Of the five cases shown under vitreous opacities, three were obviously due to the inflammation of the uveal tract posterior to the iris; two others were due to hæmorrhage into the vitreous. Many more cases would undoubtedly have shown vitreous opacities had the pupils been patent. Moreover, our pathological data show that not a few of the cases in which the fundus reflex was absent presented dense exudates into the vitreous cavity. This subject will be dealt with at length under pathology. The genesis of hæmorrhage into the vitreous is obvious, and it is more than probable that if all the cases were seen at an early stage the figure for this complication would be much higher. From the foregoing notes, it is clear that the native coucher undertakes a certain number of what we should recognise as inoperable cases. It is possible that in many of them a secondary cataract is present; but it is clear that his diagnostic powers are low. He is a standing menace to the safety of the public. It has from time to time been suggested that the presence of the lens in the vitreous chamber brings about retinal changes. The author is not, however, aware of any reliable evidence either ophthalmoscopic or pathological to support this view. As far as possible, all cases seen in Madras were submitted to ophthalmoscopic examination, whether the couching had resulted in success or failure. We were unable to discover any characteristic change which could be attributed to the couching. A large percentage of the fundi examined appeared to be absolutely normal. The most frequent departure from normal was an undue distinctness of the choroidal vessels, which was evidently due to the absorption of the pigment of the pigmentary layer of the retina. It is probably this phenomenon which has misled some into the belief that couching is followed by changes in the retina allied to those in retinitis pigmentosa _sine_ pigmento. This absorption of retinal pigment is, however, well known to occur in other conditions, as, for instance, in high myopia; moreover, in the case of couched eyes, it is not accompanied by the changes in the disc and vessels characteristic of retinitis pigmentosa, or by the equally characteristic night blindness. In searching for the explanation of this phenomenon, four solutions at once present themselves for consideration: (1) It might be, as has been suggested, a result of couching; (2) it might be due to the alterations in the refractive conditions under which the fundus is seen; (3) it might be a physiological abnormality; and (4) it might be an accompaniment of, and a direct result of pathological changes in the eye accompanying the development of cataract. The third suggestion is thrown out by our experience of normal native eyes. An important light has been thrown on the whole question by the observation that a similar change is found in quite a number of eyes which have been submitted to cataract extraction.