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Year : 2006  |  Volume : 8  |  Issue : 33  |  Page : 147-153
The use of hearing protection devices by older adults during recreational noise exposure

1 Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA
2 Department of Ophthalmology and Visual Sciences; Population Health Sciences, University of Wisconsin, Madison, USA
3 Department of Ophthalmology and Visual Sciences; Communicative Disorders, University of Wisconsin, Madison, USA
4 Department of Speech and Hearing Science, Arizona State University, Tempe, USA

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  Abstract 

A population-based study to assess the use of hearing protection devices by older adults during noisy recreational activities was performed. The population-based Epidemiology of Hearing Loss Study was designed to measure the prevalence of hearing loss in adults residing in Beaver Dam, Wisconsin. The use of hearing protection devices during noisy recreational activities was assessed by performing three examinations over a period of 10 years (1993-1995, no. of participants (n) = 3753, aged 48-92 years; 1998-2000, n = 2800, aged 53-97 years; 2003-2005, n = 2395, aged 58-100 years). The recreational activities included hunting, target shooting, woodworking/carpentry, metalworking, driving loud recreational vehicles, and performing yard work using either power tools or a chain saw. The prevalence of using hearing protection devices during any of these activities increased with time (9.5%, 15.0%, and 19.9% at baseline, 5 years, and 10 years, respectively). However, the use of hearing protection devices remained low for most activities. Those under the age of 65 were twice as likely to use hearing protection devices during noisy activities than were older adults. Men, those with a hearing handicap, and those with significant tinnitus were more likely to use hearing protection devices. Smokers and the less educated were less likely to use hearing protection devices. The results demonstrated that many adults expose themselves to potentially damaging recreational noise, leaving them at risk for hearing loss.

Keywords: Adult, hearing protectors, recreational noise, risk factors, usage rate

How to cite this article:
Nondahl D M, Cruickshanks K J, Dalton D S, Klein B, Klein R, Tweed T S, Wiley T L. The use of hearing protection devices by older adults during recreational noise exposure. Noise Health 2006;8:147-53

How to cite this URL:
Nondahl D M, Cruickshanks K J, Dalton D S, Klein B, Klein R, Tweed T S, Wiley T L. The use of hearing protection devices by older adults during recreational noise exposure. Noise Health [serial online] 2006 [cited 2014 Nov 23];8:147-53. Available from: http://www.noiseandhealth.org/text.asp?2006/8/33/147/34702
Hearing loss is a common condition among older adults. In a population-based hearing loss study conducted in the adults residing in Beaver Dam, Wisconsin, 45.9% of the adults aged between 48 to 92 years had at least a mild hearing loss. [1] In that study, hearing loss was associated with older age, male sex, less education, lower income, manual occupations, and exposure to occupational noise.

It is well known that exposure to sufficiently loud occupational noise for extended periods of time can increase the risk of developing hearing loss. However, relatively little research has focused on the relation between recreational noise exposure and hearing loss. In a large cross-sectional population-based study, Dalton et al . [2] found that individuals who regularly engaged in woodworking, metalworking, driving noisy recreational vehicles, performing yard work using either power tools or a chain saw were more likely to have a high-frequency (4000-8000 Hz) hearing loss than participants who did not engage in these noisy recreational activities (odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.08,1.31). In addition, regular woodworking increased the likelihood of having a high-frequency hearing loss by 53%. Several studies have focused on the effects of recreational use of firearms on hearing loss. [3],[4],[5],[6],[7] Additionally, McCombe et al . [8],[9] have documented the relationship between motorcycle riding and hearing loss.

While recreational noise exposure has been shown to be associated with hearing loss, and hearing protectors have been shown to be effective in attenuating excessive noise exposure if properly used, [10],[11],[12],[13] we know of few studies documenting the extent to which hearing protection is used during adult recreational noise exposure. In a letter to The Lancet in 1992, McCombe et al . [14] reported that only 15% of 106 motorcyclists, including police, social riders, and grand-prix racers, regularly used earplugs. Among 44 grand-prix racers, only 17 (39%) were regular users of earplugs. [8] The purpose of the present study was to report the prevalence of the use of hearing protection devices during noisy recreational activities among a large population of older adults.


  Materials and Methods Top


Subjects

The Epidemiology of Hearing Loss Study (EHLS) is a population-based study of hearing loss in adults aged between 48 to 92 years at baseline. [1] A private census was performed during 1987 to 1988 to identify the residents of the city or township of Beaver Dam, Wisconsin who were aged between 43 to 84 years (n = 5924). These residents were invited to participate in a study of age-related ocular disorders (The Beaver Dam Eye Study, 1988-1990, n = 4926). [15] All who participated in the baseline eye examination and were alive as of March 1, 1993 were eligible to participate in the baseline examination of the hearing study (EHLS, n = 4541). Of those eligible, 3753 (82.6%) residents participated (1993-1995); of whom, 42.3% were men. The mean age of the participants was 65.8 years (range; 48-92 years).

A 5-year follow-up examination was conducted from 1998 to 2000. [16] Of 3407 eligible, 2800 (82.2%) participated; of whom, 41.4% percent were men. The mean age of the participants during the 5-year follow-up examination was 69.3 years (range; 53-97 years).

A 10-year follow-up examination was conducted from 2003 to 2005. Of 2902 eligible, 2395 (82.5%) participated; of whom, 41.0% were men. The mean age of the participants during the 10-year follow-up examination was 72.7 years (range; 58-100 years). The EHLS was approved by the Human Subjects Committee of the University of Wisconsin-Madison. Informed consent was obtained from each participant at the beginning of the examinations.

Procedure

Each examination included a questionnaire about medical history and occupational and leisure noise exposure. The participants were asked specifically about their engagement in hunting; target shooting; woodworking/carpentry; metalworking; driving recreational vehicles such as ATVs, motorcycles, race cars, motor boats or snow mobiles; and yard work using either power tools or a chain saw. If the participants had ever engaged in any of the activities, except hunting, at least once a month, on average, in the past year they were considered to be regularly engaged in that particular activity. For hunting, the participants were considered to be engaged if they had gone hunting or fired their gun at least once in the previous year. For each activity in which the participants were considered to be engaged, the frequency of the use of hearing protection devices was determined using the categories: Never, 25% of the time, 50% of the time, 75% of the time or 100% of the time. If the participants were found to be using the hearing protection devices at least 25% of the time in the previous year then they were considered to have used the hearing protection devices during the activities at least some of the time.

Audiologic tests included pure-tone air and bone conduction audiometry. All audiometric equipment complied with American National Standards Institute standards. [17] Pure-tone audiometric testing was performed at 0.25 through 8 kHz in accordance with recommended American Speech-Language-Hearing Association procedures. [18] Bone-conduction testing was conducted at 0.5 and 4 kHz at the baseline examination and at 0.5, 2, and 4 kHz at subsequent examinations. Ambient noise levels were routinely monitored at the clinic at the Beaver Dam Community Hospital and were measured during each home or nursing home visit to ensure that the testing conditions complied with American National Standards Institute standards. [19] Audiometers were calibrated every six months.

Participants were considered to have hearing loss if their average hearing thresholds at 500, 1000, 2000, and 4000 Hz were greater than 25 dB HL in either ear. The participants and nonparticipants in the 10-year follow-up examination were compared on the basis of several baseline (1993-1995) characteristics including education, occupation, smoking history and history of cardiovascular disease. To be classified as a past or current smoker a participant had to have smoked at least 100 cigarettes in their lifetime, which was based upon a self-reported smoking history. A history of cardiovascular disease was considered to be present if the participant reported a stroke, myocardial infarction, or angina.

Additional factors were examined in multiple logistic regression models for their potential association with the use of hearing protection. These factors included a self-report of hearing handicap, defined as a score of less than 8 out of 40 on the Hearing Handicap Inventory for the Elderly-Screening Version; [20] a report of significant tinnitus in the past year, defined as tinnitus that was at least moderate in severity or caused difficulty in falling asleep; [21] a history of occupational noise exposure; [22] a history of ear surgery (tympanoplasty, mastoidectomy, or stapedectomy); and self-reported health status (excellent/good/fair/poor).

Statistical analyses were conducted with SAS 8.1 software (SAS Institute Inc, Gary, NC). The comparisons between the percent of participants who used hearing protection devices by hearing status and age group were tested using the chi-square test for general association or Fisher's exact test when the cell sizes were smaller. For general association, the Cochran-Mantel-Haenszel test was used to study the age-adjusted comparisons between participants and nonparticipants during the 10-year follow-up examination. The t test was used to assess the differences in age between participants and nonparticipants. Multiple logistic regression models were used to assess the association between participant characteristics and the use of hearing protection devices.


  Results Top


Comparisons of baseline characteristics between participants and nonparticipants in the 5-year follow-up examination have been discussed elsewhere. [16] At baseline, the nonparticipants (living and deceased) in the 5-year follow-up examination were more likely to be older and less educated than the participants, and the nonparticipants were more likely to be smokers and have a hearing loss. Comparing baseline (1993-1995) characteristics of participants and living nonparticipants in the 10-year follow-up examination revealed that living nonparticipants tended to be less educated and more likely to have a non-professional occupation than the participants [Table - 1]. When compared with participants, the deceased nonparticipants were more likely to be men, to have hearing loss, to be less educated, to have a non-professional occupation, to have a history of smoking and to have a history of cardiovascular disease at baseline. In addition, at baseline, the participants were younger (62.6 years) than the living nonparticipants (63.5 years) and those who died before being reexamined (74.0 years). Statistical significance ( P <0.0001) was observed between the age of the participants (62.6 years) and the deceased nonparticipants (74.0 years).

[Table - 2] shows characteristics of the participants during all three examinations, including the prevalence of their engagement in various noisy recreational activities. As expected, the prevalence of hearing loss increased with each successive examination. Involvement in any of the seven noisy recreational activities slightly decreased with time (49.7% at baseline, 45.8% at 5-years, and 44.8% at 10-years). The prevalence of woodworking/carpentry, metalworking, and driving loud recreational vehicles increased with time, while the prevalence of hunting, target shooting, and performing yard work using power tools decreased with time. However, it is important to note that the individuals were not involved with the same activity during all examinations; many individuals stopped and started activities during the 10-year interval of study. For example, of 369 individuals engaging in woodworking/carpentry at the baseline examination, only 113 (30.6%) were engaging in this activity at all three examinations. However, 249 participants not engaged in this activity at the baseline examination were involved at the 5-year or 10-year follow-up examinations.

With one exception (driving loud recreational vehicles), the prevalence of using hearing protection devices while engaging in noisy recreational activities tended to increase with each subsequent examination [Table - 3]. However, the actual prevalence of using the hearing protection devices was low. For each activity, with the exception of target shooting, less than 40% of participants reported using hearing protection devices, with the lowest rates reported for driving loud recreational vehicles (4.4% to 6.4%), hunting (4.6% to 10.6%), and performing yard work using power tools (4.3% to 13.5%).

In general, the use of hearing protection devices while engaging in noisy activities in the previous year did not differ by hearing loss status. Those involved with metalworking were exceptions, where the prevalence of using hearing protection devices was significantly higher for those without a hearing loss than for those with a hearing loss (23.1% versus 4.8% at baseline; 39.1% versus 7.7% at 5-years; 42.1% versus 15.9% at 10-years; P <0.05 for each comparison).

Among participants that were involved in any of the noisy activities, those who were less than 65 years old were about twice as likely to use hearing protection devices than their older counterparts (12.4% versus 5.4% at baseline; 20.3% versus 10.2% at 5-years; 27.7% versus 16.1% at 10-years; P <0.0001 for each comparison). The increased prevalence of using hearing protection devices among the younger group was evident for all the noisy activities, and statistical significance was observed for many age group comparisons.

Few women were engaged in these noisy activities. Performing yard work using power tools was the only noisy activity in which more than 25 women were engaged during any of the examinations (538 at baseline, 344 at 5 years, and 283 at 10 years). At all three examinations, women were less likely to use hearing protection devices than men in the previous year while performing yard work using power tools (2.4% vs. 5.1% at baseline, p = 0.01; 5.5% vs. 8.4% at 5 years, P = 0.09; 8.8% vs. 15.3% at 10 years, P = 0.01).

Multiple logistic regression models were used to identify the factors that were associated with the usage of hearing protection devices for those who were engaged in one of the 5 non-shooting hobbies in the previous year [Table - 4]. (The use of firearms involves additional complexities regarding the intensity of noise exposure and the environment in which the exposure occurs, [6] so hunting and target shooting were excluded from the models in [Table - 4]). A separate model was developed for each examination phase. At baseline, men and those with self-reported hearing handicap had an increased odds of using hearing protection devices, while increasing age and those with a history of smoking were associated with decreased odds of using hearing protection devices. At the 5-year and 10-year follow-up examinations, two additional factors were significant: lower educational attainment (decreased odds of using hearing protection devices) and significant tinnitus (increased odds of using hearing protection devices).


  Discussion Top


The use of hearing protection devices while engaging in noisy recreational activities was assessed by performing three examinations over a period of 10 years. In the present study, the participants demonstrated low use of hearing protection devices while engaging in noisy recreational activities and the use of the devices tended to decrease with age. These results suggest that many study participants who had engaged in noisy recreational activities were exposed to unnecessarily high levels of noise, which could increase their risk of hearing loss.

Some study participants reported not continuously using the hearing protection devices while being exposed to loud noise. Else [23] has demonstrated that hearing protection devices must be worn for a very high proportion of the exposure time in order for them to provide adequate protection. Unfortunately, most study participants did not use the hearing protection devices consistently. With the exception of target shooters, the majority of the participants never used hearing protection devices while engaging in the noisy recreational activities. While engaging in noisy recreational activities it is ideal to wear the hearing protection devices at all times. However, the current study focuses on "ever" wearing hearing protection as a more realistic measure.

Although hearing protection devices usage rates were low, they were observed to increase slightly over time. This could be due to the increased awareness of hearing health resulting from study participation. It is also possible that public awareness of the importance of hearing health increased during the 10-year period due to educational efforts made by physicians and organizations such as the National Hearing Conservation Association (http://www.hearingconservation.org/), government-funded programs such as the WISE EARS! Campaign (http://www.nidcd.nih.gov/health/wise/), or media reports of public figures (e.g., President Bill Clinton; Heather Whitestone, Miss America 1995; NFL player Mike Singletary) with hearing loss.

In this study, adults less than 65 years of age were more likely to use hearing protection devices while engaging in noisy activities than those who were 65 years of age or older. In addition, the association of increasing age with decreased odds of using hearing protection devices was demonstrated consistently during all three examinations. Since education levels have improved with time, those in the younger age group may have an increased awareness of the risks associated with recreational noise exposure and the protection options available than the older adults. However, even after adjusting for educational attainment, age was inversely related to the use of hearing protection devices. It is possible that those in the younger age group, a group likely to have better hearing thresholds, [1] may be more interested in wearing hearing protection devices because they believe it is not too late to prevent or minimize hearing loss.

Smokers were less likely to use hearing protection devices while participating in noisy hobbies than were non-smokers. Even after adjusting for age, sex, hearing handicap, and other factors, the smokers showed 50%-75% lower odds of using hearing protection devices than the non-smokers. This suggests that those willing to engage in a risky behavior like smoking may also be more willing to risk damage to hearing from excessive noise exposure. This finding is consistent with other research suggesting that smokers are less likely to engage in health-promoting activities compared to non-smokers. [24],[25]

Participants who reported having a hearing handicap had increased odds of using hearing protection devices while engaging in noisy hobbies compared to those without a hearing handicap. However, hearing loss assessed by pure-tone audiometry was not associated with the use of hearing protection devices in these models. This is further evidence that measures of hearing loss are different from those of hearing handicap, and that experiencing hearing loss without hearing handicap may not be a sufficient motivation to wear hearing protection devices.

The comfort factor may help to explain to why women participants in the study tended to use the hearing protection devices less often than men. Abel et al . [26] reported that the cross-sectional diameter of female ear canals was significantly smaller than that of males and later speculated that this may have contributed to the greater level of discomfort with ear plugs reported by women than by men. [13] In addition, since women tend to have significantly better hearing then men, [1] even in industries in which women and men work side by side, [27] it is possible that women are less concerned about hearing loss than are men.

A considerable amount of research has been devoted to assess the effectiveness of hearing protection devices in attenuating excessive noise exposure in various settings. [10],[11],[12],[13] There is ample evidence that ear plugs, muffs or a combination of the two can significantly reduce dangerous noise levels. However, Sokol [28] suggests four factors that, if missing, will lead to underutilization of the devices: 1) Comfort-the hearing protection devices must be comfortable, 2) Convenience-the hearing protection devices must be available when needed and easy to use, 3) Communication-the hearing protection devices must not interfere with important communication, and 4) Caring-people must recognize the need for hearing protection. To these four factors one might add a fifth "C": Consciousness-people need to be aware of the many available hearing protection options. [28],[29],[30]

This study documents the low use of hearing protection devices by older adults while engaging in noisy recreational activities. However, the data on hearing protection device usage were based upon self-report, so it is possible that some inaccuracies regarding usage may have occurred. One might speculate that some participants in a hearing study might feel that reporting the use of hearing protection would be viewed as a favorable outcome. If this is true, any reporting bias may tend to favor overreporting rather than underreporting. However, Lusk et al . [31] demonstrated that in an occupational setting where the outcomes can be confirmed by direct observation, self-report of the use of hearing protection devices was quite accurate.

In summary, the use of hearing protection devices while engaging in noisy recreational activities was low in this population of older adults, suggesting that many adults may unnecessarily expose themselves to potentially damaging noise. More efforts are required to increase public awareness with regard to the risk of hearing loss associated with excessive noise exposure during recreational activities.


  Acknowledgement Top


This research was supported by National Institutes of Health grants AG11099 (KJC) and EY06594 (RK, BEKK).

 
  References Top

1.Cruickshanks KJ, Wiley TL, Tweed TS, Klein BE, Klein R, Mares-Perlman JA, et al. Prevalence of hearing loss in older adults in Beaver Dam, WI: The Epidemiology of Hearing Loss Study. Am J Epidemiol 1998;148:879-86.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Dalton DS, Cruickshanks KJ, Wiley TL, Klein BE, Klein R, Tweed TS. Association of leisure-time noise exposure and hearing loss. Audiology 2001;40:1-9.  Back to cited text no. 2  [PUBMED]    
3.Taylor GD, Williams E. Acoustic trauma in the sports hunter. Laryngoscope 1966;76:863-79.  Back to cited text no. 3  [PUBMED]    
4.Johnson DL, Riffle C. Effects of gunfire on hearing level for selected individuals of the inter-industry noise study. J Acoust Soc Am 1982;72:1311-4.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Prosser S, Tartari MC, Arslan E. Hearing loss in sports hunters exposed to occupational noise. Br J Audiol 1988;22:85-91.  Back to cited text no. 5  [PUBMED]    
6.Nondahl DM, Cruickshanks KJ, Wiley TL, Klein R, Klein BE, Tweed TS. Recreational firearm use and hearing loss. Arch Fam Med 2000;9:352-7.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Stewart M, Konkle DF, Simpson TH. The effect of recreational gunfire noise on hearing in workers exposed to occupational noise. Ear Nose Throat J 2001;80:32-4,36,38-40.  Back to cited text no. 7  [PUBMED]    
8.McCombe AW, Binnington J. Hearing loss in Grand Prix motorcyclists: Occupational hazard or sports injury? Br J Sports Med 1994;28:35-7.  Back to cited text no. 8  [PUBMED]    
9.McCombe AW, Binnington J, Davis A, Spencer H. Hearing loss and motorcyclists. J Laryngol Otol 1995;109:599-604.  Back to cited text no. 9  [PUBMED]    
10.Dancer A, Grateau P, Cabanis A, Barnabe G, Cagnin G, Vaillant T, et al. Effectiveness of earplugs in high-intensity impulse noise. J Acoust Soc Am 1992;91:1677-89.  Back to cited text no. 10      
11.McCombe AW, Binnington J, McCombe TS. Hearing protection for motorcyclists. Clin Otolaryngol 1993;18:465-9.  Back to cited text no. 11  [PUBMED]    
12.Abel SM, Spencer DL. Active noise reduction versus conventional hearing protection: Relative benefits for normal-hearing and impaired listeners. Scand Audiol 1997;26:155-67.  Back to cited text no. 12  [PUBMED]    
13.Abel SM, Lam Q. Sound attenuation of the indoor/outdoor range E-A-R plug. Mil Med 2004;169:551-5.  Back to cited text no. 13  [PUBMED]    
14.McCombe AW, Binnington J, Donovan D, McCombe TS. Motorcyclists and wind noise. Lancet 1992;340:911-2.  Back to cited text no. 14      
15.Klein R, Klein BE, Linton KL, De Mets DL. The Beaver Dam Eye Study: Visual acuity. Ophthalmology 1991;98:1310-5.  Back to cited text no. 15  [PUBMED]    
16.Cruickshanks KJ, Tweed TS, Wiley TL, Klein BE, Klein R, Chappell R, et al. The 5-year incidence and progression of hearing loss: The Epidemiology of Hearing Loss Study. Arch Otolaryngol Head Neck Surg 2003;129:1041-6.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]  
17.American National Standards Institute. Specifications for audiometers. ANSI: New York, NY; 1996. S3.6.  Back to cited text no. 17      
18.American Speech-Language-Hearing Association. Guidelines for manual pure-tone audiometry. ASHA 1978;20:297.  Back to cited text no. 18      
19.American National Standards Institute 1992. Maximum permissible ambient noise levels for audiometric test rooms. ANSI: New York, NY; 1991. S3.1.  Back to cited text no. 19      
20.Ventry IM, Weinstein BE. Identification of elderly people with hearing problems. ASHA 1983;25:37-47.  Back to cited text no. 20      
21.Nondahl DM, Cruickshanks KJ, Wiley TL, Klein R, Klein BE, Tweed TS. Prevalence and 5-year incidence of tinnitus among older adults: The Epidemiology of Hearing Loss Study. J Am Acad Audiol 2002;13:323-31.  Back to cited text no. 21      
22.Cruickshanks KJ, Klein R, Klein BE, Wiley TL, Nondahl DM, Tweed TS. Cigarette smoking and hearing loss: The Epidemiology of Hearing Loss Study. JAMA 1998;279:1715-9.  Back to cited text no. 22  [PUBMED]  [FULLTEXT]  
23.Else D. A note on the protection afforded by hearing protectors-implications of the energy principle. Ann Occup Hyg 1973;16:81-3.  Back to cited text no. 23  [PUBMED]  [FULLTEXT]  
24.Castro FG, Newcomb MD, McCreary C, Baezconde-Garbanati L. Cigarette smokers do more than just smoke cigarettes. Health Psychol 1989;8:107-29.  Back to cited text no. 24  [PUBMED]    
25.Terracciano A, Costa PT Jr. Smoking and the five-factor model of personality. Addiction 2004;99:472-81.  Back to cited text no. 25  [PUBMED]  [FULLTEXT]  
26.Abel SM, Rockley T, Goldfarb D, Hawke M. Outer ear canal shape and its relation to the effectiveness of sound attenuating earplugs. J Otolaryngol 1990;19:91-5.  Back to cited text no. 26  [PUBMED]    
27.Ward WD, Royster JD, Royster LH. Auditory and nonauditory effects of noise. In: The Noise Manual, 5 th ed. Berger EH, Royster LH, Royster JD, Driscoll DP, Layne M, editors. American Industrial Hygiene Association. AIHA Press: Fairfax, VA; 2000. p. 123-47.  Back to cited text no. 27      
28.Sokol B. Ear muffs: A field guide. Occup Health Saf 2005a;74:66,68,138.  Back to cited text no. 28  [PUBMED]    
29.Miller E. Protection for the next generation. Occup Health Saf 2004;73:80-4.  Back to cited text no. 29  [PUBMED]    
30.Sokol B. Ear plugs: A field guide. Occup Health Saf 2005b;74:46,48-50,52.  Back to cited text no. 30      
31.Lusk SL, Ronis DL, Baer LM. A comparison of multiple indicators: Observations, supervisor report and self-report as measures of workers' hearing protection use. Eval Health Prof 1995;18:51-63.  Back to cited text no. 31  [PUBMED]    

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Correspondence Address:
D M Nondahl
Department of Ophthalmology & Visual Sciences, University of Wisconsin, 610 Walnut Street, Room 1040, Madison, WI 53726-2397
USA
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DOI: 10.4103/1463-1741.34702

PMID: 17851219

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    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]

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