Given the overall slow rate of VA loss, VA is unlikely to be a sensitive outcome measure for treatment trials of Stargardt disease. However, given the faster decline in younger patients and those with no or mild visual impairment, VA may be a potential outcome measure for trials targeting such subgroups of patients. These observations will need to be assessed in a prospective study bearing in mind the inherent limitations of retrospective datasets.

Our observations point to the complexity of fixation parameters. The association of increasingly eccentric and unstable fixation with longer disease duration that is typically found in cross-sectional studies may be countered within individual patients by poorly understood processes like neuronal adaptation. Nevertheless, fixation parameters may serve as useful secondary outcome parameters in selected cases and for counseling patients to explain changes to their visual functionality.

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Aims. To investigate whether there is a relationship between intraocular pressure (IOP) and diabetic retinopathy. Methods. Retrospective analysis of a retinal screening database of 5838 patients with diabetes compiled over 5 years giving information on 20 091 eye examinations. Results. Lower mean IOP was associated with the presence of hard exudates alone (p < 0.005) and hard exudates with cotton wool spots (p < 0.001). There was no statistically significant association between IOP and other grades of retinopathy. Conclusions. The mean IOP reductions observed in exudative retinopathy, although statistically significant, were probably too small to measure conventionally. The effect of low IOP on development of retinopathy may be mediated by higher ocular perfusion pressure, but why this would be specific to exudative disease is unclear.

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