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Background: Trichiasis surgery is believed to reduce the risk of losing vision from trachoma. There are limited data on the long term outcome of surgery and its effect on vision and corneal opacification. Similarly, the determinants of failure are not well understood. Methods: A cohort of people in the Gambia who had undergone surgery for trachomatous trichiasis 3–4 years earlier was re-assessed. They were examined clinically and the conjunctiva was sampled for Chlamydia trachomatis polymerase chain reaction (PCR) and general bacterial culture. Results: In total, 141/162 people were re-examined. Recurrent trichiasis was found in 89/214 (41.6%) operated eyes and 52 (24.3%) eyes had five or more lashes touching the globe. Corneal opacification improved in 36 of 78 previously affected eyes. There was a general deterioration in visual acuity between surgery and follow up, which was greater if new corneal opacification developed or trichiasis returned. Recurrent trichiasis was associated with severe conjunctival inflammation and bacterial infection. C trachomatis was detected in only one individual. Conclusions: Recurrent trichiasis following surgery is a common potentially sight threatening problem. Some improvement in the cornea can occur following surgery and the rate of visual loss tended to be less in those without recurrent trichiasis. The role of conjunctival inflammation and bacterial infection needs to be investigated further. Follow up of patients is advised to identify individuals needing additional surgical treatment.

Aim: To describe the distribution of cataract subtypes present before surgery among a defined population of older, bilaterally pseudophakic individuals. Methods: This was a cohort study of bilaterally pseudophakic individuals participating in the Salisbury Eye Evaluation (SEE), and their locally resident siblings. Subjects underwent slit lamp and retroillumination photography and grading using the Wilmer Cataract Grading System. For all individuals determined to be bilaterally pseudophakic, an attempt was made to determine for each eye the type(s) of cataract present before surgery, based on previous SEE photographs (for SEE participants) and/or medical records obtained from the operating ophthalmologist (for both SEE participants and their siblings). Results: The mean age of 223 participants providing data in this study was 78.7 (SD 5.2) years, 19.3% of subjects were black and 60.1% female. The most common surgically removed cataract subtype in this population was pure nuclear (43.5%), followed by nuclear combined with posterior subcapsular cataract (PSC) (20.6%), and nuclear combined with cortical (13.9%); less common types were pure cortical (4.9%), pure PSC (4.5%), and PSC combined with cortical (2.7%). Factors such as sex and source of lens data (study photograph versus clinical record) did not significantly affect the distribution of lens opacity types, while PSC was significantly (p = 0.01) more common among younger people and nuclear cataract was significantly (p = 0.001) more common among white compared to black people. Conclusion: Epidemiological studies have suggested that the different subtypes of cataract are associated with different risk factors. As studies begin to identify new prevention strategies for cataract, it would appear likely that different strategies will be efficacious against different types of cataract. In this setting, it will be helpful to know which cataract types are most frequently associated with surgery. Among this older, majority white population, nuclear cataract showed a clear predominance among individuals having undergone surgery in both eyes. This may be contrasted with both clinic and population based studies of younger people, which have generally found PSC cataract to predominate.

Chisholm and colleagues’ paper is important to policy makers,1 so serious errors in the trachoma analysis require correction.2 Firstly, “mass treatment with azithromycin” for trachoma was defined as azithromycin treatment for all children aged 1-10 years,3 whereas the World Health Organization recommends treatment of all residents. Secondly, data from a 1998-9 western Nepal trial were extrapolated to estimate effectiveness of mass treatment throughout sub-Saharan Africa and South East Asia. Thirdly, the …

Purpose Explore driving errors in older drivers and the subsequent decision to restrict or stop driving. Methods 1425 drivers aged 67–87, enrolled in a longitudinal study completed 5-day naturalistic driving assessment. Rate of failure to stop at red traffic lights, stop signs or safely execute left turns were modelled as predictors of stopping or restricting driving. Results 1237 (87%) completed 12-months, excluding those already restricting driving(n=35), 1.5% (18/1202) had stopped and 3.4% (41/1202) restricted their driving. Errors were observed in 32/1171 (2.7%) participants at red lights, 75/1155 (6.5%) at stop-signs, 88/1170 (7.5%) at left turns. The average failure rate per traffic light, stop sign and left turn was 0.2%, 2.2% and 0.4%, respectively. Police stopped 182 drivers during the year (15%), 81 were issued infringement notices (7%) and 34 were advised to stop or restrict driving (3%) however these factors were not predictive of incident driving change. Those with traffic light failures were more likely to stop or restrict their driving (adjusted OR 1.295; 95% CI 1.078 to 1.555 per per cent increase in failure rate). Failed stop sign (p=0.6) and left turns (p=0.4) were not predictive. Conclusions Driving errors were measured objectively in a large cohort of older drivers. While a rare event, red traffic light errors increased likelihood of subsequently restricting or ceasing driving. These findings lend support for self-regulation of driving exposure.