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Large-Print Reading for the Waiting Room
VOL. 90, NO. 3
CORRESPONDENCE
433
Large-Print Reading for the Waiting Room
Determining Mean Intraocular Pressure
Editor: Last week I was in my ophthalmologist's office. On his table full of magazines in the waiting room, there was only one magazine in large print. It was a publication consisting of about ten articles from the Reader's Digest. Realizing that patients in a doctor's office are often fearful or apprehensive, I began thinking: Why didn't he have a bunch of different items of reading material in large print, for patients who cannot read a regular magazine? The following suggestions should be of interest to ophthalmologists who read your publication, since they have crowded waiting rooms, and their patients include many people who cannot read the fine print in regular magazines and books: (1) It is possible to purchase from a Christian book store a paperback copy of the Bible in large print, for about $16. Reading the Bible, while in a doctor's waiting room, could help many apprehensive patients. (2) One of Norman Vincent Peale's publications, "Creative Help for Daily Living," is now available in large type. A subscription to this magazine does not cost any definite amount, but a contribution of $5.00 to the Foundation is considered adequate. This magazine, like the large-print Bible, could be interesting and reassuring to readers in an ophthalmologist's waiting room. (3) When business cards are printed, the name of the company or the name of the person is often in large print, whereas the office address and the telephone number are in fine print. Out of courtesy to their patients, I believe that ophthalmologists, optometrists, and opticians should order business cards that can be read easily by a person with a visual defect. VEL P. MCCULLOUGH Goodyear, Arizona
Editor: In the article, "Prognostic significance of optic disk cupping in ocular hypertensive patients," by M. E. Yablonski, T. J. Zimmerman, M. A. Kass, and B. Becker (Am. J. Ophthalmol. 89:585, 1980), the republication of data for a group of individuals with suspected glaucoma "using mainly the same subjects" as the study by Hart and associates, I may be misinterpreted. Both studies conclude that the larger the cup/disk ratio and the higher the mean intraocular pressure (lOP) over a five-year follow-up period, the more likely the eye is to develop visual field loss. Hart and associates found that the initial lOP at the first visit was not a good predictor of future progressive damage. The difference between the predictive value of the initial lOP compared to the mean lOP over time should be selfevident. The glaucomatous eye has an lOP not only higher but also more unstable than normal. One measurement (that is, the initial lOP) is not likely to show the increase in lOP to which the optic nerve head is exposed over time. Yablonski and associates found that 100% of eyes with a cup/disk ratio greater than 0.6 and a mean lOP (over five years) of 28 mm Hg or more lost visual field without therapy. This reemphasizes that the higher the prevailing lOP, the more likely that progressive damage will occur. However, the reader should not take the data to mean that a patient with a cup/disk ratio greater than 0.6 and an lOP of more than 28 mm Hg on the initial visit has a 100% risk of visual field loss in five years. The data of Yablonski and associates would be useful in those patients for whom lOP measured at several visits is already available, or for whom, after a suitable period of observation without treatment, the mean lOP level can be estimated. In this regard, it would be clinically useful
CORRESPONDENCE
433
Large-Print Reading for the Waiting Room
Determining Mean Intraocular Pressure
Editor: Last week I was in my ophthalmologist's office. On his table full of magazines in the waiting room, there was only one magazine in large print. It was a publication consisting of about ten articles from the Reader's Digest. Realizing that patients in a doctor's office are often fearful or apprehensive, I began thinking: Why didn't he have a bunch of different items of reading material in large print, for patients who cannot read a regular magazine? The following suggestions should be of interest to ophthalmologists who read your publication, since they have crowded waiting rooms, and their patients include many people who cannot read the fine print in regular magazines and books: (1) It is possible to purchase from a Christian book store a paperback copy of the Bible in large print, for about $16. Reading the Bible, while in a doctor's waiting room, could help many apprehensive patients. (2) One of Norman Vincent Peale's publications, "Creative Help for Daily Living," is now available in large type. A subscription to this magazine does not cost any definite amount, but a contribution of $5.00 to the Foundation is considered adequate. This magazine, like the large-print Bible, could be interesting and reassuring to readers in an ophthalmologist's waiting room. (3) When business cards are printed, the name of the company or the name of the person is often in large print, whereas the office address and the telephone number are in fine print. Out of courtesy to their patients, I believe that ophthalmologists, optometrists, and opticians should order business cards that can be read easily by a person with a visual defect. VEL P. MCCULLOUGH Goodyear, Arizona
Editor: In the article, "Prognostic significance of optic disk cupping in ocular hypertensive patients," by M. E. Yablonski, T. J. Zimmerman, M. A. Kass, and B. Becker (Am. J. Ophthalmol. 89:585, 1980), the republication of data for a group of individuals with suspected glaucoma "using mainly the same subjects" as the study by Hart and associates, I may be misinterpreted. Both studies conclude that the larger the cup/disk ratio and the higher the mean intraocular pressure (lOP) over a five-year follow-up period, the more likely the eye is to develop visual field loss. Hart and associates found that the initial lOP at the first visit was not a good predictor of future progressive damage. The difference between the predictive value of the initial lOP compared to the mean lOP over time should be selfevident. The glaucomatous eye has an lOP not only higher but also more unstable than normal. One measurement (that is, the initial lOP) is not likely to show the increase in lOP to which the optic nerve head is exposed over time. Yablonski and associates found that 100% of eyes with a cup/disk ratio greater than 0.6 and a mean lOP (over five years) of 28 mm Hg or more lost visual field without therapy. This reemphasizes that the higher the prevailing lOP, the more likely that progressive damage will occur. However, the reader should not take the data to mean that a patient with a cup/disk ratio greater than 0.6 and an lOP of more than 28 mm Hg on the initial visit has a 100% risk of visual field loss in five years. The data of Yablonski and associates would be useful in those patients for whom lOP measured at several visits is already available, or for whom, after a suitable period of observation without treatment, the mean lOP level can be estimated. In this regard, it would be clinically useful