Shane R. Durkin

The prevalence, severity and risk factors for pterygium in central Myanmar: the Meiktila Eye Study.

Aims: To determine the prevalence, severity and risk factors associated with pterygium in adults in central Myanmar. Methods: Population-based, cross-sectional survey of the people 40 years and over residing in rural Myanmar. Pterygium was graded for severity (T1 to T3) by visibility of episcleral vessels, and the apical extent was recorded. An autorefractor was used to measure refractive error. Results: There were 2481 subjects identified, and 2076 (83.7%) participated. The prevalence of pterygium in either eye was 19.6% (95% confidence interval (CI) 16.9 to 22.2) and of bilateral pterygium 8.0% (95% CI 7.7 to 8.3). Outdoor occupation was an independent predictor of pterygium (p<0.01). The mean apical extent from the limbus was 2.2 mm (95% CI 2.05 to 2.35). Higher-grade pterygia did not have a significantly greater apical extent (p = 0.35). The presence of pterygium was associated with astigmatism, (p = 0.01), and the amount of astigmatism increased as both the severity (p<0.01) and apical extent increased (p<0.01). Two people of the 84 people blinded in both eyes were bilaterally blind from pterygium (1.7%; 95% CI 0.2 to 6.1), and pterygium accounted for 2.2% (95% CI 0.7 to 5.0) of blindness in at least one eye. No participant had low vision in both eyes due to pterygium, but pterygium led to 0.8% (95% CI 0.3 to 1.6) of low vision in at least one eye. Pterygium was therefore associated with 0.4% (95% CI 0.04 to 1.3) of binocular visual impairment and 1.0% (95% CI 0.6 to 1.8) of visual impairment in a least one eye. Conclusions: There is a high prevalence of pterygium in central Myanmar, and the risk of developing this condition increases with outdoor occupation. Pterygium in this population is associated with considerable visual morbidity, including blindness.

Prevalence of refractive errors in a Brazilian population: the Botucatu eye study.

Purpose: To determine the prevalence and demographic associations of refractive error in Botucatu, Brazil.Methods: A population-based, cross-sectional prevalence study was conducted, which involved random, household cluster sampling of an urban Brazilian population in Botucatu. There were 3000 individuals aged 1 to 91 years (mean 38.3) who were eligible to participate in the study. Refractive error measurements were obtained by objective refraction.Results: Objective refractive error examinations were performed on 2454 residents within this sample (81.8% of eligible participants). The mean age was 38 years (standard deviation (SD) 20.8 years, Range 1 to 91) and females comprised 57.5% of the study population. Myopia (spherical equivalent (SE) < − 0.5 dropters (D)) was most prevalent among those aged 30–39 years (29.7%; 95% confidence interval (CI) 24.8–35.1) and least prevalent among children under 10 years (3.8%; 95% confidence interval (CI) 1.6–7.3). Conversely hypermetropia (SE > 0.5D) was most prevalent among participants under 10 years (86.9%; 95% CI 81.6–91.1) and least prevalent in the fourth decade (32.5%; 95% CI 28.2–37.0). Participants aged 70 years or older bore the largest burden of astigmatism (cylinder at least −0.5D) and anisometropia (difference in SE of > 0.5D) with a prevalence of 71.7% (95% CI 64.8–78.0) 55.0% (95% CI 47.6–62.2) respectively. Myopia and hypermetropia were significantly associated with age in a bimodal manner (P < 0.001), whereas anisometropia and astigmatism increased in line with age (P < 0.001). Multivariate modeling confirmed age-related risk factors for refractive error and revealed several gender, occupation and ethnic-related risk factors. Conclusions: These results represent previously unreported data on refractive error within this Brazilian population. They signal a need to continue to screen for refractive error within this population and to ensure that people have adequate access to optical correction.

Prevalence and causes of visual impairment in a Brazilian population: The Botucatu Eye Study

BackgroundThis paper reports population-based data on the prevalence and causes of visual impairment among children and adults in Botucatu, Brazil.MethodsA population-based cross-sectional study was conducted involving a random start point and then systematic sampling of an urban Brazilian population in the city of Botucatu. There were approximately 3 300 individuals aged 1 to 91 years who were eligible to participate in the study. Of this sample, 2485 (75.3%) underwent ophthalmic examination. The ophthalmic examination included uncorrected (presenting) and best corrected distance visual acuity using standardized protocols. The primary cause of decreased visual acuity was identified for all patients with visual impairment.ResultsPresenting low vision and presenting blindness were found in 5.2% (95% CI: 4.3–6.1) and 2.2% (95% CI: 1.6–2.8) of the population, respectively. Unilateral presenting low vision and unilateral presenting blindness were found in 8.3% (95% CI: 7.2–9.5) and 3.7% (95% CI: 2.9–4.4) of the population respectively. Best corrected low vision was found in 1.3% of the population (95% CI: 0.9–1.7) and best corrected blindness was discovered in 0.4% of people (95% CI: 0.2–0.7). The main cause of presenting low vision was refractive error (72.3%) and cataract was the most prevalent cause of blindness (50%).ConclusionThe main causes of low vision and blindness in this Brazilian city were uncorrected refractive errors, cataract, and retinal diseases. Programs to further reduce the burden of visual impairment need to be targeted toward the correction of refractive error and surgery for cataracts.

Prevalence of trachoma and diabetes-related eye disease among a cohort of adult Aboriginal patients screened over the period 1999-2004 in remote South Australia.

Background:  To determine the prevalence of trachoma and diabetes‐related eye disease within the adult Aboriginal population screened by the South Australian Eye Health Program between 1999 and 2004 inclusive.

Biochemical analysis of the living human vitreous.

To date, our understanding of the biochemical composition of the living human vitreous relies on extrapolations from animal or human post‐mortem studies.

Central corneal thickness among Aboriginal people attending eye clinics in remote South Australia

Purpose:  To determine the central corneal thickness (CCT) and its demographic associations among Aboriginal people attending eye clinics in remote South Australia.

Distance refractive error among Aboriginal people attending eye clinics in remote South Australia

Purpose:  To determine the prevalence of distance refractive error among Aboriginal people attending eye clinics in remote South Australia.

Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature

PURPOSE To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. DESIGN Multicenter retrospective case series. PARTICIPANTS All patients receiving intravitreal injections from 7 retinal specialists. METHODS An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. MAIN OUTCOME MEASURES Incidence of endophthalmitis after intravitreal injections. RESULTS A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. CONCLUSIONS Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.

Successful treatment of phaeohyphomycotic keratitis caused by Bipolaris australiensis

1. Denk P, Kretschman U, Gonzalez J, Gelisken F, Knorr M. Phototoxic maculopathy after arc welding: value of multifocal ERG. Klin Monatsbl Augenheilkd 1997; 211: 207–10. 2. Lucas R, Harper A, McCombe M, Mainster M, Silney D, Zamir E. Optical coherence tomography findings in welder’s maculopathy. Retin Cases Brief Rep 2007; 1: 169–71. 3. Karp K, Flood T, Wilder A, Epstein R. Photic maculopathy after pterygium excision. Am J Ophthalmol 1999; 129: 422. 4. Ruiz-del-Rio N, Moriche-Carretero M, Ortega-Canales I, Revilla-Amores R, Peralta-Calvo J. Photic maculopathy and iris damage in a psychotic patient. Arch Soc Esp Oftalmol 2006; 81: 165–8. 5. Maier R, Heilig P, Winker R, Neudorfer B, Hoeranter R, Ruediger H. Welder’s maculopathy? Int Arch Occup Environ Health 2005; 78: 681–5. 6. Jorge R, Costa R, Quirino L et al. Optical coherence tomography findings in patients with late solar retinopathy. Am J Ophthalmol 2004; 137: 1139–42. 7. Magnavita N. Photoretinitis: an underestimated occupational injury? Occup Med 2002; 52: 223–25. 8. Steinberg E, Tielsch J, Schein O, Javitt J, Sharkey P, Cassard S. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol 1994; 112: 630–38. 9. Stokkermans T, Dunbar M. Solar retinopathy in a hospitalbased primary care clinic. J Am Optom Assoc 1998; 69: 625–36. 10. American Medical Association. AMA Guides to the Evaluation of Permanent Impairment, 4th edn. Chicago: AMA Press, 1995. Successful treatment of phaeohyphomycotic keratitis caused by Bipolaris australiensis

Aboriginal versus non‐Aboriginal ophthalmic disease: admission characteristics at the Royal Adelaide Hospital

Background:  The purpose of the study is to compare characteristics of Aboriginal patient hospital admissions with non‐Aboriginal admissions to the Ophthalmology Unit of the Royal Adelaide Hospital.