ORCID Profile
0000-0002-5376-0885
Current Organisation
UNSW Sydney
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Publisher: Elsevier BV
Date: 06-2021
Publisher: Informa UK Limited
Date: 11-2020
DOI: 10.1111/CXO.13065
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-05-2017
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: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.OPHTHA.2014.01.031
Abstract: To examine the impact of topical corticosteroid use before the diagnosis of Acanthamoeba keratitis (AK) on final visual outcomes and to determine the prognostic factors predicting poorer outcomes. Cohort study. A total of 209 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, between January 1991 and April 2012. One eye was randomly excluded from analysis in the 13 cases of bilateral AK. Patient demographic, initial clinical examination findings, and management details were collected. The outcomes of patients treated with topical corticosteroids before diagnosis of AK were compared with those not treated with topical corticosteroids before diagnosis. A multivariable logistic model, optimized for prior corticosteroid use, was used to derive the odds ratios (ORs) of a suboptimal visual outcome. Suboptimal visual outcome was defined as final visual acuity (VA) ≤ 20/80, corneal perforation, or need for keratoplasty. Acanthamoeba keratitis was diagnosed on microbiological culture in 94 eyes (48.0%), on histopathologic examination in 27 eyes (13.8%), on confocal microscopy in 38 eyes (19.4%), and on the basis of a typical clinical course and response to treatment in 37 eyes (18.9%). Final VA and prior corticosteroid use data were available for 174 eyes (88.8%). In multivariable analysis, corticosteroid use before diagnosis was associated with suboptimal visual outcome (OR, 3.90 95% confidence interval [CI], 1.78-8.55), as were disease stage 3 at presentation (OR, 5.62 95% CI, 1.59-19.80) and older age (60+ years) at diagnosis (OR, 8.97 95% CI, 2.13-37.79). Corticosteroid use before diagnosis of AK is highly predictive of a poorer visual outcome. This is largely due to the initial misdiagnosis of AK as herpetic keratitis. It is important to include AK in the differential diagnosis of keratitis in all contact lens users with keratitis, particularly before making a diagnosis of herpes keratitis and before the use of topical corticosteroids in the therapy of any indolent keratitis.
Publisher: Public Library of Science (PLoS)
Date: 2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
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: Wiley
Date: 23-09-2015
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: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.OPHTHA.2022.08.002
Abstract: This study was designed to establish risk factors for the development of Acanthamoeba keratitis (AK) for daily disposable (DD) contact lens (CL) users compared with daily wear (DW) reusable lens users and for risks unique to DD users. This is important because, in many major economies, CL use is the principal cause of microbial keratitis, of which AK accounts for approximately 50% of cases with sight loss. Determining these AK risks informs practitioner advice and consumer behavior. Case-control study. Cases and controls were recruited from an Accident and Emergency Department serving South-East England. Cases were new CL users with AK recruited retrospectively from January 2011 to February 2013 and prospectively thereafter until August 2014. Controls were recruited prospectively from February 2014 to June 2015. Analysis of a self-administered questionnaire. Independent risk factors and population attributable risk percentage (PAR%) for AK. A total of 83 AK cases and 122 controls were recruited DD use was reported by 20 (24%) cases and 66 (54%) controls. In multivariable analyses adjusted for potential confounders, the odds of AK was higher for DW reusable soft lenses (odds ratio [OR], 3.84 95% confidence interval [CI], 1.75-8.43) and rigid lenses (OR, 4.56 95% CI, 1.03-20.19) than for DD lenses. Within the DD-using subset, AK was associated with the following modifiable risk factors: less frequent professional follow-up visits (OR, 10.12 95% CI, 5.01-20.46) showering in lenses (OR, 3.29, 95% CI, 1.17-9.23) lens reuse (OR, 5.41 95% CI, 1.55-18.89) and overnight wear (OR, 3.93 95% CI, 1.15-13.46). The PAR% estimated that 30% to 62% of cases could be prevented by switching from reusable soft lens to DD lens use. Acanthamoeba keratitis risks are increased > threefold in DW reusable lens users versus DD lens use. Acanthamoeba keratitis risks for DD lens users can be minimized by adherence to safe use guidelines (no reuse, overnight wear, or contamination by water). Safe CL use can be improved by increasing the prominence of risk avoidance information from manufacturers and regulators. Because AK accounts for half of severe keratitis in CL users, these measures can be expected to have public health benefits.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 13-10-2016
Abstract: The majority of anterior corneal dystrophies are caused by dominant mutations in TGFBI (transforming growth factor β-induced) collectively known as the epithelial-stromal TGFBI dystrophies. Most cases of epithelial basement membrane dystrophy (EBMD) are thought to result from a degenerative (nongenetic) process however, a minority of cases are associated with specific TGFBI mutations. We evaluated the spectrum of TGFBI mutations and associated phenotypes in a United Kingdom cohort with typical epithelial-stromal TGFBI dystrophies and an EBMD cohort. We recruited 68 probands with a clinical diagnosis of epithelial-stromal TGFBI dystrophy and 23 probands with bilateral EBMD. DNA was extracted from peripheral leukocytes, and TGFBI was bi-directly Sanger sequenced. Nine TGFBI mutations were identified. The most common occurred at the mutation hot-spot residues R124 and R555 in 61 probands these in iduals had a genotype-phenotype correlation consistent with prior reports. Four probands with lattice corneal dystrophy carried a mutation in exon 14: p.(A620D), p.(V625D), and p.(H626R). We identified a p.(G623D) mutation in five probands, including two probands from the EBMD cohort. These subjects typically had an onset of severe recurrent corneal epithelial erosion in the fourth decade with mild diffuse or geographic subepithelial corneal opacities and only small anterior stromal lattice structures in older in iduals. Symptoms of painful epithelial erosion improved markedly following phototherapeutic keratectomy. There was a strong correlation between genotype and phenotype for the majority of TGFBI mutations. In this cohort, the p.(G623D) mutation caused a greater proportion of TGFBI-associated disease than anticipated, associated with variable phenotypes including in iduals diagnosed with EBMD.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.OPHTHA.2014.07.052
Abstract: To report the risk factors for and outcomes of therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis (AK). Retrospective case series. A total of 50 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, underwent keratoplasty between January 1991 and April 2012. Patient demographics, initial clinical examination findings, and management details were collected. The ophthalmic characteristics of patients who underwent keratoplasty for AK were compared with those who did not. Patients undergoing therapeutic keratoplasty were compared with those undergoing optical keratoplasty for baseline characteristics, management details, and visual outcomes. A multivariate logistic model was used to derive the odds ratios of a poor visual outcome in all keratoplasty patients. Poor visual outcome was defined as final visual acuity of 20/200 or worse. Secondary outcomes of interest included number of clinic visits and the need for additional intraocular surgery. Of the 196 AK patients, a total of 50 patients (25.5%) underwent penetrating or anterior lamellar keratoplasty, 10 of whom (20%) underwent repeat procedures. Of these 50 patients, 26 (52%) had therapeutic keratoplasty, predominantly for corneal perforation. The remaining 24 patients (48%) underwent optical keratoplasty for visual rehabilitation. Thirty-seven (80.4%) patients in the keratoplasty group initially were misdiagnosed as having herpes simplex keratitis versus 59 (41.8%) patients who did not require a keratoplasty (P < 0.001). Final visual outcomes were significantly better in the optical group compared with the therapeutic group, with 13 (54.2%) achieving visual acuity of 20/30 or better versus 7 (26.9%), respectively. On multivariate analysis, beginning therapy at a hospital other than Moorfields and undergoing a therapeutic, rather than an optical, keratoplasty were associated significantly with a poor visual outcome from keratoplasty. The prognosis of keratoplasty differs markedly when performed for therapeutic purposes compared with visual rehabilitation. Where possible, keratoplasty should be delayed until such time as the eye is uninflamed and medically cured of Acanthamoeba.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: Springer Science and Business Media LLC
Date: 16-06-2021
Publisher: American Medical Association (AMA)
Date: 14-12-2009
DOI: 10.1001/ARCHOPHTHALMOL.2009.313
Abstract: To investigate the incidence of adverse events related to the use of varying silicone hydrogel contact lens and lens solution combinations. In iduals with myopia (N = 558) participated in 1 or more of approximately 40-participant trials in a matrix of 20 silicone hydrogel contact lens and lens-solution combinations. Visits were at baseline, 2 weeks, 1 month, and 3 months. The mean study completion rate was 90% of the expected participant-months (final data set: 840 lens-solution combinations and 2271 participant-months). Adverse events were reported as the first occurrence of each type per 100 participant-months for each lens-solution combination. The rate of all corneal infiltrative events (CIEs) was 3.1 per 100 participant-months (range, 0-10.5), and the rate of symptomatic CIEs was 1.7 per 100 participant-months (range, 0-10.5), including 1 case of microbial keratitis (0.04 per 100 participant-months). Rates for CIEs differed substantially among solution groups, with hydrogen peroxide having the lowest rate (0.6 per 100 participant-months range, 0-0.9). The rate was 0.8 per 100 participant-months (range, 0-8.0) for superior epithelial arcuate lesions, which varied by lens type, 0.04 per 100 participant-months (1 case only) for corneal erosion, and 0.4 per 100 participant-months (range, 0-2.0) for contact lens papillary conjunctivitis, which was modified by type of solution. The rate of solution-induced corneal staining for all lens-solution combinations was 4.7 per 100 participant-months (range, 0-23) and varied significantly based on lens-solution combination (P < .001). The frequency of adverse events varied with silicone hydrogel contact lens and lens solution combinations, with hydrogen peroxide having the lowest incidence of CIEs and solution-induced corneal staining, indicating that lens material and design, type of solution, and solution-lens interactions are likely contributing factors in this mode of lens wear.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.SURVOPHTHAL.2017.11.001
Abstract: Herpes simplex keratitis is commonly caused by Herpes simplex virus type 1, which primarily infects eyelids, corneas, or conjunctiva. Herpes simplex virus type 1-through sophisticated interactions with dendritic cells (DCs), a type of antigen-presenting cell)-initiates proinflammatory responses in the cornea. Corneas were once thought to be an immune-privileged region however, with the recent discovery of DCs that reside in the cornea, this long-held conjecture has been overturned. Therefore, evaluating the clinical, preclinical, and cell-based studies that investigate the roles of DCs in corneas infected with Herpes simplex virus is critical. With in vivo confocal microscopy, animal models, and cell culture experiments, we may further the understanding of the sophisticated interactions of Herpes simplex virus with DCs in the cornea and the molecular mechanism associated with it. It has been shown that specific differentiation of DCs using immunohistochemistry, flow cytometry, and polymerase chain reaction analysis in both human and mice tissues and viral tissue infections are integral to increasing understanding. As for in vivo confocal microscopy, it holds promise as it is the least invasive and a real-time investigation. These tools will facilitate the discovery of various targets to develop new treatments.
Publisher: Public Library of Science (PLoS)
Date: 16-08-2017
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: 05-08-2014
Publisher: Wiley
Date: 12-2017
DOI: 10.1111/EXD.13464
Abstract: Mucous membrane pemphigoid (MMP) is a rare, chronic and often aggressive subepidermal autoimmune blistering disease potentially affecting several mucous membranes with blisters and secondary erosions and scars. The pathogenesis of MMP is poorly understood, and the contribution of genetic predispositions, other than HLA class II allele variants to MMP, is unknown. The objective of this study is to identify susceptibility genes for MMP in a British cohort of MMP patients. A GWAS was conducted in a British cohort of 106 MMP patients. Publicly available genotypes of 2900 blood donors of the UK Blood Service and of 6740 in iduals of the 1958 British Birth Cohort served as control. Subsequently, putative susceptibility genes were independently replicated in a German cohort of 42 MMP patients. The GWAS found 38 SNPs in 28 haploblocks with an odds ratio >2 reaching genomewide significance (P < 5.7 × 10
Publisher: BMJ
Date: 19-09-2018
DOI: 10.1136/BJOPHTHALMOL-2018-312544
Abstract: Acanthamoeba keratitis (AK) is a chronic debilitating corneal infection principally affecting contact lens (CL) users. Studies were designed to test claims that the UK incidence may have increased in 2012–2014 and to evaluate potential causes. Annualised incidence data were collected from January 1984 to December 2016. Case-control study subjects were recruited between 14 April 2011 and 05 June 2017. Reusable CL users with AK were recruited retrospectively and prospectively. Controls were reusable CL users, recruited prospectively, with any disorder other than AK. Multivariable analysis of questionnaire data measured independent risk factors for AK. The current outbreak of AK started in 2010–2011 with an incidence threefold higher than in 2004–2009. Risk factors for AK were: Oxipol disinfection, CLs made of group IV CL materials, poor CL hygiene, deficient hand hygiene, use of CLs while swimming or bathing, being white British, and for those in social classes 4–9. AK is a largely preventable disease. The current outbreak is unlikely to be due to any one of the identified risk factors in isolation. Improving CL and hand hygiene, avoiding CLs contamination with water and use of effective CL disinfection solutions, or daily disposable CLs, will reduce the incidence of AK. In the longer-term, water avoidance publicity for CL users can be expected to reduce the incidence further. Ongoing surveillance of AK numbers will identify changes in incidence earlier. Evaluation of Acanthamoeba contamination in end-user drinking water would contribute to our understanding of regional variations in the risk of exposure.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.OPHTHA.2017.10.004
Abstract: This study explored the validity of the First International Consensus on Mucous Membrane Pemphigoid (MMP) guidance, which recommends that clinically indistinguishable patients, who have direct immunofluorescence (DIF)-negative biopsies, be excluded from a diagnosis of MMP. Misdiagnosis, or delayed diagnosis, of MMP with ocular involvement leads to the inappropriate use of topical therapy, the standard of care for causes of cicatrising conjunctivitis other than MMP, rather than systemic immunomodulatory therapy, resulting in irreversible clinical deterioration in patients with MMP. Prospective, cross-sectional study. Patients meeting the clinical criteria of ocular MMP, including those with positive and negative DIF findings. A case report form was used to collect the demographic details, the clinical history, and the results of a detailed clinical assessment by ophthalmologists, otolaryngologists, dermatologists, and oral medicine specialists. All anatomic sites potentially affected by MMP were examined apart from the esophagus (and larynx in a subset). The DIF results were recorded. Differences between DIF-positive and -negative patients in demography, sites of involvement, and disease severity as determined by the degree of conjunctival scarring (using Tauber staging), central corneal disease (vascularization, scarring, ulceration, and conjunctivalization), history of conjunctival or lid surgery, and requirement for systemic immunotherapy at the time of screening. A total of 73 patients with ocular MMP were recruited, of whom 20 of 73 (27.4%) had ocular-only disease. There was no significant demographic or clinical difference between patients with positive and negative DIF results. This finding included differences in disease severity for which the only significant difference was that of more severe central corneal disease in DIF-negative patients. Asymptomatic disease at different sites was frequent. These findings do not support the classification of DIF-negative patients, meeting the clinical criteria for ocular MMP, as having a different disease. This category of patients should be accepted as having DIF-negative MMP, for clinical management purposes, with patients having inflamed eyes being treated with systemic immunomodulatory therapy. The frequent finding of asymptomatic ocular, oral, and nasopharyngeal MMP is clinically significant and implies that these sites should be routinely screened in asymptomatic patients.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/23743735221103031
Abstract: Acanthamoeba keratitis (AK) is a rare but severe eye disease. A research engagement event, “The Cornea Day,” in London, UK in 2013, identified the lack of credible information about AK and a need for practical day to day management strategies. Experiences of 15 AK patients attending The Cornea Day were distilled into a survey that was administered to a wider group of 76 patients, carers, researchers, and clinicians. A Patient Information Leaflet was cocreated and then represented to additional patients for final modification. The AK Patient Leaflet (revised 2019) is available in several languages and used globally.
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: 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: Ovid Technologies (Wolters Kluwer Health)
Date: 20-10-2021
Publisher: Informa UK Limited
Date: 19-09-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-2019
Publisher: Springer Science and Business Media LLC
Date: 05-11-2021
DOI: 10.1038/S41433-021-01812-7
Abstract: To evaluate the sensitivity and specificity of polymerase chain reaction (PCR), in vivo confocal microscopy (IVCM) and culture for microbial keratitis (MK) diagnosis. Retrospective review of PCR, IVCM and culture results for MK diagnosis at Moorfields Eye Hospital between August 2013 and December 2014. PCR results were available for 259 MK patients with concurrent culture for 203/259 and IVCM for 149/259. Sensitivities and specificities with 95% confidence intervals [95% CI] were calculated for Acanthamoeba keratitis (AK) and fungal keratitis (FK), by comparison with culture, for both IVCM and PCR. For AK, FK and bacterial keratitis (BK) sensitivities were calculated, for each diagnostic method, by comparison with a composite reference standard (a positive result for one or more of culture, PCR or IVCM having a specificity of 100% by definition). For the latter, sensitivities with [95% CI] were: for AK, IVCM 77.1% [62.7–88.0%], PCR 63.3% [48.3–76.6%], culture 35.6 [21.9–51.2] for FK, IVCM 81.8% [48.2–97.7%], PCR 30.8% [9.09–61.4%], culture 41.7% [15.2–72.3%] for BK, PCR 25.0% [14.7–37.9%], culture 95.6% [87.6–99.1%]. IVCM was the most sensitive technique for AK and FK diagnosis but culture remains our gold standard for BK. These findings reflect results to be expected from service providers to UK ophthalmology units and demonstrates the need at our centre for ongoing diagnostic result audit leading to the potential to improve PCR diagnosis. Both FK and AK are now common in the UK ophthalmology units need to have all these techniques available to optimise their MK management.
Publisher: BMJ
Date: 02-2017
Publisher: Springer Science and Business Media LLC
Date: 28-10-2015
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.OPHTHA.2014.06.033
Abstract: To describe the epidemiology, clinical features, and treatment outcomes of Acanthamoeba sclerokeratitis (ASK). Retrospective case series. All cases of both Acanthamoeba keratitis (AK) and ASK identified between January 1, 2000, and January 8, 2011, at Moorfields Eye Hospital. Acanthamoeba keratitis was defined as the presence of AK with concurrent ipsilateral scleral inflammation. Topical steroids and oral nonsteroidal anti-inflammatory drugs (NSAIDs) were used as the first line of treatment. In unresponsive cases, oral NSAIDs were replaced by oral prednisolone with cyclosporine, azathioprine, or mycophenolate as steroid-sparing agents. Cyclosporine was combined with azathioprine or mycophenolate in cases unresponsive to only 1 of these drugs alone. Epidemiology, clinical phenotype, response to therapy, resolution of inflammation, visual outcome, corneal transplantation, and enucleation rate. From a series of 178 patients with AK, 36 eyes of 33 patients (18.5%) developed ASK. A total of 25 of 33 patients (76%) with ASK were tertiary referrals. The incidence of the disease in greater London was 0.13 per million, and the incidence in this population of patients with AK was 33 of 178 (18.5%). Mild scleritis/limbitis responsive to topical steroids and oral NSAIDs was present in 11 of 36 eyes (31%), and moderate/severe scleritis, requiring systemic immunosuppressive therapy, was present in 25 eyes (69%). Before the initiation of ASK treatment, 2 of 36 eyes (6%) had corrected distance visual acuity (CDVA) ≥ 20/40. The length of ASK treatment was 15.3 ± 20.7 months. The follow-up after discontinuation of scleritis treatment was 27.2 ± 31.8 months. An improvement in visual acuity was recorded in 23 of 36 eyes (64%). At the final visit, 13 of 36 eyes (36%) had CDVA ≥ 20/40. Control of scleral inflammation and pain was achieved in all but 2 eyes (2 enucleations). Cataract developed in 10 of 36 eyes (28%), and 14 of 36 eyes (39%) developed a persistent epithelial defect. Keratoplasty was performed in 21 of 36 eyes (58%), 9 therapeutic/tectonic and 12 for visual rehabilitation. Six eyes had more than 1 keratoplasty. The mild scleritis group had better outcomes in terms of visual improvement and need for keratoplasty. Acanthamoeba sclerokeratitis is associated with poor clinical outcomes. Management of ASK with anti-inflammatory/immunosuppressive treatment is usually effective in reducing both scleral inflammation and symptoms and possibly reduces the number of enucleations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
Publisher: Elsevier BV
Date: 11-2022
Abstract: The opportunistic protist Acanthamoeba, which interacts with other microbes such as bacteria, fungi, and viruses, shows significant similarity in cellular and functional aspects to human macrophages. Intracellular survival of microbes in this microbivorous amoebal host may be a crucial step for initiation of infection in higher eukaryotic cells. Therefore, Acanthamoeba-microbe adaptations are considered an evolutionary model of macrophage-pathogen interactions. This paper reviews Acanthamoeba as an emerging human pathogen and different ecological interactions between Acanthamoeba and microbes that may serve as environmental training grounds and a genetic melting pot for the evolution, persistence, and transmission of potential human pathogens.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2001
DOI: 10.1097/00006324-200101010-00008
Abstract: Superior epithelial arcuate lesions (SEALs) are an infrequent and often asymptomatic complication of conventional soft contact lens wear. The characteristic arcuate pattern of the full-thickness corneal epithelial lesion usually occurs in the area covered by the upper eyelid, within 2 to 3 mm of the superior limbus in the 10- and 2-o'clock region. Literature on SEALs and recent clinical records from clinical trials using two types of prototype high Dk soft contact lenses were reviewed to gain greater insights into the etiology of SEALs. The reported low incidence of SEALs is partly because SEALs are not usually symptomatic. The etiology of SEALs is multifactorial. Our current hypothesis is that SEALs are produced by mechanical chaffing at the peripheral cornea. This chaffing occurs as a result of inward pressure of the upper lid, in an area where the peripheral corneal topography and lens design, rigidity, and surface characteristics combine to create excessive "frictional" pressure and abrasive shear force on the epithelial surface. Patient characteristics such as gender, age, and specific corneal and lid topographies also appear to influence the occurrence of SEALs. Prototype silicone hydrogel lenses are made from higher modulus materials with surfaces that seem to differ subtly in wettability in some patients. The prevalence of SEALs may well increase with the first generations of these lenses.
Publisher: Elsevier
Date: 2019
Publisher: Elsevier BV
Date: 04-2017
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: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2007
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 11-2016
Publisher: BMJ
Date: 17-02-2016
DOI: 10.1136/BJOPHTHALMOL-2015-307371
Abstract: Microbial keratitis is a sight-threatening condition and an ocular emergency, because of the potential for rapid progression. Intensive topical antimicrobials are the mainstay and the gold standard of treatment for microbial keratitis. However, despite appropriate diagnosis and therapy, treatment failure is still common, and can result in significant morbidity due to corneal perforation and/or scarring. For this reason, clinicians continue to seek novel treatment techniques in order to expand the armamentarium of tools available to manage microbial keratitis, and in doing so improve clinical outcomes. In this review, we examine the evidence for some established, as well as a few emerging ancillary techniques used to manage microbial keratitis. These include topical corticosteroids, corneal collagen cross-linking, intrastromal antimicrobials, amniotic membrane transplantation and miscellaneous other techniques. Of these, collagen cross-linking shows some promise for selected cases of infectious keratitis, although more research in the area is required before it is accepted as mainstream treatment for this potentially blinding condition.
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: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.OPHTHA.2016.01.020
Abstract: To examine the impact of topical corticosteroid use after the start of antiamoebic therapy (AAT) on the outcomes of Acanthamoeba keratitis (AK) therapy. Cohort study. A total of 196 patients diagnosed with AK at Moorfields Eye Hospital, London, between January 1991 and April 2012. In 13 patients with bilateral AK, 1 eye was randomly excluded from analysis. Patient demographics and clinical examination findings were collected both at the start of AAT and subsequently at the time that topical corticosteroid therapy was initiated. Preliminary a priori investigations were used to identify effect modifiers/confounders and extreme associations requiring consideration in multivariate regression modeling. A multivariable logistic model, optimized for assessment of corticosteroid use after the start of AAT, was used to estimate the odds ratios (ORs) of a suboptimal outcome. Suboptimal outcome was defined as final visual acuity ≤20/80, corneal perforation, or the need for keratoplasty. In multivariable analysis, restricted to 129 eyes (1 eye per patient) free of scleritis and hypopyon at the start of AAT, topical corticosteroids were not associated with worse outcomes (OR, 1.08 95% confidence interval [CI], 0.39-3.03), even when corticosteroids had been used before the start of AAT. Risk factors significantly associated with worse outcomes were topical corticosteroid use before the start of AAT (OR, 3.85 95% CI, 1.35-11.03), a corneal ring infiltrate (together with at least 1 other feature of AK) present at the start of AAT (OR, 5.89 95% CI, 1.17-29.67), and age ≥33 years at the start of AAT (OR, 4.02 95% CI, 1.46-11.06). Many corneal specialists currently are uncertain about the risk benefit associated with the use of topical corticosteroids for the management of inflammatory complications of AK. The evidence from this study gives clinicians and patients reassurance that the potential benefits of topical corticosteroid therapy, for treating pain and discomfort, are not associated with worse outcomes when initiated after starting modern AAT. Other potential benefits, in terms of resolution of inflammatory complications, will not be demonstrated without a carefully designed randomized clinical trial.
Publisher: Wiley
Date: 29-11-2016
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: 03-2010
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 09-04-2018
DOI: 10.1167/TVST.7.2.20
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: BMJ
Date: 16-09-2015
DOI: 10.1136/BJOPHTHALMOL-2015-307091
Abstract: To evaluate a corneal impression membrane (CIM) for isolation of bacteria, fungi and acanthamoeba in suspected microbial keratitis. Consecutive patients presenting with suspected microbial keratitis were included. For each patient, s les were collected in a random order using a surgical blade and a 4-mm-diameter polytetrafluoroethylene CIM disc, and transported in brain heart infusion broth. Risk factors, best corrected visual acuity (BCVA), size, location, depth and healing time of the ulcer were recorded. The microbial isolation rate was used to compare s ling methods. 130 patients were included (mean age 62.6 years, SD 19.0). An antimicrobial had been used prior to presentation in 36 (27.7%) patients. Mean major and minor ulcer diameters were 2.1 mm (SD 2.0) and 1.6 mm (SD 1.7). Mean healing time was 12.4 days (SD 13.6). BCVA at presentation and following healing was 0.7 (SD 0.7) and 0.62 (SD 0.7) (p=0.34). There were 66 isolates (50.8%) 53 (40.8%) using a CIM and 35 (26.9%) using a blade (p=0.02). ITALIC! Staphylococcus aureus and coagulase-negative staphylococci were the commonest isolates. Isolation rate was not influenced by organism type, although in four cases ITALIC! Acanthamoeba spp. were isolated three using CIM and one a blade. In this study, the isolation of microorganisms from cases of suspected microbial keratitis was significantly higher using a CIM than a surgical blade. A CIM may be a useful alternative or addition for s le collection in microbial keratitis.
Publisher: Springer Science and Business Media LLC
Date: 02-12-2012
DOI: 10.1038/EYE.2011.288
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
Publisher: BMJ
Date: 03-01-2018
DOI: 10.1136/BJOPHTHALMOL-2017-310806
Abstract: To determine demographic and clinical features of patients with Acanthamoeba keratitis (AK) that are independent risk factors both for bad outcomes and for severe inflammatory complications (SIC). A retrospective audit of medical records of AK cases at Moorfields Eye Hospital from July 2000 to April 2012, including 12 earlier surgical cases. Cases with a bad outcome were defined as those having one or more of the following: corneal perforation, keratoplasty, other surgery (except biopsy), duration of antiamoebic therapy (AAT) ≥10.5 months (the 75th percentile of the whole cohort) and final visual acuity ≤20/80. SICs were defined as having scleritis and/or a stromal ring infiltrate. Multivariable analysis was used to identify independent risk factors for both bad outcomes and SICs. Records of 194 eyes (194 patients) were included, having bad outcomes in 93 (48%). Bad outcomes were associated with the presence of SIC, aged years, corticosteroids used before giving AAT and symptom duration days before AAT. The development of SIC was independently associated with aged years, corticosteroids used before giving AAT and herpes simplex virus (HSV) keratitis treatment before AAT. The prompt diagnosis of AK, avoidance of a misdiagnosis of HSV keratitis and corticosteroid use before the exclusion of AK as a potential cause of keratitis are essential to the provision of a good outcome for patients and for the avoidance of SIC. Older age is an unmodifiable risk factor that may reflect differences in the immune response to AK in this patient subset.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2011
Publisher: Portland Press Ltd.
Date: 04-12-2017
DOI: 10.1042/CS20171246
Abstract: For many years, oxidative stress arising from the ubiquitous production of reactive oxygen species (ROS) has been implicated in the pathogenesis of various eye diseases. While emerging research has provided some evidence of the important physiological role of ROS in normal cell function, disease may arise where the concentration of ROS exceeds and overwhelms the body’s natural defence against them. Additionally, ROS may induce genomic aberrations which affect cellular homoeostasis and may result in disease. This literature review examines the current evidence for the role of oxidative stress in important ocular diseases with a view to identifying potential therapeutic targets for future study. The need is particularly pressing in developing treatments for conditions which remain notoriously difficult to treat, including glaucoma, diabetic retinopathy and age-related macular degeneration.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
Publisher: Elsevier BV
Date: 2013
No related grants have been discovered for Nicole Carnt.