For children under 8, the HOTV chart cut vision screening referrals and caught more true problems than tumbling E

The edition in brief

In 995 Shanghai children tested with both charts, tumbling E measured vision worse than HOTV by about a line at age 3 and by more than 3 letters up to age 8, converging after that. Among 183 preschoolers, HOTV referred fewer children (18.6% vs 31.2%) while detecting more true cases (true positive rate 0.68 vs 0.44) with better specificity (0.93 vs 0.79). Tumbling E charts are commonly used in child screening in India, so switching to HOTV for under-8s could reduce false referrals. Pooled data from 168 population surveys in 61 countries found cataract surgery in outreach camps less likely to give presenting vision of 6/18 or better than fixed facilities (60.6% vs 66.6%; OR 0.59), with private hospitals doing better than government ones (OR 1.56); gaps did not narrow over 20 years. An indirect comparison of three trials in retinal vein occlusion found aflibercept 8 mg more likely to reach driving vision than faricimab (RR 1.18), while faricimab dried the retina more often and caused fewer post-injection pressure spikes. In the GALE extension, eyes started on pegcetacoplan two years earlier preserved about three times more retinal tissue in non-subfoveal geographic atrophy. A 100-eye Indian trial found a single subconjunctival triamcinolone injection non-inferior to six weeks of topical prednisolone after phacoemulsification, with more subconjunctival haemorrhage. The pearl: do a cycloplegic refraction before labelling a child amblyopic.