Ophthalmology (Eye & Ear Hospital) - Research Publications

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    Knowledge, attitudes, and self care practices associated with age related eye disease in Australia
    Livingston, P. M. ; McCarty, C. A. ; Taylor, H. R. (BMJ Publishing Group, 1998)
    Aim: To determine the level of correct knowledge about common eye disease and attitudes towards blindness prevention and treatment, and how these factors influence self care practices in a population based sample.Methods: A cluster random sample of the Victorian population was interviewed. The study population comprised residents aged 40 years of age or older living in five randomly selected Melbourne metropolitan suburbs and four randomly selected rural areas of Victoria. Questions were asked to ascertain each person's knowledge of common age related eye disease - that is, cataract, age related macular degeneration (AMD), and glaucoma. A subsample of the population was also asked questions to determine their attitudes to blindness prevention and treatment. All respondents were asked the year of their last visit to an eye practitioner.Results: A total of 3184 (89%) eligible residents were assessed. Sex (females), age (younger people), higher levels of education (secondary, trade, or tertiary education), recent visit to an eye practitioner (within the past 2 years) and English spoken at home appeared to be significant predictors of knowledge of common age related eye conditions. Younger people believed blindness prevention and blindness treatment were the highest priorities compared with other diseases; people who spoke English at home and people with knowledge of common age related eye disease also considered blindness treatment to be the highest priority compared with other diseases. People with a previous diagnosis of age related eye disease, older people, females, people with correct knowledge of common eye diseases, and those who spoke English at home were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices.Conclusion: These data show that here is a large gap in the public's knowledge and understanding of eye disease that will need to be understood for e
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    Vision impairment predicts five-year mortality
    Taylor, H. R. ; McCarty, C. A. ; Mukesh, B. N. (American Ophthalmological Society, 2000)
    Purpose: 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 3,271 participants, 231 (7.1%) were reported to have died in the intervening 5 years. Of the remaining 3,040 participants eligible to return for follow-up examinations, 2,594 (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 and cortical cataract were associated with a significantly increased risk of mortality, as were increasing age, male sex, increased duration of cigarette smoking, increased duration of hypertension, and arthritis. Conclusions: Even mild visual impairment increases the risk of death more than twofold.
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    Self-reported diabetes and distribution of HbA in a population-based sample in Victoria
    McCarty, Catherine A. ; McCarty, Daniel J. ; Van Newkirk, M. ; Taylor, Hugh R. (Austrlasian Medical Publishing, 1999-03)
    As part of the Visual Impairment Project, a population-based study of eye disease, we have studied the self-reported prevalence of diabetes mellitus in a random sample of Victorians aged 40 years and older, and examined the distribution of haemoglobin A1c (HbA1c) in participants from rural areas.
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    Ozone depletion: the ocular effects of UV-B exposure
    Taylor, Hugh R. ; McCarty, Catherine A. (Cancer Council Australia, 1996)
    Cataract is the most important eye disease associated with increased ocular exposure to UV-B. Biochemical and experimental evidence clearly links the development of cataract to UV-B exposure. Because of the difficulties in ascertaining individual ocular UV-B exposure over a lifetime, epidemiologic data have been much more limited. However; a number of epidemiologic studies have shown a consistent association between excess UV-B exposure and cortical cataracts, one of the major types of age-related cataract. These data provide the basis to recommend avoidance of unnecessary exposure of the eye to UV-B radiation, whether by avoiding outdoor activities in the middle of the day, or by protecting the eye by wearing a hat and/or UV-B absorbing eye glasses.
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    Visual impairment and socioeconomic factors
    Livingston, P. M. ; McCarty, C. A. ; Taylor, H. R. ( 1997)
    Background - Information about socio-economic factors associated with visual impairment can assist in the design of intervention programmes. Such information was collected by the Melbourne Visual Impairment Project (Melbourne VIP). Methods - The Melbourne VIP was a population based study of non-institutionalised permanent residents in nine suburbs of the Melbourne metropolitan area aged 40 years of age or older. A standardised eye examination was provided to eligible residents which included a structured interview. Variables of interest for this analysis were age, sex, country of birth, language spoken at home, education level, use of private health insurance, employment status, and living arrangements. Visual impairment was defined as a best corrected visual acuity < 6/18 and/or visual field constriction to within 20o of fixation. Results - A total of 3271 (83%) residents participated. Participants ranged in age from 40 to 98 years; 54% were female. Forty-four (1.34%) were classified as visually impaired due to visual acuity and/or visual field loss. To evaluate the independent association of the significant socio-demographic variables with visual impairment, a regression model was constructed that included age, retirement status, use of private health insurance, and household arrangement. The results showed that age was the significant predictor of visual impairment (OR: 3.19; CI: 2.29-4.43), with the mean age of people with visual impairment significantly older (75.0 years) compared with people without visual impairment (58.2 years) (t test=9.71; p=0.0001). Of the 44 visually impaired people, 39 (87%) were aged 60 years of age and older. Conclusion - The results indicate that age is the most significant factor associated with visual impairment. Of some importance was the finding that people with visual impairment were less likely to have private health insurance. With the aging of the population, the number of people affected by visual impairment will increase significantly. Intervention programmes need to be established before the onset of middle age to offset the escalation of visual impairment in the older population.
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    Vision impairment predicts 5 year mortality
    McCarty, CA ; Nanjan, MB ; Taylor, HR (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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    Vision impairment and older drivers: who's driving?
    Keeffe, JE ; Jin, CF ; Weih, LM ; McCarty, CA ; Taylor, HR (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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    Utilisation of eye care services by urban and rural Australians
    Keeffe, JE ; Weih, LM ; McCarty, CA ; Taylor, HR (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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    Use of eye care services by people with diabetes: the Melbourne Visual Impairment Project
    McCarty, Catherine A. ; Lloyd-Smith, Conrad W. ; Lee, Sharon E. ; Livingston, Patricia M. ; Stanislavsky, Yury L. ; Taylor, Hugh R. ( 1998)
    Aim - The use of eye care services by people with and without diabetes was investigated in the Melbourne Visual Impairment Project (VIP), a population based study of eye disease in a representative sample of Melbourne residents over 40 years of age and older.Methods - A comprehensive interview was employed to elicit information on history of diabetes, medication use, most recent visit to an ophthalmologist and optometrist, and basic demographic details. Presence and extent of diabetic retinopathy was determined by dilated fundus examination.Results - The Melbourne VIP comprised 3271 people who ranged in age from 40 to 98 years; 46.2% of them were male. Of 3189 people who had the fundus examination and knew their diabetes status, 162 (5.1%) reported having been previously diagnosed with diabetes and, of these, 37 (22.2%) were found to have diabetic retinopathy. Seven people (4.3%) had developed diabetes before age 30. The mean duration of diabetes was 9.2 years. People with diabetes were significantly more likely to have visited an ophthalmologist over or in the past 2 years than people without diabetes. However, 31.8% of people with diabetes had never visited an ophthalmologist. The proportion of people who had never seen an ophthalmologist was 47.1% for people without diabetes, 34.2% for people with diabetes but without diabetic retinopathy, and 25% for people with diabetic retinopathy. Sixty one per cent of people with diabetic retinopathy had seen an ophthalmologist in the past year and a further 3% within the past 2 years. People with diabetes were not significantly more likely to have visited an optometrist than people without diabetes (p=0.51). Overall, 37.7% of people with diabetes and 32.9% of people without diabetes had visited an optometrist within the past year (%2=2.25, 1 df, p=0.13). Information concerning retinal examinations was available for 135 individuals (83.3% of people with diabetes). Only 74 (54.8%) could recall ever having a dil
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    The need for cataract surgery: projections based on lens opacity, visual acuity, and personal concern
    McCarty, C. A. ; Keeffe, J. E. ; Taylor, H. R. ( 1999)
    Aim - To assess the projected needs for cataract surgery by lens opacity, visual acuity, and patient concern. Methods - Data were collected as part of the Melbourne Visual Impairment Project, a population based study of age related eye disease in a representative sample of Melbourne residents aged 40 and over. Participants were recruited by a household census and invited to attend a local screening centre. At the study sites, the following data were collected: presenting and best corrected visual acuity, visual fields, intraocular pressure, satisfaction with current vision, personal health history and habits, and a standardised eye examination and photography of the lens and fundus. Lens photographs were graded twice and adjudicated to document lens opacities. Cataract was defined as nuclear greater than or equal to standard 2, 4/16 or greater cortical opacity, or any posterior subscapsular opacities. Results: 3271 (83% response) people living in their own homes were examined. The participants ranged in age from 40 to 98 years and 1511 (46.2%) were men. Previous cataract surgery had been performed in 107 (3.4%) of the participants. The overall prevalence of any type of cataract that had not been surgically corrected was 18%. If the presence of cataract as defined was considered the sole criterion for cataract surgery with no reference to visual acuity, There would be 309 cataract operations per 1000 people aged 40 and over (96 eyes of people who were not satisfied with their vision, 210 eyes of people who were satisfied with their vision, and three previous cataract operations). At a visual acuity criterion of less than 6/12 (the vision required to legally drive a car), 48 cataract operations per 1000 would occur and people would be twice as likely to report dissatisfaction with their vision. Conclusions - Estimates of the need for cataract surgery vary dramatically by level of lens opacity, visual acuity, and patient concern. These data should be useful for the planning of health services.