Roshini Sanders

Eye disease associated with handling pet tarantulas: three case reports

Tarantulas are becoming increasingly popular as pets. They are widely available, easily maintained, and considered harmless as many are non-venomous. Unfortunately the popular American varieties that are less venomous have evolved highly urticarious hairs to leave on their webs and flick at predators. We describe three cases of ocular injury from urticarious hairs of tarantulas. All three patients presented with complaints of itchy, gritty, red eyes. Two patients associated the onset of symptoms with the handling of a tarantula, and the third case was recognised only by astute history taking. Initially a similar clinical picture was seen in the three patients. The main findings were of multiple fine intracorneal hairs with an associated keratoconjunctivitis. In all three patients the right eye was more affected than the left; …

Optometric and ophthalmic contact in elderly hip fracture patients with visual impairment

Aim:  To describe previous contact with optometry and ophthalmic services in a group of elderly patients with and without visual impairment (VI) who had fallen and sustained a fractured neck of femur.

Marginal keratitis: an uncommon form of topical dorzolamide allergy

PURPOSE To report a case of marginal keratitis resulting from topical dorzolamide hypersensitivity. METHOD Case report. RESULTS A 68-year-old woman presented with bilateral marginal keratitis 2 weeks after commencing bilateral topical dorzolamide. One week after discontinuation of topical dorzolamide, the patient was asymptomatic with complete resolution of corneal infiltrates. CONCLUSIONS Topical dorzolamide may cause a hypersensitivity reaction in the form of marginal keratitis. Discontinuation of the offending medication should result in complete resolution.

Ten years of glaucoma blindness in Fife 1990–99 and the implications for ophthalmology, optometry and rehabilitation services*

The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty‐five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one‐third of patients had a hearing impairment. One‐third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.

External validation of the OHTS-EGPS model for predicting the 5-year risk of open-angle glaucoma in ocular hypertensives

Aims To independently evaluate and compare the performance of the Ocular Hypertension Treatment Study-European Glaucoma Prevention Study (OHTS-EGPS) prediction equation for estimating the 5-year risk of open-angle glaucoma (OAG) in four cohorts of adults with ocular hypertension. Methods Data from two randomised controlled trials and two observational studies were analysed individually to assess transferability of the prediction equation between different geographical locations and settings. To make best use of the data and to avoid bias, missing predictor values were imputed using multivariate imputation by chained equations. Using the OHTS-EGPS risk prediction equation, predicted risk was calculated for each patient in each cohort. We used the c-index, calibration plot and calibration slope to evaluate predictive ability of the equation. Results Analyses were based on 393, 298, 188 and 159 patients for the Rotterdam, Moorfields, Dunfermline, and Nottingham cohorts, respectively. The discriminative ability was good, with c-indices between 0.69 and 0.83. In calibration analyses, the risk of OAG was generally overestimated, although for the Rotterdam cohort the calibration slope was close to 1 (1.09, 95% CI 0.72 to 1.46), the ideal value when there is perfect agreement between predicted and observed risks. Conclusions The OHTS-EGPS risk prediction equation has predictive utility, but further validation in a population-based setting is needed.

Glaucoma blind registration in Fife (2000-2009) - a retrospective cohort study.

Citation information: O’Colmain U, Anijeet D, Vosoughi M, Sinclair A & Sanders R. Glaucoma blind registration in Fife (2000–2009) – a retrospective cohort study. Ophthalmic Physiol Opt 2011, 31, 360–366. doi: 10.1111/j.1475‐1313.2011.00849.x

Trends in Acute Primary Angle-Closure Glaucoma, Peripheral Iridotomy and Cataract Surgery in Scotland, 1998–2012

ABSTRACT Purpose: We present rates of acute primary angle-closure glaucoma (APACG), peripheral iridotomy (PI) and cataract surgery in Scotland between 1998 and 2012. Methods: The number of patients in Scotland with APACG in each of the years between 1998 and 2012 was obtained from Information Service Division (ISD) Scotland. Data was also obtained for patients who had undergone laser PI and cataract surgery. The annual rates of APACG, PI and cataract surgery were calculated using Scotland’s population data during each of these years. Results: Between 1998 and 2012 the rate of APACG in National Health Service patients decreased by 46.4% (from 46.7 to 25.0 per million, p < 0.005). The rate of PI increased overall by 116.3% (from 38.0 to 82.2 per million), but demonstrated a decrease of 48.2% (38.0 to 19.7 per million, p = 0.002) between 1998 and 2008, and an increase of 317.3% (19.7 to 82.2 per million, p = 0.005) between 2008 and 2012. Over the same 15-year period, cataract surgery increased by 73.4% (from 354.2 to 615.2 per 100,000, p < 0.005). In this timeframe, mid-year Scottish population estimates increased by 4.6%. Conclusion: Our results demonstrate a significant reduction in the rate of APACG in the Scottish population between 1998 and 2012, along with a rising rate of PI and cataract surgery. The trend of decreasing APACG may be due to the increasing rate of cataract surgery in the same time period. This parallels patterns seen in other European countries. We discuss these findings together with other related epidemiological factors.

Patient profile and management in advanced glaucoma

Purpose: to study patient characteristics and management profile in advanced glaucoma. Method: A retrospective study of 87 case notes of patients registered blind due to glaucoma, and cross-sectional interview of 29 patients. Results: advanced glaucoma at presentation was documented in 43 cases (49%). Insufficient optometry assessment was significantly associated with advanced disease (p = 0.0339). Normal tension glaucoma patients were significantly more likely to present with advanced disease compared to other types of glaucoma (p = 0.0034). Poor compliance with medication was significantly higher in those with hearing loss (p = 0.0168). Patients with advanced field defect at presentation and those with poor compliance had significantly higher social deprivation scores compared to others on the blind register (p < 0.0001). Nine (10%) patients had partial registration before full registration and 29 (33%) patients had late registration. Of the 29 patients interviewed, 20 (69%) did not demonstrate basic knowledge regarding their disease or its management; nor had they received written information on glaucoma or instructions on drop technique. Conclusion: Special care pathways are required in advanced glaucoma taking into account co-existent morbidity, disease education and compliance.

Advanced glaucomatous visual loss and oral steroids

Blindness induced by glaucoma is a serious but preventable side effect of long term, high dose steroids

Iris prolapse in small incision cataract surgery

Iris prolapse is a rare complication after small incision cataract surgery. We looked at the possible operative and perioperative factors that might have contributed to this complication in 2 of our patients and in another 10 patients identified through a national questionnaire survey. The details of 12 cases of iris prolapse following small incision cataract surgery are presented. Since iris prolapse may occur in small incision cataract surgery, notably in the presence of certain predisposing factors, extra diligence is required in wound construction and closure in high-risk patients.