September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Nature and Incidence of End-Stage Limbal Stem Cell Deficiency in Australia and New Zealand
Author Affiliations & Notes
  • Stephanie L Watson
    Ophthalmology, Save Sight Institute, University of Sydney, Bondi Junction, New South Wales, Australia
    Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Samantha Bobba
    School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
  • Nick Di Girolamo
    School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Stephanie Watson, None; Samantha Bobba, None; Nick Di Girolamo, None
  • Footnotes
    Support  NHMRC Practitioner Fellowship (ID 394000) and a Career Development Fellowship for Author SW (APP1050524).
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6207. doi:
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      Stephanie L Watson, Samantha Bobba, Nick Di Girolamo; Nature and Incidence of End-Stage Limbal Stem Cell Deficiency in Australia and New Zealand. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6207.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To document the incidence of end-stage limbal stem cell deficiency (LSCD) in Australia and New Zealand (ANZ).

Methods : A one year pilot surveillance study was conducted in ANZ, with follow-up data sought at 12 months. The project was conducted through the Royal Australian and New Zealand College of Ophthalmologists ‘Australian and New Zealand Ophthalmic Surveillance Unit’ (ANZOSU), and commenced in April 2013, with approval from the local area health service. All practicing ophthalmologists in private and public practice in ANZ were contacted on a monthly basis by the ANZOSU; they were given a definition of end-stage LSCD and asked to report newly diagnosed cases. End-stage LSCD was defined as at least 6 clock hours of whorl-like epitheliopathy, an opaque epithelium arising from the limbus, late fluorescein staining of the involved epithelium, and superficial neovascularization or conjunctivalization.

Results : On average 286 report cards were sent by the ANZOSU to practicing ophthalmologists each month (total 3429 over 12 months) and on average 176 responses per month (total 2111; 62% response rate) were recieved. The ANZOSU by 2015 obtained contact details for 746 ophthalmologists, such that data was included from 20% of practicing ophthalmologists. During the 1-year study period from April 2013 – March 2014, 14 positive cases were reported with a 100% return rate of initial questionnaires. At the 1-year follow-up, 4 of these cases were lost to follow-up. In all patients, the diagnosis was made on the basis of clinical examination with impression cytology performed in 1 case. A range of underlying etiologies were implicated, with contact lens over-wear being the most common (n=3) followed by chemical injury (n=2). Ninety-three percent of reporting ophthalmologists utilized conservative approaches to manage these patients in the first year following diagnosis; this included topical lubricants and/or steroids.

Conclusions : This surveillance study is the first worldwide to document the incidence of end-stage LSCD, likely however underreported given the ANZOSU’s 20% ophthalmologist inclusion rate. Determining the incidence, geographical distribution, and ocular co-morbidities of patients with LSCD may enable clinicians to establish specialist treatment centers. There is potential to implement such a study internationally, allowing for further geographical comparisons and analysis.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.


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