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Seraina Agramunt,1 Lynn B Meuleners,1 Michelle L Fraser,1 Kyle C Chow,1 Jonathon Q Ng,2,3 Vignesh Raja,4 Nigel Morlet2,3 1Curtin-Monash Accident Research Centre (C-MARC), Curtin University, Faculty of Health Sciences, Perth, Australia; 2Eye & Vision Epidemiology Research (EVER) Group, Perth, Australia; 3School of Population and Global Health, The University of Western Australia, Perth, Australia; 4Sir Charles Gairdner Hospital, Perth, Australia Objectives: To analyze the association between visual impairment and driver self-regulation among a cohort of older drivers waiting for first eye cataract surgery.Methods: Ninety-six drivers with bilateral cataract aged 55+ years were assessed before first eye cataract surgery. Data collection consisted of a researcher-administered questionnaire, objective visual measures (visual acuity, contrast sensitivity and stereopsis), a visual attention test (the useful field of view test) and a cognitive test (the Mini-Mental State Examination). Driver self-regulation practices were collected using the Driving Habits Questionnaire and were also measured with an in-vehicle monitoring device. Characteristics of self-regulators and non-self-regulators were compared and a logistic regression model was used to examine the association between 3 objective visual measures and driver self-regulation status.Results: After controlling for potential confounding factors, only binocular contrast sensitivity (p=0.01), age (p=0.03) and gender (p=0.03) were significantly associated with driver self-regulation status. The odds of participants with better contrast sensitivity scores (better vision) self-regulating their driving in at least 1 driving situation decreased (odds ratio [OR]: 0.01, 95% CI: 0.00–0.28) while those of increasing age reported an increased odds of self-regulating their driving (OR: 1.08, 95% CI: 1.01–1.15). The odds of males self-regulating their driving was decreased compared with females (OR: 0.28, 95% CI: 0.09–0.86).Conclusions: Worse binocular contrast sensitivity scores, increasing age and being female were significantly associated with driver self-regulation. The study highlighted that while self-regulation was common among cataract patients, a proportion of those with poor vision did not self-regulate. Further research should determine how cataract patients could benefit from self-regulation strategies while waiting for cataract surgery. Keywords: driver self-regulation, older drivers, naturalistic data, cataract, contrast sensitivity, driving, visual impairment

A 29 year old woman, who was an intermittent contact lens wearer, is referred from her local ophthalmologist with a diagnosis of microbial keratitis. There is a large central corneal [...]

By allowing the surgeon to measure and modify corneal curvature during wound closure, intraoperative keratometry can reduce postoperative astigmatic errors. A number of keratometric devices have been developed over the last 10 years, each offering a compromise between cost, accuracy and ease of use. The Barrett keratoscope is a simple, inexpensive hand-held device which gives a qualitative indication of the degree of astigmatism. Addition of a transparent overlay, as described in this paper, sets the distance at which the keratoscope is held and allows the magnitude of the astigmatism to be determined, thereby enabling refined adjustment of the suture tension during wound closure. We describe the error in estimation of astigmatism due to the effect of the distance at which the keratoscope is held from the cornea. [ABSTRACT FROM AUTHOR]

BACKGROUND--It was previously found that high dose intravitreal ganciclovir provided superior treatment of cytomegalovirus retinitis compared with intravenous treatment. This study examined the stability and solubility of the ganciclovir solution to determine the shelf life of prepared solution, and compared the cost of intravitreal with intravenous therapy. METHODS--For the solubility studies high performance liquid chromatography was used to determine the ganciclovir concentration in various solutions. Measurements were taken of freshly made 20 mg/ml solution, the same solution stored at room temperature or frozen for 10, 17, and 24 days, after the solution was filtered, and after it was heated at 56 degrees C. For the cost comparison analysis the cost of 22 patients treated exclusively with intravitreal high dose ganciclovir was compared with cost estimates for the same patients treated with a standard intravenous therapy regimen over the same time. RESULTS--There was little variation in the concentration of ganciclovir regardless of the storage conditions, suggesting that the 20 mg/ml solution was very stable. The heating and filtering experiments suggest that maximum solubility was achieved both in the freshly prepared and thawed frozen stored solution. The total cost of the intravitreal treatment was Aus $172,435 and the estimate of intravenous treatment was Aus $490,521. This represents a total saving of $318,086 (65%), or $14,458 per patient. The average number of weeks of treatment for each patient was 27.9 (613 weeks/22 patients), so the saving per patient per year was $29,946. CONCLUSION--High dose intravitreal ganciclovir therapy may be administered in a very cost effective way, which along with its acceptability, safety, and clinical efficacy make it an attractive method of treatment of CMV retinitis. [ABSTRACT FROM PUBLISHER]

The intraocular pressure change produced by an intravitreal injection of ganciclovir, 2 mg in 0.1 ml, was studied in patients with cytomegalovirus retinitis. Using a Tono-pen XL to measure the intraocular pressure (IOP) of four patients (six eyes) we found the mean pressure immediately following injection was 44.5 mm Hg. Measurements taken on separate occasions after a 30 mm Hg decompression of the eye for 15 minutes before the injection showed a mean IOP of only 20.6 mm Hg after the injection. Mercury bag decompression of the eye significantly reduced the rise in IOP following intravitreal injection (difference in the mean IOP rise = 26.4 mm Hg, df = 54, t = 7.67, p < 0.001). Without ocular decompression before injection, all patients complained of temporary loss of vision, and reflux of the injection solution was frequently observed. Use of ocular decompression also reduced the discomfort of the injection. Throughout the full course of treatment by this means there were no adverse effects on the visual acuity. This technique is recommended to those performing intravitreal injections. [ABSTRACT FROM PUBLISHER]