Vision impairment and refractive errors in refugees presenting to community optometry clinics in Victoria, Australia.

BACKGROUND: There is a paucity of data relating to refugee eye health in Australia. This study aimed at investigating the spectrum of vision impairment and other ocular conditions in refugees utilising the Victorian Eyecare Service operated by the Australian College of Optometry. METHODS: A cross-sectional study of electronic clinical records of 518 individuals (adults and children) recognised as refugees by the Australian College of Optometry and treated between January 2013 and May 2014 were identified. Extracted data included presenting visual acuities, best-corrected visual acuities, and final refraction values (using spherical equivalents), for both eyes. Diagnoses of presenting ocular conditions were also extracted. RESULTS: Of all refugees examined, 129 (27.2 per cent) had some degree of vision impairment (≤ 6/9.5) based on presenting visual acuities in their better eye; five (1.0 per cent) being of a severe (≤ 6/60) or profound (≤ 6/120) nature. In contrast, 27 (6.3 per cent) refugees had some degree of vision impairment based on best-corrected visual acuities in their better eye; two (0.4 per cent) being of a severe or profound nature. The prevalence of myopia (≥ -0.50 D) in the better eye was 23.0 per cent (n = 114); 25 (5.0 per cent) being moderate (≥ -3.00 D) to high (≥ -6.00 D). The prevalence of hypermetropia (≥ +2.00 D) in the better eye was 3.2 per cent (n = 16); 12 (2.4 per cent) being moderate (≥ +2.25 D) to high (≥ +5.25 D). The most common ocular conditions diagnosed at initial presentation were refractive error (n = 104, 20.1 per cent) and dry eyes (n = 57, 11.0 per cent). CONCLUSION: Mild vision impairment and refractive error are significant issues for refugees attending the Australian College of Optometry, emphasising the need for optometry, particularly refractive, services in this population.

Infection control guidelines for optometrists 2016.

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.

Breaking down barriers to eye care for Indigenous people: a new scheme for delivery of eye care in Victoria.

This report describes the implementation of and outcomes from a new spectacle subsidy scheme and de-centralised care options for Aboriginal and Torres Strait Islander peoples in Victoria, Australia. The Victorian Aboriginal Spectacle Subsidy Scheme (VASSS) commenced in 2010, as an additional subsidy to the long-established Victorian Eyecare Service (VES). The Victorian Aboriginal Spectacle Subsidy Scheme aimed to improve access to and uptake of affordable spectacles and eye examinations by Indigenous Victorians. The scheme is overseen by a committee convened by the Victorian Government's Department of Health and Human Services and includes eye-health stakeholders from the Aboriginal community and government, not-for-profit, university and Aboriginal communities. Key features of the Victorian Aboriginal Spectacle Subsidy Scheme include reduced and certain patient co-payments of $10, expanded spectacle frame range, broadened eligibility and community participation in service design and implementation. We describe the services implemented by the Australian College of Optometry (ACO) in Victoria and their impact on access to eye-care services. In 2014, optometric services were available at 36 service sites across Victoria, including 21 Aboriginal Health Services (AHS) sites. Patient services have increased from 400 services per year in 2009, to 1,800 services provided in 2014. During the first three years of the Victorian Aboriginal Spectacle Subsidy Scheme program (2010 to 2013), 4,200 pairs of glasses (1,400 pairs per year) were provided. Further funding to 2016/17 will lift the number of glasses to be delivered to 6,600 pairs (1,650 per year). This compares to population projected needs of 2,400 pairs per year. Overcoming the barriers to using eye-care services by Indigenous people can be difficult and resource intensive; however the Victorian Aboriginal Spectacle Subsidy Scheme provides an example of positive outcomes achieved through carefully designed and targeted approaches that engender sector and stakeholder support. Sustained support for the Victorian Aboriginal Spectacle Subsidy Scheme at a level that meets population needs is an ongoing challenge.

How Australian and New Zealand schools of optometry prepare students for culturally competent practice.

BACKGROUND: This study is an investigation of how Australian and New Zealand schools of optometry prepare students for culturally competent practice. The aims are: (1) to review how optometric courses and educators teach and prepare their students to work with culturally diverse patients; and (2) to determine the demographic characteristics of current optometric students and obtain their views on cultural diversity. METHODS: All Australian and New Zealand schools of optometry were invited to participate in the study. Data were collected with two surveys: a curriculum survey about the content of the optometric courses in relation to cultural competency issues and a survey for second year optometry students containing questions in relation to cultural awareness, cultural sensitivity and attitudes to cultural diversity. RESULTS: Four schools of optometry participated in the curriculum survey (Deakin University, Flinders University, University of Melbourne and University of New South Wales). Sixty-three students (22.3 per cent) from these four schools as well as the University of Auckland participated in the student survey. Cultural competency training was reported to be included in the curriculum of some schools, to varying degrees in terms of structure, content, teaching method and hours of teaching. Among second year optometry students across Australia and New Zealand, training in cultural diversity issues was the strongest predictor of cultural awareness and sensitivity after adjusting for school, age, gender, country of birth and language other than English. CONCLUSION: This study provides some evidence that previous cultural competency-related training is associated with better cultural awareness and sensitivity among optometric students. The variable approaches to cultural competency training reported by the schools of optometry participating in the study suggest that there may be opportunity for further development in all schools to consider best practice training in cultural competency.

Influenza A(H1N1) and infection control guidelines for optometrists.

The emergence of a novel influenza A virus (Influenza A[H1N1]), which has not circulated previously in humans, has led to the first global influenza pandemic in 41 years. Influenza A(H1N1), commonly called 'swine flu', is a novel influenza virus made up of porcine, avian and human genes, and preferentially infects younger people. Although Influenza A(H1N1) does not appear to be likely to cause as many fatalities as previous influenza pandemics, attempts to contain it are necessary because people whose health is already compromised through underlying chronic medical conditions are at risk of death if they contract the virus. In addition, pregnant women who become infected are at increased risk of complications. This paper provides figures on the number of cases of Influenza A(H1N1) and deaths associated with this virus in Australia (using World Health Organization and Australian Government figures) and discusses infection control measures that optometrists should put in place for themselves, their staff and their patients, in the event that there is suspicion of Influenza A(H1N1) infection. Measures include isolating those who display symptoms indicative of influenza, use of surgical masks (P2 [N95]) by the infected person, frequent hand-washing, appropriate cough and sneeze etiquette, disposal of used tissues and rescheduling of non-urgent appointments for those thought to be infected. Any staff members who need to be closer than one metre to the infected person should also use personal protective equipment (for example, surgical masks, goggles or safety spectacles, gowns and gloves). The current evidence indicates that Influenza A(H1N1) should be treated by optometrists as another type of flu. As with other forms of influenza, following basic infection control guidelines will help reduce the spread of infection in optometric practices and within the community.

Infection control guidelines for optometrists 2007.

Information from peer-reviewed articles, guidelines from professional societies and manufacturers' instructions were considered to determine the risk factors in optometric practice and to make recommendations for disinfection, sterilisation and reprocessing of instrumentation and other equipment used in practice and measures for personal protection. Wherever possible, all practitioners should adopt measures to decrease the risk of transmission of infection, such as single use instruments/equipment, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for infected or immuno-suppressed individuals.

Evaluation of Melbourne Edge Test contrast sensitivity measures in the visually impaired.

AIM: Contrast sensitivity (CS) provides important information on visual function. This study aimed to assess differences in clinical expediency of the CS increment-matched new back-lit and original paper versions of the Melbourne Edge Test (MET) to determine the CS of the visually impaired. METHODS: The back-lit and paper MET were administered to 75 visually impaired subjects (28-97 years). Two versions of the back-lit MET acetates were used to match the CS increments with the paper-based MET. Measures of CS were repeated after 30 min and again in the presence of a focal light source directed onto the MET. Visual acuity was measured with a Bailey-Lovie chart and subjects rated how much difficulty they had with face and vehicle recognition. RESULTS: The back-lit MET gave a significantly higher CS than the paper-based version (14.2 +/- 4.1 dB vs 11.3 +/- 4.3 dB, p < 0.001). A significantly higher reading resulted with repetition of the paper-based MET (by 1.0 +/- 1.7 dB, p < 0.001), but this was not evident with the back-lit MET (by 0.1 +/- 1.4 dB, p = 0.53). The MET readings were increased by a focal light source, in both the back-lit (by 0.3 +/- 0.81, p < 0.01) and paper-based (1.2 +/- 1.7, p < 0.001) versions. CS as measured by the back-lit and paper-based versions of the MET was significantly correlated to patients' perceived ability to recognise faces (r = 0.71, r = 0.85 respectively; p < 0.001) and vehicles (r = 0.67, r = 0.82 respectively; p < 0.001), and with distance visual acuity (both r = -0.64; p < 0.001). CONCLUSIONS: The CS increment-matched back-lit MET gives higher CS values than the old paper-based test by approximately 3 dB and is more repeatable and less affected by external light sources. Clinically, the MET score provides information on patient difficulties with visual tasks, such as recognising faces.

Normative contrast sensitivity values for the back-lit Melbourne Edge Test and the effect of visual impairment.

BACKGROUND: The Melbourne Edge Test (MET) is a portable forced-choice edge detection contrast sensitivity (CS) test. The original externally illuminated paper test has been superseded by a backlit version. The aim of this study was to establish normative values for age and to assess change with visual impairment. METHOD: The MET was administered to 168 people with normal vision (18-93 years old) and 93 patients with visual impairment (39-97 years old). Distance visual acuity (VA) was measured with a log MAR chart. RESULTS: In those eyes without disease, MET CS was stable until the age of 50 years (23.8 +/- 0.7 dB) after which it decreased at a rate of approximately 1.5 dB per decade. Compared with normative values, people with low vision were found to have significantly reduced CS, which could not be totally accounted for by reduced VA. CONCLUSIONS: The MET provides a quick and easy measure of CS, which highlights a reduction in visual function that may not be detectable using VA measurements.

Retinal neurochemical changes following application of glutamate as a metablolic substrate.

BACKGROUND: Retinal neural and glial cells share an intricate relationship that includes uptake and recycling of the amino acid neurotransmitters, glutamate and gamma-amino butyric acid (GABA), as well as metabolic links. The aim of this work was to determine the neurochemical and morphological changes induced by the removal of glucose but with the provision of exogenous glutamate in the isolated retinal preparation incubated under aerobic conditions. The carbon skeleton of glutamate can enter the tricarboxylic acid cycle as alpha-ketogluterate, providing an alternative metabolic substrate in cases of glucose deprivation. METHODS: Isolated rat retinas were incubated in physiological media with and without glucose, using a range of glutamate concentrations to provide an alternative source of metabolic substrate. We conducted post-embedding immunocytochemistry and quantified the change in glutamate and GABA immunoreactivity within Müller cells under these different incubation conditions. RESULTS: The provision of glutamate with normal (6 mM) glucose levels resulted in a gradual accumulation of glutamate and GABA in Müller cells, with Müller loading when exogenous glutamate concentrations were above 0.1 mM. However, when these varying levels of glutamate were applied in the absence of glucose, glutamate accumulation in Müller cells was decreased compared to the 6 mM glucose condition and GABA accumulation in Müller cells was at a minimum at moderate (0.5 and 1 mM) glutamate levels. Under hypoglycaemic conditions, exogenous glutamate (0.5 to 1 mM) is rapidly metabolised by Müller cells to the extent that no glial loading is evident, despite the high concentrations. CONCLUSIONS: Normal neurochemical function appears to be maintained secondary to exogenous glutamate provision of 0.5 to 1 mM when glucose is not in the incubation medium, implying that glutamate can be used as an alternative metabolic substrate. We also show that Müller cells possess more rapid glutamate metabolic capabilities compared to the metabolism of GABA.

Aetiology and management of choroidal folds.

Choroidal folds are known to be associated with a wide variety of pathological conditions, such as central serous retinopathy, choroidal naevi, tumours and papilloedema. They may also occur with surgical procedures, especially when hypotony of the globe occurs, such as following cataract surgery, laser therapy and from post-operative choroidal oedema or inflammation. However, choroidal folds are idiopathic in the majority of cases and can be associated with benign conditions, such as hypermetropia and optic disc drusen. Numerous patterns and orientations of choroidal folds are possible, with some authors suggesting that typical presentations are associated with particular pathological conditions. They may be seen as dark and light streaks on ophthalmoscopy (often more defined with red-free viewing) but are more apparent and differentiated from retinal folds by fluorescein angiography. The aetiology of choroidal folds appears to be linked to a combination of an anatomical attachment of Bruch's membrane to the underlying choriocapillaris and congestion of the choriocapillaris. This paper reviews aspects of the differential diagnosis of choroidal folds with guidelines for optometric management. Several case reports are presented to demonstrate some of the clinical features of choroidal folds.