ORCID Profile
0000-0001-8393-9870
Current Organisations
Perth Children's Hospital
,
Sir Charles Gairdner Hospital
,
Lions Eye Institute
,
University of Western Australia
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Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1442-9071.2010.02278.X
Abstract: To report on diabetic retinopathy (DR) and the major causes of vision loss and blindness in Aboriginals in the Eastern Goldfields region of Western Australia between 1995 and 2007. Aboriginals (>16 years old) diagnosed with diabetes or eye problems from 11 communities in the Eastern Goldfields region of Western Australia were examined annually from 1995 to 2007. Data collected from prospective clinical examination included visual acuity (VA), causes of vision loss, and whether DR was present. Severity of DR was graded according to the Early Treatment of Diabetic Retinopathy Study modified Airlie House grading system. A total of 920 Aboriginals underwent 1331 examinations over the study period. There were 246 eyes with vision loss (best-corrected VA < 6/12) in 159 Aboriginals, of whom five were bilaterally blind. The four major known causes of vision loss were cataract (n = 53, 30.1%), DR (n = 44, 25.0%), uncorrected refractive error (n = 31, 17.6%) and trauma (n = 19, 10.8%). Aboriginals who had diabetes were far more likely to have vision loss (odds ratio = 8.5, 95% confidence interval 5.7-12.6, P < 0.0001). Of the 329 Aboriginals with diabetes, 82 (24.9%) had DR, and 32 (9.7%) had vision-threatening retinopathy. Of those with diabetes, 94 (42.5%) returned for follow-up examination on an average of 3.2 visits with a median time between visits of 2 years. The four major causes of vision loss in Aboriginals from the Eastern Goldfields are largely preventable and/or readily treated. DR and other diabetes-related eye conditions are a major cause of vision loss in Aboriginals, representing a significant health challenge for health services and clinicians into the future.
Publisher: Wiley
Date: 24-03-2011
DOI: 10.1111/J.1442-9071.2011.02509.X
Abstract: To validate the accuracy of clinical ophthalmic information held on the West Australian blind register. Community-based cross-sectional study. Legally blind or severely vision-impaired people were selected randomly from the Association for the Blind of Western Australia register. In iduals were reviewed by one of two consultant ophthalmologists. The positive predictive value (ppv), sensitivity and specificity for legal blindness status and diagnostic causes of vision loss were calculated using data extracted from the Association for the Blind of Western Australia blind register. 273 blind or near blind people were reviewed from the register total of 4271 in iduals. There were more women (57%) than men, median age 81 years. For legal blindness status the ppv was 0.88 (95% confidence interval [CI] 0.82-0.92), sensitivity 0.75 (95% CI 0.74-0.84) and specificity 0.6 (95% CI 0.46-0.73). The ppv for the diagnostic causes of blindness were: age-related macular degeneration = 0.95 (95% CI 0.91-0.97), retinitis pigmentosa ppv = 1 (95% CI 0.81-1.0), diabetic retinopathy ppv = 0.9 (95% CI 0.57-0.99), optic neuropathies ppv = 0.77 (95% CI 0.51-0.92) and glaucoma ppv = 0.87 (95% CI 0.7-0.96). Forty in iduals (15%) had treatable conditions contributing to their vision loss. The blind register diagnoses and legal blindness status are of high accuracy. This information allows useful linkages to other databases for studies of blindness interactions. A regular updating mechanism would improve the future accuracy of this valuable regional asset. The presence of untreated cataract suggests that regular follow up and appropriate treatment may help optimize vision in blind patients.
Publisher: BMJ
Date: 17-11-2012
DOI: 10.1136/BJOPHTHALMOL-2011-300908
Abstract: To determine the prevalence of blinding eye disease in Western Australia using a capture and recapture methodology. Three independent lists of residents of Western Australia who were also legally blind were collated during the capture periods in 2008-9. The first list was obtained from the state-wide blind register. A second list comprised patients routinely attending hospital outpatient eye clinics over a 6-month period in 2008. The third list was patients attending ophthalmologists' routine clinical appointments over a 6-week period in 2009. Lists were compared to identify those in iduals who were captured on each list and those who were recaptured by subsequent lists. Log-linear models were used to calculate the best fit and estimate the prevalence of blindness in the Western Australian population and extrapolated to a national prevalence of blindness in Australia. 1771 legally blind people were identified on three separate lists. The best estimate of the prevalence of blindness in Western Australia was 3384 (95% CI 2947 to 3983) or 0.15% of the population of 2.25 million. Extrapolating to the national population (21.87 million) gave a prevalence of legal blindness of approximately 32,892 or 0.15%. Capture-recapture techniques can be used to determine the prevalence of blindness in whole populations. The calculated prevalence of blindness suggested that up to 30% of legally blind people may not be receiving available financial support and up to 60% were not accessing rehabilitation services.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JAAPOS.2017.06.024
Abstract: This retrospective case series assessed the influence of unilateral intravitreal bevacizumab (IVB) for unilateral type 1 retinopathy of prematurity (ROP) on macular thickness and foveal development. Seven infants with unilateral type 1 ROP were treated with intravitreal bevacizumab 0.625 mg/0.025 ml in one eye only. To determine whether macular thickness and fovea structural development were affected by treatment, spectral domain optical coherence tomography was performed on both treated and untreated eyes. The mean gestational age of infants was 25.3 ± 0.3 weeks the mean birth weight, 776 ± 17.6 g. Treatment was given at a mean postmenstrual age of 37.2 ± 0.4 weeks. Foveal development was normal in 3 (43%) treated versus 5 (71%) untreated eyes. The mean central foveal thickness for treated and untreated eyes was 270.1 μm ± 19.6 and 253.0 μm ± 27.2 respectively (P = 0.15). There was small but nonsignificant difference in foveal development and thickness in eyes treated with intravitreal bevacizumab compared to fellow eyes. This study generates important data to test the hypothesis that foveal thickness is greater in unilateral type 1 ROP eyes treated with IVB compared to untreated fellow eyes.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.SURVOPHTHAL.2016.01.003
Abstract: Large population-based health administrative databases, clinical registries, and data linkage systems are a rapidly expanding resource for health research. Ophthalmic research has benefited from the use of these databases in expanding the breadth of knowledge in areas such as disease surveillance, disease etiology, health services utilization, and health outcomes. Furthermore, the quantity of data available for research has increased exponentially in recent times, particularly as e-health initiatives come online in health systems across the globe. We review some big data concepts, the databases and data linkage systems used in eye research-including their advantages and limitations, the types of studies previously undertaken, and the future direction for big data in eye research.
Publisher: Informa UK Limited
Date: 17-08-2022
DOI: 10.1080/08164622.2021.1964921
Abstract: Eye injuries, both accidental and non-accidental, are a significant cause of long-term visual impairment in children. An understanding of when and how such injuries occur is key to development of adequate prevention strategies. To evaluate accidental and non-accidental eye injuries in children presenting to the major tertiary emergency department and outpatient ophthalmology clinic in Western Australia during the nationwide COVID-19 lockdown and to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. Retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March-August 2020 and the same period in 2019. There was no significant difference in the total number of accidental eye injury presentations during the lockdown period despite a significant decrease in emergency department attendance overall. Closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, 64%), followed by adnexal injuries (39/110, 35%) and open-globe injuries (1/110, 1%). In contrast, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown. Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance. Public education regarding in-home eye injury prevention must be ongoing.
Publisher: Informa UK Limited
Date: 24-08-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
Publisher: BMJ
Date: 11-10-2013
DOI: 10.1136/BJOPHTHALMOL-2013-303993
Abstract: Determine whether blindness in people aged 18-65 years was associated with increased rates of mortality, hospitalisation and length of stay. A retrospective matched cohort study of legally blind people and normally sighted controls, aged 18-65 years, comparing mortality rates and hospital morbidity records. Together, 419 blind and 419 controls accumulated 12 258 hospital separations over the 11-year study period. The blind had an age-specific mortality rate seven times greater (12/1000 person years) than the general population (1.8/1000 person years) (p<0.001). Blindness was recorded as a comorbid condition for 76 (22%) blind in iduals, on just 255 (2.3%) hospital separation records. Psychiatric, mental or behavioural conditions were the most frequently recorded diagnoses, after dialysis and endocrine conditions. After adjusting for comorbidities, the blind cohort had 1.5 times more hospital separations (p=0.007, 95% CI 1.1 to 2.0) and 2.2 times more bed days (p=0.016, 95% CI 1.4 to 4.1) compared with the control cohort. Recognition and acknowledgement of in-patients' blind status may assist in understanding the frequent and extended health service utilisation rates. Encouraging and promoting the uptake and access to rehabilitation support services would be measures that may reduce the health service burden of blindness, the incidence of depression and other mental health problems.
Publisher: Wiley
Date: 11-04-2013
DOI: 10.1111/CEO.12101
Abstract: To evaluate the impact of blindness on hospitalization rates of children. Matched cohort study. Children confirmed as legally blind (2003-2009), age- and gender-matched to control cohort of normally sighted children from the state register of births. The rates and reasons for admission to hospital were compared using hospital morbidity records. The association of blindness with rates of admission and length of stay in hospital, 2003-2010, were estimated using multivariate negative binomial regression models. Descriptive statistics, incident rate ratios, and predicted means for hospital separations and length of stay. Fifty-nine blind and 59 control children had a combined total of 107 separations accounting for 237 bed days in hospital after the index date of legal blindness. The median age at the index date was 8 years. Over 90% of separations and 92% of bed days were incurred by 22 blind children. Blind children had four (95% confidence interval 1.9-9.3) times more hospital separations and stayed in hospital six (95% confidence interval 1.9-17.5) times longer than the control cohort children. There were more than 40 times as many comorbidities recorded by the blind children (n = 201) compared with the control children (n = 5). A third of the blind children were hospitalized for respiratory conditions. Children who are born or become blind in childhood have more and longer periods in hospital than sighted children likely because of complex comorbid health problems. There was a disproportionate incidence of comorbid respiratory diseases in the blind children.
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/CEO.13736
Publisher: Wiley
Date: 09-09-2022
DOI: 10.1111/CEO.14148
Abstract: To test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia‐control approach in Australian children. Children (6–16 years 49% Europeans, 18% East Asian, 22% South Asian, and 12% other/mixed ancestry) with documented myopia progression were enrolled into this single‐centre randomised, parallel, double‐masked, placebo‐controlled trial and randomised to receive 0.01% atropine ( n = 104) or placebo ( n = 49) eyedrops (2:1 ratio) instilled nightly over 24 months (mean index age = 12.2 ± 2.5 and 11.2 ± 2.8 years, respectively). Outcome measures were the changes in spherical equivalent (SE) and axial length (AL) from baseline. At 12 months, the mean SE and AL change from baseline were −0.31D (95% confidence interval [CI] = −0.39 to −0.22) and 0.16 mm (95%CI = 0.13–0.20) in the atropine group and −0.53D (95%CI = −0.66 to −0.40) and 0.25 mm (95%CI = 0.20–0.30) in the placebo group (group difference p ≤ 0.01). At 24 months, the mean SE and AL change from baseline was −0.64D (95%CI = −0.73 to −0.56) and 0.34 mm (95%CI = 0.30–0.37) in the atropine group, and −0.78D (95%CI = −0.91 to −0.65) and 0.38 mm (95%CI = 0.33–0.43) in the placebo group. Group difference at 24 months was not statistically significant ( p = 0.10). At 24 months, the atropine group had reduced accommodative litude and pupillary light response compared to the placebo group. In Australian children, 0.01% atropine eyedrops were safe, well‐tolerated, and had a modest myopia‐control effect, although there was an apparent decrease in efficacy between 18 and 24 months, which is likely driven by a higher dropout rate in the placebo group.
Publisher: Elsevier BV
Date: 08-2022
Publisher: American Medical Association (AMA)
Date: 07-2012
DOI: 10.1001/ARCHOPHTHALMOL.2012.164
Abstract: To estimate the long-term cumulative incidence of and risk factors for retinal detachment (RD) after phacoemulsification using linked administrative medical data. We used the Western Australian Data Linkage System to identify patients who underwent phacoemulsification in Western Australia between January 1989 and December 2001. Retinal detachment cases were those patients requiring admission for RD surgery after phacoemulsification that were validated by medical record review. Kaplan-Meier analysis was used to calculate a cumulative incidence. Cox proportional hazards regression modeling was used to determine the association between RD and risk factors, including patient demographics and operative and hospital factors. Some important risk factors, including axial length and Nd:YAG laser capsulotomy, were not examined. We identified 237 RD cases following 65 055 phacoemulsification procedures, with a 10-year cumulative incidence of 0.68% (95% CI, 0.56%-0.83%). Significant risk factors were year of surgery (hazard ratio [HR], 0.43 95% CI, 0.28-0.66 [1999-2001 compared with 1989-1993] for each 5-year period after 1985), age younger than 60 years (3.76 2.83-5.00), male sex (1.91 1.45-2.51), and anterior vitrectomy (27.60 19.27-39.52). Hospital location, patient rural or remote locality, hospital cataract surgery volume, failed intraocular lens insertion, length of stay, and patient insurance status were not significantly associated with RD. Risk for RD after phacoemulsification has almost halved for each 5-year period since its adoption in the mid 1980s. Younger patient age and male sex at surgery significantly increased risk for RD. Phacoemulsification requiring anterior vitrectomy vastly increased risk for RD.
Publisher: Wiley
Date: 08-2008
DOI: 10.1111/J.1442-9071.2008.01827.X
Abstract: The aim of this study is to determine if postoperative endophthalmitis adversely affects quality of life after cataract surgery. We compared quality of life in patients who developed endophthalmitis after cataract surgery between 1 January and 31 December 2003 with those who had uncomplicated surgery. The National Eye Institute VFQ-25 (VFQ-25) and EuroQol EQ-5D (EQ-5D) questionnaires and time trade-off utility scores were used to compare self-perceived general health and vision-related quality of life between groups. Linear regression was used to model differences between groups after adjusting for age, gender and visual acuity in the better eye. Nineteen postoperative endophthalmitis cases were compared with 30 who had uncomplicated cataract surgery. Following surgery the mean composite VFQ-25 score was 13.5% (95% confidence interval [CI]: 6.0-26.4, P < 0.01) lower in endophthalmitis cases. Endophthalmitis patients reported significantly lower (P < 0.05) general vision, near vision, peripheral vision, mental health and role difficulties subscales scores after adjusting for age, sex and visual acuity. No significant differences were found in other subscales. Mean time trade-off utility and all EQ-5D scores were similar except for mobility (95% CI: 0.04-0.68, P < 0.05). Endophthalmitis after cataract surgery negatively impacts on self-perceived vision-related quality of life, resulting in poorer psychological well-being and ability to maintain a role in daily life.
Publisher: Wiley
Date: 08-2010
DOI: 10.1111/J.1442-9071.2010.02326.X
Abstract: To compare the self-reported management of diabetic retinopathy by Australian ophthalmologists with the 1997 National Health and Medical Research Council (NHMRC) guidelines. Self-reported cross-sectional survey of patterns of practice. Questionnaires were sent to all Australian ophthalmologists, comprising questions regarding professional details, diabetic retinopathy screening attitudes ractices and specific hypothetical management scenarios. Data were analysed using Chi-squared and adjusted logistic regression. 480 of the 751 (64%) eligible Australian ophthalmologists participated. The majority (80%, n = 376) reported they consistently reviewed patient's glycaemic control, but only 55% and 41% regularly reviewed blood pressure and serum cholesterol control, respectively. Ophthalmologists generally adhered to NHMRC-recommended screening intervals, although only 38% agreed with the guidelines relating to screening of pre-pubertal diabetic patients. Fluorescein angiogram was used more than recommended, especially for mild non-proliferative diabetic retinopathy where 45% of respondents used this investigation. Practice duration >15 years was associated with more regular fluorescein angiogram use (OR = 3.74 95% CI: 2.53-5.53, P 26% referred to retinal subspecialists for management 85% of the remaining ophthalmologists performed macular laser first. Respondents with practice duration >15 years were 7.8 times (P = 0.001) more likely to perform cataract surgery first. Diabetic retinopathy management guidelines were generally well followed by Australian ophthalmologists. However, areas of practice variation existed including frequent use of fluorescein angiogram. Significant proportion of practitioners referred diabetic patients to retinal subspecialists, who were more likely to adhere to guideline recommendations. Ophthalmologists with greater experience (>15 years) were more likely to employ practices differing from NHMRC recommendations.
Publisher: BMJ
Date: 26-08-2018
DOI: 10.1136/BJOPHTHALMOL-2017-310686
Abstract: To investigate whether pterygium is an indicator of an increased risk of cutaneous melanoma (CM). A matched-cohort study, using linked health administrative data sets to identify all hospital-treated pterygium in Western Australia (WA) between 1979 and 2014. We identified pterygium cases from hospital diagnosis and/or procedure International Classification of Diseases 9th revision (ICD-9) and 10th revision (ICD-10) codes and matched cases by age, sex and residential postcode to WA Electoral Roll controls with no known history of pterygium. Both cohorts were linked to the WA Cancer Registry and the WA Deaths Registry. 23 625 people had pterygium treatment (64% male) in WA hospitals. The median age for pterygium diagnosis and/or treatment was 49 years (range 14–96). There were significantly more CM cases in the pterygium cohort compared with the control cohort (1083 vs 874 p .001). In a logistic regression analysis, there was a 24% increase in the odds of developing a CM in the pterygium cohort, compared with controls, after controlling for other predictors (OR 1.24, 95% CI 1.1 to 1.4). The incident rate ratio (IRR) of a malignant CM diagnosis was 20% greater in people who had treatment for a pterygium compared with controls (IRR 1.2, 95% CI 1.0 to 1.4). The presence of a pterygium indicates a significantly increased risk of developing a CM. Eye care providers who see patients with developing pterygia should advise these patients of this increased risk and recommend regular skin surveillance.
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/AH09805
Abstract: Objective.To evaluate the extent to which Western Australian (WA) represents the broader Australian population in terms of key socio-demographic and health economic indicators. Methods.We compared key demographic, social and health economic indicators across all Australian States and Territories from Australian government publications in the census years 1991–2006. Jurisdictional averages (JAs) were calculated as the mean (±s.d.) or median (±range). Observed jurisdiction indicators were compared with the JA and ranked according its representativeness of the JA. Results.WA was among the three closest jurisdictions to the national JA for all socio-demographic and health economic indicators examined, with the exception of uptake of private health insurance (ranked 6th) and per-capita health expenditure (ranked 5th). The Northern Territory and Australian Capital Territory were least representative for the majority of indicators. Excluding the proportions of people living in rural or remote areas (0–100%) and of indigenous origin (0.4–28.8%), variations in the indicators across the jurisdictions were relatively small. Conclusions.Population differences between Australia’s States were small, whereas Australia’s Territories were least representative of the JA. WA was the most representative population of Australia’s eight jurisdictions and continues to be in a strong position to contribute to knowledge of the Australian health system that is applicable Australia-wide. What is known about the topic?The Western Australian Data Linkage system (WADLS) is a highly successful and productive research tool that facilitates population-based health research. A potential criticism and concern of this research surrounds the representativeness of the WA population to other Australian States and Territories. Anecdotally, there is a perception that WA’s isolation from other Australian populations may lead to systematic socio-demographic and socioeconomic differences thus limiting the generalisability of research findings. What does this paper add?This paper compares Australia’s State and Territory population profiles and allows researchers to determine the extent to which contextual issues concerning key socio-demographic and health economic indicators may affect the external validity of population-based research arising from any one jurisdiction. What are the implications to practitioners?In the absence of previous evaluations in this area and with the continued emergence of new data linkage systems around the country, this information is important for health researchers and policy makers who may wish to draw conclusions and make policy decisions that rely upon extrapolating findings from population-based studies.
Publisher: Wiley
Date: 04-2011
DOI: 10.1111/J.1442-9071.2010.02446.X
Abstract: To survey the current diabetic retinopathy screening and management practices of Australian optometrists following the release of the 1997 National Health Medical Research Council Diabetic Retinopathy Management Guidelines. Cross-sectional national survey, primary care setting. 1000 Australian optometrists across different states. A self-administered questionnaire was sent to 1000 optometrists across all states during 2007/2008. Use of retinal camera, screening practices/attitudes and behaviour in diabetic retinopathy management. 568 optometrists (57%) responded to the survey. Patients' unpreparedness to drive post dilation (51%) and the fear of angle closure glaucoma (13%) were the two main barriers to optometrists not performing dilated ophthalmoscopy. Those who had strong desire to screen for diabetic retinopathy were more likely to use a retinal camera (p<0.005). Use of a retinal camera was significantly associated with an increased confidence in detecting clinical signs of diabetic retinopathy including macular oedema (P<0.001). Optometrists who read the guidelines at least once were 2.5-times (P<0.001) more likely to have confidence in detecting macular oedema than those who had never read the guidelines. Although they may be confident in diagnosis, and may use retinal cameras for screening, nearly 60% of optometrists would not refer patients with macular oedema to an ophthalmologist. Despite their self-reported desire for involvement in diabetic retinopathy, the management of macular oedema by Australian optometrists needs improvement. The use of retinal cameras and promotion of the 2008 NHMRC guidelines should be encouraged to improve overall optometric diabetic retinopathy management, particularly with macular oedema.
Publisher: Wiley
Date: 14-01-2011
DOI: 10.1111/J.1442-9071.2010.02466.X
Abstract: To explore the interaction between vision impairment, perceived quality of life loss and willingness to trade remaining life for vision gain. Community-based cross-sectional study. Legally blind or severely vision-impaired people selected randomly from the Association for the Blind of Western Australia register. In iduals were examined by consultant ophthalmologists and completed the Impact of Vision Impairment profile quality of life assessment and a Time Trade-Off evaluation. Vision-related utility values were calculated. The results were analysed using univariate and multivariate regression methods. IVI Rasch Logits and TTO utility values (TTO UV). 156 people volunteered to contribute to the study. The median age was 80 (19-97) years, and 56% were female. Being legally blind (logMAR > 1) (95% CI 1.1 to 5.2, P = 0.003), clinically depressed (95% CI -11.2 to -1.8, P = 0.007) or more than 40 years of age (95% CI 0.9 to 8.1, P = 0.015) significantly lowered overall impact of vision impairment scores. The emotional domain of impact of vision impairment was associated with willingness to trade part of remaining life. A 5-Logit increase in impact of vision impairment emotional score resulted in a 21% (95% CI 10 to 31) decrease in the odds of being likely to trade life for sight. The Australian definition of blindness compared with World Health Organisation or USA best separates those with perceived loss and appears useful in identifying vision loss-related morbidity. These results suggest that emotional health and lack of depression are important determinants for quality and value of life.
Publisher: Wiley
Date: 20-10-2011
Publisher: Wiley
Date: 08-2011
Publisher: Wiley
Date: 16-03-2020
DOI: 10.1111/CEO.13741
Publisher: Wiley
Date: 05-06-2014
DOI: 10.1111/AOS.12453
Abstract: To describe trends, risk factors and outcomes of anterior vitrectomy during cataract and intraocular lens (IOL) surgery. All patients 16 years and older undergoing cataract and IOL surgery in Western Australia (WA) from January 1980 to December 2001 (n = 115 815) were included. Hospital administrative data were used to identify all cataract and IOL procedures and subsequent admissions for retinal detachment, IOL dislocation, endophthalmitis and pseudophakic corneal oedema. Data were validated with chart review and analysed to identify trends and risk factors for anterior vitrectomy and the risk of subsequent complications. In total, 1390 (1.2%) anterior vitrectomies were performed. The rate increased with change in surgical technique. Significant risk factors for anterior vitrectomy were age <50 years (OR 1.31), male sex (OR 1.23), IOL procedure (OR 11.45) and operations in public hospitals (OR 1.99) or rural/remote (OR 1.40) areas. Anterior vitrectomy was strongly associated with increased risk of retinal detachment (RD) (RR 18.5), endophthalmitis (RR 3.6), IOL dislocation (RR 21.1) and pseudophakic corneal oedema (RR 17.3). Retinal detachments and IOL dislocations occur earlier after anterior vitrectomy. Anterior vitrectomy rates have remained stable since the introduction of phacoemulsification. Anterior vitrectomy is a major risk factor for serious complications compared with uncomplicated surgery, particularly RD and IOL dislocation. We identified an increasing trend in anterior vitrectomy being performed during extracapsular and IOL surgery.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.OPHTHA.2015.07.001
Abstract: To determine whether blindness in older people is associated with increased health service use and mortality. Retrospective matched cohort study from July 1, 1999, through June 30, 2010. A blind cohort 65 years of age and older from a volunteer blind register and a cohort of age- and gender-matched controls selected randomly from the Western Australian electoral roll. Person-level linked hospital, emergency department (ED), mental health, and death records for the blind and control cohorts were used. Generalized estimating equations assuming a negative binomial distribution were used to estimate relative rates of hospital admissions, lengths of stay, and mortality after adjusting for sociodemographic variables and comorbidity. Emergency department and mental health service visits also were quantified. Relative rates of hospital admissions, lengths of stay, and mortality, as well as crude proportions of ED and mental health service visits. The blind cohort comprised 1726 in iduals alongside 1726 matched controls 39% were men, and the mean age was 83 years. Combined, the cohorts accumulated a total of 34 130 hospital admissions amounting to 201 867 bed-days. After adjusting for the principal reason for hospital admission and comorbidity, the blind cohort was admitted to the hospital 11% (95% confidence interval [CI], 6%-17%) more often than the control cohort. The blind cohort also stayed in the hospital longer than the controls, but this effect varied by age. Blind participants 65 to 69 years of age spent 88% more days (95% CI, 27%-178%) in the hospital compared with age-matched controls, whereas there was no difference in length of stay between the cohorts by 80 years of age (rate ratio, 1.10 95% CI, 0.97-1.25). A larger proportion of the blind cohort visited a hospital ED and accessed mental health services compared with the control cohort. Health service use is increased for the elderly blind compared with age-matched controls after accounting for comorbidity. The elderly blind have more hospital admissions, ED visits, and mental health-related visits. The younger elderly blind stay longer in hospital. However, there was no evidence of worse mortality outcomes after adjusting for comorbidity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.OPHTHA.2010.11.001
Abstract: To examine the trends in major complications of cataract surgery in the Western Australian population over 22 years. Population-based study. We included 129 982 cataract/lens surgery patients across 46 health facilities. Using the Western Australian Data Linkage System, we identified all patients who underwent cataract/lens surgery in Western Australia between 1980 and 2001. Complications of interest were identified from those patients admitted to hospital or who underwent unplanned surgery after cataract surgery and were validated by medical record review. Admission for retinal detachment, dropped nucleus, wound dehiscence, pseudophakic corneal edema, intraocular lens (IOL) dislocation, and postoperative endophthalmitis requiring surgery. There were 129 982 cataract/lens procedures and 2087 (1.6%) complications. Complications fell almost 70% over the study period. Retinal detachment (n = 905 0.70%) was most common, followed by IOL dislocation (n = 361 0.28%), endophthalmitis (n = 228 0.18%), wound dehiscence (n = 227 0.17%), pseudophakic corneal edema (n = 207 0.16%), and dropped nucleus (n = 159 0.12%). The incidence of complications lessened over time, except for IOL dislocations, which has increased since 1995. Overall, the risk of complications after phacoemulsification halved since it was introduced in the late 1990s (incidence rate ratio, 0.52 95% confidence interval, 0.37-0.74), whereas complications after extracapsular extraction (ECCE) have increased over recent years. Cataract surgery remains an extremely safe procedure with comparatively few major complications. Changes in operative techniques have been accompanied by a significant decrease in complication rates over time, although the increase in IOL dislocations and complications after ECCE warrants further study. The authors have no proprietary or commercial interest in any of the materials discussed in this article.
No related grants have been discovered for Antony Clark.