Twelve tips for developing key-feature questions (KFQ) for effective assessment of clinical reasoning.

Clinical reasoning is the cognitive process that makes it possible for us to reach conclusions from clinical data. "A key feature (KF) is defined as a significant step in the resolution of a clinical problem. Examinations using key-feature questions (KFQs) focus on a challenging aspect in the diagnosis and management of a clinical problem where the candidates are most likely to make errors.

Refractive error magnitude and variability: Relation to age.

Purpose: To investigate mean ocular refraction (MOR) and astigmatism, over the human age range and compare severity of refractive error to earlier studies from clinical populations having large age ranges.

Methods: For this descriptive study patient age, refractive error and history of surgery affecting refraction were abstracted from the Waterloo Eye Study database (WatES). Average MOR, standard deviation of MOR and astigmatism were assessed in relation to age.

Visual and binocular status in elementary school children with a reading problem.

Purpose: This descriptive study provides a summary of the binocular anomalies seen in elementary school children identified with reading problems.

Methods: A retrospective chart review of all children identified with reading problems and seen by the University of Waterloo, Optometry Clinic, from September 2012 to June 2013.

Results: Files of 121 children (mean age 8.

Value of Routine Eye Examinations in Asymptomatic Patients.

Purpose: To determine if routine eye examinations in asymptomatic patients result in spectacle prescription change, new critical diagnosis, or new management of existing conditions. We also investigate whether age and time between assessments (assessment interval) impact detection rates.

Methods: The Waterloo Eye Study (WatES) database was created from a retrospective file review of 6397 patients seen at the University of Waterloo Optometry Clinic.

Key-feature questions for assessment of clinical reasoning: a literature review.

Objectives: Key-feature questions (KFQs) have been developed to assess clinical reasoning skills. The purpose of this paper is to review the published evidence on the reliability and validity of KFQs to assess clinical reasoning.

Methods: A literature review was conducted by searching MEDLINE (1946-2012) and EMBASE (1980-2012) via OVID and ERIC.

Evidence-based practice instruction by faculty members and librarians in North American optometry and ophthalmology programs.

North American optometry and ophthalmology faculty members and vision science librarians were surveyed online (14% response rate) about teaching evidence-based practice (EBP). Similar to studies of other health care programs, all five EBP steps (Ask, Acquire, Appraise, Apply, Assess) were taught to varying degrees. Optometry and ophthalmology EBP educators may want to place further emphasis on (1) the Apply and Assess steps, (2) faculty- and student-generated questions and self-assessment in clinical settings, (3) online teaching strategies, (4) programmatic integration of EBP learning objectives, and (5) collaboration between faculty members and librarians.

Increase in myopia prevalence in clinic-based populations across a century.

Purpose: The study's aim was to report prevalence estimates and age-related trends in refractive error in a clinic-based series and compare them to results from studies of a similar nature conducted since 1892.

Methods: Refractive error, patient age, and sex were collected from the files of all patients seen at the University of Waterloo School of Optometry and Vision Science clinic between January 2007 and January 2008. Patients were categorized as having myopia (<-0.

Eye examinations improve visual acuity across ages.

Objective: To investigate changes in distance best corrected visual acuity (BCVA) relative to presenting visual acuity (PVA) as a function of age and the number of years between eye examinations.

Design: Retrospective cross-sectional study.

Participants: 6397 patient files at a large Canadian Optometric Clinic.

Binocular vision and eye movement disorders in older adults.

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 80+ age groups.

Age-related cataract is associated with type 2 diabetes and statin use.

Purpose: Diabetes has been shown to be a risk factor for age-related (AR) cataract. As statins (HMG-CoA reductase inhibitors) are now commonly prescribed for patients with type 2 diabetes, their impact on AR cataract prevalence should be considered. This study determines associations between AR cataract, type 2 diabetes, and reported statin use in a large optometric clinic population.

The educational theory basis of team-based learning.

Background: Health care providers require the ability to use critical thinking skills and work effectively in a team as a part of an overall set of competencies. Therefore, educational programs should use appropriate methods based in educational theory to effectively graduate learners with these abilities. Team-based learning (TBL) is a method that has been introduced in healthcare education to foster critical thinking skills while students work in high functioning teams.

Modeling the prevalence of age-related cataract: Waterloo eye study.

Purpose: To report on the prevalence of age-related (AR) cataract in an optometric clinic population including male and female subgroups.

Methods: Retrospective patient file data reviewed for the Waterloo Eye Study database included age, sex, date of lens extraction (LE), and presence of AR cataract [nuclear sclerosis (NS), cortical cataracts (CC), posterior subcapsular (PSC) or associated LE]. Prevalence (%) was calculated for overall AR cataract, NS, CC, PSC, and bilateral LE for all Waterloo Eye Study patients.

Modifications made to the refractive result when prescribing spectacles.

Purpose: The purpose of this study was to determine how optometric practitioners modify the subjective refractive result when prescribing spectacles.

Methods: Refractive data were gathered for patient visits at the School of Optometry, University of Waterloo, between January 2007 and January 2008. The entering prescription, subjective refraction, and exiting prescription were analyzed from 5001 records for patients aged ≥ 7 years.

Evaluation of the clinical maxim: "If it ain't broke, don't fix it".

Purpose: A significant number of patients return to optometric practice dissatisfied with their spectacles. An important question is whether any of these cases are preventable. There are several different clinical maxims that are used to modify the subjective refraction when determining the refractive prescription.

Prescribing for hyperopia in childhood and teenage by academic optometrists.

Purpose: The purpose of this study was to examine the prescribing patterns of academic optometrists for infants, children, and teenagers with hyperopia and the factors that affected the decision to prescribe. A comparison was made to published guidelines for prescribing for hyperopia in children.

Methods: The Waterloo Eye Study (WatES) database is a database of all patients attending the Primary Care Clinic or the Pediatric Clinic at the School of Optometry, University of Waterloo, between February 2007 and January 2008.

Waterloo Eye Study: data abstraction and population representation.

Purpose: To determine data quality in the Waterloo Eye Study (WatES) and compare the WatES age/sex distribution to the general population.

Methods: Six thousand three hundred ninety-seven clinic files were reviewed at the University of Waterloo, School of Optometry. Abstracted information included patient age, sex, presenting chief complaint, entering spectacle prescription, refraction, binocular vision, and disease data.

Comparison of alternate cover test reliability at near in non-strabismus between experienced and novice examiners.

Purpose: The purpose of this study was to determine the reliability of the prism neutralized alternate cover test (ACT) used to measure near phoria in non-strabismic participants as measured by experienced and novice examiners and to compare the values to results obtained by eye tracking.

Methods: Two experienced optometrists and two optometry students performed the ACT at 40 cm on 50 non-strabismic participants. The ACT was then repeated with the subjects wearing an eye tracker.

What healthcare students do with what they don't know: the socializing power of 'uncertainty' in the case presentation.

Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students.

Prescribing spectacles: reasons for failure of spectacle lens acceptance.

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.

Tensions in the field: teaching standards of practice in optometry case presentations.

Purpose: Professional identity formation and its relationship to case presentations were studied in an optometry school's onsite clinic.

Methods: Eight optometry students and six faculty optometrists were audio-recorded during 31 oral case presentations and the teaching exchanges related to them. Using convenience sampling, interviews were audio-recorded of four of the students and four of the optometrists from the field observations.

A comparison of cup-to-disc ratio measurement in normal subjects using optical coherence tomography image analysis of the optic nerve head and stereo fundus biomicroscopy.

Purpose: To determine the relationships between morphometric optic nerve head (ONH) characteristics defined using optical coherence tomography (OCT) and clinical judgments of cup-to-disc (CD) ratios.

Methods: CD ratios were estimated in 20 subjects by two experienced clinicians using stereo fundus biomicroscopy. Sagittal OCT images were obtained in positions defined by clinicians corresponding to the location of their horizontal and vertical CD ratio estimates.

A comparison of cup-to-disc ratio evaluation in normal subjects using stereo biomicroscopy and digital imaging of the optic nerve head.

The cup-to-disc (CD) ratio evaluated using stereoscopic biomicroscopy was compared with that evaluated by viewing a non-stereo digital image of the optic nerve head. Twenty normal subjects (mean age 26 +/- 4 years) were evaluated by two observers. The average CD ratio was 0.

Optical coherence tomography: an introduction to the technique and its use.

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.