This study uses eye-tracking technology to assess the differences in gaze behaviours between ophthalmologists of different experience levels while interpreting retinal images of diabetic retinopathy. The differences in gaze behaviours before and after a teaching intervention which introduced a suggested search strategy is also investigated. A total of 9 trainees and 10 consultant ophthalmologists interpreted six retinal images. They were then shown a 5-min tutorial that demonstrated a search strategy. This was followed by six further retinal image interpretations. Participants completed questionnaires indicating clinical signs seen, appropriate retinopathy grade, and confidence. Eye movements were tracked during each interpretation.Overall, trainees compared to consultants demonstrated more uncertain and unstructured gaze behaviours. Trainee eye gaze metrics included: longer interpretation time, 36.5 s (SD = 6.2 vs. 31.4 s) (SD = 4.2) (p = 0.024), higher visit count, 17.38 visits (SD = 5.13) versus 12.18 visits(SD = 2.64) (p = 0.01), higher proportion of fixation, 57.0 per cent (SD = 5) versus 50.5 per cent (SD = 5) (p = 0.05) and shorter time to first fixation, 0.232 s (SD = 0.10) versus 0.821 s (SD = 0.77) (p = 0.001), respectively. The teaching intervention resulted in more focused gaze patterns in both groups. Pre-intervention and post-intervention mean proportion fixation on areas of interest were 38.6 per cent (SD = 6.8) and 51.8 per cent (SD = 13.9) for the trainee group, respectively, and 39.9 per cent (SD = 4.1) and 50.9 per cent (SD = 9.3) for the consultant group (p = 0.01).Consultants used more systematic and efficient approaches than trainees during interpretation. After the introduction of a suggested search strategy, trainees showed trends towards consultant eye gaze behaviours. Eye tracking gives an interesting insight into the thought processes of physicians carrying out complex tasks. The implication is that eye tracking may have future use in teaching and assessment. Its use in objectively assessing different teaching strategies could be a valuable tool for medical education.

Background The red reflex test (RRT) is widely used as a screening tool to detect congenital cataract. This study aims to determine the incidence of congenital cataract in Northern Ireland and to evaluate the success of the RRT screening programme. Methods Retrospective review of consecutive abnormal red reflex referrals in 2017 and 2018 inclusive. We collected data on the source and timing of referral, diagnostic outcome, visually significant cataract, and surgical intervention. Additionally, data was collected on all cases of confirmed congenital cataract diagnosed in the Regional Paediatric Ophthalmology Service within the same time period. Results In the study period, 179 children with suspected red reflex abnormalities were referred. In the same period, thirteen patients were diagnosed with visually significant congenital cataract under one year. Eight (62%) were female and seven (54%) affected both eyes. Only 46% were detected through the screening programme. Three children were above one year of age at the time of diagnosis with sub-optimal outcomes. Six patients were diagnosed with non-visually significant congenital cataract and one juvenile onset were not included. Eight infants diagnosed with lens opacities required surgical intervention. Incidence of visually significant congenital cataract in Northern Ireland was calculated at 2.8 per ten thousand live births per year. Conclusions Northern Ireland has a similar incidence of congenital cataract compared to the remainder of the UK. This study highlights that red reflex screening requires further refinement, which can be augmented by pupillary dilatation, to ensure timely diagnosis and improve visual outcomes. ​