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1.
Invest Ophthalmol Vis Sci ; 65(10): 21, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-39136629

RESUMEN

Purpose: Few studies have explored choroidal changes after cessation of myopia control. This study evaluated the choroidal thickness (ChT) and choroidal vascularity index (CVI) during and after discontinuing long-term low-concentration atropine eye drops use for myopia control. Methods: Children with progressive myopia (6-16 years; n = 153) were randomized to receive 0.01% atropine eye drops or a placebo (2:1 ratio) instilled daily over 2 years, followed by a 1-year washout (no eye drop use). Optical coherence tomography imaging of the choroid was conducted at the baseline, 2-year (end of treatment phase), and 3-year (end of washout phase) visits. The main outcome measure was the subfoveal ChT. Secondary measures include the CVI. Results: During the treatment phase, the subfoveal choroids in both treatment and control groups thickened by 12-14 µm (group difference P = 0.56). During the washout phase, the subfoveal choroids in the placebo group continued to thicken by 6.6 µm (95% confidence interval [CI] = 1.7 to 11.6), but those in the atropine group did not change (estimate = -0.04 µm; 95% CI = -3.2 to 3.1). Participants with good axial eye growth control had greater choroidal thickening than the fast-progressors during the treatment phase regardless of the treatment group (P < 0.001), but choroidal thickening in the atropine group's fast-progressors was not sustained after stopping eye drops. CVI decreased in both groups during the treatment phase, but increased in the placebo group after treatment cessation. Conclusions: On average, compared to placebo, 0.01% atropine eye drop treatment did not cause a differential rate of change in ChT during treatment, but abrupt cessation of long-term 0.01% atropine eye drops may disrupt normal choroidal thickening in children.


Asunto(s)
Atropina , Coroides , Midriáticos , Soluciones Oftálmicas , Tomografía de Coherencia Óptica , Humanos , Atropina/administración & dosificación , Coroides/patología , Coroides/diagnóstico por imagen , Coroides/efectos de los fármacos , Masculino , Femenino , Niño , Adolescente , Midriáticos/administración & dosificación , Miopía/tratamiento farmacológico , Miopía/fisiopatología , Método Doble Ciego , Estudios de Seguimiento , Refracción Ocular/fisiología , Miopía Degenerativa/tratamiento farmacológico , Miopía Degenerativa/fisiopatología , Agudeza Visual
2.
Clin Exp Ophthalmol ; 52(5): 507-515, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38400607

RESUMEN

BACKGROUND: A rebound in myopia progression following cessation of atropine eyedrops has been reported, yet there is limited data on the effects of stopping 0.01% atropine compared to placebo control. This study tested the hypothesis that there is minimal rebound myopia progression after cessation of 0.01% atropine eyedrops, compared to a placebo. METHODS: Children with myopia (n = 153) were randomised to receive 0.01% atropine eyedrops or a placebo (2:1 ratio) daily at bedtime during the 2-year treatment phase of the study. In the third year (wash-out phase), all participants ceased eyedrop instillation. Participants underwent an eye examination every 6 months, including measurements of spherical equivalent (SphE) after cycloplegia and axial length (AL). Changes in the SphE and AL during the wash-out phase and throughout the 3 years of the study (treatment + wash-out phase) were compared between the treatment and control groups. RESULTS: During the 1-year wash-out phase, SphE and AL progressed by -0.41D (95% CI = -0.33 to -0.22) and +0.20 mm (95% CI = -0.46 to -0.36) in the treatment group compared to -0.28D (95% CI = 0.11 to 0.16) and +0.13 mm (95% CI = 0.18 to 0.21) in the control group. Progression in the treatment group was significantly faster than in the control group (p = 0.016 for SphE and <0.001 for AL). Over the 3-year study period, the cumulative myopia progression was similar between the atropine and the control groups. CONCLUSIONS: These findings showed evidence of rapid myopia progression following cessation of 0.01% atropine. Further investigations are warranted to ascertain the long-term effects of atropine eyedrops.


Asunto(s)
Atropina , Longitud Axial del Ojo , Progresión de la Enfermedad , Midriáticos , Soluciones Oftálmicas , Refracción Ocular , Humanos , Atropina/administración & dosificación , Masculino , Femenino , Niño , Midriáticos/administración & dosificación , Refracción Ocular/fisiología , Método Doble Ciego , Miopía/tratamiento farmacológico , Miopía/fisiopatología , Australia Occidental , Adolescente
3.
Neurooncol Pract ; 10(3): 249-260, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37188163

RESUMEN

Background: There are no effective treatments for brain tumor-related fatigue. We studied the feasibility of two novel lifestyle coaching interventions in fatigued brain tumor patients. Methods: This phase I/feasibility multi-center RCT recruited patients with a clinically stable primary brain tumor and significant fatigue (mean Brief Fatigue Inventory [BFI] score ≥ 4/10). Participants were randomized in a 1-1-1 allocation ratio to: Control (usual care); Health Coaching ("HC", an eight-week program targeting lifestyle behaviors); or HC plus Activation Coaching ("HC + AC", further targeting self-efficacy). The primary outcome was feasibility of recruitment and retention. Secondary outcomes were intervention acceptability, which was evaluated via qualitative interview, and safety. Exploratory quantitative outcomes were measured at baseline (T0), post-interventions (T1, 10 weeks), and endpoint (T2, 16 weeks). Results: n = 46 fatigued brain tumor patients (T0 BFI mean = 6.8/10) were recruited and 34 were retained to endpoint, establishing feasibility. Engagement with interventions was sustained over time. Qualitative interviews (n = 21) suggested that coaching interventions were broadly acceptable, although mediated by participant outlook and prior lifestyle. Coaching led to significant improvements in fatigue (improvement in BFI versus control at T1: HC=2.2 points [95% CI 0.6, 3.8], HC + AC = 1.8 [0.1, 3.4], Cohen's d [HC] = 1.9; improvement in FACIT-Fatigue: HC = 4.8 points [-3.7, 13.3]; HC + AC = 12 [3.5, 20.5], d [HC and AC] = 0.9). Coaching also improved depressive and mental health outcomes. Modeling suggested a potential limiting effect of higher baseline depressive symptoms. Conclusions: Lifestyle coaching interventions are feasible to deliver to fatigued brain tumor patients. They were manageable, acceptable, and safe, with preliminary evidence of benefit on fatigue and mental health outcomes. Larger trials of efficacy are justified.

4.
Ocul Immunol Inflamm ; 31(3): 621-623, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35298343

RESUMEN

BACKGROUND: The pathophysiology of uveitis in a patient with post-streptococcal syndrome with evidence of bacterial sepsis may be difficult to classify as being infective or an inflammatory etiology. CASE REPORT: Our patient presented with uveitis with systemic features of reactive arthritis and acute renal failure in a background of sepsis with group A streptococcus. Treatment with topical steroids lead to the resolution of this type of uveitis. CONCLUSION: It is safe to consider uveitis as being inflammatory rather than infectious and treat appropriately, when evidence suggesting other features of post -streptococcal syndrome are present.


Asunto(s)
Bacteriemia , Infecciones Estreptocócicas , Uveítis , Humanos , Uveítis/complicaciones , Uveítis/diagnóstico , Uveítis/tratamiento farmacológico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus
5.
Clin Exp Optom ; 106(6): 633-639, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-36002152

RESUMEN

CLINICAL RELEVANCE: Eye injuries constitute a significant cause of preventable lifelong visual impairment or blindness. It is important to identify the context in which these injuries occur to develop intervention programs to reduce the incidence and severity of injury. BACKGROUND: To evaluate the nature, external cause, place of occurrence and incidence rate of eye injuries treated at hospitals in Western Australia. METHODS: Retrospective, population-based study of patients presenting to all emergency departments or admitted to hospital with primary or secondary eye injuries between 2005 and 2014. RESULTS: The combined incidence rate of eye injuries requiring tertiary care was 278 per 100 000 person-years (95% CI 276-280). Significantly more males (79%, 44 569) presented to emergency departments (p < 0.001), and most injuries involved the cornea and conjunctiva (83%). The injury incidence rate was 248 per 100 000 person-years (95% CI 246-250). A total of 2823 and 3951 individuals were admitted to hospital for a primary or secondary eye injury, respectively. The most frequent primary diagnosis on admission was contusion (19%). Assault (24%) was the most common cause of injury requiring inpatient treatment. Indigenous individuals were hospitalised for an eye injury at a rate of 109 per 100 000 person-years (95% CI 102-116), compared to 27 (95% CI 26-27) for non-Indigenous individuals. Each year was associated with an increase in the mean number of eye injuries (7% and 5% for emergency department and hospital admission data, respectively). CONCLUSION: Indigenous individuals and males experience eye injuries requiring tertiary management disproportionately. Indigenous female patients were conspicuously affected by eye injuries. Remedial intervention strategies should incorporate violence prevention as assault is a significant cause of eye injury.


Asunto(s)
Lesiones Oculares , Masculino , Humanos , Femenino , Estudios Retrospectivos , Australia Occidental/epidemiología , Lesiones Oculares/epidemiología , Lesiones Oculares/complicaciones , Hospitalización , Violencia , Incidencia
6.
Clin Exp Ophthalmol ; 50(9): 1001-1012, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36054556

RESUMEN

BACKGROUND: To test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia-control approach in Australian children. METHODS: Children (6-16 years; 49% Europeans, 18% East Asian, 22% South Asian, and 12% other/mixed ancestry) with documented myopia progression were enrolled into this single-centre randomised, parallel, double-masked, placebo-controlled trial and randomised to receive 0.01% atropine (n = 104) or placebo (n = 49) eyedrops (2:1 ratio) instilled nightly over 24 months (mean index age = 12.2 ± 2.5 and 11.2 ± 2.8 years, respectively). Outcome measures were the changes in spherical equivalent (SE) and axial length (AL) from baseline. RESULTS: At 12 months, the mean SE and AL change from baseline were -0.31D (95% confidence interval [CI] = -0.39 to -0.22) and 0.16 mm (95%CI = 0.13-0.20) in the atropine group and -0.53D (95%CI = -0.66 to -0.40) and 0.25 mm (95%CI = 0.20-0.30) in the placebo group (group difference p ≤ 0.01). At 24 months, the mean SE and AL change from baseline was -0.64D (95%CI = -0.73 to -0.56) and 0.34 mm (95%CI = 0.30-0.37) in the atropine group, and -0.78D (95%CI = -0.91 to -0.65) and 0.38 mm (95%CI = 0.33-0.43) in the placebo group. Group difference at 24 months was not statistically significant (p = 0.10). At 24 months, the atropine group had reduced accommodative amplitude and pupillary light response compared to the placebo group. CONCLUSIONS: In Australian children, 0.01% atropine eyedrops were safe, well-tolerated, and had a modest myopia-control effect, although there was an apparent decrease in efficacy between 18 and 24 months, which is likely driven by a higher dropout rate in the placebo group.


Asunto(s)
Atropina , Miopía , Niño , Humanos , Adolescente , Soluciones Oftálmicas , Australia , Miopía/tratamiento farmacológico , Refracción Ocular , Progresión de la Enfermedad
7.
Clin Exp Optom ; 105(6): 637-641, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-34402757

RESUMEN

CLINICAL RELEVANCE: Eye injuries, both accidental and non-accidental, are a significant cause of long-term visual impairment in children. An understanding of when and how such injuries occur is key to development of adequate prevention strategies. BACKGROUND: To evaluate accidental and non-accidental eye injuries in children presenting to the major tertiary emergency department and outpatient ophthalmology clinic in Western Australia during the nationwide COVID-19 lockdown and to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. METHODS: Retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March-August 2020 and the same period in 2019. RESULTS: There was no significant difference in the total number of accidental eye injury presentations during the lockdown period despite a significant decrease in emergency department attendance overall. Closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, 64%), followed by adnexal injuries (39/110, 35%) and open-globe injuries (1/110, 1%). In contrast, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown.Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance. Public education regarding in-home eye injury prevention must be ongoing.


Asunto(s)
COVID-19 , Lesiones Oculares , Oftalmología , COVID-19/epidemiología , Niño , Control de Enfermedades Transmisibles , Lesiones Oculares/epidemiología , Lesiones Oculares/etiología , Humanos , Pandemias , Estudios Retrospectivos
8.
Transl Vis Sci Technol ; 10(9): 3, 2021 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-34342609

RESUMEN

Purpose: To report the distribution of peripapillary retinal nerve fiber layer (RNFL) thickness in healthy young adults, investigate factors associated with RNFL thickness, and report the percentage of outside normal limits (ONL) and borderline (BL) RNFL thickness classifications based on the optical coherence tomography (OCT) manufacturer reference database. Methods: Participants of the Raine Study Generation 2 cohort (aged 18-22 years) underwent spectral domain OCT imaging with an RNFL circle scan. Eyes with inadequate scans or optic nerve pathology were excluded. Linear mixed models were used to analyze associations. Results: Data were available for 1288 participants (mean age, 20.0 years). Mean RNFL thicknesses in right and left eyes, respectively, were global = 100.5 µm, 100.3 µm (P = 0.03); temporal = 73.1 µm, 68.9 µm (P < 0.001); superotemporal = 140.6 µm, 136.3 µm (P < 0.001); superonasal = 104.9 µm, 115.1 µm (P < 0.001); nasal = 79.7 µm, 79.1 µm (P = 0.09); inferonasal = 109.8 µm, 111.5 µm (P < 0.001); and inferotemporal = 143.2 µm, 143.6 µm (P = 0.51). Longer axial length was associated with thinner RNFL globally, nasally, inferotemporally, superotemporally, superonasally, and inferonasally, as well as thicker RNFL temporally. The prevalence of ONL and BL classifications was generally higher than the expected rates of 1% and 4%, respectively, in temporal sectors and lower than expected in nasal sectors. The prevalence of global BL classifications was lower than expected (right eye, 2.3%; left eye, 2.6%). Conclusions: Measured RNFL thickness differs with axial length and between right and left eyes. More reference data are needed to better define the normal limits of RNFL variation in different populations. Translational Relevance: This study provides an improved understanding of normal variation in RNFL thickness in young adults.


Asunto(s)
Fibras Nerviosas , Disco Óptico , Adulto , Humanos , Nervio Óptico/diagnóstico por imagen , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Adulto Joven
10.
Clin Exp Ophthalmol ; 48(5): 569-579, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32100917

RESUMEN

IMPORTANCE: Atropine eyedrops are a promising treatment for slowing myopia progression in East Asian children. However, its effects on children in Australia, including those of non-Asian background, have not been well-studied. BACKGROUND: The Western Australia Atropine for the Treatment of Myopia (WA-ATOM) study aims to determine the efficacy and long-term effects of low-dose atropine eyedrops in myopia control. This paper describes the study rationale, methodology and participant baseline characteristics. DESIGN: Single-centre, double-masked, randomized controlled trial. PARTICIPANTS: Children (6-16 years) with spherical equivalent ≤-1.50 D in each eye, astigmatism ≤1.50 D and myopia progression by ≥0.50 D/year. METHODS: Enrolled children were randomly assigned 2:1 to receive 0.01% atropine or placebo eyedrops. Participants are examined every 6 months during first 3 years of the study (2-year treatment phase followed by a 1-year washout phase), and then at a 5-year follow-up (2 years after the end of the washout phase). MAIN OUTCOME MEASURES: Annual progression rate of myopia and axial length, tolerability to eyedrops and incidence and severity of unwanted effects. RESULTS: Out of 311 children who were referred, 242 were suitable for study participation, and 153 were subsequently enrolled. The baseline characteristics of enrolled participants are presented. CONCLUSIONS AND RELEVANCE: Outcomes of the WA-ATOM study will inform on the efficacy, tolerability, safety and long-term effects of low-dose atropine eyedrops in myopia control in Australian children. The impact of ocular sun exposure, iris colour and parental myopia on the efficacy of low-dose atropine will also be assessed.


Asunto(s)
Atropina , Miopía , Australia/epidemiología , Niño , Progresión de la Enfermedad , Humanos , Miopía/tratamiento farmacológico , Soluciones Oftálmicas , Refracción Ocular , Australia Occidental/epidemiología
11.
J Glaucoma ; 28(9): 843-845, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31233452

RESUMEN

PURPOSE: To describe a case of photoreceptor outer segment glaucoma (Schwartz-Matsuo syndrome) with electron microscopic evidence of photoreceptor outer segments in the trabecular meshwork (TM). DESIGN: This is a clinicopathologic case report. PARTICIPANT: A 48-year-old Filipino man. METHODS: Specimens of aqueous humor and TM in a clinical case of Schwartz-Matsuo syndrome were examined by electron microscopy. MAIN OUTCOME MEASURES: Electron photomicroscopy. RESULTS: Electron microscopy showed evidence of retinal photoreceptor outer-segments in both an aqueous humor and a TM specimen. CONCLUSION: Schwartz-Matsuo syndrome is associated with the presence of photoreceptor outer segments in the TM.


Asunto(s)
Humor Acuoso/citología , Glaucoma/cirugía , Desprendimiento de Retina/diagnóstico , Segmento Externo de las Células Fotorreceptoras Retinianas/ultraestructura , Malla Trabecular/ultraestructura , Trabeculectomía , Hemorragia Vítrea/diagnóstico , Humanos , Presión Intraocular/fisiología , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Síndrome
12.
Br J Ophthalmol ; 102(4): 496-501, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28844049

RESUMEN

AIM: To investigate whether pterygium is an indicator of an increased risk of cutaneous melanoma (CM). METHODS: A matched-cohort study, using linked health administrative data sets to identify all hospital-treated pterygium in Western Australia (WA) between 1979 and 2014. We identified pterygium cases from hospital diagnosis and/or procedure International Classification of Diseases 9th revision (ICD-9) and 10th revision (ICD-10) codes and matched cases by age, sex and residential postcode to WA Electoral Roll controls with no known history of pterygium. Both cohorts were linked to the WA Cancer Registry and the WA Deaths Registry. RESULTS: 23 625 people had pterygium treatment (64% male) in WA hospitals. The median age for pterygium diagnosis and/or treatment was 49 years (range 14-96). There were significantly more CM cases in the pterygium cohort compared with the control cohort (1083 vs 874; p<0.001). In a logistic regression analysis, there was a 24% increase in the odds of developing a CM in the pterygium cohort, compared with controls, after controlling for other predictors (OR 1.24, 95% CI 1.1 to 1.4). The incident rate ratio (IRR) of a malignant CM diagnosis was 20% greater in people who had treatment for a pterygium compared with controls (IRR 1.2, 95% CI 1.0 to 1.4). CONCLUSION: The presence of a pterygium indicates a significantly increased risk of developing a CM. Eye care providers who see patients with developing pterygia should advise these patients of this increased risk and recommend regular skin surveillance.


Asunto(s)
Melanoma/epidemiología , Pterigion/epidemiología , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios de Cohortes , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Incidencia , Masculino , Melanoma/diagnóstico , Melanoma/etiología , Persona de Mediana Edad , Pterigion/complicaciones , Análisis de Regresión , Factores de Riesgo , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/etiología , Australia Occidental/epidemiología , Adulto Joven
13.
J AAPOS ; 21(6): 499-501.e1, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29079216

RESUMEN

This retrospective case series assessed the influence of unilateral intravitreal bevacizumab (IVB) for unilateral type 1 retinopathy of prematurity (ROP) on macular thickness and foveal development. Seven infants with unilateral type 1 ROP were treated with intravitreal bevacizumab 0.625 mg/0.025 ml in one eye only. To determine whether macular thickness and fovea structural development were affected by treatment, spectral domain optical coherence tomography was performed on both treated and untreated eyes. The mean gestational age of infants was 25.3 ± 0.3 weeks; the mean birth weight, 776 ± 17.6 g. Treatment was given at a mean postmenstrual age of 37.2 ± 0.4 weeks. Foveal development was normal in 3 (43%) treated versus 5 (71%) untreated eyes. The mean central foveal thickness for treated and untreated eyes was 270.1 µm ± 19.6 and 253.0 µm ± 27.2 respectively (P = 0.15). There was small but nonsignificant difference in foveal development and thickness in eyes treated with intravitreal bevacizumab compared to fellow eyes. This study generates important data to test the hypothesis that foveal thickness is greater in unilateral type 1 ROP eyes treated with IVB compared to untreated fellow eyes.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Mácula Lútea/patología , Retinopatía de la Prematuridad/tratamiento farmacológico , Tomografía de Coherencia Óptica , Peso al Nacer , Femenino , Angiografía con Fluoresceína , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Inyecciones Intravítreas , Mácula Lútea/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores
14.
Surv Ophthalmol ; 61(4): 443-65, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26844660

RESUMEN

Large population-based health administrative databases, clinical registries, and data linkage systems are a rapidly expanding resource for health research. Ophthalmic research has benefited from the use of these databases in expanding the breadth of knowledge in areas such as disease surveillance, disease etiology, health services utilization, and health outcomes. Furthermore, the quantity of data available for research has increased exponentially in recent times, particularly as e-health initiatives come online in health systems across the globe. We review some big data concepts, the databases and data linkage systems used in eye research-including their advantages and limitations, the types of studies previously undertaken, and the future direction for big data in eye research.


Asunto(s)
Investigación sobre Servicios de Salud/organización & administración , Oftalmología , Sistema de Registros , Bases de Datos Factuales , Humanos
15.
Ophthalmology ; 122(11): 2344-50, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26394754

RESUMEN

PURPOSE: To determine whether blindness in older people is associated with increased health service use and mortality. DESIGN: Retrospective matched cohort study from July 1, 1999, through June 30, 2010. PARTICIPANTS: A blind cohort 65 years of age and older from a volunteer blind register and a cohort of age- and gender-matched controls selected randomly from the Western Australian electoral roll. METHODS: Person-level linked hospital, emergency department (ED), mental health, and death records for the blind and control cohorts were used. Generalized estimating equations assuming a negative binomial distribution were used to estimate relative rates of hospital admissions, lengths of stay, and mortality after adjusting for sociodemographic variables and comorbidity. Emergency department and mental health service visits also were quantified. MAIN OUTCOME MEASURES: Relative rates of hospital admissions, lengths of stay, and mortality, as well as crude proportions of ED and mental health service visits. RESULTS: The blind cohort comprised 1726 individuals alongside 1726 matched controls; 39% were men, and the mean age was 83 years. Combined, the cohorts accumulated a total of 34 130 hospital admissions amounting to 201 867 bed-days. After adjusting for the principal reason for hospital admission and comorbidity, the blind cohort was admitted to the hospital 11% (95% confidence interval [CI], 6%-17%) more often than the control cohort. The blind cohort also stayed in the hospital longer than the controls, but this effect varied by age. Blind participants 65 to 69 years of age spent 88% more days (95% CI, 27%-178%) in the hospital compared with age-matched controls, whereas there was no difference in length of stay between the cohorts by 80 years of age (rate ratio, 1.10; 95% CI, 0.97-1.25). A larger proportion of the blind cohort visited a hospital ED and accessed mental health services compared with the control cohort. CONCLUSIONS: Health service use is increased for the elderly blind compared with age-matched controls after accounting for comorbidity. The elderly blind have more hospital admissions, ED visits, and mental health-related visits. The younger elderly blind stay longer in hospital. However, there was no evidence of worse mortality outcomes after adjusting for comorbidity.


Asunto(s)
Ceguera/epidemiología , Servicios de Salud para Ancianos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Personas con Daño Visual/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Masculino , Servicios de Salud Mental/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Australia Occidental/epidemiología
16.
Acta Ophthalmol ; 93(1): 27-32, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24903558

RESUMEN

PURPOSE: To describe trends, risk factors and outcomes of anterior vitrectomy during cataract and intraocular lens (IOL) surgery. METHODS: All patients 16 years and older undergoing cataract and IOL surgery in Western Australia (WA) from January 1980 to December 2001 (n = 115 815) were included. Hospital administrative data were used to identify all cataract and IOL procedures and subsequent admissions for retinal detachment, IOL dislocation, endophthalmitis and pseudophakic corneal oedema. Data were validated with chart review and analysed to identify trends and risk factors for anterior vitrectomy and the risk of subsequent complications. RESULTS: In total, 1390 (1.2%) anterior vitrectomies were performed. The rate increased with change in surgical technique. Significant risk factors for anterior vitrectomy were age <50 years (OR 1.31), male sex (OR 1.23), IOL procedure (OR 11.45) and operations in public hospitals (OR 1.99) or rural/remote (OR 1.40) areas. Anterior vitrectomy was strongly associated with increased risk of retinal detachment (RD) (RR 18.5), endophthalmitis (RR 3.6), IOL dislocation (RR 21.1) and pseudophakic corneal oedema (RR 17.3). Retinal detachments and IOL dislocations occur earlier after anterior vitrectomy. CONCLUSION: Anterior vitrectomy rates have remained stable since the introduction of phacoemulsification. Anterior vitrectomy is a major risk factor for serious complications compared with uncomplicated surgery, particularly RD and IOL dislocation. We identified an increasing trend in anterior vitrectomy being performed during extracapsular and IOL surgery.


Asunto(s)
Extracción de Catarata , Implantación de Lentes Intraoculares , Vitrectomía/tendencias , Cuerpo Vítreo/patología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Migracion de Implante de Lente Artificial/epidemiología , Edema Corneal/epidemiología , Endoftalmitis/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Desprendimiento de Retina/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Australia Occidental/epidemiología
17.
Br J Ophthalmol ; 97(12): 1579-85, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24123905

RESUMEN

AIM: Determine whether blindness in people aged 18-65 years was associated with increased rates of mortality, hospitalisation and length of stay. METHODS: A retrospective matched cohort study of legally blind people and normally sighted controls, aged 18-65 years, comparing mortality rates and hospital morbidity records. RESULTS: Together, 419 blind and 419 controls accumulated 12 258 hospital separations over the 11-year study period. The blind had an age-specific mortality rate seven times greater (12/1000 person years) than the general population (1.8/1000 person years) (p<0.001). Blindness was recorded as a comorbid condition for 76 (22%) blind individuals, on just 255 (2.3%) hospital separation records. Psychiatric, mental or behavioural conditions were the most frequently recorded diagnoses, after dialysis and endocrine conditions. After adjusting for comorbidities, the blind cohort had 1.5 times more hospital separations (p=0.007, 95% CI 1.1 to 2.0) and 2.2 times more bed days (p=0.016, 95% CI 1.4 to 4.1) compared with the control cohort. CONCLUSIONS: Recognition and acknowledgement of in-patients' blind status may assist in understanding the frequent and extended health service utilisation rates. Encouraging and promoting the uptake and access to rehabilitation support services would be measures that may reduce the health service burden of blindness, the incidence of depression and other mental health problems.


Asunto(s)
Ceguera/mortalidad , Servicios de Salud/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Personas con Daño Visual/estadística & datos numéricos , Adolescente , Adulto , Anciano , Australia/epidemiología , Ceguera/etiología , Estudios de Cohortes , Comorbilidad , Depresión/epidemiología , Empleo , Femenino , Humanos , Incidencia , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Morbilidad , Adulto Joven
18.
Retina ; 33(5): 920-7, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23492942

RESUMEN

PURPOSE: To determine the risk of thromboembolic and gastrointestinal bleeding events in the 12 months after injections of bevacizumab or ranibizumab compared with photodynamic therapy and a nontreated community sample. METHODS: Hospital and death records were examined for 1,267 patients treated with vascular endothelial growth factor inhibitor and 399 patients treated with photodynamic therapy attending Western Australian eye clinics from 2002 to 2008, and 1,763 community controls, aged ≥50 years. Hospital records from 1995 to 2009 were analyzed for history of myocardial infarction (MI), stroke, and gastrointestinal bleeding before treatment. Records were searched for evidence of these events in the 12 months after treatment. RESULTS: The 12-month MI rate was higher for vascular endothelial growth factor inhibitor patients than photodynamic therapy patients and the community group (1.9/100 vs. 0.8 and 0.7, respectively). No differences were observed between patients treated with bevacizumab and ranibizumab. The adjusted MI rate was 2.3 times greater than the community group (95% confidence interval, 1.2-4.5) and photodynamic therapy rate (95% confidence interval, 0.7-7.7). The 12-month MI risk did not increase with the number of injections administered (hazard ratio, 0.9; 95% confidence interval, 0.5-1.5). Stroke and gastrointestinal bleeding did not differ between any exposure groups. CONCLUSION: Although all the adverse events examined were rare, patients treated with vascular endothelial growth factor inhibitors were significantly more likely to experience fatal or nonfatal MI than the community group. This increased risk may be related to the underlying age-related macular degeneration or vascular endothelial growth factor inhibitor use itself.


Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Degeneración Macular/tratamiento farmacológico , Infarto del Miocardio/inducido químicamente , Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Bevacizumab , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Registros de Hospitales/estadística & datos numéricos , Humanos , Inyecciones Intravítreas , Masculino , Fotoquimioterapia/efectos adversos , Ranibizumab , Estudios Retrospectivos , Accidente Cerebrovascular/inducido químicamente , Australia Occidental
19.
Clin Exp Ophthalmol ; 41(8): 773-8, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23448541

RESUMEN

BACKGROUND: To evaluate the impact of blindness on hospitalization rates of children. DESIGN: Matched cohort study. PARTICIPANTS: Children confirmed as legally blind (2003-2009), age- and gender-matched to control cohort of normally sighted children from the state register of births. METHODS: The rates and reasons for admission to hospital were compared using hospital morbidity records. The association of blindness with rates of admission and length of stay in hospital, 2003-2010, were estimated using multivariate negative binomial regression models. MAIN OUTCOME MEASURES: Descriptive statistics, incident rate ratios, and predicted means for hospital separations and length of stay. RESULTS: Fifty-nine blind and 59 control children had a combined total of 107 separations accounting for 237 bed days in hospital after the index date of legal blindness. The median age at the index date was 8 years. Over 90% of separations and 92% of bed days were incurred by 22 blind children. Blind children had four (95% confidence interval 1.9-9.3) times more hospital separations and stayed in hospital six (95% confidence interval 1.9-17.5) times longer than the control cohort children. There were more than 40 times as many comorbidities recorded by the blind children (n = 201) compared with the control children (n = 5). A third of the blind children were hospitalized for respiratory conditions. CONCLUSIONS: Children who are born or become blind in childhood have more and longer periods in hospital than sighted children likely because of complex comorbid health problems. There was a disproportionate incidence of comorbid respiratory diseases in the blind children.


Asunto(s)
Ceguera/epidemiología , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Adolescente , Ceguera/etiología , Niño , Preescolar , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Incidencia , Lactante , Enfermedades Pulmonares/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Sistema de Registros , Proyectos de Investigación , Agudeza Visual , Campos Visuales
20.
Arch Ophthalmol ; 130(7): 882-8, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22776926

RESUMEN

OBJECTIVES: To estimate the long-term cumulative incidence of and risk factors for retinal detachment (RD) after phacoemulsification using linked administrative medical data. METHODS: We used the Western Australian Data Linkage System to identify patients who underwent phacoemulsification in Western Australia between January 1989 and December 2001. Retinal detachment cases were those patients requiring admission for RD surgery after phacoemulsification that were validated by medical record review. Kaplan-Meier analysis was used to calculate a cumulative incidence. Cox proportional hazards regression modeling was used to determine the association between RD and risk factors, including patient demographics and operative and hospital factors. Some important risk factors, including axial length and Nd:YAG laser capsulotomy, were not examined. RESULTS: We identified 237 RD cases following 65 055 phacoemulsification procedures, with a 10-year cumulative incidence of 0.68% (95% CI, 0.56%-0.83%). Significant risk factors were year of surgery (hazard ratio [HR], 0.43; 95% CI, 0.28-0.66 [1999-2001 compared with 1989-1993] for each 5-year period after 1985), age younger than 60 years (3.76; 2.83-5.00), male sex (1.91; 1.45-2.51), and anterior vitrectomy (27.60; 19.27-39.52). Hospital location, patient rural or remote locality, hospital cataract surgery volume, failed intraocular lens insertion, length of stay, and patient insurance status were not significantly associated with RD. CONCLUSIONS: Risk for RD after phacoemulsification has almost halved for each 5-year period since its adoption in the mid 1980s. Younger patient age and male sex at surgery significantly increased risk for RD. Phacoemulsification requiring anterior vitrectomy vastly increased risk for RD.


Asunto(s)
Facoemulsificación , Complicaciones Posoperatorias , Desprendimiento de Retina/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Recolección de Datos , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Desprendimiento de Retina/etiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Australia Occidental/epidemiología , Adulto Joven
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