ObjectiveTo study the association between socioeconomic deprivation and prevalence of diabetic retinopathy (DR).DesignPopulation-based, cross-sectional observational study and retrospective longitudinal analysis over 12 years.SettingPrimary care, East of Scotland.MethodsOutcome data from DR screening examinations (digital retinal photography) were collected from the Scottish regional diabetes electronic record from inception of database to December 2012. The overall Scottish Index of Multiple Deprivation (SIMD) 2012 score for each patient was obtained using their residential postcode. Multiple binary logistic regression was used to analyse the relationship between overall SIMD score and prevalence of DR, adjusting for other variables: age, gender, glycated haemoglobin, cholesterol levels and duration of disease.Primary outcomeAny retinopathy (R1 and above) in either eye.ResultsA total of 1861 patients with type 1 diabetes mellitus (DM) and 18 197 patients with type 2 DM were included in the study. Prevalence of DR in type 1 and type 2 DM were 56.3% and 25.5%, respectively. Increased prevalence of DR in type 1 DM was associated with higher overall SIMD score (p=0.002), with an OR for the most deprived relative to the least deprived of 2.40 (95% CI 1.36 to 4.27). In type 2 DM, the overall SIMD score was not significantly associated with increased prevalence of DR, with an OR for the most deprived relative to the least deprived of 0.85 (95% CI 0.71 to 1.02, p=0.07).ConclusionsSocioeconomic deprivation is associated with increased prevalence of DR in patients with type 1 DM and this occurs earlier. This highlights the need for targeted interventions to address inequalities in eye healthcare.

BackgroundAmblyopia and its risk factors have been demonstrated to be more common among children from low socioeconomic backgrounds. We sought to investigate this association in a region with orthoptic-delivered screening and whole population coverage, and to also examine the association of the Health Plan Indicator (HPI) with screening outcome.MethodsScreening examination outcomes, postcodes and HPIs were extracted from the community child health database for every child who underwent preschool vision screening between March 2010 and February 2011 Tayside. We obtained the Scottish Index of Multiple Deprivation score for every child as a measure of area-based deprivation. We assessed the vulnerability/needs of the individual family through the HPI—‘Core’ (children and families receiving universal health visiting service), ‘Additional’ (receiving additional health/social support) and ‘Intensive’ (receiving high levels of support). The outcomes from follow-up examinations for those who failed screening were extracted from the orthoptic department database.Results4365 children were screened during the year 2010–2011 of whom 523 (11.9%) failed. The odds of children from the least deprived socioeconomic group passing the visual screening test was 1.4 times higher than those from the most deprived socioeconomic group (OR 1.4, 95% CI 1.07 to 1.89, p=0.01). The odds of a child from a family assigned as ‘Intensive’ failing the preschool visual screening test was three times greater than the odds of a child from a family assigned as ‘Core’ (OR 3.59, 95% CI 1.6 to 7.8, p=0.001).ConclusionsWe found that children from the most deprived backgrounds and those from unstable homes were more likely to fail preschool vision screening.

We report a case series of capsule contraction syndrome in 5 eyes of 4 patients and describe a previously unreported complication: full flexion of the haptics onto the anterior surface of the optic. Haptics have been reported to slide anterior to the optic while remaining in their original coronal plane. As surgeons move to the use of preloaded injectable IOLs, it is important to scrutinize haptic-optic junction design and IOL material in the light of this complication.

. Purpose:  To investigate the clinical features of all patients with acute–onset diplopia presenting to the ophthalmology department. Methods:  The notes of every patient who presented with acute onset (<4‐week duration) diplopia to the ophthalmology clinic over a 2‐year period were reviewed. Data regarding clinical features, underlying aetiology, past medical history, investigations and outcomes were extracted. Results:  One hundred and forty‐nine patients presented with 53.7% having an isolated third, fourth or sixth nerve palsy, 10.7% a mechanical cause, 10.1% a dysfunction of higher control, 8.1% decompensation of a pre‐existing heterophoria, 6.7% idiopathic, 5.4% causes of monocular diplopia and 5.3% another diagnosis. Neuroradiological investigation identified that <5% of patients had a serious underlying pathology, which required immediate management; 80.5% had a diagnosis and underlying aetiology, which were obvious at presentation based only on clinical information and evaluation. Conclusions:  Acute onset diplopia is an uncommon and challenging presentation for the ophthalmologist to manage. These results demonstrate that the aetiology is commonly identifiable at the first presentation based on clinical evaluation, only a small percentage require urgent radiological investigation and a small minority of cases are likely to have serious emergent pathology.

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