British Ophthalmology Research Articles

Sir Harold Ridley as the Pioneer of Intraocular Lenses: His Inspiration Drawn From World War II Pilots.

This article underscores the monumental contributions of Sir Harold Ridley to the development of intraocular lenses (IOLs), which have revolutionized cataract surgery. Sir Harold Ridley, a British ophthalmologist and medical scientist, drew inspiration from the injuries of World War II pilots to pioneer the first successful IOL implantation in 1949 at St. Thomas's Hospital. The lens, made from Perspex CQ, marked the inception of modern cataract surgery. Despite facing considerable skepticism and resistance from the medical community throughout the 1950s and 60s, Ridley's perseverance led to the gradual acceptance of IOLs by the 1970s. Today, Ridley is rightfully recognized as the "father of the intraocular lens," with his groundbreaking work having profoundly impacted the field of ophthalmology and improved the quality of life for millions globally.

A Review of Eales' Disease and Mycobacterium tuberculosis.

Eales' Disease is an idiopathic peripheral retinal vasculopathy first described by British ophthalmologist Henry Eales in 1880. Most prevalent in healthy young males, Eales' Disease often presents with symptoms of sudden blurry or decreased vision and floaters. Although no clear, standardized stage of the disease exists, it progresses through three overlapping phases-peripheral periphlebitis, ischemic capillary ischemia, and retinal neovascularization. The etiology of Eales' Disease is unknown and appears to be multifactorial, but post-TB hypersensitivity to tuberculoprotein and M. tuberculosis DNA is the most potential cause in the etiology of Eales' Disease. With a thorough examination of the clinical presentation and diagnosis of Eales' Disease-incorporating the latest clinical findings related to the condition-the investigation for Eales' Disease extends to explore recent potential connections with other ocular conditions or possible cofactors, such as glaucoma, uncontrolled diabetes, drug abuse, or inherited medical conditions. Moreover, focusing on critical insights into the treatment of Eales' Disease across its various stages of progression, the overarching goal of the paper is to refine and suggest possible future diagnostic and therapeutic strategies. Widening our understanding of pathophysiology and utilizing various treatment options for individual patients holds immense potential for advancing ocular medicine and optimizing patient care for people with this disease with unknown pathophysiology.

An abnormal immediate increase in the intraocular pressure post-intravitreal injection in patients with Eales disease

Introduction In 1880, British ophthalmologist Henry Eales described Eales' disease for the first time(1). Recurrent vitreous hemorrhaging is a hallmark of Eales' disease(2). The systemic anti- tuberculosis and the steroids usually control the disease and subsequently resolve the vitreous hemorrhage(3), but when the vitreous hemorrhage persists, anti-VEGF is an option(4).

Sir Benjamin William Rycroft OBE (1902-1967): British ophthalmologist and pioneer in corneal surgery.

An unsung hero of British ophthalmology is the largely forgotten Sir Benjamin Rycroft (1902-1967). This paper will discuss and analyse the undervalued career of this great man. Upon graduating from medical school, Rycroft became a General Practitioner. Rycroft then decided to train to become an ophthalmologist. Rycroft began his ophthalmology career in 1930s London focusing on the new ground-breaking surgery of keratoplasty (corneal grafting) before serving with distinction in the medical corps during the Second World War. He is chiefly remembered for his work after the war at the Queen Victoria Hospital in East Grinstead, Sussex, where he worked with renowned plastics surgeon Archibald McIndoe. During his time, there Rycroft became globally recognised for his skill in keratoplasty and started a campaign which radically changed the legal framework behind organ donation in the UK. Despite few knowing of him today, Rycroft is undoubtedly one of the most influential British ophthalmologists of the past century. He was for decades seen as one of the world's leading practitioners of keratoplasty and established a unit which restored sight to wounded veterans. His greatest achievement lies in his organ donation reform, which started the process of allowing organ donation to be carried out on a nationwide scale for the first time.

Retinal Development in Infants and Young Children With Albinism: Evidence for Plasticity in Early Childhood

Presented at the 2016 Association for Research in Vision and Ophthalmology meeting and at the 2015 British Isles Paediatric, Ophthalmology and Strabismus Association meeting. To investigate the time course of foveal development after birth in infants with albinism. Prospective, comparative cohort optical coherence tomography study. Thirty-six children with albinism were recruited. All participants were between 0 and 6 years of age and were seen at Leicester Royal Infirmary. A total of 181 mixed cross-sectional and longitudinal optical coherence tomography examinations were obtained, which were analyzed for differences in retinal development in comparison to 297 cross-sectional control examinations. Normal retinal development involves migration of the inner retinal layers (IRLs) away from the fovea, migration of the cone photoreceptors into the fovea, and elongation of the outer retinal layers (ORLs) over time. In contrast to controls where IRL migration from the fovea was almost completed at birth, a significant degree of IRL migration was taking place after birth in albinism, before arresting prematurely at 40 months postmenstrual age (PMA). This resulted in a significantly thicker central macular thickness in albinism (Δ=83.8 ± 6.1, P < .0001 at 69 months PMA). There was evidence of ongoing foveal ORL elongation in albinism, although reduced in amplitude compared with control subjects after 21 months PMA (Δ=-17.3 ± 4.3, P < .0001). We have demonstrated evidence of ongoing retinal development in young children with albinism, albeit at a reduced rate and magnitude compared with control subjects. The presence of a period of retinal plasticity in early childhood raises the possibility that treatment modalities, which aim to improve retinal development, could potentially optimize visual function in albinism.

Management of congenital nasolacrimal duct obstruction: results of a national survey of paediatric and oculoplastic ophthalmologists.

To survey variation in management of congenital nasolacrimal duct obstruction (CNLDO) by oculoplastic and paediatric ophthalmologists in the UK. A 14-question online survey was sent to all members of the British Oculoplastic SurgerySociety (BOPSS) and the British and Irish Paediatric Ophthalmology and Strabismus Association (BIPOSA) in February 2020. The aim was to establish preferred primary, secondary and tertiary interventions for CNLDO treatment, with emphasis on the use of nasoendoscopy and ductal intubation. Results were compared with a national survey from 2007 to observe trends in management. One hundred andthree responses from single-speciality consultants were analysed. In total, 71.8% of CNLDO patients were assessed by paediatric ophthalmologists. Fluorescein dye disappearance test was the commonest investigation, and paediatric consultants were five times more likely to perform Jones test. No clinicians performed outpatient probing. Age of first intervention was most commonly 12 months, although more interventions are being conducted at younger ages than in 2007. Preferred primary procedure for both subspecialties was syringe and probe under general anaesthetic, with 43.9% of oculoplastic consultants using nasoendoscopy vs 12.9% of paediatric consultants. Most common re-do procedure for both subspecialties was nasoendoscopy-guided syringe and probe ± intubation. In contrast to 2007, dacryocystorhinostomy is now the commonest tertiary procedure, with endonasal approach twice as common as external. Despite changes in approach since 2007, there is still considerable variation between oculoplastic and paediatric ophthalmologists regarding treatment preferences for CNLDO, particularly the use of nasoendoscopy. We propose a national audit of CNLDO treatment outcomes to potentially standardise treatment protocols.

Awareness of management of hyaluronic acid induced visual loss: A British National Survey.

Visual loss from aesthetic hyaluronic acid filler injections is an under-reported complication. Our study surveyed British Oculoplastic consultants and Consultant members of the British Eye Emergency Care Society, on their awareness of visual vascular complications of dermal fillers and its emergency management. A prospective survey of the members of the British Oculoplastic Society and the British Eye Emergency Society, using the Survey Monkey platform. There were 53 responses. Eighty five percent of responders were aware of ophthalmic artery occlusion and visual loss as a recognised complication of hyaluronic acid based fillers. Six respondents had encountered at least one case of visual loss associated with HA fillers. Approximately 27% of the respondents had some experience of the recommended appropriate management of this complication. Majority of these practitioners did not have local management guidelines for this complication (88%) nor were they aware of guidance to manage the complication (75%). This survey captures the current experience of British Ophthalmologists and Oculoplastic Surgeons in the management of visual vascular complication with dermal fillers. This may relate to the rarity of this complication. Although there is an awareness of visual loss as a complication from aesthetic dermal fillers, there appears to be a lack of knowledge of current management guidelines across Eye Specialists in UK. It is important for practitioners to be able to recognise and manage vascular compromise and further study recommendations are made.

Is Eales’ disease due to tuberculosis?

Eales’ disease, first described by the British ophthalmologist Henry Eales, is characterized by stages of vasculitis, occlusion, and retinal neovascularization. It results in recurrent vitreous hemorrhage leading to vision loss. Multifactorial causes like Mycobacterium tuberculosis (TB), human leukocyte antigen, retinal autoimmunity and free radical-mediated damage, have been hypothesized in the etiopathogenesis of this disease.

A non-randomised trial of video and written educational adjuncts in undergraduate ophthalmology

BackgroundProvision of relevant pre-learning materials has been shown to increase student engagement and improve outcomes in medical education. This non-randomised study attempts to quantify the educational gains, and relative efficacy of video and written pre-learning materials, in ophthalmology undergraduate teaching.MethodsNinety-eight final year medical students were contacted prior to their three-day ophthalmology placements at a British tertiary ophthalmology unit. All participants were sent welcome packs prior to arrival requesting they undertake 90 min of work focusing on a list of specified ophthalmic conditions. One cohort (N = 33) were sent written materials, another (N = 32) was provided with video materials and a third cohort (N = 33) were not sent any materials. On arrival participants completed a simple knowledge test, a questionnaire estimating the time they spent preparing for the placement and a self-reported knowledge score. The teaching on placement was the same for all cohorts. At the conclusion of each placement participants completed a challenging knowledge test, a clinical skills test and repeated self-reported knowledge scores.ResultsEighty seven percent of students receiving specified materials claimed to complete pre-placement work compared to 70% of those receiving learning outcomes alone (p = 0.05). Students receiving learning materials scored higher in the post-placement tests of knowledge (p < 0.001), 74.8% (72.4–77.2%) vs 63.6% (95%CI 59.3–67.9%) and skills (p = 0.04), 86.9% (83.9–89.9%) vs 81.3% (77.2–85.4%). Students using video resources outperformed students using written materials in their visual acuity assessment test (p = 0.03), 90.4% (86.6–94.2%) vs 83.6% (80.1–87.1%) whilst those receiving written rather than video material performed better in the end of placement knowledge test (p = 0.03), 77.7% (74.3–81.1%) vs 72.0% (68.9–75.1%).ConclusionThis study showed that providing pre-placement learning materials improves undergraduates’ commitment and achievement. Written materials better facilitate knowledge acquisition while video materials preferentially promote skill acquisition. This is a novel demonstration within ophthalmology and can help address the imbalance between the expectations placed on undergraduates and the resources committed to ensuring they are met.

History of the development of intraocular lenses

AbstractCouching as the first surgical method for cataract has been performed for about 4000 years. Until mid of the 20th century, attention was spent on removing the opaque lens from the line of sight – refractive correction was provided as spectacle lenses. During World War II – the British ophthalmologist Harold Ridley had to treat pilots suffering from penetrating eye injuries after being shot down. He found that splints from the cockpit cover – which were made from PMMA – did not induce inflammatory reactions. Inspired by his student Steve Parry he started to develop an intraocular implant made of PMMA – which was the birth of the modern intraocular lens. The invention of phacoemulsification by Charles Kelman and the capulorhexis by Neuhann and Gimbel led the way to the success of modern posterior chamber lenses. Until the late 1970’s, lenses were made of PMMA until the first flexible silicone lenses came up. Starting in the late 1980s the silicone lenses were successively replaced by acrylic lenses. Nowadays the majority of lenses are made from acrylic material.

William Wallace (1860-1940): British ophthalmologist and classical music composer.

William Wallace (1860-1940) received the degrees MB, MCh, and MD from the University of Glasgow, and qualified as an ophthalmologist in 1888. Even as he was training in eye surgery, he was already composing music, and Wallace became more attracted to the ear than to the eye and abandoned medicine to become a classical music composer. He never practiced ophthalmology after 1889, except during First World War when he volunteered to serve in the Royal Army Medical Corps. He studied briefly at the Royal Academy of Music in London, but was mostly self-taught. Wallace was influenced by the music of Franz Liszt and Richard Wagner, and thus became a champion for late Romantic music. He wrote many types of music: his most successful were symphonic or tone poems. He was a playwright, music critic, translator, artist, and advocate for composers' copyright interests in Parliament. After the War, he never again composed but held important positions in organized music such as Professor of Harmony and Composition at the Royal Academy of Music. Only about 30% of his compositions were performed or published in his lifetime, but recently, there has been increased interest in performing and recording his music.

The presentation, clinical features, complications, and treatment of congenital dacryocystocele.

PurposeTo determine the incidence and presenting features of congenital dacryocystocele in the United Kingdom. To report on those cases complicated by dacryocystitis, respiratory compromise, and the treatment undertaken.MethodsA prospective observational study of cases of congenital dacryocystocele presenting in the United Kingdom between September 2014 and October 2015. Infants <3 months of age presenting with a cystic swelling in the medial canthal area were included. Cases were identified via the British Ophthalmology Surveillance Unit (BOSU) reporting system.ResultsA total of 49 cases were reported during the study period. This gives an incidence of 1 in 18 597 live births. There was a 71% response rate to the questionnaire. The average age at presentation was 16.94 days. Dacryocystoceles were unilateral in 91% of cases. Dacryocystitis was a complicating factor in 49% of patients and 17% had respiratory distress. Uncomplicated dacryocystocele responded well to conservative measures in 86%. Surgical intervention was required in 23% of patients. Those cases complicated by dacryocystitis (29%) and nasal obstruction (17%) were more likely to require surgical intervention compared to those with dacryocystocele alone (14%). Digital massage appears to reduce the likelihood of requiring surgical intervention. The mean time to resolution was 19 days.ConclusionsCongenital dacryocystocele is a rare presentation in the United Kingdom. Dacryocystitis and respiratory compromise commonly complicate a dacryocystocele. The use of digital massage as an early intervention is advocated and conservative measures may be sufficient in cases of uncomplicated dacryocystocele.

Severe adverse events associated with local anaesthesia in cataract surgery: 1 year national survey of practice and complications in the UK

BackgroundRecent years have seen a major change in practice of local anaesthesia (LA) for cataract surgery.Aims(1) To estimate current usage of LA techniques for cataract surgery, (2) to estimate the...

Individual physical therapy of MGD in private setting by a moist heat device

AbstractThere is a frequent observation from patients that dry eye symptoms improve after time spent in a steam room or sauna. This presentation will outline the challenges in delivering heat to the meibomian glands and why moist heat is the gold standard in heat therapy in meibomian gland dysfunction (MGD). This understanding led to the invention of a medical device by a British ophthalmologist that was commercially developed to deliver a controlled amount of latent, moist heat (Blephasteam, Laboratoires Thea, France). Its use in patients will be presented: patient satisfaction and compliance are increased compared to conventional methods, whilst clinical signs are also improved.

Eales' disease - current concepts in diagnosis and management.

Eales' disease, first described by the British ophthalmologist Henry Eales in 1880, is characterized by three overlapping stages of venous inflammation (vasculitis), occlusion, and retinal neovascularization. Diagnosis is mostly clinical and requires exclusion of other systemic or ocular conditions that could present with similar retinal features. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, Mycobacterium tuberculosis genome, and free radical-mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages.

Vincent “Ċensu” Tabone

President of Malta who pioneered anti-trachoma campaigns From earliest childhood Vincent Tabone was very much aware of trachoma, the leading cause of infectious blindness in the world. The disease affected...

Ophthalmic injuries in British Armed Forces in Iraq and Afghanistan

British military ophthalmologists have not been deployed in support of operations since 2003. Eye injuries in British forces receive definitive treatment on return to the United Kingdom. We report the injury patterns, management strategies, and outcomes for eye injuries in British Armed Forces in Iraq and Afghanistan. Retrospective consecutive case series of eye injuries in British Armed Forces in Iraq or Afghanistan from July 2004 to May 2008. Outcomes assessed by final best-corrected visual acuity (VA; few patients lost to follow-up), rates of endophthalmitis, and proliferative vitreoretinopathy (PVR). There were 630 cases of major trauma, 63 sustained eye injuries (10%), and 48 sustained significant eye injuries. There were 21 open-globe injuries: 9 ruptures and perforating injuries, of which 7 were enucleated/eviscerated; 11 intraocular foreign body (IOFB) injuries, of which 1 was eviscerated. Primary repair was combined with posterior segment reconstruction in 9/11 cases with IOFB. Mean time to primary repair was 1.9 days (range 0-5). Intravitreal antibiotics were given at primary repair in five cases. All cases received early broad-spectrum systemic antibiotics. Median final VA was logMAR 0.25 excluding evisceration/enucleations. There were two cases of PVR and none of endophthalmitis. The number of eye injuries as a proportion of all casualties is lower than recently reported. The injuries are more severe than in civilian practise. The outcomes were comparable with previous reports, this demonstrates that, in certain cases, primary repair can be safely delayed beyond 24 h in the patient's best interests, in order to optimise the conditions for treatment.

The visual fields: An interdisciplinary history I. The evolution of knowledge

A subjective study of a hemianopic field defect was reported to the London Royal Society in 1824. The German ophthalmologist Albrecht von Graefe devised a means of mapping field defects, which evolved into quantitative perimetry as an exact method of localizing lesions in the visual pathways. Knowledge of these pathways increased during the nineteenth century; final identification of the visual cortex in the occipital lobe was achieved by Japanese and British ophthalmologists and neurologists on the basis of wartime studies of field defects due to cerebral missile wounds.

British academic ophthalmology in crisis

Where from and where to? In December 2004 the headcount for consultant ophthalmologists was 809 (2.6%) of 31 672 NHS consultants.1 Ophthalmologists provide around 10% of all NHS hospital outpatient department appointments2 and similarly perform around 7% of all NHS surgical procedures.3 In a patient care context ophthalmology is unquestionably an important service area. A survey of medical academic staffing levels undertaken by the council of the heads of the UK medical schools in 2004 identified 1146 full time equivalent (FTE) professors,4 4.2% of the 27 640 FTE NHS consultant workforce at that time.1 The survey identified just 15.6 FTE clinical professors in ophthalmology or 2.1% of consultant ophthalmologists (calculated by adjusting the consultant “head count” down by 10% to approximate FTE). Since 2000 medical student numbers have risen by 40% in Britain and four new medical schools have opened.4 Despite this expansion medical academic numbers (all grades) have declined over these 4 years from 3549 FTE to 3113 FTE, a 12% overall drop, with ophthalmology dropping by 17% from 40 FTE to 33 FTE. Of particular concern has been the dramatic 40% fall in the number of clinical lecturers, both overall and in ophthalmology.4 Since the recommendations made in the council of heads’ earlier report,5 a partial recovery in some subject areas has occurred, with worsening in others.4 General medicine and public health medicine, for instance, have made significant recent gains (23% and 30% respectively) across the 2003–4 period, but of …

Eye Surgery on the Thai Burma Border

Civil war and ethnic conflict are two of the intractable problems facing the world today, and they are followed by refugees and displaced people almost as inevitably as night follows day. This article looks at what has been achieved by two British ophthalmologists working with the local people in just one of these situations.