Wickham et al. [1] have highlighted the impact of COVID policies on ophthalmology services. Their findings are supported by our experience in Scotland. Rhegmatogenous retinal detachments (RRDs) are acute conditions that require prompt surgery [2]. The annual incidence of RRDs in Scotland was reported as 12.05/100,000 in 2010 [3]. The SARS-CoV-19 outbreak has been unprecedented. Healthcare services have worked hard to stay afloat. Subspecialty care has taken a back seat to intensive care and acute COVID wards. With UK eye departments providing only emergency care, outpatient clinics have been cancelled and workloads reduced. Anecdotal evidence from units all over the country suggests that RRD presentations have declined. Fortuitously, since August 2019 a study has been running across Scotland, prospectively collating all new RRDs, aiming to establish the incidence 10 years after the Scottish Retinal Detachment Study [3]. This has allowed us to assess the impact of the COVID-19 lockdown on RRD presentations. Fifteen surgeons in all six Vitreoretinal units across Scotland prospectively recorded all RRD presentations since August 2019. These records were collated centrally. Details such as age, sex, laterality and macular status were documented. We examined the data prior to and 5 weeks after the UK lockdown on the 23 rd March 2020. As the announcement was late in the afternoon, most of the RRDs operated on the 24 th would have presented prior to this. We therefore started counting the post lockdown numbers from 25 th March.

The prevalence of ocular candidiasis is low, presumably due to potent systemic antifungal agents and good intraocular penetration. Our findings support the view that routine fundoscopy screening may not be indicated in every culture positive patient. This paper provides an evidence base for the Royal College's Eyecare in intensive care unit recommendations regarding targeted screening of non-verbal, symptomatic or high-risk patients.

Introduction Since 2010, General Ophthalmic Services (GOS) legislation and Independent Prescribing (IP) enable community optometrists to manage primary eye conditions. No studies have assessed the effect of IP. We wished to determine the distribution of IP optometrists and associated hospital referral rates across Scotland. Methods In 2019, FOI requests (General Optical Council and NHS Education Scotland) identified all registered IP optometrists in Scotland and their registered postcodes. Data regarding community eye examinations and referrals to HES since 2010 was gathered via Information Services Division of NHS Scotland. Results As of March 2019, there were 278 IP optometrists in Scotland (23.4%). 218 IP optometrists work in 293 practices across 11 of Scotland's 14 health boards. There was a strong correlation (r=+0.96) between population density and number of IP optometrists. 56% of IP optometrists work in the two most deprived quintiles. Since IP's introduction, there has been a marked increase in anterior segment supplementary visits (+290%). Optometry referrals to GPs have reduced by 10.5%, but referrals to HES have increased by 118% (to 96,315). There was no correlation between quantity of IP optometrists and referral rates to HES (r=-0.06, 95% CI-0.64 to 0.56, p=0.86). Conclusion This is the first analysis of IP optometrists and associated referral rates in Scotland. Despite good geographical distribution and increased supplementary attendances, optometric referrals to HES have doubled and continue to rise. We propose a ratio of primary, supplementary, non-referral and referral rates to discern the true impact of IP versus non-IP community optometric behaviour.

Background The Scottish RD Survey reported an incidence of 12.05/100,000/yr in 2009. Data published from Denmark recently confirmed a 50% increase in RD presentations over the last 16 years. We set out to repeat the Scottish RD survey to determine if a similar trend has been observed in Scotland. Methods All 16 Scottish VR surgeons, who make up the collaboration of Scottish VR Surgeons (SCVRs) were asked to prospectively record all primary RDs presenting from 12th August 2019 to 11th August 2020. For consistency, the case definitions were the same as for the 2009 Scottish RD Survey. Basic demographic and clinical features were recorded. Age specific incidence was calculated from mid-year population estimates for 2019 obtained from the National Records of Scotland. Results There were 875 RRDs recorded, which gives an updated incidence of 16.02/100,000/year in Scotland. 62.8% occurred in males and the greatest increases were seen in males aged 50–59 (p = 0.0094), 60–69 (p = 0.0395) and females aged 40–49 (p = 0.0312) and 50–59 (p = 0.0024). The proportion of pseudophakic RRDs in this study is 29.4% (253/860). Compared to the 21.6% in the 2010 study, this represents a 28% increase (χ2 = 11.03, p = 0.0009). The proportion of macula-off RRDs remained generally stable at 58%. Conclusion Our study confirms that RRD is becoming more common in the UK, reflecting almost identical findings from Denmark. This trend is in part due to increasing myopia, increasing pseudophakia, and possibly other factors. This should be considered when planning VR services and allocating resources in the future.

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