Optometric support to Pacific Angel--Nepal 2012.

In September 2012, Pacific Angel (PACANGEL)--Nepal 2012 was conducted in Kaski District, Nepal. Health services were provided in optometry, family medicine, pediatrics, physical therapy, midwifery, dentistry, and pharmacy. This report is on optometric care provided. 995 patients were examined. Mean age was 41.34 (median 43). Mean entering distance visual acuity was 20/57 in the right eye, 20/60 in the left. Mean spherical error was +0.08D in the right eye, +0.09D in the left. For those patients with astigmatism, mean cylindrical error was -0.74D in the right eye, -0.54D in the left. A near addition was prescribed for 51.8% of the patients. Cataract was diagnosed in 24.17% of the patients. Other prevalent nonrefractive diagnoses were dry eye (18.17%), conjunctivitis (12.0%), and pterygium (5.17%). Eye and vision care is lacking in Nepal. Sporadic episodes of care have considerable impact on those patients receiving treatment. However, to substantially treat the greatest worldwide cause of visual impairment, local sustainable resources are imperative. Provision of care by local, linguistically competent practitioners would better suit the needs of those in need of care. Those involved in humanitarian missions could be a significant source of training such caregivers.

Military aircrew eyewear survey: operational issues.

BACKGROUND: Army aircrew are required to operate under stressful conditions within a degraded visual environment. To gain an understanding of current eyewear mission needs, we surveyed aircrew regarding operational issues associated with the current U.S. Army-issue aircrew eyewear. METHODS: An anonymous online survey was completed by 976 U.S. Army aircrew personnel recruited through an invitational e-mail. RESULTS: Of the respondents, 34% reported wearing corrective lenses. Nearly 50% of them reported dissatisfaction with the HGU-4/P Aviator spectacles. The leading problems reported were discomfort (15%), "hot spots" around the ears (13%), and break of the earcup seal (11%). Nearly 41% of the respondents wore multifocal lenses and, of those, 16% reported that the HGU-4/P's restricted field of view (FOV) adversely affected duty performance. Of those who wore Modified HGU-4/P Apache spectacles, 79% had an unacceptable FOV with the helmet display unit. A similar number of aircrew modified the Apache eyewear to increase the FOV. In addition, wind and dust created eye discomfort or affected the vision of 46% of all respondents when performing flight duties. Over 82% expressed the need for an improved aircrew spectacles and 73% desired aviation-compatible protective eyewear. DISCUSSION: The current Army HGU-4/P Aviator and the Modified HGU-4/P Apache spectacles have significant operational deficiencies and compatibility issues. Such deficiencies have led to poor wear compliance and unauthorized modification of the Army-issue Aviator eyewear, posing readiness and safety issues. The results of this survey formally identify the need for military combat eye protection that is compatible with flight systems.

Use of clinical practice guidelines by executive directors of optometric associations.

BACKGROUND: The process of developing the American Optometric Association's (AOA) Optometric Clinical Practice Guidelines began in 1989 under the direction of John F. Amos, O.D., M.S., then chair of the AOA's Clinical Care Center. The guideline development process used by the AOA was modeled after the recommendations established by the Agency for Health Care Policy and Research in response to the federal government encouraging health care groups to develop clinical guidelines to enhance the quality, appropriateness, and effectiveness of health care. The guideline topics were chosen for their importance in the education of members, health care payers, and state legislators. A principal author and a consensus panel of experts then were chosen for each subject area. This group was responsible for transforming the latest scientific research and expert judgment into a document that would apply to everyday optometric practice. Thirteen guidelines were developed and mailed to AOA members in 1994 and 1995. Additional guidelines were mailed as they were approved. Currently, there are 20 guidelines available. METHODS: A survey was mailed to the executive director of the optometric association of each state and the District of Columbia and to the chief of optometry of each of the federal services. Telephone follow-up was made to nonrespondents, and an additional copy of the survey was mailed to them with telephone follow-up again taking place for those who did not respond. RESULT: Forty-three of the surveys were returned for a response rate of 78%. Seventy-six percent of the respondents stated that they had received the guidelines. The sections that were found most useful to the respondents were those related to Description and Classification, Basis of Treatment, and Treatment Options. The guidelines were most often used by these groups to improve the quality of eye care, expand optometric involvement in health programs, affect public policy, and overcome problems with insurance groups. DISCUSSION: Optometric organizations have found the clinical practice guidelines useful beyond their primary goal of enhancing the quality of patient care. They have been used effectively to help educate other parties about optometry and its role as a primary health care profession.

Accuracy of pharmaceutical tracking data with regard to optometrists' prescribing.

BACKGROUND: The optometric scope of practice has increased dramatically over the last 30 years. This includes the ability to administer legend drugs to facilitate the examination process and prescribe legend drugs to treat the eye and adjacent areas in accordance with state laws. However, because such laws are relatively new in some states, the prescribing optometric communities in the United States may have difficulty in making their presence known amongst the pharmaceutical tracking companies. This study looked at the relationship between prescriptions written and pharmaceutical tracking company outcomes. METHOD: Optometrists were recruited from five states--Florida, Illinois, Missouri, North Carolina, and Texas--to participate in this study. They represented urban and rural practices, group and solo practices, and multidisciplinary practices. They were requested to track all prescriptions they wrote for legend pharmaceutical drugs during the months of August, September, and October 2000, as well as the number of refills authorized. Numbers were obtained from a pharmaceutical tracking company for the same optometrists for the period July to September 2000, and October to December 2000. The results reported by the optometrists were compared to the results provided by the pharmaceutical tracking company. RESULTS: There was a significant difference between the numbers reported as outcomes by the pharmaceutical tracking company and the self-reported prescriptions written. DISCUSSION: The current system for crediting prescriptions to optometrists seems to have some shortcomings. All parties involved must work to ensure that optometrists are being properly credited for the pharmaceutical prescriptions they write. Possible steps that may be taken by individuals, the optometric profession, and the pharmaceutical industry are discussed.