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Biomedical subjects

A R Reinke

Publications and source records attributed to A R Reinke.

8 recordsLinked to original sources

The dizzy patient: a review of etiology, differential diagnosis, and management.

BACKGROUND: Dizziness is a lay term used to describe a variety of sensations. Unfortunately, the term "dizziness" does not have a precise medical definition, and additional information is typically required to further define the patient's problem. METHODS: When dizziness is a presenting complaint, distinctions must be made between vertigo (a sense of false movement), near-syncope (a feeling of impending faint), disequilibrium (loss of balance), and ill-defined lightheadedness (an inability to concentrate or focus the mind). Possible causes of dizziness include conflicts between visual and vestibular information, vascular problems, adverse reactions to medication, psychological difficulties, systemic disease, and the effects of aging. RESULTS: Dizziness is a symptom of a physiological or psychological illness, and therefore management is typically directed toward treatment of the underlying illness. In some cases the cause of the dizziness cannot be found, however, or is untreatable. In these cases, management is directed toward symptom reduction. CONCLUSIONS: Dizziness is a relatively common problem that arises from a variety of causes. In many cases, optometrists can participate in the diagnosis and management of patients with complaints of dizziness.

Diagnosis, Differential↗

Second opinion: a computer expert system designed to aid in the determination of spectacle lens prescriptions.

BACKGROUND: Expert systems (ESs) are computer programs that simulate the decision-making ability of human experts. In this project, an ES was developed that used optometric data and decision rules to determine spectacle lens prescription powers. METHODS: Decision rules derived from clinical experience and standard references were provided to a commercially available shell program to create an ES called Second Opinion. The ES determined spherical, cylindrical, and add powers designed to provide maximum acuity consistent with a high probability of patient acceptance. CONCLUSIONS: Second Opinion demonstrates how a computer program can be used to analyze optometric data and offer suggestions regarding lens prescriptions.

Adult↗

Exploring the optometric application of expert computer systems: refractive error correction.

Using the commercially available shell programs NeuroShell and EXSYS, example-based and rule-based expert computer systems were developed to explore how such systems could be applied in an optometric environment. To demonstrate such an application, the example-based NeuroShell system was taught to prescribe sphere and cylinder powers for low refractive error myopes. When the system learned with only the chief complaint, habitual prescription and acuity through the habitual, and best refraction with resulting acuity, it predicted the sphere and cylinder powers prescribed by human optometrists within 0.25 diopter 97 and 98 percent of the time, respectively, for 60 test eyes. With a set of only three rules, the rule-based EXSYS system predicted sphere powers within 0.25 diopter of the prescribed powers for 100 percent of the 60 test eyes. Results with these very simple refractive problems suggest that teaching expert computer systems to prescribe ophthalmic lens corrections is possible, and further suggest that the concept could be extended to more complex and challenging patient populations.

Eyeglasses↗

Applications of expert computer systems.

An expert system is a computer program which uses artificial intelligence to make logical decisions on the basis of input data. The rules the system uses to make its decisions are called heuristics which can be provided in the form of IF . . . THEN statements, or they can be learned by the system from examples. The term "expert" is used because the rules or examples come from human experts and the program is considered to have captured their expertise. Currently there are many expert systems in business and medical use but few, if any, are used in optometry. The rule-oriented nature of many ophthalmic procedures suggests a future role for these systems, but their cost-effectiveness may not yet be favorable enough to justify development of expert systems for optometric practice.

Diagnosis, Computer-Assisted↗

Clinical comparison of air-puff and Goldmann tonometers.

Intraocular pressures (IOPs) as measured with the Topcon CT-10, Reichert XPERT and NCT II, and Keeler PULSAIR air-puff tonometers were compared to the Goldmann IOPs for 452 eyes ranging in pressure from 6-40 mmHg. For eyes with pressures in the 10-20 mmHg range, the CT-10 read consistently too high. The XPERT and the NCT II read too high in the lower part of this range and too low in the higher part. The PULSAIR read too low across the entire range. At higher pressures, all of the tonometers read too high except the PULSAIR which again read too low. CT-10, XPERT, and NCT II and PULSAIR pressures were within 4.0 mmHg of Goldmann readings for 81, 85, 89 and 72 percent of the eyes, respectively. Subjects selected the XPERT as the most preferred tonometer and the NCT II was the least preferred mainly because of perceived air-puff intensity.

Adolescent↗

A comparison of diagnostic outcomes with and without pupillary dilatation.

To compare the quality of fundus evaluations conducted with natural and dilated pupils, 500 typical adult subjects, divided into five age categories, were examined using both techniques. Direct and monocular indirect ophthalmoscopes were used with the natural pupils; direct and binocular indirect scopes were used for the dilated examinations. Retinal anomalies were classified on the basis of posterior pole or peripheral location and whether the anomalies would require significant action by the doctor. Of the 32 posterior pole anomalies which required action, 38% were missed during the natural pupil examination; 51% of the anomalies not requiring immediate action were also missed. These miss rates, along with the 287 anomalies found in the periphery (20 of which required immediate action), suggest that dilation should be strongly considered for all patients so as to optimize the probability of detecting fundus anomalies.

Adult↗

Therapeutic pharmaceutical utilization by military optometrists.

The Air Force, Army, and Navy have instituted regulations that authorize optometrists to use therapeutic pharmaceutical agents (TPAs). A survey of clinical optometrists on active duty was conducted to evaluate the impact of these regulations on military optometry. The results indicate that the majority of optometrists support the regulations and are utilizing TPAs to treat a wide variety of ocular disorders. However, the survey also found a number of optometrists in each service who were dissatisfied with certain aspects of the regulations. Some Air Force and Navy optometrists expressed concern that their regulations did not allow access to TPAs which they felt qualified to use. Some Army respondents felt that their regulation was unduly influenced by local policy and was not an equitable means of granting therapeutic privileges. These concerns suggest that a reevaluation of the therapeutic regulations might be required in the future.

Anti-Infective Agents↗

Effect of head and eye positions on fixation disparities, phorias, and ductions at near.

This study evaluated the effects of head and gaze position on near fixation disparity, phoria, and duction findings. A population of 104 non-complaining subjects divided by age into 3 groups participated in the study. The primary head and gaze position along with two others approximating the positions used for reading by nonbifocal and bifocal wearers were used. A statistically significant effect was found for the phoria data from the young group, but the magnitude was clinically insignificant. Changes in head and/or gaze positions did not significantly affect fixation disparities or duction recovery ranges. Phorias and fixation disparities showed statistically significant increases in exo deviation with increasing age regardless of head and/or gaze position. Nine of 23 presbyopic subjects gave erratic findings during fixation disparity testing and this casts doubt upon the clinical usefulness of this procedure with presbyopes.

Adolescent↗