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Background/AimsProspective data on switching anti-vascular endothelial growth factors in patients with neovascular age-related macular degeneration (nAMD) who have previously shown no/partial response are limited. This prospective study assessed the effect of switching from aflibercept to ranibizumab on anatomical and functional outcomes in patients with persistent/recurrent disease activity.MethodsSAFARI (NCT02161575) was a 6-month, prospective, single-arm study conducted in the UK and Germany. Patients, meeting strict eligibility criteria for one of two subgroups (primary treatment failure or suboptimal treatment response), received 3 monthly intravitreal ranibizumab injections (0.5 mg). Thereafter, ranibizumab was administered pro re nata at monthly visits. The primary endpoint was change from baseline (CfB) to day 90 in central subfield retinal thickness (CSRT). Best-corrected visual acuity (BCVA) and retinal morphology parameters were assessed.ResultsOne hundred patients were enrolled (primary treatment failure, 1; suboptimal treatment response, 99). In the overall population, there was a significant CfB in median CSRT of −30.75 µm (95% CI −59.50,–20.50; pConclusionSwitching from aflibercept to ranibizumab led to a significant improvement in CSRT, with ~60% experiencing stabilised/improved BCVA. Therefore, patients with nAMD who have shown a suboptimal response to aflibercept may benefit from switching to ranibizumab.

Purpose To describe the types and prevalence of long-term, established pseudophakic dysphotopsia in a typical population more than a year after cataract extraction. Design Cross-sectional observational study. Methods Fifty-five patients who had undergone cataract surgery more than a year before were administered a questionnaire that was based on photographic images of photic phenomena. Results Dysphotopsia were found in 18 of 55 patients. There was a predominance of halos and starburst effects but also substantial symptoms of arc effect, streams of light, and central flash. There was no correlation between measured dysphotopsia and age, final attained acuity, or contrast sensitivity. Conclusions Dysphotopsia in the operated eye was still a common symptom in its many forms more than a year after uncomplicated cataract surgery. There was no correlation of symptoms with age or visual function.

Dear Editor, We read with interest the article by Buller and co-workers [1] indicating that patients anticipate and experience less inconvenience from once daily (OD) eye drop regimes compared to more complicated alternatives. They suggest, therefore, that OD regimes will encourage voluntary compliance. We would propose that OD treatment regimes also reduce involuntary non-compliance and are particularly advantageous for elderly patients. We surveyed 70 consecutive glaucoma patients by means of interview administered questionnaire to determine whether the medication they were actually using was the same as that advised by the ophthalmologist at their previous clinic visit. It was found that 11/70 (16%) were not compliant with the regime recommended. Six of these 11 were using the drops at an inappropriate frequency, which was felt to be due to a failure to make the treatment regime clear during the previous consultation. The other five of the 11 non-compliant patients were using medication other than that intended. Although the initial prescription for glaucoma medication may be given by an ophthalmologist, the responsibility for ongoing prescription of treatment in many health care systems rests with the family doctor or general practitioner. The source of error in these cases, therefore, was the system of communication between specialist and general practitioner. Non-compliant patients (mean age 78.9) were significantly older than those who complied (mean age 69.9) (p=0.04). Patients using OD drop treatments were also significantly more likely to be compliant than those on more complex regimes; only 1 of 33 OD patients failed to comply, compared to 10 of 37 patients prescribed more frequent drop administration (p

The literature on the Rh factor and its relationship to human disease, physical and mental, has been reviewed. My own investigation into the incidence of Rh incompatibility in 427 cases of mental deficiency has been described. The conclusion has been drawn that Rh incompatibility, per se , is not a factor in the causation of mental deficiency.

Shorvon and Sargant (1947) have given a full account of the history and development of the use of ether in relation to excitatory abreaction. They have shown how valuable its use can be to rid patients of emotional tension which has occurred as a result of some particular battle experience, such as being blown up, buried alive, torpedoed, etc. They propound various theories as to the mechanism of excitatory abreaction, and they give a full description of the technique they employed, illustrated by examples from the numerous cases with which they dealt.