Efficacy and safety data for the XEN45 implant at 2 years: a retrospective analysis.

AIM: To report efficacy and safety measures for XEN45 in a National Health Service setting after 24-month follow-up. METHODS: This is a retrospective, non-comparative audit of records of patients who underwent XEN45 procedure between June 2015 and May 2017. The main outcome measures were intraocular pressure (IOP) reduction and number of antihypertensive medications at each timepoint. Failure was defined as requiring further surgery or removal of XEN. Success was defined as 20% reduction of IOP without additional glaucoma medications or reduction in antihypertensive medications without increase in baseline IOP. Needling rates were assessed and subgroup analysis was performed. RESULTS: A total of 151 eyes were included in the study. The main diagnoses were primary open angle glaucoma (84.1%), angle closure glaucoma (8.6%) and refractory glaucoma (7.3%). Stand-alone procedure was performed in 62.3% and combined phaco-XEN was done in 37.7%. The mean IOP at baseline was 22.1±6.5 mm Hg, and the mean IOP at 12 and 24 months was 15.4±5.9 mm Hg and 14.5±3.3 mm Hg, respectively (p<0.001). The mean number of medications was 2.77±1.1 at baseline, and 0.3±0.7 and 0.5±1.0 medications at 12 and 24 months, respectively (p<0.001). 25% of patients failed at the 24-month timepoint. Needling was required in 37.7% of patients at 24 months. Non-Caucasian ethnicity was found to be related to higher failure rate. No significant adverse events were noted. CONCLUSION: XEN45 is a viable, effective and safe procedure after 2 years of follow-up. Patients should be advised regarding failure rate as well as possible need for bleb revisions and medication use.

Ophthalmology specialist trainee survey in the United Kingdom.

BACKGROUND: Currently there are a total of 780 post-graduate ophthalmology trainees in the United Kingdom (UK). Post-graduate ophthalmology training in the UK is 7 years in duration, and follows a comprehensive competency-based curriculum. Changes to training have been proposed as part of the government's Shape of Training paper. METHODS: UK ophthalmic trainees and trainers, in partnership with the Royal College of Ophthalmologists, designed a national questionnaire to explore the confidence of trainees in different clinical and non-clinical aspects of ophthalmology. The questions and possible responses underwent a process of refinement through the Royal College of Ophthalmologists Training Committee and Trainee Group. An online survey platform was used for the questionnaire, which was sent to all ophthalmology trainees within the UK. Reminders were sent via the Royal College of Ophthalmologists and Regional Training Programme Directors. A 4-week period was allowed for responses. Quantitative data were analysed, and qualitative data analysis included collation and thematisation of free-text responses. RESULTS: A total of 188 trainees (24.1% response rate) replied. Ninety-four percent of trainees were in full-time training posts. The most popular career choice was oculoplastics (31.4%), followed by vitreo-retina (25.1%), glaucoma (24.6%) and cornea (24.0%). One-quarter had opted out of the European working time directive (EWTD), and 54.8% agreed that their work contract reflected the number of hours actually worked. In total, 34.4% of trainees thought that ophthalmic specialist training should be shortened from the current 7-year programme. Overall, 79.9% of respondents felt confident in performing phacoemulsification cataract surgery independently. For more senior trainees in years 4-7, 100% felt confident in phacoemulsification. However, overall, only 47.9% were confident in independently performing an anterior vitrectomy (91.1% of final-year trainees). Overall, 77.6% thought that all surgical ophthalmologists should be trained to perform cataract surgery. For non-clinical skills, trainees felt least confident in 'preparing a business case', with 64.5% disagreeing that they felt confident in this task. The most confidence was felt for communication with patients: 100% of trainees (all of whom have completed at least 2 years of medical work following qualification) reported feeling confident. CONCLUSIONS: Most doctors in post-graduate specialist training in ophthalmology in the UK aim to specialise in surgical sub-specialities. The subjective reports collected in this survey suggest targets for strengthening of the UK's highly rated training system. Further research is necessary to determine overall satisfaction with training, the effect of changing training within the recent Shape of Training review; and how recent newly imposed junior doctor contracts as well as Brexit affects training.

Quality indicators in a community optometrist led cataract shared care scheme.

PURPOSE: Cataract shared care schemes involving community optometrists show wide variation in practice. We report on defined key performance indicators (KPIs) which improve accountability between stakeholders. METHODS: In this prospective study over nine months at a UK public hospital, we evaluated the outcomes of consecutive direct cataract referrals from community optometrists against two KPIs agreed under a service-level agreement between the Hospital Eye Service and community optometrists: (1) 85% of patients listed for cataract listing at first consultation; and (2) 90% postoperative feedback return rate on patients discharged to community optometrists. A detailed analysis on referral triage, surgical listing and postoperative form return rate is reported in this study. RESULTS: A total of 733 direct cataract referrals were received using a designated referral form of which 86% were listed for cataract surgery. The predominant reason for not listing was a failure to reach the visual threshold set by the local clinical commissioning guidelines. Out of 569 cataract surgical episodes, 402 (71%) patients were discharged on the same day of surgery to community optometrist follow up. Completed postoperative feedback was returned from 374 patients (93%). CONCLUSION: Direct cataract referrals from accredited community optometrists led to a majority of patients receiving a definitive clinical decision during first consultation. Postoperative community follow up reduced hospital visits and allowed for convenient consultation closer to home following uncomplicated cataract surgery. A service-level agreement with an accreditation scheme measured against KPIs enhances the accountability of stakeholders involved in the cataract shared care scheme.