FEB 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 22 of 114

compared with 80.4% in those with a PIR of 5 or above. Looking at education, only 62.9% of respondents with less than a high school education had visited an eyecare provider (compared with 80.8% of those with at least a college education) or had a dilated eye exam (64.5% versus 81.4%, respectively). Individuals in the surveys in- cluded in this study were most likely to self-report having a cataract, fol- lowed by glaucoma, macular degen- e ration, and diabetic retinopathy. One unique finding from the study was that comparing those with diabetic retinopathy from 2002 and 2008, income level did not seem to affect the prevalence of having a recent dilated eye exam, although there was some difference found between the lowest and highest e ducational levels. Investigators concluded that their research adds to the general lit- erature on the influence of socioeco- nomic status and health. "… We found that eye care in the United States is suboptimal, especially among low-socioeconomic position groups. This calls for continued efforts to improve access to and use of eye care services among socioeco- nomically disadvantaged groups," they wrote. The investigators acknowledged that the recent economic crisis may make the gap between eyecare even wider than before. They also said that social and healthcare policy needs to help address socioeconomic health-related disparities. February 2014 © 2014 Novartis 1/14 VRN14003JAD-PI I MPORTANT SAFET Y INFORMATION FOR THE VERION™ REFERENCE UNIT AND VERION™ DIGITAL MARKER CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. INTENDED USES: The VERION ™ Reference Unit is a preoperative measurement device that captures and utilizes a high-resolution reference image of a patient's eye in order to determine the radii and corneal curvature of steep and fat axes, limbal position and diameter, pupil position and diameter, and corneal refex position. In addition, the VERION ™ Reference Unit provides preoperative surgical planning functions that utilize the reference image and preoperative measurements to assist with planning cataract surgical procedures, including the number and location of incisions and the appropriate intraocular lens using existing formulas. The VERION ™ Reference Unit also supports the export of the high-resolution reference image, preoperative measurement data, and surgical plans for use with the VERION ™ Digital Marker and other compatible devices through the use of a USB memory stick. T he VERION ™ Digital Marker links to compatible surgical microscopes to display concurrently the reference and microscope images, allowing the surgeon to account for l ateral and rotational eye movements. In addition, the p lanned capsulorhexis position and radius, IOL positioning, and implantation axis from the VERION ™ Reference Unit surgical plan can be overlaid on a computer screen or the physician's microscope view. CONTRAINDICATIONS: The following conditions may afect the accuracy of surgical plans prepared with the VERION ™ Reference Unit: a pseudophakic eye, eye fxation problems, a non-intact cornea, or an irregular cornea. In addition, patients should refrain from wearing contact lenses during the reference measurement as this may interfere with the accuracy of the measurements. Only trained personnel familiar with the process of IOL power calculation and astigmatism correction planning should use the VERION ™ Reference Unit. Poor quality or inadequate biometer measurements will afect the accuracy of surgical plans prepared with the VERION ™ Reference Unit. The following contraindications may afect the proper functioning of the VERION ™ Digital Marker: changes in a patient's eye between preoperative measurement and surgery, an irregular elliptic limbus (e.g., due to eye fxation during surgery, and bleeding or bloated conjunctiva due to anesthesia). In addition, the use of eye drops that constrict sclera vessels before or during surgery should be avoided. WARNINGS: Only properly trained personnel should operate the VERION ™ Reference Unit and VERION ™ Digital Marker. Only use the provided medical power supplies and data communication cable. The power supplies for the VERION ™ Reference Unit and the VERION ™ Digital Marker must be uninterruptible. Do not use these devices in combination with an extension cord. Do not cover any of the component devices while turned on. Only use a VERION ™ USB stick to transfer data. The VERION ™ USB stick should only be connected to the VERION ™ Reference Unit, the VERION ™ Digital Marker, and other compatible devices. Do not disconnect the VERION ™ USB stick from the VERION ™ Reference Unit during shutdown of the system. The VERION ™ Reference Unit uses infrared light. Unless necessary, medical personnel and patients should avoid direct eye exposure to the emitted or refected beam. PRECAUTIONS: To ensure the accuracy of VERION ™ Reference Unit measurements, device calibration and the reference measurement should be conducted in dimmed ambient light conditions. Only use the VERION ™ Digital Marker in conjunction with compatible surgical microscopes. ATTENTION: Refer to the user manuals for the VERION ™ Reference Unit and the VERION ™ Digital Marker for a complete description of proper use and maintenance of these devices, as well as a complete list of contraindications, warnings and precautions. Tracking continued from page 18 Weighing in on e conomic disparities Improving access to and use of eyecare services can result in better vision and better health outcomes for a population, study co-investiga- tor Paul Lee, MD, F. Bruce Fralick P rofessor of Ophthalmology, chair and professor of ophthalmology and visual sciences, Medical School, University of Michigan, Ann Arbor, told EyeWorld. Other researchers who have studied eyecare trends found the re- sults reported here intriguing—and in line with their own research. For instance, Anna Rius, MPH, U NESCO Chair for Visual Health and Development, Department of Optometry and Optics, Universitat Politècnica de Catalunya, Barcelona, led recent research published in Ophthalmology that tracked blind- ness and visual impairment in Spain. 2 That research found regional inequalities for visual impairment that correlated with regional in- come. Investigators also found that women were more likely than men to suffer from visual impairment or blindness. Another study published re- cently in PLoS One and led by Ellen E. Freeman, PhD, associate professor, Department of Ophthalmology, University of Montreal, used the World Health Survey, a worldwide population-based adult dataset, to analyze the frequency of far visual difficulty. 3 Investigators found that 21% of adults reported visual diffi- culty and that the rate varied ac- cording to a country's low, middle, and high income status—on average 24%, 23%, and 13%, respectively, of the population reported visual diffi- culty. Those with visual difficulty were more likely to be older, female, have a poorer socioeconomic status, little or no formal education, and have diabetes. The World Health S urvey did not include the United States. Both the World Health Survey study and the JAMA Ophthalmology study point to the value of regular eye exams to detect problems, Dr. Freeman said. "It is easy to become compla- cent about health issues, but when y ou think about how important vision is to daily life, a yearly visit to the eye doctor should not be put off," she said. "Policies that further reduce disparities in eyecare should be considered. People need to con- sider regular eyecare as important as things like cancer screening, flu shots, and blood pressure checks." EW References 1. Zhang X, Beckles GL, Chou C-F, Saaddine JB, et al. Socioeconomic disparity in use of eye care services among US adults with age- related eye diseases. JAMA Ophthalmol. 2013;131:1198-206. 2. Rius A, Artazcoz L, Guisasola L, Benach J. Visual impairment and blindness in Spanish adults: Geographic inequalities are not ex- plained by age or education. Ophthalmology. 2013 Sep 17 [epub ahead of print]. 3. Freeman EE, Roy-Gagnon MH, Samson E, et al. The global burden of visual difficulty in low, middle, and high income countries. PLoS One. 2013;8:e63315. 4. MacLennan PA, McGwin G Jr, Searcey K, Owsley C. Medical record validation of self- reported eye diseases and eye care utilization among older adults. Curr Eye Res. 2013;38: 1-8. Editors' note: The physicians interviewed have no financial interests related to this article. Contact information Freeman: eefreeman@gmail.com Lee: pleemd@umich.edu MacLennan: pmac@uab.edu Rius: arius@euot.upc.edu Self-reporting health appointments can fall short T o track disparities in eyecare, it's important that individuals who are surveyed can accurately report their eyecare utilization. A recent report analyzed this topic further by comparing self-reported eyecare utilization and eye disease against medical record information. 4 Investigators, led by Paul A. MacLennan, PhD, assistant professor, Department of Surgery, University of Alabama at Birmingham, included 2,001 adults age 70 or older who had completed the Behavioral Risk Factor Surveillance System's Visual Impairment and Access to Eye Care Module. They found that although there was generally good agreement, self-reporting tended to overestimate the number of individuals who had visited an eyecare provider within the past year and tended to underestimate the prevalence of macular degeneration, diabetic retinopathy, and cataracts. Glaucoma was not underestimated as frequently. "When we looked at [subjects'] medical records, we found that approximately 13% had misreported and had an eye exam outside of the 12-month period," Dr. MacLennan said. 13-25 News_EW February 2014-DL2-ALT-OIS-ad_Layout 1 1/30/14 4:42 PM Page 20

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