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Tronstad O, Patterson S, Zangerl B, Flaws D, Holdsworth R, Irvine L, Yerkovich S, Pearse I, Fraser JF. The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients. Aust Crit Care 2024:S1036-7314(24)00053-5. [PMID: 38604917 DOI: 10.1016/j.aucc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff. OBJECTIVE The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU. METHODS This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration. RESULTS Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep. CONCLUSION The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Lacey Irvine
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Qld University of Technology, Brisbane, Australia
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Australia
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Tong J, Khou V, Trinh M, Alonso‐Caneiro D, Zangerl B, Kalloniatis M. Derivation of human retinal cell densities using high-density, spatially localized optical coherence tomography data from the human retina. J Comp Neurol 2023; 531:1108-1125. [PMID: 37073514 PMCID: PMC10953454 DOI: 10.1002/cne.25483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/20/2023]
Abstract
This study sought to identify demographic variations in retinal thickness measurements from optical coherence tomography (OCT), to enable the calculation of cell density parameters across the neural layers of the healthy human macula. From macular OCTs (n = 247), ganglion cell (GCL), inner nuclear (INL), and inner segment-outer segment (ISOS) layer measurements were extracted using a customized high-density grid. Variations with age, sex, ethnicity, and refractive error were assessed with multiple linear regression analyses, with age-related distributions further assessed using hierarchical cluster analysis and regression models. Models were tested on a naïve healthy cohort (n = 40) with Mann-Whitney tests to determine generalizability. Quantitative cell density data were calculated from histological data from previous human studies. Eccentricity-dependent variations in OCT retinal thickness closely resemble topographic cell density maps from human histological studies. Age was consistently identified as significantly impacting retinal thickness (p = .0006, .0007, and .003 for GCL, INL and ISOS), with gender affecting ISOS only (p < .0001). Regression models demonstrated that age-related changes in the GCL and INL begin in the 30th decade and were linear for the ISOS. Model testing revealed significant differences in INL and ISOS thickness (p = .0008 and .0001; however, differences fell within the OCT's axial resolution. Qualitative comparisons show close alignment between OCT and histological cell densities when using unique, high-resolution OCT data, and correction for demographics-related variability. Overall, this study describes a process to calculate in vivo cell density from OCT for all neural layers of the human retina, providing a framework for basic science and clinical investigations.
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Affiliation(s)
- Janelle Tong
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - Vincent Khou
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - Matt Trinh
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - David Alonso‐Caneiro
- School of Optometry and Vision ScienceCentre for Vision and Eye ResearchContact Lens and Visual Optics LaboratoryQueensland University of TechnologyQueenslandBrisbaneAustralia
- School of Science, Technology and EngineeringUniversity of Sunshine CoastQueenslandSippy DownsAustralia
| | - Barbara Zangerl
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- Coronary Care UnitRoyal Prince Alfred HospitalNew South WalesSydneyAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- Department of OptometrySchool of MedicineDeakin UniversityVictoriaWaurn PondsAustralia
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Tong J, Alonso-Caneiro D, Kalloniatis M, Zangerl B. Prediction of visual field defects from macular optical coherence tomography in glaucoma using cluster analysis. Ophthalmic Physiol Opt 2022; 42:948-964. [PMID: 35598146 PMCID: PMC9544890 DOI: 10.1111/opo.12997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
Purpose To assess the accuracy of cluster analysis‐based models in predicting visual field (VF) defects from macular ganglion cell‐inner plexiform layer (GCIPL) measurements in glaucomatous and healthy cohorts. Methods GCIPL measurements were extracted from posterior pole optical coherence tomography (OCT), from locations corresponding to central VF test grids. Models incorporating cluster analysis methods and corrections for age and fovea to optic disc tilt were developed from 493 healthy participants, and 5th and 1st percentile limits of GCIPL thickness were derived. These limits were compared with pointwise 5th and 1st percentile limits by calculating sensitivities and specificities in an additional 40 normal and 37 glaucomatous participants, as well as applying receiver operating characteristic (ROC) curve analyses to assess the accuracy of predicting VF results from co‐localised GCIPL measurements. Results Clustered models demonstrated globally low sensitivity, but high specificity in the glaucoma cohort (0.28–0.53 and 0.77–0.91, respectively), and high specificity in the healthy cohort (0.91–0.98). Clustered models showed similar sensitivities and superior specificities compared with pointwise methods (0.41–0.65 and 0.71–0.98, respectively). There were significant differences in accuracy between clusters, with relatively poor accuracy at peripheral macular locations (p < 0.0001 for all comparisons). Conclusions Cluster analysis‐based models incorporating age correction and holistic consideration of fovea to optic disc tilt demonstrated superior performance in predicting VF results to pointwise methods in both glaucomatous and healthy eyes. However, relatively low sensitivity and poorer performance at the peripheral macula indicate that OCT in isolation may be insufficient to predict visual function across the macula accurately. With modifications to criteria for abnormality, the concepts suggested by the described normative models may guide prioritisation of VF assessment requirements, with the potential to limit excessive VF testing.
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Affiliation(s)
- Janelle Tong
- Centre for Eye Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Coronary Care Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Tong J, Yoshioka N, Alonso-Caneiro D, Zangerl B. Ganglion cell-inner plexiform layer measurements derived from widefield compared to montaged 9-field optical coherence tomography. Clin Exp Optom 2021; 105:822-830. [PMID: 34791988 DOI: 10.1080/08164622.2021.1993058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE With equivalent inner retinal thickness measurements compared to a more conventional composite optical coherence tomography (OCT) protocol, Widefield optical coherence tomography (WF-OCT) is a clinically viable, time-saving option facilitating detection of ocular pathologies within the central 55° of the retina. PURPOSE To compare ganglion cell-inner plexiform layer (GCIPL) thicknesses obtained using a single WF-OCT scan and standard composite OCT scans acquired in 9 fields of gaze (9F-OCT). METHODS Thirteen healthy participants underwent WF-OCT and 9F-OCT using the Spectralis OCT. The GCIPL was automatically segmented with a manual review for 9F-OCT and was manually segmented for WF-OCT. After registration, differences in GCIPL thicknesses were compared using 95% confidence intervals computed from one-sample t-tests and Bland-Altman analyses. Location-specific differences in B-scan tilt were analysed using Spearman correlations and linear regression models. To determine whether B-scan tilt influences GCIPL measurements, regression models of tilt versus differences between perpendicular and axial GCIPL thickness were applied. RESULTS While scattered locations demonstrated significant GCIPL thickness differences between WF-OCT and 9F-OCT, most differences did not exceed the axial pixel resolution of the instrument of 3.87 µm. Bland-Altman analyses indicated no notable bias using WF-OCT. Moderate correlations indicating significant location-specific differences in B-scan tilt were observed for temporal, central and inferior B-scans (r = -0.62 to 0.72), with linear regression models predicting a maximum difference in the tilt of 4.65°. The quadratic regression model indicated that at tilts greater than 27.3°, perpendicular GCIPL measurements become increasingly thin relative to axial measurements. CONCLUSIONS GCIPL thicknesses and B-scan tilts from WF-OCT are comparable to 9F-OCT, indicating that WF-OCT can be applied clinically to obtain valid inner retinal OCT measurements over 55° of the central retina with relative ease. However, for peripheral locations, B-scan tilt may need to be considered when measuring GCIPL thicknesses.
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Affiliation(s)
- Janelle Tong
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia.,School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Nayuta Yoshioka
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia
| | - David Alonso-Caneiro
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia.,School of Optometry and Vision Science, UNSW, Sydney, Australia
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Ly A, Zangerl B, Kalloniatis M. Introduction of structured record keeping in age-related macular degeneration: a before and after study. Clin Exp Optom 2021; 105:754-760. [PMID: 34538228 DOI: 10.1080/08164622.2021.1971490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Structured record keeping improves documentation in age-related macular degeneration; however, it may have a more limited effect on the management decisions of a group of already highly trained clinicians, especially in the context of other well-embedded clinical decision support tools. BACKGROUND Structured record keeping has been associated with a range of advantages including improved history taking and communication, reduced number of unnecessary referrals, and enhanced diagnostic accuracy. The aim of this study was to examine the impact of a structured record keeping, quality improvement tool on recording, reporting and management congruency. METHODS A before and after retrospective record review study was performed in a single academic, intermediate-tier care institute in New South Wales, Australia. The structured record keeping tool intervention captured 31 items in addition to the prior pre-existing medical record: six items relating to historical risk factors, two items relating to patient activation, 13 items signifying core clinical signs, five items for change analysis and five items regarding the ongoing patient management plan. RESULTS Two hundred medical records from 151 patients with age-related macular degeneration were analysed. There was a statistically significant improvement in the number of reports that explicitly specified the number of clinical structural risk factors (from 24 to 75%; Fisher's exact p < 0.001) and risk of progression to advanced disease (from 71 to 84%; p = 0.041); however, this documentation had no statistically significant effect on the report-recommended management plan and/or the final report-recommended review period. CONCLUSION Disease-specific, structured record keeping improves the outgoing documentation of key clinical signs and is effective in prompting the transposition of these signs into a quantified risk progression score. It has limited value in improving management consistency among a group of highly trained eye care staff.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Unsw Sydney, Sydney, Australia.,School of Optometry and Vision Science, Unsw Sydney, Sydney, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Unsw Sydney, Sydney, Australia.,School of Optometry and Vision Science, Unsw Sydney, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Unsw Sydney, Sydney, Australia.,School of Optometry and Vision Science, Unsw Sydney, Sydney, Australia
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Khou V, Ly A, Moore L, Markoulli M, Kalloniatis M, Yapp M, Hennessy M, Zangerl B. Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists. BMJ Open 2021; 11:e047246. [PMID: 34493511 PMCID: PMC8424861 DOI: 10.1136/bmjopen-2020-047246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Many chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times. DESIGN A retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively. SETTING A referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia. PARTICIPANTS 418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals. RESULTS Of the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content. CONCLUSIONS Most referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.
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Affiliation(s)
- Vincent Khou
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lindsay Moore
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Hennessy
- Centre for Eye Health, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Coronary Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Ho KC, Keay L, Alkhawajah SMM, Liew G, Jalbert I. Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed. J Clin Epidemiol 2021; 140:56-68. [PMID: 34487836 DOI: 10.1016/j.jclinepi.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/09/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the quality of diabetic eye disease clinical practice guidelines. STUDY DESIGN AND SETTING A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A "good quality" guideline was one with ≥60% score for "rigor of development" and in at least two other domains. RESULTS Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for "scope and purpose," "stakeholder involvement," "rigor of development," "clarity of presentation," "applicability" and "editorial independence" were 73.6% (54.2%-80.6%), 48.6% (29.2%-71.5%), 60.2% (30.9%-78.1%), 86.6% (76.7%-94.4%), 28.6% (18.0%-37.8%) and 60.2% (30.9%-78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7-5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n = 9) of the guidelines (all evidence-based) were of "good quality." CONCLUSION A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating "good quality." Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Australia; Better Vision Foundation Nepal, Kathmandu, Nepal.
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia; Singapore Eye Research Institute, Singapore
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Sally Marwan M Alkhawajah
- School of Optometry and Vision Science, UNSW Sydney, Australia; Department of Optometry and Vision Science, King Saud University, Riyadh, Saudi Arabia
| | - Gerald Liew
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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Khou V, Khan MA, Jiang IW, Katalinic P, Agar A, Zangerl B. Evaluation of the initial implementation of a nationwide diabetic retinopathy screening programme in primary care: a multimethod study. BMJ Open 2021; 11:e044805. [PMID: 34408028 PMCID: PMC8375720 DOI: 10.1136/bmjopen-2020-044805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The Australian Government funded a nationwide diabetic retinopathy screening programme to improve visual outcomes for people with diabetes. This study examined the benefits and barriers of the programme, image interpretation pathways and assessed the characteristics of people who had their fundus photos graded by a telereading service which was available as a part of the programme. DESIGN Multimethod: survey and retrospective review of referral forms. SETTING Twenty-two primary healthcare facilities from urban, regional, rural and remote areas of Australia, and one telereading service operated by a referral-only eye clinic in metropolitan Sydney, Australia. PARTICIPANTS Twenty-seven primary healthcare workers out of 110 contacted completed a survey, and 145 patient referrals were reviewed. RESULTS Manifest qualitative content analysis showed that primary healthcare workers reported that the benefits of the screening programme included improved patient outcomes and increased awareness and knowledge of diabetic retinopathy. Barriers related to staffing issues and limited referral pathways. Image grading was performed by a variety of primary healthcare workers, with one responder indicating the utilisation of a diabetic retinopathy reading service. Of the people with fundus photos graded by the reading service, 26.2% were reported to have diabetes. Overall, 12.3% of eyes were diagnosed with diabetic retinopathy. Photo quality was rated as excellent in 46.2% of photos. Referral to an optometrist for diabetic retinopathy was recommended in 4.1% of cases, and to an ophthalmologist in 6.9% of cases. CONCLUSIONS This nationwide diabetic retinopathy screening programme was perceived to increase access to diabetic retinopathy screening in regional, rural and remote areas of Australia. The telereading service has diagnosed diabetic retinopathy and other ocular pathologies in images it has received. Key barriers, such as access to ophthalmologists and optometrists, must be overcome to improve visual outcomes.
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Affiliation(s)
- Vincent Khou
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Muhammad Azaan Khan
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ivy Wei Jiang
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Paula Katalinic
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashish Agar
- Centre for Eye Health, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Coronary Care Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Tong J, Huang J, Kalloniatis M, Coroneo M, Zangerl B. Clinical Trial: Diurnal IOP Fluctuations in Glaucoma Using Latanoprost and Timolol with Self-Tonometry. Optom Vis Sci 2021; 98:901-913. [PMID: 34393206 DOI: 10.1097/opx.0000000000001751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Assessment of treatment efficacy via comparison with a target IOP is fundamental in monitoring patients with open-angle glaucoma and ocular hypertension. This article highlights that diurnal IOP fluctuations obtained using self-tonometry may more accurately reflect IOP responses to therapy. PURPOSE This study aimed to investigate fluctuations in diurnal IOP measurements in patients with open-angle glaucoma and ocular hypertension treated with latanoprost 0.005% and timolol 0.25%. METHODS In this crossover treatment trial, 14 participants performed self-tonometry with iCare HOME 4 times daily for (1) 1 week using latanoprost, (2) 4 weeks using no medications, and (3) 2 weeks using timolol. Daily peak IOPs, IOP fluctuations, and mean IOPs from different treatments were compared on an individual basis. Treatment efficacy between medications was assessed by comparing mean percentage IOP reductions with latanoprost and timolol across participants. In addition, effects of age, years since commencing latanoprost, sex, and diagnosis were investigated, and peak IOP times were compared with assess impacts on diurnal profiles. RESULTS Between individuals, IOP responses ranged from reductions in peak IOPs, IOP fluctuations, and mean IOPs on both medications to no change in any parameter and medication. IOP fluctuations showed greater mean percentage reductions than did peak and mean IOPs (χ2 = 16.51, P = .002). There were significant associations between years since commencing latanoprost and peak and mean IOP responses on timolol (r = 0.69, P = .007), and sex and relative reductions in IOP fluctuations on both medications (P = .03). There were no differences in peak IOP times between treatment conditions. CONCLUSIONS Despite variability in IOP responses to latanoprost and timolol, IOP fluctuation with self-tonometry was more consistent in evaluating target IOP, reflecting its importance in ascertaining true IOP response to topical therapies. These findings may impact clinical decision making based on target IOP criteria in patients on topical therapy.
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Affiliation(s)
| | | | | | - Minas Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, New South Wales, Australia
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Abstract
Purpose Leading causes of irreversible blindness such as age-related macular degeneration (AMD) and glaucoma can, respectively, lead to central or peripheral vision loss. The ability of sufferers to process visual motion information can be impacted even during early stages of eye disease. We used head-mounted display virtual reality as a tool to better understand how vision changes caused by eye diseases directly affect the processing of visual information critical for self-motion perception. Methods Participants with intermediate AMD or early manifest glaucoma with near-normal visual acuities and visual fields were recruited for this study. We examined their experiences of self-motion in depth (linear vection), spatial presence, and cybersickness when viewing radially expanding patterns of optic flow simulating different speeds of self-motion in depth. Viewing was performed with the head stationary (passive condition) or while making lateral-sway head movements (active conditions). Results Participants with AMD (i.e., central visual field loss) were found to have greater vection strength and spatial presence, compared to participants with normal visual fields. However, participants with glaucoma (i.e., peripheral visual field loss) were found to have lower vection strength and spatial presence, compared to participants with normal visual fields. Both AMD and glaucoma groups reported reduced severity in cybersickness compared to healthy normals. Conclusions These findings strongly support the view that perceived self-motion is differentially influenced by peripheral versus central vision loss, and that patients with different visual field defects are oppositely biased when processing visual cues to self-motion perception.
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Affiliation(s)
- Wilson Luu
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Stephen Palmisano
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Juno Kim
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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11
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Luu W, Zangerl B, Kalloniatis M, Kim J. Effects of stereopsis on vection, presence and cybersickness in head-mounted display (HMD) virtual reality. Sci Rep 2021; 11:12373. [PMID: 34117273 PMCID: PMC8196155 DOI: 10.1038/s41598-021-89751-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 04/28/2021] [Indexed: 11/08/2022] Open
Abstract
Stereopsis provides critical information for the spatial visual perception of object form and motion. We used virtual reality as a tool to understand the role of global stereopsis in the visual perception of self-motion and spatial presence using virtual environments experienced through head-mounted displays (HMDs). Participants viewed radially expanding optic flow simulating different speeds of self-motion in depth, which generated the illusion of self-motion in depth (i.e., linear vection). Displays were viewed with the head either stationary (passive radial flow) or laterally swaying to the beat of a metronome (active conditions). Multisensory conflict was imposed in active conditions by presenting displays that either: (i) compensated for head movement (active compensation condition), or (ii) presented pure radial flow with no compensation during head movement (active no compensation condition). In Experiment 1, impairing stereopsis by anisometropic suppression in healthy participants generated declines in reported vection strength, spatial presence and severity of cybersickness. In Experiment 2, vection and presence ratings were compared between participants with and without clinically-defined global stereopsis. Participants without global stereopsis generated impaired vection and presence similarly to those found in Experiment 1 by subjects with induced stereopsis impairment. We find that reducing global stereopsis can have benefits of reducing cybersickness, but has adverse effects on aspects of self-motion perception in HMD VR.
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Affiliation(s)
- Wilson Luu
- School of Optometry and Vision Science, University of New South Wales (UNSW Sydney), Kensington, Australia.
- Centre for Eye Health, University of New South Wales (UNSW Sydney), Kensington, Australia.
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales (UNSW Sydney), Kensington, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales (UNSW Sydney), Kensington, Australia
- Centre for Eye Health, University of New South Wales (UNSW Sydney), Kensington, Australia
| | - Juno Kim
- School of Optometry and Vision Science, University of New South Wales (UNSW Sydney), Kensington, Australia.
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12
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Luu W, Kalloniatis M, Bartley E, Tu M, Dillon L, Zangerl B, Ly A. A holistic model of low vision care for improving vision‐related quality of life. Clin Exp Optom 2021; 103:733-741. [DOI: 10.1111/cxo.13054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/04/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Wilson Luu
- Centre for Eye Health, The University of New South Wales, Sydney, Australia,
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, Australia,
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | | | - Megan Tu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Lisa Dillon
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
- Guide Dogs NSW/ACT, Sydney, Australia,
- Injury Division, The George Institute for Global Health, Sydney, Australia,
| | - Barbara Zangerl
- Centre for Eye Health, The University of New South Wales, Sydney, Australia,
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, Australia,
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
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13
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Gu T, Yao L, Meng X, Graff JC, Thomason D, Li J, Dong W, Jiao Y, Aleya L, Maida M, Wang CY, Zangerl B, Genini S, Ray K, Goldman E, Ji J, Alexandrov AV, Sun D, Gu W, Wang Y. A cost-effective plan for global testing - an infection rate stratified, algorithm guided, multiple-level, continuously pooled testing strategy. Sci Total Environ 2021; 765:144251. [PMID: 33387925 PMCID: PMC7833620 DOI: 10.1016/j.scitotenv.2020.144251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 05/05/2023]
Abstract
The most effective measure to prevent or stop the spread of infectious diseases is the early identification and isolation of infected individuals through comprehensive screening. At present, in the COVID-19 pandemic, such screening is often limited to isolated regions as determined by local governments. Screening of potentially infectious individuals should be conducted through coordinated national or global unified actions. Our current research focuses on using resources to conduct comprehensive national and regional regular testing with a risk rate based, algorithmic guided, multiple-level, pooled testing strategy. Here, combining methodologies with mathematical logistic models, we present an analytic procedure of an overall plan for coordinating state, national, or global testing. The proposed plan includes three parts 1) organization, resource allocation, and distribution; 2) screening based on different risk levels and business types; and 3) algorithm guided, multiple level, continuously screening the entire population in a region. This strategy will overcome the false positive and negative results in the polymerase chain reaction (PCR) test and missing samples during initial tests. Based on our proposed protocol, the population screening of 300,000,000 in the US can be done weekly with between 15,000,000 and 6,000,000 test kits. The strategy can be used for population screening for current COVID-19 and any future severe infectious disease when drugs or vaccines are not available.
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Affiliation(s)
- Tianshu Gu
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38103, USA; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Lan Yao
- Health Outcomes and Policy Research, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38103, USA; Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health [23618104], 157 Baojian Road, Harbin, Heilongjiang 150081, PR China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - J Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Donald Thomason
- Department of Physiology and Biophysics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jing Li
- Department of Orthopedic Surgery and Biomedical Engineering-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Wei Dong
- Department of Orthopedic Surgery and Biomedical Engineering-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Yan Jiao
- Department of Orthopedic Surgery and Biomedical Engineering-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, F-25030 Besançon Cedex, France
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Cong-Yi Wang
- The Center for Biomedical Research, Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Barbara Zangerl
- Centre for Eye Health and School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Sem Genini
- Unione Contadini Ticinesi, via Gorelle 7, 6592 S. Antonino, Switzerland
| | - Kunal Ray
- Academy of Scientific & Innovative Research [AcSIR], CSIR - HRDC Campus, Ghaziabad, Uttar Pradesh 201002, India
| | - Emanuel Goldman
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Jiafu Ji
- Beijing Cancer Hospital and Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, PR China
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Dianjun Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health [23618104], 157 Baojian Road, Harbin, Heilongjiang 150081, PR China
| | - Weikuan Gu
- Department of Orthopedic Surgery and Biomedical Engineering-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA; Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104, USA.
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
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14
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Jamous KF, Kalloniatis M, Boon MY, Jalbert I, Zangerl B. The short‐sighted perspective of long‐term eye health‐care. Clin Exp Optom 2021; 97:565-7. [DOI: 10.1111/cxo.12194] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 05/25/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Khalid Fahad Jamous
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia,
- Centre for Eye Health, University of New South Wales, Sydney, 2052, Australia,
- Department of Ophthalmology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia,
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia,
- Centre for Eye Health, University of New South Wales, Sydney, 2052, Australia,
| | - Mei Ying Boon
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia,
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia,
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia,
- Centre for Eye Health, University of New South Wales, Sydney, 2052, Australia,
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15
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Keay L, Liew G, Jalbert I. Quality of the Australian National Health and Medical Research Council's clinical practice guidelines for the management of diabetic retinopathy. Clin Exp Optom 2021; 104:864-870. [PMID: 33689646 DOI: 10.1080/08164622.2021.1880862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Clinical relevance: Understanding the quality of the commonly used clinical practice guidelines can help busy clinicians in selecting appropriate guidelines for evidence-based eye care for people with diabetes.Background: The National Health and Medical Research Council's (NHMRC) clinical practice guideline on diabetic retinopathy management has been widely used locally and internationally for over 10 years. However, the quality of this guideline has never been formally assessed. This study aimed to systematically evaluate the quality of the NHMRC guideline and compare it against other international guidelines.Methods: The 2008 NHMRC and another five established diabetic retinopathy management international guidelines (Scottish Intercollegiate Guidelines Network, 2017; American Academy of Ophthalmology, 2019; American Optometric Association, 2019; Royal College of Ophthalmologists, UK, 2013, and Canadian Ophthalmologic Society, 2012) were examined using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument. Scoring by four independent reviewers was aggregated into six domain and overall rating scores. Consistency among the reviewers was assessed using intraclass correlation coefficient (ICC).Results: The AGREE II domain scores for the NHMRC guideline were: scope and purpose 72%, stakeholder involvement 64%, rigour of development 77%, clarity of presentation 96%, applicability 35%, and editorial independence 15%. The NHMRC guideline's overall score (5.3 of 7) was lower than that of most other guidelines. Compared to others, the NHMRC guideline scored well in clarity of presentation and rigour of development, but less well for editorial independence. The NHMRC guideline was the least current and a need to update it was recognised by all reviewers who identified key areas for improvement.Conclusion: The quality of the NHMRC guideline was comparable to most other established international guidelines. Several areas of strengths and weaknesses in this guideline were identified. Future updates should aim to improve transparency in development and applicability in clinical practice.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and the Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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16
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Zhang S, Phu J, Xu P, Wang H, Kalloniatis M, Zangerl B. The performance and confidence of clinicians in training in the analysis of ophthalmic images within a work-integrated teaching model. Ophthalmic Physiol Opt 2021; 41:768-781. [PMID: 33682940 DOI: 10.1111/opo.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A fundamental clinical skill is the recognition of artefacts within the outputs of advanced imaging modalities. However, current teaching programmes of healthcare practitioners are becoming increasingly challenged to provide practical exposure within an already crowded curriculum. This study evaluates the impact of a novel work-integrated teaching model on the confidence and competence of clinicians in the use of optical coherence tomography (OCT) and the recognition of its artefacts. The outcomes were then used to develop a model to predict performance and guide teaching strategies. METHODS We prospectively evaluated a 6-week clinical placement for final year optometry students within a diagnostic eye clinic in 2018-2020. Participants completed a quiz on the identification of common OCT artefacts and rated their confidence levels on key areas of OCT application using a five-point Likert scale. Both were completed before (pre-rotation) and after (post-rotation) the placement. The cohort was divided into two groups; the first group was used to assess the impact of the placement and derive the prediction model for post-placement performance, which was then validated against the second group. RESULTS A significant improvement in detecting OCT imaging artefacts was seen upon completion of the placement, which was greater in participants with lower entry level performance. Across all OCT artefact subtypes, there was an improvement in detecting segmentation error, delineation error and media opacities. A model predicting post-placement student performance was developed using entry level knowledge base as the key dependent variable. Self-rated confidence improved across all domains of OCT application but was not found to be a direct predictor of actual performance. CONCLUSIONS These results highlight the benefit of a work-integrated learning programme on both academic performance and confidence whilst identifying entry level knowledge base as the key variable predicting improvement. Tailored teaching incorporating entering knowledge is the best predictor of improvement during clinical placements. Integrating clinicians into a work-integrated setting with tailored teaching and comprehensive practical exposure can be an effective method for training future or current healthcare professionals.
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Affiliation(s)
- Sophia Zhang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Pauline Xu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
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17
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Trinh M, Khou V, Zangerl B, Kalloniatis M, Nivison-Smith L. Modelling normal age-related changes in individual retinal layers using location-specific OCT analysis. Sci Rep 2021; 11:558. [PMID: 33436715 PMCID: PMC7804110 DOI: 10.1038/s41598-020-79424-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/01/2020] [Indexed: 01/29/2023] Open
Abstract
Current descriptions of retinal thickness across normal age cohorts are mostly limited to global analyses, thus overlooking spatial variation across the retina and limiting spatial analyses of retinal and optic nerve disease. This retrospective cross-sectional study uses location-specific cluster analysis of 8 × 8 macular average grid-wise thicknesses to quantify topographical patterns and rates of normal, age-related changes in all individual retinal layers of 253 eyes of 253 participants across various age cohorts (n = 23-69 eyes per decade). Most retinal layers had concentric spatial cluster patterns except the retinal nerve fibre layer (RNFL) which displayed a nasal, asymmetric radial pattern. Age-related thickness decline mostly occurred after the late 4th decade, described by quadratic regression models. The ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), and outer nuclear layer + Henle's fibre layer (ONL+HFL) were significantly associated with age (p < 0.0001 to < 0.05), demonstrating similar rates of thickness decline (mean pooled slope = - 0.07 µm/year), while the IS/OS had lesser mean pooled thickness slopes for all clusters (- 0.04 µm/year). The RNFL, OPL, and RPE exhibited no significant age-related thickness change, and the RNFL were significantly associated with sex. Analysis using spatial clusters compared to the ETDRS sectors revealed more extensive spatial definition and less variability in the former method. These spatially defined, clustered normative data and age-correction functions provide an accessible method of retinal thickness analysis with more spatial detail and less variability than the ETDRS sectors, potentially aiding the diagnosis and monitoring of retinal and optic nerve disease.
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Affiliation(s)
- Matt Trinh
- grid.1005.40000 0004 4902 0432Centre for Eye Health, University of New South Wales, Sydney, 2052 Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, University of New South Wales, Sydney, 2052 Australia
| | - Vincent Khou
- grid.1005.40000 0004 4902 0432Centre for Eye Health, University of New South Wales, Sydney, 2052 Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, University of New South Wales, Sydney, 2052 Australia
| | - Barbara Zangerl
- grid.1005.40000 0004 4902 0432Centre for Eye Health, University of New South Wales, Sydney, 2052 Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, University of New South Wales, Sydney, 2052 Australia
| | - Michael Kalloniatis
- grid.1005.40000 0004 4902 0432Centre for Eye Health, University of New South Wales, Sydney, 2052 Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, University of New South Wales, Sydney, 2052 Australia
| | - Lisa Nivison-Smith
- grid.1005.40000 0004 4902 0432Centre for Eye Health, University of New South Wales, Sydney, 2052 Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, University of New South Wales, Sydney, 2052 Australia
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18
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Yu Z, Wang G, Goldman E, Zangerl B, Xie N, Cao Y, Chen J, Day SW, Howard SC, Maida M, Ray K, Jablonski MM, Ji J, Postlethwaite A, Gu W, Sun D, Aleya L. COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution. Open Med (Wars) 2021; 16:134-138. [PMID: 33521319 PMCID: PMC7811367 DOI: 10.1515/med-2021-0210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022] Open
Abstract
While countries are in a hurry to obtain SARS-CoV-2 vaccine, we are concerned with the availability of vaccine and whether a vaccine will be available to all in need. We predicted three possible scenarios for vaccine distributions and urge an international united action on the worldwide equitable access. In case the international community does not reach a consensus on how to distribute the vaccine to achieve worldwide equitable access, we call for a distribution plan that includes the employees in international transportation industries and international travelers to halt the disease transmission and promote the recovery of the global economy.
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Affiliation(s)
- Zhuo Yu
- Heilongjiang Academy of Traditional Chinese Medicine, Sanfu Road 142, Xiangfang District, Harbin, Heilongjiang, 150040, People’s Republic of China
| | - Gang Wang
- The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin 150001, China
| | - Emanuel Goldman
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, , Newark, NJ 07103, United States of America
| | - Barbara Zangerl
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Ning Xie
- College of Business, University of Louisville, Louisville, KY 40292, United States of America
| | - Yanhong Cao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health [23618104], 157 Baojian Road, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Jingyu Chen
- Department of Chinese Medicine, First Clinical School of Medicine, Heilongjiang University Of Chinese Medicine, 24 Heping Rd, Xiangfang District, Harbin, Heilongjiang, 150040, China
| | - Sara W. Day
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, United States of America
| | - Scott C. Howard
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, United States of America
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100, Caltanissetta, Italy
| | - Kunal Ray
- School of Biological Science, Ramkrishna Mission Vivekananda Education & Research Institute, Narendrapur 700103, West Bengal, India
| | - Monica M. Jablonski
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, United States of America
| | - Jiafu Ji
- Beijing Cancer Hospital and Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, People’s Republic of China
| | - Arnold Postlethwaite
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, United States of America
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, United States of America
| | - Weikuan Gu
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, United States of America
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, Tennessee, 38163, United States of America
| | - Dianjun Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health [23618104], 157 Baojian Road, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Université de Franche-Comté 16, Route de Gray, F-25030, Besançon Cedex, France
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19
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Phu J, Tong J, Zangerl B, Ly Le J, Kalloniatis M. Authors' reply. Ophthalmic Physiol Opt 2020; 41:203-204. [PMID: 33236807 DOI: 10.1111/opo.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, Australia
| | - Janelle Tong
- Centre for Eye Health, University of New South Wales, Kensington, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, Kensington, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, Australia
| | - Janet Ly Le
- Centre for Eye Health, University of New South Wales, Kensington, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, Australia
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20
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Gyawali R, Toomey M, Stapleton F, Dillon L, Zangerl B, Keay L, Jalbert I. Quality of 2019 American optometric association clinical practice guideline for diabetic eye care. Ophthalmic Physiol Opt 2020; 41:165-170. [PMID: 33210361 DOI: 10.1111/opo.12763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The 2019 American Optometric Association (AOA) clinical practice guideline intends to assist optometrists in providing evidence-based eye care for people with diabetes. This technical report evaluated the methodological and reporting quality of the guideline. METHODS Four independent reviewers appraised the 2014 and 2019 versions of the AOA's guideline using the AGREE II instrument. Average scaled scores across the six domains of the AGREE II and an overall independent score were calculated based on the formula provided. RESULTS The 2019 guideline scored high (range: 75-93%) in all domains except for the domain of applicability (34%). In the domain of rigour of development, significant improvements were noted in the 2019 guideline (median score: 7.0, interquartile range (IQR): 6.0-7.0) compared to the 2014 guideline (median: 5.0, IQR: 4.0-6.0) (p < 0.0001). The appraisal of the guideline also identified room for further improvements, especially in relation to implementing the guideline. CONCLUSION The overall and domain specific quality of the AOA 2019 guideline was high, however, improvement in its applicability domain is required. The findings of this study will aid uptake of the guideline and inform improvement efforts for other international optometric guidelines.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Better Vision Foundation Nepal, Kathmandu, Nepal
| | - Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Eye Health, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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21
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Markoulli M, Fedtke C, Coroneo M, Kalloniatis M, Whatham A, Yapp M, Zangerl B. Clinical utility of irx3 in keratoconus. Clin Exp Optom 2020; 104:107-114. [PMID: 32924191 DOI: 10.1111/cxo.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CLINICAL RELEVANCE Diagnosis and monitoring of keratoconus is increasingly being conducted with the aid of imaging equipment such as corneal aberrometry. There is a need to also know the confidence with which ocular aberration measurements can be made. BACKGROUND To assess the repeatability of lower- and higher-order aberration measurements in patients with keratoconus using the irx3 wavefront aberrometer (Imagine Eyes, Orsay, France) and evaluate correlations with corneal curvature. METHODS The irx3 wavefront aberrometer was used to measure bilateral lower- and higher-order ocular aberrations on 33 participants with keratoconus. Three measurements were taken from each eye to determine the repeatability of lower-order aberrations (quantified as sphere and cylinder in dioptres) and higher-order aberration co-efficients (up to eighth order in micrometres), coma, trefoil and total higher-order aberration root mean square (in micrometres). Corneal curvature was measured using the Pentacam HR system (OCULUS, Wetzlar, Germany). RESULTS Repeat measurements for lower-order aberrations resulted in larger co-efficients of repeatability than higher-order aberrations. Similarly, larger co-efficients of repeatability between repeated measures across all Zernike co-efficients were observed in eyes with severe keratoconus (that is, corneal curvature > 52-D) compared to eyes with flatter corneas. The difference between repeated measures tended to be significant for the lower-order aberrations regardless of corneal curvature. The highest correlations with corneal curvature for right and left eyes respectively, were identified for total higher-order aberration root mean square (r = 0.92, p < 0.001 and r = 0.91, p < 0.001), followed closely by coma (r = -0.93, p < 0.001 and r = -0.86, p < 0.001) and the Z (3, -1) co-efficient (r = -0.92, p < 0.001 and r = -0.86, p < 0.001 for right and left eyes, respectively). CONCLUSIONS Lower-order aberrations tended to be less repeatable, indicating that instrument variability must be considered when monitoring progression. Total higher-order aberration root mean square and third-order aberrations, in particular the vertical coma Z (3, -1) co-efficient, demonstrated a stronger correlation with corneal curvature than the lower-order aberrations.
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Affiliation(s)
- Maria Markoulli
- School of Optometry and Vision Science, The University of New South Wales , Sydney, Australia
| | - Cathleen Fedtke
- School of Optometry and Vision Science, The University of New South Wales , Sydney, Australia
| | - Minas Coroneo
- Department of Ophthalmology, Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales , Sydney, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, The University of New South Wales , Sydney, Australia.,Centre for Eye Health, The University of New South Wales , Sydney, Australia
| | - Andrew Whatham
- Centre for Eye Health, The University of New South Wales , Sydney, Australia
| | - Michael Yapp
- Centre for Eye Health, The University of New South Wales , Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, The University of New South Wales , Sydney, Australia.,Centre for Eye Health, The University of New South Wales , Sydney, Australia
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22
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Phu J, Tong J, Zangerl B, Le JL, Kalloniatis M. Cluster analysis reveals patterns of age-related change in anterior chamber depth for gender and ethnicity: clinical implications. Ophthalmic Physiol Opt 2020; 40:632-649. [PMID: 32644209 PMCID: PMC7540376 DOI: 10.1111/opo.12714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022]
Abstract
Purpose To identify patterns of age‐, gender‐ and refractive‐ related changes in Scheimpflug‐based anterior chamber depth across the central 8 mm of chamber width, to derive normative models, potentially useful for angle closure disease diagnosis. Methods This was a retrospective, cross‐sectional study. Scheimpflug photography was used to obtain anterior chamber depth measurements at 57 points across the central 8 mm of the chamber width from one eye of each healthy subject (male Caucasians (n = 189), female Caucasians (n = 186), male Asians (n = 165) and female Asians (n = 181)). Sliding window and nonlinear regression analysis was used to identify the age‐related changes in chamber depth. Hierarchical cluster analysis was used to identify test locations with statistically identical age‐related shifts, which were used to perform age‐correction for all subjects, resulting in normative distributions of chamber depth across the chamber width. The model was examined with and without the contribution of spherical equivalent refractive error. Results Distinct clusters, demonstrating statistically indistinguishable age‐related changes of chamber depth over time, were identified. These age‐related changes followed a nonlinear regression (fifth or sixth order polynomial). Females tended to have a greater rate of chamber depth shallowing. Incorporating refractive error into the model produced minimal changes to the fit relative to the ground truth. Comparisons with cut‐offs for angle closure from the literature showed that ageing alone was insufficient for identifying angle closure disease. Conclusions Age‐, ethnicity‐ and gender‐related differences need to be acknowledged in order to utilise anterior chamber depth data for angle closure disease diagnosis correctly. Ageing alone does not adequately account for the angle closure disease process.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Janelle Tong
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Janet Ly Le
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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23
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Trinh M, Tong J, Yoshioka N, Zangerl B, Kalloniatis M, Nivison-Smith L. Macula Ganglion Cell Thickness Changes Display Location-Specific Variation Patterns in Intermediate Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2020; 61:2. [PMID: 32150251 PMCID: PMC7401429 DOI: 10.1167/iovs.61.3.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The purpose of this study was to examine changes in the ganglion cell layer (GCL) of individuals with intermediate age-related macular degeneration (AMD) using grid-wise analysis for macular optical coherence tomography (OCT) volume scans. We also aim to validate the use of age-correction functions for GCL thickness in diseased eyes. Methods OCT macular cube scans covering 30° × 25° were acquired using Spectralis spectral-domain OCT for 87 eyes with intermediate AMD, 77 age-matched normal eyes, and 254 non-age-matched normal eyes. The thickness of the ganglion cell layer (GCL) was defined after segmentation at 60 locations across an 8 × 8 grid centered on the fovea, where each grid location covered 0.74 mm2 (approximately 3° × 3°) within the macula. Each GCL location of normal eyes (n = 77) were assigned to a specific iso-ganglion cell density cluster in the macula, based on patterns of age-related GCL thickness loss. Analyses were then performed comparing AMD GCL grid-wise data against corresponding spatial clusters, and significant AMD GCL thickness changes were denoted as values outside the 95% distribution limits. Results Analysis of GCL thickness changes revealed significant differences between spatial clusters, with thinning toward the fovea, and thickening toward the peripheral macula. The direction of GCL thickness changes in AMD were associated more so with thickening than thinning in all analyses. Results were corroborated by the application of GCL thickness age-correction functions. Conclusions GCL thickness changed significantly and nonuniformly within the macula of intermediate AMD eyes. Further characterization of these changes is critical to improve diagnoses and monitoring of GCL-altering pathologies.
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24
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Long JC, Blakely B, Mahmoud Z, Ly A, Zangerl B, Kalloniatis M, Assaad N, Yapp M, Clay-Williams R, Braithwaite J. Evaluation of a hospital-based integrated model of eye care for diabetic retinopathy assessment: a multimethod study. BMJ Open 2020; 10:e034699. [PMID: 32354779 PMCID: PMC7213850 DOI: 10.1136/bmjopen-2019-034699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Diabetic eye disease is a leading cause of blindness but can be mitigated by regular eye assessment. A framework of issues, developed from the literature of barriers to eye assessment, was used to structure an examination of perceptions of a new model of care for diabetic retinopathy from the perspective of staff using the model, and health professionals referring patients to the new service. DESIGN Multimethod: interviews and focus groups, and a separate survey. SETTING A new clinic based on an integrated model of care was established at a hospital in outer metropolitan Sydney, Australia in 2017. Funded jointly by Centre for Eye Health (CFEH) and the hospital, the clinic was equipped and staffed by optometrists who work alongside the ophthalmologists in the existing hospital eye clinic. PARTICIPANTS Five (of seven) hospital staff working in the clinic (ophthalmologists and administrative officers) or referring to it from other departments (endocrinologists); nine optometrists from CFEH who developed or worked in the clinic; 10 community-based optometrists as potential referrers. RESULTS The new clinic was considered to have addressed known barriers to eye assessment, including access, assistance for patients unable/unwilling to organise eye checks and efficient management of human resources. The clinic optimised known drivers of this model of care: providing clear scope of practice and protocols for shared care between optometrists and ophthalmologists, good communication between referrers and eye professionals and a collegial approach promoting interprofessional trust. Remaining areas of concern were few referrals from general practitioners, fewer referrals from hospital endocrinologists than expected and issues with stretched administrative capacity. There were also perceived mismatches between the priorities of hospital management and aims of the clinic. CONCLUSIONS The new model was considered to have addressed many of the barriers to assessment. While there remain issues with the model, there were also unexpected benefits.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Brette Blakely
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Angelica Ly
- School of Optometry and Vision Health, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Health, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Health, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, Sydney, New South Wales, Australia
| | - Nagi Assaad
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- School of Optometry and Vision Health, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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25
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Tong J, Phu J, Kalloniatis M, Zangerl B. Modeling Changes in Corneal Parameters With Age: Implications for Corneal Disease Detection. Am J Ophthalmol 2020; 209:117-131. [PMID: 31469999 DOI: 10.1016/j.ajo.2019.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To apply computational methods to model normal age-related changes in corneal parameters and to establish their association with demographic factors, thereby providing a framework for improved detection of subclinical corneal ectasia (SCE). DESIGN Cross-sectional study. METHODS One hundred seventeen healthy participants were enrolled from Centre for Eye Health (Sydney, Australia). Corneal thickness (CT), front surface sagittal curvature (FSSC), and back surface sagittal curvature (BSSC) measurements were extracted from 57 corneal locations from 1 eye per participant using the Pentacam HR. Cluster analyses were performed to identify locations demonstrating similar variations with age. Age-related changes were modeled using polynomial regression with sliding window methods, and model accuracy was verified with Bland-Altman comparisons. Pearson correlations were applied to examine the impacts of demographic factors. RESULTS Concentric cluster patterns were observed for CT and FSSC but not for BSSC. Sliding window analyses were best fit with quartic and cubic regression models for CT and FSSC/BSSC, respectively. CT and FSSC sliding window models had narrower 95% limits of agreement compared with decade-based models (0.015 mm vs 0.017 mm and 0.14 mm vs 0.27 mm, respectively), but were wider for BSSC than decade-based models (0.73 mm vs 0.54 mm). Significant correlations were observed between CT and astigmatism (P = .02-.049) and FSSC and BSSC and gender (P = <.001-.049). CONCLUSIONS The developed models robustly described aging variations in CT and FSSC; however, other mechanisms appear to contribute to variations in BSSC. These findings and the identified correlations provide a framework that can be applied to future model development and establishment of normal databases to facilitate SCE detection.
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Affiliation(s)
- Janelle Tong
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
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26
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Ly A, Banh J, Luu P, Huang J, Yapp M, Zangerl B. Interocular asymmetry of the superonasal retinal nerve fibre layer thickness and blood vessel diameter in healthy subjects. PLoS One 2019; 14:e0226728. [PMID: 31869361 PMCID: PMC6927597 DOI: 10.1371/journal.pone.0226728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background Optical coherence tomography is commonly used to measure the retinal nerve fibre layer thickness in both normal and diseased eyes; however, variation among normal eyes is common and may limit the usefulness of the results. The aim of this study was to explore the interocular asymmetries in retinal nerve fibre layer thickness in a group of normal eyes and to investigate the influence of blood vessel diameter on local retinal nerve fibre layer thickness. Methods In this prospective study, retinal nerve fibre layer thickness and blood vessel diameter across 100 healthy participants were measured using two optical coherence tomography instruments. Individuals were categorised into two groups based on the presence or absence of interocular retinal nerve fibre layer thickness asymmetry beyond the 75th percentile of all participants. Results The superonasal sectoral retinal nerve fibre layer thickness was significantly greater in the left eye compared to the right, across all three sectors. Mean blood vessel diameter showed a corresponding difference in thickness at one of the superonasal sectors. Linear regression showed a positive and moderate correlation between blood vessel diameter and focal retinal nerve fibre layer thickness. This trend persisted across both arteries and veins, but veins showed larger variability between left and right eye in participants with marked superonasal retinal nerve fibre layer asymmetry. Conclusion Retinal nerve fibre layer thickness and blood vessel diameter vary significantly between eyes even in healthy individuals. These asymmetries in a normal population should be taken into consideration when interpreting the retinal nerve fibre layer thickness measurements from optical coherence tomography to assist in distinguishing normal variations from disease.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Banh
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Patricia Luu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessie Huang
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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27
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Huang J, Yapp M, Hennessy MP, Ly A, Masselos K, Agar A, Kalloniatis M, Zangerl B. Impact of referral refinement on management of glaucoma suspects in Australia. Clin Exp Optom 2019; 103:675-683. [PMID: 31852027 DOI: 10.1111/cxo.13030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/09/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In ageing populations, the prevalence of chronic diseases such as glaucoma is projected to increase, placing additional demands on limited health-care resources. In the UK, the demand for secondary care in hospital eye clinics was inflated by high rates of false positive glaucoma referrals. Collaborative care models incorporating referral refinement, whereby glaucoma suspect referrals are triaged by suitably trained optometrists through further testing, can potentially reduce false positive referrals. This study examined the impact of a referral refinement model on the accuracy of glaucoma referrals in Australia. METHODS Optometrist-initiated glaucoma suspect referrals to the Glaucoma Management Clinic (Sydney, Australia) were prospectively recruited. Glaucoma suspect referrals arising from two pathways were eligible for inclusion, either directly from a community optometrist (standard care) or following comprehensive assessment at the Centre for Eye Health (referral refinement). Main outcome measures were the positive predictive value and false positive rate of referrals. The impact of referral letter content on management outcomes was also investigated. RESULTS Of 464 referrals received between March 2015 and June 2018, 252 were for treatment of naïve glaucoma suspects and eligible for inclusion. Following ophthalmological assessment, 45.6 per cent (n = 115/252) were prescribed treatment for open angle glaucoma or ocular hypertension. Positive predictive value of community optometry referrals was 33.8 per cent (n = 25/74) and 50.6 per cent (n = 90/178) following referral refinement. The first visit discharge (false positive) rate was 26 per cent (n = 19/74) for community referrals compared to four per cent (n = 8/178) with referral refinement. Positive predictive value increased with the number of abnormal clinical examination findings associated with referral (χ2 test, p < 0.0001). The number of abnormal findings reported in referrals was significantly higher with referral refinement compared to without (n = 1.9 versus 1.5, t-test, p < 0.0001). CONCLUSION Referral refinement can improve the diagnostic accuracy of optometry-initiated referrals for glaucoma suspects in Australia, thereby decreasing unnecessary referrals to hospital and other secondary clinics.
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Affiliation(s)
- Jessie Huang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael Yapp
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael P Hennessy
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Ashish Agar
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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28
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Tong J, Phu J, Khuu SK, Yoshioka N, Choi AY, Nivison-Smith L, Marc RE, Jones BW, Pfeiffer RL, Kalloniatis M, Zangerl B. Development of a Spatial Model of Age-Related Change in the Macular Ganglion Cell Layer to Predict Function From Structural Changes. Am J Ophthalmol 2019; 208:166-177. [PMID: 31078539 DOI: 10.1016/j.ajo.2019.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/18/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To develop location-specific models of normal, age-related changes in the macular ganglion cell layer (GCL) from optical coherence tomography (OCT). Using these OCT-derived models, we predicted visual field (VF) sensitivities and compared these results to actual VF sensitivities. DESIGN Retrospective cohort study. METHODS Single eyes of 254 normal participants were retrospectively enrolled from the Centre for Eye Health (Sydney, Australia). Macular GCL measurements were obtained using Spectralis OCT. Cluster algorithms were performed to identify spatial patterns demonstrating similar age-related change. Quadratic and linear regression models were subsequently used to characterize age-related GCL decline. Forty participants underwent additional testing with Humphrey VFs, and 95% prediction intervals were calculated to measure the predictive ability of structure-function models incorporating cluster-based pooling, age correction, and consideration of spatial summation. RESULTS Quadratic GCL regression models provided a superior fit (P value <.0001-.0066), establishing that GCL decline commences in the late 30s across the macula. The equivalent linear rates of GCL decline showed eccentricity-dependent variation (0.13 μm/yr centrally vs 0.06 μm/yr peripherally); however, average, normalized GCL loss per year was consistent across the 64 macular measurement locations at 0.26%. The 95% prediction intervals describing predicted VF sensitivities were significantly narrower across all cluster-based structure-function models (3.79-4.99 dB) compared with models without clustering applied (5.66-6.73 dB, P < .0001). CONCLUSIONS Combining spatial clustering with age-correction based on regression models allowed the development of robust models describing GCL changes with age. The resultant superior predictive ability of VF sensitivity from ganglion cell measurements may be applied to future models of disease development to improve detection of early macular GCL pathology.
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29
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Choi AYJ, Nivison-Smith L, Phu J, Zangerl B, Khuu SK, Jones BW, Pfeiffer RL, Marc RE, Kalloniatis M. Contrast sensitivity isocontours of the central visual field. Sci Rep 2019; 9:11603. [PMID: 31406197 PMCID: PMC6691009 DOI: 10.1038/s41598-019-48026-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Standard automated perimetry (SAP), the most common form of perimetry used in clinical practice, is associated with high test variability, impacting clinical decision making and efficiency. Contrast sensitivity isocontours (CSIs) may reduce test variability in SAP by identifying regions of the visual field with statistically similar patterns of change that can be analysed collectively and allow a point (disease)-to-CSI (normal) comparison in disease assessment as opposed to a point (disease)-to-point (normal) comparison. CSIs in the central visual field however have limited applicability as they have only been described using visual field test patterns with low, 6° spatial sampling. In this study, CSIs were determined within the central 20° visual field using the 10-2 test grid paradigm of the Humphrey Field Analyzer which has a high 2° sampling frequency. The number of CSIs detected in the central 20° visual field was greater than previously reported with low spatial sampling and stimulus size dependent: 6 CSIs for GI, 4 CSIs for GII and GIII, and 3 CSIs for GIV and GV. CSI number and distribution were preserved with age. Use of CSIs to assess visual function in age-related macular degeneration (AMD) found CSI guided analysis detected a significantly greater deviation in sensitivity of AMD eyes from normal compared to a standard clinical pointwise comparison (−1.40 ± 0.15 dB vs −0.96 ± 0.15 dB; p < 0.05). This work suggests detection of CSIs within the central 20° is dependent on sampling strategy and stimulus size and normative distribution limits of CSIs can indicate significant functional deficits in diseases affecting the central visual field such as AMD.
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Affiliation(s)
- Agnes Y J Choi
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Bryan W Jones
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Rebecca L Pfeiffer
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Robert E Marc
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia. .,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
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30
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Yoshioka N, Zangerl B, Phu J, Choi AYJ, Khuu SK, Masselos K, Hennessy MP, Kalloniatis M. Consistency of Structure-Function Correlation Between Spatially Scaled Visual Field Stimuli and In Vivo OCT Ganglion Cell Counts. Invest Ophthalmol Vis Sci 2019; 59:1693-1703. [PMID: 29610852 DOI: 10.1167/iovs.17-23683] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the effect of stimulus size and disease status on the structure-function relationship within the central retina, we correlated the differential light sensitivity (DLS) with Goldmann stimulus size I to V (GI-V) and optical coherence tomography (OCT) derived in vivo ganglion cell count per stimulus area (GCc) within the macular area in normal subjects and patients with early glaucoma. Methods Humphrey Field Analyzer 10-2 visual field data with GI through V and Spectralis OCT macular ganglion cell layer (GCL) thickness measurements were collected from normal and early glaucoma cohorts including 25 subjects each. GCc was calculated from GCL thickness data and correlated with DLSs for different stimulus sizes. Results Correlation coefficients attained with smaller stimulus size were higher compared to larger stimulus sizes in both normal (GI-GII: R2 = 0.41-0.43, GIII-GV: R2 = 0.16-0.41) and diseased cohorts (GI-GII: R2 = 0.33-0.41, GIII-GV: R2 = 0.19-0.36). Quadratic regression curves for combined GI to V data demonstrated high correlation (R2= 0.82-0.90) and differed less than 1 dB of visual sensitivity within the GCc range between cohorts. The established structure-function relationship was compatible with a histologically derived model correlation spanning the range predicted by stimulus sizes GI to GIII. Conclusions Stimulus sizes within critical spatial summation area (GI-II) improved structure-function correlations in the central visual field. The structure-function relationship was identical in both normal and diseased cohort when GI to GV data were combined. Congruency of GI and GII structure-function correlation with those previously derived with GIII from more peripheral locations further suggests that the structure-function relationship is governed by the number of ganglion cell per stimulus area.
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Affiliation(s)
- Nayuta Yoshioka
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Agnes Y J Choi
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Katherine Masselos
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, New South Wales, Australia
| | - Michael P Hennessy
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
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31
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Huang J, Hennessy MP, Kalloniatis M, Zangerl B. Implementing collaborative care for glaucoma patients and suspects in Australia. Clin Exp Ophthalmol 2018; 46:826-828. [PMID: 29498181 PMCID: PMC6231046 DOI: 10.1111/ceo.13187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jessie Huang
- Centre for Eye Health, UNSW Sydney, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Michael P Hennessy
- Centre for Eye Health, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, UNSW Sydney, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, UNSW Sydney, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
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32
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Huang J, Katalinic P, Kalloniatis M, Hennessy MP, Zangerl B. Diurnal Intraocular Pressure Fluctuations with Self-tonometry in Glaucoma Patients and Suspects: A Clinical Trial. Optom Vis Sci 2018; 95:88-95. [PMID: 29370022 PMCID: PMC5794241 DOI: 10.1097/opx.0000000000001172] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE This article shows that self-tonometry can provide robust measures of diurnal intraocular pressure (IOP) and also detect changes to IOP in response to treatment within a short period of monitoring. These advances in IOP monitoring may contribute to improved management of glaucoma patients and suspects. PURPOSE The aim of this study was to prospectively investigate the utility of rebound self-tonometry performed over several weeks for detecting diurnal IOP fluctuations in glaucoma patients and suspects and also initial response to topical treatment in glaucoma patients. METHODS Forty patients were recruited following glaucoma-specific examination. Subsequent to successful training with the iCare HOME tonometer, patients were instructed to measure IOP, in a sitting position, four times a day over 4 to 6 weeks. Date, time, laterality, and IOP downloaded from the tonometer and clinical examination data, including applanation IOP and corneal thickness, were analyzed. A user satisfaction survey was also administered at study completion. t Test and analysis of variance were used to compare groups and IOP across days. Pearson correlation was used to compare measurements to Goldmann applanation tonometry and IOP measurements from the first day/s to the overall mean IOP. RESULTS Twenty-seven patients (18 suspects and 9 glaucoma patients) completed data collection. Patients self-measured IOP on 118 (±29) occasions for 40 (±7.4) days. Two dominant patterns of fluctuation were revealed: peak IOP upon awakening (n = 11) and at midday (n = 13). Diurnal IOP measured in the first 7 days showed strong correlation to diurnal IOP across the entire study period (r = 0.82, P < .0001). Within 24 hours of treatment commencement (latanoprost 0.005% ophthalmic solution), IOP reduced from 23.9 (±5.2) to 16.1 (±2.6) mmHg. Overall, patients rated the instrument as easy to use, although difficulties with correct alignment were expressed. CONCLUSIONS Rebound self-tonometry demonstrated utility for measuring diurnal IOP fluctuations in most patients, hence enhancing management of patient with or at risk of developing glaucoma.
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Affiliation(s)
- Jessie Huang
- Centre for Eye Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Paula Katalinic
- Centre for Eye Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Michael P Hennessy
- Centre for Eye Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia *
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
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33
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Ly A, Nivison-Smith L, Zangerl B, Assaad N, Kalloniatis M. Advanced imaging for the diagnosis of age-related macular degeneration: a case vignettes study. Clin Exp Optom 2017; 101:243-254. [PMID: 28994139 PMCID: PMC5873408 DOI: 10.1111/cxo.12607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/21/2023] Open
Abstract
Background The aim of this study is to evaluate the diagnosis, staging, imaging and management preferences, and the effect of advanced imaging among practising optometrists in age‐related macular degeneration (AMD). Methods Up to 20 case vignettes (computer‐based case simulations) were completed online in a computer laboratory in random order by 81 practising optometrists of Australia. Each case presented findings from a randomly selected patient seen previously at the Centre for Eye Health for a macular assessment in the following order: case history, preliminary tests and colour fundus photography. Participants were prompted to provide their diagnosis, management and imaging preference. One additional imaging result (either modified fundus photographs and infrared images, fundus autofluorescence, or optical coherence tomography [OCT]) was then provided and the questions repeated. Finally, all imaging results were provided and the questions repeated a third time. Results A total of 1,436 responses were analysed. The presence of macular pathology in AMD was accurately detected in 94 per cent of instances. The overall diagnostic accuracy of AMD was 61 per cent using colour fundus photography. This improved by one per cent using one additional imaging modality and a further four per cent using all imaging. Across all responses, a greater improvement in the diagnostic accuracy of AMD occurred following the presentation of OCT findings (versus other modalities). OCT was the most preferred imaging modality for AMD, while multimodal imaging was of greatest benefit in cases more often misdiagnosed using colour fundus photography alone. Overall, the cohort also displayed a tendency to underestimate disease severity. Conclusion Despite reports that imaging technologies improve the stratification of AMD, our findings suggest that this effect may be small when applied among practising optometrists without additional or specific training.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nagi Assaad
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Phu J, Khuu SK, Nivison-Smith L, Zangerl B, Choi AYJ, Jones BW, Pfeiffer RL, Marc RE, Kalloniatis M. Pattern Recognition Analysis Reveals Unique Contrast Sensitivity Isocontours Using Static Perimetry Thresholds Across the Visual Field. Invest Ophthalmol Vis Sci 2017; 58:4863-4876. [PMID: 28973333 PMCID: PMC5624776 DOI: 10.1167/iovs.17-22371] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the locus of test locations that exhibit statistically similar age-related decline in sensitivity to light increments and age-corrected contrast sensitivity isocontours (CSIs) across the central visual field (VF). We compared these CSIs with test point clusters used by the Glaucoma Hemifield Test (GHT). Methods Sixty healthy observers underwent testing on the Humphrey Field Analyzer 30-2 test grid using Goldmann (G) stimulus sizes I-V. Age-correction factors for GI-V were determined using linear regression analysis. Pattern recognition analysis was used to cluster test locations across the VF exhibiting equal age-related sensitivity decline (age-related CSIs), and points of equal age-corrected sensitivity (age-corrected CSIs) for GI-V. Results There was a small but significant test size–dependent sensitivity decline with age, with smaller stimuli declining more rapidly. Age-related decline in sensitivity was more rapid in the periphery. A greater number of unique age-related CSIs was revealed when using smaller stimuli, particularly in the mid-periphery. Cluster analysis of age-corrected sensitivity thresholds revealed unique CSIs for GI-V, with smaller stimuli having a greater number of unique clusters. Zones examined by the GHT consisted of test locations that did not necessarily belong to the same CSI, particularly in the periphery. Conclusions Cluster analysis reveals statistically significant groups of test locations within the 30-2 test grid exhibiting the same age-related decline. CSIs facilitate pooling of sensitivities to reduce the variability of individual test locations. These CSIs could guide future structure-function and alternate hemifield asymmetry analyses by comparing matched areas of similar sensitivity signatures.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Agnes Yiu Jeung Choi
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Bryan W Jones
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Rebecca L Pfeiffer
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Robert E Marc
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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Yoshioka N, Zangerl B, Nivison-Smith L, Khuu SK, Jones BW, Pfeiffer RL, Marc RE, Kalloniatis M. Pattern Recognition Analysis of Age-Related Retinal Ganglion Cell Signatures in the Human Eye. Invest Ophthalmol Vis Sci 2017. [PMID: 28632847 PMCID: PMC5482244 DOI: 10.1167/iovs.17-21450] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose To characterize macular ganglion cell layer (GCL) changes with age and provide a framework to assess changes in ocular disease. This study used data clustering to analyze macular GCL patterns from optical coherence tomography (OCT) in a large cohort of subjects without ocular disease. Methods Single eyes of 201 patients evaluated at the Centre for Eye Health (Sydney, Australia) were retrospectively enrolled (age range, 20–85); 8 × 8 grid locations obtained from Spectralis OCT macular scans were analyzed with unsupervised classification into statistically separable classes sharing common GCL thickness and change with age. The resulting classes and gridwise data were fitted with linear and segmented linear regression curves. Additionally, normalized data were analyzed to determine regression as a percentage. Accuracy of each model was examined through comparison of predicted 50-year-old equivalent macular GCL thickness for the entire cohort to a true 50-year-old reference cohort. Results Pattern recognition clustered GCL thickness across the macula into five to eight spatially concentric classes. F-test demonstrated segmented linear regression to be the most appropriate model for macular GCL change. The pattern recognition–derived and normalized model revealed less difference between the predicted macular GCL thickness and the reference cohort (average ± SD 0.19 ± 0.92 and −0.30 ± 0.61 μm) than a gridwise model (average ± SD 0.62 ± 1.43 μm). Conclusions Pattern recognition successfully identified statistically separable macular areas that undergo a segmented linear reduction with age. This regression model better predicted macular GCL thickness. The various unique spatial patterns revealed by pattern recognition combined with core GCL thickness data provide a framework to analyze GCL loss in ocular disease.
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Affiliation(s)
- Nayuta Yoshioka
- Centre for Eye Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia 2School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia 2School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia 2School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia
| | - Bryan W Jones
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Rebecca L Pfeiffer
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Robert E Marc
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia 2School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia
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Zangerl B, Whatham A, Kim J, Choi A, Assaad NN, Hennessy MP, Kalloniatis M. Reconciling visual field defects and retinal nerve fibre layer asymmetric patterns in retrograde degeneration: an extended case series. Clin Exp Optom 2017; 100:214-226. [PMID: 27728957 PMCID: PMC5434818 DOI: 10.1111/cxo.12478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/21/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Accurate diagnosis in patients presenting with lesions at various locations within the visual pathway is challenging. This study investigated functional and structural changes secondary to such lesions to identify patterns useful to guide early and effective management. METHODS Over 10,000 records from patients referred for optic nerve head assessment were reviewed and 31 patients with a final diagnosis of likely neuropathic lesions posterior to the eye were included in the current study. Fundus photographs, optic coherence tomography images and visual field tests were evaluated for changes with respect to retinal nerve fibre layer topography and prediction of structure-function paradigms. Emerging clinical patterns were examined for their consistency with the likely anatomical origin of the underlying insult in the presence of varying diagnoses. RESULTS Data from patients with lesions along the visual system allowed identification of retinal nerve fibre layer asymmetry correlated with visual field defects and ganglion cell analysis. Bilateral discordance in retinal nerve fibre loss easily discernible from an altered pattern of the temporal-superior-nasal-inferior-temporal curve was characteristic for post-chiasmal lesions. These sometimes-subtle changes supported diagnosis in cases with multiple aetiologies or with ambiguous visual field analysis and/or ganglion cell loss. CONCLUSION Intricate knowledge of the retinal architecture and projections allows coherent predictions of functional and structural deficits following various lesions affecting the visual pathway. The integration of adjunct imaging and retinal nerve fibre layer thinning will assist clinicians to guide clinical investigations toward a likely diagnosis in the light of significant individual variations. The case series presented in this study aids in differential diagnosis of retrograde optic neuropathies by using retinal nerve fibre layer asymmetric patterns as an important clinical marker.
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Affiliation(s)
- Barbara Zangerl
- Centre for Eye HealthSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesKensingtonNew South WalesAustralia
| | - Andrew Whatham
- Centre for Eye HealthSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesKensingtonNew South WalesAustralia
| | - Juno Kim
- School of Optometry and Vision ScienceThe University of New South WalesKensingtonNew South WalesAustralia
| | - Agnes Choi
- Centre for Eye HealthSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesKensingtonNew South WalesAustralia
| | - Nagi N Assaad
- Centre for Eye HealthSydneyNew South WalesAustralia
- Ophthalmology DepartmentPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Michael P Hennessy
- Centre for Eye HealthSydneyNew South WalesAustralia
- Ophthalmology DepartmentPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesKensingtonNew South WalesAustralia
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37
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Ly A, Nivison-Smith L, Zangerl B, Assaad N, Kalloniatis M. Self-reported optometric practise patterns in age-related macular degeneration. Clin Exp Optom 2017; 100:718-728. [PMID: 28266060 DOI: 10.1111/cxo.12528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The use of advanced imaging in clinical practice is emerging and the use of this technology by optometrists in assessing patients with age-related macular degeneration is of interest. Therefore, this study explored contemporary, self-reported patterns of practice regarding age-related macular degeneration diagnosis and management using a cross-sectional survey of optometrists in Australia and New Zealand. METHODS Practising optometrists were surveyed on four key areas, namely, demographics, clinical skills and experience, assessment and management of age-related macular degeneration. Questions pertaining to self-rated competency, knowledge and attitudes used a five-point Likert scale. RESULTS Completed responses were received from 127 and 87 practising optometrists in Australia and New Zealand, respectively. Advanced imaging showed greater variation in service delivery than traditional techniques (such as slitlamp funduscopy) and trended toward optical coherence tomography, which was routinely performed in age-related macular degeneration by 49 per cent of respondents. Optical coherence tomography was also associated with higher self-rated competency, knowledge and perceived relevance to practice than other modalities. Most respondents (93 per cent) indicated that they regularly applied patient symptoms, case history, visual function results and signs from traditional testing, when queried about their management of patients with age-related macular degeneration. Over half (63 per cent) also considered advanced imaging, while 31 per cent additionally considered all of these as well as the disease stage and clinical guidelines. Contrary to the evidence base, 68 and 34 per cent rated nutritional supplements as highly relevant or relevant in early age-related macular degeneration and normal aging changes, respectively. CONCLUSIONS These results highlight the emergence of multimodal and advanced imaging (especially optical coherence tomography) in the assessment of age-related macular degeneration by optometrists. Clinically significant variations in self-rated test competency and the understanding regarding nutritional supplements for different stages of age-related macular degeneration suggest that further work to up-skill optometrists may be required.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Nagi Assaad
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
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Phu J, Khuu SK, Zangerl B, Kalloniatis M. A comparison of Goldmann III, V and spatially equated test stimuli in visual field testing: the importance of complete and partial spatial summation. Ophthalmic Physiol Opt 2017; 37:160-176. [PMID: 28211185 PMCID: PMC5324678 DOI: 10.1111/opo.12355] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/22/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Goldmann size V (GV) test stimuli are less variable with a greater dynamic range and have been proposed for measuring contrast sensitivity instead of size III (GIII). Since GIII and GV operate within partial summation, we hypothesise that actual GV (aGV) thresholds could predict GIII (pGIII) thresholds, facilitating comparisons between actual GIII (aGIII) thresholds with pGIII thresholds derived from smaller GV variances. We test the suitability of GV for detecting visual field (VF) loss in patients with early glaucoma, and examine eccentricity-dependent effects of number and depth of defects. We also hypothesise that stimuli operating within complete spatial summation ('spatially equated stimuli') would detect more and deeper defects. METHODS Sixty normal subjects and 20 glaucoma patients underwent VF testing on the Humphrey Field Analyzer using GI-V sized stimuli on the 30-2 test grid in full threshold mode. Point-wise partial summation slope values were generated from GI-V thresholds, and we subsequently derived pGIII thresholds using aGV. Difference plots between actual GIII (aGIII) and pGIII thresholds were used to compare the amount of discordance. In glaucoma patients, the number of 'events' (points below the 95% lower limit of normal), defect depth and global indices were compared between stimuli. RESULTS 90.5% of pGIII and aGIII points were within ±3 dB of each other in normal subjects. In the glaucoma cohort, there was less concordance (63.2% within ±3 dB), decreasing with increasing eccentricity. GIII found more defects compared to GV-derived thresholds, but only at outermost test locations. Greater defect depth was found using aGIII compared to aGV and pGIII, which increased with eccentricity. Global indices revealed more severe loss when using GIII compared to GV. Spatially equated stimuli detected the greatest number of 'events' and largest defect depth. CONCLUSIONS Whilst GV may be used to reliably predict GIII values in normal subjects, there was less concordance in glaucoma patients. Similarities in 'event' detection and defect depth in the central VF were consistent with the fact that GIII and GV operate within partial summation in this region. Eccentricity-dependent effects in 'events' and defect depth were congruent with changes in spatial summation across the VF and the increase in critical area with disease. The spatially equated test stimuli showed the greatest number of defective locations and larger sensitivity loss.
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Affiliation(s)
- Jack Phu
- Centre for Eye HealthUniversity of New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - Sieu K. Khuu
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - Barbara Zangerl
- Centre for Eye HealthUniversity of New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthUniversity of New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
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39
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Yoshioka N, Wong E, Kalloniatis M, Zangerl B. Repeatability of Heidelberg Retinal Tomography 3 and effect of alignment algorithm on glaucoma suspects. Clin Exp Optom 2017; 100:41-48. [DOI: 10.1111/cxo.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nayuta Yoshioka
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia,
| | - Elizabeth Wong
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia,
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia,
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia,
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia,
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Quek KJ, Boyd R, Ameer OZ, Zangerl B, Butlin M, Murphy TV, Avolio AP, Phillips JK. Progressive vascular remodelling, endothelial dysfunction and stiffness in mesenteric resistance arteries in a rodent model of chronic kidney disease. Vascul Pharmacol 2016; 81:42-52. [PMID: 26771067 DOI: 10.1016/j.vph.2015.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/02/2015] [Accepted: 12/31/2015] [Indexed: 12/25/2022]
Abstract
Chronic kidney disease (CKD) and hypertension are co-morbid conditions both associated with altered resistance artery structure, biomechanics and function. We examined these characteristics in mesenteric artery together with renal function and systolic blood pressure (SBP) changes in the Lewis polycystic kidney (LPK) rat model of CKD. Animals were studied at early (6-weeks), intermediate (12-weeks), and late (18-weeks) time-points (n=21), relative to age-matched Lewis controls (n=29). At 12 and 18-weeks, LPK arteries exhibited eutrophic and hypertrophic inward remodelling characterised by thickened medial smooth muscle, decreased lumen diameter, and unchanged or increased media cross-sectional area, respectively. At these later time points, endothelium-dependent vasorelaxation was also compromised, associated with impaired endothelium-dependent hyperpolarisation and reduced nitric oxide synthase activity. Stiffness, elastic-modulus/stress slopes and collagen/elastin ratios were increased in 6 and 18-week-old-LPK, in contrast to greater arterial compliance at 12weeks. Multiple linear regression analysis highlighted SBP as the main predictor of wall-lumen ratio (r=0.536, P<0.001 n=46 pairs). Concentration-response curves revealed increased sensitivity to phenylephrine but not potassium chloride in 18-week-LPK. Our results indicate that impairment in LPK resistance vasculature is evident at 6weeks, and worsens with hypertension and progression of renal disease.
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Affiliation(s)
- K J Quek
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - R Boyd
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - O Z Ameer
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - B Zangerl
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Centre for Eye Health, University of New South Wales, Sydney, Australia.
| | - M Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - T V Murphy
- Department of Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia.
| | - A P Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - J K Phillips
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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Yoshioka N, Wong E, Kalloniatis M, Yapp M, Hennessy MP, Agar A, Healey PR, Hayen A, Zangerl B. Influence of education and diagnostic modes on glaucoma assessment by optometrists. Ophthalmic Physiol Opt 2015; 35:682-98. [DOI: 10.1111/opo.12247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Nayuta Yoshioka
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Elizabeth Wong
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Michael Kalloniatis
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Michael Yapp
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Michael P. Hennessy
- Centre for Eye Health; UNSW Australia; Sydney Australia
- Ophthalmology; Prince of Wales Hospital; Randwick Australia
| | - Ashish Agar
- Ophthalmology; Prince of Wales Hospital; Randwick Australia
| | - Paul R. Healey
- Centre for Vision Research; Westmead Millenium Institute; University of Sydney; Sydney Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine; UNSW Australia; Sydney Australia
| | - Barbara Zangerl
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
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Zangerl B, Hayen A, Mitchell P, Jamous KF, Stapleton F, Kalloniatis M. Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists. Ophthalmic Physiol Opt 2015; 35:212-24. [PMID: 25684127 DOI: 10.1111/opo.12197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/30/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Previous studies confirmed that optometrists have access to and confidence in applying clinical tests recommended for glaucoma assessment. Less is known about factors best predicting compliance with national clinical guidelines and thus by inference, the provision of suitable care by primary care ophthalmic practitioners. We utilised the unique two-tiered profession (therapeutic and non-therapeutic scope of practice) in Australia and New Zealand to assess the prospective adherence to glaucoma guidelines dependent on the clinician's background. METHODS Australian and New Zealand optometrists were surveyed on ophthalmic techniques for glaucoma assessment, criteria for the evaluation of the optic nerve head, glaucoma risk categories and review times while also recording background, training, and experience. Parameters identifying progression/conversion and patients' risk levels were analysed comparatively to ophthalmologists' opinions. Linear regression analysis identified variables significantly improving the likelihood of concordance with guidelines. RESULTS Reported application of techniques complied well with glaucoma guidelines although gonioscopy and pachymetry, pupil dilation for optic nerve head examination, and acquisition of permanent records were less frequently employed. The main predictors for entry-level diagnostic standards were therapeutic endorsement together with the associated knowledge of relevant guidance and procedural confidence. Other findings suggested a potential underestimation in the value of optic disc size and intraocular pressure for the prediction of glaucoma risk, while optometrists more frequently relied on the outcomes of non-standardised automated perimetry and auxiliary imaging. CONCLUSIONS Optometrists in Australia and New Zealand may not always exercise optimal clinical acumen regarding techniques/criteria for glaucoma diagnosis. Therapeutic endorsement was gradually adopted in different jurisdictions in various forms since 1999 and is mandatory for registration since late 2014. The result of the two-tiered optometric cohorts suggest that inclusion of therapeutic training as part of the core training is likely a key factor to enhanced compliance with glaucoma guidelines. Improved adherence to the current clinical standards should positively impact on the facilitation of appropriate glaucoma diagnosis and management. Obligatory knowledge and possibly accreditation of available guidelines might ensure a uniform standard in glaucoma testing protocols in concordance with compulsory entry-level skills.
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Affiliation(s)
- Barbara Zangerl
- School of Optometry and Vision Science, UNSW Australia, Sydney, Australia; Centre for Eye Health, UNSW Australia, Sydney, Australia
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Rogala J, Zangerl B, Assaad N, Fletcher EL, Kalloniatis M, Nivison-Smith L. In Vivo Quantification of Retinal Changes Associated With Drusen in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2015; 56:1689-700. [DOI: 10.1167/iovs.14-16221] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jamous KF, Kalloniatis M, Hennessy MP, Agar A, Hayen A, Zangerl B. Clinical model assisting with the collaborative care of glaucoma patients and suspects. Clin Exp Ophthalmol 2014; 43:308-19. [PMID: 25362898 DOI: 10.1111/ceo.12466] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimizing patient management will reduce unnecessary vision loss in glaucoma through early detection. One method is the introduction of collaborative care schemes between optometrists and ophthalmologists. DESIGN We conducted a retrospective study to evaluate the impact of the Centre for Eye Health (CFEH) on glaucoma patient outcomes and management in primary optometric care. PARTICIPANTS Patients referred to CFEH by optometrists for a glaucoma assessment were eligible for this study if written consent was provided (500 participants were randomly chosen). METHODS Clinical data were classified according to disease risk and implemented patient care and analysed against the original diagnosis and patient parameters, followed by statistical analysis. MAIN OUTCOME MEASURES Two main parameters were evaluated; suitable referral of patients for glaucoma condition assessment and appropriate implementation of follow-up care. RESULTS The majority of patients referred for glaucoma assessment (86.2%) were classified as glaucoma suspects or likely to have glaucoma, indicating suitable referral of patients for a CFEH evaluation. Further, the involvement of CFEH resulted in a false positive rate of 7.8% for those patients who proceeded to ophthalmological care. However, long-term optometric patient care was not maintained for up to a third of primarily lower risk patients. CONCLUSIONS The investigated collaborative eye health-care model led to a substantial improvement in appropriate referrals of glaucoma patients to ophthalmologists and could be suitable for optimizing patient care and utilization of resources. Improvement in follow-up of patients by optometrists is required to minimize inappropriately discontinued patient care.
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Affiliation(s)
- Khalid F Jamous
- Centre for Eye Health, UNSW Australia, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Michael Kalloniatis
- Centre for Eye Health, UNSW Australia, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia
| | - Michael P Hennessy
- Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ashish Agar
- Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, UNSW Australia, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia
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Chiang J, Wong E, Whatham A, Hennessy M, Kalloniatis M, Zangerl B. The usefulness of multimodal imaging for differentiating pseudopapilloedema and true swelling of the optic nerve head: a review and case series. Clin Exp Optom 2014; 98:12-24. [PMID: 25315395 DOI: 10.1111/cxo.12177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/27/2014] [Accepted: 04/01/2014] [Indexed: 01/08/2023] Open
Abstract
Ophthalmic practitioners have to make a critical differential diagnosis in cases of an elevated optic nerve head. They have to discriminate between pseudopapilloedema (benign elevation of the optic nerve head) and true swelling of the optic nerve head. This decision has significant implications for appropriate patient management. Assessment of the optic disc prior to the advanced imaging techniques that are available today (particularly spectral domain optical coherence tomography and fundus autofluorescence), has mainly used diagnostic tools, such as funduscopy and retinal photography. As these traditional methods rely on the subjective assessment by the clinician, evaluation of the elevated optic nerve head to differentiate pseudopapilloedema from true swelling of the optic nerve head can be a challenge in clinical practice with patients typically referred for further neuroimaging investigation when the diagnosis is uncertain. The use of multimodal ocular imaging tools such as spectral domain optical coherence tomography, short wavelength fundus autofluorescence and ultrasonography, can potentially aid in the differentiation of pseudopapilloedema from true swelling of the optic nerve head, in conjunction with other clinical findings. By doing so, unnecessary patient costs and anxiety in the case of pseudopapilloedema can be reduced, and appropriate urgent referral and management in the case of true swelling of the optic nerve head can be initiated.
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Affiliation(s)
- Jaclyn Chiang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
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Jamous KF, Kalloniatis M, Hayen A, Mitchell P, Stapleton FJ, Zangerl B. Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines. Ophthalmic Physiol Opt 2014; 34:580-91. [DOI: 10.1111/opo.12146] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/02/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Khalid F. Jamous
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
- Centre for Eye Health; University of New South Wales; Sydney Australia
- Department of Ophthalmology; Faculty of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Michael Kalloniatis
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
- Centre for Eye Health; University of New South Wales; Sydney Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine; University of New South Wales; Sydney Australia
| | - Paul Mitchell
- Centre for Vision Research; Department of Ophthalmology and Westmead Millennium Institute; University of Sydney; Sydney Australia
| | - Fiona J. Stapleton
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
- Centre for Eye Health; University of New South Wales; Sydney Australia
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Guziewicz KE, Zangerl B, Komáromy AM, Iwabe S, Chiodo VA, Boye SL, Hauswirth WW, Beltran WA, Aguirre GD. Recombinant AAV-mediated BEST1 transfer to the retinal pigment epithelium: analysis of serotype-dependent retinal effects. PLoS One 2013; 8:e75666. [PMID: 24143172 PMCID: PMC3797066 DOI: 10.1371/journal.pone.0075666] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
Mutations in the BEST1 gene constitute an underlying cause of juvenile macular dystrophies, a group of retinal disorders commonly referred to as bestrophinopathies and usually diagnosed in early childhood or adolescence. The disease primarily affects macular and paramacular regions of the eye leading to major declines in central vision later in life. Currently, there is no cure or surgical management for BEST1-associated disorders. The recently characterized human disease counterpart, canine multifocal retinopathy (cmr), recapitulates a full spectrum of clinical and molecular features observed in human bestrophinopathies and offers a valuable model system for development and testing of therapeutic strategies. In this study, the specificity, efficiency and safety of rAAV-mediated transgene expression driven by the human VMD2 promoter were assessed in wild-type canine retinae. While the subretinal delivery of rAAV2/1 vector serotype was associated with cone damage in the retina when BEST1 and GFP were co-expressed, the rAAV2/2 vector serotype carrying either GFP reporter or BEST1 transgene under control of human VMD2 promoter was safe, and enabled specific transduction of the RPE cell monolayer that was stable for up to 6 months post injection. These encouraging studies with the rAAV2/2 vector lay the groundwork for development of gene augmentation therapy for human bestrophinopathies.
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Affiliation(s)
- Karina E. Guziewicz
- Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail: (KEG); (GDA)
| | - Barbara Zangerl
- Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Centre for Eye Health, University of New South Wales, Kensington, Australia
- * E-mail: (KEG); (GDA)
| | - András M. Komáromy
- Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Simone Iwabe
- Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Vincent A. Chiodo
- Department of Ophthalmology, University of Florida, Gainesville, Florida, United States of America
| | - Sanford L. Boye
- Department of Ophthalmology, University of Florida, Gainesville, Florida, United States of America
| | - William W. Hauswirth
- Department of Ophthalmology, University of Florida, Gainesville, Florida, United States of America
| | - William A. Beltran
- Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gustavo D. Aguirre
- Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Abstract
A 1-year-old Australian Shepherd (AS) was presented for a routine hereditary eye examination. During the examination multiple raised, brown to orange lesions were noted in the fundus, which could not be attributed to a known retinal disease in this breed. As they clinically most closely resembled canine multifocal retinopathy (cmr) and no indication of an acquired condition was found, genetic tests for BEST1 gene mutations were performed. These showed the dog to be homozygous for the cmr1 (C73T/R25X) gene defect. Furthermore, ultrasound (US), electroretinography (ERG), and optical coherence tomography were performed, confirming changes typical for cmr. Subsequently, the AS pedigree members were genetically and clinically tested, demonstrating autosomal recessive inheritance with no clinical symptoms in carrier animals, as was previously described for cmr. To our knowledge, this is the first reported case of canine multifocal retinopathy in the AS breed. Further investigations are under way.
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Affiliation(s)
- Ingo Hoffmann
- Tieraerztliche Praxis für Augenheilkunde, 90471 Nuernberg, Germany.
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Affiliation(s)
- Tatyana Kuznetsova
- Department of Clinical Studies, Section of Ophthalmology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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