Since these aspects are all essential components of constructivist educational theory, TBL is solidly grounded in the theory and is a promising method to strengthen healthcare education.

The objective of this descriptive study was to determine the frequency with which patients return for re-examination due to a failure of spectacle lens acceptance and to quantify the reasons for the failure. A random sample of patient records was reviewed to determine the rate of spectacle lens prescription. Spectacles reassessment records, completed after dispensing problems were dealt with were reviewed to determine the primary reason for the failure. Spectacles were prescribed for 58% of the 44 341 patients seen over 6 years. Of the 25 718 prescriptions written, 400 patients (1.6%) returned for reassessment. The most common problem was incorrect refractive error measurement (59%), followed by inability of the patient to adapt to an accurate refractive correction (10.3%), inadequate patient education regarding lens design (9.5%), pathology (9.3%), appliance problem (5.8%), transcription errors (1.6%) and other (4.5%). The frequency of failure to adapt to spectacle prescriptions is quite low and the most common reason for this failure is inaccuracy in the measurement of the refractive error.

Although it is inaccurate to conclude that any testing format is universally reliable or valid, published research supports the use of examinations using KFQs to assess clinical reasoning. The review identifies areas of further study, including all categories of evidence. Investigation into how examinations using KFQs integrate with other methods in a system of assessment is needed.

In the last 100 years, there appears to have been a myopic shift in clinic-based populations and myopia prevalence appears to follow a predictable pattern with age.

This report describes the new optical imaging technique of optical coherence tomography (OCT). OCT is capable of high-resolution, micrometer-scale, cross-sectional imaging of biological tissue. The OCT for ophthalmic application uses 843-nm, near-infrared light, which produces a longitudinal resolution of 10 to 20 microm and a penetration depth of a few millimeters. The scans are displayed in a false color representation scale on which warm colors represent areas of high optical reflectivity and cool colors represent areas of minimal or no reflectivity. A cross-sectional view similar to a histology section is obtained. The cornea, iris, and lens may be visualized as well as the retina and optic nerve. OCT has been used to investigate several ocular diseases. These include macular disease, genetic retinal disease, retinal detachment and retinoschisis, choroidal tumors, optic nerve disorders, and glaucoma.

The risk created by faculty not articulating the rationale underlying standards of practice was that students misinterpreted the optometrists' ways as idiosyncratic. Thus, opportunities were missed in the educational setting to assist students in making responsible decisions, locating their position in practice, and shaping their professional identity. Competing responsibilities of patient care and student education left instructors with little time to articulate rationale for standards of practice. Therefore, educators must reflect on innovative ways to bring into relief the logic behind their actions when working with novices.

Citation: Leat SJ, Chan LL-L, Maharaj P-D, et al. Binocular vision and eye movement disorders in older adults. Invest Ophthalmol Vis Sci. 2013;54:3798-3805. DOI:10.1167/ iovs.12-11582 PURPOSE. To determine the prevalence of binocular vision (BV) and eye movement disorders in a clinic population of older adults. METHODS.Retrospective clinic data were abstracted from files of 500 older patients seen at the University of Waterloo Optometry Clinic over a 1-year period. Stratified sampling gave equal numbers of patients in the 60 to 69, 70 to 79, and 80þ age groups. Data included age, general and ocular history and symptoms, use of antidepressants, a habit of smoking, refraction, visual acuity, BV and eye movement status for the most recent full oculo-visual assessment, and an assessment 10 years prior. The prevalence of any BV or eye movement abnormal test (AT) result, defined as a test result outside the normal range, was determined. This included strabismus (any) or phoria; incomitancy; poor pursuits; and remote near point of convergence (NPC). The prevalence of significant BV disorders (diagnostic entities, i.e., a clinical condition that may need treatment and may have functional implications) was also determined.RESULTS. The prevalence of any BV or eye movement AT was 41%, 44%, and 51% in the 60 to 69, 70 to 79, and 80þ age groups, respectively. These figures were lower for 10 years earlier: 31%, 36%, and 40% for ages 50 to 59, 60 to 69, and 70þ, respectively. The prevalence of any BV or eye movement disorder was 27%, 30%, and 38% for the three age groups and 17%, 19%, and 24% for 10 years prior. Age and use of antidepressants most commonly predicted BV or eye movement AT or disorder.CONCLUSIONS. BV disorders are common among older adults.Keywords: aging, heterophoria, binocular vision disorders, eye movement disorders T here has been little attention paid to age-related changes in binocularity or to the prevalence of binocular vision (BV) disorders in older adults. 1 The definition of what is included as a BV disorder differs between studies, making them hard to compare. Despite this, it appears that the overall prevalence of BV disorders in prepresbyopic clinic populations is quite high, ranging from 10% 2 when only near esophoria or convergence insufficiency were included, to 21.8% 3 when any one of the following conditions were included: convergence insufficiency, basic eso-or exophoria, divergence excess, divergence insufficiency, convergence excess, or reduced fusional vergence ranges. Porcar and Martinez-Palomera 4 found a total of 15.3% who exhibited either convergence insufficiency, convergence excess, basic eso-or exophoria, or fusional vergence dysfunction in a population of university students. These studies excluded people with strabismus and the figures quoted here exclude accommodative disorders. The prevalence of strabismus has been found to be between 2.7% and 5.5% in schoolchildren [5][6][7][8][9][10][11] and is similar in the adult population. 12-14Therefore, this percentage should be ad...

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