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Purpose To describe the Versatile Teaching Eye (VT Eye), a 3D-printed model eye designed to provide an affordable examination simulator, and to report the results of a pilot program introducing the VT Eye and an ophthalmic training curriculum at a teaching hospital in Ghana. Methods TinkerCAD was used to design the VT Eye, which was printed with ABS plastic. The design features an adapter that permits use of a smartphone as a digital fundus. We developed a set of digital flashcards allowing for an interactive review of a range of retinal pathologies. An analog fundus was developed for practicing traditional slit lamp and indirect examinations as well as retinal laser practice. The model was used for a period of 2 weeks by ophthalmic trainees at Komfo Anokye Teaching Hospital, Kumasi, Ghana, to practice indirect ophthalmoscopy, slit lamp biomicroscopy, smartphone funduscopy, and retinal image drawing. Results were assessed at by means of a pre-/post-training survey of 6 residents. Results The VT Eye accommodates diverse fundus examination techniques. Its 3D-printed design ensures cost-effective, high-quality replication. When paired with a 20 D practice examination lens, the digital fundus provides a comprehensive, interactive training environment for <$30.00 (USD). This device allows for indirect examination practice without requiring an indirect headset, which may increase the amount of available practice for trainees early in their careers. In the Ghana pilot program, the model's use in indirect examination training sessions significantly boosted residents' confidence in various examination techniques. Comparing pre- and post-session ratings, average reported confidence levels rose by 30% for acquiring clear views of the posterior pole, 42% for visualizing the periphery, and 141% for capturing important pathology using personal smartphones combined with a 20 D lens (all P < 0.05). Conclusions The VT Eye is readily reproducible and can be easily integrated into ophthalmic training curricula, even in regions with limited resources. It offers an effective and affordable training solution, underscoring its potential for global adoption and the benefits of incorporating innovative technologies in medical education. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ophthalmologists/Optometrists have a high incidence of neck pain. Little research has been conducted on specific equipment that predisposes these professionals to cervical discomfort. OBJECTIVE: Primary purpose: to determine if neck position is altered by slit lamp table design. Secondary purpose: to confirm the prevalence of neck pain in eye care professionals. METHODS: A survey of work-related pain was administered to 36 subjects (8 ophthalmologist, 2 optometrists, 26 technicians). The craniovertebral (CV) angle was measured in each subject in three separate positions (resting posture, best posture, slit lamp posture) between two different slit lamps/tables: slit lamp-deep and slit lamp-shallow. RESULTS: 79% of subjects reported neck pain in the last 6 months. The mean CV angle of all subjects at resting posture, best posture, and both slit lamp postures differed significantly. There was also a difference in CV angle between slit lamps. CONCLUSION: Neck pain is more prevalent in eye professionals than in the general population. The use of slit lamps promotes a forward head posture which decreases the CV angle, putting the user at risk for neck pain. By altering slit lamp table design, the CV angle of eye care professionals can be increased, reducing the risk for neck injury. [ABSTRACT FROM AUTHOR]

Ocular toxoplasmosis is the most common cause of retinochoroiditis worldwide in humans. Some studies highlighted the idea that ocular lesions differ according to the route of infection but none of them mimicked the natural route. The current study aimed to investigate the ophthalmic outcomes in congenital and oral routes of infection with Toxoplasma in experimental animals. Mice were divided into three groups; group I: congenital infection, group II: acquired oral infection and group III: non-infected. We used Me49 chronic low-virulence T. gondii strain. We found that retina is the most affected part in both modes of infections. However, the retinal changes are different and more pronounced in case of congenital infection. The congenitally infected mice showed retinal lesions e.g. total detachment of retinal pigment epithelium from the photoreceptor layer and irregular arrangement of retinal layers. More severe damage was observed in mice infected early in pregnancy. While the postnatal orally infected mice showed fewer changes. In conclusion, the routes of Toxoplasma infection affect the ophthalmic outcomes and this may be the case in human disease. Although both are vision threatening, it seems that the prognosis of postnatal acquired ocular toxoplasmosis is better than that of congenital disease. Although both are vision threatening, it appears that the prognosis of primary acquired ocular toxoplasmosis is better than that of congenital disease. Dalia S. Ashour, Abeer E. Saad, Reda H. Elbakary, Mohamed A. El Barody. [ABSTRACT FROM AUTHOR]

Background and Objective: Training of paramedical ophthalmic assistant (PMOA) for enucleation procedure will help to breach the gap of corneal deficit for eliminating corneal blindness. This study aims to assess the gains from skill based training for enucleation procedure. Methods: 33 paramedical ophthalmic assistants took enucleation training scheduled for 2 weeks at a teaching institute in South Gujarat. Training involved various teaching aids and practical sessions. Pretest and post tests were conducted through pretested questionnaire. Focus group discussion (FGD) was also done. Data were entered in MS Office Excel 2007. Results: Amongst 33 participants, 32 were above 45 years. Approximately 90% were male. Majority (73%) were posted at district/sub district hospitals. The paired pretest and post-test average scores were 68.13 and 81.25 respectively, difference being statistically significant (P =0.002163). There was significant improvement in knowledge regarding eye donation procedure, eye bank activities and importance of blood sampling. Areas where there was further scope of improvement were donor information collection, knowledge about prerequisites and contraindications of enucleation. FGD showed participants were satisfied with training; however surgical supervision was needed for initial cases before doing enucleation independently. Interpretation and Conclusion: The current training of enucleation procedure leads to skills and capacity building of health workers. This will pave the path to curb corneal blindness. [ABSTRACT FROM AUTHOR]

Sensitive, simple and accurate thin-layer chromatography (TLC) - densitometry method for simultaneous determination of brinzolamide (BRZ) and timolol maleate (TML) in their pharmaceutical formulations was developed and validated, where separation was occurred using a mobile phase composed of chloroform: methanol: ammonia (9:0.5:0.1 by volume) on silica gel 60 F254 plates, densitometric detection was done at 254 nm for brinzolamide and 298 nm for timolol. The calibration curves are linear over the concentration range of 3-16 μg/spot for BRZ and 4-14 μg/spot for TML. The obtained results were statistically compared with those obtained by the reported methods, showing no significant difference. The developed method was validated according to the ICH guidelines and was successfully applied for simultaneous determination of brinzolamide and timolol maleate in bulk drug and in their ophthalmic preparation. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to develop and validate an instrument to measure job satisfaction in eye-care personnel and assess the job satisfaction of one-year trained vision technicians in India.Methods: A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians' job satisfaction and factors such as age, gender and experience were analysed using t-test and one-way analysis of variance.Results: Rasch analysis confirmed that the 15-item job satisfaction in eye-care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non-financial incentives, salary and workload were the most important determinants of job satisfaction.Conclusions: The 15-item JSEP instrument is a valid instrument for assessing job satisfaction among eye-care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction. [ABSTRACT FROM AUTHOR]

Background: Blindness is defined by World Health Organisation as having a visual acuity of <3/60 in the better eye. Thirty-seven million people are blind worldwide. One million and four hundred thousand are children. The causes of blindness in children vary according to region and socioeconomic development. The aim of our study is to identify a range of potential issues relating to parental awareness and perceptions of common eye diseases affecting children. Materials and Methods: The type of study was population-based, prospective, cross-sectional study conducted on parents of 200 children ranging from 0 to 16 years of age, attending Paediatric Ophthalmology clinic during the month of August and September 2014. This was an open-ended questionnaire-based study and only the participants who consented were enrolled in the study. Results: The most common eye problem detected among 200 of children was refractive errors. The incidence of refractive errors was found to be 103 out of 200 (51.5%). This is followed by 71 (35.5%) cases of squint/strabismus. Of 200 parents, 150 (75%) think the present eye condition of their child will reduce the eyesight. However, they did not know about the nature of the eye problem. Forty-four (22%) parents did not know anything about the eye condition of their child. Seventy (35%) parents were apprehensive about the use of spectacles in the children suffering from refractive errors. One hundred and six (53%) parents came to know about the eye problem of their child from the teacher of the child and 63 (31.5%) parents got information from their family doctor. Conclusions: As the number of mothers attending the eye department with the child is high, so there is more need of educating the mothers about the eye conditions of the child. Education and socioeconomic conditions affect the knowledge and awareness level of the parents regarding eye problems. Most of the children attending outpatient department were found to be in the age group of 5-8 years. This may point toward factors like dietary deficiency of Vitamin A and other important nutrients. Commonest eye problem was of refractive errors among children. [ABSTRACT FROM AUTHOR]

Background: There is an extreme paucity of eye-care personnel and training facilities in developing countries. This study was designed to develop a comprehensive framework of competency standards for ophthalmic technicians and optometrists, in Mozambique. This could then inform the evolution of socially responsive curricula for both cadres.Methods: A modified Delphi technique was used with a ten member expert panel consisting of optometrists, ophthalmic technicians and ophthalmologists, all with experience of working in a developing country context. The competencies were derived from literature, primary research data and observations from a competency development workshop. The first round involved scoring the relevance of two frameworks, one for each cadre, using a nine-point Likert scale with a free-text option to modify any competency or suggest additional competencies. The revised frameworks were subjected to a second round of scoring and free-text comment. The final versions of the agreed frameworks were sent out to the relevant stakeholders.Results: There was a 100 per cent response to round 1 and an 89 per cent response to round 2. The final versions of the competency frameworks contained six competencies, 20 elements and 88 performance criteria for optometry and six competencies, 17 elements and 61 performance criteria for ophthalmic technicians.Conclusions: Application of a consensus methodology consisting of a modified Delphi technique with primary research data allowed the development of competency frameworks for ophthalmic technicians and optometrists. This will help to shape the development of curricula for both cadres and potentially could be replicated in other regions that wish to develop socially responsive education for eye-care professionals. [ABSTRACT FROM AUTHOR]

Background: There is paucity of data on the inter-observer agreement and diagnostic accuracy between a primary-care technician (vision technician) and an ophthalmologist. Hence, the current study was conducted to assess the accuracy of vision technicians, to screen potentially sight-threatening ocular conditions at rural vision centres of southern India and their agreement with an ophthalmologist.Methods: In July to August 2010, patients presenting to seven vision centres in Adilabad district (Andhra Pradesh) were selected and screened in a masked manner by seven vision technicians followed by an examination by a consultant ophthalmologist. Agreement was assessed between vision technicians and the ophthalmologist for screening of potential sight-threatening ocular conditions and decisions for referral. The ophthalmologist's findings were considered as the reference standard.Results: Two hundred and seventy-nine patients were enrolled at seven vision centres with a mean age of 32.9 ± 21.8 years. Agreement for screening of ocular pathology was 0.82 (95 per cent CI, 0.8-0.83). There was excellent agreement for cataract (0.97; 95 per cent CI, 0.93-1), refractive error (0.98; 95 per cent CI, 0.96-1), corneal pathology (1.0; 95 per cent CI, 1.0-1.0) and other anterior segment pathology (0.95; 95 per cent CI, 0.9-1); the agreement was moderate to fair for detection of glaucoma suspects (0.43; 95 per cent CI, 0.28-0.60) and retinal pathology (0.39; 95 per cent CI, 0.14-0.63). Sensitivity for screening of anterior segment pathology was 94.6-100 per cent. There was a fair to moderate sensitivity for glaucoma suspect; 35.6 per cent (95 per cent CI, 21.9-51.2) and retinal pathology 26.3 per cent (95 per cent CI, 9.2-51.2). Specificity for screening of ocular pathology was 98.2 to 100 per cent. The kappa (κ) agreement for referral for any pathology was 0.82 (0.8-0.83) CONCLUSION: As there is good agreement between the vision technicians and the ophthalmologist for screening and referral of anterior segment pathology but moderate to fair for glaucoma suspects and retinal pathology, vision technicians would be a good resource at the primary level to screen for anterior segment pathology; however, they may need further training to detect posterior segment pathology. [ABSTRACT FROM AUTHOR]

Infections associated with the use of intraocular, periocular, or orbital implants are associated with an increase in both morbidity and in the costs of ophthalmological surgery. This is due to an increased number of visits and the need for additional treatments, at a time when some conventional therapies are losing their efficacy, or even hospitalization. To avoid such consequences, the first step should be to prevent the biomaterials that form implants from being colonized by various microorganisms, either intraoperatively or postoperatively. To this end, several lines of research have emerged that aim at equipping implants with antimicrobial properties, some of which are described in this review. [ABSTRACT FROM AUTHOR]

Why is allergic eye disease a problem for eye workers?Why is allergic eye disease, and vernal keratoconjunctivitis (VKC) in particular, a problem for eye workers and patients in hot climates?

The red eye forms a big proportion of the eye problems seen in most eye clinics in developing countries. For example, in the Bawku Hospital eye unit, Ghana, in 2004 a total of 21,391 patients were seen as outpatients, out of which 8,931 were red eyes of one type or another, representing over 40% of the total number of patients screened.

Objective: To compare participants’ responses to Web-based and paper-and-pencil versions of an ophthalmic, patient-reported outcome (PRO) questionnaire. Design: Questionnaire development. Participants: Matched subjects with ocular surface disease (OSD) (n = 68) and without OSD (controls, n = 50). Methods: Subjects completed a standard, paper-and-pencil and a Web-based version of the same questionnaire in randomized order. The administered questionnaire included several ophthalmic PRO subscales: the National Eye Institute’s (NEI’s) Refractive Error Quality of Life Instrument’s Clarity of Vision, Near Vision, Far Vision, Glare, Symptoms, Worry, and Satisfaction with Correction subscales; the Ocular Surface Disease Index’s (OSDI’s) Symptoms subscale; and the NEI’s Visual Function Questionnaire’s Driving subscale. Possible scores for each subscale ranged from 0 (no difficulty) to 100 (most difficulty). Agreement of subscale scores between modes of administration was assessed using the Bland–Altman approach and multivariable logistic regression. Main Outcome Measures: Subscale scores and an unweighted average total score for each mode of administration. Results: Mean differences in scores between modes of administration ranged from −2.1 to +2.3 units. Although no differences were found to be statistically significant, the Worry and Satisfaction with Correction subscales approached statistical significance (P = 0.07 and 0.08, respectively). Although most subscale mean differences in score did not differ significantly by gender, age (≥40 vs. <40 years), disease status (OSD vs. control), order of administration, or time between completion of the questionnaires, women had slightly greater score differences than men for the Driving (P = 0.04) and Clarity of Vision (P = 0.03) subscales; those with OSD had greater score differences for Clarity of Vision than did controls (P = 0.0006); and those aged ≥40 years had slightly greater differences in OSDI Symptoms subscale than those aged <40 years (P = 0.04). Conclusions: To our knowledge, this Food and Drug Administration and NEI collaboration is the first study to evaluate the equivalence of Web-based and paper versions of ophthalmic PRO questionnaires. We found no evidence of clinically significant differences between scores obtained by the 2 modes for any of the examined subscales. A Web-based instrument should yield scores equivalent to those obtained by standard methods, providing a useful tool that may facilitate ophthalmic innovation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

AimTo assess whether ophthalmic assistants are effective in screening people for glaucoma in India.MethodologyThe study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias.ResultsIn the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k=0.7, 95% confidence interval (CI)=0.54-0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI=91.4-97.7%) but lower for specificity at 71.4% (95% CI=60.0-78.7%).In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k=0.50, 95% CI=0.37-0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI=69.7-91.5%) but lower for specificity at 76.8% (95% CI=72.7-79.5%).ConclusionOphthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community. [ABSTRACT FROM AUTHOR]

A bstract Background: Preoperative presenting visual acuity (PPVA) is not a commonly reported indicator for the delivery of cataract services. This study aimed to evaluate the PPVA of patients undergoing cataract surgery in rural and urban areas of Nepal. Design: A prospective, non-interventional study conducted from October 2007 to March 2008 in a tertiary hospital and outreach clinics of Nepal. Participants: A total of 3023 consecutive subjects from urban and rural settings (1323 from the tertiary hospital and1700 from outreach clinics) with cataract were included. Methods: Visual acuity was tested with a Snellen E-chart at 6 m by ophthalmic assistants. All Outreach Microsurgical Eye Clinic patients were examined by either ophthalmologists or senior ophthalmic assistants. Patients at the Tertiary Eye Care Centre were examined only by ophthalmologists. Main Outcome Measures: Preoperative presenting visual acuity of patients undergoing cataract surgery was measured in both the settings. Results: The sex ratio was 0.96 (male/female). Based on PPVA, 11.5% of patients operated were blind (PPVA < 3/60 in the better eye). The proportion of blind people operated was similar in rural (11.4%) to urban (11.6%) areas. The proportion of blind eyes operated was higher in rural (50.7%) compared to urban (38.9%) areas. Conclusion: Despite a comparatively high volume of cataract surgery carried out in Nepal every year, only about one in eight patients operated for cataract in the sample population was blind. PPVA is an important indicator for the progress towards eliminating cataract blindness. [ABSTRACT FROM AUTHOR]

The aim of the present work is to identify, by means of mathematical modelling, effective strategies to keep vancomycin (a glycopeptide antibiotic) at the desired therapeutical concentration in the aqueous humour of the eye for the necessary period of time. Controlled release from polycaprolactone (PCL) microcapsules is here proposed since it represents a continuous release process, that is described by means of a mathematical model. The diffusion of the active principle from the microcapsules is modelled both considering a unique class of particles characterised by average properties and the real particle distribution; the diffusivity of the drug is not given as a numerical input but is modelled considering its movement among the empty spaces of the polymeric chains of the coating. At first a simple in vitro release process, in an aqueous solution, without the degradation of the active principle, is considered and through a comparison with experimental release data the diffusivity of vancomycin within the coating is determined. Then, after acquiring this information on the transport properties of vancomycin, the in vivo model of practical interest is considered: it describes the accumulation of the drug, released by the microcapsules, in the aqueous humour of the eye, where it undergoes degradation. The temporal curve of drug concentration is obtained for different investigated conditions and qualitative and quantitative suggestions are given for this ophthalmic therapy. [ABSTRACT FROM AUTHOR]

Abstract Ophthalmic nurses at Sydney Hospital Sydney Eye Hospital aimed to assess and evaluate the knowledge and resulting behaviours of patients using eye drop therapy for glaucoma and the effect that using interpreters or English speaking family members had on patients' understanding and compliance. Non-compliance is known to lead to progression of the disease with resulting loss of vision. The study showed that patients undergoing long-term therapy for glaucoma have areas of non-compliance that may not be apparent to staff who see them in a clinic setting. It also showed that ineffectual use or missed doses of eye drops occur in both male and female groups, young and older groups and those from non-English and English speaking backgrounds. This is in spite of the same patients' assurances that they have received clear instructions. It has been shown that the use of interpreters or English speaking family members has not affected compliance. This study has shown that even patients who have been on therapy for over 12 months are likely to benefit from continuing education and reinforcement of good technique. Poor understanding of glaucoma in the over 65 age group was not associated with a higher rate of non-compliance. Acknowledgements The authors thank Nick Marosszeky for assistance with data analysis and staff of Sydney Hospital Sydney Eye Hospital Eye Outpatients Department for their comments. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To determine the adherence to recommended glycemic and blood pressure levels in patients with diabetic retinopathy (DR). Methods: A retrospective study in a tertiary eye clinic in Melbourne, Australia. Data pertaining to blood pressure (BP) and glycosylated hemoglobin (HbA1c) level were extracted from charts over a 3-month period. Optimal HbA1c was defined as levels <7%, and optimal BP control was defined as systolic/diastolic <130/80mmHg. Results: Of the 483 patients with DR in this study, only 54% (259/482) had a recorded HbA1c measurement. Of these, only 14% (36/259) had an optimal HbA1c level. Patients with longer diabetes duration were less likely to attain optimal HbA1c levels (age and gender adjusted odds ratio (OR) 0.23; 95% confidence intervals (CIs) 0.08–0.71 for diabetes duration 11–19 years, and OR 0.18%, 95% CI 0.06–0.58 for duration >20 years versus ≤5 years). Optimal BP control was attained in only 18% (86/483) and was associated with younger age (OR 0.98; 95% CI 0.96–0.99, per year increase in age). Conclusion: Adherence to clinical guidelines for glycemic and BP control in patients with DR was low, even in a well-developed healthcare system with free ophthalmic care access. [Copyright &y& Elsevier]

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Purpose. To determine the ocular pharmacokinetics of cyclosporin A after topical ophthalmic administration. Methods. Radiolabled cyclosporin A in either a castor oil-in-water emulsion or a corn oil ointment was applied to the eyes of beagle dogs or albino rabbits using the following paradigms: (i) single doses of 0.2% emulsion to rabbits and dogs, (ii) single doses of 0.05%, 0.2%, or 0.4% emulsion to rabbits, (iii) multiple doses of 0.2% emulsion to dogs, (iv) single and multiple doses of 0.2% ointment to rabbits. The distribution of cyclosporin A was determined by measuring the distribution of radio-activity. Results. After a single dose, cyclosporin A was rapidly absorbed into the conjunctiva (Cmax: dogs, 1490 ng/g; rabbits, 1340 ng/g) and cornea (Cmax: dogs, 311 ng/g; rabbits, 955 ng/g). High concentrations (>300 ng/g) could be detected in the cornea up to 96 hours post-dose. Lower concentrations were found in the intraocular tissues, and systemic absorption was minimal. After multiple doses, there was some accumulation in the cornea, lens, lacrimal gland, and iris-cilliary body, but limited accumulation in the conjunctiva and sclera. Ocular tissue concentrations of cyclosporin A increased with increasing dose concentration; proportionally in lacrimal gland and intraocular tissues; less than proportionally in conjunctiva and cornea. The pharmacokinetic profile of the cyclosporin A corn oil ointment was similar to that of the emulsion. Conclusions. Topical ophthalmic cyclosporin A penetrated into extraocular tissues at concentrations adequate for local immunomodulation while penetration into intraocular tissues was much less and absorption into the blood was minimal. [ABSTRACT FROM AUTHOR]

Over recent years the British Government has pursued a policy encouraging the integration of primary and secondary health care. This drive to promote the efficient delivery of primary care at local centres has seen the forging of co-operative alliances between various healthcare practitioners. A notable development has been the growth of optometric practice-based schemes for monitoring the eyecare of diabetic patients. This paper reports on the first twelve months operation (April 1995-March 1996, inclusive) of such a 'collaborative care' scheme operating in the Kettering Health Area of Northamptonshire. With the co-operation of their general medical practitioner (GMP) and under the case-review of the hospital-based specialist, diabetic patients attended participating optometric practices for an annual sight test and eye examination including mandatory fundus assessment under mydriasis. A brief 'ticked menu' report was subsequently forwarded to the patient's GMP for filing or action as necessary. A copy was also sent to the hospital clinic to enable updating of the diabetic patient database and for the authorisation of the supplementary fee payable to the examining optometrist. An audit of the first year of operation has indicated that those 92% of optometrists in the locality who participated in the programme logged 34% of the projected diabetic population of the Kettering Health Area. Of these individuals, 10.8% were identified as requiring referral for ophthalmological assessment including 0.7% who needed urgent intervention. Approximately 80% of the referrals were assessed in the Ophthalmology Clinic within the twelve month timeframe of this first year audit: one-third of these patients received treatment and/or a second review over this period, the net outcome being that one-half of the original referrals were returned to the programmer for continued routine annual screening. [ABSTRACT FROM AUTHOR]

The study of the predictive value of a single set of vital signs by Tierney et al is generating an enlightening back-and-forth discussion between readers and the author. A new technology reported by Gill et al in the last "Annals" showed the possibility that a new ophthalmoscope could be used for primary care patients at high risk for not being screened. The ensuing TRACK discussion presents a strong rationale from readers and the author for selectively using a nonmydriatic scope to screen for retinopathy in diabetic patients who do not or cannot have examinations by an ophthalmologist.

Editorial. Focuses on the role of clinician-scientists in ophthalmology. Job description; Possession of training and skills to ensure that human subject protocols are appropriately designed and evaluated; Role of clinician-scientists as educators; Suggestions for enhancing the viability of the clinician-scientists in ophthalmology.