Effective population screening for glaucoma would enable earlier diagnosis and prevention of irreversible vision loss. The UK National Screening Committee (NSC) recently published a review that examined the viability, effectiveness and appropriateness of a population-based screening programme for primary open-angle glaucoma (POAG). In our article, we summarise the results of the review and discuss some future directions that may enable effective population screening for glaucoma in the future. Two key questions were addressed by the UK NSC review; is there a valid, accurate screening test for POAG, and does evidence exist that screening reduces morbidity from POAG compared with standard care. Six new studies were identified since the previous 2015 review. The review concluded that screening for glaucoma in adults is not recommended because there is no clear evidence for a sufficiently accurate screening test or for better outcomes with screening compared to current care. The next UK NSC review is due to be conducted in 2023. One challenge for POAG screening is that the relatively low disease prevalence results in too many false-positive referrals, even with an accurate test. In the future, targeted screening of a population subset with a higher prevalence of glaucoma may be effective. Recent developments in POAG polygenic risk prediction and deep learning image analysis offer potential avenues to identifying glaucoma-enriched sub-populations. Until such time, opportunistic case finding through General Ophthalmic Services remains the primary route for identification of glaucoma in the UK and greater public awareness of the service would be of benefit.

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The RecQ4 protein shows homology to both the S.cerevisiae DNA replication protein Sld2 and the DNA repair related RecQ helicases. Experimental data also suggest replication and repair functions for RecQ4, but the precise details of its involvement remain to be clarified.Here we show that depletion of DmRecQ4 by dsRNA interference in S2 cells causes defects consistent with a replication function for the protein. The cells show reduced proliferation associated with an S phase block, reduced BrdU incorporation, and an increase in cells with a subG1 DNA content. At the molecular level we observe reduced chromatin association of DNA polymerase-alpha and PCNA. We also observe increased chromatin association of phosphorylated H2AvD - consistent with the presence of DNA damage and increased apoptosis.Analysis of DmRecQ4 repair function suggests a direct role in NER, as the protein shows rapid but transient nuclear localisation after UV treatment. Re-localisation is not observed after etoposide or H2O2 treatment, indicating that the involvement of DmRecQ4 in repair is likely to be pathway specific.Deletion analysis of DmRecQ4 suggests that the SLD2 domain was essential, but not sufficient, for replication function. In addition a DmRecQ4 N-terminal deletion could efficiently re-localise on UV treatment, suggesting that the determinants for this response are contained in the C terminus of the protein. Finally several deletions show differential rescue of dsRNA generated replication and proliferation phenotypes. These will be useful for a molecular analysis of the specific role of DmRecQ4 in different cellular pathways.

Prolonged pre-operative fasting can be an unpleasant experience and result in serious medical complications. The Royal College of Nursing guidelines state a minimum fasting period of six hours for food and two hours for clear fluids, prior to elective anaesthesia or sedation in healthy patients. We audited the Moorfields South Pre-operative Assessment Unit fasting instruction policy to ensure it is clear and in accordance with national guidelines.A questionnaire assessing the clarity and accuracy of fasting instructions and patient hydration was employed to survey patients undergoing elective anaesthesia or sedation in July 2013 (first cycle) and September 2013 (second cycle). The fasting instruction policy and patient information leaflet were reviewed; they state “nothing to eat or drink from midnight” for morning surgery and “nothing to eat or drink from 7AM” for afternoon surgery.The 10 patients surveyed in the first cycle reported that the instructions they were given were clear. 70% expressed subjective dehydration and 40% showed clinical evidence of dehydration. The patients had not been encouraged to drink clear fluids up till two hours before surgery. Patients fasted for unnecessarily prolonged periods, the longest of which was 17 hours.Our interventions were: delivering a teaching session to update staff of current pre-operative fasting guidelines, producing a patient information leaflet that was correct, reader-friendly and comprehensive and displaying posters as a reminder of the updated fasting instruction policy.The 12 patients surveyed in the second cycle had been encouraged to drink clear fluids up till two hours before surgery. A dramatically reduced 25% expressed subjective dehydration and 25% showed clinical evidence of dehydration. The longest fasting period was reduced to eight hours.We encourage all hospitals to adopt a patient centered approach to pre-operative fasting, dispelling the “nil my mouth for eight hours” policy, to improve patient wellbeing and satisfaction.