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BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA systematic review of medical literature assessed the prevalence of blindness (presenting visual acuityResultsIn Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individuals (28.3% of the global total) had MSVI. From 1990 to 2015, cataract (accounting for 36.58% of all cases with blindness in 2015) was the most common cause of blindness, followed by undercorrected refractive error (36.43%), glaucoma (5.81%), age-related macular degeneration (2.44%), corneal diseases (2.43%), diabetic retinopathy (0.16%) and trachoma (0.04%). For MSVI in South Asia 2015, most common causes were undercorrected refractive error (accounting for 66.39% of all cases with MSVI), followed by cataract (23.62%), age-related macular degeneration (1.31%) and glaucoma (1.09%).ConclusionsOne-third of the global blind resided in South Asia in 2015, although the age-standardised prevalence of blindness and MSVI decreased significantly between 1990 and 2015.

BackgroundTo assess prevalence and causes of vision impairment in South-east Asia and Oceania regions from 1990 to 2015 and to forecast the figures for 2020.MethodsBased on a systematic review of medical literature, prevalence of blindness (presenting visual acuity (PVA) N5 or N8 in the presence of normal vision) were estimated for 1990, 2010, 2015 and 2020.ResultsThe age-standardised prevalence of blindness for all ages and both genders was higher in the Oceania region but lower for MSVI when comparing the subregions. The prevalence of near vision impairment in people≥50 years was 41% (uncertainty interval (UI) 18.8 to 65.9). Comparison of the data for 2015 with 2020 predicts a small increase in the numbers of people affected by blindness, MSVI and mild VI in both subregions. The numbers predicted for near VI in South-east Asia are from 90.68 million in 2015 to 102.88 million in 2020. The main causes of blindness and MSVI in both subregions in 2015 were cataract, uncorrected refractive error, glaucoma, corneal disease and age-related macular degeneration. There was no trachoma in Oceania from 1990 and decreasing prevalence in South-east Asia with elimination predicted by 2020.ConclusionsIn both regions, the main challenges for eye care come from cataract which remains the main cause of blindness with uncorrected refractive error the main cause of MSVI. The trend between 1990 and 2015 is for a lower prevalence of blindness and MSVI in both regions.

BackgroundWithin a surveillance of the prevalence and causes of vision impairment in high-income regions and Central/Eastern Europe, we update figures through 2015 and forecast expected values in 2020.MethodsBased on a systematic review of medical literature, prevalence of blindness, moderate and severe vision impairment (MSVI), mild vision impairment and presbyopia was estimated for 1990, 2010, 2015, and 2020.ResultsAge-standardised prevalence of blindness and MSVI for all ages decreased from 1990 to 2015 from 0.26% (0.10–0.46) to 0.15% (0.06–0.26) and from 1.74% (0.76–2.94) to 1.27% (0.55–2.17), respectively. In 2015, the number of individuals affected by blindness, MSVI and mild vision impairment ranged from 70 000, 630 000 and 610 000, respectively, in Australasia to 980 000, 7.46 million and 7.25 million, respectively, in North America and 1.16 million, 9.61 million and 9.47 million, respectively, in Western Europe. In 2015, cataract was the most common cause for blindness, followed by age-related macular degeneration (AMD), glaucoma, uncorrected refractive error, diabetic retinopathy and cornea-related disorders, with declining burden from cataract and AMD over time. Uncorrected refractive error was the leading cause of MSVI.ConclusionsWhile continuing to advance control of cataract and AMD as the leading causes of blindness remains a high priority, overcoming barriers to uptake of refractive error services would address approximately half of the MSVI burden. New data on burden of presbyopia identify this entity as an important public health problem in this population. Additional research on better treatments, better implementation with existing tools and ongoing surveillance of the problem is needed.

Background Social deprivation impacts on health outcomes but limited data on the impact on ophthalmic outcomes are available. We aimed to assess the impact of social deprivation on cataract presentation and surgical outcome. Methods In a retrospective, cohort study of patients undergoing cataract surgery in the North of England, we analysed the electronic patient records (Medisoft, Leeds, UK) for 24 378 patients who underwent cataract surgery at a group of ophthalmic units in the north of England between Feb 1, 2012, and Oct 31, 2017. Level of deprivation was determined by English Indices of Deprivation 2015, and outcome measures included severity of cataract (Lens Opacities Classification System), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) at presentation, and BCVA and subjective refractive outcome after cataract surgery. Spearman's rank correlations between social deprivation deciles and outcomes were calculated. Findings Patients from the lowest deprivation decile presented with more severe cataracts (odds ratio 1·69 [95% CI 1·54–1·85], p Interpretation Patients from areas of social deprivation present with poorer vision and severe cataract, so their visual outcomes are worse than those of patients from less deprived areas. Co-morbidities and education might play a role in this difference. Funding None.

This account of the early history of ophthalmology in Liverpool refers particularly to Hugh Neill, one of the many Edinburgh-educated surgeons working in Liverpool during the early 19th century.

In 1862 Jean Martin Charcot was appointed Physician at the Salpêtrière Hospital in Paris, and simultaneously John Hughlings Jackson was appointed as assistant physician at the National Hospital for the Paralysed and Epileptic, Queen Square, London. Both men made significant contributions to the development of neurology, many of which remain important to contemporary neurologists. The achievements and the work of Charcot and Hughlings Jackson are considered in the light of their respective localities and medical education, and the structure of hospital institutions and political allegiances are compared in the late 19th century in France and Britain.

A previously fit and well 43-year-old woman from West Africa presented with a 9 month history of productive cough, weight loss and unsteadiness on her feet. She denied night sweats. On examination she was apyrexial. Blood cultures were negative. Full blood count was normal, serum ACE was elevated at 194, and she was hypercalcaemic with a low parathyroid hormone level. She was HIV negative. Chest X-ray and subsequent CT chest showed bilateral hilar and mediastinal lymph node enlargement. MRI brain and spine were normal. Lumbar puncture revealed no organisms, low protein and glucose. On further questioning she gave a several months’ history of bilateral blurred vision. She was reviewed by ophthalmology and was found to have visual acuity of 6/9 and mild anterior chamber activity with mutton-fat keratic precipitates …

I was interested to read the editorial on vision screening by Evans et al .1 I share their concern that, despite the availability of free eye tests for the older population, over 50% of vision impairment is due to easily correctable conditions. I recently audited an elderly person health check; an annual assessment of the medical, social, and physical needs of all patients over 75 years at a GP practice in Wirral. While …

I was interested to read the review article on age-related macular degeneration (AMD) by Tariq Ayoub and Nishal Patel.1 While the article discussed in great detail the pathogenesis, diagnosis and management of AMD, the authors failed to mention the effect of all this on a patient's quality of life, thus supporting the findings of Stein et al.2 that clinicians undervalue or are not well aware of the broad impact of AMD on health-related quality of life. In fact, there is significant evidence that AMD reduces quality of life3 and that in severe forms of the disease this is comparable to a patient with end-stage prostate cancer.4 Furthermore, measures of quality of life, e.g. MacDQoL,5 can be (and have been) used as outcome measures to determine the effectiveness of various interventions, including many mentioned in the review article.