Newcastle upon Tyne SUMMARY Purpose. The aim of the study was to determine whether patients presenting with an isolated posterior vitreous detachment require follow-up to identify retinal breaks not apparent at presentation and whether some histories are more predictive of asso ciated serious posterior segment pathology.Methods. The notes of 295 patients presenting to eye casualty with flashes andlor floaters were reviewed.Results. One hundred and eighty-nine patients (64%) had isolated posterior vitreous detachments, 49 (16.6%) had retinal detachments and 31 (10.5%) had flat retinal tears. Three new breaks (3.3% of all tears found, 1.9% of review appointments) were identified only at follow-up. Although a subjective reduction in vision and a history of less than 6 weeks' duration were strongly predictive of retinal breaks, the large group of patients presenting with floaters alone (124/295, 42 %) still harboured a significant proportion (26.7%) of the retinal breaks. Conclusions. A follow-up visit for patients with anisolated posterior vitreous detachment can be justified to detect the small percentage of asymptomatic retinal breaks. Although a subjective reduction of vision is the symptom most predictive of serious posterior segment pathology, it would be unsafe to identify particular subgroups of patients alone for careful examination.Patients complaining of flashes and floaters make up a significant proportion of the cases presenting to eye casualty departments. Of these, between 10% and 30% 1-3 will have retinal breaks requiring immediate treatment and approximately half will have an isolated posterior vitreous detachment. ! , 4 The latter group are usually followed up in outpatients approxi mately 6 weeks after the onset of symptoms, to allow the identification of retinal breaks which may have developed after the first visit.Our aims were to determine whether significant pathology associated with posterior vitreous detach ment was being detected at the follow-up visit and to identify characteristics of the history which were more strongly indicative of the presence of retinal breaks or detachments. PATIENTS AND METHODSWe retrospectively studied 295 consecutive patients who presented to eye casualty in 1993 and 1994 with symptoms of floaters and/or flashes due to posterior vitreous detachment. Patients who were referred directly to outpatients, or who had a history of trauma or concurrent posterior segment disease such as diabetic retinopathy and vascular occlusions, were excluded. All had been examined at the first visit by the senior house officer in casualty and a diagnosis of separation of the posterior vitreous face from the retina was made using slit lamp biomicroscopy with the 90 dioptre lens or Goldmann 3-mirror contact lens. Indirect ophthalmoscopy with scleral indenta tion was also performed to identify any peripheral retinal pathology and patients were then treated immediately as necessary or given a retinal detach ment warning and followed up in clinic. Patients' symptoms, pathology, timing of f...

Changes in the UK undergraduate medical curriculum mean that a clinical placement in ophthalmology is no longer a requirement. An ophthalmic assessment is necessary for a full physical examination and failure to elicit and interpret signs could mean missing sight and life-threatening pathology. This study was to investigate current undergraduate ophthalmology teaching. An email questionnaire, about the content and delivery of the ophthalmology teaching, was sent to each UK medical school in 2007/2008. The response rate was 83%. Nineteen (79%) medical schools had a compulsory attachment to the ophthalmology department with an average length of 7.6 days (range 3.5-15 days). There was variation as to how ophthalmology was included in the curriculum. Teaching methods and standards also varied. Finally, assessments ranged from formal written and practical exams in some medical schools to informal or non-existent ones in others. The most striking finding was the variation in ophthalmology education a student may receive, with some students receiving none. It is necessary to improve the profile of ophthalmology and ensure that all students achieve a minimum basic standard.

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ABSTRACT.Purpose: In addition to measuring ocular blood flow, the ocular blood flow tonometer (OBF) can also be set to solely record intraocular pressure (IOP). In this mode it provides a quick means of tonometry which may allow nursing staff to be more easily trained in its use than conventional Goldmann tonometry. With a view to its eventual use in nurse-led clinics we undertook a study to compare both the OBF tonometer and our currently favoured nurse practitioners tonometer the tonopen XL with Goldmann tonometry. Method: IOP was measured in 99 eyes with all three tonometers in a random order. Results: There was not any statistically significant difference between the measurements of all three tonometers. Conclusions: It is concluded that OBF tonometer can provide clinically useful measurements of intraocular pressure which may in fact be more accurate than the tonopen, however, our opinion is that it possibly is not suitable for a universal glaucoma clinics application.

There is increasing evidence and appreciation of idiopathic intracranial hypertension (IIH) in medicine. The pathological processes underlying raised intracranial pressure are being studied, with new insights found in both hormonal dysregulation and the metabolic neuroendocrine axis. These will potentially lead to novel therapeutic targets for IIH. The first consensus guidelines have been published on the investigation and management of adult IIH, and the International Headache Society criteria for headache attributable to IIH have been modified to reflect our evolving understanding of IIH. Randomized clinical trials have been published, and a number of studies in this disease area are ongoing.