Face Mask-Associated Recurrent Corneal Erosion Syndrome and Corneal Infection.

ABSTRACT: In the current coronavirus disease 2019 (COVID-19) pandemic, important public health measures such as the utilization of face masks has been widely enforced, including community-wide mandatory face mask use. During this period, there have been observations of an increasing number of patients presenting with dry eye symptoms among regular mask users with no history of ocular surface pathology. Individuals have reported being aware of air blowing upward from the mask into their eyes that is likely to increase the evaporation of their tear film leading to ocular irritation. Although face mask use is essential in combatting the COVID-19 pandemic, it is important to recognize the potential effects it may have on ocular health. We report a case of face mask-associated ocular complication. After an initial cornea abrasion from mask use, the patient developed recurrent corneal erosion syndrome that was complicated by microbial keratitis after the enforcement of mandatory mask use in public areas.

Age-related macular degeneration in ethnically diverse Australia: Melbourne Collaborative Cohort Study.

PURPOSE: To determine and compare the prevalence of age-related macular degeneration (AMD) in older Australians of Anglo-Celtic and Southern European origin. METHODS: A total of 21,132 participants of the Melbourne Collaborative Cohort Study, aged 47-86 years, were assessed for AMD in 2003-2007 with non-mydriatic fundus photography. Of these, 14% were born in Southern Europe (Greece, Italy or Malta), with the remaining 86% of Anglo-Celtic origin, born in Australia, the United Kingdom or New Zealand. RESULTS: Overall, 2694 participants (12.7%) had early stages of AMD, defined as either one or more drusen ≥ 125 µm (with or without pigmentary abnormalities) or one or more drusen 63-124 µm with pigmentary abnormalities in a 6000-µm diameter grading grid, in the absence of late AMD in either eye. A total of 122 participants (0.6%) had late AMD, defined as either geographic atrophy or neovascular AMD. In logistic regression analysis, adjusted for age, sex, smoking, education and physical activity, Southern Europeans compared to Anglo-Celts had a higher prevalence of the early stages of AMD (odds ratio, OR, 1.15, 95% confidence interval, CI, 1.00-1.34), and lower prevalence of late AMD (OR 0.36, 95% CI 0.17-0.78). CONCLUSIONS: Australians of Southern European origin have a higher prevalence of the early stages of AMD and lower prevalence of late AMD compared to those of Anglo-Celtic origin. Although AMD prevalence in the older age group(s) of Southern Europeans could be underestimated due to disparity in participation rates, it is likely that both lifestyle and genetic factors play their parts in differential AMD prevalence in these ethnic groups.

The prevalence and risk factors of epiretinal membranes: the Melbourne Collaborative Cohort Study.

PURPOSE: To determine the prevalence of epiretinal membranes (ERMs) in Melbourne, Australia and its risk factors in this population. METHODS: The Melbourne Collaborative Cohort Study is a prospective study investigating the role of diet and life style in the causation of common chronic diseases. Eighty-six percent of participants were of Northern European origin born in Australia or United Kingdom and 14% were migrants from Greece or Italy (Southern European origin). Nonmydriatic digital retinal photography was implemented at Melbourne Collaborative Cohort Study follow-up. The ERMs were recorded as cellophane macular reflex without retinal folds or preretinal macular fibrosis (PMF) with retinal folds. RESULTS: A total of 22,406 participants had retinal photography, 95% (n = 21,241) were eligible for ERM grading. The ERM prevalence were 8.9% (1,882); cellophane macular reflex, 4.9% (1,047); and preretinal macular fibrosis, 3.9% (835). After adjustment for age, sex, level of education, smoking status, level of cholesterol, body mass index, waist-to-hip ratio, waist measurement, blood pressure, diabetes, and stroke, increasing age and Southern European ethnicity was significantly associated with ERMs. Overall, in Southern Europeans, ERMs odd ratio was 1.97 (95% confidence intervals, 1.67-2.31), P < 0.001; preretinal macular fibrosis was 1.82 (95% confidence intervals, 1.43-2.31), P < 0.001; and cellophane macular reflex was 1.93 (1.57-2.38), P < 0.001. CONCLUSION: In an older Australian population, the prevalence of ERMs was 8.9% and was almost two times higher in participants of Southern European origin than Northern European origin.

Non-mydriatic digital macular photography: how good is the second eye photograph?

PURPOSE: In an elderly Australian population, to evaluate the quality of fundus photographs taken non-mydriatically in both eyes, and to compare the quality of those taken second with those taken first. METHODS: From 2258 participants (4516 images) aged 70 years and older who participated in the Melbourne Collaborative Cohort Study (MCCS), digital non-stereoscopic 45 degrees retinal photographs were taken with a Canon CR6-45NM Non-mydriatic Retinal Camera and evaluated. The quality of macular images was assessed as good, fair, and poor and McNemar's test was used to analyze variation in quality. RESULTS: Gradable quality images were obtained from 95.8% eyes of participants, with 93.9% of participants having gradable photos of both eyes. The gradable rate for the eye photographed first (right), was significantly higher than that for the eye photographed second (left): 89.7% vs. 85.6%, respectively (difference of 4.12%, confidence interval [CI] of 2.68-5.54%, p < 0.001). The rate of ungradable photographs from the second eye was slightly greater than the first eye (4.5% and 3.8%, respectively), but the difference in proportion was not statistically significant (difference of 3.6%, CI of 0.17-1.5%, p = 0.384). CONCLUSIONS: In the setting of a large elderly cohort study, non-dilated 45 degrees digital retinal imaging is an excellent method for fundus examination. It is fast, easy to use, non-invasive, and a reliable AMD (age-related macular degeneration)-detecting technique with only a minor loss of information from the second eye.

Fat consumption and its association with age-related macular degeneration.

OBJECTIVE: To evaluate associations between past dietary fat intake and the prevalence of age-related macular degeneration (AMD). METHODS: Six thousand seven hundred thirty-four participants aged 58 to 69 years in 1990-1994 took part in this cohort study. Participants' nutrient intakes were estimated from a food frequency questionnaire at baseline. At follow-up from 2003 to 2006, digital macula photographs of both eyes were evaluated for early and late AMD signs. Logistic regression was used to estimate odds ratios, with adjustment for age, smoking, and other potential confounders. RESULTS: Higher trans-unsaturated fat intake was associated with an increased prevalence of late AMD; the odds ratio comparing the highest with the lowest quartile of trans fat was 1.76 (95% confidence interval, 0.92-3.37; P = .02). Higher omega-3 fatty acid intake (highest quartile vs lowest quartile) was inversely associated with early AMD (odds ratio, 0.85; 95% confidence interval, 0.71-1.02; P = .03). Olive oil intake (> or =100 mL/week vs <1 mL/week) was associated with decreased prevalence of late AMD (odds ratio, 0.48; 95% confidence interval, 0.22-1.04; P = .03). No significant associations with AMD were observed for intakes of fish, total fat, butter, or margarine. CONCLUSION: A diet low in trans-unsaturated fat and rich in omega-3 fatty acids and olive oil may reduce the risk of AMD.

Red meat and chicken consumption and its association with age-related macular degeneration.

Age-related macular degeneration (AMD) is the leading cause of blindness among older people, and diet has been postulated to alter risk of AMD. To evaluate associations between red meat and chicken intake and AMD, the authors conducted a cohort study of 6,734 persons aged 58-69 years in 1990-1994 in Melbourne, Australia. Meat intake was estimated from a food frequency questionnaire at baseline. At follow-up (2003-2006), bilateral digital macular photographs were taken and evaluated for AMD (1,680 cases of early AMD, 77 cases of late AMD). Logistic regression was used to estimate odds ratios, adjusted for age, smoking, and other potential confounders. Higher red meat intake was positively associated with early AMD; the odds ratio for consumption of red meat > or =10 times/week versus <5 times/week was 1.47 (95% confidence interval: 1.21, 1.79; P-trend < 0.001). Similar trends toward increasing prevalence of early AMD were seen with higher intakes of fresh and processed red meat. Conversely, consumption of chicken > or =3.5 times/week versus <1.5 times/week was inversely associated with late AMD (odds ratio = 0.43, 95% confidence interval: 0.20, 0.91; P-trend = 0.007). These results suggest that different meats may differently affect AMD risk and may be a target for lifestyle modification.

Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the evidence on dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration (AMD). METHODS: Seven databases were systematically searched with no limits on publication year or language using standardized criteria. Randomized controlled trials and prospective cohort, case-control, and cross-sectional studies were included. Of 2754 abstracts identified, 3 prospective cohort, 3 case-control, and 3 cross-sectional studies met the criteria. Measures of associations were pooled quantitatively using meta-analytic methods. RESULTS: Nine studies provided data on a total sample of 88 974 people, including 3203 AMD cases. A high dietary intake of omega-3 fatty acids was associated with a 38% reduction in the risk of late AMD (pooled odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.82). Fish intake at least twice a week was associated with a reduced risk of both early AMD (pooled OR, 0.76; 95% CI, 0.64-0.90) and late AMD (pooled OR, 0.67; 95% CI, 0.53-0.85). CONCLUSIONS: Although this meta-analysis suggests that consumption of fish and foods rich in omega-3 fatty acids may be associated with a lower risk of AMD, there is insufficient evidence from the current literature, with few prospective studies and no randomized clinical trials, to support their routine consumption for AMD prevention.

Alcohol consumption and the risk of age-related macular degeneration: a systematic review and meta-analysis.

PURPOSE: To review systematically the evidence currently available on alcohol consumption and the risk of age-related macular degeneration (AMD). DESIGN: Systematic review and meta-analysis of observational studies. METHODS: Seven databases were searched systematically with no limits on the year or language of publication for prospective cohort studies. References identified from pertinent reviews and articles also were retrieved. Two reviewers independently searched the above databases and selected the studies using prespecified standardized criteria. These criteria included appropriate adjustment for age and smoking in the analysis. Of the 441 studies identified initially, five cohort studies met the selection criteria. Data extraction and study quality evaluation were performed independently by two reviewers and results were pooled quantitatively using meta-analytic methods. RESULTS: The five cohort studies included 136,946 people, among whom AMD developed in 1923 (1,513 early and 410 late). Pooled results showed that heavy alcohol consumption was associated with an increased risk of early AMD (pooled odds ratio, 1.47; 95% confidence interval, 1.10 to 1.95), whereas the association between heavy alcohol consumption and risk of late AMD was inconclusive. There were insufficient data to evaluate a dose-response association between alcohol consumption and AMD or the association between moderate alcohol consumption and AMD. CONCLUSIONS: Heavy alcohol consumption (more than three standard drinks per day) is associated with an increased risk of early AMD. Although this association seems to be independent of smoking, residual confounding effects from smoking cannot be excluded completely.

Dietary antioxidants and primary prevention of age related macular degeneration: systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of dietary antioxidants in the primary prevention of age related macular degeneration (AMD). DESIGN: Systematic review and meta-analysis. DATA SOURCES: Search of seven databases without limits on year or language of publication, and retrieval of references in pertinent reviews and articles. METHODS: Two reviewers independently searched the databases and selected the studies, using standardised criteria. Randomised clinical trials and prospective cohort studies were included. Of the 4192 abstracts initially identified, 12 studies (nine prospective cohort studies and three randomised clinical trials) met the selection criteria and were included. Data extraction and study quality evaluation were independently reviewed, using standardised criteria. Results were pooled quantitatively using meta-analytic methods. RESULTS: The nine prospective cohort studies included 149 203 people, with 1878 incident cases of early AMD. The antioxidants investigated differed across studies, and not all studies contributed to the meta-analysis of each antioxidant. Pooled results from prospective cohort studies indicated that vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, alpha carotene, beta carotene, beta cryptoxanthin, and lycopene have little or no effect in the primary prevention of early AMD. The three randomised clinical trials did not show that antioxidant supplements prevented early AMD. CONCLUSIONS: There is insufficient evidence to support the role of dietary antioxidants, including the use of dietary antioxidant supplements, for the primary prevention of early AMD.

Trauma centre experience: flap reconstruction of traumatic lower limb injuries.

BACKGROUND: Decision-making in the management of combined major skeletal and soft tissue trauma to the lower limb is a complex process made more difficult by the uncertainty surrounding outcomes. The aim of this study was to review and present our experience with flap reconstruction of traumatic lower limb defects, with particular reference to in-hospital complications and outcomes related to timing, choice of flap and pre-existing complications. METHODS: Retrospective review of all lower limb flap reconstructions carried out by the Plastic and Reconstructive Surgery Unit at the Alfred Hospital from 1 July 2001 to 20 October 2005 (51-month period) was carried out. RESULTS: Sixty-four patients had 83 flap reconstructions (35 free and 48 local) of 70 separate lower limb injuries. Internal skeletal fixation was followed by earlier soft tissue coverage and lower deep metal infection rates. Twenty-seven flaps (32.5%) developed soft tissue infections, and 16 fixation devices (25.8%) were complicated by deep metal infection. There were six (12.5%) local flap partial necrosis and four (11.4%) free flap failures. Limbs in which flaps were carried out after day 5 were more likely to develop deep metal infection (P = 0.04) and suffer free flap failure or local flap partial necrosis (P = 0.02). Three patients underwent secondary amputation during their initial admission. CONCLUSIONS: The current study presented our experience with flap reconstruction of complex lower limb injuries at a major trauma centre. Thorough wound debridement, internal fixation and early soft tissue coverage (within 5 days of injury) were associated with lower infection rates and optimal outcomes.

Facts on fats.

Cardiovascular disease and age-related macular degeneration (AMD) may share common risk factors in their causal pathways. Decades of research from the cardiovascular sciences on fats have led investigators to focus on specific types of fats rather than total fat as a whole. They have established that saturated and trans-unsaturated fats (trans fats) are damaging to cardiovascular health while polyunsaturated fats, particularly the marine omega 3 fatty acids appear protective. This has led to a number of studies investigating the associations of fat and AMD. Though the causal relationship between fats and AMD remain unproven, some studies suggest that an association may be present. To be able to understand and interpret the study results and their implications, an understanding of the fats in the diet is important. This review aims to give an overview of fatty acids, particularly the trans-unsaturated fatty acids, and the relevant food groups.

Is temporal artery biopsy a worthwhile procedure?

BACKGROUND: Temporal artery biopsy (TAB) has been accepted as the gold standard for the diagnosis of giant cell arteritis (GCA) or temporal arteritis (TA) even though it is of low sensitivity and specificity. Current medical practice recommends commencing high dose steroids before performing a biopsy, and the continued use of long-term steroids even if biopsy is negative but clinical suspicion of the diagnosis is high. The aim of the present study is to determine if TAB results actually changes the management of patients suspected of GCA or TA. METHODS: Retrospective case note analysis of 70 consecutive patients with TAB over 5 years (1999-2003) from Royal Melbourne Hospital (RMH), Melbourne, Australia. RESULTS: Histology revealed five (7%) positive biopsies, five (7%) of 'healed arteritis', and 60 (86%) negative biopsies. After excluding 15 patients who were lost to follow up, management of 13 (23.6%) patients was influenced by the biopsy results: seven with negative biopsies had steroids discontinued while six patients with biopsies showing positive and healed arteritis continued on steroids. Management of 42 (76.4%) patients was not altered following biopsy results: 11 with negative biopsy continued on steroids, 19 never started because of low clinical suspicion and 12 ceased steroids some time after biopsy as there was no symptomatic improvement. CONCLUSION: With the management of 76.4% of patients unchanged following biopsy, some may argue that these patients underwent unnecessary surgery. However, TAB is a minor procedure that can yield important results for the management of GCA, which if untreated can lead to serious complications. We believe TAB should be performed where there is clinical suspicion of GCA.