Die Ophthalmologie最新文献

Background: Gene therapies offer promising approaches for the treatment of genetic diseases. With the approval of Neparvovec (Luxturna®, Novartis) in 2018, a gene therapy for the treatment of retinitis pigmentosa and Leber's congenital amaurosis in RPE65 mutations, this innovation has also reached ophthalmology practice. Despite their potential, gene therapies raise significant ethical and economic issues, particularly with regard to distributive justice, which could limit access and increase inequalities.

Aim of the paper: This article examines distributive justice from an ethical perspective, focusing on the just rationing of health resources and the affordability of gene therapies for rare diseases. The aim is to highlight areas of tension between ethical demands, economic interests and the financial sustainability of the healthcare system.

Methods: Selected literature will be reviewed to shed light on the distribution of scarce healthcare resources, potential financing models and the evaluation of appropriate pricing. In addition, challenges specific to ophthalmology are addressed.

Results: Pay-for-performance models link costs to effectiveness, but do not address all challenges. Centralized data collection and negotiation structures increase efficiency and strengthen the position vis-à-vis manufacturers, while fund models such as the HIF promote the predictability of healthcare expenditure. In ophthalmology, questions arise regarding the prioritization of patient groups, intervention thresholds and the distribution of scarce resources, for example when treating the second eye after successful treatment of the first.

Background: The increasing shortage of specialists in ophthalmology and the rising burden on university eye clinics raise questions about the appropriateness of the utilization of university resources. This study investigates the relationship between various sociodemographic determinants, such as age or social status, and the appropriateness of first presentation in a university ophthalmology outpatient clinic.

Methods: A retrospective analysis was conducted using routine data from 182,170 patients of the university outpatient clinic at the University Medical Center Freiburg (2006-2023). The appropriateness of the first presentation was operationalized by a follow-up visit within 100 days. Social status was assessed using the social index of the City of Freiburg at the postal code level. The data analysis considered relevant covariates such as age, gender, type of consultation, insurance status, distance from residence, and the social index of Freiburg.

Results: Of the included patient visits, 42.7% were classified as appropriate. An older age (odds ratio (OR) 1.36 per standard deviation (SD), 95% confidence interval (CI): 1.34-1.37) was the strongest predictor of the appropriateness of the presentation. The social index showed a weaker but significant effect (OR 1.05 per SD, 95% CI: 1.02-1.07): a lower social status was associated with increased appropriateness. The distance from residence had no significant influence.

Conclusion: The results indicate an association between increased urgency of care and both higher patient age and lower social status, with the latter potentially reflecting care gaps or delayed utilization. The study provides important insights for needs-based resource planning and health policy measures aimed at optimizing ophthalmological care structures.

Background: Dry eye disease is one of the most frequent surface diseases of the human eye. Although its etiology has not yet been established in detail, inflammatory components are increasingly considered as key factors in the development of the disease. Through inflammatory cascades stress at the ocular surface induces the release of reactive oxygen species (ROS), which additionally lead to oxidative stress. The end point of this cascade is the secretion of mediators of inflammation, which again release ROS. Corneal epithelial cells and goblet cells lose their integrity, further fueling tear film destabilization and ocular surface damage.

Aim of the study (objective): Various foodstuffs and nutrients are known for their antioxidative and/or anti-inflammatory characteristics, leading to an increasing interest of the role of nutritional supplements in the treatment of different diseases. This review summarizes dietary supplements that have shown positive effects on the ocular surface in dry eye disease in clinical studies.

Material and methods: A systematic review was performed for studies published in English on the use of dietary supplements in the treatment of dry eye disease up to July 2025 analyzing quantitative or qualitative data. PubMed served as the database, the sub-items of the review (essential fatty acids, vitamins, trace elements, minerals, plant substances and probiotics) were used as keywords. The results included reflect the clinical relevance and application possibilities, which evaluated the impact of dietary supplements in the treatment of dry eye disease.

Results: The most important nutrient categories associated with dry eye disease include essential fatty acids, vitamins, trace elements, minerals, phytochemicals, and probiotics. Oral supplementation has shown positive effects, although frequent blood count tests to determine levels are essential in cases of long-term use. Omega fatty acids are the most comprehensively studied dietary supplements with the highest rate of randomized controlled trials (evidence level 1).

Conclusion: Nutritional dietary supplementation is promising but there is a need for further clinical research, especially regarding optimized supplement dosing and potential synergistic treatment effects in combination with conventional treatment methods.

In many cases evaluating visual field findings enables precise topodiagnostics and can often directly lead to a concrete suspected diagnosis. In the routine clinical practice, the most useful examination strategy is 30° automatic grid perimetry; however, a visual field examination is not objective and depends heavily on the patient's cooperation. Therefore, the quality of the investigation, the plausibility and usability of every perimetry finding should be assessed. To categorize visual field defects topodiagnostically, it is important to determine whether the defects are monocular or binocular. Defects respecting the horizontal midline indicate nerve fiber bundle defects with a site of damage in the area of the optic nerve head, while defects respecting the vertical midline indicate visual pathway damage directly prechiasmal up to the visual cortex.