Robert John Jacobs

Background The New Zealand Ministry of Health provides funding for the delivery of health care across regions via 20 District Health Boards. Funding includes the subsidisation of therapeutic pharmaceutical agents/drugs. The distribution of optometrists and ophthalmologists across the regions was investigated to understand the accessibility of eye care in New Zealand. Changes made to the optometrists' scope of practice in 2005 and in 2014 increased the range of drugs that suitably qualified optometrists could prescribe. Therefore, the distribution of optometrists authorised to prescribe drugs and those not authorised to prescribe drugs was also investigated. Methods Information from the New Zealand Optometrists and Dispensing Opticians Board register and information from the Medical Council's website were used to create a database of ophthalmic practitioners and their locations. The χ² goodness‐of‐fit test was carried out to determine whether the distribution of the number of practitioners across the regions was in proportion to the population of the regions. Results Ophthalmologists were distributed across the regions in proportion to the regional population size. However, optometrists were concentrated in Auckland and other regions with high populations. Optometrists authorised to prescribe drugs comprised over 74 per cent of optometrists and were the majority of optometrists in most regions. Many of the regions with populations less than 200,000 had high population‐to‐practitioner ratios, indicating that they may not have sufficient numbers of ophthalmic practitioners in order to provide for the ocular needs of the community. Conclusion Better distribution of the optometric workforce could make eye care more accessible in many regions of New Zealand.

This review presents the extent to which engagement in research and new developments in clinical practice alike have contributed to the establishment and development of the primary vision care profession in New Zealand that is Optometry. Many notable changes have occurred in the scope of practice of the profession over the past three decades and an important role of visual neuroscience, neurobiology and pharmaceuticals allowed the introduction of therapeutic prescribing responsibilities to a previously optics dominated profession. Scientific, optometric, medical and clinical research are factors leading the changes in scope of practice of Optometrists. These advancements have significantly expanded the scope of practice since Optometry training began in the 1960s, and has been supported by close working relationships with other health professionals in New Zealand. This article describes the history of Optometry in New Zealand from early practitioners, to the establishment of a degree programme at the University of Auckland. Along with undergraduate teaching, a strong tradition of vision science research has established New Zealand as a centre of internationally recognised expertise in a range of areas including myopia and visual neuroscience. The Optometry profession has developed to deliver primary eye care at a community level across the country in a range of areas of special interest.

Today’s students have increased expectations for flexible learning options and evidence-based practice resources to be available to support curricular activities. We investigated: (i) the suitability of a static website for teaching ocular anatomy and physiology and an interactive version of the website with quiz and self-assessment activities and (ii) the usefulness of a blended online and in-lab environment to teach in Optometry. We administered a survey to compare responses of optometry students who had access to the interactive website, with those from students from a previous year who used the static version. We examined learning preferences of students in a focus group. Students were positive about the value of the website for their learning and the clarity of the website content. Nevertheless, objective comparison of pass rates for students using the static and interactive websites did not show significant changes. The majority of students commenting on the static website felt they did not get sufficient feedback via the website (67%) compared with only 22% from students who used self-assessments in the interactive website. Interestingly, users of the static website commented that it was perceived as just another resource while users of the interactive website commented on the usefulness of the material to review knowledge before laboratories. In the focus group, students reported they preferred a blended learning over the website alone even by students using the interactive website as they felt the need to revise content with the educator before the test. We conclude that there is acceptance of online learning methods due to the technologically ‘savvy’ environment of students in the first year of the Optometry programme but there is still dependence on the educator as the main administrator of their learning.

Background There is currently insufficient evidence to recommend vision screening for children < 36 months of age. This study assessed the effect of comprehensive vision screening, as well as the sensitivity of age‐appropriate vision tests, at two years of age on habitual visual acuity at 4.5 years of age. Methods Children born at risk of neonatal hypoglycaemia (n = 477) underwent vision assessment at 54 ± 2 months of age including measurement of monocular and binocular habitual visual acuity, assessment of binocularity and stereopsis. Of these children, 355 (74.4 per cent) had also received vision screening at two years of age (mean age = 24± 1 months), while 122 were not screened. Results Eighty (16.8 per cent) children were classified as having reduced vision at 4.5 years of age, but the prevalence of reduced vision did not differ between children who had previously been screened at two years of age and those who had not (15.5 per cent versus 20.5 per cent, p = 0.153). However, children with reduced vision at 4.5 years of age were more likely to have had visual abnormalities requiring referral detected at two years of age (p = 0.02). Visual acuity and mean spherical equivalent autorefraction measurements were also worse (higher values) in two‐year‐old children who were later classified with reduced habitual visual acuity (p = 0.031 and p = 0.001, respectively). Nevertheless, unaided binocular visual acuity, non‐cycloplegic refractive error, and stereopsis at two years all showed poor sensitivity and specificity for predicting visual outcomes at 4.5 years of age. Conclusion Our findings do not support the adoption of early vision screening in children as current vision tests suitable for use with two‐year‐old children have poor sensitivity for predicting mild–moderate habitual vision impairment at 4.5 years of age.

Purpose: Although vanishing optotype preferential‐looking tasks are commonly used to measure visual acuity ( VA ), the relative sensitivity of these tests to refractive error is not well understood. To address this issue, we determined the effect of spherical and astigmatic simulated refractive errors on adult VA measures obtained using vanishing optotypes, picture optotypes and Sloan letters. Methods: VA was determined uniocularly for adults under conditions of spherical (0.0–3.0 DS ; n = 23) and astigmatic (0.0–3.0 DC at 90° and 180°; n = 20) defocus using the Cardiff Acuity Test (vanishing optotypes), crowded linear Lea Symbols (picture‐optotype recognition task) and the Early Treatment of Diabetic Retinopathy Study ( ETDRS ) letter chart. Results: The Cardiff Acuity Test over‐estimated VA compared with the Lea Symbols and ETDRS charts in both focused and defocused conditions. The mean difference between the Cardiff Acuity Test and the ETDRS chart was 0.31 log MAR (95% limits of agreement ( LOA ) 0.10–0.52 log MAR ) in focused conditions and 0.64 log MAR (95% LOA 0.25–1.05 log MAR ) with 3D of spherical defocus. Defocus degraded VA on all charts, however there was a significant chart‐by‐defocus interaction whereby the Cardiff Acuity Test was more resistant to the effects of both spherical ( P < 0.0001) and cylindrical ( P < 0.001) optical defocus than the recognition acuity tasks at all defocus levels. Conclusion: Although the Cardiff Acuity Test provides an easy method for VA measurement in infants and toddlers, there is a considerable overestimation of VA compared with recognition acuity tasks particularly in the presence of defocus. A simple correction factor (of for example three lines overestimate) cannot be applied to Cardiff acuity measures as there is increasing over‐estimation of VA with increasing defocus. Infants with significant refractive error may fall within normal visual acuity ranges for the Cardiff Acuity Test.

Prenatal exposure to recreational drugs impairs motor and cognitive development; however it is currently unknown whether visual brain areas are affected. To address this question, we investigated the effect of prenatal drug exposure on global motion perception, a behavioural measure of processing within the dorsal extrastriate visual cortex that is thought to be particularly vulnerable to abnormal neurodevelopment. Global motion perception was measured in one hundred and forty-five 4.5-year-old children who had been exposed to different combinations of methamphetamine, alcohol, nicotine and marijuana prior to birth and 25 unexposed children. Self-reported drug use by the mothers was verified by meconium analysis. We found that global motion perception was impaired by prenatal exposure to alcohol and improved significantly by exposure to marijuana. Exposure to both drugs prenatally had no effect. Other visual functions such as habitual visual acuity and stereoacuity were not affected by drug exposure. Prenatal exposure to methamphetamine did not influence visual function. Our results demonstrate that prenatal drug exposure can influence a behavioural measure of visual development, but that the effects are dependent on the specific drugs used during pregnancy.

Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited. We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function. Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P=0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P=0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome. In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.)