The optometric recognition award program--an option for self assessment

This discussion addresses itself to the need for all optometrists to continue recognizing their professional responsibility to maintain continuing competency through meaningful optometric education experiences; and to work toward this goal by participation in the Optometric Recognition Award Program. The ORA Program is structured to enable the participant to design, record and fulfill his personal continuing optometric education needs. Fullfillment of the award requirements, 150 hours of C.O.E. in three years, results in recognition by the AOA in the form of a recognition plaque.     

The neurologic examination

The essentials of the neurological examination are reviewed from the perspective of the emergency medicine practitioner. Important historical information to be obtained, as well as indications and techniques for individual components of the physical examination, are covered. Appropriate and concise methods for documenting the results of the neurological examination in the patient record are also discussed.     

Continuing optometric education crossroads

This paper gives a brief overview of continuing optometric education from the perspective of the providers and the Commission on Continuing Education. The early history is covered as well as a discussion of some present problems and concerns of many of the providers. This is followed by recommendations for the future and a proposed plan for each provider's involvement in continuing education.     

Education for the optometric educator

Optometric education is faced with the need for new thinking in developing and training educators and new methods of financing their education. Establishing of research faculty and the instituting of research in present schools of optometry must be given a high priority in the future of optometric education.     

Is anybody home? Basic neurologic assessment of the home care client

Clients with strokes, Parkinson's disease, multiple sclerosis, brain injury, or other conditions that are neurologic in origin abound in home care. Other clients may have neurologic deficits that are not so obvious. This article describes basic neurologic assessment and how it can be performed in the home setting with minimal inconvenience to the client and the nurse. Using a catchy mnemonic, the home care nurse can ensure that valuable information is obtained during the visit.     

Professional behavior and the optometric profession

BACKGROUND: Optometry has been recognized as a profession within the United States, both legally and socially, for the better part of the past century. Historically, there have been expectations placed on the behavior of individuals within the professions that would not generally be placed on the general business person. These expectations have existed to protect the clients or patients of professionals from incompetence, uncaring, or selfish excesses. Behavior of an exceptional nature is expected of professionals because of the unusual vulnerability of clients and patients to unprofessional conduct. Doctors of Optometry, as members of the optometric profession, have professional standards placed on their behavior. METHODS: A search of the literature was conducted to discover the historical and current bases for setting standards for professional behavior. RESULTS: The literature search reinforces the rationale for the optometric professions long-standing practice of setting standards for professional conduct. CONCLUSIONS: Individual Doctors of Optometry will find that the trust resulting from high standards of professional conduct bring many positive benefits to the doctor-patient relationship. The rewards that come to both the doctor and patient from these trusting relationships make the practice of optometry truly an exceptional experience.     

An international perspective on optometric education

In many of the world's nations, optometry hardly exists because resources are not sufficient to educate optometrists nor to fund their services. In others, tradition and accommodation with other forces have rendered optometry incapable of change that would expand its scope of services. But, in a growing number of countries, there is an accelerating trend toward expansion of education and scope of practice. Optometry is coming to be defined in those parts of the globe as that independent primary health profession whose practitioners are educated in vision and health sciences, and who meet standards that qualify them to diagnose and treat visual problems and ocular disease. Review of this change, wherever it has transpired, leads to the conclusion that the scope of optometric practice expands only after corresponding expansion in optometric education. These goals are being achieved in a group of highly developed countries in which optometry has long been a major eye care provider, and in countries in which socio-economic and political conditions are improving, but where there is no significant source or tradition of primary eye care of any scope.     

The impact of treatment of eye disease on optometric practice in Missouri

In an attempt to validate the use of topographical mapping of EEG as a method of localising cerebral function, EEG was recorded during a simple motor task. A minimum of 20 sec artifact-free EEG was recorded from 24 healthy right handed subjects in each of 4 conditions: eyes open 1, motor task (left/right, order randomized), eyes open 2. EEG amplitude maps were computed in delta, theta, alpha, and beta (1 and 2). Differences were seen between the eyes open and the motor conditions in alpha, beta 1 and beta 2 localised to the motor and supplementary motor areas. It is argued that topographical mapping of EEG is a valid method of localising cognitive function in healthy individuals for the Luria task.     

Cost effectiveness in optometric health care

A case of sclerosing epithelioid fibrosarcoma and its appearance on MRI is presented. The tumor showed a zonal architecture on MRI with a large central core of very low signal intensity and a peripheral rim of intermediate to high signal intensity on T1- and T2-weighted spin echo pulse sequences. The core showed decreased cellularity with dense collagen deposition on histologic examination, and the peripheral zone increased cellularity with increased nuclear atypia. The presence of a prominent region of very low signal intensity on T1- and T2- weighted images can be seen with neural tumors, giant cell tumor of the tendon sheath, aggressive fibromatosis, and, in rare instances, with soft tissue sarcomas rich in collagen.     

Non-invasive assessment of endothelial function

Endothelial dysfunction is an early event in atherosclerosis preceding the formation of plaques. An important functional consequence of endothelial damage is reduced vasodilatory responses to a variety of pharmacological and physiological stimuli including reactive hyperaemia. Hitherto, endothelial function could only be assessed by invasive techniques, but a novel ultrasound based technique has recently been developed, which allows non-invasive evaluation of endothelial function in large systemic arteries such as the brachial artery. The technique is accurate, reproducible and able to differentiate between subjects with and without vascular dysfunction. Impaired endothelial function has been documented in young and adult individuals with various vascular risk factors including cigarette smoking, diabetes mellitus, hypercholesterolaemia, and homocystinuria. A good correlation has been found between both the presence of atherosclerotic lesions and endothelial function in the coronary arteries and the brachial artery. The method may help in identification of individuals with early vascular changes and thereby make risk factor modification possible at a very early stage of the atherosclerotic process. It may furthermore serve as a tool to monitor the impact of prevention and intervention on arterial damage.     

Tonometry in optometric practice -- the current status

The past two decades have seen enhanced optometric interest in tonometry and in other techniques to assess the ocular and/or general health status. This probably reflects several factors; an increasing role of the optometrist as a primary health care practitioner, the availability of better instrumentation for tonometry, and a far better understanding of the relationship between intraocular pressure and diseases from the group known as the glaucomas. This paper represents an attempt to provide information which may be helpful to the practitioner in determining what tonometer to use and how to utilize tonometric data most effectively.     

The utility of isokinetic dynamometry in the assessment of human muscle function

Isokinetic dynamometry has become a favoured method for the assessment of dynamic muscle function in both clinical research and sports environments. Several indices, such as peak torque, are used in the literature to characterise individual, group or larger population performance via these sophisticated data acquisition systems. Research suggests that there are several competing demands on the design of the measurement protocol which may affect the measurement of isokinetic strength and subsequent suitability of data for meaningful evaluation and interpretation. There is a need to increase measurement rigour, reliability and sensitivity to a level which is commensurate with the intended application, via more elaborate multiple-trial protocols. However, this may be confounded by logistical and financial constraints or reduced individual compliance. The net effect of the interaction of such demands may be considered to be the utility of the isokinetic dynamometry protocol. Of the factors which impinge on utility, those which relate to reliability afford the most control by the test administrator. Research data suggest that in many measurement applications, the reliability and sensitivity associated with all frequently-used indices of isokinetic leg strength which are estimated via single-trial protocols, are not sufficient to differentiate either performance change within the same individual or between individuals within a homogeneous group. While such limitation may be addressed by the use of protocols based on 3 to 4 inter-day trials for the index of peak torque, other indices which demonstrate reduced reliability, for example the composite index of the ratio of knee flexion to extension peak torque, may require many more replicates to achieve the same level of sensitivity. Here, the measurement utility of the index may not be sufficient to justify its proper deployment.     

The basal forebrain. Neuroanato-physiology and neurologic applications

The Basal Forebrain region comprises the heterogeneous set of telencephalic structures on the medial and ventral aspects of the cerebral hemisphere. Basal Forebrain structures include the septal areas, olfactory tubercule, substantia innominata, and parts of the amygdala. The basal forebrain region is the site of a system of cholinergic neurons projecting to the entire cortical surface. The Basal Forebrain is a site of convergence of sleep and thermoregulatory functions. Portions of the basal forebrain play prominent roles in the control of the body temperature. The medial preoptic/anterior hypothalamic areas have both thermosensiting and thermointegrating functions. Cholinergic neurons intrinsic to the Basal Forebrain play a fundamental role in sleep onset and maintenance. Neurons of the nucleus basalis of Meynert undergo a profound degeneration in patients with Alzheimer's disease and provide a pathological substrate of the cholinergic deficiency in their brain. Behavior changes and amnesic syndrome may complicate surgery for ruptured anterior communicating artery aneurysms. Disruption of the blood supply through the perforating branches of the anterior communicating artery may probably cause the amnesic syndrome.     

Ultrasound in the assessment of vascular function

The study of circulatory function is fundamental to the understanding of many physiological processes and pathological conditions, and has been greatly advanced by developments in the use of ultrasound. Transcutaneous measurement of blood velocity has been made possible by the use of Doppler shift methods, and many methods of spectral analysis have been developed. Blood volumetric and flow profiles can be achieved through the use of range-gated pulsed Doppler systems. A combination of Doppler velocimetry, pressure measurements and volumetric visualisations provide a powerful alternative to more conventional investigations like arteriography. Current developments indicate that the use of ultrasound in investigating vascular function is cost effective.     

MR-based assessment of vascular morphology and function

Initially, time-of-flight angiography found its way into clinical routine for imaging vascular morphology. In conjunction with phase-contrast imaging, functional and morphological assessment of vascular pathology became possible. The flow dependence and associated artifacts inherent to these techniques have restricted the clinical use of these magnetic resonance angiography (MRA) techniques to the extra- and intracranial arterial, as well as the systemic and portal, venous systems. With the advent of high-performance gradient systems a new, promising MRA strategy has been developed: contrast-enhanced 3D MR angiography. It is based on the combination of rapid 3D imaging and the T1-shortening effect of intravenously infused paramagnetic contrast. This review provides a technical overview and critically discusses the clinical application for the different MRA techniques regarding morphological as well as functional assessment of the vascular system.     

The pupillary light response: assessment of function mediated by intracranial retinal transplants

We have adapted a pupillometry measurement system to test the functional efficacy of retinae previously transplanted over the midbrain of neonatal rats in mediating a pupillary light reflex in the host eye. This has permitted us to examine factors influencing various parameters of the response, and to study transplant-mediated responses in comparison with responses mediated by way of the normal consensual pathway. Despite the unusual location of these transplanted retinae and the absence of supportive tissues normally associated with retinae in situ, it is clear that pupilloconstriction in the host eye can be elicited by transplant illumination. Under the optimal conditions here defined, response parameters for individual animals were stable with repeated testing over extended periods. When considered as individual cases, response amplitude, constriction rate and response latency were intensity dependent, although responses elicited by transplant illumination were less sensitive than normal, typically by 2-3 log units. Large-amplitude transplant-mediated pupillary responses could, however, be elicited repeatedly throughout long trains of stimuli, unlike normal responses, which rapidly failed to recover to baseline under similar test conditions. Finally, even though some cellular elements of the visual cycle are absent in transplanted retinae, pupilloconstriction in the host eye could be elicited repeatedly by transplant illumination as long as two years after transplantation took place. These observations indicate the applicability of this preparation as an assay for the effects of experimental manipulations on information processing and response plasticity in the visual system, and as a tool for examining, in general, the necessary conditions for optimal function of grafts that work by synthesizing and relaying neural signals.     

Central nervous system structure and function in Sturge-Weber syndrome: evidence of neurologic and radiologic progression

Sturge-Weber syndrome is characterized by the presence of a port-wine nevus, epilepsy, stroke-like episodes, headache, and developmental delay. We studied 20 cases to test the hypothesis that decreased cerebral blood flow alters neurologic function by affecting cellular glucose metabolism. Group A consisted of 10 patients with a mean age of 1.75 years and early seizure onset (6.8 months), whereas group B was composed of older patients (mean age, 15.3 years) with later onset of seizures (3.7 years). Neurologic disease was more severe in group A, but group B had more widespread structural brain defects - shown on computed tomographic scans and magnetic resonance imaging - and metabolic brain defects shown on hexamethylpropyleneamine oxime and [18F] fluorodeoxyglucose single photon emission computed tomographic scans. Six group A cases had hypoperfusion at baseline and five of nine had worsening of perfusion and glucose metabolism 1 year later. A total of 119 stroke-like episodes occurred in six group A cases and eight group B cases; there were 65% fewer strokes in children treated with aspirin. The data suggest that progressive hypoperfusion and glucose hypometabolism are associated with neurologic deterioration in Sturge-Weber syndrome. Longitudinal studies are needed to better define the natural history of disease and to evaluate the safety and efficacy of aspirin therapy.