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IntroductionAmblyopia is an important public health concern associated with functional vision loss and detrimental impact on the physical and mental well-being of children. The gold standard for diagnosis of amblyogenic conditions currently involves screening by orthoptists and/or ophthalmologists. The bloom of technology enables the use of home-based screening tools to detect these conditions at an early stage by the layperson in community, which could reduce the burden of screening in the community, especially during restrictions associated with the COVID-19 pandemic. Here, we propose a systematic review aiming to evaluate the accuracy and reliability of home-based screening tools compared with the existing gold standard.Methods and analysisWe aim to search for studies involving home-based screening tools for amblyopia among children aged under 18 years. Oxford Centre for Evidence-Based Medicine Level 4 evidence and above will be included, without language or time restrictions. The following platforms will be searched from inception to 31 August 2021: PubMed, Medline, The Cochrane Library, Embase, Web of Science Core Collection and Clinicaltrials.gov. Two independent reviewers will identify studies for inclusion based on a screening questionnaire. The search and screening will start on 14 August 2021 until 1 October 2021. We aim to complete our data analysis by 30 November 2021. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic accuracy studies only. Our primary outcome measure is the diagnostic accuracy of home-based screening tools, while secondary outcome measures include validity, feasibility, reproducibility and cost-effectiveness, where available.Ethics and disseminationEthical approval is not necessary as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication.PROSPERO registration numberCRD42021233511.

Importance Knowledge on the frequency and severity of complications in surgical trials for rhegmatogenous retinal detachment (RRD) is essential to determine whether surgical procedures are developed and compared adequately, taking into account not only efficacy but also harms. Objective To review standards of reporting of complications in recent randomized clinical trials of RRD surgery. Evidence review This systematic review included randomized clinical trials on RRD surgery published between January 2008 and January 2021 in Embase, MEDLINE, and Web of Science Core Collection databases. Titles, abstracts, and full-text articles retrieved were reviewed for eligibility by 2 independent authors. Eligible studies were evaluated against checklist items from the Consolidated Standards of Reporting Trials Extension for Harms criteria by 2 independent authors, and discrepancies were resolved by discussion with a third author. Findings Fifty studies were included. The median number of checklist items fulfilled was 8 (range, 0-15), of a possible total of 18. Frequently reported items were discussions balanced with regard to efficacy and adverse events (42 studies [84%]) and inclusions of harm-associated timing of data collection (41 studies [82%]). The least frequently reported items were distinctions between expected and unexpected adverse events (1 study [2%]) and mentions of the use of a validated instrument to report adverse event severity (4 studies [8%]). Frequency of complications was commonly reported (29 studies [58%]) in contrast with complication severity (10 studies [20%]). Conclusions and relevance This review suggests that severity of complications of RRD surgery has been infrequently quantified and reported in randomized clinical trials and potentially represents an important area of improvement in future RRD surgical trials.

A 34-year-old man presented with an 8-day history of swelling and ptosis affecting the right upper eyelid. An MRI scan showed right superior rectus enlargement. Histology of an incisional biopsy of the muscle demonstrated metastatic choriocarcinoma to the orbit, positive for pan-cytokeratins, beta-HCG and GATA3. Possible primary sites included testis. An ultrasound of the testes identified bilateral testicular masses, highly suspicious for primary testicular malignancy. A CT scan of the chest, abdomen and pelvis identified disseminated metastatic disease conferring a poor prognostic germ cell tumour. The overall interpretation was of disseminated testicular choriocarcinoma and the patient is currently undergoing intensive chemotherapy.

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: To evaluate the standards of harm reporting for glaucoma surgical trials and to develop a classification system for reporting surgical complication severity.Design: Systematic Review and Delphi consensus method.Methods: Systematic review of glaucoma surgical trials published from January 2010 until July 2017 with a quality assessment against the CONSORT checklist for harm. A Delphi method was employed to generate consensus (interquartile range ≤ 2) among international glaucoma experts (n=43) on severity of glaucoma surgical complications and, specifically for trabeculectomy and aqueous shunt complications, from 1 (no clinical significance) to 10 (most severe complication).Results: 47 studies were eligible. The items of the CONSORT checklist for harm that were most frequently missing were: use of a validated instrument to report severity (0%), withdrawals due to harm, and subgroup analyses reported in 3 publications (6.4%). Most glaucoma experts participating in the Delphi process (80%) completed the second round, and consensus was achieved for all but one complication. The least severe complications (graded 2) were: ‘transient loss of vision’, ‘early low intraocular pressure’, ‘choroidal detachment anterior to equator’, ‘small layered hyphema < 1 mm’, and ‘increased lens opacity not clinically significant’. The most severe complications (graded 10) were ‘endophthalmitis’ and ‘permanent severe loss of vision (hand movements or worse)’.Conclusions: Glaucoma surgical RCTs report frequency of complications but their severity is rarely reported. The quality of harm reporting is poor. We propose the use of a newly developed system of classification for assessing the severity of surgical complications based on consensus.