Motorist vision policy.

BACKGROUND: The primary purpose of public policy requiring vision testing for driver license renewal is to identify individuals with functional vision impairments and, when necessary, to restrict their driving. This is based on the presumption that poor vision is causally related to poor driving and traffic crashes. METHODS: The AOA Environmental and Occupational Vision Committee performed a synthesis of relevant empirical literature on policy-based research and developed potential options for enhancing traffic safety. RESULTS: Presently, some states require vision testing for driver's license renewal and some do not. Regional and nationwide studies report that vision-related license renewal policies are associated with enhanced traffic safety. However, contemporary vision screening tests may be of limited value in identifying individuals with functional vision impairments. CONCLUSION: The most cost-effective and valid method for identifying, treating and counseling visually impaired drivers is to require a comprehensive eye examination as a condition for driver license renewal for those with a high prevalence or high probability of vision impairment.

Potential human and economic cost-savings attributable to vision testing policies for driver license renewal, 1989-1991.

PURPOSE: This study assessed the impact of vision-related relicensing policies on traffic fatalities in the United States. There is a limited empirical basis for state vision testing policies for relicensing. Furthermore, it is uncertain whether contemporary vision standards for driver licensing achieve their implicit goal of protecting the public's health, or inappropriately restrict the mobility of competent drivers. METHODS: The 48 contiguous states and the District of Columbia were the "subjects" in this investigation. During the study period (1989 to 1991), 10 states did not require vision testing for driver license renewal. Multiple regression modeling was used to assess the impact of vision-related relicensing policies on traffic safety and to estimate the number of avoidable vehicle occupant fatalities and corresponding economic costs associated with traffic crashes involving older drivers (> or = 60 years). The primary data source for this investigation was the Fatal Accident Reporting System (FARS) database. RESULTS: Vision-related relicensing policies were significantly associated (p < 0.05) with lower vehicle occupant fatality rates of older drivers. According to the final regression model, approximately 222 fewer vehicle occupant fatalities (-12.2%) associated with older drivers would be expected for the 3-year period if mandatory vision testing policies had been in effect in 8 of the 10 states without such policies. Conservatively, those avoidable deaths represent an estimated $31 million in avoidable economic costs. CONCLUSIONS: State-level mandatory vision testing for relicensure may enhance traffic safety and reduce the economic burden of fatal crashes. Vision testing requirements should be maintained by jurisdictions with such requirements, and jurisdictions without such requirements should consider the potential traffic safety benefits of vision testing for driver license renewal.

Health care changes from a public health perspective: implications for optometry-ophthalmology relations.

BACKGROUND: Within the past 20 years, the professional scope, predominant mode of practice, and methods of reimbursement for optometric services have evolved due to technological and professional growth, and external factors. METHODS: Public health constructs are used to discuss several influential external factors affecting optometry's evolution and future. RESULTS: The public health perspective provides insights on why certain changes in health care delivery have occurred, and are used to predict the structure of future eye and vision care in America. CONCLUSIONS: The public health perspective underscores the need for proactive, collaborative involvement by optometrists and ophthalmologists to ensure some semblance of rational change in eye care delivery in the current hyperturbulent health reform environment.

Vision testing and the elderly driver: is there a problem meriting policy change?

BACKGROUND: The number of elderly drivers is increasing. The primary purpose of public policy requiring vision screening for driver's license renewal is to identify, and, when necessary, restrict drivers with functional vision impairments. Because of age-related ocular conditions, elderly drivers, as a group, have a higher incidence and prevalence of functionally impaired vision. To date, there is no empirical evidence of a significant predictive relationship between changes in vision function and automobile crashes. METHODS: Most states require vision screening for driver's license renewal, whereas some do not. Among those states requiring vision screening, there is considerable variation in the frequency and level of testing. Efforts to determine the role of vision in driving, while suggestive, have not been useful in identifying at-risk older drivers. RESULTS: Researchers have observed that older drivers are often aware of their decreased functional capacity and voluntarily adjust their driving patterns by driving less frequently, for shorter distances, during daylight hours, more slowly, and during non-rush hours. However, although not statistically significant, the decline in the mean annual traffic fatality rates with increased state vision screening requirements suggests a possible beneficial effect of vision screening. CONCLUSIONS: Because older drivers are at risk for sight-threatening conditions, they are most affected by vision screening requirements for driver's license renewal. Since a loss of driving privileges represents a major loss of mobility and independence, there is a pressing need to better understand the relationship between age-related vision changes and the frequency and severity of traffic crashes.

Musings of a Robert Wood Johnson health policy fellow.

BACKGROUND: Changes in national health policy affect all health care providers. To increase its understanding and involvement in health care development, in 1973, the medical profession, through the Institute of Medicine, developed a formal program--the Robert Wood Johnson (RWJ) Health Policy Fellowships Program--in the nation's capital. METHODS: Each year, since the mid-'70s, the RWJ Health Policy Fellowships Program provides "hands-on" health policy development experiences, to mid-career health professionals. Participants obtain an understanding of the health policy process at the national level, and an opportunity to contribute to the formulation of new policies and programs. RESULTS: The author describes his 1989-1990 RWJ Fellowship year. He reports that health professionals can and do contribute significantly in the development of national health policy. He also observes that there has been minimal participation by optometrists in the RWJ Health Policy Fellowship Program. During his fellowship, the author observed that the optometry profession was poorly understood and underrepresented at the national level. CONCLUSIONS: There is a need for direct optometric involvement in national health policy development. The RWJ Health Policy Fellowships Program provides exemplary policy experiences. This and alternative methods to increase optometric involvement and participation in health policy development, are discussed.

The effect of size on paired 'C/D' estimations.

This article describes a comparative study of the accuracy of proportional ratio estimations on stylized optic nerve head targets by experienced optometrists, student clinicians and beginning optometry students. Within limits, these estimations approximate the perceptual and cognitive tasks involved in the clinical estimation of cup-to-disc (C/D) ratios. There was no significant difference (alpha = 0.05) in the accuracy of estimations relative to clinical experience. The overall frequency of exactly correct paired estimations (i.e., both horizontal and vertical correct) for the 16 stylized targets was 18.6%. In a subanalysis of the data, less than half (45.4%) of the estimations were within +/- .05 of the true "C/D" ratios. Statistically, observers were more accurate for the smallest targets and less accurate for the medium and larger targets. Potential clinical implications of these findings, relative to C/D ratio documentation in glaucoma diagnosis and management, are presented and discussed.

Reliability of assessing the cup/disc ratio using a 90 D lens photograph.

The reliability of estimating the cup to disc (C/D) ratio using a retinal camera photograph was compared to the same task using a photograph taken with the slit-lamp and +90 D lens. Twenty observers (10 optometry students, 10 faculty members) were asked to judge the C/D ratio of four eyes by the two photographic methods. When comparing the two clinically accepted photographic methods, statistically significant differences were noted for the vertical dimension estimate in two of four eyes. However, these differences were not clinically significant. C/D ratio estimates with the retinal camera photograph were typically larger than those of the slitlamp and +90 D lens photograph. Neither photographic method provided an advantage or disadvantage to clinicians with different levels of experience.

1987 survey of military optometrists: activities, roles and attitudes.

A worldwide survey of active duty military optometrists (Air Force, Army and Navy) was conducted in the spring of 1987. The survey response rate was 79%. Statistically significant differences (alpha = 0.01) in their roles, activities and attitudes are presented and discussed. Significant interservice differences were found in: types of duties, profession/status of immediate supervisors, work assignments, frequency and types of patient encounters, awareness of therapeutic drug policies, access to specific clinical instruments, and frequency of routine clinical tests. Attitude and opinion tabulations suggest an overall satisfaction with professional experiences and interprofessional working relationships. However, there was a common perception that optometrists did not receive appropriate promotional consideration or career opportunities within this multidisciplinary setting. Implications of survey results for non-military multidisciplinary health care institutions are also discussed.

The FDA report on intraocular lenses.

Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since 9 February 1978. As of August 1982, data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409 000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45 000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of posterior chamber and anterior chamber IOLs.

The FDA report on intraocular lenses.

Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since February 9, 1978. As of August 1982, data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409,000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45,000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of the posterior chamber and anterior chamber IOLs.