Vision Exam Research Articles

Association of Contrast Sensitivity with Eye Disease and Vision-Related Quality of Life

To investigate contrast sensitivity (CS) as a screening tool to detect eye disease and assess its association with both eye disease and vision-related quality of life. Cross-sectional study. Setting and population: Adults receiving care from a free clinic and a Federally Qualified Health Center in Michigan. Screening positive for eye disease and Visual Function Questionnaire (VFQ) score. Participants received a vision exam reviewed via telemedicine for disease, completed a demographic survey, and the 9-item VFQ. The ability of CS to predict eye disease was explored and area under the curve (AUC) is reported. Logistic and linear regression were used to investigate the continuous effect of CS on the probability of screening positive for eye disease and VFQ score, respectively, adjusting for age and visual acuity. 1159 included participants were, on average, 54.9 ± 14.5 years old, 62% identified as female, 34% as White, 54% as Black, 10% as Hispanic/Latino, and reported mean VFQ score of 79.7 ± 15.3. CS ranged from 0.00 to 1.95 log units (mean = 1.54 ± 0.24), 21% of eyes had glaucoma, 19% cataract, 6% DR, and 2% AMD. AUCs were 0.53 to 0.73. A 0.3 log unit decrease in better eye CS was associated with increased odds of glaucoma (odds ratio [OR] = 1.35, confidence interval [CI] = 1.09-1.67), cataract (OR = 1.35, CI = 1.05-1.72), DR (OR = 2.05, CI = 1.51-2.77), and AMD (OR = 2.08, CI = 1.10-3.91). A 0.3 log unit increase in better eye CS was associated with a 5.9 unit increase in VFQ. While CS alone is not sufficient to identify people with eye disease, it is an important measure of visual function that can add value to comprehensive eye screening.

Adherence of parents to vision screening for school-aged children in Eastern Region, Saudi Arabia

Objectives: To assess the adherence of parents to vision screening recommendations for school-aged children. Also, to point out beliefs and barriers that prevent them from screening. Methods: This was a descriptive cross-sectional study conducted among parents from the Eastern region of Saudi Arabia to assess their adherence to vision screening for school-aged children. A self-administered questionnaire was distributed via social media among the study participants. Results: A total of 1,556 participants answered the questionnaire. Majority were females (73.8%) and residents of Al-Ahsa (70.6%). A great majority of the participants (92.5%) believed that childhood vision examination should be done in preschool. However, more than half of the participants (61.6%) did not take their children for a routine vision exam. Regarding beliefs, 85.4% participants thought that there was a lack of knowledge about the importance of the vision exam, and 68.2% did not think that their community adhered to routine vision exams. When asked about reasons for non-adherence, most participants (85%) had cited long waiting time for vision screening appointments as the main reason for non-adherence. Conclusion: Although majority of the participants understand the importance of vision screening in school-aged children. Most participants did not take their children for vision screening mainly because of difficulties in obtaining screening appointments. Future interventions should focus on improving the accessibility and coverage of vision screening programs directing school-aged children.

Newborn and infant vision screening in primary care: A clinical review.

Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that may cause future impairment or vision loss. Providers may underestimate the importance of screening or find neonatal vision assessments difficult due to poor patient cooperation or time-consuming exams, but the reversibility of vision impairment in infants makes early detection paramount to proper treatment. This article provides a clinical review of evidence-based, practical guidance to providers who care for infants from birth through 6 months of age in the primary care setting. The comprehensive eye exam in infants should include a thorough history and physical examination of eye structures, visual acuity, evaluation of extraocular movements and alignment, and assessment of the red reflex. Recommended exam maneuvers differ with age as visual acuity improves and development advances through infancy. Early detection of ocular pathology is critical to avoid permanent vision loss, serious morbidity, and even mortality. The seemingly complex vision screening exam can be completed with little to no cooperation from the patient when a competent pediatric healthcare provider prioritizes opportunistic exam maneuvers. The opportunistic exam allows providers to maximize efficiency while maintaining thorough technique during vision exams and screenings.

Subjective behavioral measures in myopic and pre-myopic children before and after the COVID lockdown.

There are environmental factors that may contribute to the onset of myopia. This study aims to evaluate the children's lifestyle changes before and after the COVID-19 lockdown and how they can influence their vision. The same questionnaire was administered to children aged between 5 and 7 in Spain every year in September before (2017-2019) and after the COVID-19 lockdown (2020-2021). All the children also passed a vision exam consisting of the measurement of visual acuity (VA) and determination of objective and subjective refraction. Children were classified as myopes, pre-myopes, or hyperopes. The cut-off points to define the refractive error were established according to the value of the spherical equivalent (SE): hyperopia (SE > +0,75D), myopia (SE ≤ -0,5D), or pre-myopia (-0.5D < SE ≥ +0.75D). Data analysis is performed with the SPSS 27.0 software (SPSS Inc., Chicago, Illinois). In the pre-COVID period, the pre-myopes were the ones who spent the longest time outdoors, and after the COVID lockdown, there were no differences between groups. There neither were any differences in the time spent doing near-work activities between the groups in both periods (p > 0.05). Regarding the spherical equivalent, in the pre-COVID period, the mean value was 0.75 ± 2.09D and after the COVID lockdown, it was 0.47 ± 1.88D (p < 0.001). Pre-myopes spent more time outdoors than myopes in the pre-COVID period, while myopes spent more time using digital devices. All these differences do not exist after the COVID lockdown, with a general increase in the time spent outdoors and a decrease in the use of digital devices. Further studies are needed to know if these lifestyle changes remain and how they influence the onset of myopia.

Development and validation of a questionnaire for assessing parents’ health literacy regarding vision screening for children: a Delphi study

Preschool vision screening is recommended to reduce the incidence of amblyopia that persists into adulthood. However, parent’s perceptions regarding the importance of screening and early intervention may constitute a significant barrier to seeking vision exams and pursuing treatment. The aim of this study is to develop and validate a questionnaire for assessing parent’s awareness, perception and health literacy of children's vision tests. The questionnaire was developed using the Delphi method with experts from the fields of pediatric ophthalmology, optometry, orthoptics, pediatric medicine, social sciences and Mother and Child Health Care centers. Experts were provided with drafts of the questions iteratively in three rounds until a consensus was reached independently on the relevant items, coherently language and redundancies. For the first, second and third stages of the Delphi process, 17, 15 and 13 experts participated in the panel respectively. Validity was achieved by wide consensus among the panel on the relevance of each question, of 75%, 85% and 90%, for the three rounds respectively. Here we describe the final questionnaire, EYES: Evaluating Young-Children Eye health Survey, which includes 31 questions regarding demographics, ocular history, parental health literacy, and perceptions of vision and vison exams.

Association between vitamin D and myopia in adolescents and young adults: Evidence of national cross-sectional study.

Studies have indicated that the observed association between vitamin D and myopia was confounded by time spent outdoors. This study aimed to elucidate this association using a national cross-sectional dataset. Participants with 12 to 25 years who participated in non-cycloplegic vision exam from National Health and Nutrition Examination Survey (NHANES) 2001 to 2008 were included in the present study. Myopia was defined as spherical equivalent of any eyes ≤ -0.5 diopters (D). 7,657 participants were included. The weighted proportion of emmetropes, mild myopia, moderate myopia, and high myopia were 45.5%, 39.1%, 11.6%, and 3.8%, respectively. After adjusting for age, gender, ethnicity, TV/computer usage, and stratified by education attainment, every 10 nmol/L increment of serum 25(OH)D concentration was associated with a reduced risk of myopia (odds ratio [OR] = 0.96, 95% confidence interval [95%CI] 0.93-0.99 for any myopia; OR = 0.96, 95%CI 0.93-1.00 for mild myopia; OR = 0.99, 95%CI 0.97-1.01 for moderate myopia; OR = 0.89, 95%CI 0.84-0.95 for high myopia). Serum 25(OH)D level was closely correlated with time spent outdoors. After categorizing time spent outdoors into quarters (low, low-medium, medium-high, and high), every 1 quarter increment of time spent outdoors was associated with 2.49 nmol/L higher serum 25(OH)D concentration. After adjusting for time spent outdoors, serum 25(OH)D level did not show significant association with myopia (OR = 1.01, 95%CI 0.94-1.06 for 10 nmol/L increment). The association between high serum vitamin D and reduced risk of myopia is confounded by longer time spent outdoors. Evidence from the present study does not support that there is a direct association between serum vitamin D level with myopia.

Gender equity in vision care seeking behavior among caregivers: evidence from a randomized controlled trial in rural China

BackgroundDespite rising incomes and rapid economic growth, there remains a significant gender gap in health outcomes among rural children in China. This study examines whether the gender gap in child health is related to the behavior of caregivers when seeking healthcare, and whether healthcare subsidies help to bridge the gender gap in rural health outcomes.MethodsFocusing on vision care specifically, we draw on data from a randomized controlled trial of 13,100 children in Gansu and Shaanxi provinces in China that provided subsidized eyeglasses to myopic children in one set of schools (henceforth, referred to as the treatment schools) and provided prescription information but not subsidized eyeglasses to myopic children in another set of schools (control schools).ResultsThe baseline results reveal that while female students generally have worse vision than male students, they are significantly less likely than male students to be taken by their caregivers to a vision exam. The experimental results indicate, however, that caregivers respond positively to both health information and subsidized healthcare, regardless of the gender of their children. When prescription information is paired with a subsidy voucher for healthcare (a free pair of eyeglasses), the uptake rate rises dramatically.ConclusionsThe gender gap in healthcare can be minimized by implementing subsidized healthcare policies.Trial registrationThe protocol for this study was approved in full by Institutional Review Boards at Stanford University (Palo Alto, California, USA) and the Zhongshan Ophthalmic Center of Sun Yat-sen University (ZOC, Guangzhou, China). Permission was received from local Boards of Education in each region and from the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. The original trial (Registration site: http://isrctn.org. Registration number: ISRCTN03252665) was designed to study the effect of providing free spectacles on children’s educational performance. The original trial was retrospectively registered on 09/25/2012.

The prevalence of amblyopia in 7–9-year-old schoolchildren in Mashhad

Background: To determine the prevalence of amblyopia in schoolchildren aged 7–9 years old in Mashhad, Iran.&#x0D; Methods: This was a cross-sectional, community-based study with schoolchildren aged 7–9 years old. We randomly selected 20 of 189 elementary schools (three schools per district; 10 male-segregated and 10 female-segregated schools) from a proportional combination of public schools across Mashhad. Basic vision exams were performed. If amblyopia was suspected, children underwent supplementary vision exams. The diagnostic criterion for amblyopia was a best corrected visual acuity (BCVA) in one or both eyes equal to or worse than 20/40 or an interocular difference of more than two lines in BCVA without any significant organic pathology.&#x0D; Results: A total of 2831 children were included in the study. All children were examined comprehensively by an optometrist, and amblyopia was detected in 49/2831 (1.7% [95% CI, 1.22?2.18]). Of the 49 children with amblyopia, 20 (40.8%) were amblyopic in the right eye, 9 (18.4%) in the left eye, and 20 (40.8%) in both eyes. Twenty-four (49%) were first graders, 15 (30.6%) were second graders, and 10 (20.4%) were third graders. The most prevalent subtype of amblyopia was anisometropic amblyopia (57.1%, [95% CI, 43.24?70.96]). &#x0D; Conclusions: Considering the prevalence of amblyopia among schoolchildren aged 7–9 years old (1.7%), timely detection of amblyopia through preschool screening programs is essential for early treatment or prevention of further visual impairment during childhood.&#x0D; &#x0D; How to cite this article: Shahpary S, Ramin S, Azimi A, Heyrani M. The prevalence of amblyopia in 7-9-year-old schoolchildren in Mashhad. Med Hypothesis Discov Innov Optom.2021 Spring; 2(1): 18-23. DOI: https://doi.org/10.51329/mehdioptometry121&#x0D;

VISUAL ACUITY IN PUBLIC SCHOOL STUDENTS FROM MANAUS: AMAZONAS

Objective Evaluate visual acuity and your relation to socioeconomic factors in students aged 6 to 15 years, enrolled in a public school located in Manaus, Amazonas. Study Design In the initial phase, all students that participated in activities related to health education, knew how the vision exam would happen, as well as were clarified about the importance of conducting the exam early. The exams were performed by an academic of medicine and another one of dentistry, in that public school was applied the Snellen Signal Scale for visual acuity, and the results were recorded on the appropriate form. Results Eighty students evaluated, 23.75% presented visual acuity changed in at least one eye, and then they were referred for consultation with ophthalmologist. It was observed there is no difference between the visual deficit and the following variables: family income, number of residents, parental education level, house type, and social classes. Conclusions This study serves to substantiate interventionist actions of public policies of health and education in an efficient way, besides enabling the improvement in the students’ quality life. Funding Support: Research Support Foundation of the State of Amazonas (FAPEAM) and University of the State of Amazonas (UEA).

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples

ABSTRACTDiabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.

Performing pediatric eye exams in primary care.

Early vision care is critical for all children. If undetected, eye disorders such as amblyopia and strabismus may result in permanent vision loss. Vision exams should include a careful history and physical including fix and follow, red reflex, and cover/uncover testing. Photo screening and visual acuity exams should be administered whenever possible.

Mise en place d’un réseau de prise en charge facilitant l’accès aux soins ophtalmologiques des patients vivant en situation de précarité, étude de faisabilité

Currently, renouncement to healthcare by socially "at-risk" patients continues to increase and access to ophthalmological care is complex. The main objective of this study is to test the feasibility of a complete organised care network allowing facilitated access to ophthalmological care for patients living in socially "at-risk" situations. A prospective interventional study was conducted within four social housing infrastructures to screen for vision problems in the "at-risk" socially population in question. Partnering with the ophthalmological department of the CHRU de Nancy, an interventional and supportive care trial for the affected population was conducted with the assistance of social workers, nursing aides, opticians, and the author. Ten screening sessions were conducted between December 2015and April 2016allowing a vision exam of sixty-five patients living in social housing. Twenty-five patients benefited from specialised care within a three-month time frame provided by the ophthalmological department, of which nineteen patients received corrective lenses. The remaining six patients received other types of ophthalmological care. The study allowed to demonstrate that the cooperation of willing actors makes it possible to improve access to visual healthcare for patients living in socially "at-risk" situations, in particular in the frame of ophthalmological care, often taking second place in a general medical consultation.

Prevalence of Vision Impairment in School Children of Puente Piedra, Peru

Purpose : To document the prevalence and sociodemographic factors associated with vision impairment in Peruvian children living in Puente Piedra, a resource-poor community in Peru. Methods : Cross-sectional study of children ages 5-19 in Puente Piedra, Peru from March to April, 2011. Participants underwent a standard vision screening exam consisting of distance visual acuity (VA), stereopsis, external eye exam, and color vision testing and completed a sociodemographic and health risk factor questionnaire. Results : 387 children were examined; the mean uncorrected visual acuity of 20/25 ± 1 line. Eyeglasses were used by 3.7%. VA less than 20/30 was present in both eyes of 8.9% of children and in the worse eye of 26.3% of children. Severe visual impairment (<20/200) was found in both eyes of one child (0.3%) and in the worse eye of 3 (0.7%) children. Thirteen (3.5%) children failed the stereopsis exam and 20 (5.5%) boys and 7 (1.9%) girls failed the color vision exam. Overall, 37.3% of children met criteria for referral to an ophthalmologist. Risk factors for referral included: history of eyeglasses use, previous eye exam, or parental concern about the child’s vision. Risk factors for untreated vision impairment included: not having seen a physician regularly, no previous eye exam, and having a blind family member. Conclusion : There was a high prevalence of untreated vision impairment in Peruvian children living in Puente Piedra. Increased screening and eye care is needed for this impoverished population.

Incidence et causes de déficiences visuelles au Gouvernorat de Mahdia, à l’est de la Tunisie : étude rétrospective à propos de 1487 cas

To study socio-demographic characteristics and main causes related to visual impairment (VI) as a function of age bracket and to analyze their trends over time in the district of Mahdia. A retrospective review was performed on 1487cases of visual impairment registered with the social authorities in Mahdia, between 1980 and 2013. The social, demographic, vision exam findings and causes were ascertained and analyzed in an SPSS database. Incidence rates of VI and blindness due to various causes were calculated based on the demographic data from the NSI to estimate the time trends using the general linear regression model and Spearman correlation. Analyses included 1487participants with a median age of 47 years, 40.6% of cases were aged under 45 years. Children accounted for 11.1% (165 patients), while age was between 16 and 45 years in 29.5% (439 patients), between 46 and 65 years in 31.5% (469 patients) and greater than 65 years in 27.8% (414 patients). The sex-ratio (M/F) was 1.78. Socially, 51% came from rural areas, 62% were illiterate, and 84% were unemployed. We observed blindness in 70% of participants and low vision in 30%. In children, the causes were dominated by congenital cataract and congenital glaucoma, each present in 31 children (18.8%). Between 16 and 45 years, glaucoma and hereditary dystrophies of the retina were found in 62 and 61 patients respectively (14% each). For age between 46 and 65 years, trachoma was responsible for 19.8% of cases of VI, glaucoma in 15.8% and cataract in 15.1%. Beyond 65 years, glaucoma accounted for 30.7% of the causes of VI and cataract 27.8% of cases. Trend analysis shows a significant increase in the incidence rate of visual impairment with an average of 12% per year (P=0.001). The mean age increased by 46% (P=0.003). Trachoma increased by 118% (P<0.0001) between 1980 and 1990, then declined by 42% (P=0.0013) between 1991 and 2013. Incidence of VI significantly increased by 4% for cataract (P=0.001), 23% (P=0.001) for glaucoma and 20% (P=0.02) for diabetic retinopathy, while VI related to refractive errors and AMD showed no significant change. Advanced age, lower educational and socio-economic status were associated with bilateral VI. Age related eye problems are the main causes of VI, and their incidence is tending to increase. Public health policies and procedures should be targeted to risk related populations and age-related diseases in order to control the incidence of visual impairment and avoid its consequences.

Influence of visual acuity on anxiety, panic and depression disorders among young and middle age adults in the United States

BackgroundPrevious research, albeit limited, has demonstrated an association of visual acuity with depression and anxiety. However, these studies are limited in that they have focused on older adults, used a convenient sample, and/or used a subjective assessment of visual function. As a result, the purpose of this study was to examine the association of objectively-measured visual acuity with depression and anxiety (and panic disorder) among a national sample of young- and middle-age U.S. adults (20–39 years). MethodsUsing data from the 2003–2004 NHANES (n=602), the presence of anxiety, depression, and panic disorders was assessed from a diagnostic interview. Visual acuity was assessed from a vision exam using the Nidek Auto Lensmeter Model (LM-990A) and expressed as LogMAR units. ResultsAfter adjusting for age, gender, race-ethnicity, body mass index, mean arterial pressure, cotinine, diabetes, and physical activity, visual acuity was not associated with panic disorder (p=0.71) or depression disorder (p=0.20), but for every 0.1 LogMAR unit change in vision, participants had a 14% (OR=1.14; p=0.04) higher odds of having an anxiety disorder. LimitationsThe main limitation of this study was the cross-sectional design. ConclusionYoung- and middle-age U.S. adults with worse visual function are at increased odds of having an anxiety disorder. Strategies to prevent and treat anxiety among those with worse visual function are needed.

Presbyopia: a pilot investigation of the barriers and benefits of near visual acuity correction among a rural Filipino population

BackgroundPresbyopia is the age-related decline in accommodation that diminishes the ability of the eye to focus on near objects. Presbyopia is common and easy to correct; however, many communities lack access to basic eye care. The purpose of this project was to assess the burden of uncorrected presbyopia in a rural Filipino population and to pilot an intervention aimed at increasing access to reading glasses in the community.MethodsIndividuals above the age of 40 who presented to a health outreach in the Philippines were invited to undergo a near vision exam to detect the presence of functional presbyopia and be fitted with ready-made, single-vision glasses. The change in stereoacuity was used as a surrogate measure of functional improvement after near vision correction. A questionnaire was administered to assess this population’s perceived barriers and benefits to correcting near vision.ResultsThe average age of the participants was 57 ± 11 years, with 87.6% of participants having an uncorrected near visual acuity of <20/50. Reading glasses improved near vision to 20/40 or better in 77.7% of participants having near-vision impairment (uncorrected near visual acuity of <20/40). Over 75% of participants also showed improvement in stereoacuity. Cost, rather than availability, was perceived to be the greater barrier to the procurement of glasses, and 84% of participants reported that the glasses dispensed would greatly improve their ability to earn a living.ConclusionsDispensing ready-made, single-vision glasses is a simple and cost-effective intervention to improve near vision and enhance depth perception. A greater understanding of the barriers and benefits to correcting near vision will inform the design and execution of a sustainable program to correct presbyopia in developing countries.

Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital.

Context:In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized.Aims:Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India.Subjects and Methods:The low vision quality of life (LVQOL) questionnaire measures vision-related quality of life through 25 questions on a Likert scale of 0–5 that pertain to (1) mobility, distance vision, and lighting; (2) psychological adjustment; (3) reading and fine work; and (4) activities of daily living. This tool was translated into Tamil and verbally administered to 55 new low vision referral patients before their first visit at the low vision clinic at Aravind Eye Hospital. Low vision aids (LVAs) were prescribed at the discretion of the low vision specialist. 1-month later, the same questionnaire was administered over the phone.Results:About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points). After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001). Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24) experienced an even larger increase than those who did not (n = 20) (8.89 points, P < 0.001).Conclusion:Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation.

Reducing older driver motor vehicle collisions via earlier cataract surgery

Older adults who undergo cataract extraction have roughly half the rate of motor vehicle collision (MVC) involvement per mile driven compared to cataract patients who do not elect cataract surgery. Currently in the U.S., most insurers do not allow payment for cataract surgery based upon the findings of a vision exam unless accompanied by an individual's complaint of visual difficulties that seriously interfere with driving or other daily activities and individuals themselves may be slow or reluctant to complain and seek relief. As a consequence, surgery tends to occur after significant vision problems have emerged. We hypothesize that a proactive policy encouraging cataract surgery earlier for a lesser level of complaint would significantly reduce MVCs among older drivers. We used a Monte Carlo model to simulate the MVC experience of the U.S. population from age 60 to 89 under alternative protocols for the timing of cataract surgery which we call “Current Practice” (CP) and “Earlier Surgery” (ES). Our base model finds, from a societal perspective with undiscounted 2010 dollars, that switching to ES from CP reduces by about 21% the average number of MVCs, fatalities, and MVC cost per person. The net effect on total cost – all MVC costs plus cataract surgery expenditures – is a reduction of about 16%. Quality Adjusted Life Years would increase by about 5%. From the perspective of payers for healthcare, the switch would increase cataract surgery expenditure for ages 65+ by about 8% and for ages 60–64 by about 47% but these expenditures are substantially offset after age 65 by reductions in the medical and emergency services component of MVC cost. Similar results occur with discounting at 3% and with various sensitivity analyses. We conclude that a policy of ES would significantly reduce MVCs and their associated consequences.

Medical Director Finalists Share Their Secrets to Success

Medical Director Finalists Share Their Secrets to Success

Technology Q&amp;A

In this new Technology Q&A column, we seek to answer questions related to technology submitted by JVIB readers. This month's question was submitted by a teacher of students with visual impairments who wrote: is a 9-year-old in an inclusion third-grade class. She is developmentally delayed, visually impaired (20/1000), and has emotional disorders. Anna recently transferred to our school. In her old school she would not participate in braille instruction. She is reading on a first-grade level. Anna participated in a low vision exam and was prescribed a + 20 hand magnifier, + 20 ClearImage microscope, 6X30 Selsi telescope, and a very basic CCTV [closed-circuit television]. Anna likes to use her low vision aids, and has been very cooperative with training to use such a close working distance. Anna cannot read her own writing. Once she becomes comfortable in her new school she will receive instruction in braille. Her teachers have two concerns that we would like the assistive technology specialist to address. What type of CCTV should we request that would allow Anna to participate in computer activities with projection magnification? Anna is not able to see the Promethean Activboards [interactive whiteboards that connect to computers and projectors] her teachers use in the classroom. She becomes frustrated using the telescope. Does the assistive technology specialist have any suggestions? The question of what type of closed-circuit televisions (CCTVs) are appropriate to use in a classroom setting is in many ways a universal one, and we hope this response will not only benefit Anna, but also provide tips for other students and those who work with them. KEY QUESTIONS TO CONSIDER A video magnifier, or CCTV system, uses a stand-mounted or handheld video camera to project a magnified image onto a video monitor, television screen, or computer monitor. Choosing the correct video magnifier involves a number of factors. When conducting an assistive technology assessment, key questions that must be answered include how much reading the student needs to do, how quickly can he or she read, and will he or she become fatigued. If the student becomes fatigued quickly while reading visually, a CCTV may not be the best answer. If she cannot keep up with the reading speed of her classmates, another method of reading may be required. Another question to ask is whether the student's eye condition is progressive. If it is, it may not be wise for the school district to invest a few thousand dollars in a video magnifier. However, the investment may still be worthwhile if there are other students in the district who could use the unit when the student in question can no longer use it. SUGGESTED SOLUTIONS One product that could help Anna is the STRIX from the Dutch company FOCI BV, distributed by Florida Reading and Vision Technology. The STRIX is a portable, handheld electronic CCTV with an adjustable angle and a 7-inch thin film transistor (TFT) display screen. A portable CCTV has the advantage of being able to be moved from place to place to accommodate various activities in the classroom and elsewhere. It has a display-freeze feature that allows you to take a temporary picture of what is on the screen, and a stand to facilitate short handwriting tasks. It also has adjustable magnification levels and various display modes. The STRIX has an auto-focus camera, can be used for reading and writing, and can be held up to magnify images across the room. The device can magnify from 4 to 22 times. In addition to its full-color (photo) mode, it displays images in high-contrast black on white (positive) and high-contrast white on black (negative) modes. The STRIX's Freeze mode freezes the image on the display screen, allowing you to save the image temporarily. …