Objective: To measure the human lamina cribrosa thickness (LCT) in vitro in fully hydrated specimens and to determine whether there is any association between thickness and age or sex. Methods: 45 fixed human optic nerves, age range 9-90 years, were dissected from the globe and frozen sectioned. The study was divided into two parts: the first investigated the overall change in LCT and cribrosal beam thickness (CBT) with age, and the second divided eyes into two specific age groups (38-49 and 78-87 years) and assessed differences with respect to age and sex. Results: LCT ranged from 345.4 to 555.9 mm between the samples. A positive relationship was found between LCT and age (LCT = 2.416age+365.5, 95% confidence interval (CI) for slope 1.31 to 3.52; r 2 = 0.30, p,0.001). A regional difference in CBT was observed, with beams being thickest at the posterior cribrosa (mean 14.8 (standard deviation (SD) 2.2) mm) and thinnest at the anterior cribrosa (9.8 (SD 2.4) mm). CBT increased with increasing age. Differences related to sex were also found, with females having relatively thinner LCT than males, irrespective of age, but this was not statistically significant. Conclusions: This study shows an increase in human LCT with increasing age. This changing structural property of the lamina cribrosa may have implications for its functioning with respect to compliance and reversibility, and has particular relevance to glaucoma, where increasing age has been identified as a strong risk factor for the development of the disease.
Introduction: Ophthalmology services have been significantly impacted by the COVID-19 pandemic. Frequency of intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injections are important in visual outcomes. Methods: We conducted an audit on intravitreal services in an NHS district general hospital in the UK including all new patients with diabetic macular oedema (CI-DMO) and wet age-related macular degeneration (AMD) who were initiated on intravitreal injection of Aflibercept (EYLEA) between 1st January to 15th July 2020, and had subsequent injections until October 2020. Data on injection dates and visual acuity was extracted, and the total number of all intravitreal injections for all indications between January to September 2020 and the same period in 2019. Delay to treatment was defined as more than 14 days, according to the fixed dosing schedule. Results: We found 31% (n=17) of patients initiated on treatment for wet AMD and 44% (N=11) for CI-DMO had delayed injections. There was no correlation between total duration of delay and change in best-corrected visual acuity (BCVA). Similarly, we found no association between duration of delay and change in BCVA. The number of intravitreal injections declined during the COVID-19 pandemic by 17.8% compared to 2019. Conclusion: Majority of patients initiated on anti-VEGF injections just before the pandemic or during the pandemic received injections on time. Where there were significant delays to treatment, there was no detected loss in vision over the short term. However, the long-term impact and impact of overall reduction in intravitreal injections are unknown.
PurposeWe aimed to assess the agreement between clinical assessment of diabetic retinopathy and Optomap ultrawide-field imaging (UWFI) in a real-life clinic setting.MethodsStructured examination findings, from diabetic patients attending routine medical retina clinics in July 2011, were retrospectively compared with the grade obtained from Optomap UWFI images, graded independently by two ophthalmologists, taken at the same visit.ResultsA total of 84 eyes (42 patients) were examined, and 74 eyes (37 patients) were suitable for analysis. The hospital Eye Service slit-lamp biomicroscopy grades for retinopathy were: no diabetic retinopathy in zero eyes; background retinopathy in 21 eyes; preproliferative retinopathy in 34 eyes; and proliferative retinopathy in 19 eyes. For retinopathy, the agreement between the Optomap UWFI and clinical grading was moderate for both graders (κ=0.57 and κ=0.63), and there was almost perfect agreement between the two graders (κ=0.92). The clinical grades for the presence of photocoagulation scars were: no photocoagulation scars in 46 eyes and photocoagulation scars visible in 28 eyes, indicating substantial agreement between the Optomap UWFI and clinical grading for both graders (κ=0.73 and κ=0.64). There were two instances where proliferative retinopathy was documented clinically but graded as preproliferative by both graders of Optomap UWFI. These were investigated, and neither patient required treatment, ie, the difference in retinopathy grade would not have affected the patient outcomes.ConclusionThis study demonstrated moderate agreement between Optomap UWFI and hospital slit-lamp biomicroscopy grading of patients’ retinopathy in a real-life medical retina clinic setting. The authors believe that Optomap UWFI is, not only a very useful adjunct to clinical examination in terms of detection and recording of retinopathy, but also, could have a role in standalone “virtual” clinics.
Introduction Randomised controlled trials provide evidence that a treatment works. Real world evidence is required to assess if proven treatments are effective in practice. Method Retrospective data collection on patients given aflibercept for diabetic macular oedema over 3 years from 21 UK hospitals: visual acuity (VA); Index of multiple deprivation score (IMD); injection numbers; protocols used, compared as a cohort and between sites. Results Complete data: 1742 patients (from 2196 eligible) at 1 year, 860 (from 1270) at 2, 305 (from 506) at 3 years. The median VA improved from 65 to 71, 70, 70 (ETDRS letters) at 1, 2 and 3 years with 6, 9 and 12 injections, respectively. Loss to follow-up: 10% 1 year, 28.8% at 3. Centres varied: baseline: mean age 61–71 years (p < 0.0001); mean IMD score 15–37 (p < 0.0001); mean VA 49–68 (p < 0.0001). Only four centres provided a loading course of five injections at monthly intervals and one 6. This did not alter VA outcome at 1 year. Higher IMD was associated with younger age (p = 0.0023) and worse VA at baseline (p < 0.0001) not total number of injections or change in VA. Lower starting VA, higher IMD and older age were associated with lower adherence (p = 0.0010). Conclusions The data showed significant variation between treatment centres for starting age, VA and IMD which influenced adherence and chances of good VA. Once treatment was started IMD did not alter likelihood of improvement. Loading dose intensity did not alter outcome at one year.
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