Siemens and Downes initially received increasing attention in the blogosphere in 2005 when they discussed their ideas concerning distributed knowledge. An extended discourse has ensued in and around the status of 'connectivism' as a learning theory for the digital age. This has led to a number of questions in relation to existing learning theories. Do they still meet the needs of today's learners, and anticipate the needs of learners of the future? Would a new theory that encompasses new developments in digital technology be more appropriate, and would it be suitable for other aspects of learning, including in the traditional class room, in distance education and e-learning? This paper will highlight current theories of learning and critically analyse connectivism within the context of its predecessors, to establish if it has anything new to offer as a learning theory or as an approach to teaching for the 21st Century.

A composite slit-lamp based system for the clinical classification and grading of cataract is described. Cataract features are classified morphologically, and individual features are graded by comparison with standard diagrams mounted adjacent to the slit-lamp. Attention has been paid to relevant aspects of measurement theory, with equal interval steps between the grades. The image degrading effect of the cataract is assessed using a 'resolution target projection ophthalmoscope'. The method may be used in conjunction with photographic and image analysing techniques.

Aims-To determine whether patients with age related macular degeneration (ARMD) benefit from cataract surgery in terms of visual function and quality of life measures, and to assess the impact of surgery on the progression of ARMD. Methods-A prospective study was carried out of patients with and without ARMD undergoing cataract surgery. Data were collected from 187 patients at the Princess Alexandra Eye Pavilion, Edinburgh and the Oxford Eye Hospital, Oxford. The patients were divided into three groups: (1) a control group with ARMD and no surgery (n=41), (2) a study group of patients with ARMD who underwent cataract surgery (n=90), and (3) a second control group of patients without ocular comorbidities who underwent cataract surgery (n=56). Visual function and quality of life assessments were carried out at baseline and 3-5 months after baseline or surgery. Results-There were significant improvements both in terms of quality of life and visual function measures in the study group. Benefits were greater in patients with moderate cataract irrespective of the degree of ARMD. No increased incidence in progression to the "wet" form of ARMD was found. Improvements in quality of life measures and visual function were more pronounced in patients with no ocular comorbidities. Conclusions-Patients with mild and moderate degrees of ARMD do benefit from cataract surgery and the benefits are greater in patients with moderate degrees of lens opacity. Longer follow up is required to assess the risk of increased ARMD progression. (Br J Ophthalmol 2000;84:1343-1348 Over the last decade it has become evident that visual acuity alone is inadequate as a criterion upon which to decide whether or not, and when, a patient should be operated upon for cataract. This decision is increasingly based on the patient's subjective dissatisfaction with his/ her current visual function and objective findings on the ophthalmological examination which confirm the aetiology of the visual loss. A number of questionnaires have been developed to assess patients' subjective impressions of their perceived trouble and satisfaction with vision and the impact of diseases on quality of life.

One year postoperatively, QoL benefits were maintained in the study group and there was no increased risk of progression of maculopathy in patients with mild and moderate degrees of ARMD. Larger numbers of patients must be assessed prospectively for longer periods to determine the relative risk of progression of different stages of ARMD after cataract surgery.

Aim: Little is known about the distribution and methods of delivery of low vision services across the United Kingdom. The purpose of this study was to determine the type and location of low vision services within the UK. Methods: Survey by means of a 29 point postal questionnaire, followed when necessary by a five point telephone questionnaire. All known potential providers of low vision services (n = 2539) including hospitals (n = 277), optician/optometry practices (n = 1683), social services (n = 177), voluntary groups (n = 190), specialist teachers (n = 205), and universities (n = 6) were surveyed. For each service provider, the type, magnitude, and geographical location were determined. The distribution of services across the United Kingdom and the ratio of providers to population density of people with a visual impairment were mapped using the Geographic Information System (GIS). Results: Data were obtained on 1945 (77%) service providers: 1679 (66%) responded to the postal questionnaire and 266 (11%) to the telephone questionnaire. Of all respondents, 59% (n = 1135) offer some form of help to people with a visual disability, of which 26% (n = 497) only sell magnifiers and 33% (n = 638) provide low vision services. It is estimated that in total just under 155 000 low vision consultations are offered annually, the bulk of which are provided by hospital eye departments. The distribution was geographically uneven and there appears to be scarcity in some areas. Conclusion: When compared to the probable number of people with a visual impairment in the UK there are apparent inadequacies in service provision in terms of distribution, magnitude, and coordination. The results highlight a need to review current services.