Purpose: To audit the information included on GOS 18 forms used by UK optometrists when referring patients to an ophthalmologist. Methods: All GOS 18 forms received in a hospital ophthalmology department over a 10-week period were photocopied and the categories of information presented were recorded. Results: A total of 444 forms were analysed. The two most common referral categories were cataract 36.7% (n ¼ 163) and glaucoma 18.4% (n ¼ 82). Only 7% (n ¼ 11) of cataract referrals included details regarding effect on patient's lifestyle and willingness for surgery. Forty-seven per cent (n ¼ 77) of referrals for cataract resulted in patients being listed for surgery. Eighty-two per cent (n ¼ 67) of referrals for glaucoma included disc assessment, intraocular pressure and visual fields. Five per cent (n ¼ 22) of optometrists gained the patients' consent for release of clinical information. Thirty-one per cent (n ¼ 137) of forms had no practitioner name and 6% (n ¼ 27) gave no practice address. Conclusion: Information included on GOS 18 forms could be improved with regard to cataract referrals. Feedback from ophthalmologists would be facilitated by inclusion of practitioner/practice details, and by completion of the consent section on the GOS 18.

We recommend that all referrals for cataract should confirm a detrimental effect on lifestyle and the patient's willingness for surgery, in addition to confirming cataract as the main cause of visual loss.

Purpose To ascertain ophthalmology trainee confidence in managing posterior capsule rupture (PCR) and vitreous loss. Methods An electronic survey was distributed to ophthalmology trainees in a single UK postgraduate training Deanery. Data collected included the stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs personally managed by the trainee, previous vitrectomy experience during vitreoretinal rotations, and attendance at advanced phacoemulsification courses. Trainees self-evaluated their confidence in managing PCR with vitreous loss, including the management of specific aspects of the procedure. Results Across training grades, only 9.1% (2/22) felt confident managing PCR without senior support. Respondents were most confident with fluidic parameters and IOL considerations, but 77.3% (17/22) lacked confidence in avoiding a dropped nucleus. Eleven respondents had completed 4350 cases (mean 576; range 383-1087). In this subgroup, mean cumulative PCR rate was 2.1% (range 0.9-4.9%), and trainees personally managed a mean 3.5 cases of PCR (range 1-7). Only 18.2% felt they could manage PCR and vitreous loss without senior support, and 45.5% stated they were not confident in avoiding a dropped nucleus. The most experienced trainee (1087 cases) had personally managed PCR just six times, and three trainees with 4350 cases had only managed PCR once each. Conclusions The Royal College of Ophthalmologists' requirement of 350 completed cases appears insufficient for independent cataract surgery, as opportunities to manage complications as a trainee are scarce. A competency-based assessment framework may be preferable, with a more targeted approach to training incorporating surgical simulation within the formal curriculum.

Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

Purpose: To evaluate visual and anatomic outcomes following pars plana vitrectomy and intravitreal or subretinal tissue plasminogen activator for submacular hemorrhage in patients with age-related macular degeneration. Methods: This was a retrospective study on patients with a minimum follow-up of 12 months undertaken at a tertiary referral center. Data collected include demographic details, visual and optical coherence tomography changes, surgical details, and complications. Surgical results were compared with patients who were age and lesion size matched and treated with anti-vascular endothelial growth factor injections alone. Results: There were 36 patients in surgical and 18 patients in control group. Patients in surgical arm had pars plana vitrectomy, intravitreal tissue plasminogen activator with air 24 (67%), 6 (16%) with C3F8 gas, 1 (3%) with SF6 gas, 4 (11%) subretinal tissue plasminogen activator with air, and 1 (3%) with C2F6 as post-operative tamponade. Mean LogMAR in tissue plasminogen activator group at baseline was 1.56, and it was improved at all time points 1.06 at 1 month (p < 0.05), 0.91 at 6 months (p < 0.05), and 1.07 at 1 year (p < 0.05). Mean best corrected visual acuity in control group at baseline was 1.22LogMAR with no significant improvement at any time points: 1 month (1.27), 6 months (1.35), and 12 months (1.36). Complications included retinal detachment 5%, vitreous hemorrhage 7.5%, and cataract 19%. Conclusion: Pars plana vitrectomy with intravitreal (or subretinal) tissue plasminogen activator and pneumatic displacement can offer better outcome in comparison to anti-vascular endothelial growth factor alone in patients with submacular hemorrhage secondary to age-related macular degeneration.