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Objectives: To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. Methods: A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. Results: Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). Conclusion: Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup. [ABSTRACT FROM AUTHOR]

Objectives Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway obstruction in the newborn. CNPAS is diagnosed clinically and confirmed with CT scanning. Early diagnosis and management is essential for this potentially life-threatening condition. Patients can be managed conservatively or surgically. Surgical treatment is usually reserved for those patients that fail conservative treatment. Our objective was to provide a radiologically-measured pyriform aperture (PA) width that predicts the need for surgical intervention. Methods This study was a retrospective chart review of patients treated in a tertiary paediatric hospital as well as a review of the literature. Outcome measures were defined as surgical or conservative intervention for the management of congenital pyriform aperture stenosis. Results Data from 26 individual patients (7 patients from our own case series and 19 patients from previously published reports) was analysed to calculate those patients requiring surgical intervention. Conclusions A PA width of less than 5.7 mm in a neonate is 88% sensitive and specific in predicting that a patient will require surgical intervention. [ABSTRACT FROM AUTHOR]

Our objective is to present a short series of four rare cases of ectopic olfactory neuroblastoma. Our methods present four case reports of ectopic olfactory neuroblastoma and a review of the literature for management and treatment of this disease. The results indicate short case series reports of ectopic olfactory neuroblastoma arising from the anterior ethmoidal sinuses, the nasopharynx, the lateral nasal wall and the floor of the nose. The discussion focuses on likely origins of ectopic olfactory neuroblastoma, its clinical features and management. We conclude that ectopic olfactory neuroblastoma is a rare disease. Treatment principles are the same for non-ectopic disease and guided by extension into adjacent structures such as the orbit or anterior cranial fossa and usually involves surgery with or without adjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Summary: Objective: The aim of this paper is to highlight our experience with the use of non-invasive positive pressure ventilation (NIPPV) in children, neonates and pre-term infants with upper airway obstruction. Methods: This was a retrospective review of our recent experience in using NIPPV for the management of upper airway obstruction in paediatric patients. Results: NIPPV was successful in preventing tracheostomy in patients with significant laryngo-tracheomalacia as well as being used to optimise the timing of surgery in subglottic stenosis. Furthermore, it proved beneficial in stabilising the airway after aryepiglottoplasty and also had a role in the management of obstructive sleep apnoea. Conclusion: The use of NIPPV in children with upper airway obstruction can be a safe and effective alternative to invasive mechanical ventilation. NIPPV can potentially be beneficial in avoiding prolonged invasive ventilation, avoiding tracheostomy, stabilizing the airway after extubation or decannulation, and management of obstructive sleep apnoea. [Copyright &y& Elsevier]

Objective: To identify the incidence and possible risk factors for the development of hypothyroidism following hemithyroidectomy and to determine a simple protocol for the post-op monitoring of thyroid function. Design: Prospective study. Setting: Tertiary Referral Centre. Patients: Eighty-two consecutive patients who underwent hemi-thyroidectomy between May 2003 and May 2005 were included. The clinical and pathological factors were obtained and statistically analysed. Results: Eighteen per cent of patients became hypothyroid post-operatively. Multivariate analysis demonstrated that risk factors for hypothyroidism following hemithyroidectomy included a pre-operative [TSH] >1.6 μIU/L [ P = 0.008, hazard ratio (HR) 14, 95% confidence interval (CI) 2–54] and lymphocytic infiltration graded 3+ or more ( P < 0.001, HR 42, 95% CI, 8–195%). There was no relationship between age, sex or weight of resected tissue and the risk of hypothyroidism. Conclusion: Patients with raised pre-operative [TSH] or with lymphocytic infiltration of their thyroid specimen should undergo regular testing of thyroid function within the first year of surgery. In all other patients, thyroid function at 12 months is sufficient. [ABSTRACT FROM AUTHOR]

Aim: The last complete report on causes of blindness in England and Wales was for data collected during April 1990 to March 1991. This current study sought to update these figures, with data collected during April 1999 to March 2000, and examine variation in cause by age group. Methods: In England and Wales, registration for blindness is voluntary and is initiated by certification by a consultant ophthalmologist. The main cause of blindness was ascertained where possible for all certificates completed during April 1999 to March 2000 and tabulated by age group. Results: A total of 34,410 BD8 certificates were received, of which 13,788 (40%) were for people certified as blind. Different causes predominated within different age groups. Age related macular degeneration (AMD) was the lead cause in those aged 65 years and above, diabetic retinopathy was the lead cause in people of working ages (16–64 years), whereas cerebral visual impairment and disorders of the optic nerve accounted for over 40% of blind certificates completed for children. Conclusion: Estimates of vision impairment based on certifications for blindness in England and Wales are likely to be imprecise. They do, however, give some measure of the burden at hospital level of sight impairing eye conditions. If factors determining the imprecision remain constant, temporal monitoring of causes may enable changes and development of new conditions leading to vision impairment to be detected. Eye (2008) 22, 905–911; doi:10.1038/sj.eye.6702767; published online 2 March 2007 [ABSTRACT FROM AUTHOR]

BackgroundA number of authors have documented the decrease in the rate of glaucoma drainage surgery, felt to be owing to increased medical therapy options. There has also been an increase in cataract extraction. The aim of this study was, using the NHS Hospital Episode Statistics (HES), to attempt to confirm these trends and to examine the possibility that these trends are not necessarily independent.MethodsThe HES was accessed for the main glaucoma procedures between 1998 and 2004 and for cataract operations performed over the same time period. Diagnostic data were also extracted from the HES data for glaucoma. Figures for the changes in glaucoma medications were obtained from pharmaceutical data.ResultsOver the period that the data are available, trabeculectomy numbers have reduced by 51%, laser trabeculoplasty by 60%, and laser peripheral iridectomy (PI) by 30%. Cataract extractions have increased by 52%. Medical treatments, especially prostaglandin use, have increased. The number of admissions for acute glaucoma did not increase.ConclusionsThe figures indicated a decrease in glaucoma drainage surgery and an increase in cataract extraction—consistent with other studies. More surprisingly, there was no increase in diagnosis of angle closure glaucoma or laser PIs within the figures and we suggest this may in part be related to the increase in cataract extraction. We speculate that this may also partly be responsible for the reduction in trabeculectomies. Although the HES data are a potentially rich source of information, there are potential inaccuracies in the data, which means interpretations must be made with caution.Eye (2008) 22, 3–7; doi:10.1038/sj.eye.6702458; published online 19 May 2006 [ABSTRACT FROM AUTHOR]

igneous rocks, but strongly differentiated chemistry and intense hydrothermal alteration camouflage their ultimate origins. We pre- sent the first in situ Hf isotope data from zircons of peralkaline granites, aimed at clarifying the protoliths of these plutons and their genetic relationship to associated metaluminous/weakly peraluminous granites. This study used rocks of the Devonian Narraburra Complex in southeastern Australia, and found that correlations between Hf isotopes and trace element ratios reveal fundamentally different origins for the nonperalkaline and peralkaline granites. The latter have a depleted mantle-like ancestry, whereas a weakly peraluminous rock formed from melts of older arc crust that were modified by interaction with juvenile, probably alkaline magmas. Juxtaposition of crust- and mantle-derived magmas reflects the high heat flow and lithosphere-scale faults associated with continental extension, and explains the diversity of A-type granites. [ABSTRACT FROM AUTHOR]

People of African Caribbean Descent (ACD) have a higher prevalence of glaucoma compared to people of European Descent (ED) and there is uncertainty if treatment outcomes are equivalent between the two groups. To assess surgical failure rates comparing ACD with ED focusing on trabeculectomy, aqueous shunt implantation, non-penetrating filtering surgery (NPFS), and minimally invasive glaucoma surgery (MIGS) by performing a systematic review in accordance with the PRISMA guidelines and to determine whether there is any evidence in to show a difference in success rates based on race. A systematic review of articles using the CENTRAL, Ovid MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov databases was completed. Additional studies were identified by contacting clinical experts and searching bibliographies. All retrospective and prospective studies on trabeculectomy, aqueous shunt implantation, NPFS, and MIGS that included at least 20% ACD were included. Two review authors independently screened search results for eligibility and inclusion and extracted the data using pre-determined fields. A total of 76 studies were identified for inclusion in the review. Glaucoma surgical outcomes in ACD appear to be poorer compared to ED overall, particularly for trabeculectomy. Data on NPFS are limited, but the studies completed thus far demonstrate surprisingly good results for ACD, particularly when compared to ED, who have significantly lower pre-operative IOPs. Evidence from studies investigating aqueous shunts does not suggest that ACD have poorer outcomes than ED. There is not enough data on MIGS to provide a significant conclusion. In a population where trabeculectomy may no longer be the gold standard, sufficiently powered studies assessing surgical outcomes in aqueous shunts, NPFS, and MIGS are needed to guide clinicians. [ABSTRACT FROM AUTHOR]

The author reflects on the National Health Service (NHS) Bill, which deals with free health and dental care. The author says that optometric services must be included to the bill specifically in hospitals that contain eye departments and clinics. He argues that the inclusion of eye-health services in the bill will result to high costs. He mentions that integration of eye-care was neglected in the NHS Act of 1951, thus, NHS Diabetic Eye Screening Program was implemented.

Lime manufacture in the UK has resulted in the generation of a number of alkaline sites (>pH 11.0) with complex indigenous microbial populations. Within the present study, retrievable cotton samples were used to investigate the fate of cellulose, the primary carbon source, within three sites aged from ≈25 to 140 years. Following 3 months incubation in situ, biofilms had formed on all cotton samples in these extreme pH conditions; with matrices comprised of carbohydrates, proteins, lipids and eDNA. Biofilms from the older sites contained greater amounts of eDNA, a structural component that aids the production of a denser biofilm. The age of the sites correlated with a shift from polysaccharides composed of β 1,4 and β 1,3 linked sugars to those composed of pyranosyl sugars within the older sites. These changes were reflected in the active biofilm communities which shifted from being Clostridiales dominated in the youngest site to Proteobacteria dominated in the older sites. The study demonstrates that the microbial communities resident in anthropogenic alkaline sites are able to form biofilms at pH values > pH 11.0 and that these biofilms evolve toward Proteobacteria dominated communities employing eDNA and pyranosyl sugar based polysaccharides to build the biofilm matrix. [ABSTRACT FROM AUTHOR]

Discusses the treatment of raised intraocular pressure and the prevention of glaucoma. Reference to a study published in the 'Archives of Opthamology' in 2002; Ethical questions surrounding the offering of lowering pressure as a treatment for glaucoma; Ocular hypertension treatment study conducted in the United States; Question of whether treating pressure in overt disease prevents progression; Potentially harmful effects of topical β blockers for glaucoma; Statement that circulating corticosteroids may influence pressure and circadian rhythms.

The southern part of the New England Orogen exhibits a series of remarkable orogenic bends (oroclines), which include the prominent Z-shaped Texas and Coffs Harbour oroclines. The oroclines are defined by the curvature of Devonian–Carboniferous forearc basin and accretionary complex rock units. However, for much of the interpreted length of the Texas Orocline, the forearc basin is mostly concealed by younger strata, and crops out only in the Emu Creek Block in the eastern limb of the orocline. The geology of the Emu Creek Block has hitherto been relatively poorly constrained and is addressed here by presenting new data, including a revised geological map, stratigraphic sections and new detrital zircon U–Pb ages. Rocks of the Emu Creek Block include shallow-marine and deltaic sedimentary successions, corresponding to the Emu Creek and Paddys Flat formations, respectively. New detrital zircon U–Pb data indicate that these formations were deposited during the late Carboniferous and that strata were derived from a magmatic source of Devonian to Carboniferous age. The sedimentary provenance and detrital zircon age distribution suggest that the sequence was deposited in a forearc basin setting. We propose that the Emu Creek and Paddys Flat formations are arc-distal, along-strike correlatives of the northern Tamworth Belt, which is part of the forearc basin in the western limb of the Texas Orocline. These results confirm the suggestion that Devonian–Carboniferous forearc basin rocks surround the Texas Orocline and have been subjected to oroclinal bending. [ABSTRACT FROM AUTHOR]

Aim To explore and describe trends in the principal disorders/conditions ('cause') for severe sight impairment (SSI) (blind) and sight impairment (SI) ( partial sight) certification in children in England and Wales since 1999. Methods We obtained certification data for SI and SSI from a national database for all individuals aged 16 years or less at the time of certification in England and Wales for the years 1999/2000 and for the years 2007/2008-2009/2010. Results In total, there were 861 certifications in the year 1999/2000, rising to 1040 certifications in 2009/ 2010. The commonest single causes of SSI certification in 1999/2000 were cerebral visual impairment (23.2%) and optic nerve disorders (23.2%). The commonest single causes of SI certification in the same year comprised nystagmus (16.7%) and optic nerve disorders (15.5%). Cerebral visual impairment was the commonest single cause of SSI in children in England and Wales annually between 2007/2008 and 2009/2010 accounting for 21%-31% of certifications. The commonest causes of SI certification in 2009/2010 were congenital globe anomalies (18.4%) and retinal dystrophy (16.6%). The proportion of SI and SSI due to optic nerve disorders has decreased since 1999/2000. Conclusions Our findings suggest that in England and Wales, cerebral visual impairment is now the commonest cause of paediatric SSI certification and hereditary retinal dystrophy and congenital globe anomalies are the commonest causes of SI certification. [ABSTRACT FROM AUTHOR]

PurposeThe last complete report on causes of blindness in England and Wales was for the data collected during April 1999-March 2000. This study updates these figures, with data collected during April 2007-March 2008.MethodsIn England and Wales, registration for blindness and partial sight is initiated with certification by a consultant ophthalmologist with the consent of the patient. The main cause of visual impairment was ascertained where possible for all certificates completed during April 2007-March 2008 and a proportional comparison with 1999-2000 figures was made.ResultsWe received 23 185 Certificates of Vision Impairment (CVIs), of which 9823 were for severe sight impairment (blindness) (SSI) and 12 607 were for sight impairment (partial sight) (SI). These totals were considerably lower than the numbers certified in the year ending 31 March 2000. In 16.6% of CVIs, there were multiple causes of visual impairment as compared with 3% of BD8s in 2000. Degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) contributed to vision impairment in 12 746 newly certified blind or partially sighted.ConclusionsAMD is still by far the leading cause of certified visual loss in England and Wales. Proportional comparisons are hampered by the increasing use of multiple pathology as a main cause of visual impairment, which is believed to have arisen owing to the change in certificate used for data collection. These figures are not estimates of the total numbers newly blind in the UK because not all those entitled to certification are offered and or accept it, but they do nevertheless document the number of people who are deemed to be sufficiently sight impaired to warrant support and have been both offered and accepted it. This is usually the case when no further ophthalmic intervention is thought likely to be of benefit in terms of restoring or improving vision. [ABSTRACT FROM AUTHOR]

Purpose: To examine trends and demographic factors affecting persistence with ocular hypotensive therapy, from a period before prostaglandins were available to when they were the most common therapy. Methods: Computerised patient records from 94 general practices across the United Kingdom, identified 5670 registered patients newly prescribed an ocular hypotensive drug (1993-2005). Persistence was defined as continuing therapy without a 90-day gap in prescription for (i) any ocular hypotensive and (ii) initial monotherapy. Time to failure with the treatment was compared using proportional hazard analyses, adjusted for age, gender, practice, year of initial treatment, and a sociodemographic indicator. Study findings were set in the context of a review of the literature. Results: Percentage persistent at 1-year rose after 1997 when prostaglandins were introduced; from 61% in 1994-1996 to 70% in 2002-2004. Persistence with any treatment did not differ between those initiated on beta-blockers compared to prostaglandins (1.05, 95% CI 0.93-1.17). However, 20% of subjects initiated on beta-blockers received a prostaglandin by 1 year. Conversely, 8% of those initiated on prostaglandins received a beta-blocker. When failure with initial therapy was considered, beta-blockers appeared worse (1.35, 95% CI 1.21-1.50); this was consistent with findings from six studies in the review (1.40, 95% CI 1.34-1.46). Neither gender nor social factors were associated with persistence, but younger subjects (35-64 years) were significantly more likely to fail as were those over 85 years. Conclusions: Introduction of prostaglandins may explain an improvement in persistence over a decade. However, whether the higher cost of initiating patients on prostaglandins is justified remains questionable unless clinically indicated. [ABSTRACT FROM AUTHOR]

Background; Age related macular degeneration (AMD) causing visual impairment is common, in older people. `Previous studies hove identihed smoking as a risk factor for AMD. However, there' is limited' `information for the older population in Britain. Methods: Population `based cross sectional analytical study based in 49 practices selected to be representative of the population of Britain. Cases were people aged 75 years and above who were visually impaired (binocularacuily <6/18) as a result of AMD. Controls were people with normal vision (6/6:or `better). `Smoking history was ascertained using an interviewer administered' questionnaire. Results: After controlling for potentially confounding factors, current smokers were twice as likely to have AMD compared to non-smokers (odds ratio 2.15, 95% Cl 1.42 to 3.26). Ex- smokers were at intermediate risk `(odds. ratio 1.13, 0.86 to 1.47). People who stopped smoking more than 20 years previously were not at increased risk of AMD causing visual loss. Approximately 28000 cases of AMI) in older people in the'United Kingdom may be uttribUtable'to smoking. Conclusion: This is the largest study of the association of smoking ,and AMD in the British population. Smoking is associated' with a twofold increased risk of developing AMD). An increased risk of AMD, which is the most commonly occurring cause of blindness in `the United Kingdom, is yet another reason `for `people to: stop smoking and governments to develop public health campaigns against this hazard.,, [ABSTRACT FROM AUTHOR]

Aims: To assess the pattern of use of antimetabolites in trobeculectomy surgery by all consultant ophthalmologists in the United Kingdom. Methods: A postal questionnaire of 12 questions regarding antimetabolite use in trabeculectomy surgery was sent to all 749 consultant ophthalmologists in the United Kingdom. The consultants were asked to estimate the number of trabeculectomies they performed per year, how often they used 5- Huorouracil (5-FU) in primary and redo surgery, their usual method of administration of 5-FU, how often they used mitomycin (MMC) in primary and redo surgery, and their usual dosage regimen of MMC. Factors that influenced the decision to use or not use ontimetabolites were also assessed. Results: The response rate of consultants returning the questionnaire was 82% (615 out of 749); 87% (533) of these consultants perform trabeculectomy surgery. Of these 533 consultants, 98 (18%) never use an antimetabolite. Most consultants (82%) use antimetabolites, but use them infrequently (only 9% using antimetabolites in more than half their cases). The preferred antimetabolite is 5-FU rather than MMC. Of the 435 consultants performing trabeculectomy surgery and using antimetabolites, 402 (93%) use 5-FU and 179 (41%) use MMC. Various factors influenced the decision to use or not use an antimetabolite, but experience of complications associated with their use was a factor for 34% of consultants. Conclusion: The use of antimetabolites, particularly MMC, in the United Kingdom is much less than in America or Japan, where trabeculectomy with MMC is the surgical procedure preferred by glaucoma specialists. [ABSTRACT FROM AUTHOR]

BACKGROUND: Visual impairment and blindness are common in older people in Britain. It is important to know the causes of visual impairment to develop health service and research priorities. The authors aimed to identify the causes of visual impairment in people aged 75 years and older in Britain. METHODS: In the MRC Trial of the Assessment and Management of Older People in the Community, trial nurses tested visual acuity in everyone aged 75 years and older in 53 general practices. For all visually impaired patients in 49 of the 53 medical practices, data regarding the cause of vision loss were extracted from the general practice medical notes. Additional follow up questionnaires were also sent to the hospital ophthalmologist to confirm the cause of vision loss. Visual impairment was defined as a binocular acuity of less than 6/18. RESULTS: There were 1742 (12.5%) people visually impaired in the 49 participating practices. Of these, 450 (26%) achieved a pinhole visual acuity in either eye of 6/18 or better. In these people, the principal reason for visual loss was considered to be refractive error. The cause of visual loss was available for 976 (76%) of the remaining 1292 visually impaired people identified. The main cause of visual loss was age related macular degeneration (AMD); 52.9% (95% confidence interval 49.2 to 56.5) of people had AMD as a main or contributory cause. This was followed by cataract (35.9%), glaucoma (11.6%), myopic degeneration (4.2%), and diabetic eye disease (3.4%). CONCLUSIONS: A substantial proportion of visual impairment in our sample of older people in Britain can be attributed to remediable causes-refractive error and cataract. There is considerable potential for visual rehabilitation in this age group. For the large proportion with macular degeneration, low vision services will be important. [ABSTRACT FROM AUTHOR]

Aims: To measure the prevalence of visual impairment in a large representative sample of people aged 75 years and over participating in the MRC trial of assessment and management of older people in the community. Methods: 53 practices in the MRC general practice research framework. Data were obtained from 14 600 participants aged 75 years and older. Prevalence of visual impairment overall (binocular visual acuity <6/18) which was categorised separately into low vision (binocular visual acuity <6/18–3/60) or blindness (binocular visual acuity of <3/60). The prevalence of binocular acuity <6/12 was presented for comparison with other studies. Visual acuity was measured using Glasgow acuity charts; glasses, if worn, were not removed. Results: Visual acuity was available for 14 600 people out of 21 241 invited (69%). Among people with visual acuity data, 12.4% overall (1803) were visually impaired (95% confidence intervals 10.8% to 13.9%); 1501 (10.3%) were categorised as having low vision (8.7% to 11.8%), and 302 (2.1%) were blind (1.8% to 2.4%). At ages 75–79, 6.2% of the cohort were visually impaired (5.1% to 7.3%) with 36.9% at age 90+ (32.5% to 41.3%). At ages 75–79, 0.6% (0.4% to 0.8%) of the study population were blind, with 6.9% (4.8% to 9.0%) at age 90+. In multivariate regression, controlling for age, women had significant excess risk of visual impairment (odds ratio 1.43, 95% confidence interval 1.29 to 1.58). Overall, 19.9% of study participants had a binocular acuity of less than 6/12 (17.8% to 22.0%). Conclusion: The results from this large study show that visual impairment is common in the older population and that this risk increases rapidly with advancing age, especially for women. A relatively conservative measure of visual impairment was used. If visual impairment had been defined as visual acuity of <6/12 (American definition of visual impairment), the age specific prevalence estimates would have increased by 60%. [ABSTRACT FROM AUTHOR]

Aim: To examine the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular oedema (CMO) following cataract surgery. Methods: Systematic literature review of randomised con- trolled trials (RCTs) that evaluated the effects of NSAIDs in the treatment of CMO following cataract surgery was done according to the Cochrane Collaboration methodology. Results: Seven trials involving a total of 266 participants were included. Four trials studied the effects of NSAIDs in chronic CMO while the other three trials examined the effect of NSAIDs in acute CMO. Little evidence of effectiveness was found for oral indomethacin and topical fenoprofen for chronic CMO in two small trials. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in two trials. Three trials examined the effect of topical NSAIDs on acute CMO. The comparisons among these studies were of a NSAID to placebo, prednisolone or another NSAID. Because of considerable heterogeneity between these study designs, their results were not combined in a meta-analysis. Conclusion: A positive effect of topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) on chronic CMO was noted. However, there is not enough evidence to show the effectiveness of NSAIDs in acute CMO following cataract surgery. [ABSTRACT FROM AUTHOR]

This is a new column for reviews from the Cochrane Eyes and Vision Group (CEVG). Its main aim is to promote access to systematic reviews of all the interventions used to prevent or treat eye diseases. It is based at the London School of Hygiene & Tropical Medicine in London, UK, and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. [ABSTRACT FROM AUTHOR]

The authors reflect on the involvement of patients of eye disease or their so-called "consumers" in eye health research. The authors say that many governments as well as the World Health Organization (WHO) endorse patient and public involvement. Moreover, the authors relate that they give their patients significant information on the benefits and dangers of treatment, for the patients to have evidence-based choices.

The article questions the use of Beta-blocker eyedrops in treating glaucoma and questions the marketing practices behind the naming of fixed-combination eyedrops. Beta-blockers, especially when used with older patients who are prone to glaucoma, can lead to falls, hypotension, arrhythmia, syncope, and myocardial infarction. Combination based Beta-blockers are now in common use, but the concentration of beta-blocker timolol in combination therapies remains at a level that will likely cause negative side-effects. Two new combination products have names that do not indicate that they contain Beta-blockers, but both offer timolol in combination with bimatoprost or travoprost.

A response to a letter to the editor regarding the discrepancy in the certification and registration of patient with vision impairment in England and Wales.

Abstract: A deep crustal seismic reflection and magnetotelluric survey, conducted in 2007, established the architecture and geodynamic framework of north Queensland, Australia. Results based on the interpretation of the deep seismic data include the discovery of a major, west-dipping, Paleoproterozoic (or older) crustal boundary, considered to be an ancient suture zone, separating relatively nonreflective, thick crust of the Mount Isa Province from thinner, two layered crust to the east. Farther to the east, a second major crustal boundary also dips west or southwest, offsetting the Moho and extending below it, and is interpreted as a fossil subduction zone. Across the region, the lower crust is mostly highly reflective and is subdivided into three mappable seismic provinces, but they have not been tracked to the surface. In the east, the Greenvale and Charters Towers Provinces, part of the Thomson Orogen, have been mapped on the surface as two discrete provinces, but the seismic interpretation raises the possibility that these two provinces are continuous in the subsurface, and also extend northwards to beneath the Hodgkinson Province, originally forming part of an extensive Neoproterozoic–Cambrian passive margin. Continuation of the Thomson Orogen at depth beneath the Hodgkinson and Broken River Provinces suggests that these provinces (which formed in an oceanic environment, possibly as an accretionary wedge at a convergent margin) have been thrust westwards onto the older continental passive margin. The Tasman Line, originally defined to represent the eastern limit of Precambrian rocks in Australia, has a complicated geometry in three dimensions, which is related to regional deformational events during the Paleozoic. Overall, the seismic data show evidence for a continental margin with a long history (Paleoproterozoic to early Mesozoic) but showing only limited outward growth by crustal accretion, because of a repeated history of overthrust shortening during repeated phases of orogenesis. [Copyright &y& Elsevier]

PurposeThis study assessed the role of specialist optometrists who were working in the community and sharing the care for glaucoma patients with, and under close supervision of, a consultant ophthalmologist working in the Hospital Eye Services (HES) to ensure high-quality standards, safety, and care.MethodsFrom February 2005 onwards, the majority of all new glaucoma referrals to our eye department were diverted to our specialist optometrists in glaucoma (SOGs) in their own community practices. Selected patients in the HES setting who were already diagnosed with stable glaucoma were also transferred to the SOGs. The completed clinical finding details of the SOGs, including fundus photographs and Humphrey visual field tests, were scrutinised by the project lead.ResultsThis study included 1184 new patients seen by specialist optometrists between February 2005 and March 2007. A total of 32% of patients were referred on to the hospital, leaving the remaining 68% patients to be seen for at least their next consultation in the community by the SOGs. The following levels of disagreement were observed between SOGs and the project lead: on cup:disc ratio (11%), visual field interpretation (7%), diagnosis (12%), treatment plan (10%), and outcome (follow-up interval and location) (17%).ConclusionThis study indicates that there is potential for a significant increase in the role of primary care optometry in glaucoma management. The study also confirms a need for a significant element of supervision and advice from a glaucoma specialist. The important issue of cost effectiveness is yet to be confirmed. [ABSTRACT FROM AUTHOR]

PurposeTo examine trends and demographic factors affecting persistence with ocular hypotensive therapy, from a period before prostaglandins were available to when they were the most common therapy.MethodsComputerised patient records from 94 general practices across the Unitd Kingdom, identified 5670 registered patients newly prescribed an ocular hypotensive drug (1993–2005). Persistence was defined as continuing therapy without a 90-day gap in prescription for (i) any ocular hypotensive and (ii) initial monotherapy. Time to failure with the treatment was compared using proportional hazard analyses, adjusted for age, gender, practice, year of initial treatment, and a sociodemographic indicator. Study findings were set in the context of a review of the literature.ResultsPercentage persistent at 1-year rose after 1997 when prostaglandins were introduced; from 61% in 1994–1996 to 70% in 2002–2004. Persistence with any treatment did not differ between those initiated on β-blockers compared to prostaglandins (1.05, 95% CI 0.93–1.17). However, 20% of subjects initiated on β-blockers received a prostaglandin by 1 year. Conversely, 8% of those initiated on prostaglandins received a β-blocker. When failure with initial therapy was considered, β-blockers appeared worse (1.35, 95% CI 1.21–1.50); this was consistent with findings from six studies in the review (1.40, 95% CI 1.34–1.46). Neither gender nor social factors were associated with persistence, but younger subjects (35–64 years) were significantly more likely to fail as were those over 85 years.ConclusionsIntroduction of prostaglandins may explain an improvement in persistence over a decade. However, whether the higher cost of initiating patients on prostaglandins is justified remains questionable unless clinically indicated.Eye (2009) 23, 1098–1110; doi:10.1038/eye.2008.213; published online 11 July 2008 [ABSTRACT FROM AUTHOR]

Aims: To study trends in the prevalence of being treated for glaucoma and ocular hypertension from 1994 to 2003, and to examine factors determining treatment in 2002. Methods: Computerised data (the DIN-LINK database) from 131 general practices across the United Kingdom, in which half a million patients aged 40 years or more were registered annually, were used. On average 10 000 patients were treated for glaucoma and ocular hypertension annually. Results: Prevalence of being treated for glaucoma and ocular hypertension increased from 1.7% in 1994 to 2.3% in 2003. Those aged 85 years or more were 13 times (95% Cl 12.2 to 13.8) more likely to be treated than those aged 40–64 years. Men were more likely to be treated than women (OR 1.24, 95% Cl 1.19 to 1.28). Subjects ‘hard pressed’ were less likely to be treated than ‘wealthy achievers’ (OR 0.92, 95% CI 0.86 to 0.99). While use of topical 13 blocker only medications has declined since 1995, use of topical prostaglandins and combination therapies has increased. In 2003, use of prostaglandins overtook 13 blocker only medications. Conclusion: Prevalence of being treated for glaucoma has increased over time, and rises with age. Differences in treatment by sex and social status could be explained by use of or access to health care or by underlying prevalence of disease. Trends in treated glaucoma emphasise the shift from use of topical 13 blockers to newer therapies. [ABSTRACT FROM AUTHOR]

Purpose The Drusen Laser Study (DLS) of high-risk age-related maculopathy (ARM) is a randomised, controlled clinical trial designed to answer two questions: (1) Do drusen resolve after macular laser photocoagulation (2) Does macular laser photocoagulation prevent choroidal neovascularisation (CNV) in high-risk eyes? In this report, we present the results of the interim, pooled analysis of CNV prophylaxis for patients in the Unilateral Group of the DLS. Methods The DLS is a randomised controlled clinical trial of prophylactic macular photocoagulation for high-risk ARM. Patients in the Unilateral Group had a neovascular complication in the first eye; their fellow eye (Study Eye) had visual acuity of 6/12 or better and drusen. Following informed consent, patients were randomised to the Treatment Group or the No Treatment Group. Patients randomised to treatment received 12 light spots of argon laser photocoagulation to their Study Eye: four burns were placed 750 lm from the centre of the fovea at 12, 3, 6, and 9 o'clock, and the eight remaining burns were placed 1500 lm from the centre of the fovea at 12, 1:30, 3, 4:30, 6, 7:30, 9, and 10:30 o'clock. Drusen were treated directly only if they were present at the protocol treatment locations. All patients were followed in an identical fashion at regular intervals. Best-corrected visual acuity was measured and recorded by a masked observer. Fluorescein angiography was performed at baseline and yearly review, as well as nonprotocol visits if symptoms suggested CNV. Five clinical centres utilised and conformed to a common DLS protocol. Patient care and data collection methodologies were deemed sufficiently similar to permit a pooled data analysis. Results There were 156 patients included in the interim analysis, and timed information was available on 153. CNV occurred in 21 of 81 (26%) patients in the Treatment Group and in 13 of 75 (17%) patients in the No Treatment Group (P =0.19). Kaplan-Meier survival analysis... [ABSTRACT FROM AUTHOR]

Objectives To identify changes in referral and treatment patterns of neovascular age-related macular degeneration with photodynamic therapy (PDT) within ophthalmology units in NHS hospitals and assess how beliefs about what would constitute a worthwhile level of clinical benefit had altered over a 12-month period. Methods Two questionnaire surveys (October 2000 and October 2001) to all clinical directors or lead consultants in UK NHS eye units. These sought data on which (if any) patients were referred or treated with PDT and the threshold of clinical benefit, in terms of numbers needed to treat, at which they would support the use of PDT. Results Response rates were 82% in the first survey and 79% in the second. The availability of PDT had significantly increased (P =0.0001). The proportion of units routinely providing PDT for patients with more than 50% classic subfoveal choroidal neovascularization (CNV) increased from 8 to 23%. Between the 2 surveys, there was a significant reduction in the threshold of effectiveness at which respondents would support the use of PDT (P =0.012). The proportion of respondents requiring further evidence before supporting the use of PDT decreased from 33 to 17% (P =0.009). There was a significant association between the threshold of support and the level of service provision for both surveys (P =0.01). Conclusions Although substantial variations exist, availability of PDT has increased over the 12-month period. The differing thresholds at which introduction of PDT would be considered justifiable varied widely. PDT is being introduced into the NHS in a fragmented manner. In common with other new health technologies, factors other than the strength of evidence appear to be influencing beliefs about the effectiveness of PDT and its subsequent provision. While it is unlikely that such an action alone will lead to evidence-based practice, the variations in beliefs identified by this survey suggest that sufficient clinical... [ABSTRACT FROM AUTHOR]

The work has been presented at The Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Fort Lauterdale, Florida, May 1999.Purpose To evaluate inter- and intraobserver variability of the R/D score in assessing the iris configuration in Pigment Dispersion Syndrome patients.Methods Fifty-seven high-resolution ultrasound biomicroscopy images were obtained by a single ophthalmologist. All images were examined twice by each of three ophthalmologists, the second assessment being at least 2 weeks after the first. Each observer was masked to their colleagues’ and their previous measurements. R/D scores were calculated at each examination. Agreement between and amongst observers was assessed using Bland–Altman plots. In addition, the R/D scores were categorised and reassessed using the Kappa statistic.Results Intraobserver variability was small, the average differences between first and second scores of each observer being less than 0.01 units. Agreement within observers was 89% or higher, with Kappa values of 0.8 or higher, indicating almost perfect agreement. Interobserver variability was, however, greater. Although there was substantial agreement between two of the observers (87% agreement, first assessment; 80%, second assessment with respective kappa statistics of 0.78 and 0.66), they only moderately agreed with the other observer (kappa statistics between 0.55 and 0.68).Conclusions This study suggests that when using R/D scores to demonstrate changes in iris configuration, assessments should preferably be made by the same observer.Eye (2002) 16, 722–726. doi:10.1038/sj.eye.6700116 [ABSTRACT FROM AUTHOR]

Purpose This study was conducted in order to investigate the effect of accommodation on the iris morphology and iridolenticular contact, in eyes with Pigment Dispersion Syndrome and Pigmentary Glaucoma, using high-resolution ultrasound.Methods We performed a prospective observational study, examining a group of 30 Pigment Dispersion Syndrome and Pigmentary Glaucoma patients (49 eyes) and a smaller group of eight ‘normals’ non-Pigment Dispersion Syndrome patients (8 eyes). All patients underwent ultrasound biomicroscopy, before and during accommodation.ResultsThe iris profile before accommodation was found convex in 48.5%, flat in 19.7% and concave in 31.8%. Following accommodation the iris configuration remained unchanged in 66.2%, increased in concavity in 20.3% and decreased in concavity in 13.5%.Conclusion The effect of accommodation on iris configuration and accommodation is highly variable. From our experience the measurement of iris configuration using ultrasound biomicroscopy may not be a useful method of evaluating the effect of different treatments on iris configuration.Eye (2002) 16, 694–700. doi:10.1038/sj.eye.6700115 [ABSTRACT FROM AUTHOR]

BACKGROUND:/aims: Topical beta antagonists are prescribed for glaucoma in approximately 500 000 people in the United Kingdom. The authors have previously shown that topical beta antagonists are associated with an excess incidence of airways obstruction. They examined whether selective topical beta antagonists are associated with excess airways obstruction. METHODS: A historical cohort study was performed to determine the incidence of airways obstruction in subjects with no previous history of airways obstruction, following treatment with topical beta antagonists for glaucoma for the period 1993-7. Cases were defined as having received a first prescription of a drug specifically used in the management of airways obstruction. RESULTS: For selective topical beta antagonists 12 of 324 treated subjects developed airways obstruction, compared with 112 of 9094 controls (adjusted hazard rate 3.0 (95% confidence interval (95% CI) 1.6 to 5.4)). For non-selective topical beta antagonists, the corresponding figures were 69 of 2321 subjects compared with the same control group (adjusted hazard rate 2.2 (1.6 to 3.0)). There was no significant difference between groups (p = 0.47, chi(2)), both being associated with a significantly increased risk of airways obstruction. CONCLUSION: Selective topical beta antagonists do appear to have an excess risk of airways obstruction in this population setting and should be subject to the same prescribing caveats as unselective topical beta antagonists. [ABSTRACT FROM AUTHOR]

Aim: New therapies are often introduced into the NHS prior to full evaluation, leading to inequities in provision. Uncertainty exists regarding the value of photodynamic therapy in the treatment of neovascular age-related macular degeneration. We ascertained the availability of this treatment and the information used to inform clinical policy. Methods: A postal survey of all clinical directors/lead consultants in the UK sought data on which (if any) patients were referred or treated with PDT by their unit, the sources of evidence informing clinical policy and the threshold of clinical benefit at which respondents would support the use of PDT. Results: 123/152 questionnaires were returned. 42% of units make some provision for PDT on the NHS, including routine provision by 9%. 14.5% of units offer the option of care in the private sector, whilst 26.5% treated or referred no patients. The threshold at which respondents considered introduction of PDT would be justifiable varied widely. Respondents cited local literature review, advice from clinicians, guidance from the Royal College and information from the pharmaceutical industry as most influential in determining current policy. However, the National Institute for Clinical Excellence (NICE) and the Cochrane Library were anticipated as playing a greater role in shaping future practice. Conclusions: Substantial variation exists in the availability of PDT. Advocates of PDT may interpret our data as an indication of the NHS failing to provide an effective therapy equitably, whilst others may deduce that patients are receiving an under-evaluated treatment in routine clinical practice. The differing thresholds at which clinicians believe treatment would be justified may further exacerbate variations and the priority given to PDT. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a paper by M. Buckle et al where they assert that the limitations of certification data to estimate the true incidence of blindness and visual impairment have been demonstrated repeatedly. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Cost effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom using a decision-analytic health economic model" in the previous issue.