Optometry - Journal of the American Optometric Association

What are the visual criteria for driving?

Paul B. Freeman — 2010-08-01

In the U.S., driving plays a vital part of our day-to-day lives and takes on more significance than just a mode of transportation. It reinforces, among a multitude of things, our perception that we are independent and in control of our ability to “come and go as we please.” It is not, however, among the inalienable rights that our Founding Fathers expressed or implied when they penned our fundamental documents; all that is subject to the “wisdom” and “clarity” of our present day lawmakers. Thus, it is extremely difficult when an otherwise competent driver is told that the privilege of driving has been revoked due to a vision problem. This revocation is typically based on a specified minimum required visual acuity level or breadth of a visual field. While these are generally the easiest and most common metrics to score clinically (and may, in fact, contribute in some fashion to one's ability to drive safely), there appear to be additional vision-related criteria which might better allow the clinician to evaluate visual risk assessment for driving. Research has shown that contrast sensitivity function and useful field of view (“a measure of visual attention skills and visual processing speed”) are 2 quantifiable functional measures that can be correlated to driving performance.

Perils of the “Unstandard” and the habitual hygiene of hydrogels

William J. Benjamin — 2010-08-01

The Fusarium crisis and, later, the Acanthamoeba outbreak, shook the contact lens field after a period in which the regulatory sector was already charged by concerns over mad cow disease. Regulations imposed in Britain and France to contain a spread of mad cow disease, officially Creutzfeldt-Jacob Disease (CJD), threatened to curtail in-office reprocessing of trial lenses even in the case of specialty contact lenses. Substantial reactionary pressure was placed on standards organizations, including the contact lens working group of the International Organization for Standardization (ISO), to quickly revise the standards on microbiological efficacy and the use of contact lens care systems to prohibit any chance that the CJD prion could be transmitted via trial lenses or misuse of contact lenses.

When are glasses medicine?

Byron Y. Newman — 2010-08-01

Every once in a while, someone writes an article that sparks the thought, “Why didn't I think of that?” Well, 2 ODs wrote such an article that appeared in the April 2010 issue of Eyecare Business, which many of us get free. Allan Barker, O.D., and Greg Stockbridge, O.D., should be complimented on their article titled “Eyeglasses and the Medical Model,” in which they point out several legitimate conditions where glasses should, indeed, be covered by medical insurance because they solve a medical problem. Drs. Barker and Stockbridge came up with “16 areas where eyeglasses should be thought of as a device to correct or aid in a patient's medical condition.” The authors state that “insurance companies routinely cover various devices that allow a person to function better in life, like crutches, splints, wheelchairs, medications, etc., but they don't think of glasses [or other optometric procedures] in this same context—despite the fact that a 7 diopter myope can't function without some sort of visual correction.” Then they add, “Even if medical insurance companies refuse to cover glasses that were prescribed for visual correction only, they should at least cover glasses recommended for various medical reasons.” The following are examples of what might be considered “medical necessity” glasses, based on the authors' list, with some modifications and brief explanations.

Association of dietary nutrient intakes in relation to progression of diabetic retinopathy in blacks with type I diabetes mellitus

Leslie E. O'Dell — 2010-08-01

The leading cause of blindness in diabetic people ages 20 to 64 years in the United States is complications of diabetic retinopathy (DR). Risk factors, including the duration of the disease, poor glycemic control, and systemic hypertension, have all been linked to progression of retinopathy. The American Diabetic Association (ADA) recommends restricting carbohydrate and fat intake for all patients with diabetes and restricting sodium intake for diabetic patients with hypertension. The investigators of the study evaluated the association of dietary nutrient intakes in relation to the 6-year progression of DR in blacks with type 1 diabetes mellitus.

The effectiveness of intravitreal injection of bevacizumab for management of central serous chorioretinopathy

Marc D. Myers — 2010-08-01

Although central serous chorioretinopathy (CSC) is typically a self-limiting disease with a good visual prognosis, there are instances in which persistent subretinal fluid (SRF) is associated with reduced visual acuity (VA). In chronic or recurrent cases, decreased VA may result from retinal pigment epithelium (RPE) dysfunction, subretinal precipitates, and subretinal choroidal neovascularization. The purpose of this study was to evaluate the effectiveness of intravitreal injection of bevacizumab for management of CSC.

Guidelines for Authors

2010-08-01

Optometry—Journal of the American Optometric Association is the official publication of the American Optometric Association (www.aoa.org). The journal is provided to all AOA members as a membership benefit. Optometry is also provided to libraries, schools and colleges of optometry, medical libraries, hospitals and government agencies.

Use of Bangerter filters with adults having intractable diplopia

Robert P. Rutstein — 2010-05-31

Abstract: Purpose: The aim of this study was to describe the use of Bangerter filters in adults having intractable diplopia.Methods/Case Reports: A series of adults having intractable diplopia caused by either cyclotorsion, retinal disease, monocular diplopia, or rapid alternating fixation who were treated with Bangerter filters is reported. Detailed case reports on 4 of the 10 patients are included.Conclusion: Bangerter filters can be used to mitigate diplopia that cannot be eliminated with either prism, modification of the spectacle prescription, vision therapy, or extraocular muscle surgery. The weakest density filter that eliminates the diplopia should be prescribed. Prospective studies reporting the long-term efficacy and quality of life with the filters are needed.

Palinopsia

Brian Abert, Pauline F. Ilsen — 2010-08-01

Abstract: Background: Palinopsia is a visual phenomenon that has been associated with brain neoplasia, epilepsy, trauma, systemic disease, psychiatric illness, and illicit as well as prescribed drug use. Despite some resemblance to diplopia, polyopia, and physiologic afterimage formation, palinopsia is actually a distinct entity often suggestive of disease through its distinct signs and symptoms. Careful patient history, visual field testing, and neuroimaging are among the tools used to diagnose palinopsia.Case Reports: Four case reports of patients with palinopsia are presented. With the first patient, the palinopsia was associated with extensive lysergic acid diethylamide (LSD) use. The second patient's palinopsia was determined to be secondary to head trauma from a motor vehicle accident. The third patient began to experience palinopsia after he had been prescribed trazodone for insomnia. The fourth patient was found to have multiple potential etiologies. These 4 unique patients highlight the causes and management of palinopsia.Conclusions: Optometrists should be aware of the symptoms of palinopsia to enable them to recognize this phenomenon and minimize the chance of misdiagnosis. Learning the physiologic mechanisms behind this uncommon disorder can help the clinician correctly identify its cause. Although palinopsia itself is not a disease, it is indicative of a disease, and the symptoms of palinopsia may be a manifestation of a serious underlying systemic dysfunction that could warrant treatment. In addition, identifying the symptoms of palinopsia can put patients at ease with regard to the often disturbing visual symptoms.

Neurosensory retinal detachment secondary to torpedo maculopathy

Yu Su, Andrew S. Gurwood — 2010-08-01

Abstract: Background: Torpedo maculopathy has been characterized as a congenital retinal pigment epithelial (RPE) nevus.Case: A 38-year-old black woman presented with a chief complaint of intermittent floating spots in the right eye of 7 months' duration. Dilated fundoscopy found a “torpedo-shaped” lesion, with the tip of the lesion pointing toward the temporal macula. Visual field testing found a paracentral nasal defect, and optical coherence tomography (OCT) found a sensory retinal detachment.Conclusion: This lesion was unique because of the visibly detectable alterations seen in the photoreceptor layer of the retina and retinal pigment epithelium (RPE) in the setting of what was confirmed as a neurosensory retinal detachment. Torpedo maculopathy, although benign, may be visually devastating if its neurosensory etiopatholgy involves the macula. Even so, it rarely requires intervention.

Ocular pulse amplitude and associated glaucomatous risk factors in a healthy Hispanic population

Dina H. Erickson, Denise Goodwin, Chad Anderson, John R. Hayes — 2010-08-01

Abstract: Background: With increasing evidence that vascular risk factors play a role in the development of glaucoma, it is critical to be familiar with factors related to intraocular blood flow, such as the ocular pulse amplitude (OPA). This study evaluates OPA and factors related to it in a healthy, Hispanic population.Methods: Refractive error, corneal curvature, Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), OPA, axial length, and central corneal thickness (CCT) measurements were obtained on 104 Hispanic subjects recruited from the community.Results: OPA ranged from 0.7 to 4.7 mmHg (mean, 2.1 ± 0.8 mmHg) and showed a significant correlation with refractive error, axial length, GAT, and DCT (r=0.250, -0.358, 0.460, 0.378; P=0.011, <0.001, <0.001, and <0.001, respectively). Mean intraocular pressure with GAT was 15.6 mmHg. Mean CCT was 541.2 μm. The average refractive error was 0.75 diopters (D) of myopia, with 25% having >1.00 D myopia.Conclusion: Normal OPA values have not been studied in Hispanic populations. OPA is thought to provide information regarding ocular blood flow; however, more studies are needed to determine its significance in glaucoma treatment.

The Nationwide Health Information Network takes shape

2010-08-01

Plans to establish a Nationwide Health Information Network (NHIN) by 2014 are on track, according to the U.S. Department of Health & Human Services' (HHS) Office of the National Coordinator of Health Information Technology (ONC). Using funds authorized under the Health Information Technology for Economic and Clinical Health (HITECH) provisions of last year's American Recovery and Reinvestment Act, the HHS recently announced 55 grants, totaling some $760 million, to develop health information exchanges (HIE)—networks through which health care institutions and practitioners can securely transmit patient health information electronically —in all U.S. states, districts, and territories. These state and regional HIEs will be the building blocks that will eventually comprise the NHIN. The HHS has also issued $220 million in grants to designated “Beacon Communities” that will serve as models for the nation's other HIE initiatives by demonstrating the use of health care information technology (HIT) in the improvement of care quality and efficiency. A new NHIN Direct option is being developed to allow health care practitioners to send and receive health information electronically, even if they do not have access to the services of a health information exchange. The HHS has also announced the establishment of regional extension centers that will offer assistance to health care providers who wish to implement electronic health records (EHRs).

Avoid “negative” advertising

Gary Gerber — 2010-08-01

Just like those who espouse the theory that all news is good news (as long as you spell my name right), there are those who advocate that all advertising is good, as long as it brings patients through the door.

2010-08-01

EDITOR'S PERSPECTIVE375 What are the visual criteria for driving?

Editorial Board

2010-08-01

Paul B. Freeman, O.D., Editor-in-Chief e-mail: pbfreeman@aoa.org

Optometry - Journal of the American Optometric Association

What are the visual criteria for driving?

Perils of the “Unstandard” and the habitual hygiene of hydrogels

When are glasses medicine?

Association of dietary nutrient intakes in relation to progression of diabetic retinopathy in blacks with type I diabetes mellitus

The effectiveness of intravitreal injection of bevacizumab for management of central serous chorioretinopathy

Guidelines for Authors

Use of Bangerter filters with adults having intractable diplopia

Palinopsia

Neurosensory retinal detachment secondary to torpedo maculopathy

Ocular pulse amplitude and associated glaucomatous risk factors in a healthy Hispanic population

The Nationwide Health Information Network takes shape

Avoid “negative” advertising

Table of Contents

Editorial Board