Systemic hypertension is an important public health concern. If optometrists are to perform a more active role in the detection and monitoring of high blood pressure (BP), there is a need to improve the consistency of describing the retinal vasculature and to assess patient's ability to correctly report the diagnosis of hypertension, its control and medication. One hundred and one patients aged > 40 years were dilated and had fundus photography performed. BP was measured and a self-reported history of general health and current medication was compared with the records of their general practitioner (GP). The status of the retinal vasculature was quantified using a numeric scale by five clinicians and this was compared to the same evaluation performed with the aid of a basic pictorial grading scale. Image analysis was used to objectively measure the artery-to-vein (A/V) ratio and arterial reflex. Arteriolar tortuosity and calibre changes were found to be the most sensitive retinal signs of high BP. Using the grading scale to describe the retinal vasculature significantly improved inter- and intra-observer repeatability. Almost half the patients examined were on medication for high BP or cardiovascular disease. Patients' ability to give their complete medical history was poor, as was their ability to recall what medication they had been prescribed. GPs indicated it was useful to receive details of their patient's BP when it was > 140/90 mmHg. The use of improved description of the retinal vasculature and stronger links between optometrists and GPs may enhance future patient care.

Choroidal folds are known to be associated with a wide variety of pathological conditions, such as central serous retinopathy, choroidal naevi, tumours and papilloedema. They may also occur with surgical procedures, especially when hypotony of the globe occurs, such as following cataract surgery, laser therapy and from post-operative choroidal oedema or inflammation. However, choroidal folds are idiopathic in the majority of cases and can be associated with benign conditions, such as hypermetropia and optic disc drusen. Numerous patterns and orientations of choroidal folds are possible, with some authors suggesting that typical presentations are associated with particular pathological conditions. They may be seen as dark and light streaks on ophthalmoscopy (often more defined with red-free viewing) but are more apparent and differentiated from retinal folds by fluorescein angiography. The aetiology of choroidal folds appears to be linked to a combination of an anatomical attachment of Bruch's membrane to the underlying choriocapillaris and congestion of the choriocapillaris. This paper reviews aspects of the differential diagnosis of choroidal folds with guidelines for optometric management. Several case reports are presented to demonstrate some of the clinical features of choroidal folds.

Ocular ischaemic syndrome is a rare condition. It often results in blindness and is linked to serious systemic morbidity. Its presentation is usually subtle and it can be misdiagnosed due to its diverse signs and symptoms. A case of ocular ischaemic syndrome is presented and current diagnostic procedures and treatment described. Recognition by the clinician is important because of the severe ocular and potential systemic sequelae. Keywords: carotid artery, ocular ischaemic syndrome, vascular disease Ocular ischaemic syndrome (01s) is an uncommonly reported, serious blinding condition, first described by Knox in 1965.' It is often misdiagnosed because of its diverse and sometimes subtle presentation.' Sturrock and Miller3 estimated the incidence to be 7.5 cases per million persons per year, based on only six cases over a two-year period in a large hospital setting. However, the exact frequency is unknown and previous reports may underestimate the incidence, when o n e considers the various ocular disorders that have similar presentations. CASE REPORTA 71-year-old Caucasian male presented for optometric examination, complaining of sore, dry eyes and a gradual reduction in distance and near acuity. He had no other presenting complaints. His previous eye examination had been two years earlier. He had a history of head trauma 30 years earlier, which is believed to have resulted in static right optic atrophy. He suffered from severe occlusive carotid artery disease ( O W ) with previous endarterectorny of the right internal carotid artery (ICA) two months before the present examination. The left ICA was reported to be completely blocked and inoperable. There was no history of diabetes.Visual acuities were R 6/24 with +1.25/ -0.75~75 and L 6/ 12 with +1.25/0.25~110. There was no improvement with pinhole (NIPH). A +3.00 D near addition enabled N5 print to be read at 33 cm. At optometric examinations two and four years previously, visual acuities were recorded as R 6/15 = (NIPH) and L 6/4.8. Previous automated visual fields demonstrated a dense temporal defect of the right eye (Figure 1). There was also a right relative afferent pupillary defect. Slitlamp examination revealed moderate signs of dry eye with a reduced tear break-up time and inferior and diffuse sodium-fluorescein and Rose Bengal staining. Non-preserved tear supplements were suggested. The ocular media were clear, but trace left iris neovascularisation was noted. Dilated ocular fundus examination revealed a pale and atrophic right optic disc. In the left posterior pole, focal and general arteriole attenuation was noted. Scattered small blot retinal haemorrhages were also noted in all four quadrants (Figure 2). Intraocular pressures (IOP) were R 9 mmHg and L 9 mmHg measured with Perkins