Glaucoma Agreement in New Zealand (GAINZ).

CLINICAL RELEVANCE: With an ageing population, ophthalmologists are becoming burdened with glaucoma management, and patient care can be delayed. Therefore, the use of optometrists in glaucoma management can help alleviate the burden. BACKGROUND: The ageing population and subsequent rise of glaucoma prevalence are putting a strain on the public health system in New Zealand. Glaucoma collaborative care between optometrists and ophthalmologists has been gaining support with the aim to reduce this burden on ophthalmologists. There has been little investigation of the agreement in care and management of mild-to-moderate severity glaucoma patients by optometrists and ophthalmologists. METHODS: One hundred and three glaucomatous eyes were used in a survey where clinical history and examination, intraocular pressures (IOPs), visual field testing and optical coherence tomography (OCT) imaging were evaluated for glaucoma progression and decision-making regarding subsequent management by four participants. Two participants were glaucoma-credentialled optometrists (Group 1), and the other two were glaucoma specialists (Group 2). RESULTS: With respect to glaucoma progression, Spearman coefficients identified strong agreement between the two groups for IOP, visual fields and overall status and moderate agreement for OCT imaging. A confusion matrix was used to analyse management and found 80% ± 10% agreement between the two groups. Review periods gave an agreement of 55% ± 20% between the two groups. CONCLUSION: There was strong agreement in the assessment of glaucoma progression between the two groups. The 80% level of agreement for subsequent management between the two groups is comparable to other published reports. These results provide some reassurance that a collaborative care system can perform safely and as intended.

Vision Bus Aotearoa: a platform for strengthening eye health teaching, research and community partnership.

CLINICAL RELEVANCE: Vision Bus Aotearoa is a fully equipped mobile eye health clinic designed to provide a novel platform for undergraduate optometry clinical training, community eye health research and deliver services to underserved communities. BACKGROUND: Aotearoa New Zealand has inequitable access to eye health care. Vision Bus Aotearoa aims to work in partnership with communities to provide comprehensive mobile primary eye health care services while training optometry students, and integrating community eye health research. METHODS: A description is provided of the governance model which has been involved throughout the project. RESULTS: The process of vehicle manufacture, clinical set-up, funding models and service delivery are described. The aims of the project are detailed in terms of optometry teaching, clinical services in partnership with communities, and research integration and implementation. CONCLUSION: Vision Bus Aotearoa represents a valuable opportunity to deliver mobile eye health care to historically underserved communities, enhance undergraduate optometry teaching and to provide a unique platform for community eye health research.

Intraocular pressure fluctuation during resistance exercise.

OBJECTIVE: To evaluate the effect of weightlifting (leg press) on intraocular pressure (IOP). DESIGN: Prospective cohort study. SUBJECTS: A total of 24 participants met the inclusion criteria and completed the study procedures. Participants had an average age of 22.7±2.7 years and included nine women. The mean baseline IOP was 13.9 mm Hg (SD=2.4) with an average body mass index of 24.5 (SD= 3.1). METHODS: The maximum load for a single lift was found for each participant. Participants then performed three leg press regimens: one repetition using 95% of maximal load (1RM), six repetitions using 75% of maximal load (6RM) and isometric push against a weight much heavier than maximal load (ISO). MAIN OUTCOME MEASURE: IOP was measured pre-exercise, during and immediately following the exercise using an iCare TA01i rebound tonometer. Blood pressure and HR were being monitored continuously during the lift. Optical coherence tomography images were obtained pre and postexercise session. RESULTS: The average maximum weight lifted by our participants was 331.9 Kg (SD=97.3). Transient increased IOP was observed across the 1RM, 6RM and ISO exercises with an average increase in 26.4 mm Hg (23.7 mm Hg to 28.7 mm Hg) to reach an average max IOP of 40.7 mm Hg (27.8 mm Hg to 54.2 mm Hg), with an absolute maximum of 70 mm Hg in one participant. CONCLUSIONS: There is a transient and dramatic fluctuation in IOP with resistance training. This coupled with regular exposure to resistance training is potentially a significant risk factor for glaucoma. It should be noted that this study has been carried out in a healthy young population, and, thus, the external validity of these results in glaucoma participants requires further investigation.

Excitatory binocular interactions in two cases of alternating strabismus.

PURPOSE: Individuals with alternating fixation due to strabismus have often been considered prime examples of monocular visual function. A growing body of evidence suggests, however, that, at least in the case of a fixed-angle strabismus, excitatory binocular function is possible in the strabismic visual cortex if interocular suppression is taken into account. We investigated whether excitatory binocular function might also be possible for patients with alternating strabismus. METHODS: Suprathreshold binocular interaction was tested in two individuals with alternating fixation and no amblyopia using a dichoptic motion coherence paradigm that can measure and account for interocular suppression. RESULTS: Both participants exhibited strong interocular suppression when stimuli of the same contrast were presented to each eye, whereas no such suppressive interactions were present for controls; however, in significantly reducing the contrast of the stimuli presented to the fixing eye, excitatory binocular interactions were demonstrated in both participants similar to those measured in controls without the contrast imbalance. CONCLUSIONS: The cortical mechanisms necessary for combining information from the two eyes seem to have been present but suppressed in our 2 participants with alternating fixation, just as they have been shown to be present in patients with fixed-angle strabismus.

Basal cell carcinoma mistaken for actinic keratosis.

Increasing age and UV exposure are well-known associations with precancerous and cancerous skin lesions, including actinic (solar) keratosis, and squamous and basal cell carcinomata. This report describes a patient with a facial skin lesion close to an eye that was initially believed to be actinic (solar) keratosis but was subsequently diagnosed as a basal cell carcinoma (BCC). The diagnosis of BCC was helped pre-operatively by manipulation of the surrounding facial skin, which revealed the characteristic rolled edges and telangiectasis. Referral to his general medical practitioner (GP) resulted in surgical excision of the lesion. This procedure was performed inexpensively by the local GP as the lesion was not large and was in an accessible position. The lesion and the course of recovery over four weeks were documented photographically. The lesion was surgically excised and the diagnosis of basal cell carcinoma was confirmed by pathological examination. The wound healed well and the final cosmetic result was excellent. This patient illustrates the importance of careful observation and photo-documentation of suspicious skin lesions. A review of the treatment options for these lesions is included in this report.