Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process.

Background: Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability.

Improving productivity, costs and environmental impact in International Eye Health Services: using the 'Eyefficiency' cataract surgical services auditing tool to assess the value of cataract surgical services.

Objective: Though one of the most common surgeries, there is limited information on variability of practices in cataract surgeries. 'Eyefficiency' is a cataract surgical services auditing tool to help global units improve their surgical productivity and reduce their costs, waste generation and carbon footprint. The aim of the present research is to identify variability and efficiency opportunities in cataract surgical practices globally.

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection.

Background: Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK.

Post-cataract eye drops can be avoided by depot steroid injections.

There are over 400 000 cataract operations now being performed annually in the UK. With the majority of those patients being older people, comorbidities such as dementia or arthritis can prevent patients putting in their own post-operative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for 4 weeks, thus potentially totalling 112 visits for drop instillation per patient.

A survey of UK practice patterns in the delivery of intravitreal injections.

Purpose: To assess UK practice patterns related to the prescription of antibiotics before, during and after intravitreal injections, the location where injections are carried out and the qualifications of those administering the injections.

Methods: Every ophthalmology unit featured in the Royal College of Ophthalmologists (UK) training directory was contacted. A healthcare professional involved in giving intravitreal injections at each institution completed a questionnaire regarding local practice patterns.

Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa.

Purpose: To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city.

Methodology: A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling.

Addressing inequalities in eye health with subsidies and increased fees for General Ophthalmic Services in socio-economically deprived communities: a sensitivity analysis.

Objectives: Poor knowledge of eye health, concerns about the cost of spectacles, mistrust of optometrists and limited geographical access in socio-economically deprived areas are barriers to accessing regular eye examinations and result in low uptake and subsequent late presentation to ophthalmology clinics. Personal Medical Services (PMS) were introduced in the late 1990 s to provide locally negotiated solutions to problems associated with inequalities in access to primary care. An equivalent approach to delivery of optometric services could address inequalities in the uptake of eye examinations.

Better value eye care for the 21st century: the population approach.

Health services globally and in the UK face challenges from increasing need and rising expectations to inequalities and financial constraints. The UK government has recently published a Public Health Framework for the first time. This has included preventable sight loss as an outcome measure for the nation's public health reflecting increasing recognition of eye health issues in the broader public health agenda.

Diabetic retinopathy equity profile in a multi-ethnic, deprived population in Northern England.

Purpose: Equity profiles are an established public health tool used to systematically identify and address inequity within health and health services. Our aim was to conduct an equity profile to identify inequity in eye health across Leeds and Bradford. This paper presents results of findings for diabetic retinopathy in Bradford and Airedale.

Nurse specialist treatment of eye emergencies: five year follow up study of quality and effectiveness.

The role of specialist nurses in triage, diagnosis and management of emergency eye conditions is well established, and encouraging reports of the safety and effectiveness of such services have been published. Specialist nurses in an emergency eye clinic in the UK seeing >7000 patients per year had been found at initial evaluation to treat 22% of the 1976 patients seen over a three month period without referring on to an ophthalmologist. A repeat of this evaluation five years later found this proportion had dropped to 17% (chi(2) = 16.

Determinants of cataract surgical opportunities and complication rates in UK higher specialist training.

Purpose: The volume of cataract surgery performed by trainee ophthalmologists in the UK, and the complication rates experienced by those trainees is unknown. As a result, no appropriate audit benchmark exists for trainees or their trainers. This study describes the surgical opportunities and rates of posterior capsule rupture (PCR) experienced by higher specialist trainees in one UK training region and explores influencing factors.

Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients.

Purpose: To investigate the influence of ethnic origin on the incidence of keratoconus and the association of atopic diseases in patients with keratoconus.

Methods: Retrospective study of new patients referred to Dewsbury District General Hospital and diagnosed with keratoconus in a 6-year period between 1994 and 2000. The ethnic origin of the patient was defined as white, Asian, or other.

An indeterminate malignant soft-tissue tumour treated by exenteration.

PURPOSE. To present a case of malignant soft-tissue tumour, which has yet to be categorised despite review by an international panel of experts, and which was treated by exenteration. PATIENT & METHODS.

Optic nerve breast metastasis mimicking meningioma.

Purpose: We report on an optic nerve breast metastasis masquerading initially as a central retinal vein occlusion and later as an optic nerve meningioma.

Methods: A 60-year-old female presented with a left central retinal vein occlusion (CRVO). She represented 7 months later with left upper ptosis, proptosis and painful rubeotic glaucoma Computed tomography (CT) and magnetic resonance imaging suggested an optic nerve meningioma.