Ophthalmology (Eye & Ear Hospital) - Research Publications
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ItemAcute hemorrhagic conjunctivitis due to enterovirus 70 in India.(Centers for Disease Control and Prevention (CDC), 1999)An outbreak of acute hemorrhagic conjunctivitis occurred in Delhi, India, during August and September 1996. The etiologic agent was confirmed as enterovirus type 70 by a modified centrifugation-enhanced culture method followed by immunofluorescence and neutralization tests. After nearly a decade, this virus is reemerging as a cause of acute hemorrhagic conjunctivitis in India.
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ItemLOSS OF HETEROZYGOSITY AT 11P13 IN WILMS-TUMORS DOES NOT NECESSARILY INVOLVE MUTATIONS IN THE WT1 GENE(STOCKTON PRESS, 1993-06)Loss of heterozygosity (LOH) in tumour cells is generally accepted as 'exposing' recessive cancer genes. The short arm of chromosome 11 shows consistent LOH in Wilms' tumours along its entire length. Occasionally, however, only the 11p13 and/or the 11p15 regions are involved. Deletions of the 11p13 region consistently predisposes to Wilms' tumorigenesis. We have analysed the recently cloned WT1 gene from the 11p13 region exon-by-exon in five tumours previously shown to have undergone LOH for the 11p13 region, using single strand conformation polymorphism analysis (SSCP) and PCR sequencing. Our analysis using SSCP failed to identify any band shifts in the WT1 gene from these tumours. In addition we also sequenced the zinc finger region of WT1, which is the part of the gene most frequently showing mutations. Only the normal sequence was found in all of these tumours. These results demonstrate that LOH in Wilms' tumours is not always related to mutations in the WT1 genes and argues strongly that another gene, probably in the 11p15 region, may be more important in Wilms' tumorigenesis.
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ItemMOLECULAR-GENETIC ANALYSIS OF CHROMOSOME 11P IN FAMILIAL WILMS-TUMOR(STOCKTON PRESS, 1994-06)In the family reported here, a mother and both of her children developed a Wilms tumour, and all three tumours were of the relatively rare monomorphous epithelial histopathological subtype. Using restriction fragment length polymorphism analysis, both sibs were shown to inherit the same maternal allele from the 11p13 region but different maternal alleles from the 11p15 region. Using a combination of single-strand conformation polymorphism (SSCP) and polymerase chain reaction (PCR) sequencing techniques, no mutations were identified in the WT1 tumour-suppressor gene from the 11p13 region, but a novel polymorphism was identified in exon 1. mRNA expression studies using the insulin-like growth factor II (IGF-II) gene, located in 11p15, showed that there was no relaxation of imprinting at this locus. There was also no evidence of loss of heterozygosity on the long arm of chromosome 16. These findings indicate that the WT1 and IGF-II genes, together with the long arm of chromosome 16, are not directly implicated in tumorigenesis in this Wilms family, but that a recombination event has occurred on the short arm of chromosome 11.
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ItemVision impairment predicts 5 year mortality(BMJ PUBLISHING GROUP, 2001-03)AIM: To describe predictors of mortality in the 5 year follow up of the Melbourne Visual Impairment Project (VIP) cohort. METHODS: The Melbourne VIP was a population based study of the distribution and determinants of age related eye disease in a cluster random sample of Melbourne residents aged 40 years and older. Baseline examinations were conducted between 1992 and 1994. In 1997, 5 year follow up examinations of the original cohort commenced. Causes of death were obtained from the National Death Index for all reported deaths. RESULTS: Of the original 3271 participants, 231 (7.1%) were reported to have died in the intervening 5 years. Of the remaining 3040 participants eligible to return for follow up examinations, 2594 (85% of eligible) did participate, 51 (2%) had moved interstate or overseas, 83 (3%) could not be traced, and 312 (10%) refused to participate. Best corrected visual acuity <6/12 (OR=2.34) was associated with a significantly increased risk of mortality, as were increasing age (OR=1.09), male sex (OR=1.62), increased duration of cigarette smoking (OR=2.06 for smoking >30 years), increased duration of hypertension (OR=1.51 for duration >10 years), and arthritis (OR=1.42). CONCLUSIONS: Even mild visual impairment increases the risk of death more than twofold. Further research is needed to determine why decreased visual acuity is associated with increased risk of mortality.
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ItemVision impairment and older drivers: who's driving?(BRITISH MED JOURNAL PUBL GROUP, 2002-10)AIM: To establish the association between impaired vision and drivers' decisions to stop driving, voluntarily restrict driving, and motor vehicle accidents. METHODS: Driving related questions were included in a population based study that determined the prevalence and incidence of eye disease. Stratified random cluster samples based on census collector districts were selected from the Melbourne Statistical Division. Eligible participants aged 44 years and over were interviewed and underwent a comprehensive ophthalmic examination. The outcomes of interest were the decision to stop driving, limiting driving in specified conditions, and driving accidents. The associations between these outcomes and the legally prescribed visual acuity (<6/12) for a driver's licence were investigated. RESULTS: The mean age of the 2594/3040 (85%) eligible participants was 62.5 (range 44-101). People with visual acuity less than 6/12 were no more likely to have an accident than those with better vision (chi(2) = 0.175, p>0.9). Older drivers with impaired vision, more so than younger adults, restrict their driving in visually demanding situations (p<0.05). Of the current drivers, 2.6% have vision less than that required to obtain a driver's licence. The risk of having an accident increased with distance driven (OR 2.57, CL 1.63, 4.04 for distance >31 000 km) but not with age. CONCLUSION: There was no greater likelihood of self reported driving accidents for drivers with impaired vision than those with good vision. While many older drivers with impaired vision limit their driving in adverse conditions and some drivers with impaired vision stop driving, there are a significant number of current drivers with impaired vision.
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ItemUtilisation of eye care services by urban and rural Australians(BMJ PUBLISHING GROUP, 2002-01)AIM: To investigate factors related to the use of eye care services in Australia. METHODS: Health, eye care service use, and sociodemographic data were collected in a structured interview of participants in a population based study. All participants had a standard eye examination. RESULTS: Men (OR 1.3 CL 1.02, 1.7), those who spoke Greek (OR 2.1 CL 1.1, 3.8) or Italian (OR 1.9 CL 1.0, 3.3), and those without private health insurance (OR 1.59 CL 1.22, 2.04) were more likely to have not used eye care services. Ophthalmology services were utilised at lower rates in rural areas (OR 0.14 CL 0.09, 0.2). Approximately 40% of participants with undercorrected refractive error, cataract, and undiagnosed glaucoma had seen either an ophthalmologist, optometrist, or both within the last year. CONCLUSION: Despite the similarity in prevalence of eye disease in urban and rural areas, significant differences exist in the utilisation of eye care services. Sex, private health insurance, urban residence, and the ability to converse in English were significant factors associated with eye healthcare service use. Many participants had undiagnosed eye disease despite having seen an eye care provider in the last year.
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ItemAssociation of demographic, familial, medical, and ocular factors with intraocular pressure(American Medical Association, 2001)Objective: To describe the distribution and associations of demographic, familial, medical, and ocular factors with intraocular pressure (lOP).Methods: A cluster stratified random sample of urban and rural residents of Victoria, Australia, aged 40 years and older. Participants completed an interview and underwent a standardized dilated ophthalmic examination including measurement of IOP with an electronic applanation tonometer (Tono-Pen). Glaucoma status (possible, probable, definite) was determined by a consensus panel. The main outcome measure was IOP.Results: The mean age of the 4576 participants was 59 years, 53% were women, 32% were born overseas, and 132 had open-angle glaucoma. Geometric mean (SD) IOP was 14.3 (± 1.5) mm Hg. The relationship between IOP and nuclear sclerosis, iris color, and family history of glaucoma depended on glaucoma status. In those with glaucoma, family history of glaucoma and country of birth were significantly associated with IOP in multivariate models (model: r²=0.08, P=0.01). In the group without glaucoma, place of residence, use of alcohol, iris color , vitamin E intake, and spherical equivalent were associated with IOP (model: r²=0.01, P=.006).Conclusion: In participants with glaucoma, genetic factors seem to be stronger predictors of IOP, whereas in those without glaucoma, lifestyle and physiological factors seem to play a greater role.