Royal College of Ophthalmologists

WHAT IS KNOWN : •Helmholtz invented the ophthalmoscope in 1850 and published his observations in a monograph in 1851. However, he did not include an illustration of what he observed; •The first published retinal paintings were created in 1853 by the artistically gifted physician Adrien Christophe van Trigt. •Shortly after Helmholtz's publication of the ophthalmoscope, the Amsterdam instrument maker Epkens designed and constructed a table-model ophthalmoscope that left the dominant hand free; •The ophthalmologist Donders in Utrecht recognized in Epkens' table model ophthalmoscope the opportunity to produce retinal paintings for publication purposes. He recruited the artistically skilled physician Adrien van Trigt as PhD student to carry out this work; •The collaboration of Donders, Van Trigt and Epkens resulted within 19 months following Helmholtz' monograph, in the publication of retinal paintings - a remarkably fast achievement, given that retinal photography was not yet available.

To identify risk factors affecting the change in visual acuity in successfully re-attached macula-off rhegmatogenous retinal detachment (RD) surgery. A cohort study, using an online database, of visual outcomes for 2770 macula-off retinal detachments that were successfully re-attached by vitrectomy and internal tamponade. The database included detailed retinal diagrams of each detachment. The change in LogMAR visual acuity from pre-operatively to post-operatively. Male patients accounted for 64.6% of the sample and the median age was 63 years old. The median pre-operative VA was counting fingers (LogMAR 1.98); this improved to 0.30 LogMAR post-operatively. An improvement in VA of ≥0.30 LogMAR was achieved by 88.0% eyes. The change in VA model identified the preoperative VA, patient age, duration of central vision loss, lens status at follow up, extent of detachment, and the number of breaks in the detached retina, as factors influencing the change in VA. The model had an adjusted R2 of 0.749, and for 75.5% of eyes, the model prediction was within ±0.30 LogMAR of the recorded VA change. Greater post-operative visual acuity improvement was more likely in eyes that were pseudophakic at follow up, and had shorter durations of central vision loss. Non modifiable factors associated with greater vision improvement included worse presenting vision, younger age, less extensive detachment and less than three breaks in the detached retina. These results confirm that prompt surgery improves functional outcomes in successfully treated macula off retinal detachments irrespective of presenting visual acuity.

The aim of this study was to investigate whether the use of the silicone tipped irrigation/aspiration (I/A) handpiece CapsuleGuard® (Bausch + Lomb, Laval, Canada) reduced rates of posterior capsule rupture (PCR) during cataract surgery. Royal College of Ophthalmologists' National Ophthalmology Database (NOD) Cataract Audit data from 01/04/2010 and 31/03/2021 and Bausch + Lomb sales figures were combined to identify centres participating in national cataract audit who have routinely adopted the silicone tipped I/A handpiece, CapsuleGuard®. Data were included only from centres with eligible cataract operations recorded on the NOD both before and after adopting CapsuleGuard®. Review of the literature was undertaken to estimate the proportion of PCR that occurs during I/A, to evaluate the impact of adoption of CapsuleGuard® on PCR occurring in this phase of surgery. Within the study period, 267 371 eligible cataract operations were performed in 14 centres with >50 eligible operations both before and after adopting CapsuleGuard®. Within centres adopting CapsuleGuard®, the rate of PCR occurrence reduction was 16.4%. Before and after the adoption of CapsuleGuard® the median change of PCR was 21.7% reduction (IQR: 4.8% to 37.7% reduction). A reduction in the rate of PCR was seen after regular adoption of CapsuleGuard® during cataract operations. Review of published studies attributing PCR to various components of the cataract operation suggest around 25% of PCR may occur during I/A; adoption of CapsuleGuard may, therefore, be associated with avoidance of a substantial proportion of the PCR during that phase of surgery.

Cataract surgical safety has improved over recent decades, with endophthalmitis rates before 2006 typically 0.13-0.15% compared with the most recent UK national estimate of 0.02%. There remains, however, substantial variation in reported rates from different centres. Due to the low event rate, this disparity may not be noticed and opportunities to improve therefore be missed. We propose a method of monitoring post-cataract endophthalmitis rates that would help centres with higher rates identify this. A statistical tool, available to download or use online, permits comparison of local endophthalmitis rate with the estimated UK rate of 0.02%. Centres are encouraged to maintain a register of endophthalmitis cases, and when the number reaches a threshold (X cases), either in a certain time period or in a fixed number of procedures, then the centre can consider itself as an outlier and trigger local investigations to improve infection control. Example outputs are offered, such as for a unit doing 5000 cataracts annually, a value of X is suggested such that the third case of endophthalmitis (X = 3) in a 12-month period would give 85% confidence, the fourth case 90% confidence and the fifth case 95% confidence that the true endophthalmitis rate for that unit was higher than the national average. This statistical tool provides a basis for units to set a threshold number of cases of endophthalmitis within a given period that would trigger local processes, thus helping inform local monitoring processes for this rare but potentially catastrophic complication of cataract surgery.

Strabismus, commonly known as eyes or squint is a condition in which the eyes do not properly align with each other. Apparent strabismus can be a result of various underlying factors, including refractive errors such as myopia, hyperopia, and astigmatism. This essay explores the relationship between apparent strabismus and different types of refractive errors. The methodology involves a literature review of relevant research articles and studies. The results indicate a significant correlation between certain types of refractive errors and apparent strabismus. The discussion delves into the implications of these findings for clinical practice and treatment strategies. In conclusion, understanding the relationship between apparent strabismus and refractive errors is crucial for accurate diagnosis and management of the condition.

Abstract Diffuse intraocular haemorrhage poses challenges for the clinician. These involve the multitude of clinical aetiologies and the variability in the treatment pathways or plan employed towards its treatment. A particular challenge involves its association with the presence of intraocular tumours. Haemorrhage is a rare manifestation in both pigmented and non‐pigmented tumours manifesting as an initial presentation or as part of the natural course of an untreated intraocular tumour. On some instances, the mere visibility and proper assessment of an intraocular tumour might be impeded with a challenging differential diagnosis.In addition, haemorrhage can be baffling for the ocular oncologist as it might develop in treated tumours and in relation to radiation related events. The latter could affect tumour presentation post treatment and lead to treatment dilemmas.This talk addresses the aetiology, pathophysiologic mechanisms, imaging and clinical features involved with the development of haemorrhage in this clinical setting taking into account the particular features of pigmented and non‐pigmented tumour paradigms.

Background/objectivesIn recent years, eye casualty clinics have seen significant increases in patient numbers with reduced capacity. COVID-19 has exacerbated this issue and demonstrated the potential of telemedicine as a solution. Our study evaluated the potential benefit of a smartphone-based lens attachment to improve the referral pathway for anterior segment related complaints in eye casualty.Subjects/methodsFifty-four consecutive patients with anterior segment complaints were recruited. A questionnaire was completed with each patient to simulate the history from the point of referral. White light and cobalt blue photos were captured using a smartphone lens. The clinician reviewing the patient was asked to document the actual diagnosis and the appropriate time-frame within which they felt the patient could safely have been seen within; both with and without the option of management advice at the time of triage. The subsequent images and questionnaires were reviewed by a single consultant Ophthalmologist who was independent to the data collection process. The assessor was asked to make a diagnosis and management plan based upon the questionnaire (‘History’), and the questionnaire with the photo (‘History with Image’), as well as rate their clinical confidence on a 1–5 scale.ResultsDiagnostic accuracy was significantly higher in “History with Image” (98.2%), when compared to “History” only (48.2%). “History with Image” prevented significantly more appointments when compared to “History” alone, at similar levels to retrospective clinic review. Preventable appointments were increased if clinical advice was possible. Timeframe of appointments between ‘History with Image’ and ‘Clinic’ appointments was similar. Clinical’Confidence was significantly higher at 4.5 with ‘History with Image’ when compared to 2.37 with ‘History Only’.ConclusionA low-cost smartphone lens attachment, alongside a standardised clinical questionnaire, can improve the referral pathway to the hospital eye service by reducing unnecessary appointments, while improving clinical confidence and diagnostic accuracy during triage. Further work to evaluate referral pathways, including the development of systems that allow for secure image transmission are needed to understand the feasibility for the widespread adoption of this technology.