486 LEITERS TO THE EDITOR ing of glaucoma: 6% did not know they had the condition and 46% scored zero for the question "What is glaucoma." Only 5% gave a completely correct answer to this question. The mean score declined in a steady fashion with age (Fig. 1). The score was unrelated to duration of disease but was higher in those with affected relatives (p<O.Ol). Understanding of the treatment was better: 57% knew that glaucoma could be effectively treated, 76% understood what would happen without treatment and 49% knew that treat ment should be lifelong, however, 41% erroneously believed that their sight would be improved by treatment. Thirty per cent gave correct responses to all of these. It was alarm ing to fnd that only 12 of 39 patients who had undergone surgery had any understanding of trabeculectomy and 44% thought this carried no risk! The familial nature of glaucoma was appre ciated by 42%, and as expected this awareness was more frequent in those with affected rela tives, (p<O.OOl). The most revealing question concerned desire to know more about glaucoma and 67% said they did not want to learn more. Those who had scored least to the 'key' question 'What is glaucoma' were less likely to want more information; those who already knew the most wanted to learn more (p<O.OOl). Such apathy was not more frequent in older patients. In summary, there is an astonishing lack of knowledge in glaucoma patients. Few com parisons are available but patients in Leices ter! and Southampton2 gave broadly e § c ' " :; 1 50·59 60-69 Age (years) Fig. 1. Mean score for question (a) according to age of patient. comparable results. Many seem to be adopt ing a 'head in the sand' attitude which presents considerable diffculty if the basic hope that improved understanding leads to better com pliance is true, however it is notable that in one large study a well organised education programme failed to increase medication compliance in benign hypertension.3 Never theless the average glaucoma patient has a woeful ignorance of the disease and efforts should certainly be made to improve this, . although this study suggests that such well meaning attempts may not be universally welcomed. A. J. Elliott, FRCS, MRCP. Senior Registrar in Ophthalmology, Addenbrookes Hospital, Cambridge. References ! Rosenthal AR, Zimmerman JF, Tanner J: Educat ing the glaucoma patient. Br J Ophthalmol1983, 67: 8147 . 2 MacKean JM and Elkington AR: Alerting close rel atives of patients with glaucoma. Br Med J 1984, 289: 80O-D1. 3 Sackett DL, Haynes RB, Gibson ES, et al: Random ised clinical trial of strategies for improving medi cation compliance in primary hypertension. Lancet1975, i: l205-D7. Sir, Skin signs during giant cell arteritis, (GCA), varying from redness of the temples to frank gangrene of the scalp, occur infrequently.! Most reported cases of the skin manifestations of GCA have been in dermatological journals. Having recently examined fve patients where these skin signs were of diagnostic importance, two are briefy described to bring this sign to the attention of ophthalmologists. Case I A male, aged 64, presented with sudden loss of right vision. Two weeks earlier he had developed a painful, rash on the temples. Visual acuity was light perception right and 6/9 Snellen left. There was right anterior ischaemic