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We often have students and colleagues to watch us work (including from abroad) and learn at Stotfold and we are actively engaged in research and have been involved with many aspects of the optometry profession.
Educational DVD's
Paediatrics Educational Video. (2006) Department of Optometric Continuing Education and Training (DOCET), London
The practice was used as a location and Paul Adler was involved in the planning and production and appeared in this educational DVD which was sent to all optometrists in the UK. The DVD was designed to teach optometrists how to undertake eye examinations on children and babes.
Research and Publications
Brief details of papers published appear below.
Vision therapy/orthoptics
Adler PM and Cregg M, Viollier A-J, and Woodhouse MJ (2007) Influence of target type and RAF Rule on the measurement of near point of convergence. Ophthal. Physiol.Opt. 27(1):22-30.
Abstract
Purpose: This study was designed to investigate if the use of different target types or the RAF rule affected the measurement of near point of convergence (NPC).
Methods: The subjects comprised three groups: (1) 20 children aged 6–9 years (2) 17 children aged 11–13 years (3) 14 adults aged 20–30 years. Five targets were used to measure the NPC: (1) pencil tip, (2) fingertip, (3) penlight, (4) N5 letter and (5) vertical line target on the RAF rule.
Results: There was no significant difference in NPC measurements between the pencil tip, fingertip and N5 target in free space. The penlight resulted in significantly more remote NPC break and recovery points compared with the fingertip and pencil tip ( p < 0.05). The RAF rule influences the NPC obtained (p < 0.001). The greatest difference in NPC measurements was observed when comparing the RAF line target and the finger in free space; the former resulted in NPC values of 1.9 times (95% CI 1.6–2.2 times) as much as those obtained with the finger.
Conclusions: Use of the penlight and RAF rule resulted in a more distant NPC break point compared with other targets. The effect of the RAF rule was more apparent for more receded NPC points.
Woodhouse MJ, Morjaria SJ ,and Adler PM (2007) Acuity measurements in adult subjects using a preferential looking test Ophthal. Physiol. Opt. 27(1):54-59.
Abstract
Preferential looking (PL), as a technique for assessing visual acuity, was designed for use with young infants. There are occasions when a practitioner may need to use a PL test with an adult who is unable to participate in acuity measures with conventional optotype tests (such as an adult with learning disabilities, stroke damage or dementia). In preparation for the development of an adult-appropriate PL test, this study compared scores with the Cardiff Acuity Test (CAT, which was designed as a PL test) and a standard LogMAR-based test, the Lea chart. One hundred and one adults with learning disabilities, attending vision screening at Special Olympics, took part in acuity measures with both tests. Athletes subsequently found to have uncorrected refractive errors were excluded and analysis was confined to 72 athletes. There was no significant difference in mean acuity with the two tests, but CAT tended to overestimate scores for poorer acuities. CAT was less sensitive than the Lea chart to interocular acuity differences. Although CAT may be a successful way to assess acuity in patients unable to participate in conventional acuity tests, the practitioner should be cautious in interpreting results. There is the potential with CAT to overestimate acuity and to miss small interocular differences, so criteria for determining 'abnormality' may need to be adjusted.
Hurst , MF, Van de Weyer, S, Smith, C, and Adler, PM. (2006) Improvements in performance following optometric vision therapy in a child with dyspraxia. Ophthal. Physiol. Opt. 2006 26: 199–210
Abstract SS, an 8-year-old boy with dyspraxia, presented for behavioural optometry assessment. He had been diagnosed with a subtle form of dyspraxia by his paediatric occupational therapist, based on poor proprioception, delayed bilateral integration and poor visual perception. A full visual assessment was carried out. SS was given a programme of reflex inhibition exercises for 3 months. Then, a programme of optometric vision therapy (OVT) exercises was prescribed at home and in practice for a period of 8 months. SS was assessed using a battery of occupational therapy Sensory Integration and Praxis Tests (SIPT) before optometric intervention, and after OVT. There were significant improvements in fusional reserves, accommodative facility and oculomotor control of pursuit and saccadic eye movements. His reading level had changed by 4 years in 11 months. The SIPT results showed improvements in the visual and motor/visual perception subtests, confirming the significant changes in visual perceptual performance. Consideration is given to treatment modalities for dyspraxia, and the studies confirming their effectivity of approach. This case study provides evidence supporting the use of OVT eye exercises in dyspraxia, ocular motility, accommodative dysfunction, learning difficulties and sports performance. The need for further research and inter-professional working is discussed.
Adler P RAF Near Point Rule. A technical note. (2004) Ophthal. Physiol. Opt. 24;469-470.
Abstract: A simple and inexpensive modification to the RAF near point rule is described. This modification allows a greater range of values for near point of convergence to be measured.
Adler P Efficacy of treatment for convergence insufficiency using vision therapy. 2002 Ophthal. Physiol. Opt. 22:565-571
Abstract
Purpose: The purpose of this study was to determine if vision therapy (VT), as practised within theconstraints of UK optometric practice, employing graded routine eye exercises, is as an effective method for treatment of convergence insufficiency (CI) as previously published data suggest. The study also evaluates the associated symptoms before and after therapy.
Methods: As many optometrists diagnose CI solely on the basis of near point of convergence (NPC) and treat only when symptoms are present (Letourneau et al., 1979; Rouse et al., 1997), in this studyCI was defined as NPC of 10 cm or greater (either with or without the presence of asthenopic symptoms for near work) accompanied by exophoria greater at near than at distance. The effect of treatment by optometric vision therapy (OVT) on the NPC and number of symptoms was investigated for 92 patients by retrospectively reviewing the clinical records. Success was defined as the restoration of NPC to normal values and significant reduction in the presenting symptoms.
Results: The effect of treatment on the NPC was shown to be highly significant (t ¼ 14.61, p < 0.001). Although treatment times were slightly longer, the success rates were higher than reported by other authors. Post-treatment values for NPC were: <10 cm (98.9%), <8.5 cm (95.7%) and <6.5 cm (80.4%). Longer treatment times were noted for patients who complained that the text appeared to move (v2, p ¼ 0.007).
Conclusion: Vision therapy is an effective method for treatment of CI.
Adler P M, Optometric Evaluation of Binocular Vision Disorders in Evans B and Doshi S- Binocular Vision and Orthoptics – Investigation and Management 2001 Chap 1;1-12. Butterworth Heinmann Oxford
Adler P M, Assessment of Accommodation - CE Optometry Feb 1998 1:2:40-42
This article is a continuing education article for optometrists and looks at the methods of assessment of accommodation in patients presenting to the optometrist.
Adler P M, Binocular Vision - Optometric evaluation of binocular vision anomalies. Optician 5638 215 24-28 1998
Adler P M, Management of Accommodation disorders CE Optometry (1998)
Adler P M, Understanding Vision Training - Optometry Today May 2 1997
Adler P M, Behavioural optometry.- Optometry Today 1994 Sept 26 24-32
Adler P M, & Grant R Literacy skills & visual anomalies- Optometry Today Jan 2 1988 15-16
Adler P M, & Grant R Literacy skills & visual anomalies- Optometry Today Jan 2 1988 15-16
Intellectual disability
Adler P M, Cregg M, Woodhouse JM, Duignan A, and Ilett G. (2005) Effect of training on attitudes and expertise of optometrists towards people with intellectual disabilities Ophthal. Physiol. Opt, London , 25(2):105-18.
Abstract:
Purpose: To determine whether participation in an educational programme, which comprised both lectures and supervised patient contacts, did more to improve the attitudes, expertise, knowledge and confidence of optometrists and student optometrists towards people with intellectual disabilities (ID) compared with receiving didactic lectures only.
Methods: Optometrists and student optometrists were invited to take part in vision screening. A series of lectures were provided followed by supervised practice for a minimum of 2 days. A questionnaire was administered before the commencement of the training, and afterwards, in order to assess the impact of the training. The results were compared with a group of control subjects who received similar lectures without the clinical experience.
Results: For both groups there were statistically significant improvements in self-reported knowledge of ophthalmic complications of ID, confidence in working with people with ID, and there was a significantly reduced perceived need for further training after the courses. There was a significantly better result for the group experiencing patient contact particularly in respect of self-reported attitudes towards people with ID. Confidence in dealing with people with ID was related to the number of such patients seen over the last year.
Conclusions: Training incorporating clinical experience, and using real patients, is particularly effective, although there is still benefit in providing lecture type courses. It is recommended that, whenever possible, courses are provided that offer hands-on experience with real patients. There is a need for further research using validated attitudinal scales to investigate the attitudes of optometrists to people with ID.
Woodhouse, JM, Adler P M, Duignan A. Vision in athletes with learning disabilities: the need for improved eye care. (2004) J Intell Disabil Res 48(8), 732-745.
Abstract
Background:Special Olympics provides sporting opportunities for people with intellectual disabilities (ID), and Lions Clubs International Opening Eyes GB offers vision screening for athletes at Special Olympics Games.
Methods:Opening Eyes GB screened the vision of UK athletes at its inaugural event in. The results were analysed and are presented here.
Results:Results showed that athletes do not differ from other people with ID in being at high risk of ocular and visual defects and many are not accessing eye care. 15% reported never having an optometric eye examination, and yet 19% of these athletes had a significant refractive error, 32% had ocular anomalies and 6% were visually impaired. Overall, findings confirmed the high prevalence of refractive errors and strabismus amongst people with ID. 40% of athletes had ocular abnormalities, including 15.6% with blepharitis, a readily treatable condition that causes discomfort. 9% had lens opacities, of which half were probably impairing sight. An important finding was that many athletes have reduced vision and 14% could be classified as visually impaired (WHO definition) even when refractive errors were fully corrected.
Conclusions:Special Olympics athletes should be encouraged to have regular eye examinations (as indeed, should all people with ID), and educators, carers and coaches need appropriate information about the visual status of their charges.
Woodhouse, JM, Adler P, Duignan A. Ocular and visual defects amongst people with learning disabilities participating in Special Olympics (2003). 23:221-232 Ophthal. Physiol. Opt.
Abstract
Purpose: To analyse data from vision screening of people with intellectual disabilities from the UK participating in Special Olympics during the National Summer Games in Cardiff 2001, in order to determine visual status and access to eye care.
Methods: Athletes were invited to take part in vision screening, according to Special Olympics protocols.
Results: Testability rates were high. Findings confirmed the high prevalence of eye and vision defects reported in other studies of people with intellectual disabilities. In particular, visual acuity was below normal for most athletes. Significant improvement to acuity could be achieved with spectacles although correction after full refraction did not always provide normal vision. Over 40% of athletes undergoing full refraction had below normal corrected acuity.
Conclusions: Athletes with intellectual disabilities were no more likely to access eye care and have adequate spectacle correction than other people with intellectual disabilities. Optometrists and carers need to be aware of the high prevalence of defects and the importance of regular eye examinations in people with intellectual disabilities
Adler P M and Duignan A. An eye-opening experience. Optometry Today Dec 1999;40-1
A general article describing the Opening Eyes programme of Special Olympics
Miscellaneous
Adler P M, Practice on the right lines.- Optometry Today - June 6 1994
Adler P M, Dealing with the Display Graphics Legislation.- J Inst Legal Administrators Summer 1993
Adler P M, Visual Dyslexia & Learning Disability. Optician - Nov 29 1985 19-29
Contact lenses
Adler P M, Soft Toric Contact Lens Update- Journal BCLA 1990 33-36
Adler P M, Aspheric Hard Gas Permeable Elliptical Lenses. Optician - Dec 5 1986 19-20
Morris J, Adler P M and Moore K, A three month trial on aspheric RGP Lens for daily and extended wear Optician - Nov 3 1989 27-29 |
