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Purpose: To examine the prevalence and risk factors for depressive symptoms in patients with neovascular age‐related macular degeneration (nAMD) presenting for anti‐vascular endothelial growth factor (anti‐VEGF) therapy. Methods: In a clinic‐based cohort of 547 patients with nAMD who presented for treatment, the Centre of Epidemiological Studies Depression 10‐point scale (CES‐D‐10) and Mental Health Index (MHI) component of the 36‐item Short Form Survey were administered to assess for the presence of depressive symptoms. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals for factors associated with an increased likelihood of depressive symptoms. Results: The prevalence of depressive symptoms was 42.04% and 31.78% as per the CES‐D‐10 and MHI scales, respectively. Poor self‐rated health (SRH) is associated with increased odds of depressive symptoms [multivariable‐adjusted OR: 3.00 (95% CI 1.90–4.73) for CES‐D‐10; OR: 2.67 (95% CI 1.67–4.28) for MHI]. Impaired activities of daily living (ADLs) [multivariable‐adjusted OR: 2.62 (95% CI 1.56–4.38) for CES‐D‐10; OR: 3.59 (95% CI 2.10–6.15) for MHI] and a visual function score within the two lowest quartiles were also associated with increased odds of depressive symptoms using both scales. Conclusion: A high prevalence of depressive symptoms was observed among nAMD patients presenting for treatment. Poorer SRH, ADL impairment and reduced visual function were associated with increased odds of depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: People with age‐related macular degeneration (AMD) experience high rates of depression, but rarely engage in or have access to tailored mental wellbeing programmes. This qualitative study investigated the perspectives of those primarily with late AMD on mental health and mental wellbeing programmes. Methods: Twenty‐eight people with late AMD in at least one eye, and one person with early AMD in both eyes, aged 56–87 years (mean age 78 years) attending a private eye clinic between December 2019 and January 2020 in Sydney, New South Wales, Australia, participated. Individual semi‐structured interviews were conducted and analysed deductively using content analysis, following the individual level factors for health promotion interventions in the behaviour change wheel: Capability (Physical & Psychological), Opportunity (Physical & Social), and Motivation (Reflective & Automatic). Results: Six major themes were identified: Capability: (1) Impact of vision loss on mobility and leisure pursuits; (2) Adjustment to living with vision loss; Opportunity: (3) Program considerations for those with AMD; (4) Stigma and self‐perception of vision loss and mental health; Motivation: (5) Accumulation of vision‐related issues as a barrier to participation; (6) Examples of others living with vision loss. General personal factors relevant to delivery of a programme in this age group were also identified: Comorbidities; Limitations using technology; Isolation; Financial concerns and Beliefs that undesired effects of aging are inevitable. Conclusions: Complex individual, environmental and social factors influence the perspectives of people with late AMD on mental health, and potential participation in mental wellbeing programmes. These factors should be considered when developing and implementing mental wellbeing programmes to improve the emotional and functional rehabilitation outcomes for people with AMD. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether dietary intake of antioxidants, fruits, vegetables and fish is associated with 12‐month treatment outcomes in neovascular age‐related macular degeneration (nAMD) patients. Methods: A total of 547 participants were diagnosed with nAMD at baseline, of whom 494 were followed up after 12 months of antivascular endothelial growth factor therapy. Dietary intakes were determined using a validated food frequency questionnaire. Presence of intra‐retinal and sub‐retinal fluid (IRF, SRF), pigment epithelial detachment (PED) and central macular thickness (CMT) were recorded from optical coherence tomography images. Best‐corrected visual acuity was recorded using log of the Minimum Angle of Resolution (LogMAR) charts. Results: Participants in the upper three quartiles combined compared to those in the first quartile of baseline dietary zinc intake had 49% reduced odds of SRF 12 months later, multivariable‐adjusted odds ratio (OR) 0.51 [95% confidence interval (CI) 0.30‐0.89]. The upper three quartiles combined compared to the first quartile of β‐carotene intake had 90% greater odds of IRF presence at 12‐month follow‐up, multivariable‐adjusted OR 1.90 (95% CI 1.04‐3.46). The highest versus lowest quartile of dietary β‐carotene intake had a nearly twofold greater odds of PED presence, multivariable‐adjusted OR 1.99 (95% CI 1.03‐3.84). Conclusion: A higher intake of dietary zinc was associated with a reduced likelihood of SRF at 1 year. Conversely, a higher intake of dietary β‐carotene was associated with an increased risk of IRF and PED. These findings underscore the importance of ongoing nutritional advice for nAMD patients presenting for treatment. [ABSTRACT FROM AUTHOR]

Importance: Numerous dietary factors have been shown to reduce progression from early to late age‐related macular degeneration (AMD), however, little is known on their impact in patients diagnosed with late‐stage disease. Background: To determine whether a dietary intake high in antioxidants and zinc, fruits, vegetables and fish is associated with favourable clinical outcomes in patients with neovascular AMD (nAMD) undergoing anti‐vascular endothelial growth factor therapy. Design: Cross‐sectional study carried out at a private ophthalmology clinic. Participants: Five hundred forty‐seven participants with nAMD. Methods: Diet was determined using a validated food frequency questionnaire. Presence of intra‐retinal and sub‐retinal fluid (IRF, SRF), pigment epithelial detachment and central macular thickness (CMT) were recorded from ocular coherence tomography images. Main Outcome Measures: Fluid presence, mean CMT and visual acuity. Results: Participants with daily zinc intake below (n = 91) vs above (n = 333) 8.1 mg had greater odds of SRF being present, multivariable‐adjusted odds ratio (OR) of 0.56 (95% CI 0.36‐0.96). This association was stronger in persons with at least 6 months of treatment, OR of 0.32 (95% CI 0.14‐0.75). In the entire cohort, participants in the lowest or first quartile compared to those in the upper three quartiles of zinc intake combined had significantly greater mean CMT (254.81 μm vs 232.15 μm, respectively, multivariable‐adjusted P =.03). Conclusions and Relevance: Low dietary zinc intake was associated with a greater likelihood of SRF presence, particularly in those treated for at least 6 months, and increased macular thickness in treated eyes with nAMD. [ABSTRACT FROM AUTHOR]

Importance There is limited literature on oral statin use and its association with dry eye. Background: To analyse the association between dyslipidaemia, use of oral statin drugs, and symptoms of dry eye disease (DED) among older adults. Design Population‐based study. Participants: Participants of the Blue Mountains Eye Study III (BMESIII), a large cohort study in suburban Sydney, aged 60 years or older (mean age = 74, range = 60–97, n = 1680) were analysed. Methods: Information on DED symptoms and statin use were obtained from an interviewer‐administered questionnaire. Serum lipid profiles were determined from fasting blood tests. Main Outcome Measures: The association of various DED symptoms, as well as their number and their severity, with dyslipidaemia and oral statin intake was evaluated. Results: At least one DED symptom was reported in 52% (n = 1029) of the population. Patients with hypercholesterolaemia (>5.5 mmol/L) did not report more DED symptoms than those without hypercholesterolaemia. Neither serum high‐density lipoprotein nor low‐density lipoprotein levels were associated with any DED symptoms. Patients taking oral statins were more likely to report one or more moderate to severe symptoms of DED (odds ratio: 2.054, 95% confidence interval: 1.281–3.295). Conclusions and Relevance: The association between oral statin use and presence of moderate to severe DED symptomatology is a novel finding that deserves further mechanistic and clinical correlation in order to determine its potential, or lack thereof, for the management of dry eye. [ABSTRACT FROM AUTHOR]

Historically, approaches to hearing health in Australia have been device-centric.2 With the Roadmap for Hearing Health,3 collaboratively created by the sector and the federal government, there is an opportunity to change direction. To date, with the notable exception of initiatives in Aboriginal communities,4 hearing health has not been approached through the lens of the social determinants of health. [Extracted from the article]

Objective To examine the prospective association between glycemic index, glycemic load (GL) of diets and intakes of carbohydrates, sugars, fiber, and the main carbohydrate containing food groups (e.g., soft drinks) with changes in percent body fat, body mass index (BMI), and waist circumference among adolescents. Design and Methods Students aged 12 at baseline ( n = 856) were examined both in 2004-2005 and 2009-2011. A semiquantitative food frequency questionnaire was administered. Anthropometric parameters were measured and defined using standardized protocols. Results After multivariable adjustment, in girls, each 1-SD increase in dietary GL was associated with concurrent 0.77 kg/m2 and 1.45 cm increase in BMI and waist circumference, respectively (both P = 0.01). Conversely, each 1-SD increase in dietary fiber intake was associated with a concurrent 0.44 kg/m2 decrease in mean BMI in girls ( P = 0.02) and 1.45 cm decrease in waist circumference in boys ( P = 0.002). Girls who consumed soft drinks once or more per day versus those who never/rarely consumed soft drinks, had a 4.45% increase in percent body fat after 5 years ( Ptrend = 0.01). Conclusions High-GL foods might adversely influence development of body composition, particularly in girls, whereas fiber-rich diets could limit excess weight during adolescence. [ABSTRACT FROM AUTHOR]

Aim: To examine associations between socio-economic, familial and perinatal factors with overweight/obesity in 6- and 12-year-old schoolchildren. Methods: Eligible year-1 (1765/2238, mean age 6.7 years) and year-7 students (2353/3144, mean age, 12.7 years) from a random cluster sample of 55 Sydney schools were examined during 2003-2005. Height, weight and body mass index were measured. Overweight or obesity was classified using International Obesity Task Force cut points. Information about each child's socio-demographic status, familial and perinatal information was sought in parental questionnaires. Results: After multivariate adjustment, lower parental education was significantly associated with prevalent overweight and obesity in 6-year-old children, odds ratio (OR) 1.52 (95% confidence interval (CI) 1.15-2.01) and OR 2.16 (CI 1.34-4.13), respectively. Smoking during pregnancy was associated with a higher likelihood of being obese among both 6- and 12-year-old children, OR 1.90 (CI 1.05-3.46) and OR 1.78 (CI 1.22-2.61). Population attributable risk estimates indicate that 14.9% and 10.1% of prevalent cases of obesity in 12-year-old children may be attributable to being: an only child or a heavy newborn, respectively. Conclusions: We show interdependent relationships between socio-economic, familial and perinatal factors and childhood weight status. Improved understanding of these pathways may help in developing childhood obesity prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives. In adults, obesity is linked to changes in the retinal microvasculature. Limited research has been conducted into this association in children. We examined in a cohort of pre-adolescents the relationship between body mass index (BMI) and retinal vascular structure, including retinal vessel diameter and retinal vessel fractals, a measure of geometric patterns reflecting vessel density. Methods. A population-based study among school children (2 353/3 144 [75.3%], median age, 12.7 years) recruited from a random cluster sample of 21 schools was conducted during 2004-5. Retinal images were taken and vessel diameter and fractal dimension were quantified using computer-based programs following standardized protocols. Anthropometric measures (weight, height, waist circumference, and BMI) were obtained and defined using standardized protocols. Results. Children with the highest quartile of BMI had narrower retinal arteriolar diameter (2.8 μm narrower, p<0.0001) and wider venular caliber (4.2 μm wider, p=0.001) than those with BMI in the lowest quartile, after adjusting for age, sex, ethnicity, mean arterial blood pressure, iris color, axial length, birth weight and fellow retinal vessel caliber. Obese children had narrower retinal arteriolar diameter (2.8 μm narrower, p=0.01) and wider venular diameter (4.5 μm wider, p=0.01) than in non-overweight/obese children. Retinal fractal dimension was not significantly associated with BMI. Increasing quartiles of waist circumference were also associated with retinal vessel diameter. Conclusions. Our data provide evidence of adverse retinal microvascular caliber changes in obese pre-adolescent children, well before the onset of metabolic and cardiovascular disease in adulthood, and support an early, generalized adverse effect of adiposity on microvascular structure. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Gopinath, Baur, Wang, Teber, Liew, Cheung, Wong and Mitchell (2010). Smaller Birth Size is Associated With Narrower Retinal Arterioles in Early Adolescence. Microcirculation 17(8), 660-668. Abstract Objective: In the current study, we aimed to examine the associations of low birth weight with retinal vascular caliber and vascular fractal dimension during early adolescence. Methods: A population-based study of 12-year-old schoolchildren (2353/3144 [75.3%]) recruited from a random cluster sample of 21 schools. Birth weight, birth length and head circumference were obtained via parent report of the child's birth record. Retinal images were taken and vessel diameter and fractal dimension were quantified using validated computer-based methods. Results: After adjusting for age, sex, ethnicity, body mass index, iris color, axial length, mean arterial blood pressure, prematurity and fellow retinal vascular caliber, children in the lowest quartiles of birth weight had ∼2.5 μm narrower mean retinal arteriolar caliber than those in the highest quartiles ( p for trend = 0.001). Associations were observed between shorter birth length and smaller head circumference with narrower retinal arterioles. Smaller head circumference was associated with decreased fractal dimension ( p for trend = 0.03). Conclusions: Children with lower birth weight were more likely to have narrower retinal arterioles, while those with smaller head circumference were more likely to have reduced complexity of their retinal microvasculature. These variations in microvascular structure in adolescence could reflect a susceptibility to cardiovascular disease during adulthood, resulting from a disadvantaged growth environment in utero. [ABSTRACT FROM AUTHOR]

The article discusses a study on the extent to which general practitioners (GP) identify and manage hearing loss among older people based on data from Australian studies, namely the BMHS and the Bettering the Evaluation and Care of Health (BPACH) surveys. The survey was done on a door-to-door census in two postcode areas in Sydney of 4,433 eligible residents over 49 years old. The study shows a low rate of GP involvement in detecting and managing age-related hearing loss and suggests improving knowledge to treat adults with impaired hearing.

The variety of clinical presentations of eye changes in patients with Graves’ disease suggests that complex interactions between genetic, environmental, endogenous and local factors influence the development/severity of Graves’ ophthalmopathy (GO). At present, the role of genetic factors in the development of GO remains unknown. Based on small case-control association studies with candidate genes, several susceptibility loci in GO have been proposed. These are human leucocyte antigen ( HLA, 6p21·3), cytotoxic T-lymphocyte antigen-4 ( CTLA-4, 2q33), tumour necrosis factor ( TNF, 6p21·3), interferon-γ ( IFN-γ, 12q14), intercellular adhesion molecule-1 ( ICAM-1, 19p13), and thyroid stimulating hormone receptor gene ( TSH-R, 14q31). Unfortunately, these results were either not confirmed or require replication in larger studies. There are many reasons for the lack of reproducibility of association studies in GO, including poor characterization of the studied groups and small sample sizes, which may result in both false positive and negative results. Thus, the genetic background of GO remains to be elucidated in future research. However, the possibility that GO may be a genetically heterogeneous disorder, or that the development of GO may be predominantly influenced by environmental factors such as cigarette smoking, can not be disregarded. [ABSTRACT FROM AUTHOR]

A letter to the editor about age-related hearing loss is presented.

Objective: Microvascular changes in microvascular angina are poorly understood due to difficulties in imaging the coronary microcirculation in vivo. The retinal microvasculature may reflect changes in coronary microcirculation. We assessed microvascular changes in the retina in patients with microvascular angina and compared them with patients with angiographically proven coronary artery disease. Methods: We performed retinal photography and coronary angiography on 915 patients. Retinal vessel calibers were measured using a validated computer‐assisted method; coronary artery disease was graded from coronary angiograms. Microvascular angina was defined as angina with <25% stenosis in all coronary epicardial arteries. Results: A total of 139 patients (15.2%) had microvascular angina, while 776 (84.8%) had coronary artery disease. Participants with microvascular angina and coronary artery disease had similar retinal arteriolar and venular calibers. After adjustment for age, ethnicity, mean arterial pressure, diabetes, current smoking, body mass index, and fellow vessel caliber, women with smaller venules were threefold more likely to have microvascular angina than women with larger venules (multivariable‐adjusted odds ratio 3.54, 95% confidence interval 1.35 to 9.24, P < 0.01). This difference was not observed in men. Conclusions: Microvascular angina in women was associated with microvascular changes distinct from those in coronary artery disease. [ABSTRACT FROM AUTHOR]