Ophthalmology

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Response to: Cost and time resourcing for ophthalmic simulation in the UK: a Royal College of Ophthalmologists’ National Survey of regional Simulation Leads in 2021
(Springer Nature, 2022-01-26) Hunt, Samantha; Dean, William; Kerins, Victoria; Brown, Adele; Buchan, John; Dean, William; Medical and Dental
No abstract available
Phacoemulsification cataract surgery: what you need to know
(International Centre for Eye Health, 2023-12-01) Dean, William; Venkatesh, Rengaraj; Dean, William; Medical and Dental
No abstract available
Developing the skills needed for successful manual small-incision cataract surgery
(International Centre for Eye Health, 2023-12-01) Dean, William; Venkatesh, Rengaraj; Dean, William; Medical and Dental
No abstract available
Basic microsurgical skills: suturing
(International Centre for Eye Health, 2023-12-01) Jones, Rebecca; Dean, William; Dean, William; Jones, Rebecca; Medical and Dental
No abstract available
Treatment patterns and long-term outcomes in anti-VEGF-treated macular oedema secondary to retinal vein occlusion: a retrospective observational study
(Springer Nature, 2025-11-14) Dinah, Christiana; Dodds, Melanie; Lotery, Andrew; Salvatore, Serena; Fletcher, Emily; Lake, Alice; Parker, Andrew; Paris Pereira, Liliana; Retiere, Anne-Cecile; Saffar, Insaf; Arrisi, Pablo; Chi, Gloria; Salvatore, Serena; Medical and Dental
Background/objectives This study reported real-world visual acuity (VA), treatment patterns, and ocular safety outcomes from patients with macular oedema secondary to branch, central, or hemi-retinal vein occlusion (BRVO, CRVO, HRVO) treated with anti-vascular endothelial growth factor (VEGF). Methods Data were collected from Medisoft electronic medical records across 16 NHS ophthalmology sites in England over 60 months. Results 3511/3465 eyes/patients with BRVO and 3568/3514 eyes/patients with CRVO or HRVO were included; <2% of patients had bilateral RVO and had both eyes included. VA change from index anti-VEGF treatment was lower with longer follow-up. In BRVO eyes, mean (95% CI) change in VA from index was +11.2 (10.6, 11.7) approximate Early Treatment Diabetic Retinopathy Study (ETDRS) letters at Month (M)6 and +8.3 (6.7, 10.0) at M60. Mean (95% CI) change in VA for CRVO/HRVO eyes was +11.5 (10.7, 12.3) approximate ETDRS letters at M6 and +7.0 (4.8, 9.2) at M60. Eyes receiving more injections displayed greater average VA gains. Median (Q1–Q3) annual number of anti-VEGF injections was lower in BRVO and CRVO/HRVO eyes with longer follow-up: M12, 7.0 (5.0–8.0) and 6.0 (4.0–8.0); M60, 2.0 (0.0–5.0) and 1.0 (0.0–5.0). Ocular safety outcome incidence through 60 months was low (endophthalmitis, retinal tears, and retinal detachment <1%). Conclusions VA improvements were observed soon after anti-VEGF treatment, but were lower with longer follow-up through 60 months, alongside lower annual injection numbers, suggesting that current single-target intravitreal anti-VEGFs may not be sufficiently durable for long-term RVO management in routine practice.
The importance of acknowledging statisticians as named authors
(Springer, 2020-04-15) Vonthein, Reinhard; Bunce, Catey; Epstein, Diana; Donachie, Paul Henry John; Donachie, Paul; Additional Professional Scientific and Technical
No abstract available
The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 4, equity of access to cataract surgery
(Springer Nature, 2019-07-29) Johnston, Robert; Day, Alexander; Donachie, Paul Henry John; Sparrow, John; Johnston, Robert; Donachie, Paul; Additional Professional Scientific and Technical
Objective: To determine whether socioeconomic status influenced the presenting visual acuity prior to first eye cataract surgery in the English National Health Service. Retrospective case series from The Royal College of Ophthalmologists' National Ophthalmology Database Audit. In total 154,223 patients undergoing first eye cataract surgery at 68 centres in England performed between 1st September 2015 and 31st August 2017. Main outcome measure: Social deprivation status and pre-operative visual acuity (VA) between centres for patients undergoing first eye cataract surgery in England. Results: The median social deprivation varied between centres and ranged from decile 2 (2nd most deprived decile) to decile 9 (2nd least deprived decile). The pre-operative VA was reported for 143,401 (93.0%) eyes. The median pre-operative VA was 0.50 LogMAR (6/19), and 27.7% eyes had a preoperative VA of 0.30 LogMAR units (6/12) or better. The median pre-operative VA for each centre ranged from 0.30 to 0.60 LogMAR (6/12 to 6/24). The median pre-operative VA was mostly stable across deciles of social deprivation (0.60 LogMAR for decile 1 and 0.50 LogMAR for all other deciles), and some evidence was found linking greater deprivation to worse pre-operative VA and to lower levels of access. Conclusions: We found no strong evidence of inequality for gaining access to first eye cataract surgery in this National Ophthalmology Database analysis, however there was a possible trend towards fewer people in the more deprived deciles accessing surgery, and that some of these are presenting with quite marked levels of visual impairment.
The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification
(Springer Nature, 2022-08-24) Donachie, Paul Henry John; Barnes, Beth; Olaitan, Martina; Sparrow, John; Buchan, John; Donachie, Paul; Admin and Clerical
Background/objectives: Posterior Capsule Opacification (PCO) is the most common long-term post-operative adverse occurrence after cataract surgery often requiring treatment with YAG laser posterior capsulotomy. This study aimed to identify potential risk factors, known at the time of cataract surgery, that influence the development of PCO. Subject/methods: A retrospective study of publicly funded cataract surgery from The Royal College of Ophthalmologists' National Ophthalmology Database. Eligible for analysis were 500,872 cataract operations performed in 41 participating centres. Results: The 500,872 operations were performed on 243,167 (48.5%) left eyes and 257,705 (51.5%) right eyes from 373,579 patients by 2196 surgeons. Post-cataract PCO was recorded for 61,778 (12.3%) eyes and the six month, one, three, five and nine year observed rates of PCO were 2.3%, 4.4%, 19.7%, 34.0% and 46.9% respectively. Different PCO profiles were observed between IOL materials and the identified risk factors that increased the risk of developing PCO included hydrophilic IOL material, axial length >26 mm, the presence of high myopia and implantation of lower IOL powers and previous vitrectomy surgery, along with younger age and female gender. Conclusions: Many factors influence the development of PCO relating to the patient, the eye, the lens and the surgery. Some factors are modifiable such as IOL material, therefore the opportunity exists to attempt to reduce PCO rates, benefitting patients and the UK NHS.
The Royal College of Ophthalmologists' National Ophthalmology Database Study of Cataract Surgery: Report 12, Risk factors for suprachoroidal haemorrhage during cataract surgery
(Springer Nature, 2023-05-12) Stewart, Stephen; Gruszka-Goh, Marta; Neo, Yan Ning; Braga, Alice; de Klerk, Timothy; Lindfield, Dan; Nestel, Achim; Donachie, Paul Henry John; Buchan, John; Gruszka-Goh, Marta; Donachie, Paul; Admin and Clerical
Objective: To establish the incidence of acute intraoperative suprachoroidal haemorrhage (AISH) during cataract surgery and identify the risk factors for this complication. Methods: Data from the Royal College of Ophthalmologists' National Ophthalmology Database was analysed. During the 11-year study period, from 01/04/2010 to 31/03/2021, 709 083 operations performed on 498 170 patients from 65 centres were eligible for inclusion. Results: AISH occurred in 0.03% (204/709 083, approximately 1 in 3 500) of eligible cataract operations performed during the study period. Posterior capsule rupture was the risk factor most strongly associated with AISH (OR: 17.6, 95% CI: 12.4-24.9, p < 0.001). Other ocular risk factors identified were raised intraocular pressure (IOP) preoperatively (OR: 3.7, 95% CI: 2.5-5.5, p < 0.001), glaucoma (OR: 1.7, 95% CI: 1.2-2.4, p = 0.004). Risk increased with age and patients aged over 90 years were at greatest risk (OR: 6.7, 95% CI: 3.5-12.8, p < 0.001). The addition of intracameral anaesthetic when performing surgery under topical anaesthetic appears to be protective (OR: 0.5, 95% CI: 0.3-0.8, p = 0.003), compared to topical anaesthetic alone. There was a 16-fold increase in the incidence of vision loss when AISH occurred. Conclusions: The risk of AISH during modern cataract surgery is approximately 1 in 3 500 and is associated with a significant increase in the risk of vision loss should it occur. Posterior capsule rupture is the risk factor most strongly associated with AISH. Preoperative IOP control is a modifiable risk factor. The use of intracameral anaesthesia may reduce the risk of AISH.
What are the perceptions and concerns of people living with diabetes and National Health Service staff around the potential implementation of AI-assisted screening for diabetic eye disease?
(Wiley, 2025-11-10) Willis, Kathryn; Shakespeare, Royce; Chandrasekaran, Lakshmi; Chaudhry, Umar; Wahlich, Charlotte; Chambers, Ryan; Bolter, Louis; Anderson, John; Olvera-Barrios, Abraham; Fajtl, Jiri; Welikala, Roshan; Barman, Sarah; Mann, Samantha; Scanlon, Peter; Habib, Maged; Egan, Catherine; Tufail, Adnan; Owen, Christopher; Rudnicka, Alicja; Scanlon, Peter; Medical and Dental
Aims: To explore attitudes of people living with diabetes (PLD) and healthcare professionals (HCP) towards the use of automated retinal image analysis systems using artificial intelligence (AI) in NHS Diabetic Eye Screening Programmes (DESP) and how these perceptions vary by sociodemographic subgroups. Methods: Two anonymous online surveys (28 questions for PLD and 21 for HCP) were developed to assess attitudes towards AI. Data were collected from four English DESPs, diabetes charities and patient groups between September and December 2023. Likert-scale responses were analysed using regression to examine subgroup differences. Results: A total of 1577 PLD and 262 HCP participated. Fifty-eight per cent of PLD believed AI would perform equally well in all subgroups, compared with 32% of HCP. Seventy-one per cent of HCP disagreed that AI could replace human grading, and 81% of PLD felt humans should remain responsible for screening outcomes. Both groups supported AI's efficiency but had concerns about data security, trust, job security and who would be responsible for AI errors. Linear regression of Likert scores showed women were less accepting of AI; PLD of Black and Asian ethnicities were more cautious of data security and impact on screening experience. HCP of Asian ethnicity generally held more negative views across themes. Those using more online applications had more positive views towards AI. Conclusions: While both PLD and HCP recognise AI's potential benefits, concerns regarding security, job impact and errors highlight the need for targeted outreach based on sociodemographic factors. Keywords: artificial intelligence; diabetes; screening; survey; technology.
A Database Evaluation of Complication Rates and Visual Outcomes of Cataract Surgery Performed by Trainees versus Independent Surgeons
(Lippincott, Williams & Wilkins, 2025-10-22) Rickels, Kaersti; Elhusseiny, Abdelrahman; Chauhan, Muhammad; Toma, Joseph; Ellabban, Abdallah; Sallam, Ahmed; Sallam, Ahmed; Medical and Dental
Purpose: To compare complication rates and visual outcomes of cataract surgery performed by trainees vs. independent surgeons. Setting: Eight United Kingdom clinical centers Design: Retrospective multicenter clinical database study Methods: We evaluated 15-year data of 35,558 cataract surgeries undertaken by trainees and 77,131 by independent surgeons for the rate of operative complications with emphasis on posterior capsule rupture (PCR) and logarithm of the minimum angle of resolution (logMAR) distance VA (defined as best available value of uncorrected or corrected VA) at 4 to 12 weeks. Recording of intraoperative complications was robust using a predetermined list of cataract surgery complications in the electronic medical record. Results: Trainees operated on less complex eyes, with lower rates of advanced cataracts and poor pupillary dilation (p<0.001). Trainee surgeries had a significantly higher rate of PCR (2.4% vs. 1.3%) compared to independent surgeons. Junior trainees had the highest PCR rate at 3.87%, compared to senior trainees at 2.12%. Using the funnel plot methodology, most surgeons appeared to approach the overall mean of PCR, 1.9%, at a surgical volume of approximately 150 cases. At 4 to 12 weeks postoperatively, there was no significant difference in the mean logMAR VA between both groups (0.197 vs. 0.200, Snellen equivalent ∼ [20/30], p= 0.095). Conclusion: PCR should be the primary metric for assessing the quality of trainee-performed cataract surgery rather than VA outcomes. Funnel plot representation of PCR provides an equitable approach for monitoring trainees' surgical progress and peer-to-peer comparisons.
Risk factors associated with progression to referable retinopathy: a type 2 diabetes mellitus cohort study in the Republic of Ireland
(Wiley, 2020-02-24) Smith, John; Wright, David; Scanlon, Peter; Noemi, Lois; Scanlon, Peter; Medical and Dental
Aim To determine factors associated with progression to referable diabetic retinopathy in people with type 2 diabetes in the Republic of Ireland. Research design and methods The study was conducted in a dynamic cohort of 2770 people with type 2 diabetes, recruited between April 2005 and July 2013. Systemic factors (systolic and diastolic blood pressure, HbA1c, lipid levels, BMI) and baseline diabetic retinopathy grading results were evaluated at 4-monthly and yearly intervals, respectively. Associations between risk factors (most recently recorded value, and rate of change in value between pairs of consecutive systemic evaluations) and development of referable diabetic retinopathy were estimated using Cox proportional hazards models. Results There was a fourfold increased risk of progression to referral when retinopathy was present at baseline vs no retinopathy at baseline (hazard ratio 4.02, 95% CI 2.80–5.78; P<0.001). Higher current values of HbA1c (hazard ratio 1.22, 95% CI 1.11–1.34; P<0.001), systolic blood pressure (hazard ratio 1.29, 95% CI 1.15–1.45; P<0.001) and triglycerides (hazard ratio 1.10, 95% CI 1.03–1.18; P=0.004) were associated with increased risk of referral. Higher current BMI (hazard ratio 0.83, 95% CI 0.73–0.95; P=0.007) and diastolic blood pressure (hazard ratio 0.91, 95% CI 0.85–0.97; P=0.006) were associated with reduced risk of referral. Conclusions Presence of retinopathy at baseline was strongly associated with increased risk of referral. Modest associations between systemic factors and risk of progression to referable retinopathy were detected.
The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 20, the hidden cost of intraocular lens choices for National Health Service funded cataract surgery in England
(Springer Nature, 2025-10-04) Malcolm, Jonathan; Donachie, Paul Henry John; Hernandez, Rodolfo; Buchan, John; Donachie, Paul; Medical and Dental
Background Patients that have a hydrophilic intraocular lens (IOL) inserted during cataract surgery are more likely to develop posterior capsular opacification (PCO) and require YAG laser posterior capsulotomy than those with hydrophobic IOLs. This study aimed to examine the cost implications of hydrophilic and hydrophobic IOL usage in NHS-funded cataract services in England and estimate the cost saving of increased hydrophobic IOL usage. Methods The cost of IOLs and YAG laser posterior capsulotomy was determined using NHS Spend Comparison Service data and Payment by Results tariffs. Data from the National Ophthalmology Database (NOD) audit was used to estimate PCO rates and the proportion of cataract cases that used hydrophilic and hydrophobic IOLs in England during the 2022 NHS year. Results The cumulative cost per case of purchasing an IOL and YAG laser posterior capsulotomy treatment over the 9-year period following cataract surgery was £148.73 (£96.83–£199.12) for hydrophilic IOLs and £107.58 (£62.99–£150.05) for hydrophobic IOLs. Of the cataract cases performed in England during the 2022 NHS year that were reported to the NOD, 52% used hydrophilic IOLs and 46% used hydrophobic IOLs. If all cases that used hydrophilic IOLs in England during the 2022 NHS year had instead used hydrophobic IOLs, the reduced need for YAG laser posterior capsulotomies could have saved around £13.0 million (£10.7 million–£15.6 million). Conclusions Hydrophilic IOLs remain popular amongst NHS-funded cataract services in England. Increasing hydrophobic IOL usage could be an effective strategy for lowering PCO rates while generating recurrent annual financial savings.
More Than Meets the Eye: A Rare Case of Posterior Scleritis Masquerading as Orbital Cellulitis
(Springer, 2020-05-18) Hogan, Christopher; Vakros, George; Jones, Rebecca; Bhalla, Sanjana; McVeigh, Katherine; Jones, Rebecca; Medical and Dental
Posterior scleritis is a rare sight-threatening condition that typically presents with an acutely painful eye, often with associated reduced visual acuity. Diagnosis can be challenging and requires specialist ophthalmological assessment. Consequences of delayed treatment include permanent loss of vision. We present a case of posterior scleritis initially managed as periorbital cellulitis. We highlight the importance of broad differential diagnoses when assessing painful periorbital swelling, and present a review of current management strategies for posterior scleritis.
Factors Influencing Retinal Pigment Epithelium-Atrophy Progression Rate in Stargardt Disease
(Association for Research in Vision and Ophthalmology, 2020-06) Cicinelli, Maria; Rabiolo, Alessandro; Brambati, Maria; Vigano, Chiara; Bandello, Francesco; Parodi, Maurizio; Rabiolo, Alessandro; Medical and Dental
Purpose: To evaluate demographic, clinical, imaging, and genetic factors associated with retinal pigment epithelium enlargement in Stargardt disease (STGD1) and to measure the agreement between short-wavelength fundus autofluorescence (SW-FAF) and near-infrared fundus autofluorescence (NIR-FAF). Methods: Retrospective cohort study of patients with STGD1 with ≥2 gradable SW-FAF images. RPE-atrophy areas were measured on SW-FAF and NIR-FAF at each visit and regressed against time to obtain the rate of RPE-atrophy enlargement. Agreement between SW-FAF and NIR-FAF with regards to baseline atrophic areas and rates of enlargement was evaluated. Baseline factors predictive of faster SW-FAF RPE-atrophy enlargement were investigated with linear mixed models. Results: Fifty-four eyes of 28 patients (median age: 45 years; 13 males) were included. SW-FAF and NIR-FAF agreed well for slow rates of RPE-atrophy progression, but agreement decreased as the rate increased. Median (interquartile range [IQR]) rate of RPE-atrophy expansion was 0.18 (0.10–0.85) mm2/year on SW-FAF and 0.24 (0.08–0.33) mm2/year on NIR-FAF. Larger baseline RPE-atrophy area (estimate: 0.057 mm2/year, P < 0.001), worse visual acuity (0.305 mm2/year, P = 0.005), multifocal disease (0.401 mm2/year, P = 0.02), and SW-FAF pattern (0.534 mm2/year, P =0 .03) were associated with a faster rate of progression (predictive R2: 0.65). Conclusions: SW-FAF and NIR-FAF are not interchangeable in the evaluation of RPE-atrophy enlargement, and both imaging modalities may be required for optimal detection of disease progression. A multivariable model based on baseline clinical and imaging information may identify patients at higher risk of fast disease progression. Translational Relevance: The knowledge of the agreement of different FAF modalities, the estimated rates of RPE-atrophy enlargement, and factors predictive of faster anatomic decay in STGD1 may allow tailored clinical management and better clinical trials design.
Progression from Early/Intermediate to Advanced Forms of Age-Related Macular Degeneration in a Large UK Cohort: Rates and Risk Factors
(Elsevier, 2020-07) Chakravarthy, Usha; Bailey, Clare; Scanlon, Peter; McKibbin, Martin; Khan, Rehna; Mahmood, Sajjad; Downey, Louise; Dhingra, Narendra; Brand, Christopher; Brittain, Christopher; Willis, Jeffrey; Venerus, Alessandra; Muthutantri, Anushini; Cantrell, Ronald; Scanlon, Peter; Medical and Dental
Purpose To estimate rates and risk factors for progression to geographic atrophy (GA) or choroidal neovascularization (CNV) among eyes diagnosed with early or intermediate age-related macular degeneration (AMD) in clinical practice. Design Retrospective cohort analysis of a multicenter electronic medical record (EMR) database from the United Kingdom. Participants Patients aged 50 years or more with diagnosis of early/intermediate AMD in at least 1 eye (the study eye) and no evidence of CNV or GA in the study eye, from 10 clinical sites using the EMR. Methods Anonymized data for 40 543 patients with a diagnosis of early/intermediate AMD were extracted between October 2000 and February 2016 from EMR database records held in the 10 sites. A sample of records randomly selected from each center was used to validate disease definitions. Records were analyzed by subgroup, based on the AMD status of the fellow eye. Multivariate Cox regression models identified other predictors of disease progression. Main Outcome Measures Progression rate (per 100 person-years) to GA or CNV in study eyes with early/intermediate AMD by fellow eye status and identified risk factors for progression. Results Study eyes with early/intermediate AMD and a diagnosis of CNV in the fellow eye progressed to CNV fastest (at a rate of 15.2 per 100 person-years), and those with a diagnosis of GA in the fellow eye progressed to GA fastest (11.2 per 100 person-years), compared with the rates per 100 person-years of progression to CNV (3.2–11.9) or GA (2.0–7.8) in the other subgroups. In individuals with bilateral early/intermediate AMD, rates of progression to GA or CNV were 2.0 and 3.2 per 100 person-years, respectively. In the multivariate model, age, female sex, and cardiovascular disease were associated with an increased risk for progression to advanced AMD, whereas diabetes and glaucoma were associated with a decreased rate of progression (hazard ratios, 0.45 and 0.64, respectively). Conclusions Progression to GA or CNV was observed frequently in eyes with early/intermediate AMD, with the status of the fellow eye affecting the rate of progression. Novel associations with risk factors were observed and require replication in other cohorts.
Fundamental principles of an effective diabetic retinopathy screening program
(Springer, 2020-03-28) Lanzetta, Paolo; Sarao, Valentina; Scanlon, Peter; Barratt, Jane; Porta, Massimo; Bandello, Francesco; Lowenstein, Anat; Vision Academy; Scanlon, Peter; Medical and Dental
Background Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults worldwide. Early detection and treatment are necessary to forestall vision loss from DR. Methods A working group of ophthalmic and diabetes experts was established to develop a consensus on the key principles of an effective DR screening program. Recommendations are based on analysis of a structured literature review. Results The recommendations for implementing an effective DR screening program are: (1) Examination methods must be suitable for the screening region, and DR classification/grading systems must be systematic and uniformly applied. Two-field retinal imaging is sufficient for DR screening and is preferable to seven-field imaging, and referable DR should be well defined and reliably identifiable by qualified screening staff; (2) in many countries/regions, screening can and should take place outside the ophthalmology clinic; (3) screening staff should be accredited and show evidence of ongoing training; (4) screening programs should adhere to relevant national quality assurance standards; (5) studies that use uniform definitions of risk to determine optimum risk-based screening intervals are required; (6) technology infrastructure should be in place to ensure that high-quality images can be stored securely to protect patient information; (7) although screening for diabetic macular edema (DME) in conjunction with DR evaluations may have merit, there is currently insufficient evidence to support implementation of programs solely for DME screening. Conclusion Use of these recommendations may yield more effective DR screening programs that reduce the risk of vision loss worldwide.
Macula service evaluation and assessing priorities for anti-VEGF treatment in the light of COVID-19
(Springer Nature, 2020-05-25) Stone, Lydia; Devenport, Adele; stratton, irene; Talks, James; Stratton, Irene; Additional Professional Scientific and Technical
Purpose: To assess the treatment position of all patients who have had an anti-VEGF injection in 2020, prior to the UK lockdown on 23 March. To assess methods of service quality evaluation in setting benchmarks for comparison after the situation stabilized. To consider what proportion could be delayed based on national guidelines and varying vision parameters. Finally, to measure how many patients actually attended. Method: A retrospective analysis of data collected from our electronic medical record was performed. Age, sex, reason for injection, visual acuity (VA) for both treated and untreated eyes and number of injections were recorded. The proportion of patients and eyes with ≥ 70 letters were calculated as an assessment of quality of service provision. The proportion of patients that could be delayed was estimated based on published guidelines and varying the parameters of difference between treated and untreated eyes. Finally, the number of patients who actually attended was recorded. Results: About 3364 eyes (2229 neovascular age-related macular degeneration (nAMD), 427 diabetic macular oedema (DMO), 599 retinal vein occlusion (RVO) and 109 other) from 2924 patients were analysed. At the last appointment with injection, 64.4% of patients achieved ≥ 70 letters in their better-seeing eye. Mean VA of the treated eye was 61.5 letters, and 36.9% achieved ≥ 70. The mean number of injections was 16, 90% with aflibercept. Of the patients receiving treatment to one eye, 57.6% was receiving treatment to their worse seeing eye. In 18.2% this eye was > 20 letters worse and in 5.07% > 40 letters worse than the untreated eye. Using Royal College of Ophthalmologists (RCOphth) guidelines, (treat nAMD 8 weekly, delay majority of RVO and DMO) 24.8% would be delayed. From 2738 appointments during the first 4 weeks of lockdown (booked prior to lockdown), doctors rescheduled 1025 and patients did not attend 820, leaving 893 who were seen (33%). Conclusions: Assessing the treatment position of patients prior to COVID-19 lockdown enables objective stratification for prioritization for continued treatment. If RCOphth guidelines were followed 24.8% could be delayed and if treating the worse seeing eye up to 57.6%. Many scheduled patients elected not to attend, with 67% not seen in the first 4 weeks. The impact of non-attendance and delays may be evaluated later.
Treatment with interleukin-33 is non-toxic and protects retinal pigment epithelium in an ageing model of outer retinal degeneration
(Wiley, 2020-10-20) Clare, Alison; Copland, David; Nicholson, Lindsay; Liu, Jian; Neal, Chris; Moss, Stephen; Dick, Andrew; Theodoropoulou, Sofia; Theodoropoulou, Sofia; Medical and Dental
The leading cause of central vision loss, age-related macular degeneration (AMD), is a degenerative disorder characterized by atrophy of retinal pigment epithelium (RPE) and photoreceptors. For 15% of cases, neovascularization occurs, leading to acute vision loss if left untreated. For the remaining patients, there are currently no treatment options and preventing progressive RPE atrophy remains the main therapeutic goal. Previously, we have shown treatment with interleukin-33 can reduce choroidal neovascularization and attenuate tissue remodelling. Here, we investigate IL-33 delivery in aged, high-fat diet (HFD) fed mice on a wildtype and complement factor H heterozygous knockout background. We characterize the non-toxic effect following intravitreal injection of IL-33 and further demonstrate protective effects against RPE cell death with evidence of maintaining metabolic retinal homeostasis of Cfh+/-~HFD mice. Our results further support the potential utility of IL-33 to prevent AMD progression.
The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection
(Springer Nature, 2020-01-07) Buchan, John; Donachie, Paul Henry John; Cassels-Brown, Andy; Liu, Christopher; Pyott, Andrew; Yip, Jennifer; Zarei-Ghanavati, Mehran; Sparrow, John; Donachie, Paul; Medical and Dental
Background Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. Methods Data were analysed from the Royal College of Ophthalmologists’ National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. Results During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% (p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). Conclusions ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.

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