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Study: Mandatory vision exam law results in increased academic scores
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ORLANDO, Fla. – According to study results presented here at Academy 2009, the American Academy of Optometry annual meeting, mandatory preschool eye exams in Kentucky had a positive effect on both reading and total academic indices.
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Kentucky, in 2000, was the first state in which preschool comprehensive eye exams were mandated. Richard E. Meetz, OD, MS, FAAO, reported at an academy-sponsored press conference that two optometry students from Kentucky sought to determine the impact of this mandate on standardized educational test scores.
According to the study abstract, the researchers obtained scores from the Kentucky Department of Education’s Core Content Test for 4th grade students from 2001 to 2006.
“We identified the 2001 to 2003 population, pre-vision law,” Dr. Meetz said, “and 2004 to 2006, post-law cohort. These were the first children to get to take the test.”
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The researchers further stratified the test scores by socioeconomic status.
“We saw a difference between the two cohorts,” Dr. Meetz reported, “and the group with the greatest effect was the lowest socioeconomic level.”
According to the study abstract, “a significant socioeconomic status effect was shown for the pre-eye exam cohorts, while the post-eye exam cohorts failed to differ by socioeconomic levels.”
“Test scores did increase significantly after the initiation of comprehensive eye exams in treatment vs. previous years,” Dr. Meetz concluded.
Ocular blood flow and structural changes
Melanie A. Pickett, OD, FAAO, of the Glaucoma Research and Diagnostic Center at Indiana University, reported that she and her colleagues “found the central retinal artery peak systolic and end systolic blood flow velocities were correlated to nerve fiber layer thickness,” she said at the press conference. “We conclude that blood flow to these critical tissues correlates positively to changes in overall structure of the optic nerve.
“We started the Indiana Glaucoma Progression Study 1.5 years ago,” Dr. Pickett continued. “There were 120 open angle glaucoma patients seen every 6 months over 3 years. The goal was to establish the role of ocular blood flow and perfusion pressure seen in glaucoma progression.”
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Dr. Pickett said, “If we reduce intraocular pressure, clinical studies have shown there is a subset that continues to progress, even if reduced surgically. In the Collaborative Initial Glaucoma Treatment Study, 13.5% continued to show visual field loss and progression.
“What else are we looking for besides IOP?” she continued. “Blood flow is coming to the top.”
Dr. Pickett cited one study that showed larger cup-to-disc ratios are associated with lower optic nerve blood flow in ocular hypertension. Another study showed the relationship between the health of the optic nerve head and amount of retinal blood flow, she said.
“We know there’s a synergistic relationship between blood flow and IOP; we’re still missing the clinical link,” she said.
Dr. Pickett and colleagues used color Doppler imaging to look at the ophthalmic artery, central retinal artery, temporal posterior ciliary artery and nasal posterior ciliary artery, she said. “We used OCT to measure the amount of cable swires that come through the optic nerve head, which tells us if a patient is falling into the normal range for their age group.”
Dr. Pickett noted that more clinical studies are needed to validate the use of blood flow measure for clinical use and to determine the type of measurement and location. “We’d love to have all of this in one clinical device,” she said. “It’s available in different devices.”
Risk factors for lens case contamination
Australian researchers found a variety of risk factors for contact lens contamination that outweighed just the age of the case.
Carol Lakkis, BScOptom, PhD, PGCertOcTher, FAAO, FVCO, FBCLA, and researchers from Clinical Vision Research Australia at the Australian College of Optometry, sought to investigate the risk factors for the development of contact lens case contamination during silicone hydrogel daily wear.
“We found reductions in compliance over 1 month of daily wear,” Dr. Lakkis reported at the press conference. “We looked at how long it takes for cases to become contaminated and what contributes to the development of case contamination.”
The researchers studied 132 subjects who wore 2-week disposable lenses on a daily wear basis. Follow-up visits were at three intervals: 7 days, 14 days and 30 days. The cases and the contact lenses were cultured. “The subjects were not aware that we were doing this,” Dr. Lakkis said. “We collated all data for a statistical modeling to try to understand what factors were associated with case contamination.”
Dr. Lakkis reported that the researchers saw more moderate and heavy contamination in the 14- and 30-day cases vs. the 7-day cases.
“The most significant risk factor was reuse of disinfecting solution,” Dr. Lakkis said. “Every subject that reused solution developed case contamination.
“Males had 6 times higher rate of case contamination,” she continued. “Other significant findings were contaminated bottle tip, failure to rinse case after discarding solution, increased contact lens wettability and noncompliance score.”
The researchers concluded in the study abstract: “Practitioners should be encouraged to review contact lens wearer compliance at all follow-up visits, with particular emphasis on factors significantly related to the development of case contamination.”
The study was funded by Alcon Research Laboratories.
Hyperopia correction in kids helps attention, accommodation
Results from the Correction of Hyperopia in Children Study (CHICS), a pilot study, showed that children with hyperopia who wore vision correction showed improvement in attention and accommodative response, but no significant effect on measures of visual function or reading.
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Hyperopic children between 6 and 11 years old who had not previously worn correction were recruited. Forty-eight children were enrolled at four clinical centers, and 85% of the children returned for the 6-week visit. Mean hyperopia was +1.97 D, and mean hyperopic correction was +1.33 D. “They were on the lower end of hyperopia,” reported Marjean T. Kulp, OD, MS, FAAO, at the press conference.
“Kids were randomized to Transitions lenses with no power and Transitions lenses with hyperopic correction,” she said. “Compliance was good; 80% to 90% reported wearing the glasses most of the time for their near work. No significant differences were seen in the groups for compliance.
“Adjusted mean outcome after 6 weeks showed a positive trend toward improved attention in those wearing correction and a statistically significant difference between groups in accommodative response – kids wearing correction had less of a lag,” Dr. Kulp said.
“Further research is needed to determine the effect of correction for longer duration and greater amounts of hyperopia,” the researchers concluded.