Aims-To evaluate the short term cardiovascular, respiratory, and intraocular pressure (IOP) eVects of four glaucoma medications in newly diagnosed glaucoma patients. Methods-141 newly diagnosed glaucoma patients were recruited and underwent a full ocular, cardiovascular, and respiratory examination, including an electrocardiogram (ECG) and spirometry. They were prescribed one of four topical glaucoma medications and reviewed 3 months later. One eye of each patient was randomly chosen for analysis, performed using analysis of variance and the 2 test. Results-Latanoprost had the greatest mean IOP lowering eVect in both the primary open angle glaucoma (POAG) (p = 0.005) and the "presumed" normal tension glaucoma (NTG) groups (p = 0.33), reducing the IOP by 8.9 mm Hg and 4.1 mm Hg respectively. Timolol was associated with lowered pulse rates and reductions in the spirometry measurements. 41% of patients using brimonidine complained of systemic side eVects and over 55% of patients using betaxolol complained of ocular irritation. 28% of patients required an alteration in their glaucoma management.Conclusions-Latanoprost appears to be a useful primary treatment for glaucoma patients, in view of superior IOP control and a low incidence of local and systemic side eVects. Timolol causes a reduction in measurements of respiratory function, a concern in view of the potential subclinical reversible airways disease in the elderly glaucoma population. Brimonidine is associated with substantial, unpredictable systemic side eVects and betaxolol causes ocular irritation and weak IOP control. Spirometry is advised in all patients receiving topical blocker therapy to control their glaucoma. (Br J Ophthalmol 2000;84:710-713) Glaucoma is a common disease within the elderly population, aVecting over 5% of those older than 75 years.

SummarySeventeen per cent of 216 cases of simple congenital ptosis developed amblyopia and 19% had a squint. Of those patients with amblyopia, 14% had amblyopia attributable to stimulus deprivation, 21 % had anisometropic amblyopia and 51 % had strabismic amblyopia. Early refraction, orthoptic assessment and treatment and, where the pupillary axis is occluded , surgery to prevent stimulus deprivation amblyopia are recommended.

Aims: To examine the effect of pupillary dilatation on the reliability of retinal nerve fibre layer (RNFL) and optic nerve head (ONH) assessments using Stratus OCT in a glaucoma clinic. Methods: Observational study of 38 patients attending a glaucoma clinic. The ''fast optic disc'' and ''fast RNFL thickness'' programs on Stratus OCT were used to measure the RNFL thickness and ONH cup to disc ratio (CDR). Two scans were done before dilatation and two after dilatation with tropicamide 1% drops. The mean values and reproducibility before and after dilatation were compared, along with the quality of scans as indicated by the ''signal strength'' score. Results: In nine patients (23.7%) no images were obtained undilated but after dilatation examination was possible in all patients. Inability to obtain an undilated scan was associated with smaller pupil size and increasing cataract. The scan quality, as judged by the signal strength score, was higher dilated than undilated for both RNFL thickness (p = 0.011) and ONH CDR (p = 0.007). Reproducibility was higher with dilated scans for RNFL thickness but not for ONH CDR. There were significant differences between the dilated and undilated examinations for three of the five RNFL thickness variables and two of the three ONH CDR categories. Conclusions: Acquisition of high quality OCT images was not possible without pupillary dilatation in about 25% of the patients. The dilated scans were more reproducible and of higher quality than the undilated scans. The two methods of examination do not appear to be interchangeable, suggesting that in follow up examinations the pupil should be in the same condition as at baseline. Pupillary dilatation is recommended before glaucoma assessments using Stratus OCT.