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This article reports on a study on the implementation of an evidence-based guideline for the referral for rehabilitation of adults who are visually impaired in the Netherlands. The purpose of the study was to find out if there are potential barriers to the implementation of the Nederlands Oogheelkundig Gezelschap (NOG) (2004) evidence-based guideline on referral. It was conducted during the annual conference of the NOG in Maastricht, the Netherlands, in March 2005, with thirteen ophthalmologists participating. They were interviewed regarding their views on the potential barriers to implementing the new guideline. All the participants were aware of the guideline, and were familiar with at least its global content. The general attitude toward the guideline was positive. However, not all recommendations were followed. Three potential barriers were found: an external barrier (time) with regard to the recommendation about the delivery of bad news, the lack of agreement with the recommendation on Charles Bonnet syndrome, and the lack of motivation to change the referral process by not perceiving a problem with it. (Contains 1 box and 1 table.)

Most of the studies of the causes of visual impairment have been population-based studies. These population-based studies provide important information on the incidence and prevalence of "theoretical" eye problems in a community. However, not all those who are visually impaired, from a theoretical point of view, consider themselves as such and hence will not visit an ophthalmologist or accept the offer of low vision counseling. Others are unaware of the possibilities of rehabilitation or are not able to come to these clinics because of health problems, mental difficulties, or other reasons (Munoz et al., 1999). This discrepancy between population-based studies and daily practice makes it difficult to develop strategies to offer low vision services to those who need them. In addition, little is known about the changes in patterns of visual impairment over time. Therefore, there is still a place for hospital-based or patient-based studies of the incidence and etiology of visual impairment. The aim of this study was to determine changes, over time, in the incidence and etiology of visual impairment in persons aged 50 and older who visited an eye clinic for an incurable age-related eye disease and who accepted an offer of rehabilitation. The participants were all the patients of the Department of Ophthalmology of the Elkerliek Hospital, Helmond, the Netherlands.

Purpose: This study was developed to explain the extraordinary rise in myopia prevalence beginning after 1950 in Indigenous Arctic communities considering recent findings about the risk factors for school myopia development. Myopia prevalence changed drastically from a historical low of less than 3% to more than 50% in new generations of young adults following the Second World War. At that time, this increase was attributed to concurrent alterations in the environment and way of life which occurred in an aggressive programme of de‐culturalization and re‐acculturation through residential school programmes that introduced mental, emotional and physical stressors. However, the predominant idea that myopia was genetic in nature won the discussion of the day, and research in the area of environmental changes was dismissed. There may have also been an association between myopia progression and the introduction of extreme mental, emotional and physical stressors at the time. Recent findings: Since 1978, animal models of myopia have demonstrated that myopiagenesis has a strong environmental component. Furthermore, multiple studies in human populations have shown since 2005 how myopia could be produced by a combination of limited exposure to the outdoors and heavy emphasis on academic subjects associated with intense reading habits. This new knowledge was applied in the present study to unravel the causes of the historical myopia epidemics in Inuit communities. Summary: After reviewing the available published data on myopia prevalence in circumpolar Inuit populations in the 20th century, the most likely causes for the Inuit myopia epidemic were the combination of increased near work (from almost none to daily reading) and the move from a mostly outdoor to a much more indoor way of life, exacerbated by fewer hours of sunshine during waking hours, the lower illuminance in the Arctic and the extreme psychophysical stress due to the conditions in the Residential Schools. [ABSTRACT FROM AUTHOR]