Brian Chua

Retinal Vessel Diameters and Obesity: A Population-Based Study in Older Persons

Objective: Obesity is linked with large vessel atherosclerosis and diabetes. Its association with microvascular changes is less clear. We investigated the associations among retinal vessel diameters, vessel wall signs, and BMI in an older population.

Effects of cataract type and location on visual function: The Blue Mountains Eye Study

AbstractPurpose To measure the effect of cataract type, severity and location on presenting, and best-corrected visual acuity, contrast sensitivity, and glare disability.Methods In all, 3654 (82.4% participation rate) eligible noninstitutionalised residents aged 49 years or older, living in two postcode areas of the Blue Mountains, Australia, received detailed eye examinations including visual acuity, contrast sensitivity, and glare disability testing. Data from right eyes were analysed using multiple regression modelling.Results The effect of age on visual acuity and contrast sensitivity only became evident in persons aged at least 60 years. Cataract severity was inversely related to visual acuity and contrast sensitivity. Late posterior subcapsular cataract caused the greatest reduction in visual acuity. Early grade cataract caused significant reduction in contrast sensitivity at intermediate and high spatial frequencies, but late grade cataract reduced contrast sensitivity across all spatial frequencies. There was insufficient study power to detect consistent significant effect of cataract on glare disability tests or cortical cataract location on visual function.Conclusions Age at least 60 years, cataract type, and cataract severity were principal determinants of visual acuity and contrast sensitivity in this study. Axial and superotemporally located cortical cataract had the greatest effect on visual function tests.

Corneal arcus and hyperlipidemia: findings from an older population

PURPOSE To quantify the association between arcus and hyperlipidemia in an older population. DESIGN Cross-sectional population-based study. METHODS Arcus and serum lipids were measured in the Blue Mountains Eye Study (n = 3,654, aged >49 years). Arcus was graded as absent, partial (<180 degrees) or circumferential (> or =180 degrees). Associations between arcus and hyperlipidemia were assessed using logistic regression, adjusting for age and vascular risk factors. RESULTS Arcus was strongly associated with age (P <.0001). After age adjustment, arcus was associated with male sex (P <.01) and diabetes (P <.02) but not with hypertension or smoking. Corneal arcus was significantly associated with progressively higher levels of total cholesterol over 5 mmol/l. Adjusted odds increased from 1.6 for cholesterol 6.0 to 6.9 mmol/l to 4.6 for cholesterol >8.0 mmol/l, and was 1.9 for high triglyceride >3.0 mmol/l. CONCLUSION This population-based finding confirms that corneal arcus was associated with hypercholesterolemia and hypertriglyceridemia in older persons.

A retrospective review of the associations between amblyopia type, patient age, treatment compliance and referral patterns

Aim: To review presenting ages, referral sources, amblyopia type and treatment compliance in children attending a typical public hospital ophthalmology clinic with no formal amblyopia screening program in place.

Temporal changes in the control of blood pressure in an older Australian population.

Trends in blood pressure prevalence and control have important public health implications. We aim to document trends in hypertension prevalence, awareness and control in the older Australian population, a group at greatest risk of blood pressure related diseases. The Blue Mountains Eye Study (BMES) is a population-based study of residents aged 49 years or older, in two postcode areas of the Blue Mountains, Australia. The first cross-section (BMES I, 1992–1994) included 3654 participants (82.4% of eligible). The second cross-section (BMES II, 1997–2000) included 3509 participants, 2335 (75.1% of BMES I survivors) and 1174 (85.2% of newly eligible residents who qualified because of age or moved into the area). Detailed history and examinations were conducted. The prevalence of hypertension increased significantly from 45.4% (95% confidence interval, CI 43.7–47.0%) to 52.2% (CI 50.6–53.9%) from 1992–1994 to 1997–2000, paralleled by an increase in the population mean body mass index (BMI) from 26.1 kg/m2 (CI 26.0–26.3 kg/m2) to 27.7 kg/m2 (CI 27.5–27.9 kg/m2). Hypertension awareness decreased significantly from 79.8 to 73.0%, while treatment and control rates decreased from 71.1 to 67.3% and 56.3 to 46.5%, respectively (P<0.0001). Our results showed that elevated BMI (P<0.0001), lack of exercise (P<0.002) and serum triglyceride >2 mmol/l (P<0.0001) were significantly associated with prevalence of hypertension. We found that the prevalence of hypertension in the older Australian population was increasing while awareness, treatment and control rates decreased. Programmes to improve community awareness of hypertension, and its association with BMI may lead to further reductions in blood pressure and the burden of cardiovascular disease.

Neuroprotective agents in glaucoma therapy: recent developments and future directions

Glaucoma, globally the second most common cause of blindness and the commonest cause of preventable visual disability, is a progressive neurodegenerative disease of the retinal ganglion cells and their axons. While reduction of intraocular pressure remains the clinician’s principal method to treat this disease, such treatment is often only partly effective, or provokes unacceptable treatment-associated comorbidities. An alternative treatment paradigm is required to manage this problem more effectively. Neuroprotection aims to protect as yet undamaged, and to rescue already damaged neurons, from the glaucoma insult(s) to retinal ganglion cells. It has the potential to prevent retinal ganglion cell death independently of the particular factors that damage the optic nerve. Research laboratories worldwide have reported exciting developments in the search for potential neuroprotective agents. This article reviews what is known to date, as well as possible future directions.

Positive association between plasma homocysteine level and chronic kidney disease

Background: Increasing experimental evidence, including recently developed animal models, supports a role for homocysteine in the development of chronic kidney disease (CKD). However, relatively few clinical/epidemiological studies have examined this hypothesis in humans. We examined the relationship between plasma homocysteine level and CKD in a population-based study of older Australians. Methods: Community-based study (1992–1994) among 2,609 individuals (58.6% women), aged 49–98 years, free of clinical cardiovascular disease in the Blue Mountains region, west of Sydney, Australia. The main outcome-of-interest was CKD (n = 461), defined as estimated glomerular filtration rate of <60 ml/min/1.73 m2. Results: Higher plasma homocys- teine levels were positively associated with CKD, independent of smoking, body mass index, diabetes mellitus, hypertension, cholesterol levels, and other confounders. The multivariable odds ratio (OR; 95% confidence intervals, CI) comparing quartile 4 of plasma homocysteine (>14 µmol/l) to quartile 1 (≤9 µmol/l) was 10.44 (6.99–15.60), p-trend <0.0001. This association persisted in both men and women separately. The results were also consistent in subgroup analyses by categories of diabetes mellitus and hypertension. Conclusions: Higher plasma homocysteine levels are associated with CKD in a community-based sample of older Australians. This association appeared to be independent of diabetes mellitus and hypertension.

Outcomes of chronic hypotony following trabeculectomy.

ment was initiated. Three weeks later, his colour vision dropped from 17 plates to 13 plates with subjective reddesaturation and a mild relative afferent pupillary defect, suggesting optic-nerve compression. An urgent CT scan was carried out, which did not indicate any significant change from the previous imaging. The risks and benefits of local and systemic treatment were discussed, and the patient opted for an orbital floor injection of 40 mg triamcinolone acetonide. This was carried out in a clean room without complication. An improvement in colour vision and red-desaturation was noted at two weeks and diplopia at four weeks. He has now been followed up for 54 weeks with no deterioration or signs of recurrence. We present the clinical and histopathological findings of a patient with an orbital mass and reduced vision. Based on initial imaging, the differential diagnosis included lymphoma, vasculitis and a granulomatous process. However, biopsy indicated that the lesion contained a mixed infiltrate of lymphocytes and mature plasma cells with phagocytic histiocytes, known as emperipolesis (typical of RDD). RDD is a rare, idiopathic, non-malignant histiocytic proliferative disorder and is usually self-limited; however, its course can be prolonged in some cases. It is relatively uncommon in the orbit with a prevalence of 0.03%–2.3%. There is a slight male preponderance, and the average age at onset is 20 years. RDD presents most commonly with bilateral, painless cervical-lymphadenopathy and raised inflammatory markers. Extra-nodal RDD occurs in 40% of cases and often presents in the head and neck. The most common ophthalmic sites are the orbit and eyelid occurring in 8.5% of cases. There have been previous reports of orbital involvement being the initial or principal manifestation of the disease and in approximately 20% of these there is no evidence of lymphadenopathy or leukocytosis (as was the case in our patient). The management of RDD is ideally conservative, as it is a self-limiting disease. However, due to uncontrolled symptoms or spread of the disease, 50% of patients receive treatment. This can be in the form of antibiotics, antituberculous treatment, immunomodulators, radiation or surgery, depending on the site(s) of disease. Our patient had type-1 diabetes and was not keen to start a course of oral steroids; furthermore, his focus of disease was in his posterior orbit, making further debulking surgery difficult and high risk. A decision was taken to treat him with intralesional 40 mg triamcinolone acetonide, via an orbital floor approach. There has been one published case of intralesional steroid being used in orbital RDD; however, the case had already been treated with oral steroids and significant debulking surgery. There have also been reports of intralesional and topical steroid being use in cutaneous RDD lesions to good effect. In conclusion, we describe an interesting case of RDD presenting as an orbital mass with optic nerve compression and responding well to one injection of intralesional steroid. Furthermore, the patient remained stable for over a year with regular follow-up and has not required any additional treatment.

Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration

ABSTRACT Aim The aim of this article is to evaluate the rate of patients developing sustained elevated intraocular pressure (IOP) after ranibizumab (Lucentis) intravitreal (IVT) injections. Design This is a retrospective study. Participants Charts of 192 consecutive patients receiving Lucentis for age-related macular degeneration (AMD) were retrospectively reviewed. Materials and methods We enrolled patients with at least two IOP measurements between injections. Elevated IOP was defined as >21 mm Hg with an increase of at least 20% from baseline. Noninjected contralateral eyes of the same patient cohort were used as control. Main outcome measures Primary outcome was defined as elevated IOP. Secondary outcomes were presence and type of glaucoma, number of injections, and time to IOP elevation. Results Elevated IOP occurred at a significantly higher rate in eyes receiving IVT ranibizumab (7.47%; n = 9) compared with control (0.93%; n = 1). Patients with preexisting glaucoma or ocular hypertension (OHT) were more likely to develop elevated IOP after IVT ranibizumab injection. Conclusion Intravitreal ranibizumab injections are associated with sustained IOP elevation in some eyes. How to cite this article Reis GMSM, Grigg J, Chua B, Lee A, Lim R, Higgins R, Martins A, Goldberg I, Clement CI. The Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration. J Curr Glaucoma Pract 2017;11(1):3-7.

Mapping trans-synaptic degeneration in the optic radiations in glaucoma: a diffusion mri study

Purpose: To evaluate Surgical Outcomes (SOs) and Visual Outcomes (VOs) in cataract surgery comparing the Centurion® phacoemulsification system (CPS) with the Infiniti® phacoemulsification system (IPS). Methods: Prospective, consecutive, no-exclusions, comparative study of Nuclear Sclerosis (NS) Grade, Cumulated Dissipated Energy (CDE), preoperative Corrected Distance Visual Acuity (CDVA), and CDVA at 1 month were recorded. SOs and VOs were documented prospectively until 1 month postoperatively. Results: There were 207 and 205 eyes each in the CPS and IPS subcohort, respectively. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade 3 or greater, CDE was 28.87% less with CPS (n = 70) compared with IPS (n = 44) (P = .010). Surgical complications were not statistically different between the two subcohorts (P = .083), but in the one case of vitreous loss using the CPS, CDVA (VOs) of 6/4 was achieved at 1 month. The mean CDVAs at 1 month for NS grade 3 and above cataracts were 0.17 logMAR (6/4) in the CPS and 0.15 logMAR (6/4) in the IPS subcohort, respectively (P = .033). Conclusions: CDE was 28.87% less, and VOs were significantly improved, in denser cataracts in the CPS compared with the IPS. Surgical facility was subjectively better for the surgeon with the CPS. The Authors recommend the CPS for cases with denser nuclei. CPS may assist novice phacoemulsification surgeons.