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PubMed1985

Economic and professional aspects of disease prevention and health promotion.

The prevention of disease and the promotion of health, along with cost containment, have become major priorities in the planning for and the delivery of health care services. As the second most prevalent chronic health problem in the United States, vision disorders create a serious health and economic threat to society and, therefore, they should be considered as a prime target for inclusion in programs of disease prevention and health promotion. In recognition of the role and scope of the third largest independent health care profession and in consideration of its cost efficient delivery of eye and vision care services, optometry must become a more active participant in the development and implementation of strategies and programs for improving, maintaining and protecting the visual health of society.

Health Promotion↗
PubMed1992

Urinalysis.

Urinalysis has been a component of patient assessment for centuries and continues to have great utility. The analysis of urine is a useful component in the evaluation of a variety of vision disorders and should be considered an important adjunct to the clinical examination for selected patients. The specimen is readily available, and a basic analysis is inexpensive and simple to perform in the office.

Eye Diseases↗
PubMed1980

Children's health outcomes in six different ambulatory care delivery systems.

This study assesses health outcomes across six widely varying delivery settings within one population sample, describing differences between actual and expected illness prevalences among children using each type of setting as a regular source. Illness measures are from independent clinical examinations of the children for anemia, acute and chronic ear problems, hearing loss and vision disorders. Comparisons of actual with expected prevalences based on each setting's patient clientele reveal three systematic patterns: children using solo practitioners had generally higher-than-expected illness prevalences, while those using the prepaid group and hospital outpatient departments had uniformly lower-than-expected prevalences. These differentials were not related to patients' economic status or to selection of providers according to recent children's health problems, and, for the prepaid group and solo practice, they were generally stronger among more exclusive users of each setting. Thus, the illness differentials appeared to represent outcomes related to system differences in quality of care. Although the differentials were small and not all were statistically signifiant, they may have substantial policy significance. Some unusual as well as characteristic features of each setting are discussed which may explain these system differentials.

Ambulatory Care↗
PubMed1999

Boys have more health problems in childhood than girls: follow-up of the 1987 Finnish birth cohort.

The purpose of this study was to describe gender differences in children's health until the age of 7 y. The study cohort consisted of all children born in Finland in 1987 (n = 60254), of whom 99.9% were identified in the follow-up. Childhood health data were received from five national registers (1987-94), from regional registers of intellectual disabilities (1987-96) and from education registers in the largest county (1996). Boys had a 20% higher risk for a low 5-min Apgar score and an 11% higher risk for being preterm. After the perinatal period, boys had a 64% higher cumulative incidence of asthma, a 43% higher cumulative incidence of intellectual disability, a 22% higher incidence of mortality and a higher, but not statistically significant, incidence of epilepsy and vision disorders. No male excess was found for diabetes or hearing disorders. The healthcare-related indicators showed poorer health for boys, who had a 37% higher mean of hospital days, a 28% higher risk for receiving social benefits due to health problems and a 13% higher risk for long-term medication. The differences in the socially defined indicators were greatest, and boys had a two- to three-fold risk of having delayed development, postponed school start or attendance in special education programmes. Gender differences in different social classes were similar. Boys' shorter gestational age at birth did not explain the gender differences in childhood health. Some of boys' poorer health seemed to be biologically based, but the social causes of health problems are amenable to change. In particular, the potential of the school system to reduce ill health among boys should be investigated.

Absenteeism↗
PubMed1998

A new computer program for mass screening of visual defects in preschool children.

AIMS: To test the effectiveness of a PC computer program for detecting vision disorders which could be used by non-trained personnel, and to determine the prevalence of visual impairment in a sample population of preschool children in the city of Beer-Sheba, Israel. METHODS: 292 preschool children, aged 4-6 years, were examined in the kindergarten setting, using the computer system and "gold standard" tests. Visual acuity and stereopsis were tested and compared using Snellen type symbol charts and random dot stereograms respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and kappa test were evaluated. A computer pseudo Worth four dot test was also performed but could not be compared with the standard Worth four dot test owing to the inability of many children to count. RESULTS: Agreement between computer and gold standard tests was 83% and 97.3% for visual acuity and stereopsis respectively. The sensitivity of the computer stereogram was only 50%, but it had a specificity of 98.9%, whereas the sensitivity and specificity of the visual acuity test were 81.5% and 83% respectively. The positive predictive value of both tests was about 63%. 27.7% of children tested had a visual acuity of 6/12 or less and stereopsis was absent in 28% using standard tests. Impairment of fusion was found in 5% of children using the computer pseudo Worth four dot test. CONCLUSIONS: The computer program was found to be stimulating, rapid, and easy to perform. The wide availability of computers in schools and at home allow it to be used as an additional screening tool by non-trained personnel, such as teachers and parents, but it is not a replacement for standard testing.

Child↗
PubMed2001

Visual disorders in children with brain lesions: 2. Visual impairment associated with cerebral palsy.

Disorders of visual function are a common finding in children with cerebral palsy. In some cases they are secondary to ophthalmologic abnormalities such as cataract or retinopathy, but more often they are due to damage of the central visual pathway. We review the literature on the prevalence and distribution of visual abnormalities in children with cerebral palsy and their relation to cognitive, motor and emotional development.

Cerebral Palsy↗
PubMed2004

[Strategies of visual acuity assessment].

Visual acuity can be assessed by different strategies. The constant-stimulus-, the stair-case-, the Best-PEST-strategies, and the EN ISO 8596 are discussed. In cases of presumed psychogenic visual impairment and malingering it can be useful to modify these strategies striving for a determination of the (minimum) visual acuity based on statistical analysis rather than "clinical experience". The EN ISO 8596 defines visual acuity by a 60 % criterion, thus implying guesswork, if recognition of the optotypes is uncertain. Therefore, the forced-choice-procedure is mandatory. Objective psychophysical (preferential looking, induction or suppression of rhythmic eye movements) and electrophysiological methods (VEP) of visual acuity assessment can be useful in infants, in the mentally handicapped, and in patients with presumed psychogenical influence or malingering.

Data Interpretation, Statistical↗
PubMed1999

Non-organic visual loss.

Visual complaints without a physical basis are not uncommon presentations to the general physician, the neurologist, or the ophthalmologist. These alleged visual disturbances may be psychogenic or feigned. The diagnosis is made when all possible contributory pathology of the visual system is excluded, and reassurance remains the cornerstone of management.

Blindness↗
PubMed2001

[Cycle disorders, polydipsia, decline of vision. Is it the fault of the hypophysis?].

Apart from partial or complete insufficiency, further diseases of the pituitary with clinical impact are those associated with hormone overproduction such as acromegaly, Cushing's disease and prolactinoma. The cardinal symptom of pituitary insufficiency or disruption of the female cycle, loss of libido or sexual potency reflecting a lesion of the gonadotrophic axis. Hyperprolactinemia also results in a loss of gonadotrophic function. Macroadenomas of the pituitary gland often give rise to visual field defects, so that an ophthalmological work-up is a must. With the exception of hyperprolactinemia, measurement of basic hormone levels is not always sufficient to detect pituitary diseases. For the establishment of hormone deficiency, therefore, stimulation tests, and for detection of hypersecretion suppression tests, are carried out. Owing to the increasing utilization of cranial MRI, incidental detection of intrasellar tumors, the so-called incidentalomas, is becoming ever more common, and these lesions require at least an endocrinological investigation.

Acromegaly↗
PubMed1992

Absence of the relative afferent pupillary defect with monocular temporal visual field loss.

We report five patients with monocular temporal visual field abnormalities who did not have clinically detectable relative afferent pupillary defects. The causes for the field defects were posterior ischemic optic neuropathy, craniopharyngioma, pituitary adenoma, pseudotumor cerebri, and traumatic optic neuropathy. We discuss the possible explanations for our observations, considering the known anatomy of the pregeniculate visual pathways and the afferent pupillary pathways.

Adenoma↗
PubMed1992

The differential diagnosis of perceptual deficits in traumatic brain injury patients.

This article describes a perceptual testing battery useful in the evaluation of the traumatic-brain-injury patient. Areas of visual perceptual deficits significant in this population are discussed. Key tests, familiar to optometrists, are indicated for the evaluation of these areas. A differential diagnosis based on the results of these tests can be made. This allows for an effective visual rehabilitation program to be developed for these patients.

Brain Injuries↗