Normative Quantitative Values for Dacryoscintigraphy and the Effect of Lid Massage.

Our objectives were to establish normative quantitative values for dacryoscintigraphy in an older population and to evaluate the effect of lid massage. Methods: We conducted a prospective study of 44 eyes of 22 participants aged between 54-90 y that had no symptoms of epiphora and no clinical tear film instability, lid abnormality, lacrimal system impairment, or patent lacrimal duct on syringing. Dacryoscintigraphy was performed and interpreted by a single nuclear medicine physician. The scan protocol involved instillation of 99mTc-pertechnetate in each eye, with a 45-min scan performed with 1-min frames. Lid massage and a sinus clearing maneuver were then performed, followed by a further 45 min of scanning. Results: The mean age of the 22 participants was 71.9 y. Quantitative analysis by half-clearance time (HCT) demonstrated a median presac HCT of 25.5 ± 15.0 min and a whole-eye HCT of 40.0 ± 19.5 min. There was no association between age or sex and HCT. Qualitatively, 29 of 44 eyes (66%) appeared to have at least 1 region of delayed clearance, with improvement noted in 23 after lid massage (79%). Conclusion: We report the quantitative values for dacryoscintigraphy in an asymptomatic older population who had normal findings on lacrimal examination. A high rate of delay in radiotracer transit on qualitative examination suggesting a low specificity. The false-positive rate was significantly improved with the novel approach of adding lid massage, and the significance of this finding merits further research.

Associations between intake of dietary micro- and macro-nutrients with Dry eye syndrome: Blue Mountains Eye Study.

BACKGROUND AND AIMS: To report on the relationship between dietary intakes of a broad range of macronutrients and micronutrients, including antioxidants and fatty acids, with the presence of dry eye symptoms. METHODS: Population-based cross-sectional study of 1952 urban Sydney residents aged 60 years or greater. Participants completed a validated semi-quantitative 145-item food frequency questionnaire and a dry eye questionnaire. RESULTS: A total of 1528 responses were recorded (78.3%) of which 902 (59.0%) were female. 53.8% of participants reported at least one dry eye symptom, more commonly by women (58.2%) compared to men (47.3%). Participants in the highest (8.11 mcg/day) versus lowest quartile of intake of dietary B12 had reduced likelihood of reporting more than 2 dry eye symptoms and 1 or more moderate-severe dry eye symptoms: OR 0.64 (95% CI: 0.41-1.00) and OR 0.63 (95% CI: 0.41-0.97), respectively. Higher dietary intakes of vitamin C, thiamine (vitamin B1), polyunsaturated fats and calcium, were all associated with a reduced likelihood of participants reporting more than 2 dry eye symptoms (p < 0.05 for all). CONCLUSIONS: Intakes of a broad range of micro- and macro-nutrients were significantly and independently associated with reduced odds of experiencing dry eye symptoms. These data suggest that clinicians may need to consider current diet in patients presenting with dry eye symptoms.

Case Report: Recurrent Severe Uveitis Secondary to Primary Progressive Multiple Sclerosis Responsive to Ocrelizumab.

PURPOSE: To report a case of severe, recurrent bilateral panuveitis secondary to primary progressive multiple sclerosis responsive to ocrelizumab infusions. OBSERVATION: We describe the clinical progression of a 40 year old female who presented with a 3-week history of insidious bilateral visual loss that was clinically consistent with panuveitis. A diagnosis of multiple sclerosis was established with serial magnetic resonance imaging (MRI) that coincided with focal neurological events separated by time. There was initially good response to high dose oral prednisolone; however, the patient would have recurrent uveitis each time the dose was weaned. Under guidance of neurology, we had initiated treatment with ocrelizumab with stability of ocular inflammation for the past 24 months. CONCLUSION: Six-monthly 600mg ocrelizumab infusions may be effective as a steroid sparing option for patients with severe, recurrent bilateral panuveitis secondary to primary progressive multiple sclerosis.

Prevalence of Refractive Error in Vientiane Province, Lao People's Democratic Republic.

PURPOSE: To determine the prevalence of adult refractive error and associated risk factors in the Vientiane Province of the Lao People's Democratic Republic. METHODS: Population-based, cross-sectional ophthalmic survey of individuals ≥ 40 years of age in Vientiane Province. Suitable refractive data was available in 1058 individuals. Demographic data, which included age and gender, was obtained from all participants. Smoking status, presence of diabetes and hypertension was also recorded. The ophthalmic examination included autorefraction, grading of cataract, applanation tonometry and ultrasound pachymetry for ocular biometry, including axial length. RESULTS: Mean refractive error measured -0.36 diopters (D) (standard deviation [SD], 1.41) and mean cylindrical error measured -0.33 D (SD 0.95). Myopia ≤ -0.5 D and ≤ -5.0 D occurred in 53.2% (95% confidence interval [CI]: 43.7 to 62.6) and 2.0% (95% CI: 0.4 to 3.6) of participants, respectively. There was a correlation between myopia and both age and higher grading of nuclear cataract (p < .001). Hyperopia ≥ +0.5 D was present in 26.4% of participants and was associated with increasing age (p < .001). Astigmatism was present in 55.8% (95% CI: 51.5 to 60.2) of the population and was associated with increased nuclear cataract (p < .001). Urban participants had a reduced prevalence of myopia compared with rural participants. CONCLUSION: Myopia was associated with younger age and a higher grade of nuclear cataract. The prevalence of myopia in the adult population of Vientiane Province was higher than that reported in neighbouring Asian regions and contributed to low vision.

Prevalence and causes of visual impairment and blindness in Lao People's Democratic Republic: the Vientiane Eye Study.

AIMS: To determine the prevalence and causes of visual impairment and blindness in Vientiane Province, the Lao People's Democratic Republic (Lao PDR). METHODS: We conducted a population-based, cross-sectional study of 1264 participants aged 40 years and older from urban and rural areas of Vientiane Province. The ophthalmic examination included presenting and pinhole Snellen visual acuity (VA) with an illiterate E chart, slit-lamp examination of the anterior segment and dilated stereoscopic fundus examination. Visual impairment and blindness were defined by both presenting and pinhole VA based on the better eye according to WHO criteria: VA worse than 6/12 to 6/18 for mild impairment, VA worse than 6/18 to 6/60 for moderate impairment, VA worse than 6/60 to 3/60 for severe impairment and VA worse than 3/60 for blindness. RESULTS: Comprehensive ophthalmic examinations were performed on 1264 participants (77.8% participation rate). Population-weighted prevalence of presenting bilateral blindness was 1.4% (95% CI 0.8 to 2.0) and bilateral visual impairment was 22.4% (95% CI 14.7 to 30.1). After pinhole correction, the corresponding prevalence of blindness was 1.3% (95% CI 0.8 to 2.0) and that of visual impairment was 12.6% (95% CI 8.2 to 16.9). Cataract was the leading cause of presenting bilateral blindness (52.9%), whereas uncorrected refractive error was the predominant cause of presenting visual impairment (40.3%). CONCLUSIONS: Visual impairment and blindness remain major public health problems in Lao PDR. There is an ongoing need to fund ophthalmic care resources and community education programmes to improve access to healthcare in this region.

Prevalence and risk factors for cataracts in the Lao People's Democratic Republic: The Vientiane Eye Study.

Purpose: To determine the prevalence and risk factors for cataracts in the Vientiane Province. Methods: We conducted a population-based study of 1264 participants aged ≥40 years of age from urban and rural areas of Vientiane Province. Data collection included demographic information, smoking history, body mass index, blood pressure, history of trauma and dilated lens examination using the World Health Organization WHO Simplified Cataract Grading System. Aphakic and pseudophakic eyes were included as operated cataracts for statistical analysis. Results: The mean age of the 1264 participants was 57.6 years. The prevalence of any cataract including operated eyes was 46.8% (95% CI: 44.1 - 49.6%): 36.9% nuclear, 21.7% cortical and 10.1% posterior subcapsular cataracts. Conclusion: The prevalence of cataract in the Vientiane Eye Study is similar compared to the prevalence reported in other studies from Asian regions; however, the median age in this study was low, reflecting the age group of the population and the rapid urbanisation occurring in the Lao People's Democratic Republic. A significant association for any cataract was found with elevated blood pressure >148mmHg (OR2.48, 95%CI:1.55 - 3.97, P < 0.01), increasing age (OR1.19, 95%CI:1.17 - 1.22, P < 0.001) and rural inhabitants for cortical cataract (OR1.99, 95%CI:1.37 - 2.90, P < 0.001). An inverse relationship between rural inhabitants with any cataract and nuclear cataract was found (OR 0.63, 95%CI: 0.45 - 0.89, P < 0.01 and OR 0.42, 95%CI: 0.31 - 0.59, P < 0.001) respectively. Nevertheless, cataract remains a high prevalence disease in this population.

Prevalence of glaucoma in the Lao People's Democratic Republic: the Vientiane Eye Study.

AIMS: To determine the prevalence and subtypes of glaucoma in Vientiane Province. METHODS: We conducted a population-based study of 1264 participants aged ≥40 years of age from urban and rural areas of Vientiane Province. Data collection included Snellen visual acuity, slip lamp examination, tonometry, gonioscopy, dilated stereoscopic disc examination and perimetry. Glaucoma was categorised by clinical subtype. RESULTS: The mean age of the 1264 participants was 57.6 years; 91.9% of eyes had a gradable disc. The prevalence of glaucoma of any category in at least one eye was 1.54% (95% CI 0.66% to 3.59%). The overall prevalence of primary open-angle glaucoma, primary angle-closure glaucoma and secondary glaucoma was 0.62% (95% CI 0.19% to 1.98%), 0.55% (95% CI 0.12% to 2.54%) and 0.37% (95% CI 0.07% to 1.86%); 12 (66.7%) of participants with glaucoma were at least unilaterally blinded by WHO definition. CONCLUSIONS: The prevalence of glaucoma in the Vientiane Eye Study is relatively low compared with the prevalence reported in other studies from Asian regions; however, the median age in this study was low, reflecting the age group of the population and the rapid urbanisation occurring in the Lao People's Democratic Republic. Nevertheless, glaucoma remains a blinding disease in this population.

Medium-term tamponade with vitrectomy and perfluorodecalin for the management of complex retinal detachments.

PURPOSE: To describe the clinical presentation, anatomical and visual outcome of a series of patients in our department with complex retinal detachments, managed with vitrectomy and perfluorodecalin (PFD) for medium-term tamponade. STUDY DESIGN: Retrospective case series. METHODS: Retrospective analysis of the medical records of all patients in the last 6 years presenting with complex retinal detachment managed with vitrectomy where PFD was used as a medium-term tamponade. RESULTS: A total of 85 eyes in 85 patients were included in the study, with a mean follow-up period of 16.0 ± 2.67 months (range 3-59). About 26 detachments presented with associated PVR-C, and 10 had giant retinal tears. The location of the retinal detachment was inferior in 40% of cases, and total in 18.9% of cases. Anatomical success, defined as retinal reattachment at 12 months, was achieved in 98.8% of cases, and there was a mean improvement in BCVA of logMAR 0.64 ± 0.20, which was statistically significant (p < 0.001, paired t-test 6.23). Of the 41 phakic eyes included in the study, 20 underwent cataract surgery within the follow-up period. CONCLUSION: In this case series, we have demonstrated a 98.8% anatomical success and significant improvement in BCVA, with no reports of retinal toxicity. Medium-term tamponade PFD appears to be an efficacious and safe technique for management of a variety of complex retinal detachments, including those secondary to GRT, the presence of PVR-C, inferior location, tractional, traumatic, and re-detachments.