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Purpose: This study explores the views of people living with Motor Neurone Disease (MND) when they consider Percutaneous Endoscopic Gastrostomy (PEG) insertion, to understand their priorities and how their decisions were informed or supported., Materials and Methods: The study took place in single multidisciplinary specialised MND clinic in New South Wales, Australia. Nine people with MND (5 male and 4 female; age range 52-73 years; disease duration 6-99 months) who were considering, or had recently undergone PEG insertion, participated. Semi-structured interviews were conducted with participants to examine individual's experience of decision-making about PEG. The data were synthesised and analysed thematically., Results: Three main themes and two sub-themes captured participant views on their decision-making. The first, " What matters most to me," comprised optimising quality of life and maintaining family membership. The second theme explored "Understanding PEG and the clinical pathway." The third theme was "Thoughts on using a decision aid.", Conclusions: This study provides a foundation for future studies examining the longer-term outcomes of accepting, delaying or declining PEG. Insights from this study may be applicable to decision-making for any aspect of MND care where the outcomes or benefits are uncertain.

Clinical imaging provided by optical coherence tomography (OCT) and its variant, OCT-angiography (OCT-A), has revolutionised eyecare practice. The imaging techniques allow for the identification and quantification of ocular structures, supporting the diagnosis and prognosis of eye disease. In this review, an overview of the usefulness of OCT-A imaging in the diagnosis and management of a range of ocular conditions is provided when used in isolation or in combination with other imaging modalities and measures of visual function (visual field results). OCT-A imaging has the capacity to identify and quantify ocular vasculature non-invasively, thereby assisting the clinician in the diagnosis or to determine the efficacy of intervention in ocular conditions impacting retinal vasculature. Thus, additional clinically useful information can be obtained in eye diseases involving conditions such as those impacting retinal vessel occlusion, in diabetic retinopathy, inherited retinal dystrophy, age-related macular degeneration, choroidal neovascularisation and optic nerve disorders. Through a clinical case series, various ocular conditions are reviewed, and the impact of OCT-A imaging is discussed. Although OCT-A imaging has great promise and is already used in clinical management, there is a lack of set standards to characterise altered vascular features in disease and consequently for prognostication, primarily due to a lack of large-scale clinical trials and variability in OCT-A algorithms when generating quantitative parameters.

Introduction: Heart transplantation is an important treatment for end-stage heart failure. Early post-transplant hyperglycemia (EPTH) and post-transplant diabetes mellitus (PTDM) are common following heart transplantation and are associated with increased morbidity and mortality., Areas Covered: This review summarizes the clinical characteristics, diagnosis, and treatment of EPTH and PTDM in cardiac transplant patients, incorporating findings from non-cardiac solid organ transplant studies where relevant due to limited heart-specific research., Expert Opinion: EPTH following heart transplantation is common yet understudied and is associated with the later development of PTDM. PTDM is associated with adverse outcomes including infection, renal dysfunction, microvascular disease, and an increased risk of re-transplantation and mortality. Risk factors for EPTH include the post-operative immunosuppression regimen, recipient and donor age, body mass index, infections, and chronic inflammation. Early insulin treatment is recommended for EPTH, whereas PTDM management is varied and includes lifestyle modification, anti-glycemic agents, and insulin. Given the emerging evidence on the transplant benefits associated with effective glucose control, and the cardioprotective potential of newer anti-glycemic agents, further focus on the management of EPTH and PTDM within heart transplant recipients is imperative.

Artificial Intelligence is a rapidly expanding field within computer science that encompasses the emulation of human intelligence by machines. Machine learning and deep learning - two primary data-driven pattern analysis approaches under the umbrella of artificial intelligence - has created considerable interest in the last few decades. The evolution of technology has resulted in a substantial amount of artificial intelligence research on ophthalmic and neurodegenerative disease diagnosis using retinal images. Various artificial intelligence-based techniques have been used for diagnostic purposes, including traditional machine learning, deep learning, and their combinations. Presented here is a review of the literature covering the last 10 years on this topic, discussing the use of artificial intelligence in analysing data from different modalities and their combinations for the diagnosis of glaucoma and neurodegenerative diseases. The performance of published artificial intelligence methods varies due to several factors, yet the results suggest that such methods can potentially facilitate clinical diagnosis. Generally, the accuracy of artificial intelligence-assisted diagnosis ranges from 67-98%, and the area under the sensitivity-specificity curve (AUC) ranges from 0.71-0.98, which outperforms typical human performance of 71.5% accuracy and 0.86 area under the curve. This indicates that artificial intelligence-based tools can provide clinicians with useful information that would assist in providing improved diagnosis. The review suggests that there is room for improvement of existing artificial intelligence-based models using retinal imaging modalities before they are incorporated into clinical practice.

Clinical Relevance: A method for determining 10-2 deployment in glaucoma with the goal of detecting additional visual field sensitivity for the purpose of functional monitoring is proposed., Background: To provide a pilot method for determining when to deploy the 10-2 visual field (VF) test grid in glaucoma by characterising the 'functional vulnerability zone'., Methods: The cross-sectional 24-2 (central 12 locations) and 10-2 VF results from 133 eyes of 133 glaucoma subjects were used to describe the central Hill of Vision using VF sensitivity. The 'volume' (defined using arbitrary units, A.U.) under the Hill was calculated. A greater A.U. on the 10-2 indicated a functional vulnerability zone (FVZ), signifying additional clinical dynamic range for potential future monitoring. The main outcome measures were calculated A.U. and 24-2 factors which were significantly related to A.U. differences between 24-2 and 10-2., Results: Over 55% of patients had an FVZ (A.U. greater using 10-2). Several 24-2 features (worse mean deviation, worse central 24-2 mean defect, and a higher proportion of defective locations) were significant in the FVZ cohort compared to non-FVZ. 24-2 mean deviation levels at which 10-2 may be favoured were low at -3.16 to -3.62 dB. Specifically, 5 or more defective central 24-2 test locations were associated with an FVZ. Subjects exhibiting a less severe defect on the 10-2 were more likely to have an FVZ, indicating its potential for future VF monitoring., Conclusions: The authors propose several clinical markers, focussing on the 24-2, which can guide clinicians on when the 10-2 may have utility in glaucoma assessment. The authors provide a pilot reference spreadsheet for clinicians to visualise the likelihood of 10-2 utility in the context of an FVZ.

Clinical Relevance: Frontloaded visual field testing (twice per eye per session) is well-tolerated by patients and technicians, representing a viable strategy that can be implemented in routine clinical practice to capture enough clinical perimetry data for effective disease diagnosis, surveillance and management., Background: To determine the experiences of patients and technicians following the implementation of frontloaded visual field testing (multiple tests per eye within the same session) in a glaucoma service., Methods: This was a retrospective, cross-sectional study. A written questionnaire was administered to patients (three questions) attending the glaucoma service at the Centre for Eye Health for glaucoma assessment and to their administering perimetry technicians (two questions). The questionnaire was administered after static automated perimetry (24-2 SITA-Faster on the Humphrey Field Analyzer) was performed twice for each eye (frontloaded) within the same session. Respondents were asked to provide a 1-5 Likert scale response to questions that targeted operational issues for frontloaded visual field testing. Responses were correlated against to demographic (age, gender, ethnicity) and clinical (diagnosis, refractive error, visual field indices, test duration) parameters., Results: Approximately 90% of patient respondents agreed that frontloaded visual field testing was clearly explained to them, that they were comfortable during the test, and would prefer completing the tests at a single visit rather than returning to repeat the test. Most technician respondents were also able to keep their patients comfortable. 13% of technician respondents felt they ran late during the session, but on average, the total test duration for four visual field tests was 13 minutes, including breaks. There was no correlation found between demographic and clinical factors, and the responses., Conclusions: Frontloaded visual field testing was well-tolerated by patients and technicians. Strategies that may be helpful for other clinics to adopt this new paradigm are described.

Background: Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD., Objective: This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD., Method: Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years ( SD  = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger., Results: First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger., Conclusions: These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

The Queen Square Screening Test for Visual Deficits (QS test) screens for changes in visual processing. Our pilot study aimed to review the applicability of the QS test in individuals with dementia compared with those with normal cognition. Participants with major and minor neurocognitive disorder scored 50/71 (n=12) and 61/71 (n=10) respectively on the QS test, compared to 65/71 for age-matched healthy controls (n=11). The QS test score correlated with cognitive impairment as measured using the Rowland Universal Dementia Assessment Scale (r = 0.74). The QS test is an affordable and easy bedside screening test for visual processing changes., Competing Interests: This study was conducted without any sponsorship or funding. The authors declare they have no financial relationships deemed relevant to the manuscript. None of the authors have any financial interest in the sale of the QS test., (© 2021 Taylor & Francis Group, LLC.)

Clinical relevance : The existing notion that topical latanoprost can lead to symptoms of headaches by reporting three cases of headache symptoms that developed following instillation of latanoprost prescribed as first-line therapy for newly diagnosed primary open-angle glaucoma (POAG) is explored in this case series. Background : Prostaglandin analogues (PGAs) are often used as first-line treatment in the treatment of POAG. An uncommon and infrequently reported side effect of PGAs is headaches. Methods : A retrospective review of patient records was conducted on patients seen at the Centre for Eye Health between April 2016 and August 2017. Clinical findings, including outcomes following interventions such a punctal occlusion, as well as the proposed pharmacological mechanism underlying this phenomenon are presented and discussed. Results : Case 1 is a 62-year-old Caucasian male diagnosed with POAG and prescribed latanoprost in both eyes. At the follow-up visit, he reported waking up in with a dull throbbing headache following instillation of the eye drops the night before. Case 2 is a 58-year-old Asian male with POAG prescribed latanoprost to both eyes. Within a week, he developed symptoms of recurrent progressively worsening headaches post-instillation which persisted into the morning. Case 3 is a 75-year-old Caucasian male with POAG prescribed latanoprost for both eyes. He developed latanoprost sensitivity as well as headache symptoms associated with the eye drops which resolved followed its cessation. All patients reported initial symptoms of headaches associated with latanoprost use however the headaches were not persistent with intermittent punctal occlusion (cases 1 and 2) or intra-class drug rechallenge (case 3). Conclusion : Although there may be a yet-undiscovered link between a headache response and latanoprost, these cases call to question the pharmacological relationship between latanoprost and headache symptoms. A systemic approach to critically examine the pathophysiological link between pharmacological therapy and potential adverse effects is proposed.

Optometry Australia's infection control guidelines 2020 deliver a revision of the paper: Infection control guidelines for optometrists 2016. A review of recent literature was undertaken, with information collected from peer-reviewed journal articles, guidelines from professional societies, government health departments and instructions from equipment manufacturers. This information was used to provide an update on current infection control best practice. The guidelines are presented in two sections: standard precautions and transmission-based precautions. The standard (routine) precautions section covers: hand hygiene; personal protective equipment; safe handling and disposal of sharps; routine environmental cleaning; reprocessing of reusable equipment, instruments and contact lenses; respiratory hygiene and cough etiquette; aseptic and clean technique; and waste management. The transmission-based precautions section covers considerations for optometry staff and/or patients when standard precautions alone may not be sufficient to prevent the spread of an infectious agent; particularly relevant during the COVID-19 pandemic. Finally, a comprehensive list of disinfection or sterilisation techniques to use on reusable devices, instruments or equipment in optometric practice is provided in an Appendix.

We report the mitochondrial genome of Sabella spallanzanii , an invasive Mediterranean sabellid introduced to Australia and New Zealand. The mitogenome is 15,581 bp long and consists of 38 genes, including 13 protein coding genes, two rRNA genes, and 23 tRNA genes. It shows deviations from the putative annelid ground pattern, such as gene order re-arrangements and regions encoding on the negative strand. It is, however, very different from the mitogenome of the closely related serpulid, Spirobranchus giganteus . Phylogenetic analyses of the mitochondrial genes support a sister relationship of Sabella spallanzanii and Spirobranchus giganteus ., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction : Polypharmacy is prevalent in hospitals and deprescribing strategies for older people are strongly promoted. However, evidence of their feasibility and sustainability among patients receiving end of life care is lacking. The objective of this review was to ascertain effectiveness and post-discharge sustainability of hospital-initiated deprescribing strategies in older people near the end of life. Areas covered : The authors searched for controlled trials, with low risk of bias and measures of effectiveness post-discharge. Intervention description, duration, and healthcare provider engagement were investigated for their impact on reduction of number of medications, proportions of patients prescribed inappropriate medications, returns to emergency, hospital admission and adverse events. Expert opinion : Limited evidence suggests hospital-initiated deprescribing interventions may reduce prescribing inappropriateness among older terminal patients in the short term, but evidence beyond 3 months is lacking for significant prevention of adverse events or health service utilization. Heterogeneity precluded meta-analysis, and short follow-up periods precluded quantitative assessment of sustainability. Trials of older people with terminal conditions with larger sample sizes and longer follow-up periods are needed to confirm the effectiveness and sustainability of deprescribing at the end of life. Objective tools to reliably identify near end-of-life status would be useful in selecting target groups for these interventions.

Background: Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease., Methods: The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted., Results: Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001)., Conclusions: The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities., (© 2019 Optometry Australia.)

Choroidal detachments occur when there is an accumulation of fluid or blood in the suprachoroidal space, a potential space situated between the choroid and the sclera. They are an uncommon ocular pathology. The most common cause of choroidal detachment is secondary to trabeculectomy; however, there are other causes such as trauma and inflammation. Clinically, choroidal detachments may vary in presentation from asymptomatic, to very poor vision, severe ocular pain, vomiting and nausea. Ocular findings associated with choroidal detachments include serous retinal detachment, secondary angle closure, and a very shallow anterior chamber. Optometrists, as primary eye care providers, need to be aware of the clinical signs and symptoms associated with choroidal detachments and ensure that appropriate and timely management, with a referral to an ophthalmologist, is instigated for optimal visual outcomes. In this review, the pathophysiology, detection, and associated risk factors for choroidal detachments are discussed, and evidence-based management recommendations in an optometric context are provided. The characteristics and management of uveal effusion syndrome are also reviewed, as this can cause idiopathic exudative choroidal detachments distinct from classical choroidal detachment., (© 2018 Optometry Australia.)

Background: The aim was to investigate the relationship of the magnitude of myopia with visual acuity in highly myopic eyes without ocular pathology., Methods: Twelve hundred and ninety-two highly myopic eyes (up to -6.00 DS both eyes, no astigmatic cut-off) with no ocular pathology from the ZOC-BHVI high myopia study in China, had cycloplegic refraction, followed by subjective refraction and visual acuities and axial length measurement. Two logistic regression models were undertaken to test the association of age, gender, refractive error, axial length and parental myopia with reduced vision., Results: Mean group age was 19.0 ± 8.6 years; subjective spherical equivalent refractive error was -9.03 ± 2.73 D; objective spherical equivalent refractive error was -8.90 ± 2.60 D and axial length was 27.0 ± 1.3 mm. Using visual acuity, 82.4 per cent had normal vision, 16.0 per cent had mildly reduced vision, 1.2 per cent had moderately reduced vision, 0.3 per cent had severely reduced vision and no subjects were blind. The percentage with reduced vision increased with spherical equivalent to 74.5 per cent from -15.00 to -39.99 D, axial length to 67.7 per cent of eyes from 30.01 to 32.00 mm and age to 22.9 per cent of those 41 years and over. Spherical equivalent and axial length were significantly associated with reduced vision (p < 0.0001). Age and parental myopia were not significantly associated with reduced vision. Gender was significant for one model (p = 0.04)., Conclusion: Mildly reduced vision is common in high myopia without ocular pathology and is strongly correlated with greater magnitudes of refractive error and axial length. Better understanding is required to minimise reduced vision in high myopes., (© 2017 Optometry Australia.)

Background: The shape of the human lens changes from almost spherical at birth to ellipsoid due to a decrease in sagittal thickness and an increase in equatorial diameter during the first two decades of life. Both dimensions increase thereafter. This study was undertaken to determine the reason for the change., Methods: Published refractive index gradients, from 20 lenses aged from seven to 82 years, were used to calculate the protein contents of concentric shells of fibre cells in human lenses. The boundaries of nuclear cores containing from 2.5 to 45 mg, in 2.5 mg increments, were determined from the isoindicial shells. Cortex thickness was determined from the distance between the 30 mg nuclear boundary and the capsule., Results: The sagittal thickness of every nuclear core decreased until age 40 years and remained constant thereafter. Over the same time frame, the equatorial diameter of the cores containing up to 30 mg of protein increased, while those of cores larger than 30 mg decreased. The volumes of the cores decreased and their shapes changed from near spherical to spheroidal. Equatorial and sagittal cortex thickness increased linearly with age at 0.0082 mm per year. The anterior sagittal cortex was 0.23 mm larger than the posterior and the equatorial cortex was 0.62 mm greater., Conclusions: Changes in lens shape observed during the first two decades of life are due to remodelling and compaction of the 30 mg nuclear core. Cortex growth is linear throughout life., (© 2017 Optometry Australia.)

Context: Sempervivum davisii Muirhead (Crassulaceae) is a traditional medicinal herb from Eastern Anatolia. To date the composition of phytochemicals and physiological properties of this herb were not subjected to any research., Objective: This study identifies compounds in S. davisii hydrophilic extracts and evaluates their potential biological properties., Materials and Methods: Ethanol-based lyophilized extracts were obtained from aerial parts of plant (10 g of ground dry plant material in 200 mL of acidified aqueous ethanol, shaken for 2 h at 22 °C with supernatant collected and freeze-dried under vacuum). Phytochemical composition was investigated by liquid chromatography mass spectrometry (LC-MS/MS, phenolics) and gas chromatography mass spectrometry (GC-MS, volatiles). Phenolic compounds were quantified by high-performance liquid chromatography (HPLC) and the Folin-Ciocalteu assay. Subsequently, antioxidant capacity [ferric reducing antioxidant power (FRAP), oxygen radical absorbance capacity (ORAC) assays] and enzyme inhibitory properties (isolated porcine pancreatic lipase) of the extracts were determined., Results: Polyphenolic compounds were the main constituents of lyophilized extracts, among which kaempferol glycosides and quercetin hexoside dominated. The extracts exhibited potent antioxidant (FRAP values of 1925.2-5973.3 μM Fe 2+ /g DW; ORAC values of 1858.5-4208.7 μM Trolox Eq./g DW) and moderate lipase inhibitory (IC 50 : 11.6-2.96 mg/mL) activities. Volatile compounds (nonanal, dehydroxylinalool oxide isomers, 2-decenal, 2-undecenal, 2,6-di-tetr-butylphenol) were also found., Conclusions: Phenolic compounds with the dominating kaempferol and quercetin derivatives are the sources of potent antioxidant properties of S. davisii hydrophilic extracts. The extracts exhibit moderate inhibitory properties towards isolated pancreatic lipase.

Purpose: The aim was to develop and validate an instrument to measure job satisfaction in eye-care personnel and assess the job satisfaction of one-year trained vision technicians in India., Methods: A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians' job satisfaction and factors such as age, gender and experience were analysed using t-test and one-way analysis of variance., Results: Rasch analysis confirmed that the 15-item job satisfaction in eye-care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non-financial incentives, salary and workload were the most important determinants of job satisfaction., Conclusions: The 15-item JSEP instrument is a valid instrument for assessing job satisfaction among eye-care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction., (© 2016 Optometry Australia.)

Background: The use of advanced imaging in clinical practice is emerging and the use of this technology by optometrists in assessing patients with age-related macular degeneration is of interest. Therefore, this study explored contemporary, self-reported patterns of practice regarding age-related macular degeneration diagnosis and management using a cross-sectional survey of optometrists in Australia and New Zealand., Methods: Practising optometrists were surveyed on four key areas, namely, demographics, clinical skills and experience, assessment and management of age-related macular degeneration. Questions pertaining to self-rated competency, knowledge and attitudes used a five-point Likert scale., Results: Completed responses were received from 127 and 87 practising optometrists in Australia and New Zealand, respectively. Advanced imaging showed greater variation in service delivery than traditional techniques (such as slitlamp funduscopy) and trended toward optical coherence tomography, which was routinely performed in age-related macular degeneration by 49 per cent of respondents. Optical coherence tomography was also associated with higher self-rated competency, knowledge and perceived relevance to practice than other modalities. Most respondents (93 per cent) indicated that they regularly applied patient symptoms, case history, visual function results and signs from traditional testing, when queried about their management of patients with age-related macular degeneration. Over half (63 per cent) also considered advanced imaging, while 31 per cent additionally considered all of these as well as the disease stage and clinical guidelines. Contrary to the evidence base, 68 and 34 per cent rated nutritional supplements as highly relevant or relevant in early age-related macular degeneration and normal aging changes, respectively., Conclusions: These results highlight the emergence of multimodal and advanced imaging (especially optical coherence tomography) in the assessment of age-related macular degeneration by optometrists. Clinically significant variations in self-rated test competency and the understanding regarding nutritional supplements for different stages of age-related macular degeneration suggest that further work to up-skill optometrists may be required., (© 2017 Optometry Australia.)

Contact lenses have been a common means of vision correction for more than half a century. Recent developments raise the possibility that the next several years will see the range of applications in which they are used broaden considerably, with an associated expansion in both the number and type of individuals who consider them to be a valuable option. To describe this new landscape, a review of recent patent submissions covering the period 1 January 2014 to 1 February 2017 was undertaken. The results show that in the main, areas where contact lenses will be applied include drug delivery, visual augmentation and biosensing., (© 2017 Optometry Australia.)

Objective: The aim of the present study was to elucidate the pattern of change in bulbar muscles using ultrasound in patients diagnosed with amyotrophic lateral sclerosis (ALS)., Methods: Changes in the mylohyoid and geniohyoid muscle complex (mylohyoid-geniohyoid-muscle-complex) thickness were recorded while swallowing 5 ml of water using M-mode ultrasound in 30 ALS patients compared to 20 healthy controls. The ratio of mylohyoid-geniohyoid-muscle-complex thickness as determined by the maximum thickness of mylohyoid-geniohyoid-muscle-complex during swallowing divided by thickness at rest, was compared between ALS patients and controls, with the correlation between thickness ratio, echogenicity and clinical parameters assessed., Results: Overall, the thickness ratio in ALS patients was 1.39 ± 0.23 (mean ± SD) compared to 1.55 ± 0.17 in controls (p < 0.05). In sub-analysis, the thickness ratio was significantly decreased in ALS patients with bulbar-onset disease compared to those with limb-onset disease (p < 0.01) and controls (p < 0.01). Thickness ratio negatively correlated with the severity of upper motor neuron involvement in the bulbar region (p < 0.05)., Conclusions: Bulbar muscle ultrasound represents a novel method to detect impaired mobility and thereby provides an objective assessment of upper motor neuron involvement in the bulbar region of ALS patients.

White-on-white standard automated perimetry (SAP) is widely used in clinical and research settings for assessment of contrast sensitivity using incremental light stimuli across the visual field. It is one of the main functional measures of the effect of disease upon the visual system. SAP has evolved over the last 40 years to become an indispensable tool for comprehensive assessment of visual function. In modern clinical practice, a range of objective measurements of ocular structure, such as optical coherence tomography, have also become invaluable additions to the arsenal of the ophthalmic examination. Although structure-function correlation is a highly desirable determinant of an unambiguous clinical picture for a patient, in practice, clinicians are often faced with discordance of structural and functional results, which presents them with a challenge. The construction principles behind the development of SAP are used to discuss the interpretation of visual fields, as well as the problem of structure-function discordance. Through illustrative clinical examples, we provide useful insights to assist clinicians in combining a range of clinical results obtained from SAP and from advanced imaging techniques into a coherent picture that can help direct clinical management., (© 2017 The Authors. Clinical and Experimental Optometry published by John Wiley & Sons Australia, Ltd on behalf of Optometry Australia.)

Background: This paper provides an updated version of the paper: Infection control guidelines for optometrists 2007., Methods: Information from peer-reviewed journal articles, guidelines from professional societies, and government health department and other websites and instructions from equipment manufacturers were considered in determining infection risk factors in optometric practice. They were used to revise the recommendations on disinfection, sterilisation and reprocessing procedures for instrumentation and other equipment used in optometric practice as well as personal infection control measures to be undertaken by staff., Results and Conclusions: Optometrists and optometric practice staff should adopt measures to minimise the risk of transmission of infection. These include appropriate hand-washing, staff vaccinations, single use instruments/equipment, appropriate disposal of waste, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for individuals who are known to be infected or immuno-suppressed. Information provided to patients regarding infection control procedures in topical drug administration, contact lens wear and use of eye make-up are additional considerations for optometrists., (© 2017 Optometry Australia.)

Monitoring intraocular pressure (IOP) is a critically important part of glaucoma management; however, clinical tonometry predominantly involves sitting postures and is unable to detect variations in response to posture changes, muscular effort, deep respirations and during a wide range of activities, such as playing high wind-resistance instruments and wearing swimming goggles in addition to eye touching and rubbing. For example, the usefulness of 24-hour tonometric phasing may be increased, if nocturnal assessments included side and prone sleeping postures rather than being limited to supine posture tonometry. Continuous monitoring of IOP, which allows unrestricted involvement in a full range of sleep and non-sleep IOP elevating activities would provide an ideal method of quantifying the frequency, duration and degree of episodes of elevation in addition to physiological and pathological circadian rhythmic variations due to treatment. Apart from the degree of exposure to episodes of elevation of IOP, genetic influences and family history of glaucoma, other factors which are or could be associated with increased susceptibility to develop or progress glaucomatous pathology include age, frailty, race, type and degree of refractive error, systemic hypotension and hypertension, vasospasm, migraine, pigmentary dispersion syndrome, pseudoexfoliation syndrome, obstructive sleep apnoea syndrome, diabetes as well as medication interactions and side effects. Such information, when combined with all details relating to episodes of elevation of IOP, appears likely to be a strong basis for the detection, diagnosis and treatment of glaucoma. This review examines the limitations of methods of longitudinal monitoring of IOP with reference to their validity and the varying degrees of invasiveness involved. Also mentioned is the potential value of knowing the frequency, duration and level of variations of optic nerve subarachnoid space pressure, as the interaction of such changes with IOP and their potential influence on the lamina cribrosa, may help determine pathological significance., (© 2016 Optometry Australia.)

Background: Accurate diagnosis in patients presenting with lesions at various locations within the visual pathway is challenging. This study investigated functional and structural changes secondary to such lesions to identify patterns useful to guide early and effective management., Methods: Over 10,000 records from patients referred for optic nerve head assessment were reviewed and 31 patients with a final diagnosis of likely neuropathic lesions posterior to the eye were included in the current study. Fundus photographs, optic coherence tomography images and visual field tests were evaluated for changes with respect to retinal nerve fibre layer topography and prediction of structure-function paradigms. Emerging clinical patterns were examined for their consistency with the likely anatomical origin of the underlying insult in the presence of varying diagnoses., Results: Data from patients with lesions along the visual system allowed identification of retinal nerve fibre layer asymmetry correlated with visual field defects and ganglion cell analysis. Bilateral discordance in retinal nerve fibre loss easily discernible from an altered pattern of the temporal-superior-nasal-inferior-temporal curve was characteristic for post-chiasmal lesions. These sometimes-subtle changes supported diagnosis in cases with multiple aetiologies or with ambiguous visual field analysis and/or ganglion cell loss., Conclusion: Intricate knowledge of the retinal architecture and projections allows coherent predictions of functional and structural deficits following various lesions affecting the visual pathway. The integration of adjunct imaging and retinal nerve fibre layer thinning will assist clinicians to guide clinical investigations toward a likely diagnosis in the light of significant individual variations. The case series presented in this study aids in differential diagnosis of retrograde optic neuropathies by using retinal nerve fibre layer asymmetric patterns as an important clinical marker., (© 2016 The Authors. Clinical and Experimental Optometry published by John Wiley & Sons Australia, Ltd on behalf of Optometry Australia.)

Background: This paper investigates viewing distances and eyestrain symptoms in young adults reading from a smartphone for 60 minutes., Methods: A survey related to common asthenopic (eyestrain) symptoms was administered to subjects before and after they read an extract from a novel on a smartphone for 60 minutes. Subjects rated their symptoms on a scale from zero (not at all) to four (extremely). The viewing distance to the smartphone was measured on a photograph taken of the subject every minute. Each subject used the same smartphone and read the same text., Results: Subjects were 18 young adults (mean age: 21.5 ± 3.3 years) with self-reported good health, normal visual acuity and no accommodative or binocular vision disorders. The mean viewing distance while using a smartphone over 60 minutes was 29.2 ± 7.3 cm. The viewing distance was significantly greater during the first, second and fifth 10-minute time periods (30.6 ± 7.2 cm, 29.7 ± 7.3 cm and 28.9 ± 8.5 cm, respectively) than during the final 10-minute time period (27.8 ± 7.7 cm) (Wilcoxon, p = 0.023, 0.02 and 0.04, respectively). The total symptom score was significantly greater post-experiment (score = 8.06) than pre-experiment (score = 3.56) (Wilcoxon, p < 0.001). Symptoms of tired eyes, uncomfortable eyes and blur increased significantly after 60 minutes of smartphone use (Wilcoxon, p < 0.05). There was a significant correlation between change in total symptom score and change in viewing distance (ρ = -0.51; p = 0.03). The only single symptom that correlated with a change in viewing distance was 'uncomfortable eyes' (ρ = -0.52, p = 0.03)., Conclusion: Viewing distances are closer and eyestrain symptoms are greater after reading from a smartphone for 60 minutes. The viewing distances measured were closer than those previously reported in the literature., (© 2016 Optometry Australia.)

Background: The Heidelberg Retina Tomograph (HRT) is a commonly-used clinical instrument for glaucoma diagnosis; however, the repeatability of the two most commonly used analysis tools, Moorfield regression analysis (MRA) and 'glaucoma probability score' (GPS) is not known and could have significant implications for patients at risk or suspected of developing glaucoma. Thus, the intra-visit repeatability of the HRT3 (an objective measure of instrument-induced variability) was investigated in a glaucoma suspect cohort., Methods: Two repeat 15° × 15° optic nerve head scans were taken from 164 eyes of 84 patients using the HRT (HRT3, software version 3) during a single visit. The variability of global and sectoral rim area, rim volume and GPS were analysed with and without image alignment using SPSS 22.0. Repeatability was evaluated as absolute difference between the two measurements., Results: Repeatability of the global rim area, rim volume and GPS were high with and without image registration. Variability increased by a small, yet significant amount without image alignment (p < 0.001 to p = 0.002). This increase was more prominent for sectoral analysis with the exception of the rim area and volume in the temporal sector (p = 0.034 to p < 0.001). Increase in the variability of the GPS was also significant (p < 0.001)., Conclusion: HRT3 demonstrated high short-term repeatability, which significantly improved with image registration for all global measurements. Sectoral analysis demonstrated higher repeatability with image registration for some of the sectors in rim area and volume analysis and all sectors for the GPS. Therefore, depending upon the assessed parameters, image registration may play a significant role in the interpretation of results in glaucoma suspects., (© 2016 Optometry Australia.)

Background: For older individuals who sustain a hip fracture, the presence of dementia can influence their access to hospital-based rehabilitation., Purpose: This study compares the characteristics and health outcomes of individuals with and without dementia following a hip fracture; and access to, and outcomes following, hospital-based rehabilitation in a population-based cohort., Method: An examination of hip fractures involving individuals aged 65 years and older with and without dementia using linked hospitalisation, rehabilitation and mortality records during 2009-2013., Results: There were 8785 individuals with and 23 520 individuals without dementia who sustained a hip fracture. Individuals with dementia had a higher age-adjusted 30-d mortality rate compared to individuals without dementia (11.7% versus 5.7%), a lower proportion of age-adjusted 28-d re-admission (17.3% versus 24.4%) and a longer age-adjusted mean length of stay (22.2 versus 21.9 d). Compared to individuals without dementia, individuals with dementia had 4.3 times (95% CI: 3.90-4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission using the Functional Independence Measure, but to a lesser extent than individuals without dementia., Conclusion: Within a population-based cohort, older individuals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility. Implications for Rehabilitation Older individuals with dementia can benefit from rehabilitation activities following a hip fracture. Early mobilisation of individuals post-hip fracture surgery, where possible, is advised. Further work is needed on how best to work with individuals with dementia after a hip fracture in residential aged care to maximise any potential functional gains.

Background: Although cataract surgery can restore sight, lengthy waiting times are common in public hospitals in Australia. We investigated the driving status of older people during their surgical waiting period., Methods: Baseline, cross-sectional data from two prospective cohort studies of patients aged 50 years and older on Australian public hospital cataract surgery waiting lists were analysed. Participants underwent assessment of vision and completed the Driving Habits Questionnaire. The vision status was compared between current drivers and former drivers., Results: Participants (n = 442) were on average 73 ± 8 years of age and approximately half were women (229/442, 52 per cent). Habitual vision was 6/12(+2) on average (0.26 ± 0.21 logMAR). There were 263 (60 per cent) current drivers, 110 (25 per cent) former drivers and 69 participants (16 per cent) who had never driven. Among the current drivers, 82/263 (31 per cent) failed visual acuity requirements for an unconditional drivers' license (6/12 acuity with one or both eyes). The former drivers had worse visual acuity than the current drivers (between group difference 0.12 ± 0.20 logMAR, p < 0.0001) and worse contrast sensitivity (between group difference -0.14 ± 0.22 log units, p < 0.0001). Both high contrast visual acuity and contrast sensitivity were independently associated with still driving. More than half (140/263, 53 per cent) of the drivers believed that their cataract had affected their driving and 23 current drivers (nine per cent) reported a crash in the last 12 months., Conclusion: We report on the level of visual impairment among older drivers waiting for cataract surgery. Approximately one-third did not meet the required visual acuity standard for driving and hence would require further ophthalmic assessment and a conditional license to continue to drive. Approximately one-quarter of the surgical candidates were no longer driving and this was associated with greater visual impairment. These findings support a need for timely and appropriately prioritised access to cataract surgical services., (© 2016 Optometry Australia.)

Background: In South Sudan, birth deliveries attended by unskilled birth attendants put the mothers and their newborns at increased risk of perinatal morbidity and mortality. The aim of this study was to identify factors associated with delivery by unskilled birth attendants or by unassisted delivery., Design: We examined data for 2,767 (weighted total) women aged 15-49 years who delivered at home 2 years prior to the South Sudan Household Health Survey 2010. Multinomial logistic regression analyses were used to identify factors associated with delivery by unskilled birth attendants or by unassisted delivery., Results: The prevalence of delivery by unskilled birth attendants was 19% [95% confidence interval (CI) 17.0, 20.5], by skilled birth attendants (SBAs) was 45% (95% CI 42.4, 47.0), and by unassisted delivery was 36% (95% CI 34.2, 38.6). After adjusting for potential confounders, the following factors were associated with the increased odds for unassisted delivery or delivery by an unskilled birth attendant: mothers with no schooling, who did not attend antenatal care (ANC) during pregnancy, who had lower quality of ANC services, from poor households, or who had no prior knowledge about obstetric danger signs., Conclusions: We found that non-utilization of maternal health care services, such as ANC, was significantly associated with unattended birth delivery or delivery by unskilled health providers. The increased uptake of SBAs at delivery will require easier access to ANC services, health promotion on the importance and benefits of SBAs for delivery, targeting both mothers and their families, and the training and deployment of more SBAs across the country.

The complex interaction between obesity, Western-style diets, and cardiovascular disease is of increasing interest, with a growing number of children being born to obese parents with poor lifestyle choices. These offspring have themselves an increased susceptibility to obesity and subsequent cardiovascular disease in adult life, which may be 'programmed' by their intrauterine environment. Cardiac microRNAs (miRNAs) are affected by multiple disease states, and have also been shown to be capable of exerting a hormone-like control on whole body metabolism. Here we sought to determine the effect of prenatal exposure to maternal obesity and/or postnatal exposure to a Western diet on miRNA expression in the heart. Unbiased small RNA sequencing was carried out on cardiac tissue from young adult mice born to lean or obese mothers; offspring were weaned onto either a low-fat control diet or a high-fat Western-style diet. We found 8 cardiac miRNAs that were significantly altered in response to maternal obesity, but only when the offspring were challenged postnatally with the Western diet. In contrast, postnatal exposure to the diet alone induced significant changes to the expression of a much larger number of miRNAs (33 in offspring of lean and 46 in offspring of obese). Many of the affected miRNAs have previously been implicated in various cardiac pathologies. The pervasive cardiac miRNA changes induced by a Western diet suggest that an individual's lifestyle choices outweigh the impact of any programming effects by maternal obesity on miRNA-related cardiac health.

Background: Population-based studies involving refractive error in South Africa are few because they are expensive to conduct and require a high level of expertise. Rapid assessment of refractive error (RARE) is a relatively less resource-intensive method designed to assess the magnitude of uncorrected refractive error (URE), spectacle coverage and barriers to access of services. This information is useful for designing and implementing programs as well as for policy development., Purpose: The purpose of this study was to determine the prevalence of uncorrected refractive error and spectacle coverage and to explore the barriers to uptake of refractive services in persons 15 to 35 years old in the eThekwini municipality, Durban, South Africa., Methods: A cross-sectional epidemiological study was conducted using the RARE protocol. A total of 1,543 participants were enumerated and 1,516 were examined. Uncorrected refractive error was defined as presenting visual acuity less than 6/12 that could be corrected to 6/12 or better using a pinhole. Spectacle coverage was defined as the proportion of need that was already met with spectacle correction., Results: The prevalence of age and sex adjusted URE was 1.5% (95 per cent CI: 0.7 -2.3). Odds for uncorrected refractive error in women were 0.5 (95 per cent CI: 0.3-0.9) lower compared to men. There was a statistically significant association between uncorrected refractive error and respondents 15 to 24 years old (p < 0.001). The spectacle coverage (6/12 cut-off) was 51.4 per cent (95 per cent CI: 28.1-74.7). The prevalence of spectacle use among participants was 3.8 per cent., Conclusions: The low prevalence of uncorrected refractive error found in this study agrees with previous studies that indicate that despite uncorrected refractive error being the most common cause of visual impairment and the second most common cause of blindness worldwide, its prevalence is relatively low in South Africans., (© 2016 Optometry Australia.)

Background: Eye rubbing is commonly associated with keratoconus and may contribute to disease onset and progression. Verbal counselling to avoid rubbing may not be successful and adverse consequences of rubbing, which occurs on contact lens removal may be more serious. This study examines the prevalence of 'removal-relief' rubbing and its potential consequences., Methods: Rubbing histories were recorded for contact lens wearing normal and keratoconic patients as well as for normal non-contact lens wearers. Analogue scaled responses were used to identify and compare abnormal rubbing habits., Results: Contact lens wearing patients (both with and without keratoconus) reported significantly more rubbing before contact lens insertion (p < 0.05) compared to non-contact lens wearers. Eye rubbing after contact lens removal ('removal-relief' rubbing) was found to be significantly more prevalent among contact lens-wearing keratoconic patients compared to contact lens-wearing non-keratoconic patients (p < 0.001 in both cases)., Conclusions: Rubbing-related trauma occurring before contact lens insertion may predispose the cornea to wound healing activities and greater levels of adverse response to contact lens wear. Such adverse responses could predispose the cornea to greater trauma, which occurs in response to rubbing on removal of contact lenses. Strong counselling to avoid eye rubbing is often not an adequate form of management for a significant number of patients with keratoconus. Evidence of relapses indicates the need for better methods of counselling and for them to be repeated regularly. Apart from keratoconus, any other keratectasia, corneal disease or wound healing (including post-surgical) may increase susceptibility to corneal rubbing trauma. Such cases also appear to warrant counselling on avoidance of rubbing., (© 2016 Optometry Australia.)