Vision screening in a primary care setting.

3759 and Ophthalmologe2004;101:1098e104.7. Rundle P, Singh AD, Rennie I. Proton beam therapy for iris melanoma: a review of 15 cases. Eye2007;21:79e82.8. Muller K, Peter J, Nicole N, et al. Lacrimal gland radiosensitivity in uveal melanoma patients. Int JRadiat Oncol Biol Phys 2009;74:497e502.9. Lommatzsch PK,Werschnik C, Schuster E. Long-term follow-up or Ru-106 brachytherapy for posterior uveal melanoma. Graefes Arch Clin Exp Ophthalmol 1993;24:82e90.MAILBOX Vision screening in a primary caresetting I was interested to read the editorial on visionscreening by Evans et al. I share their concernthat, despite the availability of free eye testsfor the older population, over 50% of visionimpairment is due to easily correctableconditions.I recently audited an elderly person healthcheck; an annual assessment of the medical,social, and physical needs of all patients over75 years at a GP practice in Wirral.While an assessment of vision formed partof the pro forma carried out by the healthcareassistant, this was self-reported and recordedbroadly, with no visual symptoms, provisionof spectacles, profound impairment one eyeand profound impairment both eyes.As part of the audit cycle, for 1 month, allpatients attending their health check had theirvisual acuity measured (with and withoutpinholes) using a Snellen chart. Additionally,attendance at optician for regular eye checkwas recorded.Twenty-four patients attended for theirelderly person health check, excluding fourpatientswho had significant ocular pathology(three with age-related macular degeneration,one had recent cataract surgery); 55% werefemale and the mean age was 80.2 years.Thirteen patients (65%) had some visualimpairment, and four patients (20%)improved with pinholes. Similarly, van derPols et al reported that vision improved withpinholes in 22.6% of a national sample ofBritish elderly, and Wormald et al reportedan improvement in 27% of their subjects(elderly people living in central London). Fullrefraction and revised prescription may be ofbenefit to these patients.Nineteen patients (95%) had regular eyetests at their optician. The one patient whodid not attend regularly was found to havea vision impairment that improved withpinholes. This patient was advised to seetheir optician for refraction.The editorial concluded that complemen-tary approaches, facilitated around a primarycare hub, may reduce the levels of treatablevision impairment in older people. This smallaudit suggests that, despite the findings ofrecent clinical trials, primary care may stillhave a role in the prevention of treatablevision impairment, albeit a small one: essen-tially to educate patients and remind them toattend their opticians regularly. Alexander J Silvester Correspondence to Dr Alexander Silvester, FoundationYear 1 Doctor, Countess of Chester Hospital NHSFoundation Trust, Liverpool Road, Chester CH2 1UL, UK;[email protected] Competing interests None. Provenance and peer review Not commissioned;externally peer reviewed.Accepted 9 July 2009Published Online First 4 March 2010 Br J Ophthalmol 2010;94:1550.doi:10.1136/bjo.2009.168138 REFERENCES1. Evans J, Smeeth L, Fletcher A. Vision screening.Br J Ophthalmol 2009;93:704e5.2. van der Pols JC, Bates CJ, McGraw PV, et al. Visual acuity measurements in a national sample of British elderly people. Br J Ophthalmol 2000;84:165e70.3. Wormald RP, Wright LA, Courtney P, et al. Visual problems in the elderly population and implications for services. BMJ 1992;304:1226e9. Rapid detection ofAcanthamoeba cysts in frozensections of corneal scrapingswith Fungiflora Y We read with great interest the article byShiraishi et al who have described a goodtechnique for the laboratory diagnosis ofAcanthamoeba cysts in corneal scrapings ofpatients with clinical features of Acantha-moeba keratitis using Fungiflora Y (FFY). Wewould like to share some of our commentsrelated to this study.Though described by the authors asa simple and fast technique, it calls for theuse of expensive machinery such as thecryotome and expertise to take frozensections. The availability of such equipmentcannot be taken for granted even in tertiarycare eye hospitals. Although the cost of FFYis not mentioned, it is possibly more expen-sive than calcofluor white (CFW). Based onour experience of routinely diagnosingAcanthamoeba keratitis in corneal scrapingsusing CFW stain and going by figure 1C inthe article by Shiraishi et al, we believe thatthe results obtained with CFW are likely tobe the same as those obtained using FFY.Both FFY and CFW stain the cellulose in theAcanthamoeba cysts and have the limitationof unstained trophozoites.In the absence of a comparative study, thesuperiority of this technique over any othermethod of detection of cyst in cornealscrapings cannot be established.The authors note that corneal scrapingswere taken twice a week but have notmentioned why they were taken or how thescrapings were evaluated in the laboratory.The patients were treated with 0.05%chlorhexidine and 1% voriconazole. Thereason for using topical voriconazole as theprimary therapy is not clear. Use of topicalvoriconazole has been described only inrecalcitrant cases of Acanthamoeba keratitis.Were the authors not sure what they weretreating? Furthermore, performing the studyonly on clinically suspected cases and non-inclusion of other types of microbial keratitisalso amount to a certain level of bias. 1550Br J Ophthalmol November 2010 Vol 94 No 11PostScriptgroup.bmj.comon November 12, 2010 Published bybjo.bmj.comDownloaded from