Ophthalmic Institutions Research Articles

Perspective on The Impact of The First Year of the COVID-19 Pandemic on Ophthalmic Residency Training in Nigeria

Background: To describe the impact of the COVID-19 pandemic on ophthalmic residency training in Nigeria, as experienced by trainers in their local institutions during the first 12 months of the pandemic. Methods: A nationwide, cross-sectional web-based survey was conducted among ophthalmology trainers in accredited ophthalmic residency training institutions in Nigeria during the 13th month of the pandemic (April 2021). Results: A total of 162 trainers from 30 training institutions responded, yielding a response rate of 63%. The mean age of respondents was 51.3 ± 8.6 years. Respondents were affiliated with federal government-owned hospitals (71%), state government-owned hospitals (20.4%), and mission/private hospitals (8.6%). Trainers reported that COVID-19 had a ‘very severe’ or ‘severe’ negative impact on various aspects of training, including surgical skills transfer (73.5%), clinical skills transfer (48.8%), refraction training (46.3%), soft skills transfer (38.2%), and research training (37.6%) in the first year of the pandemic. Facilities for online learning were available to 125 trainers (77%), while 31 trainers (19%) had access to surgical simulation facilities, 32 trainers (20%) used teleophthalmology, and 68 trainers (42%) had access to Electronic Medical Records (EMR). Teleophthalmology and EMR facilities were more available to trainers in private or mission centers compared to those in publicly-owned training institutions. Conclusions: The COVID-19 pandemic had a significantly negative impact on ophthalmic residency training in Nigeria, with surgical training being the most affected area. Online learning technologies played an essential role in mitigating some of these impacts.

Comparison and analysis of ophthalmic resources and service ability in Shanxi Province in 2014 and 2021

Objective: To compare and analyze the ophthalmic resources and service ability in Shanxi Province in 2014 and 2021, and to provide reference for the development planning of ophthalmology and eye care. Methods: In this cross-sectional study, a questionnaire survey was conducted among all ophthalmic institutions registered in the health administrative department in 11 cities of Shanxi Province by the end of 2014 and 2021 by using the National Ophthalmology Competency Resource Questionnaire (compiled by the Medical Administration and Hospital Authority of the National Health and Wellness Commission). The basic situations of ophthalmic institutions in 2014 and 2021, as well as the human resources, ophthalmic equipment configuration, technology and medical service capabilities, were recorded and compared. The chi-square test was used for statistical analysis. Results: A total of 270 questionnaires for 2014 were collected from 270 ophthalmic institutions, and 292 questionnaires for 2021 from 292 ophthalmic institutions. The institution categories in 2014 (197 general hospitals, 31 eye hospitals and 42 others) were statistically different from those in 2021 (182 general hospitals, 45 eye hospitals and 65 others) (P<0.05). The proportion of doctors with senior titles in ophthalmic institutions increased from 25.5% (346/1 358) in 2014 to 41.7% (580/1 391) in 2021, the proportion of senior technicians increased from 9.4% (14/148) to 25.3% (110/435), the proportion of doctors with junior titles decreased from 42.1% (572/1 358) to 26.5% (369/1 391), and the proportion of junior technicians decreased from 45.3% (67/148) to 39.1% (170/435). There was a significant difference in the distribution of professional titles between doctors and technicians in ophthalmic institutions (P<0.05). The number of doctors (130 to 28), nurses (152 to 50), technicians (33 to 11) and full-time optometrists (44 to 12) in the first-class ophthalmic institutions decreased, the increase of equipment with the ophthalmic A-ultrasound scan system, fundus camera and coherent optical tomography system (35.1%, 28.9% and 25.4%; P<0.05) ranked the top three, and the increase of performing the phacoemulsification procedure, intraocular lens implantation, intravitreal injection and iris surgery (30.2%, 24.7% and 20.7%; P<0.05) ranked the top three in 2021 as compared to 2014. Conclusions: The resources and service ability of ophthalmology in Shanxi Province developed in 2021 in comparison with 2014. However, there were some problems, such as changes in the type and structure of eye institutions, unreasonable proportions of professional titles, insufficient human resources in primary ophthalmic institutions, and slow improvement in the allocation of ophthalmology equipment and technical capabilities.

Machine Learning for Extraction of Image Features Associated with Progression of Geographic Atrophy

Background: Several studies have investigated various features and models in order to understand the growth and progression of the ocular disease geographic atrophy (GA). Commonly assessed features include age, sex, smoking, alcohol consumption, sedentary lifestyle, hypertension, and diabetes. There have been inconsistencies regarding which features correlate with GA progression. Chief amongst these inconsistencies is whether the investigated features are readily available for analysis across various ophthalmic institutions. Methods:In this study, we focused our attention on the association of fundus autofluorescence (FAF) imaging features and GA progression. Our method included feature extraction using radiomic processes and feature ranking by machine learning incorporating the algorithm XGBoost to determine the best-ranked features. This led to the development of an image-based linear mixed-effects model, which was designed to account for slope change based on within-subject variability and inter-eye correlation. Metrics used to assess the linear mixed-effects model included marginal and conditional R2, Pearson’s correlation coefficient (r), root mean square error (RMSE), mean error (ME), mean absolute error (MAE), mean absolute deviation (MAD), the Akaike Information Criterion (AIC), the Bayesian Information Criterion (BIC), and loglikelihood. Results: We developed a linear mixed-effects model with 15 image-based features. The model results were as follows: R2 = 0.96, r = 0.981, RMSE = 1.32, ME = −7.3 × 10−15, MAE = 0.94, MAD = 0.999, AIC = 2084.93, BIC = 2169.97, and log likelihood = −1022.46. Conclusions: The advantage of our method is that it relies on the inherent properties of the image itself, rather than the availability of clinical or demographic data. Thus, the image features discovered in this study are universally and readily available across the board.

ADVANCING PHILANTHROPY FOR OPHTHALMOLOGY IN INDONESIA: UNLEASHING THE POWER OF GIVING FOR VISION CARE

Health philanthropy plays a crucial role in supporting charitable activities in the field of ophthalmology. The Indonesian Ophthalmologists Association (PERDAMI) has been actively engaged in various social initiatives to improve eye care services. However, it is imperative to consider long-term sustainability in funding to ensure the continuity of philanthropic efforts. Additionally, the recent regulatory changes in Indonesia highlight the need for philanthropic practices to comply with legal frameworks. This study presents the key highlights of a social-entrepreneurship session presented at the 48th Annual Scientific Meeting of the PERDAMI in August 2023, with aim to emphasize the importance of collaboration among stakeholders involved in ophthalmic philanthropy, including professionals, institutions, and grantors. The future sustainability of vision care is vital, and it requires the exploration of innovative funding models, the promotion of public-private partnerships, and the cultivation of a culture of giving. By raising awareness of this issue and incorporating it into strategic planning, stakeholders can work towards ensuring the availability and accessibility of quality eye care services in Indonesia. In conclusion, this study highlights the importance of integrating collaboration, needs assessment, good governance, and sustainability considerations in health philanthropy practices within Indonesian ophthalmology. These efforts will help shape the future of vision care and empower the PERDAMI to deliver meaningful and lasting impact in eye health.

Resolution of the Federal Joint Committee on the mandatory introduction and implementation of acute pain management concepts-Importance and consequences for ophthalmology

Patient-centered and adequate postoperative pain management is an important part of amodern treatment concept and should also be standard in ophthalmology. Due to the "Regulation on the mandatory introduction and implementation of acute pain management concepts for adequate postoperative pain therapy" prescribed by the Federal Joint Committee of the German statutory healthcare system (G-BA), hospitals and outpatient facilities have been required to have regulations on pain management in place since 9December 2020. It is very likely that the need of pain management in ophthalmic surgery has been systematically underestimated so far and studies on postoperative pain hardly exist. In the opinion of the authors, the decision represents an opportunity to pay more attention to the topic and to develop standards for ophthalmology as well. This article explains the G‑BA decision and the resulting consequences for ophthalmic surgical institutions.

Discordance between Anterior Segment Anatomy and Axial Length in Cataract Surgery Candidates in France

Introduction: The aims of this study were to study ocular biometric data and their association with age and sex in a population of cataract surgery candidates and to assess the proportion of inhomogeneous eyes and the ratio anterior segment (AS) to axial length (AL). Multicentric cross-sectional analysis was conducted between April 2008 and May 2021 in public and private ophthalmic institutions in Montpellier, France. Individuals ≥40 years old who underwent ocular biometry before cataract surgery were included. Methods: Right phakic eyes were included. Ocular biometrics were measured by using the Lenstar LS900 device. We defined AS as anterior chamber depth (ACD) plus lens thickness (LT) and calculated the ratio of AS to AL. We defined inhomogeneous eyes as those with deep AS (≥4th quartile) and short AL (≤1st quartile) (AS+) or with short AS and high AL (AL+). Results: We included 11,650 individuals (11,650 eyes) (mean [SD] age 71.64 [10.50] years; 54.51% women). Older age was associated with shorter AL (p < 0.01), shallower ACD (p < 0.01), thinner central corneal thickness (p < 0.01), and larger LT (p < 0.001). Women had shorter AL, shallower ACD, and thinner central corneal thickness than men (p < 0.001). In total, 778 (6.68%) eyes were inhomogeneous (3.22% AS+ and 3.46% AL+), for a mean (SD) AS/AL ratio of 0.36 (0.01) and 0.28 (0.01), respectively, as compared with 0.32 (0.02) for homogeneous eyes (p < 0.001). Conclusion: The AS/AL ratio could be useful to screen inhomogeneous eyes before cataract surgery and justify the use of new generation formulas in these eyes to avoid the risk of refractive error.

Clinical operational considerations and responses to lockdown and reopening in the Covid-19 pandemic: experience of a tertiary ophthalmology centre in Singapore.

BackgroundMuch has been written on infection control and clinical measures for ophthalmic institutions and departments to cope with the COVID-19 pandemic. However, few articles have detailed implementation plans to manage lockdowns and subsequent re-openings. In this article, specific operational responses and their outcomes in a large tertiary ophthalmology centre are described.MethodThrough a concerted effort led by a dedicated task force, the Singapore National Eye Centre (SNEC) planned and executed an operational transformation to respond to the restrictions imposed on healthcare delivery during a national lock down. A carefully calibrated re-starting of services was carried out with the subsequent phased reopening of the country, taking into consideration unique constraints faced at that time. Strategies for operating in the new normal environment were also developed.ResultsOutpatient attendances were safely and expediently reduced by 70% (8749 vs. 29,311) and 82% (5164 vs. 29,342) in April and May 2020, respectively, compared to the corresponding months in 2019. A correspondingly large reduction in surgical load was also achieved through a similar triaging and prioritization system. Through optimizing the center’s use of space and time, as well as expanding on new models of care, a return to pre-pandemic patient load was achieved 3 months into the phased reopening of the country, and subsequently exceeded in the following months.ConclusionThe lessons gleaned from SNEC’s experience may be useful for institutions currently facing the same challenges, and for future responses to COVID-19 resurgences or other pandemics.

Perspectives of people with inherited retinal diseases on ocular gene therapy in Australia: protocol for a national survey

IntroductionVoretigene neparvovec-rzyl (Luxturna) was approved by the Australian Therapeutic Goods Administration on 4 August 2020 for the treatment of biallelic mutations in the RPE65 gene, a rare cause of congenital...

Analysis of suspected visual impairment risks based on objective refraction in 3-year-old children

To evaluate the relationship between uncorrected visual acuity and non-cycloplegic refractive value among 3-year-old children in a vision screening program in Japan. Retrospective, cross-sectional study. The participants were 1746 Japanese children screened from April 2009 to July 2018, and ranged in age from 36 to 47months. Visual acuity and handheld refractive values were collected from the clinical records of 3-year-old children in a vision screening program. Multiple logistic regression analysis was used to evaluate the association between 0.3 logarithm of the minimum angle of resolution (logMAR) and > 0.3 logMAR. Correlation analysis was also performed for the presence of myopic shift. Among the 1746 children (aged [mean ± standard deviation], 37.6 ± 1.6months; percentage of boys, 50.4%), representing 3492 eyes, 116 eyes (3.3%) had > 0.3 logMAR. Multiple logistic regression analysis revealed that the risk factors for 1.75-2.00 diopter (D) spherical power (odds ratio [OR], 2.51; 95% confidence interval [CI] 1.12-5.64; P = 0.026) and 1.25-1.50 D cylindrical power (OR, 5.66; 95% CI 1.58-20.40; P < 0.01) were increased in eyes with > 0.3 logMAR. There was no myopic shift for 10years (Spearman's rank correlation coefficient; P = 0.65). It is important to set a threshold that comprises the characteristics of the autorefractor used in screening, and to ensure that, to help prevent amblyopia a thorough eye examination in ophthalmic institutions will be conducted taking into account population-based refractive values.

Rethinking Elective Cataract Surgery Diagnostics, Assessments, and Tools after the COVID-19 Pandemic Experience and Beyond: Insights from the EUROCOVCAT Group.

The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a “de-prioritization” of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.

Infectious and Sterile Endophthalmitis in Eyes with Glaucoma Drainage Device from Two Large Ophthalmic Institutions

To describe the predisposing factors, presentation, management, and outcome of glaucoma drainage implant (GDI)-associated endophthalmitis. Retrospective chart review. Eyes that developed GDI-associated endophthalmitis between December 1, 2011, and December 23, 2019, at the Duke Eye Center and Cole Eye Institute. Patient data search was performed on the basis of diagnostic codes for GDI and endophthalmitis. Endophthalmitis was defined clinically according to each physician's discretion. Eyes with infection source other than GDI were excluded. Worse vision was defined as a decrease of more than 2 Snellen lines. Data were collected on baseline demographics, systemic and ocular comorbidities, ocular surgical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), clinical presentation, eye culture results, and treatments performed. Statistical analysis included the paired t test and odds radio calculations. Visual acuity and IOP at final follow-up. Thirty cases (0.7%) of GDI endophthalmitis were identified among 4073 GDIs performed at the 2 institutions with active follow-up. Device exposure was identified in 20 eyes (67%) on presentation. The average follow-up after presentation was 22.4 ± 25 months. The most frequently identified organism on culture was Streptococcus pneumoniae. Same-day injection of intravitreal antibiotics was the universal first-line therapy. From baseline to final follow-up, the mean BCVA decreased from-0.84 ± 0.77 to-1.30 ± 0.93 (logarithm of the minimum angle of resolution, P= 0.02). Mean IOP did not change from baseline to final visit in the overall cohort (16.2 ± 8.2 mmHg to 14.6 ± 9.4 mmHg, P= 0.30) and in the subgroup that underwent tube explant (15.9 ± 5.5 mmHg to 15.2 ± 10.4 mmHg, P= 0.97). Eighteen of 20 tube exposure cases (90%) underwent tube explant, 1 underwent tube revision, and 1 re-epithelialized. Glaucoma drainage implant-associated endophthalmitis was correlated with poor visual outcome. Immediate intravitreal antibiotic delivery was a universal first-line therapy. Tube exposure was a necessary risk factor for late-onset endophthalmitis and required surgical removal or repair.

A comparative analysis on human resources among the specialized ophthalmic medical institutions in China

BackgroundThis study compares perspectives on specialized ophthalmic medical institutions, identifies the gaps in property and geographic offerings, and explores the ways that ophthalmic medical institutions can better allocate resources. The results of this research will increase patient’s access to equitable and high-quality ophthalmic care in China.MethodsThe data for this research was gathered from the Survey of China National Eye Care Capacity and Resource for the year 2015. The paper specified the number, professional level of expertise, and educational background of ophthalmic health personnel. The authors of the paper analyzed and compared the differences in ophthalmic care in public vs. private and urban vs. rural regions in China. Descriptive statistics were used.ResultsOf the 395 specialized ophthalmic hospitals surveyed, 332 were private medical institutions (84%), and 63 were public (16%). Of the 26 607 ophthalmic personnel surveyed, working in specialized ophthalmic hospitals, 17 561 were in private hospitals (66%) and 9 046 were in public ones (34%). Furthermore, 22 578 of those personnel worked in urban ophthalmic institutions (85%) and 4 029 worked in rural ones (15%). As for regional differences, 14 090 personnel were located in eastern China (53%), 8 828 in central regions (33%), and 3 689 in the western regions (14%).ConclusionsPublic ophthalmic medical institutions still face challenges in providing equitable and widespread care. The availability of well-staffed health centers varies significantly by region. These variations impact resource allocation and directly lead to inequalities and inaccessibility of health services in certain regions of China.

COVID-19 battle: Measures implemented at a tertiary eye care center in South India

The spread of severe acute respiratory syndrome-coronavirus-2 has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Specific containment measures are needed to reduce the risk of spread while simultaneously maintaining the emergency health services. The purpose of this article is to propose the simple and effective measures implemented in our institution to ensure the minimum risk of COVID spread while taking care of the emergency patients. Effectiveness of these measures is still in the early phase of testing, but in view of lack of personal protective equipment for health caregivers, these measures could be implemented with ease and will be helpful in reducing the risk of exposure in both ophthalmic and nonophthalmic institutions.

Information Literacy among Ophthalmologists: A Study

Background: Information literacy enables Ophthalmologists – Eye Doctors to achieve a wide variety of academic, work related and personal goals. The study aims to examine the information literacy skills among ophthalmologists. Methodology: The study design is cross-sectional and convenience sampling method is adopted. A structured questionnaire was used to collect data. SPSS 18 PASW Statistical package was used for statistical analysis. Frequencies, percentages, Mann Whitney U test, Kruskal-Wallis test, chi-square were used in the study. Findings: Around 633 ophthalmologists working in 47 academic eye hospitals from 16 states of India were included in the study. The results revealed that majority of the ophthalmologists were able to find the information within a few hours and there doesn’t any association with ophthalmologists’ individual and institutional characteristics. Majority of the ophthalmologists were confident on the literacy skill “When I recognize an information need, I determine what topic I have to search”. The statistical test results showed that there exist a significant difference between ophthalmologists’ information literacy skills and designation, experience. Conclusion: The ophthalmic librarians, ophthalmic institutions, ophthalmic training institutions, and ophthalmic community should provide literacy programs to improve the information literacy skills of ophthalmologists.

Printed and Electronic Resource Preferences among Ophthalmologists: A Study in India

The Ophthalmologists – Eye Doctors continuously seek and use information for their evidence-based practice, career advancements and quality patient care. The study aims to examine and explore the ophthalmologists’ preference towards print vs. electronic information resources. The study design is cross-sectional and convenience sampling method is adopted. A structured questionnaire was used to collect data. SPSS 18 PASW Statistical package was used for statistical analysis. Frequencies, percentages, Chi-square and Fishers’ exact test were used in the study. Around 633 ophthalmologists, working in 47 academic eye hospitals from 16 states of India were included in the study. The ophthalmologists prefer electronic resources more than the printed resources as a venue for access and publish. They consider both printed &amp; electronic resources as more authenticated resources than electronic resources. They recognize electronic resources as easy to manage, use, economical, time savvy. They prefer electronic resources more than printed resources to improve their professional competency. The Ophthalmologists’ preference on resource choice doesn’t have any association with gender, age group, designation, experience, institution type. The study results revealed the ophthalmologists’ preferences on print and electronic resources. This will help the ophthalmic librarians to understand the resource choices of the ophthalmologists and manage information resources in libraries effectively. The study results will help the ophthalmic institutions and information providers for future planning

Functional and morphological changes in diabetic macular edema over the course of anti-vascular endothelial growth factor treatment

To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti-vascular endothelial growth factor (VEGF) treatment with Ranibizumab. A consecutive series of 39 study eyes with centre-involving DME were included in this study. In all subjects, best-corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD-OCT) cross-sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross-sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = -1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = -3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = -4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = -1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = -0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = -2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti-VEGF therapy with Ranibizumab in patients with DME.

Eric Cecil Cowan

After surgical training at various Belfast ophthalmic institutions, Eric Cecil Cowan completed oculoplastic and corneal fellowships at Queen Victoria Hospital, East Grinstead, and was appointed ophthalmic consultant to the main...

AIMS AND AIDS IN THE TEACHING OF BASIC SCIENCES IN OPHTHALMOLOGY

STUDY of the basic sciences as applied to the eye gives promise of becoming a regular part of the prospective ophthalmologist's training. Some institutions already require such a study before accepting a candidate for a clinical residency; presumably, an increasing number of others will do so in the future. In the belief that experience in organizing and conducting such a course at the Harvard Medical School may be of use to others, the aims of the course as it is now given and certain of the laboratory technics which have been found most practicable 1 are presented in this paper. The writing of it has been prompted by inquiries from those who are proposing to set up basic science courses in ophthalmic institutions elsewhere. AIMS A basic science course in ophthalmology should aim primarily to lay a foundation for the appreciation of clinical ophthalmology. It should be to the ophthalmic

EFFECT OF TALC IN OCULAR SURGERY

Since rubber gloves have become popular in the operating rooms of many ophthalmic institutions, one is prompted to study the effect on the ocular tissues of the talc powder on these gloves. There has been a great deal of investigation along these lines, starting in 1933, when Antopol1reported the formation of tubercles by spores of Lycopodium. At that time the spores of Lycopodium were used on surgical gloves, as talc is used today. However, even as far back as 1912, Lambert2reported a foreign body giant cell reaction to spores of Lycopodium. He used the substance as a nonspecific foreign body and stated that he could just as well have used cotton fibers, or even glass. In later years, when talc had largely replaced spores of Lycopodium, similar investigations were conducted by various workers with the express purpose of determining the effect that accidental introduction of talc

DEFUNCT LONDON EYE HOSPITALS

SPEAKING of ophthalmic hospitals and schools in England, William White Cooper related in 1857, before the First International Ophthalmological Congress,' that of the then existing eye hospitals in London two were founded in 1804: The Royal Infirmary for Diseases of the Eye, established by Mr. Wathen, oculist to George III, and Moorfields, by John Cunningham Saunders. An editorial in the Ophthalmic Review for 18662 speaks of six eye institutions in London, apart from seven ophthalmic departments in some of the larger general hospitals. Presumably the Royal Infirmary, Cork Street, must have been the sixth of the ophthalmic institutions, as the five eye hospitals existing today were all founded before 1866-the Royal Westminster Ophthalmic Hospital in 1816, by George James Guthrie; the Central London Ophthalmic Hospital in 1843, by Alfred Smee; the Western Ophthalmic Hospital (? by Henry Obre) in 1856 and the Royal Eye Hospital in 1857, by John Zachariah Laurence. Though one of the six was destined to disappear before another five years this group represented the hardy survivors of a much larger brood. A search in the library of the Royal College of Surgeons revealed a record of the existence of something approaching an eye hospital as early as 1771, whilst the Medical Directories from 1845 onwards bear witness to a large number in existence between 1845 and 1865, and to three unsuccessful attempts at the formation of new eye hospitals later on. Some of the defunct eye hospitals were ephemeral, but this can hardly be said of the Western Ophthalmic Institution, which existed for about 10 years, or the West London and Chelsea Infirmary for Diseases of the Eye, and certainly not of the North London Infirmary with its life of about 20 years and its brilliant staff.