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Purpose: In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False‐positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration. Recent findings: Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age‐related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first‐visit discharge rate was high (16.7%–48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false‐positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001). Summary: There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face‐to‐face appointments and promote communication between primary and secondary care. [ABSTRACT FROM AUTHOR]

To evaluate the current clinical practice of quantifying ductions and fields of BSV in the UK and Ireland using an online questionnaire. An anonymous online questionnaire with twenty–one questions was distributed in February 2019 via the British and Irish Orthoptic Society (BIOS) members' newsletter. Objectives were to investigate: methods used, frequency of assessment, limiting factors and opinions of importance. Informed consent was gained to include the responses in the study. The data was analyzed using descriptive statistics and Wilcoxon Signed Ranks Testing. The questionnaire was completed by 105 orthoptists. The methods reported to quantify ductions and fields of BSV respectively were: Goldmann (33% and 34%), Aimark (22 and 23%), Lister (7%), Octopus (5 and 4%), Thomson ocular motility analyzer (2 and 3%), Binocular vision analyzer (2%) and no method reported (30% and 32%). The frequency of measuring ductions and fields of BSV per week (median 1–2) was significantly less than the number of patients seen with limited ocular motility per week (median 6–9). The main reasons for never or rarely measuring ductions or fields of BSV were not enough time, no method available and only on selected patients. Respondents indicated that they would measure ductions and fields of BSV more frequently if a quicker portable method was available (median 3–5 times per week). Most agreed that measurements of ductions and fields of BSV are important (89 and 95% respectively). There is no standardized method of quantitively measuring ductions or fields of BSV, with almost a third of respondents not measuring either. Although most orthoptists agreed these measurements are important, they are infrequently performed. The main factors limiting these assessments are insufficient time and lack of a testing method. If a faster portable device was available, orthoptists would measure ductions and fields of BSV more frequently. [ABSTRACT FROM AUTHOR]

Strabismus refers to an abnormal alignment of the eyes leading to the loss of central binocular vision. Concomitant strabismus occurs when the angle of deviation is constant in all positions of gaze and often manifests in early childhood when it is considered to be a neurodevelopmental disorder of the visual system. As such, it is inherited as a complex genetic trait, affecting 2–4% of the population. A genome-wide association study (GWAS) for self-reported strabismus (1345 cases and 65,349 controls from UK Biobank) revealed a single genome-wide significant locus on chromosome 17q25. Approximately 20 variants across the NPLOC4–TSPAN10–PDE6G gene cluster and in almost perfect linkage disequilibrium (LD) were most strongly associated (lead variant: rs75078292, OR = 1.26, p = 2.24E−08). A recessive model provided a better fit to the data than an additive model. Association with strabismus was independent of refractive error, and the degree of association with strabismus was minimally attenuated after adjustment for amblyopia. The association with strabismus was replicated in an independent cohort of clinician-diagnosed children aged 7 years old (116 cases and 5084 controls; OR = 1.85, p = 0.009). The associated variants included 2 strong candidate causal variants predicted to have functional effects: rs6420484, which substitutes tyrosine for a conserved cysteine (C177Y) in the TSPAN10 gene, and a 4-bp deletion variant, rs397693108, predicted to cause a frameshift in TSPAN10. The population-attributable risk for the locus was approximately 8.4%, indicating an important role in conferring susceptibility to strabismus. [ABSTRACT FROM AUTHOR]

There is an ongoing debate under what conditions learned object sizes influence visuomotor control under preserved stereovision. Using meaningful objects (matchboxes of locally well-known brands in the UK) a previous study has nicely shown that the recognition of these objects influences action programming by means of reach amplitude and grasp pre- shaping even under binocular vision. Using the same paradigm, we demonstrated that short-term learning of colour-size associations was not sufficient to induce any visuomotor effects under binocular viewing conditions. Now we used the same matchboxes, for which the familiarity effect was shown in the UK, with German participants who have never seen these objects before. We addressed the question whether simply a high degree of distinctness, or whether instead actual prior familiarity of these objects, are required to affect motor computations. We found that under monocular and binocular viewing conditions the learned size and location influenced the amplitude of the reaching component significantly. In contrast, the maximum grip aperture remained unaffected for binocular vision. We conclude that visual distinctness is sufficient to form reliable associations in short-term learning to influence reaching even for preserved stereovision. Grasp pre-shaping instead seems to be less susceptible to such perceptual effects. [ABSTRACT FROM AUTHOR]

The optometric profession in the UK has a major role in the detection, assessment and management of ocular anomalies in children between 5 and 16 years of age. The role complements a variety of associated screening services provided across several health care sectors. The review examines the evidence-base for the content, provision and efficacy of these screening services in terms of the prevalence of anomalies such as refractive error, amblyopia, binocular vision and colour vision and considers the consequences of their curtailment. Vision screening must focus on pre-school children if the aim of the screening is to detect and treat conditions that may lead to amblyopia, whereas if the aim is to detect and correct significant refractive errors (not likely to lead to amblyopia) then it would be expedient for the optometric profession to act as the major provider of refractive (and colour vision) screening at 5–6 years of age. Myopia is the refractive error most likely to develop during primary school presenting typically between 8 and 12 years of age, thus screening at entry to secondary school is warranted. Given the inevitable restriction on resources for health care, establishing screening at 5 and 11 years of age, with exclusion of any subsequent screening, is the preferred option. [ABSTRACT FROM AUTHOR]

Statistical analysis is described of data on 1000 British drivers' accident histories and their performance on a vision screening instrument. Significant positive associations are evident between various accident variables and tests of hyperphoria, right eye visual acuity, left eye acuity and binocular acuity. The clustering of associations is strongest for older drivers. The significance of hyperphoria has received little attention previously. The age-related associations with accidents parallel the decline with age of other visual abilities. Statutory re-testing of drivers' vision at about the age of 50 is recommended. [ABSTRACT FROM AUTHOR]

Purpose: Intermittent exotropia is one of the most common types of strabismus in children especially in Asian and South Asian populations. Prevalence of exotropia in this group is estimated to range from 7–18.5× higher than esotropia. Spontaneous resolution is rare and if neglected may lead to loss of Binocular Single Vision (BSV) and negative psychosocial consequences. We aim to evaluate the outcomes of surgical management for intermittent exotropia at a unit in Birmingham (UK), an area unique for its high non‐White ethnic population (43%), majority of who are Asian/South‐Asian. Methods: Retrospective case notes review of patients diagnosed with intermittent exotropia who underwent strabismus surgery in 2019–2020 by two surgeons using two different surgical approaches with a 3 month follow‐up. Measures included pre‐ and post‐operative visual acuity and stereopsis, surgical indications, near and distance strabismus angle with refractive correction, type of surgery performed and parental satisfaction at follow‐up. Results: Nineteen children underwent surgery during this period with a mean age of 7 range (4–12). Eighteen patients had surgery for functional reasons and one for cosmetic. Two patients recovered BSV where previously Frisby negative, remaining patients maintained BSV. The mean preoperative near and distance exodeviation in prism dioptres (PD) was 30.16 and 34.47, respectively. The mean postoperative near and distance exodeviation was 1.53 PD & 5.16 PD, respectively at 3 months. Two patients developed suture granulomas which resolved with steroid drops post‐operatively. No significant difference between the two surgical techniques was noted. In all cases, parents were satisfied with the results. Conclusions: Outcomes in our multi‐ethnic population have been excellent in terms of improvement in exodeviation and maintenance of BSV. Long‐term follow‐up is required to see how many patients will show evidence of recurrence requiring reoperation and whether ethnicity impacts this. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the viability of binocular static visual acuity standards for drivers in Great Britain. Lack of equivalence between performance in the Snellen acuity test and vehicle number plate tests; Overview of studies of the relationship between visual field loss and automobile crashes; Recommendations for cognitive and perceptual tests that are better predictors of crash rates.