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Feb/Mar 2014 Quiz 2

History A 65-year-old lady presented with a ten year history of nonspecific visual disturbance and mild symptoms of dry eyes. Questioning revealed progressive nyctalopia. Previous medical history of note included Crohn’s disease requiring two bowel resections including small intestine. Figure...

Cytomegalovirus retinitis post intravitreal triamcinolone in an immunocompetent patient with juvenile glaucoma

Figure 1: Fundus photograph shows active CMV retinitis four weeks after IVTA in the right eye. Figure 2: Fundus photograph of the left eye with no CMV retinitis; atrophic disc as a result of juvenile glaucoma. Case report A 29-year-old...

Increasing access to eye care through community outreach clinics in Uganda

There has been a VISION 2020 LINK between Mulago Hospital and Makerere University in Kampala, Uganda and the Royal Free Hospital, London, since 2010. There have been regular training visits between teams from the eye departments at Mulago and the...

High-stakes scenarios in retinal vein occlusion: A survey of medico-legal implications

Central retinal vein occlusion (CRVO) is the second most common retinal vascular disease after diabetic retinopathy, and its clinical complexity often intersects with medico-legal scrutiny [1]. Missteps in timely diagnosis, inadequate follow-up or poor documentation can lead to patient harm...

Identifying life-threatening uveal melanoma: A directed application of general-purpose AI

Uveal melanoma (UM) is a rare but aggressive eye cancer, affecting approximately six people per million annually [1]. Uveal melanoma arises in three locations: the choroid, ciliary body, and iris. As the most common primary intraocular malignancy in adults, UM...

Ultrasound imaging of the eyes

Since its initial use in the eyes fifty years ago, ultrasound has established itself as a common diagnostic technique in ophthalmology. Sonographers, engineers and clinicians from all around the world have contributed to the development of ocular ultrasonography. As a...

MRI characteristics of NMO, MOG and MS-related ON

This review article examined differences of MRI appearances that can help clinicians assess and manage these important neuro-ophthalmic disorders. It also examined the role of optic nerve MRI as a prognostic indicator in acute optic neuritis (ON). The major findings...

Ocular electrophysiology

A 34-year-old woman, who is a CEO in a multinational firm, has been losing vision over the last 12 months. She has seen her opticians, who initially tried different glasses but could not improve things. Clinical examination is unremarkable. How...

Caring for adults with an ocular tumour

Detection If you screen for an intraocular tumour, dilate the pupil. If the patient is driving, use phenylephrine only. If the patient declines, document this in the casenotes. Don’t forget to look for sentinel vessels, which would indicate a ciliary...

In conversation with Robert Johnston

Robert Johnston. What is your current role with Medisoft? Clinical Director, i.e. I head up the analysis for and design of Medisoft’s ophthalmology electronic medical records (EMR) product. I don’t program: all coding is done by Medisoft’s team of computer...

An update on inherited retinal disorders (part 1) – overview and assessment of inherited retinal disease

Part 2 of this topic can be found here Inherited Retinal Disease (IRD) is the leading cause of blindness certification in the working age population (age 16-64 years) in England and Wales and the second most common in childhood [1]....

Typical or surprisingly uncharacteristic presentations of neuro-ophthalmic emergencies

Irrespective of geographical location or patient cohort, emergency departments are high risk locations capable of inspiring extreme anxiety and dread in patients and doctors alike. The stress multiplies when a walk-in or referred case is suspected of underlying neurological pathology....