The relative afferent pupillary defect (RAPD) is taught early in most medical careers. It is often tested in acute examinations, yet often the swinging flashlight test that elicits it can be very technique-dependent. In clinical settings where it can be most helpful, for example acute medical units, acute stroke units and emergency departments, it is frequently performed under conditions that work against it. Conditions like bright ambient light, a rushed single pass, and pupils examined once rather than swung repeatedly can affect the utility of this helpful neuro-ophthalmic test. This results in a sign that could either be missed, or worse falsely picked up as present when it is absent.  RAPD clearly weighs very heavily on the differential for unilateral optic nerve or severe retinal pathology. Therefore, looking at the gap between how the test is taught and how it ends  up being performed at the bedside can be very useful for clinicians.

In March and April 2025, as a final year medical student at Warwick Medical School, I spent four weeks in the Ophthalmology Department at Mawenzi Regional Referral Hospital in Moshi, Tanzania. Based mainly in the outpatient eye clinics, I observed and took part in the care of patients presenting with both acute eye emergencies and longer term follow up conditions. It was a very different picture of ophthalmic care to anything I had seen at home, and it left me thinking hard about what good outcomes really depend on.

Geographic atrophy caused by age-related macular degeneration is a permanent and worsening cause of central vision loss in older adults. Until recently, care mainly involved monitoring, visual aids, and support. Pegcetacoplan, a complement C3 inhibitor, became an important treatment after the OAKS and DERBY phase 3 trials. The trials showed that it slows the growth of areas of retinal damage, especially over 24 months. However, it did not significantly improve visual function at 24 months, and it increased the risk of new wet age-related macular degeneration. This commentary reviews what these findings mean for patients, including likely benefits, safety risks, treatment burden, and the need for longer-term evidence. Pegcetacoplan is an important advance, but it should be used with realistic expectations and careful patient selection.

In this article, we describe a child presenting to the ophthalmology department with periorbital swelling who was subsequently diagnosed with a Pott’s puffy tumour. This case highlights the importance of maintaining a high index of suspicion for orbital and intracranial complications of sinus disease in children presenting with seemingly uncomplicated eyelid swelling.

Taking a year out of medical studies to complete a BSc, MSc or related degree has long been valued for deeper learning, research experience and personal growth. However, the removal of “extra points” for intercalated degrees in allocation processes, including the foundation programme and later specialty training, has changed the incentive structure.

While advances in AI promise earlier diagnosis, improved efficiency and greater access to specialist care, their successful implementation depends not only on technological performance but also on clinicians’ ability to understand their capabilities and limitations. The widespread adoption of AI therefore creates a new educational responsibility: future ophthalmologists must develop sufficient AI literacy to safely evaluate and integrate these technologies into patient care.

The diagnosis of THS remains challenging because its presenting symptoms overlap with several potentially life-threatening conditions, including cavernous sinus thrombosis, intracerebral aneurysm, neoplasia, giant cell arteritis and inflammatory disorders such as sarcoidosis and granulomatosis with polyangiitis. Consequently, THS remains a diagnosis of exclusion and requires careful investigation to rule out the broad differential diagnosis of painful ophthalmoplegia.