The treatment ofacute angle closure glaucoma has been influenced by the development of the YAG laser and its ability to perform iridotomies as an outpatient procedure. In this retrospective study the results of YAG iridotomy were compared with surgical peripheral iridectomy. When compared with surgical peripheral iridectomy patients, YAG iridotomy patients were at greater risk of proceeding to further surgery, with this risk being significantly associated with increasing duration of attack. The authors suggest that in selected cases, surgical iridectomy should be given consideration as a primary procedure.

Contributorship: RB, JH, AC, MA and WC planned the research. RB, JH, AC and CW conducted the research. RB wrote the manuscript and JH, AC, DOPS study group members, MB and CW revised the manuscript.2 Synopsis: Over-diagnosis of papilloedema is common. Fundus photographic screening is highly sensitive for papilloedema detection; however, we found rates of false positive papilloedema diagnosis on fundus photography of 7-21% in hospital and community patient samples respectively.Word Count: 2589 words 3 ABSTRACT Background: Overdiagnosis of papilloedema is common and carries significant potential for morbidity from over-investigation and over-treatment. We aimed to determine the community prevalence of false positive diagnosis of papilloedema (FPE) on fundus imaging. Methods:We evaluated fundus images from a community cross-section of 198 12-14-year-olds from the Avon Longitudinal Study of Parents and Children (ALSPAC) longitudinal cohort study database and patient images from our hospital departmental database with and without papilloedema. We asked clinicians, in isolation, to rate the subjects as a forced-choice task to "papilloedema" or "notpapilloedema" based on the fundus images alone. Raters comprised (i) 4 neuro-ophthalmologists, (ii) 4 ophthalmologists, (iii) 4 neurologists and (iv) 4 emergency medicine physicians. Results:The prevalence of FPE in the ALSPAC population, defined as images mistaken as papilloedema by χ% of raters (Pχ) varied from P100=0% to P50=21.3±3.9%. In the hospital population, there was a lower rate of FPE, P50=7.1±10.8%. Sensitivity for papilloedema detection approached 100%, though 3 raters incorrectly labelled the same patient with unilateral disc swelling as normal, all other cases were detected by all raters.Conclusions: Fundus photography assessment in isolation is highly sensitive but poorly specific for papilloedema detection. Using this method to screen the general population has significant potential for harm as overdiagnosis occurs, even in the hands of experienced clinicians.

No abstract

No abstract