Willard Bleything.pdf - Optometric Extension Program Foundation

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Willard Bleything.pdf - Optometric Extension Program Foundation

Background and Aims

• Studies support the notion that socially disadvantaged

children are especially at risk for poor health including

vision disorders

• Most of the visual problems are functional involving

binocular vision and visual processing dysfunction

• Lenses and vision therapy remain the treatment of choice

for such disorders, however ….

• Limited access to visual care is a major concern,

particularly in the socially‐at‐risk population of youth


Socially –At‐Risk Populations

• Solon and Mozlin looked at the impact of poverty on

health, vision development and school failure 1

• Zaba examined the linkage between children’s vision, and

learning problems, delinquency, illiteracy, social and

emotional problems 2

• Duckman and Festinger made an in‐depth effort to deliver

vision care to children in foster care 3

• 1 Solan H, Mozlin R. Children in poverty; impact on health, visual development, and school failure. J Optom Devel

1997;28:7‐28.

• 2 Zaba J. Social, emotional, and educational consequences of undetected children’s vision problems. J Behav

Optom 2001;12:66‐70.

• 3 Duckman R, Festinger T. Delivery of vision care in foster care placements in New York City. J Optom Vis Devel

2002;33:116‐125.


Socially –At‐Risk – Populations

Adolescents

• Inner‐city youth: visual screening resulted in 52% referral

rate 4

• Middle /high school at‐risk children: visual screening

resulted in 97 % referral rate 5

• Socially‐at‐risk 17‐19 YO: visual screening resulted in a

80% referral rate 6

• 4 Suchoff I, Mozlin R. visual screening of an adolescent inner city population. J Behav Optom 2001; 3:71‐74.

• 5 Johnson R, Nottingham D, Stratton R, et al. The vision screening of academically and behaviorally at‐risk

pupils. J Behav Optom 1996:7:39‐42.

• 6 Johnson R, Zaba J. Visual screening of at risk college students. J Behav Optom 1995; 6:63‐65.


Health Care Delivery

• Think public health vs. private office

• Most of our experience in providing ‘private practice’ care

is with a single patient being examined followed by a

customized treatment plan of lenses and vision therapy

• The socially‐at‐risk population p has limited access to the

private practice health care delivery model

• This population is often subject to health care delivery

p p j y

under a public health model


Health Care Delivery

• How effective would it be to provide optometric care in a

group setting, based upon the enhancement of basic

visual skills, utilizing a single ‘serves all’ treatment plan

• In a sense, we are posing a question similar il to the delivery

of educational instruction

• The well‐to‐do might hire a private tutor to teach their

children, the program of studies being customized for

each student

• The public schools use a standardized ‘serves all’

curriculum that is aimed at being most effective for most

students


Aim of Study

• The aim of this project was to determine the effectiveness

of a visual intervention program, involving prescription

lenses and group delivered – visual skills based‐ single

treatment planned – vision therapy on a socially‐at‐risk at population of youth


Methods • Study Population

In 1993, Congress authorized the National Guard

to conduct alternative schools for the high school

drop out population – a group now recognized as a

key public concern.

As can be expected, learning disabilities are a

common characteristic in this special population.

Of particular significance to this project is the

research that has shown visual dysfunction to be a

key risk factor in learning disabilities, especially

reading skills.


Methods • Study Population

• Socially‐at‐risk youth between 16 – 18 years of age

• All subjects were high school dropouts and performing 4 –

6 grades below expectations

• All subjects were enrolled in the Youth ChalleNGe High

School program operated by the Oregon National Guard

near Bend, Oregon during the period of January –June

2006

• Following the tenets of the Declaration of Helsinki,

informed consent was arranged through the

administrative offices of the Youth ChalleNGe High School


Methods • Screening Protocol

• All students enrolled (n=123) were screened

• A modified version of the New York State Optometric

Association (NYSOA) Vision Screening Battery was used

• Tests omitted were color perception and form perception

• Tests added were distance retinoscopy (non‐cycloplegic),

Berry Visual‐Motor‐Integration (VMI), and the College of

Optometrists in Vision Development‐ Quality of Life

Outcomes (COVD‐QOL) questionnaire


Methods • Follow‐Up Exams

• Those referred by screening (n=55)[46%] were given

comprehensive optometric examinations by a team of 6

optometrists and 6 technicians within 6 days of the initial

screening

• Prescription lenses/frames were provided as indicated

• Of the 55 examined, 32 [58%] were provided with a new

lens prescription; an additional 7 were told to wear their

current Rx

• A total of 71% were in need of a lens Rx


Methods • Vision Therapy

• 24 of those receiving a comprehensive exam were placed

into a vision therapy intervention group

• The remaining 31 were placed into a control group with

vision therapy being made available following the study

• The vision therapy group and control group were matched

on age, gender, and VMI Standard Scores

• Exclusion criteria selected out subjects with strabismus

j

and corneal scars from prior trauma


Methods • Vision Therapy

• Vision therapy consisted of two 1‐hour sessions per week

for 12 weeks

• Half of the therapy session was devoted to developing

basic visual skills such as eye movements,

accommodative/vergence ranges and flexibility, fusion

and stereopsis

• The remaining time was spent on computerized visual

perceptual procedures (PTS II)

• The control group spent an equal amount of time in a

structured study hall working on assignments from the

courses taken at the special high school


Methods • Vision Therapy

• A room was set‐aside within the school to treat 6 subjects at a

time

• Subjects rotated from one treatment station to another every

few minutes for a period of 30 minutes and kept a log of their

performance at each station

• In an adjoining i room, another 6 subjects received computerbased

visual perceptual training; this also went for 30 minutes

• At the midpoint of the 60 minute session, the two groups

switched places thus each subject received vision training in

each of the two treatment rooms for a total of 60 minutes twice

each week


Methods • Vision Therapy

Weeks 1 2 3 4 5 6 7 8 9 10 1

1

Visual Skill Areas

Ocular Motility • • • • • • • • • • •

Accommodative Facility • • • • •

Hand/Eye Coordination • • • •

Ocular Motility / Balance Board • • •

CheiroscopicTracing • •

Fusion / Vergence • • • •

Stereopsis /Vergence • • • • •

12


Methods • Vision Therapy

• Perceptual Therapy (Perceptual Therapy System II)

• Sequential Processing

• Temporal Vision Perception Processing

• Speed of Information Processing

• Rapid Automatized Naming


Results

• Pre and post results were compared for:

• Near accommodative and vergence measures

• Saccades

• COVD Quality of Life Outcomes Questionnaire

• Two‐ tailed Paired Student’s t‐Test comparisons were

made to test statistical significance

• While general improvement was noted in most areas

measured only those that achieved statistical significance

will be reported


Results • Accommodative Facility

• Accommodative facility

• Pre test: 7.83 cycles per minute (mean of VT Group)

• Post test: 11.67 cycles per minute (mean of VT Group)

• t=3.48 ; df=23; p=0.002


Results • NPC

• Near point of convergence • Break

• Pre test : 2.29 inches (mean of VT Group)

• Post test : 0.48 inches (mean of VT Group)

• t= 3.29; df= 23; p= 0.003

• Near point of convergence • Recovery

• Pre test : 4.83 inches (mean of VT Group)

• Post test : 1.76 inches (mean of VT Group)

• t= 3.71; df= 23; p= 0.001


Results • Saccades

• King‐Devick Total time

• Pre test : 55.09 seconds (mean of VT Group)

• Post test : 43.96 seconds (mean of VT Group)

• t= 3.66; df= 21; p= 0.001


Results • Quality of Life

• COVD Quality‐of‐Life Questionnaire

• Pre test symptoms score: 34.8 (mean of VT Group)

• Post test symptoms score; 20.8 (mean of VT Group)

• t= 4.37; df= 22; p= 0.0001

• For a more complete discussion see:

Bleything WB, Landis SL. Effectiveness of the College of Optometrists in Vision Development –QOL

Questionnaire in a socially at risk population of youth. Optom Vis Dev 2008;39(1)33‐41


Conclusions

• While a group delivered – visual skills based – single

treatment plan delivery system has obvious limitations

measured against individualized therapy, such an

approach can have positive results in building visual skills

when the access to care limits delivery mode options.


Pacific University

Project Site

You are here


Mount Hood


Near base of Cascade Mountains


Former US Army Communications

Center


Vision Screening Station


Vision Screening Station


Vision Screening Station


Vision Screening Station


Therapy Room


Therapy Room


Hand – Eye Coordination


Eye Pursuits with Yoked Prism


Eye Fixations


Fusion with Accomm‐Vergence


Optometry Students Included in

Project


Core Team Members


Acknowledgements

• This project was funded, in part, by the College of

Optometrists in Vision Development Research Fund,

and the Kikuchi Research Fund at Pacific University. A

beginning pilot project received funding from the

Optometric Extension Program Foundation.

• Appreciation is extended to volunteers from the

Children’s Vision Foundation, the staff at the Youth

ChalleNGe High School, the general optometric

community, and especially to the staff at Integrated

Eye Care for use of facilities.

• A special note of appreciation for the work of Sandra

Landis, OD who supervised much of the on‐site

therapy.

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