Acta Ophthalmologica最新文献

Purpose: We lack knowledge on the potentially progressive nature of and the prevalence of complications to myopia as a characteristic trait of Stickler syndrome.

Methods: This cross-sectional study combines ophthalmic examination and medical record data on Danish patients with genetically confirmed Stickler syndrome type 1 (COL2A1) and type 2 (COL11A1). The main outcomes are axial length, spherical equivalent refraction (SER), SER over time, and myopic maculopathy category by fundus photography.

Results: The study includes 71 patients with type 1 (age: median = 29 years, IQR = 15-49 years; 44% male) and 13 with type 2 Stickler syndrome (age: median = 27 years, IQR = 9-33 years; 69% male). For type 1, the median SER was -6.00 dioptres (D) (IQR = -8.88 to -2.19 D) and -6.75. (IQR = -10.88 to -1.94) for type 2, (p = 0.52). Mean axial length was 25.99 ± 1.99 and 26.55 ± 3.45 mm, respectively (p = 0.57). SER was nonprogressive in childhood in both subtypes. Myopic maculopathy was present in 28 (43%) type 1 and five (42%) type 2 patients. The odds for higher category myopic maculopathy increased by a factor of 2.15 with each mm of axial elongation (95% CI = 1.14 to 4.04, p = 0.02) but not with age (odds ratio = 1.02 per year, 95% CI = 0.97 to 1.09, p = 0.39) in type 1.

Conclusion: We find myopia in our cohort is nonprogressive. We find no difference in axial length or refractive error between subtypes. Myopic maculopathy is common, its severity depending on axial length, not age. These findings are relevant for risk stratification of vision-threatening myopia.

Purpose: It is important for clinicians to identify patients with glaucoma at higher risk of poor adherence to topical therapy at an early stage to prescribe alternative treatments. An expert-based set of statements was developed to assist clinicians in the early identification of patients at high risk of low adherence and subsequent poorer clinical outcomes.

Methods: A two-step strategy was used. First, statements were developed by a panel of experts using data from a literature search as a starting point. Second, we measured agreement with the statements in a representative group of ophthalmologists managing patients affected by glaucoma.

Results: A total of 18 statements and consensus was reached for all. The available evidence and clinical experience have identified some subpopulations at high risk of poor adherence. These include young individuals with competing interests, being frequently away from home, multiple comorbidities and particularly when they affect joint function of the hands or cognitive abilities, being asymptomatic, and being poorly informed about the severity of the disease. The unavailability of caregivers and living alone seems to be relevant factors, particularly in older and more frail patients.

Conclusion: Taken together our results allow us to profile patients with glaucoma who will be more likely to show poor adherence to topical treatments. Moreover, the consensus statements can be used to identify patients who are unsuitable for topical drops and who would benefit more from alternative treatments.

Purpose: To evaluate long-term outcomes of anti-VEGF therapy for nAMD using the Polish Retinal Therapeutic Program Monitoring Registry.

Methods: The cohort consisted of 63 840 eyes with nAMD qualified for treatment from 2016 to 2022, with follow-up through 31 October 2023. Long-term follow-up (>5 years) was conducted for 7631 eyes. Statistical comparisons and multivariate logistic regression analysed differences between treatment failure and long-term treatment, treatment effectiveness, drug efficacy and predictive factors.

Results: The relative risk of nAMD in females was 1.45. By the last follow-up, 17 518 (48.6%) patients discontinued treatment due to patient-related factors, 7202 (20.0%) due to treatment failure, 6285 (17.4%) for other reasons and 5065 (14.0%) due to death or clinical complications. Long-term patients were significantly younger, more of them were previously treated, received fewer injections per year and had better baseline BCVA and lower CRT than the failure group. Females and previously treated patients had a higher likelihood of long-term therapy, while older age and initial ranibizumab treatment increased the risk of failure. Patients with an initial BCVA >0.4 logMAR had significantly worse BCVA outcomes, while CRT and treatment strategy showed no significant differences. Introduction of programme exclusion if treatment gap >4 months reduced long breaks, increased injection numbers, slightly lowered BCVA and had no significant effect on CRT.

Conclusion: Early visual acuity response, drug choice (aflibercept), and healthcare system modifications influence long-term success and adherence in nAMD management. While systemic changes improved continuity and injection frequency, they did not enhance visual outcomes, highlighting the need for individualized treatment strategies.

Purpose: To investigate whether primary open-angle glaucoma (POAG) is associated with an increased long-term risk of developing Alzheimer's disease, given its shared neurodegenerative features.

Methods: A 20-year longitudinal, registry-based matched cohort study was conducted using Danish national health registries from 1998 to 2018. Individuals aged 65 years or older with POAG identified by registration with the diagnostic code (ICD-10 = H40.1*) or at least four redeemed glaucoma prescriptions (ATC = S01E*) within 1 year entered the cohort. Each individual with POAG was randomly matched with five controls of the same sex and birth year. The outcome of Alzheimer's disease was defined by registration with the diagnostic code (ICD-10 = G30*, F00*). A Cox regression model adjusting for age, sex and systemic comorbidities estimated the hazard ratio (HR) for Alzheimer's disease and a Fine-Grey competing-risk model accounted for death as a competing event.

Results: The study included 61 829 individuals with POAG and 306 794 matched controls (42.63% males, 57.37% females; median age 75.22 years, IQR: 70.35-80.63). Alzheimer's disease developed in 1.61% of individuals with POAG and 1.59% of controls. POAG did not appear to increase the risk of Alzheimer's disease (adjusted HR 0.98, 95% CI: 0.93-1.03). Competing risk analyses found a slightly increased risk of Alzheimer's disease observed among men with POAG (sHR 1.12, 95% CI: 1.03-1.21), whereas no association was found among women (sHR 1.00, 95% CI: 0.94-1.07).

Conclusion: In this nationwide matched cohort study, POAG was not clearly associated with an overall increased risk of developing Alzheimer's disease over 20 years.

The Consortium for Refractive Error and Myopia (CREAM) was established in 2011, bringing together an international team of researchers studying more than 30 cohorts. Since its establishment, CREAM has played a pivotal role in research investigating the genetics of myopia and other refractive errors, serving as a key driver of progress in the field. The aim of this review is to highlight the latest advances and insights from CREAM, with a focus on research carried out in the past 5 years. We performed a literature review of journal articles authored by the CREAM consortium since the year 2020, when the last review of CREAM consortium findings was published. Key discoveries from recent CREAM studies were the identification of SIX6, CRX, PER3, PDCD6IP, MAPT, CHST6, GRHL2, USH2A, P4HTM, COL4A4 and ATM as high-confidence candidate genes associated with myopia development. Variants in enhancers and lncRNA regions were shown to have potential regulatory effects on refractive error; the DDIT4 gene was highlighted as a potential hotspot for future analyses. A polygenic risk score for predicting high myopia with an area under the curve (AUC) accuracy of 0.78 was made openly available; prediction accuracy was close to that required for clinical use. A shared genetic architecture for refractive error and axial length was confirmed. Novel findings were the identification of rare, large-effect gene variants through targeted and whole exome sequencing and the development of a polygenic risk score for predicting children at risk of developing high myopia. Large-scale multi-ancestry genome-wide association studies of the myopia endophenotypes axial length and corneal curvature doubled the number of common genetic variants known to be associated with these traits. Nevertheless, much remains to be done to fulfil the promise of myopia genetics research for improving the detection of children at above-average risk of high myopia, and the prevention and treatment of myopia.

Purpose: To assess whether atrial fibrillation (AF) is associated with an increased risk of age-related macular degeneration (AMD).

Methods: This multinational retrospective cohort study included individuals aged 50 years or older, with or without AF at baseline, from healthcare organisations across 21 countries during 2015-2020 in the TriNetX database. Participants were classified into those with and without AF, and followed for up to 5 years to observe the occurrence of AMD, including both dry and wet forms, and other cerebrovascular outcomes. The AF and non-AF groups were 1:1 propensity score-matched to balance baseline characteristics and comorbidities. Outcomes were assessed using Cox regression models and Kaplan-Meier analysis.

Results: A total of 113 974 individuals were included in the final analysis. The mean follow-up (standard deviation [SD]) is 4.09 (1.30) years in the AF group and 4.53 (0.95) years in the non-AF group. During follow-up, 1169 individuals developed AMD, 527 developed dry AMD, and 242 developed wet AMD. Compared to individuals without AF, those with AF have a significantly higher risk of developing AMD (hazard ratio [HR], 2.72; 95% confidence interval [CI], 2.42-3.11), dry AMD (HR, 2.55; 95% CI, 2.12-3.07), wet AMD (HR, 2.50; 95% CI, 1.90-3.28), and ischemic stroke (HR, 1.67; 95% CI, 1.60-1.73). Across most subpopulations, AF is consistently linked to higher risks of both dry and wet AMD.

Conclusion: Individuals with AF experience a higher risk of developing both dry and wet forms of AMD compared to individuals without AF.

Purpose: To analyse pain sensation after phototherapeutic keratectomy (PTK) using chilled eye drops or drops at room temperature during the early postoperative period.

Methods: Our randomised controlled, parallel-group study conducted in the Department of Ophthalmology, Goethe-University, Frankfurt (Main), Germany, with blinded participants and outcome assessors included patients undergoing PTK. Postoperatively, eye drops in one group were chilled and in the other group at room temperature (warm). Patients completed pain questionnaires six times on the first 3 postoperative days. Pain intensity was primarily assessed by means of the numerical rating scale (NRS) at 8 a.m. on Day 1. Secondary outcomes included pain on the visual analogue scale (VAS), sensory qualities of pain, overall pain intensity, epiphora, foreign body sensation and additional need for analgesics.

Results: Fifty-one patients were analysed in the chilled group and 49 in the warm group. Median NRS and VAS on Day 1 were 2 (range: 0-8) and 13 (0-76) in the chilled group and 1 (0-8) and 4 (0-79) in the warm group, respectively (p = 0.11 and 0.10). On Day 2, values were 2 (0-7) and 14 (0-52) in the chilled group and 2 (0-10) and 19 (0-99) in the warm group (p = 0.34 and 0.82). There was no significant difference in secondary outcomes. Additional painkillers on Day 1 were required by 29% and 18%, respectively (p = 0.23).

Conclusion: Using chilled eye drops following PTK does not reduce pain compared with eye drops at room temperature in the early postoperative period.

Purpose: The purpose of this study was to assess the agreement between the European Driving Test (EDT)-a new perimetry test designed to comply with the visual field requirements for Group 1 drivers outlined in the European Commission Directive 2009/113/EC-and the manner in which these standards are applied across European countries.

Methods: This was a cross-sectional study of patients with visual field loss who underwent fitness-to-drive visual field assessments at the University Hospital Zürich between 2023 and 2025. Patients completed monocular static and kinetic perimetry, as well as binocular perimetry with the Esterman test and the EDT, all performed using an Octopus 900 perimeter. We determined pass/fail outcomes according to Swiss, Swedish, Norwegian and British criteria. We analysed inter-country agreement and diagnostic accuracy of national criteria relative to the EDT using Fleiss' kappa, sensitivity and specificity.

Results: The study enrolled 243 patients. Pass rates were 65% (Switzerland), 76% (Sweden), 74% (Norway) and 86% (UK). Inter-country agreement was moderate (Fleiss' κ = 0.56), with lower agreement in central (κ = 0.57) than peripheral (κ = 0.69) visual fields. Compared to EDT results, national standards demonstrated high specificity (0.87-1.00) but variable and low sensitivity (0.39-0.76), particularly for the central visual field.

Conclusion: The application of common visual field standards for driver licensing varies across European countries, especially concerning central visual field criteria. Our findings support adopting a uniform perimetry algorithm to ensure consistent visual field evaluation in fitness-to-drive assessments.

Purpose: To determine the long-term blindness rate and related prognostic factors in eyes with open-angle glaucoma after trabeculectomy using adjunctive mitomycin C (MMC).

Methods: The retrospective cohort study included 714 eyes from 714 patients with open angle glaucoma who underwent trabeculectomy using MMC. We defined blindness based on the World Health Organization (WHO) criteria as best-corrected visual acuity (BCVA) <20/400 and/or central visual field <10°. We used Kaplan-Meier analysis to estimate the nonblindness rate postsurgery.

Results: Preoperatively, the mean (standard deviation) BCVA, intraocular pressure (IOP) and mean deviation (MD) using the central 30-2 program of Humphrey Field Analyser were 0.11 ± 0.31, 20.5 ± 7.1 mmHg, and -16.93 ± 7.16 dB. The follow-up period was 11.7 ± 7.3 years, and the mean postoperative IOP reduction rate was 41.4% ± 20.2%. The 10- and 20-year cumulative survival rates were 87.8% and 82.6%. The survival rates were significantly higher in the groups with better preoperative BCVA, preserved preoperative MD, and higher mean postoperative IOP reduction rate (all p < 0.001). Moreover, the analysis of prognostic factors for blindness showed that the multivariate hazard ratios for preoperative BCVA, preoperative MD and mean postoperative IOP reduction rate were 4.74, 0.92 and 0.97, respectively (all p < 0.001).

Conclusions: One-eighth and one-sixth of the eyes became blind at 10 and 20 years post-trabeculectomy using MMC. Preoperative severe visual impairment and visual field loss and postoperative nonsustained IOP reduction were identified as independent prognostic factors leading to blindness.