Konstandina Koklanis

Psychosocial impact of amblyopia and its treatment: a multidisciplinary study

Background:  To explore the meaning of amblyopia from both parents’ and children’s perspectives and to seek correlations between the experiential aspects of the condition and its treatment, the clinical characteristics of amblyopia and any apparent psychopathology.

Victorian orthoptists' performance in the photo evaluation of diabetic retinopathy

Purpose:  The aim of this study was to investigate the effectiveness of orthoptists in detecting various grades of diabetic retinopathy (DR) and retinal pathology not directly associated with diabetes and to identify factors associated with best performance.

Dietary patterns and retinal vascular calibre in children and adolescents with type 1 diabetes

To examine the association between dietary patterns and retinal vascular calibre in children and adolescents with type 1 diabetes.

The use of distance stereoacuity assessment in determining the effectiveness of minus lenses in intermittent exotropia.

PURPOSE Minus lens treatment has been advocated for intermittent exotropia to prevent progression and has been found to be effective in improving the control of the deviation in the distance. However, the effectiveness of this treatment is difficult to ascertain because of the lack of standardized outcome measures. Distance stereoacuity has been reported to be a reliable assessment of control of intermittent exotropia. In this study, its role as an outcome measure in the efficacy of minus lens treatment was examined by the use of the Frisby-Davis Distance stereotest. METHODS Patients (n = 24) with intermittent exotropia participated. Their distance stereoacuity was tested with the Frisby-Davis Distance stereotest at baseline and with varying minus lens powers (of -1, -2 and -3 D) that were tested randomly, as were the distance binocular visual acuity and angle of deviation. RESULTS Varying minus lens powers had a significant effect on the angle of deviation and binocular visual acuity but not distance stereoacuity. However, both measures of binocularity, distance stereoacuity, and binocular visual acuity tended to diminish with the stronger minus lens power of -3 D. Participants actually demonstrated difficulty in accommodating through the stronger lenses. CONCLUSIONS Distance stereoacuity (and binocular visual acuity) cannot reliably be used to determine the optimum minus lens strength that could be used in these patients to reduce the angle of deviation and regain binocularity in the distance. An additional observation was made that stronger lenses should perhaps be avoided to prevent binocular and visual discomfort.

Prevalence and risk factors for diabetic retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes.

Abstract Background: The aim of this study was to investigate the prevalence of, and traditional and emerging risk factors associated with, retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes. Methods: This was a cross-sectional study of 483 children and adolescents with type 1 diabetes. Medical files were audited to collect all relevant clinical data. Diabetic retinopathy was assessed from colour retinal images by an ophthalmologist. Results: Diabetic retinopathy was observed in 11 (2.3%) participants. Logistic regression revealed that the principal components analysis derived risk profile of: higher serum creatinine, older age, higher systolic blood pressures, higher body mass index, abnormal estimated glomerular filtration rate (eGFR) (<59 mL/min), lower high density lipoproteins (HDL) cholesterol, higher serum sodium, longer duration of diabetes and narrower retinal arteriolar calibre was associated with diabetic retinopathy (ExpB=2.60, 95% CI 1.36/4.96, p=0.004). Conclusions: These results support the concept that the pathogenesis of diabetic retinopathy is likely due to the combined influence of various risk factors, many already identified.

Validity and reliability of eye healthcare professionals in the assessment of glaucoma – a systematic review

To explore the validity and reliability of eye healthcare professionals with different levels of training in diagnosing and/or identifying glaucomatous progression.

The base-to-base induced-tropia prism test for detection of amblyopia: a pilot study.

PURPOSE To investigate the accuracy of the base-to-base prism test (BBPT), which entails inducing an esotropia with the use of base-in prisms before each eye, in the diagnosis of amblyopia. METHODS Participants were consecutive patients recruited from a pediatric ophthalmology practice who were able to perform logMAR acuity testing. All participants underwent an orthoptic examination, including logMAR visual acuity testing, and a sensorimotor evaluation. Patients with an interocular difference of 2 or more lines were considered to have amblyopia. Fixation preference was assessed by use of both the vertical fixation test and the BBPT. The agreement between the BBPT and visual acuity was analyzed and compared with the agreement between the vertical fixation test and visual acuity. RESULTS Fifty-one consecutive patients aged 4 to 17 (mean, 9.8 years; SD ± 3.4) were included, of whom 11 were diagnosed with amblyopia. Kappa analysis showed moderate but significant agreement between the BBPT and logMAR (κ = 0.453, p = 0.001), whereas the vertical fixation test demonstrated only a fair agreement (κ = 0.254, p = 0.061). The overall sensitivity for the BBPT was 72.7% (95% confidence interval [95% CI], 43.4%-90.3%) but only 40% for the vertical fixation test (95% CI, 16.8%-69.7%). For the BBPT, specificity was 80% (95% CI, 65.2%-89.5%); for the vertical fixation test, 78% (95% CI, 63.3%-88.0%). CONCLUSIONS The BBPT appears to be more sensitive than the vertical fixation test for detecting amblyopia in our patient population. The 2 tests had similar specificity.

Retinal Vascular Caliber and Kidney Function in Children and Adolescents with Type 1 Diabetes

ABSTRACT Purpose: To evaluate the relationship between retinal vascular caliber and kidney function in a cohort of Australian children and adolescents with type 1 diabetes. Methods: This was a cross-sectional study of 483 children and adolescents with type 1 diabetes, aged 7–18 years. An audit of medical files of participants who attended the Royal Children’s Hospital, Melbourne, between January 2009 and March 2014 was performed. Albumin to creatinine ratio (ACR) was acquired through spot urine samples and microalbuminuria was classified as ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males. Retinal vascular caliber was measured using a standardized protocol and later summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). Results: CRAE was significantly narrower in participants with microalbuminuria compared to those with normo-albuminuria in crude analysis (mean ± standard deviation 159.07 ± 9.90µm vs 164.49 ± 12.45 µm; p = 0.006). After adjustment for key confounders and known or potential mediators of microalbuminuria (age, sex, ethnicity, hemoglobin A1c, systolic blood pressure, total cholesterol, body mass index, duration of diabetes and CRVE) the association between narrower CRAE and microalbuminuria was attenuated and was no longer significant (95% confidence interval 0.94–1.02, p = 0.222). No significant associations between CRVE or arteriole-to-venule ratio and microalbuminuria were observed in univariate or multivariate models. Conclusions: After adjustment for potential confounding variables, retinal vascular caliber was not significantly associated with microalbuminuria in this sample of children and adolescents with type 1 diabetes. Future prospective longitudinal research is warranted to further evaluate these findings.

Vascular risk factors are associated with retinal arteriolar narrowing and venular widening in children and adolescents with type 1 diabetes

Abstract Background: The aim of the study was to describe the relationship of retinal arteriolar and venular calibre with vascular risk factors in children and adolescents with type 1 diabetes. Methods: In this hospital-based cross-sectional study, the medical files of 483 children and adolescents with type 1 diabetes were audited to collect retinal images and relevant clinical data. Retinal vascular calibre was measured using standardised protocols. Results: After multivariable adjustments, a vascular risk profile that included: older age, higher serum creatinine, higher systolic blood pressure (SBP), higher body mass index (BMI), abnormal estimated glomerular filtration rate (eGFR), lower high-density lipoproteins (HDL) cholesterol, longer duration of diabetes and higher serum sodium was associated with narrower central retinal artery equivalent (CRAE) (95% CI=−4.10/−0.76, p=0.004). A specific risk profile, including higher total cholesterol level, higher BMI, lower physical activity level, higher HbA1c, higher triglyceride levels, female gender and lower socio-economic status, was associated with wider central retinal vein equivalent (CRVE) (95% CI=1.14/5.62, p=0.003). Conclusions: In summary, these findings support evidence that cardiovascular disease may have its origins early in life. Prospective and/or intervention studies are required to confirm whether the observed associations are involved in the causal pathway for retinal vascular calibre.

Physical Activity, Sedentary Behaviors, and Retinal Vascular Caliber in Children and Adolescents With Type 1 Diabetes.

PurposeThe aim of this study was to investigate associations of physical activity and sedentary behaviors with retinal vascular caliber in children and adolescents with type 1 diabetes. DesignThis was a hospital-based cross-sectional study. MethodsA study of 122 children and adolescents with type 1 diabetes was conducted over an 8-month period. Self-reported physical activity time and time spent watching TV or playing computer or video games were obtained using interviewer-administered questionnaires. Retinal vascular caliber was measured by a trained grader using a standardized protocol and later summarized as central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) using a semiautomated computer program. ResultsAfter adjusting for confounders (age, sex, ethnicity, body mass index, systolic blood pressure, HbA1c, maternal smoking status, age at which cow’s milk was introduced, and CRVE/CRAE, respectively), narrower CRAE was independently related to more time spent playing computer/video games [ExpB = −3.85; 95% confidence interval (CI), −6.41 to −1.29; P = 0.004], whereas wider CRVE was independently related to lower physical activity level (ExpB = −1.08; 95% CI, −2.01 to −0.15; P = 0.03) and more time spent playing computer/video games (ExpB = 4.72; 95% CI, 0.52–8.92; P = 0.02). Television viewing time was not associated with retinal vascular caliber after adjustment. ConclusionsThe results of this study suggest that physical activity and sedentary behaviors in the form of “screen viewing time” are associated with retinal vessel caliber early in life. These results suggest that retinal vascular caliber may provide prognostic information beyond current traditional cardiovascular risk factors. Future longitudinal and interventional studies are warranted to evaluate the relevance of these observations.