The Scottish RD survey 10 years on: the increasing incidence of retinal detachments.

BACKGROUND: The Scottish RD Survey reported an incidence of 12.05/100,000/yr in 2009. Data published from Denmark recently confirmed a 50% increase in RD presentations over the last 16 years. We set out to repeat the Scottish RD survey to determine if a similar trend has been observed in Scotland. METHODS: All 16 Scottish VR surgeons, who make up the collaboration of Scottish VR Surgeons (SCVRs) were asked to prospectively record all primary RDs presenting from 12th August 2019 to 11th August 2020. For consistency, the case definitions were the same as for the 2009 Scottish RD Survey. Basic demographic and clinical features were recorded. Age specific incidence was calculated from mid-year population estimates for 2019 obtained from the National Records of Scotland. RESULTS: There were 875 RRDs recorded, which gives an updated incidence of 16.02/100,000/year in Scotland. 62.8% occurred in males and the greatest increases were seen in males aged 50-59 (p = 0.0094), 60-69 (p = 0.0395) and females aged 40-49 (p = 0.0312) and 50-59 (p = 0.0024). The proportion of pseudophakic RRDs in this study is 29.4% (253/860). Compared to the 21.6% in the 2010 study, this represents a 28% increase (χ2 = 11.03, p = 0.0009). The proportion of macula-off RRDs remained generally stable at 58%. CONCLUSION: Our study confirms that RRD is becoming more common in the UK, reflecting almost identical findings from Denmark. This trend is in part due to increasing myopia, increasing pseudophakia, and possibly other factors. This should be considered when planning VR services and allocating resources in the future.

Assessing the effect of Independent Prescribing for community optometrists and referral rates to Hospital Eye Services in Scotland.

INTRODUCTION: Since 2010, General Ophthalmic Services (GOS) legislation and Independent Prescribing (IP) enable community optometrists to manage primary eye conditions. No studies have assessed the effect of IP. We wished to determine the distribution of IP optometrists and associated hospital referral rates across Scotland. METHODS: In 2019, FOI requests (General Optical Council and NHS Education Scotland) identified all registered IP optometrists in Scotland and their registered postcodes. Data regarding community eye examinations and referrals to HES since 2010 were gathered via Information Services Division of NHS Scotland. RESULTS: As of March 2019, there were 278 IP optometrists in Scotland (278/1189; 23.4%). Two hundred eighteen IP optometrists work in 293 practices across 11 of Scotland's 14 health boards. There was a strong correlation (r = +0.96) between population density and number of IP optometrists. Fifty-six percent of IP optometrists work in the two most deprived quintiles. Since IP's introduction, there has been a marked increase in anterior segment supplementary visits (+290%). Optometry referrals to GPs have reduced by 10.5%, but referrals to HES have increased by 118% (to 96,315). There was no correlation between quantity of IP optometrists and referral rates to HES (r = -0.06, 95% CI -0.64 to 0.56, p = 0.86). CONCLUSIONS: This is the first analysis of IP optometrists and associated referral rates in Scotland. Despite good geographical distribution and increased supplementary attendances, optometric referrals to HES have doubled and continue to rise. We propose a ratio of primary, supplementary, non-referral and referral rates to discern the true impact of IP versus non-IP community optometric behaviour.

Twenty-four-month real-world visual outcomes of intravitreal aflibercept as monotherapy for the treatment of neovascular age-related macular degeneration.

BACKGROUND: Aflibercept is widely used as a treatment for neovascular age-related macular degeneration (nAMD). Nevertheless, there is no consensus in the optimal injection frequency in the 2nd year of treatment along with little real-world data on visual outcomes. On that basis, the primary aim of this study was to assess the visual acuity (VA) and the total number of injections needed on average for these patients during the 24-month follow-up. MATERIALS AND METHODS: This is a retrospective observational study from an electronic medical record of consecutive patients treated with intravitreal aflibercept (both naïve and nonnaïve eyes) who had completed the 24-month follow-up since the commencement of treatment. Patients followed the VIEW protocol in year 1 whereas in year 2, an as required approach/Pro Re Nata (PRN) was used. RESULTS: Eighty-seven eyes of 78 patients were analyzed. 43.7% were nonnaive eyes. Baseline VA for all eyes (logMAR) was 52.6 letters, improving to 56.2 letters at 12 months and 55 at 24 months. Almost 83.9% of the treated eyes (81.3% of the patients) did not experience any significant visual loss receiving on average of 9.9 injections in the 24 months of follow-up and attending the hospital eye service 20.3 times in total. CONCLUSIONS: Aflibercept as monotherapy for the treatment of nAMD is associated with good 2 nd year outcomes in a real-world setting using the PRN approach in year 2 and fewer injections comparing to the clinical studies, but a higher proportion of follow-up visits compared to the treat and extend regimen.

A non-surgical alternative to the management of myopathic ptosis.

Oculopharyngeal Muscular Dystrophy (OPMD) is a systemic progressive autosomal dominant myopathy which results in ptosis due to levator weakness. Surgical correction can be complicated by corneal exposure and a non-surgical alternative, such as ptosis props, can be uncomfortable in patients with preserved orbicularis function. We describe a case of a 57-year-old gentleman with OPMD, who declined surgical intervention, and self-manages his ptosis with cosmetic glue.

Fundoscopy screening for intraocular candida in patients with positive blood cultures-is it justified?

INTRODUCTION: Although the worldwide prevalence of disseminated candidaemia is rising, reported intraocular candidiasis rates are variable, even as low as 1%. The Infectious Diseases Society of America recommends fundoscopy screening for all fungal blood culture positive patients. We wished to evaluate the impact of this recommendation on our department. METHODS: A retrospective observational study was performed in NHS Greater Glasgow and Clyde (population = 1.15 million) for all patients with candida positive blood culture results over a 2-year period. RESULTS: From January 2015 to December 2016, 258 candida positive cultures were obtained from 168 adults (mean age = 62 years, range: 17-94 years; 85 females, 83 males). Candida species were isolated in 161/168 (95.8%) cases (43.5% Candida albicans, 35.7% Candida glabrata). All 168 cases were treated with intravenous antifungals. 84 patients (50%) were formally referred to ophthalmology. Of those not referred, 21 were deceased prior to culture result (12.5%) and 14 patients subsequently deteriorated (8.3%). Six patients reported visual symptoms. In total, 65% had no ocular findings and 32.5% had unrelated ocular signs. Only one patient had signs consistent with Candida chorioretinitis, making the prevalence of intraocular candida in our population 1.3% (1/80). CONCLUSIONS: The prevalence of ocular candidiasis is low, presumably due to potent systemic antifungal agents and good intraocular penetration. Our findings support the view that routine fundoscopy screening may not be indicated in every culture positive patient. This paper provides an evidence base for the Royal College's Eyecare in intensive care unit recommendations regarding targeted screening of non-verbal, symptomatic or high-risk patients.