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The Royal College of Ophthalmologists Annual Congress 2014 Final Programme & Abstracts 20-22 May 2014 The ICC, Birmingham at See us at the stand G ress ng RCO Co delivering surgical innovation Single Use Viewing Lens Kits Altomed not only brings to you its own extensive instrument range, we also deliver to you leading world ophthalmic brands such as Sterimedix, Volk, Labtician and Mani. Altomed are now official dealers for the Insight Instruments range of BIOM compatible accessories. 'Perfect-Everytime' lenses and great value. The new Insight Inverter and Wide Angle System is also available. A new high quality Capsule Dye Ask for a copy of our free colour catalogue and helpful price list. New Iris Hooks Samples available Manufactured to exacting standards in Germany & supplied in an ergonomic syringe, AlaTrypan is the new blue capsule dye for cataract surgery. The formula contains Mannitol which can help protect vulnerable cells. Pricing is set to save you money. Malyugin Ring manufacturers, MST debut a unique Iris Hook. Whilst application is standard, the MST hook has a subtly modified shape, so the hook sits parallel to the iris, preventing damage. Supplied in sets of 5. 6 sets per box. Cat No MIH 0001 Reusable. Efficiently using resources and funds. Using modern automated decontamination methods and the latest generation of trays such as Altomed Microwash, reusable instruments can be safely cleaned and sterilised without damage. 2 Witney Way, Boldon Business Park, Tyne & Wear, NE35 9PE. England Tel: +44 (0)191 519 0111 Fax: +44 (0)191 519 0283 Email: [email protected] Web: altomed.com WEDNESDAY 21ST MAY 2014 THURSDAY 22ND MAY 2014 9.00 – 10.30 8.00 – 9.00 Breakfast Meetings 8.00 – 9.00 Breakfast Meetings PRESIDENT’S SESSION: WHAT’S NEW IN OPHTHALMOLOGY? Harminder Dua Medically Unexplained Visual Loss (MUVL) Graham Holder & Michel Michaelides Simulated Ocular Surgery John Ferris Training Mike Hayward Grand Rounds: Medical Retina James Talks Grand Rounds: Inflammatory Eye Disease Clive Edelsten How to Run a Private Practice Robert Taylor Grand Rounds: Glaucoma Cecilia Fenerty Ophthalmology Out to Tender Richard Smith Grand Rounds: Oculoplastics Cornelius René NIHR CRN, Ophthalmology Specialty: focus on working with Industry Faruque Ghanchi TUESDAY 20TH MAY 2014 Glaucoma Robert Weinreb Neuro-ophthalmology Nancy Newman Corneal Surgery Donald Tan Oculoplastic Surgery Jurij Bilyk 10.30 – 11.00 Coffee & Posters 9.00 – 10.00 9.00 – 10.45 11.00 – 12.30 Amblyopia Mike Clarke Corneal Infections Parwez Hossain Glaucoma Dilemmas that Make Us Sweat! Rupert Bourne & Peter Shah Challenges of Managing Chronic Diseases of the Eye Declan Flanagan Mitochondrial Disease & the Eye Mike Burdon & Patrick Yu Wai Man Measuring Outcomes in Ophthalmology Melanie Hingorani & John Sparrow Endophthalmitis – Prevention & Management Larry Benjamin Tropical Disease and the Eye Richard Bowman Grand Rounds: FFA Adnan Tufail, Alan Bird & Srinivas Sadda Update on Retinal Vascular Disease Sobha Sivaprasad Management of Incomitant Strabismus Tony Vivian £ Laser Course (8.00 - 11.00) Samer Elsherbiny, Robin Hamilton & Jim Innes Paediatric Cataract Chris Lloyd * £ Retinal Imaging Course Part I Paulo Stanga & James Talks 10.00 – 11.00 £ Disc and Retinal Imaging in Glaucoma Diagnosis and Monitoring Course Part I Rupert Bourne & Stephen Vernon 12.30 – 1.30 Lunch 1.30 – 3.00 THE DUKE ELDER ORATION 2014 Richard Abbott Introduction by Nick Astbury Training the Trainers (9.00 - 12.00) Melanie Corbett Update on Macular Oedema Faruque Ghanchi 11.00 – 11.30 Coffee & Posters 11.30 – 1.00 Adnexal Reconstruction and Rehabilitation David Verity 11.30 – 12.00 Acquired Optic Neuropathies Nicholas Sarkies Systemic Disease & the Eye Elizabeth Graham The Great Debate Bill Aylward Corneal Transplantation Frank Larkin 12.00 – 1.00 Translational Research Paul Bishop How to Run an Emergency Eye Service Dilani Siriwardena & Richard Andrews * £ Retinal Imaging Course Part II Paulo Stanga & James Talks Uveitis for the rest of us: key knowledge for the non-specialist Phil Murray THE OPTIC UK LECTURE 2014 Neil Miller Introduction by Mike Burdon 3.00 – 3.30 Tea & Posters 3.30 – 4.30 £ Laser Course (11.30 - 2.30) Samer Elsherbiny, Robin Hamilton & Jim Innes Rapid Fire Session Andrew Dick 1.00 – 2.00 Lunch 2.00 – 3.00 4.30 – 5.30 THE BARRIE JONES LECTURE 2014 Gullapalli Rao Introduction by Allen Foster Rapid Fire Session Ian Rennie 3.00 – 3.30 5.30 – 7.00 Presidential Handover Drinks Reception For all delegates and speakers at ICC, Birmingham 3.30 – 4.00 Coffee & Posters 4.00 – 4.30 AGM 4.30 – 5.30 MONDAY 19TH MAY 2014 9.00 – 5.00 Retina Day & Drinks Reception Winfried Amoaku & Paulo Stanga THE BOWMAN LECTURE 2014 John Marshall Introduction by Alan Bird 10.45 – 11.30 Coffee & Posters 1.00 - 2.00 Lunch 2.00 – 2.15 Awards Ceremony 2.15 – 4.00 Infectious Disease of Posterior Segment Sue Lightman How to Avoid Complications in Cataract Surgery Brian Little Inherited Retina Disease Andrew Lotery & Andrew Webster Grand Rounds: Neuro-ophthalmology Mike Burdon & Gordon Plant £ Disc and Retinal Imaging in Glaucoma Diagnosis and Monitoring Course Part II Rupert Bourne & Stephen Vernon 4.00 Congress Close 5.30 – 6.30 Ophthalmic Trainees Forum SAS Forum MONDAY 19TH MAY 2014 WEDNESDAY 21ST MAY 2014 THURSDAY 22ND MAY 2014 9.00 – 5.00 9.00 – 4.30 9.15 – 4.00 Glaucoma Day & Drinks Reception Peter Shah & Fiona Spencer Allied Professions Day Larry Benjamin & Janet Marsden GP Day Seema Verma & David Rapley * For Retinal Imaging Course timings please refer to the listing in the programme 1 Annual Congress Final Programme & Abstracts Birmingham 2014 CONTENTS EPONYMOUS LECTURES 2014 General Information PRESIDENT’S SESSION – Harminder Dua Corneal Infection – Parwez Hossain Mitochondrial Disease & the Eye – Mike Burdon & Patrick Yu Wai Man Tropical Disease and the Eye – Richard Bowman Management of Incomitant Strabismus – Tony Vivian COURSE: Retinal Imaging – Paulo Stanga & James Talks Update on Macular Oedema – Faruque Ghanchi Adnexal Reconstruction and Rehabilitation – David Verity Systemic Disease & the Eye – Elizabeth Graham Translational Research – Paul Bishop RAPID FIRE SESSION: Tuesday 20th May – Andrew Dick BARRIE JONES LECTURE: GULLAPALLI RAO DRINKS RECEPTION in the Exhibition Hall BREAKFAST MEETING: MUVL – Graham Holder & Michel Michaelides BREAKFAST MEETING: Training – Mike Hayward BREAKFAST MEETING: Grand Rounds: Inflammatory Eye Disease – Clive Edelsten BREAKFAST MEETING: Grand Rounds: Glaucoma – Cecilia Fenerty BREAKFAST MEETING: Grand Rounds: Oculoplastics – Cornelius René Amblyopia – Mike Clarke Glaucoma Dilemmas that Make Us Sweat! – Rupert Bourne & Peter Shah Measuring Outcomes in Ophthalmology – Melanie Hingorni & Richard Smith Grand Rounds: FFA – Adnan Tufail COURSE: Laser Course – Samer Elsherbiny, Robin Hamilton, Jim Innes DUKE ELDER ORATION: RICHARD ABBOTT Acquired Optic Neuropathies – Nicholas Sarkies Corneal Transplantation – Frank Larkin How to Run an Emergency Eye Service – Dilani Siriwardena & Richard Andrews Uveitis for the rest of us – Phil Murray RAPID FIRE SESSION: Wednesday 21st May – Ian Rennie PRESIDENTIAL HANDOVER AGM BOWMAN LECTURE: JOHN MARSHALL Ophthalmic Trainees Forum SAS Forum ALLIED PROFESSIONS DAY BREAKFAST MEETING: Simulated Ocular Surgery – John Ferris BREAKFAST MEETING: Grand Rounds: Medical Retina – James Talks BREAKFAST MEETING: How to Run a Private Practice – Robert Taylor BREAKFAST MEETING: Ophthalmology Out to Tender – Richard Smith BREAKFAST MEETING: NIHR, CRN Ophthalmology Speciality – Faruque Ghanchi Challenges of Managing Chronic Diseases of the Eye – Declan Flanagan Endophthalmitis – Prevention & Management – Larry Benjamin Update on Retinal Vascular Disease – Sobha Sivaprasad Paediatric Cataract – Chris Lloyd COURSE: Disc & Retinal Imaging in Glaucoma Diagnosis & Monitoring Training the Trainers – Melanie Corbett The Great Debate – Bill Aylward OPTIC UK LECTURE: NEIL MILLER Awards Ceremony Infectious Disease of Posterior Segment – Sue Lightman How to Avoid Complications in Cataract Surgery – Brian Little Inherited Retina Disease – Andrew Lotery & Andrew Webster Grand Rounds: Neuro-ophthalmology GP DAY Poster Exhibition DVD Exhibition Optic UK & Exhibitor Listings Poster Abstracts DVD Abstracts Seminar Calendar 2014 2 3 4 4 4 4 5 5 5&7 6 6 7 7 8 8&9 8 10 10 10 10 11 11 11 11 12 11 & 13 12 & 16 12 12 13 13 13 14 14 14 & 17 14 14 15 18 18 18 18 19 19 19 19 20 20 & 22 20 20 21 & 23 21 21 21 21 21 22 24 34 35 38 142 148 Annual Congress Final Programme & Abstracts Birmingham 2014 EPONYMOUS LECTURERS 2014 BARRIE JONES LECTURE 2014 Dr. Gullapalli Rao Gullapalli N Rao completed his medical school and ophthalmology residency in India following which he pursued the subspeciality of cornea. After fellowship training in Boston and Rochester, he continued in Rochester and was on the clinical faculty at the University of Rochester until 1986 where he was involved in clinical care, teaching and research. His research interests included corneal endothelium, specular microscopy, neurobiology of cornea, contact lenses, corneal transplantation and Keratoprosthesis. In 1986 he moved back to India to establish the well-known L V Prasad Eye Institute for which he was the Founder Chairman and Director. BOWMAN LECTURE 2014 Professor John Marshall Professor John Marshall is the Frost Professor of Ophthalmology at the Institute of Ophthalmology in association with Moorfields Eye Hospital, University College London and the theme leader for new devices and new technologies NIHR. He is Emeritus Professor of Ophthalmology at Kings College London, Honorary Distinguished Professor University of Cardiff, Honorary Professor the City University and Honorary Professor Glasgow Caledonian University. His research over the past forty years has ranged over a number of ocular problems but has concentrated on the inter-relationships between light and ageing and the environmental mechanisms underlying age-related, diabetic and inherited retinal disease. DUKE ELDER ORATION 2014 Professor Richard Abbott Dr Abbott currently is the Thomas W. Boyden Health Sciences Professor of Clinical Ophthalmology at the University of California San Francisco and Research Associate at the Francis I. Proctor Foundation. He is the former Co-Director of Corneal and Refractive Surgery and was responsible for establishing the refractive surgery clinical and research program at UCSF. After completing his Bachelor of Science degree at Tufts University in Boston, Dr. Abbott earned his medical degree at the George Washington University School of Medicine in Washington, DC. He performed his residency at the California Pacific Medical Center in San Francisco and was a Heed and Fight for Sight fellow at the Bascom Palmer Eye Institute in Miami. OPTIC UK LECTURE 2014 Professor Neil Miller Dr. Neil Miller attended Harvard University, where he majored in biochemistry, graduating Magna cum Laude in 1967. He then matriculated to Johns Hopkins Medical School. After finishing medical school at in 1971, he took an internship in medicine at Johns Hopkins, followed by an ophthalmology residency at the Wilmer Eye Institute and a fellowship in neuro-ophthalmology at the University of California, San Francisco, with Dr. William F. Hoyt. Dr. Miller joined the staff of the Wilmer Eye Institute of the Johns Hopkins Hospital in 1975 and has been a faculty member at Johns Hopkins since then. He is currently Professor of Ophthalmology, Neurology, and Neurosurgery at the Johns Hopkins Medical Institutions, and also the Frank B. Walsh Professor of Neuro-Ophthalmology and head of the Neuro-Ophthalmology and Orbital Units of the Wilmer Institute. 3 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Tuesday 20th May 2014 11.00 – 12.30 HALL 1 CORNEAL INFECTIONS Mr Parwez Hossain, Consultant Ophthalmologist, Southampton General Hospital Dates and venue The Annual Congress will be held from Tuesday 20th to Thursday 22nd May 2014 at The ICC, Birmingham Registration opening hours Monday 19th May 2014 Tuesday 20th May 2014 Wednesday 21st May 2014 Thursday 22nd May 2014 4.00 p.m. 8.00 a.m. 7.45 a.m. 7.45 a.m. – – – – 6.30 5.00 5.00 3.00 p.m. p.m. p.m. p.m. CMV Keratitis - The Great Masquerader Professor Donald Tan, Medical Director, Singapore National Eye Centre Management of Acanthamoeba Keratitis Professor Vincent Borderie, Ophthalmic Surgeon, Centre Hospitalier National d'Ophtalmologie, Paris Security All delegates must wear their badge at all times. Please assist the hall stewards by having your badge on display. Management of Bacterial Keratitis Miss Fiona Carley, Consultant Ophthalmologist, Manchester Royal Eye Hospital Language The language of Congress is English. Continuing professional development One CPD point per hour of educational activity is awarded at Congress. The total CPD allocation for the main Congress is 23 points: Tuesday 8 points, Wednesday 8 points and Thursday 7 points Exhibition opening hours Tuesday 20th May 2014 Wednesday 21st May 2014 Thursday 22nd May 2014 Microbiologist’s Perspective Dr Helmut Schuster, Consultant Microbiologist, Health Protection Agency, Southampton General Hospital Management of Fungal & Viral Keratitis Mr Parwez Hossain, Consultant Ophthalmologist, Southampton General Hospital 8.00 a.m. – 7.00 p.m. 8.30 a.m. – 5.30 p.m. 8.30 a.m. – 3.00 p.m. 11.00 – 12.30 HALL 5 MITOCHONDRIAL DISEASE & THE EYE Mr Mike Burdon, Consultant Ophthalmologist, University Hospitals Birmingham & Mr Patrick Yu-Wai-Man, Senior Lecturer and MRC Clinician Scientist, Newcastle University Refreshments and lunch Your fee includes welcome coffee, morning coffee break, two course lunch and afternoon tea. There will be a vegetarian option but we are unable to provide for any other dietary requirements. No refunds will be given for lunch not taken 11.00 – 11.10 Mitochondrial Genetics and Physiology – What You Need to Know Mr Patrick Yu-Wai-Man, Senior Lecturer and MRC Clinician Scientist, Newcastle University 9.00 – 10.30 HALL 1 PRESIDENT’S SESSION: WHAT’S NEW IN OPHTHALMOLOGY? The President, Professor Harminder Dua, The Royal College of Ophthalmologists, London Glaucoma Professor Robert Weinreb, Distinguished Professor of Ophthalmology, University of California, San Diego, USA 11.10 – 11.30 Mitochondrial Diseases – When to Suspect It Professor Nancy Newman, Professor of Ophthalmology & Neurology, Emory University, Atlanta, USA Neuro-ophthalmology Professor Nancy Newman, Professor of Ophthalmology and Neurology, Emory University, Atlanta, USA 11.30 – 11.50 Mitochondrial Optic Neuropathies Mr Patrick Yu-Wai-Man, Senior Lecturer and MRC Clinician Scientist, Newcastle University Corneal Surgery Professor Donald Tan, Medical Director, Singapore National Eye Centre 11.50 – 12.10 Chronic Progressive External Ophthalmoplegia Professor Neil Miller, Frank B Walsh Professor of Neuro-ophthalmology, John Hopkins Hospital, Baltimore, USA Oculoplastic Surgery Professor Jurij Bilyk, Professor of Ophthalmology, Thomas Jefferson University Hospital, Philadelphia, USA 12.10 – 12.30 Retinal Involvement in Mitochondrial Diseases Professor Anthony Moore, Professor of Ophthalmology, Moorfields Eye Hospital, London 10.30 - 11.00 COFFEE & POSTERS: Meet the Authors 4 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Tuesday 20th May 2014 11.00 – 12.30 HALL 9 MANAGEMENT OF INCOMITANT STRABISMUS Mr Anthony Vivian, Consultant Paediatric Ophthalmologist, Cambridge University Hospitals 11.00 – 12.30 HALL 11 TROPICAL DISEASE & THE EYE Mr Richard Bowman, Consultant Ophthalmologist, The Hospital for Sick Children, Great Ormond Street, London 11.00 – 11.05 Introduction Mr Anthony Vivian, Consultant Paediatric Ophthalmologist, Cambridge University Hospitals 11.00 – 11.10 Studying Blindness. There’s an app for that… Mr Andrew Bastawrous, Clinical Research Fellow in International Eye Health, ICEH London School of Hygiene and Tropical Medicine 11.05 – 11.25 Assessment of patients with incomitant deviations Mr Robert Taylor, Consultant Ophthalmologist, York Hospital 11.10 – 11.15 Discussion 11.15 – 11.25 Epidemiology and management of glaucoma in sub Saharan Africa Dr Fatima Kayari, Consultant Ophthalmologist and Senior Lecturer, College of Health Sciences, University of Abuja, Nigeria 11.25 – 11.45 Strabismus following retinal detachment surgery Mr Jonathan Durnian, Consultant Ophthalmologist, Royal Liverpool University Hospital 11.45 – 12.05 The Challenges of Duane Syndrome Mr Anthony Vivian, Consultant Paediatric Ophthalmologist, Cambridge University Hospitals 11.25 – 11.30 Discussion 11.30 – 11.40 Glaucoma – wrong name? Mr Ian Murdoch, Consultant Ophthalmologist, Moorfields Eye Hospital, London 12.05 – 12.25 The use of Botulinum toxin in the management of patients with incomitant deviations Miss Joanna Hancox, Clinical Fellow, Moorfields Eye Hospital, London 11.40 -11.45 Discussion 11.00 – 2.00 HALL 6 £ RETINAL IMAGING COURSE PART I Professor Paulo Stanga, Consultant Ophthalmologist and Vitreoretinal Surgeon, Manchester Royal Eye Hospital & Mr James Talks, Consultant Ophthalmologist, Royal Victoria Infirmary, Newcastle upon Tyne 11.45 – 11.55 Outcomes of cataract surgery in children in developing countries Dr Guy Negretti, Speciality Registrar, Moorfields Eye Hospital, London 11.55 – 12.00 Discussion Pre-registered delegates only. Check availability with our registration staff. 12.00 – 12.10 Neglected Tropical Disease: An Update Dr Babar Qureshi, Director of Neglected Tropical Disease, CBM and Chair for the East Mediterranean Regional Alliance for Trachoma Control Part One – Lectures & Working Lunch 11.00 – 11.20 Comparison of Fourier Domain ( FD-OCT) and Swept-Source (SS-OCT) Optical Coherence Tomography and use of Optos® Wide-Field Fundus Autofluorescene (WT-FAF) in Vitreoretinal Disorders Professor Paulo Stanga, Consultant Ophthalmologist and Vitreoretinal Surgeon, Manchester Royal Eye Hospital 12.10 – 12.15 Discussion 12.15 – 12.25 VISION 2020 to Universal Eye Care Professor Allen Foster, Professor of International Eye Health, London School of Hygiene and Tropical Medicine, London 11.20 – 11.40 Masterclass in the Combined Benefits of Stereo FFA, Indocyanine-green Angiography (ICG), Fundus Autofluorescence and OCT Mr James Talks, Consultant Ophthalmologist, Royal Victoria Infirmary, Newcastle upon Tyne 12.25 – 12.30 Discussion 5 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Tuesday 20th May 2014 11.40 – 12.00 Paediatric Posterior Pole Pathology: Retcam® Fundus Photography and Fluorescein Angiography and Ultrasound Biomicroscopy (UBM) Mr Susmito Biswas, Consultant Ophthalmologist, Manchester Royal Eye Hospital 1.53 – 2.09 Managing Diabetic Macular Oedema Professor Baruch Kuppermann, Professor of Ophthalmology & Biomedical Engineering, University of California, USA 2.10 – 2.26 Retinal Vein Occlusion and Macular Oedema Professor Anat Loewenstein, Director Ophthalmology Department, Tel Aviv University, Israel 12.00 - 12.20 How Should We Image Vitreoretinal Disease in 2014? Professor Srinivas Sadda, Professor of Ophthalmology, University of Southern California, USA 2.27 – 2.43 Uveitic Macular Oedema Professor Miles Stanford, Consultant Ophthalmologist, St Thomas’s Hospital, London 12.20 – 12.30 Round Table & Questions from the Audience 2.44 – 3.00 Service Set Up for Macular Oedema Mrs Geeta Menon, Consultant Ophthalmologist, Frimley Park Hospital, Camberley 12.30 – 12.50 WORKING LUNCH Buffet lunch served outside the session hall to all attendees 12.50 – 1.10 Angiographic Imaging of Inflammatory Chorioretinal Disease Mr Ian Pearce, Consultant Ophthalmologist, Royal Liverpool & Broadgreen University Hospital 1.30 – 3.00 HALL 9 ADNEXAL RECONSTRUCTION AND REHABILITATION Mr David Verity, Consultant Ophthalmologist, Moorfields Eye Hospital, London 1.10 – 1.30 OCT Findings in Uveal Disorders in an Egyptian Population Professor Magdy Moussa, Professor of Ophthalmology, Tanta University, Egypt 1.30 – 1.50 Reconstruction of the periocular region after injury Professor Jurij Bilyk, Professor of Ophthalmology, Thomas Jefferson University Hospital, Philadelphia, USA 1.30 – 1.50 Functional Tests and Retinal Imaging Professor Bart Leroy, Consultant Ophthalmologist & Ophthalmic Geneticist, Ghent University Hospital, Belgium 1.50 – 2.10 The challenges of lacrimal reconstruction after injury and surgery Mr Geoffrey Rose, Consultant Ophthalmologist, Moorfields Eye Hospital, London 1.50 -2.00 Round Table & Questions from the Audience 2.10 – 2.30 Adnexal surgery in thyroid eye disease – pearls and pitfalls Mr David Verity, Consultant Ophthalmologist, Moorfields Eye Hospital, London 12.30 – 1.30 LUNCH & EXHIBITION 1.30 – 3.00 HALL 1 UPDATE ON MACULAR OEDEMA Mr Faruque Ghanchi, Consultant Ophthalmologist, Bradford Royal Infirmary 2.30 – 2.50 Socket reconstruction and rehabilitation – how to succeed Mr Raman Malhotra, Consultant Ophthalmologist, Queen Victoria Hospital, East Grinstead 1.30 – 1.34 Introduction Mr Faruque Ghanchi, Consultant Ophthalmologist, Bradford Royal Infirmary 2.50 – 3.00 Questions and Close 1.35 – 1.52 Imaging Macular Oedema Professor Yit Yang, Consultant Ophthalmologist, Wolverhampton & Midland Counties Eye Infirmary 6 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Tuesday 20th May 2014 1.30 – 3.00 HALL 5 SYSTEMIC DISEASE & THE EYE Miss Elizabeth Graham, Consultant Ophthalmologist, St Thomas’s Hospital, London 2.24 – 2.42 Imaging death and sickness in retina Professor James Morgan, Consultant Ophthalmologist, University Hospital of Wales Hypertension 2.42 – 3.00 Using patient specific stem cells to interrogate and treat recessive retinal degenerations Professor Budd Tucker, Assistant Professor, Ophthalmology and Visual Science, University of Iowa, USA 1.30 – 1.45 The ocular manifestations of hypertension Professor Miles Stanford, Consultant Ophthalmologist, St Thomas’s Hospital, London 1.45 – 2.00 Hypertension and beyond… Professor Gregory Lip, Professor of Cardiovascular Medicine, University of Birmingham 2.00 – 3.00 HALL 6 £ RETINAL IMAGING COURSE PART II Professor Paulo Stanga, Consultant Ophthalmologist and Vitreoretinal Surgeon, Manchester Royal Eye Hospital & Mr James Talks, Consultant Ophthalmologist, Royal Victoria Infirmary, Newcastle upon Tyne The Patient in Intensive Care 2.00 -2.15 The neurologists perspective – and what they want from the eye doctor Dr Robin Howard, Consultant Neurologist, St Thomas Hospital and the National Hospital for Neurology and Neurosurgery Pre-registered delegates only. Check availability with our registration staff. Part Two – Case Discussions & Demonstrations 2.15 – 2.30 What the ophthalmologist can contribute Mr Mike Burdon, Consultant Ophthalmologist, University Hospitals Birmingham A series of educational retinal cases will be available on laptops to be worked through by the delegates with the session presenters. Delegates will be allocated in to groups and the presenters will rotate between the groups to achieve one-to-one interaction. Hands-on equipment demonstrations by Optos UK and Topcon UK By the end of the symposium the delegates should have not only increased their knowledge in the interpretation of the results obtained with the presented imaging techniques but also be able to image patients themselves Rheumatoid Arthritis 2.30 -3.00 Rheumatoid arthritis Professor James Rosenbaum, Professor of Ophthalmology, Medicine and Cell Biology, Oregon Health & Science University, Portland, USA 1.30 – 3.00 HALL 11 TRANSLATIONAL RESEARCH Professor Paul Bishop, Consultant Ophthalmologist, Manchester Royal Eye Hospital Demonstrators: Professor Paulo Stanga, Consultant Ophthalmologist, Manchester Royal Eye Hospital Mr James Talks, Consultant Ophthalmologist, Royal Victoria Infirmary, Newcastle upon Tyne Mr Susmito Biswas, Consultant Ophthalmologist, Manchester Royal Eye Hospital Professor Magdy Moussa, Professor of Ophthalmology, Tanta University, Egypt Professor Srinivas Sadda, Professor of Ophthalmology, University of Southern California, USA Ms Jane Gray, Manchester Mr Ben Turley, Topcon UK Ms Anne-Marie Cairns, Optos UK 1.30 – 1.48 Translation of genetic epidemiology studies in twins Professor Chris Hammond, Consultant Ophthalmologist, St. Thomas’ Hospital & King’s College London 1.48 – 2.06 Macrophage responses in the retina as targets for therapy Professor Andrew Dick, Consultant Ophthalmologist, Bristol Eye Hospital 3.00 – 3.30 TEA & POSTERS: Meet the authors 2.06 – 2.24 UK Biobank eye and vision data – A major new research resource Professor Paul Foster, Consultant Ophthalmologist, Moorfields Eye Hospital, London 7 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Tuesday 20th May 2014 4.12 – 4.18 Translational bypass therapy using ataluren to treat nonsense-mediated choroideremia Mariya Moosajee, Dhani Tracey-White, Clare Futter, Tony Moore, Andrew Webster, Miguel Seabra UCL Institute of Ophthalmology 3.30 – 4.30 HALL 1 RAPID FIRE SESSION Professor Andrew Dick, Consultant Ophthalmologist, Bristol Eye Hospital 3.30 – 3.36 SOE PRIZE WINNER 2014 Intravitreal Aflibercept for Diabetic Macular Edema: 1 – Year Findings from the VIVID-DME and VISTADME Trials Edoardo Midena University of Padova 4.18 – 4.24 Metobolomic Analysis of Serum in Graves’ Disease and Thyroid-Associated Ophthalmopathy: A Diagnostic Tool? Matthew R Edmunds, Kristien Boelaert, Jayne A Franklyn, S John Curnow, Omar M Durrani, Stephen P Young University of Birmingham, UK 3.36 – 3.42 Can we replace Temporal Artery Biopsy (TAB) with Cranial Duplex Ultrasound (CDUS) in the diagnosis of Giant Cell Arteritis (GCA)? Adam Croft, Nicola Thompson, Martin Duddy, Fazal Khattak, Susan Mollan, Paresh Jobanputra University Hospital Birmingham 4.24 – 4.30 Results from the Sight Loss and Vision Priority Setting Partnership Michele Acton Fight for Sight 3.42 – 3.48 Ranibizumab treatment of diabetic macular oedema with bimonthly monitoring after a phase of initial treatment: 18-month outcomes of the Phase IIIb multicentre RELIGHT study Ian Pearce Multicentre study 4.30 -5.30 HALL 1 THE PROFESSOR BARRIE JONES LECTURE 2014 Professor Gullapalli Rao, Chairman, LV Prasad Eye Institute, Hyderabad, India Professor Gullapalli Rao will deliver this year’s Professor Barrie Jones Lecture. Please see page 9 for further information. 3.48 – 3.54 OCT Findings in Children with Bardet Biedl Syndrome Peter Good, John Ainsworth, Marie Tsaloumas, Alaistair Denniston, Denise Williams Birmingham Children’s Hospital 5.30 – 7.00 HALL 3 DRINKS RECEPTION All delegates and speakers are invited to a free drinks reception in the Exhibition Hall 3.54 – 4.00 Analysis of the Hedgehog signalling pathway in periocular morphoeic basal cell carcinoma John Bladen, Caroline Thaung, Michele Beaconsfield, Michael Philpott Centre for Cutaneous Research, Barts and The London 4.00 – 4.06 The effects of anti-VEGFS on human tenon’s fibroblast growth in vitro Nurul Nabila Baharudin, Siti Munirah Mohd Noh, Siti Hamimah Sheikh Abdul Kader, Zakaria Bannur, Jonathan Crowston, Sushil Kumar Vasudevan IMMB, UTIM 4.06 – 4.12 A case for re-defining the intraocular pressure referral threshold: Findings from the UK Biobank Michelle Chan, Carlota Grossi Sampedro, Stephen Vernon, James Morgan, Praveen Patel, Peng Khaw, Paul Foster Moorfields Eye Hospital Foundation Trust 8 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Tuesday 20th May 2014 THE BARRIE JONES LECTURE 2014 Tuesday 20th May 2014 4.30 - 5.30 Hall 1 EYE CARE FOR THE NEGLECTED POPULATIONS: CHALLENGES AND SOLUTIONS Dr. Gullapalli Rao, Chair, Hyderabad Eye Institute & Founder LV Prasad Eye Institute, Hyderabad, India Gullapalli N Rao completed his medical school and ophthalmology residency in India following which he pursued the subspeciality of cornea. After fellowship training in Boston and Rochester, he continued in Rochester and was on the clinical faculty at the University of Rochester until 1986 where he was involved in clinical care, teaching and research. His research interests included corneal endothelium, specular microscopy, neurobiology of cornea, contact lenses, corneal transplantation and Keratoprosthesis. In 1986 he moved back to India to establish the well-known L V Prasad Eye Institute for which he was the Founder Chairman and Director. The Institute is considered to be among the top eye institutes in the world and renowned for its innovative models of eye care delivery from primary to advanced tertiary care levels and is a WHO Collaborating Centre and one of the three global resource centres for the VISION 2020: The Right to Sight, the global initiative to eliminate avoidable blindness. It has one of the most comprehensive eye care services in the world encompassing clinical care, education, research, rehabilitation and product development. In addition, it has played a pivotal role in global eye care over the past 15 years. Dr.Rao held many international leadership positions and is on the Boards of many organisations in the field of eye care as well as in the prevention of blindness activities around the world. His standing in this area is epitomised by his appointment as Secretary – General of the International Agency for the Prevention of Blindness (1998 – 2004) and then as Chairman, Board of Trustees, President and CEO (2004 – 2008) (the first ever to be given all these responsibilities). In this capacity, he has played a key role in initiating, coordinating and mobilising Vision 2020: The Right to Sight activities, which will improve eye care worldwide and provided exemplary leadership to this program. Dr.Rao’s main areas of interest are Corneal Diseases and Eye Banking, Community Eye Health, Health Policy & Planning, Eye Care Reforms. He developed innovative models of eye care delivery and eye banking systems in addition to expanding his research interest into corneal infections, public health aspects of ophthalmology and operations research. Dr.Rao was on the editorial boards of several journals, Visiting Professor at several universities, delivered many named lectures all over the world and chaired scientific sessions in many international meetings. He published over 270 papers and on the Editorial Boards of many journals. He is married to Pratibha, a politician and a social activist and has a son and a daughter. Introduction by Professor Allen Foster, Professor of International Eye Health, London School of Hygiene and Tropical Medicine, London Vote of thanks from Professor Harminder Dua, President, The Royal College of Ophthalmologists 9 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 Free welcome coffee, tea and pastries will be served outside session halls for all delegates attending breakfast sessions 8.00 – 9.00 HALL 5 GRAND ROUNDS: INFLAMMATORY EYE DISEASE Mr Clive Edelsten, Consultant Ophthalmologist, Ipswich Hospital, Suffolk 8.00 – 9.00 HALL 1 MEDICALLY UNEXPLAINED VISUAL LOSS (MUVL) Professor Graham Holder, Consultant Electrophysiologist, Moorfields Eye Hospital, London & Mr Michel Michaelides, Consultant Ophthalmic Surgeon, Moorfields Eye Hospital, London DIAGNOSTIC AND MANAGEMENT PROBLEMS IN OCULAR INFLAMMATION In this session an eminent panel of experts will provide a case-based discussion using a series of case reports on the following themes: Granulomatous disease mimicking sarcoidosis Choroidal Vasculiltis Choice of biologics after failure of standard immunosuppression Congenital immunodeficiency and ocular inflammation Retinal Vascular Occlusion in Children 8.00 – 8.15 Clinical Approach to the Patient with Unexplained Visual Loss Professor Neil Miller, Frank B Walsh Professor of Neuro-ophthalmology, John Hopkins Hospital, Baltimore, USA 8.15 – 8.35 The Role of Electrophysiology in the Evaluation of the Patient with Unexplained Visual Loss Professor Graham Holder, Consultant Electrophysiologist, Moorfields Eye Hospital, London Panel: Mr Richard Watts, Consultant Rheumatologist, Ipswich Hospital, Suffolk Dr Paul Brogan, Consultant Rheumatologist, Great Ormond Street Hospital, London Miss Jane Ashworth, Consultant Paediatric Ophthalmologist, Manchester Royal Eye Hospital Professor James Rosenbaum, Professor of Ophthalmology, Medicine and Cell Biology, Oregon Health & Science University, Portland, USA Mr Clive Edelsten, Consultant Ophthalmologist, Ipswich Hospital, Suffolk 8.35 – 8.55 Illustrative Case Presentations Professor Nancy Newman, Professor of Ophthalmology and Neurology, Emory University, Atlanta, USA & Professor Neil Miller, Frank B Walsh Professor of Neuro-ophthalmology, John Hopkins Hospital, Baltimore, USA 8.00 – 9.00 HALL 10 GRAND ROUNDS: GLAUCOMA Miss Cecilia Fenerty, Consultant Ophthalmologist, Manchester Royal Eye Hospital 8.00 – 9.00 HALL 9 TRAINING Mr Mike Hayward, Chairman of Training Committee, The Royal College of Ophthalmologists DIFFICULT GLAUCOMA MANAGEMENT CHALLENGES Each expert will present a challenging case for discussion with the audience and panel Series of short presentations followed by time for delegates to feed back their views on the Shape of Training Shape of Training – the review and the politics Mr Mike Hayward, RCOphth Chairman of Training Committee Panel: Miss Cecilia Fenerty, Consultant Ophthalmologist, Manchester Royal Eye Hospital Mr Anthony King, Consultant Ophthalmologist, University Hospital Nottingham Mrs Anshoo Choudhary, Consultant Ophthalmologist, Royal Liverpool & Broadgreen University Hospital Miss Winifred Nolan, Consultant Ophthalmologist, Moorfields Eye Hospital, London Length and Content of Training – the times they are a changing Mrs Sally Webber, Consultant Ophthalmologist, Royal United Hospital, Bath How the ‘Shape of Training’ could improve the UK Ophthalmology Curriculum Mr William Dean, RCOphth Chairman of the Ophthalmic Trainees Group 10 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 8.00 – 9.00 HALL 7 GRAND ROUNDS: OCULOPLASTICS Mr Cornelius René, Consultant Ophthalmologist, Hinchingbrooke Hospital, Huntington 9.00 – 10.00 HALL 5 GLAUCOMA DILEMMAS THAT MAKE US SWEAT! Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals & Professor Peter Shah, Consultant Ophthalmologist, University Hospitals Birmingham NHS Foundation Trust This session will comprise of a series of 5-6 interesting short cases spanning the breadth of oculoplastic lacrimal and orbital surgery. Each case will be presented and discussed by a panel of experts. Patient with a pale cupped optic disc and borderline IOPs Mr Mike Burdon, Consultant Ophthalmologist, University Hospital Birmingham & Professor Peter Shah, Consultant Ophthalmologist, University Hospitals Birmingham NHS Foundation Trust Panel: Professor Jurij Bilyk, Professor of Ophthalmology, Thomas Jefferson University Hospital, Philadelphia, USA Mr Naresh Joshi, Consultant Ophthalmologist, Moorfields Eye Hospital, London Mr Geoffrey Rose, Consultant Ophthalmologist, Moorfields Eye Hospital, London Mr Tony Tyers, Consultant Ophthalmologist, Salisbury District Hospital Mr David Verity, Consultant Ophthalmologist, Moorfields Eye Hospital, London Young male with IOPs of 40mmhg in each eye Mr Imran Masood, Consultant Ophthalmologist, Birmingham & Midland Eye Centre & Dr Freda Sii, Senior Glaucoma Fellow, University Hospitals, Birmingham NHS Foundation Trust Middle-aged female with bilateral angle closure and 6/5 vision Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals 8.00 – 11.00 HALL 11B £ LASER COURSE Mr Samer Elsherbiny, Consultant Ophthalmologist, Birmingham & Midland Eye Centre & Mr Robin Hamilton, Consultant Ophthalmologist, Moorfields Eye Hospital, London & Mr Jim Innes, Consultant Ophthalmologist, Hull Royal Infirmary 9.00 – 10.00 HALL 9 MEASURING OUTCOMES IN OPHTHALMOLOGY Mrs Melanie Hingorani, Consultant Ophthalmologist, Hinchingbrooke Hospital & Professor John Sparrow, Consultant Ophthalmologist, Bristol Eye Hospital Pre-registered delegates only. Check availability with our registration staff. 9.00 – 9.05 Introduction Mrs Melanie Hingorani, Consultant Ophthalmologist, Hinchingbrooke Hospital The laser course will be a practical introduction to clinical laser for trainees; attendees will be expected to have completed the online Laser Course on EyeSite. There will be a number of stations where trainees can observe and then carry out laser treatments in a simulated environment. 9.05 – 9.20 National audits – experience and pitfalls Professor John Deanfield, Consultant Cardiologist/Clinical Lead, National Institute for Cardiovascular Outcomes and Research 9.00 – 10.00 HALL 10 AMBLYOPIA Mr Mike Clarke, Consultant Ophthalmologist, Royal Victoria Infirmary, Newcastle upon Tyne 9.20 – 9.35 The National Ophthalmology Audit Professor John Sparrow, Consultant Ophthalmologist, Bristol Eye Hospital 9.00 – 9.20 Does amblyopia matter in real life? Mr Nadeem Ali, Consultant Ophthalmologist, Moorfields Eye Hospital & St George’s Medical School 9.35 – 9.50 PROMs (patient reported outcome measure) in paediatric ophthalmology Professor Jugnoo Rahi, Consultant Ophthalmologist, Institute for Child Health 9.20 – 9.40 What have we learned about amblyopia treatment from clinical studies? Professor Helen Davies, Professor of Orthoptics, University of Sheffield 9.50 -10.00 Discussion 9.40 -10.00 New approaches to amblyopia treatment Professor Paul McGraw, Allen Standen Professor of Visual Neuroscience, School of Psychology, Nottingham University 11 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 9.00 – 10.00 HALL 1 GRAND ROUNDS: FFA Mr Adnan Tufail, Consultant Ophthalmologist, Moorfields Eye Hospital, London & Professor Alan Bird, Professor of Medical Ophthalmology, Moorfields Eye Hospital, London & Professor Srinivas Sadda, Professor of Ophthalmology, University of Southern California, USA 11.50 – 12.00 Questions 12.00 – 12.20 The Management of Optic Neuritis Revd. Dr Alasdair Coles, Senior Lecturer in Clinical Neuroimmunology, Consultant Neurologist, Addenbrookes Hospital, Cambridge 12.20 – 12.30 Questions 9.00 – 9.12 An unusual retinal vascular anomaly Miss Ambreen Kalhoro, Speciality Registrar, St James’s University Hospital, Leeds 12.30 – 12.50 Toxic and Nutritional Optic Neuropathies Dr Gordon Plant, Consultant Neurologist, St Thomas’s Hospital, London 9.12 – 9.24 Routine macula clinic – a diagnositic challenge… Mr Ajay Kumar Kotagiri, Research Fellow (Retina), Sunderland Eye Infirmary, Sunderland 12.50 – 1.00 Questions 9.24 – 9.36 Unusual retinal vascular proliferation: a case study Miss Farrah Islam, Registrar and Vitreoretina Fellow, Al-Shifa Trust Eye Hospital, Pakistan 11.30 – 1.00 HALL 10 CORNEAL TRANSPLANTATION Mr Frank Larkin, Consultant Ophthalmic Surgeon, Moorfields Eye Hospital, London 9.36 – 9.48 Atypical CSR Miss Kanchan Bahn, Medical Retina and Uveitis Fellow, Moorfields Eye Hospital, London 11.30 – 11.50 Long term outcomes of anterior lamella keratoplasty. Professor Vincent Borderie, Ophthalmic Surgeon, Centre Hospitalier National d'Ophtalmologie, Paris 9.48 – 10.00 Why do cilioretinal artery and central vein occlusions co-occur? Mr Jacob Low-Beer, Speciality registrar, Moorfields Eye Hospital, London 11.50 – 12.10 Influence of surgeon experience on anterior and posterior lamellar keratoplasty Mr Frank Larkin, Consultant Ophthalmic Surgeon, Moorfields Eye Hospital, London 10.00 – 11.00 HALL 1 DUKE ELDER ORATION 2014 Professor Richard Abbott, Thomas W. Boyden Endowed Chair & Health Sciences Clinical Professor of Ophthalmology, University of California, USA 12.10 – 12.30 Getting better results in DSEK. Mr Madhavan Rajan, Consultant Ophthalmologist, Addenbrookes Hospital, Cambridge 12.30 – 12.50 Graft survival and outcomes betweek PK, ALK and EK: Show me the evidence! Professor Donald Tan, Medical Director, Singapore National Eye Centre Professor Richard Abbott will deliver this year’s Duke Elder Oration. Please see page 16 for further information. 11.00 - 11.30 COFFEE & POSTERS: Meet the Authors 12.50 – 1.00 Discussion 11.30 – 1.00 HALL 1 ACQUIRED OPTIC NEUROPATHIES Mr Nicholas Sarkies, Consultant Ophthalmologist, Addenbrookes Hospital, Cambridge 11.30 – 1.00 HALL 9 HOW TO RUN AN EMERGENCY EYE SERVICE Miss Dilani Siriwardena, Consultant Ophthalmologist, Moorfields Eye Hospital, London & Mr Richard Andrews, Consultant Ophthalmologist, Moorfields Eye Hospital, London 11.30 – 11.50 How to distinguish between Papilloedema and Pseudopapilloedema Professor Neil Miller, Frank B Walsh Professor of Neuro-ophthalmology, John Hopkins Hospital, Baltimore, USA 11.30 – 11.35 Welcome & Introduction Miss Dilani Siriwardena, Consultant Ophthalmologist, Moorfields Eye Hospital, London 12 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 11.35 – 11.47 The Development of Emergency Eye Care as a New Sub-Speciality – It’s History & Future Ms Seema Verma, Consultant Ophthalmologist, Moorfields Eye Hospital, London 12.05 – 12.20 Management of uveitic macular oedema Mr Alastair Denniston, Consultant Ophthalmologist, Queen Elizabeth Hospital, Birmingham 12.20 – 12.35 Raised intraocular pressure in uveitis Professor Phillip Murray, Consultant Ophthalmologist, Birmingham & Midland Eye Centre 11.47 – 11.59 The Developing and Establishing Emergency Eye Care Service Mr Felipe Dhawahir-Scala, Consultant Ophthalmologist, Director of Acute Ophthalmic Services, Manchester Royal Eye Hospital 12.35 – 12.50 When to get help Professor Miles Stanford, Consultant Ophthalmologist, St Thomas’s Hospital, London 11.59 – 12.11 Surviving the A&E Crisis Mr John Buchan, Consultant Ophthalmologist, St James’ University Hospital, Leeds 12.50 – 1.00 Questions 12.11 – 12.23 Making Eye Casualty a High Quality Training Environment Miss Lucy Clarke, Consultant Ophthalmologist, Royal Victoria Infirmary, Newcastle Eye Centre 11.30 – 2.30 HALL 11B £ LASER COURSE Mr Samer Elsherbiny, Consultant Ophthalmologist, Birmingham & Midland Eye Centre & Mr Robin Hamilton, Consultant Ophthalmologist, Moorfields Eye Hospital, London & Mr Jim Innes, Consultant Ophthalmologist, Hull Royal Infirmary 12.23 – 12.35 Experience of Developing the Nurses’ Role Professor Janet Marsden, Professor of Ophthalmology & Emergency Eye Care, Manchester Metropolitan University Pre-registered delegates only. Check availability with our registration staff. 12.35 – 12.55 Corneal Tales from the Crypt – Keys to Avoiding Corneal Mishaps in Eye Casualty Professor Christopher Liu, Consultant Ophthalmologist, Brighton & Sussex University Hospital The laser course will be a practical introduction to clinical laser for trainees; attendees will be expected to have completed the online Laser Course on EyeSite. There will be a number of stations where trainees can observe and then carry out laser treatments in a simulated environment. 12.55 – 1.00 Final Questions 1.00 – 2.00 LUNCH & EXHIBITION 11.30 – 1.00 HALL 5 UVEITIS FOR THE REST OF US: KEY KNOWLEDGE FOR THE NON-SPECIALIST Professor Phillip Murray, Consultant Ophthalmologist, Birmingham & Midland Eye Centre 2.00 – 3.00 HALL 1 RAPID FIRE SESSION Professor Ian Rennie, Consultant Ophthalmologist, Royal Hallamshire Hospital, Sheffield 2.00 – 2.06 A British Ophthalmic Surveillance Unit (BOSU) study of severe adverse events associated with the local anaesthesia (LA) in cataract surgery Richard M H Lee, John R Thompson, Tom Eke King’s College Hospital 11.30 – 11.35 Introduction Professor Phillip Murray, Consultant Ophthalmologist, Birmingham & Midland Eye Centre 11.35 – 11.50 Investigating patients with uveitis Professor James Rosenbaum, Professor of Ophthalmology, Medicine and Cell Biology, Oregon Health & Science University, Portland, USA 2.06 – 2.12 Evaluating the Use of Intravitreal Aflibercept in Patients with Choroidal Neovascularisation Secondary to Pathological Myopia (mCNV): The MYRROR Study Francesco Bandello San Raffaele Scientific Institute 11.50 – 12.05 Assessing uveitic macular oedema Mr Pearse Keane, Specialist Registrar, Moorfields Eye Hospital, London 13 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 3.00 – 3.30 HALL 1 PRESIDENTIAL HANDOVER Professor Harminder Dua completes his term of office as President of the Royal College of Ophthalmologists and hands over to Professor Carrie MacEwen 2.12 – 2.18 Cochrane review of 5-fluorouracil in trabecukectomy: too long overlooked? Elspeth Green, Richard Wormald London School of Hygiene & Tropical Medicine 2.18 – 2.24 The impact of congenital profound of severe visual impairment (VI) on behaviour development and difficulties in the early years Michelle O’Reilly, Elena Sakkalou, Hanna Sakki, Michelle De Haan, Alison Salt, Naomi Dale UCL Institute of Child Health 3.30 – 4.00 COFFEE & POSTERS: Meet the Authors 4.00 – 4.30 HALL 1 AGM Join the President and College Officers for the 2014 AGM 2.24 – 2.30 Swept-Source Optical Coherence Tomography Assessment of Choroidal Thickness in Different Macular Disorders Salvador Pastor-Idoate, Maria Gil-Martinez, Stephen Charles, Susmito Biswas, David Henson, David B McLeod, Paulo Stanga MREH/NIHR. Wellcome Trust CRF 4.30 – 5.30 HALL 1 THE BOWMAN LECTURE 2014 Professor John Marshall, Professor of Ophthalmology, Institute of Ophthalmology, London Professor John Marshall will deliver this year’s Bowman Lecture. Please see page 17 for further information. 2.30 – 2.36 Redefining wolfram syndrome in molecular era Patrick Yu-Wai-Man, Grant Guthrie, Kamil S Sitarz, Angela Pyle, Rita Horvath, Philip G Griffiths, Patrick F Chinnery Newcastle Eye Centre, Royal Victoria Infirmary 5.30 – 6.30 HALL 10A OPHTHALMIC TRAINEES FORUM A free drinks reception offering the chance for all ophthalmologists in training to pose questions and talk to the President and College Officers 2.36 -2.42 Glaucoma prescribing trends in England 2000 to 2012 Alan Connor, Scott Fraser Royal Victoria Infirmary, Newcastle 5.30 – 6.30 HALL 10B SAS FORUM A free drinks reception offering the chance for all staff and associate grade ophthalmologists to pose questions and talk to the President and College Officers 2.42 – 2.48 Is Socioeconomic deprivation independently associated with increased prevalence of diabetic retinopathy? Liying Low, Simon Ogston, Peter Wilson, Alex Yeong, Ritchie McAlpine, Una O’Colmain, Carrie MacEwen University of Dundee 2.48 – 2.54 Corneal calcification and phosphate buffers – Do you need to prescribe phosphate free? Magdalena Popiela Singleton Hospital 2.54 – 3.00 Visual impairment and health inequalities: findings from UK biobank (UKBB) Phillippa Cumberland, Paul Foster, Peng Tee Khaw, Christopher Hammond, Pirro Hysi, Yanchun Bao, Jugnoo Rahi UCL Institute of Child Health 14 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 ALLIED PROFESSIONS DAY 9.00 – 4.30 HALL 11A ALLIED PROFESSIONS DAY Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury & Professor Janet Marsden, Professor of Ophthalmology and Emergency Care, Manchester Metropolitan University 1.30 – 3.00 CATARACT 9.00 – 10.30 UPDATES ON AMD Femtosecond laser – the way forward? Ms Brian Little, Consultant Ophthalmologist, Moorfields Eye Hospital, London AP involvement in the cataract pathway Ms Stephanie Hartley, Clinical Nurse Lead for Ophthalmology, Stoke Mandeville Hospital, Aylesbury Developments in the treatment of AMD Mr Ian Pearce, Consultant Ophthalmologist, Royal Liverpool & Broadgreen University Hospital IOLS today and in the future Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury A Protocol based approach to treatment decisions Mr Richard Hancock, Service Manager for Ophthalmic and General Medical Photography, University Hospitals Aintree, Liverpool Biometry hints and tips Mr David Sculfor, Consultant Optometrist, Stoke Mandeville Hospital, Aylesbury The nurse role in the care of patient with wet AMD Ms Sarah Stanley, Department Manager, Ophthalmic Nurse, Sunderland Eye Infirmary & Ms Kim Davies, Ophthalmic Nurse, Sunderland Eye Infirmary 3.00 – 3.30 Tea in Exhibition Hall 3.30 – 4.30 WORKFORCE PLANNING Growing your own – making mentoring work in ophthalmic settings Ms Mary Shaw, Senior Lecturer, School of Nursing & Midwifery & Social Work, University of Manchester AMD – Future Possibilities Professor Andrew Lotery, Consultant Ophthalmologist, Southampton General Hospital 10.30 -11.15 COFFEE BREAK IN EXHIBITION HALL CPD the challenges Ms Lesley-Ann Baxter, Chair, British and Irish Orthoptic Society (BIOS) 11.15 – 12.45 OPTIMISING SERVICES FOR PEOPLE WITH LEARNING DISABILITIES Workforce planning – challenges for the unit manager Ms Rebecca Turner, Clinical Lead for Ophthalmic Services, Oxford Eye Hospital Capacity, consent and flexibility – Working with people with a learning disability Professor Duncan Mitchel, Professor of Health & Disability, Manchester Metropolitan University 4.30 Close of Allied Professions Day Putting it into practice: the challenge of hospital eye care for people with learning disabilities Miss Rachel Pilling, Consultant Ophthalmologist, Bradford Royal Infirmary Stroke and its consequences; lessons for eye care professionals Dr Jennifer Stanley, Communications and Awareness Officer, Stroke Association, Scotland The Orthoptist’s role in the visual and functional assessment of children with special educations needs Ms Annette Dillon, Co-Chair, BIOS Special Education Needs Special Interest Group 12.45 – 1.30 LUNCH IN EXHIBITION HALL 15 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 DUKE ELDER ORATION 2014 Wednesday 21st May 2014 10.00 – 11.00 Hall 1 IMPROVING QUALITY OF CARE BY REDUCING MEDICAL ERROR: CREATING A GLOBAL INITIATIVE FOR OPHTHALMOLOGY Professor Richard Abbott, Thomas W. Boyden Endowed Chair & Health Sciences, Clinical Professor of Ophthalmology, University of California, USA Dr Abbott currently is the Thomas W. Boyden Health Sciences Professor of Clinical Ophthalmology at the University of California San Francisco and Research Associate at the Francis I. Proctor Foundation. He is the former Co-Director of Corneal and Refractive Surgery and was responsible for establishing the refractive surgery clinical and research program at UCSF. After completing his Bachelor of Science degree at Tufts University in Boston, Dr. Abbott earned his medical degree at the George Washington University School of Medicine in Washington, DC. He performed his residency at the California Pacific Medical Center in San Francisco and was a Heed and Fight for Sight fellow at the Bascom Palmer Eye Institute in Miami. Dr. Abbott has served on the editorial boards of several US ophthalmic journals, as well as currently serving on the editorial boards of numerous international journals. He lectures and publishes on a variety of topics focusing primarily on corneal and external diseases of the eye, as well as quality of care, patient safety, clinical practice guidelines, and medicolegal issues. Dr Abbott currently is the Senior International Advisor for the Asia Cornea Society Infectious Keratitis Study. He has authored or co-authored 90 publications and 32 book chapters and has delivered over 700 invited lectures and 27 named lectures. In addition, he served on the ophthalmic devices advisory panel of the FDA. Dr. Abbott has received numerous honors, including the U.S. President’s 25 year Volunteer Service Award; the International Golden Service Award from the Chinese Academy of Ophthalmology; the Jose Rizal Medal for International Service to the Asia Pacific region from the Asia Pacific Academy of Ophthalmology; the AE Maumenee Pan American Medal for Distinguished Service to Latin America from the Pan American Association of Ophthalmology; the Asia Pacific Cornea Foundation Medal from the Asia Pacific Cornea Society; and the American Academy of Ophthalmology’s Lifetime Achievement Award. Dr. Abbott is Past President of the American Academy of Ophthalmology (AAO) and the Past President of both the Pan American Association of Ophthalmology and the Pan American Ophthalmological Foundation. He currently serves as the Secretary for Global Alliances for the AAO. Dr Abbott is the immediate past Chairman of the Board of the Ophthalmic Mutual Insurance Company (OMIC) and a former Director of the American Board of Ophthalmology. He is a past Board Director for the International Council of Ophthalmology and currently serves as Chairman of the Clinical Practice Guidelines Committee. Dr Abbott is recognized in Who’s Who in America, Who’s Who in the World, and Best Doctors in America. He has been elected as a member of both the American Ophthalmological Society and Academia Ophthalmologica Internationalis, an international body limited to 60 active members committed to global vision research, education, and service. He lives in Mill Valley, California, with his wife, Cecilia. They have three children and five grandchildren. Introduction by Mr Nick Astbury, Consultant Ophthalmologist, Norfolk & Norwich University Hospitals NHS Foundation Trust Vote of thanks from Professor Harminder Dua, President, The Royal College of Ophthalmologists 16 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Wednesday 21st May 2014 THE BOWMAN LECTURE 2014 Wednesday 21st May 2014 4.30 – 5.30 Hall 1 A TALE OF TWO MEMBRANES DURING THE LASER REVOLUTION: BOWMAN'S AND BRUCH'S Professor John Marshall, Professor of Ophthalmology, Institute of Ophthalmology, London Professor John Marshall is the Frost Professor of Ophthalmology at the Institute of Ophthalmology in association with Moorfields Eye Hospital, University College London and the theme leader for new devices and new technologies NIHR. He is Emeritus Professor of Ophthalmology at Kings College London, Honorary Distinguished Professor University of Cardiff, Honorary Professor the City University and Honorary Professor Glasgow Caledonian University. His research over the past forty years has ranged over a number of ocular problems but has concentrated on the inter-relationships between light and ageing and the environmental mechanisms underlying age-related, diabetic and inherited retinal disease. He has also contributed to the development of lasers for use in ophthalmic diagnosis and surgery. He invented and patented the revolutionary Excimer laser for the correction of refractive disorders with in excess of 35 million procedures now having been undertaken worldwide. He also created the world’s first Diode laser for treating eye problems of diabetes, glaucoma and ageing. He has delivered 48 named lectures and received 36 honours and awards including the Nettleship Medal of the Ophthalmological Society of the United Kingdom, the Mackenzie Medal, the Raynor Medal, the Ridley Medal, the Ashton Medal, the Ida Mann Medal, the Lord Crook Gold Medal of the Worshipful Company of Spectacle Makers, the Doyne Medal of the Oxford Congress, the Barraquer Medal of the International Society of Cataract and Refractive Surgery, the Kelman Innovator Award of the American Society for Refractive and Cataract surgery, and the Lim Medal of the Singapore National Eye Centre. He has been visiting professor at numerous universities on every continent. In 2012 he received the Junius-Kuhnt award and Medal for his work on AMD and has been designated the Bowman Lecturer for the Royal College of Ophthalmologists in 2014. He is a Fellow of the Royal College of Pathologists, a Fellow of the Association for Research in Vision and Ophthalmology and has been elected a Fellow of the Academy of Medical Sciences and a Fellow of the Institute of Biology. He is also an Honorary Fellow of the Royal College of Ophthalmologists, an Honorary Fellow of The College of Optometrists, a Fellow and past Director of the Laser Institute of America, a Fellow of the Royal Society of Arts and an Honorary Fellow of Cardiff University. He has a Senior Achievement Award of the American Academy of Ophthalmology and the Euretina Award of the European Society of Retinal Surgeons. In 2009 he was honoured with a Lifetime Achievement Award by the International Society of Cataract and Refractive Surgery and the American Academy of Ophthalmologists. He is also a Fellow of several national ophthalmological societies, as well as being elected to the European Academy of Ophthalmology. Between 2011-2012 he was the Master of the Worshipful Company of Spectacle Makers. This year he was awarded the MBE in the 2013 New Year Honours List for services to Ophthalmology and an honorary Doctor of Science degree from Glasgow Caledonian University. Introduction by Professor Alan Bird, Professor of Medical Ophthalmology, Moorfields Eye Hospital, London Vote of thanks from Professor Harminder Dua, President, The Royal College of Ophthalmologists 17 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Thursday 22nd May 2014 Free welcome coffee, tea and pastries will be served outside session halls for all delegates attending breakfast sessions 8.00 – 8.10 Introduction to Private Practice and General Principles Mr Robert Taylor, Consultant Ophthalmologist, York Hospital 8.00 – 9.00 HALL 10 SIMULATED OCULAR SURGERY Mr John Ferris, Consultant Ophthalmologist, Cheltenham General Hospital 8.10 – 8.15 Questions 8.00 – 8.05 Introduction Mr John Ferris, Consultant Ophthalmologist, Cheltenham General Hospital 8.15 – 8.25 How was it for me? Mr Martin Watson, Consultant Ophthalmologist, Moorfields Eye Hospital, London 8.05 – 8.20 Cataract Surgery Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury 8.25 – 8.30 Questions 8.30 – 8.40 Partnership working – How we did it Mr John Lipton, Consultant Ophthalmologist, Royal Oldham Hospital, Manchester 8.20 – 8.30 Glaucoma Surgery Professor Andrew McNaught, Consultant Ophthalmologist, Cheltenham General Hospital 8.40 - 8.45 Questions 8.30 – 8.40 VR Surgery Mr Richard Haynes, Consultant Ophthalmologist, Bristol Eye Hospital 8.45 – 8.55 Maximising your potential Mr Paul Ursell, Consultant Ophthalmologist, Sutton Hospital, Surrey 8.40 – 8.50 Strabismus Surgery Mr John Ferris, Consultant Ophthalmologist, Cheltenham General Hospital 8.55 – 9.00 Questions 8.50 – 9.00 Questions 8.00 – 9.00 HALL 11 OPHTHALMOLOGY OUT TO TENDER: SECURING BETTER VALUE FOR PATIENTS - OR SELLING THE FAMILY SILVER? Mr Richard Smith, Consultant Ophthalmologist, Buckinghamshire Healthcare NHS Trust 8.00 – 9.00 HALL 1 GRAND ROUNDS: MEDICAL RETINA Mr James Talks, Consultant Ophthalmologist, Newcastle upon Tyne NHS Trust 8.00 – 8.05 Introduction Mr Richard Smith, Consultant Ophthalmologist, Buckinghamshire Healthcare NHS Trust A series of interesting cases that proved a diagnostic challenge or cases of more common conditions, where additional imaging helped improve the management, will be presented. 8.05 – 8.20 Commissioners Perspective Ms Alison Wakeford, Lead for Strategy, Planning and Service Redesign, Central and Southern Commissioning Support Unit Speakers: Dr Will Innes, Consultant Medical Ophthalmologist, Newcastle upon Tyne NHS Trust Mrs Vina Manjunath, Consultant Ophthalmologist, Newcastle upon Tyne NHS Trust Ms Priyanka Sharma, Medical Retina Fellow, Newcastle upon Tyne NHS Trust Mr James Talks, Consultant Ophthalmologist, Newcastle upon Tyne NHS Trust 8.20 – 8.35 Public Health Perspective Mr Jonathan Howell, Consultant in Public Health, Specialised Commissioning (West Midlands), NHS England 8.35 – 8.45 Lay Perspective Mrs Wendy Pepper & Mr Rodger Pepper, Macular Society 8.00 – 9.00 HALL 5 HOW TO RUN A PRIVATE PRACTICE Mr Robert Taylor, Consultant Ophthalmologist, York Hospital 8.45 – 9.00 Questions and Discussion 18 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Thursday 22nd May 2014 8.00 – 9.00 HALL 7 NIHR CRN, OPHTHALMOLOGY SPECIALITY: FOCUS ON WORKING WITH INDUSTRY Mr Faruque Ghanchi, Industry Studies Lead, Ophthalmology Speciality Group 9.55 – 10.15 Treatment clinics for diabetic retinopathy: What is required to meet demand? Mr Peter Scanlon, Consultant Ophthalmologist, Cheltenham General Hospital 8.00 – 8.05 Welcome Mr Faruque Ghanchi, Industry Studies Lead, Ophthalmology Speciality Group 10.15 – 10.30 Establishing and running a comprehensive glaucoma service Mr Anthony King, Consultant Ophthalmologist, University Hospital Nottingham 8.05 – 8.15 Ophthalmology Speciality Group – Supporting the delivery of eye & vision research Professor Usha Chakravarthy, Chair of Ophthalmology Speciality Group 10.15 – 10.30 Solutions to meeting the demand in a glaucoma clinic Mr Ian Cunliffe, Consultant Ophthalmologist, Birmingham Heartlands Hospital 8.15 – 8.25 Clinical Research Network: Focus on working with industry Ms Jayne Shippin, Industry Operations Manager, CCRN 9.00 – 10.45 HALL 5 ENDOPHTHALMITIS – PREVENTION & MANAGEMENT Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury 8.25 – 8.35 Delivering on the ground: The Researcher’s view Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals 9.00 – 9.05 Introduction Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville, Aylesbury 8.35 – 8.45 Experience of working with the Network – an Industry view Mr James Warburton, Novartis Pharmaceuticals & Ms Helen Townsend, Novartis Pharmaceuticals 9.05 – 9.30 Epidemiology and Clusters Mr John Sparrow, Consultant Ophthalmologist, Bristol Eye Hospital 8.45 – 9.00 Open discussion Ms Sarah Cooper, Speciality Groups Operations Manager CCRN 9.30 – 9.55 The Perfect Prevention Mr Alex Foss, Consultant Ophthalmologist, University Hospital Nottingham 9.55 – 10.20 The Ideal Treatment Mr Bill Aylward, Consultant Ophthalmologist, Moorfields Eye Hospital, London 9.00 – 10.45 HALL 11 CHALLENGES OF MANAGING CHRONIC DISEASES OF THE EYE Mr Declan Flanagan, Medical Director, Moorfields Eye Hospital, London 10.20 – 10.45 Questions 9.00 – 9.05 Introduction 9.00 – 10.45 HALL 1 UPDATE ON RETINAL VASCULAR DISEASE Miss Sobha Sivaprasad, Consultant Ophthalmologist, Moorfields Hospital and King’s College London 9.05 – 9.20 Ophthalmic epidemiology – The scale of the problem Miss Parul Desai, Consultant Ophthalmologist, Moorfields Eye Hospital, London This session will focus on the diagnostic and management dilemma of challenging retinal vascular diseases in the current era of new diagnostic modalities and therapeutic options. 9.20 – 9.45 The role of the nurse practitioners in delivering intravitreal Therapy Mr Peter Simcock, Consultant Ophthalmologist, Royal Devon and Exeter Hospital The session will be a panel discussion of cases by 4 panellists: Mr Philip Hykin, Consultant Ophthalmologist, Moorfields Eye Hospital, London 9.45 – 9.55 Mobile glaucoma clinics Mr Peter Simcock, Consultant Ophthalmologist, Royal Devon and Exeter Hospital 19 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Thursday 22nd May 2014 9.35 – 10.05 GDx Scanning Laser Polarimetry: Glaucoma diagnosis and monitoring Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals Mr Faruque Ghanchi, Consultant Ophthalmologist, Bradford Royal Infirmary Miss Sobha Sivaprasad, Consultant Ophthalmologist, Moorfields Hospital and King’s College London Professor Yit Yang, Consultant Ophthalmologist, Wolverhampton & Midland Counties Eye Infirmary 10.05 – 10.35 OCT of the Optic Disc and Nerve Fibre Layer: Glaucoma diagnosis and monitoring Mr Nick Strouthidis, Consultant Ophthalmologist, Moorfields Eye Hospital, London 9.00 – 10.45 HALL 7 PAEDIATRIC CATARACT Professor Chris Lloyd, Consultant Paediatric Ophthalmologist, Manchester Royal Eye Hospital 10.35 – 10.45 Questions and Answers 9.00 – 9.10 Introduction Professor Chris Lloyd, Consultant Paediatric Ophthalmologist, Manchester Royal Eye Hospital 9.00 – 12.00 HALL 9 TRAINING THE TRAINERS – SUPERVISION OF TRAINING IN PRACTICE Miss Melanie Corbett, Chair of RCOphth Training the Trainers Sub-Committee, Chair of RCOphth College Tutors Sub-Committee 9.10 – 9.40 Modern genomics in paediatric cataract – new diagnostic protocols Professor Graeme Black, Consultant Clinical Geneticist, St Mary’s Hospital, Manchester Pre-registered delegates only. Registration for this session closed on 2nd May 2014 9.40 – 10.10 Secondary IOLs in the management of paediatric aphakia Professor Jan Tjeerd Dr Faber, Consultant Paediatric Ophthalmologist, The Rotterdam Eye Hospital, University of Rotterdam, The Netherlands RCOphth Training the Trainers Faculty: Miss Rajni Jain Miss Sarah Maling Mr Mike Nelson Miss Fiona Spencer Mr Geoffrey Woodruff 10.10 – 10.45 Surgical Videos – “ Challenging cases, tips and tricks” Miss Jane Ashworth, Consultant Paediatric Ophthalmologist, Manchester Royal Eye Hospital & Mr Manoj Parulekar, Consultant Paediatric Ophthalmologist, Birmingham Children’s Hospital & Professor Chris Lloyd, Consultant Paediatric Ophthalmologist, Manchester Royal Eye Hospital This course will help Clinical and Educational Supervisors develop skills to make their conversations with trainees more valuable for learning. It will cover many aspects of the GMC standards required for the appraisal of trainers. 10.45 – 11.30 COFFEE & POSTERS: Meet the Authors 9.00 – 10.45 HALL 6 £ DISC AND RETINAL IMAGING IN GLAUCOMA DIAGNOSIS AND MONITORING COURSE PART I Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals & Professor Stephen Vernon, Consultant Ophthalmologist, University Hospital Nottingham 11.30 – 12.00 HALL 1 THE GREAT DEBATE Mr Bill Aylward, Consultant Ophthalmologist, Moorfields Eye Hospital, London Pre-registered delegates only. Check availability with our registration staff. FOR Mr Brian Little, Consultant Ophthalmologist, Moorfields Eye Hospital, London “Modern Cataract Surgery has become Unnecessarily Sophisticated” 9.00 – 9.05 Introduction to retinal and optic nerve imaging Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals & Professor Stephen Vernon, Consultant Ophthalmologist, University Hospital Nottingham AGAINST Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury 9.05 – 9.35 HRT Scanning: Glaucoma diagnosis and monitoring Professor Stephen Vernon, Consultant Ophthalmologist, University Hospital Nottingham 20 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Thursday 22nd May 2014 12.00 – 1.00 HALL 1 THE OPTIC UK LECTURE 2014 Professor Neil Miller, Frank B Walsh Professor of Neuro-ophthalmology, John Hopkins Hospital, Baltimore, USA 3.15 – 3.35 The First Half Mr Larry Benjamin, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury 3.35 – 3.55 The Second Half Mr Richard Packard, Consultant Ophthalmologist, Kind Edward VII Hospital, Windsor Professor Neil Miller will deliver this year’s Optic UK Lecture. Please see page 23 for further information. 1.00 – 2.00 LUNCH & EXHIBITION 3.55 – 4.00 Conclusions 2.00 – 2.15 HALL 1 AWARDS CEREMONY Chaired by Professor Harminder Dua, President, The Royal College of Ophthalmologists 2.15 – 4.00 HALL 7 INHERITED RETINA DISEASE Professor Andrew Lotery, Consultant Ophthalmologist, Southampton Eye Unit & Professor Andrew Webster, Professor of Ophthalmology, University College London 2.15 – 4.00 HALL 11 INFECTIOUS DISEASE OF POSTERIOR SEGMENT Professor Sue Lightman, Consultant Ophthalmologist, Moorfields Eye Hospital, London 2.15 – 2.40 The Utility of iPSC technology in inherited retinal disease Professor Budd Tucker, Assistant Professor, Ophthalmology and Visual Science, University of Iowa, USA Overview of the changing face of infectious disease in the UK Professor William Lynn, Professor of Medicine, University of Buckingham Tuberculosis today and in the eye Professor Sue Lightman, Consultant Ophthalmologist, Moorfields Eye Hospital, London 2.40 – 3.05 Insights into the causes of age-related macular degeneration Professor Andrew Lotery, Consultant Ophthalmologist, Southampton Eye Unit What’s new with toxoplasmosis that we need to know? Professor Marc de Smet, Professor of Ophthalmology, Clinique de Monthcoisi, Lausanne, Switzerland 3.05 – 3.30 Syndromic retinal disease Dr Eva Lenassi, Consultant Ophthalmologist, University Medical Centre, Ljubljana, Slovenia Syphilis today and the eye Miss Sarah-Lucie Watson, Consultant Ophthalmologist, Royal Berkshire Hospital, Reading 3.30 – 3.55 Update on diagnostic testing in the clinic Professor Andrew Webster, Professor of Ophthalmology, University College London 2.15 – 4.00 HALL 5 HOW TO AVOID COMPLICATIONS IN CATARACT SURGERY Mr Brian Little, Consultant Ophthalmologist, Moorfield Eye Hospital, London 2.15 – 4.00 HALL 1 GRAND ROUNDS: NEURO-OPHTHALMOLOGY Mr Mike Burdon, Consultant Ophthalmologist, University Hospitals Birmingham & Dr Gordon Plant, Consultant Neurologist, St Thomas’ Hospital, London 2.15 – 2.35 Use Your Head Mr Paul Sullivan, Consultant Ophthalmologist, Moorfields Eye Hospital, London This is an interactive session of case presentations and discussion with the faculty: 2.35 – 2.55 Pick the Winners Mr Paul Ursell, Consultant Ophthalmologist, Sutton Hospital Miss Margaret Dayan, Consultant Ophthalmologist, Royal Victoria Infirmary Dr Stephen Madill, Consultant Ophthalmologist, Princess Alexandra Eye Pavilion Miss Brinda Muthusamy, Consultant Paediatric Neuro-Ophthalmologist, Bristol Eye Hospital Dr Ghislaine Traber-Hoffman, Neuro-Ophthalmology Fellow, Moorfields Eye Hospital, London Dr Sui Wong, Consultant Neurologist, Moorfields Eye Hospital, London 2.55 – 3.15 Hit the Target Mr Milind Pande, Director & Consultant Ophthalmologist, Vision Surgery & Research Centre, Hull 21 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Thursday 22nd May 2014 2.15 – 4.00 HALL 6 £ DISC AND RETINAL IMAGING IN GLAUCOMA DIAGNOSIS AND MONITORING COURSE PART II Mr Rupert Bourne, Consultant Ophthalmologist, Hinchingbrooke/Addenbrookes/Moorfields Hospitals & Professor Stephen Vernon, Consultant Ophthalmologist, University Hospital Nottingham By the end of the symposium the delegates should not only have increased their knowledge in the interpretation of the results obtained with the presented imaging techniques but also have had the opportunity to improve their scanning skills. Additionally the symposium will provide guidance on which devices to use and when, when to repeat imaging, and how to organise one’s glaucoma imaging service which may involve nonophthalmologist personnel. Pre-registered delegates only. Check availability with our registration staff. PART TWO – CASE DISCUSSIONS & DEMONSTRATIONS 4.00 CONGRESS CLOSE A series of educational cases involving glaucoma suspects and cases will be worked through in an interactive manner led by the chairmen with input from the session presenters. There will be the opportunity during the day to get hands on experience with some of the imaging modalities. GP DAY - Thursday 22nd May 2014 9.15 - 4.00 HALL 10 GP DAY Ms Seema Verma, The Royal College of Ophthalmologists & Dr David Rapley, The Royal College of General Practitioners 11.55 – 12.20 Diabetes and the eye Miss Sobha Sivaprasad, Consultant Ophthalmologist, Moorfields Eye Hospital, London 9.15 – 9.20 Welcome and Introduction 12.20 – 12.45 Age related macular degeneration when to refer? Mr James Talks, Consultant Ophthalmologist, Newcastle Eye Centre 9.20 – 9.45 Examination of the eye in General Practice: key points Mr John Ferris, Consultant Ophthalmologist, Gloucester Royal Infirmary 12.45 – 1.45 Lunch in Exhibition Hall 1.45 – 2.10 Common eye lid problems Mr Richard Harrad, Consultant Ophthalmologist, Bristol Eye Hospital 9.45 – 10.10 The acute red eye Ms Seema Verma, Consultant Ophthalmologist, Moorfields Eye Hospital London 2.10 – 2.55 COMMISSIONING IN OPHTHALMOLOGY 10.10 – 10.35 Common eye problems in children Mr Robert Taylor, Consultant Ophthalmologist, York The Ophthalmologist’s Perspective Mr Richard Smith, Consultant Ophthalmologist, Stoke Mandeville Hospital, Aylesbury 10.35 – 11.00 The tear film: How to manage dry eyes and watery eyes Mr Geoff Rose, Consultant Ophthalmologist, Moorfields Eye Hospital, London The GP’s Perspective Dr Waqaar Shah, The Royal College of General Practitioners 2.55 – 4.00 Case discussion and question & answer session 11.00 – 11.30 Coffee break in Exhibition Hall 11.30 – 11.55 Acute visual loss Miss Susan Mollan, Consultant Ophthalmologist, University Hospital Birmingham 22 Annual Congress Final Programme & Abstracts Birmingham 2014 PROGRAMME - Thursday 22nd May 2014 OPTIC UK LECTURE 2013 Thursday 22nd May 2014 12.00 – 1.00 Hall 1 CURRENT CONCEPTS IN THE DIAGNOSIS, PATHOGENESIS AND MANAGEMENT OF NONARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY Professor Neil Miller, Professor of Neuro-ophthalmology, The Wilmer Eye Institute, The John Hopkins School of Medicine, Baltimore, USA Dr. Neil Miller attended Harvard University, where he majored in biochemistry, graduating Magna cum Laude in 1967. He then matriculated to Johns Hopkins Medical School. After finishing medical school at in 1971, he took an internship in medicine at Johns Hopkins, followed by an ophthalmology residency at the Wilmer Eye Institute and a fellowship in neuro-ophthalmology at the University of California, San Francisco, with Dr. William F. Hoyt. Dr. Miller joined the staff of the Wilmer Eye Institute of the Johns Hopkins Hospital in 1975 and has been a faculty member at Johns Hopkins since then. He is currently Professor of Ophthalmology, Neurology, and Neurosurgery at the Johns Hopkins Medical Institutions, and also the Frank B. Walsh Professor of Neuro-Ophthalmology and head of the Neuro-Ophthalmology and Orbital Units of the Wilmer Institute. Other departmental duties include Chair of the Wilmer Resident Selection. He is also Chair of the Associate Professor Reappointment Review Committee for the Johns Hopkins Medical Institutions. Dr. Miller was president of the North American Neuro-Ophthalmology Society from 2000 to 2002 and Chairman of the Executive Board from 2002 to 2004. He has been past president of the International Neuro-Ophthalmology Society on three occasions: in 1982, 1992, and 2008. He is also an emeritus member of the International Orbital Society. In 2009, he was given a lifetime achievement award by the American Academy of Ophthalmology (AAO). Dr. Miller is a member of the editorial boards of the Journal of Neuro-Ophthalmology and Neuro-Ophthalmology. He has served as a reviewer for numerous journals, including the American Journal of Ophthalmology, Archives of Ophthalmology, British Journal of Ophthalmology, Lancet, Neurology, JAMA, Journal of Neurosurgery, and the New England Journal of Medicine. He has authored or co-authored over 470 articles, 89 chapters, and 11 books, one of which was the 4th edition of Walsh and Hoyt's Clinical Neuro-Ophthalmology. With Dr. Nancy Newman of Emory University, he edited the 5th edition of this textbook, and the two of them also wrote an abbreviated version of the textbook—Walsh and Hoyt’s Clinical Neuro-Ophthalmology: The Essentials”—for medical students and residents. The 6th edition of the full textbook, again edited by Drs. Miller and Newman with the assistance of two of their colleagues, Valérie Biousse at Emory University and John Kerrison formerly at Wilmer, was published in December, 2004, and the second edition of “The Essentials” was published in 2008. A third edition of “The Essentials,” to be written with two of his colleagues at Wilmer, Prem Subramanian and Vivek Patel, is scheduled to be published in 2014. Dr. Miller also has co-authored with Michael Burdon of the UK and Anthony Payne in Australia “The Neuro-Ophthalmology Survival Guide” published in 2007 and designed for medical students, residents, and general ophthalmologists. Dr. Miller has spoken at numerous meetings around the world and has given 51 named lectures throughout the world, including the Jackson Memorial Lecture at the 2001 meeting of the American Academy of Ophthalmology, the Hoyt lecture at the 2005 meeting of the AAO, the Doyne Lecture at the Oxford Congress in the UK in 2006, the Francis Heed Adler lecture at the University of Pennsylvania in 2009, the Plenary Lecture at the 25th Anniversary Meeting of the Singapore National Eye Centre in 2011, the F. Bruce Fralick Lecture at the University of Michigan in 2012, and the Morris B. Bender, MD Lecture at Mt Sinai Medical Center in 2013. Many of Dr. Miller’s previous Fellows and residents hold faculty positions at major institutions throughout the United States and around the world. Introduction by Mr Mike Burdon, Consultant Ophthalmologist, University Hospitals Birmingham Vote of thanks from Professor Harminder Dua, President, The Royal College of Ophthalmologists 23 Annual Congress Final Programme & Abstracts Birmingham 2014 POSTERS: Rapid Fire All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. RAPID FIRE 10. Evaluating the Use of Intravitreal Aflibercept in Patients with Choroidal Neovascularisation Secondary to Pathological Myopia (mCNV): The MYRROR Study Francesco Bandello San Raffaele Scientific Institute 1. SOE PRIZE WINNER 2014 Intravitreal Aflibercept for Diabetic Macular Edema: 1 – Year Findings from the VIVID-DME and VISTADME Trials Edoardo Midena University of Padova 2. Ranibizumab treatment of diabetic macular oedema with bimonthly monitoring after a phase of initial treatment: 18-month outcomes of the Phase IIIb multicentre RELIGHT study Ian Pearce Mulitcenter study 11. Is socioeconomic deprivation independently associated with increased prevalence of diabetic retinopathy? Liying Low, Simon Ogston, Peter Wilson, Alex Yeong, Ritchie McAlpine, Una O’Colmain, Carrie MacEwen University of Dundee 3. Translational bypass therapy using ataluren to treat nonsense-mediated choroideremia Mariya Moosajee, Dhani Tracey-White, Clare Futter, Tony Moore, Andrew Webster, Miguel Seabra UCL Institute of Ophthalmology 12. Swept-Source Optical Coherence Tomography Assessment of Choroidal Thickness in Different Macular Disorders Salvador Pastor-Idoate, Maria Gil-Martinez, Stephen Charles, Susmito Biswas, David Henson, David B McLeod, Paulo Stanga MREH/NIHR. Wellcome Trust CRF 4. Metabolomic Analysis of Serum in Graves’ Disease and Thyroid-Associated Ophthalmopathy: A Diagnostic Tool? Matthew R Edmunds, Kristien Boelaert, Jayne A Franklyn, S John Curnow, Omar M Durrani, Stephen P Young University of Birmingham 13. Visual Impairment and health inequalities: findings from UK Biobank (UKBB) Phillippa Cumberland, Paul Foster, Peng Tee Khaw, Christopher Hammond, Pirro Hysi, Yanchun Bao, Jugnoo Rahi UCL Institute of Child Health 5. The effects of anti-VEGFS on human tenon’s fibroblast growth in vitro Nurul Nabila Baharudin, Siti Munirah Mohd Noh, Siti Hamimah Sheikh Abdul Kader, Zakaria Bannur, Jonathan Crowston, Sushil Kumar Vasudevan IMMB, UITM 14. A British Ophthalmic Surveillance Unit (BOSU) study of severe adverse events associated with local anaesthesia (LA) in cataract surgery Richard M H Lee, John R Thompson, Tom Eke King’s College Hospital 6. A case for re-defining the intraocular pressure referral threshold: Findings from the UK Biobank Michelle Chan, Carlota Grossi Sampedro, Stephen Vernon, James Morgan, Praveen Patel, Peng Khaw, Paul Foster Moorfields Eye Hospital Foundation Trust 15. Cochrane review of 5-fluorouracil in trabeculectomy: too long overlooked? Elspeth Green, Richard Wormald London School of Hygiene & Tropical Medicine 16. The impact of congenital profound or severe visual impairment (VI) on behaviour development and difficulties in the early years Michelle O’Reilly, Elena Sakkalou, Hanna Sakki, Michelle de Haan, Alison Salt, Naomi Dale UCL Institute of Child Health 7. Can we replace Temporal Artery Biopsy (TAB) with Cranial Duplex Ultrasound (CDUS) in the diagnosis or Giant Cell Arteritis (GCA)? Adam Croft, Nicola Thompson, Martin Duddy, Fazal Khattak, Susan Mollan, Paresh Jobanputra University Hospital Birmingham 17. Redefining wolfram syndrome in the molecular era Patrick Yu-Wai-Man, Grant Guthrie, Kamil S Sitarz, Angela Pyle, Rita Horvath, Philip G Griffiths, Patrick F Chinnery Newcastle Eye Centre, Royal Victoria Infirmary 8. OCT Findings in Children with Bardet Biedl Syndrome Peter Good, John Ainsworth, Marie Tsaloumas, Alaistair Denniston, Denise Williams Birmingham Childrens Hospital 18. Glaucoma prescribing trends in England 2000 – 2012 Alan Connor, Scott Fraser Royal Victoria Infirmary, Newcastle 9. Analysis of the Hedgehog signalling pathway in periocular morphoeic basal cell carcinoma. John Bladen, Caroline Thaung, Michele Beaconsfield, Michael Philpott Centre for Cutaneous Research, Barts and The London 19. Corneal Calcification and phosphate buffers – Do you need to prescribe phosphate free? Magdalena Popiela, Nicholas Hawksworth Singleton Hospital 24 Annual Congress Final Programme & Abstracts Birmingham 2014 POSTERS: Audit & Clinical Governance All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. AUDIT & CLINICAL GOVERNANCE 20. One year experience with ‘Nurse Injectors’ in a busy Macular service Deepali Varma, K Stoddart Sunderland Eye Infirmary Sivaprasad King’s College Hospital 31. Predictors of Failure of Primary Surgery for Congential Nasolacrimal Duct Obstruction Mahmoud Nassar, Gordon Lau, Ayad Shafiq, Michael Clarke Newcastle Eye Centre, Royal Victoria Eye Infirmary, Newcastle 21. Engaging children in feedback: Use of an animated toolkit for recording feedback of patient experiences from children and young people in ophthalmology services Robbie Walker, Yvette Annan, Mally Scrutton, Tim Withers, Jo Hancox Moorfields Eye Hospital 32. Substainability in ophthalmic practice: are we hitting the triple bottom line? J Somner, N Stone, Z Sipkova, A Koukoulli, G Lascaratos, G Jóhannesson, A Das, O Bowes, H Jewsbury, RL Perrott-Reynolds, DS Morris, R Bourne, A Cassels-Brown, V Cross Vision and Eye Research Unit, Anglia Ruskin Univeristy 22. Use of lumbar punctures in the investigation of ocular syphillis Ian Reekie, Yavische Reddy Univeristy of Kwazulu Natal 23. Safety in nurse-led corneal collagen crosslinking Melanie Mason, Dan Gore, Bruce Allan Moorfields Eye Hospital 33. The carriage of steroid treatment card for uveitic patients Simerdip Kaur, Moloy Dey, Adam Mapani, Francis Chiu, Narciss Okhravi Moorfields Eye Hospital 24. WOScOTT, The West of Scotland Optometrist Teach And Treat Clinic: Shaping the future of Community Ophthalmology in Scotland Kaleena Michael, Maria Elena Gregory, Manish Gupta, Janet Pooley, Donald Cameron NHS Greater Glasgow and Clyde 34. Stream-lining a busy macular service: Reducing the burden of ‘inactive’ wet age-related macular degeneration patients. Bushra Mushtaq, Abhijit Mohite, Huzaifa MAlick Sandwell General Hospital, Birmingham 25. Acute infective conjunctivitis – to swab or not to swab? Siegfried Wagner, Ian C Bowler, Stella J Hornby Oxford University Hospitals NHS Trust 35. Is there correlation between pain during intravitreal injection and the site of injection? Jan Sniatecki, Mohan Varikkara, Zachariah Koshy University Hospital Ayr, NHS Ayrshire and Arran 26. Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service Colm McAlinden, Helen Corson, Peter Garwood Public Health Wales 36. Efficacy of an educational intervention to improve adherence to NICE recommended follow up intervals for Glaucoma Michael James Gilhooley, R Karun, R Vemala, P Abeysiri Queen’s Hospital, Romford 27. Initial experience with barely visable and sunthreshold yellow wavelength Pascal® laser with and without Endpoint Management® in diabetic patients Maria Gil-Martinez, Salvador Pastor-Idoate, Yvonne D’souza, Sajjad Mahmood, Stephen Charles, David Henson, Paulo Stanga MREH, NIHR/Wellcome Trust CRF 37. 5 year audit of endophthalmitis following intravitreal injections within antibiotic prophylaxis. Roopa Vemala, Alastair Porteuos, Judith Field, Niaz Islam Queen’s Hospital Romford 38. Situational Analysis of Quality Improvement Processes in Cataract Surgery in Madagascar Rini Vyas, Hery Andriamanjato, Lea Raobela, Alice Harisoa, Johnathan Buchan, Andrew Cassels-Brown Leeds Teaching Hospital Trust 28. Natural history of patients receiving Lucentis for WET AMD: A 3-year prospective study Ruth Peiwan Chen, Pankaj Puri Royal Derby Hospital, Derby 29. The Impact of Rationing Cataract Surgery in Gloucestershire Miranda Buckle, Robert Johnston, Nicholas Price, John Ferris, John Sparrow, Graham Mennie Gloucestershire Hospitals NHS Foundation Trust 39. Ozurdex Outcomes in Retinal Vein Occlusion with Macular Oedema Valerie Juniat, Eleni Tsolakou, Nishal Patel Kent and Canterbury Hospital 40. Implications of multiple intravitreal injections for subsequent cataract surgery Jack Gromley, Mark Costen Hull & East Yorkshire Eye Hospital 30. Initial experience of neovascular AMD unresponsive to ranibizumab treated with aflibercept Noa Fernandez Ledo, George Kiousis, Raeba Mathew, Helena Vrizidou, Sheena Koshy, Sobha 25 2014 Final Programme p1-37.qxd:2012 FP&A post RG 2 #C6694E.qxd 20/6/14 09:28 Page 26 Annual Congress Final Programme & Abstracts Birmingham 2014 POSTERS: Audit & Clinical Governance All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. AUDIT & CLINICAL GOVERNANCE 41. Cardiopulmonary resuscitation and the standalone ophthalmic unit. Priscilla Mathewson, Samer El-Sherbiny Birmingham Midland Eye Centre 53. Proliferative diabetic retinopathy referrals from Diabtic Retinopathy Screening Service Wales (DRSSW): Role of fast track referral system Shantanu Gudsoorkar, Phillipa Knowles, Sarah Hale University of Wales, Cardiff 42. Missed pathology or disease progression? Follow up of patients with acute ‘flashes and/or floaters’ Shreya Haldar, Melanie Chak Royal Berkshire Hospital 54. Visual Impairment in acute medical admissions: streamlining ophthalmic referral Frederick R Burgess, Elizabeth D Hawkes, Owen D Ingram, James E Neffendorf Royal Bolton Hospital 43. Distorted Pathways: Trials and tribulations in Delivering Lucentis Service in Diabetic Macula Oedema (DMO) in a Large Foundation Trust Aaron Thye Wang Ng, Khazina Waraich, Jiang Li, Rangarajan Prabhu, David Kinshuck, Ramesh Sivaraj Heart of England NHS Foundation Trust 55. Are we meeting the British Rheumatology Society (BRS) Guidelines for Temporal Artery Biopsy? Sophie Hickling, Susan Mollan University Hospital Birmingham 56. Our 10 years’ experience in treating periocular spasm with botulinum toxin Aneesa Rahim, Jessica Montford, Joyce Burns, Raghavan Sampath Leicester Royal Infirmary 44. Unilateral vs Immediate Sequential Bilateral Cataract Surgery. A Comparison of Inpatient Fall Rates Alasdair Kennedy, Tom Pampiglione, Pankaj Puri, Adil Jaulim Derby Royal Hospital 57. The provision of an objective visual acuity by General Practitioners during eye casualty referrals: why is it lacking and how do we improve it? Osama Giasin, Elizabeth Goodchild, Ruth Jones, Eulee Seow, Damien Chia Ming Yeo Royal Glamorgan Hospital 45. Refractive outcomes of cataract extraction in patients having undergone previous refractive surgery: Which formula is best? Chris Matthews, Alan Connor James Cook University Hospital 46. Adherence to angle closure guidelines. Yun Wong, Scott Fraser Sunderland Eye Infirmary 58. Time from cataract surgery to Nd:YAG capsulotomy at University Hospitals Birmingham (UHB) NHS Foundation Trust Hannah Shereef, Haider Ibrahim, Mike Burdon University Hospitals Birmingham NHS Foundation Trust 47. Early experiences with dexamethasone intravitreal implant ( Ozurdex) for retinal vein occlusion: an audit and service evaluation Weijen Tan, Kerolos Bassilious, Dharmalingam Kumudhan, Winfried Amoaku Queen’s Medical Centre, Nottingham 59. Health Informatics in Ophthalmology – The Past, Present and Future Abison Logeswaran, Thuwaraga Logeswaran, Yu Jeat Chong, Yogesan Kanagasingam Imperial and City University 48. One Stop Temporal Artery Biopsy Service Karim El-Assal, Sachin Salvi, Judith West, Jennifer Tan, Irene Pepper, Zanna Currie Sheffield Teaching Hospital 60. Review of Glaucoma Domiciliary Service at Devon. Usama Faridi, Naeem Gurmani, Jim Faverty, Michael Smith, Daniel Byles Royal Devon and Exeter Hospital 49. An audit to evaluate the efficacy of Selective Laser Trabeculoplasty (SLT) as adjunctive therapy for Primary Open-Angle Glaucoma patients at a district general hospital. Rahul Dwivedi, Janine Brazier, Jose Gonzalez-Martin Southport & Ormskirk Hospital NHS Trust 61. Public knowledge of common eye disease Priyanka Mandal, Anuj Vakharia, Oluwatoyin Oyede, Philip I Murray Birmingham and Midland Eye Centre 50. Audit of Eye Casualty neuro-ophthalmology referral system at Bristol Eye Hospital Martin Bennett, Bristol Eye Hospital 62. Appropriateness of referrals into an optometrist led rapid access wet age related macular degeneration clinic. Deborah Bott, Narendra Dhingra Mid Yorkshire NHS Trust 51. Can general A&E doctors manage common eye emergencies? Michael Benjamin, Oluwatoyin Oyede, Philip I Murray Birmingham and Midland Eye Centre 52. Validity of listing for cataract surgery by hospital-based optometrists. Pallavi Tyagi, Simon Hewick Raigmore Hospital, Inverness. 63. An evaluation of the usage of Medisoft Electronic Patient Record system in Birmingham and Midland Eye Centre Lauren Atkins, Sarah Burgin, George Moussa Birmingham and Midland Eye Centre, City Hospital 26 POSTERS: Annual Congress Final Programme & Abstracts Birmingham 2014 Cataract & Refractive Surgery / Cornea & External Eye Disease All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. CATARACT & REFRACTIVE SURGERY CORNEA & EXTERNAL EYE DISEASE 64. The Development of a Virtual Reality Training Programme for Ophthalmology: Repeatability and Reproducibility Korina Theodoraki, George M Saleh, Stewart Gillan, Paul Sullivan, Fiona O’Sullivan, Bardul Hussain Moorfields Eye Hospital 75. Systemic immunosuppression in patients with refractive chronic allergic eye diseases Muhammad Ahad, Kieren Darcy, Phillip Jaycock, Stuart Cook, Derek Tole Bristol Eye Hospital 76. Acanthamoeba Keratitis: Experience at Bristol Eye Hospital 2003-2012 Haned Jasim, Derek Tole, Stuart Cook Bristol Eye Hospital 65. Patient Reported Outcome Measuring Tools in Cataract Surgery – Clinical Comparison in a Teriary Hospital Simon Fung, Peter Holm, Melanie Hingorani, Joanne Hancox Moorfields Eye Hospital 77. Hypertonic Ointment vs lubricants and bandage contact lenses for recurrent corneal erosion syndrome (RCES) Sally Blackmore-Wright, Radwan Al Mousa University Hospital Coventry and Warwickshire 66. Experience with Femtosecond Laser Cataract Surgery: A prospective review Edward Ridyard, Ritesh Gupta, Raymond Stein Bochner Eye Institute, Toronto 78. Day-before vs same-day Eye Bank provided precut tissue for DSAEK. A prospective single blinded randomised study of outcomes in a UK tertiary referral centre Evripidis Sykakis, Panagiotis Georgoudis, Fook Chang Lam, Saj Khan, Samer Hamadam Damien Lake Corneoplastic Unit and Eye Bank, Queen Victoria Hospital 67. Effect of Speed of Intravitreal Antibiotic Administration on the Outcome of Post-operative Endophthalmitis Anna Gao, Anjali Gupta, Salman Mirza Birmingham and Midland Eye Centre 68. Is second-eye cataract surgery in the NHS cost effective? Systematic reviews and economic evaluation Geoff Frampton, Petra Harris, Keith Cooper, Andrew Lotery, Jonathan Shepherd Southampton Health Technology Assessments Centre (SHTAC) 79. Corneal collagen cross-linking (C3R) with a mechanical disruption of epithelium technique for paediatric keratoconus Fook Chang Lam, Nashila Hirji, Robert Petrarca, Panagiotis Georgoudis, Damien Lake, Samer Hamada Queen Victoria Hospital 69. Artificial Iris Implants for Aniridia: Does Near Infra-Red Light Transmission Risk Retinal Phototoxicity? Imran Yusuf, Tim H M Fung, Stuart N Peirson, C K Patel Nuffield Laboratory of Ophthalmology, Oxford Univeristy 80. Cellulose spears to dry donor corneal tissue in the preparation of Ultrathin endolthelial Keratoplasty: correlation between duration of drying and residual corneal thickness Aravind Reddy, Vikas Shankar Aberdeen Royal Infirmary 70. Rotational stability of a hydrophilic toric lens implant over 2 years Ashokkumar Vyas Scarborough Hospital 81. Service Evaluation of Paediatric Cross-linking for keratoconus at Moorfields Eye Hospital Alastair Porteous, Tom Flynn, Stephen Tuft Moorfields Eye Hospital 71. Is Optical Biometry sufficient to estimate Toric IOL parameters to correct co-existing corneal astigmatism during cataract surgery? Constance Jong, Vikas Shankar, Aravind Reddy Aberdeen Royal Infirmary 82. Ultrathin (UT) DSAEK: a novel Non-double-pass technique Vikas Shankar, Paul Chua, Avarind Reddy Aberdeen Royal Infirmary 83. Five novel mutations in the CHRDL1 gene associated with X-linked Megalocornea Halah Ali, Alice E Davidson, Sek-Shir Cheong, Jens M Hertz, Jonathan B Ruddle, Stephen J Tuft, Alison J Hardcastle Institute of Ophthalmology & Moorfields Eye Hospital 72. Toric lenses in pathological corneal astigmatism Sarah Chaney, David Frazer Royal Victoria Hospital 73. Spectacle Independence and Vision-Related Quality of Life in Cataract Surgery Patients Following Implantation of the ReSTOR® Multifocal Intraocular Lens Sunil Shah, Christopher Brittain Birmingham and Midland Eye Centre 84. Deep Anterior Lamellar Keratoplasty (DALK) versus Penetrating keratoplasty (PK) for keratoconus: a systematic review Christin Henein, Mayank Nanavaty Sussex Eye Hospital CORNEA & EXTERNAL EYE DISEASE 85. Safe use and care of contact lenses by young adults Evgenia Kanonidou, Vasileios Konidaris, Christina Kanonidou, Leonidas Papazisis Department of Ophthalmology, General Hospital of Veria, GR 74. Rapid corneal cross-linking (CXL) for progressive ectasia Dan Gore, Nick Kopsachilis, Bruce Allan, External Disease Service Consultants Moorfields Eye Hospital 27 Annual Congress Final Programme & Abstracts Birmingham 2014 POSTERS: Glaucoma All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. GLAUCOMA 86. Clinical features of fast and slow progressors in the glaucoma service: Analysis of The Portsmouth Visual Fields database. Sameer Trikha, Hannaa Bobat, Clive Osmond, James Kirwan Queen Alexandra Hospital Portsmouth 99. Analysis of glaucoma referral and discharge pathways in Scotland and the need for new SIGN glaucoma referral guidelines Andreas Syrogiannis, Donald Montgomery, Jennifer Burr, Roshini Sanders NHS FIFE 87. Supramid Management after Baerveldt Tube Implantation – an Audit Jayesh Khistria, Pavi Agrawal, Gus Gazzard Moorfields Eye Hospital 100. Glaucoma treatment compliance at a UK General Practice Meena Arunakirinathan, Mital Shah, Chrystal Dooley, Asifa Shaikh Buckinghamshire Healthcare NHS Trust 88. Normal tension glaucoma or hyperlipidemia related angiopathy Souhad Lawand, Heba Eyadat Al-Sharq Hospital 101. Managing Capacity in the Ophthalmology Department – Options review Anju Kadyan, Anna Gao, Shampa Gupta Shrewsbury and Telford Hospital NHS Trust 89. Laser suture stretch for post trabeculectomy bleb management Rohit Saxena, Marta Hovan, Stephen Vernon Nottingham University Hospital 102. A comparative study of glaucoma drainage implant (GDI) surgery in children and adults at a tertiary referral centre Achilleas Mandalos, Michael Lai, Velota Sung Birmingham and Midland Eye Centre 90. Virtual Glaucoma Clinics: Patient Acceptability And Quality of Patient Education Compared to Standard Clinics. Jennifer Court, Michael Austin Singleton and Neath Port Talbot Hospitals 103. Patient orientated outcomes for selective laser trabeculoplasty. Marina Hopes, Chrysostomos Dimitriou, Nuwan Niyadurupola, David Broadway, Tom Eke Norfolk and Norwich University Hospital 91. The interobserver reliability of Van Herick measurement. Ahmed Javed, Mark Batterbury, Stephen Kaye Royal Liverpool Hospital 104. Ghrelin and Hepcidin Prohormone Levels in Patients with Primary Open-Angle Glaucoma Asaad Ghanem Masnoura Ophthalmic Center 92. Phacoemulsification with endocyclodiode laser to aid glaucoma management Line Langsaeter, Pieter Gouws, Ali Hassan East Sussex Hospital Trust 105. Outcomes of glaucoma referrals from diabetic retinopathy screening service Robert Cann, Pavi Agrawal, Gus Gazzard Moorfields South, St.George’s Hospital 93. Developing predictive model and potential biomarkers for primary open-angle glaucoma using metabolomics approach Zakaria Bannur, Lay Kek Teh, Mohd Zaki Salleh, MI Ismail, Jonathan Crowston, Sushil Vasudevan Universiti Teknologi MARA UiTm 106. Current prescribing trends in a tertiary glaucoma unit. Stephenie Tiew, Manon Owen, Anshoo Choudhary RLUH 94. Absence of OPTN E50K mutation in primary open angle glaucoma and ocular hypertension Soo Park, Yalda Jamshidi, Lik Thai Lim, Daniela Vaideanu, Scott Fraser, Jane Sowden UCL Institute of Child Health 107. Treating Glaucoma: The NOT-so-NICE Guidance Daniel Ackland, Neruban Kumaran, Rashid Zia Williams Harvey Hospital, East Kent 108. Patient Satisfaction with Peninsula Optometry Community Glaucoma Scheme Sarah Levy, Adam Booth Royal Eye Infirmary, Plymouth 95. Squeezing Generic Latanoprost: Are they the same? Umama Mulla, Kelvin Wong, Elizabeth Tanner, David Young, Alan Rotchford Gartnavel General Hospital 109. Brinzolamide 1.0%/Timolo 0.5% versus Dorzolamide 2.0%/Timolol 0.5% in the treatment of open angle glaucoma or ocular hypertension: Prospective randomized patient preference study Sheng Lim, Laura Braithwaite St Thomas’s Hospital 96. Macular Thickness Changes in Glaucoma using Spectralis Ocular Coherence Tomography Tulsi Changulani, Neeta Ray-Chaudhuri Newcastle upon tyne-RVI 97. Glaucoma Patients’ Education Scheme Mital Shah, Deborah Dow, Jane Diggory, Asifa Shaikh Buckinghamshire Healthcare NHS Trust 110. Transscleral Diode Laser Cyclophotocoagulation with patients with moderately good vision. Sharmin Ria, Alaa Attawan, Kais Khalid Scunthorpe General Hospital 98. Improving information-sharing for glaucoma patients who move to another area. Mykolas Pajaujis, Inderraj Hanspal, David Broadway, Nuwan Niyadurupola, Tom Eke Norfolk and Norwich Univeristy Hospital 28 Annual Congress Final Programme & Abstracts Birmingham 2014 POSTERS: Glaucoma / Medical Retina All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. GLAUCOMA MEDICAL RETINA 111. Prostaglandin associated periorbitopathy- case study, pathophysiology and clinical implications Hiten Sheth, Alison Matthews Amersham Hospital 121. Progression of retinal atropy in Stargardt’s Macular Dystrophy estimated from spectral-domain optical coherence tomography measurements of macular volume Rupert Wolfgang Strauss, Beatriz Munoz, Emily Fletcher, Yulia Wolfson, Milena Bittencourt, Hendrik P N Scholl Wilmer Eye Institute, John Hopkins University 112. Pre-natal Diagnosis of Rieger’s Syndrome Based on Symptoms in Pregnancy John-Sebastian Barry, Joseph Abbott Russell’s Hall Hospital, Dudley 122. The cost effectiveness of aflibercept compared to ranibizumab in the management of wet agerelated macular degeneration (wAMD) Jennifer Priaulx, Jacqueline Napier, Gabriela Vega, Matthew Rafford Bayer 113. No small enemy Miriam Lara De La Rosa Mexican Institute of Social Security MEDICAL RETINA 123. A systematic review on the use of Photodynamic Therapy to treat Central serous Chorioretinopathy. Ore-oluwa C Erikitola, Roxanne Nwanobi-Crosby, Sobha Sivaprasad Moorfields Eye Hospital 114. Emotional and Physical Impact of Wet AgeRelated Macular Degeneration (wAMD) on Patient and Caregivers Steve Winyard Royal National Institute of Blind People 124. Visual Outcome in Patients with Uveitis Ahmed Samy, Sue Lightman Oren Tomkins-Netzer, Lazha Talat, Asaf Bar, Simon Taylor, Albert Lula Moorfields Eye Hospital, Royal Surrey County Hospital NHS 115. The use of OCT in Retinal Screening: Results from the Improving Screening for Macular Oedema (ISMO) Study Roly Megaw, Shyamanga Booroah, Keith Goatman, Graham Scotland, Gordon Prescott, Peter Sharp, John Olson University of Aberdeen 125. Real-world outcomes with intra-vitreal afilbercept as initial therapy for neovascular AMD Michael Kaye, Carlo Suter, Helen Davenport, Faruque Ghanchi, Martin Mckibbin Bradford Royal Infirmary 116. Multi-centre, prospective, observational, cohort study to assess the cost-effectiveness of English, Scottish and a hybrid grading schemes for diabetic macular oedema screening: improving screening for macular oedema (ISMO) study Shyamango Borooah, Rolf Megaw, Keith Goatman, Graham Scotland, Gordon Prescott, Peter Sharp, John Olson University of Aberdeen 126. Mean visual gain atrophic retinas after five years of Ranibizumab ‘prn’ treatment in a neovascular Age-related Macular Degeneration (nvAMD) service. Archana Airody, Divya Venugopal, Nicola Topping, Richard Hanson, Gavin Walters, Richard Gale York Teaching Hospitals NHS Foundation Trust 117. AURA Study: Real-World Ultilization of AntiVEGF Therapy for Neovascular (Wet) Age-Related Macular Degeneration (wAMD) in the UK Philip Hykin, Sobha Sivaprasad, Usha Chakravarthy, Andrew Lotery, Martin Mckibbin Moorfields Eye Hospital 127. Ocular side effect of mitogen-activated protein kinase (MEK) inhibtors. Robert M J Purbrick, Wasir Saka, Denis C Talbot, Susan M Downes Oxford Eye Hospital 118. Fluoresence gradient analysis of fluorescein angiograms Nigel Davies Chelsea and Westminster Hospital 128. 6-weekly bevacizumab versus 4-weekly ranibizumab as required treatment for neovascular age-related macular degeneration: a 2-year outcome. Patrick Chiam, Nicholas Hickley, Venkat Kotamarthi Leighton Hospital, Crewe 119. A study of aged GK rats: is tau the missing link between diabetes and Alzhiemer’s Disease? Timothy Wong, Marianne Phllips, Shereen Nizari, M Francesca Cordeiro Institute of Ophthalmology, UCL 129. Aflibercept (Eylea) for Treatment Resistant Neovascular Age-Related Macular Degeneration (nAMD): Early UK Outcomes Tejal Magan, Aman Kirmani, Zine Elhousseini, Matthew Robertson, Samantha Mann St Thomas’ Hospital, London 120. Long-term visual acuity outcome in patients with diabetic macular oedema treated with fluocinolone acetonide Yit Yang, Niro Narendran, Clare Bailey, Andrew Lotery Wolverhampton Eye Infirmary 130. Central serous chorioretinopathy and pigment epithelial detachments associated with a novel MEK inhibitor. Nashila Hirji, Laura Maubon, Vasiliki Michalerea, Udai Banerji, Paul Ursell Sutton Hospital 29 POSTERS: Medical Retina / Neuro-Ophthalmology / Ocular Motility Annual Congress Final Programme & Abstracts Birmingham 2014 All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. MEDICAL RETINA NEURO-OPHTHALMOLOGY 131. Pattern scan laser for proliferative diabetic retinopathy: outcome at 1-2 year follow up Alexander Baneke, Felicity Allen, Todd Williamson, Moin Mohamed, Samantha Mann St Thomas’ Hospital 141. A national epidemiological study of chronic progressive external ophthalmoplegia – molecular genetic features and neurological burden Anna Clements, Victoria Nesbitt, Robert W Taylor, Douglass M Turnbull, Robert Mcfarland, Patrick Yu-Wai-Man Wellcome Trust Centre for Mitchondrial Research, Newcastle 132. Surveillance Clinic for Screen Positive Maculopathy Patients Miranda Buckle, Liam Price, Steve Chave, Kerry Price, Stephen Adlington, Peter H Scanlon Gloucestershire Hospitals NHS Foundation Trust 142. Diabetic retinopathy is associated with oxidative stress and migration of gene expression of antioxidant enzymes Mohamed Fathelbab, Moaz Mojaddidi, Mann AL-Barry, Hesham El-Beshbishy Taibah Univeristy 133. To investigate the impact of diabetic retinopathy of varying severity on sleep. Rupal Morjaria, Iona Alexandrew, Obaid Kousha, Victor Chong, Katharina Wulff, Russell Foster, Susan Downes Oxford Univeristy Hospitals NHS Trust 143. Vascular morphology in patients with optic nerve head drusen and optic disc oedema Anastasia Pilat, Frank Proudlock, Mark Lawden, Irene Gottlob University of Leicester 134. Glycated albumin induces IL-8 and MCP-1 modulation by minocycline in cultured retinal pigment epithelial cells Joanna DaCosta, Sobha Sivaprasad, Selim Cellek Cranfield Univeristy 144. Comparison of electroretinographical responses in albinism, idiopathic infantile nystagmus and healthy controls Zhanhan Tu, Christopher Degg, Viral Sheth, Irene Gottlob, Frank Proudlock University of Leicester 135. A systematic review and meta-analysis comparing intravitreal ranibizumab with bevacizumab for the treatment of choroidal neovascularization secondary to pathologic myopia. Mohamed Loutfi, Muhammad Siddiqui, Abdulbaset Dhedhi, Ahmed Kamal Univeristy of Liverpool 145. Comparative Analysis of the Mollon-Reffin Minimal Colour Vision Test in the visually normal and acquired ocular disease Hetan Ajwani, Carmel P Noonan, Fiona J Rowe University of Liverpool 136. Inter-injector pain scores for intravitreal injections for wet age-realted macular degeneration (AMD): a comparison of Visual Analogue Scale (VAS) and Verbal Reporting Scale (VRS) Divya Venugopal, Samalie Kakaire, Atlaf Waraich, Richard Gale, Richard Hanson York Disctrict Hospital 146. Expert Opinion in the Clinical Investigation of Acquired Isolated Horner Syndrome in the United Kingdom Jasvir Virdee, Susan Mollan, Michael Burdon Queen Elizabeth Hospital, Birmingham 137. Attitudes towards prenatal diagnostic testing for inherited retinal diseases Khuram Ahmed, Mushtaq Ahmed, Barbara Potrata, Hilary Grant, Thomas Willis, Martin Mckibbin Leeds Teaching Hospital NHS Trust 147. Cerebral migration of intraocular silicone oil: A clinical and radiological George Kalantzis, Kevin Falzon, Chin Ong , Dan Warren, Bernard Chang St James University Hospital, Leeds 138. Serpiginous-like choroiditis: as a maker for tuberculosis in a non-endemic area Weh Loong Gan, Nicholas Jones Manchester Royal Eye Hospital OCULAR MOTILITY 148. Unilateral lateral rectus resection: a simple solution to age-related distance esotropia Sohraab Yadav, Jane Young, Claire Voas-Clarke, Ian Marsh, Jon Durnian Royal Liverpool Hospital 139. Intravitreal Triamcinolone for refractory macular oedema following failed anti-VEGF treatment : One year results Peck- Lin Lip, Hema Kolli, Arijit Mitram Samer Elsherbiny, Panagiota Stavrou, Bichitra Das, Bushra Mushtaq The Birmingham & Midland Eye Centre 149. A Modified Model for Strabismus Surgery Simulation Bharat Markandey, John-Sebastian Barry Russell’s Hall Hospital, The Dudley Group NHS Trust 150. Modified Hang-back single Muscle Medical Rectus Recession for Paediatric Estopia Alastair Hardisty, Tin Chan, Claire Duckworth Sheffield Chrildren’s Hospital NEURO-OPHTHALMOLOGY 140. Retinal Ganglion cell neuroprotection and axon regeneration after optic nerve crush induced by siRNA mediated knock-down of RTP801, a negative regulator of mTOR signalling Peter Morgan-Warren, Jenna O’Neill, Martin Berry, Elena Feinstein, Robert Scott, Ann Logan University of Birmingham, UK 151. Medical rectus pulley posterior fixation suture for acquired estropia with high AC/A ratio. Rajnish Sekhri, Pouya Alagaband, James Innes, Usman Mahmood Hull and East Yorkshire Eye Hospital 30 POSTERS: Orbit & Oculoplastics / Miscellaneous Annual Congress Final Programme & Abstracts Birmingham 2014 All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. ORBIT & OCULOPLASTICS MISCELLANEOUS 152. Orbital Cellulitis in Scotland; epidemiology, aetiology, treatment and outcome: Scottish Ophthalmic Surveillance Unit Study Claire Murphy, Helen Murgatroyd, Caroline MacEwen, Iain Liveringstone, Barny Foot Ninewells Hospital Dundee 163. Ophthalmic Involvement in Midfacial trauma: Our experience in Glasgow Sonali Tarafdar, Iain Livingstone, Mamun Rahman, Clifford Weir Tennent Institute of Ophthalmology 164. Current Utilisation of electronic medical records in ophthalmic research Victoria Nowak, Zahra Kadom, Patricia Svrckova, K Y Ronald Kam Imperial College London 153. Guidance to locate sutures lost during ophthalmic surgery. Damien C M Yeo, Tafadzwa Young-Zvandasara, Garry Shuttleworth Singleton Hospital, Swansea 165. Ethnicity and education in myopia: the UK Biobank (UKBB) study Yanchan Bao, Phillippa Cumberland, Paul Foster, Peng Tee Khaw, Christopher Hammond, Pirro Hysi, Jugnoo Rahi UCL Institute of Child Health 154. Delayed Skin Graft after Debridement for Surgical Treatment of Periorbital Necrotising Fasciitis Mark Sigona, Michael Mckenna, Partha Chakraborty County Durham and Darlington NHS Foundation Trust 155. Slit Lamp Dermatoscopy James Mchugh, Juliana Helou, Chris Mclean The Royal Surrey County Hospital Guildford 166. Comparison of two prognostic models for penetrating eye injuries in district general hospitals Luke Nicholson, Damien Yeo, Rupinder Chana, Ruth Jones, Julia Escardo-Paton, Osama, Giasin, Elizabeth Goodchild Royal Gwent Hospital, Newport MISCELLANEOUS 156. Choroidal biopsy in the management of patients with choroidal metastasis Heinrich Heimann, Lazaros Konstantinidis, Sarah Coupland, Bertil Damato Royal Liverpool University Hospital 167. UK and US contrasted: A qualitative study of post-graduate training and clinical governance in ophthalmology using ethnological techniques Monica Michelotti, Andrew Davies, Jennifer Weizer, Declan Flanagan, Shahzad Mian, Paul Lee, Simon Kelly Univeristy of Michigan, Moorfields, Royal Bolton Hospital 157. Anxiety, depression and somatisation in attendees at ophthalmic A&E Adnaan Haq, Radon Reynolds, Zakariya Jarar Moorfields Eye Hospital 168. Smartphone Tele-Ophthalmology Ryan Davies, Hugh Jewsbury, Kadaba Rajkumar Princess of Wales Hospital, Bridgend 158. Photodynamic therapy as initial treatment for small choroidal melanomas Fidan Jmor, Bertil Damato, Heinrich Heimann Ocular Oncology Centre, Royal Liverpool University Hospital 169. Changing trends in Consultant Appointments Romeela Rana-Rahman, Alan Connor, Hamed Anwar Royal Victoria Infirmary, Newcastle Upon-Tyne 159. Ocular surface squamous neoplasia: Anaylasis of 78 cases from a UK ocular oncology centre Anu Maudgil, Trushar Patel, Paul A Rundle, Ian G Rennie, Hardeep Singh Mudhar Royal Hallamshire Hospital, Sheffield 170. The microbiology of Endophthalmitis: A Four Year Review Sheema Khan, Rosina Zakri, Srinivasulu Reddy, Nishal Patel East Kent Hospitals University NHS Foundation Trust 160. Treatment-seeking Behaviour for Ocular Morbidity (OM) in South-West Cameroon Emma Gees, Gillian Dalgetty, Laura Senyonjo University of Leeds 171. A Training Device for YAG Laser Capsulotomy May Fang, Chris Mclean The Royal Surrey County Hospital NHS Trust 172. Episcleral Tattooing - An Emerging Body Modification Trend James Brodie, Husam El Galhud 161. Association between Depression and Diatetic Retinopathy in sub-Saharan Africa Kirsty Hall, Eugene Sobngwi, Linda Penn Newcastle University 173. Ultraviolet (UV) blocking capability of basic spectacle lenses (CR-39) Rongxuan Lim, Fiammetta Fedele, Parul Patel, Susana Morley St Thomas’ Hospital 162. The Potential for Using Tablet Computers in Clinical Vision Testing; a method for calibrating and validating devices. Fadi Ghazala, Humza Tahir, Ian Murray, Neil Parry, Tariq Aslam Manchester Royal Eye Hospital 31 Annual Congress Final Programme & Abstracts Birmingham 2014 POSTERS: Paediatric Ophthalmology All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. PAEDIATRIC OPHTHALMOLOGY 174. Severe retinopathy of prematurity (ROP) in 23 weeks gestation babies between 2000-2013 in Newcastle David Cottrell, Ayad Shafiq, Alan Fenton Royal Victoria Infirmary, Newcastle 186. A prospective long-term study of the ophthalmic natural history of paediatric craniopharyngioma Evangelos Drimtzias, Kevin Falzon, Irfan Jeeva, Ian Simmons St James’s Univeristy Hospital, Leeds, UK 175. The effect of blood transfusion on fetal haemoglobin concentration in very preterm infants and its association with retinopathy of prematurity Christopher Stucthfield, Anoo Jain, David Odd, Cathy Williams, Richard Markham Bristol NICU and Bristol Hospital 187. Retinopathy of Prematurity in Northern Ireland from 2006-2011 Eibhlin McLoone, Sarah Chamney, Rebecca Rollins, Emma McCall. Adele Marshall, Stan Craig Royal Victoria Hospital 176. The importance of globe size in pharmacological treatment of retinopathy of prematurity Ayad Shafiq, David Cottrell, Alan Connor Royal Victoria Infirmary, Newcastle 188. Rationalising the use of Bacterial Conjunctival Swabs in Alder Hey Children’s NHS Foundation Trust – Review of a Seven Year Period (2006-2013) Neeru Vallabh, Fiona Hardiman, Theresa S Cole, Richard J Drew, William Newman Alder Hey Hospital 177. Objective visual and radiological response of recurrent childhood optic pathway gilmoas to bevacizumab Ian Simmons, Kevin Flazon, Evangelos Drimtzias St James University Hospital, Leeds 189. Incidence and Management of Non Accidental injury in south Yorkshire Ophthalmology units. Mohammed Zayed, Nadeem Ahmad, Alaa Attawan, Jessy Choi Royal Hallamshire Hospital 178. Becacizumab v Diode Laser in Stage 3+ Posterior Retinopathy of Prematurity (ROP) Sarah Moran, Michael O’Keefe, Bernadette Lanigan Childrens Univeristy Hospital Dublin 190. Study of Optical Perimetric Testing in Children (OPTIC) – Normative visual field values in children aged 5-15 years. Dipesh Patel, Bronwen Walters, Phillippa Cumberland, Isabelle Russell-Eggitt, Jugnoo Rahi, On behalf of the OPTIC study group UCL Institute of Child Health 179. Evaluation of ROPBox; a secure software tool for Remote screening of Retinopathy of Prematurity (ROP) Zahir Mirza, Stephanie West, Lucy Barker, Himanshu Patel, Gillians Adams Moorfields Eye Hospital 191. Unintentional Injuries in Visually Impaired Children Jocelyn Cherry, Julie Mytton, Amanda Hall, Cathy Williams University of Bristol 180. Development of infantile nystagmus Maria Theodorou, Richard Clement, David Taylor, Anthony Moore Institute of Child Health 192. The extended role of the Orthopist; increasing the access to Ophthalmology for Paediatric Oncology patients Danielle Guy, Olwyn Nelson, Janice Hoole, Ian Simmons Leeds Teaching Hospitals NHS Trust 181. Congenital Glaucoma in Wagner Syndrome High Jewsbury, Andrew Fry, Patrick Watts, Veronique Nas, James Morgan University Hospital of Wales, Cardiff 182. Management of Congenital Nasolacrimal Duct Obstruction: 15 years experience In the UK Lana Fu, Susmito Biswas, Ian C Lloyd, Anne E Cook, Jane L Ashworth Manchester Royal Eye Hospital 193. Rapid onset of severe ocular injury after exposure to a button battery. Yasir Khan, Sundus Maqsood, S Marpuri, V Geh, G S Bhermi Southend Univesity Hospital 183. Systemic Ciclosporin in the Management of Severe Vernal Keratoconjuncitivitis in Children. Rosalind Stewart, Arvind Chanda, Gavin Cleary, Harish Nayak Alder Hey Children’s Hospital 194. Sight-threatening ocular manifestations of JXG in childhood David Burton, Evangelos Drimtzias, Kavin Falzon, Irfan Jeeva, Ian Simmons St James’s University Hospital, Leeds, UK 184. Proposed algorithms for reducing un-necessary ROP screening. Shah Karim, Himanshu Patel, Helen Lock, Ajay Sinha, Steve Kempley, M Ashwin Reddy Barts and The London NHS Trust 185. Retinal Vessel architecture in retinoblastoma patients pre and post treatment Karen Wong, Aswin Reddy, Mandeep Sagoo, Clare Wilson Royal London Hospital 195. Head Posture and Head Movements in Infantile Nystagmus Vijay Patel, Irene Gottlob, Frank Proudlock University of Leicester Ophthalmology Dept. 32 POSTERS: Uveitis / Vitreo-Retinal Diseases & Surgery Annual Congress Final Programme & Abstracts Birmingham 2014 All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m. UVEITIS VITREO-RETINAL DISEASES & SURGERY 196. The Dublin Uveitis Evaluation Tool (DUET) – an algorithm for earlier diagnosis of spondyloarthropathies by ophthalmologists in acute anterior uveitis. Michael O’Rourke, Muhammad Haroon, Pathma Ramasamy, Oliver FitzGerald, Conor Murphy Royal Victoria Eye and Ear Hospital, Dublin 205. Anatomical and visual outcomes of posterior segment ocular trauma requiring vitreo-retinal surgery Koushik Basu, Yog Raj Sharma, Raj Vardhan Azad, Parijat Chandra, Koushik Tripathy Dr. Rajendra Prasad Centre For ophthalmic Services, India 197. Use of aqueous humour PCR for diagnosis of atypical ocular toxoplasmosis Andre Grixti, Edward Guy, Nicholas Alexander V Beare, Ian Andrew Pearce Royal Liverpool University Hospital 206. Development of the surgical procedure for cell transplantation treatment for age related macular degeneration (AMD) Christopher Jump University of Liverpool 198. Pegylated interferon a2b reduces corticosteroid requirements in patients with Bechet’s syndrome with upregulation of circulating regulatory T cells Sue Lightman, Oren Tomkins, Virginia Calder, Catey Bunce, Hilary Longhurst, Dorian Haskard, Miles Stanford Moorfields Eye Hospital 207. Comparison of efficacy and safety outcomes between EU and US petients in MIVI6/7 studies on ocriplasmin for vitreomacular traction Zachariah Koshy, on behalf of MIVI Trust study Group Multiple 199. Long Term Outcome of Repeat Ozurdex Implantations in Non-Infectious Uveitis Oren Tomkins-Netzer, Simon Taylor, Asaf Bar, Albert Lula, Satish Yaganti, Lazha Talat, Sue Lightman Moorfields Eye Hospital 200. Visual outcome and treatment strategies among patients with ischaemic retinal vasculitis Lazha Talat, Oren Tomkins-Netzer, Simon Taylor, Sue Lightman Moorfields Eye Hospital/UCL Institute of Ophthalmology VITREO-RETINAL DISEASES & SURGERY 201. Ocriplasmin for Pharmacologic Resolution of Vitreomacular Adhesion: Meta-analysis of anatomical and functional Andrew Lotery, Benedicte Lescrauwaet, Kerry Gairy University of Southampton 202. Recovery of visual symptoms following ocriplasmin therapy – further evidence from MIVI trials for ocriplasmin in vitreomacular traction Niro Narendran, Yit Yang, on behalf of the MIVITRUST Study Group International Multi-Site Studies 203. Visual function improvements with resolution of vitreomacular adhension in patients receiving ocriplasmin Tim Jackson, ON behalf of the MIVI-TUST Study Group International multi-center study 204. Measuring Metamorphopsia in Macular Disease Gerry McGowan, Tsveta Ivanova, David Yorston, Niall Strang, Velitchko Manahailov Tennent Institute of Ophthalmology 33 Annual Congress Final Programme & Abstracts Birmingham 2014 DVD EXHIBITION 1. Video of goniotomy, with tips for the assistant that allow better surgical access, and an optimal surgical arc. Gordon Lau, Ayad Shafiq Royal Victoria Infirmary, Newcastle 10. Needling revision of serverely scarred blebs: Description of the technique Rory Nicholson, Charalambos Tossounis, Hannaa Bobat, James Kirwan Queen Alexandra Hospital, Ophthalmology Department 2. TREACHER COLLINS WINNER 2014 Trabeculecomy Bleb Dysaesthesia – Review of how to prevent & how to treat Dan Lindfield, Saurabh Goyal St Thomas’, London 11. A ‘No-speculum’ Technique for Intravitreal Injections Shwan Kadare, Huw Oliphant, Tony Leong Worthing Hospital, West Sussex NHS Trust 12. Removing a dropped IOL and implanting an ARTISAN aphakic lens: The float and suck technique Charalambos Tossounis, Rary Nicholson, Richard Newsom Queen Alexandra Hospital, Ophthalmology Department 3. ‘When it just won’t fit’! Transcameral pull-through suture to enable watertight anterior chamber tube entry Avi Kulkarni, Dan Linfield Kings College Hospital, London 4. IOL haptic exchange through small incision Daniel Dragnev Hywel Dda Health Board 13. Ultrathin (UT) DSAEK: a novell Non-double pass technique Paul Chua, Vikas Shankar, Aravind Reddy Aberdeen Royal Infirmary 5. Iris clip Secondary IOL implantation technique – comparison of needle Vs Vacuum assisted enclavation Hidayat Ullah Bhutto, Siddhartha Goel Diana Princess of Wales Hospital, Grimsby 14. Subjugation of black nucleus by intramural phacoemulsification – a simplified technique Mrinal Rana, Ranjeet Kishore Rana, Kunal Rana, Nidhi Mittal Birmingham and Midland Eye Centre 6. Macular hole eruption during pars plana vitrectomy Paul Rainsbury, Emily Gosse, Jonathan Lochhead St Mary’s Hospital, Isle of Wight 15. Descemet’s stripping endothelial keratoplasty using needle push on Fichman Glide Robert Nadler, Rebecca Davie, Henry Perry, Tom Butler, Allon Barsam Luton & Dunstable University Hospital 7. Capsule supported phacoemulsification in a case of subluxed cataract Siddharth Goel, Hidayat Ullah Bhutto Diana Princess of Wales Hospital, Grimsby 8. Transconjuntival scleral flap overscrew for hypotony following trabeculectomy with mitomycin C – a novel technique Pavi Agrawal, Dilani Siriwardena Moorfields Eye Hospital 9. A Novel Technique in Predicting Efficacy of Lateral Tarsal Strip Huw Oliphant, Ali Hassan, Paul Baddeley Worthing Hospital, West Sussex NHS Trust 34 Annual Congress Final Programme & Abstracts Birmingham 2014 OPTIC UK & EXHIBITION Bayer HealthCare STAND N Bayer HealthCare is committed to the global community of patients with ophthalmic disorders. Please come and visit the Bayer Healthcare stand to find out more about our Ophthalmology portfolio. OPTIC UK Annual Congress Commercial Exhibition The UK’s largest ophthalmic exhibition will be open throughout the Congress. The exhibition is organised by Optic UK as part of their continuing support to the ophthalmic profession. Bausch & Lomb STAND A Bausch + Lomb is one of the best known and most respected healthcare brands in the world. Visit our stand to see the latest developments on the Stellaris PC platform Exhibition opening hours: Tuesday 20th May 2014 8.00 a.m. to 7.00 p.m. the Exhibition will be open during the drinks reception Wednesday 21st May 2014 8.00 a.m. to 5.30 p.m. Thursday 22nd May 2014 8.00 a.m. to 3.00 p.m. Beaver-Visitec International Inc STAND Z Beaver-Visitec International offers a broad range of high-quality precise products for ophthalmic and speciality microsurgical procedures: Beaver® Knives and Blades; Visitec® Cannulae, Instruments and Accessories; Merocel®, Keracel® and Weck-Cel® Fluid Control Products; Wet-Field® and Eraser® Electrosurgical Devices; OcuSeal® Liquid Ocular Bandage; MultiVisc™, Visc™ and Aqueo Premium™ Surgical Solutions CustomEyes® Procedure Packs. The Optic UK Lecture 2014 The sixth Optic UK Lecture will take place on Thursday 22nd May 2014. We are delighted that the eminent and world-renowned speaker Professor Neil Miller will be delivering this year’s lecture. Please see page 23 for more details on Professor Miller. BiB Ophthalmic Instruments EXHIBITING COMPANIES Blink Medical STAND V Blink Medical are attending the RCO for the first time this year and are proud to be showing their range of high quality disposable instruments and customised packs for cataract, VR, Oculoplastic and IVT procedures. Alcon Eyecare UK Ltd STAND X & H/I We would be delighted to welcome you to our stands X or H/I which feature both new and world leading products in the pharmaceutical and surgical markets. Alimera Sciences STAND D & 12 Alimera Science’s ILUVIEN® (fluocinolone acetonide 190µg, intravitreal implant) is indicated for the treatment of vision impairment associated with chronic diabetic macular oedema (DMO), considered insufficiently responsive to available therapies. ILUVIEN received NICE guidance TA301, December 2013. Allergan Ltd. STAND C Altacor STAND 7 STAND 35 Butterflies Healthcare STAND 37 Carl Zeiss Ltd STAND K ZEISS offer the complete solution for the diagnosis, treatment and management of Cataract, Refractive, Retina and Glaucoma patients. ZEISS will be showcasing an extensive product range including the new Cataract Suite Markerless, CIRRUS OCT Family and FORUM® data management. Carleton STAND E Lasers from Iridex, fundus cameras, OCT from Canon, operating microscopes, slit lamp workstations, patient chairs from Takagi Seiko, quality hand held instruments & indirects from Heine and revolutionary single use lenses from Sensor Medical Altomed Ltd STAND G As well as displaying new products such as the Sterimedix ‘2.2’ Coaxial Handpieces, MST Iris Hooks, and the new Wide Angle Viewing System from Insight USA, Altomed have dedicated a large portion of their stand this year to seating and tables, where you can bring your refreshments and relax in comfort with your colleagues. D.O.R.C. Limited STAND 26 EVA® Phaco/Vitrectomy System· CryoStar®.LEDstar.Ultra Speed Transformer.20-23-2527GTransconjunctival System Disposables Forceps & Scissors.Backflush Instruments. Vitrectomy Lenses. Glaucolight Liquids:. VisionBlue®,MembraneBlue-Dual®, LM-Blue®. EFTIAR® / SIL-1000/5000 Amo United Kingdom Limited STAND P We offer market leading technologies for myopia, hyperopia, astigmatism, presbyopia, cataract, spherical aberration and corneal health with proven educational and support programmes that help eye care professionals master refractive technologies and grow their practices. Eye News STAND 14 Launched in 1994, Eye News will be 21 next issue. Look out from contributions from all of our previous editors. Pick up a complimentary copy of the April/May issue from Stand 14 35 Annual Congress Final Programme & Abstracts Birmingham 2014 EXHIBITION Litechnica STAND J Visit stand J, where we will be exhibiting our latest range of laser systems and bespoke video solutions. With over 37 years in the industry, Litechnica are renowned for the highest level of service and aftercare. Grafton Optical STAND 19 On show will be the new ‘Avanti’ OCT from Optovue. 70,000 Scan Rate producing superb HD Images.The new Grafton Combo 1000 Chair/Stand Unit allows easy wheelchair access. Plus Reichert, CSO, DGH, Optronics and Visionix products Haag-Streit GB Ltd STAND B Visit Haag-Streit UK on Stand B to see our comprehensive ophthalmic portfolio, including the; LENSTAR biometer, MAIA microperimeter, Octopus perimeter and the latest in slit lamp imaging. MacuVision Europe Ltd STAND 31 MacuVision, the makers of MacuShield, specialise in products specifically for macular health. MacuVision are the UK’s leading eyecare supplement manufacturer. MacuVision supports world class research and are proud to “Trust the Science”. Heidelberg Engineering STAND R Heidelberg will present Glaucoma Premium Edition for SPECTRALIS, which provides objective analysis of ONL, RNFL and Posterior Pole Asymmetry. The minimum rim width is used to enhance clinical disc examination Instinctive Ltd Mainline Instruments Ltd STAND 1 Mainline Instruments will be exhibiting the reliable and accurate icare tonometer range as well as a selection of Tomey instrumentation such as topographers and A-scans. As key distributors of Keeler, a full range of equipment will be on display. STAND 16 John Weiss and Son Ltd. STAND 32/33 We will be presenting the Weiss surgical instrument range and featuring the latest DSAEK advances with the Tan EndoGlide and CamFlow, Keraring products for Keratoconus, together with the MedOne products for VR surgery. Malosa Medical STAND F Malosa Medical are the Specialists in Single-Use. Our innovative range of single-use instruments and procedure packs for every ophthalmic procedure are your guarantee of precision and safety, every time. Keeler Ltd. STAND T Keeler will be delighted to launch at the Royal College of Ophthalmologists it’s new range of Symphony K and Q Series Slit Lamps. In addition, we shall also be showing our new D-Kat Tonometer and our leading range of Indirect Ophthalmoscopes. Volk Lenses will also be available to purchase on the stand. Kestrel Ophthalmics Medisoft Limited STAND 8 Visit our stand to see how exciting new developments to Medisoft’s ophthalmology clinical system will help you increase capacity and improve service quality M.I.S.S Ophthalmics Ltd. STAND 11 Specialising in Vitreoretinal and Cataract Surgery, Distributing for Synergetics Inc, MidLabs Inc, Alchimia srl, Kirwan Surgical Inc, Surgistar Inc, Eagle Labs Inc. STAND O Kowa Optimed STAND 15 Kowa Optimed will exhibit the WX3d Retinal camera, providing Gold Standard glaucoma screening; the new AP7000 perimeter, providing automated static and kinetic perimetry; and the NDESP approved Non-myd7 retinal camera. Moorfields Pharmaceuticals STAND L Moorfields Pharmaceuticals is the manufacturing arm of the world famous Moorfields Eye Hospital NHS Foundation Trust. Leica Microsystems STAND 18 Leica Microsystems focus is to partner and support micro-surgeons and their care of patients with the highest quality, most innovative surgical microscope technology available. Visit stand No. 18 or www.leica-microsystems.com. We produce the widest range of ophthalmic specials in the U.K. and have a growing range of licensed products. Lenstec STAND 23/24 Lenstec; a manufacturer and supplier of intraocular lenses has a solid reputation in innovation and lens accuracy, with over 20 years’ experience in the industry. Premium refractive and standard monofocal lenses, viscoelastic products and disposable knives complete the portfolio of surgical solutions from Lenstec. Nature Publishing STAND 43 Novartis Pharmaceuticals Ltd STAND W Novartis is one of the world's leading pharmaceutical companies and works to discover, develop and deliver new and innovative products to treat patients, ease suffering and enhance quality of life. 36 Annual Congress Final Programme & Abstracts Birmingham 2014 EXHIBITION OpenEyes STAND 36 OpenEyes is an Electronic Patient Records (EPR) system for Ophthalmology. It has been developed 'by clinicians for clinicians' using open source software, giving a significantly lower cost of ownership by negating licence fees. OpenEyes promotes safety and efficiency by collating all ophthalmological and clinical data into a single, intuitive interface which includes the inbuilt fast, descriptive drawing tool, 'EyeDraw'. OpenEyes integrates easily with existing systems and can be deployed in a range of settings, from small ophthalmic units to specialist hospitals in the UK and abroad. OpenEyes is governed by the OpenEyes Foundation, a not-for-profit charity. Spectrum Thea STAND S & 40 Spectrum Thea Pharmaceuticals will be focusing on Innovative Preservative-Free Glaucoma products (Monopost® and Tiopex®) and Surgical Pharmaceuticals (Aprokam® and Mydriasert®) and launching the UK’s most economical preservative-free dexamethasone eye drops – Dexafree®.’ Oraya Therapeutics Inc STAND 41/42 Oraya Therapy™ Stereotactic X-ray treatment for wet AMD has been shown to reduce the number of antiVEGF injections required to treat wet AMD while improving or maintaining vision. Intended as a onetime treatment, it is a non-invasive, simple outpatient procedure. TearLab Corporation STAND 44 The TearLab Osmolarity System is the first objective and quantitative test for diagnosing and managing Dry Eye patients. It produces fast and accurate results in seconds using only 50 nanoliters (nL) of tears. Stat One Services STAND 3 Enjoy the latest VRmagic EYEsi Simulators, try the ground-breaking LKC handheld Diabetic Retinopathy Screener and see the latest Oculus BIOM innovations. TearScience STAND 17 TearScience® has pioneered devices that provide significant clinical improvement in treating Meibomian Gland Dysfunction (MGD). The TearScience® Dry Eye Solution, which includes the LipiView®and LipiFlow® devices, provides eye care professionals with a complete dry eye clinical and business franchise. Rayner Intraocular Lenses Ltd STAND U Rayner is a manufacturer of intraocular lenses and proprietary injection devices for use in cataract surgery. Rayner is also the exclusive distributor of all Geuder products in England, Scotland and Wales. Scope Ophthalmics STAND 30 The Royal College of Ophthalmologists STAND 38 Second Sight Medical Products STAND 34 Argus II Retinal Prosthesis System, intended to provide electrical stimulation of the retina to elicit visual perception in blind subjects with severe to profound Retinal Pigmentosa. Topcon GB Ltd. STAND M Topcon’s wide product portfolio of optometric and ophthalmic equipment is used and trusted in practices, clinics and hospitals across the UK. Our leading edge instruments are supported by a knowledgeable sales team and an experienced technical support department. Sigmacon UK Ltd. STAND Y Sigmacon are an independent company with a comprehensive range of ophthalmic lasers for glaucoma, retina and anterior chamber - including YAG, YAG SLT, 532nm green multispot and 577nm yellow micropulse/multisport lasers Vision Matrix STAND 2 FineVision /FineVision Toric Trifocal, Bi-FlexMY Bifocal, Micro-Incision Toric Acrylic Lenses, PreLoaded Hydrophobic And Hydrophilic Acrylic Lenses, Healaflow Glaucoma Implant, JetRing PreLoaded Tension Rings, Viscoelastics. Spectrum STAND Q Spectrum located at Stand Q will be displaying innovative products for surgical, diagnostic and refractive specialities. Including the iStent, the latest in pre-loaded small incision intraocular lens technology from HOYA, Ophthalmic Blades and instruments, Phacoemulsification and Vitrectomy systems. Spectrum the UK distributor for Nidek and Oculus diagnostic systems into ophthalmology will have some of this range along with the RetCam, Quantel Ultrasound, ECP and the latest Merge image management solutions. Wisepress STAND WP Europe’s leading conference bookseller, has a complete range of books and journals which can be purchased at the stand or posted worldwide. Please also visit our online medical bookshop. 37 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire 1. SOE PRIZE WINNER 2014 Intravitreal Aflibercept for Diabetic Macular Edema: 1-Year Findings from the VIVID-DME and VISTA-DME Trials Edoardo Midena University of Padova Introduction: Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetic retinopathy. Purpose: To evaluate the efficacy and safety of intravitreal aflibercept (IVT-AFL) compared with macular laser photocoagulation in patients with DME. Method: Two randomised, multicentre, double-masked trials in patients with clinically significant DME with central involvement. Patients were randomised 1:1:1 to IVT-AFL 2 mg every 4 weeks (2q4) plus sham laser, IVT-AFL 2 mg every 8 weeks (2q8) (after 5 initial monthly doses) plus sham laser, or laser photocoagulation plus sham IVT treatment. The primary endpoint was the mean change in best-corrected visual acuity (BCVA) at Week 52. Results: 865 patients (VIVID-DME [n=404]; VISTA-DME [n=461]) were randomized and received study medication. Both doses of IVT-AFL were statistically superior to laser treatment for the mean change in BCVA at Week 52 with improvements ranging between 10.5–12.5 letters (vs 0.2–1.2 letters for laser; P<0.0001). The 2q8 regimen demonstrated similar efficacy to 2q4 with fewer injections required. Significantly more patients demonstrated a ≥2-step improvement in the diabetic retinopathy severity score with IVT-AFL (both 2q4 and 2q8) vs laser. Overall, IVT-AFL was generally well tolerated with no differences (vs laser) in the overall incidence of adverse events (AEs)/serious AEs. Conclusion: IVT-AFL was shown to be an effective and well-tolerated treatment for DME, with significant effects on visual and anatomic outcomes. Use of a 2q8 regimen appears to decrease the injection-related burden on patients, caregivers, physicians, and overall healthcare systems. 2. Ranibizumab treatment of diabetic macular oedema with bimonthly monitoring after a phase of initial treatment: 18-month outcomes of the Phase IIIb multicentre RELIGHT study Ian Pearce, It was a multicenter study Introduction: Ranibizumab 0.5 mg is licensed for visual impairment due to diabetic macular oedema (VIDMO) using a pro-re-nata dosing regimen addressing individual patient needs with reduced treatment burden; however, it requires monthly monitoring and retreatment primarily based on visual acuity (VA). Purpose: RELIGHT investigates the impact of bimonthly follow-up and individualised retreatment, after a monthly follow-up for 6 months (M) on maintaining improvements in best-corrected visual acuity (BCVA). Method: RELIGHT was an 18M, prospective, open-label, multicentre, single-arm, Phase IIIb, UK study. Patients received three initial monthly ranibizumab injections (Day0-M2), followed by individualised VA- and optical coherence tomography (OCT)-guided retreatment with monthly (M3-M5), and subsequent bi-monthly followup (M6-M18). Key outcome measures: mean change in BCVA from baseline-M12 (primary), mean change in BCVA and central retinal thickness (CRT) from baseline-M18, safety over 18M. Results: 99 (90.8%) of 109 enrolled patients completed the study, with a mean duration of DMO of 40 months (compared with 20 months in RESTORE). Mean change in BCVA improved from +4.9 letters (M12) to +6.5 letters (M18) with a mean of 6.8 and 8.5 injections respectively. CRT decreased from −127μm (M12) to −150μm (M18). No new safety findings were reported. Conclusion: Initial VA gains were maintained with a bimonthly monitoring regimen over 12 months, offering a lower intensity regimen as a strategy for the longer term management of some patients with VI-DMO. 3. Translational bypass therapy using ataluren to treat nonsense-mediated choroideremia Mariya Moosajee, Dhani Tracey-White, Clare Futter , Tony Moore, Andrew Webster, Miguel Seabra UCL Institute of Ophthalmology Introduction: Choroideremia (incidence 1:50,000) is an X-linked recessive disorder characterised by a progressive chorioretinal dystrophy. Ataluren is a small molecule drug, which suppresses disease-causing nonsense mutations and partially restores functional protein. Over one-third of choroideremia patients harbour nonsense mutations in the CHM gene, hence translational bypass therapy may be a viable treatment option. The choroideremia zebrafish (chm-/-) is the only animal model with a nonsense mutation in the chm gene and displays similar ocular phenotype to patients. 38 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire Purpose: To identify an effective treatment for choroideremia. Method: Mutant chm-/- embryos were treated with 10 μM ataluren from 10 hours post-fertilization. The chm mutation causes embryonic lethality (mean survival 4.8 ± 1.0 days); survival was determined following ataluren treatment (n=63). Retinal ultrastructure was examined using electron microscopy at day 6 and 10. Levels of oxidative stress and apoptosis in the retina were measured using dihydroethidium staining and TUNEL assays, respectively. Functional rep1 protein was detected by Western blot analysis and in vitro prenylation assays. Results: Ataluren-treated chm-/- embryos lived 2.0 fold longer (mean survival 10.1 ± 1.6 days); p<0.0001. There was significant rescue of retinal degeneration at day 6 and 10, with reduced levels of apoptotic cell death and oxidative stress in treated chm-/- embryos. Western blot detected rep1 protein in treated chm-/samples with active prenylation function. Conclusion: This study provides ‘proof-of-concept’ for using ataluren as translational bypass therapy for treating nonsense-mediated choroideremia and may be applicable to other inherited eye disorders with a similar genetic aetiology. 4. Metabolomic Analysis of Serum in Graves’ Disease and Thyroid-Associated Ophthalmopathy: A Diagnostic Tool? Matthew R Edmunds, Kristien Boelaert, Jayne A Franklyn , S John Curnow, Omar M Durrani, Stephen P Young University of Birmingham, UK Introduction: Although 30-50% of those with Graves’ Disease (GD) develop Thyroid-Associated Ophthalmopathy (TAO) it is not yet possible to predict which will be affected, nor which will be in the 3-5% developing sight-threatening manifestations. It is known that distinct pathologies result in specific metabolic derangements. Metabolomics, the analysis of metabolite profiles in tissues or biofluids, has been shown to have the potential to derive a “metabolic fingerprint” with biomarker potential for a range of conditions (e.g. diabetes mellitus, rheumatoid arthritis, multiple sclerosis). Purpose: To assess metabolomic profiling as a novel means of differentiating a large cohort of GD, TAO and healthy control (HC) subjects, while also investigating underlying pathological processes. Method: Nuclear magnetic resonance spectra of the serum of 110 TAO (20 clinically active, 90 quiescent), 67 GD and 78 age- and sex-matched HC were acquired. Thyroid autoantibody status and PTPN22 GD susceptibility genotype were established. Data were subject to principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). Correlation between metabolite profiles, GD and TAO diagnostic criteria, PTPN22 genotype and thyroid autoantibody status were assessed. Results: Metabolomic analysis of serum was able to segregate TAO subjects from those with GD and HC. It was also possible to discriminate those with active and inactive TAO as well as severe and mild TAO. There was also good segregation of subjects by thyroid autoantibody status and PTPN22 genotype. Conclusion: Metabolomics offers the possibility of discriminating GD and TAO patients of different activity and severity and may represent a useful diagnostic, prognostic and monitoring tool in these conditions. 5. The effects of anti-VEGFS on human tenon’s fibroblast growth in vitro Nurul Nabila Baharudin, Siti Munirah Mohd Noh, Siti Hamimah Sheikh Abdul Kader, Jonathan Crowston, Zakaria Bannur, Sushil Kumar Vasudevan IMMB,UITM Introduction: Anti-VEGF agents have received recent interest because they could be potentially used as antifibrotic agents in concurrent with trabeculectomy surgery. Recent preliminary cohort studies have pointed that there is some improvement of the bleb morphology following trabeculectomy with ranibizumab and bevacizumab. The effects of these humanized monoclonal antibodies on human Tenon’s fibroblasts (HTF) as well as the effector cells of post trabeculectomy scar formation however, are not known. Purpose: This study was conducted to determine the effectiveness of ranibizumab and bevacizumab on HTF. Method: The effects of ranibizumab and bevacizumab on HTF proliferation and cell viability were determined by using MTT-based assay (3-(4, 5-dimethylthiazone-2-yl)-2, 5-diphenyl tetrazolium). Ranibizumab and bevacizumab at concentrations ranging from 0.01 to 0.5 mg/mL and 0.25 to 12.5 mg/mL respectively were administered for 24, 48, and 72 hours in serum and serum free conditions. Supernatants from the treated and untreated control cultures were also assessed for fibrosis-related protein using ELISA. Results: Ranibizumab and bevacizumab at 0.5 mg/mL and 12.5 mg/mL concentrations induced significant cell death after 48-hours under serum-free culture condition. No significant increases in the caspase 3 were seen in 39 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire those cultures treated with ranibizumab. However, its level was significantly elevated in bevacizumab treated group compared to the control monolayers. Conclusion: Ranibizumab and bevacizumab at 0.5mg/mL and 12.5mg/ml induces significant reduction in cultured HTF and this occurred in a dose-dependent manner. A significant impact on caspase 3 level was observed only with bevacizumab treatment but not by ranibizumab. Further studies are underway to determine the mechanism of cell death. 6. A case for re-defining the intraocular pressure referral threshold: Findings from the UK Biobank Michelle Chan , Carlota Grossi Sampedro, Stephen Vernon , James Morgan , Praveen Patel , Peng Khaw, Paul Foster Moorfields Eye Hospital Foundation Trust Introduction: UK optometrists were advised to refer anyone with intraocular pressure (IOP) >21mmHg to exclude glaucoma, even without additional risk factors. This sharply increased hospital referrals without improving the diagnostic yield. The value of 21mmHg (two standard deviations above the population’s mean IOP) was derived from a 1960s population survey using Goldmann applanation tonometry, but most optometrists base their referrals on non-contact tonometry, which raises the question whether >21mmHg is relevant to current referral practice. The UK Biobank is the largest ophthalmic cohort study in the UK, and presents a unique opportunity to examine the IOP distribution in a UK population. Purpose: To describe the age-specific IOP distribution by non-contact tonometry in the UK Biobank cohort, and to estimate the impact of varying the IOP threshold on referable numbers. Method: A single IOP measurement was taken on each eye using the Ocular Response Analyser, a non-contact tonometer (NCT). Goldmann-correlated IOP (IOPg) in the left eye was used in all analyses. Results: IOPg data were available for 65,026 participants (mean age 57.4 years, range 40.0-72.0 years; 54.3% women). Mean IOPg was 15.7mmHg (SD 4.0mmHg, 95% CI 15.6-15.7mmHg). The age-specific mean IOP+2SD for men varies between 23.3-24.7mmHg, for women it varies between 22.2-24.1mmHg. Raising the referral threshold to >24mmHg would reduce the number of referable subjects by 68.1%. Conclusion: The study population’s mean IOP+2SD measured with an NCT was higher than the conventional Goldmann referral threshold of 21mmHg. This makes a strong case for increasing the non-contact IOP referral threshold in patients without additional glaucoma risk factors. 7. Can we replace Temporal Artery Biopsy (TAB) with Cranial Duplex Ultrasound (CDUS) in the diagnosis of Giant Cell Arteritis (GCA)? Adam Croft, Nicola Thompson, Martin Duddy , Fazal Khattak, Susan Mollan, Paresh Jobanputra University Hospital Birmingham Introduction: TAB is currently considered the ‘gold standard’ diagnostic test for GCA. Purpose: The aim of this study was to evaluate the diagnostic utility of CDUS in patients with suspected GCA. Method: All patients undergoing CDUS between Jan 2005 and July 2011 were identified. American College of Rheumatology (ACR) criteria for GCA were used to classify patients. CDUS reports were independently classified. The relationship between the ACR criteria alone or in combination with CDUS and a final clinical diagnosis of GCA (made after a minimum of 3-month follow-up) was analysed. Results: 87 patients were included. 36 patients had a confirmed clinical diagnosis. When compared to clinical diagnosis at 3 months, the sensitivity of CDUS was 81%, specificity 98%, positive likelihood ratio (PLR) 41 , negative likelihood ratio (NLR) 0.2, positive predictive value (PPV) of 97% and negative predictive value (NPV) of 88%. In contrast, when compared to clinical diagnosis at 3 months TAB had a sensitivity of 53%, specificity 100%, PLR 2.3, NLR 0.2, PPV 100%, NPV 47%. Conclusion: CDUS had a greater sensitivity than TAB and a comparable specificity to diagnose GCA. CDUS was the strongest predictor for a diagnosis of GCA at 3 months, whereas ACR criteria when used alone were insufficiently specific. In contrast, the high positive and negative predictive value of CDUS over TAB indicates that TAB may be unnecessary particularly where clinical suspicion of GCA is high or quite low. 8. OCT Findings in Children with Bardet Biedl Syndrome Peter Good, John Ainsworth, Marie Tsaloumas , Alaistair Denniston, Denise Williams Birmingham Childrens Hospital Introduction: Bardet Biedl syndrome (BBS) is one of the Ciliopathies with multi organ involvement, but with retinal dystrophy being the most common abnormality. Retinal dystrophy is most commonly diagnosed by 40 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire Electroretinography (ERG), but in children with BBS the ERG is not always abnormal. Ocular Coherence tomography (OCT) may provide a more reliable indicator of early retinal dystrophy in BBS patients Purpose: This study compares the OCT in BBS patients with normal individuals and those with Retinitis Pigmentosa (RP), in order to identify whether the OCT in BBS shows some specific abnormalities which may aid early diagnosis Method: Fifty children (aged 3-16 years)with Genetically proven BBS underwent ERG and OCT examination. The ERGs were performed under ISCEV stimulus conditions using lid electrodes. OCT were performed using a Spectralis Spectral Domain OCT system. Two control groups of age and sex matched children (20 in each group)were studied; one being normal controls, and the other having Genetically proven RP. Statistical analysis was by Analysis of Variance. Results: In the children with BBS 42(84%) showed reductions in the ERG b wave with a mean scotopic b wave amplitude of 23.6 uV (sd 0.35)compared to 64.3 uV (sd 0.58)amongst the normal controls, and 18.5 uV(sd 0.32)in the group with RP. OCT findings included thinning of the outer nuclear layer (ONL) in 22 children (28%), and fragmentation of the cones and central rods in 48 children(96%). Amongst those with RP 18 (90%) showed thinning of the ONL and none showed fragmentation of the cones. Conclusion: This study shows that OCT abnormalities are a more sensitive indicator of early retinal dystrophy in children with BBS than the ERG, and that fragmentation of the cones is specific to BBS and not seen in RP. 9. Analysis of the Hedgehog signalling pathway in periocular morphoeic basal cell carcinoma. John Bladen, Caroline Thaung, Michele Beaconsfield , Michael Philpott Centre for Cutaneous Research, Barts and The London Introduction: The vast majority of eyelid tumours are basal cell carcinomas (BCC). Morphoeic BCC (mBCC) is a particularly aggressive subtype, which invades local tissue and adjacent structures in an uncompromising manner. The Hedgehog (Hh) signalling pathway, primarily mediated by Glioblastoma (GLI) transcription factors are associated with development of BCC, usually through mutational inactivation of the Patched-1 (PTCH1) gene. Despite the association of Hh and BCC, analysis of eyelid BCC have not been investigated at a molecular level. Purpose: Understand the signalling pathways that result in the development and aggressive nature of mBCC. Method: Periocular morphoeic and nodular BCC tissue was obtained from the Moorfields Biobank; mBCC (n=15) samples were compared to nodular BCC (n=10) and control tissue (testes, n=4). Expression of PTCH1, smoothened (SMO), GLI1 and GLI2 were assessed in histological sections using immunohistochemistry and immunofluorescence techniques. Semi-quantification was carried out comparing subtypes and control tissue using Image J. Results: Upregulation of the Hh signalling pathway was seen in mBCC compared to nodular and control tissue. Interestingly, the stroma of the morphoeic subtype demonstrated higher intensity of SMO expression. Conclusion: The Hh signalling pathway is significantly more upregulated in periocular mBCC compared to nodular BCC. The magnitude of hedgehog signalling activity may define skin tumour phenotype. Activation of the Hh pathway by adjacent ‘normal’ tissue in mBCC may play a role in its aggressive nature. 10. Evaluating the Use of Intravitreal Aflibercept in Patients with Choroidal Neovascularisation Secondary to Pathological Myopia (mCNV): The MYRROR Study Francesco Bandello San Raffaele Scientific Institute Introduction: Choroidal neovascularisation (CNV) is a frequent cause of central vision loss in patients with pathological myopia. Purpose: To evaluate use of intravitreal aflibercept (IVT-AFL) in patients with mCNV. Method: MYRROR was a Phase 3, multicentre, randomised, double-masked, sham-controlled study. Patients received 1 injection of IVT-AFL 2 mg/sham at baseline, followed by monthly assessments until Week 24. Additional injections were allowed if disease persisted or reoccurred. The primary endpoint was the mean change in best-corrected visual acuity at Week 24. From Week 24–48 patients receiving sham switched to IVTAFL 2 mg PRN. Results: 122 patients were randomised to IVT-AFL (n=91) or sham (n=31). Baseline demographics were similar. At Week 24, patients in the IVT-AFL and sham groups gained 12.1 and lost 2 letters, respectively (P<0.0001). By Week 48, patients in the IVT-AFL and ‘sham/IVT-AFL’ groups gained 13.5 and 3.9 letters, respectively. Patients in the IVT-AFL group received 2 injections (median) in week 0-8. The median number of injections in 41 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire quarter 2–4 was 0. Patients in the ‘sham/IVT-AFL’ group received 3 (median) active injections between Week 24–44. More patients had ≥1 treatment-emergent adverse event (TEAE) at Week 48 with IVT-AFL vs sham/IVTAFL (70.3% vs 58.1%); however, the incidence of ocular TEAEs was similar (37.4% vs 38.7) and the majority were mild. No deaths were reported. Conclusion: In patients with mCNV, IVT-AFL was well tolerated and associated with clinically meaningful improvements in visual outcomes. Despite few injections, improvements were maintained from Week 24–48 suggesting that short-term treatment may benefit many patients with mCNV. 11. Is socioeconomic deprivation independently associated with increased prevalence of diabetic retinopathy? Liying Low, Simon Ogston, Peter Wilson , Alex Yeong, Ritchie McAlpine, Una O'Colmain, Carrie MacEwen University of Dundee Introduction: This is the first eye health equity profile conducted in East of Scotland to identify inequalities in eye health care. Purpose: To explore the association between socioeconomic deprivation and prevalence of diabetic retinopathy (DR) in type1 and 2 Diabetes Mellitus(DM) patients in East of Scotland. Method: We collected data on diabetic retinopathy screening from Scottish diabetes electronic record between January2011-December2012. Using the residential postcode, we obtained the overall Scottish Index of Multiple Deprivation(SIMD) score for each patient. We used multiple logistic regression to analyse the relationship between overall SIMD score and prevalence of DR, adjusting for variables: age, gender, HbA1c, cholesterol levels & duration of disease. Results: In patients with type 1 DM(n=1861), 88.2% attended their annual DR screening. Increased prevalence of DR in type 1 DM was independently associated with higher overall SIMD score(OR 1.01, 95% CI 1.001.02,p=0.008), male gender(OR 1.32,p=0.015), higher HbA1c value(OR 1.35,p<0.001), higher cholesterol levels(OR 1.174,p=0.03), younger age(OR 1.17,p=0.03), and longer duration of disease(OR 3.17,p<0.001). 93.5% of type 2 DM patients (n=18197) attended their annual DR screening. The prevalence of DR was not independently associated with overall SIMD score(OR 0.998, 95% CI 0.995-1.000,p=0.074), but was strongly associated with longer duration of disease(OR 1.99,p<0.001), higher HbA1c value(OR 1.22,p<0.001), lower cholesterol levels(OR 0.93, p=0.001) and male gender(OR 1.19,p<0.001). Conclusion: Socioeconomic deprivation is independently associated with increased prevalence of diabetic retinopathy in type1DM patients. This highlights the need for targeted interventions to address inequalities in eye healthcare. 12. Swept-Source Optical Coherence Tomography Assessment of Choroidal Thickness in Different Macular Disorders Salvador Pastor-Idoate, Maria Gil-Martinez , Stephen Charles , Susmito Biswas, David Henson , David B McLeod , Paulo Stanga MREH/ NIHR.Wellcome Trust CRF Introduction: Swept-Source Optical Coherence Tomography (SS-OCT) allows the in-vivo characterization of the Bursa Premacularis (BPM) and the Space of Martegiani (SM), as well as choroidal imaging. Purpose: SS-OCT assessment of choroidal thickness (CT) and determination of the prevalence of the BPM and SM in healthy eyes and eyes with various macular disorders. Method: Retrospective, comparative and non-interventional study. 96 consecutive patients underwent 1,050nm SS-OCT (DRI-OCT1 Atlantis®, Topcon Corp, Japan). Macular CT was determined by measuring the distance between the RPE and the choroid/sclera junction at three sites along a 500μm line centred on the fovea of 48 healthy eyes and 95 eyes with macular disorders. Patients were categorised into four groups. The prevalence of the BPM and SM was assessed. Results: Mean age was 48±22 years for HE versus 59±20 years for the group with macular disorders (MDG) (p<0.05). Mean CT was 253±95µ m for HE versus 205±105µ m for the MDG (p=000.9 CI 95% [11.9983.58]). Sub-group analysis showed significant differences in Age Macular Degeneration (AMD), High Myopia (HM), Vitreomacular Adhesion (VMA) and/or Epiretinal Membrane (ERM) and Central Serous Retinopathy (CSR) groups. BPM was present in 64.6% of HE versus 32.6% of MDG (p<0.05). SM was present in 52.1% of HP versus 66.3% of MDG. Conclusion: SS- OCT allows measurement of CT in different macular pathologies and assessment of the cortical vitreous and prevalence of the BPM and SM. A thin choroid may be associated with AMD and High Myopia and a thick one with CSR. 42 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire 13. Visual impairment and health inequalities: findings from UK Biobank (UKBB) Phillippa Cumberland, Paul Foster, Peng Tee Khaw , Christopher Hammond, Pirro Hysi, Yanchun Bao, Jugnoo Rahi UCL Institute of Child Health Introduction: UKBB is a major new resource for the study of eye health and disease. Purpose: We investigated socio-economic factors associated with risk of visual impairment (VI) and with use of optical correction. Method: 109,097 participants had habitual (usual optical correction) acuity measured using the UKBB computerised system based on LogMAR and were categorised: bilateral/unilateral normal vision (LogMAR 0.2 or better), near normal ( ≥0.2 to ≤0.3), socially-significant VI (SSVI) (>0.3 to <0.5) and low vision (0.5 or worse). Socio-economic information included ethnicity, educational qualifications and employment status. Multinomial multivariable analysis was undertaken. To demonstrate the strength of associations, adjusted risk ratios (RR) for SSVI group are reported. Results: The proportion with normal bilateral vision decreased by age group: 85% (21,274) in 40-49 years, 77% (26,783) in 50-59 years, and 72% (35,218) 60-70 years. Risk of all cause VI across the acuity spectrum was consistently associated with increasing age, RR 1.07 [95% confidence interval 1.06, 1.073], being female, RR 1.11 [1.05, 1.17], having no educational qualifications, RR 1.49 [1.32, 1.66], a higher deprivation score, RR 1.07 [1.05, 1.08], being unable to work/unemployed, RR 1.58 [1.42, 1.77], and with any/all Black and Minority Ethnic (BME) groups e,g, Asian, RR 1.87 [1.75, 2.01]. Conclusion: All-cause visual impairment across the spectrum is associated independently with lower socioeconomic, employment and education status, and with BME status in patterns that are not explained by risk of underlying eye disease. This provides evidence for the inclusion of ophthalmic disorders/visual health in key UK initiatives tackling Health Inequalities. 14. A British Ophthalmic Surveillance Unit (BOSU) study of severe adverse events associated with local anaesthesia (LA) in cataract surgery Richard M H Lee, John R Thompson, Tom Eke King's College Hospital Introduction: To estimate current usage and the incidence of severe adverse events associated with LA for cataract surgery Purpose: (i) to estimate current usage of LA for cataract surgery, (ii) to estimate the incidence of severe adverse events associated with each LA technique, (iii) to compare with our 2002-03 study, which had identical methodology. Method: A prospective, observational study. The British Ophthalmological Surveillance Unit (BOSU) sends a monthly mailing to all senior UK ophthalmologists; for 13 months in 2012-3, BOSU asked for reports of ‘‘potentially sight-threatening or life-threatening complications of LA for cataract surgery’’. Reporting ophthalmologists were sent a questionnaire. Current LA practice was assessed by another questionnaire, sent to all on the BOSU mailing list. Results: Cataract surgery comprised 3.4% general anaesthesia, 92.5% LA without sedation and 4.1% LA with sedation. Of the estimated 325 000 LA’s, 8.7.% were peribulbar, 1.3% retrobulbar, 50.3% sub-Tenon’s, 0.9% sub-conjunctival, 13.8% topical and 24.2% topical-intracameral LA. There were 20 reports of complications, with 11 completed questionnaires received at the time of submission. There were 5 reports of globe perforation (all peribulbar) and 3 reports of ‘‘Potentially life-threatening’’ complications. Because of likely under-reporting, further complications probably occurred during the survey period. Conclusion: This large survey found a lower reported rate of serious complications that may be due, in part, to improved safety awareness, and a move away from sharp-needle techniques in recent years. 15. Cochrane review of 5-fluorouracil in trabeculectomy: too long overlooked? Elspeth Green, Richard Wormald London School of Hygiene & Tropical Medicine Introduction: 1 in 50 people over 40y suffer chronic open angle glaucoma. Many undergo trabeculectomy surgery with antimetabolite application used to prevent subsequent conjunctival scarring onto the sclera. This study reviewed the use of one antimetabolite; 5-fluorouracil. Purpose: To assess the effects of peroperative application and postoperative injections of 5-FU in eyes undergoing trabeculectomy on risk of surgical failure and intraocular pressure (IOP) at one year. 43 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire Method: We searched, amongst others, CENTRAL, Ovid MEDLINE, and EMBASE for randomised controlled trials prior to 25 July 2013. We used standard methodological procedures expected by The Cochrane Collaboration to extract data. Data were summarised using risk ratio (RR), and mean difference (MD), as appropriate. Population subgroups were analysed separately (high risk of failure and primary trabeculectomy). Results: In the primary trabeculectomy subgroup risk of failure was significantly reduced by peroperative and postoperative 5-FU compared to placebo (RR 0.21, 95% confidence interval (CI) 0.06 – 0.68; and 0.67, CI 0.51 – 0.88). IOP was reduced by peroperative 5-FU (MD -1.04, CI -1.6 – -0.43) and postoperative 5-FU (MD -4.67, CI -6.60 – -2.73). The greater reduction in IOP in postoperative 5-FU eyes compared to peroperative 5FU was statistically significant. The greatest benefit was in the high-risk population subgroup with postoperative 5-FU (surgical failure RR 0.44, CI 0.29 – 0.68; IOP MD -16.30, CI -18.63 – -13.97). Conclusion: The small but statistically significant reduction in surgical failures and IOP at one year in the primary trabeculectomy and high-risk groups must be weighed against the increased risk of complications and patient preference. 16. The impact of congenital profound or severe visual impairment (VI) on behaviour development and difficulties in the early years Michelle O'Reilly, Elena Sakkalou, Hanna Sakki , Michelle de Haan, Alison Salt, Naomi Dale UCL Institute of Child Health Introduction: Congenital visual impairment (VI) is associated with later autism and behaviour difficulties (Parr et al., 2010) but the early impact on behaviour development and difficulties has not been systematically studied. Purpose: This study sets out to investigate early behaviour problems in the context of profound or severe congenital VI and forms part of the first national UK longitudinal study of 100 VI infants (Optimum VI project). Method: 30 children (mean age 2.2 ± 0.3 yrs) with ‘simple’ congenital disorders of the peripheral visual system (globe, retina, anterior optic nerve) – 9 profound VI (light perception at best), 21 severe VI (basic levels of ‘form’ vision on standard Near Detection Vision Scale – NDVS, Sonksen 1983). Parent-rated behaviour was assessed on the Achenbach Child Behavior Checklist (CBCL, Achenbach 2001) and non-parametric analyses were conducted. Results: The PVI group had significantly higher behavioural problems in Internalizing (anxious/depressed and withdrawn behaviour, p=0.04), Emotionally Reactive (e.g. ‘disturbed by change’, p=0.04) and Pervasive Developmental (e.g. ‘afraid to try new things’, p=0.04) compared to the SVI group. A significant negative correlation was observed between NDVS scores and CBCL Internalizing problem T scores, r=-0.36, p=0.047, with lower vision level scores associated with higher internalizing behaviour problems. Conclusion: As early as two years VI children are at significant risk of ‘internalizing’ and ASD-like pervasive behaviour problems, highlighting the early behavioural vulnerability of this population and the possible protective role on behavioural development of developing some ‘form’ vision by the second year. 17. Redefining wolfram syndrome in the molecular era Patrick Yu-Wai-Man, Grant Guthrie, Kamil S Sitarz , Angela Pyle, Rita Horvath, Philip G Griffiths, Patrick F Chinnery Newcastle Eye Centre, Royal Victoria Infirmary Introduction: Wolfram syndrome is a progressive neurodegenerative disorder that was historically defined by a cluster of common clinical manifestations: diabetes insipidus, diabetes mellitus, optic atrophy and deafness (DIDMOAD). Although genetically heterogeneous, the majority of affected patients harbour pathogenic mutations within the WFS1 gene (4p16.1) inherited as an autosomal-recessive trait. Purpose: To define the clinical and molecular features of Wolfram syndrome. Method: This study included twenty probands with suspected inherited optic atrophy in whom previous molecular investigations had failed to identify pathogenic mitochondrial DNA mutations, and mutations within the OPA1 and OPA3 genes. The entire WFS1 coding region was sequenced using genomic DNA samples extracted from peripheral blood leukocytes. Results: Pathogenic WFS1 mutations were identified in five probands. Three probands harboured compound heterozygous autosomal-recessive WFS1 mutations. In two probands, single heterozygous autosomal-dominant WFS1 mutations were found. A wide clinical spectrum of varying disease severity was observed: (i) optic atrophy and early-onset sensorineural deafness (n = 2), (ii) optic atrophy and late-onset diabetes mellitus (n =1), and (iii) a progressive neurodegenerative phenotype (n = 2), with only one patient fulfilling the 44 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Rapid Fire DIDMOAD criteria. Based on our epidemiological data, the minimum prevalence of this disorder is estimated at 1 in 440,000 in the North of England. Conclusion: The greater availability of WFS1 testing has expanded the clinical phenotypes associated with Wolfram syndrome. Interestingly, WFS1 mutations can exhibit an autosomal-dominant mode of inheritance. Genetic screening should therefore be considered in suspected cases of inherited optic atrophy, especially if associated with sensorineural deafness or diabetes mellitus. 18. Glaucoma prescribing trends in England 2000 to 2012 Alan Connor, Scott Fraser Royal Victoria Infirmary, Newcastle Introduction: In 2009 NICE published guidance on the treatment of ocular hypertension and glaucoma. The introduction of NICE guidelines has not been without controversy, with unintended changes in the referral behavior of community optometrists. It is as yet unclear whether these additional referrals have resulted in an increase in glaucoma detection or treatment. Purpose: The aim of this study is to describe the impact NICE guidance has had on glaucoma prescribing and to describe recent glaucoma prescribing trends. Method: When community pharmacies dispense medication they seek reimbursement from the NHS Business Authority who collate and publish this data. We extracted and analysed all data relating to glaucoma medicines from Prescribing Cost Analysis reports produced by NHS Business Authority for the years 2000 to 2012. Results: The number of prescriptions dispensed has increased by 67% from 4.76 million in 2000 to 7.96 million in 2012 Over the same time period drug costs have increased by 88% from £55.2 million to £103.7 million. Prescriptions for prostaglandin analogs has increased four fold whilst there has been a three fold decrease in the use of beta blockers. The introduction of generic latanoprost in 2012 has more than halved the cost associated with this medication. NICE guidance has had no effect on the total number of prescriptions or the classes of medications prescribed. Conclusion: The introduction of the NICE guidelines has not changed glaucoma prescribing practice, though it is not clear whether this represents non-adherence to the guidelines or whether the guidelines embodied preexisting practice. 19. Corneal calcification and phosphate buffers - Do you need to prescribe phosphate free? Magdalena Popiela, Nicholas Hawksworth Singleton Hospital Introduction: Both superficial band kerotopathy and deeper calcareous calcification have been linked to the presence of phosphate buffers in topical ophthalmic medicines. The European Medicines Agency (EMA) has concluded that patients with ocular surface disease are at greatest risk. This potential side effect should be highlighted to both prescribers and patients. Purpose: To review the excipients of commonly prescribed ophthalmic medicines in order to prepare a list of phosphate buffered drugs, and also to investigate where to find this information. Method: We reviewed 77 commonly used ophthalmic drops and ointments looking for the information about their buffering agents. We reviewed information written on drugs’ boxes, bottles, patients’ leaflets, and in electronic Medicines Compendium (eMC), which contains up to date details of all medicines licenced for use in the UK. The British National Formulary (BNF) was also reviewed. Results: We found 20 phosphate-buffered, 14 non-buffered and 43 ophthalmic drugs containing buffers other than phosphate based. Most displayed the list of their excipients on their boxes and in patient’s leaflets. This information was also available on the eMC but not in the BNF. Despite the EMA recommendation none of the phosphate buffered medicines mention corneal calcification as a potential side effect. Conclusion: We present an easy reference list of phosphate buffered ophthalmic drugs to be used in caution especially in patients with compromised ocular surface. We found electronic Medicines Compendium to be a reliable and easily accessible source of information about drugs’ components. We suggest that this information should also be included in the BNF. 45 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance 20. One year experience with ‘Nurse Injectors’ in a busy Macular service Deepali Varma, K Davies , K Stoddart Sunderland Eye Infirmary Introduction: Specialist nurses administering ‘intravitreal’ therapy (IVT) under consultant supervision is now supported by the Royal College of Ophthalmologists’ and the Macular Disease Society. Several units across the UK have introduced this post to meet the increasing demand for IVT. Purpose: To audit the IVT procedures performed by specialist macular nurses over a 12 month period at a busy eye unit. Method: Data including diagnosis, visual outcomes, complications and patient experience was collected prospectively in consecutive patients suffering from wet Age related Macular Degeneration (AMD) and Diabetic Macular Edema (DME) undergoing IVT. Results: A total of 2945 intravitreal Ranibizumab (Lucentis™) injections were performed by four specialist macular nurses between 1st October 2012 and 30th September 2013 for wet AMD (n= 2898) and DME (n= 47). Besides optimal visual and anatomic outcomes, patient surveys showed high levels of patient satisfaction. Significant complications included corneal abrasion (n= 5), raised intraocular pressure (n= 1) and mild vitreous haemorrhage (n=1). No cases of retinal detachment, cataract or endophthalmitis were seen. Conclusion: Our 12 month experience demonstrates that IVT performed by trained nurses did not pose a higher risk of complications compared to those performed by ophthalmologists despite the differing indications for IVT. Patient choice, consultant judgment and clearly defined protocols are key factors for optimal outcomes following introduction of nurse injectors. This service innovation has transformed our macular service and improved clinical outcomes through timely treatment. 21. Engaging children in feedback: Use of an animated toolkit for recording feedback of patient experiences from children and young people in ophthalmology services Robbie Walker, Yvette Annan, Mally Scrutton, Tim Withers, Jo Hancox Moorfields eye hospital Introduction: Patient reported experience measures (PREMs) are important in the assessment and planning of healthcare services. When asked, children are keen to be involved in decisions about their care. We report the use of an animated toolkit to engage young people in feedback. Purpose: To demonstrate the effective use of an interactive, animated computer program specifically designed for children and young people to collect feedback in paediatric ophthalmology services. Method: Patient feedback was gathered using specially commissioned, age appropriate, animated questionnaires on a hand held tablet computer devices in Ophthalmology clinics and a surgical day care ward by trained play specialists. Results: 287 young people and 157 children completed the questionnaire. The majority of were happy with their care. Areas for improvement included clarity over who each member of the team was and information about the effect of the eye drops. 86% of children would recommend their friends attended the eye clinic if they had an eye problem. Conclusion: This age appropriate, interactive, animated tool based on an appealing medium such as a tablet computer provides an excellent opportunity to engage children and collect feedback, thereby involving them in their care. Feedback can be used to improve childrens’ experience in clinics and directly involve them in their clinical care, as well as to shape and improve services of the future, guiding healthcare planning and resource allocation. 22. Use of lumbar punctures in the investigation of ocular syphilis Ian Reekie, Yavische Reddy University of KwaZulu Natal Introduction: Ocular syphilis is rare in the developed world, but is a common presentation to ophthalmology departments in South Africa. A lumbar puncture is usually advocated to exclude progression to neurosyphilis, but these are often omitted due to lack of consensus on the need for their use. Purpose: To determine the proportion of ocular syphilis patients who are investigated by lumbar puncture and to ascertain the proportion of lumbar puncture results that are suggestive of neurosyphilis in this patient population. 46 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Method: Admissions for ocular syphilis at Addington Regional hospital and St Aiden’s mission hospital in Durban, South Africa in a 20 month period were audited. These patients’ records were retrieved and their diagnosis by serological tests confirmed. If a lumbar puncture had been performed the results of tests requested on the CSF were examined for abnormalities suggesting neurosyphilis. Results: 31 of 68 patients (45.6%) with confirmed ocular syphilis were investigated by lumbar puncture. Of these, 8 (25.8%) had CSF findings suggestive of neurosyphilis (positive CSF VDRL or FTA and/or lymphocytic pleocytosis, high protein and low glucose) and so should be under the care of infectious diseases physicians. Conclusion: Many of this series of patients with ocular syphilis were found to have CSF findings suggesting neurosyphilis. This suggests that lumbar punctures should be performed on all patients presenting with ocular syphilis. In this series, only 45.6% of patients with ocular syphilis were investigated by lumbar puncture, meaning that a significant number of possible neurosyphilis cases may have been missed, and the patients not properly followed up. 23. Safety in nurse-led corneal collagen cross-linking Melanie Mason, Dan Gore, Bruce Allan Moorfields Eye Hospital Introduction: Corneal cross-linking (CXL) is the only treatment proven to halt disease progression in keratoconus. In our hospital we have trained nurses to perform CXL. Purpose: The aim of this study was to demonstrate that a nurse-led CXL service is as safe as that performed by an ophthalmologist. Method: Design: Prospective audit Eyes with evidence of recent disease progression underwent epithelium-off rapid CXL (irradiance 4mW/cm2) by either a post-CCT ophthalmologist or a senior nurse. The nurse underwent both didactic and practical instruction in taking informed consent, corneal tomography interpretation, epithelial debridement, ultraviolet (UV) light delivery, applied pharmacology and one-week slit-lamp biomicroscopy follow-up with bandage contact lens removal. Training followed a strict competency-based approach over several months. The nurse was signed off as a competent solo practitioner after 20 supervised CXL cases. The primary safety standards at one week following treatment were no episodes of infective keratitis or UV-related corneal decompensation. Results: CXL was performed on a total of 210 eyes, of which 49 (23%) were performed by the nurse. No episodes of infective keratitis or corneal decompensation occurred in either group. One transient peripheral sterile corneal infiltrate occurred in both the nurse-treated and ophthalmologist-treated groups. One severe sterile corneal melt and 1 recurrent corneal erosion occurred in patients treated by an ophthalmologist. Appropriate ultraviolet-light power settings and riboflavin application timings were correctly delivered in all cases in both groups. Conclusion: Nurse-led CXL is as safe as that performed by ophthalmologists. 24. WOScOTT. The West of Scotland Optometrist Teach And Treat Clinic: Shaping the future of Community Ophthalmology in Scotland Kaleena Michael, Maria Elena Gregory, Manish Gupta , Janet Pooley, Donald Cameron NHS Greater Glasgow and Clyde Introduction: The new Scottish General Ophthalmic Services contract encouraged the shift of a proportion of ophthalmic care from hospitals into the community. NHS Education for Scotland (NES) developed the Teach and Treat Model to allow Optometrists to gain clinical experience by treating hospital patients under Consultant supervision. Purpose: This audit seeks to establish whether this Service Innovation provides measureable benefits to community Optometrists. Method: Prospective Audit of clinical outcomes of the first year Patient Satisfaction questionnaire Optometrists on-line questionnaire at completion of training. Results: 78 Optometrists treated 1298 patients in 12 months under the supervision of 2 Consultant Ophthalmologists . Case mix included adnexae (31.2%), anterior segment (29.8%), posterior segment (22.1%) and glaucoma (3.9%). 40% of patients had procedures/investigations in clinic, 42.1% treated and discharged at first visit, 16.6% listed for surgery, 6.8% referred to other sub-specialties. All patients felt they were treated politely, their privacy and dignity was maintained, and their condition clearly explained. All optometrist 47 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance reported improved knowledge and diagnostic ability, with 80% reported increased confidence and 40% reported reduced referral to hospital. Conclusion: This training programme provides experiential learning for optometrists, increases their confidence in managing a variety of non-sight threatening eye conditions in the community while recognising and referring more complex conditions appropriately to the hospital Ophthalmologist. This may lead to better streamlining of referrals to secondary care thus reducing the increasing pressures on the Hospital Eye Service. 25. Acute infective conjunctivitis – to swab or not to swab? Siegfried Wagner, Ian C Bowler, Stella J Hornby Oxford University Hospitals NHS Trust Introduction: Conjunctival swabs are frequently employed in infective conjunctivitis yet their impact on patient management has not been explored. Purpose: To evaluate the clinical utility of conjunctival swabs in the management of infective conjunctivitis. Method: The microbiology database was retrospectively analysed for all patients presenting to the Eye Casualty, between January 2011 and July 2013, where conjunctival swabs were taken. Microorganisms were detected by culture for bacteria and polymerase chain reaction (PCR) for chlamydia and viruses. Results: In total, 302 swabs were sent from 109 patients – 138 bacterial, 103 viral and 61 chlamydial. 22/138 (16%) of bacterial swabs were culture positive. The most frequent organisms were Staphylococcus aureus (33%) and Streptococcus pneumoniae (33%). One case of Neisseria gonorrohoeae was accordingly treated. All bacteria grown were sensitive to chloramphenicol. 58/103 (64%) of viral swabs were positive, the majority yielding Adenovirus (88%) and Herpes simplex (9%). 44 patients were offered follow-up; 6 did not attend. 20% of results were documented in the medical record. Laboratory and follow-up costs alone approximated £6,500 for those, who had viral swabs sent. 9/61 (15%) chlamydial swabs were positive, with 4 occurring in neonates. All were documented in the medical record. In one of the 9 cases was the diagnosis not suspected before testing. Conclusion: The management of patients with infective conjunctivitis incurred significant laboratory costs and unnecessary appointments. Bacterial culture did not reveal evidence of emerging resistance to chloramphenicol. Conjunctival swabs have limited clinical utility, except in neonates and suspected gonococcal/chlamydial conjunctivitis. 26. Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service Colm McAlinden, Helen Corson, Peter Garwood Public Health Wales Introduction: The Primary Eyecare Acute Referral Service (PEARS) and the Wales Eye Health Examination (WEHE) are enhanced optometry services for patients residing in Wales, enabling the examination of a patient presenting with an acute eye problem (PEARS) or those at higher risk of eye disease (WEHE). Purpose: The purpose of the study is to assess the demographics of patients accessing this service, referral patterns and clinical management. Method: Information from 2302 patients accessing the service was prospectively collected. The following information was obtained: type of examination, age, gender, self-referral or GP-referral and clinical management. Results: There were 1791 (77.8%) PEARS examinations and 511 (22.2%) WEHE. There were 1379 (59.9%) females (mean age:58.61±19.75) and 923 (40.1%) males (mean age:56.11±20.42). The majority of patients were self-referrals compared to GP-referrals (1793 [77.9%] versus 509 [22.1%] respectively). Sub-analysis indicated similar numbers of self-referrals compared to GP-referrals for the WEHE only (297 [58.1%] versus 214 [41.9%] respectively) but significantly greater numbers of self-referrals for the PEARS examinations only (1496 [83.5%] versus 295 [16.5%] respectively). For management, 75% of patients were monitored by their optometrist/OMP, 17% required referral to the HES and 8% required referral to their GP. Conclusion: Significantly higher numbers of females are accessing the service. The majority of patients selfreferred with 75% of patients being managed in the community by their optometrist/OMP, and 17% being referred to the HES. These findings have important implications for public health campaigns both for targeting specific groups, increasing awareness among GPs and demonstrating service cost effectiveness and efficacy. 48 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance 27. Initial experience with barely visible and subthreshold yellow wavelength Pascal® laser with and without Endpoint Management® in diabetic patients Maria Gil-Martinez, Salvador Pastor-Idoate, Yvonne D'Souza , Sajjad Mahmood, Stephen Charles, David Henson, Paulo Stanga MREH. NIHR/Wellcome Trust CRF Introduction: The Pascal® photocoagulator is a semi automated system that delivers single or pattern-array of multiple burns in a predetermined sequence and is now available with either 532nm Green or 577nm Yellow (YW-PL) wavelength laser sources. Purpose: To report on laser treatment parameters of barely visible YW-PL (with and without Endpoint Management® (EpM®)) in patients with Proliferative Diabetic Retinopathy (PDR) and /or Diabetic Macular Oedema (DMO) Method: Retrospective observational case series of 38 procedures of barely visible laser. Patients categorised in three treatment groups: 1- Single-session Panretinal Photocoagulation (PRP) 2-Focal or modified macular grid 3- Single-session PRP and macular grid Results: A total of 38 procedures were performed using YW-PL in 30 patients; 21 (70%) males and 9 (30%) females. The mean age was 59.81±11.53 (27.3-73. Group Number of eyes Mean number of spots (Range) Power mW (SD) Duration msec Spot Size Âμ ("on air") 1-Single-session PRP 21 1845(196-2861) 364(74) 20 200 2-Focal or Modified Grid 11 255(77-533) 183(55) 10 100 2141 (888-2805) 370(67) 20 200 186(60-698) 150(36) 10 100 3-Single-session PRP with PRP Macular Grid Macular Grid 6 Burns could be partially visualized with fundus biomicroscopy and were later confirmed with fundus autofluorescence. There were no peri-treatment laser-associated adverse effects or ocular complications associated with the PRP or macular YW-PL array treatments. Conclusion: Pascal® laser using 577nm wavelength with and without EpM® was found to be safe. 28. Natural history of patients receiving Lucentis for WET AMD: A 3-year prospective study Ruth Peiwen Chen, Pankaj Puri Royal Derby Hospital, Derby Introduction: To establish the natural history and follow-up characteristics of patients attending a one-stop intravitreal injection service for management of WET macular degeneration Purpose: To estimate the incremental demand on the service Method: 146 eyes treated at a one-stop intravitreal injection service were followed up for a period of over three years or up to point of discharge. Data on their visual acuity were collected at presentation, 12 months, 24 months, 36 months or at discharge. The reasons for premature withdrawal from treatment and the number of patients who returned to the service with either a recurrence or involvement of the other eye were recorded. Results: 146 eyes were recruited into the study. The mean visual acuity at presentation was 53 letters (95% CI: 50.67 – 55.38) with a median of 54 and a range of 21 to 85. Of the 146 eyes, 138 were followed up at 12 months, 116 at 24 months and 79 at 36 months. The main reasons for the withdrawal of patients were stabilisation of visual acuity (17 eyes), and death in 17 patients (21 eyes). 30 patients had second eye involvement in 3 years and 4 patients returned to the service after discharge due to recurrence. Conclusion: This audit gives valuable data demonstrating that 94.8% of patients were still attending the service after one year, 78.4% after two, and 54.3% after three years of treatment. These figures help estimate the demand for an effective workforce management. 49 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance 29. The Impact of Rationing Cataract Surgery in Gloucestershire Miranda Buckle, Robert Johnston, Nicholas Price , John Ferris, John Sparrow, Graham Mennie Gloucestershire Hospitals NHS Foundation Trust Introduction: In June 2010 the “Gloucestershire Cataract Assessment Questionnaire” (GCAQ) was introduced after discussion between commissioners, community optometrists, and the hospital eye service. The aim was to standardise referral practice, achieve a consistent threshold for surgery, and reduce cataract surgery volume to save money. Purpose: Here we audit the impact of the GCAQ on National Health Service cataract surgery volume and patient visual acuity (VA) in Gloucestershire. Method: Community optometrists applied the GCAQ prior to referral, and ophthalmologists when making listing decisions. Data items extracted from an electronic medical record system include: best measure VA in each eye pre-operatively and date of surgery. Results: Mean annual cataract surgery volume had been approximately stable at 4100 cases per annum between 2007-2010. After GCAQ implementation this dropped by 21% in year one, but only by 6.5% from baseline in year two. Between 2007-2010 on average 57% of eyes had pre-operative VA worse than 6/12, but after GCAQ implementation this increased by 8% in year one, and by 7.4% in year two. Between 2007-2010 on average 22% of patients had pre-operative visual acuity impairment (VA in better-seeing eye worse than 6/12). No change was noticed one year after GCAQ implementation, but in year two there was a 16% increase in this cohort. Conclusion: These data suggest that attempts to ration cataract surgery do not reduce permanently the volume of surgery and may have had an adverse impact on patients’ quality of life. Development of a national standard threshold for cataract surgery is needed to ensure patients are treated equitably. 30. Initial experience of neovascular AMD unresponsive to ranibizumab treated with aflibercept Noa Fernandez Ledo, George Kiousis, Raeba Mathew , Helena Vrizidou, Sheena Koshy, Sobha Sivaprasad King's College Hospital Introduction: With the introduction of intravitreal aflibercept as a new NICE approved treatment for wet age related macular degeneration (AMD) based on VIEW studies, there is increasing usage of this agent in patients already being treated with ranibizumab . The aim of this study was to assess the anatomical outcomes of patients switched to aflibercept irrespective of previous responsiveness to ranibizumab. Purpose: Study the outcome of patients with wet AMD who have been treated with repeated intravitreal injections of ranibizumab, and were switched to aflibercept. Method: Retrospective study on OCT outcomes of patients switched to aflibercept after initial ranibizumab therapy. The electronic medical records and the OCT scans were reviewed for the study period. Both qualitative and quantitative evaluation of morphological changes at the macula were done to better understand differences in the drying effect of these two agents. Results: Records of 44 patients with a mean age group of 78 ± 9 years were reviewed. Prior to the switch, the median visual acuity of the cohort was 53 (20-79) EDTRS. The average number of ranibizumab injections given was 19 ± 10. The initial experience of changing from a ranibizumab PRN dosing regimen to aflibercept treat and extend resulted in patients being treated with various injection regimes. Five months after initial aflibercept injection and following an average of 3.84±0.83 injections, the central retinal thickness improved by 71±83 microns from 375±102 to 300±91 (p<0.0001). The proportion of patients with intraretinal and subretinal fluid improved from baseline, 61% vs 41% and 64% vs 32% respectively. In patients with pigment epithelial detachment (PED), its height decreased by 37±97 (p=0.0016) microns. Conclusion: Despite different dosing regimens of aflibercept used, the drying effect of the drug on the macular fluid is significant in patients that are offered a choice to switch from ranibizumab to aflibercept 31. Predictors of Failure of Primary Surgery for Congenital Nasolacrimal Duct Obstruction Mahmoud Nassar, Gordon Lau, Ayad Shafiq , Michael Clarke Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Introduction: Congenital Naso-Lacrimal Duct (NLD) obstruction is the commonest cause of epiphora from birth. Most cases resolve spontaneously, however, a few require surgical interference. We are investigating success rates of surgery and possible risk factors for surgical failure. 50 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Purpose: To assess the success rate of primary surgery for Congenital NLD Obstruction and to investigate risk factors of failure of primary surgery to cause resolution of symptoms. Method: A retrospective case series of children undergoing primary surgery for Congenital NLD Obstruction. Children included were under 10 years with persistent epiphora and/or discharge from birth not responding to massage. Only primary procedures were included; and children with craniofacial or ocular abnormalities were excluded. Collected data included age at first probing in months, gender, laterality and results of first probing (failure based on need for repeat surgery). Results: We identified 104 eyes of 77 patients between January 2011 and December 2012. 13 patients were excluded (5 craniofacial abnormalities, 5 first surgery before January 2011, 2 over 10 years old and 1 ocular abnormality) and 85 eyes of 64 patients were included. Age at first probing was 9 – 111 months (mean 29.65 + 19.52 SD), 33 (51.6%) were females and 31 were males. 43 (50.6%) patients had unilateral surgery and 21 had bilateral, there were 44 (51.8%) right sided surgery and 41 left sided. 66 (77.6%) eyes had single surgery (60 probing and 6 intubation) and 19 required repeat surgery. There was no significant difference (p> 0.5) in Gender, Laterality or Age at first surgery between the single and repeat surgery groups. Conclusion: Primary surgery for Congenital NLD Obstruction has a 77.6 % success rate. Gender, Laterality and Age at first probing were not risk factors for further surgery. 32. Sustainability in ophthalmic practice: are we hitting the triple bottom line? J Somner, N Stone, Z Sipkova, A Koukoulli, G Lascaratos, G Jóhannesson, A Das, O Bowes, H Jewsbury, RL Perrott-Reynolds, DS Morris, R Bourne, A Cassels-Brown, V Cross Vision and Eye Research Unit, Anglia Ruskin University Introduction: Sustainability is a priority in healthcare planning and physicians have a duty to advocate for the cost effective and just distribution of finite resources. Purpose: To assess whether abstracts accepted by the Royal College of Ophthalmologists for its Annual Congresses between 2008 and 2013 feature examples of sustainable practice. Method: The study included 1496 abstracts. Two raters independently assessed and classified each abstract. Inter-rater reliability was assessed with the Kappa test. A third, independent rater arbitrated any disagreements. Results: There was fair agreement between the raters (Kappa 0.374). Twenty six percent of abstracts related to sustainable eye care. Fifty six percent of these were designed to save doctors’ time, money or reduce complications and further management. Twenty one percent involved informatics, technology or staff interventions that streamlined care pathways. Twelve percent related to primary and secondary preventive measures, 11% promoted improved self-care and less than 1% focused on interventions that were specifically designed to reduce the environmental impact of care. Between 16 and 38% of abstracts related to sustainability each year. Sustainability topics featured in all sub-specialty sections, most commonly in the audit and clinical governance section. Over 1000 authors and 150 organisations were involved in work on sustainability. Conclusion: Sustainable eye care interventions are commonly described but are not officially recognised or flagged for attendees at meetings. Greater recognition and promotion of sustainable eye care might facilitate research and dissemination of ideas that could increase social, ecological and economic capital. 33. The carriage of steroid treatment cards for uveitic patients Simerdip Kaur, Moloy Dey, Adam Mapani , Francis Chiu, Narciss Okhravi Moorfields Eye Hospital Introduction: The British National Formulary suggests that all patients on oral steroids for greater than 3 weeks must be issued with and carry an updated steroid card. At present, there are no studies in the literature defining current practice in the use of steroid cards in uveitic patients. Purpose: To assess the proportion of uveitic patients on steroids who carry an up to date steroid card and are aware of its significance. Also to assess the role of different healthcare professionals involved in its use. Method: We prospectively collected responses in the form of a questionnaire from 77 patients who were on oral steroids for at least 3 weeks at the time of their clinic appointment Results: 99% patients owned a steroid card but 70% admitted that this was up to date. 74% of them carried it to their appointment whilst however 79% knew the importance of doing both. 92% of patients were asked about their steroid card by a hospital pharmacist. However, only 4% of both hospital doctors and nurses ever enquired if the patient had a steroid card. 51 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Conclusion: Majority of patients on oral steroids are being issued with steroid cards. However doctors and nurses need to be more proactive and involved in educating patients on the importance of possessing a steroid card. We have implemented training for nurses, pharmacists and doctors highlighting these results and have developed an electronic poster making patients aware of the cards. 34. Stream-lining a busy macular service: Reducing the burden of 'inactive' wet age-related macular degeneration patients. Bushra Mushtaq, Abhijit Mohite, Huzaifa Malick Sandwell General Hospital, Birmingham Introduction: The need for close follow-up of patients treated with intravitreal Ranibizumab for wet age-related macular degeneration (AMD) as per guidance from NICE has substantially increased clinical workload and put a great stress on resources. Unfortunately however, there is no clear guidance about discharge policy in treated patients once they are deemed 'inactive' (remaining intervention free for a period of one year or more). Purpose: Previous audits found a delay in follow-up appointments for patients within our macular service. Our aim with this study was therefore to identify patients treated in our macular service at Sandwell and West Birmingham NHS Trust who were deemed to be 'inactive', so as to potentially reduce the burden on the service and improve clinic flow. Method: We undertook a retrospective review of patient records of all 1700 patients since the inception of intravitreal Ranibizumab at our Trust, who were still under follow-up in our medical retina clinics. For patients deemed inactive, we recorded reasons for continued follow-up. Results: A total of 445 patients were identified as inactive, of which 136 (31%) could have been discharged altogether. Of the remaining 309 patients, 112 had documented ocular co-morbidity requiring other subspecialty follow up. We therefore identified 56% (248/445) of inactive patients who could be followed up in other ophthalmic services or discharged to optometrists. Of the remainder, 47 had developed active wet AMD in the contralateral eye and 150 were patients with “only eyes”, thus requiring closer ongoing monitoring. Conclusion: A more careful use of follow-up appointments in a busy AMD service should allow for active patients to be followed up sooner as per national guidelines. Giving clear instructions on how to contact the medical retina service if they noticed sudden deterioration in either eye is paramount, since 10% (47/445) of our inactive patients developed wet AMD in their second eye. 35. Is there a correlation between pain during intravitreal injection and the site of injection? Jan Sniatecki, Mohan Varikkara, Zachariah Koshy University Hospital Ayr, NHS Ayrshire and Arran Introduction: Intravitreal injection has become one of the most common performed procedures in Ophthalmology. Most of them deliver anti-VEGF agents, where multiple injections are required. Pain accompanying the injection can have an influence on patient's compliance. There is scarse data investigating pain and location of the injection. Purpose: To evaluate whether different locations of intravitreal injection have an influence on patient reported pain. Method: The prospective study included 67 patients who received routine ranibizumab or aflibercept intravitreal injection. Patients were randomized into four groups according to the different eye quadrant site of injection. Shortly after the injection, patients were asked to rate their pain by the use of Visual Analog Scale (VAS). Topical anaesthesia was standardized and the same injection technique applied in every group. Other factors considered in this study included age, sex, indication for injection, grade of injector and diabetes mellitus. Results: The main indication for intravitreal injection was Age-Related Macular Degeneration 89%. Diabetic retinopathy accounted for 13%, central / branch retinal vein occlusion 4%, inflammatory disease 1%. The average pain score was 20,97; standard deviation 18,99. The minimum recorded pain score was 0, the maximum 60. Mean pain scores for the following eye quadrant site of injections were: supero-temporal 23,82; infero-temporal 20,43; supero-nasal 21,90; infero-nasal 21.29. There was no significant difference between the four groups (p=0,896). No correlation between diabetes nor surgeon grade and the pain has been noted. 52 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Conclusion: This series does not show any correlation between pain and site of injection. Moreover, there is no significant difference in pain between different surgeon grades who performed the procedure. 36. Efficacy of an educational intervention to improve adherence to NICE recommended follow up intervals for Glaucoma. Michael James Gilhooley, R Karim, R Vemala, P Abeysiri Queen's Hospital, Romford Introduction: NICE has reviewed the evidence to determine the appropriate interval between assessments of glaucoma patients. The RCOphth suggests delayed appointments should be rescheduled within 15% of the intended interval. Purpose: 1. Quantify adherence to NICE guidelines on glaucoma follow up intervals. 2. Quantify delays from hospital & patient rescheduling. 3. Assess long-term efficacy of an educational intervention. Method: Best practice The intervals suggested in NICE Guideline 85 for OHT and COAG. Current practice Ascertained by a prospective audit of consecutive clinic patients recording:-Requested interval -Actual interval -Source of delay -Diagnosis -IOP control -Evidence of progression Intervention A dedicated teaching session on the guidelines, emphasising follow up periods. Re-audit Identical methodology, repeated one year later. Results: Initial Practice Re-audit n= 119 83 Not Seen within recommended time:- 32% 32% Pt cancelled 9% 15% Hospital cancelled 23% 17% Cancelled twice by hospital 3% 2% Mean delay (months) 0.61 1.93 Mean interval 5.09 5.83 As percentage 12% 33% Number of patients by diagnosis and proportion progressing were similar in both samples. In the re-audit, fewer patients were outside of their ideal IOP and fewer had treatment changed. Conclusion: 1. A third of patients had their appointments delayed beyond recommendations, however, length of delays were small. 2. The source of the delay moved from hospital towards patients. 3. An educational intervention provided a modest improvement in compliance, which was negated by increased patient cancellations: the next cycle should assess an intervention to reduce these. 37. 5 year audit of endophthalmitis following intravitreal injections without antibiotic prophylaxis Roopa Vemala, Alastair Porteuos, Judith Field , Niaz Islam Queens Hospital, Romford Introduction: Topical antibiotics are used frequently in clinical practice in association with intravitreal injections, although level 1 evidence for this practice does not exist,most ophthalmologists use prophylaxis to protect them from litigation in a unlikely case of infection. The Royal College of Ophthalmologists guidelines 2009 recommended use of post injection topical antibiotics.The incidence of endophthalmitis is<0.1% in Novartis wAMD safety outcome,0.02% in14,320 injections by Fintak et al and 0.049%in the meta analysis of 105,000 injections. However Bhavsar and N Bressler suggested that low rates of endopthalmitis can be achieved using a protocol that includes topical povidine iodine, sterile lid speculum,topical anaesthetic but not 53 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance requiring topical antibiotics. Bhavsar also reported a low rate endophthalmitis (0.007%) in 15,000 intravitreal injections in absence of prophylaxis, stating povidine iodine is sufficient and no study has shown that any medication reduces the risk of endophthalmitis post operatively. Purpose: To evaluate the necessity of antibiotic prophylaxis for intravitreal injection in wAMD. Method: Audit of incidence of endophthalmitis following intravitreal injections at Queens Hospital, BHR trust between 2008 and 2013. We used a clean room, topical povidine Iodine, sterile set(gloves and speculum)and appropriate asepsis. No antibiotics were given post injection. Results: We had a total number of 6957 injections in 870 eyes of 749 patients.10 doctors administering injections with an experience ranging 20 to 551 injections. The incidence of endopthalmitis was 0.04%(3cases),which is within the documented Novartis safety data. Conclusion: We found no added risk to endophthalmitis when antibiotics were not given as prophylaxis post intravitreal injection. Topical Povidone Iodine during the injection might suffice as prophylaxis 38. Situational Analysis of Quality Improvement Processes in Cataract Surgery in Madagascar Rini Vyas, Hery Andriamanjato, Lea Raobela , Alice Harisoa, Johnathan Buchan, Andrew Cassels-Brown Leeds Teaching Hospitals Trust Introduction: The World Health Organisation / International Agency for the Prevention of Blindness initiative ‘Vision 2020’ focuses on increasing the quantity of cataract surgery globally. However, little attention has been paid to the quality of the surgery provided and visual outcomes. The implementation of Quality Improvement Processes (QIP) for cataract surgery is a priority to achieve the agreed target of elimination of cataract blindness. Purpose: A situational analysis questionnaire was conducted in Madagascar to determine current cataract surgery QIP, with the aim of informing future changes towards a quality culture. Method: A questionnaire was designed to evaluate general quality; surgical quality; personal development; patient and community. It was pre-tested and administered in Madagascar to ophthalmologists representing different units, experiences and seniority, via feedback sessions and email. Results: Thirteen ophthalmologists completed the questionnaire. Ten respondents stated their department carried out some QIP, commonly cataract surgery auditing. All ophthalmologists were able to compare their results against previous years, but only three were aware of their hospital’s results and international standards. Five stated their hospital evaluates personal development. Eleven thought patient satisfaction should be monitored but only three reported collecting patient feedback. Conclusion: Basic QIP in Madagascar have been highlighted, particularly surgical audits. More awareness on available benchmarks may help to standardise results across centres and encourage quality improvement. Formal systems for personal development appraisals and handling patient complaints would further support a quality culture. This study has identified areas where long-term QIP can be implemented, in partnership with local ophthalmologists, to improve cataract surgery outcomes in Madagascar. 39. Ozurdex Outcomes in Retinal Vein Occlusion with Macular Oedema Valerie Juniat, Eleni Tsolakou, Nishal Patel Kent and Canterbury Hospital Introduction: Ozurdex is a biodegradeable intravitreal steroid implant that is currently NICE approved for treatment of patients with MO due to RVO. Purpose: This retrospective audit aimed to evaluate the visual outcomes, anatomical outcomes, and complications in patients treated with Ozurdex for MO secondary to RVO. Method: Data was collected using Medisoft and Topcon OCT imaging. Data was analysed using Microsoft Excel and statistical analysis was carried out using Medcalc software. Results: 182 Ozurdex implants were carried out over 15 months between 2012 and 2013. 115 procedures were included in the audit. 6% were lost to follow up. The average time interval between pre-treatment baseline visual acuity (VA) and post-treatment final VA was 6 months (range 2 to 19 months). Mean difference in VA post-treatment was -0.08 (Logmar). OCT analysis showed average central retinal thickness (CRT) reduction of 159µ m post-treatment. Complications included cataract formation (4.4%) and raised intraocular pressure >35mmHg (4.3%). 3.4% patients converted into ischaemic vein occlusion. 54 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Conclusion: This audit demonstrated that Ozurdex implantations achieved anatomical improvement in patients with MO secondary to RVO that did not correlate with visual improvement. It also highlighted a lack of rigorous measures for reviewing patients post treatment. The audit recommends a dedicated retinal vein occlusion service to ensure patients are reviewed in clinic at appropriate time intervals to achieve better outcomes. Alternative treatment modalities such as laser treatment and anti-VEGF injections should be available for patients who do not achieve visual improvement with Ozurdex, and vice versa. 40. Implications of multiple intravitreal injections for subsequent cataract surgery Jack Gormley, Mark Costen, Hull & East Yorkshire Eye Hospital Introduction: The use of intravitreal therapy for conditions affecting the posterior segment continues to grow, with many patients in the original wet AMD cohort having in excess of 40 injections of anti-VEGF therapy per eye. Anecdotally, patients who have had multiple intravitreal injections are often noted to have more dense cataracts, with potentially more challenging surgery at the time of phacoemulsification. Purpose: To ascertain whether cataract surgery following multiple intravitreal injections was associated with a greater number of surgical difficulties and / or complications during subsequent cataract surgery Method: We identified 29 patients retrospectively from the hospital wet AMD database who had received in excess of 5 intravitreal anti-VEGF injections and who had also undergone subsequent cataract surgery. Operative details were taken from the operation note, and details including phaco power used, intraoperative complications, use of capsular tension ring and surgeon's comments, were recorded. Results: 29 patients (74-93y) were identified, who had received between 5 and 29 intravitreal injections of anti-VEGF therapy, and who had also had cataract surgery performed by a senior surgeon. 6 patients (20.7%) had intraoperative difficulties reported. 3 patients had unstable capsular bags requiring capsular tension ring insertion. 4 patients were noted to have extremely dense cataracts peroperatively, one of whom developed corneal decompensation postoperatively. 1 patient had a dropped nucleus. Conclusion: Although limited in scope, this small retrospective study suggests that cataract surgery in patients undergoing multiple intravitreal injections may be more problematic than 'normal'. This raises important considerations in terms of taking informed consent for these patients, appropriate case-mix stratification, timing of surgery, and ensuring the skill level of the surgeon is appropriate for the case in question. Further prospective study into this area is planned. 41. Cardiopulmonary resuscitation and the stand-alone ophthalmic unit Priscilla Mathewson, Samer El-Sherbiny Birmingham Midland Eye Centre Introduction: A safe protocol for patients who become acutely unwell or sustain cardiopulmonary arrest whilst in a stand-alone ophthalmic unit is essential and requires detailed risk assessment. Purpose: To establish the frequency of emergency medical and cardiopulmonary arrest calls at our institution over a 10-year period and to survey practice in similar stand-alone ophthalmic units. Method: Switchboard records were searched for all ‘2222’ and ‘999’ calls from our institution between June 2003 and June 2013. Seventeen months of consecutive ‘2222’ call audio-records were analysed. An online survey was conducted for the six stand-alone ophthalmic units in the United Kingdom to establish their frequency of medical emergency calls, and management protocols. Results: ‘2222’ calling was introduced to our institution in June 2005. There were an average of 2.3 ‘2222’ calls and 1.5 ‘999’ calls per month between June 2005 and June 2013. Only 9% of ‘2222’ calls and 7% of ‘999’ calls were made out of hours. Four out of the six units surveyed dial ‘2222’ to access the Emergency Medical Response Team (EMRT) of an affiliated general hospital. The remaining two units have an eye hospital based EMRT with a resident doctor on site at night. Conclusion: Cardiopulmonary arrest is an infrequent event in our unit with the majority of emergency medical calls being made between 08:00 and 20:00. More information is required regarding predisposing factors and patient outcomes across multiple centers before a safe protocol can be devised for emergency medical assistance in a stand-alone ophthalmic unit. 55 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance 42. Missed pathology or disease progression? Follow up of patients with acute ‘flashes and/or floaters’ Shreya Haldar, Melanie Chak Royal Berkshire Hospital Introduction: Posterior vitreous detachment (PVD) occurs in 75% of patients aged over 65 years and represents a significant proportion of eye emergencies (1). The natural history of patients presenting with acute photopsia and floaters is unknown. Furthermore it is not certain if these patients require follow up to detect disease progression or missed pathology. Purpose: To determine if patients presenting with acute symptoms of flashes and floaters (within 10 days) require routine follow up 10 to 14 days post presentation. Method: All patients presenting with flashes and floaters to eye casualty during August – September 2012 were reviewed. Patient notes were cross-referenced with Argon laser room and theatre records. Results: 200 patients presented with flashes and/or floaters. Of these, 110 complete patient notes were reviewed. 63/110 patients were followed up within two weeks after presentation. 3 patients (4.76%) were diagnosed with sight threatening pathology at follow up (1 retinal tear, 2 retinal detachments). Conclusion: A significant proportion of patients that presented with flashes and floaters were seen to have further pathology on follow up that required intervention. The management of these patients represent a typical eye casualty service and as such would suggest that patients presenting with acute retinal symptoms should be routinely followed up. 43. Distorted Pathways: Trials and tribulations in Delivering Lucentis Service in Diabetic Macula Oedema (DMO) in a Large Foundation Trust Aaron Thye Wang Ng, Khazina Waraich, Jiang Li, Rangarajan Prabhu, David Kinshuck, Ramesh Sivaraj Heart of England NHS Foundation Trust Introduction: Anti-VEGF (Lucentis) is NICE approved for the treatment of visual impairment in DMO. Increasing demands and limited resources pose challenges in delivering timely treatment. Our trust, serving a population of 1.2 million, has recently initiated our Lucentis service for DMO. We report our results with barriers in our service delivery. Purpose: To monitor and compare visual acuity (VA) and OCT outcomes in patients awaiting and following anti-VEGF treatment with landmark trials, identify obstacles and apply changes to the service delivery. Method: Prospective collection of patient demographics, VA, OCT findings, DMO duration, diabetic control and listing-to-treatment time. Patients with poor quality OCT are excluded. Results: We report interim results from our prospective audit. Of November 2013, 340 eyes of 272 DMO patients were listed for anti-VEGF. Patients were prioritised based on clinical urgency. To date, 80 eyes needing treatment have been audited. 40 eyes were treated with Lucentis and 40 eyes awaiting treatment. Mean listingto-treatment time is 141 days (94-205). Follow-up data revealed treated eyes had a mean VA improvement and retinal thinning of 1 line (Snellen) and 114 microns respectively. Eyes awaiting treatment had a mean VA reduction and retinal thickening of 2 lines (Snellen) and 100 microns respectively. Barriers include reduced capacity and treatment space. Conclusion: Our audit provides insight into real world logistical issues in administering Lucentis in DMO patients at one of the largest foundation trusts in the UK. Such problems need to be identified and tackled to mirror the success of anti-VEGF treatment in DMO as reported in landmark trials. 44. Unilateral vs Immediate Sequential Bilateral Cataract Surgery: A Comparison of Inpatient Fall Rates Alasdair Kennedy, Tom Pampiglione, Pankaj Puri, Adil Jaulim Derby Royal Hospital Introduction: Evidence suggests fall rates drop following unilateral cataract surgery. In a prospective study, 31 out of 84 patients reported falls preoperatively and 6 continued to fall postoperatively.(1) Furthermore, a RCT demonstrated a 34% reduction in falls.(2) In 2007, Chesterfield Royal Hospital (CRH) started providing an immediate sequential bilateral cataract (ISBC) surgery service. One advantage is that ISBC eliminates the period between two separate operations for patients with large refractive errors. Interestingly, the concept that ISBC may further reduce falls has not been explored. 56 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Purpose: The aim of this audit is to compare inpatient fall rates between unilateral surgery in Derby Royal Hospital (DRH) and ISBC surgery in CRH. Method: The time period was from 2007 to date. All data was pooled using PAS. At CRH, there were 17 ISBC patients. This data was cross matched against 6917 inpatient falls recorded in patient safety databases. In DRH, 2805 unilateral cases were cross matched against 3587 inpatient falls. Results: 2 patients fell as inpatients in the CRH group, both prior to their cataract operations. Similarly, in the DRH group, 2 fell preoperatively. No patients fell postoperatively in either group. Conclusion: Postoperative inpatient fall rates did not differ between the two patient groups. However, the ISBC group was not large enough for these findings to be significant. Another caveat was that only inpatient falls were examined thus not excluding a discrepancy in the community. A prospective study demonstrating that ISBC surgery reduces falls would support its cost effectiveness and is recommended. 45. Refractive outcomes of cataract extraction in patients having undergone previous refractive surgery: Which formula is best? Chris Matthews , Alan Connor James Cook University Hospital Introduction: Selection of an appropriate intraocular lens involves measurement of axial length and corneal curvature. Formulae based both on optical principals and postoperative refractive outcomes are in use. Refractive surgery changes the shape of the cornea and may render the use of these formulae inaccurate. Purpose: To assess the refractive outcome of patients undergoing phacoemulsificaiton who had previous refractive surgery and which method of lens calculation was most likely to result in a refractive outcome within 1D of intended outcome (RCOphth audit standard >85%) Method: A retrospective case note review of all patients attending our cataract surgery service who had a history of refractive surgery. Results: 52 eyes were included in our study of which 79% were within 1.0D of aim. Types of refractive surgery included; LASIK (40 eyes), LASEK (2 eyes), RK (6 eyes) and PRK (4 eyes). The formula used in 38 eyes was, HAIGIS-L. In this group 81.6% were within 1 D of aim. The ASCRS online calculator was used in 11 eyes. 63.6% were within 1D of aim. SRK-T was used in 3 eyes, all were within 1D of aim. The numbers are too small to make comparisons. Conclusion: Refractive surgery makes it difficult to predict post cataract extraction refractive outcomes. Within this selected group of patients we did not meet the RCOphth audit standards. Our data suggests that Haigis-L results is a more accurate prediction of refractive outcome compared to the ASCRS online calculator. 46. Adherence to angle closure guidelines Yun Wong, Scott Fraser Sunderland Eye Infirmary Introduction: This audit focuses on the adherence to the acute angle closure glaucoma (ACAG) protocol produced in October 2012 by the glaucoma unit at Sunderland Eye Infirmary. The audit also included registrar's opinions of why they deviated from this protocol. Purpose: The purpose of the audit was not to evaluate the guidelines themselves but to see how closely departmental protocols are adhered to and the possible reasons for deviations. Method: 20 consecutive cases of ACAG were identified and the relevant information was collected retrospectively using a 12 question proforma. Additionally an anonymous online questionnaire was circulated to all registrars who had worked in the unit. Results: 20 patient's notes were analysed. Only one patient had been managed completely according to the angle closure protocol. The most common cause for non adherence was addition of further medication or the patient not being discharged home on the correct treatment. The results highlighted that both iopidine and timolol were commonly added to treatment despite not being part of the guidelines. Even though 100% adherence to the guidelines was poor, on average 70% of the guidance was followed. 57 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance The SpR questionnaire revealed that 40% of registrars felt that they had adhered to the angle closure guidelines whilst a further 30% felt it was necessary to stray from them due to specific patient related reasons. Conclusion: Complete adherence to the angle closure protocol at Sunderland Eye infirmary was low. The most common failure being the addition of further medication. The questionnaire revealed that even though adherence was poor, most registrars believed that they had followed the guidelines. The study highlighted that the SpRs need to be made more aware of the existence of the protocol. We are therefore adding educational sessions into the internal teaching programme to increase awareness and will re-audit in a years time. 47. Early experiences with dexamethasone intravitreal implant (Ozurdex) for retinal vein occlusion: an audit and service evaluation Weijen Tan, Kerolos Bassilious, Dharmalingam Kumudhan , Winfried Amoaku Queen's Medical Centre, Nottingham Introduction: Ozurdex is licensed for the treatment of macular oedema following retinal vein occlusion (RVO). There is limited information on the effect of this new treatment in clinical practice. Purpose: To assess visual acuity (VA), central retinal thickness (CRT), complications in our patients and adherence of Ozurdex re-treatment with RCOphth guidelines (2010). Method: Hospital records were retrospectively searched for patients who received Ozurdex between 1/1/2012 and 1/6/2013. VA, CRT, intraocular pressure (IOP) and complications were obtained from paper and electronic records. 57 eyes were included, 37 branch RVO (BRVO) and 20 central RVO (CRVO). Data was analysed using Microsoft Excel. Results: LogMAR improvement >0.2 was observed in 7/21 (33.3%) BRVO eyes and 3/9 (33.3%) CRVO eyes at 3 months. CRT reduction >200μm was observed in 13/19 (68.4%) BRVO eyes and 3/8 (37.5%) CRVO eyes at 3 months. Among BRVO eyes without re-treatment, mean LogMAR improvement was 0.105 (n=21) at 3 months and 0.023 (n=12) at 6 months. Mean CRT reduced by 205μm (n=19) at 3 months and 18μm (n=10) at 6 months. All 61 Ozurdex re-treatments had VA and CRT which complied with RCOphth recommended criteria. 8/61 (13.1%) eyes were re-treated before the recommended interval of 4 months. 18/57 (31.6%) eyes had IOP>22mmHg after Ozurdex treatment. Conclusion: Ozurdex is effective in reducing macular oedema secondary to RVO. Optimum time for retreatment is variable, requiring close follow-up. Short term complications were mainly limited to raised IOP. 48. One Stop Temporal Artery Biopsy Service Karim El-Assal, Sachin Salvi, Judith West , Jennifer Tan, Irene Pepper, Zanna Currie Sheffield Teaching Hospital Introduction: Giant cell arteritis (GCA) is a chronic vasculitis of large and medium vessels with an Incidence of 2.2/10000 patient-years in the UK. Visual loss occurs in up to one-fifth of patients. Temporal Artery Biopsy (TAB) is the gold standard for diagnosis but delays/negative biopsies can occur due to inadequate service provision. A one stop TAB service was hence established by the Ophthalmology department in Sheffield from June 2010. Patients can be booked directly for TAB by clinicians from all specialities by means of a customised referral form. Purpose: To assess the effectiveness of the service in respect to waiting times, complications, length of biopsy specimen, histopathological results and further management based on the biopsy result. Method: A retrospective case note review of patients referred to the TAB service from June 2010 till end of September 2012 was done. 96 patients were identified. Results: 88.5%(85/96) of patients had TAB within two weeks of referral. 1%(1/96) had non-arterial biopsy. 84%(81/96) of specimens were equal to or longer than 1 cm in length. 27%(26/96) were positive biopsies. No major intra or post-operative complications were documented. Treatment was altered in 19%(18/96) based on the result. 58 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Conclusion: The service has streamlined the pathway for patients suspected with GCA from Ophthalmology and other specialities while reducing the wait time. The incidence of complications and non-arterial biopsies was low. The length of biopsy specimen was identified to be suboptimal in 16% of cases which needs improvement to reduce the possibility of false negative results. 49. An audit to evaluate the efficacy of Selective Laser Trabeculoplasty (SLT) as adjunctive therapy for Primary Open-Angle Glaucoma patients at a district general hospital Rahul Dwivedi, Janine Brazier , Jose Gonzalez-Martin Southport & Ormskirk Hospital NHS Trust Introduction: Selective Laser Trabeculoplasty (SLT), although used infrequently, offers an alternative and adjunctive treatment option to pharmacological agents in managing Primary Open Angle Glaucoma (POAG). Purpose: This audit evaluates the efficacy of SLT in lowering intraocular pressure (IOP) in POAG patients on pharmacological treatment at a district general hospital. Method: A retrospective audit of patients undergoing SLT over a seven-month period between 25/9/2012 to 27/4/2013 was performed. Data collected assessed patient demographics, pseudophakia status, IOP-lowering medication used pre-and post-SLT, number of SLT applications, IOP pre-and post-SLT and any further surgical intervention. Results: Total of 50 eyes from 50 patients (male=19, female=31). Mean age=74 years. Thirty-seven patients (74%) were phakic. Twelve different IOP-lowering drops were used by patients pre-SLT (0 drops=10%, 1 drop=12%, 2 drops=40%, 3 drops=38%). Thirty-one patients (62%) continued on same number of drops postSLT, 10% stopped one drop and 6% added one drop. Mean number of SLT applications=102 applications per eye. Mean IOP pre-SLT=27mmHg (SD=5.2). Mean IOP post-SLT=23mmHg (SD=6.1). Thirty-seven patients (74%) had an overall reduction in IOP at follow-up compared to their pre-SLT IOP. Five patients (10%) had a trabeculectomy operation on the eye treated with SLT. Conclusion: SLT demonstrates an IOP reduction in the majority of our patients, achieving a mean IOP reduction of 4mmHg, whilst allowing 10% of patients to decrease the number of their IOP-lowering medications. Although 10% of our patients eventually required surgical intervention, SLT provides an effective option at countering raised IOP that has not responded adequately to pharmacological treatment. 50. Audit of Eye Casualty neuro-ophthalmology referral system at Bristol Eye Hospital Martin Bennett Bristol Eye Hospital Introduction: BEH sits in the county of Avon with a population catchment area of approximately 1 million. It sees approximately 25,000 Eye Casualty attendances annually, of which they are approximately 18 neurology cases per week. Prior to 2011, these cases once assessed in casualty were not seen in dedicated neuro-ophthalmology clinics, as there was not enough capacity at the time. Two audits were conducted which have subsequently changed our practice. The first in 2011, which helped to quantify the number of cases seen and the need for dedicated neuro-ophthalmology clinics at BEH, as patients were followed-up in a combination of motility clinics in-house and others referred to Frenchay neurology hospital. Purpose: To quantify the number of neuro-ophthalmology cases seen in casualty. Determine the number of urgent out-patient slots required in neuro-ophthalmology and motility clinics for casualty referrals. Method: Two prospective 4-week audits completed in 2011 and 2013. Data collected from casualty notes for the following: Number of patients seen Provisional diagnosis Investigations Urgency of follow-up required Results: 18 patients were seen in the 2011 Audit. It highlighted the need for 5 – 6 urgent neuro-ophthalmology outpatient weekly slots to accommodate casualty referrals. As a result dedicated neuro-ophthalmology clinics have since been created. 59 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Conclusion: The 2011 audit was pivotal in identifying a need for urgent neuro-ophthalmology outpatient appointments for casualty referrals. The implemented recommendations have effectively addressed the problem. The 2013 re-audit confirms the appointments are being optimally utilized. As it comes to completion, absolute numbers will be adjusted accordingly. 51. Can general A&E doctors manage common eye emergencies? Michael Benjamin, Oluwatoyin Oyede, Philip I Murray Birmingham and Midland Eye Centre Introduction: Eye casualties in the general A&E department constitute 6% of the overall workload, with 69% of them treated without further consultation of eye specialists. Also 21% of UK Medical Schools do not have compulsory attachments in Ophthalmology that may have implications in the management of eye casualties. Purpose: We wished to study whether general A&E doctors can manage common eye emergencies. Method: A questionnaire was distributed to doctors working in general A&E departments in 6 Trusts and included questions on: •Grade of doctor •Adequacy of undergraduate Ophthalmology teaching •Perceived competence in using ophthalmological equipment •Confidence in formulating a differential diagnosis and management plan for common eye emergencies Results: There were 65 responses from 12 Foundation, 19 CT1-ST2, 12 ST3-6+, 13 SAS doctors and 9 Consultants. 37/65 (57%) doctors thought their undergraduate ophthalmology teaching was inadequate. Only 19/65 (29%) felt competent or highly competent in using a direct ophthalmoscope and 21/65 (32%) in using a slit-lamp. The number (%) of doctors who were confident or very confident in formulating a differential diagnosis and management plan for: the red eye was 26/65 (40%), acute loss of vision 22/65 (34%), ocular trauma 21/65 (32%) and chemical injury 28/65 (43%). Conclusion: Many doctors working in general A&E departments do not feel they are competent in using ophthalmological equipment or confident in managing common eye emergencies. 4/12 (33%) of Foundation doctors believed they were not competent in performing ophthalmoscopy and this skill is an F1 competency in the Foundation Programme curriculum. This highlights the importance of adequate undergraduate Ophthalmology teaching. 52. Validity of listing for cataract surgery by hospital-based optometrists Pallavi Tyagi, Simon Hewick Raigmore Hospital, Inverness Introduction: A model of integrated management of patients by optometrists and ophthalmologists is assessed Purpose: To assess the validity of listing for cataract surgery by hospital-based optometrists. Method: Prospective cohort of patients listed by hospital-based optometrists was examined by 2 ophthalmologists on the day of surgery Results: 63 patients (36- 1st eyes, 27- 2nd eyes) examined. Out of 36 patients, 30 (83%) had no risk factors for surgery, 4 (11%) had risk factors like Fuch’s endothelial dystrophy, glaucoma, poor dilator and trauma respectively which were correctly identified and 2 (6%) had risk factors like pseudoexfoliation and corneal guttattae which were missed by hospital optometrist. Overall risk factor identification validity was 94% (34/36) with a specificity of 100% and sensitivity of 66.7%. Listing for 2nd eyes was based on post-op cataract surgery form with priority outcome (PO) for fellow eye after first eye cataract surgery. Of the 27 patients, 2nd eyes with PO-1/2 were 48%, PO-3 were 7%, PO-4 were 15% and re-referrals were 19%. PO-1/2 were listed for anisometropia/poor VA in fellow eye and mean gap between 2 eye surgeries was 13 weeks. PO-3 listed for poor VA and mean gap was 5 months. PO-4 listed for patient preference and mean gap was 20 weeks. Re-referrals were made poor VA over time and mean gap was 6 years. Conclusion: For first eyes, the identification of risk factors by optometrists needs to be strengthened. Post-op cataract surgery form with priority outcome for community optometrists is successful in prioritising timing for surgery for fellow eye. 60 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance 53. Proliferative diabetic retinopathy referrals from Diabetic Retinopathy Screening Service Wales (DRSSW): Role of fast track referral system Shantanu Gudsoorkar, Phillipa Knowles , Sarah Hale University Hospital Of Wales , Cardiff Introduction: The fast track referral system was introduced in Cardiff and Vale Local Health Board to improve our performance and meet the National Screening Committee (NSC) criteria for referrals of possible proliferative diabetic retinopathy from DRSSW. Purpose: The previous audits of R3 referrals from DRSSW showed that only 12% (2007) and 18% (2009) of these referrals were seen in the diabetic retinopathy clinics within 2 weeks in comparison to a minimum of 60% as per NSC criteria. A robust fast track referral system was introduced to improve these figures and prevent the delay in treating this vision threatening problem. This retrospective audit was done to confirm that the changes implemented were effective meeting the standards. Method: A retrospective audit with the data of all patients referred with possible proliferative diabetic retinopathy obtained from DRSSW referral database. Further information regarding date and mode of referral, date of clinic appointment, diagnosis , date of laser treatment if necessary were obtained from the clinical portal of Cardiff and Vale Local Health Board. Results: 76.3% patients were offered appointments within 2 weeks and 84.2% within 4 weeks meeting the NSC criteria of 60% < 2weeks and 80% <4 weeks. The standards for timescales for Screening to laser (82.4% <6 weeks) and listing to laser (94%< 2 weeks) were also met. Conclusion: Implementation of a robust fast track referral system was effective in meeting the NSC criteria and successfully closing the audit loop. 54. Visual impairment in acute medical admissions: streamlining ophthalmic referral Frederick R Burgess, Elizabeth D Hawkes, Owen D Ingram, James E Neffendorf Royal Bolton Hospital Introduction: Visual loss carries increased morbidity in the elderly population and is frequently overlooked by medical physicians. Despite often having reversible disease, many patients are not referred to ophthalmologists since vision is not measured. Purpose: To assess whether those admitted to hospital with general medical problems have impaired vision (worse than 6/18 Snellen) and if it is measured. Method: We retrospectively examined case notes of 50 consecutive acute admissions to the medical admissions unit (MAU) in a 48 hour period in the over 55 age group to see if VA had been measured. We subsequently tested best corrected visual acuity (BCVA) of 30 patients aged over-55 in the MAU. Presenting complaint, diabetic status, falls history, whether they had previously seen an ophthalmologist and when they last visited an optician was also noted. Results: 0% (0/50) of patients had VA measured by the admitting medical team. 10% (3/30) of patients had BCVA below 6/18 in their better eye, 2 of whom had never seen an ophthalmologist previously. 23% (7/30) of patients had BCVA of worse than 6/12 in both eyes. Conclusion: 10% of admissions had substantially impaired BCVA and 23% had VA below DVLA driving standard. We recommend visual acuity is routinely assessed in all medically admitted patients. A proforma is suggested as a care pathway for physicians to follow regarding urgency of ophthalmic referral. This will streamline ophthalmic referrals to those most in need without overburdening the service. 55. Are we meeting the British Rheumatology Society (BRS) Guidelines for Temporal Artery Biopsy? Sophie Hickling, Susan Mollan University Hospital Birmingham Introduction: The BSR guidelines for Giant Cell Arteritis (GCA) include guidance for TAB length (between 12cm). The literature finds rates of positive TAB to be between 15% to 29%, depending on the type of practice that is surveyed. 61 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Purpose: An evaluation of a Temporal Artery Biopsy (TAB) Service to improve local practice, and compare the rate of positive TABs to the literature. Method: Prospectively collected surgical database of all undergoing a TAB from October 2012 - October 2013. Demographics, inflammatory markers, corticosteroid treatment, ischaemic complications, histopathological diagnosis, length of specimen and TAB complications were recorded. Results: Thirty cases were included, 3 males and 27 females with a mean age of 70 years (Range 59-92 years). One case had bilateral TAB. Rheumatology were the largest users of the service, followed by Ophthalmology and General Practice. The mean TAB specimen length was 13.9. 20% were positive, a further 13.3% negative biopsies were treated as clinically GCA. There was no significant difference in length between the positive (13.8±6.1mm) and negative (14.0±5.4mm) biopsies (student t-test p<0.01). No surgical complications were seen. Conclusion: This service meets the standard set. Good practice points include intraoperative measurement of specimen (to allow for histopathological fixation loss) and a patient information leaflet. 56. Our 10 years’experience in treating periocular spasm with botulinum toxin Aneesa Rahim, Jessica Montford, Joyce Burns , Raghavan Sampath Leicester Royal Infirmary Introduction: Blepharospasm is a bilateral, progressive, involuntary contraction of orbicularis and facial muscle.Occurs in 1 in 20,000 population.Cause functional blindness.Misdiagnosed as dry eye syndrome as it presents as photophobia,excessive blinking,dryness or uncontrolled closure of eyelids Purpose: Is to analyse the effectiveness of botulinum toxin injection in treating periocular spasm. Method: It’s a 10 year retrospective case notes review of 168 patients who received botulinum toxin injection for the periocular spasm are evaluated according to gender, ocular complaints, treatment outcome and complications. Results: One hundred and sixty eight patients received botulinium toxin injection for the particular spasm of which 84(50 %)had essential blepharospasm,38(27%)had hemifacial spasm,41(24%) had facial palsy with aberrant reinnervation including iatrogenic causes,4(2%)apraxia of the lid and 1(0.5%)other causes.The age group ranged from 28 to 90 years with the mean age of 62 years.57%(95) of females and 43%(73)of males received toxin.All patients underwent through ophthalmic examination to exclude ocular surface diseases.The patients with hemifacial spasm were investigated with MRI brain to rule out vascular loop and cerebropontine angle lesions prior to injection.Dose varied between 2.5U to 5U.The majority of patients received injection to 2 lids 57% (96) followed by 4 lids 33%(56)and 7%(12) lacrimal gland;however 2.3%(4)declined treatment.Muscle spasm reduced significantly within 2 days of the first injection and effect lasted for 10 to 12 weeks.96% of patients had regular injections every 3 months.Complications related to the treatment included transient ptosis 1% (2), diplopia 0.5% (1) and watering 0.5% (1).Only one patient needed surgical correction for the toxin induced ptosis.6%(10)of patients were non responsive to botulinum toxin underwent orbicularis stripping (8) and frontalis brow suspension (2). Conclusion: Treatment with botulinum toxin A was effective in periocular spasm, with very low complication rates. 57. The provision of an objective visual acuity by General Practitioners during eye casualty referrals: why is it lacking and how do we improve it? Osama Giasin, Elizabeth Goodchild, Ruth Jones, Eulee Seow, Damien Chia Ming Yeo Royal Glamorgan Hospital Introduction: An objective visual acuity is a necessary part of the clinical examination for any ophthalmic emergency. Knowing the acuity allows for a quick diagnosis as well as ensuring a safe triage. However, GPs do not always provide a VA. This limits the assessment of the triaging clinician and can slow the clinic down. Purpose: 1) Find out what are the most common reasons for not providing a VA. 2) Once we know why, we will address the issues by providing an educational leaflet to the GPs. 3) Recollect data to see if this particular technique has worked. Method: Prospective data collection of 30 consecutive telephone referrals(GPs only) followed by an intervention sent out in the post and further data collection of 28 consecutive telephone referrals. Results: During the first period, 40% of the GPs did not provide a VA. The top 3 reasons for not providing a 62 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance visual acuity were the absence of a Snellen chart(31%), lack of a visual problem(17%), and the patient being too young(9%). After our intervention, 46% of the GPs did not provide a VA. The top 3 reasons remained the same. Conclusion: An objective visual acuity is often not provided during a general practitioner’s referral to eye casualty. The lack of a Snellen chart appears to be the chief reason. However, even when specifically providing tips to overcome this, the rate did not improve. 58. Time from cataract surgery to Nd:YAG capsulotomy at University Hospitals Birmingham (UHB) NHS Foundation Trust Hannah Shereef, Haider Ibrahim, Mike Burdon University Hospitals Birmingham NHS Foundation Trust Introduction: Nd:YAG capsulotomy is a laser procedure used to treat posterior capsular opacification (PCO), the commonest long-term complication following cataract surgery. Royal College of Ophthalmologists guidelines state that the procedure is indicated for visual symptoms which can be attributed to evidence of PCO on slit-lamp examination. Purpose: To perform a service evaluation of the use of Nd:YAG capsulotomy at UHB NHS Foundation Trust. Method: For each eye, we collected data on the length of time from cataract surgery to Nd:YAG procedure, and whether patients were discharged following cataract surgery with no routine follow-up, or in regular follow-up in ophthalmology for other conditions. Results: Data for 95 (89%) of 107 consecutive eyes which had Nd:YAG capsulotomy over a 4 month period were available for analysis. The mean time from cataract surgery to Nd:YAG capsulotomy was 1142 days (3 years, 1.5 months). 46% of Nd:YAG capsulotomy procedures were performed after the second year from cataract surgery. For patients followed up after cataract surgery, the mean time from cataract surgery to Nd:YAG capsulotomy was 870 days (2 years, 5 months), compared to 1575 days (4 years, 4 months) for patients with no routine follow up (p=0.003). Conclusion: Our findings suggest that the 2 year follow-up time often quoted in studies comparing PCO rates with different intraocular lens designs is inadequate and only picks up a half of patients who will go onto develop PCO. 59. Health Informatics in Ophthalmology - The Past, Present and Future Abison Logeswaran, Thuwaraga Logeswaran, Yu Jeat Chong, Yogesan Kanagasingam Imperial and City University Introduction: Health Informatics (HI), specifically electronic patient records (EPR’s) are an increasingly important aspect of modern medicine. They provide a number of distinct advantages over paper based medicine: 1)Increased accessibility to medical records in various geographical locations 2) Provide a temporal and spatial link within different episodes of care 3) The possibility of decision support systems to increase efficiency. Purpose: To assess the specific requirements, current use and potential areas of expansion within Ophthalmology HI and EPR’s Method: A literature review was conducted using key terms: 1) Ophthalmology 2) Electronic Patient/Health Records 3) Open Standards 4) HL7 5) DICOM Results: 1) The rate of EPR/HI uptake within Ophthalmology lags behind that of other medical specialties 2) There are four main requirements of Ophthalmology that potentially underlie poor uptake of EPR’s in Ophthalmology • Medical and surgical specialty • Ophthalmology is heavily dependent on the documentation and analyze of visual data • Traditional parameters such as vital signs are different from normal medical disciplines • Ophthalmology tends to use specific diagnostic tools that are not routinely used in other disciplines 3) Examples of HI use in Ophthalmology • DRSCREEN • OpenEyes 63 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Audit & Clinical Governance Conclusion: There is evidence that HI and EPR’s are increasingly being used in ophthalmology and have the potential to assist in screening programs. However, at this present time widespread use of such system does not exist. There needs to be greater analysis of end user needs and increased use of open standards to enable data sharing and increased uptake of such systems. 60. Review of Glaucoma Domiciliary Service at Devon Usama Faridi, Naeem Gurmani, Jim Faverty , Michael Smith, Daniel Byles Royal Devon and Exeter Hospital Introduction: Glaucoma domiciliary service (GDS) is a Optician-led service with a central coordinator and is supervised by Consultant Ophthalmologists at Royal Devon and Exeter Hospital. The glaucoma patients who are unable to attend normal follow-up clinics due to significant physical and mental disabilities are offered GDS at their residence. Purpose: This study investigated the effectiveness of Glaucoma Domiciliary Service in Devon through an audit using locally produce protocols. Method: The cases were identified from the records of visiting optometrists. The medical record of 91 patients were analysed in detail for this audit, as clinical records of 14 patients were not available. The protocols were produced by using NICE guidelines by Glaucoma Consultants and optometrists. The protocols included the referral criteria, plans for the follow-up appointments, and the examination protocol during each home visit. Results: One hundred and five home-bound patients were benefitted with from GDS from January 2010 to February 2012. Patients with different forms and severity of glaucoma were seen. The main reasons for referral were patients with Alzheimer’s disease, mobility problems and frail elderly patients. The GDS protocols were followed in majority (98%) of cases. Adequate actions were taken in all patients where intra-ocular pressures were not within the target level and the follow-up appointments were according to the protocols. Conclusion: This study shows that GDS is safe and effective in managing glaucoma patients who are otherwise unable to attend hospital due to various reasons. We recommend the continuation of the service in Devon. 61. Public knowledge of common eye disease Priyanka Mandal, Anuj Vakharia, Oluwatoyin Oyede , Philip I Murray Birmingham and Midland Eye Centre Introduction: Cataract, glaucoma and age-related macular degeneration (AMD) are common eye disorders. It is vital that the public is aware of these conditions, as there are now effective treatments than can restore or prevent sight loss. Purpose: To study the public knowledge of common eye disease. Method: A questionnaire based on cataract, glaucoma and AMD was trialled on 100 members of the general public. Questions included: the part of the eye affected, being able to locate it on a diagram, symptoms, treatment and if it was a ‘blinding’ condition. Results: There were 58M, 42F; 71% aged 20-49 yrs, 29% 50 yrs and older. 65% had heard of cataract, only 24% knew it affected the lens, 82% could not locate it on the diagram but 38% thought surgery was the treatment. 48% had heard of glaucoma, 93% did not know the optic nerve was affected, 97% could not locate it on the diagram and 81% had no idea how it was treated. 82% had not heard of AMD, 95% did not know the retina was affected, 99% could not locate it on the diagram and 91% had no idea how it was treated. 48%, 69% and 92% did not think cataract, glaucoma and AMD, respectively were ‘blinding’ conditions. Conclusion: There was a lack of knowledge regarding common eye conditions, and that included people of an age when these conditions occur. Although some had heard of them, they did not understand them. It is imperative we increase public awareness to prevent sight loss 62. Appropriateness of referrals into an optometrist led rapid access wet age related macular degeneration clinic Deborah Bott, Narendra Dhingra Mid Yorkshire NHS Trust Introduction: Wet age related macular degeneration (AMD) is an ocular emergency. Patients suspected with 64 ABSTRACTS: Audit & Clinical Governance / Cataract & Refractive Surgery Annual Congress Final Programme & Abstracts Birmingham 2014 this condition should be assessed and treated within 2 weeks. In February 2013, an optometrist led service for all patients referred with this condition was established at our hospital. Purpose: To look at the appropriateness and origin of referrals into the optometrist led rapid access wet AMD clinic. Method: Retrospective review of suspected new wet AMD referrals into the optometrist clinic was carried out. The data was collected and analyzed using Microsoft Excel package. Results: 41 patients were seen in this clinic between February and July 2013. 61% of referrals were received from community optometrists, 34% from diabetic retinal screening services (DRSS) and 5% from general practitioners (GP). The mean time from referral to clinic was 6.6 days. All patients referred from community optometrists or GP were seen within 2 weeks. Referrals from DRSS took up to 25 days to be seen. Nearly half (47%) of patients were discharged at initial visit and did not require any further investigations (50% of these referrals originated from DRSS, 44% from community optometrists and 6% from GPs). From those deemed appropriate, 90% required fluorescein angiography, of which 75% were diagnosed with wet AMD. Conclusion: Referral from community optometrist or GP is the quickest. Almost half of the referrals from optometrists and DRSS were inappropriate and required no further investigations. 63. An evaluation of the usage of Medisoft Electronic Patient Record system in Birmingham and Midland Eye Centre Lauren Atkins, Sarah Burgin, George Moussa Birmingham and Midland Eye Centre, City Hospital Introduction: Across the NHS, electronic patient record (EPR) systems are replacing paper documentation, enabling improved availability and quality of patient information and more efficient auditing. However, in order for this to be achieved, EPR systems must be used correctly. Medisoft EPR system has been utilised at Birmingham and Midland Eye Centre (BMEC) Emergency Department since February 2013. Purpose: This audit assesses completeness of Medisoft clinical documentation at BMEC Emergency Department. Method: Data were collected retrospectively from Medisoft records of BMEC emergency department attendances during August and September 2013, following referral from a GP or optometrist. Results: Medisoft records of 200 attendances were reviewed. Diagnosis information was entered in the correct section in 67% of cases, and medication was entered in the correct section in 85% of cases. Correct recording of both diagnosis and medication was present in 58% of records. In 6% of cases, no diagnosis information was documented. Referral letters were scanned and linked in for 6% of patients. Conclusion: At BMEC emergency department, Medisoft is not being used fully. Although in most cases, diagnosis and medication information was recorded, improvements in training and utilisation are needed to ensure this information is recorded correctly. Instances of no diagnosis information must be eliminated, and all referral letters must be scanned. As EPR systems are adopted nationwide, other eye units may encounter similar problems; this issue requires monitoring as it pertains to accurate note keeping and therefore clinical governance. CATARACT & REFRACTIVE SURGERY 64. The Development of a Virtual Reality Training Programme for Ophthalmology: Repeatability and Reproducibility Korina Theodoraki, George M Saleh, Stewart Gillan, Paul Sullivan, Fiona O'Sullivan, Badrul Hussain Moorfields Eye Hospital Introduction: In ophthalmology, evidence has emerged for a wider spread of performance in early stage of training. What we don’t know is how an individual with minimal experience scores when undertaking the same task on several occasions (variability and reproducibility). Purpose: To evaluate the variability of performance among novice ophthalmic trainees in a range of repeated tasks using the Eyesi virtual reality (VR) simulator. Method: Eighteen subjects undertook three attempts of five cataract specific and generic 3-dimensional tasks: continuous curvilinear capsulorhexis, cracking and chopping, cataract navigation, bimanual cataract training, anti-tremor. Scores for each attempt were out of a maximum of 100 points. A non-parametric test was used to analyze the data where a P value of <0.05 was considered statistically significant. 65 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cataract & Refractive Surgery Results: Highly significant differences were found between the scores achieved in the first attempt and that during the second (P < 0.0001) and third (P < 0.0001) but not between the second and third attempt (P = 0.65). There was no significant variability in the overall score between the users (P=0.1104) or in the difference between their highest and lowest score (P=0.3878). Highly significant differences between tasks was shown both in the overall score (P=0.0001) and in the difference between highest and lowest score (P=0.003). Conclusion: This study, which is the first to quantify reproducibility of performance in entry level trainees using a VR tool, demonstrated significant intra-novice variability. The cohort of subjects performed equally overall in the range of tasks (no inter-novice variability) but each showed that performance varies significantly with the complexity of the task when using this high fidelity instrument. 65. Patient Reported Outcome Measuring Tools in Cataract Surgery – Clinical Comparison in a Tertiary Hospital. Simon Fung, Peter Holm, Melanie Hingorani, Joanne Hancox Moorfields Eye Hospital Introduction: Patient Reported Outcome Measures (PROMs) collects information on the effectiveness of care delivered to NHS patients as perceived by the patients themselves. Although there is a push to extend PROMs across the National Health Service, there is currently a lack of guidance for patients undergoing cataract surgeries. It is also unclear if the generic health questionnaire recommended was suitable for cataract patients. Purpose: This study assesses the performance of different questionnaires to determine their appropriateness for cataract patients in the UK. Method: Patients awaiting cataract surgery at Moorfields Eye Hospital were recruited for the study. A study pack of four questionnaires, including Catquest-9SF, EQ-5D-5L, NEI-SES and VF-8R were given to patients to complete during pre-assessment appointment, 2 weeks post-surgery and 3 months post-surgery. Data were Rasch-analyzed when possible to allow direct comparison of the performance of the questionnaires. Results: Fifty-five patients were recruited to date, with 25 patients completed 3 months follow-up. All questionnaires shows correlate with visual improvement. The change in Catquest-9SF, EQ-5D-5L, NEI-SES and VF-8R at 2 weeks post-surgery were 147.37% (p=0.01), 3.89% (p=0.79), 0.48% (p=0.91) and 12.44% (p=0.23) respectively. These change at 3 months were 105.65% (p<0.01), 4.13% (p=0.37), 45.65% (p=0.09) and 41.37% (p=0.18), respectively. Conclusion: Collecting patient reported outcome in cataract surgery is feasible and should be introduced into daily clinical practice. Improvements in visual function could be detected as early as 2 weeks post-surgery by Catquest-9SF, while socioemotional changes may be a delayed effect of cataract surgery. 66. Experience With Femtosecond Laser Cataract Surgery: A prospective review Edward Ridyard, Ritesh Gupta, Raymond Stein Bochner Eye Institute, Toronto Introduction: Cataract surgery is the most frequently performed surgical procedure in the world, with an estimated 15 million procedures per year. Femtosecond cataract surgery is considered to be one of the most significant advances in cataract surgery in the last 50 years. Purpose: The purpose of this study is to analyse the experience and outcomes of femtosecond laser surgery. Method: A prospective review was performed on 250 consecutive patients who underwent femtosecond laser cataract surgery. Results: Phacoemulsification was required in 50 (20%) cases whereas 200 (80%) cases had complete elimination of phacoemulsification energy. Intraoperative complications included incomplete capsulotomy (n=1, 0.4%) and no cases of posterior capsule rupture were identified. Postoperative complications included subconjunctival haemorrhage (n=243, 97%), 3 weeks post-surgery iritis (n=3, 1.2%), 2+ transient corneal edema (n=3, 1.2%) and cystoid macular edema (n=2, 0.8%). No cases of endophthalmitis, subluxated intraocular lens or wound leak were identified. In terms of refractive outcomes, a sphero equivalent of -0.37D (SD = ) was measured for the first 50 cases at three months. Conclusion: Femtosecond laser cataract surgery is associated with a high rate of patient satisfaction and relatively easy learning curve. It provides a perfect capsulotomy in nearly 100% of cases and helps eliminate phacoemulsification in 80% of cases. It was associated with no posterior capsule rupture or endophthalmitis and allowed for quick return of best corrected visual acuity. However, it is associated with an expensive capital investment, significant ongoing costs and requires more time per patient. 66 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cataract & Refractive Surgery 67. Effect of Speed of Intravitreal Antibiotic Administration on the Outcome of Post-operative Endophthalmitis Anna Gao, Anjali Gupta, Salman Mirza Birmingham and Midland Eye Centre Introduction: Prompt administration of intravitreal antibiotics is thought to be paramount in the treatment of postoperative endophthalmitis. Purpose: To compare the door-to-needle time, visual outcome, culture positive rates and the safety aspect between patients who received their intravitreal antibiotics in the casualty treatment room and those who received it in the operating theatre, at the Birmingham and Midland Eye Centre. Method: All patients who were treated for post-cataract endophthlmitis between May 2007 and April 2013, were included. Patient demographics, past ocular history, details of cataract surgery, door-to-needle time, causative organisms and antibiotic sensitivity data, treatment, visual outcome and complications were collected. Results: A total of 44 patients were included, 19 had their intravitreal antibiotics in Eye Casualty and 25 in the operating theatre. Mean time from surgery to presentation was 10 days (range 2-29 days) in the casualty group and 28 days (range 3-183 days) in the theatre group. The door-to-needle time was significantly less in the casualty group (mean=161 min., range 77-127 min) compared to the theatre group (mean=308 min, range 137-633 min). Culture negative rate was higher in the casualty group (42%) compared to the theatre group (28%). Final visual outcome was similar in both groups. 5% of patients in the casualty group went on to have vitrectomies whereas 20% of the theatre group had further surgical intervention. Conclusion: Patients were managed much more promptly if treatment was initiated in the casualty setting. The door-to-needle time does significantly affect the final visual outcome. The treatment of infective endophthalmitis appears to be safe and prompt when carried out in the casualty treatment room compared to sampling in the theatre. 68. Is second-eye cataract surgery in the NHS cost effective? Systematic reviews and economic evaluation Geoff Frampton, Petra Harris, Keith Cooper, Andrew Lotery, Jonathan Shepherd Southampton Health Technology Assessments Centre (SHTAC) Introduction: First-eye surgery can improve vision and quality of life. However, it is unclear whether cataract surgery on the second eye provides enough incremental benefit to be considered clinically and cost effective. Purpose: To determine the clinical effectiveness and cost effectiveness of second-eye cataract surgery compared to surgery in one eye alone. Method: Systematic reviews of clinical effectiveness, cost effectiveness and health-related quality of life (HRQoL) were conducted and an economic model developed to estimate the cost-effectiveness of second-eye surgery. Results: Three randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of HRQoL were included in the systematic reviews and where possible used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life years (QALY) with an incremental cost-effectiveness ratio (ICER) of £1,964 per QALY gained. Sensitivity and scenario analyses gave a worst-case ICER of £6,432 per QALY gained. Conclusion: Second-eye cataract surgery is cost-effective based on the best available data. However, no relevant RCTs have been conducted recently and the patient-reported outcomes (PROs) employed have several limitations. A well-conducted RCT that reflects the current population case mix and enables estimation of costeffectiveness would be appropriate. Clarification is needed on the selection and interpretation of PROs in cataract surgery 69. Artificial Iris Implants for Aniridia: Does Near Infra-Red Light Transmission Risk Retinal Phototoxicity? Imran Yusuf, Tim H M Fung, Stuart N Peirson, C K Patel Nuffield Laboratory of Ophthalmology, Oxford University Introduction: Artificial iris implants for aniridia and oculocutaneous albinism aim to restore iridocosmesis and the light occlusive properties of the absent or deficient anatomical iris. The native human iris serves a critical function in protecting the posterior segment from retinal hazard light (400-1400nm). Artificial iris implants 67 ABSTRACTS: Cataract & Refractive Surgery Annual Congress Final Programme & Abstracts Birmingham 2014 must replicate this photoprotection across the retinal hazard range. The light occlusive properties of clinically available artificial iris implants are unknown. Purpose: This study aimed to evaluate light transmission through clinically used artificial iris implants. Method: Spectral transmission was recorded across five Morcher BDI (67B/67F/67G/67L/68/94A) and two Dr Schmidt Artificial Iris implants using a broad-spectrum light source and spectroradiometer. Near-infrared (NIR) light as a percentage of total retinal incident light was calculated in daylight, incandescent and fluorescent light environments to simulate retinal exposure through each aniridia implant. Results: All Morcher iris implants demonstrated high levels of NIR transmission across the black iris interface, accounting for up to 82% of total retinal incident light in incandescent environments. Dr Schmidt’s Artificial Iris demonstrated total occlusion of all wavelengths of light. Conclusion: Morcher BDI iris implants transmit high-levels of near infra-red light (700-1400nm) within the retinal hazard range, risking long-term retinal photochemical toxicity across the life of the implant. Dr Schmidt’s Artificial Iris implants produce physiological light occlusion and may offer improved safety and efficacy. This study may impact on pre-operative aniridia implant selection in eligible patients with traumatic and congenital aniridia and oculocutaneous albinism. 70. Rotational stability of a hydrophilic toric lens implant over 2 years Ashokkumar Vyas Scarborough Hospital Introduction: To establish long term rotational stability of a toric lens and continued patient satisfaction Purpose: To analyse the rotational stability of hydrophilic Rayner T-flex IOL over 2 years post-surgery using serial digital photographs and software Method: In a prospective study over 2 years, 12 eyes with keratometric cylinder of ≥ 2.5D underwent routine phacoemulsification with in-the bag implantation of hydrophilic Rayner T-flex IOL. This lens has anti-vaulting haptics designed for rotational stability. Slit-lamp digital photographs were taken after maximal pupillary dilatation at 1 week, 6 months and 2 years post-operatively and analysed with Adobe Acrobat Professional software. Unaided acuities were recorded and patients were asked to rate the visual outcome as highly satisfied, satisfied or not satisfied. Results: Eyes were grouped based on the extent of IOL rotation (≤ 5 degrees, 5-10 degrees and > 10 degrees). At 2 years, all 12 eyes showed IOL rotation of < 5 degrees post-surgery. Unaided acuity was 20/40 or better in 11 out of 12 eyes. All but one patient were highly satisfied with the outcome of the surgery Conclusion: Rayner T-flex Toric IOL showed excellent rotational stability at 2 years post-surgery. It also provided excellent post-operative unaided visual acuity with a high patient satisfaction rate. 71. Is Optical Biometry sufficient to estimate Toric IOL parameters to correct co-existing corneal astigmatism during cataract surgery? Constance Jong, Vikas Shankar, Aravind Reddy Aberdeen Royal Infirmary Introduction: Toric Intraocular lenses (IOL) are increasingly used to correct higher degrees of co-existing corneal astigmatism during cataract surgery Purpose: To compare corneal curvature parameters assessed by Optical Biometry (IOL Master) and Corneal Topography in the estimation of Toric IOL. Method: Optical biometry (IOL Master) and corneal topography (TOPCON) was performed on all patients undergoing cataract surgery with toric IOL implantation. All patients had more than 2.50 Dioptres of corneal astigmatism. Corneal curvature parameters (K1, K2) from IOL master biometry was compared with topographic curvature in the flat and steep meridians for each patient Results: Forty seven eyes of forty seven consecutive patients underwent toric IOL implantation. The mean corneal astigmatism was 3.56 dioptres (range 2.26-5.22) with IOL Master and 3.29 dioptres (range 2.46-4.82) with topography. The mean difference in magnitude of corneal astigmatism between IOL master and Topography was 0.45 dioptres (range 0-2.59D) Twenty eyes (42.5%) had a difference of more than 0.5 dioptre and six eyes (12.7%) had a difference of more than 1 dioptre in the magnitude of corneal astigmatism between IOL master and topography. In eight eyes (17%), the steep meridian of astigmatism assessed by IOL master was different from topographic steep meridian by more than 10 degrees 68 ABSTRACTS: Cataract & Refractive Surgery / Cornea & External Eye Disease Annual Congress Final Programme & Abstracts Birmingham 2014 Conclusion: Correlation between corneal curvature data assessed by IOL master and Corneal topography may be necessary in estimating toric IOL parameters especially in eyes with higher degree of corneal astigmatism 72. Toric lenses in pathological corneal astigmatism Sarah Chaney, David Frazer Royal Victoria Hospital Introduction: The use of Toric intraocular lenses (IOL) for the correction of astigmatism at the time of cataract surgery has increased in recent years. Toric IOLs can also be used to correct pathological corneal astigmatism. Purpose: Our aim was to review the results of the use of Toric IOLs in complex corneal cases at the Royal Victoria Hospital, Belfast. Method: A retrospective case note review of all cases of Troic IOL insertion over a 5 year period (2008-2013) in complex corneal cases. Results: Fourteen patients had a Toric IOL placed in 1 eye. Ten of the patients were female and 4 were male. The average age was 53± 13 years. The under lying pathology was keratoconus in 9 patients, herpetic corneal scaring in 4 patients and Fuchs Endothelial dystrophy in 1 patient. Six eyes had a previous penetrating keratoplasty and 3 a previous deep anterior lamellar graft. Only 2 of the eyes had a pre-op uncorrected visual acuity of 6/18 or better. The average pre-op corneal cylinder was 4.14 Dioptres ± 3.43 D (Range 2.57- 9.27 D). Post-op 8 eyes achieved an uncorrected visual acuity equal to or better than 6/18. The average post op cylinder was 1.77D ±1.20D (Range plano-4.00D). One eye required an IOL exchange and 1 eye developed glaucoma which required a trabeculectomy and an additional sulciflex lens insertion Conclusion: Toric intraocular lenses are useful in the correction of astigmatism in patients with pathological corneal astigmatism 73. Spectacle Independence and Vision-Related Quality of Life in Cataract Surgery Patients Following Implantation of the ReSTOR® Multifocal Intraocular Lens Sunil Shah, Christopher Brittain Birmingham and Midland Eye Centre Introduction: Patients who undergo phacoemulsification with monofocal IOL implantation may remain dependent on spectacle correction at least for near vision. Multifocal IOLs are designed to optimise visual acuity across varying focal points, thus reducing spectacle dependence. Purpose: This study compared spectacle independence and vision related quality of life (QoL) in patients implanted with the ReSTOR® multifocal intraocular lens (IOL) against those with a monofocal IOL. Method: This 6 month, randomised, multicentre, controlled, double masked, parallel group study compared patients who underwent bilateral phacoemulsification followed by bilateral implantation of either ReSTOR® multifocal (n=108) or hydrophobic monofocal IOLs (n=100). The primary endpoint was achievement of VA of ≤0.1 logMAR at both near and distance. Results: Patients had a mean age of 70.4 years. At 6 months, the proportion of patients with a postoperative BCVA of ≤0.1 logMAR at near and distance was significantly higher in those who received the ReSTOR® multifocal IOLs compared to the monofocal IOLs (45.7% versus 2.1%, p<0.0001). Vision related QoL with the ReSTOR® multifocal was comparable to that in monofocal IOLs, except for a significant improvement in dependence on correction (p<0.0001). Spectacle cost showed a significant difference (p<0.0001) favouring the ReSTOR® multifocal IOL. Conclusion: Compared to monofocal, the ReSTOR® multifocal IOLs resulted in greater spectacle independence. This was reflected in patient reported quality of life. Additionally, analyses suggest a long-term cost benefit of the ReSTOR® multifocal IOL when taking into account spectacle costs. CORNEA & EXTERNAL EYE DISEASE 74. Rapid corneal cross-linking (CXL) for progressive ectasia Dan Gore, Nick Kopsachilis , Bruce Allan , External Disease Service Consultants Moorfields Eye Hospital Introduction: Rapid treatment protocols for CXL based on shorter ultraviolet light exposure times and higher irradiances are emerging. 69 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cornea & External Eye Disease Purpose: To report safety and efficacy outcomes at 6-months following rapid CXL. Method: Design: Prospective audit. Serial tomography and refractions were used to confirm pre-operative ectasia progression, defined by: >1.5 dioptre (D) increase in Kmax or K2; 0.5D increase in posterior K2; >1D increase in refractive astigmatism; >1 line loss of corrected distance visual acuity (CDVA), > 13μm decrease in pachymetry. Patients with a minimum pachymetry <375 μm were excluded. Continuous UVA exposure at 30mW/cm2 for 4 minutes was used in all eyes. Audit standards were 90% efficacy and <3% losing >2lines of visual acuity. Results: Rapid CXL was performed on 33 eyes (30 keratoconus, 3 post-LASIK, age range 17-43). At 6-months, 28 (85%) eyes had either stabilised or improved, while 5 (15%) showed signs of continued progression. No significant differences between mean pre- and post-operative keratometric indices were observed: Kmax 58.93D vs. 58.64D (P=0.47), anterior K2 50.45D vs. 50.63D (P=0.2) and posterior K2 -7.93D vs. -7.84D (P=0.96). Mean spherical equivalent remained unchanged (-2.54D vs. -2.88 D, p=0.87) as did mean refractive astigmatism (4.92 D vs. 4.86D, p=0.91). 2 (6%) eyes lost more than 2 lines of CDVA. One peripheral sterile infiltrate developed which rapidly responded to intensive topical steroids. No infective complications occurred. Conclusion: While safe and effective in the majority of patients, audit standards were not achieved at 6-months follow-up. 75. Systemic immunosuppression in patients with refractive chronic allergic eye diseases Muhammad Ahad, Kieren Darcy, Phillip Jaycock , Stuart Cook, Derek Tole Bristol Eye Hospital Introduction: Vernal (VKC) and atopic keratoconjunctivitis (AKC) are sight-threatening inflammatory diseases of conjunctiva and cornea. Severe cases may be refractory to topical conventional therapy and need systemic therapy to prevent blindness. Purpose: The aim of this study was to analyse the efficacy of systemic immunosuppressive agents in patients with refractory allergic eye diseases. Method: Non comparative, retrospective case series of 33 patients with AKC or VKC, where topical therapy, like steroids, cyclosporine and tacrolimus had failed to control the disease. 28 consecutive patients with AKC and 5 patients with VKC were analysed in this study. Information regarding duration, activity of disease, complications, visual acuity, therapeutic strategies, side effects and clinical outcome were analysed Results: In all patients systemic prednisolone was used to induce remission. On the last day of visit, disease was under control in 97% (32/33) of the cases. Following systemic immunosuppressive therapy was used: Tacrolimus in 30 patients, mycophenolate in 12 patients, Intravenous immunoglobulins in five patients and cyclosporine, methotrexate and azathioprine in four patients each. 17 patients had keratoconus, eight developed herpetic eye disease, six developed shield ulcers and five patients developed infective keratitis. 12 patients underwent corneal transplant for visual rehabilitation. At final visit (41/66) 62% of the eyes had visual acuity of 6/12 or better Conclusion: Systemic immunosuppression is a safe and effective treatment in patients with severe chronic allergic eye disease, which is refractory to conventional treatment. These patients however need careful monitoring, and the long-term benefits need to be assessed as part of a clinical trial 76. Acanthamoeba Keratitis: Experience at Bristol Eye Hospital 2003-2012 Haneen Jasim, Derek Tole, Stuart Cook Bristol Eye Hospital Introduction: Acanthamoeba keratitis (AK) has been seen more frequently at the Bristol Eye Hospital (BEH) in recent years. We aimed to quantify the number of cases and analyze their clinical progress with a casenote review. Purpose: To establish the number of cases of AK at the BEH in 2003-2012, what risk factors they were exposed to, how they were managed and their clinical outcomes. Method: Cases were identified through pharmacy records, patients’ notes were reviewed for the following information: 1) Date of first presentation 2) Clinical picture 70 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cornea & External Eye Disease 3) 4) 5) 6) Risk factors Basis of diagnosis(cultures/clinical picture) Treatment, duration and side effects Clinical outcomes Results: 32 patients were treated for AK in 2003-2012 6 patients were treated in 2003- 2007. 26 patients have been treated for AK in 2008-2012 93% were contact lens wearers. 71.8% of the cases were culture positive (scrape/ biopsy/ contact lens). 50% cases fully resolved with medical management. 37.5% patients required surgical treatment. 75% were initially misdiagnosed, with 25% diagnosed >6 weeks after initial presentation. Patients with a late diagnosis were more likely to require surgical management Conclusion: There has been an increase in cases of AK at the BEH. Some of these patients have suffered devastating consequences and further research is needed to see if this is a widespread trend and to identify risk factors for the condition. Our group will undertake a survey through the British Ophthalmic Surveillance Unit to gain this information on a national basis. 77. Hypertonic ointment vs lubricants and bandage contact lenses for recurrent corneal erosion syndrome (RCES) Sally Blackmore-Wright, Radwan Al Mousa University Hospital Coventry and Warwickshire Introduction: RCES is associated with abnormal adhesion complexes between corneal epithelial basement membrane and underlying stroma. Epithelial oedema induced by hypotonicity of tears during sleep further weakens adhesion complexes, increasing the risk of epithelial cell avulsion on awakening. Hypertonic ointments instilled before bedtime, in addition to having a lubricating effect, creates an osmotic gradient to counteract the epithelial oedema induced during eyelid closure. Purpose: To evaluate the effectiveness of sodium chloride 5% ointment used before bedtime for 6 months in reducing the frequency of acute RCES episodes compared to lubricants and BCL treatment. Method: Retrospective observational cross-over study in which RCES patients (n=52) who were initially treated with lubricants or BCL had treatment modified to sodium chloride 5% ointment. The number of acute painful episodes per year was compared before, during, and after treatment. Results: The mean number of episodes per year significantly reduced from 10.92 (SD 16.64, range 0.57-73.0) before treatment, to 0.692 (SD 1.77, range 0.0-8.0) during treatment. Wilcoxon signed rank test indicates this change is significant (Z = -6.59, p =0). Following treatment, the mean number of episodes per year remained significantly reduced at 1.33 (SD 2.80, range 0.0 – 10.9). Again, Wilcoxon signed rank test indicates this change is significant (Z= -4.32, p=0). Conclusion: A 6 month course of sodium chloride 5% ointment is more effective than lubricants or BCL in reducing the reoccurrence of painful episodes of RCES. 78. Day-before vs same-day Eye Bank provided precut tissue for DSAEK. A prospective single blinded randomised study of outcomes in a UK tertiary referral centre Evripidis Sykakis, Panagiotis Georgoudis, Fook Chang Lam , Saj Khan, Samer Hamada, Damian Lake Corneoplastic Unit and Eye Bank, Queen Victoria Hospital Introduction: Donor cornea preparation for DSAEK can be performed by the surgeon intraoperatively or prior to surgery by the eye bank. Standardization of precutting donor tissue by the eye bank has been shown to increase safety of DSAEK surgery by reducing risk of tissue-related complications and increasing surgeon’s efficiency. Purpose: As tissue preparation on the day may delay the start time of surgery, we wished to study whether preparation of the graft tissue the previous day would affect surgical outcomes. Method: DSAEK grafts of 24 consecutive patients were randomised by the Eye Bank team into either group 1(prepared on the day) or group 2 (prepared the day before) without the knowledge of the surgical team. The outcomes analysed were dislocation rate, pre and post op best corrected visual acuity (BCVA) and Endothelial cell loss. 71 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cornea & External Eye Disease Results: Each group comprised of 12 patients. For group 1, the average follow-up was 8.61±1.80months(range 5-11 months). The average preoperative LogMAR BCVA was 1.01±0.81(range 0.26 - 3.00) and postoperative was 0.34±0.16(range 0.20 0.70)(p=0.009). For group 2, the average follow-up was 8.7±2.31months(range 5-13 months). The average preoperative LogMAR BCVA was 0.98±0.54(range 0.60 - 2.00) and postoperative was 0.25±0.13(range 0.1 0.50)(p=0.003). Comparison of the two groups showed no clinically or statistically significant difference in terms of final BCVA and endothelial cell loss. Conclusion: The use of precut tissue offers a number of advantages such as safety, time saving, convenience and consistency in the quality of the cut while surgical outcomes and final clinical results are the same. 79. Corneal collagen cross-linking (C3R) with a mechanical disruption of epithelium technique for paediatric keratoconus Fook Chang Lam, Nashila Hirji, Robert Petrarca , Panagiotis Georgoudis, Damian Lake, Samer Hamada Queen Victoria Hospital Introduction: Diagnosis of keratoconus in childhood is a negative prognostic factor for progression and younger patients are at risk for faster progression of disease. Purpose: To assess the safety and efficacy of corneal collagen cross-linking in the treatment of progressive paediatric keratoconus using a technique where the corneal epithelium is physically disrupted but not removed. Method: A retrospective analysis of the visual, refractive and topographic outcomes of 25 consecutive paediatric patients with progressive keratoconus treated with C3R in a tertiary referral centre in the UK. Results: Mean age 15.9 (range: 13-18) years. 2 patients were lost to follow-up. At 12 months, proportion of patients gaining ≥2 lines in BCVA was 57%, while 7.14% lost 2 or more lines of BCVA mainly related to progression of keratoconus. 50% gained ≥2 lines in UCVA. Median difference in BCVA was an improvement of 1 line logMAR (mean: 1 line gain, SD: 2.2 lines logMAR). Median difference in UCVA was an improvement of 1 line logMAR (Mean: 0, SD 3.7 lines logMAR). KMax regressed by ≥1D in 23.53%, remained stable in 41.18%, and progressed by ≥ 1D in 23.53%. Median difference in KMax was +0.5D (mean +1.3D, SD: 3.3D). No patients developed sterile keratitis or microbial keratitis. Conclusion: Corneal collagen cross-linking after the mechanical disruption of corneal epithelium provides a safe and effective way of stabilising progressive keratoconus in children, which can otherwise progress aggressively. 80. Cellulose spears to dry donor corneal tissue in the preparation of Ultrathin endothelial Keratoplasty: correlation between duration of drying and residual corneal thickness Aravind Reddy, Vikas Shankar Aberdeen Royal Infirmary Introduction: Ultrathin(UT) corneal endothelial transplants offer excellent visual outcomes without the complexities of donor tissue preparation, insertion and post-operative graft dislocation associated with Descemet Membrane Endothelial Keratoplasty(DMEK). Double pass technique to prepare UT grafts requires a bank of microkeratome heads of various cut-depths. Drying the cornea with cellulose sponge prior to using the microkeratome allows an easy and cost effective method to prepare UT transplants Purpose: Determine degree of corneal thinning in relation to duration of drying using cellulose spears prior to using microkeratome Method: Donor corneal tissue suitable for endothelial keratoplasty was mounted on an artificial anterior chamber and epithelium removed with cellulose spears. Central corneal pachymetry (Palm Scan AP2000 with DSAEK Package) was performed at baseline and at 30, 60, 90, 120, 180, 240 and 300 seconds during the drying process. The drying process was performed using cellulose spears for 5 minutes. Results: Four donor corneas underwent drying with cellulose spears prior to the use of microkeratome. The mean baseline central pachymetry was 630μ (range 575 to 670μ). The mean central pachymetry at 30, 60, 120, 180, 240, 300 seconds of drying was 607, 580, 560, 539, 532, 525 μ respectively. The percentage thinning of cornea with the drying at 3 minutes in each of the four corneas were 93.1%, 86.79%, 82.17% and 82.89%. (Mean 86.25%). 72 1 NEW LOOK 1 NEW STAND 5 NEW PRODUCTS MOORFIELDS’ REPUTATION FOR EXCELLENCE Please come and visit us on stand L to find out more A division of +44 (0) 20 7684 9090 (option 1) www.moorfieldspharmaceuticals.co.uk CPR AD 0414 EVO Living up to Life EXCLUSIVE FOR ATTENDEES OF RCO 2014 Visiting RCO 2014? Join us at stand 18 and let us shed light on an exclusive offer: a free MediCap USB300 high-definition recording system with the purchase of a Leica ophthalmology microscope. There’s also a free gift at the stand.* Not attending? You can still find out about other offers by calling us on 01908 353447 or emailing info.europe@ leica-microsystems.com Discover more about Leica ophthalmology microscopes and the MediCap USB300 at: www.leica-microsystems.com and www.medicapture.com *limited availability ILLUMINATING OFFERS So much more to see HA + CMC INTRODUCING OPTIVE WITH NEW HA TECHNOLOGY For the first time ever, HA and CMC have finally been combined. Now you can relieve the signs and symptoms of your dry eye patients with one powerfully soothing drop.1 It’s a perfected polymer combination, and it’s only from OPTIVE®.1 UK/1435/2013 Date of Preparation: November 2013 1.Data on file, Allergan, Inc.; Protocol 10078X-001. TARGETING THE MEDIATORS OF INFLAMMATION1 IL-6 IL-8 VEGF ICAM-1 MCP-1 Delivering efficacy in the clinical setting2-5 These images are for illustrative purposes only and do not represent inflammatory mediator levels in the eye. OZURDEX® (Dexamethasone 700 micrograms intravitreal implant in applicator) Abbreviated Prescribing Information Presentation: Intravitreal implant in applicator. One implant contains 700 micrograms of dexamethasone. Disposable injection device, containing a rod-shaped implant which is not visible. The implant is approximately 0.46 mm in diameter and 6 mm in length. Indications: Treatment of adult patients with macular oedema following either Branch Retinal Vein Occlusion (BRVO) or Central Retinal Vein Occlusion (CRVO). Treatment of adult patients with inflammation of the posterior segment of the eye presenting as non-infectious uveitis. Dosage and Administration: Please refer to the Summary of Product Characteristics before prescribing for full information. OZURDEX must be administered by a qualified ophthalmologist experienced in intravitreal injections. The recommended dose is one OZURDEX implant to be administered intravitreally to the affected eye. Administration to both eyes concurrently is not recommended. Repeat doses should be considered when a patient experiences a response to treatment followed subsequently by a loss in visual acuity and in the physician’s opinion may benefit from retreatment without being exposed to significant risk. Patients who experience and retain improved vision should not be retreated. Patients who experience a deterioration in vision, which is not slowed by OZURDEX, should not be retreated. There is only very limited information on repeat dosing intervals less than 6 months. There is currently no experience of repeat administrations in posterior segment non-infectious uveitis or beyond 2 implants in Retinal Vein Occlusion. Patients should be monitored following the injection to permit early treatment if an infection or increased intraocular pressure occurs. Single-use intravitreal implant in applicator for intravitreal use only. The intravitreal injection procedure should be carried out under controlled aseptic conditions which include the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent). The patient should be instructed to self-administer broad spectrum antimicrobial drops daily for 3 days before and after each injection. Before the injection, the periocular skin, eyelid and ocular surface should be disinfected and adequate local anaesthesia should be administered. Remove the foil pouch from the carton and examine for damage. In a sterile field, open the foil pouch and gently place the applicator on a sterile tray. Carefully remove the cap from the applicator. Once the foil pouch is opened the applicator should be used immediately. Hold the applicator in one hand and pull the safety tab straight off the applicator. Do not twist or flex the tab. With the bevel of the needle up away from the sclera, advance the needle about 1 mm into the sclera then redirect toward the centre of the eye into the vitreous cavity until the silicone sleeve is against the conjunctiva. Slowly press the actuator button until an audible click is noted. Before withdrawing the applicator from the eye, make sure that the actuator button is fully pressed and has locked flush with the applicator surface. Remove the needle in the same direction as used to enter the vitreous. Immediately after injecting OZURDEX, use indirect ophthalmoscopy in the quadrant of injection to confirm successful implantation. Visualisation is possible in the large majority of cases. In cases in which the implant cannot be visualised, take a sterile cotton bud and lightly depress over the injection site to bring the implant into view. Following the intravitreal injection patients should continue to be treated with a broad spectrum antimicrobial. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Active or suspected ocular or periocular infection including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases. Advanced glaucoma which cannot be adequately controlled by medicinal products alone. Aphakic eyes with rupture of the posterior lens capsule. Eyes with Anterior Chamber Intraocular Lens (ACIOL) and rupture of the posterior lens capsule. Warnings/Precautions: Intravitreous injections, including OZURDEX can be associated with endophthalmitis, intraocular inflammation, increased intraocular pressure and retinal detachment. Proper aseptic injection techniques must always be used. Patients should be monitored following the injection to permit early treatment if an infection or increased intraocular pressure occurs. Monitoring may consist of a check for perfusion of the optic nerve head immediately after the injection, tonometry within 30 minutes following the injection, and biomicroscopy between two and seven days following the injection. Patients must be instructed to report any symptoms suggestive of endophthalmitis or any of the above mentioned events without delay. All patients with posterior capsule tear, e.g. those with a posterior lens, and/or those who have an iris defect (e.g. due to iridectomy) with or without a history of vitrectomy, are at risk of implant migration into the anterior chamber. Other than those patients contraindicated where OZURDEX should not be used, OZURDEX should be used with caution and only following a careful risk benefit assessment. These patients should be closely monitored for any signs of implant migration. Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex and not be used in active ocular herpes simplex. The safety and efficacy of OZURDEX administered to both eyes concurrently have not been studied and is not recommended. OZURDEX is not recommended in patients with macular oedema secondary to RVO with significant retinal ischemia. OZURDEX should be used with caution in patients taking anti-coagulant or anti-platelet medicinal products. Interactions: No interaction studies have been performed. Systemic absorption is minimal and no interactions are anticipated. Pregnancy: There are no adequate data from the use of intravitreally administered dexamethasone in pregnant women. OZURDEX is not recommended during References: 1. Nehme A & Edelman J. Invest Ophthalmol Vis Sci. 2008;49(5):2030-2038. 2. Pommier S & Meyer F. Realites Ophthlamologuiques 2012; 195. 3. Augustin A. et al. Poster presented at EVER 2012, October 10-13; Nice, France. 4. Querques L. et al. Ophthalmol. 2013;229:21-25. 5. Rostron E. et al. Poster presented at North of England Ophthalmological Society (NEOS) Summer Meeting 2013, June 12; Chester, UK. Date of Preparation: March 2014 UK/0062/2014 pregnancy unless the potential benefit justifies the potential risk to the foetus. Lactation: Dexamethasone is excreted in breast milk. No effects on the child are anticipated due to the route of administration and the resulting systemic levels. However OZURDEX is not recommended during breast feeding unless clearly necessary. Driving/Use of Machines: Patients may experience temporarily reduced vision after receiving OZURDEX by intravitreal injection. They should not drive or use machines until this has resolved. Adverse Effects: RVO In clinical trials the most frequently reported adverse events were increased intraocular pressure (IOP) (24.0%) and conjunctival haemorrhage (14.7%). Increased IOP with OZURDEX peaked at day 60 and returned to baseline levels by day 180. Elevations of IOP either did not require treatment or were managed with the temporary use of topical IOP-lowering medicinal products. The following adverse events were reported: Very common (≥1/10): IOP increased, conjunctival haemorrhage* Common (≥1/100 to <1/10): Ocular hypertension, vitreous detachment, cataract, subcapsular cataract, vitreous haemorrhage*, visual disturbance, vitreous opacities* (including vitreous floaters), eye pain*, photopsia*, conjunctival oedema*, anterior chamber cell*, conjunctival hyperaemia*, headache Uncommon (≥1/1,000 to <1/100): Retinal tear*, anterior chamber flare* Headache. Uveitis In clinical trials the most frequently reported adverse events in the study eye were conjunctival haemorrhage (30.3%), increased IOP (25.0%) and cataract (11.8%). The following adverse events were reported: Very common: Increased IOP, cataract, conjunctival haemorrhage* Common: Retinal detachment, Myodesopsia, vitreous opacities, blepharitis, sclera hyperaemia*, visual impairment, abnormal sensation in the eye*, eyelid pruritis, migraine. (*Adverse reactions considered to be related to the intravitreous injection procedure rather than the dexamethasone implant). Please refer to Summary of Product Characteristics for full information on side effects. Basic NHS Price: £870 (ex VAT) per pack containing 1 implant. Marketing Authorisation number: EU/1/10/638/001 Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM. Date of Preparation: May 2013. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Allergan Ltd. [email protected] or 01628 494026. Se LENe the STA Ra R 20CO Sta 1 nd 4 B t » Complete optical biometry. The all-in-one optical biometer and IOL planning platform. « LENSTAR LS 900 Improving outcomes... 9 measurements per scan In a single measurement, the LENSTAR LS 900 captures axial dimensions of all of the human eye’s optical structures. Additionally, LENSTAR measures corneal curvature, white-to- white and more. More predictable outcomes Holladay I, SRK-T, Haigis and Hoffer Q formulas are built-in, as VWDQGDUG$OVRLQFOXGHGDUH0DVNHW0RGLƂHG0DVNHWDQG6KDPPDV IOL power calculations for post refractive patients and the Olsen formula, which uses C-constant for the calculation of ELP. Optional T-cone topography With the T-Cone optional topography add-on, the axis and astigmatism measurement of LENSTAR is extended with true 11ring Placido topography, vastly improving toric IOL surgery. (01279) 456255 [email protected] www.haagstreituk.com/lenstar The Complete Solution IT STAND AT H U OT VIS AY N E R E R B O by Rayner TH THE RCO The new Cryomatic MK II Distributed by Rayner Distributed by Rayner rayner.com Mini Incision by Rayner IT STAND AT THE RCO C-flex® Aspheric and Superflex® Aspheric with RaySert® PLUS Single Use Injector rayner.com H U OT VIS AY N E R E R B O C flex® ADVANCE Aspheric C-flex Preloaded IOL Injection System TH Made in Windsor New Beautifully Crafted Q series Digital Slit Lamps Stand T www.keeler-symphony.com Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cornea & External Eye Disease Conclusion: Three minutes of drying of donor corneas with cellulose spears provides significant thinning of donor cornea. 81. Service Evaluation of Paediatric Cross-linking for Keratoconus at Moorfields Eye Hospital Alastair Porteous, Tom Flynn, Stephen Tuft Moorfields Introduction: Corneal collagen cross-linking is offered to both adults and children with keratoconus who fulfil defined clinical criteria of disease progression. Adults have the treatment under topical anaesthetic but children have either topical, with sedation if necessary, or general anaesthesia determined on a case-by-case basis. Recent studies in paediatric patients have been performed exclusively under local anaesthetic but have included no data on the patient experience. Purpose: To evaluate patient feedback of paediatric patients who have undergone cross-linking at Moorfields in order to guide changes in the service and improve the patient experience. Method: A telephone-based questionnaire was conducted asking the following: How likely are you to recommend our service to friends and family if they needed similar care or treatment (scale of one to five) Were you happy with the facilities during your stay? Did the clinical staff provide you with adequate information regarding the procedure? If you had the procedure again would you have topical or general anaesthetic? Results: Nine of the thirteen male paediatric patients were contacted. The mean Friends and Family score was 1.56. All patients were happy with the facilities and information provided. Two patients had local, three had local and sedation and four had general anaesthetic. All thirteen patients would choose to have the same anaesthetic if they were to have the procedure repeated. Conclusion: All patients were satisfied with their treatment experience. Although general anaesthesia was offered, cross-linking can be well tolerated under local anaesthetic in paediatric patients. 82. Ultrathin (UT) DSAEK: a novel Non-double-pass technique Vikas Shankar, Paul Chua, Aravind Reddy Aberdeen Royal Infirmary Introduction: Ultrathin(UT) DSAEK achieves visual outcomes comparable to those of Descemet’s Membrane Endothelial Keratoplasty (DMEK) but without the higher rates of complications associated with DMEK. A novel non-double-pass technique offers a simple, cost effective method of preparing an UT graft Purpose: To report the visual outcome, graft thickness, re-bubbling rate and graft failure with non-double-pass UT DSAEK Method: This is a retrospective case-note review of patients undergoing UT DSAEK at Aberdeen Royal Infirmary. A non-double-pass technique of preparing UT graft tissue is described elsewhere (video submission). Post-operative corneal endothelial graft thickness was measured with Corneal Optical Coherence Tomography (OCT) Results: Thirty-five patients had DSAEK over a two-year period for Fuch’s endothelial dystrophy. 20 patients had combined phacoemulsification and IOL along with DSAEK. Mean pre-operative visual acuity was 6/36. 5 patients (14%) needed re-bubbling post-operatively for partial graft detachment. 58.33% patients had 6/12 or better vision at 3 months post-op and 81.81 % had 6/12 or better at 6 months post-op. Mean post op endothelial graft thickness as measured on OCT was 93.22 microns (range 41 to 174) at 3 months, 93.3microns (range 41 to 174) at 6 months and 93.38 (range 34 to 200) at 9months post-op. Graft failure was noted in 2 patients during the learning curve (primary endothelial failure) and needed re-graft Conclusion: Ultrathin corneal endothelial transplants prepared by a non-double-pass technique provide excellent and rapid visual rehabilitation. Complications and failure rates are comparable to those prepared by the double-pass technique 83. Five novel mutations in the CHRDL1 gene associated with X-linked Megalocornea Halah Ali, Alice E Davidson , Sek-Shir Cheong , Jens M Hertz, Jonathan B Ruddle, Stephen J Tuft, Alison J Hardcastle Institute of Ophthalmology & Moorfields Eye Hospital Introduction: X-linked Megalocornea is an inherited congenital disorder characterised by non-progressive bilateral enlargement of the corneas. 81 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Cornea & External Eye Disease Purpose: We aim to test for novel mutations in the chordin-like 1 gene (CHRDL1) in six males who were phenotypically diagnosed with X-linked megalocornea. Method: Genomic DNA was isolated using standard methods in six males, two of whom were related. All 12 exons of CHRDL1 were amplified using PCR and screened for mutations with bi-directional Sanger sequencing. The extent of deletions encompassing CHRDL1 were refined by targeted proximal and distal PCRs amplifying the CHRDL1 flanking genes RGAG1 and PAK3. Fifty-three controls and the Exome Variant Server were used to exclude non-pathogenic polymorphisms. Subjects were phenotyped by consultant Ophthalmologists by performing ophthalmic examinations, pedigree assessment and optical coherence tomography. Results: Five novel X-linked CHRDL1 mutations have been identified: c.240T>A (p.Cys80X); c.871G>A (p.Cys291Tyr);c.1247_1247-1delGG ; whole CHRDL1 gene deletion (neighbouring genes PAK3 and RGAG1 not deleted); c.297C>A (p.Cys99X). The same mutation was found in two members of the same family. Conclusion: A variety of novel mutation types (nonsense, missense, frameshift and gene deletion) in CHRDL1 were identified as the cause of X-linked Megalocornea. All mutations published to date have allelic heterogeneity. The missesnse mutation identified is located within a highly conserved cysteine-rich protein domain, known to be important for Bone Morphogenic Protein signalling. Genetic screening in male children with ‘large eyes’ should be offered to distinguish between primary congenital glaucoma and megalocornea as prognoses are very different. 84. Deep Anterior Lamellar Keratoplasty (DALK) versus Penetrating Keratoplasty (PK) for keratoconus: a systematic review Christin Henein, Mayank Nanavaty Sussex Eye Hospital Introduction: Evidence supporting similar outcomes between DALK and PK for the treatment of keratoconus is questionable because the number of randomised trials is sparse and underpowered to detect any meaningful difference. Furthermore, more recent randomised studies and the evolving techniques and expertise in the DALK procedure may bear weight to overall findings. Purpose: The aim was to perform a systematic view of randomised and non-randomised comparative studies assessing the outcomes of DALK and PK for keratoconus. Method: A systematic review of English abstracts using MEDLINE (1950-2013),Embase (1980-2013) and ClinicalTrials.gov database. Inclusion criteria were sample size of at least 20 eyes in each arm and a follow-up of at least 12 months. Primary outcomes were uncorrected (UCVA) and best-corrected visual acuity (BCVA). Secondary outcomes were allograft rejection, failure, endothelial density and complications. Fixed and random effects models were applied to results combined for analysis using Microsoft excel. Results: Three randomized and 7 non-randomised studies were included. There was no significant difference in UCVA or BCVA (P>0.05). DALK had significantly less allograft rejection and more endothelial density compared to PK(p<0.05). Other secondary outcome measures were not significantly different. There was no evidence to suggest heterogeneity of study results (p>0 .05). Conclusion: Both randomised and non-randomised studies showed no difference in visual acuity between DALK and PK. DALK reduces the risk of allograft rejection and has significantly increased endothelial cell density at 12 months follow-up. 85. Safe use and care of contact lenses by young adults Evgenia Kanonidou, Vasileios Konidaris, Christina Kanonidou , Leonidas Papazisis Department of Ophthalmology, General Hospital of Veria, GR Introduction: The use of contact lenses for visual, therapeutic or cosmetic reasons has increased over the last few years and is higher among young people. Purpose: To evaluate the compliance in safe handling, care and maintenance among contact lens wearers. Method: 173 contact lens wearers (85male), aged 19-24 years old participated in the study. 91% wore them to correct ammetropia and 9% for cosmetic reasons for a mean duration of 3 years. All used monthly disposable hydrophilic contact lenses. The study was performed using anonymous self-administered questionnaire. Results: 49% washed their hands before lens insertion and 67% after lens removal. 23% followed the rub and rinse technique after the contact lens removal. 82% wore the lenses longer than recommended and 93% were not compliant with the recommended replacement schedule. Only 13% of them followed the rub and rinse 82 ABSTRACTS: Cornea & External Eye Disease / Glaucoma Annual Congress Final Programme & Abstracts Birmingham 2014 technique for the cleaning of contact lens case and 25% replaced the storage case after a period of three months. All of them were using a multipurpose solution for cleaning, disinfecting and storing. All reported occasional use of saline solution or tap water to clean, disinfect and store their lenses. The findings were not significantly different among males and females and were not correlated with the year of contact lens wearing. Conclusion: It was interesting to observe the poor hand hygiene as well as the inadequate cleaning and disinfection patterns of lenses and storage cases followed by the participants. Health professionals should therefore spend more time in educating their patients. GLAUCOMA 86. Clinical features of fast and slow progressors in the glaucoma service: Analysis of The Portsmouth Visual Fields database Sameer Trikha, Hannaa Bobat, Clive Osmond , James Kirwan Queen Alexandra Hospital Portsmouth Introduction: Increasing pressures within glaucoma services necessitate an improved understanding of progression, ensuring management is stratified according to need. Purpose: To determine clinical characteristics of patients stratified according to visual field progression. Method: We extracted Humphrey VFs from our database drawn from normal clinical practice. VF series from 4177 eyes from 2208 patients who had >5 VFs were obtained. A retrospective pilot study analysing 187 patients with POAG/NTG only was performed. Fast progressors (FP) were deemed to progress >2.0dB per year and slow (SP) between >-0.3 and <1.0dB/year. Mean presenting MD, MD change and clinical features (systemic/ocular co-morbidities) were analysed. Results: The mean rate of progression for the whole cohort of patients was -0.26dB/year, over a median of seven years. 187 patients – 57 slow progressors (SP), 60 medium progressors (MP) and 70 fast progressors were identified. Initial MD was -7.25dB in FP vs. -4.17 dB in SP. Average slope was -0.67 dB/yr (SP), -1.23 dB/yr (MP) and -3.67 dB/yr (FP). Mean change in MD over 5 VFs in FP was -13.03 dB vs. -2.75dB in SP(p < 0.001). Mean age at diagnosis was 68.5 yrs FP vs 61.3 yrs SP (p = 0.001). Multivariate regression revealed later age at diagnosis associated with more negative average slope (p =0.002), and more negative slope was also associated with hypertension, IHD (p = 0.009) and subsequent development of cognitive impairment (p = 0.001). Mean IOP reduction following treatment was 25.1% in SP vs. 21.6% in FP (p = 0.035). At the time of review, mortality rate was higher in 34.3%(FP) compared to 7.0%(SP). Conclusion: Fast progressors were associated with later age at presentation, worse initial MD and increased prevalence of hypertension, ischaemic heart disease and subsequent cognitive impairment compared to slow progressors. Initial findings warrant close scrutiny of systemic risk factors and necessitate further investigation. 87. Supramid Management after Baerveldt Tube Implantation - an Audit Jayesh Khistria, Pavi Agrawal, Gus Gazzard Moorfields Eye Hospital Introduction: Non-valved aqueous shunt implants often require luminal occlusion to prevent hypotony in the early postoperative period. This can be achieved through external ligation or use of an intraluminal supramid suture. The 3-0 nylon supramid suture acts as an aqueous flow restrictor until such time when the intraocular pressure rises above threshold and the suture can be removed. Purpose: Our aim was to compare clinical outcomes in postoperative tube-shunt surgery patients that had undergone supramid removal vs. non-removal. Method: This was a retrospective case series of 41 eyes of 36 patients. Results: The mean age was 60.9 ± 14.8 years. The spectrum of glaucoma phenotypes was similar between the two groups. Of the 41 eyes 78% (32/41) underwent either partial or complete supramid removal and 22% (9/41) required no supramid removal. The mean preoperative IOP in the supramid removal group was 27.9 mmHg on a mean of 3.1 glaucoma medications. The non supramid removal group had a mean IOP of 26.3 mmHg on a mean of 2.6 glaucoma medications. At 6 months in the supramid removal group mean IOP was 14.3mmHg (1.4 glaucoma medications) in comparison to the non-removal group where mean IOP was 15.4mmHg (0.4 glaucoma medications). Conclusion: Tube shunt surgery can result in 40-45% reduction in IOP at 6 months. IOPs were equally well controlled between the two groups and interestingly the “supramid in situ” group had lower number of medications. 83 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma 88. Normal tension glaucoma or hyperlipidemia related angiopathy Souhad Lawand, Heba Eyadat Al-Sharq Hospital Introduction: Automated perimetry has become the mainstream for assessment of functional glaucomatous loss and progressive damage. It is also standard to think that absolute scotomas are irreversibly non functional areas related to the damage incurred to the optic RNFL by increased IOP even if the IOP readings show normal values eg. normal tension glaucoma. Purpose: 1.to investigate the similarity of visual field defects that occur during suspected normal tension glaucoma and retinal angiopathy induced by hyperlipidemia 2.To consider visual field analysis and its findings a new marker in determining the effectiveness of hyperlipidemia control and/or treatment. Method: 10 patients with hyperlipidemia underwent visual field examination using the 30-2 supra threshold on the oculus twinfield and in almost all cases, enlargement of blind spots were detected. Another visual field test was conducted after prescribed treatment for hyperlipidemia and data was compared. Results: 9 out of 10 patients showed disappearance of some or all absolute scotomas after the 1st month of the prescribed recommendations. Conclusion: 1.This research suggests that hyperlipidemia can cause visual field defects similar to those seen at the onset of glaucoma. 2.The reversibility of absolute scotomas in automated perimetry makes it a less subjective method in monitoring glaucomatous changes. 3.Automated perimetry can be used to determine the effectiveness of hyperlipidemia treatment and control. 89. Laser suture stretch for post trabeculectomy bleb management Rohit Saxena, Marta Hovan, Stephen Vernon Nottingham University Hospital Introduction: Trabeculectomy aims to promote a filtering conjunctival bleb formation with a loose scleral flap to allow aqueous outflow, but tight enough to prevent hypotony and flat anterior chamber. This balance is critical to the success of the operation. Purpose: To describe the performance and safety of a new technique of laser suture stretch (LSS) for managing a tight scleral flap following trabeculectomy. Method: Medical records of a consecutive series of 42 laser suture stretch procedures performed between Oct’2009 and Dec’2012 at our hospital were reviewed. There were 21 male and 20 female patients (mean age 69.8 years). Mean follow up was for 12.9 months. The mean interval between trabeculectomy and laser suture stretch was 12 days. Outcome measures included IOP levels immediately following LSS, at three months and at last review, hypotony, bleb leak, and further surgery rates. Results: Mean pre-stretch IOP was 25.2 (Range 12-38) mmHg, reducing to a mean of 12.7mmHg (range 4-20) immediately after the procedure. None of the patients had any significant shallowing of the anterior chamber or any demonstrable bleb leak. The mean IOP at 3 months was 10.5mmHg (Range 2-29) & 12.3mmHg at last review. None of the patients required further surgery in the follow up period. Conclusion: LSS achieves loosening of scleral flap sutures in a controlled, graded manner and is a safe alternative to laser suture lysis and adjustable sutures. 90. Virtual Glaucoma Clinics: Patient Acceptability And Quality of Patient Education Compared To Standard Clinics Jennifer Court, Michael Austin Singleton and Neath Port Talbot Hospitals Introduction: Virtual glaucoma clinics allow rapid, reliable patient assessment but are patients satisfied with the service and is patient education adequate to maintain compliance? Purpose: To compare experiences and understanding of patients reviewed via the virtual clinic versus the standard clinic. 84 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma Method: 100 patient satisfaction questionnaires (PSQs) were given to consecutive patients attending glaucoma clinics in October 2013. All 135 patients reviewed via the virtual clinic from April 2013 until August 2013 were sent postal PSQs in September 2013. Data was obtained for demographics, understanding of glaucoma, their condition, satisfaction with their experience, and quality of information. Responses were analysed in conjunction with the clinical records. Results: 75% of clinic patients and 63% of virtual clinic patients responded to the PSQ. The mean satisfaction score was over 4.3/5 in all areas surveyed. Virtual clinic patients' understanding of their condition was very good, with 95% correctly identifying their diagnosis as glaucoma, 83% as ocular hypertension and 78% as suspects. There was no evidence to support inferior knowledge or self perceived understanding compared to standard clinic patients. Follow up patients knew more about glaucoma than new patients. Over 95% of patients found our information leaflet useful. 1/3 of patients sought additional information but less than 20% used the internet for this. Conclusion: A substantial proportion of glaucoma pathway patients may be seen by non-medical staff supervised by glaucoma specialists via virtual clinics. Patients are accepting of this format, reporting high levels of satisfaction and non-inferior knowledge to those seen in standard clinics. 91. The interobserver reliability of the Van Herick measurement Ahmed Javed, Mark Batterbury, Stephen Kaye Royal Liverpool Hospital Introduction: The Van Herick method is a quick and simple method to estimate peripheral anterior chamber depth and predict the risk of angle closure glaucoma. However, as a subjective test, it may not be reproducible between observers. Purpose: To determine the reproducibility of Van Herick grading between observers; to determine if some grades are more reproducible than others; to study the concordance between the temporal and nasal scores. Method: The temporal and nasal Van Herick scores of a single eye were measured in 18 patients by 15 observers. Results were analysed by assigning an eye to a Van Herick grade based on the median interobserver score and then calculating the average standard deviation and percentage consistency for each grade. Results: Grades 1 and 4 had a high average percentage consistency (80%, 84.6%) and a low average standard deviation (0.45, 0.26). Grades 2 and 3 had low average percentage consistencies (57.5%,50%) and high mean standard deviations (0.71, 0.89). The temporal and nasal scores showed good agreement (κ=0.61 p<0.001) Conclusion: The Van Herick angle grading system has good interobserver reproducibility for grades 1 and 4 but not for grades 2 and 3 so cannot be relied on for predicting the risk of angle closure glaucoma. Temporal and nasal scores are in good agreement, so that if the nasal angle cannot be measured, the temporal angle can be used as an approximation. 92. Phacoemulsification with endocyclodiode laser to aid glaucoma management Line Langsaeter, Pieter Gouws, Ali Hassan East Sussex Hospital Trust Introduction: Many glaucoma patients are reliant on several drops. Any intervention that reduces drop dependency benefits patients and health system alike. The fairly new procedure of endocyclophotogoagulation of the ciliary body during phacoemulsification has been shown to lower the intraocular pressure (IOP). A recent literature search returned 4 relevant papers that site IOP reduction of 6mm Hg, equivalent to 1 drop. Purpose: This study aims to establish the outcome of glaucoma patients who had combined phacoemulsification and endoscopic cyclodiode laser (phaco-ECP). Method: All patients who underwent combined phaco-ECP by one experienced surgeon at East Sussex Healthcare Trust between 1/9/2009 and 16/9/2013 were included in a retrospective audit. Previous interventions were not excluded and all glaucoma subtypes were included in the study. Results: The number of eyes included in the study was 284. The mean age was 78.7, with a female:male ratio of 1.95. The subtype distribution was: 76% primary open angle glaucoma, 8% pseudoexfoliation, 7% ocular hypertension, 6% normal tension glaucoma and 3% (trauma, chronic angle closure, Sturge Weber and neovascular CRVO). The mean IOP pre-procedure was 16.7mmHg and at 6 months post-up 13.8mmHg, resulting in a reduction of 18%. The mean number of drops used pre-op was 2.27 and one year post-op 0.83 85 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma resulting in a decrease of 70%. Follow-up varied between 2 months and 16+ months. Conclusion: The use of endocyclophotocoagulation during photocoagulation may be an addition in long term glaucoma management and may reduce dependency glaucoma drops. 93. Developing predictive model and potential biomarkers for primary open-angle glaucoma using metabolomics approach Zakaria Bannur, Lay Kek Teh, Mohd Zaki Salleh, MI Ismail, Jonathan Crowston, Sushil Vasudevan Universiti Teknologi MARA UiTm Introduction: Biomarkers are objectively measurable biological characteristics that can be used to diagnose, monitor or predict diseases. As ‘‘omics’’ technologies have emerged, the possibility of both measuring and using multiple biomarkers simultaneously to predict diseases has captured the imagination of many clinicians and scientists. Indeed, the molecular basis of primary open-angle glaucoma (POAG) is not fully understood. Purpose: Thus, this study aims to establish a predictive model to differentiate POAG patients from healthy volunteers using metabolomics approaches. Method: Serum samples of sixteen POAG patients and healthy volunteers were analysed by Liquid chromatography/Quadruple time-of-flight mass spectrometry system (Q-TOF LC/MS). Statistical analysis included principal component analysis (PCA), clustering tests and partial least squares analysis. A predictive model was developed and validated by Mass Profiler Professional and ROCCET softwares. The performance of the model was evaluated by measuring the area under the ROC curves, error rates, and permutation tests. Results: The model discriminates each group in separate clustering. An overall predictive accuracy of 96.7% was obtained by this model. Ten features predictive model was the best with highest sensitivity and specificity and with less variation in cross validation (AUC =0.999, CI 0.991-1). The model testing resulted in predictive accuracy around 0.95 (AUC= 0.985 95% CI: 0.944-1), and empirical p-value at 1000 times permutation test p< 0.002. Conclusion: The predictive model would be widely applicable in clinical use after further training and validation. This generates new hypothesis for designing medicine, substantial improvements in patient care and clinical outcomes. 94. Absence of OPTN E50K mutation in primary open angle glaucoma and ocular hypertension Soo Park, Yalda Jamshidi, Lik Thai Lim , Daniela Vaideanu, Scott Fraser, Jane Sowden UCL Institute of Child Health Introduction: Primary open-angle glaucoma (POAG) is a common but complex disease with a strong genetic component. Notably, few genes have been robustly associated with POAG. Purpose: This study aims to ascertain the contribution of OPTN E50K mutation to unrelated POAG and ocular hypertension (OHT) in white British subjects. Method: Two Independent cohorts comprised of 329 cases affected with either OHT (n= 57) or POAG (n=272) and 276 matched controls of white British descent were recruited in this study. The prevalence of E50K mutation was examined using TaqMan® SNP genotyping assays. Results: The E50K mutation was not present among OHT subjects (a major risk factor for POAG) and POAG individuals, as well as among the controls. Conclusion: This study confirms the absence of E50K mutation among unrelated POAG/OHT individuals from the North-East of England. 95. Squeezing Generic Latanoprost: Are they the same? Umaima Mulla, Kelvin Wong, Elizabeth Tanner , David Young, Alan Rotchford Gartnavel General Hospital Introduction: Generic Latanoprost is the most widely prescribed topical anti-glaucoma treatment. 3.5 million bottles were dispensed in England in 2011. Patients may receive different bottle types every month depending on pharmacy supplier. Some patients may find the use of different bottles difficult. Purpose: To assess the force required to expel one drop of Latanoprost from different generic bottles. Method: Three bottles of seven preparations of generic Latanoprost (Pfizer, Actavis, Beacon, Sandoz, Teva, 86 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma Tubilux, and Zentiva) were tested. A 1kN load cell was positioned horizontally with an aluminium semi cylindrical loading head attached, connected to a Zwick-Roell 250 mechanical testing unit. The bottle was inverted and force applied to expel 10 individual drops from each bottle measured . Maximum load applied (Newtons) during the delivery of each drop was analysed using Zwick-Roell software. Results: The mean force required was: Actavis 11.50N, Beacon 33.94N, Sandoz 15.99N, Teva 17.81N, Tubilux 19.29N, Xalatan 22.61N, Zentiva 18.82N. There is a statistical significance in force required between xalatan drop bottles and other manufacturers (p<0.001). Conclusion: The bottle requiring least force was Actavis (11.50N) and most was Beacon (33.94N). Normal grip force is 17.8-160N. Force required for some generic preparations was higher than the lower range of normal, suggesting that patients with weak grip force may have difficulty with expression of drops from these bottles. Bottles with lower force requirements may run out quickly due to over expression. Ophthalmologists should consider difficulties patients may have with differing bottle types of generic Latanoprost and prescribe accordingly. 96. Macular Thickness Changes in Glaucoma using Spectralis Ocular Coherence Tomography Tulsi Changulani, Neeta Ray-Chaudhuri Newcastle upon tyne-RVI Introduction: Posterior Pole Asymmetry Analysis combines mapping of the posterior pole retinal thickness with asymmetry analysis between eyes (bilateral asymmetry) and between hemispheres of each eye Purpose: To compare macular thickness and retinal nerve fibre layer thickness (RNFL) in normal and glaucomatous eyes using spectralis optical coherence tomography Method: We performed Spectralis macular and peripapillary RNFL thickness,complete ocular examination in 36 normal and 44 glaucoma patients (Male 42, female 38). Exclusion criteria were best-corrected visual acuity less than 20/40; diseases other than glaucoma , unreliable perimetry. Main Outcome measures were Mean total and hemifield Macular and RNFL thickness measurements. Reports were saved as 1.Asymmetry Analysis Single Exam Report OU 2.Spectralis RNFL Results: Eighty eyes of 80 patients (36 normal and 44 glaucomatous) were enrolled. All eyes with glaucoma had associated visual field loss (mean +/- SD Mean defect,-5.6 +/- 6.0 dB).Mean Macular thickness was significantly associated with visual field mean defect, pattern standard deviation and mean RNFL thickness. In glaucomatous eyes with visual field loss localised to 1 hemifield mean +/- SD macular thickness in the hemifield associated with field defect(269 +/- 16 micro m) was significantly less than the unaffected hemifield (282 +/- 19 micro m).Mean RNFL thickness in the affected hemifield (72 +/- 17 micro m) was significantly thinner than in the unaffected hemifield (91 +/- 14 micro m) Conclusion: Macular thickness changes are well correlated with changes in visual function and RNFL structure in glaucoma and is a good indicator of retinal ganglion cell loss. 97. Glaucoma Patients’ Education Scheme Mital Shah, Deborah Dow , Jane Diggory , Asifa Shaikh Buckinghamshire Healthcare NHS Trust Introduction: Noncompliance with glaucoma medications is common. Lack of information about glaucoma is a causative factor. Educational interventions improve compliance. Clinicians have time constraints to deliver effective educational interventions. Trained volunteers offer an alternative opportunity to educate patients, which may help improve compliance. Purpose: To assess patients’ experience and acceptability of volunteers used to provide information about glaucoma. Method: Clinicians referred patients attending glaucoma clinics at one trust to volunteers for education about glaucoma, surgical or laser interventions and eye drop technique. Patients were subsequently contacted by telephone to complete a satisfaction survey with five responses ranging from strongly disagree to strongly agree. Results: 68 patients were referred to the volunteers over a 7 months’ period. 27 (40%) were contacted by telephone. All were happy with their experience of the volunteer service with 23 patients (57.5%) strongly 87 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma agreeing that they were comfortable talking to a volunteer, 18 (45%) strongly agreeing that the volunteer was able to answer their questions and explain the condition properly and 22 (55%) strongly agreeing that speaking with the volunteer was a positive experience. 17 (42.5%) strongly agreed that they had better knowledge and understanding about glaucoma and 22 (55%) strongly agreed that they understood the importance regular therapy. Of the 17 patients surveyed about eye drop technique, 14 (82.4%) strongly agreed they were more confident with their technique. Conclusion: Patients were comfortable and accepting of the volunteer scheme and reported better understanding of glaucoma. Using volunteers to educate patients helps clinicians and improves compliance. 98. Improving information-sharing for glaucoma patients who move to another area Mykolas Pajaujis, Inderraj Hanspal, David Broadway , Nuwan Niyadurupola, Tom Eke Norfolk and Norwich University Hospital Introduction: When a glaucoma patient moves home, it is useful for their new ophthalmologists to have background clinical information. The importance of information-sharing is stressed in the 2009 NICE Guideline CG85 (Glaucoma). Purpose: We looked at quality of data-sharing, for glaucoma patients who had moved to our area. Method: We retrospectively audited data-requests for glaucoma patients who had moved to our area since 2009. Results allowed us to develop an improved system, which was then audited Results: In the first audit cycle, we identified 18 patients for whom we had requested background information. Of letters sent, the mean response time was 124 (range: 8 – 938) days and only limited information was received. We then developed a “New standard letter” which was addressed to a named consultant where possible, and specifically asked for information on IOP, disc, field, medication problems, and ‘any other relevant information’. Audit of the first 22 “New letters” showed a response rate of 22/22 (100%), mean response time 47 (range: 4 – 216) days. Completeness of data received was: IOP 16/18 (89%) old, 22/22 (100%) new; discs 7/18 (39%) old, 11/22 (50%) new; fields 7/18 (39%) old, 19/22 (86%) new; medication problems 8/18 (44%) old, 16/22 (73%) new. Receipt of background data resulted in a change of management in 11/40 patients (27%). Conclusion: Our “New standard letter” system gave quicker response times and more complete data. It is important to share information on glaucoma patients who move to another clinical team. 99. Analysis of glaucoma referral and discharge pathways in Scotland and the need for new SIGN glaucoma referral guidelines Andreas Syrogiannis, Donald Montgomery, Jennifer Burr , Roshini Sanders NHS FIFE Introduction: Glaucoma accounts for 20% of Scottish NHS new ophthalmic referrals. Purpose: The study aimed to collect national information for the SIGN group in order to provide guidance for referral recommendations Method: Survey of 16 consultant glaucomatologists in Scotland Results: Approximately10,000 new glaucoma referrals are generated annually in Scotland. 84% are from community optometrists . 33% of them are vetted by a consultant glaucomatologist. The information provided by optometrists is characterised as inadequate in 25% and by far the most common information missing is visual field testing . 80% of all patients are seen in a consultant led clinic, and they are followed up at the same clinic .Only one unit has a formal shared care community facility. An estimate of 33% are diagnosed with glaucoma with a false positive rate of 30 – 40%. Finally, 60% of stable patients are discharged in the community with simple generic advice and annual optometrist review. Conclusion: SIGN guidelines are set to mandate referral information and the Scottish Eyecare Integration Project with community electronic link will mandate digital images of the optic disc. Low risk patients will be identified for community follow up in accordance with the Scottish General Ophthalmic Service Contract. Other recommendations include patient held data and discharge to a named community professional. A national SIGN model will hopefully achieve conformity and equality in care across Scotland and identify sight threatening disease early. 88 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma 100. Glaucoma treatment compliance at a UK General Practice Meena Arunakirinathan, Mital Shah , Chrystal Dooley, Asifa Shaikh Buckinghamshire Healthcare NHS Trust Introduction: Noncompliance with glaucoma medications is common. The ophthalmologist’s ability to accurately determine patient compliance within short clinic visits is suboptimal. General practitioners in the UK are uniquely positioned to identify patients with compliance issues as they provide repeat prescriptions for medications. Purpose: To identify patient compliance with glaucoma therapy from prescriptions issued and factors identifiable from computerised patient records. Method: Identification of patients diagnosed with glaucoma, ocular hypertension or glaucoma suspect and/or prescribed topical glaucoma medications registered at a practice with 13,422 patients. Compliance was defined as mean difference in the actual number of prescriptions collected annually compared to twelve prescriptions required annually over the duration of treatment. Results: 278 patients were identified of which 139 (50%) were male. Mean age was 72 years (range: 22–100). 206 patients (74%) were prescribed glaucoma treatment. Compliance varied significantly between age groups (p=0.0057). Patients aged 50-59 collected 3.2 fewer prescriptions per year and those aged 90-99 collected 1.3 more prescriptions per year than the twelve required. Compliance was better with prostaglandin analogues compared to other medication groups but there was no statistically significant difference (p=0.0638); equally there was no difference when comparing diagnoses, co-morbidities or number of drops being taken. Conclusion: Glaucoma treatment compliance improves with increasing age. Older patients require more prescriptions and may experience drop wastage. Younger patients should be targeted with educational interventions to improve their understanding of glaucoma. Older patients may benefit from drop technique review. GPs are well placed to provide such interventions. 101. Managing Capacity in the Ophthalmology Department – Options review Anju Kadyan, Anna Gao, Shampa Gupta Shrewsbury and Telford Hospital NHS Trust Introduction: Ophthalmology services are currently facing huge capacity issues and delayed review appointments raise concerns on patient safety. Purpose: To evaluate overflow capacity in general ophthalmology clinics in a district general hospital (DGH) and review options to manage demand efficiently. Method: Prospective data from consecutive local Consultant clinics at a DGH (April-July 2013) and independent outsourced clinics commissioned subsequently (August-September 2013) to manage pending reviews was evaluated for diagnosis and outcomes. Results: A total of 144 patients data were collected from the Consultant clinics. The main diagnosis was glaucoma (n=117, 81.3%). 31 (21.5%) patients were deemed by the Consultant to have a different diagnosis from the previous doctor. Clinic review was felt not to be necessary in 17 (11.8%) patients based on the previous clinic entries. 34 patients (23.6%) were discharged, 94 (65.3%) had follow ups in general clinics, 10 (6.9%) in subspecialty clinics, 6 (4.2%) were listed for surgery or laser. Data for 129 patients from the Outsourced clinics was provided and 121 (93.8%) had glaucoma. 10 (7.8%) were discharged, 115 (89.1%) reviews arranged for general clinics, 2 (1.6%) were referred for cataract surgery and 2 (1.6%) to subspecialty clinics. Conclusion: An overwhelming majority of the patients in general clinics with delayed reviews had diagnosis of glaucoma. Consultant clinics led to three times as many discharges probably related to appropriate diagnosis and decision making skills. Majority of patients had stable glaucoma and could be managed more efficiently in Consultant-led Nurse/Optometry clinics by the Glaucoma service. 102. A comparative study of glaucoma drainage implant (GDI) surgery in children and adults at a tertiary referral centre Achilleas Mandalos, Michael Lai, Velota Sung Birmingham and Midland Eye Centre Introduction: Given the differences in the prevalent types of glaucoma in children and adults and the technical challenges of GDI implantation in paediatric eyes, it would be interesting to explore whether GDI surgery has similar outcomes and pitfalls in children compared to adults. 89 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma Purpose: To compare the postoperative outcomes and complications of GDI surgery in paediatric (<18 years old) versus older patients. Method: Retrospective, comparative study including all patients who underwent Baervedlt or Molteno implant surgery by a single surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and 22 mmHg and a 20% reduction from baseline. Results: Fifty two children (69 eyes) and 130 adults (145 eyes) were followed up for a mean of 45.7 months and 32.6 months, respectively. Mean IOP and number of medications were significantly reduced postoperatively in both groups. Overall success rate was statistically similar in children (66.7%) and adults (71.7%) at the last clinic visit. However, adults failed earlier than children. Hypotony was the most common complication in both groups in the first 6 months postoperatively. Later, bleb encapsulation was more frequent in children, while corneal decompensation occurred more frequently in adults. Children also had a higher rate of infectious endophthalmitis and required tube repositioning more frequently than adults. Conclusion: GDI surgery presents different postoperative challenges in children and adults. It is important that the surgeon remains vigilant for complications throughout the postoperative period, especially for signs of endophthalmitis or bleb encapsulation in paediatric patients. On the other hand, adults may be more prone to early corneal decompensation. 103. Patient oriented outcomes for selective laser trabeculoplasty Marina Hopes, Chrysostomos Dimitriou, Nuwan Niyadurupola, David Broadway, Tom Eke Norfolk and Norwich University Hospital Introduction: Selective laser trabeculoplasty (SLT) was introduced in the Norfolk and Norwich University Hospital glaucoma service in late 2009. Purpose: To assess effectiveness of SLT in terms that are directly relevant to patients. Method: Retrospective case-notes audit. The stated 'goal' of SLT was categorised. We looked at intraocular pressure (IOP) and whether the 'goal' of treatment had been achieved, at 1 year and at 2.5 years after SLT. Results: Notes for 52 consecutive patients (81 eyes) were analysed. Prior to SLT, mean (±SD) IOP was 19.5 (±4.2) mmHg on 1.3 (±1.2) anti-glaucoma agents. At 12 months, mean IOP was 16.3 (±4.1) mmHg using 1 (±1.2) agent; at 2.5 years mean IOP was 15.6 (±2.9) mmHg, using 1 (±1.2) agent. There were no complications. Goal-based outcomes were: (1) To avoid starting IOP-lowering medication: 8/10 patients (80%) success at 1 year, 4/10 patients (40%) success at 2.5 years. (2) To stop or reduce IOP-lowering medications: 9/15 patients (60%) success at 1 year, 8/15 patients (53%) success at 2.5 years. (3) To avoid adding IOP-lowering medication: 18/20 patients (90%) success at 1 year, 15/20 patients (75%) success at 2.5 years. (4) To avoid IOP-lowering procedure (cyclodiode laser or surgery): 2/7 patients (29%) success at 1 year, 1/7 patients (14%) success at 2.5 years. Conclusion: SLT can give a clinically useful reduction of IOP. Overall, the patient-oriented ‘goal’ was achieved in 71% and 54% of patients at 1year and 2.5 years respectively. Best success rate was when the goal was to avoid starting or adding IOP-lowering medication. 104. Ghrelin and Hepcidin Prohormone Levels in Patients with Primary Open-Angle Glaucoma Asaad Ghanem Masnoura Ophthalmic Center Introduction: Glaucoma, which is characterized by retinal ganglion cell (RGC) apoptosis, is the prominent cause of blindness. RGC apoptosis may be the result of increased intraocular pressure, neurotoxicity and apoptosis, extracellular matrix (ECM) changes, oxidative stress, and hypoxia due to ocular and systemic vascular dys-regulation Purpose: To assess the levels of ghrelin and hepcidin prohormone (Hep) in aqueous humor and plasma of human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with the severity of glaucoma. 90 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma Method: Fifty patients with POAG and thirty five patients with senile cataract (control group) were enrolled in the study prospectively. Aqueous humor samples were obtained by paracentesis from glaucoma and cataract patients who were undergoing elective surgery. Aqueous humor and corresponding plasma samples were analyzed for ghrelin and Hep concentrations by radioimmunoassay diagnostic kits and enzyme-linked immunosorbent assay respectively Results: Ghrelin and Hep levels were significantly lower in aqueous humor of POAG patients with respect to the comparative group of cataract patients (P<0.001). No significant difference in the levels of ghrelin and Hep in plasma of POAG and cataract patients. A positive correlation was found between ghrelin and Hep in aqueous humor of POAG patients (P<0.001). No significant correlation was found between either ghrelin and Hep levels and the severity of visual field loss Conclusion: Lower levels of aqueous humor ghrelin and Hep may be associated with POAG. In addition, ghrelin and Hep may be useful protein derivatives levels in aqueous humor of POAG patients as a consequence of glaucomatous damage 105. Outcomes of glaucoma referrals from a diabetic retinopathy screening service Robert Cann, Pavi Agrawal , Gus Gazzard Moorfields South, St. George's Hospital Introduction: Approximately 2% of the population have glaucoma, 50% undiagnosed (Beaver Dam and Blue Mountains Eye Studies). Diabetic retinopathy screening service (DRSS) disc photos can identify suspected glaucoma. Purpose: To determine the outcomes of glaucoma referrals made from the St. George’s DRSS to Moorfields South, including direct referrals and those made after recommendation of a glaucoma consultant. Method: Of 16,222 patients screened by the St. George’s DRSS during 2011-12 electronic records identified 235 patients graded as suspected glaucoma. Patients were graded by the DRSS alone or following disc photo review by a glaucoma consultant. Of these, paper records identified 87 suspected glaucoma referrals, 54 to Moorfields South. Patients already under a glaucoma clinic or without available notes were excluded. Medical notes of 43 patients were reviewed to determine glaucoma clinic attendance, initial diagnosis and discharge/follow-up plans. Results: 1) 88% (n=38) of Moorfields South referrals attended glaucoma clinic 2) 71% (n=27) of attendees diagnosed with ?glaucoma/POAG/NPG 3) 79% (n=30) of attendees offered follow-up 4) 58% (n=11) of referrals after glaucoma consultant review vs 84% (n=16) of direct referrals diagnosed with ?glaucoma/POAG/NPG Conclusion: This reflects a relatively effective single modality means to identify and refer suspected glaucoma. 1.4% of all screened patients had suspected glaucoma signs and 0.28% of all screened patients were newly diagnosed as ?glaucoma/POAG/NPG. The direct referral route had a better diagnostic PPV, likely reflecting more borderline cases being sent to the glaucoma consultant and more obvious cases being referred directly. 106. Current prescribing trends in a tertiary glaucoma unit Stephenie Tiew, Manon Owen, Anshoo Choudhary RLUH Introduction: In recent years, numerous new glaucoma topical therapies have emerged commercially including the increase in selection of preservative-free drops. Generic competition will increase with more drug patents expiring. Purpose: This cross-sectional study aims to assess current practice in dedicated glaucoma clinics in a tertiary eye unit in England including trends in prescribing, control of intraocular pressure and side effects relating to therapy (either branded or generic). Method: The study was conducted from May to July 2013. Data was collected prospectively from 100 consecutive patients attending glaucoma clinics. Standard proformas were filled by clinicians during clinic consultations and via corroboration with medical notes. Results: 66 patients were controlled on monotherapy for a mean duration of 3.31 years (95% CI, 0.86 to 6.2), with 30% of patients on dual therapy and 5% of patients on triple therapy. Follow-up time ranged from 1 91 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma month to 30 years (mean: 7.2 years). The first choice drug-class prescribed by clinicians was prostaglandin analogues (63%) Interestingly, 10 patients were switched between the prostaglandin analogues sub-groups with improved efficacy and tolerability (p<0.05). We found that topical carbonic anhydrase inhibitors have overtaken beta- blockers or beta-blocker combination drops as preferred 2nd line therapy and adjunctive therapy (21.7 %). 7 patients were on preservative-free drops. Only 2 patients reported a problem with generic drops. Conclusion: Practice patterns are similar to the current evidence base and guidelines. Further studies may provide further information on switching within drug-class and differences between branded and generic drops. 107. Treating Glaucoma: The Not-so-NICE Guidance Daniel Ackland, Neruban Kumaran, Rashid Zia William Harvey Hospital, East Kent Introduction: The National Institute for Health and Care Excellence (NICE) offers treatment guidance protocols for patients with ocular hypertension or suspected chronic open angle closure which are widely followed in the UK. Treatment of Goldmann applanation tonometer (GAT) derived intra-ocular pressure (IOP) is advised until a certain age depending on central corneal thickness (CCT). Purpose: Does the guidance disregard differences between the individual patients being treated and the inaccuracy of the measured IOP? Method: NICE guidance shortcomings were addressed individually with reference to published evidence. Results: Life expectancy is assumed based on population averages. General health and social priorities of the individual are not considered. Other factors overlooked by NICE when recommending target IOPs include levels of glaucoma damage, and rate of glaucoma progression. CCT is the only corneal property taken into account, despite engineering models suggesting that material properties of the cornea (i.e. Tensile Modulus, inherent stiffness and viscoelastic properties) likely dwarf CCTs effect on GAT measurements. There are also multiple other artefacts that will affect GAT measurements in the clinic, not limited to: diurnal variation, corneal curvation, corneal hydration, Valsalva manoeuvres and external pressure. There are potential areas of research to consider, such as the use of dynamic contour tonometry in patients with out-of-range corneal thickness to potentially reduce mistreatment. Conclusion: Whilst guidelines fail to cater for each and every patient in a population, the clinician must exercise their right to deviate, using their own judgement if this is likely to benefit the individual patient. 108. Patient Satisfaction with Peninsula Optometry Community Glaucoma Scheme Sarah Levy, Adam Booth Royal Eye Infirmary, Plymouth Introduction: Glaucoma patients make up a large proportion of the ophthalmic department's outpatient work load of any Hospital Eye Service (HES). There are a large number of shared care glaucoma schemes throughout the UK. There has however been very little published data as to whether patients like being cared for in shared care schemes. The aim of this study was to evaluate patients' satisfaction with our optometrist run, community based shared care scheme. Purpose: We conducted an audit of patient satisfaction with their community care using a self-completion questionnaire. Method: 120 patients were randomly identified and sent a self completion, anonymous, questionnaire. Patients were asked for details of age, gender and nine questions in relation to patient satisfaction with the community service. Patients were also asked to compare their community optometry care to the HES where all patients are initially seen. Results: 80 patients responded giving a 68% response rate. Overall 57.1% (47.5-66.25%) patient's were 'very satisfied' with the nine aspects of their care in the community and 90.4% responded they were 'satisfied' or 'very satisfied' with their care. When asked to compare their care in the community to hospital care 35 (43.8%) reported that their care was 'better' in the community, 34 (42.5%) the 'same' and 3 (3.8%) 'not as good'. Conclusion: With growing demands for new patients to be assessed and treated it is likely that community 92 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma optometry schemes are utilised more in the future. Our audit shows that the patients receiving community optometry care in the Peninsula Optometry Community Glaucoma Scheme are pleased with the service they receive. 109. Brinzolamide 1.0%/Timolol 0.5% versus Dorzolamide 2.0%/Timolol 0.5% in the treatment of openangle glaucoma or ocular hypertension: Prospective randomized patient preference study Sheng Lim, Laura Braithwaite St Thomas' Hospital Introduction: When considering adherence to topical ocular medications, side effect profile, ease of instillation and comfort are important. Dorzolamide 2.0%/timolol 0.5% (DTFC; Cosopt®) has lower pH than brinzolamide 1.0%/timolol 0.5% (BTFC; Azarga®) which may result in a variation in ocular comfort level. Purpose: This study compares patient preference with respect to ocular comfort, as well as a measure of ocular discomfort, between these two medications. Method: This was a multi-center, multi-national, single-masked, crossover study design. Patients (n= 108) were randomised 1:1 to self-administer (except for Day 7 am dose) one drop of BTFC or DTFC in both eyes BID for 7 days. Following a 48-hour washout period, on day 9 patients crossed-over to opposite treatment (selfadministered except for Day 15 am dose). After each treatment period, patients completed an ocular discomfort scale (0 no discomfort and 9 substantial discomfort). At the end of the study, patients completed a preference rating question. Results: Patient demographics were comparable at baseline. More patients (59.3%, 64/108) preferred BTFC to DTFC Mean ocular discomfort score was less with BTFC compared to DTFC (2.6 versus 3.7, P=0.0002). Conclusion: Patient preference and ocular discomfort levels for BTFC were better than that of DTFC in patients with either open-angle glaucoma or ocular hypertension. 110. Transscleral Diode Laser Cyclophotocoagulation with patients with moderately good vision. Sharmin Ria, Alaa Attawan, Kais Khalid Scunthorpe General Hospital Introduction: Assessing the use of transscleral diode laser cyclophotocoagulation (TS-CPC), in patients with refractory glaucoma and good vision. Cyclodestruction, by laser cyclophotocoagulation, of the ciliary epithelium improves the intra-ocular pressure (IOP) for refractory glaucoma. TS-CPC has been established as a safe treatment method for patients with poor vision. This loop closure focuses on patients with good vision as its use is less well documented. Purpose: Evaluating whether use of TS-CPC on refractive glaucoma patients with increased IOP and good vision, had a positive post-operative outcome with regards to; intra-ocular pressure and number of medication. Method: 25 retrospective case notes over an 18 month period reviewed from a single unit who had TS-CPC. Data collected on pre- and post- operative visual acuity (V/A), intra-ocular pressure (IOP), cup-to-disc ratio (C.D) and number of medications administered. Median average for pre-operative visual acuity was 6/6. Postoperative follow-up data collected after 1, 3, 6, 12 and 18 months. Results: Of 25 eyes, there was 12.01 mmHg IOP reduction post-operatively; greatest reduction 25.6 mmHg; the least 1.00 mmHg. 44% (11/25) of eyes had reduction in post-operative medications; 2 eyes decreased by 3 medications; 3 by 2 medications; 6 by 1 medication. 40% (10/25) eyes had complications; 2 cases of inflammation, 4 cases of distorted pupil and 6 cases with other complications. Conclusion: This study supports that TS-CPC have a positive role in the management of select patients with uncontrolled IOP with good pre-operative vision. 111. Prostaglandin associated periorbitopathy-case study,pathophysiology and clinical implications Hiten Sheth, Alison Matthews Amersham Hospital Introduction: Prostaglandin associated periorbitopathy (PAP) refers to changes that may occur in the periorbital soft tissue of patients using topical prostaglandin analogue glaucoma drops (PGAs). 93 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma The phenomenon appears little reported or discussed. Due to the subtlety of the changes the true incidence is unknown although changes are most noticeable in monocularly treated patients. These include, upper lid ptosis,deepening of the superior sulcus, mild enophthalmos,increased scleral show and involution of dermatochalasis-all secondary to orbital fat atrophy. The changes are often reversible and can be seen on MRI imaging. Purpose: To raise awareness of this phenomenon amongst ophthalmic professionals potentially initiating treatment with PGAs as the cosmetic changes may be distressing to the patient if not anticipated. Method: Case report and associated literature review. a 71 year old male Glaucoma suspect commenced on G Bimataprost 0.1mg/mL nocte to one eye only. Several clinical photographs (with written consent of the patient) illustrate the impressive physical changes to eyelid and facial appearance Results: within 3 months of commencing treatment, the patient,family and friends noticed a marked change in the appearance of the treated eye with relative deepening of the superior sulcus and resolution of eyelid bags and dermatochalasis. Conclusion: PAP seems to be relatively under-observed and under-reported and may cause distress to patients if not discussed beforehend alongside the better known side effects of PGAs. Increasing awareness will allow clinicians to better establish the true frequency and spectrum of this intriguing periorbital fat atrophy phenomenon. 112. Pre-natal Diagnosis of Rieger's Syndrome Based on Symptoms in Pregnancy John-Sebastian Barry, Joseph Abbott Russell's Hall Hospital, Dudley Introduction: Axenfeld-Rieger syndrome is a rare autosomal dominant disorder associated with anterior segment dysgenesis, glaucoma, tooth and other abnormalities (including of the umbilical cord). Purpose: To report the observation made by an affected mother with two affected children in the lineage, that pregnant ladies may be aware that their unborn child will be affected by the disorder without the need for medical testing/investigation. Method: Report the symptoms described in the history from the prenatal period (and from childbirth) and describe the associated findings on ophthalmic examination. Results: There is evidence that mothers in this lineage may be able to detect whether their pregnancies are affected based on pre-natal symptomatology (of foetal movements). Conclusion: Further corroboration is required to assess the sensitivity and specificity of this interesting observation. The fact that members of the lineage have noted differences in symptoms during pregnancy between affected and non-affected pregnancies is unique in the experience of the authors in ophthalmic disorders. The difference in symptoms is postulated to be due to restricted intra-uterine movements resulting from abnormally short umbilical cords in affected pregnancies. Maternal suspicion was apparently further confirmed at birth based on abnormalities of the umbilical cord (in particular rupture of a short cord during childbirth) prior to formal ophthalmic examination of the baby being carried out. In this lineage at least, one might postulate that intra-uterine ultrasonography could help give objective evidence to determine the risk that a pregnancy was affected by Rieger’s Syndrome. 113. No small enemy Miriam Lara De La Rosa Mexican Institute of Social Security Introduction: The depth and volume of the anterior chamber decrease steadily throughout life due to the continuous thickening of the lens with age. When the dilation pupil remains for a long time the intraocular pressure in the posterior chamber will be higher than the IOP in the anterior chamber. The trabecular meshwork thereby becomes blocked by the iris. This leads to a sudden and extreme rise in IOP called glaucoma attack. Purpose: Case report Method: July 12, 2013 Female 72 years old, she has pterygium both eyes. VA OD 0.1 Log MAR 1 OS 0.04 Log MAR 1,4 AS OD nasal pterygium with corneal invasion 5.6 x 4.0mm, anterior chamber van Hering 3. AS OS nasal pterygium with corneal invasion 6.0 x 7.0mm. 94 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Glaucoma / Medical Retina IOP OD 12mmHg IOP OI 13mmHg Pterygium removal surgery with conjunctival autograft of the left eye on September 3th, 2013. Five days after surgery, the patient presented red eye, blurred vision, severe ptosis and pupil dilation of the left eye and an extreme headache. VA OD 0.5 Log MAR 1.3 OI 0.02 LogMAR 1.7 IOP OD 12mmHg OS 40mmHg Patient was medicated with intravenous and topical hypotensors, an iridectomy was carried out on September 22nd, 2013 due to a continuing elevated IOP. Last review on October 21st, 2103 VA OD 0.05 Log MAR 1.3, OS 0.04 Log MAR 1.4. IOP OD 12mmHg OS 11mmHg Results: Glaucoma attack for block pupillary Conclusion: No small enemy, we must not forget that the retrobulbar block produces pupillary dilation that can lead to pupillary block in people with narrow anterior chamber. MEDICAL RETINA 114. Emotional and Physical Impact of Wet Age-Related Macular Degeneration (wAMD) on Patients and Caregivers Steve Winyard Royal National Institute of Blind People Introduction: wAMD is a leading cause of vision loss in older people in the Western world. The impact of wAMD on patients and caregivers is not well understood Purpose: To evaluate the physical and emotional impact of wAMD on patients and caregivers. Method: Patients, and caregivers of patients diagnosed with wAMD, who currently or previously had received intravitreal injections to treat their wAMD were surveyed. The survey was conducted in 9 countries, including the UK. Results: 910 patients and 890 caregivers (103 and 107, respectively, from the UK) were surveyed. About half of patients had wAMD in 1 eye (global:55%/UK:51%) and most had been receiving injections for >1 year (global:64%/UK:59%). Patients reported a range of disease consequences, including difficulty reading (global:61%/UK:39%) and inability to drive (global:39%/UK:35%). Many patients felt fearful (global:45%/UK:29%), sad (global:40%/UK:31%), and frustrated (global:37%/UK:36%). Most caregivers were a child or grandchild of the patient. While some (global:31%/UK:24%) felt that caregiving had a negative impact on their life; others (global:35%/UK:40%) believed the experience of being a caregiver had a positive impact. Similar to patients, some caregivers experienced sadness (global:35%/UK:41%), fear (global:28%/UK:31%,) and frustration (global:27%/UK:38%); however, nearly half (global:48%/UK:51%) felt useful. Conclusion: wAMD has a significant negative impact on the lives of most patients. Patients suffer from fear of permanent loss of vision, frustration, and sadness. Although some caregivers feel that wAMD has had a negative impact on their life, a similar proportion believe it has had a positive impact, leading many of them to feel useful. 115. The use of OCT in Retinal Screening : Results from the Improving Screening for Macular Oedema (ISMO) Study Roly Megaw, Shyamanga Booroah, Keith Goatman , Graham Scotland, Gordon Prescott, Peter Sharp, John Olson University of Aberdeen Introduction: The prevalence of diabetes is increasing and ocular complications will increase pressure on clinical services. The UK has several schemes for diabetic macular oedema (DMO) screening. Purpose: We assessed the cost effectiveness of OCT within retinal screening programmes in addition to photographic surrogate markers. Method: This prospective, observational cohort study recruited patients from Aberdeen, Birmingham, Dundee, Edinburgh, Fife, Liverpool and Oxford. Patients with exudates within 2 disc diameters (DDs) or dot/blot haemorrhages within 1 DD were included. Visual acuity, retinal photography and OCT was undertaken. 95 ABSTRACTS: Medical Retina Annual Congress Final Programme & Abstracts Birmingham 2014 Images were annotated, graded and analysed. Results were weighted to correct for sampling bias. Cost effectiveness was assessed using a Markov microsimulation model. Results: 3170 patients were included. Exudates within 1DD were the greatest predictor of DMO. 243 patients (7.7%) had DMO on OCT. Addition of OCT to English and Scottish screening systems resulted in cost savings without reducing health benefits. Deterministic sensitivity analysis suggests £58 saving per patient in England, and £47 in Scotland, when suspected DMO is monitored with 6-monthly photography plus OCT. Conclusion: Economic modelling suggests utilising OCT within retinal screening programmes, in addition to photographic surrogate markers, is cost-effective without reducing health benefits. 116. Multi-centre, prospective, observational, cohort study to assess the cost-effectiveness of English, Scottish and a hybrid grading schemes for diabetic macular oedema screening: improving screening for macular oedema (ISMO) study Shyamanga Borooah, Roly Megaw, Keith Goatman , Graham Scotland, Gordon Prescott, Peter Sharp, John Olson University of Aberdeen Introduction: Currently the grading of diabetic retinopathy in England and Scotland is relatively standardised but there is a divergence in diabetic macular oedema (DMO) screening criteria. As the prevalence of DMO rises it places an increasing financial burden on the national health service (NHS) highlighting the need to move to the most cost-effective model. Purpose: We compared the English, Scottish and a hybrid scheme with features of both to assess which was the most cost-effective. Method: 3170 patients who had photographic features of DMO in at least one eye were enrolled from 7 NHS regions. OCT was used as the gold standard for DMO diagnosis. The mean costs, years free of moderate visual loss and quality adjusted life years (QALYs) were compared between the different schemes. A Markov microsimulation model was developed to assess the cost-effectiveness of the schemes for triggering referral using data from this sample cohort. Results: The sensitivity and specificity for DMO were 72.6% and 66.8% for English, 59.5% and 79% for the Scottish and 73.3% and 70.9% for the hybrid schemes respectively. Following modelling more sensitive schemes resulted in only minimal increases in QALYs from preservation of moderate visual acuity, but led to increased costs from referral. Overall the Scottish scheme was found to be most cost-effective. Conclusion: Modifications to current screening criteria improve the cost-effectiveness of screening for DMO in the NHS. 117. AURA Study: Real-World Utilization of Anti-VEGF Therapy for Neovascular (Wet) Age-Related Macular Degeneration (wAMD) in the UK Philip Hykin, Sobha Sivaprasad, Usha Chakravarthy , Andrew Lotery, Martin McKibbin Moorfields Eye Hospital Introduction: In clinical trials, monthly ranibizumab improves visual outcomes in patients with wAMD. In real-life, this regimen is often unachievable, which may impact visual outcome. Purpose: Evaluate real-world utilisation and visual outcomes of anti-VEGF therapy for wAMD in the UK. Method: Retrospective, international (Canada, France, Germany, Ireland, Italy, Netherlands, UK, Venezuela) study. Consecutive wAMD patients (anti-VEGF-naïve) who started treatment with ranibizumab between 1 January and 31 August, 2009 were included. Data were collected until end of treatment or 31 August, 2011. Outcomes included change in visual acuity (VA) and resource utilisation. Results: 410 patients from the UK were included in the effectiveness analysis set; follow-up was documented for 396 in the first year and 350 in the second year. Mean baseline VA score was 55 letters. Most (63%) patients received their first treatment within 28 days of diagnosis. Mean number of injections in Year 1 and 2 was 5.8 and 3.2, respectively. Mean number of VA tests (reflecting monitoring) in Year 1 and 2 was 10.0 and 7.8, respectively. Mean change in VA from baseline at Year 1 and 2 was +6.0 and +4.1 letters, respectively. This compared favourably with results from all countries combined (mean VA gain; +2.4 and +0.6 letters, respectively). Injections and VA tests were less frequent in all countries combined (Year 1/Year 2; injections: 5.0/2.2, VA tests: 6.0/3.8). Conclusion: In the UK, patients were monitored more frequently and received more anti-VEGF injections, resulting in better visual outcomes in clinical practice than those in countries with less frequent monitoring and treatment. 96 Active Fluidics™ Automatically optimises chamber stability by allowing surgeons to customise and control IOP throughout the procedure. Balanced Energy™ Cataract emulsification using Ozil Intelligent Phaco and the new INTREPID Balanced Tip design. Applied Integration™ Designed to work seamlessly with other Alcon technologies for an integrated cataract procedure experience. THE BIMATOPROST FAMILY PRODUCTS TO MEET YOUR PATIENTS’ NEEDS UD Preservative Free Single Dose UD UD Preservative Free Single Dose Preservative Free Single Dose UD Preservative Free Single Dose UD Preservative Free Single Dose NEW Preservative-free monotherapy Monotherapy Preservative-free fixed combination Fixed combination Bimatoprost 0.3mg/ml, eye drops, solution, in single-dose container Bimatoprost ophthalmic solution 0.01% (0.1mg/ml) 0.3mg/ml + 5mg/ ml eye drops, solution, in singledose container bimatoprost/timolol Bimatoprost/ timolol ophthalmic solution 0.03%/0.5% (0.3mg/ml/5mg/ml) TOUGH Prescribing information can be found overleaf but gentle LUMIGAN® (Bimatoprost Ophthalmic Solution) 0.01% Abbreviated Prescribing Information Presentation: Eye drop solution, one ml contains 0.1mg bimatoprost Indications: Reduction of elevated intraocular pressure (IOP) in chronic openangle glaucoma and ocular hypertension in adults (as monotherapy or as adjunctive therapy to beta-blockers). Dosage and Administration: Please refer to the Summary of Product Characteristics before prescribing. Recommended dose is one drop in the affected eye(s) once daily, administered in the evening. More frequent administration may lessen the IOP lowering effect. If more than one topical ophthalmic medicinal product is being used, each should be administered at least 5 minutes apart. Not recommended in children or adolescents (under the age of 18). Use with caution in renal or moderate to severe hepatic impairment. Contraindications: Hypersensitivity to bimatoprost or any of the excipients. Patients who have had a suspected previous adverse reaction to benzalkonium chloride that has led to discontinuation. Warnings/ Precautions: Prior to treatment patients should be informed of the possibility of eyelash growth, darkening of the eyelid skin, increased iris pigmentation and the potential for hair growth in areas where Lumigan repeatedly comes into contact with the skin surface. Some of these changes may be permanent and may lead to differences in appearance between the eyes when only one eye is treated. The change in iris pigmentation is likely to be permanent, occurs LUMIGAN® (Bimatoprost Ophthalmic Solution) 0.03% Abbreviated Prescribing Information Presentation: Eye drop solution, one ml contains 0.3mg bimatoprost. Indications: Reduction of elevated intraocular pressure (IOP) in chronic openangle glaucoma and ocular hypertension in adults (as monotherapy or as adjunctive therapy to beta-blockers) in either Multi Dose bottles or Unit Dose vials. Dosage and Administration: Please refer to the Summary of Product Characteristics before prescribing. Recommended dose is one drop in the affected eye(s) once daily, administered in the evening. More frequent administration may lessen the IOP lowering effect. If more than one topical ophthalmic medicinal product is being used, each should be administered at least 5 minutes apart. Not recommended in children or adolescents (under the age of 18). Use with caution in renal or moderate to severe hepatic impairment. Contraindications: Hypersensitivity to bimatoprost or any of the excipients. Warnings/Precautions: Prior to treatment patients should be informed of the possibility of eyelash growth, darkening of the eyelid skin, increased iris pigmentation and the potential for hair growth in areas where Lumigan repeatedly comes into contact with the skin surface. Some of these changes may be permanent and may lead to differences in appearance between the eyes when only one eye is treated. The change in iris pigmentation is likely to be permanent, occurs slowly and may not be noticeable for several months or years. At 12 months, the incidence was 1.5% and did not increase following 3 years treatment. Periorbital tissue pigmentation has been reported to be reversible in some patients. The multidose GANFORT® (bimatoprost 0.03% / timolol 0.5%) Abbreviated Prescribing Information Presentation: Eye drop solution, one ml contains 0.3mg bimatoprost and 5mg timolol (as maleate). Indications: Reduction of intraocular pressure (IOP) in adult patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to topical beta-blockers or prostaglandin analogues in either multi-dose bottles or single-dose containers. Dosage and Administration: Please refer to the Summary of Product Characteristics before prescribing. Recommended dose is one drop in the affected eye(s) once daily, administered either in the morning or in the evening. It should be administered at the same time each day. If more than one topical ophthalmic medicinal product is to be used, each should be instilled at least 5 minutes apart. Not recommended in children or adolescents (under the age of 18). Use with caution in renal or hepatic impairment. Contraindications: Hypersensitivity to active substances or to any of the excipients. Reactive airway disease including bronchial asthma or a history of bronchial asthma, severe chronic obstructive pulmonary disease. Sinus bradycardia, sick sinus syndrome, sino-atrial block, second or third degree atrioventricular block not controlled with pace-maker, overt cardiac failure, cardiogenic shock. Warnings/ Precautions: Ganfort may be absorbed systemically. Systemic absorption can be reduced by using nasolacrimal occlusion, or closing the eyelids for 2 minutes. Following topical ophthalmic administration, the same types of cardiovascular, pulmonary and other adverse reactions as seen with systemic beta-blockers may occur, although at a lower incidence. Cardiac failure should be adequately controlled before beginning therapy. Patients with cardiovascular diseases (e.g. coronary heart disease, Prinzmetal’s angina and cardiac failure) and receiving hypotension therapy with beta-blockers should be critically assessed and therapy with other active ingredients should be considered. Patients with cardiovascular diseases should be watched for signs of deterioration and of adverse reactions. Use with caution in patients with first degree heart block and in patients with severe peripheral circulatory disturbance/disorders (i.e. severe forms of Raynaud’s disease or Raynaud’s syndrome). Respiratory reactions, including death due to bronchospasm in patients with asthma have been reported following administration of some ophthalmic beta-blockers. Use with caution in patients with mild/moderate COPD. Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycaemia or to patients with labile diabetes as beta-blockers may mask the signs and symptoms of acute hypoglycaemia. Betablockers may mask the signs of hyperthyroidism. Ophthalmic beta-blockers may induce dryness of eyes, therefore use with caution in corneal diseases. Closely slowly and may not be noticeable for several months or years. At 12 months there was one report of iris hyperpigmentation (incidence of 0.5%). Periorbital tissue pigmentation has been reported to be reversible in some patients. Contains the preservative benzalkonium chloride (0.2mg/ml) which may cause eye irritation and may be absorbed by and discolour soft contact lenses. Lenses should be removed before Lumigan instillation and may be reinserted 15 minutes after administration. Use with caution in dry eye patients, those where cornea may be compromised and in patients taking multiple BAK-containing drops. Monitoring required with prolonged use in such patients. Use with caution in patients with COPD, asthma or compromised respiratory function: those predisposed to low heart rate or low blood pressure or prior history of significant ocular viral infections or uveitis/iritis. Lumigan has not been studied in patients with heart block more severe than first degree or in uncontrolled congestive heart failure; inflammatory ocular conditions, neovascular, inflammatory, angle-closure glaucoma, congenital glaucoma or narrow-angle glaucoma. Cystoid macular oedema has been uncommonly reported (≥1/1000 to <1/100) with Lumigan 0.03% therefore Lumigan 0.01% should be used with caution in patients with known risk factors for macular oedema (e.g. aphakic patients, pseudophakic patients with a torn posterior lens capsule). It has been shown that the more frequent exposure of the eye to more than one dose of bimatoprost daily may decrease the IOP-lowering effect. There have been reports of bacterial keratitis associated with the use of multiple dose containers of topical ophthalmic products, particularly in patients with a concurrent ocular disease. Patients with a disruption of the ocular epithelial surface are at greater risk of developing bacterial keratitis. Interactions: There is a potential for the IOP-lowering effect of prostaglandin analogues (e.g. LUMIGAN) to be reduced in patients with glaucoma or ocular hypertension when used with other prostaglandin analogues. Pregnancy: Do not use unless clearly necessary. Lactation: Decision should be made taking into account the benefit of breast-feeding to child and Lumigan therapy to woman. Adverse Effects: In a 12-month clinical study, approximately 38% of patients experienced adverse reactions, the most frequently reported of which was conjunctival hyperaemia (mostly trace-mild) which occurred in 29% patients. Approximately 4% patients discontinued due to any adverse event in the 12-month study. The following undesirable effects were reported: Very Common (≥1/10) conjunctival hyperaemia; Common (≥1/100 to <1/10): punctate keratitis, eye irritation, eye pruritus, growth of eyelashes, eye pain, eyelid erythema, eyelid pruritus, skin hyperpigmentation, hypertrichosis , instillation site irritation. Please refer to Summary of Product Characteristics for full information on side effects. Basic NHS Price: £12.43 per 3ml bottle. £37.29 for 3x3ml bottle. Marketing Authorisation Number: EU/1/02/205/003004. Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM Date of Preparation: October 2013 formulation contains the preservative benzalkonium chloride which may cause eye irritation and may be absorbed by and discolour soft contact lenses. Lenses should be removed before Lumigan instillation and may be reinserted 15 minutes after administration. Monitoring required with frequent or prolonged use in dry eye patients or where the cornea is compromised. Use with caution in patients with COPD, asthma or compromised respiratory function; those predisposed to low heart rate or low blood pressure or prior history of significant ocular viral infections or uveitis/iritis. Lumigan has not been studied in patients with heart block more severe than first degree or in uncontrolled congestive heart failure, inflammatory ocular conditions, neovascular, inflammatory, angle-closure glaucoma, congenital glaucoma or narrow-angle glaucoma. Cystoid macular oedema has been uncommonly reported (≥1/1000 to <1/100) and Lumigan should be used with caution in patients with known risk factors for macular oedema (e.g. aphakic patients, pseudophakic patients with a torn posterior lens capsule). It has been shown that the more frequent exposure of the eye to more than one dose of bimatoprost daily may decrease the IOPlowering effect. There have been reports of bacterial keratitis associated with the use of multiple dose containers of topical ophthalmic products, particularly in patients with a concurrent ocular disease. Patients with a disruption of the ocular epithelial surface are at greater risk of developing bacterial keratitis. Interactions: There is a potential for the IOP-lowering effect of prostaglandin analogues (e.g. LUMIGAN) to be reduced in patients with glaucoma or ocular hypertension when used with other prostaglandin analogues. Pregnancy: Do not use unless clearly necessary. Lactation: Decision should be made taking into account the benefit of breast-feeding to child and Lumigan therapy to woman. Adverse Effects: In clinical trials the most frequently reported adverse events (>1/10) were growth of eyelashes (up to 45% in first year with new reports decreasing to 7% at 2 years and 2% at three years), conjunctival hyperaemia (mostly trace to mild - up to 44% in first year decreasing to 13% at 2 years and 12% at 3 years), and ocular pruritus (up to 14% in first year decreasing to 3% at 2 years and 0% at 3 years). Less than 9% of patients discontinued due to any adverse event in the first year with additional discontinuations being 3% at both 2 and 3 years. The following undesirable effects were reported: Very Common (≥1/10): conjunctival hyperaemia, ocular pruritus (common with Unit Dose formulation), growth of eyelashes (common with Unit Dose formulation); Common (≥1/100 to <1/10): superficial punctate keratitis, corneal erosion, ocular burning, ocular irritation, allergic conjunctivitis, blepharitis, worsening of visual acuity, asthenopia, conjunctival oedema, foreign body sensation, ocular dryness, eye pain, photophobia, tearing, eye discharge, visual disturbance/blurred vision, increased iris pigmentation, eyelash darkening, eyelid erythema, eyelid pruritus, pigmentation of periocular skin, headache, hypertension, liver function test abnormal. Please refer to Summary of Product Characteristics for full information on side effects. Basic NHS Price: £10.30 per 3ml bottle. £30.90 for 3x3ml bottle. £13.75 for 30 Unit Dose vials. Marketing Authorisation Number: EU/1/02/205/001-002; 006. Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM. Date of Preparation: October 2013 monitor IOP in patients concomitantly receiving systemic beta-blockers. The use of 2 topical beta-blocking agents is not recommended. While taking beta-blockers, patients with a history of atopy or a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge with such allergens and unresponsive to the usual dose of adrenaline used to treat anaphylactic reactions. Choroidal detachment has been reported with administration of timolol after filtration procedures. Anaesthesiologist should be informed when the patient is receiving timolol. Before treatment is initiated, patients should be informed of the possibility of eyelash growth, darkening of the eyelid or periocular skin and increased brown iris pigmentation since these have been observed during treatment with bimatoprost and Ganfort. Increased iris pigmentation is likely to be permanent, and may lead to differences in appearance between the eyes if only one eye is treated. After discontinuation of Ganfort, pigmentation of iris may be permanent. After 12 months treatment with Ganfort (multi-dose), the incidence of iris pigmentation was 0.2%. After 12 months treatment with bimatoprost eye drops alone, the incidence was 1.5% and did not increase following 3 years treatment. The pigmentation change is due to increased melanin content in the melanocytes rather than to an increase in the number of melanocytes. The long term effects of increased iridial pigmentation are not known. Macular oedema, including cystoid macular oedema has been reported with Ganfort (multi-dose). Therefore, Ganfort should be used with caution in aphakic patients, in pseudophakic patients with a torn posterior lens capsule, or in patients with known risk factors for macular oedema (e.g. intraocular surgery, retinal vein occlusions, ocular inflammatory disease and diabetic retinopathy). Ganfort should be used with caution in patients with active intraocular inflammation (e.g. uveitis) because the inflammation may be exacerbated. There is a potential for hair growth to occur in areas where Ganfort solution comes repeatedly in contact with the skin surface. Thus, it is important to apply Ganfort as instructed and avoid it running onto the cheek or other skin areas. The multi-dose formulation of Ganfort, contains the preservative benzalkonium chloride, which may cause eye irritation and may be absorbed by and discolour soft contact lenses. Lenses should be removed before Ganfort multidose instillation and may be reinserted 15 minutes after administration. Benzalkonium chloride has been reported to cause punctate keratopathy and/or toxic ulcerative keratopathy, therefore monitoring is required with frequent or prolonged use of Ganfort multi-dose in dry eye patients or where the cornea is compromised. In studies of bimatoprost 0.3 mg/ml in patients with glaucoma or ocular hypertension, it has been shown that more frequent exposure of the eye to more than 1 dose of bimatoprost daily may decrease the IOP-lowering effect. Patients using Ganfort with other prostaglandin analogs should be monitored for changes to their intraocular pressure. Interactions: Potential for additive effects resulting in hypotension, and/or marked bradycardia when ophthalmic beta-blocker solution is administered concomitantly with oral calcium channel blockers, guanethidine, or beta-adrenergic blocking agents, parasympathomimetics, antiarrhythmics and digitalis glycosides. Beta-blockers may increase the hypoglycaemic effect of antidiabetic medicinal products. Potential systemic beta-blockade (e.g. decrease heart rate, depression) has been reported during combined treatment with CYP2D6 inhibitors. Mydriasis resulting from concomitant use of ophthalmic beta-blockers and adrenaline has occasionally been reported. Pregnancy: There are no adequate data from the use of Ganfort in pregnant women. Do not use during pregnancy unless clearly necessary. Ganfort should not be used by breastfeeding women. Adverse Effects: No adverse drug reactions (ADRs) specific for Ganfort have been observed in clinical studies. The ADRs have been limited to those earlier reported for bimatoprost and timolol and the majority were ocular, mild in severity and none were serious. Based on 12-month clinical data, the most commonly reported ADR was conjunctival hyperaemia (mostly trace to mild and thought to be of a non-inflammatory nature) in approximately 26% and 21% of patients and led to discontinuation in 1.5% and 1.4% of patients for Ganfort multi-dose and Ganfort single-dose respectively. The following ADRs have been reported with Ganfort multi-dose. Very common (≥1/10): conjunctival hyperaemia. Common (≥1/100 to <1/10): headache, dizziness, superficial punctuate keratitis, corneal erosion, burning sensation, eye pruritus, stinging sensation in the eye, foreign body sensation, eye dryness, eyelid erythema, eye pain, photophobia, eye discharge, visual disturbance, eyelid pruritus, visual acuity worsened, blepharitis, eyelid oedema, eye irritation, epiphora, growth of eyelashes, rhinitis, blepharal pigmentation, hirsutism, periocular skin hyperpigmentation. The following ADRs were reported during clinical trials with Ganfort single-dose. Very common (≥1/10): conjunctival hyperaemia. Common (≥1/100 to <1/10): punctuate keratitis, eye irritation, conjunctival irritation, eye pruritus, eye pain, foreign body sensation, dry eye, lacrimination increased, erythema of eyelid, photophobia, growth of eyelashes, headache, skin hyperpigmentation. Additional adverse events that have been seen with one of the components and may potentially occur also with Ganfort. Please refer to the Summary of Product Characteristics for full information on side effects. Basic NHS Price: £13.95 per 3ml bottle. £37.59 for 3x3ml bottle. £17.50 for 30 single-dose vials. Marketing Authorisation Number: EU/1/06/340/001005. Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM. Date of Preparation: July 2013 Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Allergan Ltd. [email protected] or 01628 494026. UK/0241/2014 Date of Preparation: February 2014 M.I.S.S Ophthalmics NEW Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina 118. Fluorescence gradient analysis of fluorescein angiograms Nigel Davies Chelsea and Westminster Hospital Introduction: This study investigates the use of image analysis software to automatically delineate abnormal rate of change in fluorescence in fluorescein angiograms. Purpose: To assess software written to analyse the rate of change of fluorescence in angiograms. This may allow clinicians a more objective method for examining the results of an angiographic study rather than current subjective methods. Method: Software was written using MATLAB (Mathworks Inc). Image registration to align angiographic frames was performed. Fluorescence gradients (in fluorescence units/sec) were calculated at each pixel for dye entry (first) phase and recirculation (second) phase. Finally a gradient classifier identified areas of hyper and hypo fluorescence. Positive gradients in the second phase were used to identify hyperfluorescent pixels and the lowest quartile gradients in both first and second phases identified hypofluorescent pixels. Results: 50 angiograms were analysed from patients with diabetes, AMD and vein occlusion. 2 failed the registration process. First phase gradients ranged from 0.3 units/sec (SD 3.9) to 13.2 units/sec (SD 9.8) and second phase from -0.4 units/sec (SD 0.9) to +0.4 units/sec (SD 1.2). Hyperfluorescence ranged from 0% to 23% in the registered angiogram area. Areas of hypofluorescence ranged from 0% to 12%. Conclusion: The software was able to identify areas of abnormality in each angiogram. Areas of quantified abnormality can be colour-coded and overlaid onto an angiographic frame and/or the aligned colour fundus photograph. Data relating to gradients at individual pixels can be displayed, leading to a more standardised analysis of rates of fluorescence. 119. A study of aged GK rats: is tau the missing link between diabetes and Alzheimer’s Disease? Timothy Wong, Marianne Phillips, Shereen Nizari , M Francesca Cordeiro Institute of Ophthalmology, UCL Introduction: Research has shown that diabetes and Alzheimer’s disease (AD) share similar pathophysiology. The hallmarks of AD include neurofibrillary tangles (NFTs), which consist of abnormal tau and neurofilaments (NFs), which tend to be hyperphosphorylated. Purpose: Goto Kakizaki (GK) rats are spontaneously diabetic and are considered a model for T2DM in humans. As the brain and retina share a common embryological origin, AD pathology that occurred in the brains of AD transgenic mice also occurred in the retina. We investigate tau pathology and neurofilamentopathy in the retinas of aged GK rats, as measures of AD pathology. Method: The eyes from 23 3-, 12- and 18-month old GK rats and age-matched controls were obtained and embedded in paraffin blocks. Sections from these blocks were stained with antibodies for tau, hyperphosphorylated tau (p-tau) and NF-heavy (NFH). Immunohistochemistry images were visualized and obtained. These images were graded for distribution and fluorescence of the antibodies by three independent observers without knowledge of diabetic or control status. Results: There seemed to be an age-dependent increase of p-tau and NFH in the diabetic retina, but not the control retina. Increased levels of p-tau and NFH were found in the diabetic retina as compared to the control retina. No change of colocalization of p-tau and NFH was found in the control or diabetic retina over time. Conclusion: There is increased neurodegeneration in the diabetic retina over time and as compared to the control retina. This seems to be the first study that demonstrated AD pathology in the retinas of aged diabetic GK rats. 120. Long-term visual acuity outcome in patients with diabetic macular oedema treated with fluocinolone acetonide Yit Yang, Niro Narendran, Clare Bailey, Andrew Lotery Wolverhampton Eye Infirmary Introduction: Iluvien® (intraocular fluocinolone acetonide [FAc] implant) is recommended by NICE for chronic diabetic macular oedema (DMO) which has been insufficiently responsive to available therapies but only in pseudophakic patients. Purpose: Evaluate visual benefit in phakic patients who underwent cataract extraction during the 3-year FAME trials (NCT00344968). 103 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina Method: Mean BCVA improvement at 12 months post-cataract surgery was determined for all phakic patients who required cataract extraction during the FAME studies. BCVA improvement was compared between shamand 0.2 μg/day FAc-treated patients, including pre-specified subgroups with chronic and non-chronic DMO. Due to the post-hoc nature, statistical hypothesis testing was not performed. Results: Median cataract formation time (Kaplan-Meier estimates) was 811 days for sham-injected and 435 days for 0.2 μg/day FAc-treated patients. Median cataract extraction time (Kaplan-Meier estimate) was 550 days for 0.2 μg/day FAc-treated patients (could not estimate for sham-injected patients). At 12 months postcataract-surgery, BCVA improvement in sham-injected patients was +13.9 letters in the chronic DMO subgroup and +19.7 in the non-chronic DMO subgroup. BCVA improvement at 12 months post-cataract-surgery in 0.2 µg/day FAc-treated patients was +23.7 letters in the chronic DMO subgroup and +23.2 letters in the nonchronic DMO subgroup. Conclusion: Phakic patients treated with 0.2 µg/day FAc who required cataract surgery during the FAME trial period, experienced substantial visual improvement following cataract surgery irrespective of their status in terms of chronicity of DMO. 121. Progression of retinal atrophy in Stargardt’s Macular Dystrophy estimated from spectral-domain optical coherence tomography measurements of macular volume Rupert Wolfgang Strauss, Beatriz Munoz, Emily Fletcher , Yulia Wolfson, Millena Bittencourt, Hendrik P N Scholl Wilmer Eye Institute, Johns Hopkins University Introduction: Stargardt Macular Dystrophy (STGD) is the most common juvenile macular degeneration. Several treatment approaches are in early (pre-)clinical studies and may require efficacy measures in the future. Purpose: To estimate disease progression based on analysis of macular volume measured by spectral-domain optical coherence tomography (sd-OCT) in patients affected by Stargardt Macular Dystrophy (STGD). Method: 58 eyes of 29 STGD patients were included. Numbers and types of algorithm failures were recorded and manually corrected. In a subgroup of 36 eyes of 18 patients with at least two examinations over time, total macular volume (TMV) and volumes of all nine ETDRS subfields were obtained. Random effects models were used to estimate the rate of change per year for the population, and empirical Bayes slopes were used to estimate yearly decline in total macular volume for individual eyes. Results: 6958 single B-scans from 190 macular scans were analyzed. 2360 (33.9%) showed algorithm failures. Mean observation period for follow-up data was 15 months (range 3 to 40). The mean (± sd) TMV was 6.321 ± 1.000 mm3 at baseline and rate of decline was -0.118 mm3 per year (p=0.003). The median (interquartile range) change in TMV using the empirical Bayes estimates for the individual eyes was -0.103 (-0.145, -0.059) mm3 per year. Conclusion: Sd-OCT measurements allow to monitor the decline in retinal volume in STGD and may serve as outcome measures for clinical trials. 122. The cost effectiveness of aflibercept compared to ranibizumab in the management of wet age-related macular degeneration (wAMD) Jennifer Priaulx, Jacqueline Napier , Gabriela Vega , Matthew Radford Bayer Introduction: The National Institute for Health and Care Excellence in July 2013 recommended aflibercept as an option in TA294 for patients with wAMD. Cost and effectiveness are both important considerations when allocating scarce health care resources. Purpose: To estimate the long-term costs and outcomes of aflibercept compared to ranibizumab in wAMD. Method: An economic model was developed to consider visual acuity in both eyes and extrapolate costs and benefits of treatment beyond the time frame of clinical trials. Patients considered were those included in the VIEW studies. An indirect comparison of data from aflibercept and ranibizumab trials informed efficacy. Frequency of injections and monitoring were assumed in line with the UK marketing authorisations. Utilities at different levels of visual acuity were collected in aflibercept trials using the EQ5D instrument. Costs to the NHS and personal social services were estimated at 2012 prices. The primary outcome was cost per Quality Adjusted Life Year (QALY) gained. Results: The model predicted that aflibercept reduced costs per patient per year by £3,588 at NHS list prices whilst generating a similar number of QALYs. In a scenario where treatment of the second eye was also 104 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina considered, aflibercept remained less costly than ranibizumab with comparable outcomes. Results were sensitive to drug costs, frequency of administration and monitoring. Conclusion: This economic evaluation found that aflibercept was associated with lower costs than ranibizumab and produced similar outcomes for the treatment of wAMD in the UK 123. A systematic review on the use of Photodynamic Therapy to treat Central serous Chorioretinopathy Ore-oluwa C Erikitola, Roxanne Nwanobi-Crosby, Sobha Sivaprasad Moorfields Eye Hospital Introduction: Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterized by detachment of the neurosensory retina due to serous fluid accumulation between the photoreceptor outer segments and the retinal pigment epithelium. There are currently no set guidelines or protocols on its treatment. Purpose: This study was undertaken to assess the current literature on the use of photodynamic therapy (PDT) in the treatment of CSCR and assess PDT’s efficacy in treating this condition. Method: Randomised controlled trials (RCTs) and case series that met the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria were identified from the current literature for analysis. Data concerning treatment with PDT, mean duration of CSCR symptoms, dosing regimens (which includes: treatment dose of vertoporfin, treatment time, fluence, spot size), number of treatment session, response to treatment, mean follow up duration and complications from the treatment of CSCR were extracted and compiled into a database. Results: Since the introduction of PDT for the treatment of CSCR in 2003, there have been 2 RCTs that have assessed the efficacy of PDT in treating CSCR (includes both acute and chronic). Both RCTs compared the use of PDT with other treatments. 26 studies that met the STROBE criteria with similar outcomes to the RCT were also identified. In both RCTs by Chan el al and Bae et al, there was a mean improvement in BCVA post PDT treatment at 3 months (p=0.015 and p= 0.075 respectively). In the STROBE group also, although the studies were not heterogenous, there was a statistically significant improvement in visual acuity at 3 months in all studies. This effect was maintained at 6 months in studies with longer follow-up. Conclusion: There is sufficient scientific and statistical evidence to advocate the use of PDT in the treatment of chronic CSCR. This is clearly reflected in our systematic review. 124. Visual Outcome in Patients with Uveitis Ahmed Samy, Sue Lightman, Oren Tomkins-Netzer , Lazha Talat, Asaf Bar, Simon Taylor, Albert Lula Moorfields Eye Hospital, Royal Surrey County Hospital NHS Introduction: Uveitis, although comparatively rare when compared with other eye problems for example diabetic retinopathy and age related macular degeneration, remains a significant cause of visual handicap in the UK Purpose: To evaluate the long term clinical and functional outcome, treatment strategies, causes of vision loss and burden of disease among patients with uveitis. Method: Cross-sectional study conducted on 1077 Patients diagnosed with uveitis attending the uveitis clinic at between the years 2011-2013. Results: 1799 eyes of 1077 patients were included in this study, with an average follow-up of 7.97±0.17yrs (range 1 month to 54 years, 8159 patient years, 14226 eye years). Average BCVA remained stable throughout follow-up from 0.34±0.04 LogMAR at baseline to 0.33±0.02 LogMAR at 10 years (p=0.23), and continued to remain stable also among patients with a follow-up of over 10 years who had a final BCVA of 0.35±0.03 LogMAR. Vision loss was noted in 19.2% of eyes with an incidence for VL of 0.01 per eye year or 0.02 per patient year and for SVL 0.01 per eye year or 0.02 per patient year. Chronic cystoid macular oedema was the most common cause of VL (3.55%) and macular scarring the most common cause for irreversible SVL (4%). 525 patients (48.7%) received oral prednisolone, 320 (29.7%) requiring a dose of over 40mg a day and 130 (12.1%) also required one or more second line agents. Patients were reviewed on average 33.7±0.7 times or 5.9±0.46 times a year. Conclusion: Long term functional outcome among uveitis patients is good with BCVA remaining stable over 10 years of follow-up. In cases when vision loss occurs it is mainly related to retinal changes. The burden of disease is similar regardless the severity of disease or the risk of vision loss 105 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina 125. Real-world outcomes with intra-vitreal aflibercept as initial therapy for neovascular AMD Michael Kaye, Carlo Suter, Helen Devonport , Faruque Ghanchi, Martin McKibbin Bradford Royal Infirmary Introduction: Collection of real-world outcome data is important to determine if clinical trial outcomes are achievable in the NHS Purpose: To report the functional and anatomical outcomes following intra-vitreal aflibercept therapy for neovascular AMD (nAMD) in two UK centres Method: Treatment naïve, nAMD patients were treated with intra-vitreal aflibercept, with a loading phase of 3 monthly injections followed by two-monthly injections for the first year. Outcomes include change in mean ETDRS letter score, 1mm central retinal thickness (CRT) measured by spectral domain OCT and the absence of intra- or sub-retinal fluid at the month 4 visit, before the start of the maintenance phase. Patients with other significant ocular pathology or prior vitrectomy in the study eye were excluded. Results: For the 195 patients, mean age was 82 years and 86 were male. Mean ETDRS letter score at baseline was 51 letters and mean CRT was 412µ m. Before the third injection in the loading phase (month 2), mean ETDRS letter score increased by 7 letters and CRT decreased by 131µ m from baseline. Before the first injection in the maintenance phase (month 4), mean ETDRS letter score change from baseline was +5 letters and the CRT reduction was 104µ m but only 29% of OCT images were “dry”. Conclusion: Although the number of patients with follow-up into the maintenance phase of treatment is small, these data suggest that good functional and anatomical gains are achievable with intra-vitreal aflibercept in a real-world setting. 126. Mean visual gain and atrophic retinas after five years of Ranibizumab ‘prn’ treatment in a neovascular Age-related Macular Degeneration (nvAMD) service. Archana Airody, Divya Venugopal, Nicola Topping , Richard Hanson, Gavin Walters, Richard Gale York teaching Hospitals NHS Foundation Trust Introduction: The SEVEN UP analysis shows one third had poor visual outcome following on from clinical trials. A four-year study showed a mean 2.7 ETDRS letters decline in visual acuity in a clinical setting. Purpose: To demonstrate outcomes in patients treated with intravitreal ranibizumab for neovascular Agerelated Macular Degeneration for five years in a clinical setting. Method: Retrospective review of patients completing five years of nvAMD clinic attendance prior to August 2013. Treatment was using a ‘tight prn’ regimen. Results: 68 eyes with a mean age 83.39 (range 66-92) completed five years. 48.52% were angiographically occult with 83.82% >1DD. The mean visual acuity was 42.44 ETDRS letters (SD +/- 13.60) at baseline, 55.22(SD +/- 14.22) at 6 months and 53.36(SD +/- 17.24) at 60 months. 29.14% gained >/=15 letters. Mean baseline CRT was 328.39(SD +/- 80.17) microns, 274.4(SD +/- 49.57) at 6 months and 230.23(SD +/- 48.47) at 60 months. 66.17% showed OCT activity at 60 months. The total mean number of injections per person was 24.0 over 60 months with 5.9(+/-1.98) in year 1 and 6.6(+/-4.4) in year 5. Conclusion: Patients completing 5 years sustained a mean visual improvement, a third gaining 15 letters or more with 5 injections per year. Long term treatment was required with persistent activity in the majority. OCT thickness progressively thinned below that of healthy individuals. 127. Ocular side effects of mitogen-activated protein kinase (MEK) inhibitors Robert M J Purbrick, Wasir Saka, Denis C Talbot , Susan M Downes Oxford Eye Hospital Introduction: MEK inhibitors are small molecular weight agents under investigation for treatment of advanced cancer. Our unit assists in monitoring patients in MEK inhibitor trials and we have documented ocular side effects associated with these drugs. Purpose: To describe the ocular side effects of MEK inhibitors seen in a local study population. Method: A retrospective case series of 16 patients referred as part of safety monitoring for trials evaluating a number of MEK inhibitors. Results: Of the 16 patients in this series, eight (50%) experienced probable ocular toxicity: four cases of bilateral central serous chorioretinopathy (CSC); two patients developed significantly raised intraocular pressure (IOP); one central retinal vein occlusion (CRVO); and one case of anterior uveitis with hypopyon. All 106 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina four CSC cases resolved following cessation of the study drug; both patients with raised IOP required topical treatment acutely but had no further problems after withdrawal of MEK inhibitor; the CRVO patient requires ongoing treatment with intravitreal bevacizumab for macular oedema; the case of anterior uveitis settled with topical steroid treatment and withdrawal of the study drug. Conclusion: Animal models demonstrate that MEK inhibition induces oxidative stress, inflammation and bloodretinal barrier/RPE damage. Cases of MEK inhibitor-induced retinopathy have been reported previously, but our series is unique in that we have reliable baseline information demonstrating a temporal relationship between MEK inhibition and ocular side effects. The release of matrix metalloproteinases is directly influenced by MEK and inhibition of this pathway could raise IOP due to reduced uveoscleral outflow. 128. 6-weekly bevacizumab versus 4-weekly ranibizumab as required treatment for neovascular age-related macular degeneration: a 2-year outcome Patrick Chiam, Nicholas Hickley, Venkat Kotamarthi Leighton Hospital, Crewe Introduction: The 4-weekly bevacizumab on an as-required-basis has been shown to have equivalent effect as ranibizumab on the same regime for the treatment of neovascular age-related macular degeneration however the 6-weekly regime has not been investigated. Purpose: To compare the visual and central macular thickness (CMT) outcomes of 6-weekly bevacizumab and 4-weekly ranibizumab treatment on an as-required-basis for neovascular age-related macular degeneration over 24-month. Method: Retrospective analysis of consecutive patients who were treated with bevacizumab or ranibizumab and fitted the study criteria. Patients were followed-up 6-weekly in the bevacizumab and 4-weekly in the ranibizumab groups. All patients received 3-loading injections followed by as-required-basis treatment. Samples of 102 for bevacizumab and 101 ranibizumab were obtained to provide a study power of 80% to detect non-inferiority limit of 5 letters (significance 2.5%, one-tailed). Normality test for distribution and intention-to-treat analysis were performed. Main outcomes measured were mean change in visual acuity (unpaired t-test), CMT and number of injections (Mann-Whitney test for latter two). Results: At 12-month, the mean letter gained with bevacizumab was 7.6 and ranibizumab 10.7 (p=0.06). The 95% confidence interval (CI) for bevacizumab minus ranibizumab was -6.8 to 0.6. At 24-month, the improvements were 7.0 and 9.2 letters (p=0.31). The 95% CI was -6.3 to 2.3. The mean number of bevacizumab injections after 12-month was 6.6 and ranibizumab 5.9 (p<0.001). At 24-month, there were 11.9 and 10.3 (p<0.001). At 12-month, the CMT improvement were 139μm for bevacizumab and 150μm ranibizumab (p=0.33); at 24-month 146μm and 160 μm (p=0.43). Conclusion: The comparison between the two treatment regimes in terms of visual acuity at 12- and 24-month was inconclusive. There was no difference between the CMT changes. The number of bevacizumab injection required in 2 years was one fewer than ranibizumab. 129. Aflibercept (Eylea) for Treatment Resistant Neovascular Age-Related Macular Degeneration (nAMD): Early UK Outcomes Tejal Magan, Aman Kirmani, Zine Elhousseini , Matthew Robertson, Samantha Mann St Thomas' Hospital, London Introduction: Aflibercept was approved by NICE for NHS use in July 2013. Our local commissioners authorised earlier use in April 2013. Purpose: To report anatomical and functional outcomes of Aflibercept in eyes with nAMD showing suboptimal response with prior Ranibizumab therapy. This was defined as persisting disease activity on OCT (sub/ intra-retinal fluid or new haemorrhage), despite a full ‘loading phase’ of three injections and a further three consecutive injections administered on each subsequent visit. Method: Prospective data collection in all patients switched to Aflibercept. The main outcome measures after three Aflibercept injections were central foveal thickness (CFT), the maximal height and width of retinal pigment epithelial detachments (PED) and visual acuity; other outcomes included the number of previous injections and the proportion of eyes regarded as inactive. Results: 83 eyes of 79 patients had their therapy switched to Aflibercept, all had their outcomes assessed 6-8 weeks after the third injection. The mean CFT reduced from 388μm to 319μm, mean PED height reduced from 294μm to 218μm, PED width changed minimally from 2074μm to 1910μm and VA showed a slight gain from 69 ETDRS letters to 73 letters. The mean number of prior injections was 11.1, whilst 29% had no signs of activity after 3 injections. 107 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina Conclusion: Switching to Aflibercept resulted in improved macular anatomy, but only modest functional gains were noted, these probably reflect the chronicity of disease in these individuals. 130. Central serous chorioretinopathy and pigment epithelial detachments associated with a novel MEK inhibitor Nashila Hirji, Laura Maubon , Vasiliki Michalarea , Udai Banerji, Paul Ursell Sutton Hospital Introduction: There are rare reports of central serous chorioretinopathy (CSCR) and pigment epithelial detachments (PEDs) occurring following treatment with MEK inhibitors. However, the literature in this field is sparse. Purpose: In our study, we aimed to demonstrate the extent and frequency of ophthalmic signs and symptoms in patients commenced on a novel MEK inhibitor. Method: We retrospectively analysed the case notes of 15 patients commenced on a new MEK inhibitor, administered orally as monotherapy for the treatment of advanced tumours. The development of ocular symptoms and signs whilst they were on treatment was evaluated, and the time to resolution was noted. Results: Of the 15 patients, 5 developed PEDs and 3 developed CSCR. These were associated with minimal change in Snellen visual acuity, although patients tended to report positive visual phenomena. Symptoms and signs developed within a month of commencing treatment in 6 of these patients (within 1 week in 4 cases). In most cases, symptoms resolved spontaneously between 1 to 4 months after onset. Conclusion: Our results demonstrate that PEDs and CSCR appear to be relatively frequent side effects of MEK inhibitors. It would therefore be prudent to emphasize the likelihood of possible visual disturbances to patients on these drugs, and organise for them to have a baseline ophthalmic assessment prior to commencing treatment, followed by regular ophthalmic examinations thereafter whilst on treatment. 131. Pattern scan laser for proliferative diabetic retinopathy: outcome at 1-2 year follow up Alexander Baneke, Felicity Allen, Todd Williamson , Moin Mohamed, Samantha Mann St Thomas' Hospital Introduction: Pattern scan (PASCAL) laser has replaced argon green laser as the standard treatment for newly diagnosed proliferative diabetic retinopathy. However, recent research has suggested that it may be less effective at maintaining lasting regression of retinal neovascularisation. The Early Treatment of Diabetic Retinopathy Study group (EDTRS) guidelines were designed for the older, argon green laser, but these guidelines are still being used for the PASCAL. Purpose: We aimed to assess PASCAL laser effectiveness at reducing progression of diabetic retinopathy. Method: A retrospective database search was carried out on 31 patients (49 eyes) from St Thomas’ Hospital who had been referred with R3 grade diabetic retinopathy between October 2011 and November 2012. Laser spot number and spot size were recorded for the first 1-3 sessions within the initial 3 months of treatment. Progression was recorded at 6, 12 and 24 months post first treatment. Results: At 6, 12 and 24 months post initial treatment, further progression of diabetic retinopathy occurred in 25/49 (51%), 33/49 (67%) and 23/28 (82%) of eyes. There was a difference between the chance of progression at 12 months in patients who had a total retinal burn area of < 3x10*8µ m2 and those who had an area > 3x10*8µ m2, but this was not significant (92%, 72%, p = 0.07). Conclusion: Chance of progression of proliferative diabetic retinopathy with PASCAL laser may be higher than with the older argon green laser. EDTRS guidelines should be updated for the PASCAL laser. 132. Surveillance Clinic for Screen Positive Maculopathy Patients Miranda Buckle, Liam Price, Steve Chave, Kerry Price, Stephen Adlington, Peter H Scanlon Gloucestershire Hospitals NHS Foundation Trust Introduction: The NHS Diabetic Eye Screening programme introduced surveillance clinics as part of the 2012 & 2013 Service Specifications that NHS England will use to commission services but this did not include Optical Coherence Tomography (OCT). Purpose: To investigate the effectiveness and outcomes of surveillance clinics with OCT in Gloucestershire. Method: Surveillance clinics with OCT were introduced in Gloucestershire on 1st February 2012 and results for the preceding 2 years and the first 18 months were recorded prospectively. 108 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina Results: Gloucestershire Diabetic Eye Screening Programme (GDESP) screened 21,632 and 21,344 people with diabetes in the 2 years prior to 1st February 2012, and 21,854 and 13,291 in the following 18 months. In the first 2 years, 606 and 553 people with R1M1 were referred directly to the Hospital Eye Service (HES) and in the following 18 months, 96 and 23 patients were referred directly to the HES and 389 and 186 referred to the surveillance clinics. Of the 575 referred to the surveillance clinics, only 115 (20%) were referred to the HES, 98 (17%) were returned to annual screening, 17 (3%) did not attend and 339 (59%) were followed up in the surveillance clinics. No patient given routine follow ups or discharged from surveillance presented symptomatically to the HES and receive treatment. Conclusion: The introduction of surveillance clinics resulted in a reduction in unnecessary referrals to the ophthalmology department with no deleterious effect on patient outcomes. 133. To investigate the impact of diabetic retinopathy of varying severity on sleep Rupal Morjaria, Iona Alexander, Obaid Kousha , Victor Chong, Katharina Wulff, Russell Foster, Susan Downes Oxford University Hospitals NHS Trust Introduction: Circadian misalignment, defined as a mismatch between the sleep-wake cycle and the timing of the circadian system, can occur either because of inadequate exposure to the light-dark cycle, or reduction in light transmission resulting from ophthalmic diseases. Purpose: We investigate the impact of diabetic retinopathy on sleep in patients with varying severity of retinopathy. Method: Patients attending diabetic retinopathy clinics with no significant ocular co-morbidities completed the self-rated Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. The PSQI measures seven sleep variables (scale of 0 to 3) providing a global sum of 0 to 21. A PSQI score ≥6 indicating poor sleep. Using ETDRS grading, patients were allocated to 3 groups depending on severity of retinopathy: no/mild 1035, moderate 35-53, severe >61. Statistical analysis was performed using SPSS. Results: 327 patients participated, (57 excluded due to ineligibility/incomplete data). 270 completed questionnaires were analysed. The mean PSQI score (mild =5.10, moderate =5.18, severe =5.45 p >0.05) across the three diabetic retinopathy severity groups did not reveal a statistically significant difference. Conclusion: Retinal ganglion cells have been reported to be affected by diabetes. Melanopsin- retinal ganglion cells (mpRGCs) are integral to the entrainment of 24 hour circadian cycle with rods and cones also involved. Our study showed that no significant differences in the PSQI were identified even with increasing stages of diabetic retinopathy. Presumably therefore there are enough functioning melanopsin cells and or rods and cones for entrainment to be unaffected. 134. Glycated albumin induced IL-8 and MCP-1 modulation by minocycline in cultured retinal pigment epithelial cells Joanna DaCosta, Sobha Sivaprasad, Selim Cellek Cranfield University Introduction: Age related macular degeneration (AMD) is the leading cause of blindness in people over the age of 50 in the Western world. The pathogenesis of AMD is complex and evidence suggests chronic low grade inflammatory processes may eventually culminate in visual loss. In AMD drusen formation occurs and glycated albumin (GA) represents a component of drusen. Minocycline is a semi synthetic tetracycline derivative with improved penetration through the blood brain barrier. Apart from well recognised antimicrobial effects it also has potent anti-inflammatory and immunomodulatory effects. Purpose: To investigate glycated human serum albumin induced MCP-1 and IL-8 modulation by minocycline in retinal pigment epithelial cell culture Method: ARPE-19 cells were cultured in Dulbecco’s modified media supplemented with 10% foetal calf serum. Once cellular confluence was reached media was substituted to serum free media for 16 hours and cells were exposed to varying concentrations of GA and minocycline. After exposure cell culture media was collected and stored at -80°C for MCP-1 and IL-8 enzyme linked immunosorbant assay (ELISA). ELISA was conducted with negative and positive controls. Standards and samples were analysed in duplicate. Interplate and intraplate reproducibility tests were performed Results: The effects of minocycline on ARPE-19 cell viability and growth identified a potential narrow therapeutic window for effectiveness. Minocycline at <5μM effectively abrogated glycated albumin induced MCP-1 and IL-8 production from ARPE-19 cells in culture (p<0.05) 109 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina Conclusion: Minocycline may have a potential therapeutic role in the treatment of inflammatory changes in choroidal neovascularisation secondary to age related macular degeneration. 135. A systematic review and meta-analysis comparing intravitreal ranibizumab with bevacizumab for the treatment of choroidal neovascularization secondary to pathologic myopia Mohamed Loutfi, Muhammad Siddiqui, Abdulbaset Dhedhi , Ahmed Kamal University of Liverpool Introduction: Intravitreal injections of ranibizumab (IVR) and bevacizumab (IVB) have both been used as treatments for myopic choroidal neovascularisation. Purpose: A meta-analysis of published literature comparing IVR with IVB for the treatment of myopic choroidal neovascularization. Method: Electronic databases were searched from January 1950 to March 2013. Results: 3 studies reported on 117 patients. The mean number of lines improvement after IVR appeared better compared with IVB [fixed effects model: SMD=0.46,95%CI(0.09,0.83),z=2.44,p=0.01]. The number of patients who had a greater than 3 line improvement was similar between groups [fixed effects model: RR=0.95,95%CI(0.67,1.32),z=0.33,p=0.74]. At follow up there was no difference in number of those who had an absence of leakage [fixed effects model: RR=1.04,95%CI(0.93,1.16),z=0.64,p=0.52]. There was no statistical significance between the two groups in relation to the number of injections [random effects model: SMD=-0.25,95%CI(-1.12,0.61),z=0.57,p=0.57]. Conclusion: Early evidence suggests that intravitreal injections of ranibizumab are comparable to intravitreal injections of bevacizumab in the treatment of myopic choroidal neovascularization. Both treatments result in a statistically significant increase in visual acuity with high numbers of patients maintaining stable vision. Moreover, reduction of leakage in the retinal layers following treatment is ubiquitous; reported rates of ocular and systemic complications emphasize that the treatment is very safe. Further studies are still needed to strengthen results. 136. Inter-injector pain scores for intravitreal injections for wet age-related macular degeneration (AMD): a comparison of Visual Analogue Scale (VAS) and Verbal Reporting Scale (VRS) Divya Venugopal, Samalie Kakaire, Altaf Waraich , Richard Gale, Richard Hanson York District Hospital Introduction: Intravitreal injections are performed by a variety of health care professionals in NHS clinics. Patients’ experience of pain is an important aspect of quality of care and compliance with longterm follow up. Anecdotal evidence from patients suggest that a “favoured injector” may emerge from within the departmental team placing strain on a service which seeks to deliver individualised care wherever possible. Purpose: To study intravitreal injection pain scores using 2 different methods of reporting pain. Method: Pain scores after 176 intravitreal injections were recorded for 169 patients receiving intravitreal injections from a team of five injectors. Patients were asked to rate pain using 2 different methods - VAS and VRS - each scored between 0 and 10, 15 minutes after injection . Pain scores for the entire group and across the five injectors were compared. Correlation coefficient between VRS and VAS was calculated. Results: The group mean of 3.1± 2.7 is comparable with published series and sets a benchmark for future audit. All injectors had some pain scores > 7. No significant difference in pain score was observed among the five injectors (ANOVA:F=0.913 ;P= 0.458). Correlation between VRS and VAS is good (r= 0.912). Conclusion: Pain associated with intravitreal injections is generally mild and is independent of injector in this series. VRS correlates well with VAS and is more easily applied in a setting where patients are visually impaired. 137. Attitudes towards prenatal diagnostic testing for inherited retinal diseases Khuram Ahmed, Mushtaq Ahmed, Barbara Potrata , Hilary Grant, Thomas Willis, Martin McKibbin Leeds Teaching Hospitals NHS Trust Introduction: With increasing access to genetic testing, individuals with inherited retinal disease (IRD) may have an option to access prenatal diagnosis (PND). Prior research has identified that less than 50% are in favour of PND for IRD. 110 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Medical Retina Purpose: To explore the factors that influence peoples’ decision-making in relation to PND. Method: Semi-structured interviews were conducted with 50 adults with IRD, transcribed verbatim and analysed using thematic analysis. Interviewees were selected from a larger sample of 200 research participants in order to provide a diversity of backgrounds, knowledge and support for genetic testing. Results: Potential benefits from PND included: more information to help prepare and plan the future care of children, earlier access to novel treatments and the option to proceed to termination of pregnancy for severe, early onset disease. Negative aspects included: moral objection to termination of pregnancy, the risk associated with the procedure, concerns about accuracy of PND and personal experience of a good quality of life. Although many interviewees wouldn't access PND personally, they could see that it may be an option for others, but only in specific circumstances and not offered routinely. Conclusion: Adults with IRD have mixed views on PND. Disease severity, the impact on quality of life and the risk to future generations were important considerations. Many participants believed that it should be available but would not access it themselves. The range of attitudes suggests that adults with IRD need genetic counselling before they can make an informed choice about PND. 138. Serpiginous-like choroiditis: as a marker for tuberculosis in a non-endemic area Weh Loong Gan, Nicholas Jones Manchester Royal Eye Hospital Introduction: Tuberculosis is increasingly recognised as a cause intraocular inflammation. In the UK, the current incidence is low at 14.4 per 100,000 populations, but this has risen from 11.6 in 2001. The variable presentations and treatment outcomes of TB-associated uveitis in patients attending the Manchester Uveitis Clinic (MUC) have been reported. However, we have recently experienced a striking increase in the number of patients presenting with atypical multifocal outer retinal and inner choroidal inflammation associated with TB; this phenomenon has been described as ‘serpiginous-like choroiditis’ (SLC) and is now increasingly recognised as a marker for TB. Purpose: To describe the increasing incidence of multifocal outer retinal and inner choroidal inflammation, as a marker for intraocular tuberculosis in the United Kingdom, an non-endemic area. Method: Retrospective case series. Results: Fourteen patients presented with serpiginous-like choroiditis (SLC) over 10 years (7 within the last 2 years). Seven of 14 patients showed evidence of exposure to tuberculosis and received anti-tuberculosis treatment. Seventeen of 23 eyes showed stable or improved visual acuity. All with decreased acuity had direct macular involvement at presentation. Conclusion: Multifocal outer retinal and inner choroidal inflammation is a marker for intraocular tuberculosis of increasing importance, even in a non-endemic area. Originally described as 'serpiginous-like choroiditis', the lesions are multifocal, irregular in shape, very numerous, widespread, often asymmetrical and demonstrating both active and resolved lesions simultaneously. Active lesions show contiguous extension. We recommend that every patient with SLC should undergo testing for previous exposure to tuberculosis, and undergo anti-tuberculosis treatment if lesions are progressive and sight-threatening. 139. Intravitreal Triamcinolone for refractory macular oedema following failed anti-VEGF treatment: One year results Peck-Lin Lip, Hema Kolli, Arijit Mitra , Samer Elsherbiny, Panagiota Stavrou, Bichitra Das, Bushra Mushtaq The Birmingham & Midland Eye Centre Introduction: Intravitreal or periorbital steroid injections have been used for many years to treat macular oedema(CMO) which is non-amenable for laser treatment. Its popularity has lessened with the introduction of anti-VEGF injections. Purpose: To evaluate the anatomical and visual outcomes following Intravitreal Triamcinolone injections(IVT) in treating CMO refractory to other therapies. Method: Retrospective analysis of patients with CMO treated with IVT(4mg/0.1ml) repeated 4 monthly when indicated. Outcome measures were Snellen vision(Va) and OCT measured central retinal thickness(CRT) at preinjection(baseline), at 4-weeks post-first injection(R1) and at one year’s follow-up. Results: We studied 29 eyes in 19 patients (15 males; mean age 60.7, SD14.7, range 29-80): 25 eyes(86%) were diabetic CMO, 3 eyes(10%) were retinal vein occlusion and one was post-operative CMO, all failed to respond to Bevacizumab and laser therapies. 111 ABSTRACTS: Medical Retina / Neuro-Ophthalmology Annual Congress Final Programme & Abstracts Birmingham 2014 Average number of Bevacizumab applied pre-IVT was 5.3(mode 3, range 2-9) before it was concluded poor response. Baseline median CRT was 539µ m[IQR 414-706], which was reduced to 287µ m[264-379] (paired Wilcoxon, p<0.001) at R1 and, to 348µ m[251-483](p=0.001) at 1 year. All eyes showed total resolution of CMO after each IVT. ‘Stable/improved’ Va at R1 and one year was 69% and 72%, respectively; whilst 22% Va improved by 3 lines at both. Adverse effects: 45% developed ocular hypertension and 10% developed cataracts. Conclusion: Intravitreal Triamcinolone has a role as an effective treatment for macular oedema poorly responsive to other therapies. It remains a secondary treatment choice due to its adverse effects. NEURO-OPHTHALMOLOGY 140. Retinal ganglion cell neuroprotection and axon regeneration after optic nerve crush induced by siRNA mediated knock-down of RTP801, a negative regulator of mTOR signalling Peter Morgan-Warren, Jenna O'Neill, Martin Berry , Elena Feinstein, Robert Scott, Ann Logan University of Birmingham Introduction: Traumatic optic nerve (ON) injury results in retinal ganglion cell (RGC) apoptosis and a failure to regenerate axons. There are currently no treatments available to promote functional repair of axotomised RGC. The serine/threonine kinase, mammalian Target of Rapamycin (mTOR), is involved in numerous cellular signalling pathways associated with cell survival and growth, and is implicated as a key determinant of neuronal survival and axon regeneration after ON injury. RTP801 is a negative regulator of mTOR signalling, activated in response to cellular stress. Purpose: To investigate the effects of knock-down of RTP801 with a targeted small-interfering RNA (siRNA) on RGC survival and axonal regeneration in an ON injury model in vivo. Method: Adult male rats (n=5) underwent bilateral ON crush and received intravitreal injections of siRTP801 (20μg/10μl) in the right eye and control siRNA (siEGFP,20μg/10μl) in the left on days 0, 8 and 16 after injury. Surviving RGC and regenerating axons were quantified at day 24 with immunohistochemistry of retinal and ON sections for Brn3a and GAP43, respectively. Results: Intravitreal siRTP801 promoted significant RGC survival compared to control siRNA after ON crush (16.9±0.6 vs 9.2±0.6 RGC/250μm linear retinal sample, p<0.001), and increased the number of GAP43+ regenerating axons in the distal ON at 400μm (87.1±21.1 vs 44.9±23.0, p=0.024), 800μm (68.9±11.1 vs 28.6±15.8, p=0.015) and 1200μm (55.8±11.5 vs 15.4±9.9,p=0.02) beyond the crush site. Conclusion: Knock-down of RTP801, a negative regulator of mTOR signalling, promotes RGC survival and axon regeneration after ON crush, and is a potential novel translatable neuroprotective and axogenic treatment for traumatic ON injury. 141. A national epidemiological study of chronic progressive external ophthalmoplegia – molecular genetic features and neurological burden Anna Clements, Victoria Nesbitt, Robert W Taylor , Douglass M Turnbull, Robert McFarland, Patrick Yu-Wai-Man Wellcome Trust Centre for Mitochondrial Research, Newcastle Introduction: Chronic progressive external ophthalmoplegia (CPEO) is a classical manifestation of mitochondrial disease that is characterised by slowly progressive ptosis and ophthalmoplegia. CPEO can occur either in isolation or as part of a more severe multisystemic “CPEO plus” phenotype. Purpose: (i) To establish the prevalence of CPEO in the North of England; (ii) To define the spectrum of molecular genetic defects observed in this group of patients; and (iii) To describe the ocular and extra-ocular clinical features associated with CPEO. Method: Patients were recruited from the Mitochondrial Disease Patient Cohort Study Database funded by the MRC. The medical records of patients with suspected CPEO were retrospectively reviewed. Results: Out of a total of 631 patients currently on the database, 255 patients (40.4%) were confirmed to have CPEO. The minimum prevalence of CPEO in the North of England was estimated at 3.39 per 100,000 inhabitants, about 1 in 30,000. The most commonly identified genetic defect was a pathogenic mitochondrial DNA (mtDNA) point mutation (n=80, 31.4%), followed by a single mtDNA deletion (n=72, 28.2%), and a nuclear point mutation (n=70, 27.5%). Neurological symptoms were common in our CPEO patient cohort (n=221, 86.7%). The degree of ptosis and ophthalmoplegia was found to be more severe among patients harbouring single mtDNA deletions. 112 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Neuro-Ophthalmology Conclusion: CPEO causes significant visual impairment and it is invariably associated with the development of other neurological features. The management of this group of patients therefore requires a multidisciplinary team approach to minimise long-term morbidity. 142. Diabetic retinopathy is associated with oxidative stress and mitigation of gene expression of antioxidant enzymes Mohamed Fathelbab, Moaz Mojaddidi , Maan AL-Barry, Hesham El-Beshbishy Taibah University Introduction: Type 2 diabetes is a metabolic disease associated with serious complications, including diabetic retinopathy (DR). Purpose: The aim was to investigate biochemical parameters and the oxidative stress associated with the type 2 DR patients and to study gene expression of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) among patients with DR [DR(+)] compared with a control nondiabetic group. Method: 67 DR patients were diabetic for more than 10 years. 22 patients were DR(+),and 45 were DR(-). Their age range from 14 years to 80 years old having diabetes from 2 and 45 years. Results: BMI was 31.43 ± 5.94 and 32.33 ± 6.54, systolic blood pressure was 117.15 ± 18.16 mmHg and 126.15 ± 20.26 mmHg, diastolic blood pressure was 81.11 ± 10.55 mmHg and 82.77 ± 10.85 mmHg, HbA1c was 7.2 ± 1.1 and 8.19 ± 1.95, serum total cholesterol was 6.61 ± 1.11 and 4.11 ± 0.31, serum triglycerides were 3.52 ± 0.89 and 3.42 ± 0.79, serum low-density lipoprotein (LDL) was 2.12 ± 0.10 and 2.42 ± 0.15, high-density lipoprotein (HDL) was 2.66 ± 0.30 and 2.55 ± 0.21, SOD was 3.12 ± 0.87 and 1.53 ± 0.14, GPx was 11.14 ± 2.21 and 8.2 ± 1.84, CAT was 26.43 ± 3.34 and 9.60 ± 2.14, for DR(-) and DR(+) patients, respectively. SOD, GPx and CAT polymerase chain reaction (PCR) products of the DR(+) patients revealed the diminished expression of CAT gene followed by GPx and SOD genes. All were significant compared with the normal controls, P < 0.05. Linear regression analysis revealed a strong significant positive correlation between the retinopathy grade and the diastolic blood pressure, diabetes duration, hemoglobin A1c (HA1c)%, and fasting blood glucose (P < 0.001). A marginally significant positive correlation between the retinopathy grade and LDL-cholesterol and a significant negative correlation with total cholesterol was observed Conclusion: Poor glycemic control and alteration in mRNA gene expression of antioxidant enzymes are strongly associated with development of DR 143. Vascular morphology in patients with optic nerve head drusen and optic disc oedema Anastasia Pilat, Frank Proudlock, Mark Lawden , Irene Gottlob University of Leicester Introduction: In optic nerve head drusen (ONHD) retinal vascular abnormalities including abnormal branching, vessel trifurcations, increased capillarity and large shunt vessels have been described. In contrast the main findings in optic disc oedema (ODE) were retinal hemorrhages and venous dilatation. Purpose: We aimed to analyze quantitatively peripapillary retinal vessel morphology in ONHD and ODE. Method: Colour optic disc (OD) photographs of 25 ONHD, 22 ODE patients and 25 healthy participants were analyzed using computer-based fundus analysis (ARIA software, Peter Bankhead between two rings (diameters 4.2 and 8.4 mm) centered on the OD. OCT was used for calibration. Results: Patients with ONHD showed larger diameters of arteries without branching (p=0.05), arteries after primary/before secondary branching (p=0.04) and secondary venous branching started closer to the OD (p=0.03) compared to healthy controls. ODE patients had reduced number of small peripapillary veins and larger number of veins without branching as compared to ONHD and controls (p=0.02). Anomalous branching with arterial and venous trifurcation presented in the ODE and ONHD groups with higher prevalence in ODE patients for venous trifurcations as compared to ONHD and controls (p=0.02). Conclusion: Quantitative analyses revealed different changes than described previously with larger arteries in ONHD and increased size of the small veins in ODE. Venous trifurcations were more common in ODE. In ONHD changes may be attributed to anomalous vessel development or compensatory vascular changes due to retinal hypoxia while the increased size of small peripapillary veins and venous trifurcations in ODE may help decreasing venous pressure and prevent retinal damage. 113 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Neuro-Ophthalmology 144. Comparison of electroretinographical responses in albinism, idiopathic infantile nystagmus and healthy controls Zhanhan Tu, Christopher Degg, Viral Sheth , Irene Gottlob, Frank Proudlock University of Leicester Introduction: Previous studies describe children with albinism showing significantly better ERG results compared to controls, while idiopathic infantile nystagmus (IIN) had normal ERGs using small sample sizes and skin electrodes. Purpose: To compare ERG results between a large sample of adults with albinism, IIN and controls. To investigate the correlation between ERGs with visual fields (VF) and retinal structure measured using optical coherence tomography (OCT). Method: Sixty-seven albinism, 43 IIN and 24 controls were recruited. Dilated Ganzfeld flash ERG testing was performed using DTL™ corneal electrodes. The thicknesses of retinal layers in the foveal area were obtained using OCT and Humphrey VF test was used. Results: The IIN group demonstrated significantly smaller photopic a- and b-wave amplitudes compared to controls (P<0.001, P<0.01, respectively). The IIN group also showed significantly longer photopic b-wave latencies compared to the albinism group (P<0.01). However, the IIN group has shorter b-wave latencies compared to albinism group under scotopic conditions with standard flash. The thicknesses of macular, inner plexiform and inner segment layer were correlated with b-wave amplitude, a-wave latency and b-wave latency, respectively under photopic condition. The VF was strongly correlated with scotopic b-wave latency with dim flash. Conclusion: Our findings of reduced photopic a- and b-wave amplitudes and longer b-wave latencies in IIN may indicate a subclinical reduction of retinal function in IIN which has not been previously detected. Interestingly, participants with albinism did not show the same changes despite having nystagmus possibly because hypopigmented retinae can cause increased ERG responses. 145. Comparative Analysis of the Mollon-Reffin Minimal Colour Vision Test in the visually normal and acquired ocular disease Hetan Ajwani, Carmel P Noonan, Fiona J Rowe University of Liverpool Introduction: Currently a variety of different colour vision tests exist in clinical practice each with its own merits and limitations. The Ishihara test is commonly used to test for congenital deficiencies, which cause redgreen deficits. However acquired deficiency is also common in any ocular pathology affecting the optic nerve. Purpose: The aim of our study was to compare the Mollon-Reffin Minimal Test (MRMT) against the Ishihara and City colour vision tests. The comparison would provide information about the diagnostic accuracy of the MRMT. Method: All three tests were performed within the same clinic visit, with a small rest between each test. The main parameters of interest were correlation levels between tests for defect detection, severity grading and defect type classification. We assessed the time taken to complete testing and evaluated the patients experience of the tests. Results: We assessed 100 patients and 54 control subjects, with re-testing in the latter group to evaluate testretest reliability. We found a reasonable level of agreement between the MRMT and the other tests once considering possible confounders for defect detection, severity grading and defect type classification in the patient group. There was a strong level of agreement in the control group which suggests a high specificity relative to the other tests. The time taken to perform the MRMT is clinically acceptable in comparison to the City Test. Conclusion: Patients experiences of the MRMT were positive, and they preferred it to the other tests. We recommend that the MRMT be used to detect colour vision defects, or monitor deficiency, in patients with significant visual field defects. 146. Expert Opinion in the Clinical Investigation of Acquired Isolated Horner Syndrome in the United Kingdom Jasvir Virdee, Susan Mollan, Michael Burdon Queen Elizabeth Hospital, Birmingham Introduction: Currently there is no robust evidence on imaging required for acquired isolated Horner Syndrome (HS), additionally there is a low yield from tests employed. 114 ABSTRACTS: Neuro-Ophthalmology / Ocular Motility Annual Congress Final Programme & Abstracts Birmingham 2014 Purpose: A consensus statement would enable a multi-centre prospective study on the directed use of investigations and provide standardised agreement which clinicians may use. Method: An online survey tool was used to collect responses from members of the British Isles NeuroOphthalmology Club (BINOC). Ten multiple choice questions were used, which covered 3 HS scenarios. Results: Responses were obtained from 27 out of 45 members contacted (3 opted out). 18 NeuroOphthalmologists and 6 Neurologists took part. 83% routinely used topical medications to confirmation HS; the majority used apraclonidine 1%. 17% used drops for lesion localisation. Despite using drops, 67% had a predetermined algorithm for imaging. The consensus for non-traumatic cases is chest X-ray (58%), MRI head (79%) and MRI neck (67%). In traumatic cases, a combination of MRI/MRA head (63%) and MRI/MRA neck (67%) was favoured. In the third case involving a diabetic hypertensive, MRI thorax (29%), MRI head (71%), MRI neck (50%) and MRA neck (25%) were chosen. Follow up was favoured at 3 months if neuro-imaging was normal. Conclusion: This survey contains the preferred investigations for adult isolated HS. Almost all use of drops to diagnose HS, but few use drops to localise the HS. Interestingly, CT scanning/angiography was not preferred for any scenario. Choice of imaging was directed by the clinical history. 147. Cerebral migration of intraocular silicone oil: A clinical and radiological George Kalantzis, Kevin Falzon, Chin Ong , Dan Warren, Bernard Chang St James University Hospital, Leeds Introduction: Silicone oil (SO) is commonly used following complicated retinal detachment (RD) surgery. Neurological complications of SO endotamponade are rare. Purpose: To report a case of cerebral migration of intraocular SO mimicking an oribital mass with posterior cerebral migration. Method: Observational case report. A 74-year-old lady presented with a six-month history of chronic headaches and photophobia. She had a history of high myopia with multiple left RD surgery and SO endotamponade 20 years previously. Ophthalmological examination showed a phthisic left eye with a superonasal soft epibulbar mass. Neurological examination was unremarkable. Differential diagnosis included lymphoma, metastases or choroidal melanoma. Computed tomography showed a left globe mass with posterior extension along the optic nerve with intracranial foci. Conjunctival and carancular biopsy showed reactive lymphoid infiltration with no evidence of lymphoma. Magnetic resonance imaging findings were consistent with migration of intravitreal SO along the ipsilateral optic nerve with subsequent extension to the chiasm and subarachnoid space. Results: The possibility of the SO causing chemical meningitis was raised. However, the patient's headaches improved without treatment and it was decided not to pursue any further diagnostic work up. Conclusion: Cerebral migration of intraocular SO may present with headaches due to possible chemical meningitis and may be misdiagnosed as an orbital mass with extra-orbital spread or intracranial metastasis. OCULAR MOTILITY 148. Unilateral lateral rectus resection: a simple solution to age-related distance esotropia Sohraab Yadav, Jane Young, Claire Voas-Clarke , Ian Marsh, Jon Durnian Royal Liverpool Hospital Introduction: Acquired concomitant esotropia occurring in adults (age-related distance esotropia) is a relatively common condition seen in strabismus clinics. This condition may be managed conservatively or surgically using a variety of different techniques. Purpose: We report a case series of patients who underwent single muscle lateral rectus resection to correct their esotropia. Method: Fourty-nine randomly selected patients undergoing unilateral lateral rectus resections within the past three years were identified. Of these, 19 patients with symptomatic distance esotropia without an underlying cause were included and followed up until discharge from the clinic. Near and distance prism dioptre measurements pre- and post-operatively were compared. Results: The average age of the patients was 80.2 years (range 68 to 90 years). 10 females and 9 males made up the cohort. Mean lateral rectus resection was 4.9mm (SD 1.3) with non-adjustable sutures. Diplopia 115 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Ocular Motility resolved in all cases following surgery. Median distance esotropia measurements in primary gaze were reduced from 16.0 prism dioptres pre-operatively to 0 prism dioptres post-operatively (p<0.005) at final follow-up. Near esotropia also resolved in all cases when present. Conclusion: Age-related distance esotropia can be effectively managed with unilateral lateral rectus resection alone and this surgical procedure offers a simple solution in a potentially difficult patient group. 149. A Modified Model for Strabismus Surgery Simulation Bharat Markandey, John-Sebastian Barry Russell's Hall Hospital, The Dudley Group NHS Trust Introduction: Surgical simulation can be costly but is increasingly seen as crucial for improving patient safety. Despite the relatively low cost of models for strabismus surgery compared to other forms of ophthalmic surgery (e.g. computer-based models for cataract and VR surgery) keeping costs to a minimum without compromising quality of training is crucial in the current financial climate. Extremely successful strabismus surgery workshops run at International Meetings reportedly gained excellent feedback from trainees. Different forms of strabismus surgery simulation workshop using cadaveric heads, animal model eyes, artificial eyes and artificial heads have been described. We wished to provide elements of this training locally. Purpose: To describe a novel inexpensive head model developed to ‘house’ artificial eyes to enhance the experience of trainees at minimal cost. This was a modified commercially available mannequin with total costs for materials for a single artificial head for this purpose being very modest (£5 approximately). Method: A local artificial eye workshop was run to assess the effectiveness of the model. Artificial eyes were obtained from the leading national source. An inexpensive modification of a commercially available mannequin head was used to keep costs to a minimum. Results: Feedback from 6 trainees from pilot workshops demonstrated an excellent learning experience. Conclusion: This model could be adapted and used by strabismus trainers and trainees without the need for expensive start-up equipment. This model does not replace the need for purpose-designed high-quality models and workshops which will further enhance simulation training 150. Modified Hang-back Single Muscle Medial Rectus Recession for Paediatric Esotropia Alastair Hardisty, Tin Chan , Claire Duckworth Sheffield Children's Hospital Introduction: Unilateral medial rectus (UMR) recession has been previously described as safe and predictable for correction of esodeviations of less than 35 prism diopters (PD) using a free hangback technique. We present our outcome data for UMR recession using a modified hangback technique in a paediatric population. Purpose: To evaluate acceptability of modified hang-back UMR in a paediatric population Method: We performed a review of UMR surgery performed between August 2011 and August 2012 by a single surgeon. Our primary outcome measure was predictability of esotropia angle correction. Patient acceptability of single muscle surgery was compared with age-matched controls undergoing two-muscle surgery using a visual analogue pain scale. Operative time was compared between the two groups. Results: 9 consecutive patients were identified. All patients had a pre-operative deviation of 25-30PD (Mode: 25). All underwent 5.5mm medial rectus recession to correct 20PD. At the 2-month postoperative reviews all 9 patients had a residual esotropia of less than 8PD (Mean 5.5 Range 4-8). Mean correction was 19PD (Range 17-22). No adduction deficit was found. Single muscle surgery was associated with less post-operative pain on day 1 post surgery vs 2-muscle surgery mean 4.6 vs 7.2 (0=no pain 10=worst pain imaginable). Mean operative time was 18 minutes for single muscle vs 35 minutes for 2-muscle surgery. Conclusion: Surgical predictability of our modified hangback technique is in line with the previously described free hang-back technique. Children find this surgery more comfortable and surgical time is reduced compared with 2-muscle surgery. UMR recession surgery is a quick, simple and less painful procedure and should be considered as a primary approach in the treatment of small to moderate angle esotropia 116 ABSTRACTS: Ocular Motility / Orbit & Oculoplastics Annual Congress Final Programme & Abstracts Birmingham 2014 151. Medial rectus pulley posterior fixation suture for acquired esotropia with high AC/A ratio. Rajnish Sekhri, Pouya Alagaband, James Innes, Usman Mahmood Hull and East Yorkshire Eye Hospital Introduction: Posterior fixation (Faden Procedure)suture has traditionally been used to reduce the force of rectus muscles in their direction of action. We have alternatively suggested suturing the rectus to its pulley as a safer option. Purpose: Suturing the medial rectus muscle (MR) to its pulley 10 mm from its insertion should eliminate pulley retraction thereby reducing MR action in adduction. It also eliminates risk of globe perforation. Method: Patients with acquired esotropia (ET), high AC/A ratio and ET 10 prism diopters more for near than distance were included. 12 children fulfilled the criteria from 2010 to 2013. They had unilateral/ bilateral medial rectus pulley suture along with/without MR recession, depending on the ET for distance. Follow up was at least 3 months. A reduction in half of near esotropia was considered a success. Results: 6 children achieved the desired results with a mean reduction of near ET by 67.79%. 2 of these cases needed more than one procedure. 6 other children did not achieve desired results. Conclusion: Posterior fixation pulley suture is effective in half the cases with high AC/A ratio. A large sample can only show whether it is an alternative to Faden procedure. ORBIT & OCULOPLASTICS 152. Orbital Cellulitis in Scotland; epidemiology, aetiology, treatment and outcome: Scottish Ophthalmic Surveillance Unit Study Claire Murphy, Helen Murgatroyd, Caroline MacEwen , Iain Livingstone, Barny Foot Ninewells Hospital Dundee Introduction: Orbital cellulitis is a potentially blinding and life threatening condition. There is little published data regarding the incidence of orbital cellulitis, the current literature consisting mainly of case reports and a number of single centre retrospective case series. Purpose: This prospective study aimed (i) to establish the incidence of orbital cellulitis in Scotland over a 12 month period in children vs adults and (ii) to identify the differences in aetiology, treatment and outcomes between children and adults. Method: Cases were identified prospectively through the Scottish Ophthalmic Surveillance Unit. Reporting consultants completed an incident and follow up questionnaire after 3 months. Results: There were 20 cases of orbital cellulitis; 15 children and 5 adults. The incidence in the paediatric and adult groups was 1.6/100,000 and 0.1/100,000 respectively. Sinus disease and upper respiratory tract infection was the most common predisposing factor in children. Trauma and immunosuppression were more common amongst adults. Streptococcus and Haemophillus Influenzae were the most commonly isolated pathogens. All patients were treated with intravenous antibiotics. Seventy percent of cases had orbital or subperiosteal abscesses. All abscesses in children were drained; one abscess in an adult was managed non-surgically. Two patients had a poor outcome; one child had intracranial spread of abscess and one adult required an evisceration. Conclusion: We have described the largest series of orbital cellulitis from the United Kingdom and the current incidence and morbidity of orbital cellulitis in Scotland. We will discuss our results in context of the literature. 153. Guidance to locate sutures lost during ophthalmic surgery. Damien CM Yeo, Tafadzwa Young-Zvandasara, Garry Shuttleworth Singleton Hospital, Swansea Introduction: Sutures may fall or "ping" out of needle holders when grasped incorrectly. Finding lost sutures +/needles often presents considerable difficulties in the ophthalmic operating environment due to their size and colour. Lost sutures waste time and constitutes a health hazard. Purpose: This study aims to give a guide as to the maximum distance that such sutures may travel. Method: Sutures of differing lengths were “pinged" from a needle holder under constant conditions in an operating theatre and their distance of travel measured. 6 different commonly used sutures (5.0 Prolene W8721, 5.0 Vicryl W9953, 6.0 Vicryl W9952, 6.0 Vicryl W9760, 6.0 Prolene W8807 and 5.0 Silk W468) at 3 different lengths were studied over 5 repetitions. 117 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Orbit & Oculoplastics Results: For 6cm sutures the mean distance travelled ranged from 43.4cm (SD:8.02, 95%CI:36.37-50.43) for 6.0 Prolene W8807 to 147.2cm (SD:24.84,95%CI:125.42-168.98) for 5.0 Silk W468. For full length sutures the mean distance travelled ranged from 26.3cm (SD:4.70,95%CI:22.18-30.42) for 6.0 Prolene W8807 to 60.1cm (SD:27.84,95%CI:35.70-84.50) for 6.0 Vicryl W9552. 5.0 Vicryl W9553 sutures travelled a shorter distance than identically needled 6.0 Vicryl W9552. With only one minor exception did the suture with the shortest length not travel furthest. Conclusion: Distances travelled by sutures appeared to relate to both length and gauge. Monofilament Prolene travelled shorter distances than similar gauged filament sutures. The radius of the search for monofilament Prolene sutures should be ~75cm, but should be doubled for short filament sutures. 154. Delayed Skin Graft after Debridement for Surgical Treatment of Periorbital Necrotising Fasciitis Mark Sigona, Michael Mckenna, Partha Chakraborty County Durham and Darlington NHS Foundation Trust Introduction: Necrotising fasciitis is a potentially fatal soft tissue infection that spreads rapidly through superficial tissue planes. We present a series of five patients presenting to a District General Hospital with clinically evident necrotising fasciitis of the periorbital region. Purpose: Is delaying skin graft after debridement for periorbital necrotising fasciitis more beneficial than early skin graft or allowing healing by secondary intention alone? Method: Retrospective casenote review. Results: Patients were aged between 56 and 76. Two had bilateral periorbital involvement. Two were secondary to insect bites, one of whom also had sinus disease demonstrated on CT scan. One was secondary to herpes zoster ophthalmicus; one had concomitant tonsillitis and one had no obvious cause. Three of the patients were febrile, with temperatures ranging from 37.7 to 39.5 degrees C. All were admitted and treated with IV antibiotics. All patients required debridement of periorbital tissue, three requiring secondary debridement procedures. One patient had skin graft procedures bilaterally six days after debridement. She later developed upper lid contractures with ectropion and exposure, and required a repeat skin graft four months later. In one patient, healing by secondary intention was allowed and she subsequently developed bilateral upper lid ectropion requiring skin grafts four months after debridement. The remaining patients all had planned autografts five to eight weeks after debridement with donor tissue from contralateral lids or neck. All patients with delayed skin graft made an excellent recovery. Conclusion: This case series highlights the benefit of late surgical repair once patients have completely recovered from the initial infection and initial debridement. Early skin Graft, or healing by secondary intention alone, was shown to be associated with contractures leading to ectropion and exposure requiring further surgery. 155. Slit Lamp Dermatoscopy James McHugh, Juliana Helou, Chris McLean The Royal Surrey County Hospital Guildford Introduction: Dermatoscopy is commonly used to identify a wide variety of skin lesions. A new technique of slit lamp dermatoscopy is described, which is suitable for periocular and ocular lesions. Purpose: The technique of slit lamp dermatoscopy aids in differentiating benign lesions from malignant ones using equipment that is readily available in ophthalmology departments. Method: A variety of diagnostic contact lenses were used to assess both periocular and ocular surface lesions by viewing through a Haag Streit 900 slitlamp. Viscotear gel was used to eliminate surface reflections and the results were recorded with a Nikon Coolpix 4500 camera with slitlamp adaptor. Results: The images from several lesions are illustrated utilising a Goldman 901 contact lens and a four mirror gonio lens. The identifying features for each lesion are described. Conclusion: Slit lamp dermatoscopy offers additional information about periocular and ocular lesions that can aid in diagnosis and management. The equipment used is readily available in ophthalmology departments. The advantages of the different types of contact lenses are discussed with illustrations of the lesions. 118 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous MISCELLANEOUS 156. Choroidal biopsy in the management of patients with choroidal metastasis Heinrich Heimann, Lazaros Konstantinidis, Sarah Coupland, Bertil Damato Royal Liverpool University Hospital Introduction: Choroidal metastasis are the most common intraocular malignancy. In a significant number of cases, no underlying primary tumour is known at diagnosis. Purpose: To evaluate the potential of choroidal biopsies in identifying unknown primary tumours. Method: Retrospective review of patients with choroidal metastasis treated at the Liverpool Ocular Oncology Unit between 2007-2012. Ninety-six patients (109 eyes) were identified. Results: The median time interval between diagnosis of the primary cancer and the choroidal metastasis was 24 months (range, 0-288). Thirty-nine patients underwent ocular biopsy, confirming the diagnosis in all patients. The biopsy indicated the site of origin in 24 out of the 27 without a known primary tumour. In 7 of these 27 cases, previous systemic investigations had failed to identify the primary tumour. Seventy-three patients received external beam irradiation, 2 patients received photodynamic therapy, and 2 patients had Ru106 plaque radiotherapy. The visual acuity was stable or improved in 75.5% of the cases. Conclusion: Immediate biopsy provides a quick diagnosis that may expedite treatment and improve any opportunities for conserving vision while facilitating the general oncologic management of these patients. 157. Anxiety, depression and somatisation in attendees at ophthalmic A&E Adnaan Haq , Radon Reynolds, Zakariya Jarar Moorfields Eye Hospital Introduction: The reasons patients attend emergency medical services are complex, involving psychological, social and logistical factors, besides clinical issues. Psychiatric factors have been studied in patient presentations in GP and general A&E settings, but not in ophthalmic A&E. Purpose: To evaluate depression, anxiety and somatisation in patients attending an inner-city ophthalmic A&E. To compare different ophthalmic diagnoses with regard to these. Method: Three validated psychiatric tools were administered to patients: the Patient Health Questionnaire-8 (PHQ-8) for depression, the Generalised Anxiety Disorder (GAD-7) for anxiety and the PHQ-15 for somatisation. Patient demographics, co-morbidities and ophthalmic diagnoses were documented. Results: Of 527 patients approached, 503 completed questionnaires (95.4% response rate). Scores (mean+/SD) for the whole group were: depression (PHQ-8): 3.52+/-1.50; anxiety (GAD-7) 3.19+/-1.51; somatisation (PHQ-15) 4.46+/-1.12. Significant differences between ophthalmic diagnostic classes were found for depression (1-way ANOVA, P<0.002), with neuro-ophthalmic patients having the highest scores (mean 7.92) and corneal patients the lowest (mean 2.59). A similar profile of differences across ophthalmic classes was found for somatisation (1-way ANOVA, P<0.01). However, no statistically significant differences between diagnostic classes were found for anxiety. Conclusion: To our knowledge, this is the first study to use validated psychiatric tools to assess depression, anxiety and somatisation in ophthalmic A&E. Response rates were excellent. Significant differences in depressive symptoms and somatisation exist between different ophthalmic diagnoses. Anxiety is understandably raised in some patients, but appears constant between different diagnoses. Ophthalmologists may employ simple, validated psychiatric tools to obtain a fuller picture of the reasons behind a patient’s presentation. 158. Photodynamic therapy as initial treatment for small choroidal melanomas Fidan Jmor, Bertil Damato , Heinrich Heimann Ocular Oncology Centre, Royal Liverpool University Hospital Introduction: Verteporfin photodynamic therapy (PDT) can destroy malignant cells through cytotoxicity and ischaemia induction. It has potentially less vision-threatening side-effects than conventional radiotherapy for small choroidal melanomas at the posterior pole. Purpose: To assess PDT as primary management for small choroidal melanomas at the posterior pole. Method: Retrospective review of patients with small choroidal melanomas treated with PDT at the Ocular Oncology Centre in Liverpool. Patient and tumour characteristics, PDT session details, visual acuity, B-scan 119 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous ultrasonography measurements and colour fundus photographs at each follow-up were analysed. Results: Between 2001 and 2012, 22 eyes (from 22 patients) with small choroidal melanomas were treated with PDT. Patients were aged 62 years (mean; range 40-80 years) with 15 male and 7 female. Eight tumours were amelanotic, while 14 were melanotic. Nine melanomas (40.9%) showed complete regression in size on B-scan and colour photographs, five (22.7%) showed partial regression, five remained unchanged in dimension and two showed definite recurrence for which alternative standard treatment was offered. Baseline best corrected visual acuity (BCVA) was 0.2 logMAR (mean; range 0.0 to 0.6) compared to a post-PDT BCVA of 0.5 logMAR (mean; range -0.2 to 1.7) over a follow-up of 36.2 months (mean; range 6 – 124 months). Conclusion: PDT can induce tumour regression in a significant proportion of small posteriorly located choroidal melanomas, in which other standard treatments would be associated with a high risk of significant visual loss. Major drawbacks compared to standard treatment modalities are the necessity of more detailed follow-up and higher rates of recurrence or incomplete regression. 159. Ocular surface squamous neoplasia: Analysis of 78 cases from a UK ocular oncology centre Anu Maudgil, Trushar Patel, Paul A Rundle , Ian G Rennie, Hardeep Singh Mudhar Royal Hallamshire Hospital, Sheffield Introduction: Ocular surface squamous neoplasia is a spectrum of disease, on which few large series have been published, in particular none from the UK. Purpose: The purpose of this study is to describe experience of this condition from a UK national ocular oncology centre, including statistical analysis to elucidate factors significant in recurrence. Method: Retrospective review of case notes, clinical photographs and histopathology reports of all new histopathologically confirmed cases of conjunctival intraepithelial neoplasia (grades I-III) and invasive squamous cell carcinoma of the conjunctiva between May 1994- April 2010. 78 cases were included. Data was analysed using Kaplan Meier analysis with Cox's proportion hazard regression and Mantel-Cox log rank test. Results: 10 of 78 cases (12.8%) recurred during the follow up time (mean 37 months). One-year recurrence rate was 10.9%, and the 5-year recurrence rate was 18.5% using Kaplan-Meier analysis, with a mean time to recurrence of 9.5 months. Significant factors in recurrence were tumour size and first treatment given. Grade of OSSN, including presence of invasive disease and positive biopsy margins were not found to be statistically significant in recurrence. Conclusion: Ocular surface squamous neoplasia in an uncommon disease in the UK population. However, when managed appropriately in a specialist centre, it is associated with good outcomes, even in recurrence situations. 160. Treatment-seeking Behaviour for Ocular Morbidity (OM) in South-West Cameroon Emma Gees, Gillian Dalgetty, Laura Senyonjo University of Leeds Introduction: OM is high in Cameroon, with a prevalence of 18.9%1 and only 38.9% of individuals seeking care for their condition. There is a need to investigate why so few people seek care and how this can be improved. Previous research has shown that treatment-seeking behaviour is complex and so requires qualitative research. Purpose: To investigate treatment-seeking behaviour for OM, including barriers and motivating factors to seeking eye-care in Fako District, South-West Region, Cameroon. Method: Data collection was in the form of semi-structured interviews from eighteen individuals with OM, nine who had sought treatment and nine who had not, using purposive sampling. Analysis was conducted using thematic analysis. Results: There were many factors that acted as barriers to seeking eye-care: the most predominant were finance and distance. Motivating factors for seeking treatment included fear of sight loss and impact upon life. Peers and the church were seen to have an influence on treatment-seeking behaviour. Lack of awareness about treatment costs, eye-care and OM was widespread. The findings from this study are similar to findings from other research. However, no study has discussed unawareness of treatment costs or specifically the impact of religious beliefs. Validity of results was increased by triangulation with the Sightsavers survey. 120 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous Conclusion: There is a need to increase the amount of OM treated at community level, thus reducing indirect costs. Awareness could be increased through peer education and church-led campaigns. Furthermore, schemes to support individuals with the financial costs of eye-care are needed. 161. Association between Depression and Diabetic Retinopathy in sub-Saharan Africa Kirsty Hall, Eugene Sobngwi, Linda Penn Newcastle University Introduction: The incidence of Diabetic Retinopathy is increasing and set to impact many of the world’s diabetic population of whom 75% reside in Low and Middle Income Countries (LMIC). The relationship between depression and DR has been established in high-income countries but evidence from LMIC is scarce. Purpose: This research aimed to determine association between depression and DR in a sub-Saharan African diabetic population. Method: Analysis of cross-sectional data from the ‘Improving access to HbA1c measurements in sub-Saharan Africa’ study was used. Primary data were collected from six diabetic care facilities in Yaoundé, Cameroon. Participants were aged ≥18 years with at least a six month history of Diabetes Mellitus (DM). The presence of DR was established through ophthalmoscopy and angiography using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Depression was assessed using the Centre for Epidemiological Studies Depression scale (CES-D). A CES-D score ≥16 was used to identify clinically significant depression. Categorical data were analysed using the EPI-INFO 7 and Minitab 16 statistical packages. Results: Data were available for 158 participants. Depression was detected in 60% of the population studied. The prevalence of DR was 27.2% (23.4% non-proliferative, 2.5% pre-proliferative and 3.2% proliferative). A longer duration of DM (P<0.01), poor glycaemic control (P<0.01) and insulin use (P=0.02) were associated with DR but we found no association between depression and the DR. Conclusion: The high level of depression identified in this study suggests a need for increased detection of depressive symptoms in individuals with DR. 162. The Potential for Using Tablet Computers in Clinical Vision Testing; a method for calibrating and validating devices Fadi Ghazala, Humza Tahir, Ian Murray, Neil Parry, Tariq Aslam Manchester Royal Eye Hospital Introduction: Advancing technology and the development of LCD screens have made computers more portable, accessible and functional. With respect to vision testing, this technology has the potential to significantly improve medical care. There are many applications on the market designed to test vision using tablet computers, however as of now these tests have not been validated and cannot be used clinically. Purpose: To this end we have investigated the physical characteristics of 3 tablet computers, the iPad3, Nexus 7, and Nexus 10. Method: Using a photospectrometer, the characteristics of the RGB gamma functions for the devices were measured, allowing us to compute the possible colour range and grey-scale contrasts the devices can display. We compare the available contrasts for each screen against two common clinical tests, the Pelli-Robson contrast test chart and the Vistech grating test chart. We also measured the consistency of the luminance at various locations on the screens with different viewing angles as well as the stability of the display when switching the devices on and off. Results: While all three devices have limited contrasts available compared to the test charts, they have a large enough range to allow for vision testing. The screens displayed luminance variability at the edges but, crucially, contrast remained stable. Screen luminance stability was achieved after as little as 15 minutes of warm-up time for all devices. Conclusion: The work highlights the potential for tablet computers to produce reliable grey-scale and colour vision tests for use in clinics and demonstrates a method for calibrating such devices. 121 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous 163. Ophthlmic involvement in Midfacial trauma: Our experience in Glasgow Sonali Tarafdar, Iain Livingstone, Mamun Rahman, Clifford Weir Tennent Institute of Ophthalmology Introduction: There is a recognized association between midfacial trauma and ocular/ periocular injury. The incidence varies widely from 2.7% to 90.6% in reported series. Ophthalmic sequelae of these injuries can be anything from mild to severe requiring immediate intervention. It remains a challenge for the emergency physician to make time appropriate referral to ophthalmologist. Purpose: To evaluate the extent of ophthalmic involvement in patients presenting with mid facial trauma in Glasgow. Method: All patients who attended the maxillo-facial department of Southern General Hospital in Glasgow and Tennent Institute of Ophthalmology with mid facial trauma over 3 year period from Jan-2007 to Jan-2010 were included. Information collated prospectively from case notes, radiology report and clinical portal on a set protocol. Data was analyzed using descriptive statistics. Ocular injuries were categorized into mild, moderate , and severe based on previous publications. Results: 106 out of 142 patients were analyzed due to limited data on rest. Median age of this cohort was 28 years with a male predilection. 61% of total injuries had mild ophthalmic involvement and 11% had severe trauma. Vast majority was caused by assault followed by accident, sports injury and RTA in reducing order of frequency. Visual acuity of 6/12 or less was significantly associated with severe injury (P=0.007). Blow out fracture was associated with injuries of all grades. Conclusion: Ocular injuries occur more frequently in patients with orbital blow out fracture. Ophthalmic consultation is essential in patients with blow out fracture, diplopia and reduced visual acuity at presentation. 164. Current utilisation of electronic medical records in ophthalmic research Victoria Nowak, Zahra Kadom, Patricia Svrckova, K Y Ronald Kam Imperial College London Introduction: Electronic medical records (EMR) systems are increasingly being implemented in ophthalmic units globally. While their usefulness in clinical practice and administration has been evaluated, their current use in ophthalmic research remains unexplored. Purpose: To investigate the current extent of EMR utilisation in ophthalmological research and identify barriers to their use. Method: To guarantee an international cross-section of researchers, we examined the Methods sections of 220 papers, choosing the 20 latest retrospective clinical studies from the top 11 clinical ophthalmic journals ranked by Impact Factor (ISI Web of Knowledge), to record how many used EMR. Where use of EMR was not obvious, the corresponding author was sent a standard e-mail asking whether the source of data was mostly/entirely EMR, paper records or approximately equal. Results: Of 127 papers for which a definite source of data could be established, 61 (48%) used EMR as their main source, 46 (36%) used mostly paper notes and 20 (16%) studies used a combination. In 93 out of 220 papers (42%) the source of data could not be established despite attempted e-mail verification (61% response rate from teams). Examples of factors discouraging EMR use included records pre-dating EMR implementation and incompletely entered data. Conclusion: This is the first study investigating the practical use of electronic records in current ophthalmology research. We have identified barriers that are relevant to those who wish to use these systems for research without having to revert to paper notes. 165. Ethnicity and education in myopia: the UK Biobank (UKBB) study Yanchun Bao, Phillippa Cumberland, Paul Foster , Peng Tee Khaw, Christopher Hammond, Pirro Hysi, Jugnoo Rahi UCL Institute of Child Health Introduction: UKBB, the world’s biggest contemporary resource for the study of health and disease, recruited more than half million people aged 40-69 years. Purpose: To investigate associations between myopia and educational attainment (as proxy for education duration) and ethnicity. 122 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous Method: Spherical equivalent (SE) was used to categorise refractive error: emmetropia (SE -0.99D to +0.99D), mild myopia (SE -1.0D to -2.99D), moderate myopia (SE -3.0D to -5.99D) and high myopia (SE -6.0D or more extreme) for 110,295 subjects whose refraction was measured by Tomey RC 5000 autorefkeratometer (excluding those who had refractive/cataract surgery or retinal detachment). Odds Ratios (OR) were estimated, using bivariate logistic regression to allow for paired data, with adjustment for age, sex, and other sociodemographic factors. Results: All myopia was associated with higher educational attainment in White, Asian and Chinese subjects but not those of Black ethnicity: highest education level vs. no qualifications, OR 2.6 [95% confidence interval 2.5, 2.7], OR 2.1 [1.1, 3.8], OR 5.2 [1.1, 24] and OR 1.5 [0.8, 2.8] respectively. The strength of association between educational achievement and myopia increased with severity of myopia. Notably across all ethnic minority groups including Chinese, those without qualifications did not have an increased risk of myopia compared to White subjects, indeed South Asians had a reduced risk OR 0.6 [0.5, 0.8]. Conclusion: The nature and size of UKBB affords unique opportunities to examine the complex relationship between ethnicity and educational attainment in myopia and our early findings suggest that genetic predisposition (represented by ethnicity) can be modified by educational exposure. 166. Comparison of two prognostic models for penetrating eye injuries in district general hospitals Luke Nicholson, Damien Yeo, Rupinder Chana , Ruth Jones, Julia Escardo-Paton, Osama Giasin, Elizabeth Goodchild Royal Gwent Hospital, Newport Introduction: Several prognostic models have been developed to help ophthalmologist predict the likely outcome following penetrating eye injuries. However, these models were created using data from large tertiary centers. Purpose: We wish to assess the sensitivity and specificity of the Classification and Regression Tree (CART) model (Schmidt et al) and the Ocular Trauma Score (Kuhn et al) in a District General Hospital setting. Method: Theatre records were used to identify patients who had surgery for penetrating eye injuries from 1st October 2007 to 30th September 2012. A retrospective prognostic prediction was calculated using the CART model and the Ocular trauma score model for no vision(NPL) vs vision (PL or better) and for minimal to severe visual loss (>3/60) vs profound visual loss (<3/60). This was then compared with the final visual outcome. Sensitivity and specificity of each model were calculated. Results: 22 patients had sufficient documentation of all the criteria required to formulate a prognosis and therefore included. Using the CART model, sensitivity and specificity for vision (PL or better) vs no vision (NPL) was 100%. Positive predictive value (PPV) was 100% and Negative predictive value (NPV), 100%. As for predicting minimal-severe visual loss (>3/60) vs profound visual loss (<3/60), sensitivity was 87.5%, specificity 83.3%, PPV 93.3%, and NPV 71.4%. Using the OTS model, sensitivity for vision vs no vision was 42.1% and specificity, 100%. PPV calculated to be 100% and NPV was found to be 21.4%. As for minimal-severe visual loss vs profound visual loss, sensitivity and specificity were 43.8% and 83.3% respectively. PPV was 87.5% and NPV was 35.7%. Conclusion: The CART model appears to have a higher predictive accuracy in our cohort of patients. We recommend the use of the CART model in a district general hospital setting when dealing with a penetrating eye injury. 167. UK and US contrasted: A qualitative study of post-graduate training and clinical governance in ophthalmology using ethnological techniques Monica Michelotti, Andrew Davies, Jennifer Weizer , Declan Flanagan, Shahzad Mian, Paul Lee, Simon Kelly University of Michigan, Moorfields, Royal Bolton Hospital Introduction: International collaboration promotes information sharing and supports innovation. Providing insight into differences in clinical care and medical education can benefit all parties involved. Purpose: To compare hospital practice patterns and specialist training in ophthalmology in the UK with that in the US. 123 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous Method: A US ophthalmology trainee (second year resident) visited a variety of ophthalmology departments in the UK for five weeks to compare higher surgical training, education, and clinical governance. Supervisors of ophthalmic training in the UK and US were interviewed. Results: Differences were directly observed and confirmed with Delphi techniques in the utilization of allied health care staff and the supervision of trainees in the UK compared to the US. Clinical duty hours are more restricted in the UK given EU Working Time Directives, but current UK training is prolonged (7 years with 1 year fellowship) compared to US training (3 years with optional 1 or 2 year fellowship). The differences in surgical training in the two countries are outlined. UK trainees perform more cataract surgeries and start earlier in their training, but have less surgical experience in other subspecialties. NHS funding limits efficiency in some areas while billing and defensive medicine impacts training and patient care in the US. Conclusion: International collaboration in medicine is an invaluable experience and this nested study into practices in ophthalmology training and clinical governance in the UK and US provides unparalled insight. 168. Smartphone Tele-Ophthalmology Ryan Davies, Hugh Jewsbury, Kadaba Rajkumar Princess of Wales Hospital, Bridgend Introduction: Smartphone technology is ever advancing and Ophthalmology as a specialty is prime placed to utilise this. 'Smartphone tele-medicine' is widely used in other specialties such as dermatology with good effect. We aimed to determine whether this tool could be suitable for Junior Trainess to discuss complicated Ophthalmology patients with senior colleagues. Purpose: Assess the use of the ‘Facetime’ application on Smartphones, as a method of discussing ophthalmology patients with anterior segment pathology. Method: A group of patients with various anterior segment eye pathologies were enrolled from eye casualty / clinic patients at Princess of Wales Hospital, Bridgend. Fully informed written consent was obtained from all patients for the video consultation, recordings and photographs taken. The iphone 5 and slit lamp adaptor were used along with an attachable lighting system for illumination. A Facetime consultation was then performed between the Doctor present in clinic and a consultant not present, who was blinded to the pathology. Results: There proved to be an excellent correlation in diagnoses between the doctor present in clinic and the Consultant on the video conversation. It was possible to identify and assess lid lesions, corneal foreign bodies, loose sutures, iris trauma, cataracts and immediate post-operative reviews such as bleb appearance following trabeculectomy. Conclusion: This has the potential to become a very useful and readily accessible tool in the modern world of ophthalmology, where the use of smartphones and Tablets are commonplace. It has applications in out of hours advice for junior ophthalmologists, leading to prompt diagnosis and effective treatment. It can be applied to inter-hospital referrals, as well as in the ‘Primary care / Optometry’ to secondary care referral process. 169. Changing Trends in Consultant Appointments Romeela Rana-Rahman, Alan Connor, Hamed Anwar Royal Victoria Infirmary, Newcastle Upon-Tyne Introduction: In October of this year, “The Shape of Training” a major review of postgraduate education was published. Recommendations were that the future needs of patients should be met by less specialist doctors and more generalist doctors. Amongst various recommendations they made they suggested: Shortening training The removal of all subspecialty training from training programmes More service delivery in the community Purpose: We wanted to examine the changing trends in consultant appointments and explore if there is currently a need for generalists or community ophthalmologists. Method: We performed a retrospective analysis from January 2008 to November 2013 of all substantive consultant ophthalmology posts advertised in BMJ Careers. The number of posts in the 2013 group were pro rated for analysis. 124 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Miscellaneous Results: During the 5 years analysed there were only 25.5 (5.1%) posts advertised for general ophthalmologists and 22.5 (4.5%) posts advertised for community ophthalmologists. All the remaining 504 (90.4 %) advertisements expressed a requirement for a subspecialty interest or skills. Over the period studied, medical retina posts had increased from 27.5 in 2008-09 to 70 in 2012-13. Glaucoma posts increased from 12.5 in 2008-09 to 33 in 2012-13. Conclusion: This analysis shows that the majority of consultant delivered ophthalmology care is delivered by consultants who have a subspecialist interest. Furthermore there is no demand for general ophthalmologists, contradicting the recommendations of the shape of training report. However, the increase in number of medical retina and glaucoma posts demonstrates that consultant appointments reflect recent advancements in medical science (anti-VEGFs) and (NICE) national guidance. 170. The microbiology of Endophthalmitis: A Four Year Review Sheema Khan, Rosina Zakri, Srinivasulu Reddy , Nishal Patel East Kent Hospitals University NHS Foundation Trust Introduction: Endophthalmitis is a rare, devastating intra-ocular infection caused by endogenous or exogenous mechanisms. Exogenous endophthalmitis is most often post surgical, particularly post cataract surgery. Purpose: The aim of this study is to investigate the causes and microbiology of endophthalmitis in East Kent, United Kingdom over a four year period. Method: A retrospective single centre observational study. Intravitreal aspirates over a four year period identified from local microbiology database, used to obtain patient demographic information and electronic patient notes accessed revealing cases clinically diagnosed with endophthalmitis. All patients identified were included in the study. Results: Vitreal aspirates performed in 49 patients. Fifty-seven vitreal aspirates performed and 20 aqueous taps. Males represented 47% and females 53%. Average age 69 years. Eighteen vitreal aspirates culture positive and clinically 16 (89%) patients with endophthalmitis. One aqueous tap was culture positive (5%) and clinically positive for endophthalmitis (vitreal aspirate negative). Bacterial growth present in all culture positive cases and 1 was fungal PCR positive. Majority due to gram positive organisms 13 (81%) and gram negative responsible for 3 (19%) cases. A total of 42 vitreal aspirates were culture negative, 73% of which were clinically positive for endophthalmitis. Conclusion: Significant levels of culture negative, clinically positive endophthalmitis cases highlighting importance of clinical management rather than microbiology findings alone. Need for further investigation into protocol for accurate sampling, lab techniques for culturing and post-operative care. We advise performing aqueous and vitreous aspirates in all patients clinically suspected of endophthalmitis and advise further investigation into sources of gram negative infection. 171. A Training Device For YAG Laser Capsulotomy May Fong, Chris McLean The Royal Surrey County Hospital NHS Trust Introduction: A device is described to aid junior doctors in gaining expertise in YAG laser capsulotomy in a safe controlled simmulation. Purpose: It is advantageous to train junior doctors on surgical simmulators as the first part of their training to improve patient safety. Method: The eye simmulator consists of a used bandage contact lens bottle. The bottle is attached with tape to the head rest of the slitlamp, with the top end of the bottle pointing towards the operator. The metal cap represents the iris and the silicone stopper represets the cornea and anterior capsule. The trainee is asked to focus the helium-neon aiming beam onto the 'capsule' and to disrupt the capsule surface. Accuracy of the shots is determined by a chaged in the reflectivity of the silicone 'capsule'. Results: This training device has been very helpful in the acquisition of the skills necessary for safe YAG laser capsulotomy. Conclusion: This cheap and readily available device can help in the training of junior doctors in performing YAG laser capsulotomy. 125 ABSTRACTS: Miscellaneous / Paediatric Ophthalmology Annual Congress Final Programme & Abstracts Birmingham 2014 172. Episcleral Tattooing - An Emerging Body Modification Trend James Brodie, Husam El Galhud Maidstone Hospital Introduction: In 2007 an article was published describing the first forays into the practice of episcleral tattooing. Currently only a handful of people worldwide have undergone this procedure, whereby a needle is used to inject dye under the bulbar conjunctiva. To date there have been no previous reports of the risks and complications of this emerging practice in the medical literature. Purpose: We present a case involving a complication that arose in one of the few people in Britain to have undergone episcleral tattooing for cosmetic purposes. Method: A 43-year-old man presented to the eye casualty clinic with red, lumpy conjunctivae bilaterally, having undergone episcleral tattooing 7 weeks previously. On examination there were 3 distinct areas of conjunctival swelling in each eye, representing a total of 6 injection sites. No other gross abnormalities were identified. The clinical picture remained unchanged one month on. Results: Episcleral tattooing is carried out by individuals with no medical training. The short-term complications reported so far include: headaches, severe photophobia, persistent foreign body sensation, and migration of ink staining. More serious short-term risks such as infection, globe penetration, and peri-ocular haemorrhage could occur. For now we can only speculate as to the long-term consequences, but these may include carcinogenic change or granulomatous inflammation. Conclusion: We feel that the potential risks of the procedure should be communicated more widely to those body modification practitioners undertaking it. This practice could result in more serious presentations to acute eye services in the future. 173. Ultraviolet (UV) blocking capability of basic spectacle lenses (CR-39) Rongxuan Lim, Fiammetta Fedele, Parul Patel , Susana Morley St Thomas' Hospital Introduction: Patients with Xeroderma Pigmentosum (XP) cannot effectively repair UV-induced DNA damage and need rigorous solar ophthalmic protection. This usually consists of over-the-counter sunglasses; however, many patients find wearing these in the winter months socially unacceptable, thus limiting compliance. Furthermore, such glasses are not available on the NHS. Purpose: We investigate the UV-blocking capability of basic transparent CR-39 lenses used in NHS prescription glasses and their potential use as an alternative means of UV protection in XP patients. Method: Eight untinted CR-39 lenses (Pentax Standard 1.5 UltraTough; range -6.00DS to +5.00DS) and one CR-39 UV400 (-3.00DS) were obtained from the manufacturer. An Abet 2000 solar simulator (Abet Technologies, Inc. Connecticut) was used to simulate solar radiation. The spectrum of light transmitted through the lenses was collected using a Bentham DMC150 monochromator (Bentham Instruments, Berkshire). The lens transmission was derived by comparing the spectrum to that of the unfiltered monochromator light. Results: All tested lenses blocked 100% of UVB (290-320 nm) and variable levels of UVA (320-380nm). All myopic prescription lenses showed similar UV transmission spectrums, blocking 100% of wavelengths under 344nm. Hypermetropic prescription lenses had greater UV blocking capability that increased with greater hypermetropic spherical power. The +1.00DS and +5.00DS lenses blocked 100% of wavelengths under 349nm and 362nm respectively. The UV400 coated lens blocked 100% of wavelengths under 371nm. Conclusion: Standard refractive NHS CR-39 lenses offer XP patients significant UV protection and could be worn continuously in a socially acceptable way, thus improving compliance. PAEDIATRIC OPHTHALMOLOGY 174. Severe retinopathy of prematurity (ROP) in 23 week gestation babies between 2000-2013 in Newcastle David Cottrell, Ayad Shafiq, Alan Fenton Royal Victoria Infirmary, Newcastle Introduction: We analysed data for the most at risk group of babies over a 13 year interval in a large neonatal unit in the North of England. This retrospective data analysis provides useful data on incidence of ROP as well as results of treatment for this group of babies 126 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology Purpose: We set out to ascertain the percentage of 23 weekers needing treatment for ROP, the severity and type of the ROP, and the outcomes of treatment. We compared this to published data on this fragile age group. Method: This was a retrospective consecutive case series analysis Results: Over the 13 year period 72 babies were born, with 36 (50%) surviving into the screening period. Data existed for 35 babies. Of these 24 (69%) were treated for threshold ROP with 11 (31%) needing no treatment. 18 were treated with laser, whilst 6 received avastin injection. All were bilateral. 14 were treated between 3234 weeks gestational age. 13 babies had zone 1 disease. Resolution occurred in all cases. Conclusion: This is the largest consecutive case series of 23 weekers reported to date. The incidence of babies requiring treatment is higher than in other series. Zone 1 ROP has a 30 to 56% retinal detachment rate after treatment in other publications. In our case series, there were no retinal detachments. We reflect on the possible reasons for this as well as the role of avastin in the current management of posterior ROP. 175. The effect of blood transfusion on fetal haemoglobin concentration in very preterm infants and its association with retinopathy of prematurity Christopher Stutchfield, Anoo Jain, David Odd , Cathy Williams, Richard Markham Bristol NICU and Bristol Eye Hospital Introduction: Increasing numbers of blood transfusions and higher oxygen saturations have both been associated with increased risk of retinopathy of prematurity (ROP). Blood transfusion (with adult haemoglobin [HbA]) reduces infants’ fetal haemoglobin (HbF) concentration and as HbA has a lower affinity for oxygen than HbF, leads to increased oxygen availability. Purpose: We hypothesise that as the HbF:HbA ratio decreases with blood transfusion, more oxygen is made available to the retina, contributing to ROP development. We aimed to identify if there is an association between %HbF concentration and ROP. Method: Inborn infants born <32 weeks gestation or <1501g were enrolled. HbF: HbA ratios were calculated using high pressure liquid chromatography. Clinical data were obtained from case notes. Student t tests and logistic regression were performed to quantify the relationship between initial and mean HbF and ROP. Results: 31 infants were recruited (mean gestation 27.8w; mean birthweight 1026g): 16 did not develop ROP (64%), 9 developed ROP (36%) and 6 died before screening. Those with ROP had similar initial %HbF (85.7% vs.91.8%,p=0.229) but lower mean %HbF whilst inpatients (49.9% vs.92.7%,p<0.001) than those without ROP. Odds ratios (OR,95% CI) for developing ROP, adjusted for birthweight, gestation and transfusion volume, were 1.11(0.95-1.31) for initial %HbF and 0.90(0.82-0.99) for mean %HbF. Conclusion: These data suggest that higher %HbF concentrations may be protective against ROP development. Further studies are needed to confirm whether this is a causal and potentially modifiable association. 176. The importance of globe size in pharmacological treatment of retinopathy of prematurity Ayad Shafiq, David Cottrell, Alan Connor Royal Victoria Infirmary, Newcastle Introduction: Avastin treatment of threshold ROP may have systemic side-effects due to drug diffusion into the systemic circulation following intravitreal injection . The current dose of avastin may create a higher than necessary concentration of drug in the smaller eyes possibly predisposing those babies to greatest systemic absorption? We set out to determine the axial length as a proxy measurement for globe size in a case series of babies treated. Purpose: We set out to determine the variation of axial length in this group. We estimated the variation in vitreous concentration between the smallest to largest eyes. Method: This was a consecutive case series. 8 babies (16 eyes) were treated in a 2 year period. Data was analysed retrospectively, calculating average axial length and range. Results: The mean length was 16.18mm (range 15.3 to 17.5). Mean gestational age was 23.7 weeks (range 23.56 to 24.28). Mean age at treatment was 35.1 weeks (range 34.14 to 37.86). 15/16 eyes resolved with single injection. Conclusion: The smallest eye was 15.3mm. The largest 17.5mm. Assuming that the change in vitreous volume with a change in axial length depends on the cubic power, the concentration in the vitreous of avastin is 1.5 times greater in the smallest compared to the largest eye. If systemic absorption of avastin depends on concentration across the blood-retinal barrier,this finding should stimulate a search for optimal minimal dosing of avastin, particularly in the absence of research on systemic side-effects. 127 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology 177. Objective visual and radiological response of recurrent childhood optic pathway gliomas to bevacizumab Ian Simmons, Kevin Falzon, Evangelos Drimtzias St James University Hospital, Leeds Introduction: Chemotherapy has taken on a prominent role in the treatment of paediatric optic pathway gliomas (OPGs). While slow-growing and biologically benign tumours, they possess increased vasculature, and thus are an attractive indication for anti-angiogenic therapy. Bevacizumab-based therapy has been shown to be successful at inducing rapid objective responses in multiply recurrent OPGs. There have been no previous reports of quantifiable visual field improvement in chiasmal OPGs in the literature. Purpose: To review the indications and outcomes, both clinical and radiological, of two children with recurrent, progressive OPGs refractory to standard chemotherapy, treated with bevacizumab. Method: Interventional case series. Results: Neither patient had neurofibromatosis type 1. Both presented with progressive visual loss due to chiasmal OPGs, having failed at least two prior treatment regimens. Patient 1 had an objective improvement in both visual acuity (VA) and visual fields (VF). VA improved after 8 weeks of therapy, whilst VF improvement was demonstrable 5 months after starting treatment. No progression was recorded 7 months after completion of treatment. Patient 2, who is still on treatment, had stable VA with significant improvement of VF 4 months following treatment. Radiological tumour enhancement resolution and marginal volume reduction was observed after 2 months of treatment in both patients. Treatment-related toxicity was mild with recurrent epistaxis in patient 1 and mild proteinuria in patient 2. Conclusion: Bevacizumab-based therapy is successful at inducing objective visual and radiological responses in OPGs. It appears to be safe in children and was relatively well tolerated. 178. Bevacizumab v Diode Laser in Stage 3+ Posterior Retinopathy of Prematurity (ROP) Sarah Moran, Michael O'Keefe, Bernadette Lanigan Childrens University Hospital Dublin Introduction: We investigated outcomes following bevacizumab injection in Stage 3+ posterior ROP. Purpose: To establish whether bevacizumab is an effective treatment for Stage 3+ ROP compared to the gold standard of diode laser, and to observe occurrence of any adverse ocular or systemic events associated with bevacizumab injection. Method: We conducted a prospective case-control study in 14 premature infants with gestation 24-26 weeks and birth weight 500-1000 grams. We compared conventional laser therapy in one eye to intravitreal bevacizumab in the fellow eye in stage 3 plus disease in Zone 1 and posterior Zone 2 of the retina. Primary outcomes of regression and recurrence were recorded, as well as secondary outcomes of visual function, systemic health and development and adverse effects at one and two year follow-up. Results: We achieved regression of ROP using intravitreal bevacizumab (1.25mg in 0.1ml). There was recurrence of ROP in 3 bevacizumab treated eyes (21.43%) at a mean age of 51 weeks post menstrual age (PMA) and in 1 laser treated eye (7.14%) at 37 weeks PMA. These were successfully treated with laser or repeat injection of bevacizumab Conclusion: Bevacizumab is as effective as laser for Stage 3+ posterior ROP. Recurrence is likely to occur at a later stage in bevacizumab treated eyes, therefore these eyes require longer term follow up. At two year followup we encountered no ocular or systemic adverse effects 179. Evaluation of ROPBox; a secure software tool for Remote screening of Retinopathy of Prematurity (ROP) Zahir Mirza, Stephanie West, Lucy Barker , Himanshu Patel, Gillian Adams Moorfields Eye Hospital Introduction: Retinopathy of Prematurity requires frequent screening of infants in neonatal intensive care units to enable timely treatment and prevention of blindness. A paucity of trained screeners means it can be difficult for units to provide a continuous service throughout the year. Current remote screening systems either are nonspecific to ROP or require images and patient data to be transferred via a USB stick which is not recommended by information governance guidelines. ROPBox works with existing RetcamsTM to enable automatic secure HIPAA compliant transfer of images to www.ROPBox.net , a ROP specific EPR system. This provides protected data backup and allows remote screening of images by trained ophthalmologists. 128 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology Purpose: This study will assess the reliability of ROPBox for remote ROP screening. Method: Retrospective clinical notes review was performed on all infants screened for ROP during 2012. Images taken using RetcamTM during routine screening by a trained nurse were uploaded to ROPBox.net. Masked to the clinical outcome; images were graded remotely by a consultant paediatric ophthalmologist. Results were compared against the onsite clinical examination results. Results: 117 infants (mean gestation age =28 weeks (range 23-34), birth weight =1004g (range 465-2150) underwent 360 screenings. Correlation between clinical exam and ropbox for detecting ROP had a sensitivity of 73.2% and a specificity of 95.8%. Identification of infants requiring treatment (5%) had a sensitivity of 67% and a specificity of 100%. Conclusion: ROPBox is a useful tool to provide secure data compliant remote screening of infants with retinopathy of prematurity. 180. Development of infantile nystagmus Maria Theodorou, Richard Clement, David Taylor, Anthony Moore Institute of Child Health Introduction: Infantile nystagmus is an involuntary horizontal oscillation of the eyes which usually develops within the first 6 months after birth. Eye movement recording is challenging in young children as cooperation is required. Purpose: To obtain quantitative measurements of the development of infantile nystagmus in children. Method: Eye movements were recorded using an infrared limbal tracker. The oscillations in short duration eye movement recordings were identified by the method of close returns and the characteristics of the saccadic main sequence were used to calibrate the oscillations. These techniques were applied to 9 subjects who were all tested on more than one occasion up to the age of 4 years. Results: The range of waveforms could be described by a sum of asymmetric pendular and pseudocycloid components. The amplitude of the nystagmus decreased from upto 1.5 years and then increased again. The foveation associated with the nystagmus increased up to 1.5 years and then remained approximately constant. The average visual acuity of the subjects increased steadily. Conclusion: These findings imply that waveform changes are only associated with improved visual acuity up to 1.5-2 years of age. 181. Congenital Glaucoma in Wagner Syndrome Hugh Jewsbury, Andrew Fry, Patrick Watts, Veronique Nas, James Morgan University Hospital of Wales, Cardiff Introduction: Wagner Syndrome (WS) is an autosomal dominant vitreoretinopathy caused by mutations in the VCAN gene. Purpose: To describe three members of a British family diagnosed with the autosomal dominant vitreoretinopathy, Wagner syndrome, that developed congenital glaucoma. All three have a novel spicing mutation in VCAN, the gene responsible for Wagner syndrome. VCAN encodes Versican an extracellular matrix proteoglycan that has been found in the ciliary body and trabecular meshwork in addition to the vitreous and retina. Method: Case series and literature review Results: Each family member developed glaucoma by 3 months of age requiring multiple surgical interventions and now has significant visual loss secondary to glaucomatous optic neuropathy. In addition the siblings have each experienced recurrent anterior uveitis. Conclusion: Congenital glaucoma is a rare complication of WS. Clinicians caring for WS families need to be aware of this feature and consider screening infants at risk, particularly when close relatives are affected. Conversely, clinicians caring for patients with ‘primary congenital glaucoma’ should consider the possibility of an autosomal dominant VCAN mutation, causing WS, as an underlying aetiology. 129 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology 182. Management of Congenital Nasolacrimal Duct Obstruction: 15 years experience in the UK Lana Fu, Susmito Biswas, Ian C Lloyd, Anne E Cook, Jane L Ashworth Manchester Royal Eye Hospital Introduction: Congenital nasolacrimal duct obstruction (CNLDO) occurs commonly in newborns, with the majority spontaneously resolving by 12 months of age. There is widespread variation in the management of congenital nasolacrimal duct obstruction in the UK. Purpose: This study aims to describe management and outcomes of CNLDO in a UK tertiary hospital over a 15 year period. Method: A retrospective review of 259 case notes was undertaken, comprising consecutive patients presenting to general paediatric clinic from 1997 to 2012 with a diagnosis of CNLDO. Data included age at presentation and first probing, past ocular history, dye test and lacrimal massage advice, probing outcomes, and further management. Results: Symptoms spontaneously resolved in 77.5% of patients by the age of 12 months, decreasing to 33.6% after the age of 12 months. Overall success rate following first probing was 70.7%, with highest success rate in patients aged between 19 and 24 months (78.9%). Stent placement was eventually made in 50% of cases who failed primary probing. Second probing was successful in 57.1%, with stent placement successful in 78.6%. Conclusion: Surgical intervention in congenital nasolacrimal duct obstruction can be deferred until 18 months of age. Primary probing was less successful in patients older than 3 years. Stent placement was more successful than repeat probing, and should be recommended following failure of a primary probe. 183. Systemic Ciclosporin in the Management of Severe Vernal Keratoconjunctivitis in Children. Rosalind Stewart, Arvind Chandna, Gavin Cleary, Harish Nayak Alder Hey Children's Hospital Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic inflammatory disorder, typically of young males. In severe cases it causes significant burning, itching and discharge; with corneal vascularisation, shield ulcers and visual loss. Such cases are often challenging to manage with conventional therapies. Purpose: To describe the successful use of systemic ciclosporin in the management of refractory VKC in children. Method: A prospective observational study of 5 children with severe refractory VKC, who were commenced on systemic ciclosporin. Baseline and outcome data was collected on symptoms, visual acuity and clinical findings; and ciclosporin serum levels and side effects. Results: 5 boys (aged 6.25-13.75, mean 10.5 years) were commenced on systemic ciclosporin at 1.25-4mg/kg od in divided doses. Ciclosporin was well tolerated in 4 cases. Treatment was discontinued in 1 case due to deranged liver function tests. Of the 4 cases; 2 cases achieved complete resolution within 3 months; 1 case achieved complete resolution at 6 months following a recurrent exacerbation (burning and cobblestone papillae) which prompted increased dosing; 1 case remained to have persistent but reduced activity (cobblestone papillae and corneal epitheliopathy) with frequent exacerbations in the first 12 months but completely resolved thereafter. Serum ciclosporin levels were 18-82μg/l, significantly below the therapeutic range for post-transplant immunosuppression. Conclusion: Systemic ciclosporin offers a novel, effective and usually well tolerated treatment for severe refractory VKC in children. It should be considered as an adjuvant therapy in such cases. 184. Proposed algorithms for reducing un-necessary ROP screening Shah Karim, Himanshu Patel, Helen Lock , Ajay Sinha, Steve Kempley, M Ashwin Reddy Barts and The London NHS Trust Introduction: The role of biomarker IGF-1 and other perinatal risk factors in the development of Retinopathy of Prematurity in East London. Purpose: To identify prenatal and longitudinal postnatal risk factors including IGF-1 level associated with progression of severe ROP for neonates born <32 weeks &/or birth weight <1500gm, who required regular screening. To determine whether unnecessary screening could-be avoided in infants who are not at risk of developing severe ROP. Method: Data were collected from a prospective longitudinal study from all at risk infants as per standard protocol. 130 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology Risk factors included (i) Gestational Age (GA), (ii) Birth Weight (BW), (iii) Absolute Weight Gain in 6 weeks(AWG), (iv) Serum IGF-1 level at 31(IGF1),32(IGF2) and 33(IGF3) weeks. Patients were categorised into (1) Low Risk ROP (Stage 0 and 1) (2) High Risk ROP (Stage 2 or worse). All babies were screened using RetCam every week or alternate week depending on stages of ROP at The Royal London Hospital. Results: 36 premature babies were included in this prospective study. 15 patients developed Low Risk ROP, and 21 patients progressed to High Risk ROP (of which 4 patients required laser therapy). There were significant association (negative-correlation) of High Risk ROP with GA, BW, IGF2, IGF3 and absolute weight gain in 6 weeks, but not with IGF1 at 31 weeks. High risk babies had following features: GA (25.4±1.5 wks), BW (731.6±184grams), AWG (478.5±218.9 grams), IGF2 (12.1±6.6), IGF3 (15.2±9.3) [Mean+/-SD]. Conclusion: There were significant differences in GA, BW, AWG, IGF (at 32 and 33 weeks) between neonates with severe ROP (Stage 2 and Worse) and those with no or minimal ROP (Stage 0 or 1). Considering all risk factors above, 15 babies out of 36 (40%), could be excluded from regular ROP screening which will reduce enormous clinician’s workloads as well as neonatal systemic stress encountered with RetCam and/or BIO examination. 185. Retinal vessel architecture in retinoblastoma patients pre and post treatment Karen Wong, Ashwin Reddy, Mandeep Sagoo, Clare Wilson Royal London Hospital Introduction: Retinoblastoma is the most common childhood malignant intraocular tumour. Previous observational studies have shown that active retinoblastoma exhibits engorged and tortuous retinal vessels which subsequently settle with regression of disease. With recent development of computer software, it is possible to quantify the vessel parameters objectively with speed. Purpose: This study aimed to quantify the vessel parameters including width and tortuosity in patients with retinoblastoma before and after treatment. Method: 20 RetCam images from 10 children diagnosed with retinoblastoma at Royal London Hospital were analysed. The sentinel vessel width and tortuosity values were analyzed with semi-automated software CAIAR (Computer Aided Image Analysis of Retina) at the time of diagnosis and after effective treatment. Data were analyzed with two tailed paired-t test. Results: The mean width of sentinel vessel pre-treatment is 2.59 and post-treatment is 1.60 (p= 0.001; SD= 1.07); the mean tortuosity value of sentinel vessel pre-treatment is 2.55 and post treatment is 1.19 (p=0.011; SD= 2.02). The sentinel vessel width and tortuosity value were significantly less after effective treatment. Conclusion: Prompt treatment is paramount to saving the eye and preventing death from metastasis in retinoblastoma. Retinal vessel width and tortuousity decreases with disease regression. Following further study, the quantification of retinal vessel architecture may be of use as a valuable screening tool, predictor of disease progression and assessment of treatment response in retinoblastoma patients. 186. A prospective long-term study of the ophthalmic natural history of paediatric craniopharyngioma Evangelos Drimtzias, Kevin Falzon, Irfan Jeeva , Ian Simmons St James`s University Hospital, Leeds, UK Introduction: Craniopharyngiomas are benign epithelial tumours arising from remnants of the Rathke`s pouch. Their natural history, with regard to their effects on the visual system, has not, to date, been investigated prospectively. Purpose: To present our experience over an 8 year period of monitoring of visual function in children with craniopharyngioma. Method: Visual data, of multiple modality, of all paediatric patients younger than 16 at presentation was prospectively collected between 2004 and 2012. Results: Twenty patients were surveyed. Severe visual loss and papilledema at the time of diagnosis were more common in children under the age of 6. Visual signs, tumour calcification and optic disc atrophy at presentation are predictors of poor visual outcome with the first two applying only in children younger than 6. In contrast with previous reports, preoperative visual field (VF) defects and type of surgery were not documented as prognostic indicators of poor postoperative visual acuity (VA) and VF. Among patients 131 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology undergoing radiotherapy, better visual outcomes were recorded in children aged > 6. Contrary to previous reports calcification at diagnosis, adjunctive radiotherapy, type of surgery and preoperative visual field defects were not prognostic indicators of tumour recurrence. Conclusion: This is the first prospective long-term study of the visual natural history of craniopharyngiomas to our knowledge. Local recurrence is common in craniopharyngioma. Magnetic resonance imaging is considered to be the recommended means of follow up in patients with craniopharyngioma. However VA and VF are useful tools in monitoring for recurrence. 187. Retinopathy of Prematurity in Northern Ireland from 2006-2011 Eibhlin McLoone, Sarah Chamney, Rebecca Rollins , Emma McCall, Adele Marshall, Stan Craig Royal Victoria Hospital Introduction: Retinopathy of prematurity (ROP) is one of the leading causes of preventable childhood blindness. Screening uses considerable resources and is invasive for premature infants. Purpose: To establish the incidence of ROP and to identify baseline characteristics, demographic information and co-morbidities associated with its development. Method: Clinical information on all infants born at less than 32 weeks or 1500g were retrospectively entered on to the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) database. The infants were classified based on those who developed no ROP, any ROP and severe ROP which required treatment. Results: The number of live births in this 6 year period was 148,852. The number of infants born at less than 32 weeks or 1500g in the same time period was 1866. Of those at risk, 316 developed any ROP. Ninety- two developed severe ROP requiring treatment. The incidence of the development of any ROP was 2 per 1000 live births. Using multinomial logistical regression the main risk factors for the development of any ROP were gestational age in weeks (p=0.000), small for gestational age (p=0.017), maternal smoking (p=0.040) and total number of days of oxygen therapy at > 21% (p=0.010). Conclusion: With this data we are currently building a statistical model which will allow us to better assess the risk of the development of ROP, enabling us to modify our screening protocol accordingly and better inform parents of the risk to their child. 188. Rationalising the use of Bacterial Conjunctival Swabs in Alder Hey Children’s NHS Foundation Trust - Review of a Seven Year Period (2006-2013) Neeru Vallabh, Fiona Hardiman, Theresa S Cole , Richard J Drew, William Newman Alder Hey Hospital Introduction: The use of routine bacterial conjunctival swabs (BCS) is common and possibly represents an unnecessary demand on the microbiology department. Could the use of BCS be rationalised without effecting clinical care? Purpose: To review the impact of a new testing regime for BCS which was introduced in September 2012. Method: Results of all BCS were retrieved using the Laboratory Information System for the pre-intervention (January 2006-September 2012) and post-intervention (October 2012-October 2013) periods. The intervention was that in September 2012, BCS from departments other than ophthalmology could only be processed if discussed with Microbiology/ Infectious Diseases clinicians. Results: 3169 BCS were taken between January 2006 and October 2012. 58.0% from wards and admission units, 2.6% from the ophthalmology clinic and 30.6% from A+E. 42.7% were positive for Haemophilus spp, 20.1% for Staphylococcus aureus, 14.0% for Streptococcus pneumoniae., 11.3% for Moraxella spp. and 3.6% for Pseudomonas spp. Post-intervention only 35 swabs have been taken, which represents a drop of 93% from the number of swabs expected from the previous seven years’ experience (current average 2.69 swabs per month vs. previous average 2006-2012 of 39.12 swabs per month). 8 of these 35 swabs were from Ophthalmology. Conclusion: The results show that there were a large number of BCS being acquired from patients throughout the hospital, particularly from wards and the A&E department. Review of the use of BCS within hospitals is beneficial, and has led to a 93% reduction in the number of eye swabs being sent for testing, with an annual saving of £5,207. 132 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology 189. Incidence and Management of Non Accidental Injury in South Yorkshire Ophthalmology units Mohammed Zayed, Nadeem Ahmad, Alaa Attawan , Jessy Choi Royal Hallamshire Hospital Introduction: The population of South Yorkshire area is 1.34 million inhabitants and Non Accidental Injuries (NAI) remains a challenging clinical scenario requiring a multidisciplinary approach. Purpose: We aim to review NAI recorded in South Yorkshire and assess our referral system efficacy in line with the Royal College of Ophthalmologists guidelines. Method: A retrospective study included NAI children up to 4 years old recorded between August 2011 and August 2012 obtained from the Child protection team and Sheffield Children’s Hospital accident and emergency database. 306 children were included Results: Of 306 patients, 67 children were referred to ophthalmology (21.8%). 41 cases (61.19%) were seen by a consultant; 23 (34.3%) were seen by a Senior Specialty trainee. 3 (4.4%) were seen by junior trainee and seen by a consultant at a later date except of one child failed to attend and was discharged to local hospital. 62 patients (92.5%) were seen within 24 hours; 2 after 2 days, 2 after 3 days and 1 was referred after 5 days for lack of suspicion. 12 children had positive findings (17.9%) aged between 3 and 26 months. 7 had retinal hemorrhages in both eyes, and 1 had a retinal hemorrhage in one eye. 4 children had sub-conjunctival hemorrhages. All patients were followed up for a mean of 7.25 months. Conclusion: NAI cases referred were reviewed promptly and with strong involvement of senior ophthalmologists in line with the Royal College's recommendation. 190. Study of Optimal Perimetric Testing In Children (OPTIC) – Normative visual field values in children aged 5-15 years Dipesh Patel, Bronwen Walters, Phillippa Cumberland , Isabelle Russell-Eggitt, Jugnoo Rahi, On behalf of the OPTIC study group UCL Institute of Child Health Introduction: The evidence base for perimetry in children is incomplete. We are conducting a programme of research to address feasibility, reliability, repeatability and characterise normative values of visual fields in children. Purpose: Here we describe normative values for kinetic and static perimetry in children without visual field defects (‘controls’) using Goldmann and Humphrey perimeters and report changes in visual field (VF) area and sensitivity with age. Method: To date 145 children aged 5 to 15 years and without ocular pathology that could cause a visual field defect, have undergone kinetic perimetry (Goldmann) and static automated perimetry, SAP (Humphrey SITA 24-2 FAST) using standardised protocols. Linear regression was used to investigate associations between VF area and age. Results: VF area (Goldmann) increased with age for isopters III4e, I4e and I2e. Per year, the area of the III4e isopter increased by 193.04deg2 (95%CI: 113.68-272.41), I4e increased by 174.87deg2 (88.57-261.17) and I2e by 148.24deg2 (89.58-206.90). Piecewise regression of mean deviation (MD) in SAP demonstrated an increase in MD with age up to 12 years (0.28dB/year, 95%CI: 0.089-0.47), remaining stable thereafter (mean MD = -0.53, 95%CI: -0.96-(-0.10)). Conclusion: There is a small, linear increase in VF area with age resulting in, for example, a 14.5% greater VF area for isopter III4e at 15 years compared to 5 years. Sensitivity with SAP also increases with age, plateauing at 12 years. Interpretation of perimetry should account for developmental changes in visual fields in children. 191. Unintentional Injuries in Visually Impaired Children Jocelyn Cherry, Julie Mytton, Amanda Hall , Cathy Williams University of Bristol Introduction: Unintentional injury(UI) is a leading cause of death in under-15s and a major cause of less severe injury requiring hospital treatment. Children with visual impairment(VI) are at increased risk of harm due to the cumulative effects of incomplete development and sensory impairment. Few relevant data exist to 133 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology support this or to aid parents/teachers devising preventative strategies. Purpose: To identify and summarise the available data on the prevalence, mechanisms, risk factors and outcomes of UI in children with VI. Method: A systematic review of four databases was undertaken in 2013. A highly sensitive search strategy was developed. Inclusion criteria were children under the age of 18y with VI (author defined) and UI. Results: 22,439 articles were identified and 652 abstracts reviewed, yielding 12 papers meeting inclusion criteria. 2/3 were published pre-1990. Meta-analysis was not possible due to significant heterogeneity and risks associated with synthesis of observational data. VI children were reported with road traffic incidents, poisoning, prosthesis asphyxiation and trauma secondary to contact lens or glasses. Conclusion: There is limited published evidence on injuries in children with VI. That identified was mostly published pre-1990. Analysis of risk factors for injury is required to support the development of advice for parents and professionals. 192. The extended role of the Orthoptist; increasing the access to Ophthalmology for Paediatric Oncology patients Danielle Guy, Olwyn Nelson, Janice Hoole, Ian Simmons Leeds Teaching Hospitals NHS Trust Introduction: Trusts across the country are under financial constraints to provide high quality patient-led care with decreasing facilities and staff. The following report details the use of Orthoptists to deliver ophthalmic support to a regional paediatric oncology centre. Purpose: To demonstrate the potential effectiveness of utilising Orthoptic services within a multi-disciplinary paediatric oncology service. Method: A senior Orthoptist with experience of ophthalmology, ocular motility and oncology support was placed within the Paediatric Oncology Department for one session per week to assess patients with opportunity to liaise via email / telephone with the Ophthalmologist when necessary. Results: 174 patients were seen within the Oncology Department for visual field or acuity monitoring, orthoptic examination and diplopia relief. 46 (26%) of these were new referrals seen for the first time. 90% of patients were able to be managed by the Orthoptist alone without the immediate aid of the Ophthalmologist. Further ophthalmological examination was needed for less than 10% of patients; this included fundoscopy opinion, listing for strabismus surgery and prescription of ophthalmic medication. 3 patients required referral to hospital optometry service. A number of other queries such as sticky eye, glasses wear, watery eye etc were able to be discussed promptly with the Oncologist / patient and appropriate appointments arranged. An estimated 150 joint paediatric ophthalmological / orthoptic clinic appointments were saved over the year. Conclusion: The use of Orthoptists as part of a paediatric oncology multi-disciplinary team saves medical staff time, paediatric clinic appointments, as well as unnecessary travel and long waits for a vulnerable patient group. 193. Rapid onset of severe ocular injury after exposure to a button battery Yasir Khan, Sundus Maqsood, S Marpuri, V Geh, G S Bhermi Southend University Hospital Introduction: Button batteries are commonly used in many household electronic items and are a potential health hazard, especially in children. Therefore health professional and general public should be aware of potential danger of button batteries and packaging should carry an appropriate warning sign. Purpose: To report an unusual clinical presentation of button battery induced ocular injury. Method: Two year old girl presented with painful red eye secondary to a metallic foreign body. On examination, upper eye lid was swollen, erythematous with corneal and conjunctival abrasion. A shiny button battery lodged in the supero-nasal conjunctival fornix was noted. On removal of FB under GA surrounding conjunctiva and sclera appeared pigmented and necrotic .The battery's positive end was normal, whereas the negative end was corroded. The pH of affected ocular tissue and 9. The eye was irrigated and the pH neutralised and tissue injury was treated with topical antibiotics and steroids. Two weeks later, there was residual conjunctival fibrosis overlying an area of scleral necrosis, with mild symblepharon formation. Vision was normal in both eyes. 134 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Paediatric Ophthalmology Results: Button battery induce liquefaction necrosis by 1) Generation of an electric current that hydrolyses tissue fluid and produces hydroxide ions at battery's negative pole, 2) Leakage of battery's alkaline contents, 3) Physical pressure on adjacent tissue. Button-battery-induced ocular burn may be severe and requires prompt treatment to avoid complications. Ocular injury from button batteries is uncommon. In our case, the battery was intact and found in an unusual site with a rapid onset of injury. Conclusion: Current labelling guidelines on button batteries packaging need to be amended, we recommend that this should be changed to 0- 6 years, and advice to carefully dispose of used batteries is emphasised. Button battery impaction in eye is a medical emergency and it should be removed as quickly as possible as delay could result serious complications. 194. Sight-threatening ocular manifestations of JXG in childhood David Burton, Evangelos Drimtzias, Kevin Falzon , Irfan Jeeva, Ian Simmons St James`s University Hospital, Leeds,UK Introduction: JXG is a benign histiocytic lesion encountered primarily in infancy and childhood although adolescent and adult forms do exist. Ocular involvement is the most common extracutaneous manifestation. Purpose: To report the unusual clinical presentation of JXG in 2 paediatric cases. Method: A 7-month old boy diagnosed by biopsy with multi site Langerhans Cell Histiocytosis (LCH) developed extensive retro-bulbar orbital disease causing compressive optic neuropathy. A 3-year old boy with JXG skin lesions confirmed by biopsy presented with bilateral tractional funnel-shaped retinal detachment which was managed with scleral buckling. Results: The LCH in the first case was treated with chemotherapy initially. A CT scan revealed bilateral optic disc masses which following biopsy were diagnosed as JXG. Further chemotherapy failed to achieve tumor control as visual acuities continue to deteriorate. One year following vitreoretinal surgery in the second case new iris masses were seen in both the eyes with subsequent fibrous contracture in the anterior chamber causing distortion of the iris. Tumors were treated with bilateral subconjunctival triamcinolone injections. No perception of light was the visual outcome in both cases. Conclusion: JXG in the first case developed during the time of chemotherapy and was therefore resistant to treatment. Differentiation caused by the chemotherapy agents resulted in lineage transformation. Both cases confirm that the diagnosis of JXG should be considered as a differential diagnosis of unusual intraocular manifestations in children with recognized cutaneous JXG. 195. Head Posture and Head Movements in Infantile Nystagmus Vijay Patel, Irene Gottlob, Frank Proudlock University of Leicester Ophthalmology Dept. Introduction: The mechanisms behind Infantile Nystagmus (IN) null regions and their relationship to anomalous head postures is unclear. Purpose: Our aims are to investigate the relationship between head postures and null regions two dimensionally and to investigate the nature of head movements in IN. Method: 18 IN patients and 15 controls were recruited. Null regions were mapped in IN patients in the horizontal and vertical plane using the EyeLink II binocular pupil tracker to measure the intensity of their nystagmus. Patients also carried out a number of visual tasks, during which head posture and movements were measured using the InertiaCube head movement measuring device and Eyelink 1000 head tracker. Eye movements were also recorded using the EyeLink 1000 monocular pupil tracker. Controls only carried out head posture and head movement experiments at 1.2m and 0.6m. Results: Nystagmus characteristics in IN patients were shown to dramatically change in the vertical and horizontal planes. The individual characteristics of null regions varied between patients. Head postures were 135 ABSTRACTS: Paediatric Ophthalmology / Uveitis Annual Congress Final Programme & Abstracts Birmingham 2014 found to correlate to accessing the null region, particularly in tasks of high visual demand. Furthermore IN patients were found to make significantly more functional head movements than controls. Conclusion: The two dimensional null region acquisition protocol enables a more comprehensive analysis of null regions than traditional methods. Whether null regions are accessed using anomalous head postures is dependent on a number of factors. UVEITIS 196. The Dublin Uveitis Evaluation Tool (DUET) – an algorithm for earlier diagnosis of spondyloarthropathies by ophthalmologists in acute anterior uveitis Michael O'Rourke, Muhammad Haroon, Pathma Ramasamy , Oliver FitzGerald, Conor Murphy Royal Victoria Eye and Ear Hospital, Dublin Introduction: Early diagnosis in SpA is crucial as morbidity is related to duration of the disease. Acute anterior uveitis (AAU) is the first manifestation of SpA in 20%. An acutely painful red eye will prompt a patient to seek medical attention more readily than lower back pain of insidious onset. Purpose: This study establishes the incidence of previously undiagnosed SpA in patients presenting with AAU. Using the most significant clinical factors, a referral algorithm to the rheumatologist was generated with the aim of earlier diagnosis and treatment. Method: 104 consecutive patients with non-infectious AAU were recruited prospectively. Other causes of AAU and a known history of SpA were excluded. These patients were subsequently examined by a rheumatologist for the presence or absence of SpA. Results: A new diagnosis of SpA was made in 38%. The referral algorithm advises that patients with AAU and back pain of onset under 45 years of age with duration greater than 3 months should have HLA-B27 checked. If positive they should be referred to rheumatology. In addition, any patient with AAU and a personal history of psoriasis, even in the absence of back pain should also be referred. This algorithm has sensitivity of 95% and specificity of 98% and was subsequently validated in a second cohort of 80 patients. Conclusion: Close collaboration between ophthalmologists and rheumatologists utilizing our algorithm will result in earlier treatment intervention to improve disease outcome in SpA. 197. Use of aqueous humour PCR for diagnosis of atypical ocular toxoplasmosis Andre Grixti, Edward Guy, Nicholas Alexander V Beare, Ian Andrew Pearce Royal Liverpool University Hospital Introduction: Ocular toxoplasmosis is a major cause of posterior uveitis worldwide. Diagnosis is usually based on ophthalmological examination. However, diagnosis and treatment can be delayed in patients with atypical lesions. Furthermore, specific antibodies suggestive of recent infection are not always detected. In such cases, rapid identification of the causative agent requires aqueous humour polymerase chain reaction (PCR). Purpose: To determine the diagnostic value of aqueous humour PCR for detection of atypical toxoplasmic uveitis. Method: Retrospective, non-comparative case series of patients having aqueous PCR for Toxoplasma gondii as an investigation for posterior uveitis in St Paul’s Eye Unit, Liverpool (UK). Serum levels of anti-Toxoplasma gondii specific IgM and IgG were determined by ELISA technique. Aqueous humour obtained by anterior chamber paracentesis in clinic underwent PCR for T. gondii DNA at Toxoplasma Reference Laboratory Swansea (Wales, UK). Results: From November 2009 to December 2012, 5 patients with chorioretinitis of uncertain cause had aqueous sampling for toxoplasmosis. Three patients had multifocal chorioretinitis, and two had diffuse retinitis. Two subjects were immunosuppressed (liver transplant recipient; Waldenstroms macroglobulinaemia). All patients were seropositive for T. gondii. Aqueous PCR detected toxoplasmic DNA in 3 patients including both immunosuppressed, confirming diagnosis of toxoplasmosis despite atypical clinical presentations. Two of these subjects were IgM negative. Both patients with negative aqueous PCR were diagnosed with toxoplasma choroiretinitis due to positive anti-Toxoplasma IgM serology and clinical findings (pigmented chorioretinal scar). Conclusion: Aqueous humour PCR testing for toxoplasmosis should be performed as a diagnostic tool where atypical toxoplasmosis is a possibility, particularly in the immunosuppressed. 136 Annual Congress Final Programme & Abstracts Birmingham 2014 ABSTRACTS: Uveitis 198. Pegylated Interferon α2b reduces corticosteroid requirement in patients with Behcet’s syndrome with upregulation of circulating regulatory T cells Sue Lightman, Oren Tomkins, Virginia Calder, Catey Bunce, Hilary Longhurst, Dorian Haskard, Miles Stanford Moorfields Eye Hospital and Institute of Ophthalmology Introduction: BS often requires treatment with immunosuppressive agents and corticosteroids. INF α2a and 2b are reported in small case series to be effective in BS. The mechanism is unknown but regulatory T cells (Tregs) are induced in other diseases which respond to IFN. Purpose: To determine if IFN reduces the requirement for systemic medication at 1 and 3 years in BS. Method: A randomised clinical trial adding 26 weeks of subcutaneous pegIFN α2b/ week to standard treatment in half and follow for 3 years. Tregs in peripheral blood measured over the first year at one site. Results: At 1 year the mean dose prednisolone was 6.74±5.78 mg/day in pegIFN α2b group and 10.53±9.28 mg/day in non-IFN group (p=1.00). However in patients (69.4% in each arm) on corticosteroids at baseline, the dose was significantly lower at 1 year in the pegIFN α2b (6.5(5,15) mg/day) compared with the non-IFN group (10(8.25,16.5)mg/day) (p=0.039). There was increased quality of life and decreased immunosuppressive medications in the pegIFNα2b group up to year 3. There was a significant rise in Tregs on IFN only which was still present at 1 year. Conclusion: Adding pegIFN α2b to patients with BS on baseline steroids resulted in a significant reduction in dose with improved quality of life and trend to reduced other drugs required. The effect was seen at 1 year and was associated with a rise in regulatory T cells suggesting a mode of action. 199. Long Term Outcome of Repeat Ozurdex Implantations in Non-Infectious Uveitis Oren Tomkins-Netzer, Simon Taylor, Asaf Bar, Albert Lula, Satish Yaganti, Lazha Talat, Sue Lightman Moorfields Eye Hospital Introduction: Uveitis can be controlled using systemic or local immunosupression agents. There have been limited reports on long term outcome of treating uveitis with repeat Dexamethasone (Ozurdex) implants. Purpose: To describe the long term outcome of eyes with uveitis following repeated treatment with Ozurdex implants. Method: Patients with non-infectious uveitis that were treated with Ozurdex implants were included in the study. Anatomical and functional outcomes, as well as ocular complications were gathered retrospectively up to 24 months after treatment was started. Results: Thirty eight eyes of 27 patients with uveitis were treated with 61 Ozurdex implants. Average follow-up was 17.3±1.8 months after the first implant (range 3-54.5 months, 54.65 eye years), with 24 (63.1%) receiving multiple implantations. Following the first implantation average best corrected visual acuity (BCVA) improved from 0.47±0.05 LogMAR to 0.27±0.07 LogMAR (p<0.001) and central retinal thickness (CRT) decreased by 263±44.22μm (p=0.003). The average duration of therapeutic effect was 8.6±1.7 months, with a similar response achieved after each repeat implantation. The accumulated effect of repeat implantations resulted in continued improvement in BCVA (R2=0.91, p<0.0001) with significant improvement and stabilization of CRT. Two eyes had progression of posterior subcapsular opacities, though none required surgery. There were seven instances of raised intraocular pressure, all of which responded to pharmacological treatment. Conclusion: The accumulated effect of repeat Ozurdex implantations improves retinal thickness and resolves ocular inflammation resulting in restoration of ocular function. Ocular complications were minimal with no eyes requiring surgery for increased ocular pressure or progression of cataract. 200. Visual outcome and treatment strategies among patients with ischaemic retinal vasculitis Lazha Talat, Oren Tomkins-Netzer, Sue Lightman Moorfields Eye Hospital / UCL Institute of Ophthalmology Introduction: Ischaemic retinal vasculitis is a rare but serious cause of visual loss. However, the long term outcomes have only been addressed in a limited number of studies using small sample of cohorts. Purpose: To examine the long term visual and clinical outcome following the diagnosis of ischaemic retinal vasculitis. Method: This was a retrospective study of 60 eyes from 40 patients with ischaemic retinal vasculitis whilst under the care of a single uveitis clinic at Moorfields Eye Hospital. Demographic and clinical data were collected at onset of retinal ischaemia (Baseline) and annually till the last visit. 137 ABSTRACTS: Uveitis / Vitreo-Retinal Disease & Surgery Annual Congress Final Programme & Abstracts Birmingham 2014 Results: Following a median follow-up time of 55 months, the median visual acuity showed no significant difference from baseline up to five years and at final visit (0.18 versus 0.18 Logmar, p=0.123; Wilcoxon Ranks test). Compare to baseline, 24 eyes (40%) gained at least one line of vision, including 12 eyes that gained ≥ three lines. Ten (17%) lost at least one line of vision from baseline, including five eyes that lost ≥ three lines. Severe visual loss (≥ 6/60) occurred in 23 eyes (38%), mainly due to chronic macular oedema (26%) and macular ischaemia (21%). Retinal laser photocoagulation was not required in 14 eyes (23%), used alone in 10 (16%), or combined with systemic steroid (26%) or immunosupressants (25%). Conclusion: Early treatment with retinal photocoagulation and immunomodulatory medications can regain vision in a considerable number of cases. However, severe and irreversible visual loss secondary to macular involvement remains a challenge. VITREO-RETINAL DISEASE & SURGERY 201. Ocriplasmin for Pharmacologic Resolution of Vitreomacular Adhesion: Meta-analysis of anatomical and functional outcomes Andrew Lotery, Benedicte Lescrauwaet, Kerry Gairy University of Southampton Introduction: Two Phase III, multicenter, randomized, placebo-controlled trials (MIVI-TRUST 006-007) studying ocriplasmin as treatment for vitreomacular traction were conducted, identical in design apart from randomization ratios and region. The pre-specified integrated analysis of the combined data demonstrated favorable effects of ocriplasmin in primary and secondary outcomes. Purpose: Compare results of the pre-specified integrated analysis with meta-analysis of anatomical and functional endpoints using technology appraisal methods as required by the National Institute for Health and Care Excellence. Method: VMA resolution at Day 28 and Month 6, macular hole (MH) closure and 2 or 3-line visual acuity (VA) gain at Month 6 and avoidance of vitrectomy outcomes from each of the trials were pooled, with effects measures expressed as risk difference and risk ratio in random and fixed effect models. Heterogeneity between trials was assessed using Cochrane’s Q test and I2 statistic. Results: In a random effects model, risk difference (95% confidence interval) was 0.07 (0.02-0.11) for 3-line VA gain and 0.11 (0.04-0.18) for 2-line gain; 0.25 (0.10-0.39) for MH closure; 0.17 (0.12–0.23) and 0.14 (0.07-0.20) for VMA resolution at Day 28 and Month 6, respectively; and 0.08 (0.01-0.16) for avoided vitrectomy. Risk ratio result confirmed findings from the integrated analysis. None of the meta-analysis results showed heterogeneity assessed by a Q statistic of p< 0.05 or an I² of >50%. Details of meta-analysis are discussed. Conclusion: Meta-analysis of anatomical and functional outcomes confirmed the previously reported results, supporting validity of integrated analysis. 202. Recovery of visual symptoms following ocriplasmin therapy – further evidence from MIVI trials for ocriplasmin in vitreomacular traction Niro Narendran, Yit Yang, on behalf of the MIVI-TRUST Study Group International Multi-Site Studies Introduction: Ocriplasmin is approved by NICE in the UK for the treatment of patients with severe symptoms due to vitreomacular traction (VMT), without epiretinal membrane (ERM) or macular hole >400 μm. In the phase III MIVI studies (MIVI 6/7 NCT00781859 and NCT00798317), efficacy was demonstrated for VMT resolution at Day 28 (26.5% ocriplasmin vs 10.1% placebo; p<0.001). However, the overall percentage of patients experiencing vision alteration adverse events over the study period was higher in ocriplasmin-treated patients. Purpose: To further understand the evolution of visual events over time following intravitreal ocriplasmin. Method: Using MIVI 6/7 data, comparisons were made between the frequencies of visual events reported within the first 7 days post-injection and from Day 8 through to Month 6. Results: In the first 7 days, the respective frequencies of events in ocriplasmin and placebo groups were: ≥2line reduced acuity (7.7% vs 1.6%), visual impairment (3.2% vs 0%), floaters (12.9% vs 2.7%), blurred vision (6.5% vs 0.5%), and photopsia (10.1% vs 1.1%). By Month 6, the frequencies of these events were 138 ABSTRACTS: Vitreo-Retinal Disease & Surgery Annual Congress Final Programme & Abstracts Birmingham 2014 considerably lower in the ocriplasmin group: persistent reduced acuity following initial ≥2-line vision decrease (1.3% vs 1.1%), visual impairment (2.2% vs 1.1%), floaters (3.9% vs 4.8%), blurred vision (1.9% vs 2.7%), and photopsia (1.7% vs 1.6%). Conclusion: Initial visual disturbances following ocriplasmin injection tend to recover well over time. This observation was not reported in detail in previous publications and should be of use to clinicians in their implementation of this new therapy. 203. Visual function improvements with resolution of vitreomacular adhesion in patients receiving ocriplasmin Tim Jackson, On behalf of the MIVI-TRUST Study Group, International multi-center study Introduction: Ocriplasmin is indicated in the EU for treatment of vitreomacular traction including when associated with a macular hole ≤400 μm. Purpose: To determine whether resolution of vitreomacular adhesion (VMA) at Day 28 (primary endpoint) was associated with improved visual function. Method: Data from the MIVI-TRUST (Microplasmin for Intravitreous Injection – Traction Release without Surgical Treatment) pivotal phase III MIVI-6 and MIVI-007 studies were analysed. Results: VMA resolution at Day 28 occurred in 26.5% of ocriplasmin-treated participants compared with 10.1% placebo-injected participants (p<0.001). At Month 6, 44.7% and 20.3% of participants receiving ocriplasmin who achieved VMA resolution at Day 28 gained ≥2 and ≥3 lines in best-corrected visual acuity (BCVA), respectively, compared with 22.0% and 9.4% of participants who did not achieve VMA resolution at Day 28 (p=0.077). The mean change from baseline in visual function questionnaire (VFQ-25) composite score was +3.4 points in the ocriplasmin group and +0.7 points in the placebo group (p=0.007) at Month 6. For patients who achieved the primary endpoint, the mean change from baseline in the VFQ-25 composite score was +5.7 in the ocriplasmin group and –0.2 for the placebo group (p=0.029). For patients who did not achieve the primary endpoint, these values were +2.6 and +0.7 for the ocriplasmin and placebo groups, respectively (p=0.075). Conclusion: VMA resolution at Day 28 following ocriplasmin injection was associated with an improvement in BCVA and vision-related function. 204. Measuring Metamorphopsia in Macular Disease Gerry McGowan, Tsveta Ivanova, David Yorston , Niall Strang, Velitchko Manahailov Tennent Institute of Ophthalmology Introduction: Metamorphopsia affects many patients with Vitreoretinal conditions such as macular hole, epiretinal membrane, and macula off retinal detachment. Purpose: Currently, it is difficult to quantify metamorphopsia. We present a novel, simple, inexpensive method of measuring metamorphopsia Method: D-charts consist of 4 groups of 6 charts. 4 areas of the macula are tested: 0-1.5 degrees from fixation, 1.5-3. 3.5-7 and 7-12 degrees. Each chart is composed of an octagonal ring composed of squares arranged in straight lines. The separation of the squares in each chart ranges from 0.4 to 1.5 degrees. Patient indicates which of the 8 segments of the chart appear didtorted, and a metamorphopsia score is calculated from the total number of segments affected, and the maximum separation of the squares in degrees. The test alsoidentifies the area affected by metamorphopsia and results presented graphically. Results: 31 eyes FTMH and 27 eyes ERN tested. Median metamorphopsia score was 8.9 for FTMH and 4.9 for ERM, this was not significantly different (Mann-Whitney U-test, p=0.41). Pre and post op scores conducted in 14 patients. There was a significant reduction from median of 3.05 to 0.7 post-op (Mann-Whitney U-test, p=0.009). Conclusion: The test has been administered successfully to patients with visual acuiries ranging from 6/9 to 6/60, and proven feasible to use in busy NHS clinic. D-charts offer simple and prqctical means of measuring metamorphopsia. 139 ABSTRACTS: Vitreo-Retinal Disease & Surgery Annual Congress Final Programme & Abstracts Liverpool 2013 205. Anatomical and visual outcomes of posterior segment ocular trauma requiring vitreo-retinal surgery Koushik Basu, Yog Raj Sharma, Raj Vardhan Azad , Parijat Chandra, Koushik Tripathy Dr. Rajendra Prasad Centre For Ophthalmic Sciences, India Introduction: There remains a need to evaluate the outcomes of posterior segment trauma requiring state of the art vitreo-retinal surgerical intervention , as a single entity, as the currently available data on both anatomical and visual outcomes is scanty. Purpose: To analyze the anatomical and visual outcomes of patients with posterior segment trauma requiring vitreo-retinal surgical intervention at a tertiary care center. Method: Prospective nonrandomized study. 104 patients with posterior segment ocular trauma during a period of one year were studied with post-surgery day 1&7; 1, 3 & 6 month follow up. Results: Out of 104 eyes, 41 had open globe injury (OGI). Males are predominantly involved (87%).the most common cause for OGI was hammer and chisel (44%) and cricket ball (36.5%) for CGI. 61.9% of close globe injury (CGI) had retinal detachment and 85 % of them had single break and inferotemporal break being the most common break(33.33%). Main cause of redetachment was proliferative vitreoretinopathy. Anatomical success rate (complete retinal attachment) was 86% in retinal detachment cases after two surgery. Preoperative BCVA were 2.275769±.97 (m ± SD) and post-surgery BCVA were 1.167212±.895 (m ± SD) (p-value<0.0005). Functional success(>5/200) was possible in 70% cases. Poor outcomes are related with presence of RAPD, endophthalmitis, increased time between trauma and surgery, initial poor visual acuity. Conclusion: Vitreo-retinal surgery outcomes are excellent in posterior segment ocular trauma 206. Development of the surgical procedure for cell transplantation treatment for age-related macular degeneration (AMD) Christopher Jump University of Liverpool Introduction: AMD is characterised by deterioration of retinal pigment epithelial (RPE) cells and their underlying Bruch’s membrane. Current treatment options are limited and unsatisfactory. Subretinal implantation of a monolayer of RPE cells is a possible therapeutic option. For this treatment to be successful the cell monolayer must avoid damage and maintain its morphology during the surgical procedure. Purpose: This study investigated whether an intact monolayer of morphologically normal aRPE-19 cells can be implanted subretinally using vitrectomy techniques in ex vivo porcine eyes. Method: aRPE-19 cells were cultured on 20µ m thick polyurethane membranes until confluent. Membranes were either 6mm discs or 3mm x 5mm strips. Five of each were precut prior to cell culture and the same number cut after culture using a trephine. Ultrathin gelatin encapsulation was used on some membranes to protect cells. 3-port 23-gauge vitrectomy was performed on ex vivo porcine eyes and the membranes inserted subretinally. The effect of using a 16-gauge transcleral chute on cell morphology was also investigated. Cellular morphology and nuclei distribution were assessed using phalloidin and DAPI staining. Results: Use of strips rather than circular membranes and pre-cut membranes before cell culture resulted in less disturbance to cell morphology. Ultrathin gelatin encapsulation consistently protected cells during implantation. Use of the transcleral chute provided better maintenance of cellular morphology in all membrane types and showed less cell damage than without. Conclusion: This study has provided a better understanding towards development of an improved surgical technique for subretinal transplantation for translational in vivo studies. 207. Comparison of efficacy and safety outcomes between EU and US patients in MIVI6/7 studies on ocriplasmin for vitreomacular traction Zachariah Koshy, on behalf of MIVI TRUST study Group Multiple Introduction: The MIVI 6/7 trials studied ocriplasmin in vitreomacular traction (VMT) with and without full thickness macular holes (FTMH). The results revealed a distinct variation in efficacy and adverse event reporting between the US and EU populations Purpose: To describe the regional differences in efficacy and safety outcomes and identify factors for causation 140 ABSTRACTS: Vitreo-Retinal Disease & Surgery Annual Congress Final Programme & Abstracts Birmingham 2014 Method: Post hoc analysis (logistic regression model) of MIVI 6/7 trial data. These were two multicenter, randomized, double-blind, phase 3 clinical trials to compare a single intravitreal injection of ocriplasmin (125 µ g) with a placebo injection in patients with symptomatic vitreomacular adhesion Results: The proportion (EU/US in % of n) of patients with total PVD (6.7/16.1), gain in visual acuity > 2 lines (23.1/30) and non-surgical closures of the FTMHs (32/43.2) was lower in the EU region compared to the US region. There were differences between the two populations in positive predictors for VMT resolution namely, age<65, absence of epiretinal membrane (ERM) and FTMH<250microns. There was a higher reporting of adverse events in the US (81.6%) compared to the EU (64.2%) Conclusion: There are clear differences in outcomes between the US and EU study populations. When differences in the distribution of positive predictive baseline variables are accounted for, similar treatment effects are observed in the EU and US for all outcomes measures. 141 Annual Congress Final Programme & Abstracts Birmingham 2014 DVDs 1. Video of goniotomy, with tips for the assistant that allow better surgical access, and an optimal surgical arc. Gordon Lau, Ayad Shafiq Royal Victoria Infirmary, Newcastle Introduction: In a goniotomy procedure, the role of the assistant is crucial to the surgeon, since the eye needs to be effectively held and rotated to provide optimal access for safe and effective surgery. We set out to demonstrate the equipment that would optimise the assistant role. Purpose: This video demonstrates the equipment and technique required by the assistant as well as demonstrating the surgical technique. Method: This video was recorded via an operating microscope. Its duration is 6 minutes. Results: The operating surgeon operates from the baby s temproal side using a tilted microscope. The surgeon holds a Barkan lens in one hand and a 23 gauge needle attached to a syringe of viscoelastic in the other. The assistant uses locking forceps at the limbal conjunctiva to adduct the eye and rotate the eye for optimal cleavage arc of drainage angle. Conclusion: A change from a paediatric Clark speculum to a Baraquer wired speculum allowed for easier and smoother rotation, avoiding unintentional 'squeezing' of the globe during surgery.This video provides a helpful example of equipment that facilitates the assistants role in this surgery, where optimal surgical preparation is critical to success. 2. TREACHER COLLINS WINNER 2014 Trabeculecomy Bleb Dysaesthesia - Review of how to prevent & how to treat Dan Lindfield, Saurabh Goyal St Thomas', London Introduction: Trabeculectomy is the most common glaucoma procedure in the UK. Dysaesthesia is rare but whilst surgeons target low pressures and safety, patients desire tolerability and comfort. Purpose: This video presentation discusses the causes and methods of preventing and treating bleb dysaesthesia. Large, nasal, overhanging blebs uncovered by lids are more likely to cause bleb dysaesthesia. There is cyclotorsion of eye during supine position hence it is important to mark the eye to guide placement of flap during surgery. Method: The eye is marked at 12 O’clock using a hypodermic needle on the slit lamp prior to anaesthesia and surgery. A larger area of anti-metabolite application helps to ensure diffuse blebs. Edge to edge secure conjunctival to corneal closure helps to avoid overhanging blebs. Results: Using these techniques none of our over 200 patients in the last 3 years have needed a bleb revision for bleb dysesthesia. We discuss management of patients referred to us with bleb dysesthesia including surgical techniques like partial bleb excision, compression sutures, and autologous blood injection. Conclusion: Diffuse blebs that are completely covered by lids can be achieved by modern trabeculectomy techniques and improve patient experiences of glaucoma surgery. 3. 'When it just won't fit'! Transcameral pull-through suture to enable watertight anterior chamber tube entry Avi Kulkarni, Dan Lindfield Kings College Hospital, London Introduction: The need to avoid early post-operative hypotony has forced many changes to glaucoma drainage device technique. Non-valved tubes are frequently ligated or stented. Purpose: Despite preventative measures entry site leak can still occur causing early hypotony which can be difficult to manage. Method: Traditionally a 23-gauge (blue) needle was recommended for anterior chamber entry. A 23-gauge needle has a 0.64mm outer diameter which theoretically allows a perfect fit for both the Baerveldt (0.64mm external diameter) & Ahmed (0.635mm) tubes. However, in reality the conduit created by a 23-gauge needle often exceeds 0.64mm especially in myopic eyes. A 25-gauge (orange) needle has a 0.51mm external diameter allowing a tight and watertight fit for Baerveldt insertion. However, due to the tight fit insertion is often difficult. 142 Annual Congress Final Programme & Abstracts Birmingham 2014 DVDs Results: This video illustrates the use of a 10/0 double-armed Prolene suture on a straight needle to “pullthrough” the tube tip into the anterior chamber transcamerally. Conclusion: This technique is quick, easy and safe. It allows both Baerveldt and Ahmed tubes to be reliably and consistently passed through 25-gauge incisions. The result is a watertight fit and less risk of early postoperative hypotony and infection. 4. IOL haptic exchange through small incision Daniel Dragnev Hywel Dda Health Board Introduction: I present a case of phacoemulsification in which during the implantation of folded 3-piece silicone IOL (AMO) the trailing haptic broke. The case was managed through small incision by replacing the PMMA haptic with another taken from the same type of IOL. Purpose: The purpose of the video is to demonstrate an alternative to extraction of the whole 3-piece IOL in cases with broken haptic. Method: A phacoemulsification was performed on a dense nuclear cataract. A 3-piece silicone IOL was folded by the nurse and was implanted. The trailing haptic was caught between the arms of the implantation forceps and broke. The IOL was in the anterior chamber and the trailing haptic at the incision. The broken haptic was extracted from the optic of the IOL. A haptic from another IOL was extracted and it was inserted in the optic without taking the IOL out of the eye. The IOL was positioned in the bag. Results: Postoperatively the IOL was in the bag and was centrally positioned.The patient’s visual acuity with the operated eye was 6/9 unaided, improving to 6/6 with a pinhole. Conclusion: IOL haptic exchange is a useful alternative to explantation of the whole 3-piece IOL in cases with damaged haptic. 5. Iris clip Secondary IOL implantation technique - comparison of needle Vs Vacuum assisted enclavation Hidayat Ullah Bhutto, Siddhartha Goel Diana Princess of Wales Hospital Grimsby Introduction: Aphakia is a devastating condition in those patients who can’t tolerate contact lenses or have problems with strong glasses. Options for visual rehabilitation include sulcus fixed IOLs if there is a reasonable capsular remnant, and in the absence of capsular support, scleral fixed IOLs or A/C IOLs. Scleral IOLs are technically challenging to insert and cause problems including migration, inflammation, suture related problems at the sclera, stability issues etc. Standard angle supported ACIOLS have problems like damage to angle structures, glaucoma, uveitis, hyphaema etc (UGH syndrome). Iris clip IOLs are increasingly becoming popular because like ACIOLs they are relatively easy to insert and are fairly stable over time with minimum risk of angle damage and glaucoma. They do need reasonable iris integrity though. The main difficulty is the enclavation of the iris into the claws. Purpose: Demonstrate surgical technique that vacuum enclavation is a safe and effective alternative to needle enclavation in the application of iris clip lenses Method: We present 2 videos. In one we demo the technique of needle enclavation and in the other we demo a new vacuum enclavation technique which makes the process far easier and safer for surgeons considering the use of iris clip lenses Results: The 2 options for enclavation of iris fixated IOLs (needle and vacuum) are demonstrated Conclusion: Vacuum enclavation is a safe and effective alternative to needle enclavation in the application of iris clip lenses 6. Macular hole eruption during pars plana vitrectomy Paul Rainsbury, Emily Gosse, Jonathan Lochhead St Mary's Hospital, Isle of Wight Introduction: Macular hole surgery is a commonly performed procedure. The complication rate for this surgery has been found to be approximately 8%, with iatrogenic peripheral retinal tears making up the majority of 143 Annual Congress Final Programme & Abstracts Birmingham 2014 DVDs these cases. Purpose: In this video we present footage of a previously undescribed and potentially serious intraoperative complication during macular hole surgery. We propose a hypothesis as to why it happened, and suggest a simple solution to reduce the risk of it occurring again. Method: The patient shown was undergoing routine 25-gauge macular hole surgery when, following removal of ILM forceps from a non-valved port, a high pressure jet of fluid from the infusion cannula entered the macular hole causing it to erupt. Results: This resulted in an iatrogenic tear around the macular hole. A cautious internal limiting membrane peel was then performed, followed by routine C3F8 gas tamponade. Post-operatively the patient’s macular hole closed and his visual acuity on discharge was 6/24. Conclusion: We believe that the jet of fluid may have been generated by the rapid release of pressure from a partially blocked infusion line, following removal of the ILM forceps from a non-valved port. Surgeons performing macular hole surgery should be aware of the possibility of extreme pressure surges during vitrectomy when using non-valved ports, and consider using valved ports as an alternative. 7. Capsule supported phacoemulsification in a case of subluxed cataract Siddharth Goel, Hidayat Ullah Bhutto Diana Princess of Wales Hospital Grimsby Introduction: Zonular dehiscence can be problematic while doing phacoemulsification. If fairly small (<1/4) the bag can be stabilized by simply using an endocapsular tension ring before proceeding with standard but cautious surgery. In substantial dehiscence(>3/4) an ICCE will probably be required. In those patients between (¼-3/4) an enhanced bag stabilsation procedure during and after phaco is preferred. For less than ½ we recommend bag stabilsation using iris hooks during phaco/IA and then multiple ECTRs post IA. This avoids the need for complex Morschers segments needing scleral fixation. From ½ to ¾ Morschers segments are inevitable for a safer outcome. Purpose: Demonstrated surgical technique that capsular stabilization with iris hooks enables successful completion of phacoemulsification Method: We present a case demonstrating the use of iris hooks to keep the capsular bag in position during phaco/IA(in a patient with ¼-1/2 dehiscence) followed by multiple ECTRs to enable a successful outcome. Results: The surgical steps are demonstrated and discussed. Conclusion: Capsular stabilization with iris hooks enables successful completion of phacoemulsification in a case of a subluxed cataract with ¼-1/2 zonular weakness 8. Transconjunctival scleral flap oversew for hypotony following trabeculectomy with mitomycin C - a novel technique Pavi Agrawal, Dilani Siriwardena Moorfields Eye Hospital Introduction: Despite modern safer surgical trabeculectomy techniques, post-operative hypotony can still be problematic. When conservative measures have failed, formal bleb revision surgery via a fornix-based conjunctival flap remains the standard technique, but has the risk of stimulating scarring and causing bleb failure. Purpose: To present an alternative surgical technique for the management of hypotony following trabeculectomy. Method: A 38 year-old man with glaucoma underwent routine trabeculectomy surgery augmented with mitomycin. An initial marked wound healing response reduced aqueous drainage. He underwent early removal of a releasable suture but developed hypotony unresponsive to conservative management. Over a few weeks the visual acuity dropped from 6/6 to 6/60 due to hypotony maculopathy and his pressure was persistently low at 2 mmHg. A trans-conjunctival oversew revision was performed as the scleral flap parameters were identifiable in the overdraining bleb. Four 10-0 nylon sutures were applied through the conjunctiva into the scleral flap and the adjacent sclera. They were knotted tightly over the conjunctiva. He 144 Annual Congress Final Programme & Abstracts Birmingham 2014 DVDs was commenced on G.Dexamethasone and G.Chloramphenicol QDS post-operatively. Results: At day 1 and week 1 the intraocular pressure was 6 mmHg. The visual acuity improved to 6/18. At week 3 the intraocular pressure was 16 mmHg and he underwent argon suture lysis to increase outflow. The pressure has stabilized at 14 mmHg with 6/6 vision by 6 weeks. Conclusion: We describe an effective and minimally invasive technique to treat hypotony maculopathy following trabeulectomy. It is especially useful when the margins of the flap are identifiable preoperatively and avoids unnecessary opening of the conjunctiva. 9. A Novel Technique in Predicting Efficacy of Lateral Tarsal Strip Huw Oliphant, Ali Hassan, Paul Baddeley Worthing Hospital, West Sussex NHS Trust Introduction: Lateral tarsal strip (LTS) is a well established surgical procedure used in the treatment of epiphora secondary to horizontal lower eyelid laxity. Difficulty often arises in predicting the potential benefit of such eyelid tightening procedures. Purpose: Currently no slit lamp technique can be used to predict the potential benefits of an LTS. We have designed a simple and effective fluorescein aided slit lamp technique for determining the potential benefit of carrying out LTS, in patients with a patent nasolacrimal duct (NLD). Method: With the aid of video and still images we will demonstrate this quick and effective in clinic predictor of whether a lateral tarsal strip is likely to be effective. 2% fluorescein is instilled into the lower fornix, and the eyelid is held in an artificially elevated and horizontally tightened position. The tear film height is measured at 0 seconds, 30 seconds and 1 minute. Disappearance of the 2% fluorescein in the new lid position acts an indicator for the efficacy of Lateral Tarsal Strip. Results: Our slit lamp based videos demonstrate the disappearance of fluorescein dye in a lid position simulating that following LTS. It also helps to demonstrate the importance of ocular movement and blinking in the lacrimal drainage process. Conclusion: We feel this very simple, but new technique could be of significant value to ophthalmologists in the treatment of epiphora, particularly where the underlying cause is not fully understood. 10. Needling revision of severely scarred blebs: Description of the technique Rory Nicholson, Charalambos Tossounis, Hannaa Bobat , James Kirwan Queen Alexandra Hospital, Ophthalmology Department, Introduction: The needling of severely scarred blebs can be a challenging and difficult surgical glaucoma procedure. Purpose: We demonstrate a bleb needling technique that can be very effective on severely scarred blebs that always pose a surgical challenge Method: Topical anaesthesia is achieved with Tetracaine Hydrochloride 1% eye drops. A sub-conjunctival injection of an antimetabolite, mixed with Vision Blue (DORC) for better visualisation of the broad area of distribution, is performed a few millimetres superiorly to the edge of the bleb. 3-minutes later the solution is diluted with lidocaine 2%. By using a Glaucoma Revision Pick, angled at 60° (Lederer, 27G, BD Vistec™) attached to a 2 ml syringe filled with HEALON® OVD (AMO), a careful dissection and opening of the planes is done. Initially, a subconjunctival injection of healon between the bleb and the entry point of the pick is performed. With a clear plane of action now, we use an angled 23G MVR blade through the same path. The blade is very sharp and carefully dissects the scarred tissue slowly advancing to the anterior chamber. After an effective bleb is constructed the anterior chamber is reformed and a sub-conjunctival injection of an antibiotic and steroid is done. Results: Good intraocular pressure after the procedure with a reformed bleb. Conclusion: The utilisation of sub-conjunctival injection of healon improves visualisation of tissues and enhances safety during the needling procedure. The angled MVR blade is sharp and provides easy access to severely scared blebs. However, it needs to be used with considerable caution. 145 Annual Congress Final Programme & Abstracts Birmingham 2014 DVDs 11. A ‘No-speculum’ Technique for Intravitreal Injections Shwan Kadare, Huw Oliphant, Tony Leong Worthing Hospital, West Sussex NHS Trust Introduction: Intravitreal injections remain one of the most commonly performed procedures in most ophthalmology departments. It is felt that the use of the lid speculum reduces contact with lashes and the eyelid itself, and therefore reduces the risk of endophthalmitis. It is also felt, however, that the lid speculum can be a source of discomfort. Previously bimanual no speculum techniques have been described to achieve adequate exposure, but these require two operators. Purpose: The purpose of this DVD is to demonstrate a safe, no speculum technique which can be performed by a single operator. This reduces the time taken to perform intravitreal injections, and reduces discomfort felt by patients. Method: The eye to be injected is cleaned with povidone iodine. The middle or ring finger of the injecting hand is used to keep the upper eye lid retracted and steady. The non dominant hand holding the marker is used to measure the appropriate distance from the limbus for the injection site, and also to depress the plunger on the syringe. Results: We find this to be a rapid and safe technique for delivering intravitreal injections. Using a combination of still and motion pictures we will demonstrate this no speculum injection technique. Conclusion: While the lid speculum used in intravitreal injections is thought to be useful in preventing infection, we find it to be a significant contributor towards discomfort for patients. Using this technique a single operator can perform an intravitreal injection without speculum. 12. Removing a dropped IOL and implanting an ARTISAN aphakic lens: The float and suck technique Charalambos Tossounis, Rory Nicholson, Richard Newsom Queen Alexandra Hospital, Ophthalmology Department Introduction: Safely removing a dropped intraocular lens (IOL) can be a challenging procedure. The ARTISAN aphakic IOL (OPHTEC) implantation can be tricky and performed with different techniques. Purpose: We demonstrate a technique where the dropped IOL is removed with no instrument contact and minimal risk of injury. A less traumatic way of iris fixation of the ARTISAN lens is also demonstrated. Method: A 23G pars-plana vitrectomy is performed. The dropped IOL is a single-piece acrylic lens, located at the posterior pole. By injecting the heavy liquid, perfluorocarbon (Bausch&Lomb), the IOL is pushed to the side of the vitreous cavity and flipped onto the already formed sheet of heavy liquid. Then it is floated up to the pupillary level. A self-sealing, 6mm corneal incision is constructed superiorly and two paracentesis at the positions of 3 and 9 o’clock. The IOL is removed through the pupil with the capsular forceps. Healon GV is used and the ARTISAN lens is implanted and dialed at the appropriate position. A straight 23G aspiration cannula is connected to the aspiration tube of the phacoemulsification machine. The lens is held centrally and a vacuum is created to clip a precise and replicable amount of iris tissue between the haptics. A peripheral iridectomy is performed and the corneal incision is closed with interrupted sutures. Results: The dropped IOL was effectively and safely removed. The ARTISAN lens was implanted with minimal iris manipulation. Conclusion: The use of heavy liquid to flip and float up a dropped IOL is a safe and effective technique. The vacuum enclavation system described with the ARTISAN lens is easy to perform with minimal iris injury and inflammation. 13. Ultrathin (UT) DSAEK: a novel Non-double-pass technique Paul Chua, Vikas Shankar, Aravind Reddy Aberdeen Royal Infirmary Introduction: Ultrathin(UT) DSAEK achieves visual outcomes comparable to those of Descemet’s Membrane Endothelial Keratoplasty (DMEK). Complexities of graft preparation and high detachment rates with DMEK make UT-DSAEK a very promising technique. Double-pass technique described by Busin involves the use of micro-keratome heads of various cut-depths and intra-operative micro-pachymetry 146 Annual Congress Final Programme & Abstracts Birmingham 2014 DVDs Purpose: To describe a novel non-double-pass surgical technique to prepare an UT graft and to demonstrate the technique of UT DSAEK Method: The video describes the surgical technique in a step-wise manner including a list of the surgical instruments and equipment needed Results: This surgical technique has been used to prepare UT grafts over an 18-month period at Aberdeen Royal Infirmary by a single surgeon (ARR). The mean graft thickness was 93.3 microns. The visual outcomes, graft detachment rate and graft failure rates are comparable to UT grafts prepared with a double-pass technique Conclusion: This technique has the advantage to provide uniformly thin corneal grafts of thickness <100microns that are easy to handle surgically. The surgical procedure is simple and cost-effective and does not involve a steep learning curve 14. Subjugation of Black Nucleus by Intramural Phacoemulsification - a simplified technique Mrinal Rana, Ranjeet Kishore Rana, Kunal Rana , Nidhi Mittal Birmingham and Midland Eye Centre Introduction: Black nuclei (Cataracta Nigra) differ in their enormous size, stony hard consistency, cohesive leathery cortex, lax posterior capsule and zonular system. The phacoemulsification of black nucleus evokes phobia because of high incidence of intraoperative complications and poor visual outcome. Purpose: To evaluate the efficacy, safety and efficiency of a new simplified phacoemulsification technique called Intramural phacoemulsification in successful fragmentation of black nucleus. Method: 59 eyes of 59 patients who underwent phacoemulsification for cataracta nigra over a period of 2years were retrospectively analyzed. Phacoemulsification was done with a modified 3 step technique- nuclearcavitation, intramural-chopping and intramural-fragmentation. Outcome was measured by successful surgery, postoperative visual acuity and corneal status. Results: Success rate was seen in 58 eyes (98.4%) with only 1 case (1.6%) showing a partial zonular dehiscence. No case of tissue notching and fish mouthing of main incision seen. Stromal oedema was seen in 16 eyes (27%) in varying degrees, which resolved in 14/16 (87.5%) after 4 months and persisted causing corneal decompensation in 2(12.5%). After 6 months the BCVA was 6/9 or better in 53 eyes (89.8%), 6/126/36 in 4 (6.8%) and 6/60 or worse in 2 (3.4%). Patients’ satisfaction was achieved in 57 patients (96.6%) due to extremely poor pre-operative vision. Conclusion: A successful phacoemulsification can be performed in black cataracts by ophthalmic surgeons with reasonable skills. Phobia associated with phacoemulsification in such cases can be converted into sensible fear by following a modified phacoemulsification technique to get a good outcome. 15. Descemet's stripping endothelial keratoplasty using needle-push on Fichman Glide Robert Nadler, Rebecca Davie, Henry Perry , Tom Butler, Allon Barsam Luton & Dunstable University Hospital Introduction: There are various methods of inserting donor graft material during endothelial keratoplasty this video shows a safe new technique in practice Purpose: To describe a new technique for donor graft posterior lenticule insertion in Descemet’s stripping endothelial keratoplasty Method: Novel surgical technique for graft insertion using needle push resulting in minimal trauma to the endothelial cells Results: This video shows a safe new technique in practice Conclusion: This video highlights an alternative method of introducing donor graft material into a patient during endothelial keratoplasty. The advantages of which include no manipulation of the donor tissue is required; it is very cost-effective when compared with many existing glide techniques. Also no infusion cannula or sideport are needed as the infusion can be delivered via an introducing syringe with a 30 gauge needle. 147 The Royal College of Ophthalmologists Seminar Calendar 2014 THURSDAY 19TH & FRIDAY 20TH JUNE 2014 SKILLS IN RETINAL IMAGING, DIAGNOSIS & THERAPY Venue: Royal College of GPs, London Chair: Professor Heinrich Heimann & Professor Yit Yang FRIDAY 27TH JUNE 2014 GLOBAL OPHTHALMOLOGY Venue: Royal College of Physicians, London Chair: Mr. William Dean & Mr Saul Rajak TUESDAY 16TH SEPTEMBER 2014 GLAUCOMA SURGERY – BALANCING SAFETY & SUCCESS Venue: Royal College of Physicians, London Chair: Mr. Nick Strouthidis WEDNESDAY 24TH SEPTEMBER 2014 FRONTLINE NEURO-OPHTHALMOLOGY Venue: University Hospital Birmingham Chairs: Mr. Mike Burdon & Miss Susan Mollan TUESDAY 7TH OCTOBER 2014 NIHR MASTER CLASS FOR INDUSTRY SUPPORTED RESEARCH Venue: RCOphth, London Chair: Mr. Faruque Ghanchi WEDNESDAY 15TH OCTOBER 2014 PAEDIATRIC RETINA Venue: Royal College of Obs & Gynae, London Chair: Mr. CK Patel TUESDAY 18TH NOVEMBER 2014 HOW TO BE A RESEARCH ACTIVE OPHTHALMOLOGIST Venue: RCOphth, London Chair: Professor Andrew Lotery FRIDAY 21ST NOVEMBER 2014 EYELID SURGERY FOR THE TEAR FILM Venue: RCOphth, London Chair: Mrs Carol Lane FRIDAY 5TH DECEMBER 2014 ELIZABETH THOMAS SEMINAR Venue: East Midland Conference Centre, Nottingham Chair: Mr. Winfried Amoaku Visit the website for programmes, information and registration www.rcophth.ac.uk/seminars or contact us at [email protected] or telephone 020 7935 0702 Take action against VMT with JETREA® r Vitreomacular traction (VMT), including macular hole (MH), can be progressive and may put patients at risk of central vision loss1–4 r To date, there have been only two options to treat VMT and MH – Watch and wait – Vitrectomy r JETREA® (ocriplasmin) Intravitreal (IVT) Injection is the first and only pharmacological treatment of its kind5,6 JETREA®(ocriplasmin) is now approved by NICE as an option for treating VMT in adults, only if: r an epiretinal membrane is not present and r they have a stage II full-thickness MH with a diameter of 400 micrometres or less AND/OR r they have severe symptoms r This once only injection has been shown to provide resolution of VMT in adults, including when associated with MH of diameter ≤400 microns5,6 and JETREA® 0.5mg/0.2ml concentrate for solution for injection (ocriplasmin) Prescribing Information (Refer to full Summary of Product Characteristics (SmPC) before prescribing) Presentation: Type I glass vial containing 0.2ml concentrate for solution for injection. After dilution with 0.2ml sodium chloride 0.9% solution for injection, 0.1ml of the diluted solution contains 0.125mg ocriplasmin. Indication(s): Treatment of vitreomacular traction (VMT) in adults, including when associated with macular hole of diameter less than or equal to 400 microns. Posology and method of administration: Adults including the elderly: Intravitreal injection of 0.125mg (0.1ml of the diluted solution) to the affected eye once only as a single dose. Children and adolescents: Not recommended. Hepatic and renal impairment: No dosage adjustment necessary. Contra-indications: Hypersensitivity to ocriplasmin or any of the excipients. Active or suspected ocular or periocular infections. Warnings and precautions: Proper aseptic injection techniques must always be used and patients should be monitored for any side effects such as intraocular inflammation/infection and elevation in IOP. Patients should be instructed to report symptoms of intraocular inflammation/infection or any other visual/ocular symptoms without delay. Concurrent administration to both eyes or repeated administration in the same eye is not recommended. Clinical data is not available on concomitant use with VEGFinhibitors. Treatment is not recommended in patients with a large diameter macular hole, high myopia, aphakia, history of rhegmatogenous retinal detachment, lens zonule instability, recent ocular surgery or intraocular injection (including laser therapy), proliferative diabetic retinopathy, ischaemic retinopathies, retinal vein occlusions, exudative age-related macular degeneration (AMD) and vitreous haemorrhage. There is potential for lens subluxation or phacodonesis. Exercise caution if treating patients with non-proliferative diabetic retinopathy, history of uveitis or significant eye trauma. Ocriplasmin efficacy is reduced in patients with an epiretinal membrane or a diameter of VMA > 1500 microns. Due to potential increase in tractional forces, there is a risk of occurrence of new or enlarged macular holes. There is a risk of significant but transient loss of visual acuity during the first week after the injection. Interactions: Formal studies have not been performed. Systemic interactions are not anticipated. Administration in close temporal association, in the same eye as other medicinal products may affect the activity of both products and is not recommended. Pregnancy and lactation: Do not use unless clearly necessary. Fertility: No fertility data are available. Effects on ability to drive and use machines: If visual disturbances occur, wait until vision clears before driving or operating machinery. Undesirable effects: Very common: vitreous floaters, eye pain, conjunctival haemorrhage. Common: reduced visual acuity, visual impairment, blurred vision, increased intraocular pressure, metamorphopsia, conjunctival oedema, eyelid oedema, photopsia, conjunctival hyperaemia, ocular hyperaemia, retinogram abnormal, eye irritation, dry eye, foreign body sensation in eyes, eye pruritus, ocular discomfort, photophobia, chromatopsia. Serious: retinal haemorrhage, vitreous haemorrhage, retinal tear, retinal detachment, macular hole, macular degeneration, retinal degeneration, macular oedema, retinal oedema, retinal pigment epitheliopathy, vitreous adhesions, vitritis, anterior chamber cell, anterior chamber flare, iritis, vitreous detachment, transient blindness, lens subluxation, scotoma, visual field defect, hyphaema, pupils unequal, corneal abrasion, anterior chamber inflammation. In addition: diplopia, miosis, eye inflammation, conjunctival irritation. Prescribers should consult the SmPC in relation to the side effects. Overdose: Clinical data are limited. If an overdose occurs, close monitoring is recommended. Incompatibilities: Must not be mixed with other medicinal products except for the specified diluent. Special Precautions for Storage: Store frozen at –20°C ±5°C. Legal Category: POM. Package Quantities and Basic NHS Costs: 1 x 0.2ml vial £2,500. Ireland Price: €3,099. MA Number(s): EU/1/13/819/001. Further information available from the MA holder: ThromboGenics NV, Gaston Geenslaan 1, B-3001 Leuven, Belgium. Distributor: Alcon Laboratories (UK) Limited, Frimley Business Park, Frimley, Camberley, Surrey, GU16 7SR. Date of preparation: June 2013 (V2). References: 1. Jaffe NS. Vitreous traction at the posterior pole of the fundus due to alterations in the vitreous posterior. Trans Am Acad Ophthalmol Otolaryngol. 1967; 71(4):642–652. 2. Reese AB et al. Macular changes secondary to vitreous traction. Tr Am Ophth Soc. 1966; 64:123–134. 3. Akiba J et al. Risk of developing a macular hole. Arch Ophthalmol. 1990; 108:1088–1090. 4. Sebag J, Wang MY. Combined spectral-domain optical coherence tomography/scanning laser ophthalmoscopy imaging of vitreous and the vitreo-retinal interface. In: Holz FG, Spaide RF, eds. Medical Retina: Focus on Retinal Imaging. Berlin, Germany: Springer-Verlag; 2010; 157–168. 5. JETREA® Summary of Product Characteristics. ThromboGenics NV. Belgium; January 2013. 6. Stalmans P et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012; 367:606– 615. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Alcon Medical Information. Tel: 0871 376 1402. Email: [email protected] (ocriplasmin) Concentrate for solution for injection, 0.5mg/0.2ml ©2014 Novartis JETREA is a registered trademark of ThromboGenics N.V, licensed to Alcon. Date of publication: January 2014 JET/OCR: HCP 002:03/14:AL
