Visual impairment in school children in Northern Ireland

O'Donoghue et al describe the prevalence of refractive errors (myopia and hyperopia) and visual impairment from the Northern Ireland Childhood Errors of Refraction study, a population-based cross-sectional study of 661 white 12–13-year-old and 392 white 6–7-year-old children. Myopia was defined as 0.50DS or more myopic SER in either eye, hyperopia as ≥+2.00DS SER in either eye. Visual impairment was defined as >0.30 logMAR units (equivalent to 6/12). Levels of myopia were 2.8% in younger and 17.7% in older children: corresponding levels of hyperopia were 26% and 14.7%. The prevalence of presenting visual impairment in the better eye was 3.6% in older children compared with 1.5% in younger children. As one in four children fails to bring their spectacles to school, the authors emphasise the need to develop strategies to improve compliance with spectacle wear. See page 1155

Delayed adjustable sutures

Robbins et al report the results of closed conjunctival delayed adjustable sutures performed on 440 patients by 5 surgeons. 26% of patients required postoperative manipulation. The majority of the patients (84%) did not complain of diplopia in target gaze and/or had satisfactory cosmetic improvement. Transient complications included dellen, poor conjunctival appearance, filamentary keratitis, infection, granuloma, exposed suture and corneal abrasion. Serious complications were rare. See page 1169

Transscleral diode laser cycloablation

Rotchford et al investigated the effects of diode laser cyclophotocoagulation on central visual function in 43 patients (49 eyes) with preoperative VA ≥20/60. After a mean follow-up of 5.0 years, 67% retained VA ≥20/60. VA deteriorated by one Snellen line or more 63%) and in 16%, final VA was <20/200. The main causes for vision loss were glaucoma progression (9 eyes) and macula oedema (4 eyes). IOP was controlled in 80%. None of the treated eyes developed hypotony. The authors conclude that transscleral cycloablation can be used even in eyes with visual potential. See page 1180

SD-OCT features in adult onset foveomacular vitelliform dystrophy

Puche et al describe morphological features in 60 eyes (49 consecutive patients) with adult onset foveomacular vitelliform dystrophy (AOFVD) using SD-OCT.

In 28 eyes, SD-OCT showed hyper-reflective clumps within the outer plexiform and outer nuclear layers. In 9 eyes, the photoreceptor inner segment/outer segment (IS/OS) interface appeared highly reflective like a shell all around the vitelliform material, and appeared irregular and discontinued in 27 eyes. The vitelliform material appeared as a highly reflective dome-shaped lesion located between the photoreceptor layer and the RPE. The authors hypothesise that early changes involve the layer between RPE and the IS/OS interface, with vitelliform material accumulating beneath the sensory retina. See page 1190

Correlation between fluorescein angiography and SD OCT in CME

Jittpoonkuson et al compared the ability to detect CME and its late complications between spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) in 85 eyes who had FA and SD-OCT performed on the same day. CME associated with retinal vein occlusion (RVO), AMD, and diabetic retinopathy (DR) were missed by FA in 19%, 33% and 33% of cases, respectively. Subretinal fluid was undetectable by FA in 55%, which mainly were in the RVO group. SD-OCT gave earlier CME diagnosis than FA in three (3.53%) eyes. Late complications of CME (macular hole, subretinal fluid, RPE detachment and photoreceptor atrophy) were detectable only by SD-OCT. The authors conclude that SD-OCT is more sensitive than FA in detecting CME. SD-OCT was also more sensitive than FA for detecting subretinal fluid and late complications of long-standing CME. See page 1197

Central retinal thickness and visual acuity

Nunes et al investigated the correlation between increased retinal thickness (RT) measured with SD-OCT and best-corrected visual acuity (BCVA) in 62 eyes with clinically significant macular oedema (CSME) and type 2 diabetes. In 19 eyes with CMSE identified by SD-OCT without increased RT in the central fovea (500-mm-diameter circle), no correlation was found between RT and BCVA (R=0.06). In the 43 eyes where the SD-OCT identified an increased RT in the central fovea only a moderate correlation between RT and BCVA was found (R=0.46). The authors conclude that RT cannot be used as a surrogate outcome for visual acuity changes. See page 1201

Confocal microscopy of human corneal nerves

Al-Aqaba et al studied the distribution, morphometry and the postmortem changes of the central and peripheral human corneal nerves by ex vivo laser-scanning confocal microscopy (EVCM) in 24 eyes (14 cadavers). Five regions were examined in each eye and corneal nerve images were categorised according to their anatomical location in the cornea into sub-basal, stromal and limbal nerves. They observed that stromal nerves from the sub-Bowman's plexus perforate the Bowman's zone and terminate in bulb-like structures, from each of which a leash of subbasal nerves arises. The sub-basal nerve plexus rapidly degenerates after death but stromal and limbal nerves survive during the first five days after death. See page 1251