How good are we at advising appropriate patients with glaucoma to inform the DVLA? A closed audit loop.

PURPOSE: To establish how good we are as clinicians at advising glaucoma patients with bilateral visual field defects of their legal responsibility to inform the Driver and Vehicle Licensing Agency (DVLA). By using a sticker placed in the patients' notes to highlight driving status and visual fields, we sought to improve our success in providing and documenting this advice. METHODS: We interviewed and examined the notes of two groups of 100 consecutive glaucoma patients before and after the introduction of a 'driver sticker' placed into patients' notes at the time of visual field testing. We examined the documentation of driving status, and the provision and documentation of advice regarding the DVLA. RESULTS: In the first audit, we found only 9% of patients had driving status documented. Only 20% of drivers with bilateral field defects were advised to inform the DVLA with 11.4% documentation of this advice. After the introduction of the sticker, we succeeded in improving the documentation of driving status to 99%. We advised and documented the advice to inform the DVLA in 97% of drivers with bilateral field defects. CONCLUSIONS: We found that as a unit we were poor at documenting driving status and advising glaucoma patients with bilateral field defects to inform the DVLA. By the simple measure of introducing a sticker into patients' notes, we were able to highlight this critical group and improve our provision and documentation of appropriate advice regarding informing the DVLA.

Retinal angiography in divers.

OBJECTIVE: In the light of previous reports, to examine the possibility that professional diving might cause abnormalities of the retina and choroid. METHODS: The retinal fluorescein angiograms of 55 Royal Naval divers and 24 non-diver servicemen were compared. RESULTS: No differences were found between divers and non-divers and the prevalence of abnormalities was not correlated with diving experience. CONCLUSION: In contrast to previous reports, there seem, at least in naval personnel, to be no ocular consequences of diving.

Rhegmatogenous retinal detachment in Royal Naval personnel: a retrospective study.

A retrospective study was conducted to assess the various factors thought to influence the outcome of retinal detachment in RN personnel. A description of retinal detachment and its management, aimed at non-specialists, is given in the introduction. In the study period eight Servicemen had rhegmatogenous retinal detachments. All underwent conventional detachment surgery, but two required two further operations including vitrectomy. Important features of each patient's detachment are discussed, as is post-operative progress. All patients spent a considerable time away from duty and three were discharged from the Service on medical grounds. Poor outcome could be related to myopia, trauma, delay in presentation to primary care, the number of operations performed and to post-operative complications. Advice is given regarding assessment and management of suspected cases by non-specialists. It is hoped that reporting this study will increase awareness within the RN of retinal detachment as a sight-threatening condition.

Secondary angle closure in association with pseudoexfoliation of the lens capsule.

Two cases of pseudoexfoliation of the lens capsule are presented in which unilateral shallowing of the anterior chamber caused an acute rise in intraocular pressure. Both patients were elderly women. In one case anterior chamber shallowing was precipitated by administration of pilocarpine and the second followed central retinal vein occlusion. We suggest that pseudoexfoliation of the lens capsule weakened the zonule allowing forward shift to the lens and secondary angle closure.