IDOC: Interpreting Data from the Oyler Clinic Thesis Presented in Partial Fulfillment of the Requirements for the Degree of Master of Science in the Graduate School of The Ohio State University By Sarah K. Lasher Graduate Program in Vision Science The Ohio State University 2015 Thesis Committee: Dr. Jeffrey J. Walline, Advisor Dr. Michael J. Earley Dr. Terri A. Gossard Copyright by Sarah K. Lasher 2015 Abstract The OneSight Vision Center located within Oyler School in Cincinnati, OH is the first self-sustaining school-based vision center in the nation. The center is a Federally Qualified Health Center Look-Alike. The center opened its doors on October 1, 2012 and during its first year, 1,255 children received eye examinations, 420 of which were enrolled in the Oyler School. The examination records from the Oyler students were collected and analyzed to document the prevalence of vision anomalies and compare ocular characteristics between students with Individualized Education Programs (IEPs) and non-IEP students. Students in preschool through 12th grade were examined, and examination records were de-identified before transmittance to The Ohio State University College of Optometry. Data were dual entered, and mismatched entries were corrected based on source documents. Prevalence data for various ocular characteristics was compared using Chi- square analysis and were compared between IEP and non-IEP students of Oyler, as well as literature-based values for both IEP and non-IEP children in the general public. The ages of students examined were 3 to 19 years, and the average (± standard deviation) age was 10.7 ± 4.1 years. The students at Oyler had a significantly higher prevalence of hyperopia (Chi-square, p<0.0001), myopia (Chi-square, p=0.005), and astigmatism (Chi-square, p<0.0001) than literature values for the general public. Ocular characteristics that had a significantly higher prevalence in Oyler students with an IEP ii compared to non-IEP Oyler students were: astigmatism greater than or equal to -1.25DC (Chi-square, p=0.001), exophoria at near (Chi-square, p=0.046), exotropia at distance (Chi-square, p=0.002) or near (Chi-square, p=0.001), and a reduced near point of convergence (Chi-square, p<0.001). No other significantly different prevalences between IEP and non-IEP children were detected. Not all children who attended Oyler were examined during the school year. Those examined were more likely to have an IEP or a suspected vision-related problem. This fact alone may explain why there is a higher prevalence of ocular anomalies among Oyler students than the general population, and why few differences were detected in the prevalence of ocular anomalies between children with and without IEPs. iii Dedication This document is dedicated to every child working to overcome the challenges they face on a daily basis. We’re pulling for you. iv Acknowledgments To my advisor, Dr. Walline: I don’t know if I’ll ever be able to thank you enough for everything you’ve done. You worked so tirelessly to answer my questions, answer my emails, drop whatever you were doing to help me when I’d show up unannounced in your office, and I thank you for all of that and more. I’d like to thank Dr. Earley and Dr. Gossard for taking the time out of their insanely busy schedules to not only read this thesis, but to sit on my defense committee. You both have had such a huge impact on me, and I know that I’ll be better able to serve my community as an optometrist because I’ve had you both to look up to. I’d also like to thank Dr. Zadnik for getting me in touch with Dr. Gossard, which spawned this thesis project. To the OneSight Vision Center Staff, especially Cari VanPelt and Dr. Thiemann: you all are such an asset to that center, and I hope you realize how much your hard work is appreciated. I feel blessed to have been able to not only write a master’s thesis on the data, but also to have been the first intern to rotate there and work with all of you. Nick and Caitlin Perichak, you were both such a huge help to me in the writing process. To my parents, who raised me with the sense of drive that made me crazy enough to sign up for the Opt VII program. And to Chris – I don’t know how you put up with me studying night after night, but it will all be worth it very soon. v Vita May 2007 .......................................................…………………Morgan High School May 2011 .......................................................B.S. Biochemistry, Niagara University 2011-present………………Doctor of Optometry, Ohio State College of Optometry Fields of Study Major Field: Vision Science vi Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi List of Tables ...................................................................................................................... x List of Figures .................................................................................................................... xi Chapter 1: Introduction ....................................................................................................... 1 1.1 What is an IEP? .................................................................................................... 1 1.2 IEP’s and Eye Examinations ................................................................................ 4 1.3 Poverty, Race, and Visual Correction .................................................................. 7 1.4 Federally Qualified Health Center ..................................................................... 10 1.5 Why Oyler? ........................................................................................................ 12 1.6 Purpose of this Study.......................................................................................... 15 Chapter 2: Methods ........................................................................................................... 17 vii 2.1 IRB Approval ..................................................................................................... 17 2.2 Oyler Examination ............................................................................................. 17 2.3 Subjects .............................................................................................................. 19 2.4 Refractive Error Definitions .............................................................................. 20 2.5 Binocular Vision ................................................................................................ 20 2.6 Statistical Analysis ............................................................................................. 21 Chapter 3: Results ............................................................................................................. 22 3.1 Oyler Demographics .......................................................................................... 22 3.2 Refractive Error Prevalence ............................................................................... 27 3.3 Binocular Vision ................................................................................................ 31 3.3.1 Distance and Near Cover Test .................................................................... 32 3.3.2 Near Point of Convergence ......................................................................... 34 3.3.3 Convergence Insufficiency ........................................................................ 34 3.3.4 NRA/PRA ................................................................................................... 34 Chapter 4: Discussion ....................................................................................................... 36 4.1 Oyler Demographics .......................................................................................... 36 4.2 Refractive Error Prevalence ............................................................................... 39 4.3 Binocular Vision ................................................................................................ 42 Chapter 5: Conclusion....................................................................................................... 46 viii Bibliography ..................................................................................................................... 48 ix List of Tables Table 1: Normative values and study values listed for various binocular vision tests and CI diagnosis ...................................................................................................................... 21 Table 2: Percentage of recorded values, mean, or percent prevalence for Oyler demographics .................................................................................................................... 23 Table 3: Distribution of favorite classes among grades .................................................... 26 Table 4: Average values collected from various refractions, and prevalence of performance .....................................................................................................................