Brief exposure to dilute diesel exhaust does not alter heart rhythm or heart rate variability in healthy volunteers or well-treated patients with stable coronary heart disease. Autonomic dysfunction does not appear to be a dominant mechanism that can explain the observed excess in cardiovascular events following exposure to combustion-derived air pollution.

Air pollution exposure is associated with cardiovascular morbidity and mortality, yet the role of individual pollutants remains unclear. In particular, there is uncertainty regarding the acute effect of ozone exposure on cardiovascular disease. In these studies, we aimed to determine the effect of ozone exposure on vascular function, fibrinolysis, and the autonomic regulation of the heart. Thirty-six healthy men were exposed to ozone (300 ppb) and filtered air for 75min on two occasions in randomized double-blind crossover studies. Bilateral forearm blood flow (FBF) was measured using forearm venous occlusion plethysmography before and during intra-arterial infusions of vasodilators 2–4 and 6–8h after each exposure. Heart rhythm and heart rate variability (HRV) were monitored during and 24h after exposure. Compared with filtered air, ozone exposure did not alter heart rate, blood pressure, or resting FBF at either 2 or 6h. There was a dose-dependent increase in FBF with all vasodilators that was similar after both exposures at 2–4h. Ozone exposure did not impair vasomotor or fibrinolytic function at 6–8h but rather increased vasodilatation to acetylcholine (p = .015) and sodium nitroprusside (p = .005). Ozone did not affect measures of HRV during or after the exposure. Our findings do not support a direct rapid effect of ozone on vascular function or cardiac autonomic control although we cannot exclude an effect of chronic exposure or an interaction between ozone and alternative air pollutants that may be responsible for the adverse cardiovascular health effects attributed to ozone.

Although the majority of optometrists were interested in performing pachymetry, many lacked confidence in performing and interpreting the results. Forty-one percent of those who reported training in pachymetry still used non-validated scales to convert IOP measurements illustrating the need for further training.

Wickham et al. [1] have highlighted the impact of COVID policies on ophthalmology services. Their findings are supported by our experience in Scotland. Rhegmatogenous retinal detachments (RRDs) are acute conditions that require prompt surgery [2]. The annual incidence of RRDs in Scotland was reported as 12.05/100,000 in 2010 [3]. The SARS-CoV-19 outbreak has been unprecedented. Healthcare services have worked hard to stay afloat. Subspecialty care has taken a back seat to intensive care and acute COVID wards. With UK eye departments providing only emergency care, outpatient clinics have been cancelled and workloads reduced. Anecdotal evidence from units all over the country suggests that RRD presentations have declined. Fortuitously, since August 2019 a study has been running across Scotland, prospectively collating all new RRDs, aiming to establish the incidence 10 years after the Scottish Retinal Detachment Study [3]. This has allowed us to assess the impact of the COVID-19 lockdown on RRD presentations. Fifteen surgeons in all six Vitreoretinal units across Scotland prospectively recorded all RRD presentations since August 2019. These records were collated centrally. Details such as age, sex, laterality and macular status were documented. We examined the data prior to and 5 weeks after the UK lockdown on the 23 rd March 2020. As the announcement was late in the afternoon, most of the RRDs operated on the 24 th would have presented prior to this. We therefore started counting the post lockdown numbers from 25 th March.