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Aims-A survey was undertaken to assess the effectiveness of an integrated approach to the provision of low visual aids (LVAs) in south Devon over a 2 year follow up period. This integrated approach includes the assessment of patient needs by low vision therapists, followed by the provision of suitable LVAs, with particular emphasis on training in their use.Methods-A total of 125 patients were selected at random from the 445 patients seen in the low vision clinic at Torbay Hospital in the year 1991. These patients were sent questionnaires relating to the service over a 2 year period. Questionnaires from 111 patients were analysed at 1 year and 75 questionnaires together with 46 clinical reassessments, after 2 years. Results-Using a similar questionnaire to one used in a previous study in the UK from a unit where LVA taining was not provided, not only was a higher rate of satisfaction found with the services provided, but also the LVAs dispensed were used more frequently. The majority of the LVAs provided were of the simple, inexpensive variety and wastage was very low. Conclusions-It was concluded that this integrated approach to low vision rehabilitation with emphasis on traning in the use of less complex LVAs exceeds the performance of other types of service that rely on the dispensing of more complex LVAs.

Aims-To assess the benefits of cataract extraction in patients with age related maculopathy (ARM). Methods-1073 randomly selected cataract operations were reviewed and 99 cases of preoperatively recognised ARM were identified for investigation. Data relating to visual function were retrieved from case notes, and patient responses to a questionnaire were analysed. Results-98% had dry or unspecified ARM. Only 2% had exudative maculopathy. 81% of cases had an improvement in best distance acuity; mean change 0.44 logMAR (change of 6/36 to 6/12). 65% responded to the questionnaire; 67% felt that the operation had been worthwhile, 17% had mixed feelings, and 17% thought it not worthwhile. Conclusion-This study, which is the first of its kind to be reported, shows a clear benefit from cataract surgery in the majority of patients with ARM. However, the prevalence of ARM in this study is lower than expected, suggesting that some patients with both ARM and cataract were not listed for surgery. The design of a prospective study to quantify the subjective and objective benefits of cataract surgery in these patients is outlined and predictors of successful outcome identified. This will promote the development of guidelines for the surgical management of this group of patients. (Br J Ophthalmol 1998;82:611-616) Age related maculopathy (ARM) aVects approximately 40% of those over the age of 75 years.1 2 It is the most common maculopathy to aVect individuals with cataract, the two conditions occurring with increasing frequency with age.3 4 ARM currently contributes to around 50% of all those registered as blind and partially sighted in England and Wales 5 and a recent study has suggested that the condition may be becoming more prevalent. Although this proportion is rather lower than would be expected from prevalence data, this still constitutes around 100 000 operations in the USA and 10 000 operations in the UK each year. When treating a patient with ARM and cataract the clinician must decide whether cataract surgery will be of benefit, a decision that is often diYcult to make. Sometimes the patient is listed for surgery on the grounds that there is little to lose. However, the constraints of tight budgets and waiting lists, and the need to target resources, means that medical practice must be evidence based and it is therefore necessary to have reliable data to support the decision of whether or not to operate.Although previous investigators have identified factors associated with poor outcome following cataract surgery, including the patient age and ocular co-morbidity (especially ARM), 9-16 none has addressed specifically the benefits of surgery in these high risk groups.We have performed a retrospective analysis of case notes and circulated a self completion questionnaire in order to determine whether patients with ARM benefit from cataract surgery both in terms of visual function and patient satisfaction. In addition, we attempted to identify predictors of benefit and to determine whether we are operating on ap...

Aims-To investigate the intraobserver and interobserver repeatability of optic disc measurement using a new digital optic disc stereo camera. Methods-112 consecutive new patients presenting to a glaucoma service had dilated optic disc photography performed using a new digital stereo camera (Discam, Marcher Enterprises Ltd, Hereford). The images were analysed by two masked observers using a stereo viewer and computer simulated stereopsis. Vertical and horizontal cup:disc ratios (CDR), cup area:disc area, and cup circumference:disc circumference were computed. Intraobserver and interobserver repeatability analyses were performed. Intraclass correlation coeYcients (ICC) and 95% tolerance for change (TC) were computed. Results-220 optic discs were photographed, of which 196 were suitable for analysis (10 were of poor image quality and 14 had anomalous discs). Mean age of patients was 65 years, 60 were male and 48 female. (Br J Ophthalmol 2000;84:403-407)

Aims The vulnerability of the eye means that ocular air gun injuries figure prominently in the medical literature. This Study reports the results of the first ocular air gun injury surveillance study. Methods Ocular air gun injuries were reported to the British Ophthalmic Surveillance Unit (BOSU; United Kingdom and Eire) for the period November 2001-December 2002 (13 months). Two questionnaires were used to collect demographic details, circumstances of injury, details of injuries, medical management and outcome. Results A total of 105 initial and 99 follow-up questionnaires were returned. Eighty-six ocular air gun injuries occurred during the last 12 months of surveillance yielding a corrected, estimated incidence of 91-115 injuries/year. Injuries were most frequent in August/September, and 90% (95/105) of victims were men with mean age of 17.5 years (74% under 18 years). In all, 40% (32/81) of injuries occurred at home and 53% (43/81) in a public place. 23% (19/84) of injuries were deliberate, 66% (69/104) of injuries were severe and 20% (21/105) resulted in ruptured globes. In all, 54% (48/89) required hospital admission and 41 required surgery. A total of 11% (12/105) of eyes were either enucleated or eviscerated. Final visual acuity was pcounting fingers in 29% (26/91) but 46/12 (Snellen) in 65% (59/91). Moderate/ significant cosmetic deformities were recorded in 10% (8/77) and restricted ocular movements in 5% (4/72). Conclusions Ocular air gun injuries damage sight and leave lasting morbidity. The demographics and circumstances of injury are well documented with access to, and unsupervised use of, air guns, appearing the principal risks for injury.