Search

Purpose: This retrospective audit aimed to evaluate the impact of combined iStent®Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields. Patients and Methods: Patients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification. Results: Forty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (– 16%; p = 0.012; n = 35) and 12 months (– 29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (– 8%; p < 0.001; n = 57) and 6 months (– 16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups. Conclusion: This audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to measure the impact of age-related macular degeneration on vision-related activity limitation and preferencebased status for glaucoma patients. Design: This was a cross-sectional study. Participants: Two-hundred glaucoma patients of whom 73 had age-related macular degeneration were included in the research. Methods: Sociodemographic information, visual field parameters and visual acuity were collected. Agerelated macular degeneration was scored using the Age-Related Eye Disease Study system. Main Outcome Measures: The Rasch-analysed Glaucoma Activity Limitation-9 and the Visual Function Questionnaire Utility Index measured vision-related activity limitation and preference-based status, respectively. Regression models determined factors predictive of vision-related activity limitation and preference-based status. Differential item functioning compared Glaucoma Activity Limitation-9 item difficulty for those with and without age-related macular degeneration. Results: Mean age was 73.7 (±10.1) years. Lower better eye mean deviation (β: 1.42, 95% confidence interval: 1.24-1.63, P<0.001) and agerelated macular degeneration (β: 1.26 95% confidence interval: 1.10-1.44, P = 0.001) were independently associated with worse visionrelated activity limitation. Worse eye visual acuity (β: 0.978, 95% confidence interval: 0.961-0.996, P = 0.018), high risk age-related macular degeneration (β: 0.981, 95% confidence interval: 0.965-0.998, P = 0.028) and severe glaucoma (β: 0.982, 95% confidence interval: 0.966-0.998, P = 0.032) were independently associated with worse preference-based status. Glaucoma patients with age-related macular degeneration found using stairs, walking on uneven ground and judging distances of foot to step/curb significantly more difficult than those without age-related macular degeneration. Conclusions: Vision-related activity limitation and preference-based status are negatively impacted by severe glaucoma and age-related macular degeneration. Patients with both conditions perceive increased difficulty walking safely compared with patients with glaucoma alone. [ABSTRACT FROM AUTHOR]

Purpose: To establish a normative database using a central 10-degree grid pattern for the online circular contrast perimetry (OCCP) application. Participants: Fifty participants with mean age 65 ± 13 years were selected for this study. One eye from each participant that met inclusion criteria was randomly included in the cohort. Methods: The web-application delivered online 52-loci perimetry in a central 10-degree pattern using circular flickering targets. These targets consist of concentric sinusoidal alternating contrast rings. Users were guided by the application to the correct viewing distance and head position using in-built blind spot localization and webcam monitoring. A spinning golden star was used as the fixation target and patients performed the test in a darkened room following standard automated perimetry (SAP). Results: The reliability rates and global indices for OCCP were similar to SAP. OCCP mean sensitivity reduced with age at a similar rate to SAP. Mean sensitivity per loci of 10-degree OCCP was greater than SAP by 1.24 log units (95% CI 1.23 to 1.26) and obeyed a physiological hill of vision. Small differences existed in mean sensitivities between OCCP and SAP which increased with increasing spot eccentricity. Mean deviation (MD) displayed good agreement between the two tests. Conclusion: Central 10-degree online circular contrast perimetry via a computer-based application has comparable perimetric results to standard automated perimetry in a normal cohort. [ABSTRACT FROM AUTHOR]

Aims To describe ocular syphilis presentations to a tertiary referral eye hospital over a 5-year period and to document HIV coinfection frequency. Methods A retrospective chart review was conducted of consecutive ocular syphilis presentations to Sydney Eye Hospital from 2007 to 2012. Inclusion criteria were positive syphilis serology, ocular inflammation on clinical examination and appropriate syphilis treatment. Outcome measures were clinical features at presentation and bestcorrected visual acuity (BCVA) at interval follow-up. Results Thirty-seven eyes of 25 patients were included in the series. Patients were predominantly male (92.0%, p<0.05) with mean age 43.7±14.0 years. Eight (32.0%) patients had confirmed HIV coinfection, three newly diagnosed with HIV. Twelve (32.4%) eyes demonstrated anterior segment involvement with anterior uveitis. Twenty-five (67.6%) eyes demonstrated posterior segment involvement, including panuveitis, acute syphilitic posterior placoid chorioretinitis, retinitis, necrotising retinitis, punctate retinitis and optic neuritis. There was a significant improvement in BCVA for involved eyes ( p<0.05) at 1 month and 2-3 months follow-up. Conclusions The clinical findings of 37 eyes with ocular syphilis demonstrated a broad spectrum of clinical manifestations. Rates of HIV coinfection were high, with patients exhibiting both anterior and posterior segment inflammation. Visual outcome improved following syphilis treatment. [ABSTRACT FROM AUTHOR]

In this article, the authors present a combined method of trabeculectomy with cyclodialysis as a potential option for glaucoma surgeons. It discusses the aim of modern glaucoma surgery which is to reduce intraocular pressure (IOP) by creating a drainage pathway for aqueous fluid. It reports on trabeculectomy surgery which has been modified over the years to prevent certain complications.

Background To assess the impact of cataract on quality of life ( QoL) for patients with glaucoma. Design Cross-sectional study. Participants Two hundred forty-two patients with mild ( n = 67), moderate ( n = 80) or severe ( n = 45) glaucoma and 50 controls (glaucoma suspects). Patients with cataract of any severity were included. Methods The following data were collected: sociodemographic information, phakic/pseudophakic status, cataract grade according to the Lens Opacities Classification System ( LOCS) III, visual acuity and visual field test parameters. Glaucoma severity was stratified according to binocular visual field loss. Visually significant cataract was defined as: LOCS III criteria nuclear cataract ≥3/6.9, cortical cataract ≥3/5.9 or posterior subcapsular cataract ≥2/5.9. Main Outcome Measures Patients' QoL was measured using Rasch-transformed scores from the Glaucoma Activity Limitation-9 ( GAL-9) questionnaire. Multiple linear regression models were used to determine the association between cataract and GAL-9 (logit) score. Results Fifty-six (23.1%) patients had at least one visually significant cataract. At least one visually significant cataract (standardized coefficient [β] 1.19, 95% confidence interval 1.04-1.34, P = 0.011) and poor visual field index (better eye) (β 1.47, 95% confidence interval 1.36-1.88, P < 0.001) were independently associated with worse GAL-9 score. Conclusions Cataract influences glaucoma-related QoL among glaucoma patients of all severity levels and is an important cause of potentially reversible visual impairment among glaucoma patients. The Rasch-analysed GAL-9 questionnaire is a useful metric to quantify visual disability related to cataract in glaucoma patients. [ABSTRACT FROM AUTHOR]

Background: With recent advances in the diagnosis and management of ocular and periocular melanoma, many of which are based on results from randomized control trials, there is an increasing need for an evidence-based review of the literature for the Australasian population. The Australian Cancer Network has recently redeveloped the evidence-based Clinical Practice Guidelines for the Management of Melanoma, including a chapter on ocular melanoma. These are the first evidence-based guidelines on ocular melanoma to be created by the Australian Cancer Network. Methods: The primary research questions were formed and a detailed literature search was undertaken. Each relevant article was assessed and graded I–IV according to the level of evidence. Articles were grouped into bodies of evidence which were then assessed. Results: A total of 107 relevant articles were identified and grouped into 12 bodies of evidence. Guidelines based on this analysis were formulated and graded. These are presented below. Conclusions: The management of ocular melanoma has benefited from recent advances in imaging, molecular biology and cytogenetics, and tumours today are detected earlier and with greater accuracy than 25 years ago. With improved treatment ocular and periocular melanomas can be controlled locally, with good preservation of vision in many patients. However, there remains no cure for metastatic disease. [ABSTRACT FROM AUTHOR]

Metastatic carcinoma to the conjunctiva is a rare tumour that reflects advanced disease with a poor prognosis. A case of conjunctival metastatic breast carcinoma is described which developed 9 months after the primary cancer was removed, and led to the detection of diffuse systemic malignancy. The tumour responded to intravenous chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Importance: Targeted education may impact glaucoma patients' clinical experience. Background: The aim of this study was to measure the impact of patient‐centred glaucoma‐related education on knowledge, anxiety and treatment satisfaction. Design: This was a multicentre Australia‐wide randomized clinical trial. Participants: One hundred one newly diagnosed glaucoma patients were randomized 1:1 to intervention or control groups. Methods: Those randomized to the Glaucoma Australia educational intervention received telephone‐based counselling about glaucoma followed by mail‐out information, in addition to usual care and information from their treating ophthalmologist. The control group received only usual care and information from their treating ophthalmologist. Surveys were administered at baseline and 4 weeks following intervention. Main Outcome Measures: The Auckland Glaucoma Knowledge Questionnaire measured glaucoma‐related knowledge. The Hospital Anxiety and Depression Scale and Eye‐Drop Satisfaction Questionnaire measured anxiety and patient treatment satisfaction, respectively. Results: Mean age was 64.7 ± 11.1 years, and 52 (51.5%) were male. There was no noticeable increase in knowledge levels in the control group (mean difference: 0.04 logits, P = 0.7), compared with a 0.49‐logit (P = 0.02) increase in knowledge levels in the intervention group. Between‐group comparison showed a non‐significant increase in knowledge (0.45 logits, P = 0.07) comparing intervention participants with controls. Intervention participants experienced a statistically significant decrease in anxiety compared to controls (−0.60 logits, P = 0.02). No between‐group difference was found in Eye‐Drop Satisfaction Questionnaire scores. Conclusions and Relevance: Patient‐centred glaucoma‐related education and support services may improve knowledge and can reduce anxiety for newly diagnosed glaucoma patients. All glaucoma patients should be adequately counselled about the nature of the disease and its management. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the case of a 9-month-old boy with Beckwith-Wiedmann syndrome (BWS) and paroxysmal tonic upgaze.

Purpose: To investigate the relationship between ocular surface disease and glaucoma-related quality of life (QoL), glaucoma severity, and treatment in patients with open-angle glaucoma. Design: Cross-sectional study. Methods: setting: Clinical practice. study population: One hundred twenty-four participants—patients with mild (n = 48), moderate (n = 34), or severe (n = 19) glaucoma and 23 controls (glaucoma suspects) not receiving glaucoma treatment—were enrolled. Severity was stratified according to binocular visual field loss. observed procedures: Demographic information, the Ocular Surface Disease Index (OSDI), and Glaucoma Quality of Life-15 (GQL-15) questionnaires were administered. main outcome measures: OSDI score, GQL-15 score, number and type of glaucoma medications, daily dose of benzalkonium chloride (BAK), and visual field indices. Results: OSDI scores and the number of patients with OSD increased with increasing glaucoma severity (P < .001 and P < .005). GQL-15 scores reflected decreased QoL with increasing glaucoma severity (P < .001). These trends were maintained after sub-stratification for age and sex. On univariate regression OSDI was significantly correlated with GQL-15 summary score, glaucoma severity, multiple topical glaucoma medications, worse eye mean deviation and pattern standard deviation, use of topical beta blockers, topical carbonic anhydrase inhibitors, daily dose of BAK, and glaucoma filtration surgery. On multivariate regression GQL-15 summary score (odds ratio [OR] 4.14, 95% confidence interval [CI] 2.59–6.63, P < .001) and a daily dose of BAK greater than 3 (OR 2.47, 95% CI 1.17-5.21, P = .018) were predictive of OSDI score. Conclusions: OSD is more common in patients with increasing glaucoma severity and is associated with poorer glaucoma-related QoL and higher exposure to BAK. [Copyright &y& Elsevier]

Purpose: To evaluate 3-year safety and efficacy of two second-generation trabecular micro-bypass stents. (iStent inject®) with phacoemulsification. Materials and Methods: This multicenter retrospective study of iStent inject implantation with phacoemulsification included data from eight surgeons across Australia. Eyes with cataract and mild to advanced glaucoma [predominantly primary open-angle (POAG), primary angle closure (PAC), or normal-tension (NTG) glaucoma] or ocular hypertension (OHT) were included. Study assessments included intraocular pressure (IOP); number of ocular hypotensive medications; proportions of eyes with 0, 1, 2, or ≥ 3 IOP-lowering medications; IOP ≤ 15 mmHg or ≤ 18 mmHg; visual fields (VF); retinal nerve fiber layer thickness (RNFL); central corneal thickness (CCT); intraoperative complications; adverse events; and secondary surgeries. Results: A total of 273 eyes underwent surgery and had 36-month follow-up. At 36 months versus preoperative, mean IOP decreased by 15.5% (16.4± 4.6 mmHg to 13.9± 3.5 mmHg; p< 0.001), and 70.3% of eyes achieved IOP of ≤ 15 mmHg (versus 49.1% preoperatively; p< 0.001). The mean medication burden decreased by 68.5% (from 1.51± 1.17 to 0.48± 0.89 medications; p< 0.001); 71.4% of eyes were medication-free (versus 21.6% preoperatively; p< 0.001), while 6.2% of eyes were on ≥ 3 medications (versus 22.3% preoperatively; p< 0.001); 96.3% of eyes maintained or reduced medications vs preoperative. Significant IOP and medication reductions occurred across glaucoma subtypes (POAG, PAC, NTG, OHT): 13– 22% for IOP (p< 0.05 for all) and 42– 94% for medication (p< 0.05 for all). Favorable safety included few adverse events; stable VF, RNFL, and CCT; and filtering surgery in only 8 eyes (2.9%) over 3 years. Conclusion: In this multicenter cohort from 8 surgeons across Australia, significant IOP and medication reductions were sustained through 3 years after iStent inject implantation with phacoemulsification. Results were favorable across different glaucoma subtypes (including POAG, PAC, NTG, OHT), severities, and surgeons, thereby underscoring the real-world relevance and efficacy of iStent inject implantation for glaucoma treatment. [ABSTRACT FROM AUTHOR]

Recent advances in the understanding of dry eye disease (DED) have revealed previously unexplored targets for drug therapy. One of these drugs is diquafosol, a uridine nucleotide analog that is an agonist of the P2Y2 receptor. Several randomized controlled trials have demonstrated that the application of topical diquafosol significantly improves objective markers of DED such as corneal and conjunctival fluorescein staining and, in some studies, tear film break-up time and Schirmer test scores. However, this has been accompanied by only partial improvement in patient symptoms. Although evidence from the literature is still relatively limited, early studies have suggested that diquafosol has a role in the management of DED. Additional studies would be helpful to delineate how different subgroups of DED respond to diquafosol. The therapeutic combination of diquafosol with other topical agents also warrants further investigation. [ABSTRACT FROM AUTHOR]

Purpose: This multicenter study evaluated 2-year effectiveness and safety following implantation of two second-generation trabecular micro-bypass stents (iStent inject®) with phacoemulsification. Materials and Methods: This was a retrospective study of iStent inject implantation with phacoemulsification by nine surgeons across Australia. Eyes had mild to advanced glaucoma (predominantly primary open-angle/POAG, appositional angle-closure/ACG, or normal-tension/NTG) or ocular hypertension (OHT), and cataract. Evaluations included intraocular pressure (IOP); medications; proportions of eyes with 0 or ≥ 2 medications, reduced/stable medications versus preoperative, and IOP ≤ 15 mmHg; visual acuity; cup-to-disc ratio (CDR); visual fields (VF); adverse events; and secondary surgery. Results: A total of 340 eyes underwent surgery and had 24-month follow-up data. At 24 months, mean IOP decreased by 16% from 16.4± 4.7 mmHg preoperatively to 13.7± 3.1 mmHg (p< 0.001), and 77% of eyes achieved IOP of ≤ 15 mmHg versus 49% preoperatively (p< 0.001). Mean number of medications decreased by 67% to 0.49± 0.95 versus 1.49± 1.20 preoperatively (p< 0.001), with 74% of eyes medication-free versus 25% preoperatively (p< 0.001), and 14% of eyes on ≥ 2 medications versus 46% preoperatively (p< 0.001). Medication burden was reduced or stable in 98% of eyes versus preoperative. Stratified analyses showed significant IOP and medication reductions across glaucoma subtypes (POAG, ACG, NTG, OHT): 13– 22% for IOP (p< 0.01 for all) and 62– 100% for medication (p< 0.001 for all). Favorable safety included few adverse events; stable CDR, VF, and visual acuity; and filtering surgery in only 8 eyes (2.4%) over 2 years. Conclusion: This 340-eye multicenter dataset provides robust evidence of the safety and efficacy of iStent inject implantation with phacoemulsification, with significant and sustained IOP and medication reductions through 2 years. Results were similarly favorable across glaucoma subtypes (including POAG, ACG, NTG, OHT) and were attained across various glaucoma severities, clinical sites, and surgeons, highlighting the real-world versatility and utility of this treatment modality. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old white male with one-week history of headaches and halos who was treated with bilateral insertion of Bright Ocular cosmetic iris implants two month earlier. It notes evaluation of the visual acuity which was 6/9 in the right eye and 6/18 in the left eye and intraocular pressure also elevated with 52 mmHg in each eye. The article discusses complications following cosmetic iris implantation and surgical procedure for treatment of patient.

Background: Non-penetrating ocular injuries from badminton shuttlecocks can result in severe damage and life-long complications. This case series highlights the morbidity of such injuries, particularly in regard to post-traumatic glaucoma.Methods: This is a retrospective case series of 12 patients with shuttlecock-related blunt eye injuries sustained during badminton play without eye protection. By approaching colleagues through conference presentations and networking, the authors have attempted to gather all known cases of shuttlecock ocular injury managed in tertiary ocular emergency departments or private ophthalmological clinics in Victoria and New South Wales, Australia in 2015.Results: This is the first multicentre case series to describe badminton-related ocular injuries in Australia. Our case series demonstrates, in particular, long-term glaucoma-related morbidity for patients over a large age range (16 to 77 years), with one patient requiring ongoing management 26 years following their initial injury. The cases reported further add to the literature promoting awareness of badminton-related ocular injury.Conclusions: We encourage player education and advocacy on badminton-related eye injuries and appropriate use of eye protection to reduce associated morbidity. [ABSTRACT FROM AUTHOR]