Background The WHO's Vision 2020 global initiative against blindness, launched in 2000, prioritises children. Progress has been hampered by the global paucity of epidemiological data about childhood visual disability. The British Childhood Visual Impairment and Blindness Study 2 (BCVIS2) was undertaken to address this evidence gap. Methods UK-wide prospective population-based observational study of all those aged under 18 years newly diagnosed with visual impairment or blindness between Oct 1, 2015 and Nov 1 2016. Eligible children were notified simultaneously but independently by their managing ophthalmologists and paediatricians via the two national active surveillance schemes, the British Ophthalmic and Paediatric Surveillance Units. Standardised detailed data were collected at diagnosis and one year later. Incidence estimates and relative rates by key sociodemographic factors were calculated. Descriptive analyses were undertaken of underlying ophthalmic disorders and nonophthalmic comorbidities. FindingsOf 784 cases, 72% had additional non-ophthalmic impairments/disorders and 4% died within the year. Annual incidence was highest in the first year of life, 5•2 per 10,000 (95% CI 4•7-5•7) with cumulative incidence by 18 years of 10•0 per 10,000 (95% CI 9•4 to 10•8). Rates were higher for those from any ethnic minority group, the lowest quintile of socio-economic status, born preterm or with low birthweight. Only 44% had a single ophthalmic condition: disorders of the brain/visual pathways affected 48% overall. Prenatal or perinatal aetiological factors accounted for 84% of all conditions. InterpretationBCVIS2 provides a contemporary snapshot of the heterogeneity, multi-morbidity and vulnerability associated with childhood visual disability in a high income country, and the arising complex needs. These findings will facilitate developing and delivering healthcare and planning interventional research. They highlight the importance of including childhood visual disability as a sentinel event and metric in global child health initiatives.

Phacoemulsification, particularly first-eye surgery, has a strong positive effect on cognition and daytime alertness, regardless of IOL type.

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PurposeTo determine the ability of Saccadic Vector Optokinetic Perimetry (SVOP) to detect and characterise visual field defects in children with brain tumours using eye-tracking technology, as current techniques for assessment of visual fields in young children can be subjective and lack useful detail.MethodsCase-series study of children receiving treatment and follow-up for brain tumours at the Royal Hospital for Sick Children in Edinburgh from April 2008 to August 2013. Patients underwent SVOP testing and the results were compared with clinically expected visual field patterns determined by a consensus panel after review of clinical findings, neuro-imaging, and where possible other forms of visual field assessment.ResultsSixteen patients participated in this study (mean age of 7.2 years; range 2.9-15 years; 7 male, 9 female). Twelve children (75%) successfully performed SVOP testing. SVOP had a sensitivity of 100% and a specificity of 50% (positive predictive value of 80% and negative predictive value of 100%). In the true positive and true negative SVOP results, the characteristics of the SVOP plots showed agreement with the expected visual field. Six patients were able to perform both SVOP and Goldmann perimetry, these demonstrated similar visual fields in every case.ConclusionSVOP is a highly sensitive test that may prove to be extremely useful for assessing the visual field in young children with brain tumours, as it is able to characterise the central 30 degrees of visual field in greater detail than previously possible with older techniques.

The results suggest that improved blue-light transmission following cataract surgery has a beneficial effect on cognitive function. We advocate the RTT as an objective platform for exploring these benefits in large sample randomised controlled trials.

Childhood visual impairment confers significant potential adversity on the individual, their family, and on wider society. 1,2 To address this at societal and individual levels, primary (preventing blinding disease from occurring), secondary (treatment of established disease to reduce negative impact), and tertiary prevention approaches are required. [3][4][5] Tertiary prevention approaches comprise interventions that mitigate the impact of established visual disability or associated disorders on the life of the child and the adult they become. These interventions may be simple, such as the provision of low vision aids, or more complex, such as the provision of parenting support, or the development of individualized 'packages' of multidisciplinary care for the additional physical, educational, psychological, and social developmental needs of the affected child. 6 In recognition of the high burden of the numerous developmental and non-ophthalmic disorders that coexist in children with impaired vision, multidisciplinary assessment of children newly diagnosed with visual disability is advocated. 1,3,7 Almost two decades ago, the British Childhood Visual Impairment and Blindness Study (BCVIS; 2003) confirmed that in the UK most children newly diagnosed with severe visual impairment and blindness (SVIBL; vision worse than 1.0 logMAR [logarithm of the minimum angle of

We thank Shah et al 1 for their interest in the Portsmouth Glaucoma Refinement Scheme. 2 The scheme also uses Van Herick grading for anterior chamber depth-all patients with a Van Herick peripheral limbal anterior chamber depth of less than 25% of corneal thickness were referred to the virtual clinic for assessment by an ophthalmologist. Approximately 10% of all of those accepted from the Refinement Scheme virtual clinic to HES (from a total of 11 out of 100 referred to the virtual clinic, from our audit) were due to narrow angles suspected through Van Herick grading. Of these, 25% subsequently required laser peripheral iridotomy, slightly higher than the 17% positive predictive value, for the suggestion of occludable angles by an initial Van Herick test, outlined by Foster. 3 Conflict of interestThe authors declare no conflict of interest. References1 Shah B, Campbell P, Ford C, Goyal S, Lim KS. Re:The Portsmouth-based refinement scheme: a role for virtual clinics in the future? Eye 2013; 27(7): 892-893. 2 Trikha S, Macgregor C, Jeffery M, Kirwan J. ThePortsmouth-based refinement scheme: a role for virtual clinics in the future? Eye 2012; 26: 1288-1294. 3 Foster P. Advances in the understanding of primary angleclosure as a cause of glaucomatous optic neuropathy.

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