August Colenbrander, M.D. SKERI

August Colenbrander, MD

Photo of Gus Colenbrander""

August Colenbrander is an Affiliate Senior Scientist at the Smith-Kettlewell Eye Research Institute (SKERI). He was born and trained in the Netherlands, where he practiced ophthalmology until 1969; he then spent two years at the University of Iowa as an exchange visitor.

In 1971 he was asked to join the faculty of the Department of Ophthalmology at California Pacific Medical Center, where he directed the Low Vision Service from 1974 until his clinical retirement in 1998. His primary clinical interest is in Vision Rehabilitation.  He is a strong advocate for a multi-disciplinary approach to vision rehabilitation and continues to work closely with the Rehabilitation Engineering Research Center at SKERI.

His interests include the following:

One of his persistent interests has been in classification and coding. In the 1960’s he was involved with the development of a new ophthalmic coding system in the Netherlands. In the 1970’s he worked with the World Health organization (WHO) and with Committees of the International Council of Ophthalmology (ICO) and the American Academy of Ophthalmology (AAO) to coordinate a complete revision of the eye codes in the WHO’s “International Classification of Diseases, 9th revision” (ICD-9, 1978) and its extension, the “Clinical Modification of ICD-9” (ICD-9-CM), developed for clinical use in the United States).

During that time he also worked with the California and the American Medical Association on procedural eye codes for the California Relative Value System and “Current Procedural Terminology." Today, ICD-9-CM and CPT are the nationally mandated coding systems for health care in the USA.

Starting with his work on the vision chapter of the WHO’s “International Classification of Impairments, Disabilities and Handicaps (ICIDH, 1980) he expanded this interest to the classification of Functional Vision. He was a founding member (1993) of the International Society for Low Vision Research and Rehabilitation (ISLRR) and represents the sub-specialty of Vision Rehabilitation on the Advisory Committee of the ICO.

He coordinated an international working group producing a Guide for the Evaluation of Visual Impairment” (1999) for the “Vision-99” conference of the ISLRR. In 2000 this Guide became the basis for a revision of the vision chapter in the 5th edition of the AMA’s “Guides to the Evaluation of Permanent Impairment”, replacing the outdated Visual Efficiency Score from 1925. The same principles were incorporated in the ICO report on “Visual Standards – Aspects and Ranges of Vision Loss” (2002) and in a recent paper on “Aspects of Vision Loss – Visual Functions and Functional Vision” (2004).

Visual Acuity indicates the reciprocal of the magnification needed to bring a person’s ability to perceive details to the performance level of a standard eye. If the person requires letters that are 2x closer or 2x larger, visual acuity is said to be “1/2” (20/40, 6/12, 0.5). If the required magnification is 5x, visual acuity is said to be “1/5” (20/100, 6/30, 0.2), etc. Visual acuity and its accurate measurement, therefore, are of primary importance in vision rehabilitation.

In the 1960’s, in the Netherlands, Dr. Colenbrander republished his father’s “Arrow chart” (1937) and developed tumbling E flashcards, both based on a logarithmic progression. In the 1970’s he developed improved methods to coordinate distance and near visual acuity measurement in Low Vision patients, through a modification of Snellen’s formula.

He co-authored the ICO’s “Visual Acuity Measurement Standard” (1984) and wrote a chapter on ”Measuring Vision and Vision Loss” (2001) for Duane’s Clinical Ophthalmology.

To provide better tools for clinical Low Vision services, he developed a letter chart for use at 1 meter, reading cards with standardized sentences in multiple languages and most recently a “Mixed Contrast reading card” as a quick and simple screening tool for contrast deficits in general practice.

In the 1960’s Dr. Colenbrander was instrumental in the development of clinical data systems at the University of Utrecht and the University of Leyden. He developed an improved check-digit system to prevent errors in the recording of patient data. He received his PhD based on a human centrifuge study of the influence of otolith stimulation on visual perception.

He was the first to introduce multiple-choice exams at the University of Leyden Medical School.

While in Iowa he collaborated on the development of an ophthalmology curriculum for medical students and on related instructional materials. In this context, he developed a mannequin with interchangeable fundus slides on which medical students can practice the technique of ophthalmoscopy and the recognition of fundus details. He later wrote a chapter on “Principles of Ophthalmoscopy” (1979, 2003) for Duane’s Clinical Ophthalmology.

In 1977 he established the Ophthalmology Matching Program to match resident applicants to ophthalmology training programs throughout the United States. He expanded this program with similar programs for Ophthalmology Fellowships, Neurological Surgery, Otolaryngology, Neurology, Plastic Surgery and for related Fellowships, and directed these programs until his clinical retirement in 1998.

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