BackgroundGlaucoma is a progressive disease responsible for the second commonest cause of blindness in the UK. Identifying appropriate patients for hospital care remains an ongoing challenge for all UK hospital glaucoma services. The purpose of our study is to evaluate accuracy and outcome of community optometry referrals before and after implementation of the new general ophthalmic service contract in 2006, the Eyecare Integration Programme pilot in 2008 and the effect of NICE guidelines in glaucoma in 2009, over a 12-year periodMethodsA retrospective case analysis using a glaucoma electronic patient record was performed encompassing two six-year periods, 2000–2006 (Group A), and 2007–2012 (Group B).ResultsOne thousand six hundred twenty-two new patients’ records were analysed. Waiting times reduced from 12.3 to 9.4 weeks. Significantly more patients kept first appointment (p = 0.0002) in group B. Glaucoma symptoms were significantly more in group A (p <0.0001) and only three patients lost Snellen’ visual acuity before appointment in group B compared to 12 in group A. Documentation of intraocular pressure was made in 74.1 % of Group A and 75.9 % of Group B, optic disc appearance in 85.4 % of Group A, and 93 % of Group B and visual fields in 84.4 % of Group A and 81.3 % of Group B. Significantly less normal (p < 0,0001), more glaucoma suspects (p < 0.0001), more open angle glaucoma (p = 0.0006) and fewer other conditions (p = 0.0024) were present in group B, compared to group A.ConclusionPatients were referred earlier with shorter waiting times for hospital appointments with the new Scottish general ophthalmic service and Eyecare Integration Programme. Additionally there were fewer false positive referrals with more diagnosis of glaucomatous disease. We discuss the benefits of these national screening and referral pathways together with their limitations and further refinements.

Sir, Treatment of invasive ocular surface squamous neoplasia with proton beam therapy Ocular surface squamous neoplasia (OSSN) has the potential for causing significant ocular and systemic morbidity and mortality. We present two cases of invasive OSSN successfully treated with proton beam therapy (PBT). Both were non-resectable due to deeper scleral invasion. Case reports Case 1A 73-year-old patient was referred to the Ocular Oncology Service with a nodular lesion in the lower fornix (Figure 1a). Incisional biopsy revealed widespread carcinoma in situ with invasive focus (Figures 1c and d). Four cycles of topical MytomycinC (MMC, 0.02%) were administered; however, tumour growth continued.

We report that a more conservative approach (without tube removal) to be successful in a case where there is no evidence of tube exposure. It is important to appreciate that in some cases of orbital cellulitis without clear signs of intraocular involvement, a tube can be left in situ.

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Background: Optic nerve head drusen are acellular hyaline deposits located anterior to the lamina cribrosa,