Visual impairment and refractive error in school children in Bhutan: The findings from the Bhutan School Sight Survey (BSSS 2019).

PURPOSE: To estimate the nationwide prevalence of visual impairment and associated refractive error in school children in Bhutan. METHODS: The sample of this prospective cross-sectional national survey comprised of randomly selected classes in levels IV-IX (age 10 to 15 years) from schools throughout Bhutan. The examination included measurement of visual acuity (VA), evaluation of ocular motility, refraction under cycloplegia, examination of the external eye, media and fundus. The principal cause of impairment was determined for eyes with uncorrected VA ≤6/12. The main outcome measures were distance VA and cycloplegic refractive error. RESULTS: With a sampling frame of 1967 class-based clusters from 190 schools, 160 classes in 103 schools were randomly selected; 4985 (98.5%) of 5060 enumerated children were examined. The prevalence of uncorrected, presenting, and best-corrected visual impairment (VA≤6/12) in the better eye was 14.5%, 12.8%, and 0.34%, respectively. Refractive error was the principal cause (94.2%) of impaired vision and 88% of children who could achieve VA ≥6/9 with best correction were without necessary spectacles. The prevalence of myopia (≤ -0.5 D) was 6.64% and was associated with female gender (P = 0.004), urban schooling (P = 0.002), and greater parental education (P<0.001). The prevalence of hyperopia (≥ +2.0 D) was 2.17% and was significantly associated with lower class-level (P = 0.033), and female gender (P = 0.025). The overall prevalence of astigmatism (≥ 0.75 D) was 9.75%. CONCLUSIONS: Reduced vision because of uncorrected refractive error is a public health problem among school-age children in Bhutan. Effective school eye health strategies are needed to eliminate this easily treatable cause of visual impairment.

[Application of disparity discriminating accuracy test in evaluating the stereopsis of postoperative intermittent exotropia].

OBJECTIVE: To discuss the application of disparity discriminating accuracy test in evaluating the stereopsis of postoperative intermittent exotropia. METHODS: Patients with intermittent exotropia who underwent surgery during July 2011 to June 2013 were followed up. The stereoacuity was examined by Titmus Stereotest, Randot Stereotest and Frisby Stereotest. Twenty adult cases whose stereoacuity reached normal were chosen as experimental group. Twenty healthy adults were selected as normal control group. Both groups were examined with disparity discriminating accuracy test. Discriminating accuracy of the two groups were analyzed with Two-Way ANOVA method. Test-retest reliability was analyzed with Intraclass Correlation Coefficient analysis. RESULTS: The test-retest reliability of disparity discriminating accuracy test is excellent (ICC=0.99, P<0.01) . Discriminating accuracy under different disparities in experimental group were 0.56±0.09, 0.67±0.14, 0.77±0.15, 0.82±0.14, 0.85±0.11, 0.85±0.14, 0.87±0.10, 0.84±0.16, while those in control group were 0.77±0.09, 0.88±0.09, 0.93±0.08, 0.91±0.09, 0.95±0.08, 0.96±0.05, 0.97±0.06, 0.96±0.04. There were statistically significant differences between them (F=38.06, P<0.01) . The discriminating ability of group grating in both groups was affected by the size of disparity. Under situation of small disparity, a large difference was found between the experimental group (0.67±0.12)and control group(0.86±0.07) (F=4.84, P<0.05). CONCLUSIONS: Stereoscopic function can be evaluated comprehensively with disparity discriminating accuracy test. Use this test, a certain degree of dysfunction in stereopsis can still be found in postoperative intermittent exotropic patients who reached normal stereoacuity examined with traditional stereotests. (Chin J Ophthalmol, 2016, 52: 584-588).

Prevalência de doenças oculares e causas de comprometimento visual em crianças atendidas em um Centro de Referência em Oftalmologia do centro-oeste do Brasil / Prevalence of eye diseases and refractive errors in children seen at a referral center for ophthalmology in the central-west region, Brazil

Objetivo: Identificar os níveis de comprometimento visual e a prevalência de oftalmopatias e ametropias em crianças atendidas em um centro de referência em oftalmologia do centro-oeste brasileiro. Comparar os achados com dados publicados referentes a outras regiões do Brasil. Métodos: Estudo transversal, descritivo e retrospectivo com análise de prontuários de crianças atendidas no Centro de Referência em Oftalmologia (CEROF) da Universidade Federal de Goiás, no período compreendido entre abril de 2009 e março de 2010. Resultados: Foram avaliados 2408 prontuários, sendo 2128 (88,4%) de atendimento eletivo e 280 (11,6%) de atendimento no setor de urgências do CEROF. Houve predomínio na faixa etária de 6 a 10 anos (44,2%), seguido pela de 11 a 14 anos (29,6%). O exame foi considerado normal em 12,9% (n=274) dos atendimentos eletivos e em 6,8 (n=19) dos atendimentos de urgência. As doenças mais encontradas nas crianças foram as conjuntivites infecciosas (248 casos, 26,4%) e alérgicas (204 casos, 21,7%), blefarite (69 casos, 7,3%), calázio (34 casos, 3,6%), estrabismo (133 casos, 12,06%), as doenças de retina e vítreo (24 casos, 2,6%), catarata e alterações de cristalino (20 casos, 2,1%). As ametropias mais frequentes, contadas por olho, foram a hipermetropia (46,9%) e o astigmatismo (42,2%) e as doenças sistêmicas mais informadas foramprematuridade (30 casos) e diabete melito (26 casos). Conclusão: Este estudo identificou as principais causas de doenças oculares em crianças atendidas em um centro universitário de referência. O grupo de doenças mais prevalente foi o das doenças de córnea e conjuntiva (conjuntivites alérgicas, olho seco e ceratites). As doenças de pálpebra ocuparam o segundo lugar (blefarite, calázio, e obstrução ...

Objective: To identify the levels of visual impairment and prevalence of eye diseases and refractive errors in children seen at a referral center for ophthalmology in the Central-West region compare findings with published data for other regions of Brazil. Methods: Crosssectional, descriptive and retrospective analysis of medical records of children enrolled in the Center of Reference in Ophthalmology Universidade Federal de Goiás, in the period between april 2009 and march 2010. Results: A total of 2408 patient charts, and 2128 (88.4%) of elective care and 280 (11.6%) of care in the emergency department CEROF. Predominated in the age group 6-10 years (44.2%), followed by 11-14 years (29.6%). The examination was normal in 12.9% (n=274) of elective care and 6.8 (n=19) of emergency visits. The disease most commonly found in children were infectious conjunctivitis (248 cases, 26.4%) and allergic (204 cases, 21.7%), blepharitis (69 cases, 7.3%), chalazion (34 cases, 3.6 %), strabismus (133 cases, 12.06%), diseases of retina and vitreous (24 cases, 2.6%), cataract and lens changes (20 cases, 2.1%). Ametropia frequently told by eye, were hyperopia (46.9%) and astigmatism (42.2%) and systemic diseases were more informed prematurity (30 cases) and diabetes mellitus (26 cases). Conclusion: This study identified the main causes of eye diseases in children seen in a university referral center. The group of diseases more prevalent was the disease of the cornea and conjunctiva (allergic conjunctivitis, dry eye and keratitis). Diseases were the second eyelid (blepharitis, chalazion, and lacrimal obstructions). The refractive errors were the most common hyperopia and astigmatism. The findings in the study population are shown similar to those observed in the national literature. .

Seeing you through London 2012: eye care at the Olympics.

BACKGROUND: Provision of eye care services for competitors and their support teams has become an integral part of the modern Olympic Games. AIM: To describe the organisation of the eye clinic at London 2012 over a 4-week period and provide outline audit data. METHODS: The clinic employed multidisciplinary eye care professionals and utilised state-of-the-art instrumentation to provide the highest level of eye care. RESULTS: A total of 1406 patients from 154 countries attended the clinic over the Olympic Games, of which, 276 were competitors. All individuals received a comprehensive refractive and ocular health examination. Minor ocular injuries, glaucoma, diabetic retinopathy and macular degeneration were among the conditions detected and managed. Most patients attended the clinic to have their refractive status checked: 973 spectacles and 50 pairs of contact lenses were dispensed. CONCLUSIONS: It is hoped that this account of the provision of eye care at London 2012 will assist with the planning of this service at future events.

Utilisation of eye-care services: the effect of Scotland's free eye examination policy.

PURPOSE: To examine how the introduction of free eye examinations in Scotland affected people's use of eye care services. Particularly, to assess if more people are now having their eyes examined regularly, and whether there are differences in the way people responded to the policy across socio-economic groups. METHODS: Using the British Household Panel Survey, eye test uptake and frequency in Scotland is compared to the rest of the UK pre and post policy. Propensity to have eye tests and responsiveness to the policy is compared across socio-economic groups. In addition, using data available from a chain of private ophthalmic opticians, clinical characteristics of eye examination patients are compared pre- and post-policy. RESULTS: There is evidence that suggests that people responded positively to the policy. In particular, a higher percentage of people in Scotland have their eyes tested after the free eye care policy was introduced. Interestingly, the response to the policy varies between the different socio-economic groups. For the highest earners and most educated groups, the proportion of people having an eye test increased more than for those groups with lower income or lower education. CONCLUSIONS: Although the policy succeeded in getting more people to have their eyes tested, the socio-economic differences observed suggest that the policy has not reached the more vulnerable segments in society to the same extent, in particular, those with low education and low income. As a result, eye care services utilisation inequalities have widened in Scotland after the free eye care policy was introduced.

Place of residence and preventive health care for intellectual and developmental disabilities services recipients in 20 states.

OBJECTIVE: We identified trends in the receipt of preventive health care by adults with intellectual and developmental disabilities by type of residential setting. METHODS: We used data from the 2008-2009 collection round of the National Core Indicators (NCI) program. Participating states drew random samples of adults receiving developmental disabilities services. The study was observational, with both self-report and report by proxy. Once the random samples were drawn in each state, data were collected using the NCI Adult Consumer Survey. Trained interviewers administered the survey in person. RESULTS: The likelihood of a person receiving preventive care procedures was related to age, level of intellectual disability, mobility, health status, and state. Type of living arrangement also affected whether a person received these health services, even after controlling for state, level of disability, and other personal characteristics. In general, people living with parents or relatives were consistently the least likely to receive preventive health exams and procedures. CONCLUSION: With growing numbers of adults being served in the family home, educational and policy-based efforts to ensure access to preventive care are increasingly critical.

Validity of self-reported eye disease and treatment in a population-based study: the Los Angeles Latino Eye Study.

PURPOSE: To examine the validity of self-reported eye disease, including cataract, age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), and self-reported surgical treatment for cataract and DR in the Los Angeles Latino Eye Study (LALES). DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 6357 Latinos aged 40+ years from the LALES. METHODS: Participants underwent a detailed interview, including survey questions about ocular health, diagnoses, and timing of last eye examination, and a standardized clinical examination. Self-report was compared with examination to determine sensitivity and specificity by length of time since last eye examination. Stepwise logistic regression was used to determine factors associated with inaccurate self-report. MAIN OUTCOME MEASURES: Sensitivity and specificity were calculated for 4 self-reported eye diseases (cataract, AMD, glaucoma, and DR) and for surgical treatment of cataract and DR. Odds ratios (ORs) were determined for factors associated with inaccurate self-report underestimating eye disease and treatment. RESULTS: For each disease, sensitivity and specificity in those who reported their last eye examination as <1 year ago were 36.8% and 92.5% for cataract, 37.7% and 96.3% for glaucoma, 5.1% and 98.9% for AMD, and 25.7% and 94.2% for DR, respectively. Self-report was less accurate with increasing time since last eye examination. Inaccurate self-report was independently associated with better visual acuity (OR, 2.4), <2 comorbidities (OR, 1.7), last eye examination/visit 1 to 5 years ago and ≥ 5 years ago (OR, 2.3 and 4.9, respectively), and less education (OR, 1.3 for 7-12 years and 1.7 for <7 years). Of 88 participants surgically treated for cataract who reported an eye examination <1 year ago, sensitivity and specificity of self-reported surgical history were 90.9% and 99.9%, respectively. Of the 31 participants treated for DR (laser/surgery) and reporting an eye examination <1 year ago, sensitivity and specificity of self-reported surgical history were 19.4% and 99.6%, respectively. CONCLUSIONS: Among Latinos, self-reporting of eye disease and surgical history provides a significant underestimate of the disease burden. This may lead to significant misclassification in vision research if self-report alone is used to identify persons with eye disease.

Preschool vision testing by health providers in the United States: findings from the 2006-2007 Medical Expenditure Panel Survey.

BACKGROUND: Few data are available regarding the rate of preschool vision screening. The purpose of this study is to estimate the current rate of vision testing among children ages 3 through 6 years by any health care provider and to the characterize the children reported to have been tested. METHODS: We conducted a cross-sectional analysis of the 4,237 children aged 3 through 6 years included in either the 2006 or 2007 Medical Expenditure Panel Survey. Household respondents were asked whether selected children ever had vision testing by a doctor or other health provider. Data were weighted to make estimates representative of the civilian noninstitutionalized population. RESULTS: Overall, 64.9% (95% CI, 62.9%-66.9%) of children 3 through 6 years of age were reported to have ever had vision testing. The likelihood of previous reported testing increased with age, from 42.9% among 3-year-olds to 79.4% among 6-year-olds (P < 0.001). After adjusting for age, family income, insurance status, whether the child had a regular health care provider, and whether the child had special health care needs, we found that lower odds of testing were reported among non-Hispanic white children (odds ratio [OR], 0.73; 95% CI, 0.55-0.97) and among Hispanic children (OR, 0.62; 95% CI, 0.47-0.82) compared with non-Hispanic black children (OR, 1). CONCLUSIONS: These findings highlight the gaps in the delivery of preschool vision screening. Improved population-level surveillance of children's vision and methods to track use of vision-related health services are needed to inform policy makers to develop new strategies to improve care.

Multiplicative rating scales do not enable measurement of vision-related quality of life.

PURPOSE: Many questionnaires for the measurement of visual impairment exist. One, the Houston Vision Assessment Test (HVAT), takes a different approach: the patient is asked to rate overall impairment and the proportion attributed to vision, then through multiplication the visual and non-visual (physical) impairments are calculated. The purpose of this study was to determine whether the scores derived from this approach can be considered to be measures. METHODS: The participants were 193 cataract patients awaiting surgery (mean age 74.1 ± 9.8 years, 54 per cent female and 53.6 per cent were awaiting first eye surgery), who self-administered the HVAT, which consists of 10 questions, whereby impairment on each activity and the proportion attributable to vision is rated. Therefore, total, visual and physical impairments are calculated. For each question, multiplying the impairment (five response categories) by the proportion due to eyesight (five categories) gives 10 possible levels of visual impairment. Assessment of the multiplicative rating scales included frequency of category use and hierarchical ordering of response categories using category thresholds. Summary statistics of Rasch analysis were generated for the rating scale and overall questionnaire performance. RESULTS: In the multiplicative scale, higher response categories were under-utilised and thresholds were disordered, indicating that the categories did not function as intended. Some of the dysfunction arose from disordered thresholds in the 'proportion due to eyesight scale', but repairing this gave little improvement to the multiplicative scale. The ill-defined nature of the disordered categories precluded further repair by combining categories. Measurement precision, as indicated by person separation reliability, was poor (0.70). CONCLUSION: Rasch analysis demonstrated that the categories of the multiplied rating scale of the HVAT were not ordered, as the user would expect; this precludes measurement. This provides evidence against the use of multiplicative rating scales in quality-of-life questionnaires. It would be better to use a single rating scale for each construct of interest.

Determinants of previous dilated eye examination among type II diabetics in Southwestern Nigeria.

PURPOSE: To assess the prevalence and factors influencing previous dilated eye examination in screening for retinopathy among type II diabetics. METHODOLOGY: Cross-sectional study of type II diabetic patients receiving treatment at a tertiary hospital in southwestern Nigeria was conducted with information on gender, age, duration of diabetes, current medication and previous dilated eye examination recorded. Eye examination included visual acuity, pen torch examination, applanation tonometry and direct ophthalmoscopy of the dilated eye in a dark room. Visual acuity was presented as classified by WHO while data was analyzed using SPSS version 11 and statistical significance inferred at P<0.05. RESULTS: Eighty three type II diabetics with mean age 57.5+/-10.8 years and mean duration of diabetes of 6.6 years were studied. Visual impairment (<6/18 in the better eye) and blindness (<3/60 in the better eye) were recorded in 3.6% and 12% of the patients respectively while diabetic retinopathy was present in 21.6%. Only 24 [28.9%] diabetics had previous dilated eye examination; absence of eye symptoms [50.8%] and lack of referral [45.8%] were the main barriers to having previous dilated eye examination. Previous dilated eye examination was significantly influenced by the presence of visual impairment/blindness [P=0.002], longer duration diabetes mellitus [P=0.006], current insulin treatment [P=0.040] and presence of non-diabetic vision threatening eye diseases [P=0.016]. CONCLUSION: Dilated eye examination rate is low; inadequate knowledge about diabetic retinopathy as well as low referral rates is contributory. Massive health education on diabetic retinopathy as well as development of sustainable retinopathy screening protocol would be helpful.

Do income effects mask social and behavioural factors when looking at universal health care provision?

OBJECTIVES: To investigate whether permanent and transitory income effects mask the impact of unobservable factors on the uptake of health check-ups in Britain. METHODS: We used a secondary data representative of the British population, the British Household Panel Survey. Outcome variables included uptake of dental health check-ups, eyesight tests, blood pressure checks, cholesterol tests, mammograms and cervical smear tests. Transitory income was measured as monthly household income and permanent income as average income over 13 years. Estimation method applied dynamic random effect probit model. RESULTS: Results showed the absence of permanent and transitory effects on the uptake of eyesight tests, cholesterol tests, mammograms and cervical smear tests. Permanent income was associated with dental check-ups and transitory income with uptake of blood pressure tests. CONCLUSIONS: The presence of income effects on the uptake of blood pressure checks may be due to factors associated with income, such as stress or lifestyles, rather than income per se. A permanent income effect on dental health care in Britain, which is not free of charge, could indicate the possibility of economic constraints to service uptake, but it does not guarantee that income is the only factor that matters as there may important cultural and behavioural barriers.

Temporal lobe epilepsy does not impair visual perception.

Temporal lobe epilepsy (TLE) can impair interictal cognitive function. In the perceptual domain, previous psychophysical studies demonstrated specific deficits in auditory and tactile perception in patients with TLE. This study compared performance of 25 TLE subjects and 27 controls on two low-level, visual tasks: luminance discrimination and frequency discrimination. Both tasks were performed under a relatively easy and a relatively difficult condition, by adjusting the stimulus duration. TLE subjects performed as well as controls on both tasks at both stimulus durations. These results imply that interictal occipital lobe function, as reflected in performance on low-level visual tasks, is not impaired in TLE, consistent with functional imaging data. Furthermore, since TLE subjects performed normally while taking therapeutic doses of multiple AEDs, the data suggest that these AEDs do not impair visual perception.

Changes in eye care utilization following an eye health promotion campaign.

BACKGROUND: The Vision Initiative is a public health campaign that promotes the early detection of the main causes of vision loss through regular eye examinations. Target groups are people over 50 years, with diabetes, a family history of glaucoma or age-related macular degeneration and those who have noted a change in vision. METHODS: In 2005, a range of initiatives promoted the main campaign messages using metropolitan and regional television, radio and newspapers. Campaign outcomes such as last visits to an eye specialist were evaluated comparing pre- and post-campaign data. Participation was volunteer based from randomly selected Melbourne suburbs. Recruitment was by mail. Participants were between 70 and 79 years of age. A questionnaire collected information about demographics, utilization of eye care services, general health and lifestyle. Key features of the five main eye diseases that cause vision loss in Australia were assessed. RESULTS: The percentage of people that reported to have visited an eye specialist within the last year increased significantly from 61% to 70% (P<0.001). Also the percentage of people with diabetes that reported to have a dilated fundus examination within the last 2 years increased significantly from 52% to 70% (P<0.001) and the percentage of people reporting to always wear sunglasses when going out in the sun increased significantly from 33% to 39% (P<0.001). CONCLUSIONS: Following the campaign, there was an improvement in the utilization of eye care services, especially by people with diabetes. However, other Australian public campaigns may contribute to the increased awareness of the effect of diabetes on eye health.

Patterns of detection and optical correction among ophthalmologists.

OBJECTIVE: To verify age of first ophthalmic evaluation and optical prescription along with present optical correction among ophthalmologists of different age groups. METHODS: A cross-sectional study was conducted with a nonprobabilistic sample (n = 578) of ophthalmologists and resident physicians using a self-administered questionnaire. RESULTS: The first ophthalmologic exam was undergone before age 7 for 33.3% of the ophthalmologists aged between 23 and 30 years, for 25.8% of those aged from 31 to 42 , and for 15.8% of those aged from 43 to 76 years (P < 0.0005). The first ophthalmologic exam was undergone at 8 to 22 years of age for 60.7% of the ophthalmologists aged between 23 and 30, for 54.9% of those aged between 31 and 42, and for 47.4% of those aged from 43 to 76 years of age. Use of the first optical prescription (eyeglasses) between 0 and 7 years was reported by 10.0%, from 8 to 20 years of age by 59.6%, from 21 to 40 years by 18.1%, and 41 years or older by 12.3% . Present use of optical correction was reported by 69.0%. Concerning type of corrective device chosen, 63.7% wore only eyeglasses, 29.8% wore eyeglasses and contact lenses, and 6.5% wore contact lenses only. CONCLUSION: Among the sample of opthalmologists, the first ophthalmic evaluation and corresponding optical correction usually occurred relatively late (8 to 20 years of age). However, in the younger group of ophthalmologists, there was a highly significant increase in the number of subjects who had undergone an ophthalmologic exam before age 7. Eyeglasses were reported as the correction of choice by those in all age groups.

Patterns of detection and optical correction among ophthalmologists

OBJECTIVE: To verify age of first ophthalmic evaluation and optical prescription along with present optical correction among ophthalmologists of different age groups. METHODS: A cross-sectional study was conducted with a nonprobabilistic sample (n = 578) of ophthalmologists and resident physicians using a self-administered questionnaire. RESULTS: The first ophthalmologic exam was undergone before age 7 for 33.3 percent of the ophthalmologists aged between 23 and 30 years, for 25.8 percent of those aged from 31 to 42 , and for 15.8 percent of those aged from 43 to 76 years (P < 0.0005). The first ophthalmologic exam was undergone at 8 to 22 years of age for 60.7 percent of the ophthalmologists aged between 23 and 30, for 54.9 percent of those aged between 31 and 42, and for 47.4 percent of those aged from 43 to 76 years of age. Use of the first optical prescription (eyeglasses) between 0 and 7 years was reported by 10.0 percent, from 8 to 20 years of age by 59.6 percent, from 21 to 40 years by 18.1 percent, and 41 years or older by 12.3 percent . Present use of optical correction was reported by 69.0 percent. Concerning type of corrective device chosen, 63.7 percent wore only eyeglasses, 29.8 percent wore eyeglasses and contact lenses, and 6.5 percent wore contact lenses only. CONCLUSION: Among the sample of opthalmologists, the first ophthalmic evaluation and corresponding optical correction usually occurred relatively late (8 to 20 years of age). However, in the younger group of ophthalmologists, there was a highly significant increase in the number of subjects who had undergone an ophthalmologic exam before age 7. Eyeglasses were reported as the correction of choice by those in all age groups.

OBJETIVO: Verificar em oftalmologistas de diferentes faixas etárias a idade do primeiro exame oftalmológico, dos primeiros óculos e tipos e correlação óptica em uso, a fim de substituir estudos sobre a evolução dos cuidados oftalmológicos nas últimas décadas. MÉTODOS: Foi realizado estudo transversal em amostra prontamente acessível formada por oftalmologistas e residentes (n = 578), por meio da aplicação de questionário. RESULTADOS: Submeteram-se ao primeiro exame oftalmológico até os 7 anos de idade, 33,3 por cento dos oftalmologistas na faixa etária de 23 a 30 anos; 25,8 por cento na faixa etária de 31 a 42 anos e 15,8 por cento de 43 a 76 anos (teste exato de Fischer P < 0,0005). O primeiro exame oftalmológico ocorreu entre 8 e 20 anos de idade em 60,7 por cento dos oftalmologistas na faixa etária de 23 a 30 anos; 54,9 por cento na faixa etária de 31 a 42 anos e 47,4 por cento na de 43 a 76 anos. Manifestaram terem usado os primeiros óculos entre 0 e 7 anos 10,0 por cento, entre 8 e 20 anos 59,6 por cento, entre 21 e 40, 18,1 por cento; e de 41 anos ou mais, 12,3 por cento. Dos 69,0 por cento que mencionaram uso de correção óptica, 63,7 por cento usavam apenas óculos, 29,8 por cento intercalavam o uso de óculos e de lentes de contato e 6,5 por cento usavam apenas lentes de contato. CONCLUSÕES: A época do primeiro exame oftalmológico e da correção óptica ocorreu tardiamente (entre 8 e 20 anos). Porém na faixa etária mais jovem houve um aumento altamente significativo dos indivíduos submetidos a exeme oftalmológico até os 7 anos de idade. Registrou-se preferência por uso de óculos em todos os grupos etários.

Influences on screening for chronic diabetes complications in type 1 diabetes.

Screening for the long-term complications of diabetes is a critical component of diabetes management; however, evidence demonstrates that screening rates in diabetes populations are suboptimal. Our objective was to determine the use and predictors of optimal screening behavior, defined as receiving a fasting lipid test, dilated eye exam, spot urine test, foot examination, blood pressure reading, and hemoglobin A1c (HbA1c) in the previous year in a representative cohort of subjects with type 1 diabetes. Data are from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective cohort study of subjects with childhood onset type 1 diabetes. Data from 325 participants who responded to a survey during 1999-2001 were included in analyses. Reported screening rates were as follows: 87.9% had at least one HbA1c measurement in the past year, 63% had a foot exam, 73.3% had a spot urine test, 81.9% had a dilated eye exam, 93.5% had a blood pressure reading and 68.7% received a fasting lipid profile. Within this group, 37.7% of subjects reported undergoing all five tests (optimal screening). Independent correlates of optimal screening were receiving care from a specialist provider (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.4-4.1) and blood glucose monitoring at least weekly (OR = 2.6; 95% CI: 1.1-6.2). These findings indicate that a large proportion of persons with type 1 diabetes are not being screened at the optimal level. Our data indicate that efforts to rectify this should focus on men and those who do not monitor blood glucose, and should involve primary care practitioners.

Preschool vision screening frequency after an office-based training session for primary care staff.

OBJECTIVE: Although vision screening for preschool children is recommended for detecting amblyopia, many pediatric and family medicine practices do not screen preschool-aged children. The aim of this study was to determine the effect of a training program for primary care clinical staff on vision screening behavior and attitudes. METHODS: All local pediatric and family medicine practices were mailed invitations for free training sessions in preliterate eye chart vision screening. The clinical support staff at each participating practice location received a single training session. The lead ancillary medical employee of each practice location was surveyed immediately before and after training, and again 4 to 6 months later, to determine the effect of a single training session on screening behavior and attitudes. RESULTS: Twenty-nine (26%) of 110 practice locations received training in vision screening. Four to 6 months after training, reported screening frequency of 3-year-olds increased, but not of other ages. The reported comfort level with screening 3-year-olds and 4-year-olds was improved 4 to 6 months after training. Most practices responded that the training was beneficial and worthwhile, but lasting impact on practice behavior for the cohort was modest. CONCLUSIONS: Direct, practical training in preliterate eye chart vision screening may increase the number of 3-year-old children screened and improve clinical support staff comfort with screening preschool children. A single training session is not sufficient in itself, however, to achieve the goal of universal preschool vision screening in the primary care setting.

Video-endoscope versus endoscope for paranasal sinus surgery: influence on visual acuity and color discrimination.

Endoscopic and video-endoscopic visual acuity and color discrimination were investigated using a standard disk for testing visual acuity and a color discrimination test. A 1-chip-CCD-Camera (CCC) or 3-chip-CCD-Camera plus digital image processing (digivideo) on the endoscope and a 15 inch high resolution video monitor were used. Color discrimination was investigated by comparing the ability to sort colored disks of low chromatic saturation (desaturated Panel D-15 Test), ranging from yellow to red, under direct vision or via monitor using the same 1-CCC- and 3-CCC-system. Visual acuity deteriorated by 1.58 +/- 0.16 steps (+/- SEM) for the 1-CCC and 1.21 +/- 0.16 steps for the 3-CCC plus digivideo compared to vision through the endoscope (p < 0.001 and p < 0.001). Visual acuity was significantly better for the 3-CCC-video-endoscope compared to the 1-CCC-video-endoscope (p = 0.0045). The difference in color discrimination between the naked eye and the 1-CCC-monitor system was not significant. More mistakes were made with the 3-CCC-monitor system. The impairment of image quality with the video endoscope, which is experienced by many surgeons, is reflected in a marked loss of visual acuity in our experiments. Sharpness and contrast of the video-image are significantly enhanced by the 3-CCC plus digital image processing, compared to the 1-CCC. Color discrimination, however, was not impaired by the 1-CCC, indicating that color perception with the video-endoscope can be very good and may not contribute significantly to the loss of image quality.