Miriam Claire Keane

Multiple sclerosis: patients’ information sources and needs on disease symptoms and management

Objective: To investigate the current information sources of patients with multiple sclerosis (MS) in the early stages of their disease and to identify patients’ preferred source of information. The relative amounts of information from the different sources were also compared. Methods: Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources. Results: A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources. Conclusion: This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future. Practice implications: More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse.

Evaluating the effectiveness of multidisciplinary low-vision rehabilitation.

Purpose. To objectively evaluate the changes in vision-specific quality of life (QoL) after multidisciplinary low-vision rehabilitation at the Royal Society for the Blind Low-Vision Clinic. Methods. The standard care model at the Royal Society for the Blind Low-Vision Clinic is optical management at the initial assessment, with subsequent referral to multidisciplinary services as required. Participants completed the Impact of Vision Impairment Questionnaire (IVI) and Veterans Affairs Low-Vision Visual Functioning Questionnaire (VA LV VFQ-48) before initial assessment, at 30 days (to assess the outcome of optical management) and at 3 months follow-up (to assess the outcome of multidisciplinary services). Results. Seventy-one participants completed the study. Using the VA LV VFQ-48, an improvement (p < 0.05) was seen at 30 days follow-up in overall visual ability, and the reading, visual information, and visual motor subscores. However, at 3 months follow-up, all subscores were not significantly different from pre-rehabilitation levels. In contrast, for the IVI, there was no improvement in both the overall score and the mobility subscale at 30 days follow-up, but a significant improvement at 3 months follow-up. Greater improvements in visual function were seen for those with low vision (<20/60–20/200) compared with those with blindness, those aged >85 years compared with those aged 80 to 85 and <80 years, and those without glaucoma (visual motor subscore). Conclusions. The VA LV VFQ-48 and IVI demonstrated improvements in QoL after low-vision rehabilitation. The timing of the observed changes varied between the two questionnaires, reflecting the different content of these instruments and the timing of delivery of multidisciplinary services, but also suggests that continued rehabilitation may be warranted to maintain a patients QoL.

A comparison of endothelial and penetrating keratoplasty outcomes following failed penetrating keratoplasty: a registry study

Purpose To compare graft survival and visual outcomes for endothelial keratoplasty (EK) after a first penetrating keratoplasty (PK), with outcomes of repeat PK after a first PK. Methods 400 eyes with a second graft (65 EKs, 335 PKs) performed after failure of a primary PK were identified through the Australian Corneal Graft Registry, a national prospectively followed cohort. Grafts were performed after January 2008 (follow-up of the second graft extending to 6.75 years maximum). Kaplan–Meier graft survival plots were constructed and Cox proportional hazards regression was used to identify independent risk factors for graft failure. Best-corrected Snellen visual acuity (BCVA) at last follow-up was compared with pregraft acuity. Results Poor Kaplan–Meier graft survival was observed for PK-EK compared with PK-PK (log-rank=29.66, p<0.001). Variables retained in multivariate analysis as significantly influencing survival of the second graft included graft type (PK-EK or PK-PK, p<0.001), length of survival of the previous PK (global p=0.011), graft era (global p=0.018), occurrence of rejection in the second graft (p=0.005) and a history of raised intraocular pressure at any time (p=0.048), but not indication for the first graft. BCVA improved in the majority of surviving grafts and attainment of 6/12 vision was similar for both PK-EK and PK-PK groups. Conclusions Our registry findings suggest that repeat PK may deliver a better outcome in terms of graft survival than EK after a failed PK that was performed initially for keratoconus or pseudophakic bullous keratopathy. For surviving grafts, visual outcomes appeared equivalent across groups.

Predictive genetic testing experience for myocilin primary open-angle glaucoma using the Australian and New Zealand Registry of Advanced Glaucoma

Purpose:Predictive genetic testing of relatives of known myocilin (MYOC) gene mutation carriers is an appropriate strategy to identify individuals at risk for glaucoma. It is likely to prevent irreversible blindness in this high-risk group because this treatable condition might otherwise be diagnosed late. The Australian and New Zealand Registry of Advanced Glaucoma has established genetic testing protocols for known glaucoma genes, including MYOC.Methods:Through the Australian and New Zealand Registry of Advanced Glaucoma, we investigated the experience of 40 unaffected individuals who had undergone predictive genetic testing for MYOC mutations through questionnaires.Results:The main motivations for being tested were (i) to make appropriate interventions and (ii) to reduce uncertainty. All our respondents perceived strong benefits, either medical or emotional, in being tested. However, different concerns were raised by the respondents that need to be addressed during counseling. Greater family awareness was reported by the majority of the respondents, and the ability to provide information to children was a strong motivation for being tested.Conclusion:This study provides valuable information on the personal and familial impacts of having predictive genetic testing for glaucoma, which will help health professionals to better address the issues faced by patients and provide them adequate support.Genet Med 16 7, 558–563.

Co-expression of a scFv antibody fragment and a reporter protein using lentiviral shuttle plasmid containing a self-processing furin-2A sequence.

It is often desirable to co-express a reporter protein with a potential therapeutic protein, to verify correct targeting of an expression strategy. Vectors containing a viral self-processing 2A sequence have been reported to drive equimolar expression of two or more transgenes from a single promoter. Here, we report on the co-expression of a secreted antibody fragment and an intracellular reporter protein, enhanced yellow fluorescent protein from lentiviral shuttle plasmids by inserting a furin-2A (F2A) sequence between the two cDNAs, in two different orientations, in the expression cassette. We show that the order of these two transgenes relative to the F2A sequence affects expression levels. Reduced expression of each transgene positioned downstream of F2A, compared with upstream of F2A, was observed (p<0.05). Moreover, protein expression from double-cDNA plasmids was significantly lower than from their corresponding single transgene counterparts (p<0.05).

The influence of Australian eye banking practices on corneal graft survival

Objective: To identify eye banking practices that influence corneal graft survival.

E-Mental health in South Australia: Impact of age, gender and region of residence

Respondents to the 2008 South Australian Health Omnibus survey (n=2996) indicated whether, in the previous 12 months, they had searched for information on the Internet relating to emotional issues such as depression, anxiety or relationship problems. Logistic regression was used to examine the penetration of e-mental health in rural and metropolitan areas (region of residence), and determine if other demographic variables (age group, gender) also impacted on the likelihood of an individual reporting that they had used the Internet to obtain such information. Overall, 9% of respondents reported that they had used the Internet for this purpose. The multivariate model was significant, F(11, 2985)=4.82, P<0.0001, with middle-aged rural females most likely to report doing so (18.1%), whereas older rural males were least likely to report doing so (2.2.%). These findings have important implications for the design of e-mental health promotional programs that provide information and interventions to improve mental health.

Comparison of Ishihara and Hardy-Rand-Rittler Pseudoisochromatic Plates in Non-Arteritic Anterior Ischaemic Optic Neuropathy

Pseudoisochromatic plates, such as Ishihara and Hardy-Rand-Rittler (HRR) tests, are designed as screening tools to test colour vision defects. The tests are often designed to detect congenital red-green colour blindness and their measurement properties for acquired optic neuropathies are not known. The aim of this study is to determine the sensitivity and specificity of Ishihara and HRR pseudoisochromatic plates in detecting dyschromatopsia in patients with unilateral non-arteritic anterior ischaemic optic neuropathy. Nineteen such patients were tested using Ishihara and the HRR plates in the affected and the unaffected (control) eye. The results were correlated to that on an anomaloscope (Oculus HMC Anomaloskop MR®). Mild deuteranomaly was the dyschromatopsia detected by an anomaloscope in the affected eye of the patients. The sensitivity and specificity of the Ishihara test in the affected eyes are 75% and 40%, respectively. The sensitivity and specificity of the HRR test in eyes affected with non-arteritic anterior ischaemic optic neuropathy are 100% and 20%, respectively. It is concluded that the anomaloscope that was considered the “gold standard” has several limitations and may not detect all acquired dyschromatopia. On the other hand, whilst it is correct that pseudoisochromatic plates are screening tests and the results must be correlated with other optic nerve functions, the HRR test has a higher sensitivity and specificity than Ishihara colour plates in detecting dyschromatopsia in non-arteritic anterior ischaemic optic neuropathy eyes.

Is there evidence for a surgeon learning curve for endothelial keratoplasty in Australia

Expected outcomes from endokeratoplasty may vary with surgeon experience.

Penetrating keratoplasty versus deep anterior lamellar keratoplasty for treating keratoconus

This is the protocol for a review and there is no abstract. The objectives are as follows: To compare visual outcomes after penetrating keratoplasty and DALK for keratoconus and identify the factors contributing to poor outcomes. 1 Penetrating keratoplasty versus deep anterior lamellar keratoplasty for treating keratoconus (Protocol) Copyright