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Aims To determine the ophthalmological outcome at 6.5 years of age in children treated for retinopathy of prematurity (ROP), and registered in the national Swedish National Register for ROP register. Methods Data on ROP, treatment and ophthalmological outcome were retrieved from the register. Visual acuity (VA), refractive errors and strabismus, together with visual impairment (VI) and any significant eye problem, defined as VA >0.5 logarithm of the minimal angle of resolution (logMAR) and/or strabismus and/or any refractive error were analysed. Risk factors such as sex, gestational age (GA), birth weight SD score, number of treatments and retreatments, postnatal age and postmenstrual age at first treatment were analysed. Results Follow-up data were available in 232 of 270 children born between 2007 and 2014 who had been treated for ROP. VI (VA >0.5 logMAR) was found in 32 (14%), strabismus in 82 (38%), refractive errors in 114 (52%) and significant eye problem in 143 (65%) children. Retreatment was a risk factor for VI and refractive errors. Male sex and neonatal brain lesion were risk factors for strabismus. An additional week of GA at birth reduced the risk for refractive errors, strabismus and significant eye problems. Conclusion The results of the present study revealed a high number of eye problems in children treated for ROP, emphasising the need for long-term follow-up. Retreatment of ROP was a risk factor for VI, and emphasises the importance of an accurate first treatment for the long-term ophthalmological outcome.

Purpose: The cytoskeleton of the extraocular muscles (EOMs) is significantly different from that of other muscles. We aimed to investigate the role of obscurin, a fundamental cytoskeletal protein, in the EOMs. Methods: The distribution of obscurin in human and zebrafish EOMs was compared using immunohistochemistry. The two obscurin genes in zebrafish, obscna and obscnb, were knocked out using CRISPR/Cas9, and the EOMs were investigated using immunohistochemistry, qPCR, and in situ hybridization. The optokinetic reflex (OKR) in five-day-old larvae and adult obscna−/−;obscnb−/− and sibling control zebrafish was analyzed. Swimming distance was recorded at the same age. Results: The obscurin distribution pattern was similar in human and zebrafish EOMs. The proportion of slow and fast myofibers was reduced in obscna−/−;obscnb−/− zebrafish EOMs but not in trunk muscle, whereas the number of myofibers containing cardiac myosin myh7 was significantly increased in EOMs of obscurin double mutants. Loss of obscurin resulted in less OKRs in zebrafish larvae but not in adult zebrafish. Conclusions: Obscurin expression is conserved in normal human and zebrafish EOMs. Loss of obscurin induces a myofiber type shift in the EOMs, with upregulation of cardiac myosin heavy chain, myh7, showing an adaptation strategy in EOMs. Our model will facilitate further studies in conditions related to obscurin., Originally included in thesis in manuscript form.

Background The purpose of the study was to compare the real-world aflibercept treatment and visual outcomes, and to examine the adherence to pandemic guidelines in two groups of patients with treatment-naïve neovascular age-related macular degeneration (nAMD) before and during the first year of the COVID-19 pandemic in Sweden up to the 1-year follow-up. Methods This is a retrospective observational study including 2915 treatment naïve eyes with nAMD. Using data from the Swedish Macula Register (SMR), 1597 eyes initiating treatment between 1 July 2018 and 31 January 2019 (pre-pandemic group) were compared with 1318 eyes starting treatment between 1 February and 31 August 2020 (pandemic group). The eyes were then followed for 1 year ± 2 months, hence the first group was unaffected by the pandemic while the second group was affected. The focus was on baseline characteristics, visual acuity (VA) change from baseline, number of injections, treatment regimen, number of appointments and the frequency and length of appointment delays. The Wilcoxon Signed-Rank Test was used to compare baseline VA to follow-up VA within the respective groups. The Mann-Whitney U-test and Fisher’s exact test were used to compare outcomes between the groups. Results Baseline characteristics were similar between the two groups. The percentage of eyes with an available follow-up VA after 1 year was 58% in the pre-pandemic group vs. 44% in the pandemic group. VA in the pre-pandemic group had increased significantly after 1 year, from 62.2 ± 14.1 letters to 64.8 ± 16.1 letters (n = 921); p < 0.0001. In the pandemic group, VA increased from 61.1 ± 15.8 to 64.9 ± 16.9 (n = 575); p < 0.0001. There was no significant difference in mean VA change between the groups; p = 0.1734. The pre-pandemic group had significantly more delays than the pandemic group, 45% vs. 36%; p < 0.0001. Conclusions The pre-pandemic and pandemic groups had similar VA gains at 1-year follow-up, but with a reduced number o

Aims: To estimate the changes in intraocular pressure (IOP) during the first 24 h after transscleral cyclophotocoagulation (TCP). Methods: A prospective single-centre study, where patients with glaucoma destined for treatment with TCP were asked for participation. The IOP was measured prior to TCP and at 1, 2, 4, 6 and 24 h post-TCP. An IOP spike was defined as an elevation of IOP of ≥5 mmHg compared with baseline. The visual acuity (VA) was examined at baseline and after 24 h. Results: The mean IOP prior to TCP in 58 eyes of 58 patients was 26.2 (±8.9 SD) mmHg. Twenty-three eyes (40%) experienced an IOP spike at some examination timepoint during the first 24 h. The mean value of the IOP spike was 12.1 (±6.9) mmHg. Fifty-six per cent of the eyes with pseudoexfoliation glaucoma (PEXG) experienced an IOP spike, and 16% had an IOP spike ≥20 mmHg. The IOP was significantly reduced at the 24 h examination by 8.1 (±7.8) mmHg (n = 58). The VA 24 h after TCP was unchanged compared with baseline. Conclusion: Clinically significant IOP spikes were common in the first 24 h post-TCP. Almost one in five eyes had an increase of 10 mmHg and in almost one in 10 eyes, the IOP increase was 20 mmHg or higher. Eyes with PEXG had a higher occurrence of IOP spikes and displayed a greater magnitude of IOP elevation. Prophylactic post-operative IOP-lowering medication should be considered to prevent further glaucoma damage.

Background: Exfoliative glaucoma (XFG) is a subtype of open-angle glaucoma characterized by distinctive extracellular fibrils and a yet unknown pathogenesis potentially involving immune-related factors. The aim of this exploratory study was to identify biomarkers for XFG using data from autoimmunity profiling performed on blood samples from a Scandinavian cohort of patients. Methods: Autoantibody screening was analyzed against 258 different protein fragments in blood samples taken from 30 patients diagnosed with XFG and 30 healthy donors. The 258 protein fragments were selected based on a preliminary study performed on 3072 randomly selected antigens and antigens associated with the eye. The “limma” package was used to perform moderated t-tests on the proteomic data to identify differentially expressed reactivity between the groups. Results: Multiple associated genes were highlighted as possible biomarker candidates including FUT2, CDH5, and the LOX family genes. Using seven variables, our binary logistic regression model was able to classify the cases from the controls with an AUC of 0.85, and our reduced model using only one variable corresponding to the FUT2 gene provided an AUC of 0.75, based on LOOCV. Furthermore, over-representation gene analysis was performed to identify pathways that were associated with antigens differentially bound to self-antibodies. This highlighted the enrichment of pathways related to collagen fibril formation and the regulatory molecules mir-3176 and mir-876-5p. Conclusions: This study suggests several potential biomarkers that may be useful in developing further models of the pathology of XFG. In particular, CDH5, FUT2, and the LOX family seem to have a relationship which merits additional exploration., CC BY 4.0 DEED© 2024, The Author(s).Correspondence Address: R. Potter; Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; email: ryan.potter@his.seOpen access funding provided by University of Gothenburg. This study was funded by Synskadades Vänner Skaraborg (SVS).

Fuchs endothelial corneal dystrophy (FECD) is caused by a corneal endothelial cell loss, leading to corneal edema and visual impairment. The most significant genetic risk factor for FECD is an expansion of the CTG18.1 locus in transcription factor 4 (TCF4). The current treatment for severe FECD is corneal transplantation, with Descemet stripping automated keratoplasty (DSAEK) as a common surgical method. Although successful in most cases, the risk for transplant failure due to diverse causes must be considered. In this study, we investigated if presence of TCF4 CTG18.1 expansion with more than 31 (n ≥ 31) repeats in donated corneal grafts could be a reason for corneal transplant failure after DSAEK. For this, nine consecutively failed DSAEK corneal grafts were genotyped for CTG18.1 repeat length. One-sided Mann–Whitney U test was performed to evaluate if failed DSAEK corneal grafts had longer CTG18.1 repeats than healthy controls from the same population. All failed corneal grafts had CTG18.1 n ≤ 27 with a median of 18 (IQR 8.0) repeats for the longest allele. There was no statistical difference in CTG18.1 repeat lengths between failed corneal grafts and the geographically matched healthy control group. In conclusion, none of the nine failed corneal grafts in our material had CTG18.1 repeat lengths ≥ 31, a cut-off known to have a biological relevance in FECD. Thus, our results suggest that the assessment of donors and inspection of the corneal tissue before the decision for procurement is sufficient, in terms of recognizing FECD in the donor.

Background/Aims: The goal of health research is to improve patients care and outcomes. Thus, it is essential that research addresses questions that are important to patients and clinicians. The aim of this study was to develop a list of priorities for glaucoma research involving stakeholders from different countries in Europe. Methods: We used a three-phase method, including a two-round electronic Delphi survey and a workshop. The clinician and patient electronic surveys were conducted in parallel and independently. For phase I, the survey was distributed to patients from 27 European countries in 6 different languages, and to European Glaucoma Society members, ophthalmologists with expertise in glaucoma care, asking to name up to five research priorities. During phase II, participants were asked to rank the questions identified in phase I using a Likert scale. Phase III was a 1 day workshop with patients and clinicians. The purpose was to make decisions about the 10 most important research priorities using the top 20 priorities identified by patients and clinicians. Results: In phase I, 308 patients and 150 clinicians were involved. In phase II, the highest-ranking priority for both patients and clinicians was € treatments to restore vision'. In phase III, eight patients and four clinicians were involved. The top three priorities were € treatments to stop sight loss', € treatments to restore vision' and € improved detection of worsening glaucoma'. Conclusion: We have developed a list of priorities for glaucoma research involving clinicians and patients from different European countries that will help guide research efforts and investment.

Purpose: To analyse the temperature of the corneal surface in keratoconus during corneal customized crosslinking (CXL) with a preserved epithelium (epi-on) under oxygen flow, and epi-off CXL in room air, and to assess the effect of pre-heating the oxygen. Methods: This masked, intra-individual comparing randomized study included 14 participants with bilateral progressive keratoconus treated with bilateral CXL: one eye with epi-on CXL under a flow of 2.5 L/min oxygen; the fellow eye with epi-off CXL in room air. In a second setting involving 12 healthy participants, room-tempered oxygen was flushed over one eye and oxygen pre-heated to 37°C over the fellow eye. The corneal surface temperature was assessed with infrared photography. Results: A reduction in corneal surface temperature was seen from the pre-treatment application of topical riboflavin in the epi-off group (−1.1 ± 1.0°C, p < 0.001). The temperature increased during the first half of the CXL treatment in both groups (+0.7 ± 1.2°C, p = 0.041 for epi-on; +0.7 ± 0.9°C, p = 0.023 for epi-off CXL, respectively). In epi-on CXL an overall temperature increase was seen during the treatment (+0.8 ± 1.2°C, p = 0.016). In the second setting, pre-heating the oxygen rendered a surface temperature increase of +1.8 ± 0.2°C (p < 0.001). Conclusion: In epi-off CXL, the application of topical room-tempered riboflavin decreases the corneal surface temperature, likely due to increased evaporation. A slight temperature increase is seen during CXL with both epi-on and epi-off CXL, albeit far below the corneal safety limit. The corneal temperature can, however, be increased by applying pre-heated oxygen, a possible approach to modify or augment the treatment effect in CXL.

Purpose: This study aimed to investigate various aspects of treatment for retinopathy of prematurity (ROP) in Sweden over the past 14 years, nationally and at a hospital level. Methods: Data on screening and treatment for ROP in infants born in Sweden from 2008 to 2021 were extracted from the national ROP register, SWEDROP. During this period, Swedish screening guidelines were reduced from gestational age (GA) < 32 weeks to <31 weeks in 2012 and to <30 weeks in 2020. Results: Altogether, 10 959 infants were screened and 600 infants treated for ROP during the study period. Parallel to changed guidelines, the number of screened infants decreased (p < 0.000) and the incidence of ROP and frequency of treatment increased (p < 0.001), while both remained similar in infants with a GA below 30 weeks. Among treated infants, GA and BW were reduced over the years (p < 0.001). Laser treatment (85.2% of primary treatments) became less common and anti-VEGF injections (13.6%) became more common over time (p < 0.001). Altogether 16 eyes were treated with the encircling band and 13 with vitrectomy. The total frequency of retreatment (32.7% of treated eyes) remained similar over time but was more common after primary anti-VEGF injection (67.7%) than laser treatment (27.2%). There were differences between the seven university hospitals regarding type of treatment and number of retreatments (p < 0.001). Conclusion: The frequency of treatment and retreatment for ROP remained similar over time, but the type of treatment changed and anti-VEGF injections became more common. Differences between treating hospitals emphasize the importance of centralizing the most severe cases.

Purpose: To compare the safety of a standardized, commercially available intracameral combination of mydriatics and anesthetic (ICMA) with a reference topical mydriatic regimen for cataract surgery. Patients and Methods: The safety results from two international, randomized, controlled clinical studies were combined to compare ICMA at the beginning of cataract surgery (ICMA group) to the reference topical mydriatic regimen (reference group). Data were collected on ocular and systemic adverse events, corneal and anterior chamber examination, endothelial cell density, retinal thickness and visual acuity. Analysis was performed on a pooled safety set from both studies, preoperatively and up to 1 month postoperatively. Results: 342 patients received ICMA and 318 the reference topical regimen. Ocular adverse events were reported in 17.0% of patients in the ICMA group and 18.6% in the reference group. No difference was shown between groups in endothelial cell density (2208 ± 498 cells/mmfor ICMA group versus 2241 ± 513 cells/mmfor the reference group; p=0.547) and retinal thickness (change from baseline less than 50 µm in 94.7% versus 95.0% of patients, respectively) at 1 month postoperatively. At 1-day post-surgery, less patients in the ICMA group had moderate or severe (Grades 2 and 3) superficial punctate corneal staining (3.9% versus 7.0% for the reference group; p=0.064). Postoperatively, some ocular symptoms were also less frequently reported in the ICMA group. Best-corrected visual acuity increased in 96.0% of patients in the ICMA group and 95.8% in the reference group at 1 month. Conclusion: ICMA injection at the beginning of cataract surgery was demonstrated to be safe and may also provide perioperative and postoperative advantages over the standard topical mydriatic regimen.

Purpose: To investigate the influence of laser trabeculoplasty (LTP) on subsequent surgery with combined phacoemulsification/ Kahook Dual Blade goniotomy (phaco-KDB) in patients with open-angle glaucoma or intraocular hypertension. Patients and Methods: Patients undergoing phaco-KDB between 2019 and 2021 were divided into previously LTP treated and previously non-LTP treated, and LTP-treatment included argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). The primary goal was to investigate if previous LTP influenced later surgical outcome of phaco-KDB. The secondary goal was to investigate if the outcome of LTP could be predictive of the outcome of subsequent phaco-KDB. We also compared IOP-and medication reductions between LTP and non-LTP treated patients. Results: A total of 111 LTP treated patients were compared to 139 non-LTP treated patients. In LTP treated patients, surgical success of phaco-KDB was 82.9%, compared to 88.5% in non-LTP treated patients (P=0.20). Reductions in IOP and medications were similar between groups. Furthermore, within the LTP group, patients with successful LTP-treatment had a subsequent surgical success of phaco-KDB in 80.7%, compared to 83.0% in patients with unsuccessful LTP-treatment (P=0.765). Conclusion: Previous LTP treatment does not predict the outcome of phaco-KDB. Furthermore, no correlation was found between the LTP effect and a later surgical success of phaco-KDB.

The global all-ages prevalence of epidemiologically-measured 'functional' presbyopia was estimated at 24.9% in 2015, affecting 1.8 billion people. This prevalence was projected to stabilise at 24.1% in 2030 due to increasing myopia, but to affect more people (2.1 billion) due to population dynamics. Factors affecting the prevalence of presbyopia include age, geographic location, urban versus rural location, sex, and, to a lesser extent, socioeconomic status, literacy and education, health literacy and inequality. Risk factors for early onset of presbyopia included environmental factors, nutrition, near demands, refractive error, accommodative dysfunction, medications, certain health conditions and sleep. Presbyopia was found to impact on quality-of-life, in particular quality of vision, labour force participation, work productivity and financial burden, mental health, social wellbeing and physical health. Current understanding makes it clear that presbyopia is a very common age-related condition that has significant impacts on both patient-reported outcome measures and economics. However, there are complexities in defining presbyopia for epidemiological and impact studies. Standardisation of definitions will assist future synthesis, pattern analysis and sense-making between studies., Den globala prevalensen för alla åldrar av epidemiologiskt uppmätt "funktionell" presbyopi uppskattades till 24,9% 2015 och berörde 1,8 miljarder människor. Denna prevalens beräknades stabiliseras på 24,1% år 2030 på grund av ökande närsynthet, men påverka fler människor (2,1 miljarder) på grund av befolkningsdynamiken. Faktorer som påverkar förekomsten av presbyopi är ålder, geografiskt läge, stad kontra landsbygd, kön och, i mindre utsträckning, socioekonomisk status, läskunnighet och utbildning, hälsokunskap och ojämlikhet. Riskfaktorer för tidig ålderssynthet var bland annat miljöfaktorer, kost, krav på nära håll, brytningsfel, ackommodativ dysfunktion, läkemedel, vissa hälsotillstånd och sömn. Presbyopi visade sig påverka livskvaliteten, i synnerhet synkvaliteten, arbetskraftsdeltagandet, arbetsproduktiviteten och den ekonomiska bördan, den psykiska hälsan, det sociala välbefinnandet och den fysiska hälsan. Den nuvarande kunskapen gör det tydligt att presbyopi är ett mycket vanligt åldersrelaterat tillstånd som har betydande inverkan på både patientrapporterade resultatmått och ekonomi. Det är dock komplicerat att definiera presbyopi för epidemiologiska studier och effektstudier. Standardisering av definitioner kommer att underlätta framtida synteser, mönsteranalys och meningsskapande mellan studier., A prevalência global, para todas as idades, da presbiopia "funcional" medida epidemiologicamente foi estimada em 24,9% em 2015, afectando 1,8 mil milhões de pessoas. Prevê-se que esta prevalência estabilize em 24,1% em 2030 devido ao aumento da miopia, mas que afecte mais pessoas (2,1 mil milhões) devido à dinâmica populacional. Os factores que afectam a prevalência da presbiopia incluem a idade, a localização geográfica, a localização urbana versus rural, o sexo e, em menor grau, o estatuto socioeconómico, a literacia e a educação, a literacia em saúde e a desigualdade. Os factores de risco para o aparecimento precoce da presbiopia incluem factores ambientais, nutrição, exigências na proximidade, erro refrativo, disfunção acomodativa, medicamentos, certas condições de saúde e sono. Verificou-se que a presbiopia tem impacto na qualidade de vida, em particular na qualidade da visão, na participação na força de trabalho, na produtividade do trabalho e nos encargos financeiros, na saúde mental, no bem-estar social e na saúde física. O conhecimento atual torna claro que a presbiopia é uma doença muito comum relacionada com a idade que tem impactos significativos tanto nas medidas de resultados relatados pelos doentes como na economia. No entanto, existem complexidades na definição de presbiopia para estudos epidemiológicos e de impacto. A normalização das definições ajudará a futuras sínteses, análises de padrões e a fazer sentido entre estudos.

PURPOSE: The prevalence of myopia in Scandinavia tends to be lower than in other parts of the world. This study aimed to investigate the incidence of myopia and its predictors in Swedish children to characterise this trend. METHODS: A 2-year longitudinal study was conducted following a cohort of schoolchildren aged 8-16 years. Myopia was defined as a spherical equivalent refraction (SER) ≤ -0.50 D. The study enrolled 128 participants, 70 (55%) females with a mean age of 12.0 years (SD = 2.4). RESULTS: The cumulative incidence of myopia during the follow-up period was 5.5%, and the incidence rate of myopia was 3.2 cases per 100 person-years. Participants with myopia at baseline exhibited a faster increase in refractive error during the follow-up period. Likewise, participants with two myopic parents exhibited a more marked change towards myopia, regardless of their initial refractive error. CONCLUSION: In the current study, similar to prevalence, the incidence of myopia was low when compared with other parts of the world. These results lead us to formulate a new hypothesis that the normal emmetropisation process may be protected by low educational pressure practised in Sweden during early childhood. Further research is necessary to test this new hypothesis., SYFTE: Förekomsten av närsynthet i Skandinavien tenderar att vara lägre än i andra delar av världen. Syftet med denna studie var att undersöka förekomsten av myopi och dess prediktorer hos svenska barn för att beskriva denna trend. METOD: En 2-årig longitudinell studie genomfördes med en kohort av skolbarn i åldrarna 8-16 år. Myopi definierades som en sfärisk ekvivalent refraktion (SER) ≤ -0,50 D. Studien omfattade 128 deltagare, varav 70 (55%) var flickor med en medelålder på 12,0 år (SD = 2,4). RESULTAT: Den kumulativa förekomsten av myopi under uppföljningsperioden var 5,5% och förekomsten av myopi var 3,2 fall per 100 personår. Deltagare med myopi vid baslinjen uppvisade en snabbare ökning av brytningsfelet under uppföljningsperioden. På samma sätt uppvisade deltagare med två myopiska föräldrar en mer markant förändring mot myopi, oavsett deras initiala brytningsfel. SLUTSATS: I den aktuella studien var förekomsten av myopi låg, i likhet med prevalensen, jämfört med andra delar av världen. Dessa resultat leder oss till att formulera en ny hypotes om att den normala emmetropiseringsprocessen kan skyddas av det låga utbildningstryck som tillämpas i Sverige under tidig barndom. Ytterligare forskning är nödvändig för att testa denna nya hypotes., FORMÅL: Forekomsten av nærsynthet i Skandinavia er generelt lavere enn i andre deler av verden. Denne studien hadde som mål å undersøke forekomsten av nærsynthet og prediktorer for nærsynthet hos svenske barn for å beskrive denne trenden. METODER: En toårig longitudinell studie ble gjennomført i en kohort av skolebarn i alderen 8-16 år. Myopi ble definert som en sfærisk ekvivalent refraksjon (SER) ≤ -0,50 D. Studien omfattet 128 deltakere, hvorav 70 (55 %) var jenter med en gjennomsnittsalder på 12,0 år (SD = 2,4). RESULTATER: Den kumulative forekomsten av nærsynthet i løpet av oppfølgingsperioden var 5,5 %, og forekomsten av nærsynthet var 3,2 tilfeller per 100 personår. Deltakere med nærsynthet ved baseline viste en raskere økning i brytningsfeil i løpet av oppfølgingsperioden. Deltakere med to nærsynte foreldre viste også en mer markant endring i retning av nærsynthet, uavhengig av deres opprinnelige brytningsfeil. KONKLUSJON: I denne studien var forekomsten av nærsynthet lav sammenlignet med andre deler av verden, i likhet med prevalensen. Disse resultatene får oss til å formulere en ny hypotese om at den normale emmetropiseringsprosessen kan være beskyttet av det lave pedagogiske trykket som praktiseres i Sverige i tidlig barndom. Videre forskning er nødvendig for å teste denne nye hypotesen., OBJECTIVO: A prevalência da miopia na Escandinávia tende a ser mais baixa do que noutras partes do mundo. Este estudo teve como objetivo investigar a incidência da miopia e os seus preditores em crianças suecas para caraterizar esta tendência. MÉTODOS: Foi efectuado um estudo longitudinal de 2 anos numa coorte de crianças em idade escolar com idades compreendidas entre os 8 e os 16 anos. A miopia foi definida como uma refração esférica equivalente (SER) ≤ -0,50 D. O estudo incluiu 128 participantes, 70 (55%) do sexo feminino, com uma idade média de 12,0 anos (DP = 2,4). RESULTADOS: A incidência cumulativa de miopia durante o período de acompanhamento foi de 5,5%, e a taxa de incidência de miopia foi de 3,2 casos por 100 pessoas-ano. Os participantes com miopia na linha de base apresentaram um aumento mais rápido do erro refrativo durante o período de acompanhamento. Da mesma forma, os participantes com dois pais míopes apresentaram uma mudança mais acentuada para a miopia, independentemente do seu erro refrativo inicial. CONCLUSÃO: No presente estudo, à semelhança da prevalência, a incidência de miopia foi baixa quando comparada com outras partes do mundo. Estes resultados levam-nos a formular uma nova hipótese de que o processo normal de emetropização pode ser protegido pela baixa pressão educacional praticada na Suécia durante a primeira infância. É necessária mais investigação para testar esta nova hipótese.

Aims To explore whether circulating matrix metalloproteinase-2 (MMP-2), MMP-9, MMP-9/neutrophil gelatinase-associated lipocalin, MMP-9/tissue inhibitor of metalloproteinase-1 (TIMP-1), MMP-14, TIMP-2 and TIMP-3 were associated with the severity and progression of diabetic retinopathy (DR) in patients with type 1 diabetes (T1D). Methods Baseline and prospective analyses were conducted over a period of 10.5 person-years. In 2009, recruitment and biochemical analyses (MMPs, TIMPs, glycated haemoglobin (HbA1c), serum creatinine, macroalbuminuria) were performed. Fundus photography, performed at baseline and at follow-up in accordance with the regional screening programme, was compared after being categorised according to the International Clinical Diabetic Retinopathy Disease Severity Scale. 'DR progression at least one leve' was calculated. High MMP-2 was defined as >= 178 ng/mL (>= 75th percentile) and high TIMP-2 as >= 205 ng/mL (>= 75th percentile). DR was dichotomised as 'at least moderate DR' or 'no/mild DR'. Results The study included 267 participants, 57% of whom were men. At baseline, the prevalence of high MMP-2 (p=0.001) and high TIMP-2 (p=0.008) increased with the severity of DR. 'At least moderate DR' (adjusted OR (AOR) 2.4, p=0.008) and macroalbuminuria (AOR 3.6, p=0.025) were independently associated with high MMP-2. 'At least moderate DR' (AOR 2.3, p=0.009) and macroalbuminuria (3.4, p=0.031) were independently associated with high TIMP-2. DR progression occurred in 101 (46%) patients (p<0.001). HbA1c >= 53 mmol/mol was associated with the progression of DR (crude OR 3.8, p=0.001). No other MMPs or TIMPs were linked to the severity or the progression of DR. Conclusions High levels of MMP-2 and TIMP-2 indicated more severe DR or diabetic nephropathy. Only HbA1c was associated with the progression of DR in 267 patients with T1D.

Syfte: Syftet med denna studie var att undersöka prevalensen av myopi hos hjälpsökande i Kenya och analysera associerade miljöfaktorer hos denna population. Material och metod: Hjälpsökande undersöktes under spannet av åtta dagar i och runt städerna Nairobi, Naivasha och Nakuru i Kenya. En subjektiv, binokulär refraktion utfördes på alla deltagande med hjälp av flipprar, provglas och provbåge. Vid avslutad refraktion fick deltagarna besvara en enkät angående miljöfaktorer som i resultatet analyserades för att undersöka eventuella samband mellan miljöfaktorer och deltagarnas refraktion. myopi definierades i denna studie med en sfärisk ekvivalent (SER) på: ≤ -0,50D. Resultat: Totalt deltog 125 deltagare mellan åldrarna 8 - 20 med en medelålder på 15,1 (standardavvikelse (SD) ±3,21). Myopi observerades hos 42,4% av deltagarna. Inget signifikant förhållande observerades mellan deltagarnas refraktion och utomhustid (p=0,221), närarbete (p=0,445) eller ålder (p=0,142). Vid jämförelse av skolgående och icke-skolgående deltagare observerades en signifikant skillnad i tid spenderad utomhus (p=0,01). Det observerades även en signifikant skillnad mellan grupperna som tidigare haft korrektion och inte angående utomhustid (p=0,014), ålder (p>0,001) och SER (p=0,008). Slutsats: Studien visar att nästan hälften av deltagarna hade myopi, vilket är en betydligt högre prevalens än vad tidigare studier i Kenya har observerat. Detta kan troligtvis bero på att denna studie riktade sig till aktivt hjälpsökande deltagare snarare än en slumpmässigt vald demografisk grupp. Det observerades inget samband mellan deltagarnas SER och utomhustid, närarbete eller ålder., Purpose: The purpose of this study was to investigate the prevalence of myopia among individuals seeking visual help in Kenya and analyze associated environmental factors in this population. Methods: Over eight days, individuals were seeking help for their vision in the cities of Nairobi, Naivasha, and Nakuru in Kenya. A binocular, subjective refraction was conducted on all participants using flippers, trial lenses, and trial frames. Following the refraction, participants completed a questionnaire regarding environmental factors. The results were then analyzed to explore potential correlations between environmental factors and participants' refraction. For this study, myopia was defined as a Spherical Equivalent Refraction (SER) of ≤ -0.50D. Results: A total of 125 participants aged between 8 and 20, with a mean age of 15.1 years (Standard deviation (SD) ±3.21), were included in the study. Myopia was observed in 42.2% of the participants. There was no significant correlation found between participants’ refraction and outdoor time (p=0.221), near work (p=0.445), or age (p=0.142). However, a significant difference in time spent outdoors was observed when comparing participants who attended school and those who did not (p=0.01). Furthermore, significant differences were observed between groups with and without previous correction regarding outdoor time (p=0.014), age (p=<0.001), and Spherical Equivalent Refraction (SER) (p=0.008). Conclusion: The study highlights a significantly higher prevalence of myopia, affecting almost half of the participants, compared to previous observations in Kenya. This discrepancy is likely attributed to the study's focus on actively help-seeking participants rather than a randomly selected demographic group. Furthermore, no significant association was found between participants' Spherical Equivalent Refraction (SER) and outdoor time, near work, or age.

PURPOSE: This study reports clinical outcomes up to 6 years after Descemet's membrane endothelial keratoplasty (DMEK) performed at the Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden. METHODS: The study has a cross-sectional and case series design. Inclusion criteria were all DMEK-operated eyes during 2013-2018 until repeat keratoplasty. RESULTS: Altogether 162 eyes from 120 patients were enrolled. Among eyes without preoperative comorbidities, examined 1-6 years after DMEK, 85.8% achieved visual acuity of 0.1 logMAR or better. The median endothelial cell density (ECD) loss was 27% in a cohort of eyes examined 1-2 years post-DMEK, 31% at 2-3 years, 42% at 3-4 years, and > 60% at 4-6 years post-DMEK. ECD at the examination timepoint was correlated with donor ECD (as expected) and time since surgery. CONCLUSION: The results from DMEK surgeries in Örebro, Sweden, are promising. Further studies with even longer follow-up are needed to evaluate graft sustainability.

Background: Evaluation of the optic disc is an important clinical practice among eyecare practitioners. Inter-observer variability makes it difficult to establish a clear conclusion regarding the estimation of the vertical cup-to-disc ratio (VCDR), especially in the context of glaucoma. Aim: To determine the effect of age and gender on VCDR in a normotensive population and to estimate the mean VCDR of individuals of African descent. Setting: The University Eye Clinic, Imo State University, Owerri, Nigeria. Methods: A cross-sectional study was used to assess the VCDR morphology of participants. The mean age was 36.7 ± 12.98 years (range: 18 years – 60 years). Descriptive statistics were used to summarise the data characteristics while linear regression was used to determine the correlation of age, gender and VCDR. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 21. Results: From 102 participants selected for the study, 82 eyes were objectively examined in this study. The mean VCDR was 0.34 (95% confidence interval [CI]: 0.23–0.52, standard deviation [s.d.] = 0.09). Although the mean VCDR for men (0.35 ± 0.08) was slightly larger than that of women (0.33 ± 0.10), the difference was only 2%. Simple regression analysis showed a weak positive but significant correlation between age and VCDR (R = 0.24, R2 = 0.057, p = 0.031), while the multiple regression revealed no interaction between age, gender and VCDR (all p > 0.05). Conclusion: Our study did not provide statistically significant evidence to support a correlation between VCDR, age and gender. However, age and VCDR are weakly correlated (R = 0.24, p = 0.031), with a small increase in VCDR with age. Contribution: This study sheds light on the correlation between demographic factors and the optic disc or nerve head, which could have implications for glaucoma diagnosis, especially concerning the African population.

Purpose: This cross-sectional survey study aimed to explore the phacoemulsification techniques among Swedish cataract surgeons, and investigate the association between technique preferences and surgical outcomes, particularly posterior capsular rupture (PCR). Methods: A survey questionnaire was responded by 170 cataract surgeons and data from 192 494 cases, linked to the surgeons, were analysed from the Swedish National Cataract Registry (SNCR) for 2021–2022. Surgeons' demographic characteristics, surgical techniques and complications were assessed. Associations between surgical technique preferences and outcomes were analysed with binary logistic regression. Results: The chopping technique (stop and chop or direct chop) was favoured by 64.6% of surgeons, followed by divide and conquer (32.4%), and tilt and tumble (7.6%). Surgeons' annual caseloads varied widely (range 11–2687). No significant correlation was found between technique preference and PCR rates, which was consistently 0.5%–0.6% in all groups, except for a trend suggesting reduced risk with tilt and tumble. Mentoring activity (35.0%) and public surgical setting (40.3%) was highest in the direct chop group. Notably, 75% of the surgeries were performed by surgeons with more than 10 years' experience. Confounding factors, such as high-volume surgeons having a low frequency of complications, have been accounted for in a logistic regression. Conclusion: This study provides insights into cataract surgery practices in Sweden and suggests that surgeons can choose their preferred approach without significantly affecting complication rates. This research also underscores the need for continued exploration of surgical practices and their impact on patient outcomes, particularly in the case of the tilt and tumble technique, which is less commonly employed.

PURPOSE: To assess the effect of an intensive initial intraocular pressure (IOP)–lowering treatment strategy on the progression of visual field damage. DESIGN: A randomized, controlled, open-label, 2-center clinical trial. METHODS: A total of 242 patients with newly detected early or moderate untreated open-angle glaucoma were enrolled at 2 university hospitals in Sweden. Participants were randomly allocated (1:1) to either initial treatment with intensive IOP-lowering medications followed by 360° laser trabeculoplasty (LTP), or to traditional mono-therapy, which was increased when deemed necessary. The primary study outcome of interest was the predicted remaining visual field, as measured by the visual field index (VFI) at projected end of life. RESULTS: The median untreated IOP was 24 mm Hg in both treatment groups. During follow-up, median and mode IOP were 17 mm Hg in the mono- and 14 mm Hg in the multi-treatment group. In the mono-treatment group, the median VFI at projected end of life was 79.3% and in the multi-treatment group 87.1% (P =.15). The annual rate of progression of visual field damage was faster in mono-treatment than in multi-treatment participants; median losses per year were 0.65 and 0.25 percentage units, respectively (P =.09). Progression events occurred in 21% of the mono- and in 11% of the multi-treatment participants (P =.03). Adverse events, mostly mild, were reported in 25% of the mono- and in 36% of the multi-treatment participants. Differences in visual field outcomes between treatment groups were more pronounced in participants having higher baseline IOP, defined by median split of untreated IOP values. CONCLUSIONS: In the overall analysis, the visual field outcomes were not overwhelmingly better in the multi-treatment group, but post hoc analysis showed definite benefit in patients with higher untreated IOP. Based on the results of this study, initial intensive treatment may be considered in glaucoma patients with high untreated IOP a

Purpose: To study the prioritization effects of the of COVID-19 pandemic on Swedish cataract surgery using a national healthcare registry with high coverage. Setting: A study from the Swedish National Cataract Register (NCR), involving all patients undergoing cataract surgery in Sweden during 2019–2022 – before, during and after the COVID-19 pandemic. Results: With the pandemic outbreak, the number of cataract surgeries fell by 22% in 2020 (15 369 procedures), albeit with large regional differences (−43% to +58%). The numbers recovered in 2021, and in 2022, a new top notation was seen (n = 149 952). On a national level, the patients were younger (−0.46 years, p < 0.001), with a larger proportion of less difficult cases (p < 0.001) and the proportion of males was higher (p < 0.001) during the pandemic, but all these variables also differed substantially between different regions and clinics. Conclusion: A national registry with high coverage can map the consequences of an event disrupting elective surgery in detail. During the COVID-19 pandemic, the impact on Swedish cataract surgery varied largely between different regions, clinics, and healthcare providers, leading to inequality in the availability of surgery. These differences likely owed to variations in healthcare policy approaches in different parts of the country. The present study shows that outcomes at one clinic or region cannot be extrapolated to larger regions under these circumstances. It actualizes the need to aim for a healthcare on equal terms, but it also shows a system that delivers care to many despite difficult times.

Purpose: To evaluate long-term postoperative corneal changes after phacoemulsification cataract surgery. Methods: Twenty patients who participated in a previous study regarding corneal endothelial changes after phacoemulsification cataract surgery were examined after 7 years. The patients were divided in three groups based on their initial increase in central corneal thickness day one after the surgery: < 5% increase, 6–20% increase and ≥ 20% increase. The primary outcome measures were corneal endothelial cell loss (ECL), endothelial cell count (ECC) and endothelial morphology. Results: After 7 years, a difference in cell loss between the groups was observed, except for groups 1 and 2. Endothelial cell count (ECC) differed significantly between groups 1 and 3 at 3 months. At 7 years, there was no difference in ECC between the three groups. Cell loss was found exclusively in group 1 between 3 months and 7 years. Endothelial cell morphology showed a converging pattern between 3 months and 7 years. Conclusion: After phacoemulsification cataract surgery, long-term ECC and morphology appear to converge towards a comparable steady state regardless of initial corneal swelling and endothelial cell loss.

Purpose: To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia. Methods: Case report. Patients: A seventy-five-year-old male patient with Type 2 diabetes, previous myocardial infarction, and pacemaker implantation. Results: Patient was observed with sudden loss of vision at the Department of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of A. aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to Endophthalmitis Vitrectomy Study protocol was administered with quick resolution of endophthalmitis. Conclusion: Aggregatibacter endophthalmitis is a rare, but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmologic treatment is effective with intravitreal injections of ceftazidime and vancomycin.

AimTo evaluate changes in the ocular surface and tear film with age and mutational status in congenital aniridia. Methods45 participants with congenital aniridia (89 eyes) in a prospective, cross-sectional study. Whole-exome sequencing identified the causative mutation. Examinations included slit-lamp biomicroscopy, in vivo confocal microscopy, Ocular Surface Disease Index (OSDI) score, blink rate, Schirmer I test, Oxford Staining Score (OSS), tear film break-up time (TFBUT) and Ocular Protection Index (OPI). ResultsThere were age-dependent increases in OSDI (beta=0.34, 95% CI 0.03 to 0.66; p=0.030), blink rate (beta=0.18, 95% CI 0.08 to 0.27; p<0.001) and OSS (beta=0.05, 95% CI 0.03 to 0.07; p<0.001) and age-dependent reductions in tear production (beta=-0.23, 95% CI -0.43 to 0.02; p=0.029) and TFBUT (beta=-0.10, 95% CI -0.17 to -0.04; p<0.001). Perturbed OSDI, OSS, blink rate, tear production and TFBUT were noted after the age of ten and OSDI, OSS, blink rate and TFBUT correlated with deficient corneal nerves and limbal stem cell function. OSDI, blink rate, Schirmer, OSS, TFBUT and OPI were not associated with type of PAX6 mutation, but OSDI, OSS and blink rate associated with grade of aniridia-associated keratopathy. ConclusionsOcular surface damage and dry eye signs appear in congenital aniridia regardless of mutation, appearing after 10 years of age and progressing thereafter. An early treatment window may exist for therapies to protect the ocular surface homoeostasis and limbal function, to possibly delay keratopathy development and progression., Funding Agencies|Dr. Rolf M. Schwiete Foundation in Mannheim, Germany; European Union COST Action ANIRIDIA-NET; Aniridia Norway [CA18116]

Purpose: To evaluate the long-term effect of laser trabeculoplasty (LTP) in patients randomized to multi-treatment in the Glaucoma Intensive Treatment Study (GITS). Methods: Patients with untreated newly diagnosed open-angle glaucoma were treated with three intraocular pressure (IOP)-lowering substances for 1 week and then 360 degrees argon or selective LTP was performed. IOP was measured just before LTP and repeatedly during the 60-month study period. Our previous report on 12 months follow-up data revealed no effect of LTP in eyes having an IOP <15 mmHg before the laser treatment. Results: Before LTP, the mean IOP +/- standard deviation in all 152 study-eyes of 122 multi-treated patients was 14.0 +/- 3.5 mmHg. Three eyes of three deceased patients were lost to follow-up during the 60 months. After exclusion of eyes that received increased therapy during follow-up, the IOP was significantly reduced at all visits up to 48 months in eyes with pre-LTP IOP >= 15 mmHg; 2.6 +/- 3.1 mmHg at 1 month and 1.7 +/- 2.8 mmHg at 48 months, n = 56 and 48, respectively. No significant IOP reduction was seen in eyes with pre-LTP IOP <15 mmHg. Seven eyes, i.e., <13%, with pre-LTP IOP >= 15 mmHg at baseline had required increased IOP-lowering therapy at 48 months. Conclusion: LTP performed in multi-treated patients may provide a useful IOP reduction that is maintained over several years. This was true on a group level when the initial IOP was >= 15 mmHg, but if the pre-laser IOP was lower than that, chances of LTP success were small., Originally included in thesis in manuscript form.

Purpose: To investigate the 20-year outcome, in best-corrected visual acuity (BCVA), and subjective visual function (VF-questionnaire, VF-14) after cataract surgery in type 2 diabetics, compared with non-diabetics. Methods: 109 type 2 diabetics and 698 non-diabetics, who had cataract surgery during 1 year at one institution, were included in this prospective, longitudinal, population-based cohort study. BCVA and VF-14 responses were recorded pre- and postoperatively, and every 5 years up to 20 years after surgery. Retinopathy was graded before surgery. Results: There was no significant difference between diabetics and non-diabetics, in change in BCVA from 10 years or more after surgery, p = 0.45, p = 0.44 and p = 0.83, at 10, 15 and 20 years, respectively, as well as in self-perceived visual function (VF-14) at any time after surgery, p = 0.72, p = 0.20 and p = 0.78, 10–20 years, respectively. At any follow-up, there was no significant difference in BCVA in relation to retinopathy level before surgery, p = 0.1 at 20 years. There was a trend from 10 years after surgery and onward that patients with no retinopathy at baseline lost fewer letters during the 20 years than diabetics with retinopathy. Patients with known type 2 diabetes at surgery had a significantly lower survival compared with the non-diabetics at each follow-up, p = 0.003. Conclusion: In surviving diabetics, BCVA and subjective visual function were retained in most cases up to 20 years after cataract surgery. Cataract extraction is effective in causing a sustainable improvement in visual function also in type 2 diabetics. Knowledge of these long-term outcomes is essential when counselling diabetics for cataract surgery.

Purpose: To investigate the prevalence, incidence and risk factors of DR in elderly people living with type 2 diabetes. Methods: Individuals >80 years, in the Swedish National Diabetes Register (NDR) between 2008 and 2017, were included. Prevalence and incidence were calculated and stratified by age. Estimates were assessed by longitudinal binary logistic regression models. Results: One hundred forty-one thousand, one hundred fifty-eight individuals with type 2 diabetes were included, median age 83 years, 53.3% females and with a median HbA1c 52 mmol/mol. The DR prevalence was stable at 336.2 cases/1000 patients in 2008 (95% CI, 330.2-342.3), with no significant changes during the 10-year period. Crude DR incidence rate: 88.5 cases/1000 patient years (95% CI, 87.6-89.4). The incidence rate was lower at higher ages. The effect of age on incident DR varied by sex, with females having an increasingly higher risk than males from 83 years of age, OR 1.25 (1.11-1.42) at age 90 years. The risk of incident DR with longer diabetes duration increased more rapidly at worse glycaemic control. Conclusion: The growing population of elderly with type 2 diabetes shows a stable proportion of DR and proposes an increased need for DR screening and eye care. Established risk factors for DR, such as diabetes duration and level of glycaemic control, are also important in the elderly; however, age and sex should be considered., Supported by grants from the Kamprad foundation for Entrepreneurship, Research & Charity [grant number 20180060], the Centre for Clinical Research, Region Värmland and ALF-funding Region Örebro County, Sweden.

Neuroscientific research has consistently shown more extensive non-visual activity in the visual cortex of congenitally blind humans compared to sighted controls; a phenomenon known as crossmodal plasticity. Whether or not crossmodal activation of the visual cortex retracts if sight can be restored is still unknown. The present study, involving a rare group of sight-recovery individuals who were born pattern vision blind, employed visual event-related potentials to investigate persisting crossmodal modulation of the initial visual cortical processing stages. Here we report that the earliest, stimulus-driven retinotopic visual cortical activity (<100 ms) was suppressed in a spatially specific manner in sight-recovery individuals when concomitant sounds accompanied visual stimulation. In contrast, sounds did not modulate the earliest visual cortical response in two groups of typically sighted controls, nor in a third control group of sight-recovery individuals who had suffered a transient phase of later (rather than congenital) visual impairment. These results provide strong evidence for persisting crossmodal activity in the visual cortex after sight recovery following a period of congenital visual deprivation. Based on the time course of this modulation, we speculate on a role of exuberant crossmodal thalamic input which may arise during a sensitive phase of brain development.

Aims/Purpose: The aim of this study was to assess vision-related activity difficulties among patients with neovascular AMD using a Swedish version of the mass of activity inventory (MAI). Methods: Participants were patients diagnosed with neovascular AMD receiving treatment for the disease in a hospital in southeast Sweden. Participants completed the Swedish version of the MAI questionnaire. MAI can be used to measure the overall visual ability and visual ability in 4 functional domains: reading, mobility, visual motor function and visual information processing. Best corrected distance and near visual acuity (VA) were also measured. Results: Among the 196 participants (mean age=78.5 years, SD=7.67, 66% female) the median VA in the better seeing eye was 0.18 logMAR (IQR=?0.34), and in the worse eye was 0.54 logMAR (IQR=0.98). The median visual ability for all participants was 1.92 logits (IQR=2.69). There was a significant negative correlation between distance VA in the better eye and visual ability (rho=0.4025, p<0.01). Using ROC curves, we tested the capacity of the MAI to detect cases of any vision impairment (VA worse than 0.3 logMAR in the better seeing eye), the area under the curve (AUC) was 0.717 (95% CI=0.643 - 0.791 p<0.001). When we tested for detection of moderate vision impairment (VA worse than 0.5 logMAR in the better seeing eye) the AUC was 0.738 (95% CI=0.648 - 0.829 p?<0.001). Conclusions: The results indicate that the Swedish version of the MAI produce measures of visual ability that are consistent with clinical measures among patients with nAMD. The Swedish version of the MAI can be used as outcome measure in interventions for people with nAMD. References 1. Macedo, A.F. et al. Predictors of problems reported on the EQ-5D-3L dimensions among people with impaired vision in northern Portugal. Health Qual Life Outcomes 2022; 20: 132.

SIGNIFICANCE: Suspected clinically significant macular edema (SCSME) from exudates differed among ethnic groups in our underserved population. African American and Asian subjects had higher prevalence than Hispanics and non-Hispanic Caucasians, from the same clinics. Men had higher prevalence than women. Highly elevated blood glucose was frequent and associated with SCSME. PURPOSE: We investigated the association between the presence of SCSME from exudates and hemoglobin A1c (HbA1c), as well as demographic factors such as age, sex, and ethnic group. Our population was underserved diabetic patients from the same geographic locations. Ethnic groups were White Hispanic, non-Hispanic Caucasian, African American, and Asian, with a high proportion of underrepresented minorities. METHODS: In a diabetic retinopathy screening study at four community clinics in Alameda County, California, nonmydriatic 45° color fundus images were collected from underserved diabetic subjects following the EyePACS imaging protocol. Images were analyzed for SCSME from exudates by two certified graders. Logistic regression assessed the association between SCSME from exudates and age, sex, ethnic group, and HbA1c. RESULTS: Of 1997 subjects, 147 (7.36%) had SCSME from exudates. The mean ± standard deviation age was 53.4 ± 10.5 years. The mean ± standard deviation HbA1c level was 8.26 ± 2.04. Logistic regression analysis indicated a significant association between presence of SCSME from exudates and HbA1c levels (p<0.001), sex (p=0.027), and ethnicity (p=0.030). African Americans (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.06 to 2.50; p=0.025) and Asians (OR, 1.63; 95% CI, 1.05 to 2.54; p=0.029) had a higher risk than Hispanics. After adjusting for ethnicity, sex, and age, the odds of developing SCSME from exudates increased by 26.5% with every 1% increase in HbA1c level (OR, 1.26; 95% CI, 1.18 to 1.36; p<0.001). CONCLUSIONS: In our underserved population, many diabetic patients ha

PURPOSE: To describe the bacterial findings by a targeted sequencing approach from corneal samples of patients with microbial keratitis and factors influencing culture outcome of indirectly inoculated corneal specimen. METHODS: Prospective inclusion of patients fulfilling predefined criteria of microbial keratitis. Samples from the corneal lesion were collected and dispensed in liquid transport medium, from which both culture and targeted amplification and sequencing of the V3-V4 region of the 16S rRNA gene were carried out. Additional standard corneal culture from the corneal lesions was also performed. Factors influencing culture outcome of indirectly inoculated corneal samples were identified by a multivariate regression model incorporating quantitative data from sequencing. RESULTS: Among the 94 included patients with microbial keratitis, contact lens wear (n = 69; 73%) was the most common risk factor. Contact lens wearers displayed significant differences in the bacterial community composition of the corneal lesion compared to no lens wearers, with higher abundance of Staphylococcus spp., Corynebacterium spp., and Stenotrophomonas maltophilia. Targeted sequencing detected a potential corneal pathogen in the highest proportional abundance among 9 of the 24 (38%) culture-negative patients with microbial keratitis. Age, bacterial density in the sample, and prior antibiotic treatment significantly influenced culture outcome of indirectly inoculated corneal samples. CONCLUSION: Targeted sequencing may provide insights on pathogens in both culture negative episodes of microbial keratitis and among subgroups of patients with microbial keratitis as well as factors influencing culture outcome of indirectly inoculated corneal samples.

PURPOSE: Myopia is the most important risk factor for developing retinal tears and retinal detachment (RD). Due to altered lifestyle factors myopia is increasing in the world. In this study, the correlation between educational level and risk for retinal detachment were analysed. METHODS: A case-control registry study was conducted including a total of 10 268 individuals. Data were collected from registries of the Swedish National Board of Health and Welfare as well as the Swedish Central Bureau of Statistics. Cases were defined as ICD-10 H33 (retinal detachments and breaks). For each case, a matched control was selected with the same age and sex, living in the same county at the time of diagnosis. The study population was divided into seven groups with regard to educational level and compared using conditional logistic regression. RESULTS: In the total population, the odds ratio (OR) increased in a proportional fashion with a higher level of education. The odds ratio for the total population at the highest education level was 1.77 and increased to 2.00 when excluding individuals with diabetes. Out of the 5134 cases, 72% were men and 28% women. A statistically significant difference between sexes was only confirmed for the second highest education level. CONCLUSION: Individuals with a longer education have a significantly higher risk for retinal complications in the form of RD and breaks. Higher education is a risk factor for retinal complications in both sexes but seemingly more strongly in men.

Dry eye disease (DED) is a chronic eye disease and a common complication among the world's population. Evaporation of moisture from tear film or a decrease in tear production leads to an unstable tear film which causes DED. The tear film breakup time (TBUT) test is a common clinical test used to diagnose DED. In this test, DED is diagnosed by measuring the time at which the first breakup pattern appears on the tear film. TBUT test is subjective, labour-intensive and time-consuming. These weaknesses make a computer-aided diagnosis of DED highly desirable. The existing computer-aided DED detection techniques use expensive instruments for image acquisition which may not be available in all eye clinics. Moreover, among these techniques, TBUT-based DED detection techniques are limited to finding only tear film breakup area/time and do not identify the severity of DED, which can essentially be helpful to ophthalmologists in prescribing the right treatment. Additionally, a few challenges in developing a DED detection approach are less illuminated video, constant blinking of eyes in the videos, blurred video, and lack of public datasets. This paper presents a novel TBUT-based DED detection approach that detects the presence/absence of DED from TBUT video. In addition, the proposed approach accurately identifies the severity level of DED and further categorizes it as normal, moderate or severe based on the TBUT. The proposed approach exhibits high performance in classifying TBUT frames, detecting DED, and severity grading of TBUT video with an accuracy of 83%. Also, the correlation computed between the proposed approach and the Ophthalmologist's opinion is 90%, which reflects the noteworthy contribution of our proposed approach.

This paper presents an educational serious game aimed at raising awareness about ophthalmic issues. The game, titled’Disability Racer,’ is based on the mechanics of a car battle-royale and was developed for the computer platform. It incorporates four ophthalmic conditions, challenging players to compete against each other while experiencing impaired vision. To mirror real-life problem-solving, the’glasses’ item has been included, which, when collected, temporarily improves the player’s vision. In this way, the game promotes an understanding of the importance of regular ophthalmic check-ups. Copyright © 2024 by SCITEPRESS – Science and Technology Publications, Lda.

OBJECTIVE: Excessive dietary sodium intake has known adverse effects on intravascular fluid volume and systemic blood pressure, which may influence intraocular pressure (IOP) and glaucoma risk. This study aimed to assess the association of urinary sodium excretion, a biomarker of dietary intake, with glaucoma and related traits, and to determine whether this relationship is modified by genetic susceptibility to disease. DESIGN: Cross-sectional observational and gene-environment interaction analyses in the population-based UK Biobank study. PARTICIPANTS: Up to 103 634 individuals (mean age 57 years, 51% women) with complete urinary, ocular, and covariable data. METHODS: Urine sodium:creatinine ratio (UNa:Cr; mmol:mmol) was calculated from a midstream urine sample. Ocular parameters were measured as part of a comprehensive eye examination and glaucoma case ascertainment was through a combination of self-report and linked national hospital records. Genetic susceptibility to glaucoma was calculated based on a glaucoma polygenic risk score (PRS) comprising 2 673 common genetic variants. Multivariable linear and logistic regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to model associations and gene-environment interactions. MAIN OUTCOME MEASURES: Corneal-compensated IOP, optical coherence tomography derived macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness, and prevalent glaucoma. RESULTS: In maximally adjusted regression models, a one standard deviation increase in UNa:Cr was associated with higher IOP (0.14mmHg; 95% CI, 0.12 to 0.17; P<0.001) and greater prevalence of glaucoma (OR, 1.11; 95% CI, 1.07 to 1.14; P<0.001), but not mRNFL or GCIPL thickness. Compared to those with UNa:Cr in the lowest quintile, those in the highest quintile had significantly higher IOP (0.45mmHg; 95% CI, 0.36 to 0.53, P<0.001) and prevalence of glaucoma (OR, 1.30; 95% CI, 1.17 t

PURPOSE: To evaluate progression of keratoconus in patients where CXL treatment was interrupted due to insufficient swelling of the cornea. METHODS: A retrospective review was conducted of all patients with keratoconus diagnosis who underwent CXL at the Department of Ophthalmology, Örebro University Hospital (USÖ) during the years 2010-2017. In total 377 eyes of 280 patients were screened for inclusion. In 17 eyes (15 patients), the treatment was interrupted due to insufficient swelling of the cornea. Patient journals were reviewed and keratometry examinations were analysed for long-term progression. RESULTS: Eleven eyes (nine patients) were included in the study. Five eyes showed no signs of progression after the interrupted CXL treatment. In one eye progression continued, however, first after a period of a number of years, indicating a delayed course of clinical progression. CONCLUSION: This study indicates that debridement of the corneal epithelium and riboflavin administration without intense UVA radiation may slow or arrest the progression of keratoconus, likely due to photosensitisation from ambient light.

AIM: To study changes in aetiology, prematurity, comorbidity and ophthalmological outcomes in children with surgically treated hydrocephalus to provide information needed to maintain the best possible healthcare for a fragile and changing population. METHODS: Two population-based cohorts, born two decades apart in Region Västra Götaland Sweden, surgically treated for hydrocephalus at Sahlgrenska University Hospital in Gothenburg were recruited at approximately 10 years of age. The participants were examined according to an ophthalmological protocol, including history taking regarding perceptual visual dysfunction (PVD). Gestational age, aetiology and comorbidities were registered. RESULTS: The 1989-1993 group, comprised 52 children (48% girls; mean age 10, range 7.7-12.8 years), was compared with 24 children, born in 2007-2012 (29% girls; mean age 10, range 7.0-13.8 years). Extreme prematurity (gestational age ≤ 28 weeks) increased over time (p = 0.001). The vast majority of the children showed ophthalmological abnormalities, although motility defects and nystagmus decreased in the latter population. Subnormal visual acuity was associated with extreme prematurity (RR = 4.69; p = 0.030), and PVD with learning disability (RR = 2.44; p = 0.032). CONCLUSION: Paediatric hydrocephalus populations may change with improved healthcare. Since a high percentage shows ophthalmological abnormalities and more children are born extremely preterm, the entirety needs consideration both neurologically and ophthalmologically., This study was financially supported by the foundation De Blindas Vänner and the Region Halland, Sweden.

Background Assessing and managing pain in newborns is important for normal development and reduction of morbidity. Aim To assess whether skin conductance measurements (SCM) can be used as an objective method for measuring procedural pain during screening for retinopathy of prematurity (ROP) in preterm infants and to identify painful components of the examination. Methods 65 separate SCM were performed in 33 infants born at <32 weeks gestational age (wGA) eligible for ROP screening (median 26+4 wGA, range 23+3 to 31+3; median weeks postmenstrual age 37+2, range 31+0 to 49+6). SCM was measured before, during and after eye examination (fundoscopy and/or wide-field digital retinal imaging [WFDRI]), and compared to changes in heart rate (HR), pulse oximetry saturation (SpO2) and behavioral state measured with the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Results A major increase of SCM could be seen during both fundoscopy and WFDRI (p<0.01, respectively). No correlation was found between SCM and wGA. N-PASS changed significantly during ROP examination (p<0.01). While N-PASS could only distinguish painful response from baseline during fundoscopy and WFDRI, SCM detected responses during each stage of the investigations i.e. the application of mydriatics, fundoscopy, anesthetic drops, speculum and WFDRI. HR increased only during digital retinal imaging (p = 0.049), while SpO2 decreased only during fundoscopy (p = 0.042). Conclusion SCM may be used as a continuous and objective method to evaluate pain and its intensity during screening for ROP, enabling the separation of the different painful components of the investigation. Selecting and grading the different painful stages improves the possibility to assess and continue to improve pain management more specifically in these patients., De två första författarna delar förstaförfattarskapet

Purpose To evaluate the refractive outcome and strabismus at 5 years of age, in children operated for various types of non-syndromic craniosynostosis, and further analyse the refractive and strabismic development over time. Methods Eighty-nine children, who had undergone operations for non-syndromic craniosynostosis, were examined at 5 years of age. These children also underwent ophthalmological examination preoperatively and up to 1 year after the operation. An age-matched control group including 32 healthy children was also recruited. Strabismus and eye motility were registered. Refraction was measured in cycloplegia. Results There was a difference regarding the refractive outcome between the different types of craniosynostosis. Higher values of hypermetropia were found in the metopic craniosynostosis group on both eyes. In the unicoronal craniosynostosis group, high values of hypermetropia and a higher degree of astigmatism were found on the side contralateral to the craniosynostosis. Strabismus was found in 11/88 children of whom 10/11 had unicoronal craniosynostosis. A vertical deviation on the side ipsilateral to the fused suture was highly prevalent (6/10 cases). Ophthalmological dysfunctions were rare in children operated for sagittal craniosynostosis. Conclusion Ocular manifestations such as strabismus, astigmatism and anisometropia were highly prevalent in children operated for unilateral coronal craniosynostosis. Children operated for metopic craniosynostosis had higher rates of hypermetropia. The screening and follow-up protocols need to be tailored with regard to the type of craniosynostosis.

Purpose: To determine whether the retinal nerve fiber layer thickness can be used as an indicator for systemic neurodegeneration in diabetes. Methods: We used existing data from 38 adults with type 1 diabetes and established polyneuropathy. Retinal nerve fiber layer thickness values of four scanned quadrants (superior, inferior, temporal, and nasal) and the central foveal thickness were extracted directly from optical coherence tomography. Nerve conduction velocities were recorded using standardized neurophysiologic testing of the tibial and peroneal motor nerves and the radial and median sensory nerves, 24-hour electrocardiographic recordings were used to retrieve time- and frequency-derived measures of heart rate variability, and a pain catastrophizing scale was used to assess cognitive distortion. Results: When adjusted for hemoglobin A1c, the regional thickness of the retinal nerve fiber layers was (1) positively associated with peripheral nerve conduction velocities of the sensory and motor nerves (all P < 0.036), (2) negatively associated with time and frequency domains of heart rate variability (all P < 0.033), and (3) negatively associated to catastrophic thinking (all P < 0.038). Conclusions: Thickness of the retinal nerve fiber layer was a robust indicator for clinically meaningful measures of peripheral and autonomic neuropathy and even for cognitive comorbidity. Translational Relevance: The findings indicate that the thickness of the retinal nerve fiber layer should be studied in adolescents and people with prediabetes to determine whether it is useful to predict the presence and severity of systemic neurodegeneration.

Purpose: To investigate central retinal morphology and optic retinal nerve fibre layer (RNFL) in prematurely born young adults and compare to term born controls. Materials and Methods: The participants were 59 prematurely born individuals, with a birthweight <= 1.500 g, and 44 term born controls, all 25-29 years of age. Visual acuity (VA) and contrast sensitivity (CS) were assessed. The retinal macular thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness and RNFL thickness were assessed with Cirrus optical coherence tomography (OCT). Results: Central macular thickness was increased (mean 26.7 mu m) in prematurely born individuals compared to controls. The macular GC-IPL was thinner (mean 3.84 mu m), also when excluding those with previous retinopathy of prematurity (ROP) and those with neurological complications. Gestational age at birth and previous treatment of ROP were risk factors for a thicker macula, however, not for reduced GC-IPL. The average peripapillary RNFL was thinner (mean 4.61 mu m) in the prematurely born individuals, also when excluding those with previous ROP and/or neurological complications. Within the prematurely born group, treated ROP was correlated with increased average RNFL. Further, both better VA and CS were associated with thinner optic nerve RNFL and thicker average GC-IPL. Conclusion: Macular and optic nerve morphology were influenced by premature birth as assessed with OCT in adult individuals. Gestational age at birth and treatment for ROP seemed to affect central macular thickness, and treated ROP affected the peripapillary RNFL. Thus, retinal sequelae remained in adulthood.

Purpose: The purpose of this study was to examine the differences of optic nerve subarachnoid space (ONSAS) volume in patients with normal tension glaucoma (NTG) and healthy controls in different body positions. Methods: Eight patients with NTG and seven healthy controls underwent magnetic resonance imaging (MRI) examinations in head up tilt (HUT) +11 degrees and head down tilt (HDT) -5 degrees positions according to a randomized protocol determining the starting position. The ONSAS volume in both body positions was measured and compared between the two groups. The results were analyzed using a generalized linear model. Results: Between HDT and HUT, the postural ONSAS volume change was dependent on starting position (P < 0.001) and group (P = 0.003, NTG versus healthy). A subgroup analysis of those that were randomized to HUT examination first, coming directly from an upright position, showed that the patients with NTG had significantly larger positional ONSAS volume changes compared to the healthy controls; 121 ± 22 µL vs. 65 ± 37 µL (P = 0.049). Analysis of the ONSAS volume distribution showed different profiles for patients with NTG and healthy controls. Conclusions: There was a significant difference in ONSAS volume change between patients with NTG and healthy subjects when subjected to posture changes, specifically when going from upright to head-down posture. This indicates that patients with NTG had been exposed to a lower ONSAS pressure when they came from the upright posture, which suggests an increased translaminar pressure difference in upright position. This may support the theory that NTG has a dysfunction in an occlusion mechanism of the optic nerve sheath that could cause abnormally negative ONSAS pressures in upright posture.

Background: The purpose of this study was to compare driving-simulator performance of participants with visual-field loss (VFL) from panretinal photocoagulation (PRP) of proliferative diabetic retinopathy (PDR) with a normally sighted control group. Furthermore, we investigated the effects of VFL of different extent on driving. Methods: Data on performance and safety from a traffic-simulator test for 27 participants with VFL from PRP of PDR were retrospectively compared with data from 83 individuals without visual deficits in a cross-sectional study. Individuals with diabetes that regained their driving licences after a successful simulator test were then followed in a national accident database. Results: Diabetes participants passed the test in 56% of the cases. Compared with the control group, diabetes participants had more risky “failed to give way” events and longer reaction times. Failed diabetes participants had lower mean sensitivity in the superior visual field than those who passed. None of the participants with a regained licence were involved in a motor vehicle accident during the 3–6-year follow-up after the simulator test. Conclusions: Diabetes participants had worse performance and safety than the controls. However, even individuals with VFL from PRP might drive safely, which highlights the need for individual assessments in licencing issues.