Ophthalmology

doi:10.1136/bmj.318.7185.717

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Rapid responses are electronic letters to the editor and new ones are published each day. Read latest responses.

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Alistair R Fielder (a.fielder@ic.ac.uk), professor,
Christopher Bentley, specialist registrar,
Merrick J Moseley, senior lecturer

Imperial College School of Medicine, Western Eye Hospital, London NW1 5YE

Correspondence to: Professor Fielder

Introduction

When pondering recent advances in any clinical discipline there is a tendency to focus on new techniques, drugs, surgical instruments, and at the most fundamental level, on molecular biology. This article is no exception, as progress in all these spheres is essential if headway is to be made. But we are all also aware that new surgical tools quite soon become tarnished, replaced, and even forgotten. We have therefore included topics where the “advance” has served to highlight how little we know rather than how much progress has been made. We hope these finding will soon affect clinical practice.

Summary points

Several new topical drugs have been developed for open angle glaucoma which can be used alone or in combination

Outcome of glaucoma surgery can be improved in high risk patients by topically applied antimetabolites

Endoscopic devices permit direct visualisation for many intraocular and extraocular surgical procedures

Early exposure to light is not a factor in the development of retinopathy of prematurity

Effectiveness of the standard treatment of amblyopia has been called into question

Many visually impaired elderly people in the community are unidentified and do not get treatment or support

Guidelines are available on breaking the news of a child's visual impairment to parents

Methods

This review is not systematic but a pot pourri of topics identified with the rationale stated in the introduction in mind. Although we did not do a detailed critical appraisal of all cited publications, most of the reported findings remain uncontroversial. Where this is not so, we refer to any ongoing debate.

Primary open angle glaucoma

Primary open angle glaucoma is one of the biggest causes of vision impairment worldwide and affects over five million people. Although its genetic basis is slowly unfurling,1 these findings have yet to affect management. Glaucoma has traditionally been perceived as having a “correct order …