Optometry - Journal of the American Optometric Association

Thinking beyond ourselves

Paul B. Freeman — 2012-01-01

For many of us, each New Year begins with at least 1 resolution that requires some action to better our lives: typically personal weight loss and exercise promises to oneself or the more-time-with-friends-and-family resolutions. I think it is safe to say most of these fall by the wayside in short order. There may also be resolutions having to do with patient care that can be made and that may actually be easier to maintain, in that these resolutions don’t require any more effort than just doing what we have been trained to do: keep our patients medically and functionally as sound as we can. Once the proper diagnosis has been made, the medical part of eye care (and one part of the resolution) seems, for the most part, to be pretty straightforward. However, the diagnosis and management of the functional aspects of eye care are less so. What makes this divergence of endpoints so frustrating is that there are numerous articles in well-respected journals encouraging us to do just that: improve function as well as structure. For example, a recent article stated “Every clinician recognizes that [visual acuity], although representing the gold standard of outcome, may not always accurately describe a patient’s level of visual function.” Certainly this is a very perceptive observation. Unfortunately, it is a long way from a manuscript to the practical application; although “every clinician recognizes” this (improved function), it is not always the case that it is addressed in practice. For example, consider the patient with wet macular degeneration who goes from 20/200 to 20/60 with the latest treatment and is returned to the primary eye care practitioner with a letter stating the patient has been successfully treated. Of course, this is certainly an improvement and, although it sounds (and indeed is!) significant, the patient may still be complaining about poor function. Or the patient who has been treated and attains 20/20 but has terrible contrast sensitivity yet the same letter of success is sent, despite the same functional complaints. Or the amblyopic child who, after treatment improves from 20/200 to 20/25, yet is still having problems in school. In these cases, the gold standard (improvement in visual acuity) has been met but the functional outcome may not be satisfactory.

Seeing well is the key to learning in a world of 3-D

Jill Luebbert — 2012-01-01

As paraoptometrics, it is important for us to understand that there is a new way to help support lifelong vision and eye health: the 3-D Public Health Prevention Model. This model of “secondary prevention” was developed by Michael Duenas, O.D., associate director of Health Sciences and Policy for the American Optometric Association (AOA), and was presented December 2010 at the Inaugural 3-D Human Factors Symposium in New York City. The basis for this model is that the ability to comfortably perceive stereovision in a 3-D presentation is actually a highly sensitive assessment tool, able to appraise a wide range of subtle symptoms related to vision and eye health for people of all ages. Now this 3-D imagery is bringing “vision discomfort/asthenopia” to the forefront; it is a blessing in disguise by opening doors of communication about the need for a complete eye health and vision evaluation to possibly diagnose and treat the visual discomfort caused by refractive errors, convergence/divergence, and accommodation dysfunctions. As was stated most recently in an editorial in Optometry, “binocular vision screenings will not only be more readily available but people of all ages will pay unwittingly and electively to have them done!”

Risk of endophthalmitis remains low

Marc D. Myers — 2012-01-01

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have not only changed how neovascular age-related macular degeneration (AMD) is managed, but its expanded indications are impacting the management of retinal vascular occlusion, neovascular glaucoma, and diabetic macular edema. Here the authors describe risk factors and outcomes associated with the most feared complication of these intravitreal injections, endophthalmitis.

Letter

Jerome Sherman, Samantha Slotnick — 2012-01-01

The recently published article by Christopher Suhr, O.D., et al., in the August 2011 issue of Optometry, presents some valuable information about the physiological causes of solar maculopathy. We would like to complement this case by addressing the physiological impact of the solar radiation and how this relates to the appearance of the optical coherence tomography (OCT).

Response

Christopher Suhr — 2012-01-01

I would like to thank Drs. Sherman and Slotnick for their letter in reference to our solar maculopathy article. As we continue to progress in our technology we are able to determine the various changes in anatomy that occur from various conditions in a more precise manner. In the case of solar maculopathy, we can definitely benefit from the use of high-definition optical coherence tomography (OCT) to better evaluate the anatomical structures beyond what the older versions of OCT could do.

Guidelines for Authors

2012-01-01

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.

Demyelinating optic neuritis presenting as a clinically isolated syndrome

Nicky R. Holdeman, Tammy Nguyen, Rosa A. Tang — 2012-01-01

Abstract: Background: Clinically isolated syndrome (CIS) describes a single, first-occurrence attack caused by inflammation/demyelination in 1 or more locations in the central nervous system. The optic nerve is a frequent site affected by this neurologic event. As the name implies, CIS is an isolated condition but is often considered a precursor to multiple sclerosis (MS). When distinctive brain lesions detected by magnetic resonance imaging (MRI) accompany CIS, the person is considered at a high risk for MS. Treatment is aimed at delaying the onset of a second neurologic episode, reducing the accumulation of MRI-detected brain lesions and delaying the development of definite MS.Case Report: This article describes a 40-year-old woman who experienced a sudden loss of vision in the right eye. Testing ultimately found a normal MRI, demyelination of the optic nerve, and progressive thinning of the retinal nerve fiber layer, leading to a diagnosis of CIS.

Remote treatment of intermittent central suppression improves quality-of-life measures

Eric S. Hussey — 2012-01-01

Abstract: Background: Intermittent central suppression (ICS) is a repetitive intermittent (“on-and-off”) loss of central visual sensation without strabismus or amblyopia. These repetitive seconds-long suppressions have been suggested to create visual confusion and instability that would cause vision symptoms, contribute to reading complaints, and even impair reading.Methods: Teacher-identified Job Corps students were diagnosed with ICS and then treated with 5-Hz electronic liquid crystal shutter alternate occlusion.Results: Twenty-six young adult students (19.7 ± 1.6 y) had their ICS treated over 5.9 ± 3.7 months. Suppression periods decreased in length (P < 0.0001) and “binocular” nonsuppressed periods increased in length (P < 0.0001). Overall, College of Optometrists in Vision Development (COVD) quality-of-life (QOL) scores improved (P < 0.0001), 16 reading behavior COVD QOL questions improved (P < 0.0001), and individual QOL questions improved. Posttherapy reading scores (N = 18) improved 3.7 (± 2.6) years (P < 0.0001).Conclusions: Treating ICS with electronic alternate occlusion reduced suppression periods, increased binocular periods, and improved symptoms as measured in the COVD QOL questionnaire. Positive changes also occurred in reading scores. These data suggest ICS should be considered a probable cause for symptoms of reading problems.

A survey of optometry leadership: Participation in disaster response

2011-10-28

Abstract: Background: A study was completed to assess the academic and state-level professional optometry leadership views regarding optometry professionals as surge responders in the event of a catastrophic event.Methods: A cross-sectional survey was conducted using a 21-question, self-administered, structured questionnaire. All U.S. optometry school deans and state optometric association presidents were mailed a questionnaire and instructions to return it by mail on completion; 2 repeated mailings were made. Descriptive statistics were produced and differences between deans and association presidents were tested by Fisher exact test.Results: The questionnaire response rate was 50% (25 returned/50 sent) for the state association presidents and 65% (11/17) for the deans. There were no statistically significant differences between the leadership groups for any survey questions. All agreed that optometrists have the skills, are ethically obligated to help, and that optometrists should receive additional training for participation in disaster response. There was general agreement that optometrists should provide first-aid, obtain medical histories, triage, maintain infection control, manage a point of distribution, prescribe medications, and counsel the “worried well.” Starting intravenous lines, interpreting radiographs, and suturing were less favorably supported. There was some response variability between the 2 leadership groups regarding potential sources for training.Conclusions: The overall opinion of optometry professional leadership is that with additional training, optometrists can and should provide an important reserve pool of catastrophic event responders.

Corneal collagen cross-linking: An introduction and literature review

Brandon J. Dahl, Eric Spotts, James Q. Truong — 2012-01-01

Abstract: Background: This literature review analyzes the scientific evidence available regarding corneal collagen cross-linking (CXL) as a treatment option for progressive keratectasia.Methods: A literature search was performed using dates from 1990 to August 2010 regarding CXL Specific areas of focus for the literature review include safety and efficacy of the procedure as a stand-alone treatment or when used in conjunction with Intacs® corneal implants (Addition Technology™) or photorefractive keratectomy (PRK).Results: A total of 50 clinical trials and studies were identified, 20 of which met the inclusion criteria. Results of the included literature support the conclusion that CXL is a safe and efficacious treatment for progressive keratectasia. The results of CXL alone have shown stabilization or improvement in the maximum keratometry readings, best-corrected visual acuity, uncorrected visual acuity, and spherical and cylinder refractive measurements. CXL has been shown to enhance the effects of Intacs and has been proven successful when used in conjunction with PRK.Conclusion: CXL is an effective treatment for limiting the progression of keratectasia, thus reducing the need for penetrating keratoplasty. CXL has a similar side-effect profile and similar risk level as PRK.

The Florida Heiken Children's Vision Program

Virginia A. Jacko, Alan P. Levitt, Steven E. Marcus, Alfred A. Rosenbloom — 2012-01-01

Many schoolchildren in America are required to undergo a vision check of some sort before entering classes – and with good reason. Formal studies have long shown that vision problems in children and teenagers may contribute to poor school performance, behavior issues, and even delinquency. “Undetected and untreated vision problems can lead to poor academic performance in school, self-esteem issues with attendant emotional components, and, when triggered by other factors, antisocial behavior,” notes researcher Joel N. Zaba, O.D.

Nutrients in the battle against age-related eye diseases

James G. Elliott, Nancy Sumner Williams — 2012-01-01

Growing evidence suggests that nutrition can attenuate the risk and/or progression of age-related eye diseases. Optometrists should inquire about their patients’ dietary intakes and supplement use, and be able to counsel patients on good nutrition for eye health.

Top 10 tax blunders

James R. Armstrong, Jodi Permenter — 2012-01-01

It is the start of a new year and tax season is under way. Make a New Year’s resolution that includes avoiding these common tax-filing mistakes. Self-employed health insurance deductions, “bonus” depreciation on equipment, and sales tax deductions for large purchases are just a few of the commonly overlooked ways taxpayers can reduce their federal incomes taxes.

Taking steps to limit appointment no-shows

Gary Gerber — 2012-01-01

Every practice deals with the reality of missed appointments. Regardless of whether or not the reason is legitimate, no-shows impact the bottom line. At a time when a practice’s overhead meter keeps running in terms of labor, rent, and utility costs, missed appointments equal lost revenue and scheduling issues. After all, time is money, which is why practitioners need to address this problem head on and identify effective solutions.

2012-01-01

Editorial Board

2012-01-01

Optometry - Journal of the American Optometric Association

Thinking beyond ourselves

Seeing well is the key to learning in a world of 3-D

Risk of endophthalmitis remains low

Letter

Response

Guidelines for Authors

Demyelinating optic neuritis presenting as a clinically isolated syndrome

Remote treatment of intermittent central suppression improves quality-of-life measures

A survey of optometry leadership: Participation in disaster response

Corneal collagen cross-linking: An introduction and literature review

The Florida Heiken Children's Vision Program

Nutrients in the battle against age-related eye diseases

Top 10 tax blunders

Taking steps to limit appointment no-shows

Table of Contents

Editorial Board