Keratoconus is an eye condition that weakens the rounded clear covering of the eye, the cornea, and leads it to become cone-shaped over time. This causes serious progressive near-sightedness at a relatively young age.
Now, the largest clinical study ever of the condition has provided new insights into those at greatest risk. The researchers say that patients with keratoconus and their families, as well as doctors, should be aware of other potential health problems uncovered in the study.
The investigation checked medical insurance data of than 16,000 people – half with confirmed keratoconus and half from those with similar characteristics but no keratoconus. This enables researchers to see which characteristics and medical conditions were most associated with keratoconus, and which weren’t. The people in the study were mostly in their 30s and 40s.
Lead author, Dr Maria Woodward, Assistant Professor of Ophthalmology at University of Michigan, put the importance of this research into context by saying: “Eye health relates to total body health, and we as ophthalmologists need to be aware of more than just eyeballs when we see patients.”
The study confirmed many suspicions about the condition raised by previous small studies – but casts doubt on others. For instance, men were already known to have a higher risk, which the study confirmed.
And people with Down syndrome have a six times higher susceptibility to keratoconus than the general population. This reinforces the high importance of screening and treatment for the condition in members of the Down syndrome community, starting at a young age.
One major revelation, previously unknown, is that people of African American and Latino heritage have 50 percent higher chance than whites of contracting keratoconus. Equally revealing is the finding of a 39 percent lower rate among people of Asian heritage that contradicts previous research.
Diabetes and other chronic illness: what’s the link to keratoconus?
In a real conundrum it appears that while diabetes causes other negative effects to the eye, the cornea may be strengthened as a by-product of those changes. This is suggested by a finding of 20 percent lower prevalence of keratoconus among people with diabetes.
The researchers also looked at other chronic conditions thought to be associated with keratoconus – such as allergic rhinitis, mitral valve prolapse, collagen vascular disease, aortic aneurysm and depression – and found no higher odds of the condition.
But when it came to people who had been diagnosed with sleep apnoea – which interrupts breathing during sleep, and can cause snoring, daytime sleepiness and a higher risk of heart disease and stroke – there was a statistically significant higher chance of also having keratoconus. Similarly, people with asthma had higher susceptibility to also having the eye condition.
The authors note that because they used insurance data, they can only see associations of conditions recorded on medical bills, and not cause and effect. And, their findings might not apply to people with no health insurance and therefore less access to medical care. They also can’t tell which of the people had other risk factors for keratoconus, such as eye rubbing, a family history of the condition, and other conditions not present in the database.
Source:
University of Michigan Health System
![Yoga positions increase IOP]()
Glaucoma sufferers need to exercise great care while performing certain yoga positions or other activities that involve head-down postures due to their tendency to increase pressure within the eye.
Glaucoma is a leading cause of irreversible blindness and is frequently called the sneak thief of sight due to the difficulty of detecting it early. Elevated intraocular pressure (IOP) can damage the optic nerve causing moderate to severe vision loss. It is the most common known risk factor for glaucoma.
Importantly, it is the only modifiable risk factor for which treatment can slow or prevent the progression of glaucoma.
A just-released study by the New York Eye and Ear Infirmary of Mount Sinai built on previous research that studied just the headstand yoga position and found it doubled IOP. The new study had healthy participants with no eye-related disease and glaucoma patients perform a series of inverted yoga positions, including downward facing dog, standing forward bend, the plow, and legs up the wall. IOP was measured five times in each group: while seated, immediately assuming the pose, two minutes while holding the pose, immediately after returning to the seated position, and 10 minutes after resting in a seated position.
Both normal and glaucoma study participants showed a rise in IOP in all four yoga positions, with the greatest increase of pressure occurring during downward facing dog. When the measurements were taken after the participants returned to a seated position and again after waiting ten minutes, the pressure in most cases remained slightly elevated from the baseline.
Doctors involved in the study say further research is needed but urge people to heed the warning about avoiding risky positions that increase eye pressure. They encourage physical exercise as part of active and healthy lifestyles but warn glaucoma patients, in particular, about certain activities such as lifting heavy weights and doing push-ups as risky for damaging the optic nerve.
Full details are in the journal PLOS ONE.
The University of Melbourne has announced Health agencies are closer to eliminating preventable blindness in Indigenous Australians. Prof Taylor says that with continued support from the government, the gap for Indigenous vision can be closed within in the next 4 years.
This is good news as almost 37 per cent of Aboriginal adults are affected by diabetes, and approximately 13 per cent have lost their vision from the disease.
Read more in the Media Release: Closing the gap in Indigenous eye heath is within reach
LEADERSHIP INSPIRING CHANGE
The Parliamentary Friends Group for Eye Health and Vision Care is an opportunity to engage with leaders inspiring change. The 2015 March event was Co-Chaired by Mr Andrew Laming MP and Mr Stephen Jones MP. The event was attended by Vision 2020 members and over 20 parliamentarians including the Hon Bronwyn Bishop MP. Ms Bishop is the current Speaker of the House of Representatives.
RANZCO Fellow, Dr Hessom Razavi, gave an inspiring speech about the need for leaders to have compassion and to take action. Hessom was born in Iran and migrated to Australia with his family in 1989. Community-orientated parents heighted his awareness of inequality and his passion for contributing to the self-empowerment of disadvantaged groups.
Hessom has actively worked in Western Australia providing outreach clinics and surgery to regional, remote and Indigenous communities. Indigenous Australians go blind six times as often as non-indigenous Australians. But in most places, Aboriginal patients have the poorest access to specialist eye services. Much of this blindness is due to diabetic retinopathy, of which around 90 per cent is avoidable, through safe and effective screening and treatment. This year, Hessom is completing a fellowship with the Centre for Eye Research Australia.
Other inspiring speeches were delivered by; Brandon Ah Tong from Vision 2020 Australia, Dr Jessica Gallagher a female Paralympian dual medalist, Samuel Kiom a Senior Manager at Papua New Guinea Eye Care and Shannon Peckham the first indigenous female to graduate from optometry.
The event was attended by RANZCO President Dr Brad Horsbourgh, RANZCO CEO David Andrews, Dr Iain Dunlop, Professor Hugh Taylor and Suzanne Lyon.
BLOG IMAGE: DR HESSOM RAZAVI AND HON BRONWYN BISHOP MP
The Indonesian examiners will observe the RANZCO Advanced Clinical Exam (RACE) on 26-27 March 2015 at the Sydney Eye Hospital as part of an examiner exchange program between RANZCO and Indonesian College of Ophthalmologists. Earlier this year a team led by Christine Younan and consisting of Humayun Baig and Patrick Lockie visited Jakarta to support the national exams as external examiners.
RANZCO is supporting the Indonesian College of Ophthalmology through an examiner exchange program which includes:
- Indonesian examiners observe clinical ophthalmology exams in Australia, and
- Australian ophthalmologists participate in Indonesian clinical exams as external examiners.
In this way, knowledge and skills will be gained by Indonesian College of Ophthalmology to assist with the management of their national ophthalmology training program and to build the capacity of their teaching faculty. The exchange of examiners visiting Indonesia and Australia respectively will enhance the standard of eye care and provide an opportunity for Fellows of RANZCO and Fellows of the Indonesian College of Ophthalmology to participate in inter-College activities, allowing for development of networks and sharing of learning.
BLOG IMAGE: (FAR)DR SYNTIA NUSANTI MEMBER OF NATIONAL EXAM COMMISSION, (MIDDLE)DR IKKE SUMANTRI CHAIRWOMAN OF THE NATIONAL EXAM, (FRONT) DR TRI RAHAYU – CPD CHAIR AND UNIVERSITY OF INDONESIA’ PROGRAM DIRECTOR DISCUSSED THE RANZCO INDONESIAN COLLEGE OF OPHTHALMOLOGY COLLABORATION WITH RANZCO’S DAVID ANDREWS (CEO), DR NEIL MURRAY (CHAIR OF THE OBCK BOARD OF EXAMINERS AND BOARD MEMBER), GERHARD SCHLENTHER (POLICY AND PROGRAMS), KATE MORRISON (ASIA PACIFIC PROJECT OFFICER)
Uveitis was a major theme at the recent RANZCO South Australian Branch Meeting held at the lovely Sanctuary conference centre at Adelaide Zoo over the weekend of 28 – 29 March. With more than 70 delegates, speakers and sponsors, attending, a mixture of thought-provoking research and case studies were presented.
The branch meeting began on the Saturday with a special appearance by world-renowned cataract and refractive surgeon, Dr David Lubeck, at the Alcon breakfast. Formal proceedings were opened by Dr Garry Davis, SA branch chair, with a session discussing acute/infectious uveitis with Dr Lyndell Lim and Dr Tony Hall. The focus was on uveitis in those with compromised immune systems, with interesting case references to HIV, syphilis and tuberculosis. Later that day, Younger Fellows discussed career and practice management issues at a networking session, and the conference dinner at the Adelaide Oval was a vibrant social evening.
The second day began with an update on the My Eye Health program, which continues to promote eye awareness and health across South Australia and the Northern Territory. Sessions throughout the day focused on chronic non-infectious uveitis with interactivity and Q&A sessions helped flesh out key concerns. Rapid fire sessions highlighted key decision-making aspects faced by many ophthalmic surgeons. The meeting closed with a presentation on the Top 10 tips for uveitis management, bringing together the major learnings from the two days.
The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Asia-Pacific Academy of Ophthalmology (APAO) have signed the Memorandum of Understanding (MOU) in which RANZCO will provide support to the APAO’s Leadership Development Program (LDP). This includes an annual grant to sustain program activities, sponsorship to experts to present workshops, and administrative and travel expense support. The agreement was signed at the APAO LDP Alumni Reception at the APAO Congress in Guangzhou, China on 3 April 2015.
RANZCO President, Dr Bradley Horsburgh and APAO President, Rajvardhan Azad signed the agreement with RANZCO CEO, Dr David Andrews also present at the signing.
The APAO Leadership Development Program commenced in 2009 to identify individuals with the potential to become leaders in ophthalmology. Supporting the APAO LDP aligns well with RANZCO’s strategy to be a leader in eye care education and professional development in the Asia-Pacific region.
Also at the APAO Congress, RANZCO Fellows Drs Neil Murray and Cathy Green received awards recognising their long-standing service to eye health in the region. Dr Murray received the Outstanding Service in Prevention of Blindness Award. Dr Murray has worked internationally in high, medium and low resource settings over the past 23 years in many Asia-Pacific countries. Through his work with the Fred Hollows Foundation and Chair of RANZCO’s International Development Committee, Dr Murray has taken opportunities to lead development of partnerships, securing of funding, strengthening of eye care education and leadership development initiatives in the Asia-Pacific region. He has been a Trustee of the International Agency for the Prevention of Blindness (IAPB) since early 2014.
Dr Green received the APAO Distinguished Service Award. Along with her career as a glaucoma specialist, she is the convenor and designer of the RANZCO Leadership Development Program, which aims to develop and enhance leadership skills for ophthalmologists in Australia and New Zealand. She is an APAO LDP Program Director and has participated as invited faculty for leadership programs including the Royal College of Ophthalmologists of Thailand and the Philippine Academy of Ophthalmology. Dr Green has provided eye care and teaching in countries such as Cambodia, Fiji, Nepal, Myanmar and Timor Leste.
The 30th APAO Congress was held in Guangzhou, China in early April with more than 5,000 attendees and nearly 1000 speakers. Australian and New Zealand Fellows were actively involved, including representation on the planning committee.
BLOG IMAGE: DRS CATHY GREEN AND NEIL MURRAY WITH THEIR APAO AWARDS RECOGNISING THEIR LONG-STANDING SERVICE TO EYE HEALTH IN THE ASIA-PACIFIC REGION.
On 8 May 2015, RANZCO and the Indonesian College of Ophthalmology (KOI) signed a Memorandum of Understanding (MOU) to affirm the desire to continue a collaboration that commenced in June 2013. This agreement follows on the successful examiner exchanges between the two colleges funded by the Australia-Indonesia Institute (AII) this year as part of its support of maintaining people-to-people links between the two countries. The aims of the examiner exchanges were to further enhance standards of ophthalmology education and training in Indonesia and to provide an opportunity for RANZCO and KOI representatives to participate in inter-Collegiate activities.
DR GONDHOWIARDJO TJAHJONO (KOI) AND DR CATHERINE GREEN (RANZCO) SIGNING MOU ON 8 MAY 2015
The new three year MOU will seek to collaborate on strengthening accreditation processes for Indonesian ophthalmology training institutions through capacity building activities and exploring opportunities for collaboration on continuing professional development.
The Ophthalmology Residency Training Technical team, together with Dr Mark Renehan, and Craig Dobney from RANZCO, conducted the first Objective Structured Clinical Exam (OSCE) for Ophthalmology at the University of Health Sciences (UHS).
It was a mock examination in preparation for the OSCE that will become part of the assessment program of the Ophthalmology Residency Training (ORT) in December. Setting up the mock OSCE required a significant amount of preparation and planning by the ORT faculty, and it was a very successful event.
ORT students from Year 1 were the candidates and they examined the patients while trainees from Year 2 and Year 3 observed. Members of the ORT team and other Ophthalmologists from Cambodia examined the candidates, using the performance criteria checklists that they developed in the RANZCO workshop last April, based on the new ORT curriculum and also after assessing the patients that visited UHS as part of this exam.
For the mock OSCE there were 5 stations that were held in the simulation centre of the UHS. These stations were Anterior segment, Posterior Segment, Refraction, Communication & History taking, and Neuro Ophthalmology / Paediatrics. Dr Mark Renehan assisted in the preliminary examining of the patients (pictured).
After the OSCE, both candidates and examiners completed an evaluation of the exam and its processes. Then a post exam meeting was held with RANZCO and the ORT Technical team to discuss any improvements required in the lead up to the OSCE in December.
We would like to thank all those that participated in this exam in making it a successful platform to improving assessment of ophthalmology students in Cambodia. RANZCO’s collaboration with the UHS is funded by the Australian Department of Foreign Affairs and Trade.
Recent Trainee and Supervisor Workshops held at the Royal North Shore Hospital Sydney were deemed a success.
TRAINEE WORKSHOP
A very successful Ophthalmic Simulation Communications and Clinical Scenario Workshop was held on Saturday 20 June 2015 at Royal North Shore Hospital. The Workshop targeted trainees and provided them with an opportunity to deal with challenging scenarios in which professional actors took the part of patients. A professional facilitator was present at each scenario together with an ophthalmology consultant to provide clinical and professional advice. Feedback from all participating trainees, consultants and facilitators was overwhelmingly positive.
Many thanks to the five consultants who so freely gave of their time and expertise on the day. While being the last in a series of Workshops funded by the Commonwealth Government through the Specialist Training Program (STP), RANZCO is hopeful of being able to offer this highly valuable training experience in the future.
SUPERVISOR WORKSHOP
The last in the series of Ophthalmic Supervisor Training Workshops was held at Royal North Shore Hospital on 9 May 2015. Scenario based, professional actors took the part of trainees and supervisors were able to explore techniques for handling difficult communication issues.
Professional facilitators were also present at each scenario to assist the process. Feedback from this and previous workshops has been extremely positive and while the Workshops were funded by the Commonwealth Government through the Specialist Training Program (STP), RANZCO intends to use knowledge gained to develop further training resources and activities for Supervisors.
