Khyber Alam

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...

Keratoconus is characterized by progressive thinning and increasing irregularity of the cornea, leading to substantial degradation in optical quality through the induction of both lower‐ and higher‐order aberrations (HOAs). In addition to inducing myopic and astigmatic refractive error, asymmetric corneal steepening generates complex optical distortions of the ocular wavefront, resulting in persistent reductions in image quality with conventional optical corrections including spectacles and soft contact lenses (CLs). In keratoconus, HOAs that comprise the ocular wavefront are significantly elevated, with marked variability in composition both across the population and between fellow eyes. Largely this is dominated by vertical coma, reflecting the asymmetric deformation of the cornea, with smaller contributions from trefoil and spherical aberrations. Rigid gas permeable CLs, including scleral lenses, can mask anterior corneal irregularity and partially reduce these aberrations, to improve vision quality. However, image quality in eyes with keratoconus remains reduced relative to nondiseased eyes due to residual HOAs, arising predominantly from the irregular posterior corneal surface and internal optics. This narrative review aims to translate the complex optics relating to the ocular wavefront in keratoconus into clinically relevant insights, examine current evidence on the origins of HOAs, describe related visual consequences, and outline implications for optical correction. An introduction to Zernike polynomials is presented, aiming to define the mathematical representation and facilitate a deeper understanding of wavefront data. These concepts provide a foundation for optimizing clinical care and guiding future approaches to customized optical correction in keratoconus.

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.

Purpose: Collaborative care between optometry and ophthalmology has demonstrated the potential to improve timely access to care. This study examines three settings where real-time optometry-facilitated telehealth was used to expedite specialist eye care in rural and remote Western Australia. Referrals to ophthalmology were triaged to telehealth or face-to-face services. For telehealth, optometrists performed a comprehensive in-person assessment, then facilitated video-consultation with an ophthalmologist during the same attendance for collaborative decision making. Methods: In 2023, retrospective chart review was undertaken for ophthalmology services in towns more than 1500 km from the capital city. Optometrists performed comprehensive in-person assessments and facilitated telehealth in three settings: hospital, community clinic and visiting outreach. Attendance rates were compared between collaborative telehealth and face-to-face ophthalmology. Follow up outcomes and diagnoses for telehealth consultations were reported. Results: A total of 1876 non-surgical ophthalmology episodes of care were delivered in the 12-month period, of which 1044 (55.7%) were delivered by optometry using telehealth. Of those managed by telehealth, only 83 episodes of care required a subsequent face-to-face ophthalmology consultation. The hospital setting provided the greatest proportion (76.4%) of telehealth. Adjusted logistic regression showed the odds of attendance were 3.6 (95% CI: 2.6–5.0) times higher for telehealth appointments than face-to-face ( p < 0.001). Surgical rates of outreach ophthalmology were high (30.0 to 74.1% of activity). Common diagnoses in telehealth included cataract, pterygium for direct surgical booking and chronic conditions (glaucoma, diabetic retinopathy) for instituting appropriate management. Conclusions: Collaborative telehealth with optometry improves access to ophthalmology services in rural Australia and should be considered in metropolitan settings and other countries.

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

Objective: Recent advances in technology and the impact of COVID‐19 have expanded the adoption of digital health. Synchronous collaborative telehealth between optometry and ophthalmology has been used to expedite specialist eye care in Western Australia since 2011. Optometrists perform an in‐person assessment and participate in videoconferencing with ophthalmology to facilitate shared decision‐making. This study utilises existing implementation theory to assess factors influencing implementation success, sustainability and scalability of this telehealth model. Setting: Regional, rural, and remote Western Australia. Design: In‐depth interviews were undertaken using an interview guide based on the Consolidated Framework for Implementation Research (CFIR). Deductive analysis was used to code themes to the framework, and inductive analysis was used for themes relating to sustainability and scalability. Participants: Sixteen clinical and non‐clinical staff with experience in telehealth for eye care in rural Western Australia. Results: Key themes identified using the CFIR included the relative advantage of telehealth (innovation), optimising workflow and role clarification (implementation process), funding (external setting), technological infrastructure (inner setting), a champion, and ownership and adaptability (individuals). Stakeholder buy‐in, resource allocation, integration into public health infrastructure, asynchronous telehealth, and artificial intelligence were themes pertaining to both sustainability and scalability. Conclusion: This study proposes key considerations in the implementation and maintenance of a collaborative telehealth model for eye care in rural areas which may be used as a basis for guideline development or to replicate the model in other contexts.

Background/Objectives: Inherited retinal diseases (IRDs) are a leading cause of blindness in working‐age adults. Although artificial intelligence (AI) shows potential for disease classification, progress is limited by small datasets, reliance on labelled data and limited integration of multiple imaging modalities. RETFound, a foundation model pretrained on over 900,000 fundus photographs, may address these limitations. While RETFound is based on the transformer architecture, convolutional neural networks (CNNs), such as ResNet and EfficientNet_B0, have also demonstrated strong performance in classifying retinal diseases. This study adapted RETFound and CNNs for analysing fundus autofluorescence (FAF) and pseudocolour ultra‐widefield (UWF) images, establishing a framework to classify IRDs. Subjects/Methods: Deidentified FAF and UWF images were obtained from controls and patients with Best disease, rod‐cone dystrophy, Stargardt disease and choroideremia. Images underwent preprocessing and were used to fine‐tune RETFound. Model performance was compared with classical machine learning algorithms (logistic regression, support vector machine, gradient boosting and random forest) and deep learning architectures (ResNet18, ResNet50, vision transformer, EfficientNet_B0 and ConvNeXt‐Tiny) pretrained on ImageNet. Results: The fine‐tuned RETFound model achieved an accuracy of 0.815, with the best performance for rod‐cone dystrophy (F1 = 0.820). RETFound outperformed classical machine learning models and a vision transformer pretrained on ImageNet. ResNet18 achieved a weighted F1 of 0.839 and demonstrated the best classification performance for Stargardt disease and choroideremia (F1 0.821 and 0.728, respectively). ResNet50 achieved a weighted F1 of 0.825 and demonstrated the best classification performance for normal retinas and Best disease (F1 0.945 and 0.616, respectively). ResNet architectures achieved the best performance overall. Conclusions: ResNet architectures and fine‐tuned RETFound both demonstrated strong accuracy in classifying IRD classes, demonstrating potential for clinical application and deployment in eye care settings as tools for IRD diagnosis, triage and management.

Background/Objectives: Ocular Allergy (OA) has profound effects on the quality of life (QoL) and ocular health of affected individuals. This study aimed to survey health practitioners in Australia on their knowledge and practices regarding currently available evidence-based diagnostic, treatment, and collaborative care approaches to OA. Methods: The Survey on Ocular Allergy for Health Practitioners (SOAHP), a validated tool, was distributed to various health practitioners across Australia in 2022. The survey data were analysed using descriptive statistics, Fisher’s exact test, and non-parametric tests. Results: A total of 155 participants completed the survey including Allergists/Immunologists (n = 6), General Practitioners (GPs) (n = 29), Ophthalmologists (n = 11), Optometrists (n = 66) and Pharmacists (n = 43). The survey revealed strengths and weakness in health practitioner approaches to OA. In terms of diagnosis, a significant 83.2% of participants were aware that itchy eyes are the hallmark symptom of OA; however, only 67.7% were aware that histamine is what causes the itching. Further to this, 57.4% of participants did not ask about QoL in clinical practice. In terms of management, only 30.3% were aware that some topical allergy eye drops act on eosinophils, and 74.9% were aware of the indications of mast cell stabiliser use. Finally, in terms of collaborative care, 68.4% did not believe there was a clear collaborative care model in Australia. Conclusions: This study revealed patterns in health practitioner approaches to OA. As expected, Ophthalmologists and Optometrists exhibited higher awareness and implementation of evidence-based approaches, compared to GPs and Pharmacists. However, these distinct patterns are likely influenced by differences in training and clinical responsibilities. Nonetheless, all practitioner groups showed gaps in knowledge and evidence-based practices surrounding OA. Thus, educational initiatives are required to ensure best patient-centered care is achieved, with reduced burden on the healthcare system.

Purpose: To review the optical principles of contact lens correction in keratoconus, with a focus on residual ocular wavefront error and its impact on vision performance. Findings: Corneal rigid gas permeable (RGP) contact lenses, commonly used in keratoconus management, often fail to improve vision quality to levels observed in non‐diseased eyes due to residual higher‐order aberrations (HOAs), primarily originating from posterior corneal irregularity. Dependent on the nature of the residual wavefront error, various lens parameter modifications, including optic zone asphericity, base‐down prism and scleral lens vault adjustments, can improve vision outcomes. Wavefront‐guided corrections have demonstrated potential to provide vision quality equivalent to that of healthy eyes, particularly when sufficient time is allowed for neural adaptation. Summary: This review examines the optical characteristics of the cornea in keratoconus, including the induction of elevated ocular wavefront errors. Challenges relating to optical correction with contact lenses are discussed, with an exploration of the origins of residual HOAs and their subsequent impacts on vision quality and quality‐of‐life. A range of contact lens modalities and parameter modifications are discussed, with evidence supporting their efficacy in reducing residual ocular wavefront error. Emerging data on wavefront‐guided corrections are presented, along with future directions for personalised optical corrections tailored to individual patient presentations.