County Roscommon in the west of Ireland is a relatively remote rural area whose population of 55 000 is served by two community medical ophthalmologists and three optometrists. Eye surgical services are not available within the county. In order to assess the needs of the community for prevention of blindness from glaucoma, a simple random sample of the population of County Roscommon was taken for a community based glaucoma survey. A total of 2186 people over the age of 50 were examined which represented a 99*5% response rate. The high response rate was achieved by the community basis of the study and vigorous follow up of non-attenders. Intraocular pressure was measured using applanation tonometry, disc evaluation by both direct ophthalmoscopy and stereoscopic biomicroscopy, and visual field analysis using the Henson CFS 2000 and experimental computer controlled video perimetry. Diagnostic criteria were consistent with the preferred practice pattern of the American Academy of Ophthalmology. A crude prevalence of approximately 2% for primary open angle and normal tension glaucoma was found. The population profile of intraocular pressure showed a pattern which decreased with increasing age unlike the Framingham and Ferndale studies but similar to Japanese data.

Objective-To determine the prevalence of visual disability and common eye disease among elderly people in inner London.Design-Cross sectional random sample survey. Setting-Inner London health centre. Subjects-Random sample of people aged 65 and over taken from practice's computerised age-sex register.Main outcome measures-Presenting binocular Snelien 6 m distance acuity and best monocular 3 m Sonksen-Silver acuity to classify prevalence ofblindness by World Health Organisation criteria (less than 3/60 in better eye) and American criteria for legal blindness (better eye equal to 6/60 or less) and of low vision by WHO criteria (best acuity 6/18) and visual impairment by American criteria (less than 6/12 or 20/40 but greater than 6/60 or 20/200 in better eye). Principal cause of visual loss by diagnosis, referral indication by cause to hospital eye service, and proportion of cases known to primary care.Results-207 of 288 (72%) eligible people were examined. 17 (8%) housebound subjects were examined at home. The prevalence of blindness was 1% by WHO criteria and 3*9% by American criteria.

The purpose of the study was to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years of age living in the London Borough of Haringey. A cross-sectional voluntary sample of persons were subjected to detailed ophthalmic assessment including automated tangent screen suprathreshold visual field testing, applanation tonometry and stereoscopic disc evaluation in 50 community-based survey clinics over an 8 month period. Cases and suspects were referred to Moorfields Eye Hospital for more detailed assessment and confirmation of the diagnosis. Of 873 eligible persons examined (out of a total of 1022), 32 definite cases of glaucoma were identified, a prevalence of 3.9%; 42% of these had been previously diagnosed. Approximately 10% of the sample required further assessment and follow-up when ocular hypertensives and glaucoma suspects were included. An age-standardised comparison with the findings of the Roscommon survey revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7. Significant risk factors for glaucoma included age, African birthplace and darker skin colour. Neither diabetes nor hypertension reached significance. Despite the lack of a population base, this study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population. Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case-finding resources should be provided to meet local needs.

A matched-control study of plasma retinol, alpha-tocopherol, carotenoid, and cholesterol concentrations and the polyunsaturated fatty acid content of plasma and erythrocyte phospholipids was undertaken in 65 elderly patients with age-related maculopathy and 65 control subjects matched for age and sex. Despite the high statistical power of the study and large variations between subjects in the variables under consideration, no significant differences were noted between patients and control subjects. However, several statistically significant differences were noted between male and female subjects independent of their classification with maculopathy or as controls and age: plasma cholesterol, total phospholipids, alpha-tocopherol, and beta-cryptoxanthin concentrations were higher in females than in males. The mean plasma cholesterol concentration for the upper tertile of the whole sample was 7.6 mmol/L. Plasma concentrations of total carotenoids, alpha-carotene, and beta-carotene, but not alpha-tocopherol, were significantly lower in smokers than in non-smokers. The results of this study do not provide any evidence in favor of changing the dietary intake of polyunsaturated fatty acids or fat-soluble vitamins to protect against age-related maculopathy.

SUMMARYThis study reports the prevalence of defective stereopsis in an elderly population. Of 728 individuals over the age of 65 who attempted a Frisby stereotest, only 27% had full stereopsis and 29% had no stereopsis. In the elderly population defective stereopsis is a common finding in the absence of any other ocular morbidity. The prevalence of defective stereopsis increased with age. This finding was noted as a part of a survey of ey e health of elderly people living in an inner city. The finding was not associated with any sy mptoms. The significance of this finding is discussed.To our knowledge, there are no population-based preva lence estimates of orthoptic abnormalities in the elderly.Little is known about normal binocular function in this age group although stereoacuity is considered to be an ability METHODAs part of a pilot study the purpose of which was to improve baseline estimates of the prevalence of common eye disease in an inner city elderly popUlation, all patients over 65 years from two general practitioner agelsex regis ters were invited to participate in a survey of eye health.The sample consisted of two clusters from London's inner In the centre of one square of each of the three plates is a 3 cm circle printed on the reverse giving the impression of a 'hole' or 'a circle sticking OUt'.7 The Frisby test was selected for its ease of presentation in this age group because it does not require any additional spectacles to create the stereoscopic effect. Because most people in this age group require presbyopic correction, additional redl green or polarised lenses required by the Wirt or TNO tests would have been clumsy to administer. The test was explained in a systematic way to all participants and in most cases the concept of the test was quickly grasped. In

Aim-To assess uniformity of the corneal endothelial cell mosaic in children. Methods-36 healthy children (5-11 years old, 16 boys, 20 girls) were assessed by specular microscopy. Endothelial cell density (ECD) was calculated from measured cell areas, and the number of sides/cell noted. The clinical specular microscope [1][2][3] has been widely used on many diVerent types of individuals with and without a range of eye diseases. 4 It has become commonplace to assess endothelial cell density (ECD) and, perhaps the percentage of six sided cells ("hexagons"), particularly within the central corneal region.5 6 As part of ongoing studies to assess the corneal endothelium in more detail, 5 7 8 further investigations were undertaken on children because reports on the corneal endothelium of children have been infrequent and the data diVer somewhat. These studies confirmed that the corneal endothelium in children has a higher ECD than in young adults.

The findings confirm that ocular motility problems are not exclusive to scleral buckling, with the incidence being similar in both groups. Slinging of the extraocular muscles and the accompanying dissection, resulting in the 'fat adherence syndrome', must be considered as contributory factors. The visual deficits which inevitably occur as the result of retinal detachment seem to play a more major role in the disruption of binocularity in these cases.

The ocular effects ofthe a-adrenoceptor blocking drug bunazosin, administered as eyedrops, have been measured in a placebo-controlied double-blind single-dose study in 15 healthy volunteers. The drug significantly reduced intraocular pressure over 10 hours, and there was no associated change in pulsatile ocular blood flow. Characteristic effects of a-adrenoceptor blockade were observed -miosis, ptosis, and conjunctival hyperaemia. The miosis alone persisted for more than 24 hours in nine out of 15 subjects.