Biologic therapies have increased the treatment options for sight-threatening uveitis. Despite experimental rationale, the lack of evidence from randomized controlled studies limits our understanding of when to commence therapy, which agent to choose and how long to continue treatment. Additionally, the high cost and potential side effects of all biologic agents have limited their current use to uveitis refractory to immunosuppression.

Age-related macular degeneration (AMD) is the commonest cause of blindness in the population over 60 years of age and accounts for over 50% of those registered blind in the UK. The incidence is increasing and as older generations live longer a growing number of patients will be affected in the future. Affected patients lose central vision, important in all aspects of everyday life. This review outlines risk factors for AMD, clinical features, treatment and management strategies for patients, families and physicians caring for those with AMD. Recent trials are included along with practical clinical advice. While there is no curative treatment at present, intervention can reduce the risk of developing AMD and limit disease progression if it occurs. These modalities are discussed here. As new discoveries in the field of genetics and novel therapies emerge, a brighter future seems certain for the ageing population.

Aims To estimate the incidence of penetrating injuries with retained intraocular foreign bodies (IOFBs) in the United Kingdom, and to provide epidemiological data on the aetiology, management, and visual outcome of such injuries. Methods Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period June 2004 to May 2005 inclusive. Questionnaire data were obtained from UK ophthalmologists at presentation and 6 months following presentation. Results Data were available on 97 patients at presentation and 95 patients at follow-up. The minimum estimated incidence of IOFBs in the United Kingdom identified in this study was 0.16 per 100 000. All patients were male. Hammering was the most common mechanism of injury, occurring in 62% of patients. The IOFB was found in the anterior segment in 24%, the posterior segment in 73%, and involved both segments in 3%. Endophthalmitis was diagnosed in 9% of patients. Best-corrected visual acuity of the injured eye at final follow-up was 6/12 or better in 67%, 6/18 to 6/60 in 11%, and worse than 6/60 in 22%. Prognostic factors for a poor visual outcome included poor visual acuity at presentation, prolapse of intraocular tissue, development of endophthalmitis, development of retinal detachment, and large size of IOFB. Conclusions The incidence of IOFB in the United Kingdom appears to have reduced compared to previous studies. The majority of patients (67%) retain good visual acuity in the injured eye; however, a significant minority (22%) sustain long-term severe visual loss.

There are an increasing number of treatment options. As the vast majority of published studies in uveitis are case series or nonrandomized trials, there remains a lack of level 1 evidence to guide the choice and duration of therapy. Standard initial treatment for steroid-resistant disease is to add a single immunosuppressant to the regime, with additional agents being substituted or added as required. Combination of two immunosuppressants in addition to steroids may be indicated especially in chronic uveitis. High cost and limited long-term experience with biologic agents have restricted their use to uveitis refractory to immunosuppressants, but evidence suggests a potential therapeutic role earlier in Bechet's disease.

Purpose To investigate the possible link between normal tension glaucoma (NTG) and autoimmunity. Methods We studied the serum of 95 patients: 31 with NTG, 32 with primary open-angle glaucoma (POAG), and 32 age-and sexmatched controls. Blood was drawn from each patient and serum was examined for the presence of antinuclear antigens (ANA), autoantibodies to extractable nuclear antigens (ENA), anti-double-strand DNA, serum protein electrophoresis, and immunoglobulin (IgG, IgA, and IgM) levels. Results In the NTG group, the relative risks for ANA and ENA positivity were 2.5 and 4.4 times, respectively, that of the control group. There was a statistically significant difference between IgA levels in the NTG and control group (P ¼ 0.024), but there was no statistically significant difference between both groups regarding IgM or IgG levels. In the POAG group, the relative risks for ANA and ENA positivity were 0.77 and 2.9 times, respectively, that of the control group. The relative risk for detection of paraprotein in the POAG group was 0.97 times that of the control group. Also, there was a statistically significant difference between IgA levels in the POAG and control group (P ¼ 0.011), but there was no statistically significant difference between both groups regarding IgM or IgG. Conclusion These results support the hypothesis that humoral immune mechanisms may have a role in the pathogenesis of NTG.

Over a 1-year period, bevacizumab and ranibizumab can be safely and successfully used to treat inflammatory CNV secondary to PIC, avoiding the need for systemic immunosuppression in the majority of patients.

Aim To set-up a glaucoma electronic patient record (GEPR) and study referral details to a new glaucoma service, concentrating on highrisk patients. Method A GEPR was designed using the pre-existing hospital information technology (IT) infrastructure. Referral details of all new patients to the glaucoma service were completely electronically entered and analysed. Results A GEPR was successfully established. A total of 402 referrals were studied. In all, 43% (40) of high-risk clinic patients (IOP429 mmHg, or C/D ratio 40.8 or moderate to advanced visual field defects) had to wait longer than 8 weeks from GP referral to be seen at the glaucoma service. Of these, nine patients lost more than one line of Snellen's visual acuity attributable to glaucoma. The optometrist failed to document IOP in 17%, fundoscopy in 30%, and visual fields in 45% of all referrals. Conclusions A GEPR can be introduced in an NHS setting without disruption of clinical care and ophthalmic training, and facilitates detailed, accurate and rapid audit. Study of high-risk glaucoma referrals showed inadequate optometric referral details and poor prioritisation of urgent cases. This information is being utilised with the cooperation of local optometrists to refine the pattern of glaucoma referrals. Eye (2005) 19, 956-962.

In this case presentation, we present a young vegan patient who developed a CRVO secondary to severe irondeficiency anaemia (IDA) attributable to menstrual losses and limited iron intake. CRVO is a rare complication of IDA. With rising calls for sustainable diets and rising evidence for a plant-based diet, there has been a rise in popularity of such diet forms. While there are ocular benefits from this diet trend, the potential for nutritional deficiencies including iron needs to be monitored especially in susceptible individuals. Iron is essential for retina metabolism and function; however, excess iron contributes to disease states in the eye. Therefore, supplementation needs to be judicious.