Complete Journal
Aust Orthopt J 2018 Volume 50
A Case of Duane’s Retraction Syndrome and Synergistic Convergence
Authors: Paula Freijah, Amira Komen, Catherine Lewis, Konstandina Koklanis
Aust Orthopt J 2018 Volume 50: 4-6
Abstract: Duane’s retraction syndrome (DRS) is a congenital eye movement disorder characterised by a limitation of horizontal gaze and narrowing of the palpebral fissure with globe retraction in adduction. Synergistic convergence, on the other hand, is a rare variant of DRS defined by simultaneous bilateral adduction on attempted lateral gaze. We report the case of an 11-year-old girl who presents with type III DRS of her right eye and synergistic convergence of her left eye.
Autoimmune Retinopathy: Three Case Reports
Author: Jo Lynch
Aust Orthopt J 2018 Volume 50: 7-12
Abstract: Autoimmune retinopathy (AIR) is an uncommon condition which should be considered when a patient presents with unexplained visual loss. The three main forms are melanoma-associated retinopathy (MAR), cancer-associated retinopathy (CAR) and non-paraneoplastic autoimmune retinopathy (npAIR). The visual loss is painless and can decline either rapidly or gradually. Symptoms may include reduced best-corrected visual acuity (BCVA), photopsias which are often described as flickering or shimmering effects, visual field loss, nyctalopia, loss of colour vision and delayed adaptation to changing light conditions. AIR is usually, but not always, bilateral and may be asymmetrical. The fundus exam and optical coherence tomography (OCT) are usually normal, however the electroretinogram (ERG) results are abnormal. The damage to retinal photoreceptors occurs when antiretinal antibodies are created by an autoimmune reaction to retinal proteins. Serology may reveal the presence of a range of anti-retinal antibodies but is not diagnostic without concurrent clinical manifestations. Immunosuppressive treatment may limit disease progression. Patients with AIR are often misdiagnosed or have their diagnosis delayed. In patients with unexplained visual loss, particularly if their symptoms include photopsias, it is important to take a comprehensive medical history and undertake extensive clinical testing, including BCVA, OCT, visual field, colour vision testing, ERG and antiretinal antibody serology. This paper presents a case each of CAR, MAR and npAIR.
A Rare Clinical Case of Unexplained Unilateral Vision Loss on a Background of Metastatic Breast Cancer
Authors: Jessica Boyle, Humayun Baig, Jacqui Thomson
Aust Orthopt J 2018 Volume 50: 13-19
Abstract: A rare clinical case of unexplained unilateral vision loss occurring in a 59-year-old Caucasian female is described. The vision loss occurred in association with an ipsilateral afferent pupil defect and on a background of primary breast carcinoma with extensive bony metastases. However, there was no clinically detectable orbital infiltration, orbital pseudo-tumour, compressive visual pathway lesion, optic neuritis or retinal pathology that could account for the ocular symptomatology. The patient was receiving palliative oral capecitabine chemotherapy at the time of presentation. Findings on clinical examination, perimetry testing, fundus photography, optical coherence tomography and magnetic resonance imaging are presented. Other differential diagnoses underlying this case of severe, sub-acute vision loss are discussed
Teaching Orthoptics to Ophthalmology Residents: A Needs Assessment Study
Authors: Kailin Karen Zhang, Désirée Lie
Aust Orthopt J 2018 Volume 50: 20-25
Aims: This is a needs assessment study with the primary aim of examining the relevance of orthoptic tests to ophthalmology residents’ practice, and their confidence in performing and interpreting the tests, to establish the need for further orthoptic education during residency.
Method: Participants were Years 1 to 5 ophthalmology residents from a tertiary hospital training program where no formal orthoptic training is offered. An online nine-question survey was conducted over four weeks to assess residents’ perceptions of the relevance of orthoptic tests to their practice, their confidence in performing and interpreting ten common orthoptic tests, and preferences for curriculum content and delivery. Responses consisted of 5-point Likert scale options and selection of tests out of ten options. Data were analysed by descriptive statistics using median and range.
Results: Of 31 eligible residents, 23 (74%) responded. Relevance to practice was rated high among all respondents (median rating 4 out of 5, range 2 to 5) for all ten tests. Self-rated confidence in test performance was generally low (median rating 3, range 1 to 5). Confidence in test interpretation was higher (median rating 4, range 1 to 5). Respondents selected five tests for which they desired further training. Preference for e-learning was high, with 70% considering this modality ‘very useful’.
Conclusion: Ophthalmology residents consider orthoptics to be relevant to their practice. Baseline self-reported confidence in test performance is low. They express a desire for further orthoptic training and e-learning is an acceptable teaching format.
Excluding Non-English Speaking People from Health Research Including Falls Research for Community-Dwelling Older People
Author: Karen Pedemont
Aust Orthopt J 2018 Volume 50: 26-30
Abstract: The exclusion of people with limited or no English language skill from health research occurs often, due to logistical and financial constraints. Exclusion limits the generalisation of study outcomes especially in culturally and linguistically diverse populations. This includes falls research for community-dwelling older people. Reduced vision has been reported in the literature to be a significant independent risk factor for falls in this population. Excluding non-English speaking people from health research also impacts on eye research. The aims of this review are to increase the awareness of the issues arising from the exclusion of non-English speaking older people from health research and to encourage researchers to include this vulnerable population in health research. English language skill is a valid indicator of health status and older people with limited English language skill have significantly poorer self-reported health status than those who speak English only. Despite this, guidelines governing inclusion of this population in health research are inconsistent. Resources and advocacy of inclusion will ensure ongoing equity of access to health care services for this population.
Functional Impact of Perifoveal Geographic Atrophy in Patients with Dry AMD: A Systematic Review
Authors: Jessica Boyle, Meri Vukicevic, Konstandina Koklanis, Catherine Itsiopoulos, Wilson J Heriot
Aust Orthopt J 2018 Volume 50: 31-40
Abstract: Conventional parameters such as best-corrected visual acuity (BCVA) often grossly underestimate the profound visual limitations experienced by patients with perifoveal geographic atrophy (GA) secondary to dry age-related macular degeneration (AMD). Foveal preservation in these patients means that BCVA is often only moderately impaired, despite significant challenges often reported in undertaking day-to-day vision-requiring tasks. BCVA may lead to a misrepresentation of the extent of real-world visual dysfunction in this clinical population and yet, is widely used as the gold standard measure in assessing patient eligibility for disability entitlements and driving. This systematic review investigated the relationship between microperimetry thresholds and performance on tests of functional vision and visual function in patients with perifoveal GA.
A systematic search of the Embase, CINAHL, Medline, PubMed and Web of Science electronic databases was conducted to identify all relevant studies published between January 2002 and December 2017 in the English language and involving human participants. A search of the grey literature was also conducted. Ten relevant articles were found and a critical appraisal undertaken.
Only two of the 10 studies investigated functional deficits specifically in patients with perifoveal GA. The remaining eight studies were more broadly defined and failed to subclassify participants according to GA location. Microperimetry was found to represent a valuable tool in quantifying visual deficits in these patients and was much more sensitive than conventional measures, including BCVA and low-luminance visual acuity. This review highlighted the importance of a multimodal approach to assessment to better capture the real-world visual dysfunction experienced by patients with perifoveal GA.
Selected Abstracts from Orthoptics Australia 75th Annual Conference, Adelaide 19 – 21 November 2018
Aust Orthopt J 2018 Volume 50: 41-45