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1. Retinoblastoma with and without Extraocular Tumor Extension

Author: Swathi Kaliki, MD, Vijitha S. Vempuluru, MD, Ido Didi Fabian, MD, Elhassan Abdallah, MD, Shehu U. Abdullahi, MD, Rula A. Abdulqader, MD, Aminatu A. Abdulrahaman, MD, Sherif Abouelnaga, MD, Dupe S. Ademola-Popoola, FMCOph, FWACS, Adedayo Adio, FWACS, Mahmoud A. Afifi, MD, Armin R. Afshar, MD, Priyanka Aggarwal, MD, Ada E. Aghaji, FMCOph MSc, Alia Ahmad, MRCPCH UK, Marliyanti N.R. Akib, MD, Adeseye M. Akinsete, MBBS, Lamis Al Harby, MD, Saleh A. Al Mesfer, MD, Mouroge H. Al Ani, MD, Silvia Alarcón Portabella, MD, Safaa A.F. Al-Badri, MD, Ana Patricia A. Alcasabas, MD, Saad A. Al-Dahmash, MD, Amanda Alejos, MD, Ernesto Alemany-Rubio, MD, Amadou I. Alfa Bio, MD, Yvania Alfonso Carreras, MD, Christiane E. Al-Haddad, MD, Hamoud H.Y. Al-Hussaini, MD, MSc, Amany M. Ali, MD, Donjeta B. Alia, MD, Mazin F. Al-Jadiry, MD, Usama Al-Jumaly, MD, Hind M. Alkatan, MD, Charlotta All-Eriksson, MD, PhD, Ali A.R.M. Al-Mafrachi, FIBMS, Argentino A. Almeida, MD, Khalifa M. Alsawidi, MD, Athar A.S.M. Al-Shaheen, MD, Entissar H. Al-Shammary, MD, Doreen Amankwaa-Frempong, MBChB, Primawita O. Amiruddin, MD, Inggar Armytasari, MD, Nicholas J. Astbury, FRCS, FRCOphth, Hatice T. Atalay, MD, Eda Ataseven, MD, La-ongsri Atchaneeyasakul, MD, Rose Atsiaya, OCO, Rudolf Autrata, MD, PhD, Julia Balaguer, MD, PhD, Ruhengiz Balayeva, PhD, Honorio Barranco, MD, PhD, Paulina Bartoszek, MD, Katarina Bartuma, MD, PhD, Covadonga Bascaran, MD, MSc, Nikolaos E. Bechrakis, MD, Maja Beck Popovic, MD, Ainura S. Begimkulova, MD, Sarra Benmiloud, MD, Rokia C. Berete, MD, PhD, Jesse L. Berry, MD, Anirban Bhaduri, MD, Sunil Bhat, MBBS, MD, Arpita Bhattacharyya, MD, Eva M. Biewald, MD, Elaine Binkley, MD, Sharon Blum, MD, Nadia Bobrova, MD, H. Culver Boldt, MD, Maria Teresa B.C. Bonanomi, MD, PhD, Gabrielle C. Bouda, MD, Hédi Bouguila, MD, PhD, Rachel C. Brennan, MD, Bénédicte G. Brichard, MD, PhD, Jassada Buaboonnam, MD, Aléine Budiongo, MD, Matthew Burton, FRCOphth, Patricia Calderón-Sotelo, MD, Doris A. Calle Jara, MD, Jayne E. Camuglia, FRANZCO, Miriam R. Cano, MD, MSc, Michael Capra, FRCPI, Shani Caspi, MD, Nathalie Cassoux, MD, PhD, Guilherme Castela, MD, Luis Castillo, MD, Jaume Català-Mora, MD, PhD, Isabel Caviedes, MD, Arthika Chandramohan, MD, Guillermo L. Chantada, MD, PhD, Shabana Chaudhry, MD, Bhavna Chawla, MD, Wensi Chen, MD, Faraja S. Chiwanga, MSc, Tsengelmaa Chuluunbat, MD, PhD, Krzysztof Cieslik, MD, Antony Clark, FRANZCO, Ruellyn L. Cockcroft, MB ChB , M Med Paed, Codruta Comsa, MD, Maria G. Correa Llano, MD, Timothy W. Corson, PhD, Line Couitchere, MD, Kristin E. Cowan-Lyn, MD, MBBS, Monika Csóka, MD, PhD, Wantanee Dangboon, MD, Anirban Das, MD, Pranab Das, MD, Sima Das, MS, Jacquelyn M. Davanzo, BSN, BSPH, Alan Davidson, MBChB, MPhil, Sonia De Francesco, MD, Patrick De Potter, MD, PhD, Karina Q. Delgado, MD, PhD, Hakan Demirci, MD, Laurence Desjardins, MD, Rosdali Y. Diaz Coronado, MD, Helen Dimaras, PhD, Andrew J. Dodgshun, M Phil, Carla R. Donato Macedo, MD, Monica D. Dragomir, MD, PhD, Yi Du, MD, Magritha Du Bruyn, MD, Johannes P. Du Plessis, MMed (Paed), Gagan Dudeja, MBBS, MS, Katrin Eerme, MD, I Wayan Eka Sutyawan, MD, Asmaa El Kettani, MD, Amal M. Elbahi, MD, James E. Elder, MBBS, Alaa M. Elhaddad, MD, PhD, Moawia M.A. Elhassan, MD, Mahmoud M. Elzembely, MD, Connor Ericksen, MD, Vera A. Essuman, FWACS, Ted Grimbert A. Evina, MD, Ifeoma R. Ezegwui, FMCOph, FWACS, FAEH, Zehra Fadoo, MBBS, Adriana C. Fandiño, MD, Mohammad Faranoush, MD, Oluyemi Fasina, FWACS, Delia D.P.G. Fernández, MSc, Ana Fernández-Teijeiro, MD, PhD, Allen Foster, FRCOphth, Shahar Frenkel, MD, PhD, Ligia D. Fu, MD, Soad L. Fuentes-Alabi, MD, MPH, Juan L. Garcia, MSc, David García Aldana, MD, Henry N. Garcia Pacheco, MD, Jennifer A. Geel, MBChB, MMed, Fariba Ghassemi, MD, Ana V. Girón, MD, Marco A. Goenz, MD, Aaron S. Gold, OD, Hila Golberg, MD, Glen A. Gole, MD, FRANZCO, Nir Gomel, MD, Efren Gonzalez, MD, Graciela Gonzalez Perez, MD, Liudmira González-Rodríguez, MD, Malka Gorfine, PhD, Jaime Graells, MD, Pernille A. Gregersen, MD, Nathalia D.A.K. Grigorovski, MD, Koffi M. Guedenon, MD, D Sanjeeva Gunasekera, MD, Ahmet K. Gündüz, MD, Himika Gupta, MD, Sanjiv Gupta, MS, Vineeta Gupta, MD, Theodora Hadjistilianou, MD, Patrick Hamel, MD, Syed A. Hamid, FCPS, Norhafizah Hamzah, MSc, Eric D. Hansen, MD, J William Harbour, MD, M. Elizabeth Hartnett, MD, Murat Hasanreisoglu, MD, Sadiq Hassan, MD, FWACS, Shadab Hassan, FRCS, FCPS, Wojciech Hautz, MD, Huda A. Haydar, CHD, Stanislava Hederova, MD, Laila Hessissen, MD, Hoby Lalaina, MD, Suradej Hongeng, MD, Diriba F. Hordofa, MD, G. Baker Hubbard, MD, Marlies Hummlen, MD, Kristina Husakova, MD, Allawi N. Hussein Al-Janabi, MD, Affiong A. Ibanga, MB.BCh, FMCOph, Russo Ida, MD, Vesna R. Ilic, MD, Ziyavuddin Islamov, MD, Vivekaraj Jairaj, DNB, Teyyeb A. Janjua, MD, FCPS, FRCSEd, Irfan Jeeva, FRCOphth, Xunda Ji, MD, Dong Hyun Jo, MD, PhD, Michael M. Jones, MD, PhD, FRANZCO, Theophile B. Amani Kabesha, MD, PhD, Rolande L. Kabore, MD, Abubakar Kalinaki, MD, Pius Kamsang, MD, Mehmet Kantar, MD, Noa Kapelushnik, MD, Tamar Kardava, PhD, Rejin Kebudi, MD, Jonny Keomisy, MD, Tomas Kepak, MD, Petra Ketteler, MD, Zohora J. Khan, MD, Hussain A. Khaqan, MD, Vikas Khetan, FRCS, FACS, Alireza Khodabande, MD, Zaza Khotenashvili, MD, Jonathan W. Kim, MD, Jeong Hun Kim, MD, PhD, Hayyam Kiratli, MD, Tero T. Kivelä, MD, Artur Klett, MD, PhD, Irem Koç, MD, Jess Elio Kosh Komba Palet, MD, Dalia Krivaitiene, MD, PhD, Mariana Kruger, Mmed Paed, PhD, Kittisak Kulvichit, MD, Mayasari W. Kuntorini, MD, Alice Kyara, BA, Geoffrey C. Lam, FRANZCO, Scott A. Larson, MD, Slobodanka Latinović, MD, PhD, Kelly D. Laurenti, MD, Yotam Lavi, MD, PhD, Alenka Lavric Groznik, MD, Amy A. Leverant, MD, Cairui Li, MD, Kaijun Li, MD, Ben Limbu, MD, Chun-Hsiu Liu, MD, Quah Boon Long, FRCS (Ed), MMed ( Ophth), FAMS, Juan P. López, MD, Robert M. Lukamba, MD, Sandra Luna-Fineman, MD, Delfitri Lutfi, MD, Lesia Lysytsia, MD, Shiran Madgar, MD, George N. Magrath, MD, Amita Mahajan, MD, Puja Maitra, MD, Erika Maka, MD, Emil K. Makimbetov, MD, Azza M.Y. Maktabi, MD, Carlos Maldonado, MD, Ashwin Mallipatna, MD, Rebecca Manudhane, MD, Lyazat Manzhuova, MD, Nieves Martín Begue, MD, PhD, Sidra Masud, MBBS, Ibrahim O. Matende, MD, M. Med (Oph), Clarissa C.D.S. Mattosinho, MD, Marchelo Matua, BAPH, Ismail Mayet, MD, Freddy B. Mbumba, MD, MMed Paed, John D. McKenzie, MD, Azim Mehrvar, MD, Aemero A. Mengesha, MD, Vikas Menon, MD, Gary John V.D.D. Mercado, MD, Marilyn B. Mets, MD, Edoardo Midena, MD, PhD, Audra Miller, MD, Divyansh K.C. Mishra, DNB, Furahini G. Mndeme, MD, Ahmed A. Mohamedani, FRCPath, Mona T. Mohammad, MD, FRCS, Annette C. Moll, MD, PhD, Margarita M. Montero, MD, Claude Moreira, MD, PhD, Prithvi Mruthyunjaya, MD, MHS, Mchikirwa S. Msina, MMed Ophth, Gerald Msukwa, MMed Ophth, Sangeeta S. Mudaliar, DNB Pediatric, Hassan Muhammad, MD, Kangwa I. Muma, MMed Ophth, FCOphth, Francis L. Munier, MD, Timothy G. Murray, MD, MBA, Kareem O. Musa, FWACS, FMCOphth, FICO, Asma Mushtaq, MD, Anne A. Musika, MD, Hamzah Mustak, MD, Tajudeen Mustapha, MBBS, FWACS, Okwen M. Muyen, MD, Khumo H. Myezo, Msc, Gita Naidu, MMed Paed, PhD, Natasha Naidu, MBCHB, FCS Ophthalmol, Akshay Gopinathan Nair, MD, Sundaram Natarajan, FRCS, Larisa Naumenko, MD, PhD, Paule Aïda Ndoye Roth, MD PhD, Yetty M. Nency, MD, Vladimir Neroev, MD, PhD, Yvonne Ng, MBChB ( Auckland) , FRANZCO, Marina Nikitovic, MD, PhD, Elizabeth D. Nkanga, FMCOph, Henry E. Nkumbe, MD, Marcel N. Numbi, MD, Kalle Nummi, MD, Murtuza Nuruddin, FRCS, Mutale Nyaywa, MD, MMed Ophth, FCOphth, Chinsisi Nyirenda, MD, Ghislaine Obono-Obiang, MD, Scott C.N. Oliver, MD, Joaquin Ooporto, MD, Miriam Ortega-Hernández, MD, Alexander Oscar, MD, Diego Ossandon, MD, Halimah Pagarra, MD, PhD, Vivian Paintsil, FWACP, Luisa Paiva, MD, Mahesh Shanmugam Palanivelu, FRCSED, Ruzanna Papyan, MD, Raffaele Parrozzani, MD, PhD, Claudia R. Pascual Morales, MD, Katherine E. Paton, MD, FRCSC, Jacob Pe'er, MD, Jesús Peralta Calvo, MD, Sanja Perić, MD, PhD, Chau T.M. Pham, MD, Remezo Philbert, MD, David A. Plager, MD, Pavel Pochop, MD, PhD, Rodrigo A. Polania, MD, Vladimir Polyakov, MD, Jimena Ponce, MD, Ali O. Qadir, MD, Seema Qayyum, FCPS, Jiang Qian, MD, Ardizal Rahman, MD, Purnima Rajkarnikar, MD, Rajesh Ramanjulu, MD, Aparna Ramasubramanian, MD, Marco A. Ramirez-Ortiz, MD, MPH, Jasmeen K. Randhawa, BA, Léa Raobela, MD, Riffat Rashid, MS, M. Ashwin Reddy, FRCOphth, Lorna A. Renner, FRCPCH (UK), David Reynders, MD, Dahiru Ribadu, FMCOph, Petra Ritter-Sovinz, MD, Anna Rogowska, MD, Duangnate Rojanaporn, MD, Livia Romero, MD, Soma R. Roy, DCO, Raya H. Saab, MD, Svetlana Saakyan, MD, PhD, Ahmed H. Sabhan, MD, Mandeep S. Sagoo, FRCS (Ed), Azza M.A. Said, MD, Rohit Saiju, MD, Beatriz Salas, MD, Sonsoles San Román Pacheco, MD, Gissela L. Sánchez, MD, Alma Janeth Sanchez Orozco, MD, Phayvanh Sayalith, MD, Trish A. Scanlan, MRCPI, MSc, Christoph Schwab, MD, Ahad Sedaghat, MD, Rachna Seth, DNB MNAMS, Mariana Sgroi, MD, Ankoor S. Shah, MD, PhD, Shawkat A. Shakoor, MS, Manoj K. Sharma, MD, Sadik T. Sherief, MD, Carol L. Shields, MD, David Sia, MB ChB, FRANZCO, Sorath Noorani Siddiqui, MD, Sidi Sidi cheikh, MD, PhD, Sónia Silva, MD, Arun D. Singh, MD, Usha Singh, MS, Penny Singha, MD, Rita S. Sitorus, MD, PhD, Alison H. Skalet, MD, PhD, Hendrian D. Soebagjo, MD, PhD, Tetyana Sorochynska, MD, PhD, Grace Ssali, MD, Andrew W. Stacey, MD, Sandra E. Staffieri, PhD, Erin D. Stahl, MD, David M. Steinberg, PhD, David K. Stones, MBChB, FCPaed, Caron Strahlendorf, MD, Maria Estela Coleoni Suarez, MD, Sadia Sultana, FCPS, Xiantao Sun, MD, Rosanne Superstein, MD, Eddy Supriyadi, MD, PhD, Supawan Surukrattanaskul, MD, Shigenobu Suzuki, MD, PhD, Karel Svojgr, MD, PhD, Fatoumata Sylla, MD, Gevorg Tamamyan, MD, PhD, Deborah Tan, MBBS, Alketa Tandili, MD, PhD, Jing Tang, MD, Fanny F. Tarrillo Leiva, MD, Maryam Tashvighi, MD, Bekim Tateshi, MD, PhD, Kok Hoi Teh, MD, Edi S. Tehuteru, MD, Luiz F. Teixeira, MD, Manca Tekavcic Pompe, MD, PhD, Abdullah Dahan M. Thawaba, MD, Tuyisabe Theophile, MSc, Helen Toledano, MBChB, Doan L. Trang, MD, Fousseyni Traoré, MD, Devjyoti Tripathy, MD, Samuray Tuncer, MD, Harba Tyau-Tyau, MD, Ali B. Umar, MD, FMCPath, Emel Unal, MD, Ogul E. Uner, BA, Steen F. Urbak, MD, PhD, Tatiana L. Ushakova, MD, Rustam H. Usmanov, MD, Sandra Valeina, MD, Paola Valente, MD, Milo van Hoefen Wijsard, MD, Jacqueline Karina Vasquez Anchaya, MD, Leon O. Vaughan, FRCS (Ed), Nevyana V. Veleva-Krasteva, MD, PhD, Nishant Verma, MD, Andi A. Victor, MD, PhD, Maris Viksnins, MD, Edwin G. Villacís Chafla, MD, Victor M. Villegas, MD, Victoria Vishnevskia-Dai, MD, Keith Waddell, DM, FRCP, FRCS, FRCOphth, Amina H. Wali, MD, FMCOph Nigeria, Yi-Zhuo Wang, MD, Nutsuchar Wangtiraumnuay, MD, FICO, Julie A. Wetter, MMed Rad Onc, FCRad Onc, Widiarti P. Riono, MD, Matthew W. Wilson, MD, Amelia D.C. Wime, MD, Atchareeya Wiwatwongwana, MD, Damrong Wiwatwongwana, MD, Charlotte Wolley Dod, MD, Emily S. Wong, FCOphth HK, FHKAM, Phanthipha Wongwai, MD, PhD, Si-qi Wu, MSc, Daoman Xiang, MD, PhD, Yishuang Xiao, MSc, Bing Xu, MD, Kang Xue, MD, Antonio Yaghy, MD, Jason C. Yam, FRCSEd, Huasheng Yang, MD, Jenny M. Yanga, MD, Muhammad A. Yaqub, MD, FCPS, FRCSEd, Vera A. Yarovaya, MD, Andrey A. Yarovoy, MD, PhD, Huijing Ye, MD, Roberto I. Yee, MD, Yacoub A. Yousef, MD, Putu Yuliawati, MD, Arturo M. López, MD, Ekhtelbenina Zein, MD, Yi Zhang, MD, PhD, Katsiaryna Zhilyaeva, MD, Nida Zia, MBBS, MCPS, Othman A.O. Ziko, MD, PhD, Marcia Zondervan, MBA, Sabrina Schlüter, MD, and Richard Bowman, FRCOphth
Subjects: External beam radiotherapy, Extraocular extension, Multimodal treatment, Retinoblastoma, Tumor, Ophthalmology, RE1-994
Abstract: Purpose: To study the treatment and outcomes of children with retinoblastoma (RB) with extraocular tumor extension (RB-EOE) and compare them with RB without extraocular tumor extension (RB-w/o-EOE). Design: Multicenter intercontinental collaborative prospective study from 2017 to 2020. RB-EOE cases included those with overt orbital tumor extension in treatment-naive patients. Cases with microscopic orbital extension detected postenucleation were excluded from the study. Participants: A total of 319 children with RB-EOE and 3116 children with RB-w/o-EOE. Intervention: Chemotherapy, enucleation, exenteration, radiotherapy. Main Outcome Measures: Systemic metastasis and death. Results: Of the 3435 RB patients included in this study, 309 (9%) were from low-income countries (LIC), 1448 (42%) from lower-middle income, 1012 (29%) from upper-middle income, and 666 (19%) patients from high-income countries. There was an inverse relationship between the percentage of RB-EOE and national income level, with 96 (31%) patients from LIC, 197 (6%) lower-middle income, 20 (2%) upper-middle income, and 6 (1%) patients from high-income countries (P = 0.0001). The outcomes were statistically significant for RB-EOE compared with RB-w/o-EOE: systemic metastasis (32% vs. 4% respectively; P = 0.0001) and metastasis-related death (63% vs. 6% respectively; P = 0.0001). Multimodal treatment was the most common form of treatment (n = 177; 54%) for RB-EOE, with most cases undergoing a combination of intravenous chemotherapy and enucleation (n = 97; 30%). Adjuvant external beam radiotherapy (EBRT) after surgery (enucleation/orbital exenteration) was given in only 68 (21%) cases. Kaplan–Meier analysis for systemic metastasis and metastasis-related death in RB-EOE was 28% and 57% at 1 year, 29% and 60% at 2 years, and 29% and 61% at 3 years, respectively. Cox regression analysis revealed that the risk of death from RB-EOE was greater in patients aged >4 years than
Published: 2025
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2. Multilevel regression modelling of melanoma incidence

Author: Brown, Antony Clark
Subjects: 610.21, G340 Statistical Modelling, melanoma, cancer, statistical modelling, modelling
Abstract: This thesis is concerned with developing and implementing a method for modelling and projecting cancer incidence data. The burden of cancer is an increasing problem for society and therefore, the ability to analyse and predict trends in large scale populations is vital. These predictions based on incidence and mortality data collected by cancer registries, can be used for estimation of current and future rates, which is helpful for public health planning. A large body of work already exists on the use of various modelling strategies, methods and fitting techniques. A multilevel method of preparing the data is proposed, fitted to historical data using regression modelling, to predict future rates of incidence for a given population. The proposed model starts with a model for the total incidence of the population, with each successive level stratifying the data into progressively more specific groupings, based on age. Each grouping is partitioned into subgroups, and each subgroup is expressed as a proportion of the parent group. Models are fitted to each of the proportional age-groups, and a combination of these models produces a model that predicts incidence for a specific age. A simple, efficient implementation of the modelling procedure is described, including key algorithms and measures of performance. The method is applied to data from populations that have very different melanoma incidence (the USA and Australia). The proportional structure reveals that the proportional age trends present in both populations are remarkably similar, indicating that there are links between causative factors in both populations. The method is applied fully to data from a variety of populations, and compared with results from existing models. The method is shown to be able to produce results that are reliable and stable, and are generally significantly more accurate than those of other models.
Published: 2007

3. The epidemiology of eye injuries in Western Australia: a retrospective 10-year study

Author: Magda K Blaszkowska, Stephen E Bartnik, Julie M Crewe, Antony Clark, and David A Mackey
Subjects: Ophthalmology, Optometry
Abstract: Eye injuries constitute a significant cause of preventable lifelong visual impairment or blindness. It is important to identify the context in which these injuries occur to develop intervention programs to reduce the incidence and severity of injury. To evaluate the nature, external cause, place of occurrence and incidence rate of eye injuries treated at hospitals in Western Australia. Retrospective, population-based study of patients presenting to all emergency departments or admitted to hospital with primary or secondary eye injuries between 2005 and 2014. The combined incidence rate of eye injuries requiring tertiary care was 278 per 100 000 person-years (95% CI 276–280). Significantly more males (79%, 44 569) presented to emergency departments (p < 0.001), and most injuries involved the cornea and conjunctiva (83%). The injury incidence rate was 248 per 100 000 person-years (95% CI 246–250). A total of 2823 and 3951 individuals were admitted to hospital for a primary or secondary eye injury, respectively. The most frequent primary diagnosis on admission was contusion (19%). Assault (24%) was the most common cause of injury requiring inpatient treatment. Indigenous individuals were hospitalised for an eye injury at a rate of 109 per 100 000 person-years (95% CI 102–116), compared to 27 (95% CI 26–27) for non-Indigenous individuals. Each year was associated with an increase in the mean number of eye injuries (7% and 5% for emergency department and hospital admission data, respectively). Indigenous individuals and males experience eye injuries requiring tertiary management disproportionately. Indigenous female patients were conspicuously affected by eye injuries. Remedial intervention strategies should incorporate violence prevention as assault is a significant cause of eye injury.
Published: 2022
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4. Low-concentration atropine eyedrops for myopia control in a multi-racial cohort of Australian children: A randomised clinical trial

Author: Samantha Sze‐Yee Lee, Gareth Lingham, Magdalena Blaszkowska, Paul G. Sanfilippo, Adrian Koay, Maria Franchina, Audrey Chia, James Loughman, Daniel Ian Flitcroft, Christopher J. Hammond, Augusto Azuara‐Blanco, Julie M. Crewe, Antony Clark, and David A. Mackey
Subjects: Atropine, Adolescent, myopia control, atropine, Australia, axial length, Refraction, Ocular, Ophthalmology, Myopia, Disease Progression, Humans, myopia, Ophthalmic Solutions, Child, randomised controlled trial
Abstract: BackgroundTo test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia-control approach in Australian children.MethodsChildren (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.ResultsAt 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 amplitude and pupillary light response compared to the placebo group.ConclusionsIn 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.
Published: 2022
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5. Western Australia Atropine for the Treatment of Myopia (WA‐ATOM) study: Rationale, methodology and participant baseline characteristics

Author: Julie Crewe, Fred K. Chen, Michael D. Richards, Jason Charng, James Loughman, Tan Tai Truong, Ian Flitcroft, Fletcher Ng, Augusto Azuara-Blanco, Antony Clark, Nicola S Logan, Samantha Sze Yee Lee, Gareth Lingham, David A. Mackey, Audrey Chia, and Christopher J Hammond
Subjects: Atropine, Pediatrics, medicine.medical_specialty, genetic structures, Astigmatism, Refraction, Ocular, Placebo, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Myopia, medicine, Humans, Child, 030304 developmental biology, 0303 health sciences, business.industry, Incidence (epidemiology), Australia, Western Australia, medicine.disease, Iris colour, Ophthalmology, Tolerability, Baseline characteristics, Disease Progression, 030221 ophthalmology & optometry, Ophthalmic Solutions, business, medicine.drug
Abstract: Importance Atropine eyedrops are a promising treatment for slowing myopia progression in East Asian children. However, its effects on children in Australia, including those of non-Asian background, have not been well-studied. Background The Western Australia Atropine for the Treatment of Myopia (WA-ATOM) study aims to determine the efficacy and long-term effects of low-dose atropine eyedrops in myopia control. This paper describes the study rationale, methodology and participant baseline characteristics. Design Single-centre, double-masked, randomized controlled trial. Participants Children (6-16 years) with spherical equivalent ≤-1.50 D in each eye, astigmatism ≤1.50 D and myopia progression by ≥0.50 D/year. Methods Enrolled children were randomly assigned 2:1 to receive 0.01% atropine or placebo eyedrops. Participants are examined every 6 months during first 3 years of the study (2-year treatment phase followed by a 1-year washout phase), and then at a 5-year follow-up (2 years after the end of the washout phase). Main outcome measures Annual progression rate of myopia and axial length, tolerability to eyedrops and incidence and severity of unwanted effects. Results Out of 311 children who were referred, 242 were suitable for study participation, and 153 were subsequently enrolled. The baseline characteristics of enrolled participants are presented. Conclusions and relevance Outcomes of the WA-ATOM study will inform on the efficacy, tolerability, safety and long-term effects of low-dose atropine eyedrops in myopia control in Australian children. The impact of ocular sun exposure, iris colour and parental myopia on the efficacy of low-dose atropine will also be assessed.
Published: 2020
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6. Acute Uveitis in a Background of Streptococcal Sepsis: Infective or Inflammatory?

Author: Ankita Kothari and Antony Clark
Subjects: Ophthalmology, Immunology and Allergy
Abstract: The pathophysiology of uveitis in a patient with post-streptococcal syndrome with evidence of bacterial sepsis may be difficult to classify as being infective or an inflammatory etiology.Our patient presented with uveitis with systemic features of reactive arthritis and acute renal failure in a background of sepsis with group A streptococcus. Treatment with topical steroids lead to the resolution of this type of uveitis.It is safe to consider uveitis as being inflammatory rather than infectious and treat appropriately, when evidence suggesting other features of post -streptococcal syndrome are present.
Published: 2022

7. Paediatric eye injuries during a COVID-19 pandemic lockdown

Author: David A. Mackey, Alice H. Johnson, Maria Franchina, Magda Blaszkowska, Joel Lewis, Geoffrey C. Lam, and Antony Clark
Subjects: medicine.medical_specialty, genetic structures, Visual impairment, Eye injuries, Eye Injuries, Injury prevention, Pandemic, medicine, Humans, Child, Pandemics, Retrospective Studies, business.industry, Medical record, Attendance, COVID-19, Emergency department, medicine.disease, eye diseases, Ophthalmology, Accidental, Emergency medicine, Communicable Disease Control, medicine.symptom, business, Optometry
Abstract: Clinical relevance 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. Background 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. Methods 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. Results 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.
Published: 2021

8. Non‐accidental and accidental eye injuries in children in Western Australia

Author: Alice H. Johnson, Geoffrey C. Lam, Antony Clark, David A. Mackey, Swati Sinkar, and Katherine Barnes
Subjects: medicine.medical_specialty, business.industry, MEDLINE, Human factors and ergonomics, Poison control, Western Australia, medicine.disease, Suicide prevention, Occupational safety and health, Eye injuries, Ophthalmology, Eye Injuries, Accidents, Accidental, Emergency medicine, Injury prevention, medicine, Humans, Child, business
Published: 2020
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9. Distribution and Classification of Peripapillary Retinal Nerve Fiber Layer Thickness in Healthy Young Adults

Author: Antony Clark, Fred K. Chen, David A. Mackey, Samantha Sze Yee Lee, Gareth Lingham, Seyhan Yazar, and Jason Charng
Subjects: Adult, Retinal Ganglion Cells, young adults, medicine.medical_specialty, genetic structures, Optic Disk, Biomedical Engineering, Nerve fiber layer, Optic disk, Spectral domain, Article, Young Adult, chemistry.chemical_compound, Nerve Fibers, Optical coherence tomography, Ophthalmology, medicine, Humans, the Raine Study, medicine.diagnostic_test, business.industry, retinal nerve fiber layer, Optic Nerve, Mean age, Retinal, eye diseases, Left eye, medicine.anatomical_structure, classification, chemistry, Optic nerve, epidemiology, sense organs, business, Tomography, Optical Coherence
Abstract: Purpose: To report the distribution of peripapillary retinal nerve fiber layer (RNFL) thickness in healthy young adults, investigate factors associated with RNFL thickness, and report the percentage of outside normal limits (ONL) and borderline (BL) RNFL thickness classifications based on the optical coherence tomography (OCT) manufacturer reference database. Methods: Participants of the Raine Study Generation 2 cohort (aged 18–22 years) underwent spectral domain OCT imaging with an RNFL circle scan. Eyes with inadequate scans or optic nerve pathology were excluded. Linear mixed models were used to analyze associations. Results: Data were available for 1288 participants (mean age, 20.0 years). Mean RNFL thicknesses in right and left eyes, respectively, were global = 100.5 µm, 100.3 µm (P = 0.03); temporal = 73.1 µm, 68.9 µm (P < 0.001); superotemporal = 140.6 µm, 136.3 µm (P < 0.001); superonasal = 104.9 µm, 115.1 µm (P < 0.001); nasal = 79.7 µm, 79.1 µm (P = 0.09); inferonasal = 109.8 µm, 111.5 µm (P < 0.001); and inferotemporal = 143.2 µm, 143.6 µm (P = 0.51). Longer axial length was associated with thinner RNFL globally, nasally, inferotemporally, superotemporally, superonasally, and inferonasally, as well as thicker RNFL temporally. The prevalence of ONL and BL classifications was generally higher than the expected rates of 1% and 4%, respectively, in temporal sectors and lower than expected in nasal sectors. The prevalence of global BL classifications was lower than expected (right eye, 2.3%; left eye, 2.6%). Conclusions: Measured RNFL thickness differs with axial length and between right and left eyes. More reference data are needed to better define the normal limits of RNFL variation in different populations. Translational Relevance: This study provides an improved understanding of normal variation in RNFL thickness in young adults.
Published: 2021
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10. Pterygia are indicators of an increased risk of developing cutaneous melanomas

Author: Paul G. Sanfilippo, Tim Threlfall, David A. Mackey, Antony Clark, and Julie Crewe
Subjects: Adult, Male, medicine.medical_specialty, Skin Neoplasms, Adolescent, Pterygium, Cohort Studies, Young Adult, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Risk Factors, Internal medicine, Epidemiology, medicine, Humans, Melanoma, Early Detection of Cancer, Aged, Aged, 80 and over, business.industry, Incidence, Incidence (epidemiology), Case-control study, Western Australia, Middle Aged, medicine.disease, eye diseases, Sensory Systems, Surgery, Cancer registry, Ophthalmology, Case-Control Studies, 030220 oncology & carcinogenesis, Cohort, 030221 ophthalmology & optometry, Regression Analysis, Female, Skin cancer, business, Cohort study
Abstract: AimTo investigate whether pterygium is an indicator of an increased risk of cutaneous melanoma (CM).MethodsA 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.Results23 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; pConclusionThe 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.
Published: 2017
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11. Teleworking in the Countryside

Author: Michael Antony Clark
Published: 2018
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12. Telecottages and Telework

Author: Michael Antony Clark
Published: 2018
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13. The Wider Experience of Teleworking

Author: Michael Antony Clark
Published: 2018
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14. The Telework Facilitators

Author: Michael Antony Clark
Published: 2018
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15. Summary and Conclusion

Author: Michael Antony Clark
Published: 2018
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16. The Information Economy and the Emergence of Rural Telework

Author: Michael Antony Clark
Subjects: Market economy, Information economy, Business
Published: 2018
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17. The Characteristics and Dynamics of Telework

Author: Michael Antony Clark
Subjects: Computer science, Dynamics (mechanics), Statistical physics
Published: 2018
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18. Telework and the Changing Rural Economy

Author: Michael Antony Clark
Subjects: Rural economy, Development economics, Business
Published: 2018
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19. The Organisational Perspective of Telework

Author: Michael Antony Clark
Subjects: Perspective (graphical), Engineering ethics, Sociology
Published: 2018
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20. Research Methodology

Author: Michael Antony Clark
Published: 2018
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21. Health Service Use and Mortality of the Elderly Blind

Author: James B. Semmens, Antony Clark, William H. Morgan, Julie Crewe, Aqif Mukhtar, Katrina Spilsbury, and Nigel Morlet
Subjects: Male, Mental Health Services, Emergency Medical Services, Pediatrics, medicine.medical_specialty, Health Services for the Aged, Blindness, Rate ratio, Emergency medical services, Humans, Medicine, Hospital Mortality, Registries, Generalized estimating equation, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Retrospective cohort study, Western Australia, Emergency department, Length of Stay, medicine.disease, Comorbidity, Confidence interval, Hospitalization, Ophthalmology, Cohort, Female, business, Visually Impaired Persons
Abstract: Purpose To determine whether blindness in older people is associated with increased health service use and mortality. Design Retrospective matched cohort study from July 1, 1999, through June 30, 2010. Participants 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. Methods 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. Main Outcome Measures Relative rates of hospital admissions, lengths of stay, and mortality, as well as crude proportions of ED and mental health service visits. Results The blind cohort comprised 1726 individuals 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. Conclusions 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.
Published: 2015
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22. Teleworking in the Countryside : Home-Based Working in the Information Society

Author: Michael Antony Clark and Michael Antony Clark
Subjects: Telecommuting--Ireland, Telecommuting--Great Britain, Cottage industries--British Isles, Cottage industries--Great Britain, Cottage industries--Ireland, Telecommuting--British Isles
Abstract: This title was first published in 2000. Since the 1970s there has been widespread debate on the potential of information communication technologies on the organization of work and in particular, the implications of and opportunities engendered through telework and the decentralization of the workplace. However, despite the possible spatial, cultural, social and economic implications, much of the telework debate has been informed by anecdotal examples, journalistic reporting and individual forecasts. This book aims to further the debate by analyzing the scale, nature and experience of telework in the countryside. It examines how and by whom, telework is set up, and what policy and social changes are taking place to facilitate it in rural areas. Individual teleworkers and the organizations using them are questioned to assess whether rural teleworking is proving as advantageous in practice as it is thought to be in theory. Its conclusions suggest that teleworking may not yet be the solution to the many rural problems such as unemployment and depopulation and that businesses and local authorities still need to develop their policies and strategies to allow this type of working to reach its potential.
Published: 2017

23. Long-term trends and outcomes of anterior vitrectomy in Western Australia

Author: Antony Clark, Nigel Morlet, Jonathon Q. Ng, David B. Preen, and James B. Semmens
Subjects: Male, medicine.medical_specialty, genetic structures, medicine.medical_treatment, Population, Vitrectomy, Intraocular lens, Cataract Extraction, Artificial Lens Implant Migration, Age Distribution, Postoperative Complications, Endophthalmitis, Lens Implantation, Intraocular, Risk Factors, Ophthalmology, medicine, Humans, Sex Distribution, Risk factor, education, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, business.industry, Corneal Edema, Retinal Detachment, Retinal detachment, Western Australia, General Medicine, Phacoemulsification, Middle Aged, Cataract surgery, Prognosis, medicine.disease, eye diseases, Surgery, Vitreous Body, Female, sense organs, business, Follow-Up Studies
Abstract: Purpose To describe trends, risk factors and outcomes of anterior vitrectomy during cataract and intraocular lens (IOL) surgery. Methods 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. Results 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
Published: 2014
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24. Hospitalization rates of children who are blind

Author: Antony Clark, Nigel Morlet, Julie Crewe, Margaret Crowley, William H. Morgan, James B. Semmens, Katrina Spilsbury, Aqif Mukhtar, and Geoff Lam
Subjects: Pediatrics, medicine.medical_specialty, Index date, business.industry, Incidence (epidemiology), Legal blindness, Bed days, Confidence interval, Ophthalmology, Health problems, Matched cohort, Cohort, Medicine, business
Abstract: Background To evaluate the impact of blindness on hospitalization rates of children. Design Matched cohort study. Participants Children confirmed as legally blind (2003–2009), age- and gender-matched to control cohort of normally sighted children from the state register of births. Methods 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. Main Outcome Measures Descriptive statistics, incident rate ratios, and predicted means for hospital separations and length of stay. Results 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. Conclusions 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.
Published: 2013
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25. Macular morphology following unilateral bevacizumab injection for retinopathy of prematurity: an OCT study

Author: Maram Isaac, Nasrin Tehrani, Kamiar Mireskandari, Antony Clark, Carol A. Westall, and Tom Wright
Subjects: Male, Vascular Endothelial Growth Factor A, medicine.medical_specialty, genetic structures, Birth weight, Spectral domain, Angiogenesis Inhibitors, Gestational Age, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Foveal, Ophthalmology, medicine, Birth Weight, Humans, Macula Lutea, Retinopathy of Prematurity, Intravitreal bevacizumab, Fluorescein Angiography, Retrospective Studies, Bevacizumab Injection, business.industry, Postmenstrual Age, Infant, Newborn, Gestational age, Infant, Retinopathy of prematurity, medicine.disease, eye diseases, Bevacizumab, Pediatrics, Perinatology and Child Health, Intravitreal Injections, 030221 ophthalmology & optometry, Female, sense organs, business, Infant, Premature, Tomography, Optical Coherence
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.
Published: 2016

26. Poster Abstracts

Author: Katrina Spilsbury, Julie Crewe, Margaret Crowley, Antony Clark, William H. Morgan, James B. Semmens, Nigel Morlet, Jonathon Q. Ng, and Syed Aqif Mukhtar
Subjects: Gerontology, Ophthalmology, business.industry, Medicine, Co morbidity, business, Cohort study
Published: 2012
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27. Diabetic retinopathy management by Australian optometrists

Author: Daniel S W Ting, Antony Clark, Joshua Yuen, Jill E Keeffe, David B. Preen, Jonathon Q. Ng, Hugh R. Taylor, and Nigel Morlet
Subjects: National health, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Cross-sectional study, Diabetic retinopathy screening, Health services research, Diabetic retinopathy, medicine.disease, Ophthalmoscopy, Ophthalmology, Diabetes mellitus, Medicine, Optometry, business, Management practices
Abstract: Background: 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. Design: Cross-sectional national survey, primary care setting. Participants: 1000 Australian optometrists across different states. Methods: A self-administered questionnaire was sent to 1000 optometrists across all states during 2007/2008. Main outcome measures: Use of retinal camera, screening practices/attitudes and behaviour in diabetic retinopathy management. Results: 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
Published: 2011
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28. Assessing the diagnostic validity of a blind register

Author: William H. Morgan, Margaret Crowley, Antony Clark, Katrina Spilsbury, Julie Crewe, Aqif Mukhtar, Jonathon Q. Ng, Nigel Morlet, and James B. Semmens
Subjects: Pediatrics, medicine.medical_specialty, genetic structures, Blindness, business.industry, Legal blindness, Glaucoma, Diabetic retinopathy, medicine.disease, Predictive value, Confidence interval, Ophthalmology, medicine, Diagnostic validity, Optometry, Medical diagnosis, business
Abstract: Background: To validate the accuracy of clinical ophthalmic information held on the West Australian blind register. Design: Community-based cross-sectional study. Participants: Legally blind or severely vision-impaired people were selected randomly from the Association for the Blind of Western Australia register. Methods: Individuals were reviewed by one of two consultant ophthalmologists. Main Outcome Measures: 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. Results: 273 blind or near blind people were reviewed from the register total of 4271 individuals. 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 individuals (15%) had treatable conditions contributing to their vision loss. Conclusions: 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.
Published: 2011
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29. Quality of life of the most severely vision-impaired

Author: Julie Crewe, James B. Semmens, Margaret Crowley, Jonathon Q. Ng, Nigel Morlet, Antony Clark, Aqif Mukhtar, William H. Morgan, and Katrina Spilsbury
Subjects: Gerontology, Visual acuity, genetic structures, Cross-sectional study, business.industry, Health services research, eye diseases, Quality-adjusted life year, Ophthalmology, Quality of life (healthcare), Value of life, medicine, medicine.symptom, Young adult, business, Depression (differential diagnoses)
Abstract: Background: To explore the interaction between vision impairment, perceived quality of life loss and willingness to trade remaining life for vision gain. Design: Community-based cross-sectional study Participants: Legally blind or severely vision-impaired people selected randomly from the Association for the Blind of Western Australia register. Methods: Individuals 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. Main Outcome Measures: IVI Rasch Logits and TTO utility values (TTO UV). Results: 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. Conclusions: These results suggest that emotional health and lack of depression are important determinants for quality and value of life.
Published: 2011
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30. Further survey of Australian ophthalmologist's diabetic retinopathy management: did practice adhere to National Health and Medical Research Council guidelines?

Author: David B. Preen, Jill E Keeffe, Hugh R. Taylor, Jonathon Q. Ng, Nigel Morlet, Antony Clark, and Joshua Yuen
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Cross-sectional study, medicine.medical_treatment, Health services research, MEDLINE, Guideline, Diabetic retinopathy, Cataract surgery, Fluorescein angiography, medicine.disease, Logistic regression, eye diseases, Ophthalmology, medicine, business
Abstract: Background: To compare the self-reported management of diabetic retinopathy by Australian ophthalmologists with the 1997 National Health and Medical Research Council (NHMRC) guidelines. Methods: 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/practices and specific hypothetical management scenarios. Data were analysed using Chi-squared and adjusted logistic regression. Result: 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. Conclusion: 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.
Published: 2010
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31. Diabetic retinopathy and the major causes of vision loss in Aboriginals from remote Western Australia

Author: Hussein Farah, David B. Preen, William H. Morgan, Kiele Armstrong, Dao-Yi Yu, Sam Kain, Antony Clark, and James B. Semmens
Subjects: medicine.medical_specialty, Refractive error, Pediatrics, Visual acuity, genetic structures, medicine.diagnostic_test, business.industry, Physical examination, Diabetic retinopathy, medicine.disease, eye diseases, Confidence interval, Ophthalmology, Diabetes mellitus, Epidemiology, Medicine, medicine.symptom, business, Retinopathy
Abstract: Purpose: 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. Methods: 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. Results: A total of 920 Aboriginals underwent 1331 examinations over the study period. There were 246 eyes with vision loss (best-corrected VA
Published: 2010
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32. Quality of life after postoperative endophthalmitis

Author: James B. Semmens, Priya Mahendran, Nigel Morlet, Elisabeth Tropiano, David B. Preen, Katrina Spilsbury, Jonathon Q. Ng, and Antony Clark
Subjects: Male, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Population, Visual Acuity, Cataract Extraction, Endophthalmitis, Quality of life, Surveys and Questionnaires, Internal medicine, medicine, Humans, Mobility Limitation, education, Adverse effect, Aged, Aged, 80 and over, education.field_of_study, business.industry, Diabetic retinopathy, Cataract surgery, medicine.disease, eye diseases, Confidence interval, Surgery, Ophthalmology, Mental Health, Linear Models, Quality of Life, Female, medicine.symptom, business
Abstract: Purpose: The aim of this study is to determine if postoperative endophthalmitis adversely affects quality of life after cataract surgery. Methods: 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. Results: 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
Published: 2008
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33. Big data and ophthalmic research

Author: James B. Semmens, Antony Clark, Nigel Morlet, and Jonathon Q. Ng
Subjects: Disease surveillance, Databases, Factual, business.industry, Big data, Health services research, Globe, Health outcomes, Data science, Disease etiology, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, Resource (project management), medicine.anatomical_structure, 030221 ophthalmology & optometry, Medicine, Humans, 030212 general & internal medicine, Health Services Research, Registries, business, Data Linkage
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.
Published: 2015

34. Quality management in local government: four case studies

Author: Antony Clark and Alex Appleby
Subjects: Organizational Behavior and Human Resource Management, Quality management, Work (electrical), Borough, Local government, media_common.quotation_subject, Business, Management and Accounting (miscellaneous), Quality (business), Business, Management principles, Public administration, Quality policy, media_common
Abstract: Looks at the growing importance of quality management in local government. Explores the work undertaken in three London Borough Councils and one District Council in Essex which are attempting to apply management principles to all areas of their activity. Compares each council using a framework for quality management. Describes the differences in their approaches to implementing quality, exploring why those differences may have come about. Identifies a number of important questions which should be considered when planning any local government quality initiative.
Published: 1997
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35. Quality management in local government, the same as in the private sector but different

Author: Antony Clark and Alex Appleby
Subjects: Organizational Behavior and Human Resource Management, Quality management, Total quality management, business.industry, media_common.quotation_subject, Environmental economics, Public relations, Private sector, Public domain, Work (electrical), Local government, Business, Management and Accounting (miscellaneous), Quality (business), business, Quality policy, media_common
Abstract: Looks at the growing importance of quality management in local government. Identifies the current thinking behind total quality and the need to apply established theory in the public domain, and explores the approaches and methodologies which are currently available to do this. Develops a framework for total quality from the work of a number of quality gurus. This framework can be used to examine the key requirements of total quality implementation, and hence expanded to take account of the special purpose of, and constraining conditions which apply to, local authorities.
Published: 1997
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36. Mortality and hospital morbidity of working-age blind

Author: Julie Crewe, Aqif Mukhtar, William H. Morgan, James B. Semmens, Antony Clark, Nigel Morlet, and Katrina Spilsbury
Subjects: Adult, Employment, Male, medicine.medical_specialty, Pediatrics, Adolescent, medicine.medical_treatment, Population, Comorbidity, Blindness, Cohort Studies, Cellular and Molecular Neuroscience, Young Adult, Epidemiology, medicine, Humans, education, Depression (differential diagnoses), Aged, education.field_of_study, Rehabilitation, business.industry, Depression, Mortality rate, Incidence (epidemiology), Incidence, Mental Disorders, Australia, Health Services, Length of Stay, Middle Aged, medicine.disease, Mental health, Sensory Systems, Ophthalmology, Female, Morbidity, business, Visually Impaired Persons
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) (p0.001). Blindness was recorded as a comorbid condition for 76 (22%) blind individuals, 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.
Published: 2013

37. Myocardial infarction after intravitreal vascular endothelial growth factor inhibitors: a whole population study

Author: David B. Preen, Mark C. Gilles, Charlotte M McKnight, Tom Briffa, Nigel Morlet, Anna Kemp, Wayne Reynolds, Frank M Sanfilippo, Jonathon Q. Ng, Ian L. McAllister, and Antony Clark
Subjects: Male, medicine.medical_specialty, Gastrointestinal bleeding, genetic structures, Bevacizumab, Population, Myocardial Infarction, Infarction, Angiogenesis Inhibitors, Antibodies, Monoclonal, Humanized, Gastroenterology, chemistry.chemical_compound, Macular Degeneration, Internal medicine, Ranibizumab, medicine, Humans, Myocardial infarction, education, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, business.industry, Vascular Endothelial Growth Factors, General Medicine, Western Australia, medicine.disease, Hospital Records, Surgery, Vascular endothelial growth factor, Stroke, Ophthalmology, Choroidal neovascularization, chemistry, Photochemotherapy, Intravitreal Injections, Female, medicine.symptom, business, Gastrointestinal Hemorrhage, medicine.drug
Abstract: To determine the risk of thromboembolic and gastrointestinal bleeding events in the 12 months after injections of bevacizumab or ranibizumab compared with photodynamic therapy and a nontreated community sample.Hospital and death records were examined for 1,267 patients treated with vascular endothelial growth factor inhibitor and 399 patients treated with photodynamic therapy attending Western Australian eye clinics from 2002 to 2008, and 1,763 community controls, aged ≥50 years. Hospital records from 1995 to 2009 were analyzed for history of myocardial infarction (MI), stroke, and gastrointestinal bleeding before treatment. Records were searched for evidence of these events in the 12 months after treatment.The 12-month MI rate was higher for vascular endothelial growth factor inhibitor patients than photodynamic therapy patients and the community group (1.9/100 vs. 0.8 and 0.7, respectively). No differences were observed between patients treated with bevacizumab and ranibizumab. The adjusted MI rate was 2.3 times greater than the community group (95% confidence interval, 1.2-4.5) and photodynamic therapy rate (95% confidence interval, 0.7-7.7). The 12-month MI risk did not increase with the number of injections administered (hazard ratio, 0.9; 95% confidence interval, 0.5-1.5). Stroke and gastrointestinal bleeding did not differ between any exposure groups.Although all the adverse events examined were rare, patients treated with vascular endothelial growth factor inhibitors were significantly more likely to experience fatal or nonfatal MI than the community group. This increased risk may be related to the underlying age-related macular degeneration or vascular endothelial growth factor inhibitor use itself.
Published: 2013

38. Hospitalization rates of children who are blind

Author: Julie M, Crewe, Geoff, Lam, Antony, Clark, Katrina, Spilsbury, Aqif S, Mukhtar, Nigel, Morlet, William H, Morgan, Margaret, Crowley, and James B, Semmens
Subjects: Lung Diseases, Male, Adolescent, Incidence, Visual Acuity, Infant, Comorbidity, Length of Stay, Blindness, Cohort Studies, Hospitalization, Patient Admission, Research Design, Child, Preschool, Outcome Assessment, Health Care, Humans, Female, Registries, Visual Fields, Child
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.
Published: 2013

39. Risk for retinal detachment after phacoemulsification: a whole-population study of cataract surgery outcomes

Author: Jonathon Q. Ng, Nigel Morlet, David B. Preen, Antony Clark, and James B. Semmens
Subjects: Adult, Male, medicine.medical_specialty, Databases, Factual, medicine.medical_treatment, Vitrectomy, Kaplan-Meier Estimate, Young Adult, Postoperative Complications, Risk Factors, medicine, Humans, Cumulative incidence, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, Phacoemulsification, business.industry, Incidence (epidemiology), Data Collection, Incidence, Hazard ratio, Retinal Detachment, Retinal detachment, Western Australia, Cataract surgery, Middle Aged, medicine.disease, Surgery, Ophthalmology, Treatment Outcome, Capsulotomy, Female, business
Abstract: Objectives To estimate the long-term cumulative incidence of and risk factors for retinal detachment (RD) after phacoemulsification using linked administrative medical data. Methods 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. Results 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. Conclusions 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.
Published: 2012

40. Prevalence of blindness in Western Australia: a population study using capture and recapture techniques

Author: William H. Morgan, Richard Parsons, Antony Clark, Jonathon Q. Ng, Margaret Crowley, Julie Crewe, Nigel Morlet, James B. Semmens, Geoffrey C. Lam, and Aqif Mukhtar
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, National Health Programs, medicine.medical_treatment, Visual impairment, Population, Legal blindness, Blindness, Cellular and Molecular Neuroscience, Young Adult, medicine, Prevalence, Humans, Registries, education, Child, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, Rehabilitation, Models, Statistical, business.industry, Public health, Infant, Retrospective cohort study, Western Australia, Middle Aged, medicine.disease, Sensory Systems, Ophthalmology, Child, Preschool, Population Surveillance, Optometry, Population study, Female, medicine.symptom, business, Demography
Abstract: AIM: To determine the prevalence of blinding eye disease in Western Australia using a capture and recapture methodology. METHODS: 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 individuals 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. RESULTS: 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%. CONCLUSION: 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.
Published: 2011

41. Assessing the diagnostic validity of a blind register

Author: Julie M, Crewe, William H, Morgan, Nigel, Morlet, Katrina, Spilsbury, Aqif, Mukhtar, Antony, Clark, Jonathon Q, Ng, Margaret, Crowley, and James B, Semmens
Subjects: Adult, Aged, 80 and over, Male, Adolescent, Reproducibility of Results, Vision, Low, Western Australia, Middle Aged, Blindness, Sensitivity and Specificity, Young Adult, Age Distribution, Cross-Sectional Studies, Predictive Value of Tests, Child, Preschool, Humans, False Positive Reactions, Female, Registries, Sex Distribution, Child, Visually Impaired Persons, Aged
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.Individuals 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 individuals. 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 individuals (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.
Published: 2011

42. Investigating school physics laboratory software and hardware

Author: Antony Clark
Subjects: Software, business.industry, General Physics and Astronomy, business, Computer hardware, Education
Abstract: This article outlines the considerable potential uses of a school physics laboratory computer and offers questions that all readers might find useful to consider when exploring software and hardware.
Published: 1993
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43. Quality of life of the most severely vision-impaired

Author: Julie M, Crewe, Nigel, Morlet, William H, Morgan, Katrina, Spilsbury, Aqif, Mukhtar, Antony, Clark, Jonathon Q, Ng, Margaret, Crowley, and James B, Semmens
Subjects: Adult, Aged, 80 and over, Male, Visual Acuity, Vision, Low, Western Australia, Middle Aged, Blindness, Young Adult, Cross-Sectional Studies, Quality of Life, Humans, Female, Health Services Research, Quality-Adjusted Life Years, Registries, Visually Impaired Persons, Aged
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.Individuals 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 (logMAR1) (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.
Published: 2010

44. Diabetic retinopathy management by Australian optometrists

Author: Daniel S W, Ting, Jonathon Q, Ng, Nigel, Morlet, Joshua, Yuen, Antony, Clark, Hugh R, Taylor, Jill, Keeffe, and David B, Preen
Subjects: Diabetic Retinopathy, National Health Programs, Australia, Diagnostic Techniques, Ophthalmological, Cross-Sectional Studies, Health Care Surveys, Surveys and Questionnaires, Practice Guidelines as Topic, Humans, Guideline Adherence, Health Services Research, Practice Patterns, Physicians', Delivery of Health Care, Optometry
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 (p0.005). Use of a retinal camera was significantly associated with an increased confidence in detecting clinical signs of diabetic retinopathy including macular oedema (P0.001). Optometrists who read the guidelines at least once were 2.5-times (P0.001) 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.
Published: 2010

45. Diabetic retinopathy and the major causes of vision loss in Aboriginals from remote Western Australia

Author: Antony, Clark, William H, Morgan, Sam, Kain, Hussein, Farah, Kiele, Armstrong, David, Preen, James B, Semmens, and Dao-Yi, Yu
Subjects: Adult, Male, Diabetic Retinopathy, Native Hawaiian or Other Pacific Islander, Health Care Surveys, Geographic Information Systems, Visual Acuity, Humans, Vision, Low, Female, Middle Aged, Blindness, Severity of Illness Index
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 VA6/12) 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, P0.0001). 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.
Published: 2010

46. Whole population trends in complications of cataract surgery over 22 years in Western Australia

Author: James B. Semmens, Nigel Morlet, David B. Preen, Jonathon Q. Ng, and Antony Clark
Subjects: Male, medicine.medical_specialty, genetic structures, medicine.medical_treatment, Population, Intraocular lens, Cataract Extraction, Rate ratio, Cataract, Endophthalmitis, Postoperative Complications, Risk Factors, medicine, Humans, education, Aged, Retrospective Studies, education.field_of_study, Wound dehiscence, business.industry, Incidence, Retinal detachment, Phacoemulsification, Western Australia, Cataract surgery, medicine.disease, eye diseases, Surgery, Ophthalmology, Population Surveillance, Female, sense organs, business
Abstract: Objective To examine the trends in major complications of cataract surgery in the Western Australian population over 22 years. Design Population-based study. Participants We included 129 982 cataract/lens surgery patients across 46 health facilities. Methods 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. Main Outcome Measures Admission for retinal detachment, dropped nucleus, wound dehiscence, pseudophakic corneal edema, intraocular lens (IOL) dislocation, and postoperative endophthalmitis requiring surgery. Results 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. Conclusions 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. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Published: 2010

47. Is Western Australia representative of other Australian States and Territories in terms of key socio-demographic and health economic indicators?

Author: James B. Semmens, David B. Preen, Antony Clark, Jonathon Q. Ng, and C. D'Arcy J. Holman
Subjects: Male, education.field_of_study, Economic growth, medicine.medical_specialty, Health economics, business.industry, Health Policy, Public health, Population, Censuses, Population health, Western Australia, Census, Indigenous, Economic indicator, Social Class, Health care, Medicine, Humans, Female, Health Expenditures, business, education, Demography
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.
Published: 2009

48. Differences in diabetic retinopathy management by primary eye care providers in Australia

Author: Nigel Morlet, Joshua Yuen, Daniel S W Ting, David B. Preen, Antony Clark, and Jonathon Q. Ng
Subjects: Ophthalmology, Nursing, Practice patterns, business.industry, Primary health care, Health services research, Medicine, Diabetic retinopathy, Eye care, business, medicine.disease
Published: 2011
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49. Diabetic retinopathy in Australian Aboriginal people: response

Author: David B. Preen, Kiele Armstrong, William H. Morgan, Antony Clark, Hussein Farah, Sam Kain, Dao-Yi Yu, and James B. Semmens
Subjects: Ophthalmology, business.industry, medicine, Optometry, Diabetic retinopathy, medicine.disease, business
Published: 2011
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50. The Engineering Education Scheme: a school's point of view

Author: Antony Clark
Subjects: Scheme (programming language), Point (typography), Engineering education, ComputingMilieux_COMPUTERSANDEDUCATION, Mathematics education, General Physics and Astronomy, computer, Education, computer.programming_language
Abstract: This article outlines possible means of applying `classroom' physics, the special opportunities offered by the Engineering Education Scheme and some of the consequences.
Published: 1993
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