The timing of patching treatment and a child's wellbeing.

eration of primary care ophthalmologists. This could share some modules with ophthalmic surgical training, but would concentrate on developing areas such as teaching skills, epidemiology, population based research and management skills to a higher level than is usually attained in ophthalmic surgical training. It is difficult to guess what effect the impending changes in the way clinical services are commissioned will have on the way ophthalmology is practised in the future. The need for vitreoretinal surgery, treatment for choroidal neovascularisation, neuro-ophthalmology, and other ophthalmic specialist services will continue to exist, but we cannot be sure that they will necessarily happen under the same roof. We do not know for certain whether primary care ophthalmology will take place in hospitals, treatment centres, general practice, optometric practices, or other premises. Are we moving towards a new ‘‘hub and spoke’’ concept where ophthalmic primary care becomes the hub and the ophthalmic specialties the spokes? The breadth and pace of political change might mean that the concepts of ophthalmic primary care are implemented without rehearsal and without the luxury of a safety net, as hospital provision of ophthalmic primary care is scaled down. We may be travelling in the right direction, but it feels like driving without headlights. The challenge for academic ophthalmology will be to find ways of evaluating the effects of change as they occur and disseminating the learning points rapidly.