PURPOSE:Secondary glaucoma encompasses a broad spectrum of disease entities arising from diverse ocular pathologies and is often refractory to conventional treatment. Glaucoma drainage devices (GDDs) have therefore become an important surgical option. This study evaluates the efficacy and safety of the PAUL® Glaucoma Implant (PGI) across a broad spectrum of secondary glaucoma types. METHODS:This retrospective observational cohort study included 96 eyes from 92 patients who underwent PGI implantation for secondary glaucoma between April 2021 and September 2024, with a minimum follow-up of 12 months. Secondary glaucomas were categorized into neovascular, uveitic, post-vitrectomy, traumatic and other types. Surgical success was defined according to World Glaucoma Association intraocular pressure (IOP) thresholds (≤21, ≤18, ≤15, and ≤12 mmHg), with failure defined by IOP above threshold, hypotony-related complications, need for further glaucoma surgery, or device explantation. RESULTS:At one year, 83% of eyes achieved an IOP ≤21 mmHg, with 42% maintaining this level without topical medication. Success rates declined with stricter IOP targets but did not differ significantly among secondary glaucoma subtypes. Mean IOP decreased significantly from 28.0 mmHg preoperatively to 13.6 mmHg at 12 months, corresponding to an average reduction of approximately 51%, and remained stable during long-term follow-up. Visual acuity and visual field parameters remained largely stable. Postoperative complications occurred in 26% of eyes and were predominantly transient; no intraoperative complications were observed. Removal of the intraluminal Prolene stent was associated with further IOP reduction without subtype-specific differences. CONCLUSION:The PGI was associated with effective and sustained IOP reduction across a heterogeneous population of secondary glaucoma, with an acceptable complication profile in this retrospective cohort. These findings support the PGI as a useful surgical option for complex secondary glaucoma, although controlled comparative studies are needed to define its relative role among established GDDs.
PURPOSE:To evaluate the impact of introducing faricimab and high-dose aflibercept on intravitreal injection (IVI) demand and treatment costs for retinal diseases in a large tertiary retina centre. METHODS:This retrospective longitudinal registry study included all anti-VEGF treatment episodes at Oslo University Hospital, Norway, between 2021 and 2025. Annual injection volumes, treatment patterns, and costs were assessed following the introduction of faricimab (2023) and high-dose aflibercept (2025). High-dose aflibercept was generally administered at 50 μL (5.7 mg). Costs components were estimated using a health-economic model. RESULTS:A total of 142 960 treatment episodes comprising 169 700 IVIs in 7865 patients (mean age 75.5 years, 56.6% female) were included. Macular degeneration was the most common diagnosis. Treated patients increased from 4148 in 2021 to 4982 in 2025. Injections increased from 31 780 in 2021 to a peak of 35 508 in 2024 before declining to 33 696 in 2025, while mean injections per patient decreased from 7.7 to 6.8. Following its introduction in 2023, faricimab became the most used agent. Off-label bevacizumab proportion decreased from 50.6% in 2021 to 30.0% in 2025. Mean treatment cost per patient increased from NOK 38029 in 2021 to NOK 40187 in 2025 (+5.7%), while total treatment costs increased from NOK 158 million to NOK 200 million (+26.9%). CONCLUSIONS:The introduction of faricimab and high-dose aflibercept was associated with reduced per-patient treatment intensity, while the treated population continued to increase. Longer-acting anti-VEGF drugs may reduce pressure on retinal services by lowering injection frequency; however, their introduction was associated with higher overall costs.
PURPOSE:This study investigated the self-perceived competence, knowledge, confidence and attitudes of the UK optometric workforce with regard to nutritional advice for patients. METHODS:A validated questionnaire (NUTrition COMPetence) was used to survey the optometric workforce, which was adapted to UK optometric practice and nutritional guidelines. Distribution of the questionnaire was conducted online via social media, local optical councils, and personal contacts and sent to a random sample of members of the College of Optometrists UK. To better understand the sample, further information on educational background, years in practice and current roles were collected. RESULTS:Two hundred and sixty individuals completed the questionnaire, of which 238 identified as GOC registered optometrists, with the majority working in a community setting (n = 189). Self-perceived confidence in nutrition knowledge was [mean score (SD) 17.19 (±4.11) out of a maximum of 35 points], nutrition skills [mean score (SD) 23.73 (±7.80) out of a maximum count of 55], nutrition related counselling and communication [mean score (SD) 26.06 (±6.82) out of a maximum of 45 points]. Attitudes towards nutrition care scored highest with 31.33 (±6.06) out of 40 and was rated highest out of all constructs. Higher qualifications were associated with increased levels of self-reported confidence and communication of nutrition information (p = 0.015). CONCLUSIONS:UK optometrists have a very positive attitude towards providing nutritional care. However, there is a lack of training which impacts confidence and ultimately patient advice. Within the current framework of the UK National Health Service and its focus to make every contact count, it is paramount to implement more nutritional training.
PURPOSE:To evaluate the outcomes of intraluminal stent removal from the Paul glaucoma implant (PGI). METHODS:A retrospective observational study of all cases undergoing PGI stent removal from August 2022 to August 2025 at a single Danish tertiary centre. Primary endpoints were intraocular pressure (IOP) and IOP-lowering medications. Secondary endpoints were success rates and complications. RESULTS:A total of 114 consecutive PGI implantations with an intraluminal polypropylene 6-0 stent were performed from March 2022 to December 2024. A total of 88 eyes (77%) underwent stent removal at a mean of 113.5 ± 64.3 days after PGI implantation. Success at 6 months after stent removal, defined as 1) ≥20% IOP reduction with no increase in medications or 2) reduction of ≥1 number of IOP-lowering medications, was met in 77% (68 eyes) of the eyes. Washout of IOP-lowering medications prior to stent removal was performed in 68 eyes with an average IOP before and 1 week after stent removal of 24.5 ± 5.9 mmHg and 14.0 ± 7.4 mmHg, respectively. Clinically hypotony occurred in nine eyes after stent removal; three needed re-stenting. No other complications related to stent removal occurred. Stent removal <2 months after surgery was associated with a sixfold higher risk of clinical hypotony (p = 0.046). CONCLUSION:This study demonstrates that stent removal is an effective way to further reduce the IOP in the majority of patients after PGI surgery and that the risk of hypotony is low when removal is avoided in the early postoperative period.
PURPOSE:Fovea-sparing geographic atrophy (GA) patients retain near-normal central vision. To better understand GA progression in relation to the fovea, we performed a semi-automated image analysis of regional atrophy growth in a long-term GA natural-history cohort. METHODS:Prospective-observational, single-centre-study (02/2013-07/2025) at the Division of Eye and Vision, Karolinska Institutet/St. Erik Eye Hospital, Stockholm, Sweden. Longitudinal square-root-transformed GA area and distance-growth rates [mm/year] in all retinal quadrants were calculated from fundus autofluorescence images. Eyes were stratified based on best-corrected visual acuity: fovea-sparing (≥65 ETDRS) and fovea-involving (<65 ETDRS). RESULTS:65 eyes (65 patients) presented fovea-sparing and 91 eyes (91 patients) fovea-involving. Median follow-up was 18 months (range: 5-125). The fovea-involving group decreased in BCVA (Wilcoxon, p < 0.001). Total area growth was faster for fovea-sparing than fovea-involving lesions: 0.34 vs. 0.26 (Mann-Whitney U, p = 0.0019). The same was true for the superior, inferior, and temporal quadrants (Mann-Whitney U, all p < 0.0472). Fovea-sparing lesions showed slower distance growth towards the fovea than outwards in all quadrants: superior 0.09 vs. 0.21; nasal 0.08 vs. 0.18; inferior 0.06 vs. 0.17; temporal 0.09 vs. 0.20 (Wilcoxon, all p < 0.001). Lesions closer to the fovea (≤500 μm) at baseline showed decreased regional growth towards the fovea. Outwards growth was not related to lesion location. CONCLUSIONS:In this longitudinal cohort, fovea-sparing lesions showed faster total and regional growth than fovea-involving lesions, mainly caused by a faster outward expansion component. Location 500 μm or closer to the fovea resulted in slower growth, which supports a foveal self-protecting mechanism. These are relevant findings for patients with fovea-sparing lesions.
PURPOSE:To describe the clinical and genetic characteristics of patients with biallelic disease-causing variants in the PRCD (Progressive Rod-Cone Degeneration) gene. METHODS:Multicentre, retrospective cohort study of 19 patients from 13 families across nine reference centres in six countries. Clinical assessments included best-corrected visual acuity (BCVA), kinetic visual field (VF), optical coherence tomography, and fundus autofluorescence (FAF). BCVA and VF area progression rates were estimated using linear mixed models on log-converted variables. Genetic testing was performed via Sanger sequencing, targeted gene panels, whole-exome sequencing, or whole-genome sequencing. RESULTS:Median age at symptom onset was 11 years, with nyctalopia as the main initial complaint. Mean age at low vision and legal blindness in the best-seeing eye was 35 and 38 years, respectively. BCVA declined at 0.046 logMAR/year (95% CI: 0.027-0.065; p < 0.001), corresponding to a 10.0% annual loss. VF area (V4e isopter) decreased by 19.4% annually. The time to reach the limit of significant change was <2 years for both BCVA and VF area. FAF showed a gradient from hyperautofluorescent arc in the youngest patient to extensive atrophy in older patients with advanced disease. Five distinct loss-of-function variants were identified, including two nonsense, two splice-site variants, and a whole-gene deletion. CONCLUSION:Biallelic PRCD variants cause autosomal recessive retinitis pigmentosa, most often manifesting during childhood and showing relatively rapid progression of visual function loss. This information could prove useful for patient counselling and the planning of prospective natural history studies and targeted therapeutic approaches.
PURPOSE:Infectious keratitis (IK) is a vision-threatening condition with diverse microbial aetiologies, yet conventional culture-based diagnostics often have limited sensitivity. We investigated whether 16S/18S rRNA amplicon-based next-generation sequencing (NGS) can enhance aetiological assessment when used alongside standard microbiological methods. METHODS:In this prospective paired-sample study, 57 patients with IK underwent corneal sampling with conventional culture, PCR (HSV/VZV and Acanthamoeba) and 16S/18S metabarcoding. Microbiological findings were interpreted in a structured workflow incorporating clinical correlation and comparison with samples from the contralateral healthy eye. RESULTS:Excluding entirely viral cases, NGS did not significantly increase the overall diagnostic outcome compared with culture and PCR alone (n = 53, 42% vs. 51%, p = 0.27) but improved the combined diagnostic yield (n = 53) to 58%. NGS identified clinically relevant pathogens in 39% of cases, including four cases not detected by culture, whereas culture identified nine cases missed by NGS. Concordance between methods was observed in 55% of positive cases. NGS on samples from the contralateral eye aided interpretation of NGS data in over 25% of cases by distinguishing commensal background from likely pathogens. Although microbiological findings led to treatment modification in 16% of cases, these were all in cases diagnosed by conventional methods. CONCLUSION:Based on our findings, 16S/18S metabarcoding may be useful as a targeted supplementary test in atypical, refractory or culture-negative IK cases where conventional sampling is compromised. Findings should be interpreted alongside conventional microbiology, clinical findings and preferably contralateral-eye sampling.
PURPOSE:To evaluate outcomes in glaucoma eyes (G) compared with non-glaucoma eyes (NG) after Descemet membrane endothelial keratoplasty (DMEK), with a particular focus on the role of prior glaucoma surgery. METHODS:In this retrospective cohort study, 2538 eyes undergoing DMEK were analysed, including 241 glaucoma eyes (G) and 2297 non-glaucoma eyes (NG). Outcomes included visual acuity, intraocular pressure, endothelial cell loss, rebubbling rate, repeat DMEK, and graft survival. Subgroup analyses were performed comparing treated glaucoma eyes (MG) with surgically treated glaucoma eyes (SG). RESULTS:G eyes showed worse outcomes compared with NG eyes, including higher endothelial cell loss, increased repeat DMEK rates (14% vs. 6%, p < 0.001), and reduced graft survival (5-year survival 85.2% vs. 92.1%, p < 0.001). Within G eyes, SG eyes demonstrated poorer graft survival than MG eyes (HR 2.32, p = 0.020). The highest risk was observed in eyes with multiple prior glaucoma procedures. CONCLUSION:Glaucoma eyes (G) had worse DMEK outcomes than non-glaucoma eyes (NG), particularly among surgically treated glaucoma eyes (SG). SG eyes were more strongly associated with endothelial cell loss, repeat DMEK, and graft failure than medically treated glaucoma eyes (MG). These findings may help guide risk stratification and patient counselling, although residual confounding and differences in glaucoma severity cannot be excluded.
PURPOSE:To identify incident open-angle glaucoma (OAG) cases detected through regular ophthalmic care and from screening in a population-based cohort and study the additional yield of screening in a population with high prevalence of pseudoexfoliation (PEX). METHODS:Longitudinal, population-based study in Thessaloniki, Greece. Among eligible subjects, 1092 were examined at the follow-up stage. Previously undiagnosed glaucoma was defined as the absence of prior self-reported glaucoma or ocular hypertension or prior medical/surgical treatment. Glaucoma severity was assessed using the Hodapp-Parrish-Anderson criteria. RESULTS:The population at risk, after excluding glaucoma patients diagnosed at baseline, consisted of 1042 participants. Forty-six subjects developed incident OAG and 27 of them (58.7%, 95% CI: 43.5-71.7) were undiagnosed at follow-up visit, corresponding to a 2.6% (95% CI: 1.6-3.6) 12-year incidence rate of undiagnosed OAG. After stratification, the incidence of undiagnosed OAG was 1.8% in non-PEX subjects (14 of 772) and 4.8% in PEX subjects (13 of 270). Glaucoma stage did not differ significantly between previously diagnosed and undiagnosed cases (p = 0.46 for better eye and p = 0.72 for worse eye). Among undiagnosed cases, 7 had moderate or worse visual field loss in both eyes, and 17 in at least one eye. CONCLUSIONS:The overall rate of undiagnosed incident OAG in this population-based cohort was substantial. A screening programme could have detected a significant number of glaucoma cases. The high rates of undiagnosed glaucoma among PEX subjects could suggest a higher additional yield of screening in this group. More studies are needed to evaluate the cost-effectiveness of screening in populations with high PEX prevalence.
BACKGROUND:Quality of life (QoL) is a key outcome in Graves' orbitopathy (GO), but prior studies have reported overall QoL changes without evaluating whether improvements occur specifically in patients who achieve objective clinical response. Thus, it remains unclear to what extent clinical response translates into improved QoL, or whether treatment failure adversely affects well-being. METHODS:In this prospective study, 40 patients with moderate-to-severe active GO were assessed at baseline and 12 and 24 weeks after initiation of intravenous methylprednisolone (IVMP). Clinical response was assessed based on clinical activity score (CAS) improvement. QoL was evaluated using GO-QOL (function and appearance) and TED-QOL (overall, function and appearance) questionnaires. RESULTS:At 24 weeks, GO-QOL function declined in non-responders but not in responders. However, this difference was no longer significant after adjustment for confounders. For TED-QOL overall and function domains, treatment response at 12 weeks remained an independent predictor of QoL improvement after adjustment. Additionally, responders demonstrated a more favourable QoL trajectory during the first 12 weeks. Clinically meaningful improvement in all TED-QOL domains was more frequent in responders at 12 weeks, whereas deterioration in TED-QOL overall and function domains was more common in non-responders. No such pattern was observed for GO-QOL. TED-QOL, but not GO-QOL, demonstrated fair to moderate agreement between clinical response and clinically meaningful improvement at 12 weeks. CONCLUSIONS:Clinical response to IVMP is associated with substantial short-term gains in TED-QOL, whereas non-responders face a higher risk of QoL decline. In contrast, GO-QOL does not reflect clinical response.
PURPOSE:To assess the proportions and progression of refractive errors (spherical equivalent, astigmatism and anisometropia) in preschool children, to examine associations with demographic and environmental factors and to describe emmetropisation by providing normative reference values for early refractive development. METHODS:This retrospective cohort study included children in Flanders, Belgium undergoing routine vision screening, with non-cycloplegic refractive measurements at 12, 24 and 30 months using the PlusoptiX photoscreener, linked to maternal and child epidemiological data. Refractive errors were classified using predefined thresholds. Linear models assessed associations between SE and demographic, perinatal and socio-economic variables. Emmetropisation was evaluated using paired measurements, with rates defined as monthly changes in SE or cylinder power. RESULTS:Mean SE remained mildly hyperopic across all ages, with clinically negligible sex differences. Higher maternal education and more privileged socio-economic status were associated with slightly lower SE, particularly at 30 months. We observed clear ethnic differences in both SE and astigmatism type, with African children showing the highest SE, followed by Asian children and European children the lowest, highlighting ethnicity as a possible confounding factor for epidemiological studies. We observed evidence of emmetropisation for both SE and astigmatism, with faster rates of change in eyes with higher initial refractive errors. CONCLUSION:This study provides normative data on refractive development and proportions of early refractive errors in a multi-ethnic cohort of preschool children. The inclusion of normative emmetropisation tables offers practical guidance for paediatric ophthalmologists in clinical assessment. Observed ethnic differences highlight the importance of considering ethnicity in both clinical practice and future epidemiological research.
Abstract Purpose To evaluate bleb morphology longitudinally using sonography following glaucoma drainage device (GDD) surgery. Methods Prospective observational cohort study conducted from January 2022 to March 2024, with follow‐up up to 12 months postoperatively. Bleb morphology, including superior and inferior bleb height, transverse and longitudinal dimensions, and total bleb height, was assessed using 15‐MHz ultrasound (Quantel Medical, Compact Touch). Results Forty‐eight eyes undergoing PGI implantation were prospectively enrolled. Preoperative mean IOP was 23.6 mmHg (range, 13–42) on 3.2 medications. Mean total bleb height increased from 2.33 mm (range, 0.64–6.6) at day 14 to 4.14 mm (1.21–7.66) at month 3 and remained stable through month 12 (4.21 mm; 2.13–9.4). Double‐layered blebs predominated by month 1 and persisted thereafter. Mean IOP decreased to 12.7 mmHg at day 14 and remained between 13 and 15 mmHg through 12 months, while medication use declined to 0.9 drops. Mixed‐model analysis showed that absolute bleb height was significantly associated with higher IOP ( β = 0.86, p = 0.043), independent of time. Accelerated bleb enlargement within the first 3 months correlated with higher IOP ( β = 3.57, p = 0.003), whereas later changes showed no consistent associations. Conclusions Ultrasound imaging revealed progressive bleb enlargement after PGI implantation, stabilizing by 3–6 months. In the subgroup of patients who completed the 12‐month follow‐up, IOP reduction remained stable throughout the first postoperative year. Absolute bleb height showed a consistent association with IOP across time, whereas early growth rate was only predictive during the early postoperative period. These findings provide the first longitudinal sonographic evidence of bleb remodelling after GDD surgery and may guide postoperative assessment and intervention timing.
PURPOSE:To review the efficacy and safety of oral doxycycline antibiotics versus topical macrolides in the treatment of meibomian gland dysfunction (MGD). DESIGN:Systematic review and meta-analysis. METHODS:A comprehensive search of PubMed, Scopus, Embase, and ClinicalTrials.gov through December 2024 identified randomised controlled trials (RCTs) comparing oral tetracyclines with topical macrolides for MGD. Eligible studies reported outcomes related to tear film stability, meibomian gland function, ocular surface health, or symptom severity. Data extraction followed PRISMA guidelines and risk of bias was assessed using Cochrane methods. RESULTS:Among 3699 publications (1964-2024), six RCTs from distinct locations (374 patients) met inclusion criteria, describing only topical azithromycin and oral doxycycline. Treatment regimens were comparable: one month of topical azithromycin (1-1.5%, once to four times daily) versus three to 8 weeks of oral doxycycline (100-200 mg daily). Both treatments significantly improved MGD signs and symptoms. In pooled analyses, topical azithromycin showed superiority in reducing tear debris (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.15-0.74); however, while the total symptoms score favoured azithromycin, the result was borderline (OR, 0.62; 95% CI, 0.38-1.00) and sensitivity-dependent. Subgroup analysis showed doxycycline was superior for corneal fluorescein staining (standardised mean difference [SMD], 0.64; 95% CI, 0.22-1.05), whereas 1% azithromycin was superior for tear breakup time (mean difference [MD], -1.40; 95% CI, -2.20 to -0.60) and dropout-causing adverse events (risk ratio [RR], 0.07; 95% CI, 0.01-0.49). CONCLUSIONS:Both topical azithromycin and oral doxycycline are effective for MGD management. Topical azithromycin demonstrated a more favourable safety profile and may represent a useful therapeutic option, particularly for patients with low tolerance to systemic medications. However, further high-quality studies are needed to strengthen the evidence base.
PURPOSE:To evaluate changes in the prevalence and incidence of type 2 diabetes, the association between type 2 diabetes and diabetic retinopathy (DR), and the impact of type 2 diabetes and DR on visual acuity (VA) in Finland during 2000-2017. METHODS:We used three nationwide health examination surveys conducted in 2000, 2011 and 2017, with a total of 18 966 participants representing the Finnish population aged 18 years and older. All surveys were linked to national health registers covering diagnoses related to diabetes and DR between 2000 and 2017. All surveys included a health examination, in which distance and near VAs were measured. All data were analysed at the individual level. RESULTS:The prevalence of type 2 diabetes increased from 2.6% to 9.6% between 2000 and 2017, while its annual incidence increased from 0.5% to 0.7%. The annual incidence of DR among type 2 diabetes patients decreased from 1.4% to 0.3% between 2000 and 2017. Both distance and near VA were the best among individuals without diabetes, significantly worse among type 2 diabetes patients without DR, and the worst among type 2 diabetes patients with DR. Both distance and near VAs significantly improved between 2000 and 2017 in these study groups. CONCLUSIONS:The prevalence of type 2 diabetes has increased during the 2000s, which can be explained by the improved screening and unfavourable changes in lifestyle. However, the incidence of DR has decreased among type 2 diabetes patients, indicating the successful development and effectiveness of screening and therapies for both diabetes and DR.
PURPOSE:Retinal telangiectatic capillaries (TelCaps) are microvascular abnormalities associated with chronic vascular macular oedema and suboptimal response to intravitreal therapy. Targeted laser photocoagulation is beneficial but requires precise localization using indocyanine green angiography (ICG-A), the reference standard. However, ICG-A is invasive and not easily repeatable. This study evaluated OCT performance for TelCaps identification and en face localization versus ICG-A. METHODS:ICG-A and OCT images from 62 patients with TelCaps secondary to diabetic retinopathy or vein occlusion were analysed in a masked fashion. TelCaps were identified on OCT cube B-scans using predefined structural criteria and subsequently localized on co-registered infrared en face images. Sensitivity, positive predictive value (PPV) and subgroup analyses were used to assess OCT accuracy for lesion localization versus ICG-A and to evaluate the influence of anatomical factors. RESULTS:ICG-A identified 148 TelCaps, whereas OCT detected 157 lesions. ICG-stained TelCaps appeared as isolated large lesions or clustered microvascular abnormalities. OCT-identified and en face localized lesions showed 87% sensitivity (95% CI, 81%-92%) and 82% PPV (95% CI, 75%-88%). Sensitivity was higher for isolated lesions (92%) and those adjacent to hard exudates, but lower for clustered lesions (62%) and those distant from exudates. False positives were mainly lesions without retinal thickening or exudates, while false negatives predominantly involved clustered lesions. CONCLUSION:OCT represents a valuable non-invasive tool for identifying and localizing TelCaps on en face images in eyes with macular oedema and hard exudates, supporting its use for guiding focal laser photocoagulation. While it may reduce the need for systematic ICG-A in selected patients, angiography remains essential in complex equivocal cases, particularly for clustered lesions, where OCT may be less effective.
PURPOSE:Since 2015, the uncommon yet severe Acanthamoeba keratitis (AK) and Fusarium keratitis (FK) have increased in the Netherlands, predominantly in contact lens (CL) users. We investigated risk factors for acquisition and severity of AK and FK among CL users. METHODS:For this retrospective case-control study, we approached AK and FK cases diagnosed in 16 cornea reference centres between 2009 and 2019. CL-wearing controls were recruited in 2020 through social media. Besides, we assessed risk factors for treatment failure (corneal transplantation and/or final visual acuity ≤0.25) among cases included in the case-control study. Odds ratios (OR) with 95% confidence intervals (95%CI) were computed in multivariable logistic regression analyses. RESULTS:The case-control study comprised 220 cases (181 AK, 39 FK) and 1020 controls. Identified risk factors were previous eye injury (OR: 16.0, 95%CI: 3.4-76.7), occupational/recreational surface water contact (OR: 9.1, 95%CI: 3.5-23.2), cleaning/rinsing CLs with tap water (OR: 3.3, 95%CI: 1.7-6.4), cigarette smoke exposure (OR: 1.9, 95%CI: 1.1-3.5) and napping in CLs (OR: 1.9, 95%CI: 1.0-3.6). Treatment failure occurred in 85/179 (47%) AK and 23/35 (66%) FK cases. Evisceration or enucleation was performed in 9/179 (5%) AK and 5/35 (14%) FK cases. Age > 42 years (OR: 5.6, 95%CI: 2.3-14.6), hard CL use (OR: 3.3, 95%CI: 1.0-14.0), corticosteroid eye drops prior to diagnosis (OR: 3.8, 95%CI: 1.5-10.5) and a ring infiltrate at diagnosis (OR: 15.3, 95%CI: 4.8-57.4) were associated with AK treatment failure. CONCLUSION:Identified preventable risks warrant enhanced communication between eye care providers and CL wearers promoting healthy CL wear and care practices. Increased awareness among ophthalmologists is needed to prevent corticosteroid treatment prior to AK diagnosis to reduce treatment failure.
PURPOSE:To investigate visual impairment (VI) associated with Usher syndrome (USH), a syndromic form of retinitis pigmentosa. METHODS:This register-based study used data from the Register of the Finnish Federation for Visual Impairment for persons registered with USH-related VI from 1985 to 2019. Temporal trends in incidence, prevalence, recorded age at onset of VI, severity of registered VI, and sex distribution were analysed. RESULTS:The mean annual incidence of USH-related VI remained relatively stable across decades (p > 0.05), ranging from 0.19/100000 in 1985-1989 to 0.09/100000 in 2010-2019. In contrast, prevalence increased significantly over time (p < 0.001), from 0.70/100000 in 1985-1989 to 2.84/100000 in 2010-2019. The mean recorded age at onset of VI remained relatively stable. A significant shift in severity distribution was observed (p = 0.041), with fewer registrations classified as Near-Total Blindness and Total Blindness. In the 2010s, the severity distribution of VI differed between women and men. CONCLUSION:As the first nationwide, long-term register-based study of USH-related VI, this 35-year analysis demonstrates stable incidence alongside increasing prevalence, with an observed redistribution of registered VI severity away from Near-Total Blindness and Total Blindness. These findings reflect both the expected natural disease course and broader system-level influences on registration patterns, underscoring the value of long-term register data for monitoring rare disease epidemiology when interpreted in light of established clinical characteristics of USH, VI classification criteria, and the healthcare system context. Together, they support the need to refine approaches to VI classification, rehabilitation and public health planning for people with USH.
Geographic atrophy (GA) is the chronic loss of retinal pigment epithelium, photoreceptors and choriocapillaris, marking the dry late stage of age-related macular degeneration (AMD). GA prevalence is expected to rise in the upcoming decades. Advanced GA leads to central scotomas, reducing visual acuity and quality of life, potentially resulting in profound central vision loss. GA shares features with various retinal diseases and can therefore be complicated to distinguish from mimicking diseases. While no cure exists for GA, therapies like pegcetacoplan and avacincaptad aim to slow atrophy growth, making an accurate diagnosis essential for effective treatment. Misdiagnosis can lead to inappropriate treatment recommendations, impacting patient health and financial burden. This paper outlines the similarities and differences among prevalent diseases such as late-onset Stargardt disease, PRPH2-associated disease and maternally inherited diabetes and deafness (MIDD), resembling GA to aid in accurate diagnosis.
