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Background/objectives: To obtain a picture of the current status, training and governance for advanced practice and extended roles in the ophthalmic hospital non-medical workforce., Methods: A 10 question, quantitative survey was designed with multidisciplinary members of the UK Ophthalmology Alliance and sent to the membership to obtain information on expanded non-medical roles., Results: 34 of the 58 UKOA member hospitals responded (58% response rate). All responding units were using registered optometrists, orthoptists and nurses to undertake expanded outpatient roles and 28/34 (82%) had expanded roles for undertaking procedures. Some units had large numbers of staff undertaking these roles. There were noticeable trends for certain professional groups to undertake certain roles. For example, nurses were undertaking most procedures, apart from lasers which were mainly delivered by optometrists. Nurses had the lowest banding and optometrists the highest for apparently similar roles. Training was mostly in-house apprenticeship style although some formal external qualifications were undertaken., Conclusions: Ophthalmology is developing many innovative roles for the non-medical workforce and, with the launch of the OCCCF training, this is likely to increase. Terminology is confusing and a categorisation suitable for ophthalmology is proposed.

Reducing the burden of late-life morbidity requires an understanding of the mechanisms of ageing-related diseases (ARDs), defined as diseases that accumulate with increasing age. This has been hampered by the lack of formal criteria to identify ARDs. Here, we present a framework to identify ARDs using two complementary methods consisting of unsupervised machine learning and actuarial techniques, which we applied to electronic health records (EHRs) from 3,009,048 individuals in England using primary care data from the Clinical Practice Research Datalink (CPRD) linked to the Hospital Episode Statistics admitted patient care dataset between 1 April 2010 and 31 March 2015 (mean age 49.7 years (s.d. 18.6), 51% female, 70% white ethnicity). We grouped 278 high-burden diseases into nine main clusters according to their patterns of disease onset, using a hierarchical agglomerative clustering algorithm. Four of these clusters, encompassing 207 diseases spanning diverse organ systems and clinical specialties, had rates of disease onset that clearly increased with chronological age. However, the ages of onset for these four clusters were strikingly different, with median age of onset 82 years (IQR 82-83) for Cluster 1, 77 years (IQR 75-77) for Cluster 2, 69 years (IQR 66-71) for Cluster 3 and 57 years (IQR 54-59) for Cluster 4. Fitting to ageing-related actuarial models confirmed that the vast majority of these 207 diseases had a high probability of being ageing-related. Cardiovascular diseases and cancers were highly represented, while benign neoplastic, skin and psychiatric conditions were largely absent from the four ageing-related clusters. Our framework identifies and clusters ARDs and can form the basis for fundamental and translational research into ageing pathways.

Aniridia is a rare congenital disorder in which there is a variable degree of hypoplasia or the absence of iris tissue associated with multiple other ocular changes, some present from birth and some arising progressively over time. Most cases are associated with dominantly inherited mutations or deletions of the PAX6 gene. This article will review the clinical manifestations, the molecular basis including genotype-phenotype correlations, diagnostic approaches and management of aniridia.