Deciphering the signs

28 February 2019
Winter 2019

New advances in eye screening technology are identifying conditions that would otherwise have remained hidden. But how do we interpret the results?

We are fortunate to work in a profession that is constantly evolving. The eye is an amazingly complex organ and provides a non-invasive window to the vascular system and brain that other medical specialties can only dream of. Our understanding of these systems is ever-growing and as new technology and techniques are developed, our examination, diagnostic and treatment powers advance too. But with greater technology comes greater responsibility.

Issue 3 of Acuity provides an opportunity to reflect on this. We take a fresh look at pseudophakic cystoid macular oedema (PCMO), a condition familiar to us all. Or so we think... With optical coherence tomography (OCT) technology becoming more widespread, community optometrists can now identify PCMO that would previously have remained hidden. The challenge comes in interpreting this diagnosis. If there are just a few small cysts, the patient is achieving good vision and is happy with the outcome of surgery, PCMO can be clinically insignificant; we can simply marvel at our ability to look at these tiny fluid-filled cysts in living tissue that is mere fractions of a millimetre thick. If the PCMO is clinically significant, treatment may be required. George Winter discusses recent studies and NICE guidelines, and when to use combined NSAIDs and corticosteroid treatment reactively or prophylactically. 

Eventually, optometrists may play an important role in detecting Alzheimer’s disease at an early stage 

The importance of our interpretation of novel tests is highlighted again in our cover feature. Madeleine Bailey discusses how OCT angiography may eventually form part of a battery of ophthalmic tests to identify Alzheimer’s disease (AD) early. Retinal nerve fibre layer thickness measured by conventional OCT may also be a useful tool in this regard. 

AD is a devastating condition, and these non-invasive tests may prove instrumental in the fight against this increasingly common disease, but further work is required before we are ready to make definitive diagnoses based on ocular examinations. Eventually, optometrists may play an important role in detecting AD at an early stage.

Of course, without the research of innovative vision scientists, optometry would not evolve, but stagnate. Professor Shahina Pardhan has worked tirelessly to drive our profession forward over the last 30 years. Her successes are all the more remarkable as optometric academia was a male-dominated field when she became the first female Professor of Optometry in the UK in 2001. Although progress is being made, gender inequalities still exist, and Shahina remains active in the Women in Vision UK network, which strives to increase the profile of women in optometry and vision science research. You can read her story in this issue's one to one.

Of course there’s lots more to discover in this issue. Please contribute by submitting ideas for case studies or content for future issues to 

Kieran RG Loft MSc BSc (Hons) MCOptom DipTp (IP)
Acuity Clinical Editor


Related further reading

We are pleased to announce that each nation's health system has confirmed that they support a move to the ‘Green’ phase on Tuesday 10 May 2022. From then, the College’s COVID-19 Amber phase guidance will no longer apply in all UK nations.

This outlines a COVID-19 Urgent Eyecare Service delivered from a network of optical practices, acting as urgent eye care hubs, to support the immediate and recovery phase of the coronavirus pandemic.

Read our response to GOC's call for evidence to review the Opticians Act (1989).