supply-side and demand-side scenarios are presented. METHODS: Data from the Australian Bureau of Statistics on age and gender of people listing optometry as their major qualification in the 2011 census were projected over a 25-year period, accounting for factors such as concordance with Health Workforce Australia figures for registered optometrists in Australia in 2011, ageing, attrition, hours worked, new graduates and immigration. Data were compared to the numbers of optometrists calculated as necessary to meet the demand for services of the Australian population to 2036 using nine different scenarios. RESULTS: It was estimated that there would be a surplus of over 1,200 equivalent full-time optometrists (EFTO) in 2036 for the highest service demand scenario of 13.8 million Medicare services, where 21 hours of a 38-hour week per EFTO were allowed for the provision of optometric services under Medicare. Substantial surpluses were predicted in all states and territories except Queensland, Tasmania and the Northern Territory where predicted supply was within six EFTO of predicted demand. CONCLUSIONS: Projections using current weightings for mortality, attrition, proportion of optometrists in active practice, working hours, immigration, new graduates and 21 hours per EFTO per week available for Medicare services indicate that in 2036, there will be excess optometrists in relation to projected demand for services, if service utilisation is maintained at current levels or increased by 10 or 20 per cent. Substantially greater excesses result if each EFTO has 28 or 35 hours per week available for Medicare services.

Optometry Australia Entry-level Competency Standards for Optometry 2014.

BACKGROUND: Competency standards for entry-level to the profession of optometry in Australia were first developed in 1993, revised in 1997 and 2000, and again in 2008, when therapeutic competency standards were introduced but differentiated from the entry-level competencies. Therapeutic competencies were an additional requirement for the purpose of endorsing optometric registration to allow prescription of medicines for conditions of the eye. Recent changes to educational and registration requirements mean that therapeutic competencies are now required at entry-level. To address this and to ensure the standards reflect current best practice, a full revision of the standards was undertaken. METHODS: A steering committee oversaw the review of the standards, which involved a literature review, workshops with optometrists and broad consultation with stakeholders, including the Optometry Board of Australia, individual optometrists and employers of optometrists, to identify changes needed. Representatives of the profession from Australia and New Zealand and from academia in Australia were involved. A modified document based on the feedback received was circulated to the State Divisions and the National Board of the then Optometrists Association Australia. RESULTS: The updated standards reflect the state of entry to the optometric profession in 2014; competencies for prescribing of scheduled medicines are included, new material has been added, other areas have been modified. The updated entry-level competency standards were adopted on behalf of the profession by the National Board of the then Optometrists Association Australia in March 2014. DISCUSSION: Competency standards have been updated so that they continue to be current and useful for the profession, individual optometrists and Australian and New Zealand registration authorities for the purposes of accreditation of optometric programs and assessment of overseas-trained optometrists. This paper details the revision process and presents the 2014 version of competency standards for entry-level to the profession of optometry in Australia.

Optometric practice in Australian Standard Geographical Classification--Remoteness Areas in Australia, 2010.

BACKGROUND: This paper assesses the distribution of the optometric workforce and population per equivalent full-time optometrist (EFTO) across the five Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA) categories in the states and territories of Australia. METHODS: Data from the database of Optometrists Association Australia on the addresses of primary, secondary and visiting practices and the number of hours worked by optometrists were used to determine the number of EFTOs in each ASGC-RA category in the states and territories. Population to EFTO ratios were calculated for each ASGC-RA by using population data for 2009 and 2010 from the Australian Bureau of Statistics. RESULTS: In the major cities (RA1), the proportion of optometric practitioners was greater than the corresponding proportion of the Australian population. The numbers of optometrists in the inner and outer regional areas (RA2 and RA3, respectively) were calculated as sufficient to provide an initial consultation to the corresponding populations every four to five years, while in the remote and very remote regions (RA4 and RA5, respectively), the numbers of optometrists were calculated as sufficient to provide an initial consultation once every nine or more years. CONCLUSIONS: The number of optometrists in practice in Australia is sufficient to meet the needs of the Australian population overall. The issue of the provision of optometric care in remote and very remote regions of Australia is unlikely to be addressed by increasing the number of optometrists as the sparse populations and the large areas over which these populations are spread are unlikely to be able to sustain optometric practices. This means that new service-delivery models could be necessary for the provision of optometric services in these regions.

The Australian optometric workforce 2009.

BACKGROUND: This paper presents the findings of the Optometrists Association Australia 2009 optometric workforce study. METHODS: Data from the Association's database, the Australian Bureau of Statistics, Medicare Australia and the Department of Veterans Affairs were applied to create a profile of the optometric workforce in Australia, including the number of optometrists in clinical practice, the number of equivalent full-time optometrists (EFTOs), population to optometrist ratios and workloads in the states and territories and Australia overall. RESULTS: In July 2009, 3,719 (87.4 per cent) of the 4,255 optometrists registered to practise in Australia were in clinical practice. Adjusting for the number of hours worked, there were 3,664 EFTOs. The ratio of population to EFTO was 5,944:1 overall. Ratios were higher in the states without schools of optometry (South Australia 8,631:1, Western Australia 7,687:1, Tasmania 7,615:1, Australian Capital Territory 7,635:1) and highest in the remote and lightly populated Northern Territory (9,367). The ratios were fewer than 6,200 people per EFTO in states with optometry schools: New South Wales (5,247), Queensland (5,723) and Victoria (6,126). Women comprised 45.3 per cent of the profession, while 45 per cent of the profession was aged under 40 years. The majority of the female (80.7 per cent) and male (60.7 per cent) optometrists were aged under 50 years. On average male and female optometrists worked 40.3 and 32.9 hours per week, respectively. The average time per week spent on Medicare and Veterans Affairs consultations was estimated to be 22.2 hours, varying from 20.1 hours in NSW to 30.6 hours in SA. CONCLUSIONS: Population to optometrist ratios indicate that the number of optometrists in 2009 was more than adequate to meet the needs of the community. Further analysis is needed to determine whether the supply of optometrists meets community needs at more local levels.

Influenza A(H1N1) and infection control guidelines for optometrists.

The emergence of a novel influenza A virus (Influenza A[H1N1]), which has not circulated previously in humans, has led to the first global influenza pandemic in 41 years. Influenza A(H1N1), commonly called 'swine flu', is a novel influenza virus made up of porcine, avian and human genes, and preferentially infects younger people. Although Influenza A(H1N1) does not appear to be likely to cause as many fatalities as previous influenza pandemics, attempts to contain it are necessary because people whose health is already compromised through underlying chronic medical conditions are at risk of death if they contract the virus. In addition, pregnant women who become infected are at increased risk of complications. This paper provides figures on the number of cases of Influenza A(H1N1) and deaths associated with this virus in Australia (using World Health Organization and Australian Government figures) and discusses infection control measures that optometrists should put in place for themselves, their staff and their patients, in the event that there is suspicion of Influenza A(H1N1) infection. Measures include isolating those who display symptoms indicative of influenza, use of surgical masks (P2 [N95]) by the infected person, frequent hand-washing, appropriate cough and sneeze etiquette, disposal of used tissues and rescheduling of non-urgent appointments for those thought to be infected. Any staff members who need to be closer than one metre to the infected person should also use personal protective equipment (for example, surgical masks, goggles or safety spectacles, gowns and gloves). The current evidence indicates that Influenza A(H1N1) should be treated by optometrists as another type of flu. As with other forms of influenza, following basic infection control guidelines will help reduce the spread of infection in optometric practices and within the community.

Optometrists Association Australia Universal (entry-level) and Therapeutic Competency Standards for Optometry 2008.

BACKGROUND: Competency standards for entry-level to the profession of optometry in Australia were first developed in 1993, revised in 1997 and expanded in 2000 to include therapeutic competency standards. The entry-level standards cover the competencies required by a person entering the profession without therapeutic endorsement of their registration. The therapeutic competency standards address the additional competencies required for therapeutic endorsement of registration. This paper presents a revised version of the universal (entry-level) and therapeutic competency standards for the profession of optometry in Australia in 2008. METHODS: Expert members of the profession and representatives from schools of optometry, registration boards in Australia, state divisions of Optometrists Association Australia and the New Zealand Association of Optometrists were consulted in the process of updating the standards. RESULTS: Three new elements of competency have been added to the standards. Twenty-three new performance criteria with associated indicators have been added. Some performance criteria from the earlier document have been combined. Substantial alterations were made to the presentation of indicators throughout the document. The updated entry-level (universal) and therapeutic competency standards were adopted on behalf of the profession by the National Council of Optometrists Association Australia in November 2008. DISCUSSION: Competency standards are used by Australian and New Zealand registration authorities for the purposes of registration and therapeutic endorsement of registration via the Optometry Council of Australia and New Zealand accreditation and assessment processes. They have also been used as the basis of the World Council of Optometry Global Competency-Based Model.

Optometric supply and demand in Australia: 2001-2031.

BACKGROUND: Major influences on health workforce supply include factors such as graduate numbers, retention rates and immigration. This report presents a model of the relationship of the projected Australian optometric workforce and projected optometric service demand for the period 2001 to 2031. Two contrasting hypothetical optometric supply-side scenarios are presented. METHODS: Data from the Australian Bureau of Statistics on age and gender of people listing optometry as their major qualification in the 2001 census were projected over a 30-year period, accounting for factors such as ageing, attrition, new graduates and migration. Data were compared to the numbers of optometrists calculated as necessary to meet the demand for services of the Australian population to 2031. RESULTS: The projections indicated that in 2031, there would be 4,072 equivalent full-time optometrists, an excess of 6.9 per cent compared with demand and that of these 38 per cent would be female. Application of a 'high' growth scenario, based on increases in the proportion of optometrists in active practice, working hours by females and graduate and immigrant numbers, resulted in a projected oversupply of up to 30 per cent. Use of a 'low' growth scenario, based on decreases in the proportion of optometrists in active practice, working hours, graduate and immigrant numbers, resulted in a projected undersupply of at least 21.5 per cent. CONCLUSIONS: Projected numbers of optometrists using current weightings for mortality, attrition, proportion of optometrists in active practice, working hours, immigration and new graduates indicate that in 2031, there will be adequate numbers of optometrists to meet the demand for services, if service utilisation is maintained at current levels or increased slightly. The adequacy of projected numbers varies considerably if alterations are made to the weighting factors using 'high' and 'low' growth scenarios.

The mobility of optometrists practising in Australia in 2005: do optometry graduates move to states without schools of optometry?

BACKGROUND: Three schools of optometry in the eastern states of Australia provide optometrists for the entire country. Concerns have been expressed about attracting optometrists to practise in the other states. This paper analyses the source of optometric qualification of optometrists practising in each state, to assess the proportion who have chosen to practise in a state different from that in which they qualified and to determine whether there are gender differences in preparedness to move to a different state. METHOD: Data on year and school of qualification, primary professional activity and current state or territory of practice were extracted from the Optometrists Association Australia database to determine a profile of place of qualification of optometrists in each state or territory of Australia in 2005. RESULTS: More than 77 per cent of practising optometrists from Australian schools practised in the state where they graduated. The majority of optometrists for the Australian Capital Territory (ACT), South Australia (SA) and Western Australia (WA) were New South Wales graduates; the majority of Tasmanian optometrists were Victorian graduates. Optometrists from overseas accounted for 17.3, 24.6 and 19.9 per cent of optometrists in practice in SA, Tasmania and WA, respectively, but less than 7.5 per cent elsewhere. The highest number of optometrists who had qualified outside Australia practised in NSW. Female graduates from 2000 and later were more likely to move interstate than their male counterparts. DISCUSSION: Approximately 14 per cent of practising optometry graduates practised in states without schools, where 21 per cent of the population resided. This indicates some degree of mobility but the market needs to work further to match supply of optometric services to demand at state level. Further analysis is necessary to determine patterns of graduate movement in the years following graduation, to determine whether movement to different states is short- or long-term.

Threshold recognition of phantom-contour objects requires constant contrast velocity.

Recognition of phantom objects--those with contours defined by rapid contrast reversal of adjacent fields of dark and light random dots--was investigated under conditions of abrupt or ramped onset and offset. Discrimination contrast thresholds were determined for a random-dot phantom letter in four possible orientations. For abrupt onset or offset, thresholds were almost independent of the duration of presentation time, over a range that varied tenfold, from 34-340 msec. However, when the onset and offset were shaped by a triangular envelope, thresholds were raised, so that form blindness occurred even when peak d ot contrasts exceeded 60%. Also under ramped onset and offset conditions, threshold contrast varied strictly linearly with stimulus duration in all subjects, suggesting a new construct--contrast velocity, the rate of change of contrast critical for phantom-object recognition.

Infection control guidelines for optometrists 2007.

Information from peer-reviewed articles, guidelines from professional societies and manufacturers' instructions were considered to determine the risk factors in optometric practice and to make recommendations for disinfection, sterilisation and reprocessing of instrumentation and other equipment used in practice and measures for personal protection. Wherever possible, all practitioners should adopt measures to decrease the risk of transmission of infection, such as single use instruments/equipment, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for infected or immuno-suppressed individuals.

The Australian optometric workforce 2005, analysed by local government areas.

BACKGROUND: Previous studies of the Australian optometric workforce have taken a coarse view of the distribution of optometrists, at best comparing concentrations of optometrists in city and country areas and between states and territories. A more discriminating approach recognising the size and variation in population density of the country is necessary for a more realistic insight into the optometric workforce. This study addresses the distribution of optometrists across smaller geographic units, known as local government areas (LGAs). METHODS: The number of equivalent full-time optometrists in each Australian LGA was determined using data from the Optometrists Association Australia database. Data from the Australian Bureau of Statistics and the Australian national health program (Medicare) were applied to determine the demand for services based on age distributions in LGAs and to calculate the adequacy of the number of optometrists. RESULTS: Optometrists are concentrated in areas of high population with capital city regions and their surrounds well-serviced but with rural and remote LGAs with low populations generally not having optometrists. The highest excesses of optometrists occur in the capital city LGAs of Melbourne, Sydney and Adelaide (64, 60 and 28.4 equivalent full-time optometrists respectively). The highest deficits occur in Casey (Victoria), Lake Macquarie (New South Wales) and Onkaparinga (South Australia), (-16.4, -15.6 and -13.4 equivalent full-time optometrists, respectively). CONCLUSIONS: There are substantial variations in the distribution of optometrists across LGAs in Australia but the variation is often a poor indicator of the ease with which people can access optometric services. In metropolitan areas, people may live close to an optometric practice in a neighbouring LGA. In rural areas, an LGA may appear to have an adequate number of optometrists but some residents may be several hours from the nearest optometrist or the optometric service is provided on a part-time basis.

Monocular and binocular thresholds for abruptly and gradually presented illusory contours.

BACKGROUND: In this study, monocular thresholds and binocular summation for abrupt onset/offset versus gradually revealed phantom letter E (illusory contours) stimuli are compared to determine the suitability of these stimuli for assessment of the integrity of two of the major retinal streams: the magnocellular and the parvocellular pathways. Such tests are important in progressive retinal disease where disease severity may differ between the classes of retinal ganglion cells and between the two eyes. Abrupt onset phantom contours have long been considered to activate the magnocellular visual pathway and we propose that gradually revealed high contrast ramped onset/offset stimuli are more likely to promote the more sustained processing of the parvocellular stream. METHODS: Contrast discrimination thresholds for monocular and binocular viewing were compared in a counter-balanced order in 70 young normal subjects, using tests of contrast threshold for a flicker-defined letter E produced by alternation of light and dark dots. Three onset/offset conditions were used - abrupt onset that was maintained for 34 milliseconds (four frames of 8.5 milliseconds) then discontinued, ramped onset over 34 milliseconds (four frames) with offset over 34 milliseconds and ramped onset over 85 milliseconds (10 frames) with offset over 85 milliseconds. RESULTS: Contrast thresholds for identification of the orientation of the E, when presented with four frames ramped onset and offset when compared to the four frames abrupt onset/offset were three times higher, irrespective of monocular or binocular viewing conditions. Threshold contrasts were seven times higher when the 10 frames ramped onset/offset stimuli were compared to abrupt four frames onset/offset. Binocular contrast thresholds were reduced by approximately 40 per cent compared to monocular thresholds for all conditions. The binocular increase in contrast sensitivity is approximately equal for abrupt transiently presented stimuli and for gradually presented more sustained stimuli. DISCUSSION: The results indicate that the same mechanisms of monocular processing and binocular summation are used for identification of a flickering contrast-defined phantom contour under presentation conditions, which are characteristic of the temporal and contrast preferences of the primate magnocellular and parvocellular visual pathways. This suggests that the phantom contour E test may be useful for clinical differentiation of the integrity of the M and P retinal ganglion-derived visual pathways, regardless of whether it is applied monocularly or binocularly.

Parietal function in good and poor readers.

BACKGROUND: While there are many psychophysical reports of impaired magnocellular pathway function in developmental dyslexia (DD), few have investigated parietal function, the major projection of this pathway, in good and poor readers closely matched for nonverbal intelligence. In view of new feedforward-feedback theories of visual processing, impaired magnocellular function raises the question of whether all visually-driven functions or only those associated with parietal cortex functions are equally impaired and if so, whether parietal performance is more closely related to general ability levels than reading ability. METHODS: Reading accuracy and performance on psychophysical tasks purported to selectively activate parietal cortex such as motion sensitivity, attentional tracking, and spatial localization was compared in 17 children with DD, 16 younger reading-age matched (RA) control children, and 46 good readers of similar chronological-age (CA) divided into CA-HighIQ and a CA-LowIQ matched to DD group nonverbal IQ. RESULTS: In the age-matched groups no significant differences were found between DD and CA controls on any of the tasks relating to parietal function, although performance of the DD group and their nonverbal IQ scores was always lower. As expected, CA and RA group comparisons indicated purported parietal functioning improves with age. No difference in performance was seen on any of the parietally driven tasks between the DD and age-nonverbal IQ matched groups, whereas performance differentiated the DD group from the age-matched, higher nonverbal IQ group on several such tasks. An unexpected statistical difference in performance between lower reading age (DD and RA children) and all higher reading age (CA) children was seen on a test of chromatic sensitivity, whereas when high and low nonverbal IQ normal readers were compared performance was not different CONCLUSION: The results indicate that performance on purported parietal functions improves with age and may be more associated with nonverbal mentation than reading accuracy. Performance on a cognitively demanding task, traditionally considered to rely on ventral stream functions, was more related to reading accuracy.

The Australian optometric workforce 2005.

BACKGROUND: This paper presents the findings of the Optometrists Association Australia 2005 optometric workforce study. METHODS: Data from the association's database, the Australian Bureau of Statistics, Medicare and the Department of Veterans Affairs were applied to create a profile of the optometric workforce in Australia, including the number of equivalent full-time optometrists (EFTOs), population to optometrist ratios and workloads. RESULTS: In February 2005, 2,866 (76.7 per cent) of the 3,738 optometrists registered to practise in Australia were in clinical practice. Adjusting for the number of hours worked, there were 2,712 EFTOs in Australia. The ratio of population to EFTO for Australia was 7,016. Ratios were higher in the states without schools of optometry (South Australia 9,413, Western Australia 8,810 and Tasmania 8,172) and in the remote and lightly populated Northern Territory (10,521). The lowest ratio was in New South Wales (6,053). The proportion of women in clinical practice has gradually increased since 1977 and was slightly more than 41 per cent in 2005. The percentage of the profession under the age of 40 years was 48.6. The percentages of female and male optometrists under the age of 50 were 89.3 and 72.5, respectively. On average, female optometrists worked approximately 82 per cent of the hours worked by male optometrists. The average time per week spent on Medicare and Veterans Affairs consultations was 25.8 hours. CONCLUSIONS: The profession of optometry in Australia is undergoing considerable change in age and gender make-up. In 2005, the number of optometrists was adequate for the needs of the Australian population. Further analysis is needed to determine whether the supply of optometrists meets community needs at local levels.

Changes in ocular accommodation when shifting between global and local attention.

BACKGROUND: The link between cognitive changes in attentional focus and the physiological parameters of the eye is not well understood. The aim of the current work was to examine the role of ocular accommodation, that is, the process of changing the shape of the crystalline lens in order to focus an image onto the retina, in active shifts of visual attention between global and local information. METHOD: Ten adult participants (aged 19 to 27) viewed sequences of complex global/local figures presented at the same location. They were asked to identify either a global or local red target letter and to look for either a global or local letter x (probe) in the sequence following. Target and probe items were separated by a temporal gap of approximately one second. Refraction was measured using a Canon Autorefractor R1 at the time of target appearance and again at the time of probe presentation. Particular interest was paid to trials where participants were required to shift attention either from a local to global level or in the reverse direction. The difference between the two measurements of refraction gave a 'change score' which provided an indication of the change of accommodation. RESULTS: No significant change in refraction was observed when shifting from the local to the global condition. A mean change in refraction of -0.128 dioptres was observed for the global to local condition. The 95 per cent confidence interval for this difference did not overlap zero, indicating a significant change in refraction, which was attributed to an increase in accommodation. DISCUSSION: The results suggest that while a change in accommodation occurs in shifting attention from the global to the local aspect of the complex figures, a similar change is not observed in the reverse direction. These results are consistent with the hypothesis that it is more difficult to restrict attentional focus than it is to widen it.

Clinical application of the multifocal visual evoked potential.

BACKGROUND: Measures of visual function thresholds such as visual acuity and visual fields are generally dependent on subjective responses and assume maintenance of fixation, attention and motivation. In the young, elderly, cognitively impaired or malingering populations, such measures may be inaccurate or difficult to obtain. The Visual Evoked Response Imaging System (VERIS) has been claimed to give more objective topographic recordings of retinal and cortical function. This paper aims to explore the adequacy of this technique in four unusual, unrelated, clinically difficult cases. METHODS: Multifocal visual evoked potentials (mfVEPs) recorded on the VERIS System 3.01 are used to assess visual function in four cases with contradictory clinical findings or unreliable subjective responses. RESULTS: Patient 1 had sustained a head injury and had normal ocular and pupil examination but light perception in the right eye and 6/5 acuity in the left. Multifocal VEPs showed a marked depression of the right visual field with little macular response. Patient 2 had sustained a head injury, had a left field hemianopia, possible macular sparing and loss of much of the right field, reduced but variable visual acuities, good near vision and normal ocular fundi. Multifocal VEPs showed a severe depression in both visual fields (L more than R) with little macular response. Patient 3 had a left optic nerve meningioma and experienced great difficulty with visual field assessment. mfVEPs showed a bilateral depression in the superior field particularly the left field, with a larger deficit in the left eye. Patient 4 had unexplained visual acuity and peripheral field deficits. mfVEP results were inconclusive in this case. DISCUSSION: Where there is difficulty performing traditional techniques or conflicting clinical findings, mfVEPs may provide additional objective information to aid in the assessment of patients.

Practice standards for optometry and optometric practice accreditation.

BACKGROUND: To assist optometrists to deliver care more efficiently and effectively, in 1995 Optometrists Association Australia decided to develop standards that would assist optometrists in better managing their practices. Existing practice management standards for health professionals were thought to be either not specific enough for optometric practice or to have shortcomings in the context of optometric practice in Australia. METHODS: Following a literature search, material previously developed by Optometrists Association Australia to assist practitioners with management of their practices and standards from other professions were used to assist with the development of a draft set of standards for optometric practices in Australia. Successive drafts were circulated for comment to optometrists in practice, non-optometrists with experience in the development of practice standards for other health professions and to Australian General Practice Accreditation Limited. The comments were used to refine the standards and the accreditation guidelines to their final form. RESULTS: Optometric Practice Standards suitable for use in a practice accreditation program were developed. The standards comprise seven sections--Practice administration, Quality assurance, Rights and needs of the patient, Practice services, Practice facilities, Communication and Patient records. These sections are divided into criteria that provide the detail of the requirements of the standard. Indicators describing how criteria can be assessed accompany the criteria.