Hamed Niyazmand

Purpose: This study aimed to investigate whether short‐term inferior‐nasal gaze, commonly adopted during near work, alters macular perfusion differently from superior‐nasal gaze, and whether these gaze‐dependent changes vary between myopes and emmetropes. Methods: Twenty‐six healthy participants aged 18–35 years, comprising 14 emmetropes (−0.12 ± 0.26 D) and 12 myopes (−3.23 ± 2.22 D), underwent optical coherence tomography angiography to assess changes in the macular perfusion density (PD) during a 5‐min period of sustained superior‐nasal and inferior‐nasal gaze, compared with measurements captured in primary gaze. The choriocapillaris flow deficit density and PD of the deep choroid, and the retinal deep and superficial vascular plexuses were quantified across modified ETDRS regions over a 2 mm area centered on the fovea. Regional PD changes associated with oblique gaze direction and refractive group were examined using repeated measures ANOVA. Results: There was a significant gaze by region interaction for retinal deep vascular plexus PD ( p = 0.02), with PD reducing significantly by −1.6 ± 0.4 % in the temporal 1–2 mm region during inferior‐nasal gaze, while no significant changes were observed during superior‐nasal gaze in all regions ( p > 0.05). There was no significant main effect of gaze or gaze by region interaction on PD in any other chorioretinal layer, and PD responses to oblique gaze did not differ significantly between myopes and emmetropes (all p > 0.05). Conclusions: Reductions in macular PD of the retinal deep vascular plexus were observed associated with a brief period of inferior‐nasal gaze, whereas superior‐nasal gaze had no significant impact on the PDs. These findings may provide a better insight into the impact of near work activities on retinal perfusion which may be important for understanding mechanisms of myopia development.

Indigenous or First Nations peoples of Australia are defined as those who identify as Aboriginal and/or Torres Strait Islander, are of Aboriginal and/or Torres Strait Islander descent, and are reco...

With the ageing population, it is predicted that the number of people living with distance vision impairment will be 895 million people by 2050.1 Many chronic eye conditions, such as glaucoma, requ...

Introduction: Globally, falls are the leading cause of injury hospitalisation, with vision being a significant falls risk factor. Community optometrists, as primary eye care professionals, are well positioned to contribute to falls prevention care. However, scant studies have evaluated if education could enable optometrists to incorporate falls prevention care into practice. This two-phase pilot study aimed to design and develop an online education program for community optometrists to deliver primary falls prevention care and to evaluate optometrists’ reaction to, and learning from, the education. Methods: In phase one, an education program was designed by optometrists and falls experts and published online. In phase two, community optometrists were recruited through convenience sampling to undertake the education. Guided by the New World Kirkpatrick model® of training evaluation, reaction and learning were evaluated using pre/post surveys. Quantitative data were analysed using Wilcoxon sign-rank tests and McNemar Exact Tests and qualitative responses using inductive content analysis. Results: Participants (n=13) reported high levels of satisfaction and engagement with the online education and unanimously endorsed its relevance to clinical practice. Participants demonstrated significantly improved knowledge and awareness of falls prevention post-education, compared to pre-education and were significantly more confident to enact falls prevention care. Perceived enablers to providing falls prevention care included having access to practical resources and ongoing education. Time constraints during consultation and cost to patients for further care if subsequent referrals were made were identified as possible barriers to providing falls prevention care. Conclusion: Online education improved community optometrists’ knowledge and confidence to provide falls prevention care. Further research that evaluates the effectiveness of continuing education for optometrists to enact falls prevention care into practice is required.

Community optometrists are primary eye care professionals who are well positioned to provide assessment and treatment for vision-related falls prevention.

Transient changes in intraocular pressure (IOP) cause axial elongation and choroidal thinning; however, associated effects on anterior eye components which could be relevant to myopia remain unclear. This study aimed to investigate the impact of transient IOP changes on anterior eye and to assess the repeatability of anterior chamber measurement and segmentation. The right eye of 21 healthy adults (40 ± 16 years) was included. Baseline axial length and anterior chamber parameters including anterior chamber angle, anterior chamber depth, angle opening distance (AOD), and trabecular iris space area (TISA) were measured three times using optical coherence tomography. Participants wore modified swimming goggles to induce a transient change in IOP. The same parameters were measured 5 minutes after wearing and immediately upon removal of the swimming goggles. ANOVA was used to assess the effects of IOP change on the anterior eye. Intrasession repeatability of semi-automated segmentations was calculated using within-subject standard deviation. Swimming goggles increased IOP (2.4 ± 2.7 mmHg, p < 0.05) and axial length (16 ± 25 µm, p < 0.05). Transient increase in IOP had no effects on anterior chamber parameters (all p > 0.05); however, negative correlation was found between change in IOP and change in nasal anterior chamber angle (r = -0.47) and between age and change in anterior chamber depth (r = -0.44). Within-subject SD of three repeated scans of AOD500, AOD750, TISA500, TISA750 for nasal angle were 36μm, 63μm, 11μm², and 21μm² and for temporal angle were 79μm, 98μm, 27μm², and 46µm², respectively. Transient increase in IOP led to axial elongation but had no significant effect on anterior eye parameters. A greater increase in IOP correlated with greater narrowing of nasal anterior chamber angle. Semi-automated segmentation of the angle parameters provided repeatable measurements; however, the repeatability was worse in the temporal compared to the nasal quadrant.

Eye health literacy is an important factor in determining eye health outcomes. Ophthalmic disorders are increasingly common due to various factors associated with ageing population and other important determinants of health such as socio-economic status, environmental, cultural, individual, behavioural, and biological factors. Therefore, understanding the importance of health literacy in promoting preventive practices, early identification, and prompt management of eye diseases is critical. Currently, glaucoma, diabetic retinopathy, and age-related macular degeneration are the leading causes of irreversible vision impairment. However, the impact of enhanced eye health literacy on these diseases has not been sufficiently studied. In this topical review, findings from relevant peer-reviewed articles published after 1998 are presented. The results indicate that enhancing knowledge about eye health and ophthalmic care can significantly contribute to the prevention and management of these conditions, and thus decrease the burden of vision impairment. Patients with adequate health literacy can make informed decisions about their health, adhere to treatment programs, and communicate effectively with healthcare providers. Educational level, socioeconomic status, age, gender, family history of eye disease, regular eye check-ups, and remoteness influence the level of health literacy across the world. However, due to differences in health infrastructure, geographical and cultural characteristics, research conducted in other countries is not necessarily applicable in Australia. In summary, despite the increasing burden of vision impairment, there is a lack of wholistic research regarding the status of eye health literacy in Australia and abroad, therefore suggesting a critical gap in research and universal eye health literacy tools.

The global prevalence of myopia has increased significantly in recent decades, and it is anticipated that half the population of the world will be myopic by 2050. The dramatic increase in myopia cannot be explained solely by genetic factors; hence, environmental factors such as near work may play an important role in myopia development. Near work activities involve accommodation, convergence, and pupil constriction, which lead to various mechanical changes that alter the structural and optical properties of the anterior eye. Mechanical changes associated with near work activities include ciliary body contraction, medial rectus contraction, lateral rectus relaxation, changes in the eyelid-cornea interaction, pupil size, and crystalline lens shape and position. These structural variations lead to optical changes including a change in spherical refractive power, astigmatism, accommodative convergence, higher order aberrations, and retinal image quality. Several differences in near work-related optical and structural changes have been observed between myopes and non-myopes. These differences elucidate mechanisms that potentially underpin near work-associated axial elongation and myopia development. This narrative review explores anterior segment structural and optical changes during near work and their potential mechanistic contribution to myopia development, while highlighting literature gaps that require further research.

Inherited retinal disease (IRD) refers to a heterogeneous group of genetic eye disease that causes progressive vision loss and was once regarded untreatable. However, regulatory approval for Luxturna (voretigene neparvovec-rzyl) for patients with biallelic mutation in the RPE65 gene has heralded new optimism for patients with the disease. One critical question in designing clinical trial in patients with IRD is choosing appropriate outcome measures to assess the retina, taking into consideration the slow disease progression and the inherent low vision associated with the disease. In this review, the functional and structural endpoints that have been utilised in human retinal gene therapy clinical trials in patient selection as well as measures of safety and efficacy are described. For clinicians, an appreciation of these specialised measures of eye health in a patient with IRD will enhance understanding of retinal health assessments, disease prognosis as well as facilitating discussions with patients potentially eligible for retinal gene therapy clinical trial.

SIGNIFICANCE: Myopia prevalence has increased over the last few decades. Studies have documented that the choroid is considered an important biomarker in myopia development. As myopia and choroidal thinning are associated with increased glaucoma risk, understanding the role of the choroid in myopia and glaucoma is imperative. PURPOSE: This study investigates the effect of transiently elevated intraocular pressure on axial length, subfoveal choroidal thickness, and central retinal thickness in emmetropes, low myopes, and high myopes. METHODS: This study involved 29 young adults (23 ± 1 years), including 10 emmetropes (−0.50 D < SE < +0.50 D), 10 low myopes (−6.00 D < SE ≤ −0.50 D), and 9 high myopes (SE ≤ −6.00 D). Participants were fitted with modified swimming goggles for 5 minutes to transiently change intraocular pressure. Noncontact tonometry, optical biometry, and optical coherence tomography were used to measure intraocular pressure, axial length, central retinal thickness, and subfoveal choroidal thickness, respectively. Measurements were taken at before, during goggle wear, immediately after, and 3 minutes after goggles removal. Repeated‐measures analysis of variance with Bonferroni adjustment was used to assess the effect of transiently changed intraocular pressure and to elucidate any differences between refractive groups in response to the intraocular pressure change. RESULTS: Intraocular pressure increased by 1.7 ± 2.1 mmHg (p=0.002) from baseline, accompanied by axial elongation of 14 ± 21 μm (p = 0.012) and subfoveal choroidal thinning of 13 ± 15 μm (p=0.01). However, central retinal thickness did not change significantly (p>0.05). Most of the changes in the axial length were due to changes in the choroidal thickness. Observed changes returned to baseline immediately following goggles removal. There was no significant difference between refractive error groups' changes associated with the transient increase in intraocular pressure (p>0.05). CONCLUSIONS: Transiently increased intraocular pressure caused temporary axial elongation and subfoveal choroidal thinning, with no significant differences between refractive groups. Further studies are required to assess the impact of long‐term increased intraocular pressure on ocular components.