Comparison of CT and positron emission tomography/CT coregistered images in planning radical radiotherapy in patients with non-small-cell lung cancer.

Imaging with F-18 fluorodeoxyglucose positron emission tomography (PET) significantly improves lung cancer staging, especially when PET and CT information are combined. We describe a method for obtaining CT and PET images at separate acquisitions, which allows coregistration and incorporation of PET information into the radiotherapy (RT) planning process for non-small-cell lung cancer. The influence of PET information on RT planning was analysed for 10 consecutive patients. Computed tomography and PET images were acquired with the patient in an immobilization device, in the treatment position. Using specially written software, PET and CT data were coregistered using fiducial markers and imported into our RT planning system (Cadplan version 6). Treatment plans were prepared with and without access to PET/CT coregistered images and then compared. PET influenced the treatment plan in all cases. In three cases, geographic misses (gross tumour outside planning target volume) would have occurred had PET not been used. In a further three cases, better planning target volume marginal coverage was achieved with PET. In four patients, three with atelectasis, there were significant reductions in V20 (percentage of the total lung volume receiving 20 Gy or more). Use of coregistered PET/CT images significantly altered treatment plans in a majority of cases. This method could be used in routine practice at centres without access to a combined PET/CT scanner .

Meeting the support and information needs of women with advanced breast cancer: a randomised controlled trial.

Addressing psychosocial and quality of life needs is central to provision of excellent care for people with advanced cancer. This study tested a brief nurse-delivered intervention to address the needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Australia. One hundred and five women with advanced breast cancer were recruited and randomised to receive the intervention or usual care, then asked to complete the European Organisation of Research and Treatment of Quality of life Q-C30 version (2.0) (EORTC Q-C30) (version 2) and Supportive Care Needs Survey (SCNS) at 1 month and 3 months postrecruitment. No significant differences were detected between intervention and usual care groups in the SCNS or the EORTC Q-C30 subscale scores. However, when the groups were divided into high needs (score of above 50) and low baseline needs (score of 50 or below) for each SCNS subscale, a significant difference between intervention and usual care groups was found in the psychological/emotional subscale among women with high baseline needs. In conclusions, this study demonstrated that a face-to-face session and follow-up phone call with a breast care nurse significantly reduced the psychological and emotional needs of those with high initial needs. There was no evidence of the intervention influencing the quality of life; or perceived needs of women with low initial psychological/emotional needs or perceived needs in other domains. Possibly, the intervention was not sufficiently intense to achieve an effect.

Mapping the quality of life and unmet needs of urban women with metastatic breast cancer.

Enhancing quality of life and reducing the unmet needs of women are central to the successful management of advanced breast cancer. The objective of this study was to investigate the quality of life and support and information needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Melbourne, Australia. A consecutive sample of 105 women with advanced breast cancer completed a questionnaire that contained the European Organization of Research and Treatment of Cancer Quality of Life Q-C30 and the Supportive Care Needs Survey. Between one quarter and a third of the women reported difficulties with their physical, role and social functioning, and a little over a quarter of the women reported poor global health status. Fatigue was a problem for most women. The highest unmet needs were in the psychological and health information domains. Almost no differences in unmet needs were detected when comparing different demographic and disease characteristics of women. Health care providers should routinely monitor the quality of life and needs of women with advanced breast cancer to ensure that appropriate treatment, information or supportive services are made available.

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation.

Chemoradiation is now used more commonly for gastric cancer following publication of the US Intergroup trial results that demonstrate an advantage to adjuvant postoperative chemoradiotherapy. However, there remain concerns regarding the toxicity of this treatment, the optimal chemotherapy regimen and the optimal method of radiotherapy delivery. In this prospective study, we evaluated the toxicity and feasibility of an alternative chemoradiation regimen to that used in the Intergroup trial. A total of 26 patients with adenocarcinoma of the stomach were treated with 3D-conformal radiation therapy to a dose of 45 Gy in 25 fractions with concurrent continuous infusional 5-fluorouracil (5-FU). The majority of patients received epirubicin, cisplatin and 5-FU (ECF) as the systemic component given before and after concurrent chemoradiation. The overall rates of observed grade 3 and 4 toxicities were 38 and 15%, respectively. GIT grade 3 toxicity was observed in 19% of patients, while haematologic grade 3 and 4 toxicities were observed in 23%. Our results suggest that this adjuvant regimen can be delivered safely and with acceptable toxicity. This regimen forms the basis of several new studies being developed for postoperative adjuvant therapy of gastric cancer.

A myopic shift in Australian Aboriginals: 1977-2000.

BACKGROUND/AIMS: The prevalence of myopia has been reported to have increased in a number of population groups. We compared the refraction of Australian Aboriginal adults in 2000 with data collected in 1977 to assess whether there had been a change in the prevalence of myopia. METHOD: Australian Aboriginal adults aged 20 to 30 years old were selected from Central Australian communities in 2000. Refraction was determined by noncycloplegic autorefraction. This was compared to mydriatic retinoscopy data collected in 1977. "Observer trials" were undertaken to assess the comparability of noncycloplegic autorefraction measurements and cycloplegic retinoscopy. Spherical equivalence cylinder and spheric were determined for all right and left eyes and compared using an analysis of variance. RESULTS: A total of 128 adults (58 males, 70 females) were examined in 2000 and compared with 161 adults (107 males, 54 females) examined in 1977. The mean spherical equivalent in 2000 was -0.55 D +/- 0.88 D and in 1977 was +0.54 D +/- 0.81 D. The difference of -1.09 D was highly significant (F = 126, P < .001). Intraclass correlation coefficients showed good agreement between noncycloplegic autorefraction and cycloplegic retinoscopy. Neither gender, schooling, nor diabetes was associated with an increased risk of myopia. CONCLUSIONS: There appears to have been a significant shift toward myopia in Australian Aboriginals between 1977 and 2000. The cause of this myopic shift is unknown but mirrors that observed in other populations in recent years.

Vision impairment and older drivers: who's driving?

AIM: To establish the association between impaired vision and drivers' decisions to stop driving, voluntarily restrict driving, and motor vehicle accidents. METHODS: Driving related questions were included in a population based study that determined the prevalence and incidence of eye disease. Stratified random cluster samples based on census collector districts were selected from the Melbourne Statistical Division. Eligible participants aged 44 years and over were interviewed and underwent a comprehensive ophthalmic examination. The outcomes of interest were the decision to stop driving, limiting driving in specified conditions, and driving accidents. The associations between these outcomes and the legally prescribed visual acuity (<6/12) for a driver's licence were investigated. RESULTS: The mean age of the 2594/3040 (85%) eligible participants was 62.5 (range 44-101). People with visual acuity less than 6/12 were no more likely to have an accident than those with better vision (chi(2) = 0.175, p>0.9). Older drivers with impaired vision, more so than younger adults, restrict their driving in visually demanding situations (p<0.05). Of the current drivers, 2.6% have vision less than that required to obtain a driver's licence. The risk of having an accident increased with distance driven (OR 2.57, CL 1.63, 4.04 for distance >31 000 km) but not with age. CONCLUSION: There was no greater likelihood of self reported driving accidents for drivers with impaired vision than those with good vision. While many older drivers with impaired vision limit their driving in adverse conditions and some drivers with impaired vision stop driving, there are a significant number of current drivers with impaired vision.

Prevalence and predictors of open-angle glaucoma: results from the visual impairment project.

PURPOSE: To determine the prevalence and investigate predictors of open-angle glaucoma in Victoria, Australia. DESIGN: Two-site, population-based cross-sectional study. PARTICIPANTS: Permanent residents aged 40 years and older at recruitment from 1992 through 1996. METHODS: A cluster-stratified random sample of 4744 participants from two cohorts, urban and rural, participated. Participants completed a standardized interview regarding demographic, lifestyle, and medical characteristics and a dilated eye examination including measurement of intraocular pressure, visual fields, cup-to-disc ratios, and paired stereo photography of the optic discs. A consensus panel of six ophthalmologists determined glaucoma diagnosis. MAIN OUTCOME MEASURE: Diagnosis of glaucoma (possible, probable, definite). RESULTS: The prevalence of possible glaucoma cases was 1.2% (95% confidence interval [CI], 0.60, 1.7), of probable cases was 0.70% (95% CI, 0.39, 1.0), and of definite cases was 1.8% (95% CI, 1.4, 2.2). There was a significant increase in glaucoma prevalence with age across all definitions, but there was no difference in age-standardized rates between genders. A total of 60% of probable and definite glaucoma cases were undiagnosed before this study. Adjusted for age, the strongest risk factor for glaucoma was a positive family history of glaucoma (odds ratio, 3.1; 95% CI, 1.6, 5.3). Glaucoma patients who had not attended an eye care provider in the last 2 years were eight times (95% CI, 3.2, 20.4) more likely to have undiagnosed disease. CONCLUSIONS: These results support the importance of the genetic or familial basis of many glaucoma cases and highlight the need to develop appropriate techniques to screen for undiagnosed disease.

Correction of refractive error in the Victorian population: the feasibility of "off the shelf" spectacles.

AIMS: To assess the feasibility of providing a stock of ready made spectacles for correction of refractive error in the general population. METHODS: Data were collected in the Visual Impairment Project, a population based survey of Victorian residents aged 40 years or older in randomly selected urban and rural sample areas. This included a refractive eye examination and the proportion of subjects with hypermetropia, emmetropia (defined as -1.0 to +1.0D spherical equivalent), and myopia documented in the 40-60 year age group. RESULTS: 2595 (54.8%) participants were aged between 40 and 60 years. Those with a best corrected visual acuity of less than 6/12, astigmatism of more than 1.25D, and anisometropia of more than 0.5D were excluded. 516 participants had refractive error which was deemed suitable for correction by "off the shelf" spectacles. This represents 19.9% of all participants between 40 and 60 years of age. Provision of spectacles in 0.5D increments would provide suitable stock spectacles for 85.5% of a -3.0 to +3.0D range or 89.2% of a -3.50 to +3.50D range. CONCLUSIONS: Ready made "off the shelf" spectacles could significantly alleviate visual morbidity due to refractive error in up to 20% of an urban population in Australia. This approach may also be useful in developing countries with poor access to optometric services.

Assessment of trachoma prevalence in a mobile population in Central Australia.

Trachoma is reported to be hyperendemic in Australia. This study was conducted in a desert area of Central Australia to implement and evaluate the WHO SAFE strategy to control trachoma. The aim of the study was to obtain baseline trachoma prevalence data and to determine whether a single annual visit is adequate for a treatment program targeting households with active cases in a highly mobile population. All registered residents of two Aboriginal communities were eligible for examination. Four visits over the course of 13 months were made to the communities for ocular examinations of residents present at the time of the visit. Examination, diagnosis, and grading of trachoma followed WHO guidelines. The overall examination rate was 75%, refusal rate was <1%, but approximately 50% of community residents were absent during the examination period. Prevalence varied on each visit, but the overall prevalence of active trachoma was 49% over the 13-month period. Children less than 10 years of age had the highest prevalence of active trachoma (79%), over the course of the 13 months, yet the prevalence at any one visit was approximately 60%. Trachomatous scarring was present in 23% of the population. These results suggest that many cases of active trachoma may be missed if a prevalence survey is conducted at only one point in time. Multiple examinations should be conducted to adequately establish prevalence in the population. Antibiotic treatment and health promotion campaigns need to be developed in consideration of local community dynamics.

Assessment of adult stereopsis using the Lang 1 Stereotest: a pilot study.

BACKGROUND AND PURPOSE: To assess the use of the Lang 1 Stereotest as a vision-screening test for adults, for which little is known or reported. METHOD: The Lang 1 Stereotest was administered to 292 consecutive participants of the Visual Impairment Project (VIP) five year followup study, which is a population based study of eye disease in Melbourne, Australia. 56.9% were female. The mean age was 59.4 years, range 44-90 years. A "positive" stereoscopic response was recorded where the stereoscopic target image was correctly named; a "partial positive" response where depth was appreciated but the shape could not be named; and a "negative" response where there was no appreciation of a stereo effect. The responses were further categorized so that the test was either "passed" or "failed". A "pass" score was 3/3 positive responses; 3/3 partial positive responses or 2/3 positive and/or partial positive responses where the negative response was at the 550" of arc stereoacuity level. "Failure" was 3/3 negative responses and 2/3 negative responses where the positive or partial positive response as at the 1200" level. RESULTS: Of the 292 participants tested, 19 (6.5%) participants "failed" the test. In addition to strabismus and anisometropia, failure was associated significantly (p<0.001) with reduced distance visual acuity (<6/12) irrespective of the ocular morbidity. CONCLUSION: The Lang 1 Stereotest correctly identified people with vision defects associated with reduced stereopsis. This suggests the Lang 1 Stereotest is an appropriate for the vision screening of adults as it is for children.

Association of demographic, familial, medical, and ocular factors with intraocular pressure.

OBJECTIVE: To describe the distribution and associations of demographic, familial, medical, and ocular factors with intraocular pressure (IOP). METHODS: A cluster stratified random sample of urban and rural residents of Victoria, Australia, aged 40 years and older. Participants completed an interview and underwent a standardized dilated ophthalmic examination including measurement of IOP with an electronic applanation tonometer (Tono-Pen). Glaucoma status (possible, probable, definite) was determined by a consensus panel. The main outcome measure was IOP. RESULTS: The mean age of the 4576 participants was 59 years, 53% were women, 32% were born overseas, and 132 had open-angle glaucoma. Geometric mean (SD) IOP was 14.3 (+/-1.5) mm Hg. The relationship between IOP and nuclear sclerosis, iris color, and family history of glaucoma depended on glaucoma status. In those with glaucoma, family history of glaucoma and country of birth were significantly associated with IOP in multivariate models (model: r(2) = 0.08, P =.01). In the group without glaucoma, place of residence, use of alcohol, iris color, vitamin E intake, and spherical equivalent were associated with IOP (model: r(2) = 0.01, P =.006). CONCLUSION: In participants with glaucoma, genetic factors seem to be stronger predictors of IOP, whereas in those without glaucoma, lifestyle and physiological factors seem to play a greater role.

Cause-specific prevalence of bilateral visual impairment in Victoria, Australia: the Visual Impairment Project.

PURPOSE: To study the cause-specific prevalence of eye diseases causing bilateral visual impairment in Australian adults. DESIGN: Two-site, population-based cross-sectional study. PARTICIPANTS: Participants were aged 40 years and older and resident in their homes at the time of recruitment for the study. The study was conducted during 1992 through 1996. METHODS: The study uses a cluster stratified random sample of 4744 participants from two cohorts, urban, and rural Victoria. Participants completed a standardized interview and eye examination, including presenting and best-corrected visual acuity, visual fields, and dilated ocular examination. The major cause of vision loss was identified for all participants found to be visually impaired. Population-based prevalence estimates are weighted to reflect the age and gender distribution of the two cohorts in Victoria. MAIN OUTCOME MEASURES: Visual impairment was defined by four levels of severity on the basis of best-corrected visual acuity or visual field: <6/18 > or =6/60 and/or <20 degrees > or =10 degrees radius field, moderate vision impairment; severe vision impairment, <6/60 > or =3/60 and/or <10 degrees > or =5 degrees radius field; and profound vision impairment <3/60 and/or <5 degrees radius field. In addition, less-than-legal driving vision, <6/12 > or =6/18, and/or homonymous hemianopia were defined as mild vision impairment. In Australia, legal blindness includes severe and profound vision impairment. RESULTS: The population-weighted prevalence of diseases causing less-than-legal driving or worse impairment in the better eye was 42.48/1000 (95% confidence interval [CI], 30.11, 54.86). Uncorrected refractive error was the most frequent cause of bilateral vision impairment, 24.68/1000 (95% CI, 16.12, 33.25), followed by age-related macular degeneration (AMD), 3.86/1000 (95% CI, 2.17, 5.55); other retinal diseases, 2.91/1000 (95% CI, 0.74, 5.08); other disorders, 2.80/1000 (95% CI, 1.17, 4.43); cataract, 2.57/1000 (95% CI, 1.38, 3.76); glaucoma, 2.32/1000 (95% CI, 0.72, 3.92); neuro-ophthalmic disorders, 1.80/1000 (95% CI, 0, 4.11); and diabetic retinopathy, 1.53/1000 (95% CI, 0.71, 2.36). The prevalence of legal blindness was 5.30/1000 (95% CI, 3.24, 7.36). Although not significantly different, the causes of legal blindness were uncorrected refractive errors, AMD, glaucoma, other retinal conditions, and other diseases. CONCLUSIONS: Significant reduction of visual impairment may be attained with the application of current knowledge in refractive errors, diabetes mellitus, cataract, and glaucoma. Although easily preventable, uncorrected refractive error remains a major cause of vision impairment.

Visual impairment and eye diseases in elderly institutionalized Australians.

OBJECTIVE: To study the prevalence and distribution of visual impairment and eye diseases by age and gender in an urban institutionalized population. DESIGN: Cross-sectional study. PARTICIPANTS: Four hundred three residents of nursing homes and hostels. METHODS: Fourteen nursing homes were randomly selected from 104 nursing homes and hostels located within a 5-km radius of each of nine clusters studied in the Visual Impairment Project (VIP) urban cohort. Participants completed a standardized orthoptic and dilated ophthalmic examination, including measurement of visual acuity and visual fields. The major cause of vision loss was identified for participants with visual impairment. MAIN OUTCOME MEASURES: Presenting visual acuity and ophthalmic diagnoses. RESULTS: The participants' mean age was 82 years (standard deviation, 9.24), with an age range of 46 years to 101 years. Women outnumbered men by 318 to 85. Seventy-one (22%) of 318 women had bilateral profound visual impairment (blindness), defined as best-corrected visual acuity <3/60 and/or visual field constriction <5 degrees compared with 10 (12%) of 85 men. However, this difference is not significant when age-standardized. Age-related macular degeneration was the principal diagnosis of vision loss in the better eye of 74 (44%) of the 167 participants with bilateral low vision (<6/18 and/or visual field constriction to <20 degrees radius). The age-adjusted rate of blindness or profound visual impairment in the VIP institutional cohort of 5.2% (95% confidence interval [CI], 1.8, 8.6) was significantly greater than in the VIP urban and rural cohorts of 0.13% (95% CI, 0, 0.25) and 0.29% (95% CI, 0, 0.57), respectively. CONCLUSIONS: Underestimation of visual impairment may occur in residential population-based studies that exclude institutional or residential nursing homes and hostels for the aged citizens. Expanded methods are required for visual assessment in institutional populations.

Functional implications of vision impairment.

This study investigated the functional implications of vision impairment. A total of 508 participants in the Visual Impairment Project completed the VF-14 questionnaire, vision-related functional tasks, an interview, and the ophthalmic examination. Participants with less than 6/12 presenting acuity were more likely to report a moderate to high degree of difficulty performing VF-14 items (odds ratios from 6 to 44). They were also more likely to be unable to recognize a 10 cent coin (OR; 7.0, 95% CL; 2.6, 19.3) or correctly read a telephone number (OR; 10.1, 95% CI; 5.6, 18.1). As demonstrated by the VF-14 and the functional tasks administered in this study, visual impairment affects the ability of people to conduct a variety of common daily tasks.

A measure of handicap for low vision rehabilitation: the impact of vision impairment profile.

This study aims to further develop the Impact of Vision Impairment (IVI) profile into a practical, valid instrument for use in low vision rehabilitation. The IVI item pool was derived from focus groups of people with impaired vision, relevant content of existing quality of life questionnaires, and the administration of two trial versions. The second trial version of IVI was administered to 256 people who were vision impaired. Items were deleted if they were of little or no concern or were unable to be performed by most people, had moderate to high inter-item correlation, or did not contribute to a factor in the factor analysis. Two items were deleted due to floor and ceiling effects, 11 due to moderate to high inter-item correlation r> or =0.6. None were removed as a result of factor analysis. The first three factors explained 59% of the variance.This reduced version of the IVI, a tool able to determine rehabilitation needs for people who are vision impaired, will now undergo its final validation procedures.

Fluoroquinolone and fortified antibiotics for treating bacterial corneal ulcers.

AIM: To compare the clinical efficacy of commercially available fluoroquinolone drops with the use of combined fortified antibiotics (tobramycin 1.3%-cefazolin 5%) in treatment of bacterial corneal ulcer. METHODS: The medical records of 140 patients with a diagnosis of bacterial corneal ulcer who were admitted to the Royal Victorian Eye and Ear Hospital, Melbourne, Australia between January 1993 and December 1997 were reviewed retrospectively. Final outcome and results of 138 ulcer episodes were compared between those treated initially with fluoroquinolone and those who received fortified antibiotics. Two patients had been treated with chloramphenicol. RESULTS: No significant treatment difference was found between fluoroquinolone and fortified therapy in terms of final visual outcome. However, serious complications such as corneal perforation, evisceration, or enucleation of the affected eye were more common with fluoroquinolone therapy (16.7%) compared with the fortified therapy (2.4%, p= 0.02). The duration of intensive therapy was less with fluoroquinolone especially in those over 60 years of age (4 days v 6 days, p=0.01). Hospital stay was also less in the fluoroquinolone group compared with the fortified group for all patients and was significantly less with fluoroquinolone treatment (7 days v 10 days, p=0.02) in patients in the age group over 60 years old. CONCLUSIONS: Monotherapy with fluoroquinolone eye drops for the treatment of bacterial corneal ulcers led to shorter duration of intensive therapy and shorter hospital stay compared with combined fortified therapy (tobramycin-cefazolin). This finding may have resulted from quicker clinical response of healing as a result of less toxicity found in the patients treated with fluoroquinolone. However, as some serious complications were encountered more commonly in the fluoroquinolone group, caution should be exercised in using fluoroquinolones in large, deep ulcers in the elderly.

Age-specific causes of bilateral visual impairment.

OBJECTIVES: To describe the age-specific prevalence of common eye diseases causing bilateral visual impairment and estimate the total number of Australians with cause-specific visual impairment. METHODS: Cluster-stratified random sample of 5147 residents aged 40 years and older from urban and rural areas and aged-care facilities. Participants completed a standardized interview and eye examination. Four levels of bilateral visual impairment were defined: less than 20/40 to 20/60 and/or homonymous hemianopia (mild), less than 20/60 to 20/200 or better and/or less than 20 degrees to 10 degrees radius field (moderate), less than 20/200 to 10/200 and/or less than 10 degrees to 5 degrees radius field (severe), and less than 1O/ 200 and/or less than 50 radius field (profound). The major cause of vision loss was identified for all participants found to be visually impaired. RESULTS: Uncorrected refractive error was the most common cause of bilateral visual impairment across all decades of life, rising from 0.5% in 40- to 49-year-olds to 13% among those aged 80 years and older. Prevalence of visual impairment due to diabetic retinopathy was 0.7% in 50- to 59-year-olds and 0.8% in those older than 80 years. Visual impairment due to glaucoma had a prevalence of 0.7% among 60-year-olds and rose to 4% of those older than 90 years. The prevalence of visual impairment due to cataract (only present in those aged 70 years or older) rose from 0.6% to 11% in those older than 90 years, and the prevalence of visual impairment due to age-related macular degeneration rose from 0.8% to 16% in those older than 90 years. CONCLUSIONS: The predominant causes of visual impairment change with age. Recognition of these patterns is fundamental for early diagnosis and treatment of eye disease and, where appropriate, referral for rehabilitation.

Prevalence of amblyopia and associated refractive errors in an adult population in Victoria, Australia.

The study aimed to describe the prevalence of amblyopia and associated refractive errors among an adult Australian population. The Visual Impairment Project (VIP) is a population-based study of age-related eye disease in the state of Victoria, Australia. Data were collected through standardised interviews and orthoptic and ophthalmic dilated examinations. Amblyopia was defined as best-corrected visual acuity of 6/9 or worse in the absence of any pathological cause. The participants were 3,265 urban residents and 1,456 rural residents of the VIP ranging in age from 40-92 years (mean = 59 years; 53% female). The prevalence of unilateral amblyopia was 3.06% (95% C.I. 2.59, 3.53). Amblyopia was not found to be statistically different by age group (p=0.096), gender (p=0.675), or place of birth (p=0.14). Anisometropia was statistically more common (p<0.001) in amblyopic cases (51.1%) compared to the normal population (9.7%), and 54% of amblyopic eyes had visual acuity of worse than 6/12. Amblyopia is a significant cause of unilateral reduced visual acuity in a population aged 40 years and older. Anisometropia was more prevalent and the degree of anisometropia was greater in the amblyopic group compared with the normal population. Oblique astigmatism was more prevalent in the amblyopic group compared with the normal population.

Patterns of glaucoma medication use in urban and rural Victoria.

PURPOSE: The purpose of the present study was to describe patterns of glaucoma medication use among people who self-report a history of glaucoma in a population-based study of age-related eye disease. METHODS: The present study was comprised of a population-based cluster stratified sample of 5000 Victorians aged 40 years and older. Participants completed an interview regarding demographic characteristics, medical history and use of medications. Participants also completed orthoptic and dilated fundus examinations, including measurement of intra-occular pressure (IOP) and visual fields. Glaucoma history and use of glaucoma medication was self reported. Glaucoma disease status was confirmed by a specialist consensus group. RESULTS: The most common glaucoma medications used were beta-adrenoceptor blocking agents (63%), followed by sympathomimetics (18%) and cholinergic agents (16%). There were no differences in glaucoma medication use by gender, age, years since diagnosis, rural or urban residence or a history of glaucoma surgery. Among participants using medication, 16.1% exceeded 21 mmHg IOP. CONCLUSION: The high prevalence of the use of beta-adrenoceptor blocking agent medication reflects the shift from the use of pilocarpine over the past 20 years. The prevalence of IOP greater than 21 mmHg highlights the difficulty in managing high IOP.

Prospective epidemiologic evaluation of laboratory animal allergy among university employees.

OBJECTIVES: Evaluation of incidence and risk factors for development of laboratory animal allergy (LAA) among new hires previously unexposed to lab animals. METHODS: Baseline, 6-month and yearly follow-up, questionnaires, pulmonary functions, and methacholine challenges were collected from 98 never-before occupationally exposed and 90 control laboratory researchers. The two groups were followed between 6 and 36 months. RESULTS: At baseline, there were no differences in atopy, pulmonary functions, or methacholine reactivity between the two groups. The incidence of work-related asthma was comparable in the two groups, approximately 2.5% at 6 months and 4.5% at 24 months. The rate of decline in FEV1 was statistically significantly greater in the animal-exposed than nonanimal-exposed workers, and animal-exposed smokers' FEV1 declined significantly more rapidly than any other groups'. CONCLUSION: Despite the low incidence of laboratory-animal allergy and work-related asthma in this group, this study corroborates previously described interaction between smoking and animal exposure.