Aim To explore visual field (VF) progression in a cohort of secondary care-treated glaucoma and ocular hypertensive (OHT) patients. Methods We extracted VFs from our database drawn from our normal clinical practice. VF series from 4177 eyes from 2208 patients who had five or more VFs were obtained, the 'better' eye was selected and the rate of VF progression was calculated using mean deviation (MD) data. Results The median rate of progression for the whole sample was À 0.1 dB/year (interquartile range (IQR) À 4 to 0 dB/year) over a median of 6.7 years (IQR 4.9-8.7). Of 2208 patients, 477 (21.2%) progressed at 4 À 0.5 dB/year; 46 (2.1%) progressed at 4 À 2.0 dB/year. Of those with a 'final MD' of worse than À 10 dB (N ¼ 244) in their better eye; 14.0% were 'fast progressors' (4 À 2 dB/year), 33.7% 'moderate progressors' ( À 1 to À 2 dB/year), and 28.8% 'slow progressors' ( À 0.3 dB to À 1 dB/year). Of those with 'initial MD' better than À 3 dB and those with worse than À 3 dB, 31/1679 (1.8%) and 213/529 (40.3%) respectively, had a final MD of worse than À 10 dB. Conclusion Fast progressors, while important, are relatively rare. Moderate and slow progressors make up the majority of the progressing population within this data set. The risk of significant visual loss is much higher in those with initial damage. With increasing life expectancy, moderate and slow progressors may become increasingly clinically important.

Two national surveys of vision impairment and blindness were undertaken in The Gambia in 1986 and 1996. These provided data for the inception of The Gambia’s National Eye Health Programme (NEHP) within the Ministry of Health and Social Welfare. There have been important developments in the eye health services provided by the NEHP in the last 20 years. At the same time, the population has also undergone major demographic changes that may have led to substantial changes in the burden of eye disease. We conducted a National Eye Health Survey of vision impairment, blindness and its comorbidities in adults in The Gambia in 2019. We examined a nationally representative population-based sample of adults 35 years and above to permit direct comparison with the data available from the previous surveys. Alongside a comprehensive vision and eye examination, the survey provides nationally representative data on important comorbidities in this population: diabetes, hypertension, obesity, hearing impairment, disability and mental health. Secondly, it estimates access to assistive technologies and eye health services. Thirdly, it is powered to allow a five-year follow up cohort study to measure the incidence and progression of eye disease.

Two national surveys of vision impairment and blindness were undertaken in The Gambia in 1986 and 1996. These provided data for the inception of The Gambia’s National Eye Health Programme (NEHP) within the Ministry of Health and Social Welfare. There have been important developments in the eye health services provided by the NEHP in the last 20 years. At the same time, the population has also undergone major demographic changes that may have led to substantial changes in the burden of eye disease. We conducted a National Eye Health Survey of vision impairment, blindness and its comorbidities in adults in The Gambia in 2019. We examined a nationally representative population-based sample of adults 35 years and above to permit direct comparison with the data available from the previous surveys. Alongside a comprehensive vision and eye examination, the survey provides nationally representative data on important comorbidities in this population: diabetes, hypertension, obesity, hearing impairment, disability and mental health. Secondly, it estimates access to assistive technologies and eye health services. Thirdly, it is powered to allow a five-year follow up cohort study to measure the incidence and progression of eye disease.

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MultiColor enables combined harmatomas to be further characterised and may represent a valuable diagnostic and management tool: MultiColor and NIR define tumour boundaries and macular involvement, which may be useful for assessing visual impact; GR highlights inner retinal distortion, which may aid surgical management decisions.

Background/aimsThe 1986 Gambia National Eye Health Survey provided baseline data for a National Eye Health Programme. A second survey in 1996 evaluated changes in population eye health a decade later. We completed a third survey in 2019, to determine the current state of population eye health, considering service developments and demographic change.MethodsWe estimated prevalence and causes of vision impairment (VI) in a nationally representative population-based sample of adults 35 years and older. We used multistage cluster random sampling to sample 10 800 adults 35 and above in 360 clusters of 30. We measured monocular distance visual acuity (uncorrected and with available correction) using Peek Acuity. Participants with either eye uncorrected or presenting (with available correction) acuity <6/12 were retested with pinhole and refraction, and dilated exams were completed on all eyes by ophthalmologists using a direct ophthalmoscope, slit lamp and 90 D lens.ResultsWe examined 9188 participants (response rate 83%). The 2013 census age–sex adjusted prevalence of blindness (presenting acuity<3/60 in better seeing eye) was 1.2% (95% CI 0.9 to 1.4) and of moderate or severe VI (MSVI,<6/18 to ≥3/60) was 8.9% (95% CI 9.1 to 9.7). Prevalence of all distance VI (<6/12) was 13.4% (12.4–14.4). Compared with 1996, the relative risk of blindness decreased (risk ratio 0.7, 95% CI 0.5 to 1.0) and MSVI increased (risk ratio 1.5, 95% CI 1.2 to 0.17).ConclusionSignificant progress has been made to reduce blindness and increase access to eye health across the Gambia, with further work is needed to decrease the risk of MSVI.

PurposeTrabeculectomy is the most commonly performed surgical procedure for the treatment of glaucoma in the UK. The overarching aim is to achieve good IOP control, and thereby halt or slow further visual field loss. We aim to analyse whether trabeculectomy is successful in achieving long‐term visual field stability.MethodsA retrospective analysis was performed on consecutive patients who underwent a trabeculectomy between 2001 and 2010 at the Queen Alexandra Hospital in Portsmouth and the Queen Elizabeth hospital, Birmingham under the care of two specialists (JK and PS). Only eyes with at least five years of follow‐up post‐operatively, as well as visual fields before surgery and at least 5 years after were included. Patient demographics and comorbidities, intraocular pressures before and after surgery, visual field information prior to surgery and at the most recent follow‐up were collated and analysed.Results146 eyes of 110 patients met the eligibility criteria. Median follow‐up time was 10.0 years (range 5–17.5 years) and median visual field progression per year was −0.12 dB. 69% (n = 101) achieved stable visual fields post op (MD loss/year < 0.3 dB), 14% (n = 20) showed borderline/minimal progression (0.3–0.5 dB MD loss/year), 13% (n = 19) had moderate progression (0.5–1 dB loss/year), and 4% (n = 6) showed rapid progression (MD loss >1 dB/year). Median IOP reduction at final follow‐up compared to before surgery was 47% (median final IOP was 11 mmHg). Eyes that achieved good IOP control (<12 mmHg at final review, n = 96) had a median visual field progression of −0.08 dB/year. All six cases of rapid deterioration were confounded by concurrent severe systemic diseases (two cases of metastatic cancer, one case each of infective endocarditis and severe hypotension) and non‐glaucoma ocular conditions (one case each of diabetic maculopathy and advanced age‐related macular degeneration) during the follow‐up period.ConclusionsIn the majority of these cases (83%, n = 121), trabeculectomy resulted in visual field stability. Its positive effect on visual field stability is enhanced when the final IOP is less than 12 mmHg.

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