ORCID Profile
0000-0002-1351-0072
Current Organisation
University of New South Wales
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2000
DOI: 10.1097/00006324-200011000-00007
Abstract: To investigate the microcyst response to extended wear (EW) with high oxygen transmissible (Dk/t) silicone hydrogel lenses. Microcysts were monitored for 12 months in subjects wearing low Dk/t hydrogel lenses on a 6-night EW schedule or high Dk/t hydrogel lenses on a 30-night EW schedule. Subjects wearing low Dk/t lenses transferred to the high Dk/t EW lenses and schedule after 12 months and were monitored for a further 6 months. The mean number of microcysts did not deviate from baseline in the high Dk/t group. Microcysts in the low Dk/t group increased over 12 months, and more microcysts were observed in low Dk/t lens wearers compared with high Dk/t lens wearers after 3 months. Microcysts increased in 50% of subjects 1 week after transfer to high Dk/t lenses and returned to baseline levels seen with high Dk/t lens wear within 3 months. EW with high Dk/t silicone hydrogel lenses did not cause an increase in microcyst numbers. It is not necessary to discontinue lens wear with patients who transfer from low to high Dk/t lenses because the increase in microcysts is transitory. This result has implications for practitioners when fitting and assessing the success of high Dk/t hydrogel lenses.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JTOS.2017.05.003
Abstract: The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-024298
Abstract: The CareTrack study found that a wide range of appropriateness of care (ie, care in line with evidence-based or consensus-based guidelines) was delivered across many health conditions in Australia. This study therefore aimed to demonstrate the feasibility of using the CareTrack method (a retrospective onsite record review) to measure the appropriateness of eye care delivery. Cross-sectional feasibility study. Two hundred and thirteen patient records randomly selected from eight optometry and ophthalmology practices in Australia, selected through a combination of convenience and maximum variation s ling. Retrospective record review designed to assess the alignment between eye care delivered and 93 clinical indicators (Delphi method involving 11 experts) extracted from evidence-based clinical practice guidelines. Number of eligible patient records, s ling rates and data collection time. This feasibility study also tested the ability of 93 clinical indicators to measure percentage appropriate eye care for preventative, glaucoma and diabetic eye care. A secondary outcome was the percentage of practitioner–patient encounters at which appropriate eye care was received. A median of 20 records (range 9 to 63) per practice were reviewed. Data collection time ranged from 3 to 5.5 hours (median 3.5). The most effective s ling strategy involved random letter generation followed by sequential s ling. The appropriateness of care was 69% (95% CI 67% to 70%) for preventative eye care, 60% (95% CI 56% to 58%) for glaucoma and 63% (95% CI 57% to 69%) for diabetic eye care. Appropriateness of eye care can be measured effectively using retrospective record review of eye care practices and consensus-based care indicators.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.EXER.2013.08.016
Abstract: Nutrition disorders and their correlates such as obesity are increasingly prevalent worldwide. A number of studies to date have suggested numerous potential associations between diet and tear film health this paper will provide a summary of the available literature. The tear film is characterized through its protein and lipid content and through clinical measurements of characteristics such as osmolarity, volume and stability. Malnutrition, protein and vitamin-A deficiencies are extremely deleterious to tear film health and supplementation with oral vitamin A in this setting is of clear benefit. The relative impact of diet on tear film within what would be considered normal ranges of consumption is less clear. A number of population studies have suggested that hyperlipidemia and a diet low in omega-3 fatty acids are risks factor for dry eye disease. Numerous studies have investigated the effectiveness of oral supplementation with antioxidants, omega-3 (e.g. fish oil and linseed oil) and omega-6 (e.g. evening primrose oil) fatty acids in the last 10 years. Taken together, these suggest a small benefit of oral supplementation on tear film volume, stability and decreased ocular symptoms in patients previously diagnosed with diseases involving the ocular surface (e.g. Sjögren's syndrome, meibomian gland dysfunction, dry eye disease) and contact lens wearers suffering from dry eye. More research is required to determine the exact composition, dosage and indications for their use and to fully characterize how these nutraceuticals modulate the tear film.
Publisher: Wiley
Date: 03-08-2012
DOI: 10.1111/J.1755-3768.2012.02482.X
Abstract: To establish if impression cytology combined with histochemical and immunocytochemical staining can be used to assess epithelium of the human upper lid margin. Following an initial eye examination of 40 healthy subjects (19 soft contact lens wearers and 21 non-contact lens wearers, aged 18-57 years), lid margin staining was assessed with lissamine green using slit l biomicroscopy and graded (grade 0-3). Impression cytology of the upper lid margin of both eyes was collected, fixed and stained with periodic acid Schiff (PAS) and haematoxylin for cell morphology analysis (Nelson grade) or for immunocytochemistry (keratinization-related proteins: filaggrin, transglutaminase1 (TGase1) and cytokeratin 1/10). In 57% of all subjects, grade 0 lissamine green staining showed a thin line (the Marx line), just posterior to the meibomian gland ducts. Grade 2 or 3 lissamine green staining was observed in 17% of all subjects. There was no difference between contact lens and non-contact lens wearers for lid margin staining or Nelson grade (p = 0.4, Fisher's exact test). PAS/haematoxylin staining and immunocytochemistry showed transition in epithelial cell morphology, with marginal conjunctival epithelium, mucocutaneous junction and squamous epithelium, adjacent to meibomian gland ducts. This transition in epithelium was associated with differential expression of keratinization-related proteins (filaggrin, cytokeratin 1/10 and TGase1). Lid margin epithelium can be successfully s led using impression cytology and further characterized using histochemistry and immunocytochemistry staining techniques. This approach can be applied to assess lid margin changes in conditions such as dry eye and meibomian gland dysfunction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
Publisher: Informa UK Limited
Date: 06-02-2023
DOI: 10.1080/08164622.2022.2033107
Abstract: Current levels of appropriateness for primary diabetic eyecare delivered by Australian optometrists are presented along with realistic targets (benchmarks) for quality improvement. The demonstrated methods can be used in practice evaluation and benchmarking of other clinical practice areas and settings. To examine the appropriateness of diabetic eye-care delivery and establish achievable benchmarks of care (ABCs) for optometry practices in Australia. In a retrospective audit, clinical records of patients with type-II diabetes obtained from a randomly selected nationally representative s le of optometry practices were assessed against evidence-based clinical indicators. Appropriate care is defined as care delivered in compliance with the indicators. The ABC for each indicator was calculated as the average performance for the top 10% of optometry practices after Bayesian adjustment to account for a low number of eligible records. The audit of 420 randomly selected patient records from 42 practices against 12 clinical indicators showed an overall appropriateness of 69% (95% confidence interval (CI) 66%, 73%) for overall diabetic eye care. While a high level of appropriateness was identified for recall period (93%, 95% CI 85%, 100%) and referral (100%, 95% CI 38%, 100%), larger gaps existed in history taking (46%, 95% CI 44%, 52%), dilated fundus examination (80%, 95% CI 76%, 84%) and iris examination (0%, 95% CI 0%, 56%). The ABCs for 8 of 12 indicators were 100%, and the remaining three indicators had ABCs above 80%. An ABC for the iris examination indicator could not be calculated owing to the low number of eligible patient record cards. This study demonstrated a systematic process of practice evaluation and benchmarking in optometry practices. The diabetic eye care delivered by Australian optometrists was largely appropriate however, improvement opportunities exist for history taking and physical examination. The ABCs demonstrate that excellence in primary diabetic eye care is attainable and will serve as an important tool in future initiatives to reduce the identified evidence-to-practice gaps.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CLAE.2017.11.002
Abstract: To investigate the performance of lissamine green strips from different manufacturers. Additionally, the repeatability, need for sequential dye instillation and impact of repeated lid evertion on lid wiper staining were assessed. Study 1 was a prospective, randomised cross-over study where controlled volumes of lissamine green solution prepared from strips (Biotech, Lissaver, GreenGlo, OPGreen) were instilled (right eye: single left eye: double instillation) on five different days, with OPGreen being tested twice. Lids were everted and digital photographs taken, which were later assessed by a masked observer. Study 2 was an investigator-masked, randomised, controlled study testing the impact of single versus repeated lid evertion. Lid wiper staining was graded (0 to 3 in 0.5 steps). Lid wiper staining differed significantly between lissamine green solutions, with GreenGlo showing the highest amount of staining, and Lissaver the least (all p>0.009). There were no differences in lid wiper staining over two days, using the OPGreen solution (all p>0.05). The number of drops instilled (single versus double) did not significantly affect lid wiper staining (all p>0.05). Repeated lid evertion increased lid wiper staining (p=0.007 when combined with double drop instillation). Light absorbance patterns and measured concentrations aligned with clinical findings. There were significant differences in performance between lissamine green solutions. Lid wiper staining was impacted by repeated lid evertion but sequential instillation and use of the Korb grading scale provided little advantage over simpler methods Clinicians must consider this when investigating lid wipers, especially when interpreting a negative finding.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.JCLINEPI.2021.08.031
Abstract: To assess the quality of diabetic eye disease clinical practice guidelines. A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A "good quality" guideline was one with ≥60% score for "rigor of development" and in at least two other domains. Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for "scope and purpose," "stakeholder involvement," "rigor of development," "clarity of presentation," "applicability" and "editorial independence" were 73.6% (54.2%-80.6%), 48.6% (29.2%-71.5%), 60.2% (30.9%-78.1%), 86.6% (76.7%-94.4%), 28.6% (18.0%-37.8%) and 60.2% (30.9%-78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7-5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n = 9) of the guidelines (all evidence-based) were of "good quality." A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating "good quality." Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 18-10-2013
Publisher: Springer Science and Business Media LLC
Date: 06-02-2023
DOI: 10.1038/S41433-023-02413-2
Abstract: Increased density and altered morphology of dendritic cells (DC) in the cornea and conjunctiva occur during active allergic conjunctivitis. This study investigated whether inflammation (characterised by altered DC density and morphology) persists during the symptom-free phase of allergic conjunctivitis. Twenty participants (age 43.3 ± 14.3 years, 55% female) assessed during their active (symptomatic) phase of allergic conjunctivitis were re-examined during the asymptomatic phase. Ocular allergy symptoms and signs were evaluated during both phases, and five ocular surface locations (corneal centre, inferior whorl, corneal periphery, corneal limbus, and bulbar conjunctiva) were examined using in vivo confocal microscopy (HRT III). DC were counted manually, and their morphology was assessed for cell body size, presence of dendrites, presence of long dendrites and presence of thick dendrites using a grading system. Mixed model analysis (DC density) and non-parametric tests (DC morphology) were used to examine differences between phases. DC density at corneal locations did not change between the active and asymptomatic phases ( p ≥ 0.22). However, corneal DC body size was smaller and fewer DC presented with long dendrites during the asymptomatic phase ( p ≤ 0.02). In contrast, at the bulbar conjunctiva, DC density was reduced during the asymptomatic phase compared to the active phase ( p = 0.01), but there were no changes in DC morphology. Dendritiform immune cell numbers persist in the cornea during the symptom-free phase of allergic conjunctivitis, whereas conjunctival DC appear to return to a baseline state. The morphology of these persisting corneal DC suggests their antigen-capture capacity is reduced during the asymptomatic phase.
Publisher: Public Library of Science (PLoS)
Date: 11-02-2020
Publisher: Informa UK Limited
Date: 2012
DOI: 10.1111/J.1444-0938.2011.00663.X
Abstract: The optometrist's role in primary eye care is expanding to include not only diagnosis but also management and co-management of a range of eye diseases and visual disorders. This role calls for evidence-based practice, including an ability to source and reliably assess the various forms of evidence, on which eye care might be based. It is not known whether optometrists registered to practise in Australasia use high or low quality evidence as a basis for their clinical decisions. The present study addressed this question by surveying 3,589 optometrists registered to practise in Australia and New Zealand. A 16-item questionnaire was made available for completion online. Responses from the 279 optometrists who completed the questionnaire (response rate 7.8 per cent) indicate that, after the patient's history, symptoms and signs, optometrists in our s le place most weight on knowledge and information gained via undergraduate and postgraduate education, including continuing education, as a basis for clinical decision-making. These findings highlight the need for current, critically evaluated content in optometric education and suggest that optometrists currently prefer to receive information and knowledge from an educator rather than sourcing and assessing the material independently.
Publisher: Informa UK Limited
Date: 03-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
Publisher: Informa UK Limited
Date: 26-11-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
DOI: 10.1097/OPX.0000000000001063
Abstract: To determine tear neuropeptide levels in contact lens wearers and non-wearers, and to examine relationships with indices of corneal innervation, tear function, and ocular discomfort. A cross-sectional, single-visit, investigator-masked pilot study. Assessments included Ocular Comfort Index (OCI), central and mid-peripheral corneal nerve density and morphology (HRT-Rostock), corneal sensitivity (Cochet-Bonnet aesthesiometer), tear Substance P and calcitonin gene-related peptide (CGRP) concentration (ELISA), in situ tear osmolarity (TearLab), tear secretion (Phenol Red Thread), and noninvasive tear break-up time (NITBUT Keeler Tearscope). Groups were compared using independent t-test or Mann–Whitney U test, and regional differences assessed using paired t-tests. Associations were analyzed using Pearson or Spearman correlation. Significance was determined at P .05. Twenty contact lens wearers (7M:13F, 32 ± 5 years) and 20 non-wearers (7M:13F, 31 ± 5 years) completed the study. OCI score was numerically higher in lens wearers (32.27 ± 5.33) than non-wearers (27.66 ± 9.94). Tear osmolarity was higher [298.0 (IQR 291.0–309.8) vs. 288.5 (282.3–298.3) mOsmol/L P = .01] whereas NITBUT was lower (9.8 ± 3.4 vs. 13.8 ± 5.6 s P = .01) in lens wearers compared with non-wearers. Tear neuropeptide concentrations were not different between groups [Substance P 4.29 ng/ml (IQR 1.57–6.05), CGRP 14.89 ng/ml (5.08–59.26)], and there were no differences in nerve morphology or ocular surface sensitivity. Higher nerve density, interconnections, and tortuosity were observed in the central cornea than mid-peripherally ( P .05). OCI score was moderately associated with nerve tortuosity ( r = 0.42, P = .01). CGRP was associated with central nerve density ( ρ = 0.38, P = .02), as was tear secretion ( r = −0.37, P = .02). Nerve interconnections were strongly associated with corneal sensitivity (ρ = 0.64, P .001). Relationships were demonstrated between nerve density, tear CGRP, and corneal sensitivity. Markers of corneal neurobiology and sensory function do not appear to be altered in contact lens wear despite worse tear function (osmolarity and stability) in lens wearers. This suggests that mechanisms other than overt changes in corneal innervation regulate tear function during lens wear. The relationship between nerve tortuosity and ocular discomfort requires elucidation.
Publisher: Informa UK Limited
Date: 17-10-2023
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.CLAE.2019.06.001
Abstract: To investigate the effect of Blephadex™ Eyelid Wipes on Demodex mites, ocular microbiota, bacterial lipase, tear film characteristics and ocular comfort after one month of daily use. Twenty subjects were randomly assigned to use the Blephadex™ Eyelid Wipes on either eye once daily for 30 days whilst the contralateral eye was left untreated in this observer-masked, within-subject study. Demodex count, eyelid bacterial colony count, Tearscope Plus non-invasive tear break up time (NITBUT), Lipiview® tear film lipid layer thickness and phenol red thread test tear volume were measured at baseline and 30 days. Bacterial lipase was quantified from single bacterial colonies using a glycerol monolaurate assay. Ocular comfort was assessed at both visits using the Ocular Surface Disease Index (OSDI) questionnaire and visual analogue scales (VAS) to capture monocular symptoms of itching, dryness and overall discomfort. Six males and 14 females, median age 63.5 (range 48-76) completed the study. A statistically significant reduction in Demodex count was observed in treated eyes only (median ± IQR: treated eyes 2 ± 3 vs. 0 ± 2, ANOVA p = 0.04). Bacterial colony count, lipase production, NITBUT, lipid layer thickness and tear volume remained unchanged (p > 0.05). Overall comfort improved over time in treated eyes only (15 ± 32 vs. 10 ± 16, p = 0.05). Dryness symptoms significantly reduced in both treated and untreated eyes (23 ± 42 vs. 12 ± 21 and 23 ± 41 vs. 10 ± 15, p = 0.02). The OSDI and ocular itch scores remained unchanged (p > 0.05). In this pilot study, no changes were observed in ocular microbiota, tear film characteristics or bacterial lipase in eyes treated with Blephadex™ Eyelid Wipes after one month of daily use in this normal healthy population. Although a statistically significant reduction in Demodex count was observed in treated eyes, overall numbers of Demodex were low. A parallel group, placebo-controlled, randomised clinical trial in a population with active blepharitis is warranted to further elucidate these preliminary findings.
Publisher: Wiley
Date: 03-06-2020
DOI: 10.1111/OPO.12699
Abstract: To meet the needs of an ageing population and optimise health expenditure, delivery of care should be based on evidence. However, the level of evidence‐based care delivered to patients with eye conditions is rarely assessed. This study thus aimed to determine the percentage of eyecare encounters at which a s le of adult Australians received appropriate care (i.e., eyecare in line with evidence‐based or consensus‐based guidelines). A cross‐sectional retrospective review of optometry practice records was conducted using random stratified (by state) s ling in mainland Australia. Eighty‐five clinical indicators were developed from evidence‐based clinical practice guideline recommendations and refined by panels of experts using a modified Delphi process. Healthcare records of patients 18 years and over were examined against these indicators, representing appropriate care for three common eye conditions (preventative eyecare, glaucoma, and diabetic eyecare). Encounters occurred in optometry practices that were selected to be representative of the socioeconomic profile of Australian practices. The primary outcome measure was percentage compliance of eyecare delivery against the clinical indicators. From 426 optometry practices contacted by mail or telephone, 90 (21%) replied, 46 proved eligible and 42 were included in the study and visited for data collection. From these 1260 patient records were reviewed. Appropriate eyecare was received by Australian patients at an average of 71% (95%CI 70%, 73%) of eligible encounters. The percentage of appropriateness of eyecare at the condition level for preventative, glaucoma and diabetic eyecare was 81% (95%CI 79%, 83%), 63% (95%CI 61%, 64%), and 69% (95%CI 66%, 73%), respectively. Appropriateness of eyecare delivery was lowest for the domains of history taking and physical examination for all eye conditions. There were pockets of excellence but consistent delivery of appropriate eyecare needs improvement, and gaps in eyecare delivery should be addressed.
Publisher: Informa UK Limited
Date: 05-2015
DOI: 10.1111/CXO.12238
Abstract: Evidence-based practice (EBP) involves integration of the best available evidence from research, the patient's preferences or circumstances, the clinical environment and the health practitioner's expertise. There have been several qualitative studies of EBP in health-care but none has focused on the profession of optometry. Therefore, the aim of the present study was to assess optometrists' perceptions of EBP in optometry. This exploratory qualitative study employed focus group meetings and in idual telephone interviews to gauge understanding of and opinions about EBP in a convenience s le of Australian and Saudi Arabian optometrists. Results were summarised in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. NVivo software was used for qualitative analysis of the results. Most participants were supportive of EBP however, their perceptions did not generally reflect a deep understanding of the definition or process of EBP. Participants reported using a combination of low and high level evidence to inform their clinical decisions. In line with findings from other health professions, barriers included lack of time and lack of access to information, while enablers such as education, organisational support and self-motivation were cited. Our findings suggest a need for better training of optometrists in EBP as well as resources and approaches that support EBP in optometry, such as an EBP database of pre-appraised evidence and more secondary sources of evidence, such as systematic reviews and critically appraised topics.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2004
Publisher: F1000 Research Ltd
Date: 10-11-2022
DOI: 10.12688/F1000RESEARCH.123815.1
Abstract: Background : To gain an understanding of the intersection of risk factors between the most prevalent eye health conditions that are associated with vision impairment and non-communicable diseases (NCDs). Methods: A series of rapid reviews of reviews reporting on non-modifiable risk factors, age and sex, and modifiable risk factors, including social determinants, were conducted for five common eye health conditions that are the leading causes of vision impairment globally (refractive error including uncorrected refractive error, cataract, age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy) and five prevalent NCDs (cancer, cardiovascular disease, chronic respiratory disease, dementia, and depressive disorders). Articles published within approximately 5 years to the end of 2019 were identified through expert recommendation, PubMED, Ovid Medline, the Lancet Global Burden of Disease series, the International Agency for Research on Cancer and World Cancer Research Fund. Results: Of 9,213 records identified, 320 records were eligible. Eye health conditions and NCDs share many risk factors. Increased age was found to be the most common shared risk factor, associated with increased risks of AMD, cataract, diabetic retinopathy, glaucoma, refractive error, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and dementia. Other shared risk factors included smoking, obesity, alcohol consumption (mixed results), and physical activity was protective, though limited evidence was found for eye conditions. Social determinants are well documented as risk factors for NCDs. Conclusion: There is substantial overlap in common established risk factors for the most frequent vision impairing eye conditions and leading NCDs. Increasing efforts should be made to integrate preventative and risk reduction interventions to improve health, with greatest shared benefits for initiatives which aim to reduce smoking, improve diet, and promote physical activity.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2021
DOI: 10.1186/S12909-020-02417-6
Abstract: Credentialing assessment for overseas-educated optometrists seeking registration in Australia and New Zealand is administered by the Optometry Council of Australia and New Zealand. The aim was to review the validation and outcomes of the written components of this exam to demonstrate credentialing meets entry-level competency standards. The Competency in Optometry Examination consists of two written and two clinical parts. Part 1 of the written exam comprises multiple choice questions (MCQ) covering basic and clinical science, while Part 2 has 18 short answer questions (SAQ) examining diagnosis and management. Candidates must pass both written components to progress to the clinical exam. Validity was evaluated using Kane’s framework for scoring (marking criteria, item analysis), generalization (blueprint), extrapolation (standard setting), and implications (outcome, including pass rates). A competency-based blueprint, the Optometry Australia Entry-level Competency Standards for Optometry 2014, guided question selection with the number of items weighted towards key competencies. A standard setting exercise, last conducted in 2017, was used to determine the minimum standard for both written exams. Item response theory (Rasch) was used to analyse exams, produce reliability metrics, apply consistent standards to the results, calibrate difficulty across exams, and score candidates. Data is reported on 12 administrations of the written examination since 2014. Of the 193 candidates who sat the exam over the study period, 133 (68.9%) passed and moved on to the practical component. Ninety-one (47.2%) passed both the MCQ and SAQ exams on their first attempt. The MCQ exam has displayed consistently high reliability (reliability index range 0.71 to 0.93, average 0.88) across all 12 administrations. Prior to September 2017 the SAQ had a set cutscore of 50%, and the difficulty of the exam was variable. Since the introduction of Rasch analysis to calibrate difficulty across exams, the reliability and power of the SAQ exam has been consistently high (separation index range 0.82 to 0.93, average 0.86). The findings from collective evidence support the validity of the written components (MCQ and SAQ) of the credentialing of the competency of overseas-educated optometrists in Australia and New Zealand.
Publisher: Springer Science and Business Media LLC
Date: 06-03-2014
Abstract: There is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India. 355 subjects were selected from the district using multi stage random s ling. A pre tested semi structured questionnaire was used to collect information regarding each in idual’s awareness, knowledge, and perception regarding eye donation. Each response was scored in idually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels. Of the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p 0.001), female gender (p 0.001) and education (p 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban). Awareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2009
Publisher: Informa UK Limited
Date: 05-2014
DOI: 10.1111/CXO.12119
Abstract: This study investigated the referral pathways offered to patients with age-related macular degeneration (AMD), diabetic retinopathy (DR) or glaucoma (GL) by ophthalmologists and optometrists. Australian ophthalmologists and optometrists were surveyed regarding referral decisions to other eye-care specialists (inter- or intra-professional), general medical practitioners (GPs), low vision rehabilitation (LVR) and support services. Thematic analysis and concept mapping were applied to highlight current and ideal referral pathways. The survey was completed by 155 optometrists and 50 ophthalmologists and deemed representative of their respective professions in Australia. Not surprisingly, the vast majority of the participating optometrists (97 to 99 per cent) referred to ophthalmologists regardless of the underlying condition. Clear differences (Chi-square: p < 0.05) were observed in the referral patterns of optometrists and ophthalmologists to GPs and support services. General medical practitioner services were almost exclusively used for patients with DR, while AMD triggered a significantly higher referral rate to low vision rehabilitation and support services than the other two disorders. While ophthalmologists predominantly referred patients with AMD, DR or GL to low vision rehabilitation services, optometrists' referrals were highly skewed toward ophthalmology. Referrals to other supporting services by the two groups were not greatly used. The perceived referral pathways by the two eye-care professionals suggested a unidirectional route, potentially highlighting the need for a more collaborative approach that facilitates optimal use of eye health care and allied services.
Publisher: Informa UK Limited
Date: 25-02-2021
Publisher: Wiley
Date: 06-1999
DOI: 10.1046/J.1440-1606.1999.00205.X
Abstract: Purpose: The aim of the study was to measure the effects of long‐term extended wear of hydrogel lenses. Methods: Nine subjects wearing disposable hydrogel lenses and age‐ and sex‐matched non‐lens‐wearing control subjects were enrolled. Using confocal microscopy, stromal keratocyte cell densities were measured. Results: Anterior stromal keratocyte density was reduced in the lens‐wearing group (544 ± 206 cells/mm 2 ) compared to the non‐lens‐wearing group (804 ± 145 cells/mm 2 ) ( P 0.01). Posterior stromal keratocyte density was lower in the lens‐wearing group (514 ± 111 cells/mm 2 ) than in the control group (628 ± 101 cells/mm 2 ) ( P 0.05). Conclusions: These preliminary findings indicate that extended wear of hydrogel lenses reduces stromal keratocyte density. The mechanisms for this alteration may include hypoxic, cytokine‐mediated or mechanical effects.
Publisher: Informa UK Limited
Date: 23-02-2021
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JTOS.2018.09.006
Abstract: A review of ocular surface and meta-analysis of tear stability (tear break up time, TBUT) and tear secretion (Schirmer test) values in healthy children was conducted. Articles published between 1996 and 2017 indexed on MEDLINE, PubMed, Embase, Scopus and Google Scholar were retrieved using defined search terms. Statistical analysis (including sensitivity analysis and meta-regression) was performed. 23 studies were summarised (5,291 participants neonates (0-29 days), infants (1 month - 1 year) or children (1-18 years) and a meta-analysis conducted using 15 eligible studies (1,077 participants). The combined mean TBUT in children was 14.64 seconds (s) (95% CI, 11.64, 17.64) and 21.76 s (95% CI, 20.43, 23.09) for sodium fluorescein TBUT and non-invasive TBUT respectively (NIBUT). The combined mean NIBUT was 32.5 s (95% CI, 31.78-33.22) in neonates. The combined mean Schirmer I with and without anesthesia were 16.26 mm/5 min (95% CI, 13.17, 19.36) and 29.30 mm/5 min (95% CI, 27.65, 30.96) in children and 9.36 mm/5 min (95% CI, 6.54, 12.18) and 17.63 mm/5 min (95% CI, 12.03, 23.23) in neonates. Meta-regression showed a significantly lower TBUT in children from studies conducted in Asia (p = 0.004). There is paucity of data on ocular surface variables in healthy children, making it difficult to draw valid comparisons with adult values.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Cold Spring Harbor Laboratory
Date: 07-12-2018
DOI: 10.1101/490383
Abstract: Despite the existence of evidence-based recommendations to decrease risk and progression of Age-Related Macular Degeneration (AMD) for some time, self-reported practices suggest that eyecare professionals’ advice and people with AMD’s adherence to these recommendations can be very poor. This study uses qualitative methods to explore Australian eyecare professionals’ perspective on barriers to effective AMD care. Seven focus groups involving 65 optometrists were conducted by an experienced facilitator. A nominal group technique was used to identify, prioritize and semi-quantify barriers and enablers to AMD care. Participants in idually ranked their perceived top five barriers and enablers with the most important granted a score of 5 and the least important a score of 1. For each barrier or enabler, the number of votes it received and its total score were recorded. Barriers and enablers selected by at least one participant in their top 5 were then qualitatively analysed, grouped using thematic analysis and total score calculated for each consolidated barrier or enabler. In-depth in idual interviews were conducted with 10 ophthalmologists and 2 optometrists. Contributions were audio-recorded, transcribed verbatim and analysed with NVivo software. One hundred and sixty-nine barriers and 51 enablers to AMD care were identified in the focus groups. Of these, 102 barriers and 42 enablers were selected as one of their top 5 by at least one participant and further consolidated into 16 barriers and 10 enablers after thematic analysis. Factors impacting AMD care identified through analysis of the transcripts were coded to three categories of influence: patient-centered, practitioner-centered, and structural factors. Eyecare professionals considered poor care pathways, people with AMD’s poor disease understanding / denial, and cost of care / lack of funding, as the most significant barriers to AMD care they considered shared care model, access, and communication as the most significant enablers to good AMD care. These findings suggest that Australian eyecare professionals perceive that there is a need for improved patient support systems and appropriately funded, clearer care pathway to benefit people with AMD.
Publisher: Informa UK Limited
Date: 11-2014
DOI: 10.1111/CXO.12194
Abstract: Eye health-care in Australia encompasses patients with chronic disorders being referred to ophthalmologists for detailed assessment and subsequent management. An increasing case load and relative decrease in ophthalmologists predicted over the next few years portend of an upcoming bottleneck in care delivery. To improve the efficiency and effectiveness of patient care within a rapidly changing health system, we propose that minor adjustments to existing services could improve the proficiency of resources. Such changes will require service providers to rethink their positions and roles and actively collaborate with each other for improved patient outcomes.
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.1111/CXO.13085
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2001
DOI: 10.1097/00006324-200101010-00008
Abstract: Superior epithelial arcuate lesions (SEALs) are an infrequent and often asymptomatic complication of conventional soft contact lens wear. The characteristic arcuate pattern of the full-thickness corneal epithelial lesion usually occurs in the area covered by the upper eyelid, within 2 to 3 mm of the superior limbus in the 10- and 2-o'clock region. Literature on SEALs and recent clinical records from clinical trials using two types of prototype high Dk soft contact lenses were reviewed to gain greater insights into the etiology of SEALs. The reported low incidence of SEALs is partly because SEALs are not usually symptomatic. The etiology of SEALs is multifactorial. Our current hypothesis is that SEALs are produced by mechanical chaffing at the peripheral cornea. This chaffing occurs as a result of inward pressure of the upper lid, in an area where the peripheral corneal topography and lens design, rigidity, and surface characteristics combine to create excessive "frictional" pressure and abrasive shear force on the epithelial surface. Patient characteristics such as gender, age, and specific corneal and lid topographies also appear to influence the occurrence of SEALs. Prototype silicone hydrogel lenses are made from higher modulus materials with surfaces that seem to differ subtly in wettability in some patients. The prevalence of SEALs may well increase with the first generations of these lenses.
Publisher: MDPI AG
Date: 29-09-2023
DOI: 10.3390/BIOM13101469
Publisher: Wiley
Date: 22-11-2020
DOI: 10.1111/OPO.12762
Abstract: Many dry eye questionnaires are available, but these may not be suitable for paediatric eye care. The feasibility of use and repeatability of symptom questionnaires administered to children was examined. Participants aged 6‐15 years ( n = 62 25M:37F 40% male) completed six questionnaires twice in random order at a single visit: Symptoms assessment in dry eye (SANDE), ocular surface disease index (OSDI), numerical rating scale (NRS), ocular comfort index (OCI, n = 30), dry eye questionnaire 5 (DEQ‐5) and the instant ocular symptoms survey (IOSS). Completion time and need for assistance were recorded and relationships with age examined (Pearson correlation, independent t‐test). The number of participants requiring assistance and with which items were compared (linear mixed model, pairwise test). Repeatability (coefficient of repeatability (CoR), limit of agreement, bias) and intraclass correlation coefficient (ICC) were examined. Completion time was ≤2 min for each in idual questionnaire. Younger participants took longer to complete ( r = −0.43 to −0.60, p ≤ 0.01), and required more assistance ( p ≤ 0.001). Forty‐eight participants required assistance with at least one questionnaire. Older children (13–15 years) only required assistance with OSDI ( p ≤ 0.004) and NRS ( p ≤ 0.003). Participants required more assistance with SANDE, OSDI and NRS than with DEQ‐5 and IOSS ( p ≤ 0.02) and with gritty (OSDI, 77% of participants OCI, 100%) and foreign body sensation (NRS, 92%) items. CoR was similar for all questionnaires with no evidence of a learning effect ( p 0.05). ICC was moderate to excellent. Dry eye questionnaires can be used reliably in paediatric eye care more time and assistance may be required for younger children. The DEQ‐5 and IOSS are recommended for use in younger age children.
Publisher: Wiley
Date: 18-11-2021
DOI: 10.1111/OPO.12763
Abstract: The 2019 American Optometric Association (AOA) clinical practice guideline intends to assist optometrists in providing evidence‐based eye care for people with diabetes. This technical report evaluated the methodological and reporting quality of the guideline. Four independent reviewers appraised the 2014 and 2019 versions of the AOA’s guideline using the AGREE II instrument. Average scaled scores across the six domains of the AGREE II and an overall independent score were calculated based on the formula provided. The 2019 guideline scored high (range: 75–93%) in all domains except for the domain of applicability (34%). In the domain of rigour of development, significant improvements were noted in the 2019 guideline (median score: 7.0, interquartile range (IQR): 6.0–7.0) compared to the 2014 guideline (median: 5.0, IQR: 4.0–6.0) ( p 0.0001). The appraisal of the guideline also identified room for further improvements, especially in relation to implementing the guideline. The overall and domain specific quality of the AOA 2019 guideline was high, however, improvement in its applicability domain is required. The findings of this study will aid uptake of the guideline and inform improvement efforts for other international optometric guidelines.
Publisher: BMJ
Date: 24-08-2023
Abstract: Baseline ocular surface characteristics in children require investigation. This study characterised blinking and relationships with ocular symptoms, tear film and digital device use. 45 children aged 6–15 years (56% female) participated in a cross-sectional study. Ocular surface symptoms (Instant Ocular Symptoms Survey, Dry Eye Questionnaire 5, Symptoms Assessment in Dry Eye, Ocular Surface Disease Index, Ocular Comfort Index and Numerical Rating Scale) and clinical indices (lipid layer thickness, tear secretion and stability, meibomian gland) were assessed. Blink rate and interblink interval were measured in situ using a wearable eye-tracking headset (Pupil Labs GmbH, Germany). Associations between blinking, ocular surface, age, and digital device use (bivariate and partial correlations) and between automated and manually counted blink rate (Bland & Altman) were examined. Mean blink rate and interblink interval were 20.5±10.5 blinks/min and 2.9±1.9 s during conversation. There was no difference between automated and manual blink rate (p=0.78) and no relationship between blinking and digital device use, age or sex. Mean group symptoms were within normal range and not associated with clinical measurements including blinking. Greater tear volume was associated with a faster blink rate (r=0.46, p=0.001) and shorter interblink interval (r=−0.36, p=0.02). Older age was associated with improved tear volume (r=0.37, p=0.01) and stability (r=0.38, p=0.01). Blinking characterised in situ was not impacted by age or habitual digital device use. A faster blink rate was associated with greater tear volume but not symptoms. Improved tear function was found with age suggesting that the ocular surface continues to develop through childhood.
Publisher: Wiley
Date: 18-08-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2009
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.CLAE.2004.09.003
Abstract: Recent technological advances have lead to novel descriptions of the microanatomy of the corneal stroma. In the first section of this review, these findings and the role they play in the maintenance of vital properties such as corneal transparency, mechanical strength, homeostasis, wound-healing response and metabolism are described. In the second part, contact lens induced stromal alterations such as acidosis, oedema, striae, thinning and opacities are reviewed as well as the more recently described phenomenon of microdot deposits and keratocyte loss with an emphasis on how lens wearing stromal effects can be minimised.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2007
Publisher: Informa UK Limited
Date: 08-04-2021
Publisher: Wiley
Date: 28-03-2021
DOI: 10.1111/OPO.12801
Abstract: Evidence‐based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence‐based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery. PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were ‘environmental context and resources’ (time, resources, equipment issues, patient factors), ‘knowledge’ (awareness issues), ‘skills’ (skills proficiency) and ‘belief about consequences’ (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling. The barriers and facilitators identified in this review were erse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2023
DOI: 10.1038/S41433-023-02426-X
Abstract: Corneal and conjunctival epithelial dendritic cells (DC) have an established role in vernal keratoconjunctivitis, however, their role in more prevalent forms of allergic eye disease remains unclear. This study evaluated corneal and conjunctival epithelial DC density, morphology, and distribution observed using in vivo confocal microscopy (IVCM) in allergic conjunctivitis. In this prospective, observational study, 66 participants (mean age 36.6 ± 12.0 years, 56% female): 33 with allergic conjunctivitis and 33 controls were recruited. IVCM was performed at the corneal centre, inferior whorl, corneal periphery, corneal limbus, and temporal bulbar conjunctiva. DC were counted and their morphology was assessed as follows: largest cell body size, presence of dendrites, and presence of long and thick dendrites. Mixed model analysis (DC density) and non-parametric tests (DC morphology) were used. DC density was higher in allergic participants at all locations ( p ≤ 0.01), (corneal centre median (IQR) 21.9 (8.7–50.9) cells/mm 2 vs 13.1 (2.8–22.8) cells/mm 2 periphery 37.5 (15.6-67.2) cells/mm 2 vs 20 (9.4–32.5) cells/mm 2 limbus 75 (60-120) cells/mm 2 vs 58.1 (44.4–66.2) cells/mm 2 conjunctiva 10 (0–54.4) cells/mm 2 vs 0.6 (0–5.6) cells/mm 2 , but not at the inferior whorl 21.9 (6.2–34.4) cells/mm 2 vs 12.5 (1.9–37.5) cells/mm 2 , p = 0.20. At the corneal centre, allergic participants had larger DC bodies ( p = 0.02), a higher proportion of DC with dendrites ( p = 0.02) and long dendrites ( p = 0.003) compared to controls. Corneal and conjunctival DC density was increased, and morphology altered in allergic conjunctivitis. These findings imply that the ocular surface immune response was upregulated and support an increased antigen-capture capacity of DC in allergic conjunctivitis.
Publisher: Cold Spring Harbor Laboratory
Date: 22-11-2022
DOI: 10.1101/2022.11.19.22282503
Abstract: To compare blinking measured in situ during various tasks and examine relationships with ocular surface symptoms. Day-to-day repeatability of blink rate and interblink interval was assessed. Twenty-four students (28.6±6.3 years 8M:16F) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two non-reading tasks (conversation, walking) in a randomised cross-over study. Ocular surface symptoms and clinical signs were assessed. Blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman’s correlation). The smartphone reading task was completed twice to determine coefficient of repeatability. Blink rate was lower (mean 10.7±9.7 blinks/min) and interblink interval longer (mean 9.6±8.7s) during all reading tasks compared to conversation (mean 32.4±12.4 blinks/min 1.5±0.6s) and walking (mean 31.3±15.5 blinks/min 1.9±1.3s) (p .001). There were no significant differences in blink parameters between any of the reading tasks, nor between conversation and walking. Changes in blinking occurred within one minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. Coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8s for interblink interval. Spontaneous blinking can be reliably measured in situ . Blink rate was reduced and interblink interval increased during reading compared to conversation and walking. Changes in blinking were immediate and sustained, and not associated with ocular surface symptoms or signs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Publisher: Springer Science and Business Media LLC
Date: 06-06-2023
DOI: 10.1038/S41433-022-02122-2
Abstract: Smartphone use by children is rising rapidly, but its ocular surface impact is unknown. This study examined the effect of smartphone use on blinking, symptoms, and tear function in children. Prospective intervention study where 36 children aged 6–15years (14 M:22 F) played games on a smartphone continuously for one hour. Symptoms (SANDE, IOSS, NRS) and tear film (lipid layer thickness, tear secretion, stability) were assessed before and after gaming. Blink rate and interblink interval were measured in situ using an eye tracking headset, before (during conversation) and continuously throughout gaming. Symptoms and tear film changes were examined using paired t -tests. Changes in blinking throughout one hour were examined using repeated measures ANOVA, post-hoc comparisons with Bonferroni correction. Associations examined using Pearson bivariate correlation. Significance level was 0.05. Symptoms worsened following one hour smartphone gaming (SANDE + 8.2units, p = 0.01 IOSS + 1.3units, p 0.001 NRS-average +6.3units, p = 0.03 NRS-comfort +7.6units, p = 0.04 NRS-tiredness +10.1units, p = 0.01), but tear film remained unchanged. Blink rate reduced from 20.8 blinks/min to 8.9 blinks/min ( p 0.001) and interblink interval increased from 2.9 s to 8.7 s ( p = 0.002) within the first minute of gaming relative to baseline conversation, and this effect remained unchanged throughout one hour of gaming. Smartphone use in children results in dry eye symptoms and immediate and sustained slowing of blinking, with no change in tear function evident up to one hour. Given the ubiquitous use of smartphones by children, future work should examine whether effects reported herein persist or get worse over a longer term causing cumulative damage to the ocular surface.
Publisher: Informa UK Limited
Date: 22-02-2023
Publisher: Informa UK Limited
Date: 03-2014
DOI: 10.1111/CXO.12102
Abstract: The aim was to obtain an overview of general medical practitioner (GP) referral pathways to ocular health care and allied services for people identified with age-related macular degeneration (AMD), diabetic retinopathy (DR) or glaucoma (GL). A questionnaire was developed to survey GPs in Australia. Questions included demographic information and referral patterns to ocular and health service providers. The survey was posted to 1,050 randomly selected GPs across Australia. Fifty-eight GPs participated in this study amounting to a 6.5 per cent response rate. Nearly all GPs referred patients to ophthalmologists (AMD: 98 per cent DR: 98 per cent GL: 95 per cent). A smaller proportion of GPs also referred to low vision rehabilitation (LVR) services (AMD: 34 per cent DR: 33 per cent GL: 22 per cent), optometrists (AMD: 26 per cent DR: 34 per cent GL: 31 per cent), or support services (AMD: 17 per cent DR: 40 per cent GL: 19 per cent). For the three tested conditions, there were no statistically significant differences in the proportions of GPs, who referred to ophthalmologists (p = 0.43), optometrists (p = 0.48) or to low vision rehabilitation services (p = 0.31). The proportion of GPs who referred to support services was significantly higher for patients diagnosed with DR than AMD or GL (p < 0.05). The majority of GPs referred patients with AMD, DR or GL to ophthalmologists. Fewer GPs considered referrals to optometrists, low vision rehabilitation or support services. General practitioners may need to be more aware about the central role of optometrists in the delivery of primary eye health care. In the interest of optimising eye care, closer working relationships between GPs and optometrists should be fostered.
Publisher: Informa UK Limited
Date: 16-01-2022
DOI: 10.1080/08164622.2021.2004861
Abstract: Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery. To determine the appropriateness of and barriers to glaucoma care by optometrists. A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative s le of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care. Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms. Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were erse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
Publisher: Springer Science and Business Media LLC
Date: 13-02-2007
DOI: 10.1007/S10456-007-9063-3
Abstract: Corneal vascularisation is a potentially devastating occurrence that can cause blindness. Currently, treatments for this condition are limited. In these studies, we have investigated a novel inhibitor of angiogenesis, 12-methyl tetradecanoic acid (12-MTA), to treat corneal vascularisation in mouse models of corneal alkali injury and corneal Pseudomonas aeruginosa infection. The effectiveness of 12-MTA was compared to treatment with dexamethasone. 12-MTA was found to be at least as effective as dexamethasone in reducing the angiogenesis that occurs following alkali injury or P. aeruginosa infection of the cornea. The major effect of both 12-MTA and dexamethasone in these models was to reduce the linear incursion of new blood vessels into the central cornea. A significantly better result was obtained at 14 days post-alkali injury when treatment was not delayed. A major advantage of treatment of alkali injury with 12-MTA compared to that with dexamethasone was the finding that there was a 5-fold less level of PMN infiltration and no persistent epithelial defects in corneas treated with 12-MTA compared to 50% of those treated with dexamethasone. Our studies indicate that 12-MTA may provide clinically significant advantages over conventional steroids for the treatment of vessel growth in the cornea.
Publisher: Informa UK Limited
Date: 02-01-1999
DOI: 10.1111/J.1444-0938.1999.TB06778.X
Abstract: PURPOSE: The aim of this investigation was to measure levels of corneal staining in successful daily and extended wearers of disposable hydrogel contact lenses. METHODS: Twenty-four subjects on a daily wear (DW) schedule and 20 subjects on an extended wear (EW) schedule were examined at six-monthly intervals over a two-year period. Subjects wore two types of disposable hydrogel lenses. Measurements were taken from the eye wearing an etafilcon A contact lens only. The cornea was ided into five equally sized zones and the extent and depth of corneal staining were assessed on a zero to four scale. RESULTS: The overall levels of corneal staining were low with median values below or equal to grade 0.5 in all groups. There was no difference in the extent, depth or geographical distribution of corneal staining between the DW and EW groups. Staining was more frequently recorded in the superior and inferior areas of the cornea than in the central, nasal or temporal regions (Pearson's Chi-Square, p < 0.10). CONCLUSIONS: The mode of wear with disposable contact lenses is not a contributing factor to the amount of corneal staining seen in successful wearers. Low levels of corneal staining should be expected in successful DW and EW wearers.
Publisher: Wiley
Date: 02-01-2023
DOI: 10.1111/OPO.13087
Abstract: Dendritic cells (DC) play a crucial role in ocular surface defence. DC can be visualised in vivo by confocal microscopy but have not yet been fully characterised in humans. This study investigated the diurnal variation, topographical distribution and repeatability of DC density and morphology measurements. In vivo confocal microscopy (IVCM) was conducted on 20 healthy participants (mean age 32.7 ± 6.4 years, 50% female) at baseline and repeated after 30 minutes, 2, 6 and 24 h. Images were captured at the corneal centre, inferior whorl, corneal periphery, limbus and bulbar conjunctiva. DC were counted manually, and their morphology was assessed for cell body size, presence of dendrites, and presence of long and thick dendrites. Mixed‐model analysis, non‐parametric analyses, Bland and Altman plots, coefficient of repeatability (CoR) and kappa were used. There were no significant changes in DC density ( p ≥ 0.74) or morphology ( p 0.07) at any location over the 24‐h period. The highest DC density was observed at the corneal limbus followed by the peripheral cornea ( p 0.001), with the lowest density at the corneal centre, inferior whorl and bulbar conjunctiva. Most DC at the corneal periphery, limbus and bulbar conjunctiva had larger cell bodies compared with the corneal centre ( p ≤ 0.01), and the presence of long dendrites was observed mostly at non‐central locations. Day‐to‐day CoR for DC density ranged from ±28.1 cells/mm 2 at the corneal centre to ±56.4 cells/mm 2 at the limbus. Day‐to‐day agreement of DC morphology determined by kappa ranged from 0.5 to 0.95 for cell body size, 0.60 to 0.95 for presence of dendrites, and 0.55 to 0.80 for the presence of long dendrites at various locations. No diurnal changes are apparent in corneal or conjunctival DC. Substantial topographical differences exist in DC density and morphology. IVCM provides good repeatability of DC density and acceptable agreement of DC morphology.
Publisher: Informa UK Limited
Date: 17-02-2023
Publisher: Research Square Platform LLC
Date: 23-03-2023
DOI: 10.21203/RS.3.RS-2614660/V1
Abstract: Background: Choroidal naevus is a benign, relatively common ocular tumour. Discerning common naevi from rare primary eye melanoma and managing these patients using an evidence-based approach remains an ongoing clinical challenge. We surveyed primary eyecare practitioners on their current management and use of imaging for choroidal naevus patients. Methods: A random s le of 1,130 optometrists and ophthalmologists registered to practice in Australia were surveyed using a purpose-designed questionnaire containing demographics, imaging techniques used, and knowledge (K), attitude (A), and practice (P) questions. Results: 93 optometrists and 82 ophthalmologists responded. More than 50% practised independently, most in metropolitan centres (n=113/175). Imaging techniques were often used to detect and monitor choroidal naevus, with 72% of practitioners using optical coherence tomography and colour fundus photography. KAP scores indicated moderate knowledge (mean=5.2/9, SD=1.8). Recent mnemonics for risk of naevus-to-melanoma transformation were underutilised being used by less than 50% of practitioners. Scores indicated very positive attitude (mean=6.5/8, SD=1.2) but moderate practice (mean=13.9/25, SD=2.9) in this area. A significant difference between optometrists and ophthalmologists was found for knowledge, but not attitude or practice scores. Choroid naevus patients were referred to a specialist ophthalmologist by a third of all practitioners. Conclusion: Many eyecare practitioners utilised several imaging techniques to detect and monitor choroidal naevi. Gaps in knowledge were found associated with choroidal naevus growth. Findings align with recent studies highlighting eyecare pathways for choroidal naevus patients that provide diligent screening and review, timely referral for signs of potential melanoma-related risk, and that encourage multi-disciplinary care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Publisher: Informa UK Limited
Date: 2013
DOI: 10.1111/CXO.12018
Publisher: Informa UK Limited
Date: 28-02-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2003
DOI: 10.1097/00003226-200311000-00006
Abstract: The structure of mucin balls collected from silicone hydrogel contact lens wearers was examined to determine their nature. Tears containing mucin balls were collected using a capillary tube. These were processed for light microscopic histochemistry, scanning electron microscopy, and electron microscopic elemental analysis. Mucin balls were also observed in vivo using confocal microscopy. Histology showed that the mucin balls were PAS positive, indicating that glycoproteins form a major component. Lipids and bacteria were not detected. Scanning electron microscopy did not show the surface to be smooth but revealed a variation in density across the surface. Elemental analysis was inconclusive. Mucin balls are likely to be made from collapsed mucin and are unlikely to have been formed as a result of pearling around a silicon, lipid, or bacterial kernel.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
Publisher: Springer US
Date: 2002
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CLAE.2017.09.011
Abstract: Contact lens discomfort remains poorly understood, not least due to lack of associations between clinical signs and symptoms. This study aimed to explore the relationships between osmolarity, comfort and lid wiper epitheliopathy in contact lens wear. Twenty subjects participated in a randomized, cross-over study where comfilcon A and lotrafilcon A lenses were each worn for 10days separated by a 7days washout period. Tear and contact lens osmolarity, ocular symptoms including comfort, tear stability and production, and lid wiper epitheliopathy were measured. Comfort and tear stability decreased and upper lid wiper staining and foreign body sensation increased with lens wear. These were not affected by lens type. A reduction in tear production was seen after 10days of comfilcon A lens wear. High proportions of lid wiper epitheliopathy were observed at the upper (range 65%-85%) and lower (range 90%-100%) lid margins. Tear and contact lens osmolarity were unaffected by lens wear or type. Contact lens osmolarity was associated with comfort (r=0.45, p=0.009). Tear osmolarity moderately correlated with tear stability (r=-0.53, p=0.014) and tear production (r=-0.44, p=0.012) but not with lid wiper staining. A relationship between comfort and contact lens osmolarity and between tear osmolarity and tear stability and production were found, however, this study was unable to demonstrate an association between comfort and tear osmolarity or lid wiper epitheliopathy. Further studies using contact lenses with a wider range of comfort responses are warranted to investigate these associations further.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2019
Publisher: Wiley
Date: 08-11-2022
DOI: 10.1111/OPO.12912
Abstract: A recent nationwide medical record audit of optometry practices has identified an evidence‐to‐practice gap in primary diabetic eyecare delivery. This study aimed to explore the determinants (barriers and enablers) to appropriate diabetic eyecare delivery in Australia. A qualitative study involving focus‐group discussions and interviews of a purposeful s le of Australian optometrists was conducted. Participants were asked about the perceived barriers to adherence to four underperforming clinical indicators related to primary diabetic eyecare identified by the recent national optometry practice audit. The Theoretical Domain Framework was used for thematic analysis and coding salience to identify key behavioural determinants. Optometrists participated in eight focus groups ( n = 27) and in idual interviews ( n = 4). The most salient barriers were related to Environmental resources (e.g., limited chair time) Beliefs about consequences (e.g., lack of perceived importance) Knowledge (e.g., poor understanding) Professional role/identity (e.g., the perceived role of optometry in care process) Social influences (e.g., the influence of senior optometrists) and Intentions (e.g., apathy). Key enablers were Environmental resources (e.g., electronic record system and practice aids) Knowledge (e.g., keeping up with knowledge rofessional development) reinforcements (e.g., fear of legal actions) and behavioural regulations (e.g., self‐monitoring/audit). This study shows that the evidence‐to‐practice gap in primary diabetic eyecare delivery in Australia can be attributed in part to several interconnected factors related to optometrists' in idual capability and motivation as well as the social and practice environment within which they sit. These behavioural determinants will inform the design of an intervention to improve the appropriateness of primary diabetic eyecare delivery.
No related grants have been discovered for Isabelle Jalbert.