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When I was starting off in ophthalmology my then boss had a standard spiel after completing a cataract case. It did not vary and I do not recall an instance of it not taking place. “The operation went well and...

The past and the future for paediatric ophthalmology

The past 25 years have seen remarkable advances in clinical eye care for children in the UK. This has led to both improved outcomes and better patient and family experiences. There have been substantial changes to patient pathways, major advances...

Initiatives in macular service provision

A report from Monitor in October 2015 identifies good practices that will realise most of the potential productivity gain in elective care available to NHS hospitals. These include: stratifying patients by risk and creating low-complexity pathways for lower-risk patients (tailoring...

Traumatic ‘toy’ gun injury leading to permanent vision loss

Pseudoxanthoma elasticum (PXE) is a progressive, inherited disorder of connective tissue that affects the skin, cardiovascular system and retina. Ocular manifestations of the disease are related to Bruch’s membrane, a thin elastic tissue layer located between the retinal pigment epithelium...

Pathological myopia: a trainer’s perceptive

High myopia is defined as myopic refraction of greater than -6 dioptres with an axial length greater than 26.5mm, while pathological myopia is myopic refraction with posterior pole degeneration [1]. These degenerative changes can affect a young population and in...

Choroidal folds

Choroidal folds are undulations of the choroid, Bruch’s membrane and pigment epithelium, with wrinkling of the overlying retina. They may be idiopathic but can also be caused by a number of different conditions. Case report A 60-year-old male patient was...

Birdshot retinochoroiditis

Birdshot retinochoroiditis (BRC) is a chronic, sight-threatening uveitis, most commonly affecting caucasian individuals in their fourth to sixth decades [1]. The disease is associated with HLA-29 and is characterised by progressive inflammation at the level of retina and choroid, with...

Gene therapy for inherited retinal disease: the Manchester Ocular Gene Therapy Group MDT service

The authors describe the process set up in Manchester for the optimum delivery and assessment of a new gene therapy treatment for patients with RPE65 IRD. Inherited retinal dystrophies (IRDs) are the second commonest cause of severe visual impairment in...

Time is vision in central retinal artery occlusion

Central retinal artery occlusion (CRAO) is a rare but devastating vascular episode that can have severe impact on vision. Treatment is very time-limited and needs to be initiated very quickly to salvage any vision. The majority of patients present to...

The power of the full blood count

Vishal Shah walks us through his thought process whilst highlighting the importance of routine investigations when dealing with unusual retinovascular presentations. Retinal changes can arise in anaemia, leukaemia, lymphoma, myeloproliferative and myelodysplastic syndrome. They are often the first manifestation of...

Ocular electrophysiology

A 34-year-old woman, who is a CEO in a multinational firm, has been losing vision over the last 12 months. She has seen her opticians, who initially tried different glasses but could not improve things. Clinical examination is unremarkable. How...

Discussing treatment modalities for bilateral wet AMD

A 65-year-old lady with bilateral wet AMD and vision of 6/24 comes with an internet search about current therapies. How do you explain the various treatment modalities available? There are two NICE approved treatments for wet age-related macular degeneration (AMD)....