Julie Crewe

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.

Resident and infiltrating cells in the rat iris during the early stages of experimental melanin protein-induced uveitis (EMIU)

Experimental melanin protein-induced uveitis (EMIU) is reported to be a model of anterior uveitis and choroiditis in which the retina is spared. In this study, we chose to compare EMIU with experimental autoimmune uveoretinitis (EAU), a well-recognised model of endogenous posterior uveitis, with regard to the nature and dynamics of the cellular infiltrate in the iris. Female Lewis albino rats were immunised with mixtures of crude retinal extract/complete Freunds adjuvant (CFA) (EAU), phosphate-buffered saline/CFA (controls), or iris melanin/CFA (EMIU) using established protocols. Animals were sacrificed on days 10 and 13 (around disease onset). Following whole body perfusion fixation, irides were dissected from the remainder of the globe. Iris wholemount preparations were then subjected to immunohistochemical analysis in order to investigate both the dynamics of infiltrating leukocytes and the effects of the inflammatory changes on resident immune cells in the iris. The nature of the cellular infiltrate in both EMIU and EAU models was essentially similar, namely there was a rich infiltrate of EDI+ mononuclear cells, Ox42+ neutrophils and T cells. Resident tissue macrophages (ED2+) were slightly below normal densities in the iris of EAU animals and marginally elevated in EMIU animals, MHC class II (Ia) staining, associated in the normal eye with dendritic cells (DC), was considerably elevated in EMIU. It is likely that this was due to both increased DC numbers and an influx of Ia+ exudate macrophages. No striking difference was found in the nature and phenotype of the cellular infiltrate in the iris at the onset of the disease in these two models of uveitis (EAU and EMIU). This suggests that the anterior segment inflammation in both models represents non-specific changes secondary to cytokine release associated with interaction of activated antigen-specific T cells and target antigens, namely retinal photoreceptors in EAU and uveal tract melanin-containing cells in EMIU. Alternatively, it may suggest that antigen-presenting cells resident in the iris and ciliary body in normal eyes have access to ocular antigens on both sides of the blood-ocular barrier and are capable of activating circulating antigen-specific T cells in these models.

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.

A comprehensive list of asthmagens to inform health interventions in the Australian workplace

Objective: To develop a comprehensive list of asthmagens which may occur in occupational settings in Australia.

Assessing the diagnostic validity of a blind register

Background:  To validate the accuracy of clinical ophthalmic information held on the West Australian blind register.

Hospitalization rates of children who are blind

To evaluate the impact of blindness on hospitalization rates of children.

Prevalence of blindness in children

Childhood blindness carries a high financial cost for the community as well as a high individual cost impacting normal motor, language and social development of the child. These factors are all compounded when the child enters the education system and adulthood. There are very little accurate data available on the prevalence of blindness in children. We have recently published the results of a capture and recapture estimate of the total blind population in Western Australia.1 This estimate was derived from three independent lists of legally blind people and is a well-validated method for the accurate determination of population sizes.2 Here, we add additional analysis of a subset of data on the children contained within the original capture and recapture lists to provide an estimate of the prevalence of blindness in those aged less than 18 years. Blind children were identified either from the voluntary register of the Association for the Blind of Western Australia (list …

Congenital blindness is protective for schizophrenia and other psychotic illness. A whole-population study.

Congenital/early blindness is reportedly protective against schizophrenia. Using a whole-population cohort of 467,945 children born in Western Australia between 1980 and 2001, we examined prevalence of schizophrenia and psychotic illness in individuals with congenital/early blindness. Overall, 1870 children developed schizophrenia (0.4%) while 9120 developed a psychotic illness (1.9%). None of the 66 children with cortical blindness developed schizophrenia or psychotic illness. Eight of the 613 children with peripheral blindness developed a psychotic illness other than schizophrenia and fewer had developed schizophrenia. Our results support findings from small case studies that congenital/early cortical but not peripheral blindness is protective against schizophrenia.

Does including colour-blind men enhance search and rescue teams?: Letter to the Editor

Dating back many years there are anecdotal reports that persons with colour-vision deficits (CVD) have unusual abilities to locate camouflaged installations not otherwise apparent to individuals with normal trichromatic colour vision (nCV).1, 2.

Pterygia are indicators of an increased risk of developing cutaneous melanomas

Aim To investigate whether pterygium is an indicator of an increased risk of cutaneous melanoma (CM). Methods A matched-cohort study, using linked health administrative data sets to identify all hospital-treated pterygium in Western Australia (WA) between 1979 and 2014. We identified pterygium cases from hospital diagnosis and/or procedure International Classification of Diseases 9th revision (ICD-9) and 10th revision (ICD-10) codes and matched cases by age, sex and residential postcode to WA Electoral Roll controls with no known history of pterygium. Both cohorts were linked to the WA Cancer Registry and the WA Deaths Registry. Results 23 625 people had pterygium treatment (64% male) in WA hospitals. The median age for pterygium diagnosis and/or treatment was 49 years (range 14–96). There were significantly more CM cases in the pterygium cohort compared with the control cohort (1083 vs 874; p<0.001). In a logistic regression analysis, there was a 24% increase in the odds of developing a CM in the pterygium cohort, compared with controls, after controlling for other predictors (OR 1.24, 95% CI 1.1 to 1.4). The incident rate ratio (IRR) of a malignant CM diagnosis was 20% greater in people who had treatment for a pterygium compared with controls (IRR 1.2, 95% CI 1.0 to 1.4). Conclusion The presence of a pterygium indicates a significantly increased risk of developing a CM. Eye care providers who see patients with developing pterygia should advise these patients of this increased risk and recommend regular skin surveillance.