Acute corneal hydrops mimicking full thickness perforation.

A 26-year-old Caucasian female with keratoconus presented with an acutely painful and red left eye. Visual acuity on presentation was 3/60. Slit lamp examination revealed localised Descemet's membrane break with iris partially plugging it. There was a bulging stromal cyst which would intermittently flatten and reform. The appearance when the cyst was flattened mimicked a full thickness corneal perforation. However, no obvious overlying epithelial defect was detected and an intermittent leakage through micro-perforations in the corneal epithelium was the probable cause of the variable appearance. The anterior chamber reformed and iris plug freed following an insertion of a bandage contact lens and taped eyelid. On follow-up, the Descement's membrane had healed with visual acuity improving to 6/18. Our case illustrates the importance of identifying corneal hydrops mimicking a full thickness perforation as conservative management has a greater chance of recovery.

The patient's role in the decision-making process--a perspective from the Liverpool Ocular Oncology Centre.

PURPOSE: To examine the patient's role in the decision-making process in a tertiary adult ocular oncology service. METHODS: A prospective study was carried out of patients attending for follow-up at the Liverpool ocular oncology centre (LOOC), a tertiary adult ocular oncology service. Participants were patients who attended the clinic between September and October 2003. Through supervised completion of questionnaires, the main factors observed were: patients' preferred level of participation, patients' perceived level of participation, sources of information used by patients, and which sources they found most useful. RESULTS: In all, 39 patients were included in the study. The majority of patients (69.2%) would have preferred to make a shared decision with the doctor (10.3% preferring an active role, 20.5% preferring a passive role), while 48.7% perceived having had a shared role (25.6% felt they had had an active role, 25.6% a passive one). Outside the LOOC, general ophthalmologists were the most frequently cited source of information from health professionals, and were also scored as the most useful. Family and friends were the most common source of informal information, followed by use of the Internet. Tape recordings of the consultations were reported as the most popular resource provided by the LOOC. CONCLUSIONS: Patients attending the LOOC have a strong desire for involvement in the decision-making process. Patients receive little formal or informal information outside this tertiary centre. Further work is required to assess the effectiveness of physicians' communication skills and the influence of their recommendations on patient choice.

Comparison of optometry vs digital photography screening for diabetic retinopathy in a single district.

PURPOSE: To compare (a). the clinical effectiveness and (b). cost effectiveness of the two models in screening for diabetic retinopathy. METHODS: (a). Retrospective analysis of referral diagnoses of each screening model in their first respective years of operation and an audit of screen positive patients and a sample of screen negatives referred to the hospital eye service from both screening programmes. (b). Cost effectiveness study. PARTICIPANTS: (1). A total of 1643 patients screened in the community and in digital photography clinics; (2). 109 consecutive patients referred to the Diabetic Eye Clinic through the two existing models of diabetic retinopathy screening; (3). 55 screen negative patients from the optometry model; (4). 68 screen negative patients audited from the digital photography model. RESULTS: The compliance rate was 45% for optometry (O) vs 50% for the digital imaging system (I). Background retinopathy was recorded at screening in 22% (O) vs 17% (I) (P=0.03) and maculopathy in 3.8% (O) vs 1.7% (I) (P=0.02). Hospital referral rates were 3.8% (O) vs 4.2% (I) Sensitivity (75% for optometry, 80% for digital photography) and specificity (98% for optometry and digital photography) were similar in both models. The cost of screening each patient was pound 23.99 (O) vs pound 29.29 (I). The cost effectiveness was pound 832 (O) vs pound 853(I) in the first year. CONCLUSION: The imaging system was not always able to detect early retinopathy and maculopathy; it was equally specific in identifying sight-threatening disease. Cost effectiveness was poor in both models, in their first operational year largely as a result of poor compliance rates in the newly introduced screening programme. Cost effectiveness of the imaging model should further improve with falling costs of imaging systems. Until then, it is essential to continue any existing well-coordinated optometry model.