ORCID Profile
0000-0002-7203-5443
Current Organisation
UNSW Sydney
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Publisher: Informa UK Limited
Date: 05-2018
DOI: 10.1111/CXO.12653
Abstract: It is critical to consult patients to develop patient-centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made about cataract surgery services. This observational qualitative study was undertaken in two public hospitals and one private practice in Sydney, Australia. The study involved 19 women and men with age-related cataracts and no previous cataract surgery, aged > 18 years, able to speak conversational English or Mandarin. A multi-stage attribute development process was followed, including: literature review, semi-structured interviews with surgery candidates in three eye clinics, and review by an expert panel. The main outcome measures were primary attributes for making choices about cataract surgery. Wait time, cost, institutional reputation, surgeon experience and travel time were identified as principal attributes lower value was placed on consultation length and accessibility. Non-English speaking participants indicated greater interest in pre-operative information than English speakers, but expressed trust in the Australian healthcare system. Findings suggest in iduals prioritise attributes which consume time or incur costs when accessing care (wait time, cost and travel time). They also consider factors associated with the outcome of their cataract surgery (surgeon experience and institutional reputation). Similar to other decision-making processes, patients are likely to trade between these different attributes depending on their personal preferences and circumstances.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
Publisher: Springer Science and Business Media LLC
Date: 11-08-2015
DOI: 10.1007/S00417-015-3120-1
Abstract: The most likely etiology of post-LASIK dry eye is corneal nerve damage however, no direct relationship between post-LASIK dry eye symptoms and nerve damage has been established, and limited information is available about the relationship between dry eye signs and corneal reinnervation after LASIK. Tear neuropeptides (SP and CGRP) are important in the maintenance of corneal nerve health, but the impact of LASIK has not yet been studied. This study evaluated changes in nerve morphology, tear neuropeptide, and dry eye, so as to establish the relationship between reinnervation and dry eye and to assess the role of tear neuropeptides in reinnervation post-LASIK. Twenty non-dry eye volunteers who had undergone bilateral myopic-LASIK completed this study. Corneal nerve morphology (density, width, interconnections, and tortuosity), SP and CGRP concentration, and dry eye were monitored over time prior to, 1 day, 1 week, 1, 3, and 6 months post-LASIK. Dry eye symptoms and tear function, except for osmolarity (P = 0.003), remained unchanged post-LASIK. Corneal nerve morphology decreased immediately, and did not return to preoperative levels by 6 months post-LASIK (P < 0.001). Increased tear SP concentration was observed 3 months post-LASIK (P < 0.001). Associations between reinnervation as measured by increased density and lower tear SP (P = 0.03), and between increased density and decreased dry eye symptoms (P = 0.01) were found post-LASIK. An inverse relationship between reinnervation post-LASIK and dry eye symptoms was found, confirming that post-LASIK dry eye is a neuropathic disease. This study is the first to demonstrate an association between tear SP and post-LASIK reinnervation, suggesting that strategies for manipulating neuropeptide concentration to improve reinnervation may improve ocular comfort post-LASIK.
Publisher: MDPI AG
Date: 28-10-2022
DOI: 10.3390/ANTIBIOTICS11111496
Abstract: Infection of the ocular surface can have devastating consequences if not appropriately treated with antimicrobials at an early stage [...]
Publisher: Elsevier BV
Date: 2015
Publisher: Wiley
Date: 13-02-2013
DOI: 10.1111/OPO.12025
Abstract: Assessment of corneal sensory function is more frequently being carried out using novel non-contact methods, which promise better stimulus control and a greater intensity range than more traditional techniques. An examination of the characteristics of the air-jet stimulus of these 'non-contact' aesthesiometers is important to enable an understanding of how these instruments stimulate the cornea. The purpose of this study was to model the air-jet stimulus of the CRCERT-Belmonte Aesthesiometer (CBA) and its interaction with the cornea. A computerised simulation was used to model the CBA stimulus and this model was then examined in the context of verbal descriptions of the supra-threshold stimulus provided by 27 human subjects with normal corneas. The computational fluid dynamics model and the subjective descriptions considered CBA airflow values between 70 and 400 mL min(-1) . The computational fluid dynamics results showed that the CBA air-jet stimulus behaves as expected in terms of force exerted and stabilises and subsides quickly during the 1 s duration for which it is turned on/off. The computer modelling demonstrated that the stimulus of the CBA consists of a central core of air flow, similar in diameter to the CBA nozzle, which exerts maximum pressure at the corneal apex. This core is surrounded by a less prominent zone of lower pressure, extending out to the corneal periphery at higher flow rates. The computer modelling results were confirmed by the subjective descriptions of intensity and corneal area stimulated, whereas relation to duration of sensation was more equivocal. The CBA probably stimulates sensory receptors over a greater area of the ocular surface compared to the traditional nylon filament aesthesiometer and may recruit neurons sensitive to additional stimulus modalities. Future computational models should also incorporate temperature as an important aspect of the corneal response. This study has effectively demonstrated that it is possible to create a virtual model of an air-jet aesthesiometer stimulus using computational methods and that this model is corroborated by subjective descriptions provided by subjects.
Publisher: Wiley
Date: 07-08-2014
DOI: 10.1111/OPO.12146
Abstract: Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma were released by the Australian National Health and Medical Research Council in 2010. Comparable guidance has been made available by respective bodies in the USA and UK at a similar time. Key to successful translation of guidelines into clinical practice includes clinicians having the necessary skills to perform required tests. Optometrists in Australia and New Zealand were invited to participate in an online survey exploring these aspects. The results provide insights for improving glaucoma diagnosis and management by optometric primary eye care practitioners. An online questionnaire was developed to investigate glaucoma assessment of optometrists as a function of demographic details, educational background and experience. Key points to ascertain compliance with current guidelines were the availability of equipment, procedural confidence in techniques, and preferences in visual field tests. Chi square statistics was employed to support similarity to national averages and highlight differences between the two countries. Multivariate linear regression analysis identified variables significantly associated with in idual tests being available to optometrists and their confidence in applying them. Thirteen per cent of all Australian and 36% of the New Zealand optometrists responded to the survey in 2013, which reflected the demographics/geography of the practising populations. Techniques considered essential or preferred for glaucoma assessment were widely available in both countries with the exception of gonioscopy and pachymetry. After correcting for availability, regression models highlighted therapeutic endorsement and knowledge of glaucoma guidelines as the main variables to maintain high diagnostic confidence. Correlations to number of years in optometric practice mirrored a changed emphasis in teaching and technology over the past 10-15 years. Australian and New Zealand optometrists were well equipped to perform glaucoma assessments with the possible exception of gonioscopy. Advanced imaging modalities were not yet fully integrated into optometric practice, although optical coherence tomography has shown use by 23-32% of optometrists. A marked increase in use, availability and procedural confidence of gonioscopy and other techniques with therapeutically endorsed optometrists demonstrates the advantage and importance of additional training.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 18-10-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.AJO.2018.07.040
Abstract: To survey the demographics, risk factors, microbiology, and outcomes for infectious keratitis in Asia. Prospective, nonrandomized clinical study. Thirteen study centers and 30 sub-centers recruited consecutive subjects over 12-18 months, and performed standardized data collection. A microbiological protocol standardized the processing and reporting of all isolates. Treatment of the infectious keratitis was decided by the managing ophthalmologist. Subjects were observed for up to 6 months. Main outcome measures were final visual acuity and the need for surgery during infection. A total of 6626 eyes of 6563 subjects were studied. The majority of subjects were male (n = 3992). Trauma (n = 2279, 34.7%) and contact lens wear (n = 704, 10.7%) were the commonest risk factors. Overall, bacterial keratitis was diagnosed in 2521 eyes (38.0%) and fungal keratitis in 2166 eyes (32.7%). Of the 2831 microorganisms isolated, the most common were Fusarium species (n = 518, 18.3%), Pseudomonas aeruginosa (n = 302, 10.7%), and Aspergillus flavus (n = 236, 8.3%). Cornea transplantation was performed in 628 eyes to manage ongoing infection, but 289 grafts (46%) had failed by the end of the study. Moderate visual impairment (Snellen vision less than 20/60) was documented in 3478 eyes (53.6%). Demographic and risk factors for infection vary by country, but infections occur predominantly in male subjects and are frequently related to trauma. Overall, a similar percentage of bacterial and fungal infections were diagnosed in this study. Visual recovery after infectious keratitis is guarded, and corneal transplantation for active infection is associated with a high failure rate.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 10-02-2014
Abstract: To establish the use of selected reaction monitoring (SRM) mass spectrometry for quantification of tear proteins. Tear s les were collected on multiple occasions (7-10 days) from healthy subjects with contact lens wear (CL = 3) and without contact lens wear (NCL = 4). Tear proteins were denatured using 8M urea, reduced with iodoacetamide, precipitated by acetone, and digested using trypsin. Internal standards were included by adding isotopically-labelled standards of known concentrations to the s les. Lactoferrin, lysozyme, prolactin-induced protein, lipocalin 1, and proline-rich protein 4 were quantified using liquid chromatography-triple quadruple mass spectrometry in conjunction with selected reaction monitoring. The limits of quantification for the selected peptides were below 50 pg/μL. The recovery of peptides from spiked digested tears was greater than or equal to 56% and the coefficient of variation values were less than or equal to 16%. The concentration of lactoferrin (1.20 ± 0.77 μg/μL), lysozyme (2.11 ± 1.50 μg/μL), and lipocalin-1 (1.75 ± 0.99 μg/μL) were consistent with previous ELISA studies. Tear levels of prolactin-induced protein (0.09 ± 0.06 μg/μL) and proline-rich 4 (0.80 ± 0.50 μg/μL) are reported here for the first time. The SRM method can be used for simultaneous detection and quantification of selected proteins in low volumes of human tear s les (2.5 μL per s le) without prior purification of each protein component or need for antibodies.
Publisher: Public Library of Science (PLoS)
Date: 16-08-2017
Publisher: Elsevier BV
Date: 08-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Publisher: Wiley
Date: 19-06-2007
Abstract: While the role of CC chemokines in mononuclear cell trafficking and activation has been well studied, the functional role of CC chemokines in the regulation of polymorphonuclear neutrophil (PMN) recruitment in vivo has not been widely examined. Bacterial infection of the cornea (keratitis) is a relatively common, sometimes sight-threatening disease, which features acute inflammation with ulceration and PMN infiltration. Here, we demonstrate a critical role for the chemokines, CCL2 and CCL3, in the Pseudomonas aeruginosa-induced model of corneal infection in BALB/c mice. Treatment of mice with anti-CCL2 or anti-CCL3 antibodies resulted in a significant reduction in severity of corneal damage and PMN infiltration at 1 and 7 days after infection compared to control antibody-treated eyes, but did not significantly alter the rate of bacterial clearance from the cornea. Our findings provide strong evidence that CCL2 and CCL3 are critical regulators of PMN recruitment, and may lead to therapeutic strategies via targeting of the CC chemokines, CCL2 and CCL3, in the management of P. aeruginosa keratitis.
Publisher: MDPI AG
Date: 15-02-2023
DOI: 10.3390/IJMS24043928
Abstract: Plastics are synthetic materials made from organic polymers that are ubiquitous in daily living and are especially important in the healthcare setting. However, recent advances have revealed the pervasive nature of microplastics, which are formed by degradation of existing plastic products. Although the impact on human health has yet to be fully characterised, there is increasing evidence that microplastics can trigger inflammatory damage, microbial dysbiosis, and oxidative stress in humans. Although there are limited studies investigating their effect on the ocular surface, studies of microplastics on other organs provide some insights. The prevalence of plastic waste has also triggered public outcry, culminating in the development of legislation aimed at reducing microplastics in commercial products. We present a review outlining the possible sources of microplastics leading to ocular exposure, and analyse the possible mechanisms of ocular surface damage. Finally, we examine the utility and consequences of current legislation surrounding microplastic regulation.
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: Association for Research in Vision and Ophthalmology (ARVO)
Date: 10-2008
DOI: 10.1167/IOVS.07-0699
Abstract: To examine the distribution of macular and peripapillary nerve fiber layer (NFL) thickness and optic disc parameters in early-adolescence Australian children and to compare these with previously reported findings in younger children. The Sydney Childhood Eye Study is a population-based cross-sectional survey of children's eye health. During 2004 and 2005, 2367 (75.3%) of 3144 eligible year 7 students from a random cluster s le of 21 secondary schools in Sydney, Australia, were examined. The comprehensive eye examination included measurement of macular and NFL thickness and optic disc parameters by optical coherence tomography (StratusOCT Carl Zeiss Meditec, Dublin, CA). Macular, NFL thickness, and optic disc parameters were normally distributed in early-adolescence children. Mean (+/-SD) thicknesses of the central 1 mm, and inner and outer macular rings were 197.4 +/- 18.7, 271.9 +/- 15.0, and 239.5 +/- 13.5 microm, respectively. The foveal minimum thickness was 161.6 +/- 19.9 microm. The mean (+/-SD) of average NFL thickness was 103.6 +/- 10.6 microm. Mean (+/-SD) vertical and horizontal disc diameters were 1.88 +/- 0.25 and 1.61 +/- 0.20 mm corresponding cup-to-disc ratios were 0.39 +/- 0.14 and 0.44 +/- 0.16. There were minimal sex differences in these parameters after adjustment for multiple ocular and demographic variables. Compared with parameters in the childhood group, the macula was generally slightly thicker and the optic disc slightly larger in the early-adolescence group, although differences between these two age groups were small. The foveal minimum and NFL thickness were similar between the two age groups. This study describes the normative distribution of macular, NFL, and optic disc parameters in early-adolescence children and also demonstrates minimal differences between the sexes. These parameters were also largely unchanged between early childhood and early adolescence, although the comparisons were made in two cross-sectional s les, rather than from longitudinal measures.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
DOI: 10.1097/OPX.0000000000000888
Abstract: Ocular discomfort is among the main causes of contact lens wear discontinuation. This study investigated the association between subjective ocular comfort ratings and diurnal changes in tear protein concentrations with and without contact lens wear. The study was a prospective, open-label, single-group two-staged investigation. Basal tears were collected from 30 experienced contact lens wearers twice a day (morning and evening) using a noninvasive method without lens wear (stage 1) and during wear of Etafilcon A contact lenses (stage 2) for 7 to 10 days. Subjects rated their ocular comfort on a scale of 1 to 100 (with 100 as extremely comfortable) at each time of tear collection. Tears were analyzed using liquid quadrupole mass spectrometry in conjunction with selected reaction monitoring (SRM) method. End-of-day comfort was reduced when wearing lenses (87.8 ± 14.3 AM vs. 79.2 ± 16.6 PM) compared to no lens wear (88.3 ± 12.6 AM vs. 84.7 ± 13.3 PM) (AM vs. PM, p 0.05). A greater reduction in comfort over the day was seen during lens wear (p 0.01). The concentration of prolactin-induced protein increased from morning to evening in both stages (mean ± SD 0.08 ± 0.04 mg/ml, AM vs. 0.09 ± 0.05 mg/ml, PM, p 0.05). There was no change in the concentration of lactoferrin (1.20 ± 0.77 mg/ml), lysozyme (2.11 ± 1.50 mg/ml), lipocalin 1 (1.75 ± 0.99 mg/ml), or proline-rich protein 4 (0.80 ± 0.49 mg/ml). The prolactin-induced protein concentration was negatively associated with discomfort levels in tears (p 0.05, r = −0.29). Only the absolute concentration of prolactin-induced protein correlated with subjective comfort ratings. Taking into consideration that prolactin-induced protein can be associated with disruption in water transport in lacrimal glands, our findings may indicate that changes to aqueous secretion are associated with contact lens discomfort.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.AJO.2005.12.051
Abstract: To determine tear osmolality (TO) and tear meniscus height (TMH) in patients with functional (FNLDO) and primary acquired (PANDO) nasolacrimal duct obstruction. Additionally, to determine the effect of successful dacryocystorhinostomy surgery on these tear parameters. Prospective case-controlled interventional case series. Up to 20 microl of basal tears were collected from 20 age- and gender-matched control subjects, 33 patients with FNLDO, 28 patients with PANDO, and 31 patients after successful dacryocystorhinostomy. TMH was measured with videoreflective dacryomeniscometry, and TO was measured with vapor pressure osmometry. Thirty-nine percent of the patients with FNLDO (13/33) elected to undergo dacryocystorhinostomy surgery, compared with 64% of the patients with PANDO (18/28 P = .09). TMH was significantly higher in the disease groups (FNLDO median, 630 +/- 187 microm PANDO median, 620 +/- 210 microm) compared with the control subjects (median 262 +/- 50 microm P < .01). In those patients who underwent surgery, TMH was slightly higher in FNLDO than PANDO (P = .08), and TMH reduced significantly after surgery (P .05). TO was similar in those patients who progressed to surgery compared with the total group and was unaffected by surgery. TO was similar in normal control subjects and in the watery eye group and was unchanged after dacryocystorhinostomy surgery. Despite the slightly higher TMH in patients with FNLDO, a higher proportion of patients PANDO elected to have surgery. Relative to FNLDO, patients with PANDO who progressed to surgery had lower TMH and normal TO, which suggests that a complete lacrimal drainage obstruction induces negative feedback that results in no reduction in TO.
Publisher: BMJ
Date: 16-01-2020
DOI: 10.1136/BJOPHTHALMOL-2019-315160
Abstract: To evaluate the effects of a proprietary formulated eye drop with Leptospermum spp honey versus a conventional lubricant eye drop on tear film properties in subjects with symptoms related to dry eye disease after 28 days of treatment. Forty-six subjects with symptoms related to dry eye (Ocular Surface Disease Index (OSDI) score ) were enrolled and randomly assigned to receive either the test formulated eye drop (Optimel by Melcare Biomedical Pty Ltd) or control eye drops (Alcon, USA) in this double-masked study. Inferior lipid layer thickness (LLT), tear film evaporation rate (TER), fluorescein tear film break-up time (TBUT), corneal staining and subjective symptoms (OSDI and visual analogue scales (VAS)) were measured before and after 28 days of instilling the eye drops. Forty-two subjects completed the study (21 subjects in each group). After 28 days of treatment, TER showed a significantly greater reduction with the formulated eye drop compared with the control (p=0.01). TBUT showed a slight but not statistically significant increase with the formulated eye drop compared with the control (p=0.06), and a significantly greater reduction (improvement) in OSDI scores was observed with the formulated eye drop compared with the control (p=0.01). No significant differences were found between the two groups for inferior LLT, corneal staining and any of the VAS scores. The formulated eye drops were effective in reducing tear film evaporation rate and were more effective for improving symptoms of dry eye compared with the control eye drops after 28 days of treatment. NCT03622619 .
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2009
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/01658100701473705
Abstract: To evaluate a multi-source surveillance system used in a 12-month study of contact lens related microbial keratitis in Australia and New Zealand. All practicing ophthalmologists and optometrists were surveyed on 6 occasions over 12 months via post or the Internet. Participation was defined as reporting at least once during the study period and the response rates represented those who responded on all six occasions. Cases were also detected through hospital audit. All ophthalmologists and a sub-group of optometrists were contacted by phone to elicit a response (active surveillance). The utilization and cost-effectiveness of active surveillance were compared to reports received via the post or the Internet. Case ascertainment and cost-effectiveness were compared for different sources of case capture. The rate of participation for ophthalmologists was 95.8% (711/742) and 88.5% (657/742) responded for all reporting periods. Active surveillance was required for 63% (416/661) of responses in Australia (AU) and 73% (59/81) in New Zealand (NZ) at AUD23.14 per practitioner. Internet reporting was more widely used in New Zealand (NZ: 31% vs. AU:17%, p=0.006) and was the most cost effective mode of reporting (AUD1.43 per practitioner). Postal reporting (AUD AU:3.54,NZ:9.84 per practitioner) was under-utilized (3% of responses). Average start-up costs comprised 50% of study costs followed by active follow-up (42%), postal (6%) and Internet reporting (2%). Ophthalmologists (50.4%, 144/286 of cases) were the most cost-effective source of cases, followed by hospital audit (24.5%, 70/286) and optometry (25.1%, 72/286). Duplicate reporting occurred in 13% (37/286) of cases. High response rates were obtained by substantial resource commitment to active follow-up. Internet reporting was widely used and was cost-effective. Hospital audit and supplementary reporting by optometry were used for the first time in a study of contact lens related microbial keratitis, and contributed significantly to case capture.
Publisher: BMJ
Date: 13-04-2016
DOI: 10.1136/BJOPHTHALMOL-2016-308473
Abstract: To explore the relationship between serum concentration of sex hormones and dry eye symptoms and signs in postmenopausal women. A cross-sectional analysis was undertaken. Subjects were 46 postmenopausal women with dry eye (mean age 64.4±5.2 years, 13.7±6.4 years since menopause not undergoing hormone replacement therapy). Ocular symptoms (Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI)), tear function (tear osmolarity, non-invasive tear break-up time, tear secretion), corneal and conjunctival staining, and meibomian gland (MG) appearance, were recorded. Venous blood was collected and serum concentrations of 17β-oestradiol (E2), 3-α-androstanediol-glucuronide (3α-diol-G), and dehydroepiandrosterone sulfate (DHEA-S) were determined using ELISA. Multiple linear regression analysis was used to examine predictors of dry eye symptoms and signs. Mean serum concentration of E2, 3α-diol-G and DHEA-S was 9.02±13.40 pg/mL, 1.59±1.02 ng/mL and 0.74±0.53 μg/mL, respectively. Ocular symptoms were elevated (mean scores 27.0±18.1 (OSDI) and 40.3±8.4 (OCI)) but signs were within normal ranges. Higher serum E2 concentration along with capped glands, lid telangiectasia and older age was a significant predictor of worse MG secretion quality (p<0.001, R Serum oestrogen appears to be a key factor in MG signs. Although serum hormone levels did not contribute significantly to dry eye symptoms in this study, it is possible that oestrogen plays a role through its effect on meibum secretion. These findings suggest that MG dysfunction underpins dry eye symptoms in non-Sjögren's dry eye in postmenopausal women. ACTRN12612000281897.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: WHO Press
Date: 11-2019
Publisher: MDPI AG
Date: 14-01-2023
DOI: 10.3390/NANO13020349
Abstract: A clinical study of antimicrobial contact lenses containing the cationic peptide Mel4 was conducted. The few adverse events that occurred with this lens occurred on or after 13 nights of wear. The current study examined whether the Mel4 contact lenses lost activity during wear and the mechanism of this loss. Participants wore contact lenses for up to 13 nights. Lenses were tested for their ability to reduce the adhesion of Pseudomonas aeruginosa and Staphylococcus aureus. The amount of protein and lipid extracted from lenses was measured. The ability of trypsin to affect the antimicrobial activity of Mel4-coated contact lenses was measured. Mel4-coated contact lenses lost their antimicrobial activity at six nights of wear for both bacteria. The amount of lipids (13 ± 11 vs. 21 ± 14 μg/lens at 13 nights wear) and proteins (8 ± 4 vs. 10 ± 3 mg/lens at 13 nights of wear) extracted from lenses was not different between Mel4-coated and uncoated lenses, and was not different after three nights when antimicrobial activity was maintained and thirteen nights when they had lost activity (lipid: 25 ± 17 vs. 13 ± 11, p = 0.2 protein: 8 ± 1 vs. 8 ± 4 mg/lens, p = 0.4). Trypsin digestion eliminated the antimicrobial activity of Mel4-coated lenses. In summary, Mel4-coated contact lenses lost antibacterial activity at six nights of wear, and the most likely reason was proteolytic digestion of the peptide. Future studies will design and test proteolytically stable peptide mimics as coatings for contact lenses.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 30-03-2011
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 04-08-2015
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.1111/CXO.13082
Publisher: MDPI AG
Date: 29-09-2023
DOI: 10.3390/BIOM13101469
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JTOS.2017.08.003
Abstract: This article presents an Executive Summary of the conclusions and recommendations of the 10-chapter TFOS DEWS II report. The entire TFOS DEWS II report was published in the July 2017 issue of The Ocular Surface. A downloadable version of the document and additional material, including videos of diagnostic and management techniques, are available on the TFOS website: www.TearFilm.org.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
DOI: 10.1097/OPX.0000000000000996
Abstract: To establish the effect of lipid supplements on the tear lipid layer and their influence on lens wear comfort in habitual lens wearers. Forty habitual soft contact lens wearers were recruited to a double-masked, randomized crossover trial. An emulsion drop containing phosphatidylglycerine (Systane Balance Alcon) and a saline drop as a placebo or a liposomal spray containing phosphatidylcholine (Tears again BioRevive) and a saline spray as a placebo were used three times a day for 2 weeks with 48 hours washout between each intervention. Ocular comfort, lipid layer grade, and stability of the tear film using a Tearscope and tear evaporation rate using a modified VapoMeter were assessed after 6 hours of lens wear with lenses in situ. Neither of the lipid supplements improved lens wear comfort compared to baseline. The noninvasive surface drying time significantly reduced with the placebo spray at day 1 ( P = .002) and day 14 ( P = .01) whereas the lipid spray had no effect. With the lipid drop and placebo, noninvasive surface drying time was unchanged compared to baseline ( P .05) on day 1, but by day 14, noninvasive surface drying time was reduced with the lipid drop ( P = .02) and placebo ( P .001). Symptomatic wearers showed shorter noninvasive surface drying time compared to asymptomatic wearers with the spray treatment on both days ( P = .03) but not with the lipid drop ( P = .64). The placebo drop significantly changed the lipid layer distribution ( P = .03) with a higher percentage of thinner patterns compared to the baseline distribution at day 14. A weak but significant correlation was shown between ocular comfort and noninvasive surface drying time ( r = −0.21, P = .003) and tear evaporation rate ( r = 0.19, P = .008). Ocular comfort was not associated with lipid layer patterns ( r = 0.13, P = .06). Ocular comfort during contact lens wear improved with increased tear film stability and a reduced tear evaporation rate. However, the lipid supplements did not improve ocular comfort from baseline.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.CLAE.2015.04.007
Abstract: A contaminated contact lens case can act as a reservoir for microorganisms that could potentially compromise contact lens wear and lead to sight threatening adverse events. The rate, level and profile of microbial contamination in lens cases, compliance and other risk factors associated with lens case contamination, and the challenges currently faced in this field are discussed. The rate of lens case contamination is commonly over 50%. Coagulase-negative Staphylococcus, Bacillus spp., Pseudomonas aeruginosa and Serratia marcescens are frequently recovered from lens cases. In addition, we provide suggestions regarding how to clean contact lens cases and improve lens wearers' compliance as well as future lens case design for reducing lens case contamination. This review highlights the challenges in reducing the level of microbial contamination which require an industry wide approach.
Publisher: Informa UK Limited
Date: 07-2017
DOI: 10.1111/CXO.12544
Abstract: This paper provides an updated version of the paper: Infection control guidelines for optometrists 2007. Information from peer-reviewed journal articles, guidelines from professional societies, and government health department and other websites and instructions from equipment manufacturers were considered in determining infection risk factors in optometric practice. They were used to revise the recommendations on disinfection, sterilisation and reprocessing procedures for instrumentation and other equipment used in optometric practice as well as personal infection control measures to be undertaken by staff. Optometrists and optometric practice staff should adopt measures to minimise the risk of transmission of infection. These include appropriate hand-washing, staff vaccinations, single use instruments/equipment, appropriate disposal of waste, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for in iduals who are known to be infected or immuno-suppressed. Information provided to patients regarding infection control procedures in topical drug administration, contact lens wear and use of eye make-up are additional considerations for optometrists.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.OPHTHA.2012.05.020
Abstract: To determine the association of single nucleotide polymorphisms (SNPs) of defensin 1B and toll-like receptor 4 with contact lens keratitis susceptibility and severity, and to understand the factors that influence study participation. Retrospective, case-control study. Ninety cases of keratitis and 185 controls recruited from studies conducted at Moorfields Eye Hospital and throughout Australia from 2003 to 2005 were analyzed for genetic associations. The reasons for participation of a subset of 146 participants from 1 site were also investigated. Buccal swab s les were collected on Whatman FTA cards and mailed by post for analysis. DEFB1 (rs1799946, -52, rs1800972, -44, and rs11362, -20) and TLR4 (rs4986790, D299G) SNPs were screened by pyrosequencing and analyzed using a regression model for susceptibility (sterile, microbial keratitis [MK], controls) and severity. Study participation was investigated for age, gender, condition, and phone follow-up also using regression analysis. Relative risk of developing contact lens-related keratitis and more severe forms of the disease based on genetic profiles. Carriers of risk alleles of DEFB1 -52 and -20 showed a trend toward increased susceptibility to keratitis (-52: odds ratio [OR], 1.45 95% confidence interval [CI], 0.99-2.11 P = 0.051 -20: OR, 1.37 95% CI, 0.95-1.98 P = 0.088). A DEFB1 promoter haplotype (G-G-A) had a tendency toward decreased susceptibility of MK (OR, 0.68 95% CI, 0.45-1.03 P = 0.062) and reduced severity (OR, 0.56 95% CI, 0.30-1.07 P = 0.066). The TLR4 D299G was not associated with type and severity of keratitis. Older age (OR, 1.07 95% CI, 1.05-1.08) and follow-up phone call (OR, 2.0 95% CI, 1.2-3.5) were independent predictors of study participation. Genetic variation in DEFB1 that may lead to decreased protein expression of hBD-1 exhibits a tendency toward increased susceptibility and severity of contact lens-related keratitis. Investigation of these and other hBD genes that play important roles in animal models in a larger s le size is warranted. The approach of requesting s les from retrospective case series was generally feasible, although significant resources, including repeat phone calls, are required. More targeted strategies to recruit younger in iduals to participate in genetic studies may be useful.
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: Informa UK Limited
Date: 22-02-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Wiley
Date: 29-11-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Wiley
Date: 05-2019
DOI: 10.1111/CEO.13484
Abstract: Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community. Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK. Retrospective review of clinical records of patients with MK. All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database. Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection. Yearly rate of CLMK. Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 06-2018
Abstract: The aim of this study was to examine cohesion, coaggregation, and coculture between bacteria commonly isolated from contact lens cases. Staphylococcus epidermidis, Staphylococcus haemolyticus, Micrococcus luteus, and Acinetobacter radioresistens (two strains each) isolated from contact lens cases of two asymptomatic wearers were used in this study. In the cohesion assay, bacteria were grown, washed, and examined by incubating lens cases with two different types of bacteria sequentially and assessing the number of adhered cells of each isolate. The ability of isolates to interfere with the growth of other isolates was tested by growing strains in cocultures for 24 hours and determining the numbers of cells of in idual strains. For coaggregation, equal proportions of two bacterial suspensions were mixed and allowed to coaggregate for 24 hours. Inhibition of coaggregation was tested by the addition of lactose (0.06 M) or sucrose (0.06 M) or pronase. The initial adhesion of M. luteus or A. radioresistens significantly (P < 0.05) enhanced the subsequent adhesion of the staphylococci. The addition of A. radioresistens in liquid media significantly (P < 0.05) enhanced the growth of staphylococci. S. epidermidis or S. haemolyticus coaggregated with M. luteus or A. radioresistens. The degree of coaggregation varied between 30% and 54%. The highest coaggregation (54% ± 5%) was seen between A. radioresistens 22-1 and S. epidermidis 22-1, isolated from the same lens case. Only lactose or sucrose treatment of staphylococci could partly inhibit coaggregation of some pairs. Coaggregation, cohesion, and growth promotion may facilitate the process of bacterial colonization of contact lens cases.
Publisher: BMJ
Date: 21-06-2007
Publisher: Informa UK Limited
Date: 17-02-2023
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.JAAPOS.2008.11.004
Abstract: To determine whether differences exist in morphological structures of dominant and nondominant eyes in children ages 6 or 12 years. The following structural features were assessed: axial length, refraction, corneal radius of curvature, and retinal features-measured with the use of optical coherence tomography (OCT)-including macular and retinal nerve fiber layer thickness and optic disk parameters. Of 4,118 children examined from 2003 to 2005 in the Sydney Myopia Study, 3,382 (82.1%) had OCT data for analysis. Comprehensive standardized eye examinations were performed, including best-corrected visual acuity. Ocular dominance was determined using the hole-in-card test, repeated on 3 occasions. Dominance was assigned only if the 3 measurements were identical. "Fast" scans of the optic disk and retina were performed using OCT. Dominance was observed in 85% of subjects, with boys having a tendency toward right eye dominance. The dominant eye was longer (p = 0.001 and p = 0.0003 for 6- and 12-year-old patients, respectively) and more myopic (p = 0.002 and p = 0.0001, respectively) than its counterpart. No retinal features consistently identified dominant from nondominant eyes in both age groups. Although dominant eyes tended to be longer and slightly more myopic than nondominant eyes, we found no consistent ocular structural differences between dominant and nondominant eyes with the use of OCT.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2008
Publisher: Informa UK Limited
Date: 09-2016
DOI: 10.1111/CXO.12414
Abstract: Although cataract surgery can restore sight, lengthy waiting times are common in public hospitals in Australia. We investigated the driving status of older people during their surgical waiting period. Baseline, cross-sectional data from two prospective cohort studies of patients aged 50 years and older on Australian public hospital cataract surgery waiting lists were analysed. Participants underwent assessment of vision and completed the Driving Habits Questionnaire. The vision status was compared between current drivers and former drivers. Participants (n = 442) were on average 73 ± 8 years of age and approximately half were women (229/442, 52 per cent). Habitual vision was 6/12(+2) on average (0.26 ± 0.21 logMAR). There were 263 (60 per cent) current drivers, 110 (25 per cent) former drivers and 69 participants (16 per cent) who had never driven. Among the current drivers, 82/263 (31 per cent) failed visual acuity requirements for an unconditional drivers' license (6/12 acuity with one or both eyes). The former drivers had worse visual acuity than the current drivers (between group difference 0.12 ± 0.20 logMAR, p < 0.0001) and worse contrast sensitivity (between group difference -0.14 ± 0.22 log units, p < 0.0001). Both high contrast visual acuity and contrast sensitivity were independently associated with still driving. More than half (140/263, 53 per cent) of the drivers believed that their cataract had affected their driving and 23 current drivers (nine per cent) reported a crash in the last 12 months. We report on the level of visual impairment among older drivers waiting for cataract surgery. Approximately one-third did not meet the required visual acuity standard for driving and hence would require further ophthalmic assessment and a conditional license to continue to drive. Approximately one-quarter of the surgical candidates were no longer driving and this was associated with greater visual impairment. These findings support a need for timely and appropriately prioritised access to cataract surgical services.
Publisher: Informa UK Limited
Date: 20-04-2023
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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: Informa UK Limited
Date: 11-2013
DOI: 10.1111/CXO.12055
Abstract: The aim was to develop and validate an instrument called the 'Children's Vision for Living Scale' (CVLS) for the assessment of vision-related quality of life in Saudi Arabian children with and without amblyopia. A 43-item child self-report questionnaire was initially developed based on interviews with children with amblyopia, their parents and eye-care professionals, and a literature review. Following a process that involved the removal of redundant items, 28 items remained and were piloted on children aged five to 12 years with and without amblyopia (n = 48 amblyopic, n = 53 non-amblyopic) living in Saudi Arabia. Rasch analysis was applied to determine whether the 28-item questionnaire fitted the Rasch model. Rasch analysis was used to assess the validity and reliability of the questionnaire. Principal components analysis (PCA) was used to check dimensionality. A 21-item questionnaire resulting from this process was administered in children with (n = 81) and without (n = 82) amblyopia in Saudi Arabia for further validation. The final 21-item questionnaire had good validity and reliability as demonstrated by person separation of 2.02, person reliability of 0.80 (mean square and standard deviation: infit = 1.01 ± 0.39 outfit = 1.01 ± 0.40) and item reliability of 0.93 (item infit range = 1.33 to 0.78 item outfit range = 0.78 to 1.30). The mean difference between person and item scores of 0.33 ± 0.53 logits (scale range, 2 to -2) indicates that the items are well targeted to the populations. The PCA (dimensionality measures) shows the percentage of variance explained by measures equal to 26.4 per cent (modelled 26.9 per cent) and an eigenvalue of the first contrast of 2.5, which demonstrated good stability. The 21-item CVLS is a valid uni-dimensional child self-report instrument for the assessment of the impact of amblyopia on vision-related quality of life in children with and without amblyopia living in Saudi Arabia.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.JTOS.2021.11.012
Abstract: The widely used immortalised human meibomian gland epithelia cell (iHMGEC) line has made possible extensive studies of the biology and pathophysiology of meibomian glands (MG). Tissue culture protocols for iHMGEC have been revised and modified to optimise the growth conditions for cell differentiation and lipid accumulation. iHMGEC proliferate in serum-free medium but require serum or other appropriate exogenous factors to differentiate. Several supplements can enhance differentiation and neutral lipid accumulation in iHMGEC grown in serum-containing medium. In serum-free medium, rosiglitazone, a peroxisome proliferator activator receptor-γ (PPARγ) agonist, is reported to induce iHMGEC differentiation, neutral lipid accumulation and expression of key biomarkers of differentiation. iHMGEC cultured in serum-containing medium under hypoxia or with azithromycin increases DNAse 2 activity, a biomarker of terminal differentiation in sebocytes. The production of lipids with composition similar to meibum has not been observed in vitro and this remains a major challenge for iHMGEC culture. Innovative methodologies such as 3D ex vivo culture of MG and generation of MG organoids from stem cells are important for further developing a model that more closely mimics the in vivo biology of human MG and to facilitate the next generation of studies of MG disease and dry eye.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.CLAE.2010.10.004
Abstract: To determine whether risk taking personality is associated with compliance in contact lens wear, and how practitioner perception of compliance compares with wearer risk taking and non-compliant behaviour. Optometrists in Australia, recruited through professional organizations, were asked to enroll up to 10 current contact lens wearers each. Wearers completed a questionnaire assessing risk-taking propensity (20-item instrument), non-compliant behaviour and demographics. Non-compliance was scored on four components (maximum score 40, lens disinfection, 20 hand hygiene, 8 case hygiene, 6 case replacement, 6). Independently, practitioners ranked each wearer's non-compliance on a 1-5 scale. Associations between wearer risk taking propensity, non-compliant behaviour and practitioner perceived non-compliance were investigated using Pearson correlation. Significant associations were entered into a linear regression model predicting overall non-compliant behaviour. Seventy-three wearers were recruited by 18 optometrists (mean 4, range 1-10). Wearer risk taking was associated with less compliance (p<0.01) as was younger age (p 0.6) Linear regression indicated that risk taking was the only independent significant factor predicting non-compliance, explaining 24% of the variation in behaviour. A higher risk taking personality style of contact lens wearers in Australia is associated with less compliant behaviour. Risk taking is a better predictor of compliance than age, gender and practitioner perception and helps explain the in idual characteristics of wearers that may influence lens care and maintenance.
Publisher: Wiley
Date: 04-2008
DOI: 10.1111/J.1442-9071.2008.01722.X
Abstract: We examine the referral pathways and treatment for contact lens-related microbial keratitis in Australia and New Zealand. Cases were reported in May 2003-September 2004 data on presentation, referral and treatment collected from practitioners and via patient interview. Severity was graded, 1-week cure rate estimated, delays in treatment and medications documented. Hospital and private clinic managements were compared. A total of 297 eligible cases were reported detailed information on treatment and referral pathways was available on a subset of these cases. Presentation was to optometrists (81/200, 41%), general practitioners (GPs) (69/200, 34%) or emergency departments (46/200, 23%). Optometrists referred to private ophthalmologists (47/79, 60%) more often than hospitals (27/79, 34%). GPs initiated treatment (39/68, 57%) but also referred to hospitals (22/68, 32%) and to private ophthalmologists (7/68, 10%). Of all cases, 67% (195/297) were managed in hospitals (29% admitted, 87/297). Hospitalized cases were predominantly managed with fortified aminoglycoside/cephalosporin (66/81, 82%) and others fluoroquinolones (168/195, 86%). Steroids were used in 36% (98/276) commencing on day 5 (median, interquartile range = 3-7). One-week cure rate was 60% (49/82) in private clinics, 72% (62/86) for hospital outpatient cases and 37% (25/67, P /=12 h) receiving therapy were experienced by 33% (55/168) because of initial inappropriate treatment (48/55), time delays (7/55) but not remoteness (P = 0.6). The majority of treatment is via hospital clinics, but milder disease is managed in private clinics. The referral process via optometrists, GPs and emergency departments is generally efficient however, one-third of cases experienced some delays before receiving appropriate therapy highlighting the need for timely diagnosis.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.AJO.2021.03.005
Abstract: To explore demographics, disease characteristics, and wear habits in cosmetic contact lens (CL)-related corneal infections in Asia. Prospective multicenter cross-sectional study. Cases of CL-related corneal infection presenting over a 12-month period were prospectively identified from 11 centers in 8 countries in Asia. Case demographics, clinical features, microbiology, and compliance characteristics were compared between wearers using CLs for cosmetic purposes and those using CLs for the correction of refractive errors. Six hundred and ninety-four CL wearers with corneal infection presented: 204 cosmetic CL (29.4%) and 490 (70.6%) refractive CL wearers. Cosmetic CL infections comprised 7%-54% of cases across the region. Compared with noncosmetic CL wearers, cosmetic CLs wearers were significantly more likely to be female (90% vs 59%), young (aged <25, 68% vs 44%), and to have a shorter period of wear experience. Lenses worn by cosmetic CL wearers were more likely to be hydrogel materials and manufactured with the pigment located on the back surface of the CL. Presenting disease characteristics and visual outcomes were similar in both groups. Causative organisms were similar between the 2 groups however, there was a higher rate of Acanthamoeba disease (9%) in cosmetic wearers, compared with refractive wearers (1% P < .005). Cosmetic CL infections represent a significant proportion of CL-related infections in Asia. Cosmetic CL users with corneal infections are generally young, female, and wearing hydrogel CLs. Internet supply, quality control, and regulation of the sale of these products provide significant challenges in managing this population of vulnerable wearers.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 27-06-2019
DOI: 10.1167/TVST.8.3.52
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2011
Publisher: Springer Science and Business Media LLC
Date: 18-05-2007
Abstract: To investigate factors affecting refractive outcome following LASIK for myopia. Six hundred and seventy-four consecutive uncomplicated myopic LASIK surgeries, performed by a single surgeon, either using the Technolas 217 planoscan (n=372) or the NIDEK EC 5000 (n=302), were evaluated. Stratified random s ling was used to match the groups for refractive error, patient age, and gender. The final analysis included 302 patients from each treatment group. Conditions were identical for both surgeries, and pre-operative refractive errors were between -1.00 and -14.00 DS and <-1.50 DC. Refractive success was defined as -0.50 to +0.50 DS of the targeted refraction measured 3 months after surgery. A stepwise logistical regression analysis was used to determine variables associated with refractive failure. A successful refractive outcome was achieved in 78% (235/302) of surgeries using the Technolas laser and in 88% (266/302) using the NIDEK laser. Predictor variables for not achieving refractive success were pre-operative refractive error of above -5.00 DS, age more than 40 years, and surgery performed with the Technolas laser. Both the Technolas 217 and the NIDEK EC-5000 excimer lasers achieve a successful refractive outcome in the majority of cases. However, patient and surgical factors can influence refractive outcome.
Publisher: MDPI AG
Date: 08-06-2022
DOI: 10.3390/NANO12121965
Abstract: This study investigated the fluorescence and biocompatibility of hydrophilic silicon quantum dots (SiQDs) that are doped with scandium (Sc-SiQDs), copper (Cu-SiQDs), and zinc (Zn-SiQDs), indicating their feasibility for the bioimaging of tear film. SiQDs were investigated for fluorescence emission by the in vitro imaging of artificial tears (TheraTears®), using an optical imaging system. A trypan blue exclusion test and MTT assay were used to evaluate the cytotoxicity of SiQDs to cultured human corneal epithelial cells. No difference was observed between the fluorescence emission of Sc-SiQDs and Cu-SiQDs at any concentration. On average, SiQDs showed stable fluorescence, while Sc-SiQDs and Cu-SiQDs showed brighter fluorescence emissions than Zn-SiQDs. Cu-SiQDs and Sc-SiQDs showed a broader safe concentration range than Zn-SiQDs. Cu-SiQDs and Zn-SiQDs tend to aggregate more substantially in TheraTears® than Sc-SiQDs. This study elucidates the feasibility of hydrophilic Sc-SiQDs in studying the tear film’s aqueous layer.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-07-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
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: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 12-2010
DOI: 10.1167/IOVS.10-5796
Abstract: Lens case hygiene practices are important in maintaining safe contact lens wear. However, the effectiveness of various lens case cleaning practices have not been evaluated and compared. This in vitro study aimed to evaluate and compare the efficacy of cleaning practices that are most commonly carried out by lens wearers and recommended by practitioners. Pseudomonas aeruginosa 122, Serratia marcescens ATCC 13880, and Staphylococcus aureus ATCC 6538 were the challenge bacteria for biofilm formation on unused lens cases from two different manufacturers. After establishment of the biofilm, each lens case was subjected to one of the six cleaning regimens: "rinsed," "rubbed and rinsed," "air-dried," "soaked in a multipurpose contact lens solution," "tissue-wiped," and "lids recapped." The level of residual biofilm was quantified at the end of each cleaning regimen. The efficacy of each cleaning regimen was then compared. Mechanical rubbing and wiping of lens cases were the most effective cleaning regimen tested in reducing biofilm. Soaking lenses in disinfecting solution for 6 hours removed the majority of biofilm from lens cases. Rinsing lens cases alone provided only minimal efficacy in reducing biofilm. Air-drying or recapping the cases with the lid without any other additional cleaning methods were the least efficient at removing biofilm. Based on this study, digital rubbing and rinsing and/or wiping the lens cases with tissue is recommended. Air-drying or recapping the lens case lids after use without any additional cleaning methods should be discouraged with non-antimicrobial lens cases.
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.OPHTHA.2008.08.032
Abstract: To describe in detail corneal indentation (CI) in the management of a series of patients treated for acute angle closure (AAC). Retrospective, consecutive, noncomparative case series. Seven consecutive patients (8 eyes) referred to the authors with the diagnosis of AAC. Patients presented to the Prince of Wales Hospital, Randwick, or to the private practices of the authors. Seven patients (8 eyes) underwent CI as part of their early management for AAC. Reduction in intraocular pressure (IOP), symptoms of AAC and pain relief. Of the 7 patients, complete data were available for 6. The IOP was significantly reduced (P<0.05) and 3 of 4 patients with severe acute pain reported early resolution of pain after CI. The average reduction in IOP was 20.9 mmHg (range +1 to -45). All patients subsequently underwent definitive management with laser peripheral iridotomies or lensectomy using phacoemulsification. Three patients treated acutely with CI without any medical agents had a mean IOP reduction of 21 mmHg (range, 20-23) after indentation. Corneal indentation is a rapid, portable, and effective method of reducing elevated IOP in the setting of AAC. It can be performed with instrumentation that is readily at hand and allows for rapid pain relief. This reduction in IOP improves corneal clarity and permits further definitive management of the patient with AAC. The authors have no proprietary or commercial interest in any materials discussed in this article.
Publisher: BMJ
Date: 15-01-2014
DOI: 10.1136/INJURYPREV-2013-041124
Abstract: Falls result in >$1 billion in treatment, disability, lost output and mortality each year in Australia and people with cataract are at increased risk. Previous research is inconclusive one large Australian study using linked hospital data found no protective effect of cataract surgery. We aim to examine the impact of cataract-related vision impairment on falls risk and the additional effects of delays in access to surgery, refractive management (type of spectacles and changes to spectacle prescription) and the resulting level of function, particularly binocular function which can impact balance. A prospective, 24-month cohort study is planned involving over 700 patients aged 70 years or older with bilateral cataract presenting for surgery at five public hospital eye clinics in Sydney, Melbourne and Perth, Australia. The primary outcomes will be self-reported falls and falls requiring medical care, assessed objectively using administrative data sets. Secondary outcomes include community participation, quality of life, mood and depressive symptoms. McNemar's test will be used to evaluate differences in falls rate before, after first eye and after second eye cataract surgery. Generalised Estimating Equations linear regression analysis will be undertaken to examine factors associated with falls risk and the secondary outcomes. With limited resources to further shorten public waiting lists, there is a need to better understand an in iduals' risk of fall injury or other negative consequences while waiting for surgery. The findings of this project will inform the development of strategies to reduce falls risk in the many older people with cataract.
Publisher: Informa UK Limited
Date: 17-10-2023
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: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.OPHTHA.2012.01.052
Abstract: To establish risk factors for moderate and severe microbial keratitis among daily contact lens (CL) wearers in Australia. A prospective, 12-month, population-based, case-control study. New cases of moderate and severe microbial keratitis in daily wear CL users presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners. Case detection was augmented by record audits at major ophthalmic centers. Controls were users of daily wear CLs in the community identified using a national telephone survey. Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Multiple binary logistic regression was used to determine independent risk factors and univariate population attributable risk percentage (PAR%) was estimated for each risk factor. Independent risk factors, relative risk (with 95% confidence intervals [CIs]), and PAR%. There were 90 eligible moderate and severe cases related to daily wear of CLs reported during the study period. We identified 1090 community controls using daily wear CLs. Independent risk factors for moderate and severe keratitis while adjusting for age, gender, and lens material type included poor storage case hygiene 6.4× (95% CI, 1.9-21.8 PAR, 49%), infrequent storage case replacement 5.4× (95% CI, 1.5-18.9 PAR, 27%), solution type 7.2× (95% CI, 2.3-22.5 PAR, 35%), occasional overnight lens use (<1 night per week) 6.5× (95% CI, 1.3-31.7 PAR, 23%), high socioeconomic status 4.1× (95% CI, 1.2-14.4 PAR, 31%), and smoking 3.7× (95% CI, 1.1-12.8 PAR, 31%). Moderate and severe microbial keratitis associated with daily use of CLs was independently associated with factors likely to cause contamination of CL storage cases (frequency of storage case replacement, hygiene, and solution type). Other factors included occasional overnight use of CLs, smoking, and socioeconomic class. Disease load may be considerably reduced by attention to modifiable risk factors related to CL storage case practice.
Publisher: Microbiology Society
Date: 12-2008
DOI: 10.1099/JMM.0.2008/003723-0
Abstract: Pseudomonas aeruginosa is one of the common pathogens associated with corneal infection, particularly in contact lens-related keratitis events. The pathogenesis of P. aeruginosa in keratitis is attributed to the production of virulence factors under certain environmental conditions. The aim of this study was to determine differences in the virulence factors of P. aeruginosa isolated from contact lens- and non-contact lens-related keratitis. Associations were assessed between type III secretion toxin-encoding genes, protease profiles, biofilm formation, serotypes and antibiotic-resistance patterns among 27 non-contact lens- and 28 contact lens-related P. aeruginosa keratitis isolates from Australia. Strains with a exoS + / exoU − genotype and a type I protease profile predominated in the non-contact lens-related keratitis isolates, whereas the exoS − / exoU + and a type II protease profile was associated with contact lens-related isolates ( P .05). A strong biofilm formation phenotype was found to be associated with the possession of the exoU gene, and serotypes E, I and C. The exoS gene was strongly associated with serotypes G, A and B, while exoU was associated with serotypes E and C. Six out of fifty-five (11 %) clinical isolates were non-susceptible (intermediate-resistant or resistant) to ofloxacin and moxifloxacin. All resistant isolates were from non-contact lens-related keratitis. The results suggest that P. aeruginosa isolates from different infection origins may have different characteristics. A better understanding of these differences may lead to further development of evidence-based clinical guidelines for the management of keratitis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 04-2009
DOI: 10.1167/IOVS.08-1882
Abstract: The purpose of this study was to investigate the effect of bovine lactoferrin (BLF) on human corneal epithelial wound healing using an in vitro alkali-induced wound model and to understand its role in promoting wound healing. Confluent human corneal limbal epithelial (HCLE) cells wounded using 0.5 microL of 0.1 M sodium hydroxide were treated with BLF (0, 0.1, 1, 2.5, and 5 mg/mL) or anti-human interleukin-6 (IL-6) receptor neutralizing antibody (anti-IL-6 antibody 1, 10, and 50 microg/mL) or tyrphostin AG1295 (an inhibitor of platelet-derived growth factor [PDGF] receptor kinase 1 and 10 microM), IL-6, or PDGF-BB. The conditioned medium collected for BLF treatment (0 and 5 mg/mL) was analyzed using a protein array for a number of cytokines/growth factors involved in corneal wound healing. A preliminary animal study using mice was carried out to determine the effect of BLF on alkali wounds. BLF at 2.5 and 5 mg/mL promoted wound healing (P<0.01). During wound closure, BLF upregulated PDGF-BB 180-fold and IL-6 10-fold compared with control. Treatment with tyrphostin AG1295 (10 microM P<0.01) or anti-IL-6 antibody (50 microg/mL P or=2.5 mg/mL stimulates HCLE wound healing, and this stimulation is mediated through the upregulation of PDGF or IL-6.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: Elsevier BV
Date: 10-2021
Publisher: Informa UK Limited
Date: 2012
DOI: 10.1111/J.1444-0938.2011.00634.X
Abstract: The tear film is a nourishing, lubricating and protecting layer that bathes the ocular surface. It is continuously replenished through cycles of production and elimination via evaporation, absorption and drainage. These processes are often referred to as tear film dynamics. Osmolality is an objective clinical measurement that provides insight into the balance of these complex tear film dynamics. Balanced tear production and elimination is vital for tear film integrity, stability and normal osmolality. Imbalances cause alterations of the tear film structure and composition, ultimately leading to tear film instability and measurable tear film hyperosmolality. Elevated tear film osmolality is considered a core mechanism in dry eye, forming the basis of dry eye symptoms and leading to ocular surface damage. Despite its immense potential in the diagnosis of dry eye, tear film osmolality is not commonly assessed. This review will focus on the current knowledge of tear film dynamics and tear film osmolality.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CLAE.2019.05.002
Abstract: Contact lens wearers aged 15-25 years are at higher risk of corneal inflammation, yet little is known about corneal inflammatory state in this group. Previous investigations show density of corneal epithelial dendritic cells (CEDC) may increase with contact lens wear. However, it is not known how corneal distribution or morphology of CEDC alters with lens wear or whether these markers are affected by age. This study characterised CEDC in adolescent and young adult contact lens wearers to determine effects of contact lens wear and age on CEDC density, distribution and morphology. Forty participants (20 contact lens wearers, 20 healthy non-wearers age 16-36 years 16M:24F) completed this pilot study. Corneal images were captured using in vivo confocal microscopy (HRTII, Rostock). CEDC were manually counted in a 1 mm A lower ratio of central to mid-peripheral CEDC density was found with younger age (ρ = 0.42, P = 0.01). CEDC morphology was not associated with age or contact lens wear. CEDC density in the mid-peripheral cornea was higher in soft lens wearers than non-wearers (P = 0.04), but central density did not differ. CEDC density and morphology were not significantly different between centre (median density 11 cells/mm Density, distribution and morphology of CEDC do not differ in established contact lens wearers. A relatively lower density of CEDC in the central cornea of younger patients may allude to a more naive immune status in this group and warrants further study. Decreased central CEDC density identified in orthokeratology lens wear requires confirmation in a larger group.
Publisher: Informa UK Limited
Date: 2014
DOI: 10.1111/CXO.12078
Abstract: A population-based, cross-sectional telephone survey was conducted to estimate the penetrance and characteristics of contact lens wear in Australia. Based on postcode distribution, 42,749 households around Australia were randomly selected from the national electronic telephone directory. During calls, the number of in iduals and contact lens wearers in each household aged between 15 and 64 years was ascertained. Contact lens wearers were interviewed using a structured questionnaire, to determine details of demographics, lens type, mode of lens wear and hygienic habits. Contact lens wear characteristics and habits were compared by lens type and mode of use. Of the 32,405 households contacted, 19,171 (59.2 per cent) agreed to participate. The penetrance of contact lens wear during the study period was 5.01 per cent (95% CI: 4.78-5.24). The mean age of lens wearers was 36.5 ± 18.3 years and 63.4 per cent were female. There were significant differences in the habits and characteristics of lens wearers depending on their lens type and mode of use. The penetrance of contact lens wear concurs with market estimates and equates to approximately 680,000 contact lens wearers aged between 15 and 64 years in Australia. This is the most detailed and extensive population-based survey of contact lens wearers ever conducted. The discrepancies found between the characteristics of lens wearers surveyed in this study compared to those in previous studies of contact lens practitioners highlights the importance of study design. These results may be applied to other regions with similar health-care and regulatory systems.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
Publisher: MDPI AG
Date: 15-11-2022
DOI: 10.3390/PATHOGENS11111354
Abstract: Staphylococcus aureus (S. aureus) is a frequent cause of eye infections with some isolates exhibiting increased antimicrobial resistance to commonly prescribed antibiotics. The increasing resistance of ocular S. aureus to ciprofloxacin is a serious concern as it is a commonly used as a first line antibiotic to treat S. aureus keratitis. This study aimed to analyse genetic mutations in the genomes of 25 S. aureus isolates from infections or non-infectious ocular conditions from the USA and Australia and their relationship to ciprofloxacin resistance. Overall, 14/25 isolates were phenotypically resistant to ciprofloxacin. All isolates were analyzed for mutations in their quinolone resistance-determining regions (QRDRs) and efflux pump genes. Of the fourteen resistant isolates, 9/14 had ciprofloxacin resistance mutations within their QRDRs, at codons 80 or 84 within the parC subunit and codon 84 within the gyrA subunit of DNA gyrase. The highest resistance (MIC = 2560 μg/mL) was associated with two SNPs in both gyrA and parC. Other resistant isolates (3/14) had mutations within norB. Mutations in genes of other efflux pumps and their regulator (norA, norC, mepA, mdeA, sepA, sdrM, mepR, arlR, and arlS) or the DNA mismatch repair (MMR) system (mutL and mutS) were not associated with increased resistance to ciprofloxacin. The functional mutations associated with ciprofloxacin resistance in QRDRs (gyrA and parC) and norB suggests that these are the most common reasons for ciprofloxacin resistance in ocular isolates. Novel SNPs of gyrA Glu-88-Leu, Asn-860-Thr and Thr-845-Ala and IIe-855-Met, identified in this study, need further gene knock out/in studies to better understand their effect on ciprofloxacin resistance.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.JTOS.2013.09.001
Abstract: Almost half the patients who undergo laser in situ keratomileusis (LASIK) experience dry eye following the procedure. However, the etiology of LASIK-induced dry eye is unclear. The purpose of this review is to examine and summarize the current evidence for the etiology of LASIK-induced dry eye, with a focus on ocular surface sensitivity and corneal innervation. Evidence suggests that the alteration of corneal nerves after LASIK is the most likely cause of the subjective symptoms of LASIK-induced dry eye, even though corneal sensitivity and the clinical indicators of dry eye return to apparently normal values within a year due to the partial recovery of the corneal nerve plexus. The hypothesis is explored that dry eye symptoms following LASIK may result from abnormal sensation due to LASIK-induced corneal neuropathy. Other factors, such as alterations in conjunctival goblet cell density, might also contribute to the symptoms and signs of LASIK-induced dry eye. Inter-relationships between nerve morphology, tear neuropeptide levels and dry eye require further investigation. A better understanding of this phenomenon may result in improved management of post-LASIK dry eye.
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.CLAE.2007.10.003
Abstract: To assess the response to clinical guidelines based on recent epidemiological studies of contact lens-related microbial keratitis. Incidence rates for silicone hydrogel extended wear were summarized from recent studies. Risk factors were listed and two key factors identified: overnight wear and poor hygiene accounting for 43% and 33% of risk, respectively. A pre-guidelines, web-based survey was conducted to assess the need for information and level of knowledge on CL-related microbial keratitis (n=162). Comparisons to a post-guidelines survey (n=51) measured whether new information was acquired through an educational brochure posted to the membership. In the pre- and post-guidelines surveys, 52% (85/162) vs. 43% (22/51, p=0.3) indicated they did not have enough information on CL-related microbial keratitis. The importance attached to risk factors was generally reflective of the magnitude of risk and practitioners made appropriate recommendations about low risk modalities. Hygiene practices were rated as highly important in both surveys (>90%) with increased awareness of handwashing (p=0.03). Overnight wear of hydrogel lenses was considered highly important in 94% (201/213). However, despite evidence to the contrary, only 53% in the pre-guidelines and 58% in the post-guidelines surveys indicated that silicone hydrogel overnight wear was a highly important risk factor. Research evidence has been disseminated to the BCLA membership and responses gathered via a web survey. There are some areas of disconnect between practitioner opinion, as gauged in this survey, and the evidence from the research, particularly with regards to increased risk with overnight wear.
Publisher: Springer Science and Business Media LLC
Date: 17-08-2009
Abstract: A retrospective case-control study was conducted at a tertiary referral hospital to determine the characteristics of and risk factors for contact lens (CL) related presumed microbial keratitis. Two hundred and ninety-one cases of presumed microbial keratitis were retrospectively identified over a 2-year period. Records were reviewed for a history of CL wear and, where identified, CL, demographic, and clinical data were collected. Lens wearing controls (n=186) were identified by a community telephone survey. Multiple logistic regression estimated risk factors for infection and vision loss. Ninety-nine (34%) new cases of presumed microbial keratitis were associated with CL wear. Overnight soft CL use was associated with an increased risk of infection compared to daily disposable CL wear (odds ratio (OR): 8.03, 95% confidence interval (CI): 1.82-35.46). Compared with older CL wearers, 15-24 year olds had a 3.5 times greater risk of infection (OR, 95% CI: 1.7-7.4). Of the 84 cases with available data, 24 (29%) lost two or more lines of best-corrected visual acuity. Delaying treatment by 49-72 h had a 4.5 times (OR, 95% CI: 1.4-14.9) greater risk of visual loss compared to seeking treatment early. Of the 99 cases of infection, 88 were scraped and 78% (69/88) of these returned a positive culture. Gram-positive bacteria were the predominant causative organisms. Overnight use of CL and youth carry a greater risk of infection. Practitioners should reinforce the importance of proper CL care at all times, and early presentation following the onset of symptoms.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
DOI: 10.1097/OPX.0000000000001129
Abstract: Established reusable contact lens (CL) wearers show higher tear inflammatory cytokine concentrations and greater conjunctival metaplasia in the region covered by standard soft CLs. The balance of proinflammatory to anti-inflammatory cytokines, but not in idual tear cytokine concentrations, was associated with self-reported CL discomfort. Daily disposable (DD) lenses are often used to improve CL discomfort, but the effect on ocular inflammatory responses has not been fully investigated. This study aimed to compare the concentrations of tear cytokines and conjunctival cell morphology in healthy habitual DD and reusable soft CL wearers. Thirty-six established daily CL wearers, including 14 DD and 24 reusable wearers, were enrolled. Symptoms and ocular surface integrity were evaluated. The concentration of tear cytokines (interleukin 1β [IL-1β], IL-6, IL-10, IL-12(p70), IL-17A, and tumor necrosis factor α) were determined using Multiplex assays. The ratios of proinflammatory and anti-inflammatory cytokines were calculated. Impression cytology was performed on the conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. Differences in variables by CL replacement schedules and the associations between variables were analyzed. Reusable CL wearers had higher concentrations (in pg/mL) of IL-1β (26 ± 7 vs. 16 ± 11), IL-6 (42 ± 14 vs. 25 ± 20), IL-10 (83 ± 23 vs. 49 ± 36), IL-12(p70) (145 ± 44 vs. 91 ± 68), IL-17A (93 ± 26 vs. 54 ± 44), and tumor necrosis factor α (312 [171 to 468] vs. 189 [6 to 447]) (all P .01) and greater conjunctival metaplasia in the region covered by CLs (0.7 [0.2 to 1.6] vs. 0.4 [0.04 to 1.2], P = .01) compared with DD wearers. There was a positive association between CL discomfort and ratios of IL-1β to IL-10 and IL-12(p70) to IL-10 (ρ = 0.42 and ρ = 0.33, P .05). Higher ocular inflammatory responses, as indicated by higher tear cytokine concentrations and higher conjunctival epithelial metaplasia, were found in reusable CL wearers than in DD CL wearers. The balance of proinflammatory and anti-inflammatory cytokines may be helpful to assess the inflammatory status of the eye.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Informa UK Limited
Date: 03-09-2019
Publisher: Informa UK Limited
Date: 26-03-2021
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: Informa UK Limited
Date: 2014
DOI: 10.1111/CXO.12066
Abstract: Work-related physical discomfort has been reported in Australian optometrists. The purpose of this paper is to explore the personal consequences of work-related discomfort. Forty-seven optometrists with self-reported work-related discomfort participated in a 30-minute telephone or face-to-face interview related to ergonomics and physical comfort. Self-employed, employee, locum and retired optometrists participated. Four avenues were investigated namely, description of discomfort, non-work contributing factors, whether the participant has ever stopped work due to discomfort, and the treatments accessed to alleviate discomfort. These data were subject to qualitative and quantitative analyses. Reported discomfort ranged from mild to severe. Eight participants (17 per cent) ascribed their discomfort entirely to work and seven (15 per cent) cited non-work factors as the cause. Many participants (32, 68 per cent) reported that non-work factors, for ex le, sport and driving, aggravated existing work-related discomfort and for some, their discomfort impacted on home and leisure activities. There were 15 participants (32 per cent), who have stopped work because of discomfort, including two who have ceased working as an optometrist and two who now work reduced hours. The majority (32) continue to work despite discomfort. Many participants (31, 66 per cent) seek treatment to alleviate discomfort, with seven participants (15 per cent) reporting that they receive multiple therapies per week. Work-related discomfort was generally viewed as a personal issue, with most participants accessing treatment in their own time (27, 57 per cent) and funding it personally or with private health insurance. Only four participants have received funding through workers' compensation or income protection insurance. Work-related discomfort has significant financial and personal costs for some Australian optometrists. These qualitative data can be used to develop quantitative tools for assessing the impact of discomfort on quality of life for optometrists and their families. The results also highlight the need for preventative action to reduce work-related discomfort within the optometric profession.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 15-07-2011
DOI: 10.1167/IOVS.10-6785
Abstract: Lens case hygiene is important for safe contact lens wear. However, there are no evidence-based data to suggest optimum hygiene regimens. This in vitro study aimed to evaluate and compare the effectiveness of manufacturers' guidelines and several other regimens in removing biofilm using various types of contact lens cases and disinfecting agents. Biofilms of Staphylococcus aureus ATCC 6538 and Pseudomonas aeruginosa 122 were formed on two types of unused contact lens cases. Subsequently, each contact lens case was subjected to one of four cleaning regimens using two different multipurpose disinfecting solutions or distilled water: "rinse and air-dry (guidelines)," "rub, rinse and air-dry," "tissue-wipe and air-dry," and "rub, rinse, tissue-wipe, and air-dry." The levels of residual biofilm were then quantified using viable counts and compared. The manufacturers' guidelines resulted in 1 to 2 log CFU reduction of either biofilm. "Rub, rinse, tissue-wipe, and air-dry" was the most effective cleaning regimen (P < 0.001), capable of removing 4 to 6 log CFUs of bacteria higher levels of biofilm were removed by mechanical friction from nonridged cases than that of ridged cases (P < 0.001). Biofilm removal varied with multipurpose solution tested. Current manufacturers' guidelines are not adequate in eliminating microbial contamination. Simply incorporating a rubbing/wiping step in daily case hygiene reduces viable organism recovery. Factors such as the cleaning regimen, antimicrobial potency of multipurpose solution, and the interior topography of a lens case may impact the surface detachment of biofilm during the cleaning process.
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: 28-02-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
DOI: 10.1097/OPX.0000000000000947
Abstract: To establish the effect of lipid supplements on tear lipid biochemistry and their influence on lens wear comfort in habitual lens wearers. Forty habitual soft contact lens wearers were recruited to a double-masked, randomized crossover trial. An emulsion drop containing phosphatidylglycerol (Systane Balance Alcon) and a liposomal spray containing phosphatidylcholine (Tears again BioRevive) along with saline placebos were used three times a day for 14 days with 48 hours of washout between each intervention. The Contact Lens Dry Eye Questionnaire categorized participants into symptomatic and asymptomatic wearers. Ocular comfort was measured using the Ocular Comfort Index. Basal tears (15 μl from each eye) were collected with lenses in situ and assayed for the concentration and activity of phospholipase (sPLA 2 ) and the concentration of a malondialdehyde (MDA). Electrospray ionization mass spectrometry characterized the tear lipidome. Neither of the lipid supplements improved lens wear comfort compared to baseline. The spray treatment did not affect the concentration of the majority of lipid classes either at day 1 or at day 14. Both the lipid and placebo drops resulted in increased concentration of several lipid classes after day 1 of use, but by day 14, the concentration of most of the lipid classes had returned to baseline levels. With the lipid spray, sPLA 2 activity (0.38 ± 0.2 vs. 0.73 ± 0.6 mmol/min/ml, p = 0.03) and lysophosphatidylethanolamine (LPE) (1.3 ± 0.5 vs. 2.7 ± 0.07 pmol/μl, p = 0.02) were higher in the symptomatic group compared to asymptomatic group at day 1 but not at day 14. The lipid drop resulted in increased LPE concentration in symptomatic wearers at day 1 (1.7 ± 0.3 vs. 2.4 ± 0.3 pmol/μl, p = 0.01) and at day 14 (1.7 ± 0.4 vs. 2.5 ± 0.5 pmol/μl, p = 0.04). Ocular comfort was inversely proportional to the level (r = -0.21, p = 0.007) and activity of sPLA 2 (r = -0.20, p = 0.01). There was an association between sPLA 2 and LPC (r = 0.41, p 0.001) and LPE (r = 0.40, p = 0.001), and a negative association with ( O -acyl)-ω-hydroxy fatty acids (OAHFAs) (r = -0.30, p = 0.03) in tears. Contact lens wear comfort was associated with sPLA 2 concentration and activity in tears. Lipid biochemistry was transiently influenced by exogenous supplements. Although the specific supplement formulations tested did not differ from placebo in this study, the results do suggest a potential role for lysophospholipids and OAHFAs in modulating symptoms during contact lens wear.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
DOI: 10.1097/OPX.0000000000001110
Abstract: The concentration of selected proteins and inflammatory mediators in tears of symptomatic and asymptomatic contact lens wearers were quantified. The level of leukotriene B4 was higher in the symptomatic group. This may suggest that inflammation can be the cause of discomfort sensation at the end of day. The present study aims to quantify the concentration of selected tear lipids and proteins in symptomatic and asymptomatic contact lens wearers. Unstimulated evening tears were collected using glass capillary tubes from 45 healthy, adapted contact lens wearers. Twenty-two had self-described symptoms of dryness and discomfort with contact lenses and 23 were asymptomatic. Tear proteins were assayed using selected reaction monitoring mass spectrometry. Enzyme immunoassay kits were used to measure prostaglandins, leukotriene B4, and cysteinyl leukotrienes. Ocular comfort was rated on a scale of 1 to 100 at the time of tear collection. The average evening comfort level was above 70 for the asymptomatic (83.96 ± 9.51, mean ± SE) and equal or below 70 for the symptomatic group (57.28 ± 12.38) ( P .001). LTB 4 was significantly higher in symptomatic than asymptomatic contact lens wearers (0.32 ± 0.06 ng/mL vs. 0.17 ± 0.04 ng/mL, respectively P = .03). Lysozyme was slightly but not significantly lower in symptomatic subjects (symptomatic 0.58 ± 0.10 mg/mL vs. asymptomatic 1.73 ± 0.46 mg/mL P = .10). The levels of lactoferrin, lipocalin 1, proline-rich 4, prolactin-induced protein, prostaglandins, and cysteinyl leukotrienes were unchanged ( P .1) between symptomatic and asymptomatic subjects. The LTB 4 concentration was significantly higher in symptomatic contact lens wearers compared to the asymptomatic group, and this may partly mediate the discomfort response during lens wear in the symptomatic lens wearers. No other differences were found in the level of tear factors of interest between the two groups.
Publisher: Elsevier BV
Date: 06-2021
Publisher: MDPI AG
Date: 14-09-2020
DOI: 10.3390/ANTIBIOTICS9090600
Abstract: This study investigated genomic differences in Australian and Indian Pseudomonas aeruginosa isolates from keratitis (infection of the cornea). Overall, the Indian isolates were resistant to more antibiotics, with some of those isolates being multi-drug resistant. Acquired genes were related to resistance to fluoroquinolones, aminoglycosides, beta-lactams, macrolides, sulphonamides, and tetracycline and were more frequent in Indian (96%) than in Australian (35%) isolates (p = 0.02). Indian isolates had large numbers of gene variations (median 50,006, IQR = 26,967–50,600) compared to Australian isolates (median 26,317, IQR = 25,681–33,780). There were a larger number of mutations in the mutL and uvrD genes associated with the mismatch repair (MMR) system in Indian isolates, which may result in strains losing their efficacy for DNA repair. The number of gene variations were greater in isolates carrying MMR system genes or exoU. In the phylogenetic ision, the number of core genes were similar in both groups, but Indian isolates had larger numbers of pan genes (median 6518, IQR = 6040–6935). Clones related to three different sequence types—ST308, ST316, and ST491—were found among Indian isolates. Only one clone, ST233, containing two strains was present in Australian isolates. The most striking differences between Australian and Indian isolates were carriage of exoU (that encodes a cytolytic phospholipase) in Indian isolates and exoS (that encodes for GTPase activator activity) in Australian isolates, large number of acquired resistance genes, greater changes to MMR genes, and a larger pan genome as well as increased overall genetic variation in the Indian isolates.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 18-10-2013
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.CLAE.2010.01.001
Abstract: To determine whether hypo-osmotic saline drops can improve contact lens associated discomfort and dryness by decreasing contact lens osmolality. Fifteen symptomatic subjects wore Lotrafilcon A lenses bilaterally for 6h on two different days. According to randomisation, hypo-osmotic (280mmol/kg) or hyper-osmotic (380mmol/kg) saline drops were applied four times during each day and ocular symptoms, tear film and contact lens parameters, and contact lens osmolality were assessed. Sixty percent of the subjects preferred the hypo-osmotic saline drops, compared to 33%, who preferred the hyper-osmotic ones. Subjects experienced significantly less dryness and lens awareness with hypo-osmotic saline drops compared to hyper-osmotic ones (p 0.05). Interestingly, the difference in contact lens osmolality between drops did not reflect the osmolality difference between the two saline drops. Hypo-osmotic saline drops were preferred by a greater number of subjects and contact lens osmolality tended to be lower with the use of hypo-osmotic saline. Hypo-osmotic drops have the potential to decrease contact lens osmolality which in turn may help improve ocular comfort. This has possible impact on the practitioners' choice of the lens rewetting drop recommended and the design of future lens rewetting drops.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Wiley
Date: 10-10-2018
DOI: 10.1111/CEO.13057
Abstract: Referral letters constitute the first step on the pathway to cataract surgery however, little is known on how effective referral letters are in providing adequate information to triage patients and inform surgical prioritization. Benchmarking exercises are important to document referral processes and to identify areas where improvements can be made. Cross-sectional study with longitudinal follow-up conducted at two metropolitan public hospitals in New South Wales, Australia. A total of 400 sequential cataract referral letters. An audit of cataract referral letters was performed and content benchmarked against international prioritization tools. Medical records were reviewed 1 year following referral. Referral quality and waiting times. Two-thirds of patients referred for cataract surgery were yet to have their initial hospital appointment in the year following referral (65%, 245/376). One half of referrals seen in clinic (49%, 64/113) were not listed for cataract surgery. Multivariate analysis revealed referral letter content was not indicative of surgical booking, with the major predictors being hospital-recorded visual acuity and grading of cataract (P < 0.0001). Referral content lacked sufficient detail to apply prioritization tools developed in other settings. This audit highlights a disconnect between referral letter content and hospital assessment of patients. Current referrals to public hospitals are poorly targeted, with high numbers of referred patients not proceeding to surgery. Patients commonly waited over 1 year to have their ophthalmic assessment at these public hospital eye clinics, revealing lengthy 'wait-for-waits' as a barrier to care. Standardized referral templates may facilitate improvement of referral pathways and shorten waiting times.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2009
DOI: 10.1038/EYE.2009.115
Abstract: To assess pre-operative visual function, psychological factors, personality traits and satisfaction in myopic patients seeking laser-assisted in situ keratomileusis (LASIK). Eligible patients seeking LASIK (n=183) and successful contact lens wearers (n=23) not interested in LASIK completed the Institute for Eye Research Quality of Life (QOL) Scale. Of the 183 patients seeking LASIK who completed the QOL instrument before LASIK, 30 declined the procedure and 153 underwent LASIK. One hundred and two patients who underwent LASIK attended their 3-month post-operative follow-up appointment and 51 patients failed to present for their post-operative follow-up appointment. Multiple comparisons (One-way Analysis of Variance (ANOVA)) were conducted to determine differences in visual function, psychological factors, personality traits and satisfaction between patient groups. Successful soft contact lens (SCL) wearers reported better functional vision (P=0.001), felt more attractive (P=0.007), had a lower frequency of disturbing visual and ocular symptoms (P=0.027) and higher overall satisfaction with their current optical correction (P<0.001) than patients seeking LASIK. LASIK patients lost to follow-up showed higher self-efficacy, adaptability and well-being than the patients who completed their appointments and those who declined surgery (P<0.05). Psychological characteristics, the perception of visual and ocular symptoms and satisfaction with the current method of optical correction play an important role in the decision to undergo LASIK. The IER QOL Scale is a valid and reliable instrument able to discriminate between different groups seeking choices for myopic correction. Psychological factors may influence the level of satisfaction with LASIK.
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: 09-2007
DOI: 10.1016/J.AJO.2007.05.010
Abstract: To assess the effects of refraction and axial length on optical coherence tomography (OCT) measures of childhood optic disk parameters. Population-based cross-sectional study. Of 4,118 children examined in the Sydney Myopia Study (Sydney Childhood Eye Study) from 34 randomly selected primary schools and 21 secondary schools from 2003 through 2005, 3,529 (85.7%) were included in the analysis (1,395 6-year-old children [year 1 students] and 2,134 12-year-old children [year 7 students]). Comprehensive standardized eye examinations included best-corrected visual acuity, cycloplegic autorefraction, biometry measurements, and fast optic disk scans using OCT. After adjusting for magnification, the mean optic disk area was positively associated with axial length (P(trend) < .0001, both age groups) but was not associated consistently with spherical equivalent refraction (SER). Optic disk parameters in childhood are influenced by axial length, but not by refractive error itself.
Publisher: Informa UK Limited
Date: 03-2020
DOI: 10.1111/CXO.12928
Abstract: Previous research has shown that cataract surgery referral letters to major metropolitan public hospitals in New South Wales have insufficient detail to inform patient triage or apply prioritisation tools. This study aimed to canvass the views of optometrists working in New South Wales and the Australian Capital Territory (NSW/ACT) on standardising the referral process for public hospital cataract surgery. An online survey was sent to all NSW/ACT members of Optometry Australia in October 2017. Respondents were asked to select clinical and personal information to be included on a referral template using a list of 25 items. Data were also gathered on preferences for the cataract referral process and sources of cataract referral guidelines. Two hundred and thirteen (response rate 13 per cent) optometrists completed the survey. There was close to universal support for inclusion of items like visual acuity (99 per cent), whereas other items had low support, including the date and details of previous refraction (26 per cent), history of falls (29 per cent) and health insurance status (29 per cent). Three-quarters of optometrists stated they would be willing to administer and report data from a patient survey about the functional impact of their cataract and level of visual disability. The preferred format of a standardised cataract referral template varied, although time efficiency and ease of completion were commonly cited reasons for preferences. Confirmation of receipt of referral from the public hospital, and a copy of the referral letter for the optometrist's records were also desirable. For the 61 per cent of respondents who reported accessing guidelines for cataract referral, 69 per cent stated the main source was Optometry NSW/ACT with fewer accessing guidelines directly from a public hospital or the NSW Health website. Optometrists' preferences will be useful to inform the design and implementation of a standardised cataract referral template.
Publisher: Wiley
Date: 09-01-2020
DOI: 10.1111/OPO.12663
Abstract: To compare the risk of vision loss following contemporary laser‐assisted in situ keratomileusis (LASIK) with different types and modality of use of contact lenses. Data from a previously published study were used to derive the incidence of vision loss (≥ 2 line loss of best corrected spectacle acuity) following microbial keratitis for different contact lens types and wearing modality, stratified by duration of lens wear. A literature search on vision loss following LASIK was performed between 2003 and 2019. The prevalence of vision loss at six months post‐surgery was captured from clinical trials published after 2003. A proportion meta‐analysis was applied to derive the prevalence of vision loss following LASIK. A least‐squares fitting of cumulative vision loss (P, /10 000 wearers) over time ( t , years) using an exponential model estimated the years of contact lens wear to which the risk of vision loss with LASIK was equivalent. Vision loss following LASIK occurred in 66 (95% confidence interval [CI] 34–108) per 10 000 wearers. As a conservative estimate based on the lower confidence interval of the estimated equivalent years of contact lens wear, daily wear contact lenses and extended overnight silicone wear hydrogel contact lens need to be worn for 103 (95% [CI] 103–391) and 25 (95% [CI] 25‐79) years respectively, to equal the rate of vision loss equivalent to a one‐off LASIK procedure. The risk of vision loss to the in idual is low with either contact lens wear or refractive surgery. Contact lens wear does not pose a higher risk of vision loss than LASIK surgery for the most common wear modalities.
Publisher: Elsevier BV
Date: 2013
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 18-10-2013
Publisher: MDPI AG
Date: 27-07-2022
DOI: 10.3390/ANTIBIOTICS11081011
Abstract: Staphylococcus aureus is a major cause of ocular infectious (corneal infection or microbial keratitis (MK) and conjunctivitis) and non-infectious corneal infiltrative events (niCIE). Despite the significant morbidity associated with these conditions, there is very little data about specific virulence factors associated with the pathogenicity of ocular isolates. A set of 25 S. aureus infectious and niCIEs strains isolated from USA and Australia were selected for whole genome sequencing. Sequence types and clonal complexes of S. aureus strains were identified by using multi-locus sequence type (MLST). The presence or absence of 128 virulence genes was determined by using the virulence finder database (VFDB). Differences between infectious (MK + conjunctivitis) and niCIE isolates from USA and Australia for possession of virulence genes were assessed using the chi-square test. The most common sequence types found among ocular isolates were ST5, ST8 while the clonal complexes were CC30 and CC1. Virulence genes involved in adhesion (ebh, clfA, clfB, cna, sdrD, sdrE), immune evasion (chp, esaD, esaE, esxB, esxC, esxD), and serine protease enzymes (splA, splD, splE, splF) were more commonly observed in infectious strains (MK + conjunctivitis) than niCIE strains (p = 0.004). Toxin genes were present in half of infectious (49%, 25/51) and niCIE (51%, 26/51) strains. USA infectious isolates were significantly more likely to possess splC, yent1, set9, set11, set36, set38, set40, lukF-PV, and lukS-PV (p 0.05) than Australian infectious isolates. MK USA strains were more likely to possesses yent1, set9, set11 than USA conjunctivitis strains (p = 0.04). Conversely USA conjunctivitis strains were more likely to possess set36 set38, set40, lukF-PV, lukS-PV (p = 0.03) than MK USA strains. The ocular strain set was then compared to 10 fully sequenced non-ocular S. aureus strains to identify differences between ocular and non-ocular isolates. Ocular isolates were significantly more likely to possess cna (p = 0.03), icaR (p = 0.01), sea (p = 0.001), set16 (p = 0.01), and set19 (p = 0.03). In contrast non-ocular isolates were more likely to possess icaD (p = 0.007), lukF-PV, lukS-PV (p = 0.01), selq (p = 0.01), set30 (p = 0.01), set32 (p = 0.02), and set36 (p = 0.02). The clones ST5, ST8, CC30, and CC1 among ocular isolates generally reflect circulating non-ocular pathogenic S. aureus strains. The higher rates of genes in infectious and ocular isolates suggest a potential role of these virulence factors in ocular diseases.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Wiley
Date: 10-11-2014
DOI: 10.1111/OPO.12096
Abstract: To calibrate and validate a commercially available dermatology instrument to measure tear evaporation rate of contact lens wearers. A dermatology instrument was modified by attaching a swim goggle cup such that the cup sealed around the eye socket. Results for the unmodified instrument are dependent on probe area and enclosed volume. Calibration curves were established using a model eye, to account for in idual variations in chamber volume and exposed area. Fifteen participants were recruited and the study included a contact lens wear and a no contact lens wear stage. Day and diurnal variation of the measurements were assessed by taking the measurement three times a day over 2 days. The coefficient of repeatability of the measurement was calculated and a linear mixed model assessed the influence of humidity, temperature, contact lens wear, day and diurnal variations on tear evaporation rate. The associations between variables were assessed using Pearson correlation coefficient. Absolute evaporation rates with and without contact lens wear were calculated based on the new calibration. The measurements were most repeatable during the evening with no lens wear (COR = 49 g m⁻² h) and least repeatable during the evening with contact lens wear (COR = 93 g m⁻² h). Humidity (p = 0.007), and contact lens wear (p < 0.01), significantly affected the tear evaporation rate. However, temperature (p = 0.54) diurnal variation (p = 0.85) and different days (p = 0.65) had no significant effect after controlling for humidity. Tear evaporation rates can be measured using a modified dermatology instrument. Measurements were higher and more variable with lens wear consistent with previous literature. Control of environmental conditions is important as a higher humidity results in a reduced evaporation rate.
Publisher: Informa UK Limited
Date: 26-11-2019
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JTOS.2019.06.005
Abstract: Women are more prone to ocular surface symptoms and circulating estrogen levels have been implicated. Fluctuations in estrogen during the menstrual cycle may influence ocular symptoms but existing research is incomplete and conflicting, partly due to paucity of validated questionnaires to assess daily ocular symptoms. This study aimed to evaluate daily fluctuations in ocular symptoms across a complete menstrual cycle and to compare symptoms in normally menstruating women and women using the combined oral contraceptive pill (OCP). To do this, a short online tool to assess daily symptoms was developed. 36 normally menstruating women and 36 women using the combined OCP were recruited. A two-item questionnaire, the Instant Ocular Symptoms Survey (IOSS) was developed and administered on a smartphone platform every day for 40 days. Linear mixed model analysis was used to examine differences in symptom scores over time and between groups. The IOSS was found to be effective for measuring instantaneous symptoms, exhibiting good diagnostic abilities and repeatability. (AUC ± SE = 0.80 ± 0.07 and ICC = 0.75). Daily ocular symptoms showed a cyclic fluctuation across the cycle (p = 0.004) and highest symptoms were recorded on day 2 of the cycle when estrogen levels are lowest. Symptom scores were significantly higher in the OCP group (p = 0.02). Effects of menstrual phase and OCP use should be considered in the interpretation of ocular symptoms in clinical practice. These findings enhance the current understandings of ocular surface and systemic pain during menstrual cycle.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Publisher: Elsevier
Date: 2019
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.CLAE.2019.06.007
Abstract: Exploratory analysis to assess the association of single nucleotide polymorphisms (SNPs) in the interleukin (IL) 10 and IL-17 genes with severity of contact lens keratitis. This was a retrospective case control study of 88 contact lens keratitis cases (25 severe) and 185 healthy contact lens wearers recruited from studies conducted at Moorfields Eye Hospital and in Australia-wide during 2003-2005. Buccal swab s les were collected on Whatman FTA cards and mailed by post for DNA extraction and SNP genotyping. IL-10 (rs1800871 rs1800896 rs1800872) and IL-17 (rs1800871 rs1800896 rs1800872) SNPs were screened by pyrosequencing. Genetic association analyses were performed via Cochran-Armitage trend tests and logistic regression models using PLINK software. None of the SNPs tested showed evidence of association with severity of contact lens keratitis at P < 0.05. Nevertheless, minor allele G in SNP rs2397084 of the IL-17F gene was associated with increased risk of severe MK, with OR=2.1 (95% CI=0.9-4.8, P = 0.066). Our study cannot exclude with confidence that genetic variation in the IL-17 F proinflammatory cytokine is associated with more severe outcomes of MK. However, there is general body of information that the IL-17 pathway is important in the mechanisms of MK. Studies with larger power and the expanded array of laboratory tools will elucidate the exact role of IL-17 in MK.
Publisher: BMJ
Date: 21-02-2020
DOI: 10.1136/BJOPHTHALMOL-2019-315440
Abstract: To evaluate the effects of 0.01% and 0.02% atropine eye drops on myopia progression, pupil diameter and accommodative litude in myopic children. A cohort study assessed 400 myopic children ided into three groups: 138 and 142 children were randomised to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine eye drop applied to both eyes once nightly. Control children (n=120) only wore SV spectacles. Repeated measurements of spherical equivalent refractive errors (SERs), axial length (AL), pupil diameter and accommodative litude were performed at baseline, and 4, 8 and 12 months after treatment. After 12 months, the SER change was −0.38±0.35D, −0.47±0.45D, −0.70±0.60D and AL change was 0.30±0.21 mm, 0.37±0.22 mm, 0.46±0.35 mm in the 0.02%, 0.01% atropine and control groups, respectively. There were significant differences in the change in AL and SER between three groups (all p .001). Between baseline and the 12-month visit, the overall change in accommodative litude was 1.50±0.25D, 1.61±0.31D and change in pupil diameter was 0.78±0.42 mm, 0.69±0.39 mm, with 0.02% and 0.01% atropine, respectively. Accommodative litude significantly decreased and pupil diameter significantly increased in two atropine groups (all p .001). Moreover, there was no statistical difference in the change difference in accommodative litude and pupil diameter between two atropine groups (p=0.24, p=0.38), whereas the accommodative litude (p=0.45) and pupil diameter (p=0.39) in the control group remained stable. 0.02% atropine eye drops had a better effect on myopia progression than 0.01% atropine, but 0.02% and 0.01% atropine showed similar effects on pupil diameter and accommodative litude after 12 months of treatment. ChiCTR-IPD-16008844.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.JTOS.2019.10.008
Abstract: Aromatase inhibitors (AIs) limit the synthesis of oestrogen in peripheral tissues thus lowering levels of oestrogen. The primary aim was to evaluate whether women treated with AIs have altered dry eye symptoms and signs. A sub-aim was to investigate whether symptoms of dry eye in postmenopausal women were associated with symptoms of non-eye pain, ocular pain and self-rated pain perception. This cross-sectional, observational, single visit study recruited 56 postmenopausal women (mean age 64.1 + 7.9 years) and 52 undergoing AI treatment (mean age 66.6 + 9.0). Ocular symptoms (OSDI, MGD14) and pain questionnaires (PSQ, OPAS) were administered and signs of dry eye and meibomian gland dysfunction were evaluated. Almost half of each group reported dry eye symptoms, defined as OSDI>12 (48% control, 46% AI). The PSQ score was significantly higher in the AI group (p = 0.04). Neither frequency or severity of dry eye (or MGD) symptoms scores were significantly different between groups. In the AI group, meibomian gland expressibility score was worse (p = 0.003) there were no differences in any other signs. Higher OSDI scores were associated with higher OPAS eye-pain scores (r = 0.49, p < 0.001), but not OPAS non-eye pain (r = 0.09, p = 0.35). Pain perception (PSQ) showed a moderate positive association with OPAS eye-pain (r = 0.30, p = 0.003). In this study elevated ocular symptoms were observed in both the AI treated and the untreated groups, with no difference between the groups. Women undergoing AI treatment for early stage breast cancer had worse meibum expressibility score and increased pain perception compared to an untreated group of women.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 05-12-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-10-2018
Publisher: Elsevier BV
Date: 08-2020
DOI: 10.1016/J.CLAE.2019.11.004
Abstract: This study investigated the efficacy of pre-conditioning lens cases on bacterial biofilm formation and removal. Silver impregnated (MicroBlock / ProGuard™ & i-Clean) and control storage cases were pre-conditioned for 24 h with their respective multipurpose solutions (MPDSs). Cases were then inoculated with 2 ml of 10 Pre-conditioning the MicroBlock / ProGuard™ cases with MPDS significantly reduced biofilm formation (-1.1 log Pre-conditioning of silver-impregnated ProGuard™ lens cases inhibited initial bacterial biofilm formation. Synergi MPDS was more effective than AQuify MPDS in removing bacterial biofilm in silver impregnated cases and tissue-wiping significantly improved biofilm removal.
Publisher: Informa UK Limited
Date: 30-07-2013
DOI: 10.3109/02713683.2013.811259
Abstract: Using an in vitro cell culture model, bovine lactoferrin (BLF) stimulates healing of alkali-induced human corneal epithelial wounds. The present study examined the efficacy of BLF in promoting healing of corneal injury in vivo and explored BLF modulation of interleukin-1 (IL-1) during wound healing. Alkali injury was induced to BALB/c mice by exposure of the mouse cornea to a sodium hydroxide (NaOH)-soaked filter disc for 2 min. The corneal surface was irrigated after the injury with saline. Topical BLF in phosphate buffered saline (PBS) (10 µl, 62.5 μM), bovine serum albumin (BSA) (10 µl, 62.5 μM in PBS) or PBS only (10 µl) were applied three times daily to both the alkali-injured and uninjured eyes for 3 d. Wound healing was assessed using 0.1% fluorescein staining under slit l microscope. The corneas at 6 h, 24 h or 3 d post-injury and treatment were excised and examined histologically, homogenized corneal tissue was evaluated for expression of IL-1α and IL-1β. After 6 h post-wounding and treatment no significant reduction of wound area was observed between treatments and infiltrating cells or IL-1 expression were not elevated in any group. By 24 h, BLF-treatment resulted in accelerated wound closure (100%) compared to PBS and BSA treatment (70% and 65%, respectively). BLF treatment reduced infiltrating cells compared to controls and no elevation of IL-1, whereas controls displayed elevated infiltrating cells and increased levels of IL-1. After 3 d, mice treated with BLF exhibited complete wound closure while control corneas still exhibited some minor defects. Resolution of inflammation with minimal remaining infiltrating cells was observed in all corneas by day 3, coincident to normal levels of IL-1α and IL-1β. BLF accelerated healing of corneal alkali injury in BALB/c mice which was associated with suppression of IL-1 and reduced infiltrating cells.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 10-2006
DOI: 10.1167/IOVS.06-0564
Abstract: To examine factors influencing the severity of soft contact lens (SCL)-related microbial keratitis. Cases were detected via surveillance studies in Australia and New Zealand. Factors affecting disease severity (costs, days of symptoms, and 2 or more lines of vision loss) were examined and included age gender delay in SCL removal, seeking consultation, or receiving treatment overnight wear SCL material (hydrogel or silicone hydrogel [SiH]) and causative organism. Two hundred ninety-seven cases were identified: 61% female, age: 35 +/- 13 years (mean +/- SD). Treatment costs were (median [interquartile range]) $760 [1859] and indirect costs were $468 [1810]. Patients were symptomatic for 7 [11] days, and vision loss occurred in 14.3% of cases. Cases with pathogenic causative organisms (66/297, 22%) were 11.4 times (95% confidence interval [CI], 4.2-30.9) more likely to result in vision loss, had longer duration of symptoms (21 [40] vs. 6 [8] days, P < 0.001) and incurred higher costs (5,512 [14,733] vs. 1,048[8,325], P 12 hours) before treatment increased the likelihood of vision loss (P = 0.048) disease duration (P = 0.004), and associated costs (P = 0.009). Remoteness increased the risk of vision loss (odds ratio [OR] = 5.1 95% CI 1.6-16.6), and in iduals over 28 years of age had longer disease duration (P = 0.02). In overnight wear and after adjustment for culture result and treatment delays, SiH wearers had slightly shorter disease duration (4 [4] vs. 7 [10] days, P = 0.02) but a rate of vision loss and cost similar to those of hydrogel wearers. The causative organism was the major determinant of severity however, modifiable factors such as delays in treatment had considerable influence. Duration of symptoms was shorter in SiH wearers, but other factors dominated disease outcome in this population study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-2019
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 18-10-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
Publisher: OSA
Date: 2018
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.OPHTHA.2008.05.003
Abstract: To assess the relative risks (RR) of microbial keratitis (MK) for contemporary contact lens (CL) types and wearing schedules. A 2-year prospective case-control study begun in December 2003. Cases were 367 CL wearers attending Moorfields Eye Hospital with proven or presumed MK. Controls were 1069 hospital controls, who were CL wearers with a disorder unrelated to CL wear, and 639 population-based controls who were CL wearers randomly selected from the Moorfields catchment area. Hospital patients completed a self-administered questionnaire population-based controls were interviewed by telephone. Multivariate analysis was done both for all cases of MK, and for the moderate and severe MK subgroups alone. The RR for developing MK, and vision loss, for all lens types compared with planned replacement soft lenses (the referent). Compared with planned replacement soft lenses (the referent), the RR of MK was significantly increased with daily disposable (DD) CLs (RR, 1.56x [95% confidence interval (CI), 1.1-2.1] P = 0.009) and differed between different brands of DD lens, was reduced for rigid lenses (RR, 0.16x [95% CI, 0.06-0.4] P or=20/40. The RR for overnight wear, for any lens type, was 5.4 times higher (95% CI, 3.3-10.9 P<0.001). Comparison of the DD soft CL types with planned replacement soft lenses (the referent), showed significant differences between brands for the risk of MK. The risk of MK has not been reduced in users of DD and silicone hydrogel CLs. However, vision loss is less likely to occur in DD than in reusable soft CL users. Different brands of CL may be associated with significantly different risks of keratitis understanding these differences should lead to the development of safer soft lenses. These findings suggest that lens/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination.
Publisher: Elsevier BV
Date: 04-2023
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: Springer Science and Business Media LLC
Date: 07-2011
DOI: 10.1038/EYE.2011.151
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
DOI: 10.1016/J.JCRS.2017.07.029
Abstract: To clarify the effect of first-eye cataract surgery on the incidence of falls and identify components of visual function associated with fall risk. Eight public hospital eye clinics in Sydney, Melbourne, and Perth, Australia. Prospective cohort study. The study recruited patients who had bilateral cataract, were aged 65 years or older, and were on public hospital cataract surgery waiting lists. Comprehensive assessments of vision, physical function, and exercise activity were performed before and after first-eye cataract surgery. Falls were reported prospectively for up to 2 years and associations with falls were assessed using generalized linear mixed models. Of the 329 patients recruited, 196 (66.6%) completed first-eye surgery within the study period. First-eye cataract surgery reduced incident falls by 33% (adjusted incidence rate ratio 0.67 95% confidence interval [CI], 0.49-0.92 P = .01). Poorer dominant-eye visual acuity was associated with falls during the study timeline (incidence rate ratio, 2.20 95% CI, 1.02-4.74 P = .04). Patients with larger than a spherical equivalent of ±0.75 diopter change in the spectacle lens (operated eye) had a 2-fold greater incidence of falls in the period after first-eye cataract surgery than those with less or no change in lens power (incidence rate ratio, 2.17 95% CI, 1.23-3.85 P = .008). First-eye cataract surgery significantly reduced incident falls. Major changes in the dioptric power of spectacle correction of the operated eye after surgery increased the fall risk. Cautious postoperative refractive management is important to maximize the benefit of cataract surgery as a fall-prevention measure.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
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: Informa UK Limited
Date: 07-2014
DOI: 10.1111/CXO.12147
Abstract: The greater prevalence of dry eye in women compared to men suggests that sex hormones may have a role in this condition. This review aims to present evidence for how sex hormones may affect the ocular structures involved in the production, regulation and maintenance of the normal tear film. It is hypothesised that hormone changes alter the homeostasis of the ocular surface and contribute to dry eye. Androgens impact on the structure and function of the meibomian and lacrimal glands and therefore androgen deficiency is, at least in part, associated with the aetiology of dry eye. In contrast, reports of the effects of oestrogen and progesterone on these ocular structures and on the conjunctiva are contradictory and the mechanisms of action of these female-specific sex hormones in the eye are not well understood. The uncertainty of the effects of oestrogen and progesterone on dry eye symptoms is reflected in the controversial relationship between hormone replacement therapy and the signs and symptoms of dry eye. Current understanding of sex hormone influences on the immune system suggests that oestrogen may modulate a cascade of inflammatory events, which underlie dry eye.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 26-03-2012
DOI: 10.1167/IOVS.11-8197
Abstract: To evaluate microbial contamination in silver-impregnated contact lens (CL) storage cases while establishing the effect of "wet " and "dry " case maintenance and to determine its association with clinical signs, symptoms, and compliance. Two noncontemporaneous prospective studies were conducted. Regular storage cases in study 1 (n = 40) and silver-impregnated cases in study 2 (n = 41) were used in conjunction with CL solution and CLs (balafilcon A). Cases were replaced monthly and collected at 1, 3, and 4 (for silver-impregnated cases only) months. Regular cases and the fourth-month silver-impregnated cases were maintained dry, and the other cases were maintained wet between uses. At collection, storage cases were s led and cultured for microbial identification and enumeration. Ocular clinical findings, subjective responses to CL wear, and compliance were recorded at each visit. The percentages of microbial contamination for silver-impregnated and regular cases were 71% and 82% respectively. There were significantly (P < 0.005) fewer organisms in silver-impregnated cases (1.7 log CFU per well) than in regular cases (4.1 log CFU per well). In particular, silver-impregnated cases showed lower levels of Gram-negative bacteria (P = 0.04), Gram-positive bacilli (P = 0.03), and fungi (P = 0.006). Maintaining the silver-impregnated cases wet resulted in a lower percentage of contamination (71% P < 0.01) than maintaining them dry (94%). There was no association between any clinical signs, symptoms, or compliance and microbial contamination of storage cases. More than 70% of the storage cases used in daily wear CL care for a month was contaminated irrespective of the types of cases. However, silver-impregnated cases were colonized by reduced levels of Gram-negative bacteria.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 12-02-2015
DOI: 10.1111/OPO.12197
Abstract: Previous studies confirmed that optometrists have access to and confidence in applying clinical tests recommended for glaucoma assessment. Less is known about factors best predicting compliance with national clinical guidelines and thus by inference, the provision of suitable care by primary care ophthalmic practitioners. We utilised the unique two-tiered profession (therapeutic and non-therapeutic scope of practice) in Australia and New Zealand to assess the prospective adherence to glaucoma guidelines dependent on the clinician's background. Australian and New Zealand optometrists were surveyed on ophthalmic techniques for glaucoma assessment, criteria for the evaluation of the optic nerve head, glaucoma risk categories and review times while also recording background, training, and experience. Parameters identifying progression/conversion and patients' risk levels were analysed comparatively to ophthalmologists' opinions. Linear regression analysis identified variables significantly improving the likelihood of concordance with guidelines. Reported application of techniques complied well with glaucoma guidelines although gonioscopy and pachymetry, pupil dilation for optic nerve head examination, and acquisition of permanent records were less frequently employed. The main predictors for entry-level diagnostic standards were therapeutic endorsement together with the associated knowledge of relevant guidance and procedural confidence. Other findings suggested a potential underestimation in the value of optic disc size and intraocular pressure for the prediction of glaucoma risk, while optometrists more frequently relied on the outcomes of non-standardised automated perimetry and auxiliary imaging. Optometrists in Australia and New Zealand may not always exercise optimal clinical acumen regarding techniques/criteria for glaucoma diagnosis. Therapeutic endorsement was gradually adopted in different jurisdictions in various forms since 1999 and is mandatory for registration since late 2014. The result of the two-tiered optometric cohorts suggest that inclusion of therapeutic training as part of the core training is likely a key factor to enhanced compliance with glaucoma guidelines. Improved adherence to the current clinical standards should positively impact on the facilitation of appropriate glaucoma diagnosis and management. Obligatory knowledge and possibly accreditation of available guidelines might ensure a uniform standard in glaucoma testing protocols in concordance with compulsory entry-level skills.
Publisher: Elsevier BV
Date: 11-2007
DOI: 10.1016/J.AJO.2007.06.037
Abstract: To evaluate associations between disease severity, causative organism, and climatic variation in contact lens-related microbial keratitis in Australia. Prospective, observational case series. Contact lens wearing patients (n = 236) with presumed microbial keratitis presenting to private and hospital ophthalmologists in Australia between October 1, 2003 and September 30, 2004 were identified prospectively. Clinical details, management information, and microbiology data were collected and cases were graded for severity based on lesion size and location criteria. Causative organisms were assigned to "environmental" or "endogenous" groups. Climate zone and daytime temperature and humidity were determined for the geographic location of each event. The main outcome measures were disease severity, causative organism, and climate zone. Severe contact lens-related microbial keratitis was more likely to occur in warmer, humid regions of the country (P < .001), compared with smaller, increasingly peripheral corneal lesions that were more common in cooler conditions (P < .001). Culture-proven keratitis was predominantly caused by environmental organisms with Pseudomonas aeruginosa being recovered most frequently. Environmental organisms were isolated more commonly from tropical regions of the country and also accounted for nearly all cases of vision loss that occurred during the study period. Humidity did not have a significant effect on causative organism. Climatic conditions play a role in disease severity and causative organism in contact lens-related microbial keratitis and therefore have implications for practitioners involved in contact lens care and contact lens wearers who live in or travel to the tropics.
Publisher: BMJ
Date: 05-01-2019
DOI: 10.1136/BJOPHTHALMOL-2018-312881
Abstract: To estimate the incidence of culture-positive microbial keratitis in Queensland and analyse trends in the organisms and their sensitivities cultured from corneal scrapes, especially low-incidence organisms. Retrospective multicentre case series of all positive corneal scrapes in Queensland, Australia between 2005 and 2015. Pathology organisations in Queensland were identified by online and local directory search and agreed to participate. Digital records of scrapes provided patient demographics and culture and susceptibility results. Trends in the incidence, organisms and sensitivities were monitored with linear regression. The yearly incidence of microbial keratitis was estimated from the Queensland population. The included corneal scrapes totalled 3182, while 1006 were excluded. The included scrapes yielded 4111 organisms. Pseudomonas aeruginosa was the most common single isolate (729, 17.7%), although Gram-positive organisms were more common overall (2737, 66.6%). Fungal organisms were cultured in 6% of cases, while Acanthamoeba comprised only 1% of records. Bacterial organisms were sensitive to all recorded antibiotics in 89% of all isolates and none of the reported antibiotics showed a decreasing trend in susceptibility. The incidence of protozoal isolation decreased over time (p=0.055). Cultures positive for yeasts showed a linear increase in incidence (p=0.045) while moulds showed a spike in incidence in 2010–2012 (p=0.0008). The estimated incidence of microbial keratitis was 0.66 cases per 10 000 people, the rate of antibiotic susceptibility is high and stable, the incidence of keratitis secondary to protozoa is likely to be decreasing while the incidence of keratitis culturing yeast is increasing.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
Publisher: Springer Science and Business Media LLC
Date: 02-12-2012
DOI: 10.1038/EYE.2011.288
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.OPHTHA.2008.09.053
Abstract: To assess the relative risks of acute, nonulcerative complications with recently introduced contact lens (CL) wear modalities (compared with the previously most common soft lens wear schedule), and to identify any other associated factors. A 2-year prospective case-control study commencing in December 2003. Cases were 877 CL wearers attending Moorfields Eye Hospital with CL-related disorders other than microbial keratitis. Controls were 1069 hospital controls who were CL wearers presenting with a disorder unrelated to CL wear, and 639 population-based controls who were CL wearers randomly selected from the Moorfields catchment area. Hospital patients completed a self-administered questionnaire population controls were interviewed by telephone. The relative risks of developing the CL-related disorders with different CL types were evaluated. For the more common disorders, multivariable analysis was undertaken. The relative risk of developing an acute, nonulcerative, CL-related disorder. Compared with planned replacement soft CL, daily disposable lenses significantly reduced the risk of toxic/hypersensitivity (odds ratios for CL solution disorders and papillary conjunctivitis 0.1 and 0.5 P<0.001 and P = 0.05, respectively) and metabolic disorders (0.4 P=0.04), but the most commonly used brand was associated with increased risks of sterile keratitis (2.7x 95% confidence interval [CI], 1.7-4.1 P<0.001), mechanical disorders (2.2x 95% CI, 1.5-3.2 P<0.001), and a tendency for patients to have lens removal difficulties (P<0.001). Silicone hydrogel CL wear was free from hypoxic complications but associated with an increased risk of sterile keratitis (2.0x 95% CI, 1.2-3.3 P=0.005), mechanical disorders (1.8x 95% CI, 1.1-2.8 P=0.015), and attendance with any nonulcerative complication (1.9x 95% CI, 1.5-2.6 P<0.001) when compared with other reusable soft lenses. Significant additional risk factors were identified for sterile keratitis (overnight wear [ON], more days per week of lens wear, poor hand hygiene, smoking, and less CL experience) and mechanical disorders (ON and less CL experience). Neither of the 2 recently introduced CL modalities-daily disposable and silicone hydrogel lenses-reduced the overall risk of acute nonulcerative disorders.
Publisher: Informa UK Limited
Date: 09-2013
DOI: 10.1111/CXO.12017
Abstract: There are few publications describing what optometrists like about clinical work. The purpose of this paper is to explore what optometrists in practice find satisfying with their work and what they find stressful. Sixty Australian optometrists participated in a 30-minute semi-structured telephone or face-to-face interview during the period August 2009 to March 2010. The interviews covered a range of topics related to ergonomics and physical comfort, including three questions related to satisfaction with clinical optometry, job satisfaction and self-perceived work-stress. These data were subject to qualitative and quantitative analysis. Participants reported that they liked clinical optometry because of work-related factors (for ex le, clinical challenge) (n = 47, 78 per cent), people-related factors (e.g. helping people) (n = 29, 48 per cent) and relationships with patients (n = 28, 47 per cent). Clinical freedom was the most frequently cited reason for participants liking their current job (n = 18, 30 per cent). Self-employed participants were more likely to value relationships with their patients (Chi-square, p < 0.01). Employee and locum participants were more likely to value relationships with staff (Chi-square, p < 0.05) and colleagues (Chi-square, p < 0.05). There were 32 participants (53 per cent) who perceived their work as stressful, most commonly related to clinical issues (n = 25, 42 per cent), workload demands (n = 20, 33 per cent) and management tasks (n = 15, 25 per cent). Clinical issues were a stressor for employee and locum participants (Chi-square, p < 0.01) and urban practitioners (Chi-square, p < 0.05). Management tasks were a stressor for independently practising participants (Chi-square, p < 0.01). Understanding what clinical optometrists like and find stressful about their work is important for employers, industry and the profession, as these are key elements of employment satisfaction. The information presented in this paper can be used as a basis for developing quantitative tools for assessing job satisfaction and job stress more extensively in the optometric profession.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2011
Publisher: Elsevier BV
Date: 2013
Publisher: Elsevier BV
Date: 07-2017
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: Wiley
Date: 18-04-2008
DOI: 10.1111/J.1475-1313.2008.00564.X
Abstract: Visual abnormalities are common in children and adolescents with intellectual disability, but it is not known whether these abnormalities impact on their quality of life. As a first step towards addressing this question, this study collects self-perceptions on visual performance and life quality in school children with intellectual disability. Questionnaires were modified from those used to assess vision- and health-related quality of life in children with normal development, with guidance from a focus group of in iduals who work or live with children with intellectual disability. The survey was conducted in a population of Chinese children with intellectual disability, using self-completion and caregivers' responses. Responses from subjects showed comparable dimensions in vision-related quality of life to those revealed by previous studies in children with normal development. Some differences were apparent, however, and possible explanations for these are discussed. Our results showed good internal consistency and correlations between subscales within and across questionnaires. The assessment of vision-related quality of life is feasible in children and adolescents with at least mild-to-moderate intellectual disability. In this population of children with intellectual disability, perceived visual function is associated with quality of life.
Publisher: Elsevier BV
Date: 07-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
Publisher: Elsevier BV
Date: 07-2017
Publisher: BMJ
Date: 16-08-2017
DOI: 10.1136/BJOPHTHALMOL-2017-310610
Abstract: Sex hormones are associated with the physiology and pathophysiology of almost all organs in the body, as well as most diseases. Interest in the associations between sex hormones and ocular tissues has increased in recent years. Androgens may have a positive effect on dry eye, whereas the effects of oestrogen on ocular conditions remain unclear. Intracrinology, the local synthesis and metabolism of hormones that is unique to humans, is of relevance to the eye and may help to explain why studies of the relationship between oestrogens and dry eye signs and symptoms are inconclusive. Knowledge of the pathways of hormone formation and metabolism is crucial to understanding the pathogenesis of ocular disease including dry eye. This review examines the mechanisms of steroidal sex hormone biosynthesis and reviews the significance of locally produced sex hormones, with a focus on ocular surface tissues. Much of the current literature is based on animal studies, which may not be transferable to humans due to the absence of intracrine production in animals. A large proportion of the human studies investigate systemic hormone levels rather than local levels. There is subsequently a need for additional studies to provide a better understanding of the local production of sex hormones within the human eye and ocular surface and to clarify the relationships between ocular levels of sex hormones and conditions including dry eye.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JTOS.2017.05.008
Abstract: The goals of the TFOS DEWS II Definition and Classification Subcommittee were to create an evidence-based definition and a contemporary classification system for dry eye disease (DED). The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept. Ocular symptoms, as a broader term that encompasses reports of discomfort or visual disturbance, feature in the definition and the key etiologies of tear film instability, hyperosmolarity, and ocular surface inflammation and damage were determined to be important for inclusion in the definition. In the light of new data, neurosensory abnormalities were also included in the definition for the first time. In the classification of DED, recent evidence supports a scheme based on the pathophysiology where aqueous deficient and evaporative dry eye exist as a continuum, such that elements of each are considered in diagnosis and management. Central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostasis. The scheme also allows consideration of various related manifestations, such as non-obvious disease involving ocular surface signs without related symptoms, including neurotrophic conditions where dysfunctional sensation exists, and cases where symptoms exist without demonstrable ocular surface signs, including neuropathic pain. This approach is not intended to override clinical assessment and judgment but should prove helpful in guiding clinical management and research.
Publisher: Elsevier BV
Date: 03-2007
DOI: 10.1016/J.AJO.2006.11.042
Abstract: To determine the reproducibility of optical coherence tomography (OCT) measurements of macular thickness, peripapillary nerve fiber layer (NFL) thickness, and optic disk parameters and to investigate the effect of axial length and refractive error on these measurements in children with healthy eyes. Cross-sectional study. The Sydney Childhood Eye Study examined 2,353 year 7 students (75.3% response) from a random cluster s le of 21 secondary schools across Sydney. A consecutive subs le of 120 children had OCT (StratusOCT, Carl Zeiss, Dublin, California, USA) performed by a single operator, which was repeated with a brief rest between the two sessions. Scans of the NFL, macula, and optic disk were performed. Intersubject variability of measurements of macular thickness, NFL thickness, and optic disk parameters assessed using intraclass correlation coefficients accounted for >85%, >62%, and >38% of total variability of measurements, respectively. Corresponding coefficients of variability were <5%, <8%, and <13%. Magnification effects attributable to axial length and refractive error on the measurement of these parameters were statistically not significant. The StratusOCT demonstrated reproducible measurements of macular and NFL thickness. Measurement of most optic disk parameters were also reproducible. Magnification attributable to axial length and refractive error had minimal impact on measurements of macular and NFL thickness.
Publisher: Elsevier BV
Date: 02-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Informa UK Limited
Date: 11-2012
DOI: 10.1111/J.1444-0938.2012.00711.X
Abstract: Work-related physical discomfort exists within the optometric profession. It is not well understood how optometrists manage this issue in their workplaces. An online questionnaire was sent by e-mail to approximately 1,700 Australian optometrists. Participants were asked if they experienced work-related discomfort in any of eight nominated body regions. If so, they were asked to describe specific work tasks, which contribute to their work-related discomfort, and strategies they have adopted to minimise their discomfort. These data were subject to qualitative and quantitative analyses. There was a 25 per cent response rate and 416 optometrists participated in the questionnaire. Work-related physical discomfort was reported by 339 respondents (81 per cent), most commonly with the use of the phoropter (n = 144, 35 per cent) and slitl (n = 94, 23 per cent). Males were more likely to report lower back discomfort with phoropter use (Chi-squared, p < 0.01) and ophthalmoscopy (Chi-squared, p < 0.01). To minimise discomfort, optometrists 41 years and older were more likely to report that they adjust their posture (Chi-squared, p < 0.03) and females were more likely to report that they alter their work schedule (Chi-squared, p < 0.05). A recurrent theme expressed by participants was an inability to make changes to improve their comfort due to room and equipment design, poorly maintained equipment, non-supply of suitable equipment or furniture and inherent difficulties within optometric tasks. There is a need for all optometrists to have skills to evaluate their own personal risk of discomfort in the consultation room. Owners and managers of optometric practices also need greater awareness of the importance of room and equipment design and maintenance on work-related discomfort. This has implications for the well-being of optometrists, for their productivity and for compliance with health and safety legislation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2019
DOI: 10.1097/OPX.0000000000001429
Abstract: Contemporary soft contact lenses do not affect mechanical sensitivity of the cornea, whereas conjunctival sensitivity is increased compared with nonwearers. Orthokeratology lens wear, however, reduces corneal sensitivity. The effects of contact lenses on lid margin sensitivity are unclear, and the link between ocular surface sensitivity and discomfort requires further exploration. Although up to 50% of contact lens wearers experience discomfort with varying severity, impact, and frequency, the relationship between ocular surface sensitivity and ocular surface discomfort experienced during contact lens wear is unclear. The purpose of this review is to examine and summarize the current evidence for the impact of both historical and contemporary contact lens wear on ocular surface sensitivity, the etiology of changes in ocular surface sensitivity, contact lens wear–related factors associated with changes in ocular surface sensitivity, and the relationship between sensitivity and discomfort. Despite minimal effects on mechanical corneal sensitivity with contemporary soft contact lens wear, orthokeratology reduces corneal sensitivity through pressure-related effects. This review addresses the relevance of conjunctival and potentially lid margin sensitivity in tolerance and discomfort with contemporary lens wear and the impact of instrument and stimulus characteristics. Less invasive techniques particularly for lid margin sensitivity measurements are required. Given the potential interactions between a contact lens and the varied types of ocular surface nociceptors, instruments that allow for exploration of cold and chemical sensitivity particularly may better allow the effects of lens wear to be elucidated compared with those that explore high-threshold mechanical sensitivity alone. A better understanding of the relationships between lens wear and ocular surface sensitivity may result in improved management of contact lens discomfort.
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: Association for Research in Vision and Ophthalmology (ARVO)
Date: 06-01-2017
Abstract: To examine the coaggregation and cohesion between the commonly isolated bacteria from contact lens cases. Four or five strains each of commonly isolated bacteria from contact lens cases, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Serratia marcescens, were grown, washed, mixed in equal proportions, and allowed to coaggregate for 24 hours. Lactose (0.06 M), sucrose (0.06 M), and pronase (2 mg/mL 2 hours, 37°C) were used to inhibit coaggregation. Oral bacterial isolates of Actinomyces naeslundii and Streptococcus sanguinis were used as a positive control for coaggregation. Cohesion was performed with the ocular bacteria that demonstrated the highest level of coaggregation. Production of growth-inhibitory substances was measured by growing strains together on agar plates. The oral bacterial pair showed >80% coaggregation. Coaggregation occurred between ocular strains of S. aureus (2/5) or S. epidermidis (2/5) with P. aeruginosa strains (3/5) 42% to 62%. There was only slight coaggregation between staphylococci and S. marcescens. Staphylococcus aureus coaggregated with S. epidermidis. Lactose or sucrose treatment of S. aureus but pronase treatment of P. aeruginosa reversed the coaggregation. There was no cohesion between the ocular isolates. P. aeruginosa was able to stop growth of S. aureus but not vice versa. This study demonstrated for the first time that ocular isolates of P. aeruginosa and S. aureus could coaggregate, probably through lectin-carbohydrate interactions. However, this may not be related to biofilm formation in contact lens cases, as there was no evidence that the coaggregation was associated with cohesion between the strains.
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: Informa UK Limited
Date: 11-2018
DOI: 10.1111/CXO.12686
Abstract: Patient-reported outcome measures (PROMs) are becoming increasingly recognised as a key component in assessing the relative effectiveness of cataract surgery. This manuscript presents the protocol methodology and baseline characteristics of a prospective cohort study investigating patient-centred predictors of cataract surgery outcomes. Patients with bilateral cataract (aged ≥ 50 years) scheduled for their first eye cataract surgery were recruited at four public hospitals and three private ophthalmology clinics in Sydney, Australia. Participants underwent a comprehensive assessment of clinical measures of vision (for ex le, visual acuity, contrast sensitivity) and PROMs prior to first eye surgery and three months after first and second eye surgery. The PROMs of interest included health-related quality of life, visual disability and satisfaction with vision. The characteristics of the baseline cohort of 359 participants are reported in this manuscript. Enrolment occurred over a two-year period with the majority recruited from urban public hospitals (96 per cent, n = 345). Health-related quality of life was scored highly (80 out of 100). Self-reported visual disability was considered within normal ranges compared to cataract populations in other high-income countries (-0.94 logits). Three-quarters of participants (n = 263/351) were dissatisfied with their pre-operative vision. There is a complex and wide range of patient-centred experiences prior to first eye cataract surgery in the public hospital setting. Gaining further insight into the patient perspective may allow eye health professionals to more appropriately time surgery, better manage patient expectations and provide direction for future prioritisation initiatives of cataract wait lists. Companion papers will follow, detailing results of surgery in terms of PROMs.
Publisher: Public Library of Science (PLoS)
Date: 27-08-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2011
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JTOS.2019.07.001
Abstract: Numerous studies have reported a wide range of corneal epithelial dendritic cells (CEDC) density using in-vivo confocal microscopy in healthy participants. It is necessary to establish normal CEDC values for healthy corneas to enable differentiation from pathological corneas. This meta-analysis aimed to establish CEDC density and distribution and examine their relationship with age and sex. A systematic review of the literature of studies using the Heidelberg Retinal Tomograph with Rostock Corneal Module and reporting CEDC density in healthy subjects up to December 2018 was conducted via Medline, Google Scholar, Scopus, PubMed, Embase and Cochrane library. A random effect modeling approach was used to obtain the results of meta-analysis and meta-regression was conducted to estimate the effect of age and sex. 38 studies reported central and 9 reported peripheral inferior CEDC density of 1203 participants (mean age 46.0 ± 12.2, range 18-81 years). CEDC density in the central and peripheral inferior cornea was 26.4 ± 13.6 cells/mm This study established that the density at the peripheral inferior cornea is three-fold higher than at the central cornea. Peripheral but not central CEDC density decreased with increasing age. There are limited studies in youth (<18 years), precluding a more detailed analysis. Sex does not appear to be a significant factor in CEDC density.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.CLAE.2017.10.005
Abstract: To report the density and morphology of cells that are analogous to corneal Langerhans cells and their associations in keratoconus. This prospective cross-sectional study included a convenience s le of keratoconus subjects aged between 18-65 years. Corneal topography, assessment of ocular symptoms, tear variables, corneal sensitivity, in-vivo confocal microscopy were performed. The number of Langerhans cells were manually counted and averaged across three central corneal images. Cell morphology was graded on a 0-3 scale, where grade 3 indicates cells with long visible dendrites. Associations of Langerhans cells with other variables were evaluated using Spearman's correlation. Twenty-one keratoconus subjects with a mean age of 43±11 years were included. Eighty-one percent of them were males, 48% had mild keratoconus and 52% were contact lens wearers. Langerhans cells were present in the central cornea in 91% of subjects. Median cell density was 15 cells/mm Langerhans cells were present in a significant number of subjects suggesting the possibility of inflammation in keratoconus. Based on the association of Langerhans cells with nerve parameters, we propose inflammation as the underlying cause for corneal nerve changes in keratoconus.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.CLAE.2010.02.002
Abstract: To identify the demographics profile of lens wearers, and to evaluate the scope and level of noncompliant, behaviours in lens wearers. 210 contact lens wearers who attended an optometry clinic at an education and research institute, were surveyed using a self-administered questionnaire. The questionnaire was constructed to gather information regarding contact lens wearer demographics, contact lens hygiene behaviours and, attitudes toward lens care. Multivariate testing between lens wearers' demographic, hygiene, behaviours and attitude to aftercare visit were analysed. One hundred and eleven (62%) of participants responded, with a mean age of 33.8+/-12 years. 55% of the respondents were female. Major non-compliance aspects identified were poor hand hygiene (11%), inadequate cleaning of lenses (13%) and lens storage cases (61%), and wearers not remembering how often they were advised to return for an aftercare (50%). Lens wearers who purchased contact lenses, from the internet were 3.8 times more likely to forget their aftercare schedule than those who purchased contact lenses from the optometrists (95% CI=1.2-12.2, p=0.024). Poor hand hygiene, inadequate lens care, and not remembering when to come back for aftercares are the common non-compliant behaviours in lens wearers. Purchase of lenses via the internet was associated with lack of awareness of aftercare visit.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 05-01-2011
DOI: 10.1167/IOVS.09-4809
Abstract: Silver-impregnated contact lens (CL) storage cases are designed to reduce microbial contamination during use, but there are limited data on their effectiveness. This study evaluated early antimicrobial activity of silver-impregnated CL cases and silver-release characteristics in vitro. Three silver-impregnated CL storage cases-MicroBlock (CIBA Vision, Atlanta, GA), i-clean (Sauflon Pharmaceuticals Ltd., London, UK), and Nano-case (Marietta Vision, Marietta, GA)-were evaluated. Test organisms included the ISO14729 panel and two clinical isolates, Delftia acidovorans and Stenotrophomonas maltophilia. Each well of the case was challenged with 2 mL of the organism in phosphate-buffered saline at 10(3), 10(4), 10(5), and 10(6) CFU/mL. Survivors were recovered after 6, 10, and 24 hours' incubation at 25°C. Inductively coupled plasma mass spectrometry was used to quantify the release of silver from the cases for similar incubation conditions and for time points up to 28 days. Significant differences in antimicrobial activity were observed between cases (P ≤ 0.001). Activity was apparent only after 24 hours. MicroBlock showed the highest activity against Pseudomonas aeruginosa (2.4 ± 0.5 log reduction at 10(6)), Serratia marcescens (3.3 ± 0.9 log reduction at 10(6)), D. acidovorans (2.8 ± 0.1 log reduction at 10(3)), and Fusarium solani (0.5 ± 0.2 at 10(3)). The i-clean case was most effective against Staphylococcus aureus (5.4 ± 1.1 log reduction), whereas Nano-case showed the greatest activity against S. maltophilia (0.2 ± 0.3 log reduction at 10(3)). MicroBlock was the only case to demonstrate silver release over 28 days. Current silver-impregnated CL storage cases show variation in their in vitro antimicrobial activity. Broadly, the MicroBlock case demonstrated robust activity against most Gram-negative bacteria, whereas the i-clean case was more effective against S. aureus. Silver-release data suggest different modes of action for different cases.
Publisher: Informa UK Limited
Date: 28-02-2021
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.OPHTHA.2008.04.002
Abstract: To establish the absolute risk of contact lens (CL)-related microbial keratitis, the incidence of vision loss and risk factors for disease. A prospective, 12-month, population-based surveillance study. New cases of CL-related microbial keratitis presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners (numerator). Case detection was augmented by records' audits at major ophthalmic centers. The denominator (number of wearers of different CL types in the community) was established using a national telephone survey of 35,914 in iduals. Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Visual outcomes were determined 6 months after the initial event. Annualized incidence and confidence intervals (CI) were estimated for different severities of disease and multivariable analysis was used in risk factor analysis. Annualized incidence (with CI) of disease and vision loss by CL type and wear modality and identification of independent risk factors. We identified 285 eligible cases of CL-related microbial keratitis and 1798 controls. In daily wear rigid gas-permeable CL wearers, the annualized incidence per 10,000 wearers was 1.2 (CI, 1.1-1.5) in daily wear soft CL wearers 1.9 (CI, 1.8-2.0) soft CL wearers (occasional overnight use) 2.2 (CI, 2.0-2.5) daily disposable CL wearers 2.0 (CI, 1.7-2.4) daily disposable CL wearers (occasional overnight use) 4.2 (CI, 3.1-6.6) daily wear silicone hydrogel CL wearers 11.9 (CI, 10.0-14.6) silicone hydrogel CL wearers (occasional overnight use) 5.5 (CI, 4.5-7.2) overnight wear soft CL wearers 19.5 (CI, 14.6-29.5) and in overnight wear of silicone hydrogel 25.4 (CI, 21.2-31.5). Loss of vision occurred in 0.6 per 10,000 wearers. Risk factors included overnight use, poor storage case hygiene, smoking, Internet purchase of CLs, <6 months wear experience, and higher socioeconomic class. Incidence estimates for soft CL use were similar to those previously reported. New lens types have not reduced the incidence of disease. Overnight use of any CL is associated with a higher risk than daily use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: Springer Science and Business Media LLC
Date: 08-02-2008
Abstract: To evaluate an office-based Lanindar (light and nociceptive interaction noting distress and response) test to assist in the assessment of patient suitability for assisted topical anaesthesia (ATA) during phacoemulsification. The Lanindar test was carried out at the preoperative assessment of 716 consecutive patients in the office of one of the authors (ICF). A standard desk l was shone in each patient's eye after pupillary dilation, while simultaneously elevating the upper eyelid digitally. A negative test indicated patient hypersensitivity to the light and aversion to digital pressure on the upper eyelid. A positive test was indicated by the patient feeling comfort and lack of blepharospasm and withdrawal in response to the light and digital pressure. chi (2) and Fisher's exact tests were used to assess the association between Lanindar results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Visual acuities at 1 and 4 weeks post-operative periods were compared between the ATA and ALA/GA (assisted local anaesthesia/general anaesthesia) group of patients. About 86.7% were Lanindar positive and 98.9% of these patients tolerated ATA. chi (2) and Fisher's exact tests demonstrated a significant association of a positive Lanindar test with successful ATA (chi (2)=660, P<0.001, Fisher's: P<0.001). The positive predictive value and specificity of the test were 98% (95% CI=98.04-99.7%) and 93.14% (95% CI=88.23-98.04%), respectively. Visual acuity outcomes were similar in the ATA and ALA/GA groups. The Lanindar is a simple, highly specific, office-based test to determine patient suitability for phacoemulsification under ATA.
Publisher: Informa UK Limited
Date: 07-2015
DOI: 10.1111/CXO.12233
Abstract: Defining the threshold for therapeutic and surgical intervention in patients with keratoconus presents a considerable challenge given the lack of clear, evidence-based data. Little is known about the patterns of practice and referral criteria of optometrists within Australia. All members of the NSW branch of Optometrist Association Australia were invited to complete an online survey in January 2013. This survey was designed to elicit practice information regarding the evaluation and therapeutic treatment of patients with keratoconus in the optometric setting. Responses were received from 71 optometrists, of whom 65.2 per cent had 15 years or greater experience as an optometrist. Many (35.4 per cent) responded that they prescribed soft contact lenses daily. This percentage dropped to 9.2 per cent for rigid gas-permeable lenses (RGP), although 47.7 per cent said they would prescribe RGP lenses at least once per month. The main barriers to prescribing were experience with fitting RGP lenses, time and low market demand. In terms of patient referral to an ophthalmologist, the results were variable, with 34.4 per cent stating that they would refer on progression of corneal signs, 23.4 per cent suggesting no set time and 7.8 per cent would refer on initial diagnosis. Many optometrists (62.9 per cent) would refer a patient for possible surgery, when visual acuity dropped to between 6/9 and 6/12. The size or location of the practice was not associated with the number of newly diagnosed cases of keratoconus. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal topographic unit suggested an increased likelihood of prescribing RGP lenses but did not appear to alter referral patterns. Optometrists have an integral role in the diagnosis and management of patients with keratoconus. Our survey provides a basic snapshot of current, local practice. Additionally, ophthalmology should continue to work with optometry to develop guidelines for referral and co-management to optimise future outcomes for our patients.
Publisher: Public Library of Science (PLoS)
Date: 02-02-2017
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 09-04-2020
DOI: 10.1167/TVST.9.5.2
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 10-06-2014
Abstract: Dry eye is common in Asian populations, but there are limited validated instruments available to assess ocular symptoms within these populations. This study aimed to develop and assess the psychometric properties of a Chinese version of the ocular comfort index (OCI-C). The OCI was translated and back translated by 32 bilingual volunteers and a preliminary OCI-C was produced for analysis 165 bilingual volunteers completed both the OCI and the preliminary OCI-C. The item scores for preliminary OCI-C were compared with the OCI using Cronbach's α. Repeatability of the total score of OCI-C was evaluated in a subgroup of 20 participants after a week by calculating the coefficient of repeatability (CoR) and intraclass correlation coefficient (ICC) for the OCI-C score 322 subjects, including 81 dry eye subjects, completed the OCI-C to verify the sensitivity in dry eye diagnosis. Rasch analysis was used to estimate interval measures from ordinal Likert score and assess psychometric property of item-fit, category function, targeting of items to subjects, and person separation reliability. Cronbach's α for all items was above 0.85. The CoR was ± 5.84 and the ICC was 0.96 (95% confidence interval 0.91-0.98). The total score of OCI-C was able to differentiate dry eye (40.0) with non-dry eye (30.2) (P < 0.0001). In the Rasch analysis model, the OCI-C showed robust psychometric properties for item-fit and category calibration: person-separation reliability: 2.47 and item reliability: 8.42. The psychometric properties of the OCI-C are comparable with the OCI and the instrument is appropriate as a diagnostic tool and to determine the severity of dry eye in this population.
Publisher: Wiley
Date: 11-08-2020
DOI: 10.1111/OPO.12723
Abstract: Corneal nerves exhibit high plasticity, which allows successful reinnervation after nerve damage caused by laser in‐situ keratomileusis (LASIK) surgery. This study aimed to examine corneal subbasal nerve orientation during regeneration after LASIK. This study involved 20 healthy, myopic subjects who had undergone bilateral Femto‐LASIK 12–16 months prior with a superior hinge position. The corneal subbasal nerve plexus at the central, mid‐temporal and mid‐superior cornea on the right eye were imaged using in vivo confocal microscopy. Global nerve fibre orientation (indicating the overall pattern) and variation of nerve fibre orientation (indicating the consistency of the orientation) was determined using customised MATLAB™ software ( roducts/matlab.html ). Differences in nerve orientation variables between groups were examined using the Mann‐Whitney U test. Linear mixed models with Bonferroni adjustment were conducted to examine differences between corneal regions, and over time, after LASIK. There were no differences between post‐LASIK and control groups in global nerve orientation at any of the examined corneal regions. The post‐LASIK subjects had a greater variation of nerve orientation at the central ( p = 0.007) and temporal ( p = 0.049) cornea than the controls. There was a difference in global nerve fibre orientation between corneal regions ( p 0.001) in the controls but not in the post‐LASIK group. The variation of nerve fibre orientation was higher at the central, compared to the temporal and superior cornea after LASIK ( p 0.001), although there were no differences between corneal regions in controls. Our results demonstrate that there was an increased variability in the corneal subbasal innervation patterns following LASIK when compared to controls.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Informa UK Limited
Date: 09-2009
Publisher: Elsevier BV
Date: 04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 09-03-2012
DOI: 10.1167/IOVS.11-8416
Abstract: Deprivation of oxygen to the ocular surface during contact lens wear has been implicated in the alteration of sensory function. This study investigates whether increasing oxygen availability through discontinuation of contact lens wear or transfer into highly oxygen transmissible (high Dk/t) lenses leads to a change in corneal or conjunctival sensitivity. Twenty-seven long-term extended wearers of low Dk/t soft contact lenses ceased lens wear for 1 week and were refitted with high Dk/t silicone hydrogel lenses. A control group of 25 nonwearers matched for age and sex was also recruited. Central corneal and inferior conjunctival sensitivity were measured using an air-jet aesthesiometer. Threshold was determined using a staircase technique. Measurements were taken during low Dk/t lens wear after 1 week of no wear and after 1, 3, 6, and 12 months of high Dk/t lens wear. Measurements were carried out on one occasion on the nonwearers. Corneal sensitivity decreased 1 week after discontinuation of low Dk/t lenses and no further change in sensitivity occurred with high Dk/t lens wear. Conjunctival sensitivity did not change over the same time frame. Ocular surface sensitivity in long-term low Dk/t soft lens wearers was similar to that of nonwearers. Sensitivity was higher in females than males in the nonwearers, but not in the lens-wearing group. An interaction of sex on change in conjunctival threshold was found in the lens wearers. These findings indicate that factors other than oxygen availability alone determine sensitivity of the ocular surface. Silicone hydrogel contact lenses appear to have only a minor impact on ocular surface sensitivity in previous lens wearers.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 11-2018
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.CLAE.2021.02.017
Abstract: The purpose of this study was to investigate the effect of Mel4 antimicrobial peptide-coated contact lenses (MACL) on the microbiota of the conjunctiva and lenses during three months of extended wear. One hundred and seventy-six participants were recruited into a randomised, contralateral, double masked, biweekly extended wear MACL and uncoated control lens trial. At the one month and 3-month visit, the conjunctival microbiota was s led using sterile cotton swabs and contact lenses were collected aseptically. Standard microbiological procedures were employed for culture of the swabs and contact lenses and identification of the isolated microorganisms. Gram-positive bacteria (predominantly coagulase-negative staphylococci) were the most frequently isolated microbes from both contact lenses and conjunctiva. There was no difference in the frequency of isolation of most bacteria or fungi from the conjunctival swabs of eyes wearing either MACL or control lenses. The only exception was a higher frequency of eyes harbouring Staphylococcus arlettae when wearing control lenses (5%) versus MACL ( 1 microbial type per s ling occasion for either conjunctiva swabs or contact lenses. MACL wear did not change the conjunctival microbiota during extended wear, and the types of microbes isolated from MACL were similar to those isolated from control lenses.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Publisher: Informa UK Limited
Date: 09-2017
DOI: 10.1111/CXO.12581
Abstract: Contact lens-associated microbial keratitis poses a diagnostic dilemma for optometrists on two fronts. The distinction between sterile inflammation and microbial infection is often blurred. In addition, there is a requirement with nearly 50 per cent of the Australian and New Zealand optometric profession being therapeutically endorsed, to distinguish between cases of infection that can be managed in the community verses those that require escalation to public hospitals that have access to laboratory diagnostic tools and advanced imaging techniques, such as in vivo confocal microscopy. Pattern recognition and incorporation of knowledge of aetiology and risk factors assists optometrists to decide on optimal management strategies. Skilled optometrists will utilise emerging diagnostic and therapeutic technologies to ensure safe management strategies and better outcomes for these cases.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2011
Publisher: BMJ
Date: 03-11-2019
DOI: 10.1136/BJOPHTHALMOL-2016-309498
Abstract: Sex hormones could provide a future treatment avenue for dry eye post menopause. However, there are few well-controlled studies. This study investigates the impact of testosterone and oestrogen on dry eye symptoms and signs in postmenopausal women. A randomised double-blind placebo-controlled pilot study was conducted involving 40 women with dry eye (age 63.9±5.1 years, 13.2±6.3 years post menopause). Ten women were assigned to each of four treatment groups: transdermal testosterone, oestradiol, testosterone/oestradiol combination and placebo. Assessment at baseline and after 8 weeks: ocular symptoms, tear osmolarity, tear stability, tear secretion, meibomian gland assessment, corneal and conjunctival sensitivity, serum concentrations of 17β-oestradiol, 3-α-androstanediol-glucuronide and dehydroepiandrosterone sulfate. Differences from placebo were examined using one-way analysis of variance and Dunnett's t-test. Within-group analyses included paired t-tests and Spearman correlation. Dryness intensity after 8 weeks was significantly worse in the oestrogen group compared with placebo (p=0.04). No significant changes in other symptoms, tear function, meibomian gland function, lid morphology, corneal or conjunctival sensitivity were observed in any of the groups when compared with the change in placebo after 8 weeks. Within-group analyses showed increased tear secretion in the testosterone/oestradiol combination group (p=0.03) and a strong association between increased serum androgen and improved tear stability in the testosterone group (ρ=0.83,p=0.01). Oestrogen supplementation may worsen ocular symptoms in postmenopausal women with dry eye, whereas no impact of testosterone therapy on symptoms was apparent. The positive effects of oestrogen and testosterone on tear function require confirmation in a larger study, with s le size calculated from the data generated herein. Placebo control is essential in studies of dry eye therapies. ACTRN12612000281897.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.EXER.2011.02.016
Abstract: Assessment of corneal sensory function is commonly carried out using the Cochet-Bonnet aesthesiometer. The limitations of this instrument have lead to development of newer instruments, such as the CRCERT-Belmonte aesthesiometer, which utilise a jet of air as their stimulus. Recent work, however, has demonstrated contradictory effects on ocular surface sensitivity when measured with different types of aesthesiometer. The purpose of the present study was to compare clinical measurements of corneal sensitivity obtained with the CRCERT-Belmonte and the Cochet-Bonnet aesthesiometers and to examine their stimulus characteristics in terms of force exerted. No association was found between central corneal sensitivity measured with the two aesthesiometers in a group of normal subjects. Sensitivity was measured to be lower with the Cochet-Bonnet aesthesiometer than with the CRCERT-Belmonte. Over half of the subjects could not be assessed with the standard Cochet-Bonnet filament and 11% could not be assessed with either filament, as their corneal sensitivity was outside of the range of the instrument. In contrast, all subjects were within the stimulus range of the CRCERT-Belmonte aesthesiometer. Corneal sensitivity measurements made with the non-contact CRCERT-Belmonte aesthesiometer and the Cochet-Bonnet aesthesiometer are not comparable. Due to dissimilarities in the composition of their stimuli, and thus mode of stimulation, it is possible that the two instruments measure different aspects of the neural response. The underestimation of corneal sensitivity by the Cochet-Bonnet aesthesiometer and its inability to measure sensitivity of some subjects at all are important considerations in the assessment of sensitivity loss. Subtle changes are unlikely to be detected with this instrument, particularly at higher sensitivity levels. The Cochet-Bonnet should therefore be used with caution and the 0.08 mm diameter used as the filament of choice. Adoption of a non-contact aesthesiometer as standard for ocular sensitivity measurement should be considered. The non-contact instrument allows superior stimulus reproducibility and better control over stimulus characteristics, in addition to the ability for exploration of the response of all three types of neuro-receptors on the ocular surface.
Publisher: Informa UK Limited
Date: 17-04-2014
DOI: 10.3109/09286586.2014.903980
Abstract: To assess the reasons for refusing cataract surgery in illiterate in iduals in a tribal area of India. A prospective study evaluated 1046 subjects who had undergone screening in eye c s and included 398 of 492 referred subjects with cataract who refused to seek cataract surgery. Subjects were assessed to elicit general and specific reasons for non-compliance. Multiple logistic regression analysis was applied to determine the associations p < 0.05 was considered significant. Overall, 83% (329/398) of subjects reported that they could manage with their current vision. The five most common reasons they did not proceed with cataract surgery were: fear of losing current vision, work priority, lack of support systems, a dependency due to old age, and expenses required after surgery. Odds of seeking treatment were lower among unemployed subjects (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19-0.86 p = 0.01) and in patients with family income <1000 Indian rupees per month (OR 0.5, 95% CI 0.34-0.94 p = 0.02), and higher among those unilaterally blind (OR 10.8, 95% CI 3.3-35.6 p ≤ 0.01). In a tribal setting, 83% of in iduals referred for cataract surgery did not proceed with surgery. Reasons given for non-compliance were not directly related to the surgery but focused on valid day-to-day difficulties anticipated to increase following surgery. Beyond accessibility and cost of surgery, other social and infrastructural factors need to be addressed to increase the uptake of cataract surgery.
Publisher: Wiley
Date: 21-12-2016
DOI: 10.1111/OPO.12271
Abstract: Acanthamoeba keratitis is a severe, often sight threatening, corneal infection which in Western countries is predominantly seen in daily wear of contact lenses. This review aims to summarise the pathobiology and epidemiology of contact lens-related Acanthamoeba keratitis, and to present strategies for prevention, particularly with respect to modifiable risk factors in contact lens wear. The virulence of Acanthamoeba and resistance to treatment in keratitis appears to be linked with the production of a low molecular weight protease MIP133 by the organism, in response to binding to corneal epithelial cells through a mannose binding protein, and to the ability of the organism to convert from the trophozoite to the resistant cyst form. Recent epidemiological studies in contact lens relate disease have confirmed the link between solution topping up and Acanthamoeba keratitis and have reinforced the importance of avoidance of tap water, either as part of the care for the contact lens or storage case, handling lenses with wet hands or showering while wearing lenses. In the most recent analysis from the USA, there were no strong effects for solution type, water source or water disinfection process. Wearer age, lens wear time and history to appear to be linked with Acanthamoeba keratitis. Daily disposable contact lens use would be expected to reduce the prevalence of Acanthamoeba disease although this is unproven. While Acanthamoeba keratitis remains challenging to diagnose and manage, strategies to limit the disease severity in contact lens wearers should include attention to recently identified risk factors, particularly those related to water contact. Public health awareness measures, the use of daily disposable contact lenses, a better understanding of the contribution of the host immunity and the development of standardised methods for culture of amoeba and testing of contact lens care systems against Acanthamoeba in the licensing process may be of value. Alternative treatments for the future may include those which target the mannose binding protein or the genes which control conversion to the cyst form.
Publisher: Wiley
Date: 26-05-2007
DOI: 10.1111/J.1442-9071.2007.01511.X
Abstract: To analyse the patient, clinical and microbiological variables associated with poor outcomes from keratitis in patients presenting to a major public hospital in Australia. A retrospective audit of the records of all patients who had a corneal scraping in 5 years at Princess Alexandra Hospital (Brisbane, Australia) was carried out. The outcome of a patient's episode of keratitis was classified as poor if they had final visual acuity of 6/60 or worse had vision loss during treatment or a complication of keratitis or needed surgical intervention. A final outcome was established in 207 cases during the 5-year period. Final vision of 6/12 or better was found in 48% (100) of cases while a poor outcome was seen in 28% (58). Linear regression showed poor outcomes were directly associated with age (P < 0.001) and disease severity (P < 0.001). Univariate analysis indicated that poor outcomes were more likely in patients who had had prior ocular surgery (P = 0.005) or ocular surface disease (P = 0.01) and were also associated with presenting visual acuity of worse than 6/60 (P < 0.001) and isolation of Streptococcus pneumoniae (P = 0.002). While patients with traumatic keratitis, contact lens-related keratitis or negative corneal cultures (P = 0.009) were more likely to have good outcomes. Multivariate analysis showed that the relative risk of a patient having a poor outcome was 4.3x (CI 2.0-9.5) if they had severe keratitis, 4.1x (CI 1.8-9.5) if they had keratitis related to ocular surface disease and 3.8x (CI 1.8-8.3) if they were over 50 years old. An outcome of poor vision, vision loss during treatment, surgical intervention or complication of keratitis is more likely in patients with severe keratitis, keratitis related to prior ocular surface disease or older age.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.EXER.2018.11.015
Abstract: Sex steroids impact regulation of the ocular surface tissues and thus influence dry eye. Most tissues in the human body synthesise and metabolise active sex steroids at levels required by the tissue. This is likely to also be the case for humans in ocular surface tissues. This study investigated the presence and quantities of selected sex steroids, in addition to sex steroid precursors and metabolites, in human tears. Detection of sex steroids in tears is challenging due to trace level analyte concentrations and low volumes of available tears. Immunoassays have previously been employed to assess sex steroids in tears, however, this approach only allows a single analyte to be measured and can overestimate concentrations. This study evaluated ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS) and tandem mass spectrometry (MS/MS) methods for the concurrent detection and estimation of fourteen sex steroid and metabolite compounds in human tears. Basal tears were collected and pooled from 5 healthy pre-menopausal women (total 100 μL). Following protein precipitation and centrifuging, extract volumes equivalent to 14 μL of pooled tears were analysed. A Thermo Scientific Q Exactive™ Plus MS was used to compare novel high-resolution MS atmospheric pressure chemical ionization (APCI) and electrospray ionisation (ESI) methods for detection of fourteen target sex steroids, including dehydroepiandrosterone-sulphate (DHEAS), testosterone, oestradiol and their metabolites, using standards and pooled tears. The MS was programmed to switch between positive and negative polarity ionization modes at designated times through the UPLC run, in order to detect each analyte at optimal sensitivity. Analytes were analysed using APCI in standard mixtures at concentrations of 0.1, 0.3, 1, 3, 10, 30, 100 and 1000 pg/mL, per component, to determine the limits of detection (LOD) and quantification. Both parallel reaction monitoring (PRM) MS/MS and selected ion monitoring (SIM) MS, were evaluated by plotting narrow range mass-to-charge ratio (m/z) chromatograms for each analyte. An APCI UPLC-MS method to simultaneously measure 14 sex steroids using standards was successfully developed following comparative evaluation of all available LC-MS techniques. Preliminary experiments found APCI to be more sensitive than ESI using standards. Narrow m/z range SIM MS resulted in better sensitivity, in tear s les, than PRM. One sex steroid and two androgen metabolites were detected, with the developed APCI UPLC-MS method, and their concentrations estimated in human tears that had been extracted with a protein crash. Progesterone, androsterone-glucuronide (ADT-G) and 3αDiol-G were successfully detected in the tear extract and their concentrations in the pooled tear s le were estimated (with 95% confidence intervals) to be 0.10 ± 0.03 pg/μL, 30.9 ± 18.3 pg/μL and 9.8 ± 4.3 pg/μL respectively. The concentrations of the remaining 11 sex steroids in the tear s le were below the LODs of the method. This work shows that high mass resolution UPLC-MS can detect certain sex steroids and metabolites in tears, but that sensitivity of the technique and the low available tear volumes limit its application to a broader range of sex steroids. The investigation of sex steroids in tears and ocular surface tissue will aid understanding of the influence of sex steroids on ocular surface tissues facilitating better targeted treatment for dry eye.
Publisher: Springer Science and Business Media LLC
Date: 24-07-2018
DOI: 10.1007/S00417-018-4065-Y
Abstract: To evaluate the relative proportion of conjunctival MUC5AC+ and MUC5AC- goblet cells in a post-LASIK population and their association with dry eye indicators and corneal nerve morphology using a MUC5AC+ Goblet Cell Index. Twenty subjects who had undergone LASIK > 12 months previously and 20 age-matched controls were recruited. Dry eye symptoms, tear breakup time, osmolarity, meniscus area and corneal nerve morphology were examined. Conjunctival impression cytology s les were collected from inferior-temporal bulbar conjunctiva using Millicell® inserts. Total goblet cell density was determined from positive cytokeratin-7 (CK7) immunolabelling MUC5AC+ goblet cell density was determined from both CK7+- and MUC5AC+-immunolabelled cells. The ratio of MUC5AC+ to total density was defined as the "MUC5AC+ Goblet Cell Index". Differences in variables between groups and the associations between goblet cell variables and clinical assessments were examined. No significant differences in the total and MUC5AC+ goblet cell density and tear film parameters were found between groups, although greater ocular discomfort was reported in the post-LASIK group (P = 0.02). A higher MUC5AC+ Index was associated with worse/greater dry eye symptoms (ρ = 0.55, P = 0.01) and higher nerve tortuosity (ρ = 0.57, P = 0.01) in the post-LASIK group lower nerve density and thickness was found in controls (ρ > -0.45, P < 0.05), but not associated with tear film parameters. The MUC5AC+ Goblet Cell Index provides an indicator of mucin secretion for assessing the goblet cell function in dry eye. In the post-LASIK participants, we found an increased MUC5AC+ Index associated with worse dry eye symptoms and adverse changes in corneal nerve morphology.
Publisher: Informa UK Limited
Date: 10-2009
Publisher: Springer Science and Business Media LLC
Date: 06-09-2019
No related grants have been discovered for Fiona Stapleton.