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Background: Diabetic retinopathy (DR) may worsen during pregnancy, but its course in the postpartum remains poorly understood. Understanding the natural history of DR during and after pregnancy can help determine when sight‐threatening DR treatment should be administered. Methods: A prospective longitudinal cohort study recruited pregnant women with pre‐existing type 1 (T1D) or type 2 diabetes from two tertiary Diabetes Antenatal Clinics in Melbourne, Australia. Eye examination results in early pregnancy, late pregnancy, and up to 12‐months postpartum were compared to determine DR changes. Two‐field fundus photographs and optical coherence tomography scans were used to assess DR severity. Results: Overall, 105 (61.4%) women had at least two eye examinations during the observation period. Mean age was 33.5 years (range 19–51); 54 women (51.4%) had T1D; 63% had HbA1c <7% in early pregnancy. DR progression rate was 23.8% (95% CI 16.4–32.6). Having T1D (RR 4.96, 95% CI 1.83–13.46), pre‐existing DR in either eye (RR 4.54, 95% CI 2.39–8.61), and elevated systolic blood pressure (adjusted RR 2.49, 95% CI 1.10–5.66) were associated with increased risk of progression. Sight‐threatening progression was observed in 9.5% of women. Among the 19 eyes with progression during pregnancy, 15 eyes remained stable, three eyes progressed, and only one eye regressed in the postpartum. Conclusions: Nearly 1 in 4 women had DR progression from conception through to 12‐months postpartum; almost half of these developing sight‐threatening disease. DR progression occurring during pregnancy was found to predominantly remain unchanged, or worsen, after delivery, with very few eyes spontaneously improving postpartum. [ABSTRACT FROM AUTHOR]

Introduction: Zostavax, the live-attenuated vaccine used to prevent herpes zoster (HZ), has been available to individuals aged 70 and 71–79 years (phased catch-up) via Australia's National Immunisation Program (NIP) since 2016. There are limited data characterising the incidence of HZ at the level of the Australian population. National prescription data for antivirals used to treat HZ may be used as a proxy for HZ incidence. We aimed to examine trends in antiviral prescriptions supplied for the treatment of HZ in Australia pre- and post-2016, and to assess whether Zostavax's inclusion on the NIP correlated with a reduction in HZ antiviral prescription rates. Methods: Using the Australian Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme prescribing data, we analysed antiviral prescriptions supplied for the treatment of HZ Australia-wide between 1994 and 2019. Annual prescription rates were calculated, and trends and changes in HZ antiviral use were explored descriptively and using Poisson models. Results: HZ antiviral prescription rates increased 2.6-fold (160%) between 1995 and 2015 [25.4 (95% CI 25.2, 25.6) and 65.3 (95% CI 64.9, 65.6) prescriptions per 10,000 people, respectively], and then decreased 0.45-fold (55%) between 2016 and 2018 [60.9 (95% CI 60.6, 61.2) and 27.5 (95% CI 27.3, 27.9) prescriptions per 10,000 people, respectively]. The prescription rate for the antiviral famciclovir restricted specifically for treating HZ in immunocompromised individuals increased 8.5-fold (750%) between 2006 (year first listed) and 2019 [0.3 (95% CI 0.3, 0.3) and 2.5 (95% CI 2.4, 2.6) prescriptions per 10,000 people, respectively]. Conclusion: The introduction of the live-attenuated HZ vaccine on Australia's formal national vaccination program was associated with a reduction in HZ antiviral prescription rates within the Australian population. The data suggest that the introduction of Shingrix, the non-live subunit zoster vaccine, may also be associated with a similar reduction in HZ antiviral prescriptions used to treat the immunocompromised, as well as the general population, given its accepted greater efficacy over Zostavax. [ABSTRACT FROM AUTHOR]

Background: Diabetic retinopathy (DR) may be affected by pregnancy. The majority of prevalence data regarding DR in pregnancy predate the advent of contemporary guidelines for diabetes management during pregnancy. This study reports DR prevalence and associated risk factors in women with pregestational diabetes during pregnancy and the postpartum in Australia. Methods: A total of 172 pregnant women with type 1 (T1DM) or type 2 diabetes diagnosed pre‐pregnancy were prospectively recruited from two obstetrics hospitals in Melbourne (November 2017–March 2020). Eye examinations were scheduled in each trimester, at 3‐, 6‐, and 12‐months postpartum. DR severity was graded from two‐field fundus photographs by an independent grader utilising the Airlie House Classification. Sight‐threatening DR (STDR) was defined as the presence of diabetic macular oedema or proliferative DR. Results: Overall, 146 (84.9%) women had at least one eye examination during pregnancy. The mean age was 33.8 years (range 19–51), median diabetes duration was 7.0 years (IQR 3.0–17.0), 71 women (48.6%) had T1DM. DR and STDR prevalence during pregnancy per 100 eyes was 24.3 (95% CI 19.7–29.6) and 9.0 (95% CI 6.1–12.9); while prevalence in the postpartum was 22.2 (95% CI 16.5–29.3) and 10.0 (95% CI 5.4–17.9), respectively. T1DM, longer diabetes duration, higher HbA1c in early pregnancy, and pre‐existing nephropathy were significant risk factors. Conclusions: The prevalence of DR in pregnant women was similar to the non‐pregnant diabetic population in Australia. One in nine participants had STDR during pregnancy and the postpartum, highlighting the need to optimise DR management guidelines in pregnancy given the significant risk of vision loss. [ABSTRACT FROM AUTHOR]

Importance The epidemiology of episcleritis and scleritis in Australia is largely unknown. Background: To determine the incidence, prevalence and clinical characteristics of episcleritis and scleritis in Melbourne. Design Retrospective longitudinal study. Participants: Patients aged ≥18 years with episcleritis or scleritis seen at the Royal Victorian Eye and Ear Hospital from November 2014 to October 2015. Methods: Medical record review confirmed clinical diagnosis and characteristics. Incidence and prevalence were calculated using estimates of the adult population in areas of Melbourne with ≥30 ocular presentations/year to the emergency department. Main Outcome Measures: Diagnosis of active episcleritis or scleritis, aetiology, ocular complications and treatments. Results: From a general population of 3 408 068, we confirmed 149 new and 23 pre‐existing cases of active episcleritis, and 35 new and 23 pre‐existing cases of active scleritis. Incidence per 100 000 person‐years was 4.4 (95% confidence interval [CI] 3.7‐5.1) for episcleritis and 1.0 (95% CI 0.7‐1.4) for scleritis, while 12‐month prevalence was 5.1 (95% CI 4.3‐5.9) and 1.7 (1.3‐2.2) per 100 000 persons, respectively. Systemic disease was associated with 10% of episcleritis compared with 34% of scleritis (P <.001). Ocular complications were seen in 3% (6/184) of episcleritis eyes and 44% (32/72) of scleritis eyes, with the commonest being anterior uveitis (12/72) and ocular hypertension (14/72). At presentation, scleritis patients were commonly treated with oral non‐steroidal anti‐inflammatory drugs (60%) and prednisolone (19%). By 12 months, 24% of scleritis patients required immunosuppressants. Conclusions and Relevance: Rates of episcleritis and scleritis in our single‐centre Australian study were low. Episcleritis was usually benign, whereas scleritis had increased ocular complications and systemic disease. [ABSTRACT FROM AUTHOR]

Aim To report the 6-month results of a clinical trial that compared intravitreous bevacizumab (BVB) 1.25 mg versus triamcinolone acetonide (TA) 4 mg when administered as an adjunct during cataract surgery to patients with diabetic macular oedema (DMO). Methods Prospective, double-masked, single-centre (Royal Victorian Eye and Ear Hospital, Melbourne) clinical trial. Patients with visually significant cataract and centreinvolving DMO (either current or prior) were randomised (1: 1) to receive either intravitreous BVB 1.25 mg or TA 4 mg at the time of cataract surgery and if required at review. Main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to the 6-month time point of this 12-month study. results 61 eyes of 58 patients were enrolled. At baseline, both groups were similar in terms of BCVA and CMT (p>0.2). At 6 months, there was no significant difference in vision between the groups, with mean letter gain of +21.4 (95% CI +14.5 to +28.4) in the TA group and +17.3 (95% CI +12.1 to +22.6) in the BVB group (p=0.35). The TA group had a significant sustained anatomical improvement at 6 months, with a reduction in CMT (-51.4 µm; 95% CI -98.2 to -4.7) compared with thickening in the BVB group (+15.6 µm; 95% CI-26.4 to +57.7, p=0.04). Conclusions When given as an adjunct to cataract surgery, both TA and BVB improved visual outcomes at 6 months postoperatively. However, only TA resulted in sustained improvement in CMT, with the majority not requiring any further treatment postoperatively. [ABSTRACT FROM AUTHOR]

Importance: The number of females practising ophthalmology is rising. It is known that practice patterns between female and male ophthalmologists differ. Understanding the differences will help to inform future workforce planning. Background: To investigate the differences in clinical practice between female and male ophthalmologists in Australia. Design Cross‐sectional study. Participants: Ophthalmologists participating in the Royal Australian & New Zealand College of Ophthalmologists workforce survey, and/or Medicine in Australia: Balancing Employment and Life survey, and those who made claims from Medicare Benefits Schedule Australia. Methods: Combined analysis of de‐identified 2014 data from the surveys and Medicare Benefits Schedule. Main Outcome Measures: Hours worked, service provision, remuneration and social circumstances. Results: Female ophthalmologists provided 35% fewer services per ophthalmologist per year (2834 vs 4328) than male ophthalmologists. Female ophthalmologists received approximately half the annual income of male ophthalmologists; median self‐reported net personal annual income was AUD122 500 (interquartile range [IQR] 96 000‐225 000) for females compared to AUD245 000 (IQR 180 000‐365 000) for males (P = .01). The median self‐reported hours worked per week was 35.0 (IQR 28.0‐46.0) for females and 41.8 (IQR 36.5‐48.5) for males (P = 0.04). A higher proportion of females practise in medical subspecialties, while a higher proportion of males practise in surgical subspecialties. Conclusions and Relevance: Female ophthalmologists earn less compared to male ophthalmologists after accounting for lower service provision and hours worked. Difference in income may be partially accounted for by higher total number of services and procedural services provided by male ophthalmologists. Understanding differences between female and male ophthalmologists will help to inform future medical workforce planning. [ABSTRACT FROM AUTHOR]

Importance: Few prior studies have described the epidemiology of uveitis in the Australian population. Background: To report the incidence and period prevalence of active uveitis in Melbourne and detail their subtypes and aetiologies. Design: Cross‐sectional study using retrospective medical record review in a tertiary hospital. Participants: Patients with a coded diagnosis of uveitis who attended the emergency department or specialist ocular immunology clinic at the Royal Victorian Eye and Ear Hospital between November 2014 through October 2015 (N = 1752). Methods: Medical records were reviewed to confirm the date of diagnosis and subtype of uveitis. Incidence and prevalence rates were calculated utilizing estimates of the adult population residing in areas of greater Melbourne with more than 30 ocular‐related presentations to the emergency department annually. Main Outcomes and Measures: Presence and date of onset, anatomical distribution and aetiology of uveitis. Results: During the study period, 734 new cases of uveitis and 502 cases of pre‐existing uveitis requiring active treatment were confirmed. These figures yielded an incidence of 21.54 (CI 20.03, 23.15) per 100 000 person‐years and a period prevalence of 36.27 (CI 34.30, 38.35) per 100 000 persons. The distribution of prevalent uveitis cases was anterior (75%), intermediate (6%), posterior (15%) and panuveitis (4%). An infectious aetiology accounted for 13.4% of cases, a systemic associated disease for 26.4% of cases, and no cause was identified in 60.2% of cases. Conclusion and Relevance: The incidence and prevalence rates of uveitis in urban Australia were lower than recent studies from the United States and Europe. [ABSTRACT FROM AUTHOR]

OBJECTIVE--To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS--A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. RESULTS--A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS--There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabeticmacular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate readability of eye drop labels and accurate recall of prescription instructions in a glaucoma population. Methods: A hospital-based, cross-sectional study. A trained, interviewer examined patient ability to read standard and larger font medication labels. A questionnaire was administered to ascertain accurate recall of prescribed eye drops. Clinical information was obtained through independent chart review. Glaucoma severity was classified according to a glaucoma staging system. The setting for the study was the glaucoma outpatient clinic, Royal Victorian Eye and Ear Hospital (Melbourne, Australia), a major tertiary referral centre. A total of 200 glaucoma patients (96.2% response), aged 45–90 years, on eye drops took part in the study. Non-English-speaking patients were excluded. The main outcome measure was the ability to read prescribed medication labels and accurately recall treatment regime was compared with glaucoma severity and the number of eye drops. Results: Of the glaucoma patients, 12% were unable to read standard pharmacy labels. Only 5.5% were unable to read the larger font labels. Of the patients, 32% were not able to accurately recall the type of drops or prescribed frequency of instillation. An inability to read standard labels was associated with a threefold reduction in the likelihood of accurate medication recall (95% confidence intervals, 1.40–7.66, P < 0.05). Patients with three or more types of eye drops were five times less likely to recall their medications (95% confidence interval, 0.07–0.57, P < 0.05). Conclusions: Inability to read or recall prescribed eye drops was associated with glaucoma severity and the number of prescribed eye drops. These factors may impact significantly on patients' adherence to glaucoma medications. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- Fractal analysis can quantify the geometric complexity of the retinal vascular branching pattern and may therefore offer a new method to quantify early diabetic microvascular damage. In this study, we examined the relationship between retinal fractal dimension and retinopathy in young individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS -- We conducted a cross-sectional study of 729 patients with type 1 diabetes (aged 12-20 years) who had seven-field stereoscopic retinal photographs taken of both eyes. From these photographs, retinopathy was graded according to the modified Airlie House classification, and fractal dimension was quantified using a computer-based program following a standardized protocol. RESULTS -- In this study, 137 patients (18.8%) had diabetic retinopathy signs; of these, 105 had mild retinopathy. Median (interquartile range) retinal fractal dimension was 1.46214 (1.45023-1.47217). After adjustment for age, sex, diabetes duration, AlC, blood pressure, and total cholesterol, increasing retinal vascular fractal dimension was significantly associated with increasing odds of retinopathy (odds ratio 3.92 [95% CI 2.02-7.61] for fourth versus first quartile of fractal dimension). In multivariate analysis, each 0.01 increase in retinal vascular fractal dimension was associated with a nearly 40% increased odds of retinopathy (1.37 [1.21-1.561). This association remained after additional adjustment for retinal vascular caliber. CONCLUSIONS-- Greater retinal fractal dimension, representing increased geometric complexity of the retinal vasculature, is independently associated with early diabetic retinopathy signs in type 1 diabetes. Fractal analysis of fundus photographs may allow quantitative measurement of early diabetic microvascular damage. [ABSTRACT FROM AUTHOR]

Objective: To determine how well the current Pharmaceutical Benefits Scheme (PBS) eligibility criteria for subsidy of lipid-lowering drugs compare with current national guidelines for determining the population at high risk of developing cardiovascular disease (CVD).Design and Participants: Analyses of the population-based, cross-sectional Australian Diabetes, Obesity and Lifestyle (AusDiab) study, conducted in 1999-2000. The 1991 Framingham risk prediction equation was used to compute 5-year risk of developing first-time CVD in 8286 participants aged 30-74 years with neither CVD nor diabetes. Based on the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand guidelines, people with either 5-year CVD risk > or = 15% or with 5-year CVD risk of 10%-< 15% and the metabolic syndrome were defined as having estimated high absolute CVD risk.Main Outcome Measures: 5-year CVD risk; estimated population with high CVD risk.Results: Among participants without prevalent CVD or diabetes, 7.9% of men and 1.5% of women had a 5-year CVD risk > or = 15%. Of the estimated residential Australian population in 2000 aged 30-74 years without CVD or diabetes, 717 000 people were considered to be at high absolute CVD risk. Among the high-risk AusDiab participants without CVD or diabetes, only 16.9% of men and 15.4% of women were being treated with lipid-lowering drugs. Of the 9.6% of participants free of CVD and diabetes who were untreated but eligible for subsidy under PBS criteria, only 27.4% had an estimated high absolute CVD risk.Conclusion: Strategies for CVD prevention using lipid-lowering medications can be improved by adoption of the absolute-risk approach. [ABSTRACT FROM AUTHOR]

The article presents research on the effectiveness of Pharmaceutical Benefits Scheme (PBS) eligibility criteria for subsidy of lipid-lowering drugs in determining the population who are at high risk of developing cardiovascular disease (CVD). It says that cross-sectional Australian Diabetes, Obesity and Lifestyle (AusDiab) study conducted in 1999-2000 was analyzed. The results suggest that strategies and criteria for CVD prevention could be improved by adoption of the absolute-risk approach.

OBJECTIVE -- Alterations in retinal vascular caliber may reflect early subclinical microvascular dysfunction. In this study, we examined the association of retinal vascular caliber to incident retinopathy in young patients with type 1 diabetes. RESEARCH DESIGN AND METHODS -- This was a prospective cohort study of 645 initially retinopathy-free type 1 diabetic patients, aged 12-20 years. Participants had seven-field stereoscopic retinal photographs taken of both eyes at baseline and follow-up. Retinal vascular caliber was measured from baseline photographs using a computer-based program following a standardized protocol. Incident retinopathy was graded according to the modified Airlie House classification from follow-up photographs. RESULTS -- Over a median follow-up of 2.5 years, 274 participants developed retinopathy (14.8 per 100 person-years). After adjustments for age, sex, diabetes duration, glycemia, mean arterial blood pressure, BMI, and cholesterol levels, larger retinal arteriolar caliber (fourth versus first quartile) was associated with a more than threefold higher risk of retinopathy (hazard rate ratio 3.44 [95% CI 2.08 -5.66]). Each SD increase in retinal arteriolar caliber was associated with a 46% increase in retinopathy risk (1.46 [1.22-1.74]). This association was stronger in female than in male participants. After similar adjustments, retinal venular caliber was not consistently associated with incident retinopathy. CONCLUSIONS -- Retinal arteriolar dilatation predicts retinopathy development in young patients with type 1 diabetes. Our data suggest that arteriolar dysfunction may play a critical role in the pathogenesis of early diabetic retinopathy and that computer-based retinal vascular caliber measurements may provide additional prognostic information regarding risk of diabetes microvascular complications. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the relationship between body mass index (BMI) and weight and retinal vascular caliber in children in Singapore. Changes in retinal vascular caliber have been linked with obesity and metabolic syndrome in adults. Retinal arteriolar or venular caliber was not associated with height. It concluded that greater BMI and weight were associated with larger retinal venular caliber in healthy children.

Background Despite decades of evidence from observational studies, the use of hormone therapy for the prevention of cardiovascular disease (CVD) among postmenopausal women is controversial. The recent completion of several randomised clinical trials examining the effects of hormone therapy on CVD presents an opportunity to provide a more precise estimate of the cardiovascular risks of hormone therapy. Objective To summarise the effects of hormone therapy on CVD in postmenopausal women. Search strategy MEDLINE, EMBASE, the Cochrane Library, DARE and CENTRAL were searched for clinical trials reporting mortality and/or CVD outcomes in association with hormone therapy. Bibliographies and editorials were also reviewed. All studies were reviewed and rated for quality independently by two reviewers. Selection criteria High quality, randomised placebo-controlled clinical trials of hormone therapy (duration greater than one year) in non-hospitalised postmenopausal women were included. Data collection and analysis Summary relative risks were estimated for all-cause mortality, coronary heart disease (CHD) mortality, non-fatal acute myocardial infarction (AMI) and all stroke. Main results Seven randomised clinical trials met the inclusion criteria. The use of hormone therapy had no significant effect on all-cause mortality, non-fatal AMI or CHD mortality, with relative risks of 1.02 [95% confidence interval (CI) 0.93–1.13], 1.00 (0.88–1.14) and 0.99 (0.82–1.21), respectively. For all stroke, the summary relative risk was 1.29 (1.13–1.48). Author's conclusions This systematic review, incorporating the latest available trial data, shows that hormone therapy does not significantly change the risk of all-cause morality, CHD death or non-fatal AMI but increases the risk of stroke in postmenopausal women. [ABSTRACT FROM AUTHOR]