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We present a case of a man with hepatitis C with acute visual loss in his left eye over a 3-day period. Initial evaluation suggested a possible idiopathic orbital inflammatory syndrome as underlying cause for his symptoms. Initial response to systemic glucocorticoids and antiviral treatment were encouraging with improvement in the patient9s visual acuity. After a period of loss to follow up and discontinuation of treatment, the patient re-presented with visual loss in his left eye. Re-evaluation confirmed a diagnosis of marginal zone B-cell lymphoma. This case illustrates the importance of considering the various ocular manifestations of hepatitis C.

OBJECTIVES: To determine the positive predictive value (PPV) of disc haemorrhages (DHs) for the diagnosis of open angle glaucoma (OAG). METHODS: A retrospective review of 618 consecutive new referrals by community optometrists to a hospital glaucoma service, including 54 patients with DHs. All patients had a comprehensive eye examination. The primary outcome was whether the patient was diagnosed with OAG in either eye, with a secondary outcome of whether they were discharged at the first visit (first visit discharge rate, FVDR). RESULTS: 54 of 618 patients (8.7%) had a DH noted at the time of referral, including 21 referred with DH alone. 29 patients with DHs were diagnosed with OAG for a PPV of 54% (95% CI 40–67%), falling to 24% (95% CI 8–47%) in those with DH alone. The overall FVDR was 35%, increasing to 57% in those referred due to DH alone. The FVDR for those referred with DH alone was significantly higher than the FDVR of 25% among the 564 patients referred with suspected glaucoma without a DH (P = 0.001). The FVDR decreased to 35% for patients with a DH plus one other feature of glaucoma and to 0% for patients with a DH and at least two other features suggestive of glaucoma. CONCLUSIONS: Almost 60% of patients referred due to isolated DHs were discharged at the first visit to the glaucoma clinic, however almost one in four was diagnosed with OAG. Patients with DH and other features suggestive of glaucoma had a higher probability of glaucoma diagnosis.

AIM To examine the accuracy of referrals by community optometrists for suspected primary angle closure, including primary angle closure suspects, primary angle closure and primary angle closure glaucoma. METHODS A retrospective review of 769 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital in Scotland. Ninety-five of 715 eligible subjects (13%) were referred due to suspected angle closure. All subjects had a comprehensive eye examination in the glaucoma clinic, including gonioscopy, with angle closure defined according to the International Society of Geographical and Epidemiological Ophthalmology classification as iridotrabecular contact over at least 270 degrees. RESULTS Fifty-nine of 95 subjects referred due to suspected angle closure were confirmed to have an occludable angle, while 36 of 95 (38%) had open angles (positive predictive value = 62%). Of 620 patients referred to the glaucoma clinic for reasons other than narrow angles, 601 (97%) had open angles on gonioscopy and 19 (3%) had narrow angles. Using the 620 patients referred with 'open angles' as a control group, sensitivity was estimated as 76% and specificity 94%. Eleven of 95 (12%) patients referred for possible angle closure were discharged at the first visit compared to 156 of 620 (25%) referred to the glaucoma clinic for other reasons (p = 0.003). In a multivariable model, suspect angle closure detected by the optometrist (OR = 56.0, 95% CI 35.2-89.2, p

BackgroundSince the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs).AimTo assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists.MethodologyA retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October–November 2014 (group 1) and September–October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines.ResultsThree hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. (p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%).ConclusionPatients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria

PURPOSE: Corneal central thickness (CCT) is an important risk factor for glaucoma, which also influences intraocular pressure (IOP) measurements. Recently, all community optometrists in Scotland were provided with pachymeters. This study examined the accuracy of CCT measured by community optometrists compared to measurements in the glaucoma clinic. METHODS: A retrospective analysis of consecutive patients referred to the glaucoma clinic at a university hospital between June and November 2016. 142 of 715 (19.9%) patients had CCT measurements included in the referral, all of whom had repeat measurements in the glaucoma clinic. CCT was measured using the PachPen (Accutome Inc) which generates a CCT reading by automatically taking the average of up to 9 measurements. Measurements were compared using Bland-Altman analysis. RESULTS: CCT measured by community optometrists was slightly thicker than CCT in the glaucoma clinic (558.3 ± 41.5 vs. 552.6 ± 58.8 µm, P 20 µm, 40 (14.1%) by >30 µm and 17 (6.0%) by >50 µm. There was no significant relationship between difference in CCT and IOP (−0.02, 95% CI −0.05 to 0.002, P = 0.077), gender (0.00, 95%CI −0.01 to 0.01, P = 0.805), or age (−0.01, 95% CI −0.08 to 0.06, P = 0.791). CONCLUSIONS: There was good overall agreement between CCT measured by community optometrists and measurements obtained in the glaucoma clinic. The tendency for thicker CCT measurements by community optometrists may be due to more peripheral or non-perpendicular positioning of the pachymeter relative to the cornea.