Australian and New Zealand Journal of Ophthalmology (Aust New Zeal J Ophthalmol)

Publications in this journal

• Article: Different faces of the white cataract: A phaco surgeon’s perspective

  Surendra Basti
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  ABSTRACT: Purpose: To develop a system of categorizing white cataracts so that the salient features, as would be pertinent to phacoemulsification surgery, could be recognized pre-operatively.Methods: Patients with total cataracts were carefully evaluated using slit-lamp biomicroscopy and slit-lamp photography. An attempt was made to determine whether pre-operative evaluation could ascertain the presence or absence of features of these cataracts that often cause surgical difficulties, namely, increased intralenticular pressure (ILP), milky cortex and brown nuclear colour.Results: Using a standardized method of biomicroscopic evaluation, it was found that the status of the ILP, cortex and nuclear colour could be determined consistently. Surgical strategies based on such a system of categorization has permitted white cataracts to be consistently managed using phacoemulsification.Conclusions: Systematic pre-operative evaluation and categorization of white cataracts based on the ILP, status of the cortex and nuclear colour can permit proper surgical planning and successful management of such cases with phacoemulsification.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(1):53 - 56.
• Article: Posterior uveitis in Hodgkin’s disease

  H Towler, M De La Fuente, S Lightman
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  ABSTRACT: Purpose: To describe the features of posterior uveitis in patients who either developed or were known to have, biopsy-proven Hodgkin’s disease (HD).Methods: Four patients were identified who were attending the uveitis clinic. Their charts were reviewed retrospectively and information on their HD was obtained from other hospitals where necessary. Their case histories are presented.Results: Two patients presented with uveitis prior to the diagnosis of HD and in the other two, the HD was thought to be in remission. The commonest ocular signs were of vitritis and discrete, white, chorioretinal lesions. No difference in the ocular findings were apparent between those who had a known diagnosis of HD and the those that did not.Conclusions: HD can occur in the eye and can mimic posterior uveitis. In two of the patients, the uveitis preceded the diagnosis of HD and at the time of presentation all investigations were normal. No specific diagnostic features were apparent, though three of the patients had vitritis and chorioretinal lesions.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(5):326 - 330.
• Article: Localization of IgG in the normal and dystrophic rat retina after laser lesions*

  PhD Yi Chu MD, Valerie A Alder PhD, Martin F Humphrey PhD, Ian J Constable MB, BS, FRACO, FRACS
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  ABSTRACT: Purpose: To test the hypothesis that access to extravasated plasma protein IgG may influence photoreceptor survival following laser photocoagulation and to determine whether this correlates with the retinal glial reaction.Methods: A total of 45 rats (18 Royal College of Surgeons (RCS) dystrophic and 18 RCS-rdy+ congenic control) were used for this experiment. Nine non-lasered littermates of same age were used as controls. The superior retinas of postnatal day 23 rats were irradiated with a grid pattern of 40 argon green laser lesions of 50 μm in diameter and two powers (150 and 300 mW) for 0.2 s. At various times after laser lesions (up to 14 days), animals were perfused, the retinas snap frozen and sectioned on a cryostat. A one-step immunohistochemical technique was used by incubating with rabbit anti-rat IgG conjugated directly to horseradish peroxidase. Adjacent sections were processed using an antibody to glial fibrillary acidic protein (GFAP) by the standard avidin–biotin complex method.Results: The labelling pattern for extravasated IgG after laser lesion was very similar in both RCS and RCS-rdy+ rat retinas. At 6, 12 and 24 h after lesions, IgG immunoreactivity (IR) was very intense in the lesion core and flanks. The outer plexiform layer (OPL) and photoreceptor inner segments provided a ready pathway for lateral spread of IgG. However, in the outer nuclear layer (ONL), IgG localization was much more restricted. Despite very intense IgG IR in the ONL of the coagulated lesion core, there was always a very sharply delineated boundary where the label abruptly halted. The GFAP labelling in both RCS dystrophic and RCS-rdy+ congenic control rat retinas showed that this boundary was between normal and necrotic cells because there was a core where GFAP was not produced by Müller cells. By 2 days after lesions, the coagulated cells in the lesion core were being removed by phagocytic cells that were IgG IR. Labelled phagocytic cells were also found among the inner and outer segment region on the lesion flanks. There was still IgG IR in the lesion, but the label was faint. No IgG IR was found in the retina at 3, 4, 7 and 14 days after lesions. Absorption control with pure rat IgG showed the label to be specific.Conclusions: The extravasated IgG was derived from the choroidal circulation because at no stage was IgG localized around the retinal vasculature. The IgG labelling was surprisingly widespread and, therefore, did not correlate with photoreceptor sparing, although it preceded the widespread Müller cell expression of GFAP and may, therefore, trigger glial reaction.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(2):117 - 125.
• Article: Baseline ophthalmic findings in the Vitamin E, Cataract and Age‐Related Maculopathy (VECAT) study

  L D Robman PhD, G Tikellis GradDip, S K M Garrett BapplSc, C A Harper Fraco, J J McNeil Fracp, H R Taylor Fraco, C A McCarty PhD
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  ABSTRACT: Purpose: To describe the methodology of eye examination and the baseline eye characteristics of the Vitamin E, Cataract and Age-Related Maculopathy (VECAT) study participants.Methods: A sample of volunteers from an urban area of Melbourne, Australia, were recruited to participate in a randomized, controlled trial investigating the effect of vitamin E on the development of cataract and age-related maculopathy. Standardized eye examinations involved clinical assessment, which included Wilmer grading of the lens, digital photography of the lens with Nidek EAS-1000 lens camera and stereo photography of the macular area with the Nidek 3-DX fundus camera. All cases of ophthalmic findings were determined on the basis of pathology in the worse eye.Results: Most eyes were free from abnormalities. The most frequent findings were cataract and age-related macular changes. Nuclear cataract (nuclear opacity grade ≥2) was present in 4.5%, cortical cataract (cortical opacity grade ≥2) in 14.3% and posterior subcapsular cataract in 3.0% of participants; in addition, coronary cataract was observed in 13.6%. Soft drusen larger than 125 μm were found in 11.4%, retinal pigment epithelium changes in 9.5%, epiretinal membrane in 6.6% and age-related macular degeneration in 0.5% of participants.Summary: Due to the selection criteria, the majority of participants had clear or minor lens changes and/or minor retinal age-related changes. Precise instrumental documentation will allow an accurate assessment of the incidence and dynamics of these changes throughout 4 years of observation.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(6):410 - 416.
• Article: Vision impairment and handicap: The RVIB Employment Survey

  Suzie E Wright BA, Cathy A McCarty PhD, Mary Burgess, Jill E Keeffe PhD, The Steering Committee for the RVIB Employment Survey
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  ABSTRACT: Purpose: The purpose of this study was to examine the association between type of vision impairment and disability and the handicap or impact of vision loss on functioning.Methods: Participants were interviewed for the Royal Victorian Institute for the Blind Employment Survey, and asked to self-report whether totally blind or not (vision impaired). Causes of visual impairment were also reported. Eyesight was rated on a scale from 0 (completely blind) to 10 (best possible eyesight). Difficulty with mobility, personal care, household activities, work and hobbies and social interactions were also rated. Participants with vision impairment also rated their level of disability in reading and seeing other people’s reactions using the same scale.Results: Of the 250 participants, 39 self-reported total blindness. Participants with vision impairment experienced greater levels of difficulty in almost all areas than people who self-reported total blindness. People with vision impairment due to glaucoma and macular degeneration reported significantly more difficulty with reading newspapers, while there was a borderline significant relationship between difficulty with seeing people’s reactions and macular degeneration.Conclusions: In summary, we found that difficulty associated with everyday tasks was greater than might be expected from self-report of vision. This study confirms the need for visual function tools to supplement the use of objective visual acuity measurements in people with vision impairment.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(3‐4):204 - 207.
• Source

  Available from: psychology.adelaide.edu.au

  Article: Determining the visibility of noise in motion signals

  Nicholas R Burns, Johannes M Zanker
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  ABSTRACT: A procedure is described for generating stimuli to study the detection of noise components in motion signals. By using random dots with intensities distributed according to a Gaussian probability function, a temporally and spatially continuous mixture of signal and noise components can be realized in random dot kinematograms. These stimuli were used in a noise detection task, a signal detection task and a direction discrimination task. Signal-to-noise ratio (‘coherence’) thresholds for the signal detection and direction discrimination tasks were consistent with previous research. Noise can be detected at levels of approximately 0.5–2.5%, depending on the size of the motion stimulus. We argue that the noise in the motion stimulus becomes detectable when it exceeds the noise intrinsic to the various stages of motion processing. Therefore, the method provides a simple procedure for obtaining measures of equivalent input noise and can be used for estimating internal noise levels of motion processing mechanisms.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(3‐4):254 - 257.
• Article: Global form perception: interactions between luminance and texture information

  Rick Van Der Zwan PhD, David R Badcock DPhil, Brent Parkin BSc(Hons
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  ABSTRACT: Purpose: This experiment reports the independence of first- and second-order processing mechanisms in form perception.Methods: Symmetrical dot patterns were created using either luminance-increment dots (luminance above background), or texture-defined dots (average luminance equal to background). The proportion of luminance increment or texture dots defining each pattern was varied among fields of noise dots of the same type to determine symmetry detection thresholds.Results: Differences in detection thresholds were found between luminance- and texture-defined patterns. Further, symmetry detection thresholds for luminance-increment dot patterns were resistant to noise defined by dots of opposite contrast polarity (luminance-decrement dots) or texture, while texture-defined patterns were resistant to neither texture nor luminance-decrement noise.Conclusions: These data suggest that symmetry perception, along with other types of form perception, use both first- and second-order processing mechanisms. The data are compatible with a second-order system that includes a negative half-wave rectifying non-linearity.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(3‐4):268 - 270.
• Article: In vitro potency and stability of fortified ophthalmic antibiotics

  Mustafa Kemal Arıcı Md, Zeynep Sümer Md, Cenap Güler Md, Orhan Elibol Md, Gülendame Saygı PhD, Salih Çetinkaya PhD
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  ABSTRACT: Purpose: This study evaluates the in vitro potency, stability and contamination of the fortified ophthalmic antibiotic preparations of cefazolin, vancomycin, gentamicin and tobramycin stored for 4 weeks. The effects of the different solvents and storage temperatures on the antimicrobial potency and stability were also examined.Methods: The fortified stock solution of cefazolin and vancomycin were prepared by reconstituting with 0.9% sodium chloride and with artificial tears. Gentamicin and tobramycin were prepared by adding parenteral forms into their commercial ophthalmic solutions. The antimicrobial potency was measured by the minimum bactericidal concentration for cefazolin (33.3 mg/mL) and vancomycin (31 mg/mL) against Staphylococcus aureus, and for tobramycin (13.5 mg/mL) and gentamicin (13.5 mg/mL) against Pseudomonas aeruginosa. The stability of solution was evaluated by measuring absorbance spectra and pH. During the study period the levels of contamination of the stock solutions were examined by culturing on blood and on Sabouraud-dextrose media.Results: There were no differences in the antimicrobial potency of the cefazolin, vancomycin and tobramycin within the 4-week period; however, the potency of gentamicin was decreased at both temperatures after 21 days. It was found that different solvents or storage temperatures had no effect on the potency. Throughout the 4-week period, no change was found in the absorbance spectra of gentamicin and tobramycin, whereas the absorbance spectra of cefazolin and vancomycin stored at 24°C increased in both of the solvents used (P < 0.05). In all of the antibiotics, pH changed at 24°C after 7–10 days; however, at 4°C, only the pH of tobramycin exhibited changes after 14 days (P < 0.05). No contamination was detected in the stock solutions during the study period.Conclusion: Topical fortified antibiotic solutions used for longer than 7 days should be stored at ≤ 4°C, those stored at 24°C should be discarded after 7 days.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(6):426 - 430.
• Article: Generation and characterization of a recombinant adenovirus expressing vascular endothelial growth factor for studies of neovascularization in the eye

  Meaghan J T Yu BSc, Wei-Yong Shen MDS, May C Lai PhD, Ian J Constable FRACO, Piroska E Rakoczy PhD
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  ABSTRACT: There is accumulating evidence that an increased expression of vascular endothelial growth factor from retinal pigment epithelial cells may be important in choroidal neovascularization. In vivo studies have demonstrated that subretinal injection of recombinant adenovirus vectors produces long-term transgene expression specifically within retinal pigment epithelial cells. A recombinant adenovirus encoding of vascular endothelial growth factor (Ad.RSV.VEGF) was therefore produced and characterized in order to determine whether an upregulation of vascular endothelial growth factor expression is sufficient to induce choroidal neovascularization. Ad.RSV.VEGF was produced by homologous recombination and its identity confirmed by restriction enzyme analysis. Ad.RSV.VEGF was characterized in vitro by the transduction of cultured retinal pigment epithelial cells. The in vitro characterization confirmed vascular endothelial growth factor mRNA and protein expression from Ad.RSV.VEGF and demonstrated the biological activity of the vascular endothelial growth factor protein. A preliminary in vivo study suggested that the subretinal injection of Ad.RSV.VEGF induced vascular leakage.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(3‐4):250 - 253.
• Article: Carrots, carotene and seeing in the dark

  Wayne Smith FAFPHM, Paul Mitchell FRACO, Ross Lazarus FAFPHM
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  ABSTRACT: Should older people eat more carrots, or at least increase their carotene intake to prevent loss of night vision? Participants in the Blue Mountains Eye Study were asked about their ability to see in the dark. Nutrient and food intake were estimated from a food frequency questionnaire. Associations between self-reported poor night vision and estimated nutrient intake were investigated using logistic regression. Poor night vision among women was associated with higher beta-carotene (P for trend = 0.03) and total vitamin A intake (P for trend = 0.048). Increased consumption of carrots, but no other food high in beta-carotene, was associated with significant increased reporting of poor night vision among women (P for trend = 0.04). While carrot intake may protect against difficulty in seeing at night, it is probable that people attributing poor driving ability to their vision may be eating more carrots in the hope of reversing this decline.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(3‐4):200 - 203.
• Article: Diabetic retinopathy and nephropathy in Fiji: Comparison with data from an Australian diabetes centre

  Belinda Brooks RN, BS Robert Chong MB, BS Ivan Ho MB, Fiona Capstick RN, Lynda Molyneaux RN, Than T Oo MD, Malcolm Tester FRACO, And Dennis Yue FRACP
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  ABSTRACT: Background: As part of a project to improve diabetes care in Fiji, we assessed the magnitude of problems posed by diabetic retinopathy in that country and compared the findings with those from an Australian diabetes centre. The relationship between diabetic retinopathy and nephropathy was also examined in a subset of patients.Methods: A medical team from Australia screened a total of 446 type 2 diabetic patients (ethnicity: Fijian/Indian 16/84%) for diabetic retinopathy in five towns from the Western Division of Viti Levu, Fiji. The findings were compared with data obtained from 1659 type 2 diabetic patients who had attended an Australian diabetes centre (ethnicity: Indian/ Anglo-Celtic 12/88%). In both cohorts, retinopathy was assessed by direct fundoscopy and a spot urine sample was collected for determination of albuminuria (defined as a concentration > 50 mg/L).Results: The prevalence of diabetic retinopathy increased linearly with duration of diabetes. It was higher in Fiji, even when cases from the same ethnicity (i.e. Indians) and duration were compared (P < 0.05). Extrapolation of the data points suggests a delay in the diagnosis of diabetes in Fiji. Of those patients with retinopathy in Fiji, more than half had moderate to severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy, significantly higher than patients in the Australian cohort (χ2 = 29.2; P < 0.0001). Retinopathy was not a predictor of albuminuria in Fijian Indians (χ2 = 0.4; P = 0.5). In contrast, Australian Indians with retinopathy had significantly more albuminuria (χ2 = 10.2; P = 0.001).Conclusions: Severe diabetic retinopathy is common in both ethnic groups in Fiji. A delay in the diagnosis of diabetes as well as poor glycaemic control are possible factors. The availability of laser therapy is important to prevent loss of vision, but it is also essential that appropriate training of health professionals is integrated with a programme of diabetic complication screening to support this form of therapy.
  Australian and New Zealand Journal of Ophthalmology 07/2008; 27(1):9 - 13.
• Article: Antineutrophil cytoplasmic antibody in uveitis and scleritis

  FRACS Richard A. D. Mills FRACO, Tarun S. Weeramanthri MB BS, Peter N. Hollingsworth D.Phil, FRACP, FRCPA, FRACS Richard L. Cooper FRACO
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  ABSTRACT: We report a case where the detection of antineutrophil cytoplasmic antibody (ANCA) at the time of diagnosis of a case of sclero-uveitis predicted the later development of systemic features and prompted an early and definitive diagnosis of systemic vasculitis.
  Australian and New Zealand Journal of Ophthalmology 06/2008; 19(1):71 - 73.
• Article: Fungi and eyelashes

  FRCS Frank P. English FRACO, W. Barnes PhD, Guang Wen Zhang MD, PhD Don P. McManus BSc, LT Phillip Campbell ADC
  Australian and New Zealand Journal of Ophthalmology 06/2008; 19(1):89 - 90.
• Article: Cytomegalovirus retinopathy and the immune deficiency syndrome: Results of treatment with ganciclovir

  Peter McCluskey MB BS, FRACO, FRACS, Denis Wakefield MD, FRACP, FRCPA, FRACO Mark Morgan MB BS, FRACO Ron Binneter MB BS
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  ABSTRACT: Cytomegalovirus (CMV) infection of the retina is the commonest potentially blinding ocular manifestation of AIDS. Recently the acyclic nucleoside dihydroxypropoxymethyl guanine (DHPG, ganciclovir) has become available to treat sight-threatening CMV retinopathy. This paper reports the clinical features and results of ganciclovir therapy in 48 patients seen over a four-year period. Seven patients were excluded from the study due to inadequate followup, leaving 41 patients as the study group. All patients responded clinically to this therapy. Patients were treated initially with high-dose ganciclovir (1 0 mglkglday) and then continued on lower dose treatment (5 mg/kg/day) indefinitely. Significant bone marrow toxicity developed in 12 patients (29.3%) requiring temporary cessation of therapy. Patients treated with ganciclovir retained vision and had increased survival times when compared to untreated patients. A poor visual outcome occurred when there was involvement of the macula or optic acquired nerve head at presentation or when there was an interruption of ganciclovir therapy.
  Australian and New Zealand Journal of Ophthalmology 06/2008; 18(4):385 - 391.
• Article: Council Lecture

  B. D. Coote FRACO
  Australian and New Zealand Journal of Ophthalmology 06/2008; 19(1):3 - 7.
• Article: MITRAL VALVE PROLAPSE AND RETINAL INFARCTION

  ANDREW HOPKINS mb, bs, fracp, JOHN YlANNlKAS mb, bs, fracp, fraco IAN C. FRANCIS fracs
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  ABSTRACT: Several neurological syndromes, including syncope, convulsions, amnesia, transient ischaemic attacks and cerebral infarction, have been associate with mitral valve prolapse. It has been presumed that emboli may account for some of these. We report a case of retinal infarction in association with mitral valve prolapse.
  Australian and New Zealand Journal of Ophthalmology 06/2008; 15(1):79 - 82.
• Article: Vogt Koyanagi Harada disease

  Ronald Lowe
  Australian and New Zealand Journal of Ophthalmology 06/2008; 18(4):437 - 437.
• Article: Spontaneous arteriovenous shunts of the cavernous sinus—ophthalmological considerations

  G. M. Halmagyi MB BS, FSc(Med), FRACP, FRACR J. M. Hallinan MB BS, V. S. Grinnell MD
  Australian and New Zealand Journal of Ophthalmology 11/2007; 17(4):439 - 443.
• Article: Screening for congenital colour vision defects

  R Littlewood FRACO, F Hyde
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  ABSTRACT: A prospective comparison between the Ohkuma1 and Ishihara2 pseudoisochromatic (PIC) plates was carried out in a group of 400 patients attending a general ophthalmology practice. The sensitivity of the Ohkuma test was compared to the Ishihara test, and the specificity of both was determined by reference to anomaloscopy as a gold standard.Both tests correctly identified the same group of 24 patients as having a red/green confusion axis, and the Ohkuma test was equally as sensitive as the Ishihara. The grading plates in both tests are unreliable, but the Ohkuma test is quicker, easier to administer, gives less ambiguous responses and has a clearer cut-off score for abnormality. On the basis of this experience the Ohkuma test is recommended as more appropriate for routine colour vision screening than either the 24 or 38 plate Ishihara tests.
  Australian and New Zealand Journal of Ophthalmology 11/2007; 21(1):31 - 35.
• Article: The role of botulinurn toxin in third nerve palsy

  FRACS Nick Saad FRACO, John Lee FRCS, FCOphth, MRCP
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  ABSTRACT: Isolated third nerve paresis is a rare diagnosis among patients presenting to the Botulinum Toxin Clinic at Moorfields Eye Hospital. Ten patients with this diagnosis are reviewed in this study. Head trauma is a common cause of third nerve palsy and is often severe enough to cause damage to fusion potential. If fusion is present and there is adequate adduction of the divergent eye, then botulinum toxin injection of the lateral rectus may induce long-term control of the ocular deviation. Three of the four patients who experienced tong-term control of their ocular deviation following toxin injection shared these features. Toxin injected into the lateral rectus did not, however, reliably assess medial rectus function and therefore predict the outcome of horizontal squint surgery. Reasons for this are discussed.
  Australian and New Zealand Journal of Ophthalmology 11/2007; 20(2):121 - 127.