Acta Ophthalmologica最新文献

Purpose: This study characterized and assessed vision-related quality of life (VRQoL) in patients with neovascular age-related macular degeneration (nAMD) who discontinued treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF), comparing them to those undergoing treatment. Secondarily, it explored reasons for treatment discontinuation against medical advice.

Methods: This survey-based cross-sectional study used data collected for the Danish study, "Identification of Patient-Reported Barriers in Treatment for nAMD" (I-OPTA) at Odense University Hospital, Denmark. I-OPTA included a self-developed questionnaire and the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Main outcomes were demographics, treatment details, NEI-VFQ-25 scores, and reasons for treatment discontinuation against medical advice. Linear regression models investigated the impact of variables on the composite NEI-VFQ-25 score.

Results: The study included 172 (32.6%) patients who had discontinued treatment and 356 (67.4%) patients who were undergoing treatment; 10 (5.8%) discontinued against medical advice. Discontinued patients were older (median 81.0 years, p-value = 0.004), had lower best-corrected visual acuity (BCVA) in the worse-seeing eye (p-value<0.001), had a shorter treatment duration (p-value = 0.001) and lived alone (p-value = 0.044). Discontinued patients showed lower scores in all NEI-VFQ-25 domains except ocular pain. Higher BCVA correlated with a higher composite score of NEI-VFQ-25. Reasons for discontinuation against medical advice included treatment burden and perceived inefficacy.

Conclusion: Patients who discontinued treatment for nAMD report lower VRQoL, with lower BCVA in the worse-seeing eye, older age, living alone, and unilateral treatment possibly contributing to treatment discontinuation. Future studies on visual acuity and retinal fluid in this group could guide decisions on treatment discontinuation, emphasizing patients' quality of life.

Purpose: To analyse the frequency and type of coexisting systemic disorders in children operated on for cataract in Sweden.

Methods: Data were retrieved from the Swedish National Pediatric Cataract Register (PECARE) for children operated between January 1, 2007, and December 31, 2023 (n = 975), including follow-ups at age 1, 2, 5 and 10. Cataracts due to uveitis, trauma or radiation, and lens extraction due to luxation were excluded. Genetic screening was not mandatory during this period.

Results: Of the 872 children who remained after exclusions, 466 (53.4%) had unilateral cataracts and 406 (46.6%) had bilateral cataracts. Coexisting systemic disorders were found in 132/872 (15.1%), of which 5/132 (3.8%) were strongly suspected, 64/132 (48.5%) defined and 63/132 (47.7%) undefined. Overall, 20/872 (2.3%) were developmentally delayed without any systemic disorder diagnosis. Systemic disorder was present in 20/466 (4.3%) with unilateral cataracts, 112/406 (27.6%) with bilateral cataracts, 22/138 (15.9%) with bilateral inherited cataracts and 11/32 (34.4%) with parental consanguinity.

Conclusion: Coexisting systemic disorders were present regardless of laterality, but more common among children with bilateral cataracts. Prevalence was similar among children with consanguineous parents, and lower among children with hereditary cataracts. National consensus regarding genetic screening for systemic disorders is needed.

Purpose: To assess the longitudinal change of choroidal thickness (ChT) and tessellated fundus progression in Chinese adults over 4 years.

Methods: In this population-based longitudinal cohort study, 1646 right eyes of 1646 participants were examined. Fundus photographs were obtained and ChT was measured using swept-source optical coherence tomography. Participants were categorized into high-myopia, low-myopia, and non-myopia groups, and the tessellated fundus was graded 0-3 based on the fundus photographs.

Results: The mean baseline age, refractive error, axial length (AL), and macular ChT were 62.51 ± 9.89 years, -0.48 ± 3.18 D, 23.71 ± 1.58 mm, and 199.7 ± 77.3 μm, respectively. At the 4-year follow-up, a significant reduction in macular ChT of 4.05 ± 6.24, 4.44 ± 6.87, and 3.51 ± 5.17 μm per year was observed in the non-myopia, low-myopia, and high-myopia groups, respectively. Age, baseline ChT, and AL changes (with β^non-M = -78.439, β^HM = -56.505) were independently related to the rate of macular ChT change (all p < 0.05). Furthermore, the decrease in the ChT distribution pattern varied with different refractive groups. Moreover, 4.31% of the participants had tessellated fundus progression; these participants had more ChT reduction over 4 years than those without tessellated fundus progression (p < 0.001).

Conclusions: Choroidal thinning was found to be associated with age and AL elongation. For every 1 mm increase in AL, the decrease rate of ChT in the high-myopia group was slower than that in the non-myopia group. Progression of tessellated fundus was associated with a faster decrease in ChT, highlighting its potential as a biomarker for myopia progression.

Purpose: To investigate the prevalence, developmental stages, and factors affecting the progression of subfoveal nodules (SFN) in Coats' disease.

Methods: A retrospective review of medical records and multimodal images was conducted for patients with Stage 2A-3A Coats' disease in a tertiary university setting. SFN development was classified into five stages: Stage 0 - macular exudation without subfoveal hard exudate; Stage 1 - subfoveal exudation; Stage 2 - consolidation of exudation; Stage 3- vascularization of SFN; Stage 4 - scarring and subfoveal fibrotic nodule. Factors influencing the formation and progression of SFN were analysed.

Results: The study included 44 eyes of 43 patients, with a mean age of 6.9 ± 4.1 years and a mean follow-up of 33 months. SFN prevalence was 48% initially and 91% at final follow-up. No differences were noted in baseline demographics or clinical characteristics across SFN stages. Patients developing SFN earlier than 9 months were significantly younger than those developing in a longer period (>9 months) (5.9 ± 2.7 vs. 8.9 ± 3.6, p = 0.037), and the mean number of intravitreal (IV) anti-VEGF/steroid injections applied per year was lower in the latter group (3.69 ± 1.29 vs. 1.12 ± 1.21, p = 0.001). The risk of early SFN development was 2.4 times higher in patients under 7 years and four times higher in those receiving three or fewer IV anti-VEGF/steroid injections per year.

Conclusion: The prevalence of SFN (91%) in this study was found to be higher compared with the literature. More frequent anti-VEGF/steroid injections, compared with conventional treatment, may slow the progression of SFN.

Purpose: Acquired brain injury (ABI) may cause homonymous visual field (VF) defects. Standard automated perimetry (SAP) is the gold standard for VF assessment, but it can be challenging in ABI. Continuous visual stimulus tracking (SONDA; Standardised Oculomotor and Neurological Disorders Assessment) simplifies the perimetric task to following a moving stimulus on a screen. We investigated whether tracking performance (agreement between gaze and stimulus position) measured with a SONDA-based eye movement perimetry technique (SONDA-EMP) (1) can detect visual function loss in patients with homonymous VF defects, (2) can quantify visual function loss (in terms of SAP Mean Sensitivity [MS]) and (3) shows a learning effect.

Methods: Tracking performance was evaluated in 16 cases with unilateral ABI (median [IQR] age 66 [62-68] years; SAP MS 19 [15-21] dB; 8/8 with left-/right-sided VF defect) and compared to previously collected data of 36 controls (age 70 [67-72] years). All participants monocularly tracked a moving stimulus (Goldmann size III) at three Weber contrasts (40%, 160% and 640%), while their eye movements were recorded.

Results: ABI significantly decreased tracking performance (p < 0.0001) compared to controls at all contrasts, independently of VF defect side (p = 0.53). Performance improved from 40% to 160% contrast (p < 0.0001), but not from 160% to 640% (p = 0.53). SAP MS correlated moderately to strongly with tracking performance (r = 0.46 [p = 0.07], 0.73 [p = 0.01], 0.67 [p = 0.004], for 40%, 160% and 640% contrast, respectively). Retesting showed no significant learning effect.

Conclusion: SONDA-EMP can detect visual function loss from ABI. The reduction in tracking performance depends on the amount of VF loss.

Central serous chorioretinopathy (CSC) is a chorioretinal disease characterised by serous subretinal fluid (SRF) in the macula, resulting in sudden central vision loss. It predominantly affects working-age adults, particularly men aged 30 to 60 years. Its multifactorial pathophysiology is modulated by systemic factors, such as corticosteroid use, psychological stress, and hypertension. Previous studies suggest that broader environmental influences, including seasonal variation, may contribute to disease onset. This study aimed to systematically review and analyse the evidence on seasonal variation in CSC incidence. A systematic search was conducted across 10 databases (PubMed, Embase, Cochrane Central, Web of Science Core Collection, Current Contents Connect, Data Citation Index, Derwent Innovations Index, KCI-Korean Journal Database, ProQuest™ Dissertations and Theses Citation Index, and SciELO Citation Index) on 22 June 2025. Eligible studies included observational designs reporting CSC incidence or frequency across seasons; case reports and reviews were excluded. Five studies, with 907 participants in total, met the inclusion criteria. Three studies with sufficient data were included in quantitative meta-analysis, while the remaining two conference abstracts were included in the qualitative synthesis. Seasonal variation in CSC incidence was reported across studies. Meta-analysis using summer as the reference season showed a significantly increased incidence of CSC in spring (OR 1.42; 95% CI: 1.18-1.73; p = 0.0003) and autumn (OR 1.23; 95% CI: 1.02-1.48; p = 0.03). No significant difference was found for winter (OR 0.97; 95% CI: 0.80-1.19; p = 0.80). The remaining 2 studies not included in the meta-analysis also reported seasonal trends consistent with these findings. The findings indicate a significant seasonal variation in CSC incidence, with a consistently increased risk during spring and autumn compared with summer. Further research is needed to examine how seasonal environmental and physiological mechanisms may contribute to CSC development.

Purpose: Assessment of patient preferences for local adverse effects (AEs) of intraocular pressure (IOP)-lowering eye drops.

Methods: A total of 10 000 eye drop-treated patients aged 40-75 years were sampled from the Danish national registries. A discrete choice experiment (DCE) was distributed to each patient to elicit preferences for distinct levels of five representative local AE attributes of IOP-lowering drops: acute discomfort, persistent discomfort, blurred vision, non-persistent cosmetic changes, and persistent cosmetic changes. Preference weights were computed using conditional logistic regression and normalised using profile-based normalisation. The mildest severity levels were used as a reference. Heterogeneity analyses were conducted across patient covariates to examine variation in preference patterns.

Results: A total of 2445 patients (24% response rate; 55% male; median age: 67 years) completed the DCE, with 2096 providing additional covariate data. 95% reported a diagnosis of glaucoma or ocular hypertension. More females than males reported currently experiencing AEs (48% vs. 35%). 25% had previously discontinued treatment with IOP-lowering eye drops due to AEs. The DCE revealed significant differences in the patients' preferences for avoiding AEs. Severe blurred vision, persistent cosmetic changes, and persistent discomfort exhibited the highest levels of disutility. Moderate acute discomfort and non-persistent cosmetic changes were least important. The patients' preferences varied notably by age and gender.

Conclusion: This study provides novel insight into patients' preferences for AEs of IOP-lowering eye drops by identifying the characteristics that most strongly influence treatment choices. These insights support future clinical studies and shared decision-making, facilitating personalised care that can improve adherence, quality of life, and long-term patient outcomes.

Purpose: The TWO-ROP algorithm is a modified screening protocol based on US data for low-risk infants that limits screening to a single outpatient exam at 38 or 40 weeks to reduce the retinopathy of prematurity (ROP) screening burden without compromising safety. The aim of this study was to validate the algorithm on an external data set outside the United States.

Methods: This is a retrospective study of premature infants screened for ROP at a tertiary centre in Greece. Infants with higher birth weight (BW) and greater gestational age (GA) were included and stratified into three groups: group 1 (BW < 1500 g, GA ≥ 32 weeks), group 2 (BW ≥ 1500 g, GA < 32 weeks) and group 3 (BW ≥ 1500 g, GA ≥ 32 weeks). The rate of ROP and type 1 ROP were evaluated.

Results: Five hundred and fifty-three of the 1251 infants (44.2%) met the inclusion criteria. Groups 1, 2 and 3 had 139 (25.1%), 283 (51.2%) and 131 (23.7%) patients. Fourteen patients (2.5%) had ROP, including 7 in group 1, 7in group 2 and 0 in group 3 (p < 0.001). No patient met the criteria for type 1 ROP. No cases of treatment warranted ROP (TW-ROP) were observed in the cohort, indicating no missed cases under the TWO-ROP algorithm. When applying the algorithm, 14.3%-14.9% (mean 14.6%) of ROP examinations were saved.

Conclusion: The TWO-ROP algorithm can reduce examinations while ensuring safety in Greece when using the local screening guidelines. This is the first ex-US validation and supports the potential for risk-stratified screening globally to optimize resources while maintaining safety.

Background: Evaluating keratometric power with Zeiss index (PKZ), paraxial thick cornea power (Gullstrand [PG]) and power referenced to the front (PFV) and back vertex plane (PBV) and raytracing power (PR), and modelling the deviation from PKZ with a multivariable linear prediction model.

Methods: A dataset of 4604 Casia2 measurements from a cataractous population was Copula expanded to N = 30 000 maintaining the individual univariate distributions and interactions. PKZ was compared with paraxial thick lens corneal power PG, PFV, PBV, and PR using measured pupil size and variations of apertures from 1 to 6 mm.

Results: On average, PKZ/PG/PFV/PBV was 43.05/42.74/42.83/43.59 D, and PR was 43.03 D with the measured pupil size. Varying pupil size from 1 (1) 6 mm increased mean PR with aperture size (42.84/42.91/43.02/43.17/43.37/43.62 D). The multivariate linear models predicting the deviation of PG-PKZ, PFV-PKZ, and PBV-PKZ with corneal radii and central thickness performed well, with R² = 0.93 and a root mean squared prediction error of 0.01 D, whereas the equivalent model for PR-PKZ with corneal radii and asphericities, corneal thickness, and aperture sizes performed less well, with R² = 0.79 and a root mean squared prediction error of 0.18 D.

Conclusion: Corneal power derived using the paraxial thick cornea model differs from keratometric power and a linear model performs well in predicting the differences. However, raytracing power differs even more from keratometry with the linear model far less effective.