Objectives To compare diabetic retinopathy (DR) grading and management plan between virtual review using widefield Clarus imaging and macular optical coherence tomography (OCT) versus slit lamp clinical examination and macular OCT. Method New referrals over 3 months from the National Diabetic Eye Screening programme (DESP) were screened. Patients who had both Clarus widefield imaging and macular OCT were included. All patients underwent slit lamp examination in clinic. Data obtained from electronic patient records included referral reason, DR grading and management plan. Two graders retrospectively reviewed imaging and formulated a management plan blinded to results from patients' clinic visit. Results from virtual examination were compared with those from slit lamp examination. Results One-hundred and two eyes of 51 patients were assessed. 11 fundus photos from 7 patients and 15 fundus photos from 10 patients were deemed inadequate by grader G1 and G2, respectively. Eighteen (35%) patients and 11 (22%) patients from virtual assessment by G1 and G2, respectively were found to need a face a face appointment to aid diagnosis. Compared to slit lamp examination, 15% and 7.5% of patients from G1 and G2's virtual assessment respectively had different proposed management plan. Agreement of DR grading between both virtual graders and slit lamp examination was fair (Kappa's coefficient = 0.56). One case of slit lamp noted retinal neovascularization, which was graded as background retinopathy by DESP was also graded as such on virtual assessment. Conclusion Widefield Clarus and OCT imaging allowed two-thirds of DESP referrals to be safely managed virtually.

AimTo compare the visual outcomes of an urban population with age-related macular degeneration (AMD) undergoing ranibizumab monotherapy to the results from major clinical trials.ProceduresProspective data was collected from 164 wet AMD patients receiving intravitreal ranibizumab. Visual acuities were obtained with the Early Treatment Diabetic Retinopathy Study chart. All patients underwent a loading phase of three monthly treatments of ranibizumab. Patients were monitored monthly using a retreatment criterion. Treatment was further individualized by sequentially lengthening follow-up intervals when stable.ResultsAt 12 and 24 months, respectively, the percentage of eyes that maintained vision was 91% and 88.6%. We found that 20.3% of eyes had improved vision at 12 months and 20% at 24 months. At 12 months, 8.3% of eyes’ vision worsened and 12% worsened at 24 months.ConclusionIndividualized ranibizumab monotherapy is effective in preserving vision in wet AMD and follows the same trends as the pivotal trials.

Purpose To investigate segmented macular layer volumes from a healthy adult twin cohort (TwinsUK), exploring changes with age and heritability. Methods Macular spectral domain optical coherence tomography images were acquired from monozygotic (MZ) and dizygotic (DZ) twins in a cross-sectional study. The following layer volumes were derived for circles of 3 and 6 mm diameter around the foveal center, using automated segmentation software: retinal nerve fiber layer (RNFL), ganglion cell–inner plexiform layer (GCIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptors (PR), retinal pigment epithelium (RPE), and total retinal volume (TRV). Correlation coefficients (intereye; age; intrapair for MZ and DZ pairs) were quantified; heritability was estimated using structural equation modeling. Results Scans from 184 participants were included. Intereye correlation was highest for TRV and GCIPL. Negative correlations with age (for 3- or 6-mm areas, or both) were observed for TRV, RNFL, GCIPL, and INL. Positive correlations were observed for PR, RPE, and OPL. For all layers, intrapair correlation was greater for MZ than DZ pairs. Heritability estimates were highest (>80%) for TRV and GCIPL volume, and lowest for RPE volume. Conclusions Although TRV was negatively correlated with age, all layers did not show negative correlation. Some inner layers thinned with age, whereas some outer volumes increased (not the ONL). Reduced RPE phagocytic function with age and remodeling in the OPL could be contributing factors. Heritability estimates were highest for inner retinal layers (particularly GCIPL), and lowest for RPE volume.

Aim: The aim of this study was to explore the knowledge of patients and staff in relation to the costs of selected ophthalmic interventions. Methods: A questionnaire was designed with the help of the Patient-Public Involvement Committee at Moorfields Eye Hospital. It was subsequently distributed to all patients attending the ophthalmic accident and emergency department and selected outpatient clinics over a two-week period. The questionnaire asked participants to estimate the costs of nine treatments or investigations and supplementary questions were also asked in relation to costs. Results: Participants comprised of 436 patients (210 males, 219 females, 7 did not self-identify) and 71 staff (32 males, 39 females) who returned completed questionnaires. Staff gave an estimated cost that was not statistically different from the actual cost for four out of the nine treatments. The mean values for the patients' answers were all significantly different from the actual costs. Both patients and staff had a tendency to over estimate the costs of treatments. Some participants had not considered how much these procedures cost the NHS to provide (36% of patients and 21% of staff respectively). Conclusions: Unsurprisingly, staff are more knowledgeable than patients of the costs of treatments they provide. Despite this, there were still multiple treatments which staff were not able to estimate the costs of accurately (5 out of 9). In this study, accurately was defined as no significant difference from the actual value. If the participant group who have never considered how much it costs the NHS to provide their care could be targeted with an educational program on costs of healthcare this may lead to better use of healthcare resources in the future.