Philip Raey Kidd Turnbull

Eye tracking technology has undergone significant advancements since its inception in the late nineteenth century. Initially confined to laboratory research due to their size and cost, eye trackers...

There is potential to expand the number of collaborative care and multidisciplinary team-based care models that optometrists are involved in, working at full scope to deliver high quality patient care. Ongoing work to generate research evidence, change policy and secure long-term funding is needed to support implementation. Implementation of new models of multidisciplinary team-based care or collaborative care can support quality healthcare delivery and the sustainability of future health systems. This narrative review synthesises research on models of multidisciplinary team-based care or collaborative care that involve optometrists in Australia and New Zealand. Outcomes related to patient health and experience, health service delivery including costs, and practitioner experience including workforce satisfaction were extracted from published evaluations. Additionally, barriers and facilitating factors to implementation were synthesised from identified studies. In total, 12 models of care were identified, most were task shifting or task sharing models between optometry and hospital-based ophthalmology for managing eye conditions. These collaborative models were developed to address long waiting lists for hospital-based ophthalmology services, and their implementation resulted in a corresponding decrease in waiting times for appointments. However, patient health outcomes, patient, and practitioner experiences were seldom reported. In primary care settings, models of multidisciplinary team-based care (n =3) were generally well-received by patients and practitioners. However, more objective measures may help quantify the social and economic benefits of these models. Despite the impetus for multidisciplinary team-based care, barriers to wider implementation persist. Implementation science can help identify strategies to overcome barriers to adopting evidence-based models of care. Future studies should incorporate economic evaluations, to inform advocacy and policy, to generate system-level change that support health organisations to deliver multidisciplinary team-based care. Finally, future work should consider embedding the patient perspective from outset to ensure that models of care are people-centred.

Mild traumatic brain injury (mTBI) is typically assessed using subjective symptom reports, yet subtle neurophysiological disruption may persist beyond clinical recovery. Eye-tracking provides an objective index of cognitive, sensorimotor, and autonomic function, particularly when implemented in immersive three-dimensional (3D) virtual reality (VR). This case report describes changes in 3D VR eye-tracking before, immediately following, and with recovery from mTBI. A 49-year-old male completed baseline testing as part of a larger study, then sustained an mTBI 10 weeks later. Eye-tracking was repeated at 1 week ('Injury') and ~11 weeks post-injury ('Recovery'). The battery assessed fixation, pursuit, saccades, inhibitory control (anti-saccade and Stroop), vestibulo-ocular reflex (VOR), egocentric localization, and pupillary light reflex (PLR). Injury-phase demonstrated widespread alterations in precision, inhibitory control, and autonomic metrics. Fixation BCEA increased 4.8-14.8%. Pursuit, fixation, and VOR error worsened. VOR gain worsened (1.04 to 0.79) but showed partial recovery (0.85). Anti-saccade accuracy declined (87.5% to 62.5%). Stroop accuracy improved; however, latency increased substantially, suggesting compensation. PLR constriction amplitude decreased by ~50%. This case demonstrates multi-domain oculomotor disturbance post-mTBI, with persistent abnormalities despite symptom improvement. Immersive 3D VR eye-tracking may provide a sensitive, objective method for detecting neurophysiological dysfunction and monitoring recovery.

Age-related macular degeneration (AMD) is a common condition that causes vision impairment in the elderly, significantly impacting their physical and psychosocial well-being. Historically, treatment options to slow or prevent atrophic AMD progression have been limited but are recently increasing in number. This scoping review aims to provide an overview of the research (both preclinical and clinical) on non-neovascular AMD (including early, intermediate, and geographic atrophy) treatments published in the past decade. Our study protocol was prospectively registered on the Open Science Framework.Searches were conducted on MEDLINE, Embase, ProQuest, and CINAHL for studies investigating treatments for atrophic AMD (including early, intermediate, and geographic atrophy stages) published between 1 January 2014 and 14 July 2024, the search date. Data screening, full-text review, and extraction were independently performed by two researchers. Study characteristics and outcomes were summarised, and the results were synthesised narratively. The search identified 1,211 studies, of which 132 were included in this review. Studies were most often conducted in the United States (n = 92, 68.7%) or Europe (n = 25, 18.5%) and most frequently investigated antioxidant or anti-inflammatory treatments (n = 30, 22.7%) or complement pathway inhibitors (n = 25, 18.9%) as potential therapies. Over three quarters (n = 101, 76.5%) of the included studies reported positive outcomes. Across the decade, the number of studies published increased at an annual rate of 24.0%.This review highlights the growing body of research on atrophic AMD treatments over the past decade, with antioxidant and anti-inflammatory treatments emerging as prominent, promising avenues. However, more phase III human clinical trials are needed to ensure that future therapies effectively serve the global AMD population.

Purpose: To investigate the efficacy of a novel test for diagnosing colour vision deficiencies using reflexive eye movements measured using an unmodified tablet. Methods: This study followed a cross-sectional design, where thirty-three participants aged between 17 and 65 years were recruited. The participant group comprised 23 controls, 8 deuteranopes, and 2 protanopes. An anomaloscope was employed to determine the colour vision status of these participants. The study methodology involved using an Apple iPad Pro’s built-in eye-tracking capabilities to record eye movements in response to coloured patterns drifting on the screen. Through an automated analysis of these movements, the researchers estimated individuals’ red–green equiluminant point and their equivalent luminance contrast. Results: Estimates of the red–green equiluminant point and the equivalent luminance contrast were used to classify participants’ colour vision status with a sensitivity rate of 90.0% and a specificity rate of 91.30%. Conclusions: The novel colour vision test administered using an unmodified tablet was found to be effective in diagnosing colour vision deficiencies and has the potential to be a practical and cost-effective alternative to traditional methods. Translation Relevance: The test’s objectivity, its straightforward implementation on a standard tablet, and its minimal requirement for patient cooperation, all contribute to the wider accessibility of colour vision diagnosis. This is particularly advantageous for demographics like children who might be challenging to engage, but for whom early detection is of paramount importance.

Background Population-based eye health surveys are an important source of evidence describing the eye health needs of a population, although differences in participation rates between population groups may lead to response bias. In some high-income settings, participation in surveys has decreased over time, although whether this has occurred for eye health surveys is unclear. The aim of this study was to compare participation in population-based eye health surveys conducted over the previous ~20 years between country income levels and different population sub-groups. Methods Participation rates were extracted from an existing database of all population-based eye health surveys undertaken anywhere in the world between 2000–2023 that estimated the prevalence of vision impairment. Overall participation and participation rates disaggregated between population groups (identified using the PROGRESS+ framework) were extracted and compared between country income levels. Results Participation was reported by 374 (86.6%) of the 432 included eye health surveys, was generally high (median=89.5%, interquartile range [IQR]: 81.1-94.6%) and did not change over the study period. Participation was lowest in high-income countries (79.2%, IQR 70.4-90.0%). Just over one-quarter of studies (n=125, 28.9%) disaggregated participation by gender/sex. In these studies, women were more likely to participate than men in low income (women: 90.5%, IQR 75.3-96.2 vs men: 86.8%, IQR 59.1-90.1%), lower-middle income (92.2%, IQR 86.1-95.5% vs 88.8%, IQR 80.1-93.4%), and upper-middle income (91.2%, IQR 85.8-94.6% vs 86.3%, IQR 77.4-90.1%) countries, but not in high-income countries where participation was similar (87.9%, IQR 80.8-95.4% vs 89.3%, IQR 79.1-92.9%). Participation rates disaggregated by age were reported by 68 surveys (15.7%) and participation was not significantly associated with age. Participation disaggregated between other population sub-groups was infrequently reported (<10% of surveys) and could not be meaningfully compared. Conclusions Researchers could consider alternative recruitment strategies that achieve better participation in high income countries and for men in low- and middle-income countries.

To improve equity in eye care, optometry training clinics should be accessible to all population groups so that future optometrists develop skills working with different population groups. In the 2019 World Report on Vision, the World Health Organization highlighted a need to improve access to eye care globally. In Aotearoa New Zealand, a renewed focus on equity followed the 2022 health system reform. The School of Optometry and Vision Science (SOVS) at The University of Auckland has an important role in promoting equity within the eye health sector. The aim of this study was to assess whether the SOVS teaching clinics are accessible to a range of population groups. The demographics and travel distances of patients accessing the SOVS teaching clinics within the five-year period immediately prior to the New Zealand health system reform (2017-2021) were assessed. The representativeness of patients accessing the main teaching clinic was compared to the wider New Zealand population. Information describing patient ethnicity was not available for 82% of the 18,981 patients. Compared to the New Zealand population, people who accessed the main teaching clinic were more likely to live in areas with low levels of deprivation, and those who lived in areas of high deprivation travelled the furthest (all p < 0.01). Compared to patients accessing the main teaching clinic, a person accessing care at a fully subsidised community-based clinic was 27 times more likely to live in an area with the highest level of deprivation. Due to its location, the teaching clinic where New Zealand optometrists are trained is less accessible to people who live in areas with high levels of deprivation, and greater focus on collecting patient ethnicity information is required. Funding for routine, community outreach services would address inequities and embed a culture of equity into optometry education.