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Lauschke J.L.,Vision Eye Institute Chatswood | Lauschke J.L.,Prince of Wales Hospital | Lawless M.,Vision Eye Institute Chatswood | Lawless M.,University of Sydney | And 5 more authors.
Clinical and Experimental Ophthalmology | Year: 2016

Background: Keratometry is a critical determinant of the postoperative refractive outcome. This study evaluates the comparability of keratometry measurements obtained using the Verion Optical Imaging System with devices used in current clinical practice. Further, it determines the interobserver reliability of the Verion Optical Imaging System. Design: Retrospective analysis of patient data. Participants: Keratometric data was obtained from 100 patients presenting for pre-operative evaluation. Furthermore, repeatability and reproducibility were assessed using 15 healthy volunteers. Methods: Corneal curvature values acquired by the Verion Optical Imaging System were compared with existing keratometry devices including autokeratometry, partial coherence interferometry (IOLMaster) and Scheimpflug corneal topography (Pentacam). Main Outcome Measures: Direct comparison of corneal power, cylinder, axis of astigmatism and vector analysis were performed using correlation and Bland–Altman analyses. Reproducibility and reliability of the device were assessed using within-subject standard deviation and intraclass correlation coefficients for experienced and inexperienced technicians. Results: There was no statistically significant difference between Verion values and those obtained by other methods in relation to mean keratometry, corneal astigmatism, steep meridian and vector analyses (P > 0.05). Bland–Altman plots showed narrow limits of agreement for keratometry and astigmatism and wider agreement for steep meridian. Intraoperator reliability for both experienced and inexperienced operators and interoperator reproducibility showed no statistically significant differences between values. Conclusion: Measurements show no significant difference from those obtained by the other devices. This suggests the Verion system is en par with instruments used in current clinical practice. The Verion Optical Imaging System produces repeatable data with no difference related to operator experience. © 2015 Royal Australian and New Zealand College of Ophthalmologists


Hodge C.,Vision Eye Institute Chatswood | Hodge C.,University of Sydney | Chan C.,Vision Eye Institute Chatswood | Chan C.,University of New South Wales | And 5 more authors.
Clinical and Experimental Optometry | Year: 2015

Background: Defining the threshold for therapeutic and surgical intervention in patients with keratoconus presents a considerable challenge given the lack of clear, evidence-based data. Little is known about the patterns of practice and referral criteria of optometrists within Australia. Methods: All members of the NSW branch of Optometrist Association Australia were invited to complete an online survey in January 2013. This survey was designed to elicit practice information regarding the evaluation and therapeutic treatment of patients with keratoconus in the optometric setting. Results: Responses were received from 71 optometrists, of whom 65.2 per cent had 15 years or greater experience as an optometrist. Many (35.4 per cent) responded that they prescribed soft contact lenses daily. This percentage dropped to 9.2 per cent for rigid gas-permeable lenses (RGP), although 47.7 per cent said they would prescribe RGP lenses at least once per month. The main barriers to prescribing were experience with fitting RGP lenses, time and low market demand. In terms of patient referral to an ophthalmologist, the results were variable, with 34.4 per cent stating that they would refer on progression of corneal signs, 23.4 per cent suggesting no set time and 7.8 per cent would refer on initial diagnosis. Many optometrists (62.9 per cent) would refer a patient for possible surgery, when visual acuity dropped to between 6/9 and 6/12. The size or location of the practice was not associated with the number of newly diagnosed cases of keratoconus. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal topographic unit suggested an increased likelihood of prescribing RGP lenses but did not appear to alter referral patterns. Conclusion: Optometrists have an integral role in the diagnosis and management of patients with keratoconus. Our survey provides a basic snapshot of current, local practice. Additionally, ophthalmology should continue to work with optometry to develop guidelines for referral and co-management to optimise future outcomes for our patients. © 2014 Optometrists Association Australia.


PubMed | University of New South Wales and Vision Eye Institute Chatswood
Type: Journal Article | Journal: Clinical & experimental optometry | Year: 2015

Defining the threshold for therapeutic and surgical intervention in patients with keratoconus presents a considerable challenge given the lack of clear, evidence-based data. Little is known about the patterns of practice and referral criteria of optometrists within Australia.All members of the NSW branch of Optometrist Association Australia were invited to complete an online survey in January 2013. This survey was designed to elicit practice information regarding the evaluation and therapeutic treatment of patients with keratoconus in the optometric setting.Responses were received from 71 optometrists, of whom 65.2 per cent had 15 years or greater experience as an optometrist. Many (35.4 per cent) responded that they prescribed soft contact lenses daily. This percentage dropped to 9.2 per cent for rigid gas-permeable lenses (RGP), although 47.7 per cent said they would prescribe RGP lenses at least once per month. The main barriers to prescribing were experience with fitting RGP lenses, time and low market demand. In terms of patient referral to an ophthalmologist, the results were variable, with 34.4 per cent stating that they would refer on progression of corneal signs, 23.4 per cent suggesting no set time and 7.8 per cent would refer on initial diagnosis. Many optometrists (62.9 per cent) would refer a patient for possible surgery, when visual acuity dropped to between 6/9 and 6/12. The size or location of the practice was not associated with the number of newly diagnosed cases of keratoconus. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal topographic unit suggested an increased likelihood of prescribing RGP lenses but did not appear to alter referral patterns.Optometrists have an integral role in the diagnosis and management of patients with keratoconus. Our survey provides a basic snapshot of current, local practice. Additionally, ophthalmology should continue to work with optometry to develop guidelines for referral and co-management to optimise future outcomes for our patients.


Wells M.,The Eye Practice | Wu N.,The Eye Practice | Kokkinakis J.,The Eye Practice | Sutton G.,Vision Eye Institute Chatswood | Sutton G.,University of Sydney
Clinical and Experimental Optometry | Year: 2013

Background: Corneal pachymetry is an important aspect of modern eye care. This study aims to compare the measurement of central corneal thickness (CCT) using automated optical pachymetry, anterior segment optical coherence tomography (AS-OCT) and ultrasound. Methods: Fifty volunteers participated in this study. Central corneal thickness was measured using the Topcon TRK-1P (Topcon, Tokyo, Japan) automated optical pachymeter, the Visante AS-OCT (Carl Ziess Meditec, Dublin, CA, USA) and the Pachmate 55 handheld ultrasonic pachymeter (DGH, Exton, PA, USA). Pearson correlation coefficients were calculated to compare automated optical pachymetry and AS-OCT with ultrasound. Bland-Altman plots were generated and limits of agreement (LOA) calculated. Results: Fifty eyes were measured for comparison. The mean and standard deviation of the CCT measured by optical pachymetry was 523.7 ± 42.3μm (range: 412 to 594), 536.0 ± 36.9μm (range: 425 to 607) for AS-OCT and 553.4 ± 40.7μm (range: 431 to 630) for ultrasound. Comparison of optical pachymetry and AS-OCT with ultrasound, generated Pearson correlation coefficients of 0.96 and 0.98, respectively. Measurements using optical pachymetry and AS-OCT were consistently lower than when measuring with ultrasound. Bland-Altman plots revealed mean differences of 29.7μm between optical pachymetry and ultrasound (LOA -5.4 to -54.1) and of 17.4μm (LOA +0.9 to -35.7) between AS-OCT and ultrasound. Conclusion: Due to AS-OCT and automated optical pachymetry consistently measuring lower than ultrasound, it should be noted that these devices are not interchangeable in clinical practice. © 2012 The Author Clinical and Experimental Optometry © 2012 Optometrists Association Australia.


PubMed | Vision Eye Institute Chatswood
Type: Case Reports | Journal: Journal of cataract and refractive surgery | Year: 2011

We present a case of unilateral keratectasia in a laser refractive surgery patient. Laser in situ keratomileusis (LASIK) was performed in the first eye, but because of difficulty lifting the femtosecond-created cap in the second eye, photorefractive keratectomy was performed in that eye. Neither eye had risk factors for keratectasia; both had identical low scores on the Randleman risk factor score. Although femtosecond laser caps were created in both eyes, ectasia developed in only the LASIK eye, in which the cap was lifted. We believe this is the first case of this complication reported in the literature. It highlights our incomplete knowledge of the risk factors for keratectasia following LASIK and suggests that unlifted flaps do not undergo the same biomechanical weakening as flaps that are lifted.

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