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Supriya Dabir,1 Mohan Rajan,1 Liji Parasseril,1 Vaidehi Bhatt,2 Preetam Samant,3 CAB Webers,4 TTJM Berendschot4 1Department of Retina, Rajan Eye Care Pvt Ltd, Chennai, India; 2Rajiv Gandhi Medical College, Thane, India; 3Department of Retina, PD Hinduja Hospital and Medical Research Center, Mumbai, India; 4University Eye Clinic, Maastricht, the NetherlandsCorrespondence: Supriya DabirRajan Eye Care Hospital Pvt. Ltd, No. 5, Vidyodaya East 2nd Street, T. Nagar, Chennai, Tamil Nadu 600017, IndiaTel +919900974800Email supriad@gmail.comPurpose: Diabetic macular oedema (DME) is a vision-threatening complication of diabetic retinopathy. Spectral domain optical coherence tomography angiography (OCTA) is useful for assessing DME. We performed serial OCTA measurements before and after 3 monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections to understand its relationship with best corrected visual acuity (BCVA), central macular thickness (CMT) and vascular indices.Methods: OCTA assessment consisting of 6 × 6 mm scans centred on fovea and en-face retinal angiograms were obtained. Scans were done at baseline and at 1 month following each of the 3 intravitreal injections of anti-VEGF (ranibizumab, Lucentis®).Results: Our prospective study included 24 eyes of 24 subjects, aged 63.0 ± 5.0 years. There was a mean gain of 0.07 LogMAR (3 letters) and reduction of CMT, vessel density (VD) and perfusion density (PD) by end of 3rd month. CMT was independently associated with improvement in BCVA. There were significant reductions in FAZ area, VD and PD over 3 months from baseline.Conclusion: At three months, intravitreal anti-VEGF therapy is associated with visual function recovery in DME, with reduction in CMT being the most reliable predictor of response. OCTA shows a reduction in VD and PD respectively suggestive of reduced macular perfusion in the short term. Simultaneous reduction in FAZ size can be due to reversal of manual displacement of the retinal capillaries resulting from resolution of intraretinal oedema.Keywords: diabetic macular oedema, superficial capillary plexus, vascular density, perfusion density, foveal avascular zone, optical coherence tomography angiography, macular ischemia

To quantify retinochoroidal vascular parameters using swept-source optical coherence tomography (SS-OCTA) in quiescent posterior and panuveitis. In this cross-sectional study, subjects with quiescent posterior and panuveitis underwent fundus imaging using SS-OCTA (DRI Triton®, Topcon, Japan). The metrics calculated were fractal dimension (FD), foveal avascular zone (FAZ) area, retinal vascularity index (capillary density index-CDI), and choroidal vascularity index (CVI). We included 38 eyes of 20 patients, 9 males aged 34.7 ± 10.5 years, 30 eyes of 30 age- and gender-matched healthy controls, 10 females aged 33.6 ± 8.5 years. Comparing patients with controls, we found a lower FD (p <.001), larger FAZ (p >.001), lower CDI in the superficial plexus (p =.019), and lower CVI (p <.001). We also found lower retinal and choroidal and thicknesses (p <.001 and p =.025, respectively). Patients with quiescent posterior and panuveitis have a significantly reduced retinochoroidal vascular density compared to healthy control subjects. [ABSTRACT FROM AUTHOR]

Purpose: To compare the characteristics of eyes that had manual vs. automated segmentation of choroidal neovascular membrane (CNVM) using optical coherence tomography angiography (OCTA). Methods: All patients with CNVM underwent OCTA using the Zeiss Angioplex Cirrus 5000. Slabs of the avascular outer retina, outer retina to choriocapillaris (ORCC) region and choriocapillaris were generated. Manual segmentation was done when there were significant segmentation artifacts. Presence of activity of CNVM was adjudged by the presence of subretinal fluid (SRF) on structural OCT and was compared to activity detected on en face OCTA slabs based on well-defined criteria. Results: Eighty-one eyes of 81 patients were recruited of which manual segmentation was required in 46 (57%). Eyes with automated segmentation had significantly more CNVM in the ORCC (75%) whereas those with manual segmentation had deeper CNVM (sub-RPE = 22%, intra-PED = 22%) (p<0.001). Twenty eyes (25%) were found to have active CNVM on both the structural OCT and OCTA while an additional 19 eyes were presumed to have active CNVM on OCTA alone. There was only modest concordance between disease activity detected using structural OCT and OCTA (Kappa = 0.47, 95% CI = 0.30 to 0.64). Conclusions: Manual segmentation of OCTA is required in more than 50% eyes with CNVM and this progressively increases with increasing depth of CNVM location from the ORCC to below the RPE. There is moderate concordance between OCTA and structural OCT in determining CNVM activity. [ABSTRACT FROM AUTHOR]

Zia Sultan Pradhan,1 Shruthi Sreenivasaiah,1 Thanemozhi Srinivasan,1 Sujani Shroff,1 Sathi Devi,1 Dhanaraj AS Rao,1 Carroll AB Webers,2 Narendra K Puttaiah,1 Harsha Laxmana Rao1,2 1Department of Glaucoma, Narayana Nethralaya, Bangalore, India; 2Department of Ophthalmology, University Eye Clinic Maastricht, University Medical Center, Maastricht, the NetherlandsCorrespondence: Zia Sultan Pradhan, Department of Glaucoma, Narayana Nethralaya, 121/C, Chord Road, 1st “R” Block, Rajajinagar, Bangalore, 560010, India, Tel +91 80 66121300, Email zedpradhan@gmail.comPurpose: To evaluate the effect of the signal strength index (SSI) on a comparison of the vascular and structural OCT measurements between eyes with pseudoexfoliation syndrome (PXF) and healthy controls of Asian-Indian origin.Methods: In this cross-sectional study, 33 eyes of 33 PXF patients and 40 healthy eyes of 40 controls underwent OCT and OCT angiography (OCTA). Eyes with intraocular pressure (IOP) > 21mmHg, glaucomatous disc changes, or any other ocular pathology were excluded. Peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness were determined from the optic disc scans. Parafoveal VD and ganglion cell complex (GCC) thickness were measured from the macular scans. These parameters were compared between the groups using mixed effect models after adjusting for clinical confounders such as IOP, as well as SSI of the scans.Results: The 2 groups were demographically similar. Average RNFL (94μm vs 100μm, p = 0.01) and GCC (91μm vs 95μm, p = 0.03) were thinner in the PXF group compared to controls. The average peripapillary VD appeared lower in the PXF groups compared to controls (58.2% vs 58.8%, p = 0.04), but after adjusting for IOP and SSI, no difference was noted (p = 0.39). After accounting for confounders, parafoveal VD in the PXF group was significantly lower compared to controls (44.3% vs 46.8%, p = 0.008).Conclusion: Peripapillary RNFL thickness, parafoveal GCC thickness and parafoveal VD were decreased in eyes with PXF when compared to controls. VD measurements are associated with the SSI and, therefore, clinicians and researchers evaluating OCTA scans quantitatively must consider the SSI value during analysis and interpretation.Keywords: optical coherence tomography angiography, signal strength index, vessel density, pseudoexfoliation syndrome

Purpose: Blindness in glaucoma is difficult to assess with merely the use of the current World Health Organization (WHO) definition (a visual field restricted to 10° in a radius around central fixation), as this criterion does not cover other types of visual field loss that are encountered in clinical practice and also depict blindness. In this study, a 5-point ordinal scale was developed for the assessment of common visual field defect patterns, with the purpose of comparing blindness as outcome to the findings with the WHO criterion when applied to the same visual fields. The scores with the two methods were compared between two ophthalmologists. In addition, the variability between these assessors in assessing the different visual field types was determined. Methods: Two glaucoma specialists randomly assessed a sample of 423 visual fields from 77 glaucoma patients, stripped of all indices and masked for all patient variables. They applied the WHO criterion and a 5-point ordinal scale to all visual fields for the probability of blindness. Results: The WHO criterion was mostly found applicable and in good agreement for both assessors to visual fields depicting central island of vision or a temporal crescent. The percentage of blindness scores was higher when using the ordinal scale, 21.7% and 19.6% for assessors A and B, respectively, versus 14.4% and 11.3% for the WHO criterion. However, Kappa was lower, 0.71 versus 0.78 for WHO. Conclusions: The WHO criterion is strictly applied and shows good agreement between assessors; however, blindness does not always fit this criterion. More visual fields are labeled as blind when a less stringent criterion is used, but this leads to more interobserver variability. A new criterion that describes the extent, location, and depth of visual field defects together with their consequence for the patient’s quality of life is needed for the classification of glaucoma blindness. [ABSTRACT FROM AUTHOR]

Hellen CS Römkens, Henny JM Beckers, Jan SAG Schouten, Tos TJM Berendschot, Carroll AB Webers Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands Purpose: The aim of this study is to generate reference values for anterior chamber morphometrics to facilitate the interpretation of anterior chamber images acquired with swept-source optical coherence tomography (SS-OCT) in a Caucasian population.Materials and methods: Non-glaucomatous Caucasian subjects, who were newly referred to the outpatient department of the University Eye Clinic Maastricht UMC+, were asked to undergo anterior segment assessment with SS-OCT imaging prior to routine eye examination (including visual acuity and refractive error measurements, Goldmann applanation tonometry, slit lamp examination and funduscopy).Results: A total of 647 Caucasian subjects, aged 40–80 years, were included. Mean age (± standard deviation) was 61.7±10.3 years, and 294 were male (45%). Mean refractive error was -0.63±3.17 D. OCT images and measurements were obtained in all cases. The mean temporal trabecular iris angle at 500 µm (TIA500) was 27.04°±12.04°, the mean nasal TIA500 was 27.43°±11.75°, the mean anterior chamber depth (ACD) was 2.75±0.39 mm and the mean lens vault (LV) was 0.44±0.30 mm. A smaller temporal TIA500, shallower ACD and higher LV were found in female and hyperopic subjects.Conclusion: Reference values for anterior chamber morphometrics in Caucasians were generated, quantified and presented. These values offer tools for the interpretation of anterior segment images of Caucasians and differentiation between presumed mechanisms of angle closure. Keywords: reference value, anterior chamber, optical coherence tomography, Caucasian

PurposeTo investigate the relationship between visual field loss and health-related quality-of-life (HRQOL) in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG).MethodsWe conducted a cross-sectional study among 537 OHT and POAG patients from seven hospitals in The Netherlands. Clinical information was obtained from medical files. Patients completed a questionnaire, containing generic HRQOL instruments (EQ-5D and Health Utilities Index mark 3), vision-specific National Eye Institute Visual Functioning Questionnaire (VFQ-25), and glaucoma-specific Glaucoma Quality-of-Life questionnaire (GQL-15). The impact of visual field loss on HRQOL scores was analysed with multiple linear regression analyses.ResultsA relationship between mean deviation (MD) and HRQOL was found after adjusting for age, gender, visual acuity, medication side effects, laser trabeculoplasty, and glaucoma surgery. We found interaction between MD in both eyes for GQL and VFQ-25 scores. The relationship between MD and utility was non-linear, with utility only affected at MD-values below −25 dB in the better eye. Visual acuity, side effects, and glaucoma surgery independently affected HRQOL. Binocular MD and MD in the better eye had similar impacts on HRQOL, whereas MD in the worse eye had an independent effect. HRQOL was affected more by binocular defects in the inferior than in the superior hemifield.ConclusionVisual field loss in progressing glaucoma is independently associated with a loss in both disease-specific and generic quality-of-life. It is important to prevent progression, both in early and in advanced glaucoma, especially in patients with inferior hemifield defects and severe defects in either eye. [ABSTRACT FROM AUTHOR]

AimsTreatment delay of progressive vision-threatening conditions should be minimal. In this study, the treatment delay of patients with a rhegmatogenous retinal detachment (RRD) undergoing retinal detachment surgery was quantified, and causes for this delay were evaluated.Materials and methodsConsecutive patients (n=205) presenting with a primary RRD between June 2006 and June 2007 at the tertiary referral center (TRC) were interviewed. Five categories of delay were discerned in the following: ‘patient delay,’ ‘general practitioner's delay,’ ‘referring ophthalmologist's delay,’ ‘delay at the TRC’ and ‘delay before surgery at the TRC’. In addition, overall delay was calculated.ResultsIn total, 186 eyes were included in the analysis. Median overall delay between the patients' first symptoms and RRD surgery was 10 days. Almost 60% of this overall delay time was due to patient delay and the delay of the general practitioner. More than 50% of patients had a delay owing to unawareness of the symptoms. The median patient delay was significantly lower in patients with a vitreous hemorrhage and in patients with a history of a RRD in the fellow eye.ConclusionsThe major reason for patient delay with a RDD was the patients' unawareness and unfamiliarity with the symptoms of a retinal detachment.Eye (2009) 23, 1393–1399; doi:10.1038/eye.2008.272; published online 12 September 2008 [ABSTRACT FROM AUTHOR]

PurposeTo determine the most cost-effective case-finding strategy for the ophthalmologist to detect and treat ocular hypertension (OH) and primary open-angle glaucoma (POAG) at an early stage to prevent blindness.DesignA Markov cost-effectiveness simulation model.MethodsThree case-finding strategies are analysed and compared. The simulated cohort consists of all initial patients of at least 40 years old visiting an ophthalmic practice. All patients undergo ophthalmoscopy, but tonometry is routinely performed to: (1) all initial patients, (2) high-risk patients only, or (3) no one. The population characteristics are based on data of 1000 initial patients. Transition probabilities are taken from the literature. The (direct) costs of diagnosis and treatment represent those for the Netherlands. The time-horizon of the model is 20 years. An annual discount rate of 4% is used.Main Outcome MeasuresCosts, proportion of patients becoming blind, years of blindness.ResultsThe costliest strategy (1) leads to least blindness. The incremental cost-effectiveness ratio, which shows extra costs per year of vision saved in comparison to the cheapest strategy (3), is lower for strategy (1) than for strategy (2). It amounts to \[euro]1707, not including extra costs due to blindness (eg associated with the use of disability facilities). When such costs exceed \[euro]1707 per patient per year, which is most likely, then strategy (1) becomes cost saving.ConclusionIt is most cost-effective to routinely perform tonometry to all initial ophthalmic patients to prevent blindness due to glaucoma.Eye (2008) 22, 354–362; doi:10.1038/sj.eye.6702637; published online 24 November 2006 [ABSTRACT FROM AUTHOR]

Purpose To present the complicated case of a young man with Bechterew uveitis and secondary glaucoma, who underwent glaucoma implant surgery. Methods From the age of 8 years he presented with multiple attacks of anterior uveitis of his right eye. Each attack was treated with high dose of corticosteroids, leading to pressure rise. Quickly tampering the amount of steroids lead to reactivation of his uveitis. From 2011 on, he developed intraocular pressures up to 40 mmHg, treated with local drops and acetazolamide. Results A tube implantation (Baerveldt 350) was performed with good eye pressure for the first 6 postoperative weeks continuing under maximal therapy (due to the Vicryl ligature). After these 6 weeks he developed multiple attacks of hypotony, for what an anterior chamber filling was performed each time with different types of viscoelasticum. After 3 attempts a bleb revision was performed, leading again to a massive intraocular pressure rise. Mainwhile the uveitis remained fairly inactive. Conclusion Patients with juvenile rheumatoid arthritis often have a very difficult intraocular pressure regulation. Their response to a Baerveldt implantation is really unpredictable. It is either too high or too low. [ABSTRACT FROM AUTHOR]

Background: With rising health-care expenditures and workforce shortages, sustainable alternatives to traditional outpatient follow-up strategies are required to optimise care efficiency. We aimed to investigate the cost-effectiveness and clinical effectiveness of patient-initiated follow-up (PIFU) supported by asynchronous telemedicine for patients with spondyloarthritis compared with usual care in daily practice., Methods: TeleSpA was a multicentre, pragmatic, open-label, randomised controlled trial. Patients with spondyloarthritis and stable disease were randomly assigned (1:1) to either the PIFU and asynchronous telemedicine group or usual care group. All patients received a scheduled outpatient visit at baseline and after 1 year. Patients were monitored remotely at 6 months (PIFU and asynchronous telemedicine) or at the discretion of the treating rheumatologist (usual care). The primary outcome was the number of rheumatology visits within a 1-year period. A trial-based 1-year health-economic evaluation from a Dutch health-care perspective (only including health-care costs) and societal perspective (also including travel costs and work productivity losses), per the Dutch guidelines was used to estimate cost-effectiveness. The safety analysis was done in the intention-to-treat population and was based on spontaneous reports of adverse events and serious adverse events or as observed by the research team. The primary analysis was in the intention-to-treat population. Individuals with relevant lived experience were involved in the study design. This trial was registered with the Dutch National Trial Register (NL71041.068.19) and ClinicalTrials.gov (NCT04673825) and is completed., Findings: Between Dec 2, 2020, and June 20, 2022, 200 patients were randomly assigned to PIFU and asynchronous telemedicine (n=100) or usual care (n=100). 79 (40%) of 200 participants were women, 121 (60%) were men, and the mean age was 55·0 years (SD 11·9). After 1 year, the mean number of rheumatology visits was 1·9 (SD 1·5) for the PIFU and asynchronous telemedicine group and 2·6 (1·3) in the usual care group (mean difference -0·7 [95% CI -1·0 to -0·3]; 25·4% reduction; p<0·0001). PIFU and asynchronous telemedicine was cost-effective from a health-care perspective, saving health-care costs (-€180 [95% CI -921 to 560]) without a loss in quality-adjusted life-years (0·004 [95 % CI -0·022 to 0·030]). Seven non-trial-related adverse events occurred in the PIFU and asynchronous telemedicine group and eight in usual care group (including one death)., Interpretation: PIFU and asynchronous telemedicine resulted in significant and clinically meaningful reductions in rheumatology visits. This was not at the expense of health outcomes and saved health-care costs., Funding: Dutch Arthritis Society., Competing Interests: Declaration of interests KH received speaker honoraria from UCB. AB received unrestricted research grants from AbbVie and Eli Lilly, consulting fees from Galapagos, and honoraria for lectures from Pfizer, Novartis, and UCB. HEV received unrestricted research grants from Galapagos and Boehringer Ingelheim, and consulting fees from AbbVie, Novartis, Pfizer, UCB, and Johnson and Johnson. AvT received unrestricted research grants from Novartis, Pfizer, and UCB; consulting fees from Novartis, Galapagos, Johnson and Johnson, and UCB; travel support from AbbVie; and speakers fees from Pfizer and Novartis. CW declares no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Objective: To review the evidence on barriers and facilitators to application of treat-to-target (T2T) in axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) in daily practice., Methods: A systematic search was conducted in MEDLINE/Embase up to December 2023, focusing on axSpA/PsA. Any type of quantitative/qualitative original research was eligible for inclusion if barriers or facilitators to application of T2T were explored. In a qualitative synthesis, barriers/facilitators were classified by the level to which they apply (healthcare provider [HCP], patient, organisation)., Results: Of 28 included studies, most focused on PsA (n = 21/28). Studies included patients (n = 23/28), HCP (n = 4/28) or both (n = 1/28). In total, over 25 barriers and 15 facilitators to application of T2T were identified. At the HCP level, most studies focused on the measurement of the target, especially in PsA, highlighting that agreement among instruments was suboptimal. At the patient level, the role of patient-reported outcomes (PROs), while deemed relevant, was shown to act as a barrier to achieve targets that included PRO components. At the organisational level, the increased time and resources needed for T2T were considered a barrier, although it was noted that T2T could also reduce healthcare use and sick leave. Notably, for several components, no facilitators were identified at all., Conclusion: Various barriers and facilitators were identified, acting on several levels. Data in axSpA were scarce, as was evidence on certain components of T2T. Future research should address these knowledge gaps and explore how these barriers and facilitators could be targeted to improve application of T2T in practice., Competing Interests: Declaration of competing interest AvT received unrestricted research grants from Novartis, Pfizer and UCB, received consulting fees from Novartis, Galapagos, Johnson and Johnson and UCB, and received speakers fees from Pfizer and Novartis. The other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To describe the evolution of the OMERACT Fellows Program (OM FP) and to evaluate the innovative changes implemented in the 2023 program., Methods: The OM FP, the first of its kind in global rheumatology, was developed in 2000 to mentor early career researchers in methods and processes for reaching evidence-driven consensus for outcome measures in clinical studies. The OM FP has evolved through continuing iterations of face to face and online feedback. Key new features delivered in 2023 included e-learning modules, virtual introductory pre-meetings, increased networking with Patient Research Partners (PRPs), learning opportunities to give and receive personal feedback, ongoing performance feedback during the meeting from Fellow peers, PRPs, senior OMERACTers (members of the OMERACT community) and Emerging Leader mentors, involvement in pitching promotions, two-minute Lightning Talks in a plenary session and an embedded poster tour. An online survey was distributed after the meeting to evaluate the program., Results: OM FP has included 208 fellows from 16 countries across 4 continents covering 47 different aspects of rheumatology outcomes since its inception. Over 50 % have remained engaged with OMERACT work. In 2023, 18 Fellows attended and 15 (83 %) completed the post-meeting survey. A dedicated OM FP was deemed important by all respondents, and 93 % would attend the meeting in future. The PRP/Fellow Connection Carousel and Lightning Talks were rated exceptional by 93 %. Key components to improve included clarification of expectations, overall workload, the Emerging Leaders Mentoring Program, and the content and duration of daily summary sessions., Conclusion: The innovations in the 2023 OM FP were well received by the majority of participants and supports early career rheumatology researchers to develop collaborations, skills and expertise in outcome measurement. Implementation of feedback from Fellows will enhance the program for future meetings, continuing to facilitate learning and succession planning within OMERACT., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lara Chapman Grants or contracts from any entity: HEE/NIHR Clinical Doctoral Research Fellowship (ID NIHR30217) Nilasha Ghosh Consulting fees: Musculo Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: GoodRx Clinical Review Board Francis Guillemin Grants or contracts from any entity: NOVARTIS Max Weinbrecht-Mischkewitz OMERACT, Minister Erna Hamiltons Legat, and The Parker Institute, Bispebjerg and Frederiksberg Hospital and the Department of Internal Medicine, Rheumatology, Clinical Immunology and Osteology, Schlosspark-Klinik, University Medicine Berlin - Funding for OMERACT 2023 registration fee and travel costs Romi Haas Support for attending meetings and/or travel: 2023 Advancing Women's Success Grant, Monash University - Support to attend OMERACT meeting 2023 Colorado Springs Rachael A. Gordon Grants or contracts from any entity: Sjogrens Foundation Pilot Grant - NIH 5T32AI089443–13 - support for attending meetings and/or travel, (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: During the coronavirus disease 2019 (COVID-19) crisis, people with inflammatory rheumatic diseases (iRDs) might have been more vulnerable for adverse work outcomes (AWOs) and restrictions in work ability and work performance. Our objectives were to compare AWOs during the pandemic and current work ability between iRD patients and controls, understand which patients are most vulnerable for these outcomes and (3) explore the role of work characteristics on work performance while working remotely., Methods: Patients and population controls in a Dutch COVID-19 cohort study provided information in March 2022 on work participation in March 2020 (pre-pandemic, retrospective) and March 2022 (current). AWOs comprised withdrawal from paid work, working hours reduction or long-term sick leave. Multivariable logistic/linear regression analyses compared outcomes (AWOs/work ability) between groups (patients/controls) and within patients., Results: Of the pre-pandemic working participants, 227/977 (23%) patients and 79/430 (18%) controls experienced AWOs following pandemic onset. A minority of AWOs (15%) were attributed to COVID-19. Patients were more likely to experience any-cause AWOs (odds ratio range 1.63-3.34) but not COVID-related AWOs, with female patients and patients with comorbidities or physically demanding jobs being most vulnerable. Current work ability was lower in female patients compared with controls [β = -0.66 (95% CI -0.92 to -0.40)]. In both groups, when working remotely, care for children and absence of colleagues had varying effects on work performance (positive 19% and 24%, negative 34% and 57%, respectively), while employer support and reduced commuting had mainly positive effects (83% and 86%, respectively)., Conclusion: During the pandemic, people with iRDs remained at increased risk of AWOs. COVID-related AWOs, however, were infrequent., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: To investigate which factors are associated with treatment intensification (TI) in axial spondylarthritis (axSpA) patients with high disease activity (HDA)., Methods: Patients with axSpA and HDA (Ankylosing Spondylitis Disease Activity Score [ASDAS]≥2.1) from the Dutch SpA-Net registry were included. TI was defined as: 1) higher dose or shorter interval of the same drug, 2) switch from current drug to another due to inefficacy, or 3) addition of a new drug. Only anti-inflammatory drugs were considered. Primary determinants considered were ASDAS, Assessment of SpondyloArthritis international Society Health Index (ASAS HI) and physician global (PhGA). Acceptable symptom state according to patient (PASS-patient) or physician (PASS-physician) were included in sensitivity analyses. Patient-centered and physician-centered logistic regression models were used to investigate the association between potential determinants and TI., Results: In total, 121 patients with HDA were included. TI was conducted in a minority (41/121, 33.9%), and mainly involved a switch or addition of a drug. In multivariable regression analyses, a higher ASDAS was associated with TI in the patient-centered model (ORASDAS = 1.94, [95%CI 1.00-3.74]). However, in the physician-centered model, this association attenuated, and PhGA or PASS-physician were the primary factors associated with TI (ORPhGA = 1.71 [1.24-2.34]; ORPASS-physician = 94.95). Interestingly, patient-centered factors (ASAS HI/PASS-patient/education level) did not contribute to TI., Conclusion: In practice, treatment is intensified in a minority of axSpA patients with HDA. Physician-centered factors are associated with the decision to change treatment, independently of disease activity or patient perspective. Further research is needed to better understand these decisions., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: To explore residual disease, defined as substantial symptoms and disease burden despite a remission or low disease activity (LDA) state, in patients with axial spondyloarthritis (axSpA), and to determine which factors are associated with residual disease., Methods: For this cross-sectional observational study, 1 timepoint per patient was used from SpA-Net, a web-based monitoring registry for SpA. Patients with an Ankylosing Spondylitis Disease Activity Score (ASDAS) < 2.1 (LDA) were included. Indicators of residual disease (outcomes) included fatigue (primary outcome), pain, physical functioning, health-related quality of life (HRQOL), and peripheral symptoms. Sex was the primary explanatory factor for residual disease. Other explanatory factors included demographics and disease-related factors. Associations between these factors and presence and extent of residual disease were explored using logistic and linear regression., Results: In total, 267 patients in an LDA state were included. Mean age was 50.6 (SD 14.3) years and 100 (37.5%) were female. Residual disease occurred frequently (n = 114 [42.7%] had fatigue scores > 4/10; n = 34 [17.8%] had pain scores > 4/10), including in those in remission (ASDAS < 1.3). Physical HRQOL was reduced in 27% and moderate/poor in 33%. Multivariable regression analyses showed that reported fatigue was more severe and prevalent in female patients (fatigue severity [0-10]: B female = 0.78, 95% CI 0.18-1.38; fatigue > 4/10: OR female = 3.29, 95% CI 1.74-6.20). Other indicators of residual disease (ie, pain, peripheral symptoms, physical HRQOL) were also more severe and/or more prevalent in females., Conclusion: Residual disease is frequent in patients with axSpA who are in an LDA state, including remission, and it is particularly prevalent in female patients. Future studies should address how to manage or prevent residual disease in axSpA., (Copyright © 2023 by the Journal of Rheumatology.)

Objective: To demonstrate the value of diagnosing axSpA, by comparing health and costs associated with available diagnostic algorithms and perfect diagnosis., Methods: Using data from SPACE and other cohorts, a model was developed to estimate health (quality-adjusted life-years, QALYs) and costs (healthcare consumption and work productivity losses) of different diagnostic algorithms for axSpA amongst patients with low back pain referred to a rheumatologist, over a 60-year horizon. The model combined a decision-tree (diagnosis) with a state-transition model (treatment). The three algorithms (Berlin [BER, highest specificity], Modification 1 [M1; less strict inflammatory back pain (IBP) criterion] and Modification 2 [M2; IBP not mandatory as entry criterion, highest sensitivity]) were compared. Changes in sensitivity/specificity were explored and the value of perfect diagnosis was investigated., Results: For each correctly diagnosed axSpA patient, up to 4.7 QALYs and €60,000 could be gained/saved, considering a societal perspective. Algorithm M2 resulted in more health and lower costs per patient (24.23 QALYs; €157,469), compared to BER (23.96 QALYs; €159,423) and M1 (24.15 QALYs; €158,417). Hypothetical improvements in M2 sensitivity resulted in slightly more value compared to improvements in specificity. Perfect diagnosis can cost €7,500 per patient and still provide enough value., Conclusion: Correct diagnosis of axSpA results in substantial health and cost benefits for patients and society. Not requiring IBP as mandatory for diagnosis of axSpA (algorithm M2) provides more value and would be preferable. A considerably more expensive diagnostic algorithm with better accuracy than M2 would still be considered good value for money., Competing Interests: Declaration of Competing Interest CW has nothing to disclose. SG has nothing to disclose. AvT reports grants from Pfizer, UCB; grants and consulting fees from Novartis; consulting fees from Galapagos; outside the submitted work and paid to the institution. FvG reports grants from Pfizer, Reuma Nederland, Stichting Vrienden van Sole Mio, Assessment of SpondyloArthritis international Society (ASAS); consulting fees from MSD, Novartis, UCB, Eli Lilly, AbbVie, BMS; and is member of ASAS Executive Committee and ASAS treasurer (unpaid); outside the submitted work. DvdH reports personal fees from AbbVie, Bayer, BMS, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, Takeda, UCB Pharma, outside the submitted work; and is Associate editor of Annals of the Rheumatic Diseases, Editorial board member of Journal of Rheumatology and RMD Open, advisor of ASAS and Director of Imaging Rheumatology bv. MJ has nothing to disclose. AB reports grants from Abbvie; consulting fees or honoraria from UCB, Galapagos, Abbvie, Pfizer, Novartis; outside the submitted work and paid to the institution., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: SR received research grants from AbbVie, Galapagos, Novartis, Pfizer and UCB, and consulting fees from AbbVie, Eli Lilly, Novartis, MSD, Pfizer, UCB and Sanofi. EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly and holds research grants from Pfizer and Lilly. AS has received speaker/consulting fees from Abbvie, Lilly, UCB and Novartis. AO has nothing to declareCasper Webers has nothing to declare. XB, received consulting fees and research grants from Abbvie, BMS, Eli-Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB. XB is an Editorial Board member of Annals of Rheumatic Diseases.Robert Landewé received consulting fees from AbbVie, Bristol Myers Squibb, Celgene, Jansen, Galapagos, Glaxo-Smith-Kline, Novartis, Pfizer, UCB, and is Director of Rheumatology Consultancy BV. DvdH, received consulting fees from AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma and is Director of Imaging Rheumatology bv.

The 2022 ASAS-EULAR recommendations for the management of axial spondyloarthritis (axSpA) propose to consider dose reduction of biological disease-modifying antirheumatic drugs (bDMARDs) for patients in sustained remission. However, this recommendation does not offer clear guidance for daily clinical practice. In this review, we analyze randomized clinical trials and real-world data on tapering and discontinuation of bDMARDs in patients with axSpA. We discuss the scientific rationale and benefits of tapering, identify advice to apply tapering in current practice, and delineate aspects to be investigated in future research., Competing Interests: Conflicts of interest The authors have nothing to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose of Review: For almost a decade, treat-to-target (T2T) has been advocated as a management strategy for axial spondyloarthritis (axSpA), despite a lack of trial evidence. Recently, the first and only published T2T trial in axSpA did not meet its primary endpoint. The purpose of this review is to discuss whether we should continue with a T2T approach in axSpA and to describe some experiences with T2T in clinical practice., Recent Findings: The trial showed no superiority of T2T compared with usual care; however, several secondary trial outcomes and the health economic analysis actually favoured T2T, and there are conceivable reasons for the negative trial results. Furthermore, several knowledge gaps related to an optimal T2T approach in axSpA were identified. In clinical practice, a T2T approach was applied to only a limited extent, possibly because of several challenges., Summary: Despite one negative trial, it is too early to abandon T2T in axSpA. Not only more evidence from clinical trials but also research on the optimal target and management of all facets of axSpA, are highly needed. For successful implementation of T2T in clinical practice, it is important that barriers and facilitators to application are identified and subsequently addressed., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Studies on long-term consequences of COVID-19, commonly referred to as post-COVID condition, in patients with inflammatory rheumatic diseases are scarce and inconclusive. Furthermore, classifying patients with inflammatory rheumatic diseases as having post-COVID condition is complicated because of overlapping symptoms. Therefore, we investigated the risk of post-COVID condition and time until recovery, and compared the prevalence of symptoms seen in post-COVID condition, between patients with inflammatory rheumatic diseases and healthy controls, with and without a history of COVID-19., Methods: In this substudy we used data from an ongoing prospective cohort study in the Netherlands. All adult patients with inflammatory rheumatic diseases from the Amsterdam Rheumatology and Immunology Center in Amsterdam, the Netherlands, were invited to participate in the study between April 26, 2020, and March 1, 2021. All patients were asked, but not obliged, to recruit their own control participant of the same sex, of comparable age (< 5 years), and without an inflammatory rheumatic disease. Demographic and clinical data, including data on the occurrence of SARS-CoV-2 infections, were collected via online questionnaires. On March 10, 2022, all study participants received a questionnaire on the occurrence, onset, severity, and duration of persistent symptoms during the first 2 years of the COVID-19 pandemic, independent of their history of SARS-CoV-2 infection. Additionally, we prospectively monitored a subset of participants who had a PCR or antigen confirmed SARS-CoV-2 infection in the 2-month period surrounding the questionnaire in order to assess COVID-19 sequelae. In line with WHO guidelines, post-COVID condition was defined as persistent symptoms that lasted at least 8 weeks, started after the onset and within 3 months of a PCR or antigen-confirmed SARS-CoV-2 infection, and could not be explained by an alternative diagnosis. Statistical analyses included descriptive statistics, logistic regression analyses, logistic-based causal mediation analyses, and Kaplan-Meier survival analyses for time until recovery from post-COVID condition. In exploratory analyses, E-values were calculated to investigate unmeasured confounding., Findings: A total of 1974 patients with inflammatory rheumatic disease (1268 [64%] women and 706 [36%] men; mean age 59 years [SD 13]) and 733 healthy controls (495 [68%] women and 238 [32%] men; mean age 59 years [12]) participated. 468 (24%) of 1974 patients with inflammatory rheumatic disease and 218 (30%) of 733 healthy controls had a recent SARS-CoV-2 omicron infection. Of those, 365 (78%) of 468 patients with inflammatory rheumatic disease and 172 (79%) of 218 healthy controls completed the prospective follow-up COVID-19 sequelae questionnaires. More patients than controls fulfilled post-COVID condition criteria: 77 (21%) of 365 versus 23 (13%) of 172 (odds ratio [OR] 1·73 [95% CI 1·04-2·87]; p=0·033). The OR was attenuated after adjusting for potential confounders (adjusted OR 1·53 [95% CI 0·90-2·59]; p=0·12). Among those without a history of COVID-19, patients with inflammatory diseases were more likely to report persistent symptoms consistent with post-COVID condition than were healthy controls (OR 2·52 [95% CI 1·92-3·32]; p<0·0001). This OR exceeded the calculated E-values of 1·74 and 1·96. Recovery time from post-COVID condition was similar for patients and controls (p=0·17). Fatigue and loss of fitness were the most frequently reported symptoms in both patients with inflammatory rheumatic disease and healthy controls with post-COVID condition., Interpretation: Post-COVID condition after SARS-CoV-2 omicron infections was higher in patients with inflammatory rheumatic disease than in healthy controls based on WHO classification guidelines. However, because more patients with inflammatory rheumatic disease than healthy controls without a history of COVID-19 reported symptoms that are commonly used to define a post-COVID condition during the first 2 years of the pandemic, it is likely that the observed difference in post-COVID condition between patients and controls might in part be explained by clinical manifestations in the context of underlying rheumatic diseases. This highlights the limitations of applying current criteria for post-COVID condition in patients with inflammatory rheumatic disease, and suggests it might be appropriate for physicians to keep a nuanced attitude when communicating the long-term consequences of COVID-19., Funding: ZonMw (the Netherlands organization for Health Research and Development) and Reade foundation., Competing Interests: We declare no competing interests., (© 2023 Elsevier Ltd. All rights reserved.)

Objective: We aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring process followed and (3) the impact on outcomes., Design and Procedures: In this retrospective observational study we evaluated a quality improvement (QI) method which has been practiced at the focal institution since 2012: internal benchmarking of cataract surgery outcomes (CATQA). We evaluated quality parameters, procedures followed and clinical outcomes. We created tables and line charts to examine trends in key outcomes., Setting: Aravind Eye Care System, India., Participants: Phacoemulsification surgeries performed on 718 120 eyes at 10 centres (five tertiary and five secondary eye centres) from 2012 to 2020 were included., Interventions: An internal benchmarking of surgery outcome parameters, to assess variations among the hospitals and compare with the best hospital., Outcome Measures: Intraoperative complications, unaided visual acuity (VA) at postoperative follow-up visit and residual postoperative refractive error (within ±0.5D)., Results: Over the study period the intraoperative complication rate decreased from 1.2% to 0.6%, surgeries with uncorrected VA of 6/12 or better increased from 80.8% to 89.8%, and surgeries with postoperative refractive error within ±0.5D increased from 76.3% to 87.3%. Variability in outcome measures across hospitals declined. Additionally, benchmarking was associated with improvements in facilities, protocols and processes., Conclusion: Internal benchmarking was found to be an effective QI method that enabled the practice of evidence-based management and allowed for harnessing the available information. Continuous improvement in clinical outcomes requires systematic and regular review of results, identifying gaps between hospitals, comparisons with the best hospital and implementing lessons learnt from peers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)