Clare Fraser

Clare Fraser
Sydney Hospital & Sydney Eye Hospital · Department of Ophthalmology

MBBS, MMed, FRANZCO

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125
Publications
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Introduction
Skills and Expertise

Publications

Publications (125)
Article
Purpose: The flicker electroretinogram (ERG) is a sensitive indicator of retinal dysfunction in birdshot chorioretinopathy (BCR). We explored recordings from a handheld device in BCR, comparing these with conventional recordings in the same patients and with handheld ERGs from healthy individuals. Methods: Non-mydriatic flicker ERGs, using the han...
Article
Introduction: Although fundoscopy is a crucial part of the neurological exam, it is challenging, underutilised and unreliably performed. We aimed to determine: the prevalence of fundus pathology amongst neurology inpatients and; the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF...
Article
Neuro-sarcoidosis has important ophthalmic and neuro-ophthalmic manifestations. Sarcoidosis most commonly affects the uveal tract (iris, ciliary body, and choroid) however the optic nerve is commonly involved. Sarcoid related optic neuritis is an important differential diagnosis in optic neuritis especially in atypical presentations. The use of mul...
Article
Background: Giant cell arteritis (GCA) is the most common type of systemic vasculitis in the elderly. Untreated, it can lead to irreversible blindness. Its diagnosis relies on a temporal artery biopsy (TAB). However, a proportion of patients have small vessel vasculitis (SVV) on biopsy; the prognosis of which remains unclear. The aim of this study...
Article
Background: The electronegative electroretinogram (ERG) reflecting inner retinal dysfunction can assist as a diagnostic tool to determine the anatomical location in eye disease. The aim of this study is to determine the frequency and aetiology of electronegative ERG in a tertiary ophthalmology centre and to develop a clinical algorithm to assist p...
Article
Visual Snow refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions like tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously we hypothesised, that visual snow syndrome may be characteris...
Preprint
Full-text available
Purpose: (1) To develop a deep learning algorithm to identify major tissue structures of the optic nerve head (ONH) in 3D optical coherence tomography (OCT) scans; (2) to exploit such information to robustly differentiate among healthy, optic disc drusen (ODD), and papilledema ONHs. It was a cross-sectional comparative study with confirmed ODD (105...
Article
Full-text available
Background Optic neuritis (ON) occurs in immune-mediated disorders including multiple sclerosis (MS), aquaporin-4 antibody-positive (AQP4) neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein (MOG) antibody-associated demyelination (MOGAD). Accurate determination of aetiology is critical for appropriate treatm...
Article
Objective To investigate the management impact of non-mydriatic fundus photography (NMFP) implementation for appropriate ED patients; compare the diagnostic accuracy of direct ophthalmoscopy (DO) and NMFP, and determine the prevalence of fundus pathology in a regional Australian ED. Methods This before/after crossover study prospectively enrolled...
Article
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Background and Purpose: Visual Snow (VS) is a disorder characterised by the subjective perception of black-and-white visual static. The aetiology of this condition is not known. In our previous work we suggested that there is a link between short-wave (S or “blue” cone) signals and severity of visual snow symptoms. Therefore we aimed to further cha...
Article
Study objectives: Obstructive sleep apnea (OSA) was recently shown to be associated with quantifiable retinal vascular changes, which correlate with disease severity. This follow-up study examines the response of retinal vascular changes in OSA patients receiving continuous positive airway pressure (CPAP) treatment. Methods: This prospective coh...
Article
Full-text available
Purpose: The purpose of this study was to investigate cone function deterioration in patients with retinitis pigmentosa (RP) using full field electroretinogram (ffERG), pattern electroretinogram (pERG), and optical coherence tomography (OCT) and their correlation with visual acuity (VA). Methods: Clinical records (2008-2018) of patients with RP...
Article
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Purpose: To investigate the functional and structural biomarkers and their correlation with Usher syndrome (USH). Methods: Medical records, imaging and electrophysiology test results of USH patients attending the Save Sight Institute between 2012 and 2017 were reviewed. Best corrected visual acuity (BCVA), ultra-widefield autofluorescence (UW-FA...
Article
Objective Abnormalities of eye movement and visual processing are common in traumatic brain injury. The King-Devick test (KDT) has been widely used in the detection and recovery of concussion. Current recommendations propose performing the initial test at baseline and then repeating annually to account for potential learning effects. In practice, t...
Article
X‐linked retinitis pigmentosa (XLRP) accounts for a significant proportion of certifiable blindness in working‐age adults. The objectives of this study were to: (1) synthesize the best available evidence regarding the natural history of disease progression and (2) identify the best current clinical biomarkers for monitoring disease progression, whi...
Article
Background: In recent years, CTLA-4 and PD-1/PD-L1 checkpoint inhibitors have proven to be effective and have become increasingly popular treatment options for metastatic melanoma and other cancers. These agents work by enhancing autologous antitumor immune responses. Immune-related ophthalmologic complications have been reported in association wi...
Article
Optic nerve sheath meningiomas (ONSMs) are rare, benign neoplasms of the anterior visual pathway. The optimal modality of radiotherapy for treatment has not yet been established. This is the first study to show significant difference in visual outcomes between radiotherapy subtypes in the management of ONSM. We performed a retrospective analysis of...
Article
Objective: To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. Methods: Prospective cross-sectional study investigating non-mydriat...
Article
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Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a new retinal optical coherence tomography (OCT) finding. The Optic Disc Drusen Studies Consortium had made recommendations to distinguish PHOMS from true optic disc drusen (ODD) in 2018. While publications on PHOMS have increased since then, the accuracy of the definition of PHOM...
Article
Objective To compare the diagnostic performance of an artificial intelligence deep learning system with that of expert neuro‐ophthalmologists in classifying optic disc appearance. Methods The deep learning system was previously trained and validated on 14,341 ocular fundus photographs from 19 international centers. The performance of the system wa...
Article
Statins are effective and well-tolerated hypolipidaemic agents which have been increasingly studied for their pleiotropic immunomodulatory and anti-inflammatory effects. Statins have potential therapeutic benefit in a range of neuro-ophthalmological conditions but may also induce or exacerbate certain neurological disorders. This literature review...
Article
Purpose : Electrophysiological monitoring in Birdshot Chorioretinopathy (BCR) provides an objective assessment of disease activity, and the light-adapted 30 Hz flicker electroretinogram (ERG) has been shown to be sensitive to retinal dysfunction. This study explored use of a hand-held, full-field electroretinographic device (RETeval, LKC Technologi...
Article
Background: Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied. Methods: We trained, validated, and externally tested a deep-learning system to classify optic disks as being norm...
Article
Full-text available
X-linked retinoschisis (XLRS) is a leading cause of hereditary juvenile macular degeneration in males resulting in significant vision impairment. Outcome measures to monitor disease progression or therapeutic interventions have evolved with technology. A systematic review was undertaken to evaluate outcome measures for XLRS. Inclusion criteria were...
Article
Aim: Positron emission tomography/computed tomography (PET/CT) can detect cranial and large vessel inflammation in giant cell arteritis (GCA). We aimed to determine the change and significance of vascular activity at diagnosis and 6 months. Method: Newly diagnosed GCA patients underwent time-of-flight fluorine-18-fluoro-2-deoxyglucose PET/CT fro...
Conference Paper
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The Australian Sports Brain Bank was established in March 2108 with the aim of characterising the spectrum of neurodegenerative disease among ex-players of Australian contact sports. To date, the ASBB has received over 250 pledges and ten post-mortem brain donations. We will present the clinical and pathological findings of our completed brain exam...
Article
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Objectives: The recognition and management of concussion has become a major health concern across all sports. Despite recent attention, concussion assessment and return-to-play protocols appear to be highly variable between leading professional sporting bodies across Australia. Without readily available guidelines, players at all levels may be at r...
Conference Paper
Full-text available
Background and Aims: The Australian Sports Brain Bank launched in March 2018, as a collaboration between the Neuropathology Department of RPA Hospital and the Brain & Mind Centre, University of Sydney. The aim of the ASBB is to describe the spectrum of neurodegenerative disease that may be associated with sporting and non-sporting concussion in Aus...
Article
Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Seco...
Article
Importance: There is limited literature on the use of optical coherence tomography in the assessment of retinal nerve fibre layer (RNFL) thickness in sports-related repetitive mild traumatic brain injury. Background: To evaluate RNFL thickness in professional rugby league players. RNFL thinning may serve as a proxy for wider white matter degener...
Article
Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disease associated with dysfunction of the retinal pigment epithelium and photoreceptor outer segments in a peri-foveal arrangement. If chorioretinal atrophy develops, patients risk losing vision. We retrospectively analysed three patients with genetically proven MIDD, assessing a...
Article
Full-text available
Over recent years, human autoantibodies targeting myelin oligodendrocyte glycoprotein (MOG Ab) have been associated with monophasic and relapsing central nervous system demyelination involving the optic nerves, spinal cord, and brain. While the clinical relevance of MOG Ab detection is becoming increasingly clear as therapeutic and prognostic diffe...
Article
Background: Ocular dysfunction, including eye movement defects, has been documented in up to 69% of patients with concussion. However, standard sports-related concussion assessment protocols do not typically include any clinical examination of the ocular system. Objective: The aim of this article is to inform general practitioners (GPs) about oc...
Article
Purpose of review: Inherited myopathies, and in particular mitochondrial myopathies, are heterogeneous disorders, and ocular manifestations may be the presenting feature or offer important diagnostic clues. The ophthalmologist may be key to diagnosis, facilitating recognition of associated potentially life-threatening organ manifestations and an i...
Article
Introduction There is limited research on the visual deficits found in dementia. The Queens Square Screening Test for Visual Deficits (QS test) is designed to screen for changes in visual processing. Our study aimed to validate this test and examine the types of visual processing deficits found in dementia. Methods We assessed the QS test in parti...
Article
The triad of central nervous system symptoms, visual disturbance and hearing impairment is an oft-encountered clinical scenario. A number of immune-mediated diseases should be considered among the differential diagnoses including: Susac syndrome, Cogan syndrome or Vogt-Koyanagi-Harada disease; demyelinating conditions such as multiple sclerosis or...
Article
Full-text available
Objectives PET/CT has not been well studied as a first‐line test for giant cell arteritis (GCA). In part this is due to historical limitations in visualizing the cranial arteries. The Giant Cell Arteritis and PET Scan (GAPS) study assessed the accuracy of a newer generation PET/CT of the head, neck and chest for GCA. Methods 64 newly suspected GCA...
Article
Full-text available
Purpose: To compare functional and structural changes in the retina in patients with aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). Design: Cross-sectional study; biochemical study of human retinas. Participants: A total of 181 participants, including 22 consecutive...
Article
Full-text available
Background Antibodies to myelin oligodendrocyte glycoprotein (MOG) have been identified in both children and adults with demyelination, with a strong association with bilateral or recurrent optic neuritis (ON). However, the full clinical spectrum of this newly described condition is unknown. We sought to describe non‐ON inflammatory ophthalmologica...
Article
A 71-year-old man was referred to neuro-ophthalmology for evaluation of reading problems associated with pituitary adenoma. Perimetry showed a right temporal crescent syndrome ("half moon" syndrome) suggesting left occipital disease. Cranial magnetic resonance imaging, electroencephalogram, and cerebrospinal fluid examination (14-3-3 protein) were...
Article
Purpose of review: Obstructive sleep apnea (OSA) is increasing in prevalence. The intermittent hypoxia of OSA has wide-ranging effects on a patient's general health outcomes. However, gold-standard investigations and treatment are expensive and a significant burden on patients. Therefore, OSA research remains focused on improving the means of diag...
Article
Background: Obstructive sleep apnea (OSA) is a common pulmonary disorder with many systemic sequelae. Its association with diseases seen in neuro-ophthalmology is being increasingly recognized. Treatment of OSA with continuous positive airway pressure (CPAP) may reverse the pathology in some eye diseases. Evidence acquisition: We conducted a sea...
Article
Full-text available
Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate is practically zero, these tumors can blind or disfigure patients. Given that the clinical course can be variable, and treatment has the capacity to cause morbidity itself, the man...
Article
A 20 year old woman presented with bilateral constant positive visual phenomenon, since she was 9 years old. The symptoms had been worsening and becoming more intrusive in the last 3 years. Recently she has also had a migrainous episode. All ophthalmic and neurological investigations were normal. Her symptoms met the diagnostic criteria for visual...
Article
Inherited optic neuropathy is a rare cause of debilitating vision loss. It may occur in constellation with other syndromic features of neurological impairment, or present as an isolated finding. We describe a sibling pair, without a family history of vision loss, who developed visual impairment in early childhood consistent with optic neuropathy. G...
Article
Purpose of review: Giant cell arteritis (GCA) is a challenging condition to manage because of the potential for acute irreversible vision loss and corticosteroid-related morbidity. Recent developments offer the potential to improve both the assessment and treatment of patients. Recent findings: Vascular imaging is increasingly being used in the...
Article
Purpose: To assess differential patterns of axonal loss and demyelination in the optic nerve in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Design: Cross-sectional study. Participants: One hundred ninety-two participants, including 136 MS patients (272 eyes), 19 NMOSD patients (38 eyes), and 37 healthy control...
Article
Aims: The aims of this study are as follows: (1) to describe a standardised methodology for the ice test, and where necessary a heat test; (2) to determine the effects of local cooling vs. heating on ptosis in myasthenia gravis (MG) patients. Methods: Twenty-three MG patients with ptosis were identified from a tertiary referral neuroimmunology c...
Article
Full-text available
To test the hypothesis that latency delay in the fellow eyes of optic neuritis (ON) patients and to compensate for delayed transmission of visual information, latency change of multi-focal visual evoked potential (mfVEP) traces in fellow eyes of 15 ON patients were analyzed. Patients with low risk (LR) for developing multiple sclerosis (MS) were ex...
Article
Monitoring optic nerve sheath meningiomas (ONSM) in Neurofibromatosis type 2 (NF2) patients remains difficult. Other ocular manifestations of NF2 may obscure ophthalmic assessment of optic nerve function in these patients. Serial magnetic resonance imaging (MRI) used to assess the optic nerve is not without limitations, being expensive and often re...
Article
Full-text available
Background: Concussion is regarded as a common injury in rugby league, however no studies have explored the long-term neurophysiological and cognitive effects of repeated concussion injuries in this sport. Methods: Former professional rugby athletes (n=25) were compared to 25 age-matched participants with no history of a concussion. All participan...
Article
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Objective To investigate primary retinal functional changes in non-optic neuritis (ON) eyes of patients with MS by full-field electroretinography (ERG). Methods Seventy-seven patients with relapsing-remitting MS with no history of clinical ON in at least 1 eye and 30 healthy controls were recruited in the cohort study. Full-field ERGs were recorde...
Article
Full-text available
Background: Making an accurate diagnosis of optic disc drusen (ODD) is important as part of the work-up for possible life-threatening optic disc edema. It also is important to follow the slowly progressive visual field defects many patients with ODD experience. The introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) has i...
Article
A 78-year-old Caucasian man with significant vascular disease reported sudden onset of worsened vision during a routine wound-care appointment for non-healing necrotic leg ulcers. He described painless blurring of vision with grey scotomas in his RE, his only well-seeing eye, following trauma to the LE as a child. He presented with retinal ischemia...
Article
Purpose To examine the relationship between both static and dynamic retinal vascular caliber and the severity of obstructive sleep apnea (OSA). Design Prospective cross-sectional study. Methods Adult patients undergoing diagnostic polysomnography studies at a private Australian university teaching hospital were recruited. OSA severity was defined...
Article
Ethambutol is utilised in the treatment of Mycobacterium avium and Mycobacterium tuberculosis infection. The authors report two siblings who developed the adverse effect of ethambutol-induced optic chiasmopathy, with recovery following cessation of ethambutol. Discussion explores potential genetic predisposition to development of this condition and...
Article
We report the histopathological findings in 3 patients where injections of botulinum toxin were used prior to strabismus surgery. In all cases we found evidence of permanent extraocular muscle atrophy and fibrosis. © 2016 American Association for Pediatric Ophthalmology and Strabismus
Article
Full-text available
Purpose The multifocal visual evoked potential (mfVEP) provides a topographical assessment of visual function, which has already shown potential for use in patients with glaucoma and multiple sclerosis. However, the variability in mfVEP measurements has limited its broader application. The purpose of this study was to compare several methods of dat...