Ophthalmology

Retinal imaging may offer an answer to early screening for disease and for monitoring interventions

Shaun M Frost · Yogesan Kanagasingam · S Lance Macaulay

Managing ocular damage caused by taser barbs

Annette K Hoskin · David A Mackey

The challenge is delivering accessible screening services, followed by optimal management, to the community.

Jonathon Q Ng MB BS, BA, PhD · Nigel Morlet MB BS, FRANZCO, FRACS

A study comparing single-field fundus photography with expert clinical examination finds the former is a valid tool in detecting diabetic retinopathy in Indigenous people in remote communities of Central Australia.

Janice J-Y Ku MB BS · John Landers PhD, FRANZCO · Tim Henderson MB, ChB, FRANZCO · Jamie E Craig DPhil, FRANZCO

A small exploratory study finds that most patients with diabetes attending for routine blood monitoring are willing to undergo non-mydriatic retinal photography administered by pathology collection staff.

Melanie F Larizza BBSc, GradDip(Sec) · Lauren A Hodgson BSc(Hons) · Eva K Fenwick MA, BA(Hons) · Ryo Kawasaki PhD, MD, MPH · Ralph Audehm MB BS · Jie Jin Wang PhD, MB BS, MMed(OphthalPath) · Tien Y Wong PhD, FRCEEd, MMed · Ecosse L Lamoureux PhD, BEd, MApplSci

Indigenous Australians have six times more blindness than the national average, but 94% of the vision loss is preventable with eye examinations and timely access to treatment. The Roadmap emphasises regional needs-based planning for service delivery and accountability.

Hugh R Taylor MD, FRANZCO, AC · Andrea I Boudville MIH · Mitchell D Anjou MScOptom

To the Editor: We describe a case of unilateral central retinal vein occlusion (CRVO) in a 29-year-old woman during exposure to high altitude. She complained of blurred vision in her left eye, first noted when trekking to a maximum altitude of 6189 metres in Nepal 2 months earlier. She was not hypertensive and was not taking any medication, and had no previous history of thrombosis. Examination using a ...

Holly L Hutton · Randev Mendis · Lyndell L Lim

To the Editor: Most of us in the medical profession would have had encounters with colour blind doctors at some stage, perhaps unknowingly. Colour blindness, more formally known as congenital colour vision deficiency (CVD), affects 8% of males and 0.4% of females.1 For those of us who perceive the world in a different spectrum, tasks involving colour in the workplace may provoke anxiety.2 One could argue ...

Navin I Dadlani

To the Editor: O’Connor and colleagues have presented conclusions from their research1 that are congruent with my empirical observations. I congratulate them for highlighting the overriding themes, and add a perspective from England. The burgeoning of chronic treatable ocular diseases such as age-related macular degeneration means that hospital capacity is overwhelmed. The peaks in demand seen today surpass the best predictions from a decade ago; pharmacological ...

Jagdeep Singh Gandhi

To the Editor: Patients who survive subarachnoid haemorrhage (SAH) are at significant risk of visual impairment, further complicating their recovery. This may arise as a result of Terson syndrome,1 which is the phenomenon of intraocular haemorrhage associated with any intracranial bleed and raised intracranial pressure. We report a case of missed Terson syndrome at a tertiary referral centre. A 36-year-old previously well woman presented with a ...

Akbar N Ashrafi · Rahul Chakrabarti · John Laidlaw

Objective: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases. Design, setting and participants: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the ...

Patricia M O’Connor PhD · C Alex Harper MB BS, FRANZCO · Cathy L Brunton BNurs · Sandra J Clews RN · Sharon A Haymes BScOptom, PhD, MPH · Jill E Keeffe OAM, PhD

John Cawte had an extraordinary passion for the human condition that made him an innovator in the field of transcultural psychiatry. His mentors included anthropologist Margaret Mead and Kamilaroi Elder Bill Reid. His belief that doctors working with Indigenous people had to understand and respect the different cultural and spiritual belief systems of their patients — a given today — was revolutionary for its time. Born in Adelaide in 1925, John graduated from the University of Adelaide Medical School in 1949. From 1951 to 1963, he was Superintendent at Enfield Receiving House in Adelaide — an experience eloquently described in his memoir The last of the lunatics (Melbourne University Press, 1998). From 1955 to 1956, John studied community-based psychiatry as a Harkness Fellow at Johns Hopkins and Harvard Universities. In the early 1960s, John helped to establish the University of New South Wales School of Psychiatry and School of Public Health and Community Medicine. He held a personal chair in psychiatry and community medicine at the university until his retirement in 1991. Spending all his free time working in remote communities, John recognised earlier than most the important role of traditional healers, documented in Medicine is the law: studies in psychiatric anthropology of Australian tribal societies (University Press of Hawaii, 1974). In 1967, he developed the Arid Zone Project, establishing medical and community services centred around Bourke in western NSW. The project continued for 30 years and was a model for university–community partnerships. Through it, University of NSW academics, including Fred Hollows, formed warm relationships with Aboriginal leaders and developed holistic models of health and community services. In 1977, John founded the Aboriginal Health Worker, now in its fourth decade of national publication. An initiated member of the Warramirri clan from Elcho Island, he worked with the Elders to help record some of their healing practices — at their request — to promote cultural understanding. This project resulted in the publication of The universe of the Warramirri: art, medicine and religion in Arnhem Land (UNSW Press, 1993) and Healers of Arnhem Land (UNSW Press, 1996). In 1989, John was made an Officer of the Order of Australia, for his services to psychiatry and Aboriginal health. John died, aged 86, at Little Bay on 26 October 2011, and is survived by his five children and five grandchildren.

Rose Ellis · Max Kamien

Clement J Walter was a talented, innovative and understated ophthalmologist. He was born in Pambula, New South Wales, on 29 August 1915 and grew up near Bega. He lost his parents and sister when young and was brought up by family friends. Clem was dux of Bega High School and graduated in optometry from Sydney Technical College with a special medal in 1939. Having no close family support, Clem’s sole income was derived from hard work and lecturing in optometry. He began his medical studies at the University of Sydney in 1941, graduating in 1947 with a distinguished undergraduate record. During this time, he married Sue in 1942 and, in 1946, their daughter Michele was born. After residency at Sydney Hospital, Clem undertook ophthalmic training at Sydney Eye Hospital and gained his Diploma in Ophthalmology in 1951. He then became a Staff Ophthalmologist at Royal Newcastle Hospital, where he worked until 1974. Clem provided the best possible expertise to patients irrespective of their income and he excelled in his public and private work. In 1972, Clem received Fellowship of the Royal Australian and New Zealand College of Ophthalmologists. Clem was always interested in medical retinal work and, when he moved to Sydney in 1975, he developed a large city laser and medical retina practice consisting solely of tertiary referrals. He imported the first Nd:YAG laser to Australia when there were only three such lasers functioning in the world. Ill health forced Clem to retire officially in the late 1980s. However, Fred and Ian Wechsler persuaded him to assist in their comprehensive ophthalmic practice in Burwood for many years. They admired his intellect, ingenuity and talent. He set the gold standard for a medical ophthalmic consultation and refraction. He designed his own indirect ophthalmoscope. He bred a camellia (which bears his name), and carried out all his own boat and car repairs. His humility was like a breath of fresh air in an era of advertising and aggressive self-promotion. After a stroke, he retired in 2001 and joined his daughter Michele, her husband Malcolm and their two boys in Berwick, Victoria. We all mourn the passing on 27 June 2011 of a truly remarkable pioneer who contributed so much to ophthalmology.

Alfred W Wechsler · Donald B Dunlop · Ian B Wechsler