Since the Victorian public health acts, the now named environmental health practitioner (EHP) (previously public health inspector or environmental health officer) has been pivotal in providing healthier housing through a range of policy initiatives and legislative requirements. The role of the practitioner has changed substantially in the past decade, particularly as the public health and well-being agendas have brought focus to the socio-economic determinants of health, including housing, with a renewed vision of tackling the most acute health inequalities through evidence-based practice and taking a population-based approach. The now established Housing Health and Safety Rating System has enabled a far greater focus on evidence than previously. However, for many households on low incomes living in owner-occupied and privately rented housing the situation is inequitable and, for many, has negative health effects. The private-sector housing renewal budget has been discontinued and the allied housing and social care resource has been cut. As a result, EHPs and colleagues need to promote the importance of their work at every opportunity as Public Health England came into being in 2013 and public health has been transferred from the National Health Service to local authorities. This presents both opportunities and challenges in demonstrating the effectiveness of housing strategies and interventions by fine-tuning arguments for securing greater resources through joint strategic needs assessments presented to health and well-being boards.

BACKGROUND:

To evaluate changes of choroidal circulation quantitatively using laser speckle flowgraphy (LSFG) in patients with acute zonal occult outer retinopathy (AZOOR).

DESIGN:

Retrospective observational case series.

PARTICIPANTS:

Sixteen eyes of 11 AZOOR patients: 7 non-treated eyes with good visual acuity and 9 systemic corticosteroid-treated eyes with progressive visual acuity loss. Six eyes with thyroid-associated ophthalmopathy receiving systemic corticosteroid therapy served as controls.

METHODS:

The mean blur rate (MBR), an index of quantitative relative blood flow velocity, in the affected area was measured by LSFG. The changes of MBR, best-corrected visual acuity (BCVA), and the average threshold at the affected area on Humphrey perimetry during 24-week follow-up were analysed.

MAIN OUTCOME MEASURES:

MBR, BCVA, and the average threshold.

RESULTS:

In non-treated eyes, the average MBR significantly increased at 24 weeks (119.3% against baseline, P = 0.016), with a significant increase of the average threshold. In corticosteroid-treated eyes, the MBRs at 1, 4, 12, and 24 weeks were significantly higher than the pre-treatment value (130.4%, 122.3%, 122.7%, and 123.6%, respectively, P = 0.0039, for all), with significant improvement of BCVA and the average threshold (P = 0.014 and P = 0.009, respectively). The increase in MBR at 4 weeks in corticosteroid-treated AZOOR eyes was significantly higher than that in corticosteroid-treated control eyes (122.3% vs. 105.0%, P = 0.0028).

CONCLUSIONS:

In eyes with AZOOR, the MBR at the affected area significantly increases along with improvement of visual functions. These results suggest that impaired choroidal circulation is involved in the pathogenesis of AZOOR.

A 39-year-old man was admitted with a sudden visual loss in the left eye. Visual acuities were 10/10 on the right and 1/10 on the left. Fundus examination did not show any abnormalities. Visual acuity improved to 10/10 and visual field defect regressed in the following 2 weeks. Three years later, the patient returned with acute visual loss in the right eye. Visual acuities were 2/10 on the right and 10/10 on the left. Right optic disc had blurred margins with mild oedema. The tests revealed methylenetetrahydrofolate reductase A1298C mutation with positive lupus anticoagulant and hyperhomocysteinaemia. Enoxaparin was initialised with vitamin B12 supplementation. Complete visual recovery occurred in the following 3 weeks in both eyes. Thrombophilic screening seems to be important in the treatment and prevention of an attack in the second eye of patients with non-arteritic anterior ischaemic optic neuropathy.

The purpose of this paper is to report an unusual case of accumulation of residual subretinal fluid after surgery for acute rhegmatogenous retinal detachment, sparing the fovea. A 28-year-old male presented with a four-day history of acute visual loss in his right eye secondary to bulbous rhegmatogenous retinal detachment, sparing the fovea. The patient underwent an uneventful pars plana vitrectomy and scleral buckling procedure. At four weeks postoperatively (after complete gas resorption), the visual acuity was 20/40. However, the patient complained of blurred vision. A dilated fundus examination showed a fat retina and the presence of multiple yellowish subretinal deposits resembling vitelliform lesions in the macula. Some lesions were encroaching on the fovea, and were connected via a tract to a previous horseshoe tear with evidence of a thin layer of subretinal fluid. The patient symptoms persisted for one year postoperatively. However, the retina remained fat with evidence of retinal pigment epithelium mottling and faint scars corresponding to previous lesions. Persistent subretinal fluid with thick subretinal precipitate can occur even after successful surgery for acute retinal detachment sparing the fovea and cause visual dysfunction.

Sudden sensorineural hearing loss with vertigo (SSNHL_V) and vestibular neuritis (VN) are common neuro-otologic disorders that cause acute spontaneous vertigo. The SSNHL_V and VN lesion sites are thought to be within the labyrinth and the vestibular nerve, respectively. Neurolabyrinthitis of a viral origin is the most commonly accepted etiology of SSNHL_V, and neural degeneration due to viral infection (predominantly in the superior vestibular nerve) is thought to be responsible for the pathophysiology of VN. The objective of this study was to compare the static vestibular imbalance between SSNHL_V and VN patients during the acute stage of the disease. We compared the results of spontaneous nystagmus (SN), subjective visual vertical (SVV), and canal paresis (CP) between SSNHL_V and VN patients within 10 days from the onset of vertigo. Significant SN was observed in 58% of SSNHL_V and 90% of VN patients (p < 0.001), and abnormal SVV was observed in 10% of SSNHL_V and 78% of VN patients (p < 0.001). However, CP values were not significantly different between the 2 groups (50.8 ± 19.7% in SSNHL_V and 57.1 ± 18.9% in VN). In conclusion, significant SN and abnormal SVV are less frequently encountered in SSNHL_V than in VN even though the caloric test did not reveal significant differences at the acute stage.

Papilloedema is the descriptive term for optic disc swelling caused by proven elevated intracranial pressure (ICP). Commonly, there is preservation of vision, particularly central vision, visual acuity and colour vision, early in the disease process. However, some patients with raised ICP may present with a combination of disc swelling and visual loss. We report on two patients who presented with visual loss and optic disc swelling. They were initially referred to the neuro-ophthalmology clinic with a provisional diagnosis of optic neuritis given the clinical picture of disc swelling with reduced visual acuity. However they were subsequently found to have papilloedema.

We introduce a case of blindness after a periorbital fat graft and its resulting court ruling in regard to a surgeon's liability of compensation. A 19-year-old woman received an injection of preserved autologous fat to her nasal dorsum. During the injections, she complained of pain and lost vision of her right eye. The pupil responded to light but showed a blepharoptosis and a limitation of the extraocular muscle of her right eye. Upon a fundoscopy, a cherry red spot was observed. Brain magnetic resonance imaging and angiography showed an acute infarction of the ophthalmic nerve. Upon an angio-computed tomography, the ophthalmic artery branch was not visualized. Her right eye remained blind 3 weeks after admission. She claimed compensation for damage from the surgeon. The court determined a ruling in favor of the plaintiff (patient); however, the responsibility was limited to 70%. As a result, the defendant has to pay 84,750 US$ to the patient and 6450 US$ to her parents. Roe (the presiding judge) stated that in this case, the injected autologous fat seems to have been put into the ophthalmic artery and the central retinal artery along the vascular countercurrent because of excessive applied pressure. The court also said that because the plaintiff had a history of rhinoplasty, the defendant should have injected the fat more slowly at low pressure to avoid the vascular injury. We think there is a question about "how slowly and how low the pressure should be" for the fat injection. A further study of injection pressure, particle size, temperature, and release in the amount of fat for safe, periorbital, fat grafts should follow this study.

Pleomorphic xanthoastrocytoma (PXA) is a brain neoplasm included in the astrocytic group, exceptionally manifesting with meningeal dissemination. We described a 27-year-old patient presented with acute bilateral visual loss and papilledema with normal brain computed tomography scan, initially mimicking idiopathic intracranial hypertension (IIH). Brain and spinal cord magnetic resonance imaging (MRI) study revealed a subtle area of hyperintensity of the gyri surrounding the left central sulcus, and contrast enhancement of the thoracic leptomeninges. Brain biopsy of the parietal lesion revealed nonanaplastic PXA. Treatment with temozolomide was given. Yearly control MRI demonstrated new brain lesions and marked progression of leptomeningeal spinal enhancement. In spite of this, the patient has remained stable with no new symptoms. Nonanaplastic PXA may present with widespread meningeal dissemination with acute visual loss and papilledema mimicking IIH, and no clinical progression at 3 years.

BACKGROUND:

Retinal nerve fiber layer (RNFL) loss occurs with multiple sclerosis and after optic neuritis. Vision or RNFL changes at presentation of optic neuritis are not predictive of outcome, but vision loss at 1 month correlates with vision deficits at 6 months. We hypothesized that RFNL thinning at 1 month would predict RNFL loss at 6 months.

METHODS:

We prospectively studied the RNFL by optical coherence tomography (OCT) and scanning laser polarimetry (SLP), and determined the threshold field mean deviation, in 25 subjects with acute optic neuritis over a 6-month period. RNFL values, including the amount of thinning at 1-month, were correlated with 6-month outcome.

RESULTS:

Baseline visual performance and RNFL values were similar for eyes grouped by 1 month RNFL thinning. Eyes with 1 month RNFL thinning had greater and significant RNFL thinning at 6 months, for all quadrants by OCT and for the nasal and inferior quadrants by SLP. RNFL thinning by OCT and SLP at 1 month correlated with 6-month OCT (r = 0.58; p = 0.006) and SLP (r = 0.59; p = 0.002) RNFL thinning, respectively.

CONCLUSION:

Early RNFL loss at 1 month was predictive of the RNFL thinning at 6 months, which corroborated the importance of the 1-month time point for predicting the outcome of an optic neuritis attack.

Here we report a case of Churg-Strauss syndrome (CSS) and central retinal artery occlusion (CRAO), with good visual recovery. A 58-year-old Japanese man with CSS experienced acute painless loss of vision in his right eye. CRAO was diagnosed by fundoscopic findings (retinal whitening with a cherry-red spot). Steroid pulse therapy (methylprednisolone at 1 g daily for 3 days) followed by combined treatment with prednisolone (30 mg/day) and cyclophosphamide (150 mg/day) was administered; his visual acuity recovered to 20/30 in 1 month, and no recurrence has occurred for 1 year. Steroid pulse therapy may be effective for CRAO in CSS patients.