Aim-The use of eye care services by people with and without diabetes was investigated in the Melbourne Visual Impairment Project (VIP), a population based study of eye disease in a representative sample of Melbourne residents 40 years of age and older. Methods-A comprehensive interview was employed to elicit information on history of diabetes, medication use, most recent visit to an ophthalmologist and optometrist, and basic demographic details. Presence and extent of diabetic retinopathy was determined by dilated fundus examination. 2 3 There is a high rate of vision loss due to diabetic retinopathy when diabetes has been present for more than 30 years, with approximately two thirds of people having lost vision after 35 years of diabetes. Results-The 4Current treatments, if appropriately timed and rigorously applied, may be eVective in preventing up to 98% of severe visual loss and blindness due to diabetic retinopathy. [5][6][7][8] This emphasises the need to ensure that individuals with diabetes receive adequate screening and are oVered timely treatment. Recommendations in Australia are for people with diabetes to have a dilated pupil examination at least every 2 years. People with signs of diabetic retinopathy, if not already seeing an ophthalmologist, should be referred to an ophthalmologist for further management. Prompt and eVective delivery of ophthalmic care to people with diabetes not only reduces personal suVering caused by blindness but also yields substantial cost savings. Previous studies have shown that the costs of providing preventative eye care are much less than the costs involved with providing support for a subsequent disability. [10][11][12] Studies from the United States have shown that current recommendations for periodic screening for diabetic retinopathy are not well adhered to. [13][14][15] However, little research has been done in Australia to determine whether people with diabetes receive regular eye examinations in accordance with recommendations. Our recent study showed that most general Br J Ophthalmol 1998;82:410-414 410

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Background/Objective: The high demand on the upper limbs during manual wheelchair (WC) use contributes to a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Leveractivated (LEVER) WCs have been presented as a less demanding alternative mode of manual WC propulsion. The objective of this study was to evaluate the shoulder muscle electromyographic activity and propulsion characteristics in manual WC users with SCI propelling a standard pushrim (ST) and LEVER WC design. Methods: Twenty men with complete injuries (ASIA A or B) and tetraplegia (C6, n ¼ 5; C7, n ¼ 7) or paraplegia (n ¼ 8) secondary to SCI propelled ST and LEVER WCs at 3 propulsion conditions on a stationary ergometer: self-selected free, self-selected fast, and simulated graded resistance. Average velocity, cycle distance, and cadence; median and peak electromyographic intensity; and duration of electromyography of anterior deltoid, pectoralis major, supraspinatus, and infraspinatus muscles were compared between LEVER and ST WC propulsion. Results: Significant decreases in pectoralis major and supraspinatus activity were recorded during LEVER compared with ST WC propulsion. However, anterior deltoid and infraspinatus intensities tended to increase during LEVER WC propulsion. Participants with tetraplegia had similar or greater anterior deltoid, pectoralis major, and infraspinatus activity for both ST and LEVER WC propulsion compared with the men with paraplegia. Conclusions: Use of the LEVER WC reduced and shifted the shoulder muscular demands in individuals with paraplegia and tetraplegia. Further studies are needed to determine the impact of LEVER WC propulsion on long-term shoulder function.

To investigate demographic aspects of the access to services at the Royal Victorian Eye and Ear Hospital (RVEEH), routine registration records on outpatients were linked to the population of state health regions, the distribution of ophthalmologists and projected population growth. In the six-month period September 1990 to March 1991, 19 339 persons came to the hospital (Emergency Department or Outpatients) at least once with an eye problem. Most (93%) lived in the Melbourne metropolitan area. The largest group (40%) came from Health Region 6, the Western Metropolitan region, which also has the lowest density of ophthalmologists in Victoria (1.6 per 100 000 total population, excluding ophthalmologists in the central business district of Melbourne).In the sample, 7243 patients (37%) were aged 65 years or older. Of these older patients, 75% had multiple visits to the hospital for a given illness, compared with 30% in younger patients (P