Optometry - Journal of the American Optometric Association RSS feed: Articles in Press. Optometry- Journal of the American Optometric Association leads the way in providing doctors of optometry (O.D.) and optometry students with research that helps improve the quality of eye and vision care everywhere. It contains peer-reviewed articles on various clinical aspects of the profession and presents readers with educational material on current research in vision problems, eye disease, and other vision abnormalities. The content covers a range of topics with an emphasis in primary care optometry, contact lenses, sports vision, low vision, pharmaceuticals, and practice enhancement. In addition to articles, regular features include editorial perspectives, book reviews, medical abstracts, health notes, industry news, and office management.http://www.optometryjaoa.com//inpress?rss=yesElsevier Inc.en © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved. Optometry - Journal of the American Optometric Association1529-18392010-07-26 © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optometryjaoa.com/article/PIIS1529183910002770/abstract?rss=yesAbstract: Background: The purposes of this investigation were to determine whether vergence adaptation occurs after vergence range testing and vergence facility testing and to determine whether vergence adaptation correlates with the results of these tests.Methods: Thirty subjects participated in 3 testing sessions on different days. During each session 1 of the following was tested: base-out prism bar vergences, vergence facility (12 base-out/3 base-in binocular prism flippers for 1 minute), and 5 minutes viewing with 6 prism diopters of base-out prism. Before and after each test, the near phoria was measured using the modified Thorington method.Results: There was no correlation between the amplitude of the vergence ranges and the amplitude of vergence facility. Significant vergence adaptation as indicated by an esophoric shift of approximately 3 prism diopters occurred in all testing sessions. The amplitude of vergence adaptation did not correlate with either the amplitude of the blur vergence range or vergence facility. There was a significant correlation between the amplitude of vergence adaptation and the amplitude of the break vergence range.Conclusions: The lack of correlation between the blur vergence range and the vergence facility is not likely because of vergence adaptation. The lack of correlation between the break vergence range and the vergence facility may be in part caused by vergence adaptation.Vergence adaptation in clinical vergence testing - Corrected ProofCatherine McDaniel, Nick Fogt10.1016/j.optm.2010.01.012Optometry - Journal of the American Optometric Association (2010)2010-07-26Optometry - Journal of the American Optometric Association2010-07-26http://www.optometryjaoa.com/article/PIIS1529183910003143/abstract?rss=yesAbstract: Purpose: The aim of this analysis was to describe characteristics and trends of malpractice payments by optometrists since the inception of the National Provider Data Bank (NPDB) as they assumed increasing prescriptive authority.Methods: NPDB data files were analyzed for details of optometrist malpractice payments from 1991 through 2008. Payment amounts, sources, and allegations were all identified and summarized, along with geographic and demographic data.Results: Between 1991 and 2008, a total of 609 optometrist malpractice payments were reported nationally, ranging from $50 to $2,050,000 (median, $57,500; mean, $156,055 ± 246,556), with 603 (99%) less than $1,000,000. Annual inflation-adjusted mean dollars and frequency of payments increased only nominally over the 18-year interval, from $154,573 to $155,151, and 30 to 40, respectively. More than half of all cases originated in 11 states. Alleged errors in diagnosis accounted for 55% of all cases.Conclusion: Malpractice payments on behalf of optometrists are relatively infrequent (on average, less than 34 nationally each year) and usually relatively small (almost half less than $50,000). The frequency of payments and mean payments have increased little over the last 2 decades.Malpractice payments by optometrists: An analysis of the national practitioner data bank over 18 years - Corrected ProofRobert S. Duszak, Richard Duszak10.1016/j.optm.2010.05.009Optometry - Journal of the American Optometric Association (2010)2010-07-26Optometry - Journal of the American Optometric Association2010-07-26http://www.optometryjaoa.com/article/PIIS1529183910003155/abstract?rss=yesAbstract: Background: Retinopathy is associated with the use of interferon and ribavirin for the treatment of chronic hepatitis C. Common ocular complications include cotton wool spots, retinal hemorrhages, and macular edema.Case Report: A 53-year-old black man with a history of drug and alcohol abuse was admitted to the Department of Veterans Affairs clinic for substance abuse treatment. Results of a liver biopsy showed chronic hepatitis C, and treatment with interferon and ribavirin was initiated. A comprehensive eye examination was performed just before the initiation of treatment, and the patient was then periodically monitored for the presence of retinopathy. No retinopathy was found at the initial visit or at his 1-month or 2-month follow-up examinations. His 4-month retinal evaluation found cotton wool spots in both eyes and retinal hemorrhages in the left eye. The retinopathy persisted for several months but resolved in both eyes before his treatment was discontinued. Throughout his treatment period there were no visual complaints or visual acuity changes.Conclusions: Although this patient was visually asymptomatic, and his retinopathy resolved during treatment, we chose to monitor the patient monthly during treatment because of the risk of serious (although rare) ocular complications.Retinopathy associated with pegylated interferon and ribavirin treatment for chronic hepatitis C - Corrected ProofShelly Adams, Mark Ostermeier10.1016/j.optm.2010.04.094Optometry - Journal of the American Optometric Association (2010)2010-07-26Optometry - Journal of the American Optometric Association2010-07-26CLINICAL CAREhttp://www.optometryjaoa.com/article/PIIS1529183910003349/abstract?rss=yesAbstract: Background: Myasthenia gravis (MG) is an autoimmune disease that affects the voluntary skeletal muscles. It is characterized by transient weakness of the muscles that improves with rest. Muscle weakness involving the eyes can produce signs or symptoms of diplopia, blurred vision, ptosis, and ophthalmoplegia. Ptosis is defined as an abnormal eyelid “drooping” beyond the normal 1 to 2 mm of the upper limbus of the cornea. Hence, most patients with MG have ophthalmic manifestations. Among all patients with MG, up to half will have exclusively ocular symptoms. In these cases, the condition is referred to as ocular myasthenia.Case Report: A 60-year-old man was referred from a neurology clinic for management of intermittent diplopia for greater than 1 year and intermittent bilateral ptosis for the prior year. He reported that he first noticed symptoms of MG at the age of 42, but did not receive the diagnosis until 1 year before his aforementioned neurology examination. He was prescribed spectacles with bilateral ptosis crutches. A diagnosis of severe seronegative MG was subsequently confirmed with neurologic examination and antibody testing.Conclusions: Because patients with undiagnosed myasthenia gravis may present initially with ocular signs or symptoms, it is important for the optometrist to be familiar with the condition and the simple “in-office” tests that can be performed to establish a tentative diagnosis and management plan. The optometrist can also participate in the management of ocular manifestations of myasthenia and should be familiar with the use of a ptosis crutch (in addition to prism spectacles or occlusion therapies if indicated) as a nonsurgical intervention for ptosis.On the frontline: What an optometrist needs to know about myasthenia gravis - Corrected ProofJoseph A. Pruitt, Pauline F. Ilsen10.1016/j.optm.2009.09.023Optometry - Journal of the American Optometric Association (2010)2010-07-23Optometry - Journal of the American Optometric Association2010-07-23http://www.optometryjaoa.com/article/PIIS1529183910002526/abstract?rss=yesAbstract: Background: Neuro-ophthalmic manifestations of aneurysmal subarachnoid hemorrhage are commonly linked to a palsy of the cranial nerve in close proximity to the aneurysm or to chronic intracranial hypertension.Case Report: A patient with subarachnoid hemorrhage secondary to a rupture of an intracranial right ophthalmic segment internal carotid artery aneurysm presented with an acute-onset contralateral abducens nerve palsy. There were no clinical or radiologic features of chronic intracranial hypertension. Magnetic resonance imaging showed a co-existent ectatic basilar artery on the left side of the pons in close relation to the sixth nerve.Conclusion: Abducens weakness in the above-50 age group is most commonly caused by a vascular etiology. The authors discuss the pathogenesis of this rare clinical entity and present pertinent literature review.Ophthalmic segment aneurysmal subarachnoid hemorrhage presenting with contralateral abducens nerve palsy: A false localizing sign - Corrected ProofSunil V. Furtado, Dilip Mohan, Alangar S. Hegde10.1016/j.optm.2010.03.008Optometry - Journal of the American Optometric Association (2010)2010-07-12Optometry - Journal of the American Optometric Association2010-07-12CLINICAL CAREhttp://www.optometryjaoa.com/article/PIIS1529183910002484/abstract?rss=yesAbstract: Background: Fabry disease is an X-linked lysosomal storage disorder that causes progressive complications within the kidneys, brain, and heart. Ocular manifestations of this disease are often present at a very young age, thereby facilitating early diagnosis, before the signs and symptoms of renal disease, stroke, or hypertrophic cardiomyopathy. Early diagnosis by the eye care provider may eventually reduce the morbidity and mortality of this disease through the institution of therapy before the development of sclerotic end organ damage. This study evaluated 23 Fabry-affected members of a single cohort for the presence of ocular signs of Fabry disease.Methods: Twenty-three patients of a single family were seen on a single day. Patients were given comprehensive ophthalmic examinations and completed a health and lifestyle questionnaire.Results: Eight hemizygous men (mean age, 32.3 years) and 15 heterozygous women (mean age, 26.9 years) from a single family of 43 known Fabry patients were evaluated. Corneal verticillata was present in all patients. Additional findings in the male patients included anterior capsule opacity (25% total) and Fabry cataract (12.5%). Thinning of the retinal nerve fiber layer was observed in one man whose medical history was significant for stroke. Conjunctival and/or retinal vessel tortuosity was present in the majority of patients (62.5% and 75% of hemizygotes, respectively; 40% and 13.3% heterozygotes, respectively). Additional findings in the women included anterior capsule opacity. The majority of patients (87.5% hemizygotes, 60% heterozygotes) felt Fabry disease had an impact on their quality of life.Conclusions: All evaluated patients who had Fabry disease had corneal verticillata, which generally does not affect vision and is readily recognizable by slit lamp examination. Greater than 60% showed conjunctival and/or retinal vessel tortuosity. The eye care provider can play a crucial role in the early recognition of ocular manifestations of Fabry disease and decrease both the time to accurate diagnosis and the delay in the institution of disease-modifying therapy.Ocular manifestations of Fabry disease within in a single kindred - Corrected ProofAlbert M. Morier, John Minteer, Robert Tyszko, Rachel McCann, M. Virginia Clarke, Marsha F. Browning10.1016/j.optm.2010.02.011Optometry - Journal of the American Optometric Association (2010)2010-07-09Optometry - Journal of the American Optometric Association2010-07-09ISSUE HIGHLIGHThttp://www.optometryjaoa.com/article/PIIS1529183910002769/abstract?rss=yesAbstract: Objective: This study compares different vision screening batteries and documents the failure rates of different vision tests in children who receive periodic vision screenings.Methods: Vision screenings were conducted on 1,992 preschool through fifth grade children attending schools in lower socioeconomic areas in New York City. The screening battery incorporated visual acuity, retinoscopy, cover test, stereopsis, near point of convergence, ocular motility, accommodation, color vision, and ocular health.Results: Slightly less than one third (30%) of the children screened failed the State University of New York (SUNY) battery and were referred for a comprehensive examination, of which 249 (41%) children actually passed distance visual acuities. The referral rate for distance visual acuity alone was 19%. The referral rate for the Modified Clinical Technique (MCT) was 22%. A greater percentage (33%) of the children in grades kindergarten through fifth were referred compared with the preschoolers (20%). Only a small percentage (8%) of the children wore corrective lenses at the time of testing. There was a significant increase in the prevalence of binocular vision problems found in children from grades kindergarten through 5.Conclusions: Poor visual acuity and binocular vision problems exist in schoolchildren despite ongoing vision screenings. The results provide evidence for the necessity of periodic rescreening starting in kindergarten and the importance of screening for hyperopia and binocular vision problems in addition to distance visual acuities.An analysis of vision screening data from New York City public schools - Corrected ProofMarie I. Bodack, Ida Chung, Ira Krumholtz10.1016/j.optm.2010.05.006Optometry - Journal of the American Optometric Association (2010)2010-07-09Optometry - Journal of the American Optometric Association2010-07-09http://www.optometryjaoa.com/article/PIIS1529183910002502/abstract?rss=yesAbstract: Background: Vision loss in retinitis pigmentosa (RP) is a slowly progressive and inexorable threat to patients' independence. It is not surprising that RP patients, many of whom are young when diagnosed, are at high risk for stress related to their vision loss. To address these issues, eye care providers need to be aware of what coping strategies RP patients use to successfully manage their vision loss.Methods: We held focus groups with 8 legally blind RP patients to help us better understand how they cope with the stress that is generated from their progressive vision loss and fluctuations in vision. Focus group sessions were audio-taped and resulting notes were coded using conventional qualitative analytic techniques.Results: Two themes were identified: (1) “kicking and screaming” captured the ways in which RP patients fight to maintain their independence in the face of worsening vision; and (2) “there are so many worse things” describes how RP patients keep their vision loss in perspective. These RP patients demonstrated high levels of resiliency. In particular, they often used humor as a coping mechanism.Conclusion: Understanding the ways in which RP patients manage their gradual, impending vision loss may lead to improved quality of care for this patient population.Coping strategies to manage stress related to vision loss and fluctuations in retinitis pigmentosa - Corrected ProofAva K. Bittner, Lori Edwards, Maureen George10.1016/j.optm.2010.03.006Optometry - Journal of the American Optometric Association (2010)2010-06-30Optometry - Journal of the American Optometric Association2010-06-30CLINICAL RESEARCHhttp://www.optometryjaoa.com/article/PIIS1529183910002514/abstract?rss=yesAbstract: Background: A cranial nerve (CN) III palsy can be caused by a life-threatening aneurysm, typically of the posterior communicating artery. The “rule of the pupil” states the majority (96%) of such cases will present with abnormal pupil findings caused by compression of the fibers, located superficially along CN III. Careful examination of the size and reactivity of the pupils is critical.Case Report: This case describes the complex management of a 79-year-old man with sudden-onset ptosis and diplopia consistent with a superior division CN III palsy. The pupils were normal but because of the incomplete nature of the palsy, the “rule of the pupil” could not be applied, and an aneurysm remained a threat. After urgent testing, microvascular infarct was deemed the cause. However, the palsy failed to resolve after 3 months. Further investigation found myasthenia gravis as the final diagnosis.Conclusions: Several important points are outlined regarding CN III palsies. First, lack of pupil involvement in an incomplete palsy is not equivalent to pupil sparing in a complete palsy. Second, after initial diagnosis, if subsequent findings are no longer consistent, further investigation is warranted. Lastly, myasthenia gravis should be considered as a differential in apparent palsy cases.Normal pupil findings can give a false sense of security in a presumed cranial nerve III palsy patient: A unique case report - Corrected ProofSarah Dougherty Wood10.1016/j.optm.2010.03.007Optometry - Journal of the American Optometric Association (2010)2010-06-30Optometry - Journal of the American Optometric Association2010-06-30CLINICAL CAREhttp://www.optometryjaoa.com/article/PIIS1529183910000898/abstract?rss=yesAbstract: Background: Angle closure most commonly occurs in older hyperopic patients as a result of primary relative pupil block. Less frequently, angle closure occurs in highly myopic patients with conditions other than primary relative pupil block. This report presents the diagnosis, pathophysiologic mechanism, and management of a patient with both high myopia and bilateral advanced phacomorphic angle-closure glaucoma caused by isolated spherophakia.Case: A 40-year-old asymptomatic man with very high myopic astigmatism presented with chronic angle closure and an intraocular pressure of 42 mmHg in both eyes. Additionally there was a nonmyopic fundus and 24-mm axial length, with a clear crystalline lens protruding through the pupillary plane in each eye, confirmed by B-scan ultrasonography. Gonioscopy and A-scan and B-scan ultrasonography identified the pathogenesis of intraocular pressure elevation, angle closure, and high myopia to be lenticular in origin. Initial medical therapy and subsequent laser iridotomy relieved the pupil block angle closure and successfully lowered intraocular pressure.Conclusion: Angle closure can occur in highly myopic eyes. Careful gonioscopy and ultrasonography can lead to the correct diagnosis and tailored management for these eyes. Phacomorphic angle-closure glaucoma from spherophakia is associated with Weill-Marchesani syndrome as well as a few other uncommon syndromes. Isolated pseudophakia is a rarely reported cause of phacomorphic angle closure.Bilateral phacomorphic angle-closure glaucoma in a highly myopic patient secondary to isolated spherophakia - Corrected ProofJoseph Sowka, Nadine Girgis10.1016/j.optm.2010.02.010Optometry - Journal of the American Optometric Association (2010)2010-05-31Optometry - Journal of the American Optometric Association2010-05-31ISSUE HIGHLIGHT