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Purpose: The purpose of the study was to evaluate temporal changes in age‐ and sex‐stratified incidence rates of retinal vein occlusion (RVO) commenced in anti‐vascular endothelial growth factor (anti‐VEGF) treatment, proportion of patients remaining in active anti‐VEGF therapy over time, and to develop a forecasting model for future number of patients with RVO in active anti‐VEGF therapy. Methods: This was a registry‐based study of patients with RVO in the Capital Region of Denmark from commenced in anti‐VEGF therapy from 1 January 2007 to 30 June 2022. Census data were extracted from Statistics Denmark for incidence rate analyses and forecasting data of future demographics. Results: A total of 2641 patients with RVO were commenced in anti‐VEGF therapy, of which 2192 were later discontinued. Number of patients rose dramatically during the first years of introduction of anti‐VEGF therapy, after which growth was slower and followed the demographic changes. Trend analyses revealed that the COVID‐19 epidemics impacted with fewer referrals and more aggressive discontinuation practices. Annual incidence of RVO in 2012–2021 was 13.1 per 100 000 (95% CI: 12.6–13.6 per 100 000). Proportion of patients with RVO remaining in active anti‐VEGF treatment was 55.0%, 40.1%, 30.8% and 12.1% after Years 1, 2, 3 and 8, respectively. According to our forecast, number of patients with RVO in active anti‐VEGF therapy will grow slowly but continually at least until year 2035. Conclusion: Our study reports incidence rates and provides prognostic modelling of number of patients with RVO in anti‐VEGF therapy. [ABSTRACT FROM AUTHOR]

Purpose: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). Methods: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. Results: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. Conclusions: The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity. [ABSTRACT FROM AUTHOR]

Central serous chorioretinopathy (CSC) is a prevalent exudative maculopathy and the ongoing verteporfin shortage restricts current treatment possibilities. Topical non‐steroidal anti‐inflammatory drugs (NSAID) have previously been proposed as a treatment for CSC, although its exact efficacy remains unclear. In this systematic review and meta‐analysis, we outlined the efficacy of topical NSAIDs for the treatment of CSC. We searched 11 literature databases on 13 December 2022, for any study describing topical NSAID treatment for CSC. Thirteen eligible studies were included with a total of 1001 eyes of 994 patients with CSC. Six studies were case reports, two were cohort studies and five were non‐randomized comparative studies. Where specified, topical NSAIDs used were bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. Studies were predominantly of cases with acute CSC and several case studies reported treatment outcomes simultaneously with discontinuation of corticosteroid use, which complicated treatment evaluation. Meta‐analyses of comparative studies revealed a statistically significant but clinically irrelevant best‐corrected visual acuity improvement of −0.04 logMAR (95% CI: −0.07 to −0.01 logMAR; p = 0.01) at 1‐month follow‐up, which became statistically insignificant at 3‐month follow‐up (−0.03 logMAR; 95% CI: −0.06 to 0.003 logMAR; p = 0.08). Further, we found no benefit in complete subretinal fluid resolution at 1‐month follow‐up (OR: 1.20; 95% CI: 0.81–1.76; p = 0.37) or 3‐month follow‐up (OR: 1.17; 95% CI: 0.86 to 1.59; p = 0.33). Taken together, available evidence does not support the use of topical NSAIDs for the treatment of CSC. [ABSTRACT FROM AUTHOR]

We systematically reviewed the literature on the prevalence of geographic atrophy (GA) in Nordic populations, conducted meta‐analyses on age‐stratified estimates, and calculated current and future number of patients and those potentially eligible for intravitreal complement inhibitor treatment. We followed the PRISMA guidelines, and our protocol was registered in PROSPERO. Ten databases were searched on 22 April 2023 for population‐based studies of GA prevalence. Based on clinical descriptive analyses of GA and eligibility criteria of the phase III studies for intravitreal pegcetacoplan (complement C3 and C3b inhibitor), we were able to calculate the proportion of patients with GA potentially eligible for therapy. Finally, we extracted population data for Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) from Eurostat, applied prevalence statistics to the extracted census and forecasting data to estimate the number of patients with GA, and then applied the proportion eligible for intravitreal pegcetacoplan therapy. We identified six studies with a total of 10 159 individuals. Prevalence of GA was estimated to 0.4% (95% confidence intervals [CI]: 0.2%–0.8%), 1.5% (95% CI: 0.7%–2.6%), and 7.6% (95% CI: 4.6%–11.3%) for individuals aged 60–69, 70–79, and 80+ years, respectively. In Nordic countries, we estimate a total of 166 307 individuals with GA in 2023, increasing to 277 893 in 2050. Of these, 90 803 individuals in 2023, increasing to 151 730 in 2050, are potentially eligible for intravitreal complement inhibitor treatment. Considering these large numbers, our study highlights the importance of this topic in the coming years and its potential to significantly impact our clinical practice, organization, and staffing. [ABSTRACT FROM AUTHOR]

Introduction: Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen’s d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience.We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: −0.4, d: −2.7, d: −3.8, d: −4.8, d: −4.5, and d: −5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge).A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy.Methods: Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen’s d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience.We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: −0.4, d: −2.7, d: −3.8, d: −4.8, d: −4.5, and d: −5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge).A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy.Results: Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen’s d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience.We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: −0.4, d: −2.7, d: −3.8, d: −4.8, d: −4.5, and d: −5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge).A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy.Conclusion: Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen’s d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience.We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: −0.4, d: −2.7, d: −3.8, d: −4.8, d: −4.5, and d: −5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge).A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a feared complication and a leading course of visual impairment, but the connection between DR and depression including the direction has never been studied in a nationwide cohort. We aimed to assess, whether the associations between DR and diagnosed depression are bidirectional. We performed a national register-based cohort study of individuals with type 2 diabetes, who attended diabetic eye screening between January 2013 and June 2022. Level of DR was extracted from the Danish Registry of Diabetic Retinopathy. The severity of DR was assessed according to the International Clinical Diabetic Retinopathy severity scale. Diagnosed depression was ascertained by physician diagnostic codes of unipolar depression (F32), recurrent depression (F33) or dysthymia (F34.1) from the Danish National Patient Register. We estimated presence of diagnosed depression according to DR level at index date and risk of diagnosed depression during follow-up using multivariable logistic and Cox regression, respectively. Secondly, we assessed whether diagnosed depression at index date could predict incident DR. We included 240,893 individuals with type 2 diabetes with baseline rates of diagnosed depression ranging from 5.2 to 6.0 % for DR level 1–4. At index date, individuals with type 2 diabetes and DR were less likely to have a history of diagnosed depression (multivariable adjusted OR, 0.77 [95 % CI 0.73–0.82]). In 226,523 individuals with type 2 diabetes followed for 1,159,755 person-years, 1.7 % developed at least one episode of diagnosed depression. In a model adjusted for age and sex, individuals with DR at index date had an increased risk of incident diagnosed depression compared to those without DR (HR 1.25 [95 % CI 1.16–1.36]). Adjusting for marital status, use of glucose-, lipid- and blood pressure lowering medication, HbA1c, diabetic neuropathy and Charlson comorbidity index waived the above risk (multivariable adjusted HR 1.02 [95 % CI 0.93–1.12]). Furthermore a previous history of diagnosed depression was not associated with increased risk of incident DR (multivariable adjusted HR 0.89 [95 % CI 0.77–1.03]). In this nationwide cohort study, individuals with DR at first screening were 23 % less likely to have a history of depression, but our data did not support a bidirectional association between DR and depression. Selection bias may have occurred as diagnosed depression is a known barrier for attending DR-screening. • Depression in individuals with type 2 diabetes has been associated with poor health outcomes and increased mortality. • Individuals with diabetic retinopathy (DR) were 23 % less likely to have a history of depression at index date. • DR did not independently predict incident depression nor did a history of depression increase the risk of incident DR. [ABSTRACT FROM AUTHOR]

Background: Retinal fundus images, obtained from routine eye screenings, contain important information, not only concerning microvascular lesions of the retina, but potentially also of the progression and manifestation of various other diabetes complications. Recent advances in the field of machine learning, so-called deep learning neural networks (DNN), make it possible to automatically detect retinal lesions from fundus photos. Our overall aim is to develop a DNN to detect retinal vascular lesions. In this abstract, we describe a pre-processing step consisting of application of a DNN. Methods: For each eye, 5 retinal images of parts of the eye are taken, and collected into a joint mosaic image, used for image grading. There is no automated labelling of the images to identify left or right eyes. To distinguish left- from right eye images, we used a set of 1,916 unique, high-definition retina mosaic fundus images from diabetes patients followed at Steno Diabetes Center Copenhagen (SDCC) between 2003-2017. We trained and validated a DNN, using 964 left-eye (training set: 713, validation: 251) and 952 right-eye images (training set: 706, validation: 246). A DNN is a method that finds the optimal algorithm for relating a large set of input (mosaic fundus images) to output (left or right eye). The DNN used was based on the InceptionV3 architecture and run for 100 epochs with 100 gradient descent steps pr. epoch. Results: The DNN classification obtained a validation AUC-ROC of 0.92 and a validation accuracy of 0.86. Conclusions: The DNN successfully distinguished left-eye from right-eye images. We plan to use the DNN to identify right- and left-eye images in the SDCC image database comprising ∼ 80,000 left-eye and right-eye images. We will subsequently develop a DNN for automated detection of referable diabetic retinopathy of retinal fundus images, for use in the clinic. Disclosure: L. Díaz: None. D. Vistisen: Stock/Shareholder; Self; Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S. M. Valerius: None. J.N. Hajari: None. H. Lund-Andersen: None. S. Byberg: None. [ABSTRACT FROM AUTHOR]