Biomedical subjects
Publications and source records attributed to Peter G Swann.
The presence of interface debris is commonly reported in patients having undergone LASIK refractive surgery. The patient described here had numerous large particles believed to be plastic and metal artefacts from the surgery at the level of the stroma/flap interface, along with a corneal scar consistent with a foreign body injury. The aetiology and possible sequelae of the particles and scar are discussed.
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Blepharitis is a ubiquitous disease and arguably, among the most common conditions that eye care practitioners encounter. Usually, its diagnosis is straight forward. However, any deviation from its predicted clinical appearance should cause the practitioner to consider other possibilities. The patient described in this report was diagnosed with blepharitis and treated as such. However, the true cause of her difficulties was basal cell carcinoma. This condition is briefly reviewed.
An unusual case of bilateral oculodermal melanocytosis or the naevus of Ota is reviewed. In this condition, there is hyperpigmentation of ocular structures and the skin of the face. In this case, a pigmentary mottling of the fundus was observed using long wavelength light.
BACKGROUND: Diabetes mellitus is a systemic disease affecting approximately 750,000 Australians of whom more than 70,000 are Queenslanders. It can have serious ocular consequences and patients with diabetes require regular eye examinations to determine the degree of ocular involvement and the stage of retinopathy, if present. It is important that optometrists detect diabetic retinal changes and refer appropriately. We sought to determine the proficiency of optometrists at detecting retinal changes caused by diabetes. METHODS: The study comprised four parts: 1. Nineteen randomly recruited Australian optometrists practising in Queensland completed a questionnaire on their experiences seeing patients with diabetes. 2. They examined the ocular fundi of 10 patients. 3. They viewed retinal slides of 12 additional cases. 4. They attended a follow-up seminar on diabetes and the cases. They were informed that the patients did not necessarily have diabetes and instructed not to discuss the condition with the patient or their colleagues. The optometrists were allowed seven minutes per station to examine the patient or the slides and write down their responses before moving to the next station. RESULTS: When the slides and patients were considered together, cases where diabetic retinopathy was present were correctly identified by 94.0 per cent of the optometrists and cases where retinopathy was not present were correctly identified by 93.6 per cent of the optometrists. When all assessments were considered together, the correct detection/differential diagnosis rate was 88.3 per cent. Sub-classification of diabetic retinopathy severity agreed with that of the reference examiners in 58.3 per cent of assessments and there was agreement on management in 79.4 per cent of cases. Of the 22 assessments undertaken by each optometrist, there were, on average, 2.5 errors. CONCLUSION: Randomly selected Australian optometrists are able to detect and grade diabetic retinal changes solely by retinal examination and refer the patients requiring specialist care.
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A case of giant papillary conjunctivitis associated with the wearing of an ocular prosthesis is described. Potential causes and treatment regimens are briefly reviewed.
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INTRODUCTION: Optic discs can show a variety of congenital malformations, mostly due to incomplete development. CASE STUDY: The subject of this report is a particularly rare abnormality, known as megalopapilla, in which the optic disc is significantly larger than usual.
Diabetes is the major cause of legal blindness in people of working age. There are other non-retinopathic ocular changes that can also have a very significant impact on vision. This review examines the effects of diabetes mellitus on the cornea, the lens and the optic nerve and also its effects on vision.
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Static automated visual field testing is now an integral part of the detection and monitoring of primary open angle glaucoma. However, although many aspects of testing are automated, interpretation of the large amounts of data produced by these instruments is not. Two major challenges facing the practitioner are differentiating between the visual fields of a patient with early glaucoma and those of a normal patient, and identifying whether small reductions in sensitivity are due to a true defect or a product of other factors. This paper presents a clinical overview of how to systematically review visual field plots and how to recognise defects arising from patient factors, as well as some of the alternative testing techniques available for the assessment of the glaucoma patient.
We describe a family that shows autosomal dominant pattern dystrophy of the retinal pigment epithelium. There were 10 affected family members encompassing three generations. The various manifestations of these dystrophies, their inheritance characteristics, affects on vision function and their pathogenesis are discussed.
BACKGROUND: In all Australian states optometrists are permitted to use diagnostic topical ocular drugs in the practice of their profession. In addition, legislation has just been passed in Victoria allowing optometrists to prescribe topical S4 medications for ocular conditions. Changing optometric legislation to incorporate S4 ophthalmic agents is a topical issue within optometry. METHODS: By postal survey, we asked Queensland optometrists to gauge their level of education, current mode of practice and whether they were in favour of gaining access to prescription-only therapeutic medications. Their opinions on the education requirements, perceived potential public benefits and the possible barriers to optometrists gaining prescribing rights to therapeutic agents were also investigated. RESULTS: A 45 per cent response rate to the survey (231 responses out of 517) was obtained. The majority of respondents (88 per cent) wanted to be able to prescribe therapeutic agents. Over 50 per cent considered themselves competent and believed they were capable of treating dry eye, blepharitis, allergic conjunctivitis, corneal abrasions and contact lens induced papillary conjunctivitis. Over 90 per cent would be confident recommending topical lubricants and antihistamines, while 65 per cent felt they were adequately prepared to prescribe topical antibiotics. Education level, in particular the completion of a therapeutic drugs course, was the main factor that determined whether the respondents practised or were willing to practise at a higher level. CONCLUSION: The majority of Queensland optometrists are well aware of the issues surrounding the use of pharmaceutical agents. Many optometrists feel they are well prepared for prescribing ocular therapeutic agents.
Hyperpigmentation of the ocular tissues and of the skin around the eye is uncommon. In ocular melanosis, the episclera, uveal tract and the angle of the anterior chamber may be involved. Heterochromia iridis may be present, if the iris is affected. In oculodermal melanocytosis or the naevus of Ota, hyperpigmentation of the skin follows the distribution of the first and second divisions of the fifth cranial nerve. This report documents a patient with episcleral pigment, heterochromia iridis and numerous tiny pigmented nodules on the iris (mammillations). The possible significance of these findings is discussed.