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Once you have recovered sufficiently from the test (or from partying), we invite you to send us your feedback, corrections, and suggestions for entries, facts, mnemonics, strategies, resource ratings, and the like (see p. Some common problems are as follows: Certain review books are too detailed to allow for review in a reasonable amount of time or cover subtopics that are not emphasized on the exam. Many sample question books were originally written years ago and have not been adequately updated to reflect recent trends. If a given review book is not working for you, stop using it no matter how highly rated it may be or how much it costs. Do not worry about finding the "perfect" book, as many subjects simply do not have one, and different students prefer different formats. Supplement your chosen books with personal notes from other sources, including what you learn from question banks. There are two types of review books: those that are stand-alone titles and those that are part of a series. Some recent editions reflect major improvements, whereas others contain only cursory changes. Apps Charts and diagrams may be the best approach for physiology and biochemistry, whereas tables and outlines may be preferable for microbiology. With the explosion of smartphones and tablets, apps are an increasingly popular way to review for the Step 1 exam. All of these apps offer flexibility, allowing you to study while away from a computer (eg, while traveling). Practice Tests Taking practice tests provides valuable information about potential strengths and weaknesses in your fund of knowledge and test-taking skills. Some students use practice examinations simply as a means of breaking up the monotony of studying and adding variety to their study schedule, whereas other students rely almost solely on practice. After taking a practice test, spend time on each question and each answer choice whether you were right or wrong. Knowing why a wrong answer choice is incorrect is just as important as knowing why the right answer is correct. Do not panic if your practice scores are low as many questions try to trick or distract you to highlight a certain point. Use the questions you missed or were unsure about to develop focused plans during your scheduled catch-up time. Textbooks and Course Syllabi Most practice exams are shorter and less clinical than the real thing. Use practice tests to identify concepts and areas of weakness, not just facts that you missed. Syllabi also tend to be less organized than top-rated books and generally contain fewer diagrams and study questions. Your test performance will be influenced by both your knowledge and your test-taking skills. Test-taking skills and strategies should be developed and perfected well in advance of the test date so that you can concentrate on the test itself. We suggest that you try the following strategies to see if they might work for you. If you are still unsure about the answer after this time, mark the question, make an educated guess, and move on. Following this rule, you should have approximately 20 minutes left after all questions are answered, which you can use to revisit all of your marked questions. Remember that some questions may be experimental and do not count for points (and reassure yourself that these experimental questions are the ones that are stumping you). In the past, pacing errors have been detrimental to the performance of even highly prepared examinees. Dealing with Each Question There are several established techniques for efficiently approaching multiple choice questions; find what works for you. One technique begins with identifying each question as easy, workable, or impossible.

Due to the variability of studies and paucity of data, no consistent associations regarding dietary outcomes and access to other food outlets were evident. The body of evidence regarding access to other food outlets, such as supermarkets, grocery stores, and convenience/corner stores, and dietary intake and quality is limited and inconsistent. The studies used multiple approaches to assess food access and dietary intake, quality, and variety. The studies used multiple approaches to assess food access and measures of weight status. Due to the wide variation in methods used to determine food access, making comparison across studies was challenging. Despite this variability, the relationship between convenience stores and weight status was consistent across the evidence. Five of these studies were completed in an adult sample; two assessed this relationship among children. Due to the variability of studies and paucity of data, no consistent associations regarding weight status and access to other food outlets were evident. The evidence base included several studies of weaker design, mostly cross-sectional, by independent investigators with sufficient sample sizes. The findings across studies were inconsistent for all food outlet types, except for convenience stores, which were evaluated in only seven studies. Although food access was assessed across geographic, ethnic, racial and income groups, the variability in methodology made it difficult to compare studies. Limited access to affordable and healthy food is a challenge, particularly for families living in rural areas and low-income communities. Innovative approaches to bring healthy food retail options into communities have proliferated, especially in underserved areas. These include creating financing programs to incentivize grocery store development; improving availability of healthy food at corner stores and bodegas, farmers markets and mobile markets, shelters, food banks, community gardens/cooperatives, and youth-focused gardens; and creating new forms of wholesale distribution through food hubs. These and other promising equityoriented efforts need to continue and be evaluated and then successfully scaled up to other communities. Similar efforts are needed to reduce access to , and consumption of, calorie-dense, nutrient-poor foods and sugarsweetened beverages in community settings. A combination of dietary and physical activity interventions is effective for preventing or slowing excess weight gain and reducing the proportion of young children ages 2 to 5 years who become overweight or obese. Successful strategies include: curricular enhancements of classroom education for children on both nutrition education and physical activity, outreach engagement to parents about making positive changes in the home, improvements in the nutrition quality of meals and snacks served in the child care program, modifying food service practices, improving the mealtime environment, increasing physical activity play, reducing sedentary behaviors, and improving outdoor playground environments. Evidenced-based healthy eating and physical activity practices should be implemented in child care settings with training and technical assistance for staff. At the Federal, state, and local levels, policies are needed that create strong nutrition and physical activity standards and guidelines in child care settings. There is a need to strengthen policies at the Federal, state, and local levels for strong nutrition and physical activity standards and guidelines in child care settings. Both reviews examined the impact of obesity prevention approaches on the weight status of children ages 2 to 5 years. The studies used a variety of intervention strategies targeting behaviors that affect body weight. Most approaches were multi-component, with a combination of interventions targeting children, their parents, and/or staff of early care and education programs. The body of available evidence describes a large variation in excessive weight gain prevention approaches, making comparison across studies challenging. The evidence base included several studies of strong design by independent investigators, specifically controlled trials, with sufficient sample sizes. Some inconsistency was evident across studies and may be explained by differences in the populations sampled, outcome measures, duration or exposure of intervention, and follow-up periods.

The number of people rendered blind due to corneal disorders is small as compared to cataract, but the patients are mostly children or adolescents, the most productive members of the society, unlike elderly cataract patients. The corneal blindness can 496 Textbook of Ophthalmology related macular degeneration and retinal vascular disorders. Senile cataract develops at a relatively younger age in India than in developed countries. With the introduction of low cost intraocular lens implantation technology in India, the restoration of good quality vision in cataract patient is feasible. However, due to paucity of resources, especially ophthalmic surgeons, a significant percentage of cataract patient remains unoperated resulting in a huge backlog. Many of these eyes are lost due to dislocation of the lens and secondary glaucoma, or spoiled by quacks. The cataract blindness is reversible but the blindness caused by glaucoma is irreversible. The coexistence of glaucoma and senile cataract may pose diagnostic problem and many eyes may be lost while waiting for cataract extraction. Perhaps the percentage of blindness due to diabetes in India is much higher because of poor control of the disease. In recent years, there has been a considerable increase in the longevity of people. Immunization against measles and early control of diarrhea are important strategies to prevent corneal xerosis. Early management of trachoma, conjunctivitis and corneal ulcer prevents corneal damage. Although in the past three decades, the blindness due to trachoma and conjunctivitis is substantially reduced, still there are more than 0. Presently there are about 505 eye banks in the country performing nearly 12975 keratoplasties each year. Both the government and voluntary agencies have to promote awareness in the society regarding eye donation. Besides the above mentioned components of community ophthalmology, school eye health programs and occupational eye health services help in controlling the childhood blindness from amblyopia and trauma respectively. Adulthood Blindness in India High myopia, trauma, abiotrophic defects, uveitis and neurological disorders are responsible for blindness in adult life. The ocular hazards can happen both at work and at play leading to serious visual loss. Factors Influencing the Prevalence of Blindness in India Besides age, other factors which influence the rate of blindness include sex, ethnicity and availability of health care services. The prevalence of blindness is higher in women than in men mainly due to their preoccupation in household activities and relatively lower level of health consciousness. Old Age Blindness in India Blindness in elderly persons occurs mainly due to cataract, glaucoma, diabetic retinopathy, age- Community Ophthalmology 497 the blindness is more prevalent in certain ethnic groups probably due to their customs and genetic trait. Severe visual loss is more common in people coming from a lower socioeconomic status as found in most population based surveys. The adverse environmental factors and nonavailability or nonaffordability of the health care services lead to a higher prevalence of blindness as well as higher mortality and morbidity rates in poor people. Besides poverty, low standards of personal and environmental hygiene, illiteracy, ignorance, superstition, scarcity of water and medical services beyond the reach of the poor contribute to the higher prevalence of blindness in underprivileged community. The blindness caused by infectious diseases in India has considerably declined of late. Blindness due to ophthalmia neonatorum and retinopathy of prematurity has reduced significantly owing to early diagnosis and proper treatment. The main objective of Vision 2020 is to eradicate the avoidable blindness in order to give all people in the world, particularly the millions needlessly blind, right to sight. The project is targeted to attain the best possible vision for all people thereby improving their quality of life. This can be achieved through the establishment of a sustainable comprehensive eye care system as an integral part of every national health system. The 59th World Health Assembly in 2006 has given substantial support to this global initiative for prevention of blindness.