1.1 Moorfields is formally linked to the Institute Division of Epidemiology. The International Centre for Eye Health is a World Health Organisation Collaborating Centre for the Prevention of Blindness and has moved to the London School of Hygiene and Tropical Medicine (LSHTM). The Trust epidemiology research unit has therefore developed a formal link to the LSHTM which will strengthen our research programme with support in the fields of health economics, social science, statistics and public health medicine. Research is primarily concerned with the commonest conditions causing blindness and visual impairment, and the health services necessary for disease prevention and eye health care.

1.2 The work of the Epidemiology Research Unit includes the Cochrane Eyes and Vision Group (CEVG) and support for the development of the Phenotyping Unit and the Clinical Trials Unit. The epidemiology unit supports the development of the evidence base for ophthalmic medical and surgical practice through the CEVG and the Clinical Trials Support Unit. The work of the CEVG includes:

1.2.1 20 completed reviews, 20 published protocols and 30 titles in progress

1.2.2 A contract with BMJ publications for Evidence Based Ophthalmology, a book which summarises the available trial evidence in the speciality and highlights major gaps in the evidence

1.2.3 Links to the development of clinical guidelines by the Royal College of Ophthalmologists

1.2.4 Links to international agencies such as the American Association for Ophthalmology and the 20:20 vision initiative of the World Health Organisation.

1.2.5 A user synopsis at the front end of all systematic reviews. Although reviews tend to be specific to interventions, there is usually a relevant 'suite' around one topic.

1.2.6 A successful grant from the Guide Dogs for the Blind Association (GDBA) to summarise all the available evidence of the effectiveness of treatments for age related macular disease and make them accessible to sufferers and persons at risk.

1.3 The work of the unit over the past year has focused on establishing a robust description of visual impairment in the UK as a major public health issue. The programme also supported the identification and prioritisation of research programmes in the National Five-Year Plan including prevention and rehabilitation. Progress has been achieved in this area with the following:-

1.3.1 Development of an electronic system for notification and certification of individuals registered as blind or partially sighted in the UK. Further development of this work is being discussed with the Royal College of Ophthalmologists and the DoH and will eventually be linked to the electronic patient record.

1.3.2 MRC funded collaborative trial (with LSHTM), in the elderly focusing on multidimensional screening of fifteen thousand elderly patients over 75 and supported by the GP Research Network. This constitutes the biggest data set of visual impairment in the elderly in the western world. Preliminary results confirm a higher prevalence of visual impairment in Britain's elderly compared to USA and Australia almost certainly due to unmet clinical need for correction of refractive error and cataract surgery. An MRC funded RCT of vision screening of the elderly has now been completed. This focused on the lack of evidence of effectiveness of screening identified in the Cochrane review.

1.3.3 Analysis of the data from the fifteen thousand patients above is continuing in order to establish the cause of visual loss and identify a large population sample with age-related macular degeneration. A case control study will then investigate major risk factors.

1.3.4 A multicentre trial of photodynamic therapy (PDT), with Belfast and the MRC clinical trials unit - graded a mid alpha but no funding available. Now under appeal supported by recommendations from NICE and the Macular Disease Society.

1.3.5 Tracking survey of uptake of PDT in the NHS over the last year - 2 questionnaire surveys completed and final to follow. Wide variation in attitudes and availability has been revealed.