Antony Clark

Whole Population Trends in Complications of Cataract Surgery over 22 Years in Western Australia

OBJECTIVE To examine the trends in major complications of cataract surgery in the Western Australian population over 22 years. DESIGN Population-based study. PARTICIPANTS We included 129 982 cataract/lens surgery patients across 46 health facilities. METHODS Using the Western Australian Data Linkage System, we identified all patients who underwent cataract/lens surgery in Western Australia between 1980 and 2001. Complications of interest were identified from those patients admitted to hospital or who underwent unplanned surgery after cataract surgery and were validated by medical record review. MAIN OUTCOME MEASURES Admission for retinal detachment, dropped nucleus, wound dehiscence, pseudophakic corneal edema, intraocular lens (IOL) dislocation, and postoperative endophthalmitis requiring surgery. RESULTS There were 129 982 cataract/lens procedures and 2087 (1.6%) complications. Complications fell almost 70% over the study period. Retinal detachment (n = 905; 0.70%) was most common, followed by IOL dislocation (n = 361; 0.28%), endophthalmitis (n = 228; 0.18%), wound dehiscence (n = 227; 0.17%), pseudophakic corneal edema (n = 207; 0.16%), and dropped nucleus (n = 159; 0.12%). The incidence of complications lessened over time, except for IOL dislocations, which has increased since 1995. Overall, the risk of complications after phacoemulsification halved since it was introduced in the late 1990s (incidence rate ratio, 0.52; 95% confidence interval, 0.37-0.74), whereas complications after extracapsular extraction (ECCE) have increased over recent years. CONCLUSIONS Cataract surgery remains an extremely safe procedure with comparatively few major complications. Changes in operative techniques have been accompanied by a significant decrease in complication rates over time, although the increase in IOL dislocations and complications after ECCE warrants further study. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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

OBJECTIVE To evaluate the extent to which Western Australian (WA) represents the broader Australian population in terms of key socio-demographic and health economic indicators. METHODS We compared key demographic, social and health economic indicators across all Australian States and Territories from Australian government publications in the census years 1991-2006. Jurisdictional averages (JAs) were calculated as the mean (+/-s.d.) or median (+/-range). Observed jurisdiction indicators were compared with the JA and ranked according its representativeness of the JA. RESULTS WA was among the three closest jurisdictions to the national JA for all socio-demographic and health economic indicators examined, with the exception of uptake of private health insurance (ranked 6th) and per-capita health expenditure (ranked 5th). The Northern Territory and Australian Capital Territory were least representative for the majority of indicators. Excluding the proportions of people living in rural or remote areas (0-100%) and of indigenous origin (0.4-28.8%), variations in the indicators across the jurisdictions were relatively small. CONCLUSIONS Population differences between Australias States were small, whereas Australias Territories were least representative of the JA. WA was the most representative population of Australias eight jurisdictions and continues to be in a strong position to contribute to knowledge of the Australian health system that is applicable Australia-wide.

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

Purpose: To determine the risk of thromboembolic and gastrointestinal bleeding events in the 12 months after injections of bevacizumab or ranibizumab compared with photodynamic therapy and a nontreated community sample. Methods: Hospital and death records were examined for 1,267 patients treated with vascular endothelial growth factor inhibitor and 399 patients treated with photodynamic therapy attending Western Australian eye clinics from 2002 to 2008, and 1,763 community controls, aged ≥50 years. Hospital records from 1995 to 2009 were analyzed for history of myocardial infarction (MI), stroke, and gastrointestinal bleeding before treatment. Records were searched for evidence of these events in the 12 months after treatment. Results: The 12-month MI rate was higher for vascular endothelial growth factor inhibitor patients than photodynamic therapy patientsand the community group (1.9/100 vs. 0.8 and 0.7, respectively). No differences were observed between patients treated with bevacizumab and ranibizumab. The adjusted MI rate was 2.3 times greater than the community group (95% confidence interval, 1.2–4.5) and photodynamic therapy rate (95% confidence interval, 0.7–7.7). The 12-month MI risk did not increase with the number of injections administered (hazard ratio, 0.9; 95% confidence interval, 0.5–1.5). Stroke and gastrointestinal bleeding did not differ between any exposure groups. Conclusion: Although all the adverse events examined were rare, patients treated with vascular endothelial growth factor inhibitors were significantly more likely to experience fatal or nonfatal MI than the community group. This increased risk may be related to the underlying age-related macular degeneration or vascular endothelial growth factor inhibitor use itself.

Risk for Retinal Detachment After Phacoemulsification: A Whole-Population Study of Cataract Surgery Outcomes

OBJECTIVES To estimate the long-term cumulative incidence of and risk factors for retinal detachment (RD) after phacoemulsification using linked administrative medical data. METHODS We used the Western Australian Data Linkage System to identify patients who underwent phacoemulsification in Western Australia between January 1989 and December 2001. Retinal detachment cases were those patients requiring admission for RD surgery after phacoemulsification that were validated by medical record review. Kaplan-Meier analysis was used to calculate a cumulative incidence. Cox proportional hazards regression modeling was used to determine the association between RD and risk factors, including patient demographics and operative and hospital factors. Some important risk factors, including axial length and Nd:YAG laser capsulotomy, were not examined. RESULTS We identified 237 RD cases following 65 055 phacoemulsification procedures, with a 10-year cumulative incidence of 0.68% (95% CI, 0.56%-0.83%). Significant risk factors were year of surgery (hazard ratio [HR], 0.43; 95% CI, 0.28-0.66 [1999-2001 compared with 1989-1993] for each 5-year period after 1985), age younger than 60 years (3.76; 2.83-5.00), male sex (1.91; 1.45-2.51), and anterior vitrectomy (27.60; 19.27-39.52). Hospital location, patient rural or remote locality, hospital cataract surgery volume, failed intraocular lens insertion, length of stay, and patient insurance status were not significantly associated with RD. CONCLUSIONS Risk for RD after phacoemulsification has almost halved for each 5-year period since its adoption in the mid 1980s. Younger patient age and male sex at surgery significantly increased risk for RD. Phacoemulsification requiring anterior vitrectomy vastly increased risk for RD.

Quality of life of the most severely vision‐impaired

Background:  To explore the interaction between vision impairment, perceived quality of life loss and willingness to trade remaining life for vision gain.

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

Purpose:  To report on diabetic retinopathy (DR) and the major causes of vision loss and blindness in Aboriginals in the Eastern Goldfields region of Western Australia between 1995 and 2007.

Quality of life after postoperative endophthalmitis

Purpose:  The aim of this study is to determine if postoperative endophthalmitis adversely affects quality of life after cataract surgery.

Diabetic retinopathy management by Australian optometrists

Background:  To survey the current diabetic retinopathy screening and management practices of Australian optometrists following the release of the 1997 National Health Medical Research Council Diabetic Retinopathy Management Guidelines.

Mortality and hospital morbidity of working-age blind

Aim Determine whether blindness in people aged 18–65 years was associated with increased rates of mortality, hospitalisation and length of stay. Methods A retrospective matched cohort study of legally blind people and normally sighted controls, aged 18–65 years, comparing mortality rates and hospital morbidity records. Results Together, 419 blind and 419 controls accumulated 12 258 hospital separations over the 11-year study period. The blind had an age-specific mortality rate seven times greater (12/1000 person years) than the general population (1.8/1000 person years) (p<0.001). Blindness was recorded as a comorbid condition for 76 (22%) blind individuals, on just 255 (2.3%) hospital separation records. Psychiatric, mental or behavioural conditions were the most frequently recorded diagnoses, after dialysis and endocrine conditions. After adjusting for comorbidities, the blind cohort had 1.5 times more hospital separations (p=0.007, 95% CI 1.1 to 2.0) and 2.2 times more bed days (p=0.016, 95% CI 1.4 to 4.1) compared with the control cohort. Conclusions Recognition and acknowledgement of in-patients’ blind status may assist in understanding the frequent and extended health service utilisation rates. Encouraging and promoting the uptake and access to rehabilitation support services would be measures that may reduce the health service burden of blindness, the incidence of depression and other mental health problems.

Big data and ophthalmic research

Large population-based health administrative databases, clinical registries, and data linkage systems are a rapidly expanding resource for health research. Ophthalmic research has benefited from the use of these databases in expanding the breadth of knowledge in areas such as disease surveillance, disease etiology, health services utilization, and health outcomes. Furthermore, the quantity of data available for research has increased exponentially in recent times, particularly as e-health initiatives come online in health systems across the globe. We review some big data concepts, the databases and data linkage systems used in eye research-including their advantages and limitations, the types of studies previously undertaken, and the future direction for big data in eye research.