Meri Vukicevic

Butterflies and black lacy patterns: the prevalence and characteristics of Charles Bonnet hallucinations in an Australian population

Background:  Charles Bonnet Syndrome (CBS) is characterized by vivid, elaborate and recurrent visual hallucinations in psychologically normal people. It most often occurs in older, visually impaired persons. The prevalence of the syndrome has been reported at 1–40% in Asia, Europe and North America. The aim of this study was to examine the prevalence and characteristics of CBS in the older aged, visually impaired population in Australia.

Prevalence of optical coherence tomography-diagnosed postoperative cystoid macular oedema in patients following uncomplicated phaco-emulsification cataract surgery

Background:  Postoperative cystoid macular oedema is a complication of uneventful cataract surgery. Whereas improved surgical techniques have decreased the incidence of cystoid macular oedema, it remains a cause of unfavourable visual outcome following surgery. Fundus fluorescein angiography has been the ‘gold standard’ for diagnosing subclinical cystoid macular oedema; however, non‐invasive cross‐sectional imaging of the retina with optical coherence tomography may be equally effective at detecting the condition and offers the ability to quantify and repeat results over time.

Experiences of patients undergoing anti-VEGF treatment for neovascular age-related macular degeneration: A systematic review

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) often entails intra-vitreal injection of an anti-vascular endothelial growth factor (VEGF) agent, that begins with a three-month loading phase of four weekly injections followed by regular monthly visits with clinician-determined re-treatment. The effects of AMD on quality of life and visual function have been extensively reported in the literature, however, less is known about the burden imposed on patients by the arduous and often indefinite treatment schedule which habitually follows a diagnosis of wet AMD. To date, no systematic review has been conducted of research investigating patients’ experiences of anti-VEGF treatment for AMD. A systematic search of the Embase, Medline, PsycINFO and PubMed electronic databases was undertaken to identify all studies between January 2004 and December 2013, published in the English language and involving human participants. A hand-search of an additional four journals was conducted. Ten articles were identified for inclusion in this review. A critical appraisal was undertaken using the Critical Appraisal Skills Programme Qualitative Research Checklist and the results synthesised to form a narrative review. Few studies to date have investigated patients’ experiences of treatment for AMD. These studies have focused primarily on patients’ experiences of the injection procedure with respect to pain and anxiety. Anticipated discomfort is often greater than actual discomfort experienced during intra-vitreal injection. However, different stages of the treatment procedure produce varying levels of patient discomfort. No one method of anaesthesia has consistently been shown to be more effective in reducing discomfort associated with treatment. Common reasons underlying patient apprehension surrounding treatment include the thought of having an injection, fear of losing eyesight and fear of the unknown. Whilst these studies have not been without their methodological limitations, they provide a platform for further exploration of the patient experience.

Phototoxic maculopathy associated with arc welding: clinical findings and associated functional vision impairment

luxation was noted 7 weeks following the fourth laser treatment (8 months after the initial DLCC application). To our knowledge, however, this is the first reported case of late-onset crystalline lens subluxation occurring 5 years after DLCC. There was no clinical evidence of collagen disorders, pseudoexfoliation syndrome or other diseases that can potentially predispose to lens instability. The patient denied any history of ocular trauma including the 5-year follow-up period following DLCC. We believe that the diode laser-induced destruction of ciliary processes and the disruption of the zonules is a progressive process and can lead to delayed zonular dehiscence and lenticular subluxation/dislocation. We recommend that patients should be informed about this rare complication especially when repeated treatments are necessary. With the increasing use of DLCC in sighted eyes, cataract surgeons should be aware of the potential zonular weakness in this group of patients. In conclusion, dislocation of the crystalline lens may occur as a rare complication after DLCC, especially when repeated treatments are needed.

Diabetes, Diabetic Retinopathy, and Retinal Vascular Alterations: A Systematic Review.

AbstractThe aim of this review is to summarize the available findings from previous research that has focused on retinal vascular caliber characteristics in diabetes and diabetic retinopathy and identify any gaps that exist in the current literature. A systematic Medline, EMBASE, and PubMed search of relevant articles was conducted with coverage up to the 30th of September, 2012. The search was not restricted by language but was limited to studies conducted in humans. The majority of articles conducted on children and adolescents with type 1 diabetes have reported that arterioles with larger caliber were present in the early stages of diabetic retinopathy (n = 5). Only a few studies conducted on older individuals with type 1 diabetes (n = 2) suggest that smaller retinal arteriolar caliber is associated with increased severity of diabetic retinopathy. Much stronger trends have been identified between venular caliber and older individuals with diabetes, with the vast majority of studies reporting that retinal venular dilation represents a later sign of severe diabetic retinopathy (n = 6), with only 1 study highlighting associations with incident diabetes (n = 1). Significant developments have occurred to better understand the relationship between retinal vascular caliber and the onset and progression of diabetes and diabetic retinopathy. Recent evidence suggests that retinal arteriolar dilation may be a possible risk factor in the early development diabetic retinopathy and retinal venules are dilated in persons with severe diabetic retinopathy. Despite this, the clinical significance of these findings requires further evaluation.

Rehabilitation strategies used to ameliorate the impact of centre field loss

It has been shown that loss of macular vision has an impact upon a persons ability to read normal-size print and perform daily living tasks. The aim of this study was to report the results of a random control trial of eccentric viewing and magnification interventions on the performance of activities of daily living, including a clinical evaluation of client perceptions. A random control design was used to compare the impact of three interventions (eccentric viewing, magnification, and combined intervention) upon near print size and the performance of daily living tasks. Data were analysed using one-way analysis of variance. Results of the random control study in relation to the dependent variables of near print size and performance of activities of daily living demonstrated that intervention significantly improved performance. Eccentric viewing intervention demonstrated greater improvement in dynamic activities such as shopping, whilst magnification intervention demonstrated the greatest improvement in h...

Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Abstract Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.

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.

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.

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.