School Vision Screening Research Articles

The sight test fee Potential to spread alarm

The sight test fee Potential to spread alarm

The sight test fee Authors' reply

The sight test fee Authors' reply

The sight test fee Many people cannot afford to pay fees for NHS services

The sight test fee Many people cannot afford to pay fees for NHS services

The sight test fee Similar experience in Leeds

The sight test fee Similar experience in Leeds

The sight test fee Relatives at risk can have free test

The sight test fee Relatives at risk can have free test

The sight test fee Little evidence to support conclusions

EDITOR, - D A H Laidlaw and colleagues' paper on the effect of the sight test fee precipitated a predictable furore in the media.1 I was disappointed to see that the authors had included data from 1988 when …

The sight test fee Need for more cautious analysis

EDITOR, - D A H Laidlaw and colleagues describe the effect of the introduction of the sight test fee on the number of referrals to Bristol Eye Hospital.1 They use the numbers of referrals for 1984-8 to predict the expected numbers of referrals in 1989-92. This use of their data would have been appropriate if the introduction of the fee on 1 April 1989 had been made without prior warning. …

The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection.

To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989. Review of referral records and clinical notes. Referrals to the Bristol Eye Hospital. 51,919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail. Numbers of referrals; rate of adult true positive glaucoma referrals. Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion. The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.

Early signs of myopia in Chinese schoolchildren.

We looked for the earliest signs of the onset of myopia in 194 emmetropic (-0.25 to +0.75 D) eyes by following them for 1 to more than 2 years. Visual acuity examination, cycloplegic retinoscopy, and A-scan ultrasonography were performed at intervals of 6 to 12 months. Of the 194 eyes 64 became myopic during the observation time. Our results show that during the progression from emmetropia to myopia the change in visual acuity is not a good indicator of the onset of myopia. When visual acuity decreased to below 6/6 (20/20) cycloplegic retinoscopy showed that most of the 64 eyes had become truly myopic and A-scan ultrasonography revealed a significant increase in vitreous chamber depth and axial length as compared to the non-myopic eyes. In the early stage of myopia development the anteroposterior diameter of the eye elongates. However, changes in anterior chamber depth and lens thickness did not differ between the myopic and non-myopic group. Our results suggest that routine ocular refraction should be conducted in addition to the school vision screening. For those who have visual acuity 6/6 (20/20) and ametropia of -0.25 D or more minus we would like to be able to prevent or at least retard the development of myopia.

Relative effectiveness of different modes of glaucoma screening in optometric practice

This study analyses records from 189 optometric practices in England and Wales on the glaucoma screening of 123,415 patients aged > 40 years during a prospective 6 month period. Its purpose is to compare the effectiveness of the various modes of screening which were used. All optometrists tested every patient by ophthalmoscopy. The 146 who, in addition, conducted tonometry on a routine basis detected a confirmed glaucoma in 0.35% of their patients, whilst the 43 who used tonometry 'on suspicion' detected a case in 0.25%, (P < 0.02). The 47 optometrists who conducted perimetry frequently (i.e. in > or = 15% of sight tests) detected a case in 0.46% of patients, whilst the other 142, who did little or no perimetry, detected a case in 0.29%, (P < 0.001). Eleven optometrists who relied mainly on ophthalmoscopy had a detection rate of only 0.12%. Optometrists with the most comprehensive modes of screening had the greatest referral accuracy. It was concluded that more widespread adoption of routine tonometry for people aged approximately greater than 40 years is necessary to reduce the present substantial number of false negatives; and that the frequent use of visual field analysis is additionally required to achieve the best results.

Screening for glaucoma: age and sex of referrals and confirmed cases in England and Wales

This paper is based on a prospective survey covering 275,600 sight tests by optometrists in England and Wales. It analyses the age and sex distribution of 1402 referrals for suspected glaucoma and 456 confirmed cases of the disease. The proportion of sight tests which led to a confirmed case increased with age, for both sexes, to a maximum at approximately 70 years, and then tended to decline. Cases of glaucoma in people aged 36-51 years accounted for about a tenth of the total, which is more than is generally recognized. Wider adoption of routine tonometry for middle aged people would help to ensure that these cases are detected at an early stage. Confirmed cases of glaucoma in which raised intraocular pressure had not been given as a reason for referral, i.e. probable low tension glaucomas, increased from 5% of patients < 51 years old to 13% of patients > 75 years old. Glaucoma was found to be much more common in men.

Screening for glaucoma: age and sex of referrals and confirmed cases in England and Wales

This paper is based on a prospective survey covering 275600 sight tests by optometrists in England and Wales. It analyses the age and sex distribution of 1402 referrals for suspected glaucoma and 456 confirmed cases of the disease. The proportion of sight tests which led to a confirmed case increased with age, for both sexes, to a maximum at ≈70 years, and then tended to decline. Cases of glaucoma in people aged 36–51 years accounted for about LI tenth of the total, which is more than is generally recognized. Wider adoption of routine tonometry for middle aged people would help to ensure that these cases are detected at an early stage. Continued cases of glaucoma in which raised intraocular pressure had not been given as a reason for referral, i.e. probable low tension glaucomas, increased from 5% of patients <51 years old to 13% of patients >75 years old. Glaucoma was found to be much more common in men.

The Marketing of a Professional Service: Opticians

In less than a decade, a series of rapid and radical changes in legislation have led to structural and competitive changes in the market for eye care. In the short period between 1984–9 the ban on advertising was lifted; dispensing of spectacles for most people by unqualified and unregistered suppliers was permitted; National Health Service (NHS) spectacles were phased out; universal free sight testing was abolished; and the sale of simple, ready-made, non-prescription reading spectacles by unqualified vendors was legalized.This article considers the effects of the partial deregulation of the profession of opticians on the marketing strategies employed both by newcomers attracted by liberalization, and of traditional opticians compelled to adapt their operations and organization. First, the changes in the legal framework are examined and compared with that in which the opticians operated prior to 1984. Second, the competitive and commercial marketing environment which has developed as a result of this leg...

Preliminary Report of the Colorado School Vision Screening Interdisciplinary Task Force

Preliminary Report of the Colorado School Vision Screening Interdisciplinary Task Force

Do patient charge increases reduce the use of prescription medicines? An economic perspective

Patient charges are increasingly advocated by government as a policy tool to raise revenue and regulate the utilization of primary health care. Since the Conservative government came to power in 1979, the charge for NHS prescriptions has risen sharply from 20 pence per item in 1979 to £3.05 in April 1990. Charges for sight testing were introduced in April 1989. An introduction, or increase, in patient charges often provokes fierce political and medical debate about likely effects on patients. Such debate can be informed by empirical evidence from the growing number of economic studies in the US and UK which quantify the statistical relationship between patient charges and health care utilization. This paper reviews the evidence on drug prescriptions and patient charges and presents data for the UK. The implications of patient charges for the efficiency and equity of primary health care provision are considered.

Efficiency of referral for suspected glaucoma.

To examine the efficiency of referral for suspected glaucoma to general practitioners and consultants by optometrists. A prospective survey covering 5% of all sight tests performed by optometrists in England and Wales over six months, with analysis of referred patients. 241 optometrists' practices in areas representative of England and Wales in socioeconomic terms. Of 275,600 people attending for a sight test, 1505 were referred with suspected glaucoma (0.9% of those aged over 4%). Outcomes were recorded for 1228 patients, 1103 (90%) of whom attended for examination by a consultant ophthalmologist (8% on a private basis). The analysis was confined to the 704 cases in which the information on diagnosis was received directly from a consultant or general practitioner. Diagnoses reported by consultant ophthalmologists. Waiting times before an appointment for examination by a consultant ophthalmologist. Glaucoma was confirmed in 283 of the 704 referred patients, and another 222 patients were considered to require further monitoring. In all, 112 (41%) of 275 confirmed cases of glaucoma were in patients with intraocular pressures greater than or equal to 30 mm Hg. At all levels of intraocular pressure the accuracy of referral was greater when the optometrist also recorded the presence of suspicious optic discs or loss of visual field, or both; but only 331 (47%) out of the 704 referred patients had been tested with a field screener. The median waiting time for an NHS clinic appointment was nine weeks. Almost a 10th of confirmed cases of glaucoma were in people in a high risk category for glaucoma who had to wait at least 14 weeks for an appointment. Closer cooperation, especially at the local level, among consultants, general practitioners, and optometrists is needed to improve testing and referral for suspected glaucoma. Optometrists should be encouraged to perform all the three main tests--ophthalmoscopy, tonometry, and perimetry--in patients before referral and to report precisely on reasons for referral to help prioritisation. The optometrist's referral letter to the general practitioner should always be passed on to the consultant. Similarly, the diagnosis should always be reported back to the optometrist.

Proposal for limitation and control of fines in calcareous sands based upon their influence in some concrete properties

The development and final conclusions of a research programme which has gone on for four years are explained here. The products of Basque Country quarries have been analysed, studying also the influence of calcareous and clay fines in mortars, as well as in crushed calcareous aggregate concretes, this being the objective of the present article. 42 different concrete mixes in duplicate, with the same workability, have been made, taking the contents of fines and clay in sand and the cement content as variables. This process has involved handling a total of 14 tonnes of aggregate and the manufacturing of more than 900 standardized cylinders. It is concluded that up to 15% of fines in calcareous and ground sand are admissible, provided that the proportion of clay fines is controlled by means of a sand equivalent sight test and, even better, by the methylene blue test method. This research work has been the basis for the new text of the corresponding paragraphs in the recent Spanish Concrete Standard EH-88, but could be, a reference for others with a similar type of aggregate.

Home Sight Tests for the Housebound

Home Sight Tests for the Housebound

Children referred from school vision screening.

Children referred from school vision screening.

Using closed captioned television to teach reading to adults

Abstract The use of closed captioned television to teach reading to adults was investigated in this study, using a pre‐experimental design. Of most interest were the effects of the use of closed captioned television as a medium for sight vocabulary development. Also of interest were students’ reactions to using closed television as a means of reading instruction. Results indicated that, overall, students improved significantly on a pre‐post word recognition measure; however, student performance did not differ across treatments. Also, there were no significant differences among groups on measures administered after each lesson. Moreover, the group using closed captioned television, without instruction, did evidence a degree of success in reaching a specific criterion level on weekly sight vocabulary tests. Finally, student attitudes toward closed captioned television were extremely positive, not only toward its use as a means of learning to read, but as a means of increasing general knowledge. This pre‐exp...