Search

Purpose: To evaluate if retinal vascular calibers and systemic risk factors in patients with no or minimal diabetic retinopathy (DR) can predict risk of long‐term progression to proliferative diabetic retinopathy (PDR). Methods: This was a matched case–control study of patients with diabetes having no or minimal DR at baseline with (cases) or without (controls) subsequent development of PDR. We collected six‐field, 45‐degree retinal images, demographic and clinical data from the Funen Diabetes Database. Results: We included 52 eyes from 39 cases and 107 eyes from 89 controls matched on sex, age, type of diabetes, time from first to last screening episode and baseline DR level. Cases had higher HbA1c (73 vs. 55 mmoL/moL; p < 0.001), triglycerides (1.32 vs. 1.16 mmoL/L; p = 0.02) and longer duration of diabetes (19 vs. 14 years; p = 0.01), but the groups did not differ in calibers of retinal arterioles (229 vs. 227 μm; p = 0.49), venules (289 vs. 290 μm; p = 0.83) or the arterio‐to‐venule ratio (0.78 vs. 0.77; p = 0.86).In a multivariable logistic regression model with cluster robust standard error, HbA1c (OR 1.54 per 10 mmoL/moL; 95%‐CI: 1.15–2.07; p = 0.004), triglyceride (OR 1.39 per 1 mmoL/L; 95%‐CI: 1.03–1.86; p = 0.03) and duration of diabetes (OR 1.09 per year; 95%‐CI: 1.03–1.16; p = 0.003) were independent risk factors for PDR. Conclusion: Retinal vascular calibers did not predict long‐term development of PDR in contrast to well‐established risk factors like HbA1c, triglyceride and duration of diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Prediction of the early treatment response is important in neovascular age‐related macular degeneration (nAMD). Hence, we aimed to test if non‐invasive measurements of the retinal vascular structure were able to predict a successful outcome of initial intravitreal treatment. Methods: In 58 eyes of 58 patients with treatment‐naïve nAMD, advanced markers of retinal vascular structure were measured by Singapore I Vessel Assessment prior to initial intravitreal treatment with three monthly injections of aflibercept with subsequently categorization of patients as full treatment responders (FTR) or non/partial treatment responders (N/PR), with the former defined as loosing fewer than five Early Treatment Diabetic Retinopathy Study letters and having no residual intra‐ or subretinal fluid or macular haemorrhage. Results: Of 54 eyes attending follow‐up, 44.4% were categorized as FTR. Patients with FTR were older (81.5 vs. 77 years, p = 0.04), and prior to treatment those eyes had a lower retinal arteriolar fractal dimension (Fd) (1.21 vs. 1.24 units, p = 0.02) and venular length‐diameter ratio (LDR) (7.3 vs. 15.9 units, p = 0.006), but did not differ with respect to other retinal vascular parameters. In multiple logistic regression models, a lower chance of FTR was independently predicted by a higher retinal venular LDR (odds ratio [OR] 0.91, 95% CI 0.82–0.99, p = 0.03, for each 1 unit increment) and marginally by a higher retinal arteriolar Fd (OR 0.83, 95% CI 0.68–1.00, p = 0.05, for each 0.01 unit increment). Conclusion: Retinal venular LDR independently predicted the initial treatment response in nAMD. If confirmed by long‐term, prospective studies, this might help to guide treatment. [ABSTRACT FROM AUTHOR]

Purpose: The Danish Registry of Diabetic Retinopathy includes information from >200 000 patients who attends diabetic retinopathy (DR) screening in Denmark. Screening of patients with uncomplicated type 2 diabetes is often performed by practicing ophthalmologists, while patients with type 1 and complicated type 2 diabetes attends screening at hospitals. We performed a clinical reliability study of retinal images from Danish screening facilities to explore the inter‐grader agreement between the primary screening ophthalmologist and a blinded, certified grader. Methods: Invitations to participate were sent to screening facilities across Denmark. The primary grader uploaded fundus photographs with information on estimated level of DR (International Clinical Diabetic Retinopathy scale as 0 [no DR], 1–3 [mild, moderate or severe nonproliferative DR {NPDR}], or 4 [proliferative DR {PDR}]), region of screening, image style, and screening facility. Images were then regraded by a blinded, certified, secondary grader. Weighted kappa analysis was performed to evaluate agreement. Results: Fundus photographs from 230 patients (458 eyes) were received from practicing ophthalmologists (52.6%) and hospital‐based grading centres (47.4%) from all Danish regions. Reported levels of DR by the primary graders were 66.8%, 12.2%, 13.1%, 1.3% and 5.5% for DR levels 0–4. The overall agreement between primary and secondary graders was 93% (κ = 0.83). Based on screening facility agreement was 96% (κ = 0.89) and 90% (κ = 0.76) for practicing ophthalmologists and hospital‐based graders. Conclusion: In this nationwide study, we observed a high overall inter‐grader agreement and based on this, it is reasonable to assume that reported DR gradings in the screening programme in Denmark, accurately reflect the truth. [ABSTRACT FROM AUTHOR]

Purpose: To compare diabetic retinopathy (DR) severity identified on handheld retinal imaging with ultrawide field (UWF) images. Methods: Mydriatic images of 225 eyes of 118 diabetic patients were prospectively imaged with the Aurora (AU) handheld retinal camera [5‐field protocol (macula‐centred, disc‐centred, temporal, superior, inferior)] and compared with UWF images. Images were classified based on the international classification for DR. Sensitivity, specificity, kappa statistics (K/Kw) were calculated on an eye and person‐level. Results: Distribution of DR severity by AU/UWF images (%) by eye was no DR 41.3/36.0, mild non‐proliferative DR (NPDR) 18.7/17.8, moderate 10.2/10.7, severe 16.4/15.1, proliferative DR (PDR) 13.3/20.4. Agreement between UWF and AU was exact in 64.4%, within 1‐step 90.7%, k = 0.55 (95% CI:0.45–0.65), and kw = 0.79 (95% CI:0.73–0.85) by eye, and exact in 68%, within 1‐step 92.9%, k = 0.58 (95% CI:0.50–0.66), and kw = 0.76 (95% CI:0.70–0.81) by person. Sensitivity/specificity for any DR, refDR, vtDR and PDR were as follows: 0.90/0.83, 0.90/0.97, 0.82/0.95 and 0.69/1.00 by person and 0.86/0.90, 0.84/0.98, 0.75/0.95 and 0.63/0.99 by eye. Handheld imaging missed 37% (17/46) eyes and 30.8% (8/26) persons with PDR. Only 3.9% (1/26) persons or 6.5% (3/46) eyes with PDR were missed if a referral threshold of moderate NPDR was used. Conclusions: Data from this study show that comparing UWF and handheld images, when PDR was the referral threshold for handheld devices, 37.0% of eyes or 30.8% of patients with PDR were missed. Due to the identification of neovascular lesions outside of the handheld fields, lower referral thresholds are needed if handheld devices are used. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate treatment efficacy in diabetic macular oedema (DME) comparing a study population receiving combined intravitreal vascular endothelial growth factor (VEGF) inhibition and focal/grid photocoagulation with a matched, real‐world population receiving standard of care treatment. Methods: In an exploratory study, we included 43 eyes from 32 patients from a previously published study as well as 46 eyes from 38 standard‐of‐care patients. The study population had received a loading dose of three monthly aflibercept injections followed by focal/grid photocoagulation and additional aflibercept pro re nata. Principal measurements at 12 months were numbers of intravitreal injections, best corrected visual acuity (BCVA) and central retinal thickness (CRT). Results: At baseline, there were no differences between groups regarding age, sex, body mass index, haemoglobin A1C, systolic pressure or type of diabetes, but the study population had a higher diastolic pressure (81.6 versus 72.1 mmHg, p = 0.03) and a lower duration of diabetes (12.3 versus 23.2 years, p = 0.03). At month 12, patients in the study group had a higher visual acuity (79.6 versus 74.3 ETDRS letters, p = 0.03), despite having received fewer aflibercept injections (4.4 versus 5.9, p < 0.01) with a higher likelihood of having only received the three mandatory injections in the loading phase (39.5% versus 13.0%, p = 0.01). Conclusion: In comparison to a matched, real‐world DME‐population, patients in combined treatment with intravitreal aflibercept and postloading focal/grid photocoagulation obtained a better functional outcome despite having received fewer intravitreal injections. Future randomized studies are needed to evaluate the long‐term efficacy of this combined treatment regimen. [ABSTRACT FROM AUTHOR]

Purpose: Angiostatic agents have proven effective in the treatment of macular oedema in patients with branch retinal vein occlusion (BRVO). However, treatment is inconvenient and expensive, and novel treatment regimens are warranted. We aimed to evaluate if combination treatment of navigated central retinal laser and aflibercept lowered the treatment burden in these patients. Methods: Treatment‐naïve patients with BRVO and macular oedema were included at two centres and randomized 1:1 to three monthly injections of 2.0 mg aflibercept with (Group A) or without (Group B) navigated central laser, followed by aflibercept as needed from month 4 through 12. Re‐treatment need was evaluated, and secondary endpoints included functional and anatomical outcomes and safety evaluated by retinal microperimetry. Results: We evaluated 41 eyes of 41 patients with a mean age of 69.6 years. Baseline median best‐corrected visual acuity (BCVA) was 70.0 letters, and median central retinal thickness (CRT) was 502 μm with no difference between Groups A (n = 21) and B (n = 20). Percentage of patients needing re‐treatment after month three was 71% and 80% (p = 0.72). At month 12, groups did not differ in number of injections after loading (1 versus 2, p = 0.43), change in BCVA (+12.8 versus +15.1 letters, p = 0.48), CRT (−195 versus −181 μm, p = 0.82), or retinal sensitivity (+3.3 versus +4.1 dB, p = 0.67). Conclusion: In treatment‐naïve BRVO patients, addition of navigated central laser to aflibercept did not lower treatment burden or affect functional or anatomical outcomes. A low number of intravitreal injections were needed for successful outcome in both treatment arms. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a sight‐threatening complication of diabetes mellitus (DM) and it contributes substantially to the burden of disease globally. During the last decades, the development of multiple imaging modalities to evaluate DR, combined with emerging treatment possibilities, has led to the implementation of large‐scale screening programmes resulting in improved prevention of vision loss. However, not all patients are able to participate in such programmes and not all are at equal risk of DR development and progression. In this review, we discuss the relevance of the currently available imaging modalities for the evaluation of DR: colour fundus photography (CFP), ultrawide‐field photography (UWFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), OCT angiography (OCTA) and functional testing. Furthermore, we suggest where a particular imaging technique of DR may aid the evaluation of the disease in different clinical settings. Combining information from various imaging modalities may enable the design of more personalized care including the initiation of treatment and understanding the progression of disease more adequately. [ABSTRACT FROM AUTHOR]

Purpose: Using OCT‐A to investigate the association between neurodegeneration and vascular morphology in diabetic retinopathy (DR). Methods: Cross‐sectional study. One hundred and sixty‐two patients were enrolled and following fundoscopy were assigned to two groups according to DR severity: 54 patients to the group of no clinical signs of DR (noDR) and 54 to the non‐proliferative DR (NPDR) group. Fifty‐four age‐matched patients without known diabetes were recruited as the control group. Patients underwent full ophthalmic examination followed by OCT‐A. Central retinal thickness (CRT), vessel density (VD) in the superficial and deep retinal layers and foveal avascular zone (FAZ) area were measured. Additionally, ganglion cell complex (GCC) layer thickness along with global loss volume (GLV) and focal loss volume (FLV) indices was measured. Results: In total, 85 men with mean age of 51.93 ± 9.03 and 77 women with age of 50.14 ± 10.35 were examined. Mean diabetes duration was 4.62 ± 2.16 years in the noDR group and 11.34 ± 2.73 years in the NPDR group (p < 0.001). Superficial VD (sVD) and deep VD (dVD) were significantly different only between noDR and NPDR groups (p < 0.001 for both comparisons), but no statistically significant difference was observed between the controls and the DR groups. Global loss volume was significantly higher in the NPDR (4.38 ± 2.22) compared to the noDR group (3.24 ± 1.76; p < 0.03). Focal loss volume was significantly higher in both noDR (1.22 ± 1.03) and NPDR (2.09 ± 1.72) groups compared to controls (0.95 ± 0.83; p < 0.001 between noDR and NPDR and p = 0.02 between control and noDR groups). Significant associations were found between GLV and deep VD (p < 0.01, r = −0.48), FLV and superficial VD (p < 0.01, r = −0.42) and FLV with deep VD (p < 0.01, r = −0.64). Conclusion: In this study, we evaluated the impact of DR in both the vascular layers and neural components of the retina as expressed by FAZ, sVD, dVD and GCC thickness, FLV and GLV using OCT‐A. We found that FLV was significantly higher in both noDR and NPDR groups indicating that in progressive DR stages FLV values might be increased, which might serve as an early index of neuronal damage in patients with diabetes even in the absence of overt DR signs. [ABSTRACT FROM AUTHOR]

Purpose: Metabolic and structural microvascular retinal alterations are essential components in diabetic retinopathy (DR). The present study aimed to measure changes at different stages of non‐proliferative DR (NPDR) and to explore interactions of imaging‐based metrics. Methods: This cross‐sectional, cohort study included 139 eyes from 80 diabetic patients. Each patient underwent dilated fundal examinations including colour fundus photography, retinal oximetry and optical coherence tomography angiography (OCTA), analysed by semi‐automated and automated software. Diabetic retinopathy (DR) severity was classified according to the International Clinical Diabetic Retinopathy (ICDR) Severity Scale, ranging from no DR to severe NPDR (level 0–3). Retinal metabolism was evaluated by oximetry as retinal arteriolar (raSatO2) and venular oxygen saturation (rvSatO2), and macular microvascular structure was measured by OCTA as the area of foveal avascular zone (FAZ), vessel density (VD), vessel diameter index (VDI), FAZ circularity and fractal dimension (FD) in the superficial and deep retinal capillary plexus. Results: A trend for increasing rvSatO2 was found with increasing DR severity (51.3%, 53.3%, 54.2%, 59.8%, p = 0.02). Increasing severity of DR associated with decreasing FD in the superficial and deep plexus (p < 0.001 and p = 0.014), and in the superficial plexus decreasing VD (p < 0.001), increasing VDI (p = 0.003) and decreasing FAZ circularity (p = 0.006). A few interactions were identified between raSatO2, rvSatO2 and VDI, but only in the deep capillary plexus (p < 0.01 and p < 0.01). Conclusion: Alterations of the venular retinal vascular oxygen saturation and microvascular structural abnormities were found continuously throughout the DR‐spectrum. Given the sparse correlations between metabolic and structural abnormalities, it seems that these occur independently in DR. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the association between retinal laser burden and vascular oxygen saturation in patients with proliferative diabetic retinopathy (PDR) treated with different extent of retinal laser. Methods: The study was a prospective, interventional study of patients with treatment‐naïve PDR. Patients were treated with navigated retinal laser (Navilas®, OD‐OS GmbH, Teltow, Germany) in different doses. Retinal oximetry was obtained at baseline (BL) prior to laser and after 6 months (M6). Patients were divided into three groups according to total laser spots applied: <1500 spots (Group 1), 1500–2000 spots (Group 2), and >2000 spots (Group 3). Results: We included 33 eyes of 28 patients with treatment‐naïve PDR. The groups did not differ according in BL characteristics. Between BL and M6, retinal arteriolar oxygen saturation did not change but retinal venular oxygen saturation (median with interquartile range) decreased in Groups 1 and 2 (1: 65.5 ± 8.8% versus 60.5 ± 9.5%, p = 0.04; 2: 65.3 ± 7.3% versus 63.0 ± 13.5%, p = 0.04). Focal retinal venular oxygen saturation, located to quadrants with retinal neovascularization, decreased in Group 2 from BL to M6 (67.5 ± 13.3% versus 61.5 ± 8.8%, p = 0.04). Retinal venular diameter decreased from BL to M6 in Group 1 (174.5 ± 15.3 μm versus 165.1 ± 28.7 μm, p = 0.01). Conclusions: In this study of patients with treatment‐naïve PDR, we showed that a less extensive laser treatment caused a reduction in retinal venular oxygen saturation and diameter 6 months after treatment. Our results suggest that less extensive laser treatment may be sufficient to improve the retinal metabolic environment conducive to PDR regression. [ABSTRACT FROM AUTHOR]

Purpose: There is a relative paucity of self‐reported vision problems data in European countries. Methods: In this context, we investigated self‐reported vision problems through European Health Interview Survey 2, a cross‐sectional European population survey based on a standardized questionnaire including 147 medical, demographic and socioeconomic variables applied to non‐institutionalized individuals aged 15 years or more in 28 European countries, in addition to Iceland and Norway. Results: The survey included 311 386 individuals (54.18% women), with overall crude prevalence of self‐reported vision problems of 2.07% [95% CI; 2.01–2.14]. Among them, 1.70 % [1.61–1.78] of men, 2.41% [2.31–2.51] of women and 4.71% [4.53–4.89] of individuals aged 60 or more reported to have a lot of vision problems or to be not able to see. The frequency of self‐reported vision problems was the highest in Eastern European countries with values of 2.43% [2.30–2.56]. In multivariate analyses, limiting long‐standing illness, depression, daily smoking, lack of physical activity, lower educational level and social isolation were associated with self‐reported vision problems with ORs of 2.66 [2.42–2.92], 2.16 [2.01–2.32], 1.11 [1.01–1.23], 1.31 [1.21–1.42], 1.29 [1.19–1.40] and 1.45 [1.26–1.67], respectively, while higher income was associated with less self‐reported vision problems with OR of 0.80 [0.73–0.86]. Conclusions: This study demonstrated inequalities in terms of prevalence of self‐reported vision problems in Europe, with higher prevalence in Eastern European countries and among women and older individuals. [ABSTRACT FROM AUTHOR]

Purpose: To review studies focusing on cilioretinal arteries (CLRA) in order to assess the overall prevalence and establish the prevalence of CLRA in a Hungarian Caucasian population. Methods #1: Systematic literature review of published studies with at least 100 participants. Methods #2: Non‐mydriatic digital colour photographs were taken of 1000 consecutively enrolled healthy Caucasian young adult volunteers. Images were graded by two trained independent observers. Number and location of identified cilioretinal arteries were recorded and statistically analysed. Results #1: Prevalence of CLRA ranges from 6.9% to 49.5%. Detection with fluorescein angiography yields the highest values followed by fundus photography and ophthalmoscopy. Unilateral presence of CLRA is between 70.30% and 93.65%, and temporal location is between 80.77% and 100%. Results #2: We found at least one CLRA in 36.5% of the participants and in 22.75% of all the examined eyes. Cilioretinal arteries (CLRA) were unilateral in 75.34% and bilateral in 24.66%. Of all the identified CLRA, 96.16% were originating from the temporal rim of the optic disc. We identified at least one temporal CLRA supplying the macula in 28% of the participants and 16.95% of the examined eyes. Conclusion: Prevalence of CLRA varies depending on identification method. Unilateral presence is unequivocally more frequent similarly to temporal location. From a risk of bias standpoint, high‐quality studies are rare. Our data on the distribution pattern of CLRA are similar to that in the international literature. Based on our findings, we assume that slightly more than one‐third of the Hungarian Caucasian population has a CLRA. [ABSTRACT FROM AUTHOR]

Purpose: This study was based on data from a 12‐month prospective clinical trial and aimed to examine changes in retinal microvascular structure in eyes treated with intravitreal aflibercept in combination with focal/grid laser photocoagulation for diabetic macular oedema (DME). Methods: We included 32 treatment naïve eyes of 22 patients with centre involving DME. The treatment algorithm comprised a loading phase of three monthly injections of aflibercept and focal/grid laser photocoagulation [baseline (BL)‐month 3 (M3)] followed by a pro re nata (PRN) aflibercept phase until month 12 (M12). Eyes were divided into groups with and without need for PRN treatment after loading. Parameters of retinal microvascular structure were measured in 45° optic disc centred fundus images at BL, M3 and M12 using a semi‐automated software (VAMPIRE®, Vessel Assessment and Measurement Platform for Images of the Retina, Universities of Dundee and Edinburgh, UK). Results: A significant decrease in retinal arteriolar calibre was demonstrated at both M3 (−11.2 μm, p = 0.005) and M12 (−11.5 μm, p = 0.04) as compared to BL in eyes that needed PRN treatment during follow‐up. In contrast, arteriolar calibre remained unchanged in eyes without need for PRN treatment (M3: −1.6 μm, p = 0.79 and M12: −7.0 μm, p = 0.22). For retinal venules, vessel calibre decreased both in eyes with and without need for PRN therapy at M3 (−9.5 μm, p = 0.01 and −11.6 μm, p = 0.01) as well as at M12 (−15.6 μm, p = 0.001 and −11.0 μm, p = 0.04). Conclusion: Early changes in retinal arteriolar calibre are associated with an increased treatment burden during the first year of DME treatment. [ABSTRACT FROM AUTHOR]

Purpose: To examine the efficacy of intravitreal aflibercept and navigated laser as compared to intravitreal aflibercept and conventional laser in diabetic macular oedema (DME) treatment. Methods: In 12‐month randomized clinical trial, 48 eyes of 37 patients with centre‐involved DME at Odense University Hospital were randomized 1:1 to receive three monthly injections of aflibercept followed by navigated (group A) or conventional (group B) focal/grid laser. From month four through twelve, patients were examined monthly, and additional injections were given pro re nata (PRN) (central retinal thickness [CRT]>20% from lowest measurement or loss in visual acuity [VA]>5 Early Treatment Diabetic Retinopathy Study [ETDRS] letters compared with baseline). Outcome measures; (1) percentage of eyes that needed additional injections after laser in group A and B, (2) mean number of injections in group A and B, and (3) mean change in VA and CRT in group A and B. Results: In the PRN phase, 60.5% of patients needed additional injections without differences between groups A and B (58.3 versus 63.2%, p > 0.99). The mean number of injections between baseline and month 12 was 4.4 (4.2 versus 4.6, p = 0.41). From baseline to month 12, VA improved by 8.4 ETDRS letters, and CRT was reduced by 97.4 μm (+9.4 versus +7.1 letters, p = 0.17, and −83.2 versus −115.4 μm, p = 0.21). Conclusion: No difference in need for retreatment was detected between treatment arms of aflibercept and navigated versus conventional laser. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine the prevalence of characteristics and pathologies of the vitreo‐macular interface within the general population. Methods: The Gutenberg Health Study is a population‐based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo‐macular interface were graded on volume scans including visibility of an epiretinal membrane, full‐thickness macular hole, lamellar hole and pseudohole. Overall and age‐specific prevalences including 95% confidence intervals [95%‐CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression. Results: A total of 1890 people aged 40–80 years were included in the study. Of these, 4.7% (95%‐CI: 3.8%–5.8%) had an epiretinal membrane in at least one eye, 0.1% a full‐thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure. Conclusions: Epiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the progression characteristics of ellipsoid zone (EZ) loss in eyes with macular telangiectasia type 2 (MacTel) as reflected by area and linear measurements, and their relevance for visual acuity. Methods: Participants were selected from the MacTel Study cohort. Linear and area measurements of EZ loss were performed in Spectral‐Domain Optical Coherence Tomograph (SD‐OCT) volume scans. Progression characteristics and correlations between linear and area measurements were analysed using linear mixed effects models. Results: A total of 134 eyes of 70 patients were included (85 eyes with follow‐up, mean 4.7 years, range: 1.4–8 years). Ellipsoid zone (EZ) loss significantly progressed at a mean annual increment of 0.057 mm2 (p = 0.005). The progression rate was non‐linear and interacted significantly with initial EZ lesion size indicating an exponential growth before reaching a plateau. There was a strong heterogeneity in area sizes between fellow eyes. EZ break length had a significant linear effect on EZ break area (b = 1.06, p < 0.001) and could predict it. The location of the EZ break had a significant impact on visual acuity. Conclusion: Ellipsoid zone (EZ) loss in MacTel has a non‐linear progression characteristic, and its rate depends on area size at baseline, which must be taken into account at sample selection in clinical trials. Our results show a good correlation of linear and area measures of EZ loss and a segregation of best‐corrected visual acuity by EZ location, which may help routine clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Non‐invasive retinal markers of disease activity could pave the way for individualized treatment in neovascular age‐related macular degeneration (nAMD). We aimed to evaluate if retinal vascular oxygen saturation and calibres could predict the initial treatment response after a loading phase of intravitreal aflibercept in nAMD. Method: A total of 149 eyes were included (nAMD, n = 76; dry AMD, n = 30; normal eyes n = 43). Of these, 57 treatment‐naïve eyes with nAMD received three monthly injections with 2.0 mg aflibercept and were subsequently stratified according to functional and structural response according to development in best‐corrected visual acuity and macular retinal thickness. The retinal vascular oxygen saturation and calibres were measured prior to treatment and 1 month after the third injection. Results: Patients with nAMD and dry AMD had higher retinal arteriolar oxygen saturation as compared to normal eyes (94.3% versus 95.2% versus 92.6%, p = 0.04). Thirty‐nine (68.4%) and 12 (21.1%) eyes with nAMD were functional and structural responders. After the loading phase, structural nonresponders developed a higher retinal arteriolar (95.3% versus 93.3%, p = 0.03) and venular (64.7% versus 59.4%, p = 0.02) oxygen saturation, and responders developed a lower retinal arteriolar calibre (118.0 versus 114.3 μm, p < 0.01). In a multiple logistic regression model, increasing retinal venular oxygen saturation associated with a negative structural treatment outcome (odds ratio 1.17 for each 1% increment after the loading phase, 95% confidence interval 1.01–1.36, p = 0.03). Conclusion: Changes in the retinal venular oxygen saturation associate independently with initial treatment response in nAMD, but functional and structural retinal measurements prior to treatment could not predict the treatment response. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor inhibitors (anti‐VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment protocols of anti‐VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME treatment. Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approximately 20–50% of patients receiving anti‐VEGF monotherapy for centre involving DME. Further, a lower retreatment rate and a more stable reduction in retinal thickness have been demonstrated in more studies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti‐VEGF trials. Hence, this paper aimed to provide an overview of the currently available data relevant to the potential role of focal/grid laser photocoagulation in DME treatment including a thorough overview of the current most commonly used laser systems. Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valuable option as adjunctive therapy to anti‐VEGF treatment. However, more well‐designed studies on combination therapy are warranted to determine the full potential of modern retinal photocoagulation systems. In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients. [ABSTRACT FROM AUTHOR]

Purpose: To describe the relationship between choroidal thickness (CT) and myopia in relation to physical activity (PA) in a population‐based child cohort. Methods: In a prospective study of 307 children from the CHAMPS Study Denmark, we used objective data from GT3X accelerometer worn at four periods between 2009 and 2015 to determine the amount and intensity of PA. Intensity was estimated as counts/minutes, and cut‐off points were defined at four intensity levels. Eye examinations were performed in 2015 and included autorefraction in cycloplegia, axial length (AL) by biometric and fovea‐centred enhanced depth imaging optical coherence tomography. By a semi‐automated method, we measured the CT at 17 targets per eye representing anatomically different locations (subfoveal, 1 and 3 millimetre in each direction of fovea). Results: Mean age at the eye examination was 15.4 ± 0.7 years. The mean AL was 23.5 ± 0.9 mm, and the mean subfoveal CT was 369 ± 87 μm. Choroidal thickness (CT) was 331 ± 68 μm for the overall macula, 355 ± 78 μm for the 1‐mm zone and 304 ± 60 μm for the 3‐mm zone. All CT measurements were thinner in myopic eyes (p < 0.0001) and in boys (p < 0.05). We found no association between total PA and the CT by either mixed model analysis (p = 0.074) or linear regression by any intensity levels (p = 0.22, p = 0.15 and p = 0.43). Conclusion: Among adolescents aged 14–17 years, there was no association between objective PA exposures and the CT, AL or refractive error. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate changes in retinal vascular geometry over time after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR). Methods: Thirty‐seven eyes with PDR were included. Wide‐field fluorescein angiography (Optomap, Optos PLC., Dunfermline, Scotland, UK) was used to diagnose PDR at baseline and to assess activity at follow‐up month three and six. At each time‐point, a trained grader measured retinal vessel geometry on optic disc (OD) centred images using semiautomated software (SIVA, Singapore I Vessel Assessment, National University of Singapore, Singapore) according to a standardized protocol. Results: At baseline, the mean age and duration of diabetes were 52.8 and 22.3 years, and 65% were male. Mean HbA1c was 69.9 mmol/mol, and blood pressure was 155/84 mmHg. Of the 37 eyes with PDR, eight (22%) eyes had progression at month three and 13 (35%) progressed over six months. Baseline characteristics, including age, sex, duration of diabetes, HbA1c, blood pressure, vessel geometric variables and total amount of laser energy delivered did not differ by progression status. However, compared to patients with progression of PDR, patients with favourable treatment outcome had alterations in the retinal arteriolar structures from baseline to month six (calibre, 154.3 μm versus 159.5 μm, p = 0.04, tortuosity 1.12 versus 1.10, p = 0.04) and in venular structures from baseline to month three (fractal dimension 1.490 versus 1.499, p = 0.04, branching coefficient (BC) 1.32 versus 1.37, p = 0.01). Conclusion: In patients with PDR, successful PRP leads to alterations in the retinal vascular structure. However, baseline retinal vascular geometry characteristics did not predict treatment outcome. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine associations between physical activity (PA) and myopia in Danish school children and investigate the prevalence of myopia. Methods: This is a prospective study with longitudinal data on PA in a Danish child cohort. Physical activity (PA) was measured objectively by repeated ActiGraph accelerometer measurement four times with different intervals (1–2.5 years) at the mean ages 9.7, 11.0, 12.9 and 15.4 years. Mean intensity of PA was estimated as counts/minutes, and time spent in sedentary, light, moderate and vigorous PA was summed using defined cut‐off points. The ophthalmologic examination was conducted at the mean age of 15.4 ± 0.7 years and included cycloplegic autorefraction and biometry. Results: A total of 307 children participated in the Childhood Health, Activity, and Motor Performance School (CHAMPS) Eye Study. The cycloplegic spherical equivalent (SE) was 0.30 ± 1.46 dioptres. The prevalence of myopia was 17.9% (SE ≤−0.5 dioptres). Mean axial length (AL) was 23.5 ± 0.9 mm. For all participants, the overall mean daily distribution of PA was 67.2% in sedentary, 25.6% in light, 4.4% in moderate and 2.9% in vigorous PA. Age‐ and sex‐adjusted linear regression showed no association between PA and SE or AL. In a prospective slope analysis, there was no association between accumulated PA during the 7 years and AL or SE. Conclusion: The prevalence of myopia among Danish children was 17.9%. By logistic regression and slope analysis, we found no association between PA and myopia, in this first of its kind study based on objective and repeated PA data. [ABSTRACT FROM AUTHOR]

Purpose This study aims to estimate the prevalence and risk factors of diabetic retinopathy ( DR) in patients enrolled in a large Danish quality-assuring database for diabetes: the Funen Diabetes Database ( FDDB). Methods All patients with type 1 (T1 DM) and type 2 DM (T2 DM) diabetes mellitus (DM) were included in a cross-sectional study. The level of DR per patient was determined based on the eye with highest level of DR. All ocular and non-ocular data were extracted at the latest examination that corresponded to the most recent DR-grading data. Results Data from 17 152 patients were analysed; 83.1% had T2 DM. Prevalence of DR was 23.8% (T1 DM: 54.3%, T2 DM: 21.2%). T1/T2 DM patients were statistically significantly different regarding age, duration of diabetes, BMI, systolic blood pressure ( BP), cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, s-creatinine and u-albumin (p < 0.001 for all). Increasing level of DR showed statistically significant association with age, duration of diabetes, systolic BP, HbA1c, s-creatinine and u-albumine with increasing level of DR (all are p < 0.001) both T1 DM/T2 DM patients. Conclusion The patients in FDDB had good systemic control with median values of BP, serum lipids, cholesterol and HbA1c all close to or below national guidelines at the time of data extraction, but still a high level of DR was found in this cohort. DR was more common in patients with T1 DM than T2 DM, but as T2 DM patients are more numerous, their level of DR despite acceptable control is still concerning. Most important associated factors for higher levels of DR were age, duration of diabetes, HbA1c, s-creatinine and u-albumine. [ABSTRACT FROM AUTHOR]

Purpose To provide sex-stratified normative data on retinal thickness and study the relationship with sex, age and refractive status. Methods Population-based study including 2617 women and 1891 men, aged 38-87 (mean 61 ± 8) years, without diabetes, glaucoma and retinal diseases, and spherical equivalent refraction ( SER) within ±6 dioptres. Retinal thickness was measured with optical coherence tomography (spectral domain Cirrus HD- OCT). Results Women had thinner retina than men. Retinal thickness was significantly associated with refraction, where mean change in retinal thickness per 1 D increase in SER was −1.3 (0.2) μm in the fovea, 0.7 (0.1) μm in the pericentral ring and 1.4 (0.1) μm in the peripheral ring. In the fovea, there was a non-monotonic curved relationship between retinal thickness and age in both sexes with a maximum at about 60 years (p < 0.001). In the pericentral ring, the mean reduction in retinal thickness per 10-year increase was 2.7 (0.3) μm in women and 4.0 (0.4) μm in men and corresponding results in the peripheral ring were 2.3 (0.3) μm in women and 2.6 (0.4) μm in men. In both regions, there was evidence for a nonlinear pattern with an increased rate of change with higher age. There was a significant interaction between sex and age for retinal thickness of the pericentral ring (p = 0.041). Conclusion Women had thinner retina than men, and thickness varied with refractive status. Retinal thickness was associated with age in all macular regions, and the rate of change in retinal thickness varied at different ages. [ABSTRACT FROM AUTHOR]

The article examines the efficacy of Segmentation and the Ruler method for computed tomography (CT) measurement. It mentions the use of enhanced depth imaging spectral-domain optical coherence tomography (EDI-SD OCT) to visualize the choroid which is believed to be involved in the pathophysiology of several vision-threatening diseases such as age-related macular degeneration.

Purpose To examine the incidence of retinal detachments and to evaluate patient profiles and surgical characteristics. Methods Retrospective review of patients operated for primary retinal detachment ( RD) and redetachment between 2010 and 2012 at the Department of Ophthalmology, Odense University Hospital, Denmark. We included all RD such as rhegmatogenous retinal detachment ( RRD), tractional retinal detachment ( TRD) and exudative retinal detachment (ERD). Results In total, 779 RD surgeries were performed: 83.7% ( n = 652) primary operations and 16.3% ( n = 127) reoperation. For primary operation, pars plana vitrectomy ( PPV), scleral buckling and combined operations were performed in 95.1% ( n = 620), 4.6% ( n = 30) and 0.3% ( n = 2) respectively. Over time there was less use of silicone oil and greater use of gas tamponade (p = <0.001), less simultaneous cataract operations (p = <0.001), less use of cryotherapy (p = 0.045) and more use of peeling procedures (p = <0.001) in primary operations. The annual incidence of surgery for primary RD was 22.0 [95% confidence interval ( CI) 20.4-23.8] per 100 000 inhabitants aged >15 years. Retinal detachment (RD) was more common in males than females (1.8:1), and mean age at presentation was 61.8 years (standard deviations ± 12.3). The annual incidence for RRD and TRD operation was 20.72 (95% CI 19.11-22.43) and 1.25 (95% CI 0.9-1.7) per 100 000 inhabitants >15 years. Conclusion This study presents the first overall incidence for RD in Denmark. The highest incidence of RRD was among males aged 60 to 79 years, whereas TRD was among females at same age. Pars plana vitrectomy (PPV) was the preferred surgical technique, and during 2012 all RD patients were treated with PPV, independent of lens status and age. [ABSTRACT FROM AUTHOR]

Purpose To examine associations between cardiovascular risk factors and age-related macular degeneration ( AMD). Methods A population-based, cross-sectional study of Caucasians aged 65-87 years was conducted in Norway in 2007/2008. Retinal photographs were graded for AMD. Multivariable logistic regression analyses were performed based on questionnaires addressing habits of smoking, alcohol consumption, physical activity, health and medication; and physical examination comprising anthropometric measurements, blood pressure and blood sampling. Cardiovascular disease status was obtained from a validated end-point registry. Results Gradable photographs were available for 2631 participants, of whom 92 (3.5%) subjects had late AMD. In the multivariable analysis of late AMD, significant interactions were found between sex and the variables age, triglyceride level, use of lipid-lowering drugs and physical exercise. Current daily smoking was significantly related to late AMD in both sexes (odds ratio ( OR) 4.06, 95% confidence interval ( CI) 1.69-9.76 and OR 3.59, 95% CI 1.17-11.04, women and men, respectively) compared with never smokers. Higher number of pack years was associated with the presence of large drusen (>125 μm) ( OR 1.04, 95% CI 1.01-1.09 per 5 years). Higher systolic blood pressure ( OR 1.06, 95% CI 1.01-1.12 per 5 mmHg), overweight ( OR 2.87, 95% CI 1.13-7.29) and obesity ( OR 2.92, 95% CI 1.06-8.03), physical exercise duration ( OR 0.41, 95% 0.18-0.96 for 30 min or more compared with less) and frequency ( OR 0.46, 95% CI 0.23-0.92 for weekly or more often compared to less) were associated with late AMD in women only. Conclusions Smoking was strongly associated with AMD, in line with results from other populations. Also, late AMD was related to higher systolic blood pressure, physical inactivity, overweight and obesity in women. [ABSTRACT FROM AUTHOR]

. Purpose: To determine the prevalence and risk factors for retinopathy in a nondiabetic population. Methods: The study population included 5869 participants without diabetes aged 38-87 years from the Tromsø Eye Study, a substudy of the population-based Tromsø Study in Norway. Retinal images from both eyes were graded for retinopathy. We collected data on risk factors from self-report questionnaires, clinical examinations, laboratory measurements and case note reviews. The cross-sectional relationship between potential risk factors and retinopathy was assessed using logistic regression analysis. Results: The overall prevalence of retinopathy was 14.8%. Men had a higher prevalence of retinopathy compared with women (15.9% versus 14.0%, p = 0.04). In men, retinopathy was associated with hypertension (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.24-2.04) and HbA1c (OR per %, 1.41; 95% CI, 1.01-1.96). In women, retinopathy was associated with age (OR per 10 years, 1.32; 95% CI, 1.14-1.52), log-transformed urinary albumin excretion (OR per log unit, 1.46; 95% CI, 1.14-1.87) and hypertension (OR, 1.36; 95% CI, 1.08-1.71). In women, retinopathy was associated with very low levels of urinary albumin excretion (urinary albumin/creatinine ratio >0.43 mg/mmol). Conclusion: This study confirms results from previous studies on the strong association between blood pressure and retinopathy. A novel finding is the sex differences in risk factors for retinopathy, suggesting a sex difference in the pathogenesis leading to retinopathy. [ABSTRACT FROM AUTHOR]

. Purpose: To determine the prevalence of visual impairment, retinopathy and macular oedema, and assess risk factors for retinopathy in persons with diabetes. Methods: The present study included 514 participants with diabetes aged 46-87 years from the Tromsø Eye Study, a sub-study of the population-based Tromsø Study in Norway. Visual acuity was measured using an auto-refractor. Retinal images from both eyes were graded for retinopathy and macular oedema. We collected data on risk factor exposure from self-report questionnaires, clinical examinations, laboratory measurements and case note reviews. Regression models assessed the cross-sectional relationship between potential risk factors and diabetic retinopathy. Results: The prevalence of visual impairment (corrected Snellen visual acuity <20/60 in the better-seeing eye) was 1.6%. The prevalence of diabetic retinopathy was 26.8% and macular oedema 3.9%. In a multivariable logistic regression model, retinopathy was associated with longer diabetes duration (odds ratio, OR 1.07, 95% CI 1.03-1.11), insulin use (OR 2.14, 95% CI 1.19-3.85), nonfasting glucose (OR 1.07, 95% CI 1.00-1.15) and microalbuminuria (OR 1.89, 95% CI 1.28-2.81). Sub-group analyses showed association between retinopathy and even low levels of microalbuminuria (1.16 mg/mmol). Conclusion: The findings suggest that low levels of microalbuminuria may be a useful risk predictor for identifying individuals with diabetes at high risk of retinopathy. The study confirms previous findings that insulin use, longer diabetes duration and higher levels of blood glucose are associated with retinopathy in persons with diabetes. The prevalence of diabetic retinopathy was similar as reported in other studies. [ABSTRACT FROM AUTHOR]

. Purpose: To describe the study design and methodology of the Tromsø Eye Study (TES), and to describe visual acuity and refractive error in the study population. Methods: The Tromsø Eye Study is a sub-study of the Tromsø Study, a population-based multipurpose longitudinal study in the municipality of Tromsø, Norway. The Tromsø Eye Study was a part of the sixth survey of the Tromsø Study, conducted from October 2007 through December 2008. The eye examination included information on self-reported eye diseases, assessment of visual acuity and refractive errors, retinal photography and optical coherence tomography. Retinal images were graded for diabetic retinopathy and age-related macular degeneration, and with computer-assisted measurements of arteriolar and venular diameters. In addition, TES researchers have access to the large comprehensive Tromsø Study database including physical examination results, carotid artery ultrasound, electrocardiogram, bone densitometry, cognitive tests, questionnaires, DNA, blood and urine samples and more from the present and the five previous surveys. Results: Visual acuity was assessed in 6459 subjects and refraction in 6566 subjects aged 38-87 years. Snellen visual acuity <20/60 was found in 1.2% (95% CI 0.95-1.5) of the participants and there was no gender difference. Visual impairment increased with age, and in the age group 80-87 years, the overall visual acuity <20/60 was 7.3% (95% CI 3.3-11.2). Spherical equivalent showed an increasing trend with age and there was no clinically relevant difference between men and women. Retinal photography was performed in 6540 subjects. Conclusion: Prevalence of visual impairment was low but increased with age. There was a trend towards hyperopia with age and no clinically relevant difference in refraction between the sexes. TES aims to provide epidemiological research on several eye and eye-related diseases. Owing to a comprehensive data collection, it has the opportunity to explore issues related to environmental factors, cognition and their interaction with diseases in this community. [ABSTRACT FROM AUTHOR]

Purpose: To determine the number of patients with diabetes mellitus (PwDM) who were certified as visually impaired (CVI) over the past 5 years in Northern Ireland, UK. Methods: CVI data were collected from 11 sites and 50 eye‐specialists using pre‐defined CVI forms. Eye‐specialists must provide patient demographics and vision information such as visual acuity and diagnosis for certification purposes. Data were transcribed into Microsoft Excel before analysis was undertaken to produce an annual CVI report for eye and healthcare professionals. Our analysis determined the contribution of diabetes and diabetic eye disease (DED) to the sight‐impairment burden between 2014 and 2018. Results: In 2014, 332 CVIs were registered: 184 as severely sight impaired (SSI) and 142 sight impaired (SI). Of the 24 who had diabetes, 19 were certified due to diabetic retinopathy (DR) and 2 to diabetic macular oedema (DMO). Between 2015 and 2017 the number of CVIs increased to 412, 428 and 453 respectively with PwDM having grown to 48, 43 and 41, respectively. PwDM were also certified due to AMD and glaucoma (range of 2%–31% and 2–4% respectively) from 2015 to 2017. After an intense education campaign, in 2018, the total CVI submissions increased to 575; of these 368 were SSI and 196 were SI. The number of people who were certified as having diabetes more than doubled in 2018 to 107 of these, 51 (48%) were certified due to DED. AMD was found to be the second largest cause of visual impairment in PwDM at 40%, the remaining people had other ophthalmic issues such as keratoconus and optic atrophy. Conclusions: PwDM were previously underrepresented in the sight impaired registers in Northern Ireland. Since the awareness campaign and introduction of improved pre‐defined forms in 2018, Northern Ireland is now on par with certification rates in the rest of the UK. This information provides insight into the epidemiology of sight impairment in Northern Ireland while providing appropriate data for policymaking and service planning purposes. [ABSTRACT FROM AUTHOR]

Purpose: To determine the correlation of diabetic retinopathy (DR) findings identified on ultrawide field (UWF) color photos, ultrawide field fluorescein angiograms (UWF‐FA) and optical coherence tomography (OCT) angiograms (OCTA). Methods: This was a cross‐sectional study. Images taken on the same visit were prospectively collected from adult patients with diabetes at a tertiary center in the Philippines. Patients underwent imaging with UWF and UWF‐FA (Optos plc, Dunfermline, Scotland, UK), and OCT with OCTA (Carl Zeiss Meditec Inc, Dublin, CA, USA). Images were evaluated for the presence of DR lesions and center‐involving diabetic macular edema (ciDME). Ischemia was identified on UWF‐FA using Image J Fiji software (National Institutes of Health, Bethesda, MD, USA) and nonperfusion index (NPI) was determined using previously validated protocols. Automated measurements of the macular vessel density (VD), vessel perfusion (VP) and foveal avascular zone (FAZ) metrics were obtained on OCTA. Results: Images from 69 eyes were included in the analysis. Increasing DR severity was associated with higher NPI (r = 0.55944, p < 0.001) and remained significant after distinguishing between cones (Cone Nonperfusion Index [CPI]: r = 0.55617, p < 0.0001) and rods (Rod Nonperfusion Index [RPI]: r = 0.55285, p < 0.0001). In eyes with NPDR, higher NPI is correlated with the presence of ciDME (r = 0.51156, p 0.0017). Furthermore, macular nonperfusion on UWF‐FA was correlated with higher NPI (r = 0.42899, p 0.0101), CPI (r = 0.50028, p 0.0022) and RPI (r = 0.49027, p 0.0028). Central VD and VP were correlated with the presence of ciDME (r = 0.52456, p < 0.0001; r = 0.51952, p < 0.0001) on OCT. A larger FAZ area was correlated with decreased central VD (r = −0.60089, p 0.0001) and decreased central VP (r = −0.59224, p 0.0001). Conclusions: The collective findings of UWF, UWF‐FA and OCTA provide complementary information on diabetic eyes, and may offer insights on the pathogenesis and progression of DR. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic test accuracy (DTA) of trained nurses, mid‐level and senior ophthalmologists in Vietnam against a reference standard from the UK, and assess the impact of further training on graders. Methods: Fundus photographs were taken and graded at two different time points by trained nurses, mid‐level ophthalmologists and senior ophthalmologists in Vietnam using the UK National Screening Committee classification system. A reference standard from the UK regraded all images in masked fashion and DTA was calculated using sensitivity and specificity (with 95% CIs), and positive and negative predictive values. Results: Between September and November 2018, 431 people with diabetes attended diabetic retinopathy (DR) screening in Southern Vietnam. The sensitivity for detecting any DR for all grader groups in Vietnam was low (<43%) against the reference standard in the UK. The sensitivity for detecting referable DR and referrable diabetic macular oedema was particularly low (<20%) for all grader groups. Subsequently, an additional subset of images from 138 consecutive patients screened from March to April 2021 was regraded in the UK to evaluate graders' performance after additional training was delivered. A significant improvement in DTA among all grader groups in Vietnam was identified, with sensitivity for detecting any DR exceeding 85%. Nurses achieved the highest sensitivity for grading referable DR (76.9%, 60.3–88.3%) and mid‐level ophthalmologists attained the highest sensitivity for detecting referable maculopathy (77.5%, 61.2–88.6). Conclusions: Grading accuracy was low in Vietnam in the first six months of implementing a training programme. Many factors may have contributed to poor grader performance, including inadequate training and feedback, insufficient time to participate in quality assurance testing and competing work responsibilities. After further training was delivered, DTA among all graders in Vietnam increased. Findings from this study are particularly important for DR programme planners in low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Background/Aims: To determine the performance of combinations of structural and functional screening tests in detecting sight‐threatening eye disease in a cohort of elderly subjects recruited from primary care Methods: 505 subjects ≥ 60 years underwent: Frequency Doubling Technology (FDT) perimetry; iVue OCT (iWellness® and peripapillary retinal nerve fibre layer (RNFL) scans); IOP with the Ocular Response Analyzer (ORA), all performed by an ophthalmic technician. The reference standard was a full ophthalmic examination by an experienced clinician who was masked to the index test results. Subjects were classified as presence or absence of sight‐threatening eye disease (clinically significant cataract, primary open angle glaucoma, intermediate or advanced AMD and significant diabetic retinopathy). Univariate and multivariate logistic regression was used to determine the association between abnormal screening test results and the presence of sight‐threatening eye disease. Results: 171 subjects (33.8%) had one or more sight‐threatening eye disease(s). The multivariate analysis found significant associations with any of the target conditions for visual acuity < 6/12, an abnormal FDT and peripapillary RNFL thickness outside the 99% normal limit. The sensitivity of this optimised screening panel was 61.3% (95% CI 53.5‐68.7); specificity 78.8% (CI 74.0‐83.1), positive predictive value 59.5% (CI 53.7‐65.2) and an overall diagnostic accuracy of 72.9% (CI 68.8‐76.8). Conclusion: A subset of screening tests may provide an accurate and efficient means of population screening for significant eye disease in the elderly. This study provides useful preliminary data to inform the development of further larger, multicentre screening studies to validate this screening panel. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Optimizing the Treatment of Rhegmatogenous Retinal Detachment," that was published in the 2016 issue.