Aims-There is increasing awareness of the needs of children with low vision, particularly in developing countries where programmes of integrated education are being developed. However, appropriate low vision services are usually not available or affordable. The aims of this study were, firstly, to assess the need for spectacles and optical low vision devices in students with low vision in schools for the blind in Kenya and Uganda; secondly, to evaluate inexpensive locally produced low vision devices; and, finally, to evaluate simple methods of identifying those low vision students who could read N5 to N8 print after low vision assessment. Methods-A total of 230 students were examined (51 school and 16 university students in Uganda and 163 students in Kenya, aged 5-22 years), 147 of whom had a visual acuity of less than 6/18 to perception of light in the better eye at presentation. After refraction seven of the 147 achieved 6/18 or better. Eighty two (58.6%) of the 140 students with low vision (corrected visual acuity in the better eye of less than 6/18 to light perception) had refractive errors of more than 2 dioptres in the better eye, and 38 (271%) had more than 2 dioptres of astigmatism. Results-Forty six per cent of students with low vision (n=64) could read N5-N8 print unaided or with spectacles, as could a further 33% (n=46) with low vision devices. Low vision devices were indicated in a total of 50 students (3570/o). The locally manufactured devices could meet two thirds of the need. $ e . Conclusion-A corrected distance acuity of 1/60 or better had a sensitivity of 99 lI% and a specificity of 56-7% in predicting the ability to discern N8 print or better. The ability to perform at least two of the three simple tests of functional vision had a sensitivity of 95-50/o and a specificity of 63.3% in identifying the students able to discern N8 or better. (BrJ Ophthalmol 1995; 79: 814-820)

Between 1973 and 2003, the low vision clinic at Moorfields Eye Hospital provided nearly 100,000 low vision consultations. The demographics of patients attending the clinic remained remarkably constant over this time. The number of spectacle-mounted devices prescribed to new patients fell between 1973 and 2003. It is thought this is in part the result of the increased availability of electronic magnification devices and the development of illuminated hand magnifiers. The development of the acrylic bright field magnifier and LED-illuminated LVDs have had particular clinical impact.

SummaryThe City Eye Study is a nine year longitudinal prospective epidemiological study.During the first three year phase the study recruited 1029 volunteers, aged between 54 and 65 years, primarily from companies and organisations working in or around the City of London.The analysis of the first cohort data shows a significant association between nuclear lens opacities and moderate to heavy cigarette smoking. The Relative Risk for nuclear lens opacity and cigarette smoking ranges from 1.0 for past light-smokers through 2.6 for past heavy-smokers, to 2.9 for present heavy smokers.

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