PurposeTo compare diabetic retinopathy (DR) severity grading between Optomap ultrawide field scanning laser ophthalmoscope (UWFSLO) 200° images and an Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard field view.MethodsOptomap UWFSLO images (total: 266) were retrospectively selected for evidence of DR from a database of eye clinic attendees. The Optomap UWFSLO images were graded for DR severity by two masked assessors. An ETDRS seven-field mask was overlaid on the Optomap UWFSLO images, and the DR grade was assessed for the region inside the mask. Any interassessor discrepancies were adjudicated by a senior retinal specialist. Kappa agreement levels were used for statistical analysis.ResultsFifty images (19%) (P<0.001) were assigned a higher DR level in the Optomap UWFSLO view compared to the ETDRS seven-field view, which resulted in 40 images (15%) (P<0.001) receiving a higher DR severity grade. DR severity grades in the ETDRS seven-field view compared with the Optomap UWFSLO view were identical in 85% (226) of the images and within one severity level in 100% (266) of the images. Agreement between the two views was substantial: unweighted κ was 0.74±0.04 (95% confidence interval: 0.67–0.81) and weighted κ was 0.80±0.03 (95% confidence interval: 0.74–0.86).ConclusionCompared to the ETDRS seven-field view, a significant minority of patients are diagnosed with more severe DR when using the Optomap UWFSLO view. The clinical significance of additional peripheral lesions requires evaluation in future prospective studies using large cohorts.
This year, 1982, marks the centenary of the Sydney Eye Hospital, originally the ophthalmic department of the old Sydney Infirmary, which was founded with the settlement of the Colony in 1788. Established in 1882, the hospital was transferred to its present site 60 years ago, and it still provides ward accommodation. After alternating periods of stagnation and progress the new hospital (stage 1) was completed in 1974, with modern clinic and research facilities. It is now the largest eye hospital in the southern hemisphere and is a first-class referral centre with an annual attendance of 75000. The Department of Ophthalmology, University of Sydney, is based at the hospital, providing undergraduate instruction and a comprehensive postgraduate training programme for Australian ophthalmologists and others in more distant continents.
Glaucoma is a common eye condition that features progressive optic nerve damage with corresponding visual field loss. According to The Royal College of Ophthalmologists' The Way Forward: Glaucoma Report, it is destined to become an escalating problem due to an increasingly elderly population expected in the next 2 decades. In order to cope with the anticipated demand, hospital eye services are required to re-think the way care is delivered, and it is likely that more multidisciplinary clinical staff will be needed to manage glaucoma patients. Medical treatment with eye drops is sufficient for most patients, with surgery offered to those with worsening glaucoma despite medical and/or laser treatment, or patients who are intolerant to such treatment. This article aims to provide an overview of glaucoma with a focus on the prescribing options available and the associated challenges of the medical treatment of glaucoma.
Background Combining cataract surgery with Descemet's membrane endothelial keratoplasty (DMEK) surgery compared to staged surgeries provides a cost-effective method with faster visual rehabilitation and is more convenient for the patient. However, the combined procedure can lead to a refractive shift that can be difficult to predict. We aimed to assess the refractive outcomes of our patients. Methods All patients who underwent combined DMEK procedures with phacoemulsilfication and insertion of IOLs between January 2016 and October 2022 were identified using the Medisoft audit tool. Data including demographics, keratometry, postoperative refraction and refractive aim were obtained. Results Twenty eyes which underwent combined procedure for Fuchs' endothelial dystrophy were included. The average age was 72.4 years (range 60-95) and 70% were female (n=14). Eighteen (90%) of patients had improved visual acuity postoperatively with a mean improvement of 0.4 LogMAR overall. The average change in predicted outcome was a hyperopic shift of +0.55D (range -0.99 to +2.49D) with 65% (n=13) of patients achieving a more hyperopic outcome than aimed for. Three patients who achieved +1.50D over the predicted outcome had steeper K-readings of >46D, however, there was no other significant difference in K-readings between the patients who achieved a more myopic outcome and those that that achieved a hyperopic outcome. Conclusion Refractive outcomes of patients undergoing combined cataract and DMEK surgery can be unpredictable. We suggest aiming for a more myopic target (such as -1.00D instead of -0.50D) in these patients may better protect against an unfavourable hyperopic outcome particularly in this age group.
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