Intended for healthcare professionals

Clinical Review Recent advances


BMJ 1999; 318 doi: (Published 13 March 1999) Cite this as: BMJ 1999;318:717
  1. Alistair R Fielder (, professor,
  2. Christopher Bentley, specialist registrar,
  3. Merrick J Moseley, senior lecturer
  1. Imperial College School of Medicine, Western Eye Hospital, London NW1 5YE
  1. Correspondence to: Professor Fielder


    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


    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 …

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