Jenny L Hepschke - Academia.edu (original) (raw)

Papers by Jenny L Hepschke

Research paper thumbnail of ORIGINAL CONTRIBUTION Age, Gender, and Side Differences of Cutaneous Electrical Perceptual Threshold Testing in an Able-Bodied Population

Research paper thumbnail of Modifications in Macular Perfusion and Neuronal Loss After Acute Traumatic Brain Injury

Investigative Opthalmology & Visual Science

Research paper thumbnail of A Novel Look Into Animating Ophthalmology Education

Research paper thumbnail of Seeing the Difference in Tertiary Ophthalmology Education: Deficiencies in the Teaching and Confidence of the Contemporary Medical Workforce Across Regional and Metropolitan Australia

Research paper thumbnail of Diagnostic Optic Nerve Features in Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay

JAMA Neurology

This case report describes the optic nerve features of a male patient aged 23 years with a diagno... more This case report describes the optic nerve features of a male patient aged 23 years with a diagnosis of autosomal recessive spastic ataxia of Charlevoix-Saguenay.

Research paper thumbnail of Cortical oscillatory dysrhythmias in visual snow syndrome: a magnetoencephalography study

Brain communications, Dec 18, 2021

Visual snow refers to the persistent visual experience of static in the whole visual field of bot... more Visual snow refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions such as tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously, we hypothesized that visual snow syndrome may be characterized by disruptions to rhythmical activity within the visual system. To test this, data from 18 patients diagnosed with visual snow syndrome, and 16 matched controls, were acquired using magnetoencephalography. Participants were presented with visual grating stimuli, known to elicit decreases in alpha-band (8-13 Hz) power and increases in gamma-band power (40-70 Hz). Data were mapped to source-space using a beamformer. Across both groups, decreased alpha power and increased gamma power localized to early visual cortex. Data from the primary visual cortex were compared between groups. No differences were found in either alpha or gamma peak frequency or the magnitude of alpha power, p. 0.05. However, compared with controls, our visual snow syndrome cohort displayed significantly increased primary visual cortex gamma power, p = 0.035. This new electromagnetic finding concurs with previous functional MRI and PET findings, suggesting that in visual snow syndrome, the visual cortex is hyperexcitable. The coupling of alpha-phase to gamma amplitude within the primary visual cortex was also quantified. Compared with controls, the visual snow syndrome group had significantly reduced alpha-gamma phase-amplitude coupling, p , 0.05, indicating a potential excitation-inhibition imbalance in visual snow syndrome, as well as a potential disruption to top-down 'noise-cancellation' mechanisms. Overall, these results suggest that rhythmical brain activity in the primary visual cortex is both hyperexcitable and disorganized in visual snow syndrome, consistent with this being a condition of thalamocortical dysrhythmia.

Research paper thumbnail of Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad

Journal of Current Glaucoma Practice, 2022

Research paper thumbnail of Age, gender, and side differences of cutaneous electrical perceptual threshold testing in an able-bodied population

Journal of Spinal Cord Medicine (JSCM), 2010

To investigate age, gender, and left-right differences in cutaneous electrical perceptual thresho... more To investigate age, gender, and left-right differences in cutaneous electrical perceptual threshold (EPT) testing in an able-bodied, Australian sample. Prospective experimental. Hospital-based spinal cord injuries unit. Cutaneous electrical stimulation of the 28 dermatomes at ASIA sensory key points (C2-S4/S5) was performed on 29 female and 16 male healthy volunteers aged 21 to 76 years. Mean EPTs for each dermatome were compared (repeated measures ANOVA) for left-right, gender-related, and age-related (</ >50 years of age) differences. There was no group difference between sides (repeated measures ANOVA, P = 0.934). Women across all ages had lower group mean EPTs than men (P < 0.0001). Women younger than age 50 years had lower mean EPTs than those older than age 50 years (P = 0.008). There was no group difference between younger and older men (P = 0.371). Analysis of individual dermatomes revealed no significant differences in thoracic dermatomes between genders or age gro...

Research paper thumbnail of Pediatric Microbial Keratitis

Pediatric Infectious Disease Journal, 2020

Supplemental Digital Content is available in the text. Aims: The purpose of this study was to rep... more Supplemental Digital Content is available in the text. Aims: The purpose of this study was to report the epidemiology, etiology, microbiologic profile and management of pediatric microbial keratitis in a quaternary and 3 tertiary ophthalmic referral centers across Sydney, New South Wales, Australia. Methods: This is a retrospective cohort study of patients ≤ 18 years of age with a clinical diagnosis of microbial keratitis presenting between 1 January 2010 and 31 December 2016 identified from hospital coding and pathology databases. Data were extracted from the medical records. Epidemiology, predisposing factors, referral patterns, microbial profile and treatment outcomes were analyzed. Results: Eighty eyes from 80 pediatric patients with microbial keratitis were included in the study (10% had bilateral disease). The mean age was 11 ± 5.3 years (range 0–18 years), and 44 were male (55%). Thirty-six percent of patients had ocular and 13.5% systemic comorbidities. The most common risk factor overall was contact lens wear in 26%, trauma (24%), and external lid and eye disease (20%). Overall, 74 organisms were identified, and of those, the most common isolates were Gram-positive organism. Antimicrobial resistance to common antibiotics was low across all isolates. Visual acuity following treatment was worse than 6/60 for 7 patients (11.3%%), 6/15–6/60 for 15 patients (24.2%) and better than 6/12 for 40 patients (64.5%). Preexisting corneal disease and delay of presentation were associated with worse visual prognosis. Serious complications were noted in 16 (21.3%) of patients. Conclusions: Contact lens wear, trauma and existing ocular disease remain the most significant risk factors in the pediatric population. Preexisting corneal disease and delay in presentation were associated with poor visual acuity. The majority of patients have a good visual outcome although serious complications are not uncommon and may cause lifelong visual disability.

Research paper thumbnail of Migraine Aura: Pathophysiology, Mimics, and Treatment Options

Seminars in Neurology, 2019

Recent insights into the clinical presentation and pathophysiology of migraine aura have paved th... more Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Secondary vascular perturbations also contribute to the various symptoms of a migraine attack. Calcitonin gene-related peptide (CGRP) plays a key role in many of these steps, and a growing class of CGRP-antagonists have emerged as a novel, efficacious preventative therapy. It is still not fully understood why a preponderance of migraine aura symptoms is visual, and this issue is an active area of research. In addition, the pathophysiological changes responsible for visual snow syndrome are under investigation. Before diagnosing a patient with migraine aura, it is important to consider the differential diagnosis of transient visual phenomena, w...

Research paper thumbnail of Sharpening the focus on ophthalmology teaching: perceptions of medical students and junior medical officers

Clinical & Experimental Ophthalmology, 2018

Worldwide, ophthalmology teaching is being reduced or eliminated from medical school curricula. T... more Worldwide, ophthalmology teaching is being reduced or eliminated from medical school curricula. The current state of ophthalmic teaching in Australia is unknown. To evaluate the perceptions of junior medical officers (JMOs) and medical students on ophthalmology teaching in Australian medical schools. Survey-based cross-sectional study. A total of 838 JMOs and medical students from across Australia. Fifty-six hospitals and 20 medical schools across Australia were contacted. Hardcopy and online surveys were distributed to participants at consenting institutions, evaluating the characteristics of ophthalmology teaching received during medical school and participant confidence in basic ophthalmological clinical skills and knowledge. Factor analysis was performed on confidence scores. Likert scale confidence ratings, teaching methods encountered versus preferred. Four hundred and thirty-two (51.6%) surveys were received from JMOs and 406 (48.4%) from medical students. The most common form of teaching received were lectures (71.3% JMOs, 65.5% medical students), while the most preferred type were hospital tutorials (37.7% JMOs, 61.6% medical students). Mean confidence in ophthalmology-specific skills and knowledge topics were not high for medical students (skills: 2.66/5, 95% confidence interval [CI] = 2.55-2.76; knowledge: 2.88/5, 95% CI = 2.80-2.96) and JMOs (skills: 2.52/5, 95% CI = 2.43-2.60; knowledge: 2.84/5, 95% CI = 2.77-2.91). Many participants voiced the need for more ophthalmology teaching, particularly clinically oriented opportunities. JMOs and medical students do not show high levels of confidence in basic ophthalmological clinical skills and knowledge, and report inadequate emphasis on ophthalmology during medical school.

Research paper thumbnail of Seeing the Difference - Painless progressive Vision loss in a Vasculopath

Survey of Ophthalmology, 2017

A 78-year-old Caucasian man with significant vascular disease reported sudden onset of worsened v... more A 78-year-old Caucasian man with significant vascular disease reported sudden onset of worsened vision during a routine wound-care appointment for nonhealing necrotic leg ulcers. He described painless blurring of vision with grey scotomas in his right eye, his only well-seeing eye, after trauma to the left eye as a child. He presented with retinal ischemia, a cotton wool spot, and optic nerve swelling. Temporal artery biopsy showed myxoid degeneration and extensive calcium deposition, which also was present on imaging throughout his carotid and vertebral arterial system-the clinical picture of calciphylaxis.

Research paper thumbnail of Assessment of corneal curvature using Verion Optical Imaging System - a comparative study

Clinical & Experimental Ophthalmology, 2016

Keratometry is a critical determinant of the postoperative refractive outcome. This study evaluat... more Keratometry is a critical determinant of the postoperative refractive outcome. This study evaluates the comparability of keratometry measurements obtained using the Verion Optical Imaging System with devices used in current clinical practice. Further, it determines the interobserver reliability of the Verion Optical Imaging System. Retrospective analysis of patient data Keratometric data was obtained from 100 patients presenting for pre-operative evaluation. Furthermore, repeatability and reproducibility were assessed using 15 healthy volunteers. Corneal curvature values acquired by the Verion Optical Imaging System were compared with existing keratometry devices including autokeratometry, partial coherence interferometry (IOLMaster) and Scheimpflug corneal topography (Pentacam). Direct comparison of corneal power, cylinder, axis of astigmatism and vector analysis were performed using correlation and Bland-Altman analyses. Reproducibility and reliability of the device were assessed using within-subject standard deviation and intraclass correlation coefficients for experienced and inexperienced technicians. There was no statistically significant difference between Verion values and those obtained by other methods in relation to mean keratometry, corneal astigmatism, steep meridian and vector analyses (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Bland-Altman plots showed narrow limits of agreement for keratometry and astigmatism and wider agreement for steep meridian. Intraoperator reliability for both experienced and inexperienced operators and interoperator reproducibility showed no statistically significant differences between values. Measurements show no significant difference from those obtained by the other devices. This suggests the Verion system is en par with instruments used in current clinical practice. The Verion Optical Imaging System produces repeatable data with no difference related to operator experience.

Research paper thumbnail of Augmented Kinetic Observational Proptometry: An Improved Technique for Clinical Assessment of Proptosis and Enophthalmos

Ophthalmic Plastic & Reconstructive Surgery, 2011

Search by Subject Search using Medical Subject Headings (&lt; b&gt; MeSH&lt;/b&gt... more Search by Subject Search using Medical Subject Headings (&lt; b&gt; MeSH&lt;/b&gt;), a controlled vocabulary for indexing life sciences content.&lt; br/&gt; Note that some records do not have MeSH. These include Patents and the latest PubMed and PubMed Central records.

Research paper thumbnail of Management of Periorbital Necrotising Fasciitis Utilising Negative Pressure Wound Therapy: A Case Report

Current Trends in Ophthalmology, 2019

Necrotising fasciitis is a fulminant, rapidly progressive infection associated with extensive tis... more Necrotising fasciitis is a fulminant, rapidly progressive infection associated with extensive tissue destruction and significant mortality. Given the robust blood supply of the face, periorbital necrotising fasciitis is rare in this region. Traditional management consists of prompt initiation of antibiotics and adequate surgical debridement. This report documents the outcome of Type 2 periorbital necrotising fasciitis in a 49-year-old, immunocompetent man, in whom negative pressure wound therapy, was combined with conventional measures. The negative pressure wound therapy was applied directly to the involved orbit, suggesting its safety and efficacy in relation to use over the orbit. Negative pressure wound therapy may be a useful adjunct to the armamentarium of the oculoplastic surgeon for the reconstruction of periorbital defects produced by the surgical debridement of periorbital necrotising fasciitis.

Research paper thumbnail of Cortical Oscillatory Dysrhythmias in Visual Snow Syndrome: A MEG Study

Visual Snow (VS) refers to the persistent visual experience of static in the whole visual field o... more Visual Snow (VS) refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions like tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously we hypothesised, that VSS may be characterised by disruptions to rhythmical activity within the visual system1. To test this, data from 18 patients diagnosed with visual snow syndrome (VSS), and 16 matched controls, were acquired using Magnetoencephalography (MEG). Participants were presented with visual grating stimuli, known to elicit decreases in alpha-band (8-13Hz) power and increases in gamma-band power (40-70Hz). Data were mapped to source-space using a beamformer. Across both groups, decreased alpha power and increased gamma power localised to early visual cortex. Data from primary visual cortex (V1) were compared between groups. No differences were found in either alpha or gamma peak fr...

Research paper thumbnail of Short-Wave Sensitive (“Blue”) Cone Activation Is an Aggravating Factor for Visual Snow Symptoms

Background and Purpose: Visual Snow (VS) is a disorder characterised by the subjective perception... more Background and Purpose: Visual Snow (VS) is a disorder characterised by the subjective perception of black-and-white visual static. The aetiology of this condition is not known. In our previous work we suggested that there is a link between short-wave (S or “blue” cone) signals and severity of visual snow symptoms. Therefore we aimed to further characterise this potential link. Methods: Patients (n = 22) with classic VS based on the diagnostic criteria and healthy controls (n = 12), underwent Intuitive Colorimetry (IC) testing (Cerium Visual Technologies). Twelve hue directions (expressed as angle in CIE 1976 LUV space relative to D65) were rated on a five-point scale from preferred (relieving, positive score) to non-preferred (exacerbating, negative score), and overall preferred and non-preferred angles were chosen. Results: A non-preferred violet region near the tritanopic confusion line / S-cone axis (267 deg.) was strongly associated with exacerbation of VS symptoms (range 250–3...

Research paper thumbnail of Mucormycosis: early treatment is the key to survival

Medical Journal of Australia

Research paper thumbnail of Pediatric Microbial Keratitis

Pediatric Infectious Disease Journal

Research paper thumbnail of Olfactory ensheathing cells but not fibroblasts reduce the duration of autonomic dysreflexia in spinal cord injured rats

Autonomic Neuroscience, 2016

Autonomic dysreflexia is a common complication after high level spinal cord injury and can be lif... more Autonomic dysreflexia is a common complication after high level spinal cord injury and can be life-threatening. We have previously shown that the acute transplantation of olfactory ensheathing cells into the lesion site of rats transected at the fourth thoracic spinal cord level reduced autonomic dysreflexia up to 8weeks after spinal cord injury. This beneficial effect was correlated with changes in the morphology of sympathetic preganglionic neurons despite the olfactory cells surviving no longer than 3weeks. Thus the transitory presence of olfactory ensheathing cells at the injury site initiated long-term functional as well as morphological changes in the sympathetic preganglionic neurons. The primary aim of the present study was to evaluate whether olfactory ensheathing cells survive after transplantation within the parenchyma close to sympathetic preganglionic neurons and whether, in this position, they still reduce the duration of autonomic dysreflexia and modulate sympathetic preganglionic neuron morphology. The second aim was to quantify the density of synapses on the somata of sympathetic preganglionic neurons with the hypothesis that the reduction of autonomic dysreflexia requires synaptic changes. As a third aim, we evaluated the cell type-specificity of olfactory ensheathing cells by comparing their effects with a control group transplanted with fibroblasts. Animals transplanted with OECs had a faster recovery from hypertension induced by colorectal distension at 6 and 7weeks but not at 8weeks after T4 spinal cord transection. Olfactory ensheathing cells survived for at least 8weeks and were observed adjacent to sympathetic preganglionic neurons whose overall number of primary dendrites was reduced and the synaptic density on the somata increased, both caudal to the lesion site. Our results showed a long term cell type-specific effects of olfactory ensheathing cells on sympathetic preganglionic neurons morphology and on the synaptic density on their somata, and a transient cell type-specific reduction of autonomic dysreflexia.

Research paper thumbnail of ORIGINAL CONTRIBUTION Age, Gender, and Side Differences of Cutaneous Electrical Perceptual Threshold Testing in an Able-Bodied Population

Research paper thumbnail of Modifications in Macular Perfusion and Neuronal Loss After Acute Traumatic Brain Injury

Investigative Opthalmology & Visual Science

Research paper thumbnail of A Novel Look Into Animating Ophthalmology Education

Research paper thumbnail of Seeing the Difference in Tertiary Ophthalmology Education: Deficiencies in the Teaching and Confidence of the Contemporary Medical Workforce Across Regional and Metropolitan Australia

Research paper thumbnail of Diagnostic Optic Nerve Features in Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay

JAMA Neurology

This case report describes the optic nerve features of a male patient aged 23 years with a diagno... more This case report describes the optic nerve features of a male patient aged 23 years with a diagnosis of autosomal recessive spastic ataxia of Charlevoix-Saguenay.

Research paper thumbnail of Cortical oscillatory dysrhythmias in visual snow syndrome: a magnetoencephalography study

Brain communications, Dec 18, 2021

Visual snow refers to the persistent visual experience of static in the whole visual field of bot... more Visual snow refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions such as tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously, we hypothesized that visual snow syndrome may be characterized by disruptions to rhythmical activity within the visual system. To test this, data from 18 patients diagnosed with visual snow syndrome, and 16 matched controls, were acquired using magnetoencephalography. Participants were presented with visual grating stimuli, known to elicit decreases in alpha-band (8-13 Hz) power and increases in gamma-band power (40-70 Hz). Data were mapped to source-space using a beamformer. Across both groups, decreased alpha power and increased gamma power localized to early visual cortex. Data from the primary visual cortex were compared between groups. No differences were found in either alpha or gamma peak frequency or the magnitude of alpha power, p. 0.05. However, compared with controls, our visual snow syndrome cohort displayed significantly increased primary visual cortex gamma power, p = 0.035. This new electromagnetic finding concurs with previous functional MRI and PET findings, suggesting that in visual snow syndrome, the visual cortex is hyperexcitable. The coupling of alpha-phase to gamma amplitude within the primary visual cortex was also quantified. Compared with controls, the visual snow syndrome group had significantly reduced alpha-gamma phase-amplitude coupling, p , 0.05, indicating a potential excitation-inhibition imbalance in visual snow syndrome, as well as a potential disruption to top-down 'noise-cancellation' mechanisms. Overall, these results suggest that rhythmical brain activity in the primary visual cortex is both hyperexcitable and disorganized in visual snow syndrome, consistent with this being a condition of thalamocortical dysrhythmia.

Research paper thumbnail of Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad

Journal of Current Glaucoma Practice, 2022

Research paper thumbnail of Age, gender, and side differences of cutaneous electrical perceptual threshold testing in an able-bodied population

Journal of Spinal Cord Medicine (JSCM), 2010

To investigate age, gender, and left-right differences in cutaneous electrical perceptual thresho... more To investigate age, gender, and left-right differences in cutaneous electrical perceptual threshold (EPT) testing in an able-bodied, Australian sample. Prospective experimental. Hospital-based spinal cord injuries unit. Cutaneous electrical stimulation of the 28 dermatomes at ASIA sensory key points (C2-S4/S5) was performed on 29 female and 16 male healthy volunteers aged 21 to 76 years. Mean EPTs for each dermatome were compared (repeated measures ANOVA) for left-right, gender-related, and age-related (</ >50 years of age) differences. There was no group difference between sides (repeated measures ANOVA, P = 0.934). Women across all ages had lower group mean EPTs than men (P < 0.0001). Women younger than age 50 years had lower mean EPTs than those older than age 50 years (P = 0.008). There was no group difference between younger and older men (P = 0.371). Analysis of individual dermatomes revealed no significant differences in thoracic dermatomes between genders or age gro...

Research paper thumbnail of Pediatric Microbial Keratitis

Pediatric Infectious Disease Journal, 2020

Supplemental Digital Content is available in the text. Aims: The purpose of this study was to rep... more Supplemental Digital Content is available in the text. Aims: The purpose of this study was to report the epidemiology, etiology, microbiologic profile and management of pediatric microbial keratitis in a quaternary and 3 tertiary ophthalmic referral centers across Sydney, New South Wales, Australia. Methods: This is a retrospective cohort study of patients ≤ 18 years of age with a clinical diagnosis of microbial keratitis presenting between 1 January 2010 and 31 December 2016 identified from hospital coding and pathology databases. Data were extracted from the medical records. Epidemiology, predisposing factors, referral patterns, microbial profile and treatment outcomes were analyzed. Results: Eighty eyes from 80 pediatric patients with microbial keratitis were included in the study (10% had bilateral disease). The mean age was 11 ± 5.3 years (range 0–18 years), and 44 were male (55%). Thirty-six percent of patients had ocular and 13.5% systemic comorbidities. The most common risk factor overall was contact lens wear in 26%, trauma (24%), and external lid and eye disease (20%). Overall, 74 organisms were identified, and of those, the most common isolates were Gram-positive organism. Antimicrobial resistance to common antibiotics was low across all isolates. Visual acuity following treatment was worse than 6/60 for 7 patients (11.3%%), 6/15–6/60 for 15 patients (24.2%) and better than 6/12 for 40 patients (64.5%). Preexisting corneal disease and delay of presentation were associated with worse visual prognosis. Serious complications were noted in 16 (21.3%) of patients. Conclusions: Contact lens wear, trauma and existing ocular disease remain the most significant risk factors in the pediatric population. Preexisting corneal disease and delay in presentation were associated with poor visual acuity. The majority of patients have a good visual outcome although serious complications are not uncommon and may cause lifelong visual disability.

Research paper thumbnail of Migraine Aura: Pathophysiology, Mimics, and Treatment Options

Seminars in Neurology, 2019

Recent insights into the clinical presentation and pathophysiology of migraine aura have paved th... more Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Secondary vascular perturbations also contribute to the various symptoms of a migraine attack. Calcitonin gene-related peptide (CGRP) plays a key role in many of these steps, and a growing class of CGRP-antagonists have emerged as a novel, efficacious preventative therapy. It is still not fully understood why a preponderance of migraine aura symptoms is visual, and this issue is an active area of research. In addition, the pathophysiological changes responsible for visual snow syndrome are under investigation. Before diagnosing a patient with migraine aura, it is important to consider the differential diagnosis of transient visual phenomena, w...

Research paper thumbnail of Sharpening the focus on ophthalmology teaching: perceptions of medical students and junior medical officers

Clinical & Experimental Ophthalmology, 2018

Worldwide, ophthalmology teaching is being reduced or eliminated from medical school curricula. T... more Worldwide, ophthalmology teaching is being reduced or eliminated from medical school curricula. The current state of ophthalmic teaching in Australia is unknown. To evaluate the perceptions of junior medical officers (JMOs) and medical students on ophthalmology teaching in Australian medical schools. Survey-based cross-sectional study. A total of 838 JMOs and medical students from across Australia. Fifty-six hospitals and 20 medical schools across Australia were contacted. Hardcopy and online surveys were distributed to participants at consenting institutions, evaluating the characteristics of ophthalmology teaching received during medical school and participant confidence in basic ophthalmological clinical skills and knowledge. Factor analysis was performed on confidence scores. Likert scale confidence ratings, teaching methods encountered versus preferred. Four hundred and thirty-two (51.6%) surveys were received from JMOs and 406 (48.4%) from medical students. The most common form of teaching received were lectures (71.3% JMOs, 65.5% medical students), while the most preferred type were hospital tutorials (37.7% JMOs, 61.6% medical students). Mean confidence in ophthalmology-specific skills and knowledge topics were not high for medical students (skills: 2.66/5, 95% confidence interval [CI] = 2.55-2.76; knowledge: 2.88/5, 95% CI = 2.80-2.96) and JMOs (skills: 2.52/5, 95% CI = 2.43-2.60; knowledge: 2.84/5, 95% CI = 2.77-2.91). Many participants voiced the need for more ophthalmology teaching, particularly clinically oriented opportunities. JMOs and medical students do not show high levels of confidence in basic ophthalmological clinical skills and knowledge, and report inadequate emphasis on ophthalmology during medical school.

Research paper thumbnail of Seeing the Difference - Painless progressive Vision loss in a Vasculopath

Survey of Ophthalmology, 2017

A 78-year-old Caucasian man with significant vascular disease reported sudden onset of worsened v... more A 78-year-old Caucasian man with significant vascular disease reported sudden onset of worsened vision during a routine wound-care appointment for nonhealing necrotic leg ulcers. He described painless blurring of vision with grey scotomas in his right eye, his only well-seeing eye, after trauma to the left eye as a child. He presented with retinal ischemia, a cotton wool spot, and optic nerve swelling. Temporal artery biopsy showed myxoid degeneration and extensive calcium deposition, which also was present on imaging throughout his carotid and vertebral arterial system-the clinical picture of calciphylaxis.

Research paper thumbnail of Assessment of corneal curvature using Verion Optical Imaging System - a comparative study

Clinical & Experimental Ophthalmology, 2016

Keratometry is a critical determinant of the postoperative refractive outcome. This study evaluat... more Keratometry is a critical determinant of the postoperative refractive outcome. This study evaluates the comparability of keratometry measurements obtained using the Verion Optical Imaging System with devices used in current clinical practice. Further, it determines the interobserver reliability of the Verion Optical Imaging System. Retrospective analysis of patient data Keratometric data was obtained from 100 patients presenting for pre-operative evaluation. Furthermore, repeatability and reproducibility were assessed using 15 healthy volunteers. Corneal curvature values acquired by the Verion Optical Imaging System were compared with existing keratometry devices including autokeratometry, partial coherence interferometry (IOLMaster) and Scheimpflug corneal topography (Pentacam). Direct comparison of corneal power, cylinder, axis of astigmatism and vector analysis were performed using correlation and Bland-Altman analyses. Reproducibility and reliability of the device were assessed using within-subject standard deviation and intraclass correlation coefficients for experienced and inexperienced technicians. There was no statistically significant difference between Verion values and those obtained by other methods in relation to mean keratometry, corneal astigmatism, steep meridian and vector analyses (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Bland-Altman plots showed narrow limits of agreement for keratometry and astigmatism and wider agreement for steep meridian. Intraoperator reliability for both experienced and inexperienced operators and interoperator reproducibility showed no statistically significant differences between values. Measurements show no significant difference from those obtained by the other devices. This suggests the Verion system is en par with instruments used in current clinical practice. The Verion Optical Imaging System produces repeatable data with no difference related to operator experience.

Research paper thumbnail of Augmented Kinetic Observational Proptometry: An Improved Technique for Clinical Assessment of Proptosis and Enophthalmos

Ophthalmic Plastic & Reconstructive Surgery, 2011

Search by Subject Search using Medical Subject Headings (&lt; b&gt; MeSH&lt;/b&gt... more Search by Subject Search using Medical Subject Headings (&lt; b&gt; MeSH&lt;/b&gt;), a controlled vocabulary for indexing life sciences content.&lt; br/&gt; Note that some records do not have MeSH. These include Patents and the latest PubMed and PubMed Central records.

Research paper thumbnail of Management of Periorbital Necrotising Fasciitis Utilising Negative Pressure Wound Therapy: A Case Report

Current Trends in Ophthalmology, 2019

Necrotising fasciitis is a fulminant, rapidly progressive infection associated with extensive tis... more Necrotising fasciitis is a fulminant, rapidly progressive infection associated with extensive tissue destruction and significant mortality. Given the robust blood supply of the face, periorbital necrotising fasciitis is rare in this region. Traditional management consists of prompt initiation of antibiotics and adequate surgical debridement. This report documents the outcome of Type 2 periorbital necrotising fasciitis in a 49-year-old, immunocompetent man, in whom negative pressure wound therapy, was combined with conventional measures. The negative pressure wound therapy was applied directly to the involved orbit, suggesting its safety and efficacy in relation to use over the orbit. Negative pressure wound therapy may be a useful adjunct to the armamentarium of the oculoplastic surgeon for the reconstruction of periorbital defects produced by the surgical debridement of periorbital necrotising fasciitis.

Research paper thumbnail of Cortical Oscillatory Dysrhythmias in Visual Snow Syndrome: A MEG Study

Visual Snow (VS) refers to the persistent visual experience of static in the whole visual field o... more Visual Snow (VS) refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions like tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously we hypothesised, that VSS may be characterised by disruptions to rhythmical activity within the visual system1. To test this, data from 18 patients diagnosed with visual snow syndrome (VSS), and 16 matched controls, were acquired using Magnetoencephalography (MEG). Participants were presented with visual grating stimuli, known to elicit decreases in alpha-band (8-13Hz) power and increases in gamma-band power (40-70Hz). Data were mapped to source-space using a beamformer. Across both groups, decreased alpha power and increased gamma power localised to early visual cortex. Data from primary visual cortex (V1) were compared between groups. No differences were found in either alpha or gamma peak fr...

Research paper thumbnail of Short-Wave Sensitive (“Blue”) Cone Activation Is an Aggravating Factor for Visual Snow Symptoms

Background and Purpose: Visual Snow (VS) is a disorder characterised by the subjective perception... more Background and Purpose: Visual Snow (VS) is a disorder characterised by the subjective perception of black-and-white visual static. The aetiology of this condition is not known. In our previous work we suggested that there is a link between short-wave (S or “blue” cone) signals and severity of visual snow symptoms. Therefore we aimed to further characterise this potential link. Methods: Patients (n = 22) with classic VS based on the diagnostic criteria and healthy controls (n = 12), underwent Intuitive Colorimetry (IC) testing (Cerium Visual Technologies). Twelve hue directions (expressed as angle in CIE 1976 LUV space relative to D65) were rated on a five-point scale from preferred (relieving, positive score) to non-preferred (exacerbating, negative score), and overall preferred and non-preferred angles were chosen. Results: A non-preferred violet region near the tritanopic confusion line / S-cone axis (267 deg.) was strongly associated with exacerbation of VS symptoms (range 250–3...

Research paper thumbnail of Mucormycosis: early treatment is the key to survival

Medical Journal of Australia

Research paper thumbnail of Pediatric Microbial Keratitis

Pediatric Infectious Disease Journal

Research paper thumbnail of Olfactory ensheathing cells but not fibroblasts reduce the duration of autonomic dysreflexia in spinal cord injured rats

Autonomic Neuroscience, 2016

Autonomic dysreflexia is a common complication after high level spinal cord injury and can be lif... more Autonomic dysreflexia is a common complication after high level spinal cord injury and can be life-threatening. We have previously shown that the acute transplantation of olfactory ensheathing cells into the lesion site of rats transected at the fourth thoracic spinal cord level reduced autonomic dysreflexia up to 8weeks after spinal cord injury. This beneficial effect was correlated with changes in the morphology of sympathetic preganglionic neurons despite the olfactory cells surviving no longer than 3weeks. Thus the transitory presence of olfactory ensheathing cells at the injury site initiated long-term functional as well as morphological changes in the sympathetic preganglionic neurons. The primary aim of the present study was to evaluate whether olfactory ensheathing cells survive after transplantation within the parenchyma close to sympathetic preganglionic neurons and whether, in this position, they still reduce the duration of autonomic dysreflexia and modulate sympathetic preganglionic neuron morphology. The second aim was to quantify the density of synapses on the somata of sympathetic preganglionic neurons with the hypothesis that the reduction of autonomic dysreflexia requires synaptic changes. As a third aim, we evaluated the cell type-specificity of olfactory ensheathing cells by comparing their effects with a control group transplanted with fibroblasts. Animals transplanted with OECs had a faster recovery from hypertension induced by colorectal distension at 6 and 7weeks but not at 8weeks after T4 spinal cord transection. Olfactory ensheathing cells survived for at least 8weeks and were observed adjacent to sympathetic preganglionic neurons whose overall number of primary dendrites was reduced and the synaptic density on the somata increased, both caudal to the lesion site. Our results showed a long term cell type-specific effects of olfactory ensheathing cells on sympathetic preganglionic neurons morphology and on the synaptic density on their somata, and a transient cell type-specific reduction of autonomic dysreflexia.