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Background: Selective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational study evaluates real-world outcomes of SLT comparing optometrist-treated to ophthalmologist-treated eyes., Methods: Adults aged ≥40 years receiving first SLT treatment at three UK hospital eye units (Aintree, Manchester, Macclesfield) between 1 August 2018 and 1 August 2021 were analysed using anonymised local audit data. Outcomes included intraocular pressure (IOP), visual acuity (VA), drop burden, complications including post-SLT IOP spikes, and composite treatment failures including repeat laser or glaucoma surgery, evaluated at 6-monthly intervals up to 24 months. Groups were compared with parametric and non-parametric tests, accounting for intereye correlation, and Kaplan-Meier survival analysis using composite treatment failure endpoints was conducted., Results: 207 eyes (131 patients) were analysed, 84 (56 patients) optometrist-treated eyes compared with 123 ophthalmologist-treated eyes (75 patients). No statistically significant differences (p>0.05) were found in change in VA, IOP or glaucoma drops from pre-SLT baseline between optometrist and ophthalmologist-treated eyes, at all time points. More cataracts were detected in optometrist-treated eyes, however, this did not affect differences in VA or cataract surgery frequency. More optometrist-treated eyes underwent glaucoma surgery, however, ophthalmologist-treated eyes had higher drop burden and chance of composite treatment failure up to month 18., Conclusion: Outcomes of SLT treatment by optometrists and ophthalmologists are comparable up to 24 months post-treatment. Ophthalmologist-treated eyes may have had more aggressive eye-drop treatment, preventing the need for surgery., Competing Interests: Competing interests: RH is an expert witness for the General Optical Council and is a member of the 2022 NICE guideline committee. None of the other authors have competing interests with respect to this study., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To assess the validity of an online referral guide for melanocytic fund us lesions available to optometrists., Methods: A prospective inter-observer agreement assessment of a novel grading system for melanocytic fundus lesions using digital images from the Liverpool Ocular Oncology Centre., Results: The study was completed by 94.5% (52/55) of optometrists recruited. A total of 2594 valid grading scores were obtained for 400 different melanocytic lesions which were assigned to three management categories (monitor, routine referral or urgent referral). The linear weighted kappa value between the optometrists and the ocular oncologist was 0.66 (95% CI 0.64-0.68). Optometrist inter-observer agreement was 0.62 (95%CI 0.57-0.67)., Conclusions: This online referral guide for melanocytic lesions shows substantial agreement between optometrists and a gold standard opinion. It is easily accessible and could be helpful to community optometrists managing patients with a melanocytic fundus lesion., (Ophthalmic & Physiological Optics © 2011 The College of Optometrists.)

A 35-year-old man presented with keratoconus; his best corrected visual acuities were -18.00/+10.00 ×180 (6/60) oculus dexter and -10.00/+8.00 ×5 (6/36) oculus sinister. Bilateral steep central corneal thinning, paracentral ectasia and Vogts striae were present. Normal fundi. Corneal topography disclosed 7.4 dioptres of irregular astigmatism in the central 3 mm with thinning (335 μm). Electroretinography (ERG) showed no response. There were no medical or environmental influences for his keratoconus. Occurrence of keratoconus and congenital stationary night blindness (CSNB) in the patient may represent a chance association, but keratoconus has not been previously linked with CSNB1 either as a chance or true association though both show genetic predisposition.

Purpose: To report two cases of refractory vernal ulcers in which the fitting of a large-diameter (22 mm) hydrogel (Contaflex T75) bandage contact lens (BCL) ameliorated the signs and symptoms of the condition., Methods: Two patients with refractory vernal ulcers are described. Mechanisms of the effect of a large-diameter lens across the ocular surface are discussed in this condition., Results: The first patient is a 10-year-old boy who had been treated unsuccessfully for a left vernal corneal ulcer with topical prednisolone 0.5% and olopatadine. The vernal ulcer resolved 2 weeks after the fitting of a large-diameter BCL. The second patient is a 4-year-old boy who had been intolerant of all his previous topical medications partly because of his ocular discomfort in association with the right vernal ulcer. A large-diameter BCL was fitted in his right eye. The BCL was removed 2 weeks later with complete healing of the corneal vernal ulcer. Owing to his improved comfort, the patient was able to tolerate topical prednisolone 0.5% drops., Conclusions: Large-diameter BCLs may be a useful treatment option in the management of refractory vernal ulcers.