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Objective To search for and critically appraise the psychometric quality of patient-reported outcome measures (PROMs) developed or validated in optic neuritis, in order to support high-quality research and care. Methods We systematically searched MEDLINE(Ovid), Embase(Ovid), PsycINFO(Ovid) and CINAHLPlus(EBSCO), and additional grey literature to November 2021, to identify PROM development or validation studies applicable to optic neuritis associated with any systemic or neurologic disease in adults. We included instruments developed using classic test theory or Rasch analysis approaches. We used established quality criteria to assess content development, validity, reliability, and responsiveness, grading multiple domains from A (high quality) to C (low quality). Results From 3142 screened abstracts we identified five PROM instruments potentially applicable to optic neuritis: three differing versions of the National Eye Institute (NEI)-Visual Function Questionnaire (VFQ): the 51-item VFQ; the 25-item VFQ and a 10-item neuro-ophthalmology supplement; and the Impact of Visual Impairment Scale (IVIS), a constituent of the Multiple Sclerosis Quality of Life Inventory (MSQLI) handbook, derived from the Functional Assessment of Multiple Sclerosis (FAMS). Psychometric appraisal revealed the NEI-VFQ-51 and 10-item neuro module had some relevant content development but weak psychometric development, and the FAMS had stronger psychometric development using Rasch Analysis, but was only somewhat relevant to optic neuritis. We identified no content or psychometric development for IVIS. Conclusion There is unmet need for a PROM with strong content and psychometric development applicable to optic neuritis for use in virtual care pathways and clinical trials to support drug marketing authorisation.

To primarily report the baseline characteristics and visual acuity (VA) outcomes of advanced nurse practitioners (ANP) compared to ophthalmologists following YAG posterior capsulotomy (YAGPC). We secondarily looked to characterise the risk factors that lead to a repeated YAGPC.Retrospective consecutive case series of 6,308 eyes attending the Birmingham and Midlands Eye Centre.ANPs performed 33.1% of YAGPC compared to 66.9% ophthalmologists. Compared to ophthalmologists, ANPs performed YAGPC in lower proportion of patients with ocular co-morbidities (p 0.001) and had lower proportion of patients requiring further YAGPC compared to ophthalmologists (p 0.001). Median pre, post-operative and LogMAR gain in VA of 0.48 (IQR 0.30-0.78), 0.18 (IQR 0.10-0.40) and 0.30 (0.08-0.48) LogMAR units, respectively. Multivariate regression showed that ANPs had a significantly lower rate of repeat YAGPC compared to ophthalmologists even when adjusting for age, ethnicity, training grade and ocular co-morbidities. No difference in visual outcomes was found between operator grade and ethnicity on multivariate analysis.YAGPC leads to excellent visual outcomes. ANPs can deliver safe and effective YAGPC.

To primarily measure the visual acuity (VA) outcomes and, secondarily, the baseline characteristics and complication rate of YAG anterior capsulotomy (AC, YAGAC) compared to surgical anterior capsulectomy in patients with anterior capsular contraction syndrome. Retrospective consecutive case series attending the Birmingham and Midlands Eye Centre. A total of 141 eyes were included (YAGAC: 108 and surgical AC: 33). The surgical AC group had a higher proportion of uveitis than the YAGAC group (eight [24.2%] and two [1.9%] respectively, p

Patient reported outcome measures (PROMs) capture impact of disease and treatment on quality of life, and have an emerging role in clinical trial outcome measurement. This study included a systematic review and quality appraisal of PROMs developed or validated for use in adults with uveitis or scleritis. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and grey literature sources, to 5 November 2021. We used established quality criteria to grade each PROM instrument in multiple domains from A (high quality) to C (low quality), and assessed content development, validity, reliability and responsiveness. For instruments developed using classic test theory-based psychometric approaches, we assessed acceptability, item targeting and internal consistency. For instruments developed using Item Response Theory (IRT) (e.g. Rasch analysis), we assessed response categories, dimensionality, measurement precision, item fit statistics, differential item functioning and targeting. We identified and appraised four instruments applicable to certain uveitis types, but none for scleritis. Specifically, the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ), a 3-part PROM for Birdshot retinochoroiditis (Birdshot Disease & Medication Symptoms Questionnaire [BD&MSQ], the quality of life (QoL) impact of Birdshot Chorioretinopathy [QoL BCR], and the QoL impact of BCR medication [QoL Meds], the Kings Sarcoidosis Questionnaire (KSQ), and a PROM for cytomegalovirus retinitis. These instruments had limited coverage for these heterogeneous conditions, with a focus on very rare subtypes. Psychometric appraisal revealed considerable variability between instruments, limited content development, and only one developed using Item Response Theory. In conclusion, there are few validated PROMs for patients with uveitis and none for scleritis, and existing instruments have suboptimal psychometric performance. We articulate why we do not recommend their inclusion as clinical trial outcome measures for drug licensing purposes, and highlight an unmet need for PROMs applicable to uveitis and scleritis.

Material can be deposited in the cornea as a result of a wide range of systemic and ophthalmic diseases, as well as local and systemic therapies. Causes include local infection or trauma, systemic malignancy, a wide range of medications and a host of genetic and metabolic diseases. Some of these can be acutely life threatening, so generalists caring for both children and adults should have a basic awareness of the pattern and distribution of corneal deposits to facilitate timely diagnosis, investigation, management or onward referral to avoid significant morbidity or mortality. This article outlines causes of corneal deposits found in patients presenting to primary care, ophthalmic clinics or encountered on the wards to help generalists avoid missing serious pathology. It also provides insight into the natural history of underlying causative conditions and their possible treatments.

*Correspondence, Jesse Panthagani: j.panthagani@bham.ac.uk OBJECTIVE: Ocular Mucous Membrane Pemphigoid (OcMMP) is a rare disease characterised by chronic autoimmune-driven conjunctival inflammation leading to progressive scarring, and blinding sequelae. The purpose of this study was to characterise the conjunctival gene 'fingerprint' involved in the fibrosis signalling pathways in the pathogenesis of OcMMP.Ocular surface gene expression studies were undertaken on conjunctival swabs from OcMMP and age-matched control patients. The NanoString nCounter Human Fibrosis panel (NanoString Technologies Inc.) quantified RNA expression from 770 genes. Differentially expressed genes (DEG) and pathway analysis were determined using HyperScale architecture designed by ROSALIND, Inc. with normalisation, fold changes (≥+1.5-fold or ≤-1.5-fold) and p-values adjustment (0.05) using the Benjamini-Hochberg method. Significantly identified genes were aligned to the aldehyde dehydrogenase (ALDH)/retinoic acid fibroblast autoregulation conjunctival scarring signalling pathway, known to be central to immune-mediated mucosal scarring in OcMMP.6 OcMMP patients (8 eyes, mean age 76.5 (±7.0 SD) years, 6 (66%) male, 3 (50%) biopsy-positive) and 8 age-matched cataract patients (15 eyes; age 73.1 (±9.3) years, 3 (37%) male), serving as controls were analysed. Ninety-three DEGs were observed between OcMMP and controls (48 upregulated and 45 downregulated). Of these, the top 10 upregulated DEGs were COL3A1, COL1A1, FN1, TPSAB1/B2, THBS1, SERPINE1, SPP1, COL5A1, OASL and IL1B. 44 pathways that had a global significance score greater or equal to 2, the most significant representing extracellular matrix (ECM) remodelling, synthesis, and degradation.The conjunctival genetic 'fingerprint' predominantly suggests an activated fibroblastic phenotype in the OcMMP patients and could represent (i) novel targets for drug discovery and (ii) surrogate outcomes/novel biomarkers for the monitoring of disease progression.

Background/Objectives To describe the visual and clinical outcomes of patients with post endothelial keratoplasty (EK) cystoid macular oedema (CMO) refractory to topical treatment with intravitreal sustained-release dexamethasone implant (Ozurdex). Subjects/Methods 131 eyes from 111 patients undergoing solitary or combined EK (52 DSAEK (40.0%) and 79 DMEK (60.0%)) at Southend University Hospital between January 2020 and February 2022 with a minimum follow-up of 6 months were evaluated. Patients suspected of having CMO underwent spectral-domain macular optical coherence tomography (SD-OCT) Patients with diabetes were not included in this series. Results CMO was identified in 5.3% (n = 7) of cases, with 2 of these patients responding to topical corticosteroid treatment. The remaining 5 patients underwent intravitreal dexamethasone implant, with 1 patient requiring repeat implant due to CMO recurrence. All presented within 2 months postoperatively. 4 out of 5 eyes treated with intravitreal dexamethasone achieved a Snellen BCVA ≤6/9.5. 1 patient had an uncontrolled rise in intraocular pressure (IOP) despite maximal medical treatment requiring an urgent PreserFlo Ab-Externo MicroShunt. Conclusions The use of intravitreal sustained-release dexamethasone implant in the management of post EK CMO refractory to topical therapy is effective and safe in most cases, but patients should be monitored and treated promptly for any secondary IOP response.

Anterior capsular contraction syndrome (ACCS) describes the progressive fibrotic phimosis of the anterior capsular bag that usually occurs a few months after cataract surgery. YAG laser anterior capsulotomy (YAGAC) is the most common treatment option due to the low-risk profile of this intervention.In this series, we evaluated the outcomes of an advanced nurse practitioner (ANP) in conducting this laser intervention, comparing the results with those of ophthalmologists.Our study represents a single-centre, retrospective, continuous case series of 108 eyes that underwent YAGAC due to ACCS between January 2017 and July 2020 at the Birmingham and Midland Eye Centre, the second largest tertiary referral centre in the United Kingdom.The groups treated by ANPs and ophthalmologists were similar in respect to age, gender, and laterality of the laser procedure. Eyes treated by ophthalmologists had significantly more ocular comorbidities (p.001), the most common of which was glaucoma. Although the complication rate was higher in the ophthalmologist group, it did not reach statistical significance. However, there was a trend toward significance in the retreatment rate, with 8.6% (7/81) of eyes lasered by ophthalmologists requiring further YAGAC, and no repeat procedure was needed in the ANP group.YAGAC leads to good visual outcomes and a low complication rate in both ophthalmologist and ANP groups.Advanced nurse practitioners can deliver results that are comparable with those of experienced ophthalmologists.

Nystagmus is the repetitive to and fro movement of the eyes, which may be physiological or pathological. The movements can be horizontal, vertical, torsional or a combination of these movements. It starts by a slow movement of the eye away from the visual target. The second movement brings the eye back to the visual target. If this second movement is quick, the nystagmus is called jerk nystagmus. If the second movement is slow, the nystagmus is said to be pendular. Maintaining steady gaze is dependent upon visual fixation, the vestibulo-ocular reflex and the gaze-holding neural integrator system. Pathological nystagmus typically presents with the symptom of oscillopsia, which is the illusory movement of the surrounding environment. Nystagmus that develops outside of early infancy is termed acquired nystagmus. There may be serious underlying pathology that will require further investigation and management. This article reviews the terminology, pathophysiology, causes and treatment of acquired nystagmus.

Objective This study aims to evaluate the quality and readability of online resources on keratoconus treatment. Methods A Google.com search was conducted on August 9, 2020; 32 web sites were selected for analysis. Popularity was assessed by Google and Alexa rank. The quality of web sites was analyzed using the quality criteria for consumer health information (DISCERN) tool, the Journal of the American Medical Association (JAMA) benchmark, and the Health On the Net Code of Conduct Certification (HONcode). The readability of the web sites was assessed using the Fleschwebr hea Reading Ease, the Automated Readability Index, and the Fleschted Readability Results The JAMA benchmark scores, unlike the DISCERN scores, were correlated with the Google and Alexa rank. One web site (3.1%) met all the JAMA benchmark criteria, and 3 (9.3%) others had HONcode certification. The median DISCERN score was 33 (range, 29.6–43.1; maximum possible, 80). Rnib.org.uk scored the highest at 57 (71.0%). The mean Flesch–Kincaid Reading Ease score (52.9 ± 7.1) corresponded to uk" n DIdifficult to read.” Thirty-one web sites (96.8%) had a Flesch–Kincaid Grade higher than the American Medical Association recommendation of sixth grade level. The median Automated Readability Index score was 7 (range, 6.2–7.3). Conclusion The majority of online information currently available on keratoconus treatment is complex and highly variable. Rnib.org.uk is the best currently available source. Clinicians should inform patients on how to assess the credibility of online information and recommend suitable information sources.

Facial nerve palsy is a rare but known complication of dental local anaesthesia and may be underreported. We describe a case of a transient facial nerve palsy following the administration of an inferior alveolar nerve block and discuss the immediate practical management. Knowing the likely transient nature of this complication means the patient can be reassured and unnecessary referral avoided. While the blink reflex is inhibited, steps are needed in order to protect the cornea and prevent secondary infection and scarring.