Orientador: Maria Elisabete Rodrigues Freire Gaparetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T00:37:44Z (GMT). No. of bitstreams: 1 Nilsen_MayaraLarissa_M.pdf: 13542367 bytes, checksum: 2c541a68bc9e258aec285432b8188965 (MD5) Previous issue date: 2012 / Resumo: Dentre as ações necessárias de promoção de saúde, destaca-se a promoção da saúde ocular, pois, segundo a Organização Mundial de Saúde, aproximadamente 70% dos casos de cegueira mundial poderiam ser evitados se fossem realizadas ações de promoção da saúde por meio de técnicas simples como a aplicação de testes para avaliar a acuidade visual. Considerando tais afirmações este estudo teve como objetivos: 1) Acompanhar a inserção do enfermeiro das Estratégias de Saúde da Família na avaliação da acuidade visual de crianças matriculadas na 1a série do ensino fundamental do município de Limeira; 2) Avaliar a acuidade visual dessas crianças. Método: Realizou-se estudo analítico com crianças da 1a serie do ensino fundamental de 05 escolas do município de Limeira/SP com a participação dos enfermeiros que atuam nas Estratégias de Saúde da Família. As variáveis investigadas foram: sexo, idade, identificação da escola, avaliação da acuidade visual, uso de lentes corretivas, valores da acuidade visual e os sintomas apresentados durante a avaliação. Os instrumentos utilizados foram à tabela de Snellen e um questionário que foi aplicado às crianças por meio de entrevista. Resultados: A amostra foi composta por 143 crianças, sendo 55,9% do sexo feminino e 44,1% do sexo masculino com idade média de 5,95 anos. A média geral da acuidade visual foi de 0,857 para o olho direito; 0,846 para o olho esquerdo e 0,913 em ambos os olhos. Dessas crianças 2,1% já utilizavam correção e 17,5% apresentaram sintomas indicativos de dificuldade visual durante a realização do teste, com a prevalência do sinal de franzir de testa em 11,9% das crianças. Os resultados evidenciaram que em 7,0% das crianças houve diferença de acuidade visual entre o olho direito e o olho esquerdo. Foi verificada significância entre a acuidade visual e a presença de sintomas de dificuldade visual, com valor de p?0,05 que foi correlacionado por meio do teste de Mann-Whitney U. Foram encaminhadas 38 (26,6%) crianças ao oftalmologista. Conclusão: Considerando a interferência dos problemas visuais na aprendizagem, foi realizada a promoção da saúde ocular na escola e verificou-se que após a capacitação, o enfermeiro do programa de saúde da família pode contribuir na detecção precoce de problemas visuais, contribuindo para a diminuição de repetência e da evasão escolar / Abstract: Among the actions needed to promote health, there is the promotion of eye health because, according to the World Health Organization, approximately 70% of cases of blindness worldwide could be prevented if they were carried out actions to promote health through techniques simple as the application of tests to assess visual acuity. Considering such statements this study aimed to: 1) Monitor the insertion of nurses Strategies of Family Health in visual acuity of children enrolled in the first grade of the city of Limeira, 2) evaluate the visual acuity of these children. Method: We performed analytical study with children of primary school first series of 05 schools in the city of Limeira / SP with the participation of nurses working in Family Health Strategies. The variables were: gender, age, school ID, visual acuity, corrective lenses, values of visual acuity and symptoms during the evaluation. The instruments used were the Snellen chart and a questionnaire that was administered to children through interviews. Results: The sample consisted of 143 children, with 55.9% female and 44.1% male with an average age of 5.95 years. The average visual acuity was 0.857 for the right eye; 0.846 to 0.913 and left eye to both eyes. 2.1% of these children were using correction and 17.5% had symptoms indicative of visual difficulty during the test, with the prevalence signal frown in 11.9% of children. The results showed that 7.0% of children were no difference in visual acuity between the right eye and the left eye. Significance was found between visual acuity and symptoms of visual impairment, with p ? 0.05 which was correlated by means of the Mann-Whitney U test Were referred 38 (26.6%) children the ophthalmologist. Conclusion: Considering the interference of visual problems in learning, was held to promote eye health in school and it was found that after the training, the nurse of the family health program can help in early detection of visual problems, contributing to the decrease Repetition and dropout / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

D.Phil. / Visual acuity and refractive state probably are the two most basic or fundamental quantities that concern optometry, ophthalmology and vision science. Both of these variables are complicated and their mathematical and statistical use in research and other activities has been poorly understood. During particularly the last decade, modern statistical multivariate methods have become available to optometry and ophthalmology and this has assisted with the understanding of concepts such as refractive state (and its underlying nature, namely, dioptric power). It is now possible to transform measurements of refractive state from the conventional notation that is commonly used in the fields of optometry and ophthalmology to an orthodox mathematical form that can be understood by scientists and mathematicians. With this matrix form of refractive state it then is possible to use appropriate methods of linear algebra and multivariate statistics. Other theoretical approaches and analytical procedures or methods also have become accessible or have been developed recently as a consequence of this significant shift in thought as regards the fundamental nature of dioptric power. On the other hand, the scientific understanding of visual acuity (that is, the measurement of the resolving ability of the eye) perhaps has been somewhat neglected. Certainly there has been an abundance of research involving visual acuity and there also has been discussion concerning some of the difficulties that become apparent when measuring or attempting to interpret results from studies involving visual acuity. Visual acuity, unlike refractive state, can be represented by means of a single number and thus univariate, rather than multivariate, statistical methods are appropriate. And, of course, univariate statistics is less complicated than the multivariate form. But there are various difficulties with the understanding and researching of visual acuity. Some of these difficulties are relatively simple and thus can be solved more easily. For example, visual acuity measurements can be obtained from charts designed according to a logarithmic scale, or measurements from other charts can be transformed to a logarithmic scale. And thereby the ordinal nature of the basic or more common visual acuity scale is avoided and certain statistical methods become available that otherwise would not be possible. But more fundamentally visual acuity probably cannot truly be considered without the subject from which the measurement is obtained and, more particularly, the refractive state of the eye concerned. So the visual acuity and refractive state of an eye, perhaps, should be more appropriately regarded as a unitary concept that ideally should not be separated into two distinct parts. Thus to truly understand the relationship between visual acuity and refractive state we need to understand the 4-dimensional (mathematical) nature of the particular relationship involved. It follows then that the relationship between visual acuity and refractive state is a multivariate problem and that multivariate methods are best suited to its consideration. If we then begin to take into account other variables such as age or the ocular health, or say, iris aperture diameter of the eye then the complicated multivariate nature of the situation becomes even more obvious. In this dissertation an attempt is made to consider the possibilities of a modern multivariate approach to studies involving visual acuity, refractive state and other variables. The methodology used in this dissertation differs from those used in previous studies involving visual acuity and refractive state and other related variables. For example, here Jackson crossed cylinders are used extensively to produce dioptric blur or defocus in experimental subjects (positive and negative spheres also are used to a more limited extent). In previous published studies spherical or, less commonly, cylindrical lenses were used instead. Another difference between this dissertation and previous research studies is that the visual stimulus that the subjects observed, generally but not always, was a meridionally-independent or non-directional letter 0. The reasons for this choice is explained in the dissertation but in other research an enormous variety of visual stimuli have been used depending upon the interests of the researchers. But even more essentially this dissertation differs significantly from that of previous studies in terms of the manner in which the various experimental and other results (for instance, that from earlier researchers such as HB Peters) are presented. Entirely new, and largely unpublished, methods are used in many parts of this dissertation that probably represent a paradigmatic transition in understanding of visual acuity and its relation to refractive state. New terms such as decompensation and accompensation surfaces of constant visual acuity and antistigmatic ellipses are defined herein. (Briefly, one imagines starting from a state of compensation (of the refractive state of, say, an eye viewing a stimulus).

Dynamic Visual Acuity (DVA) in the visual periphery has not been extensively studied. DVA is a measure of an observer's ability to resolve critical details in a target when there is relative motion between the target and the observer. This dissertation examined static and dynamic acuity in the 25-55 deg region of retinal eccentricity under a variety of conditions. Functionally, this region of the visual field is just beyond the "blind spot," but not yet in the "far" visual periphery of 60-90 deg of eccentricity. Traditionally, DVA research has been confined to the assessment of DVA for the foveal (or "central") visual system. However, the peripheral (or "ambient") visual system provides very important information content for the visual and neuro-vestibular systems. This peripheral visual information content is also used to create a sense of ego motion (termed "vection"), and for alerting the visual system to targets entering or leaving the field of view. Past findings involving visual acuity in the peripheral retina have demonstrated that peripheral acuity performance has components related to the notion of "attention" as well. This is particularly true if the peripheral vision research results are to be applied to visually and attentionally complex and/or dynamic real-world environments. In this experiment, the 25-55 deg eccentric region of the retina was tested for DVA in 50 observers. This study used a mixed four-factor research design with Eccentricity (25, 35, 45, 50, 55 deg) as a between-subjects factor. Tracking Difficulty (monitor only, easiest, moderate, most difficult tracking levels), Landolt C Target Velocities (0.0, 4.88, 14.62, and 24.40 deg/s), and Target Direction ("F/R:" fixed or random direction of target appearance) were used as within-subjects factors. A computer presented the Landolt C ring targets under the stated conditions in a random fashion. Acuity was determined for each trial by a modified descending method-of-limits approach with the Landolt C ring target gap widths utilized as the determinant for the acuity measure. The Tracking Task was designated as the primary task, with the secondary task being to indirectly observe the orientation (up, down, right, left) of the Landolt C rings being presented under the various conditions of Target Velocity and Target Direction in the retinal periphery. The resulting Analysis of Variance (ANOVA) revealed significant differences (p < 0.05) for each of the main effects of Eccentricity, Tracking Task Difficulty, Velocity, and Target Direction (F/R). Only two of the two-way interactions were found to be significant (p < 0.05)-- those of Tracking Difficulty x Target Velocity and Target Velocity x Target Direction interactions. The results are discussed in terms of the psychophysical, attention, and "tunnel vision" like models of peripheral visual performance, along with other related human factors literature in the domain of "situation awareness" that are relevant to this general problem area. The results of a separate follow-on mini-study are discussed using a Two-way Contingency Table analysis across all of the treatment conditions when verbal intrusion was embedded in the previously described experimental conditions. This mini-study revealed a significant association (p < 0.05) with not seeing the peripheral targets as accurately when intrusion was present, versus when there was no verbal intrusion. This effect was more pronounced at the highest velocities (14.62 and 24.40 deg/s) as compared with the slower ones (0 and 4.88 deg/s) in terms of the strength of the association, as assessed by a Kappa test statistic. Taken all together, and with consideration given to the relatable scientific literature, these results indicate that the more "busy" a person is with cognitive, visual, or motor-skills tasks, the more likely an individual will show degradation in static or dynamic peripheral visual acuity tasks. Peripheral vision often serves as a "warning" or "status" sensory modality for what is occurring in the local task environment, separate from the foveal visual system. Future research is suggested given the sensitivity of the peripheral visual system to these factors, particularly with regard to how factors involving the notion of attention may affect such "peripheral visual awareness" issues. These issues in turn may play an important role from a human factors and safety perspective in a variety of person-rated vehicular domains. Specific areas that are highlighted for future research in the domain of attention and "peripheral visual awareness" include the low-altitude high-performance flying realm, the flying environment more generally, and in other dynamic multi-task vehicular environments such as that encountered while simultaneously driving and using a car cellular phone. / Ph. D.

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The vestibular system senses head motion and facilitates gaze stabilization, allowing for clear vision during movement. The vestibulo-ocular reflex (VOR) causes the eyes to move opposite head motion, thus maintaining focus on a target. Consequently, uncompensated loss of vestibular function leads to reduced VOR function resulting in dizziness, nausea, and visual disturbance. Different testing methods have been developed to measure VOR loss. These tests generally require bulky, expensive equipment, and must be performed by a trained examiner. A newly developed digital form of the dynamic visual acuity (DVA) test requires less equipment, is cost-effective, and may be performed at home making it more accessible. The purpose of this study was to determine the validity and test-retest reliability of the digital DVA test and provide normative data for healthy adults. Fifteen adults – 10 female and 5 male (mean age = 22.0 ± 3.1, range: 19-31 years) – completed the study. Exclusion criteria included age older than 49 years, history of vestibular or neurological disorders, and history of significant head injury. Subjects were screened for normal vestibular function using video head impulse testing. The study consisted of two visits, 3-15 days apart. Participants underwent DVA testing with both the validated NeuroCom (InVision software) system and newly developed digital DVA during the initial visit and the digital DVA during the second visit. The digital DVA system consists of a laptop computer paired with a head/eye tracker (Tobii Eye Tracker 5) and Health in Motion software (Blue Marble Health Company). Outcome measures of interest were the difference between static and dynamic visual acuity measured in LogMAR (DVA loss) for rightward and leftward head movement. Pearson Product-Moment bivariate correlations were used to determine validity of the digital DVA outcomes compared to NeuroCom outcomes. Intraclass correlation coefficients (ICCs) were calculated to determine test-retest reliability of the digital DVA. Pearson correlation coefficients for validity were r = 0.025 and r = -0.015 for left and right DVA loss, respectively. ICCs for test-retest reliability were r = 0.366 and r = 0.313 for left and right DVA loss, respectively. Mean values across both sessions for left and right DVA loss measured by digital DVA were 0.26 ± 0.13 and 0.26 ± 0.11, respectively. Correlations between the digital DVA and standard computerized DVA were poor indicating the need for further development of the current digital system/software. Test-retest reliability for the digital DVA system in its current state was also poor. Tobii sensor used in the software is limited by a 200 ms delay in reporting head motion to the software. Future development of a digital DVA may need to consider other sensors. The current digital DVA will not replace the computerized system; however, it may provide important information for clinicians who do not have access to computerized DVA.

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