We study a controversial application of algorithmic profiling in the public sector, the Austrian AMAS system. AMAS was supposed to help caseworkers at the Public Employment Service (PES) Austria to allocate support measures to job seekers based on their predicted chance of (re-)integration into the labor market. Shortly after its release, AMAS was criticized for its apparent unequal treatment of job seekers based on gender and citizenship. We systematically investigate the AMAS model using a novel real-world dataset of young job seekers from Vienna, which allows us to provide the first empirical evaluation of the AMAS model with a focus on fairness measures. We further apply bias mitigation strategies to study their effectiveness in our real-world setting. Our findings indicate that the prediction performance of the AMAS model is insufficient for use in practice, as more than 30

Estimating heterogeneous treatment effects is important to tailor treatments to those individuals who would most likely benefit. However, conditional average treatment effect predictors may often be trained on one population but possibly deployed on different, possibly unknown populations. We use methodology for learning multi-accurate predictors to post-process CATE T-learners (differenced regressions) to become robust to unknown covariate shifts at the time of deployment. The method works in general for pseudo-outcome regression, such as the DR-learner. We show how this approach can combine (large) confounded observational and (smaller) randomized datasets by learning a confounded predictor from the observational dataset, and auditing for multi-accuracy on the randomized controlled trial. We show improvements in bias and mean squared error in simulations with increasingly larger covariate shift, and on a semi-synthetic case study of a parallel large observational study and smaller randomized controlled experiment. Overall, we establish a connection between methods developed for multi-distribution learning and achieve appealing desiderata (e.g. external validity) in causal inference and machine learning.

PURPOSE To evaluate the long-term outcomes of patients with non-infectious uveitis treated with 0.19 mg fluocinolone acetonide insert (FAi) for up to 36 months in clinical practice. METHODS A retrospective study conducted at a single uveitis center. RESULTS Fifty eyes of 39 patients were included. Mean best corrected visual acuity (BCVA) and central retinal thickness (CRT) remained stable until month 36 after FAi implantation (61.04 vs. 70.25 letters and 370.8 vs. 332.5 µm, respectively). The recurrence rate was 34% (17 eyes) after 36 months, of which 82% (14 eyes) received high-dose corticosteroids before FAi. Mean intraocular pressure (IOP) remained unchanged (13.38 vs. 15.74 mmHg), while most phakic eyes (13 of 14 eyes) required cataract surgery. CONCLUSIONS We show that FAi effectively prevents recurrences of non-infectious uveitis for up to three years in clinical practice, comparable with randomized clinical trials. Patients who received high-dose corticosteroids before FAi have an increased risk for early recurrence and should be considered for scheduled re-treatment.

To determine real-life quantitative changes in OCT biomarkers in a large set of treatment naive patients in a real-life setting undergoing anti-VEGF therapy. For this purpose, we devised a novel deep learning based semantic segmentation algorithm providing the first benchmark results for automatic segmentation of 11 OCT features including biomarkers for neovascular age-related macular degeneration (nAMD). Training of a Deep U-net based semantic segmentation ensemble algorithm for state-of-the-art semantic segmentation performance which was used to analyze OCT features prior to, after 3 and 12 months of anti-VEGF therapy. High F1 scores of almost 1.0 for neurosensory retina and subretinal fluid on a separate hold-out test set with unseen patients. The algorithm performed worse for subretinal hyperreflective material and fibrovascular PED, on par with drusenoid PED, and better in segmenting fibrosis. In the evaluation of treatment naive OCT scans, significant changes occurred for intraretinal fluid (mean: 0.03 µm3 to 0.01 µm3, p < 0.001), subretinal fluid (0.08 µm3 to 0.01 µm3, p < 0.001), subretinal hyperreflective material (0.02 µm3 to 0.01 µm3, p < 0.001), fibrovascular PED (0.12 µm3 to 0.09 µm3, p = 0.02) and central retinal thickness C0 (225.78 µm3 to 169.40 µm3). The amounts of intraretinal fluid, fibrovascular PED, and ERM were predictive of poor outcome. The segmentation algorithm allows efficient volumetric analysis of OCT scans. Anti-VEGF provokes most potent changes in the first 3 months while a gradual loss of RPE hints at a progressing decline of visual acuity. Additional research is required to understand how these accurate OCT predictions can be leveraged for a personalized therapy regimen.

Aims/Purpose: Our objective was to compare the diagnostic accuracy of diabetic retinopathy (DR) screening using a non‐mydriatic handheld digital camera as well as a stationary digital fundus non‐mydriatic camera to the standard fundus examination in medical mydriasis by an experienced observer. Methods: The evaluation of images using a digital handheld non‐mydriatic camera in a clinical setting, coupled with pupil dilation for ungradable images, provides a valid method for identifying an advanced stage of DR requiring therapeutic measures. The hand held non mydriatic fundus camera could represent an alternative to the conventional screening in medical mydriasis in order to improve the access to DR screening in areas and populations with less access to the existinmedical infrastructure. Results: The mean age of the 100 examined diabetic participants was 61.2 years (SD ± 9.08). The proportion of upgradable images in both types of non‐mydriatic imaging was 3% (1 eye – 2%, both eyes – 1%). When compared to the detection of any stage of DR, an advanced stage of DR showed higher diagnostic accuracy. The sensitivity for the advanced stage of DR was 13% for Reviewer 1 (positive predictive value [PPV] 5%) and 14% for Reviewer 2 (PPV 6%). The specificity was 94% for Reviewer 1 (negative predictive value [NPV] 96%) and 95% for Reviewer 2 (NPV 97%). Conclusions: The evaluation of images using a digital handheld non‐mydriatic camera in a clinical setting, coupled with pupil dilation for ungradable images, provides a valid method for identifying an advanced stage of DR requiring therapeutic measures. The handheld non mydriatic fundus camera could represent an alternative to the conventional screening in medical mydriasis in order to improve the access to DR screening in areas and populations with less access to the existing medical infrastructure. References 1. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B (2018) IDF diabetes atlas: global estimates of diabetes prevalence for 2017.

Panel surveys are an important tool for social science researchers, but nonresponse in any panel wave can significantly reduce data quality. Panel managers then attempt to identify participants who may be at risk of not participating using predictive models to target interventions before data collection through adaptive designs. Previous research has shown that these predictions can be improved by accounting for a sample member’s behavior in past waves. These past behaviors are often operationalized through rolling average variables that aggregate information over the past two, three, or all waves, such as each participant’s nonresponse rate. However, it is possible that this approach is too simple. In this paper, we evaluate models that account for more nuanced temporal dependency, namely recurrent neural networks (RNNs) and feature-, interval-, and kernel-based time series classification techniques. We compare these novel techniques’ performances to more traditional logistic regression and tree-based models in predicting future panel survey nonresponse. We apply these algorithms to predict nonresponse in the GESIS Panel, a large-scale, probability-based German longitudinal study, for surveys conducted between 2013 and 2021. Our findings show that RNNs perform similar to tree-based approaches, but the RNNs do not require the analyst to create rolling average variables. More complex feature-, interval-, and kernel-based techniques are not more effective at classifying future respondents and nonrespondents than RNNs or traditional logistic regression or tree-based methods. We find that predicting nonresponse of newly recruited participants is a more difficult task, and basic RNN models and penalized logistic regression performed best in this situation. We conclude that RNNs may be better at classifying future response propensity than traditional logistic regression and tree-based approaches when the association between time-varying characteristics and survey participation is complex but did not do so in the current analysis when a traditional rolling averages approach yielded comparable results.

BACKGROUND:Optical coherence tomography and electroretinography studies have revealed structural and functional retinal alterations in individuals with schizophrenia spectrum disorders (SSDs). However, it remains unclear which specific retinal layers are affected; how the retina, brain, and clinical symptomatology are connected; and how alterations of the visual system are related to genetic disease risk. METHODS:Optical coherence tomography, electroretinography, and brain magnetic resonance imaging were applied to comprehensively investigate the visual system in a cohort of 103 patients with SSDs and 130 healthy control individuals. The sparse partial least squares algorithm was used to identify multivariate associations between clinical disease phenotype and biological alterations of the visual system. The association of the revealed patterns with individual polygenic disease risk for schizophrenia was explored in a post hoc analysis. In addition, covariate-adjusted case-control comparisons were performed for each individual optical coherence tomography and electroretinography parameter. RESULTS:The sparse partial least squares analysis yielded a phenotype-eye-brain signature of SSDs in which greater disease severity, longer duration of illness, and impaired cognition were associated with electrophysiological alterations and microstructural thinning of most retinal layers. Higher individual loading onto this disease-relevant signature of the visual system was significantly associated with elevated polygenic risk for schizophrenia. In case-control comparisons, patients with SSDs had lower macular thickness, thinner retinal nerve fiber and inner plexiform layers, less negative a-wave amplitude, and lower b-wave amplitude. CONCLUSIONS:This study demonstrates multimodal microstructural and electrophysiological retinal alterations in individuals with SSDs that are associated with disease severity and individual polygenic burden.

To evaluate the effectiveness of 0.19-mg fluocinolone acetonide implant (FAi) for preventing inflammatory relapses in noninfectious uveitis with posterior segment involvement in standard clinical practice. Further, to assess the value of remission induction therapy with intraocular and periorbital administered high-dose corticosteroids before FAi. A retrospective cohort study in a tertiary referral center specialized in uveitis management. The primary study outcomes were the best-corrected visual acuity (BVCA) and central retinal thickness (CRT) within a 12-month observation period. The secondary outcomes were intraocular pressure (IOP) and intraocular inflammation. The main safety measures were IOP increase and cataract formation. In total, 76 eyes of 57 patients received FAi. Locally administered high-dose corticosteroids were applied in 68.4

IntroductionTreatment of severe mental illness (SMI) symptoms, especially negative symptoms and cognitive dysfunction in schizophrenia, remains a major unmet need. There is good evidence that SMIs have a strong genetic background and are characterized by multiple biological alterations, including disturbed brain circuits and connectivity, dysregulated neuronal excitation-inhibition, disturbed dopaminergic and glutamatergic pathways, and partially dysregulated inflammatory processes. The ways in which the dysregulated signaling pathways are interconnected remains largely unknown, in part because well-characterized clinical studies on comprehensive biomaterial are lacking. Furthermore, the development of drugs to treat SMIs such as schizophrenia is limited by the use of operationalized symptom-based clusters for diagnosis. MethodsIn line with the Research Domain Criteria initiative, the Clinical Deep Phenotyping (CDP) study is using a multimodal approach to reveal the neurobiological underpinnings of clinically relevant schizophrenia subgroups by performing broad transdiagnostic clinical characterization with standardized neurocognitive assessments, multimodal neuroimaging, electrophysiological assessments, retinal investigations, and omics-based analyzes of blood and cerebrospinal fluid. Moreover, to bridge the translational gap in biological psychiatry the study includes in vitro investigations on human-induced pluripotent stem cells, which are available from a subset of participants. ResultsHere, we report on the feasibility of this multimodal approach, which has been successfully initiated in the first participants in the CDP cohort; to date, the cohort comprises over 194 individuals with SMI and 187 age and gender matched healthy controls. In addition, we describe the applied research modalities and study objectives. DiscussionThe identification of cross-diagnostic and diagnosis-specific biotype-informed subgroups of patients and the translational dissection of those subgroups may help to pave the way toward precision medicine with artificial intelligence-supported tailored interventions and treatment. This aim is particularly important in psychiatry, a field where innovation is urgently needed because specific symptom domains, such as negative symptoms and cognitive dysfunction, and treatment-resistant symptoms in general are still difficult to treat.

Melhorar o envolvimento dos alunos é de vital importância para os professores do ensino escolar e superior. A tecnologia educacional tem sido associada ao envolvimento dos alunos, e os professores em formação e em serviço precisam desenvolver habilidades e conhecimentos de Tecnologia da Informação e Comunicação (TIC) para aplicá-los em sala de aula, bem como desenvolver habilidades de TIC nos alunos. Diante disso, o objetivo deste estudo foi realizar uma pesquisa de revisão bibliográfica sobre a importância da tecnologia no contexto de ensino e aprendizagem acadêmica. Especificamente, foi dado ênfase aos assuntos de Tecnologia da Informação e Comunicação aplicado ao ensino escolar. Além disso, foi abordado a metodologia do Engagement acadêmico estudantil. Esta revisão descobriu que a tecnologia educacional apoia o engajamento dos alunos, sendo o comportamental e o afetivo as dimensões mais prevalentes. Ferramentas de Redes Sociais (FRS), ferramentas de organização e compartilhamento de conhecimento, ferramentas baseadas em texto e ferramentas de criação de sites foram as mais eficazes na promoção do engajamento. No entanto, é necessário cautela ao empregar FRS e ferramentas de avaliação, pois também foram mais propensos a levar ao desengajamento. Mais pesquisas são necessárias sobre como a tecnologia educacional afeta o desengajamento, como as ferramentas são usadas nos programas de formação de professores on-line e como integrar efetivamente o FRS nos programas de educação.

Background Schizophrenia spectrum disorders (SSDs) are presumed to be associated with retinal thinning. However, evidence is lacking as to whether these retinal alterations reflect a disease-specific process or are rather a consequence of comorbid diseases or concomitant microvascular impairment. Methods The study included 126 eyes of 65 patients with SSDs and 143 eyes of 72 healthy controls. We examined macula and optic disc measures by optical coherence tomography (OCT) and OCT angiography (OCT-A). Additive mixed models were used to assess the impact of SSDs on retinal thickness and perfusion and to explore the association of retinal and clinical disease-related parameters by controlling for several ocular and systemic covariates (age, sex, spherical equivalent, intraocular pressure, body mass index, diabetes, hypertension, smoking status, and OCT signal strength). Results OCT revealed significantly lower parafoveal macular, macular ganglion cell-inner plexiform layer (GCIPL), and macular retinal nerve fiber layer (RNFL) thickness and thinner mean and superior peripapillary RNFL in SSDs. In contrast, the applied OCT-A investigations, which included macular and peripapillary perfusion density, macular vessel density, and size of the foveal avascular zone, did not reveal any significant between-group differences. Finally, a longer duration of illness and higher chlorpromazine equivalent doses were associated with lower parafoveal macular and macular RNFL thickness. Conclusions This study strengthens the evidence for disease-related retinal thinning in SSDs.

Long total waiting times (TWT) experienced by patients during a clinic visit have a significant adverse effect on patient’s satisfaction. Our aim was to use big data simulations of a patient scheduling calendar and its effect on TWT in a general ophthalmology clinic. Based on the simulation, we implemented changes to the calendar and verified their effect on TWT in clinical practice. For this retrospective simulation study, we generated a discrete event simulation (DES) model based on clinical timepoints of 4.401 visits to our clinic. All data points were exported from our clinical warehouse for further processing. If not available from the electronic health record, manual time measurements of the process were used. Various patient scheduling models were simulated and evaluated based on their reduction of TWT. The most promising model was implemented into clinical practice in 2017. During validation of our simulation model, we achieved a high agreement of mean TWT between the real data (229 ± 100 min) and the corresponding simulated data (225 ± 112 min). This indicates a high quality of the simulation model. Following the simulations, a patient scheduling calendar was introduced, which, compared with the old calendar, provided block intervals and extended time windows for patients. The simulated TWT of this model was 153 min. After implementation in clinical practice, TWT per patient in our general ophthalmology clinic has been reduced from 229 ± 100 to 183 ± 89 min. By implementing a big data simulation model, we have achieved a cost-neutral reduction of the mean TWT by 21%. Big data simulation enables users to evaluate variations to an existing system before implementation into clinical practice. Various models for improving patient flow or reducing capacity loads can be evaluated cost-effectively.

Purpose: To evaluate functional outcome after retinal detachment (RD) repair surgery in eyes with a multifocal intraocular lens (mIOL). Setting: Ludwig-Maximilians-University, Munich, Germany. Design: Single-center case control study. Methods: 52 pseudophakic eyes with successful anatomical outcome after surgical RD repair were included. Retrospectively, 21 mIOL eyes were compared with a matched group of 21 monofocal eyes over 6 weeks. Prospectively, corrected distance visual acuity (CDVA) was evaluated over 12 months in these eyes. Furthermore, uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), defocus curves, and patient-reported outcomes were evaluated at 1 year in 24 mIOL eyes. Results: 52 eyes of 48 patients comprised the study. The mean CDVA (logMAR) improved significantly from 1.35 ± 1.38 to 0.29 ± 0.37 at 6 weeks and remained stable at 12 months postoperatively in monofocal eyes ( P = .001) and from 1.16 ± 1.2 to 0.37 ± 0.29 (6 weeks) and 0.20 ± 0.36 (12 months) in mIOL eyes ( P = .001). Univariate factorial analysis of variance showed no statistically significant differences in CDVA at 6 weeks or 12 months postoperatively for IOL type or for preoperative macular status ( P > .05). In the prospective cohort of 24 mIOL eyes, a mean CDVA of 0.13 ± 0.33 logMAR, UDVA of 0.21 ± 0.34 logMAR, UIVA of 0.17 ± 0.28 logMAR, and UNVA of 0.23 ± 0.32 logMAR was achieved. Macular status did not affect final outcome significantly ( P > .05). Most patients stated they usually did not need spectacles; no patient wanted mIOL replacement. Conclusions: 1 year after successful anatomical repair after 23-gauge vitrectomy with gas tamponade, functionality of mIOL was restored, and CDVA was comparable with that of patients with monofocal IOL.

Importance Although multiple imputation models for missing data and the use of mixed-effects models generally provide better outcome estimates than using only observed data or last observation carried forward in clinical trials, such approaches usually cannot be applied to visual outcomes from retrospective analyses of clinical practice settings, also called real-world outcomes. Objective To explore the potential usefulness of survival analysis techniques for retrospective clinical practice visual outcomes. Design, Setting, and Participants This retrospective cohort study covered a 12-year observation period at a tertiary eye center. Of 10 744 eyes with neovascular age-related macular degeneration receiving anti-vascular endothelial growth factor (VEGF) therapy between October 28, 2008, and February 1, 2020, 7802 eyes met study criteria (treatment-naive, first-treated eyes starting anti-VEGF therapy). Eyes were excluded from the analysis if they received photodynamic therapy or macular laser, any previous anti-VEGF therapy, treatment with anti-VEGF agents other than ranibizumab or aflibercept, or had an unknown date or visual acuity (VA) value at first injection. Main Outcomes and Measures Kaplan-Meier estimates and Cox proportional hazards modeling were used to consider VA reaching an Early Treatment Diabetic Retinopathy Study (ETDRS) letter score of 70 (Snellen equivalent, 20/40) or better, duration of VA sustained at or better than 70 (20/40), and VA declining to 35 (20/200) or worse. Results A total of 7802 patients (mean [SD] age, 78.7 [8.8] years; 4776 women [61.2%]; and 4785 White [61.3%]) were included in the study. The median time to attaining a VA letter score greater than or equal to 70 (20/40) was 2.0 years (95% CI, 1.87-2.32) after the first anti-VEGF injection. Predictive features were baseline VA (hazard ratio [HR], 1.43 per 5 ETDRS letter score or 1 line; 95% CI, 1.40-1.46), baseline age (HR, 0.88 per 5 years; 95% CI, 0.86-0.90), and injection number (HR, 1.12; 95% CI, 1.10-1.15). Of the 4439 of 7802 patients (57%) attaining this outcome, median time sustained at an ETDRS letter score of 70 (20/40) or better was 1.1 years (95% CI, 1.1-1.2). Conclusions and Relevance In this cohort study, patients with neovascular age-related macular degeneration beginning anti-VEGF therapy were more likely to experience positive visual outcomes within the first 2.0 years after treatment, typically maintaining this outcome for 1.1 years but then deteriorating to poor vision within 8.7 years. These findings demonstrate the potential usefulness of the proposed analyses. This data set, combined with the statistical approach for retrospective analyses, may provide long-term prognostic information for patients newly diagnosed with this condition.

Wir möchten uns herzlich bei Herrn Professor Ramin Khoramnia und Kollegen für den Leserbrief „Materialeigenschaften von Kunstlinsen: Gibt es patientenrelevante Unterschiede?“ bedanken. Dieser behandelt sehr verständlich wichtige weitere Differenzialdiagnosen der Eintrübung von Intraokularlinsen (IOL) in der Praxis. Insbesondere wird hier auf die unterschiedlichen Eigenschaften zwischen hydrophoben und hydrophilen IOL eingegangen. Wie in unserer Kasuistik zur Trübung einer IOL nach kombinierter Katarakt und minimal-invasiver Glaukomchirurgie beschrieben, handelte es sich im vorliegenden Fall um eine Fibrinauflagerung auf einer hydrophoben Acrylat-Linse (enVista MX60P, Bausch & Lomb Incorporated Rochester, NY, USA) [3]. Die Eingabe von rtPA in die Vorderkammer in der frühen postoperativen Phase wäre sicherlich eine Behandlungsoption gewesen, in Studien wird hier ein Zeitraum von 2 bis 8 Tagen postoperativ als vielversprechend zur Fibrinolyse genannt [2]. Auch uns sind Eintrübungen einer IOL nach Eingabe von rtPA ausschließlich von hydrophilen Modellen bekannt [1]. In unserem Fall stellte sich die Patientin jedoch mehr als 3 Wochen postoperativ mit einer ausgeprägten Fibrinplatte auf der Vorderfläche der IOL vor, sodass wir auf die Möglichkeit einer rtPA-Eingabe verzichteten und uns für das beschriebene Vorgehen mit dem Nd:YAG-Laser entschieden. Der Zeitpunkt der richtigen Diagnosestellung ist also entscheidend für das weitere Vorgehen. Hier war der Nd:YAG-Laser aufgrund der bereits organisierten Fibrinplatte die erfolgversprechendste Option und ging zudem, wie auch von Ihnen bereits erwähnt, ohne das mit einem intraokularen Eingriff verbundene Endophthalmitisrisiko einher.

Background: Diabetes prevalence is constantly rising, involving the eyes with damage including development of diabetic macular oedema. Since 2012, intravitreal anti-vascular endothelial growth factor medication is available for diabetic macular oedema treatment. Endocrinological studies have shown that fewer women are affected by diabetes. However, when affected, they exhibit more severe diabetic complications than men. We have investigated gender-related differences in diabetic macular oedema and outcome in an ophthalmological tertiary referral hospital. Methods: We included 88 patients (54 males and 34 females) with 112 eyes (68 male and 44 female) having clinically significant diabetic macular oedema, treated with anti-vascular endothelial growth factor medication. A 1 year follow-up was performed in all patients (visual acuity and optical coherence tomography). Previous retinal surgery was an exclusion criterion, as were other retinal pathologies. Results: The mean visual acuity and mean central retinal thickness at baseline were 0.53 logMAR (male 0.49 and female 0.595) and 469 μm (male 452 μm and female: 494 μm), respectively. After 360 days, mean visual acuity changed by −0.07 (±0.36) logMAR (male −0.11 and female +0.01) and mean central retinal thickness changed by −119 μm (male −113 μm and female −127 μm). For visual acuity, a significant difference was noted at baseline ( p = 0.02) and at 1 year ( p < 0.001). Males received 5.6 injections and females received 5.68 injections in 1 year. Conclusion: Our study showed that female patients with diabetic macular oedema were diagnosed with and treated for diabetic macular oedema at a stage when visual acuity and optical coherence tomography were worse than those in their male counterparts. This gender difference could not be reduced, despite similar numbers of injections. Female diabetic patients should therefore be assessed early for ophthalmological pathologies.

To evaluate the potential of an integrated virtual medical retina clinic in secondary care for diabetic patients screened and referred by the UK National Diabetic Eye Screening Program (DESP). This retrospective cohort study included diabetic patients referred by the DESP to either a virtual or a traditional doctor’s appointment (face-to-face, F2F) at the Moorfields Eye Hospital NHS Foundation Trust (London, UK) between January 2015 and December 2018. The primary outcome was the proportion of patients that qualified for a virtual-clinic appointment according to hospital guidance. Secondary outcomes included the rate of attendance, mean time from DESP referral to initial hospital appointment, mean time-to-discharge and -to-treatment of either panretinal photocoagulation or intravitreal injection of anti-vascular endothelial growth factor. We included 12,563 patients in this study. While 8833 patients (70.7%) would have qualified for a virtual appointment according to local triage guidance, only 2306 (18.4%) were referred to a virtual consultation due to capacity constraints. For routine referrals, mean time to the first hospital appointment was 66.9 days with a standard deviation of ±35.9 and 80.9 ± 44.4 days for a virtual and a F2F consultation, respectively. The mean time from referral to discharge to community was 71.7 ± 30.8 and 86.3 ± 37.0 days for a virtual and a F2F consultation, respectively. We did not observe a statistically significant difference in the mean time-to-treatment in the sub-cohort that required intravitreal therapy for maculopathy (virtual clinics: 220.7 ± 84.8; F2F: 178.0 days ± 80.7; p value > 0.05). Moreover, we observed a non-inferior attendance rate in virtual as compared to F2F clinics. A significant proportion of diabetic patients referred to a F2F clinic could initially be managed in a virtual clinic. Increasing the adoption of virtual clinics in the management of diabetic patients that do not need long-term management or monitoring in secondary services may help alleviate service demands without diminishing quality of clinical care. Collectively, our analyses suggest that virtual consultations are a faster and clinically appropriate alternative for a substantial proportion of diabetic patients.

Purpose To determine the anatomical and functional outcomes of an extended 6-month intravitreal anti-vascular endothelial growth factor (anti-VEGF) upload in choroidal neovascularization (CNV) secondary to chronic central serous chorioretinopathy (CSCR). Methods A retrospective database analysis was performed applying the following inclusion criteria: (1) diagnosis of CSCR, (2) diagnosis of secondary CNV, and (3) treatment of at least six consecutive injections of anti-VEGF. Outcome measures included the change of central retinal subfield thickness, remodeling of the pigment epithelium detachments, and change in visual function. Results Twenty-one eyes of 21 patients were included. Mean patient age was 65 ± 8.3 years, and 35% of the patients ( n = 8) were female. Mean disease duration before diagnosis of CNV was 48 ± 25.3 months. Mean central retinal thickness decreased from 346 ± 61 to 257 ± 57 μm ( p < 0.01) after the sixth injection while mean visual acuity improved from 0.65 ± 0.35 to 0.49 ± 0.29 (logMAR; p < 0.01). Of note, an extended upload of six as opposed to three injections yielded an additional mean central retinal thickness reduction (280 ± 46 μm vs. 257 ± 57 μm, p = 0.038). Significant CNV remodeling was observed as a decrease in pigment epithelium detachment (PED) vertical ( p = 0.021) and horizontal diameter ( p = 0.024) as well as PED height ( p < 0.01). Conclusion An extended anti-VEGF upload of six consecutive injections seems to be effective in inducing CNV remodeling and fluid resorption in CNV complicating chronic CSCR.