Background The WHO's Vision 2020 global initiative against blindness, launched in 2000, prioritises children. Progress has been hampered by the global paucity of epidemiological data about childhood visual disability. The British Childhood Visual Impairment and Blindness Study 2 (BCVIS2) was undertaken to address this evidence gap. Methods UK-wide prospective population-based observational study of all those aged under 18 years newly diagnosed with visual impairment or blindness between Oct 1, 2015 and Nov 1 2016. Eligible children were notified simultaneously but independently by their managing ophthalmologists and paediatricians via the two national active surveillance schemes, the British Ophthalmic and Paediatric Surveillance Units. Standardised detailed data were collected at diagnosis and one year later. Incidence estimates and relative rates by key sociodemographic factors were calculated. Descriptive analyses were undertaken of underlying ophthalmic disorders and nonophthalmic comorbidities. FindingsOf 784 cases, 72% had additional non-ophthalmic impairments/disorders and 4% died within the year. Annual incidence was highest in the first year of life, 5•2 per 10,000 (95% CI 4•7-5•7) with cumulative incidence by 18 years of 10•0 per 10,000 (95% CI 9•4 to 10•8). Rates were higher for those from any ethnic minority group, the lowest quintile of socio-economic status, born preterm or with low birthweight. Only 44% had a single ophthalmic condition: disorders of the brain/visual pathways affected 48% overall. Prenatal or perinatal aetiological factors accounted for 84% of all conditions. InterpretationBCVIS2 provides a contemporary snapshot of the heterogeneity, multi-morbidity and vulnerability associated with childhood visual disability in a high income country, and the arising complex needs. These findings will facilitate developing and delivering healthcare and planning interventional research. They highlight the importance of including childhood visual disability as a sentinel event and metric in global child health initiatives.

(BrJ7 Ophthalmol 1994; 78: 605-607) Local anaesthesia has become increasingly popular for a variety of intraocular procedures, particularly with the increasing popularity of day case surgery. The main techniques used to administer local anaesthesia are peribulbar and retrobulbar injections. However the effect of these on intraocular pressure (IOP) has received little attention in patients with glaucoma, in whom transient severe increases in IOP may have the potential to cause further compromise of visual function.This study was initiated to examine the effect on IOP of peribulbar and retrobulbar injections, in patients with and without glaucoma, undergoing extracapsular cataract extraction or trabeculectomy. (TABLE 1) In all subjects, there was a mean increase in IOP of 5-8 mm Hg (SD 6-0, 95% confidence interval 4-6, 7-0) at 1 minute after injection. The mean increase in IOP at 5 minutes in those patients who did not undergo ocular compression was 3-6 mm Hg (SD 5-9, 95% CI 2-2, 5 0), compared with baseline. In those patients who received ocular compression, there was a mean decrease in IOP of 5 2 mm Hg (SD 5 5, 95% CI -3*3, -7 0). The maximum IOP rise was 25 mm Hg at 1 minute and 23 mm Hg at 5 minutes (Table 3) (TABLE 1) Both the peribulbar and retrobulbar injection techniques produced a similar increase in IOP at 1 minute and 5 minutes. The difference between techniques was not statistically significant. The mean volume used in the peribulbar injection was 9 ml, and in retrobulbar injection 3-5 ml (p<0-01, unpaired t test).

The high specificity of the step VEP for FVL warrants increased suspicion of an organic cause should the step VEP spatial threshold be abnormal.

Our findings suggest that the Tono-Pen XL cannot be used as a substitute for GAT in the management of patients with glaucoma or OHT.

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