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Bianka Sobolewska,1 Muhammed Sabsabi,1 Focke Ziemssen2,3 1Center for Ophthalmology, Eberhard- Karls University, Tuebingen, Germany; 2University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tuebingen, Germany; 3Department of Ophthalmology, University Hospital Leipzig, Leipzig, GermanyCorrespondence: Bianka SobolewskaCenter of Ophthalmology, Eberhard-Karls University, Elfriede-Aulhorn-Straße 7, Tuebingen, 72076, GermanyTel +49 7071 29-88088Fax +49 7071 29-3730Email bianka.sob@gmx.dePurpose: Since non-adherence (NA) to intravitreal therapy with VEGF drugs is one of the most important modifiable factors compromising treatment outcome of nAMD, the purpose of this study was to investigate the contributing factors and barriers during long-term nAMD treatment.Methods: Barriers and potential reasons for NA were prospectively measured using the Adherence Barriers Questionnaire Intravitreal Therapy (ABQ-IVT). A random sample of patients receiving intravitreal therapy was drawn based on data for different treatment periods. Three age-sex matched groups included the treatment periods of ≤ 30 months (group 1), between > 30 months and ≤ 60 months (group 2), and > 60 months (group 3). The occurrence of gaps between treatments and/or OCT visits was evaluated.Results: NA with gaps of > 56 days after the scheduled appointment was detected in 39%, 89%, and 100% of patients in group 1, 2, and 3, respectively (groups 1 and 2 vs group 3, p < 0.001). Two or more of such gaps were observed in 6%, 72%, and 94% of patients in group 1, 2, and 3, respectively. The overall ABQ-IVT score showed corresponding differences between the groups: 25.89 ± 7.68 (group 1, 95% CI 22.07– 29.71), 34.72 ± 10.32 (group 2, 95% CI: 29.59– 38.86), and 33.28 ± 9.04 (group 3, 95% CI 28.78– 37.77). Accordingly, the score was inversely correlated with the number of regular follow-up visits in groups 2 and 3 (Pearson correlation coefficient r = − 0.65 (p = 0.003) and r = − 0.5 (p = 0.034), respectively). Within the groups of longer treatment duration, univariate logistic regression analysis showed higher odds of time commitment and challenge accompanying person to be relevant barriers.Conclusion: NA is an arising problem with increasing duration of intravitreal therapy. Treatment barriers, detected by the ABQ-IVT, might change or increase during the course of the treatment.Keywords: non-adherence, anti-VEGF, treatment barriers, age-related macular degeneration, ABQ-IVT

Friederike C Kortuem,1,&ast; Focke Ziemssen,1,2,&ast; Karsten U Kortuem,3 Constanze Kortuem1 1University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany; 2Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany; 3University Eye Hospital Ulm, University of Ulm, Ulm, Germany&ast;These authors contributed equally to this workCorrespondence: Focke ZiemssenDepartment of Ophthalmology, University Hospital Leipzig, Liebigstr. 12, Leipzig, 04103, GermanyTel +49 341 97 21650Fax +49 341 97 21659Email focke.ziemssen@med.uni-tuebingen.dePurpose: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic forced ophthalmologists to adjust their working conditions to ensure patient and staff safety, while still providing effective and timely treatment. This international survey among ophthalmologists was initiated to capture what actions ophthalmologists were taking and what their opinions were on the risks of infection in their workplace, the delay in treatment, the use of telemedicine and telephone for appointments, and the regional specifications and measures implemented by the respective authorities.Methods: An open-source web tool was used to develop an online survey, to which ophthalmologists worldwide were invited via e-mail using international mailing lists (Media Mice, Singapore; Texere Publishing Inc, USA; CGO Gerling) and incentivized using a lottery. The physicians provided their level of agreement relating to the offered statements and gave free answers to the questions regarding the actions taken (conducted November 5th 2020 to December 20th 2020).Results: After 91,000 invitations, responses were collected from 1122 ophthalmologists. Despite the use of large international mailing lists, mainly doctors from Europe participated. Half of the participants expressed great concern about possible SARS-CoV-2 infection in their patients. A significant number of younger ophthalmologists (≤ 50 years: 76.9%, n = 313; > 50 years: 69.6%, n = 181) feared the delays that COVID-19 could cause to treatment. Reductions in patient numbers were broadly observed, with more ophthalmologists of younger age reporting greater declines. Nearly all ophthalmologists indicated that they provided disinfectant and the majority also used masks and questionnaires for screening. For 60.3% (n = 412) of ophthalmologists, telephone calls reduced the risk of ‘no-shows’; 71.6% (n = 497) disagreed that telemedical evaluation is possible without slit lamp findings and fundus photos; and 57.0% of participants felt content with the governmental measures during the COVID-19 pandemic.Conclusion: The COVID-19 pandemic has significantly influenced the work of ophthalmologists. Based on the limited response rate, certain statements were only possible to evaluate for the European Union: with a noticeable reduction in patient numbers, delay in treatment was a major worry. Measures to protect and reassure patients should be undertaken, especially regarding those with vision-threatening diseases requiring treatment.Keywords: COVID-19, survey, infection control, occupational safety

Praveen J Patel,1 Focke Ziemssen,2 Eugene Ng,3 Anushini Muthutantri,4 David Silverman,5 Elizabeth A Tschosik,6 Ronald A Cantrell6 1NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, and University College London Institute of Ophthalmology, London, UK; 2University of Tuebingen, Tuebingen, Germany; 3Institute of Eye Surgery, UPMC Whitfield and Waterford Institute of Technology, Waterford, Ireland; 4IQVIA, London, UK; 5Roche Products Limited, Welwyn Garden City, Hertfordshire, UK; 6Genentech, Inc., A Member of the Roche Group, South San Francisco, CA, USACorrespondence: David SilvermanOphthalmology, Roche Products Limited, 6 Falcon Way, Shire Park, Welwyn Garden City AL7 1TW, UKTel +44 1707 36 6394Email david.silverman@roche.comPurpose: To gain comprehensive information on the burden of illness due to geographic atrophy (GA).Methods: This cross-sectional study with a retrospective chart review involved patients aged ≥70 years with physician-confirmed bilateral symptomatic GA due to age-related macular degeneration (GA group), as well as patients of similar age with no ophthalmic condition that in the opinion of the investigator affected visual function (non-GA group). Data relating to patients’ current disease status and sociodemographics were self-reported on patient questionnaires at study entry and extracted from patient charts. Historical data on health care resource utilization (HCRU) were also collected via patient questionnaires and retrospective chart review (GA group only). Overall vision-related functioning and quality of life (QoL) were compared between the GA and non-GA groups using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) composite and subscales, and change in vision over the past year was assessed using the Global Rating of Change Scale.Results: Vision-related functioning and QoL were poorer in patients with vs without GA (n=137 vs 52), as demonstrated by significantly lower NEI-VFQ-25 composite score (mean, 53.1 vs 84.5 points, respectively; P

Josep Callizo,1 Focke Ziemssen,2 Thomas Bertelmann,3 Nicolas Feltgen,3 Jessica Vögeler,4 Mirja Koch,4 Nicole Eter,5 Sandra Liakopoulos,6 Steffen Schmitz-Valckenberg,7 Georg Spital8 1Department of Ophthalmology, Georg-August University, Goettingen, Germany; 2Center for Ophthalmology, Eberhard Karl University of Tuebingen, Tuebingen, Germany; 3Georg-August-University Goettingen, University Eye Hospital, Goettingen, Germany; 4Novartis Pharma GmbH, Clinical Research, Nuremberg, Germany; 5Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; 6Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; 7Department of Ophthalmology, University of Bonn, Bonn, Germany; 8Augenzentrum Am St. Franziskus Hospital, Muenster, GermanyCorrespondence: Josep CallizoDepartment of Ophthalmology, Georg-August University, Robert-Koch-Str. 40, Goettingen 37075, GermanyTel +495513966776Fax +495513966787Email josep.callizo@med.uni-goettingen.dePurpose: The non-interventional OCEAN study (NCT02194803) evaluated frequency and monitoring of ranibizumab injections for retinal vein occlusion (RVO) in routine practice in Germany.Methods: RVO patients (including branch and central RVO (BRVO/CRVO)) receiving ranibizumab were included. Best-corrected visual acuity (BCVA) testing, imaging and treatment were performed at the investigators’ discretion and documented over 24 months.Results: Overall, 744 RVO patients (27% BRVO, 16% CRVO, remaining unspecified RVO) were included. For 74% of patients, data were available for the 12-month visit and for 56% for the 24-month visit. Mean baseline BCVA was 52.0 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (BRVO: 55.9, CRVO: 43.9). BCVA improved rapidly within the first 3 months, reaching 64.3 letters at 12 months and 64.7 at 24 months. CRVO patients showed less improvement than those with BRVO. Patients received a median of 4 (5) injections over 12 (24) months, with 100% of patients receiving injections at baseline, 70% at Month 1 and 81% at Month 2. Overall, 40% of patients demonstrated a ≥15 letter increase within the first 3 months (42% BRVO, 46% CRVO). Patients with low initial BCVA (

Mariya Gosheva,1 Christian Klameth,1 Lars Norrenberg,2 Lucien Clin,3 Johannes Dietter,4 Wadood Haq,4 Iliya V Ivanov,4–6 Focke Ziemssen,1 Martin A Leitritz7 1University Eye Hospital, Centre for Ophthalmology, Tuebingen, 2Department of Obstetrics and Gynecology, Klinikum am Steinenberg, District Hospital Reutlingen, Reutlingen, 3School of Informatics, Reutlingen University, 4Division of Experimental Ophthalmology, Centre for Ophthalmology, Institute for Ophthalmic Research, 5Vision Rehabilitation Research Unit, Centre for Ophthalmology, University Eye Hospital, Eberhard Karls, 6ZEISS Vision Science Lab, Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen, 7Section for Experimental Ophthalmic Surgery and Refractive Surgery, University Eye Hospital, Centre for Ophthalmology, Tuebingen, Germany Purpose: Nowadays, complex digital imaging systems allow detailed retinal imaging without dilating patients’ pupils. These so-called non-mydriatic cameras have advantages in common circumstances (eg, for screening or emergency purposes) but present limitations in terms of image quality and field of view. We compare the usefulness of two non-mydriatic camera systems (ie, a handheld versus a stand-alone device) for fundus imaging. The primary outcome was image quality. The secondary outcomes were learning effects and quality grade-influencing factors.Methods: The imaging procedures followed standard protocol and were all performed by the same investigator. Camera 1 (DRS®) was a stand-alone system, while Camera 2 (Smartscope® PRO) was a mobile system. In order to evaluate possible learning effects, we selected an examiner with no prior training in the use of these systems. The images were graded separately by two experienced and “blinded” ophthalmologists following a defined protocol.Results: In total, 211 people were enrolled. Quality grade comparisons showed significantly better grades for Camera 1. Both systems achieved better quality grades for macular images than for disc-centered images. No remarkable learning effects could be demonstrated.Conclusions: Both camera systems are useful for fundus imaging. The greater mobility of Camera 2 was associated with lower image quality. For screening scenarios or telemedicine, it must be determined whether image quality or mobility is more important. Keywords: imaging, non-mydriatic, handheld camera, learning curve

Spyridon Dimopoulos, Martin Alexander Leitritz, Focke Ziemssen, Bogomil Voykov, Karl Ulrich Bartz-Schmidt, Faik Gelisken Centre for Ophthalmology, Eberhard-Karls University, Tuebingen, Germany Purpose: To report the visual and morphological outcomes following intravitreal bevacizumab in neovascular age-related macular degeneration (nAMD) with submacular, predominantly hemorrhagic, lesions.Methods: Retrospective study of patients with a follow-up after 1 year. All eyes with submacular hemorrhages larger than 50% of the total lesion size and received only anti-VEGF (vascular endothelial growth factor) monotherapy (intravitreous administration of 1.25 mg bevacizumab, PRN). The primary endpoint was the change in hemorrhage size and time to resolution, in association with the mean best-corrected visual acuity (BCVA). The eyes were grouped based on the size of the hemorrhage: group A (≥1 to

Martin Alexander Leitritz, Focke Ziemssen, Karl Ulrich Bartz-Schmidt, Bogomil Voykov Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany Purpose: To evaluate a digital high-speed camera combined with digital morphometry software for dynamic measurements of phakic intraocular lens movements to observe kinetic influences, particularly in fast direction changes and at lateral end points. Materials and methods: A high-speed camera taking 300 frames per second observed movements of eight iris-claw intraocular lenses and two angle-supported intraocular lenses. Standardized saccades were performed by the patients to trigger mass inertia with lens position changes. Freeze images with maximum deviation were used for digital software-based morphometry analysis with ImageJ.Results: Two eyes from each of five patients (median age 32 years, range 28–45 years) without findings other than refractive errors were included. The high-speed images showed sufficient usability for further morphometric processing. In the primary eye position, the median decentrations downward and in a lateral direction were -0.32 mm (range -0.69 to 0.024) and 0.175 mm (range -0.37 to 0.45), respectively. Despite the small sample size of asymptomatic patients, we found a considerable amount of lens dislocation. The median distance amplitude during eye movements was 0.158 mm (range 0.02–0.84). There was a slight positive corrlation (r=0.39, P