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Background/aims To describe baseline characteristics and 12-month outcomes with vascular endothelial growth factor (VEGF) inhibitors of treatment-naïve hemiretinal vein occlusion (HRVO) compared with branch (BRVO) and central (CRVO) variants in routine clinical care. Methods A database observational study recruited 79 HRVO eyes, 590 BRVO eyes and 344 CRVO eyes that initiated therapy over 10 years. The primary outcome was mean change in visual acuity (VA--letters read on a logarithm of minimal angle of resolution chart) at 12 months. Secondary outcomes included mean change in central subfield thickness (CST), injections and visits. Results At baseline, mean VA in HRVO (53.8) was similar to CRVO (51.9; p=0.40) but lower than BRVO (59.4; p=0.009). HRVO eyes improved to match BRVO eyes from soon after treatment started through 12 months. Mean change in VA was greater in HRVO (+16.4) than both BRVO (+11.4; p=0.006) and CRVO (+8.5; p<0.001). Mean change in CST in HRVO (-231 µm) was similar to CRVO (-259 µm; p=0.33) but greater than BRVO eyes (-151 µm; p=0.003). The groups had similar median burdens of eight injections and nine visits. Conclusions HRVO generally experienced the greatest mean change in VA of the three types of RVO when treated with VEGF inhibitors, ending with similar 12-month VA and CST to BRVO despite starting closer to CRVO. Inclusion of HRVO in BRVO or CRVO cohorts of clinical trials would be expected to proportionally inflate and skew the visual and anatomic outcomes. [ABSTRACT FROM AUTHOR]

Background/rationale Artificial intelligence (AI)-based clinical decision support tools, being developed across multiple fields in medicine, need to be evaluated for their impact on the treatment and outcomes of patients as well as optimisation of the clinical workflow. The RAZORBILL study will investigate the impact of advanced AI segmentation algorithms on the disease activity assessment in patients with neovascular agerelated macular degeneration (nAMD) by enriching three-dimensional (3D) retinal optical coherence tomography (OCT) scans with automated fluid and layer quantification measurements. Methods RAZORBILL is an observational, multicentre, multinational, open-label study, comprising two phases: (a) clinical data collection (phase I): an observational study design, which enforces neither strict visit schedule nor mandated treatment regimen was chosen as an appropriate design to collect data in a real-world clinical setting to enable evaluation in phase II and (b) OCT enrichment analysis (phase II): de-identified 3D OCT scans will be evaluated for disease activity. Within this evaluation, investigators will review the scans once enriched with segmentation results (i.e., highlighted and quantified pathological fluid volumes) and once in its original (i.e., non-enriched) state. This review will be performed using an integrated crossover design, where investigators are used as their own controls allowing the analysis to account for differences in expertise and individual disease activity definitions. Conclusions In order to apply novel AI tools to routine clinical care, their benefit as well as operational feasibility need to be carefully investigated. RAZORBILL will inform on the value of AI-based clinical decision support tools. It will clarify if these can be implemented in clinical treatment of patients with nAMD and whether it allows for optimisation of individualised treatment in routine clinical care. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of the study was to report the estimated incidence, cumulative rate, risk factors and outcomes of submacular haemorrhage (SMH) with loss of vision in neovascular age‐related macular degeneration (nAMD) receiving intravitreal injections (IVT) of vascular endothelial growth factor (VEGF) inhibitor in routine clinical practice. Methods: Retrospective analysis of treatment‐naïve eyes receiving IVTs of VEGF inhibitors (ranibizumab, aflibercept or bevacizumab) for nAMD from 1 January 2010 to 31 December 2020 that were tracked the Fight Retinal Blindness! registry. Estimated incidence, cumulative rate and hazard ratios (HR) of SMH with loss of vision during treatment were measured using the Poisson regression, Kaplan–Meier survival curves and Cox proportional hazard models. Results: We identified 7642 eyes (6425 patients) with a total of 135 095 IVT over a 10‐year period. One hundred five eyes developed SMH with loss of vision with a rate of 1 per 1283 injections (0.08% 95% confidence interval [95% CI] [0.06; 0.09]). The estimated incidence [95% CI] was 4.6 [3.8; 5.7] SMH with loss of vision per year per 1000 treated patients during the study. The cumulative [95% CI] rate of SMH per patient did not increase significantly with each successive injection (p = 0.947). SMH cases had a mean VA drop of around 6 lines at diagnosis, which then improved moderately to a 4‐line loss at 1 year. Conclusions: Submacular haemorrhage (SMH) with loss of vision is an uncommon complication that can occur at any time in eyes treated for nAMD in routine clinical practice, with only limited recovery of vision 1 year later. [ABSTRACT FROM AUTHOR]

Background/Aims To compare the efficacy of ranibizumab (0.5 mg) with aflibercept (2 mg) in the treatment of cystoid macular oedema due to branch retinal vein occlusion (BRVO) over 12 months. Methods A multicentre, international, database observational study recruited 322 eyes initiating therapy in real-world practice over 5 years. The main outcome measure was mean change in EDTRS letter scores of visual acuity (VA). Secondary outcomes included anatomic outcomes, percentage of eyes with VA >6/12 (70 letters), number of injections and visits, time to first inactivity, switching or non-completion. Results Generalised mixed effect models demonstrated that mean (95% CI) adjusted 12-month VA changes for ranibizumab and aflibercept were similar (+10.8 (8.2 to 13.4) vs +10.9 (8.3 to 13.5) letters, respectively, p=0.59). The mean adjusted change in central subfield thickness (CST) was greater for aflibercept than ranibizumab (-170 (-153 to -187) µm vs -147 (-130 to -164) µm, respectively, p=0.001). The overall median (Q1, Q3) of 7 (4, 8) injections and 9 (7, 11) visits was similar between treatment groups. First grading of inactivity occurred sooner with aflibercept (p=0.01). Switching was more common from ranibizumab (37 eyes, 23%) than from aflibercept (17 eyes, 11%; p=0.002). Conclusion Visual outcomes at 12 months in this direct comparison of ranibizumab and aflibercept for BRVO in real-world practice were generally good and similar for the 2 drugs, despite a greater effect of aflibercept on CST and time to first grading of inactivity. [ABSTRACT FROM AUTHOR]

Objective To study the uptake of annual diabetic retinopathy screening and study the 5-year trends in the detection of screen-positive diabetic retinopathy and non-diabetes- related eye disease in a cohort of annually screened individuals. Design Retrospective retinopathy screening attendance and retinopathy grading analysis. Setting Community-based retinopathy screening centres for the Diabetic RetinaScreen Programme. Participants 171 557 were identified by the screening programme to be eligible for annual diabetic retinopathy screening. 120 048 individuals over the age of 12 consented to and attended at least one screening appointment between February 2013 to December 2018. Main Outcome Measures Detection rate per 100 000 of any retinopathy, screen-positive referrable retinopathy and nondiabetic eye disease. Results Uptake of screening had reached 67.2% in the fifth round of screening. Detection rate of screen-positive retinopathy reduced from 13 229 to 4237 per 100 000 screened over five rounds. Detection of proliferative disease had reduced from 2898 to 713 per 100 000 screened. Non-diabetic eye disease detection and referral to treatment centres increased almost eightfold from 393 in round 1 to 3225 per 100 000 screened. The majority of individuals referred to treatment centres for ophthalmologist assessment are over the age of 50 years. Conclusions Screening programme has seen a reduced detection rate both screen-positive retinopathy referral in Ireland over five rounds of screening. Management of nondiabetic eye diseases poses a significant challenge in improving visual outcomes of people living with diabetes in Ireland. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions We aimed to describe a 2‐year outcome of eyes managed by practitioners benchmarked using a funnel plot by their frequency of treatment using vascular endothelial growth factor (VEGF) inhibitors for naive retinal vein occlusion (RVO).A multicentre, international, observational study of 29 doctors in 12 countries managing 1110 eyes with RVO commencing VEGF inhibitors between 1 January 2012–2022 tracked in the Fight Retinal Blindness! registry.We identified 3 outlying ‘intensive’ practitioners (managing 350/1110 eyes [32%]), 22 ‘typical’ practitioners (604/1110, [54%]) and 4 outlying ‘relaxed’ practitioners (156/1110, [14%]) with respective 24‐month outcomes in Branch and Central RVO including the primary outcome, mean adjusted change in visual acuity (VA) in BRVO: +16.2, +13.6, +9.3 letters (p < 0.01) and CRVO: +14.2, +12.7, +4.8 letters (p < 0.01); adjusted change in macular thickness in BRVO −179, −150, −159 μm (p < 0.01) and CRVO −324, −283, −232 μm (p < 0.01); time‐in‐range with VA > 68 letters in BRVO 90, 78, 68 weeks (p < 0.01) and CRVO 69, 60, 54 weeks (p = 0.04); median injections 18, 13 and 10; median final injection intervals, BRVO 6, 9, 10 weeks and CRVO 6, 9 and 12 weeks; with no significant difference in adverse outcomes.At 24 months, the intensive practitioners were treating RVO using VEGF inhibitors with twice the frequency of the relaxed practitioners; however, their patients had gained twice (BRVO) to three times (CRVO) more letters of VA. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions To assess clinical outcomes of cataract surgery in eyes treated with intravitreal injections for cystoid macular oedema (CMO) secondary to retinal vein occlusions (RVOs).Eyes receiving intravitreal injections for CMO secondary to RVOs that underwent cataract extraction were identified from the Fight Retinal Blindness! Registry and matched 1:1 by 9 parameters with phakic controls also receiving intravitreal injections for the same condition. VA change at 12 months, central subfield thickness (CST) and injection frequency before and after surgery were compared between the two groups. The effect of baseline features on the final VA including age, CST, treatment frequency among others was tested.We included 193 eyes that had cataract extraction (exposed) matched with 193 phakic eyes that did not have surgery (matched). VA (95%CI) changed by +9.9 (7, 12.8) letters in exposed eyes versus −2.4 (−4.1, −0.7) letters in matched eyes (p < 0.01). The mean [SD] VA at 12 months was similar in exposed and matched eyes [60.7 (23.0) vs. 61.1 (24.3) letters, respectively, p = 0.81]. The mean [SD] CST was similar between groups before and at surgery, but it was greater in exposed compared with matched eyes [353 (152) vs. 322 (123) μm, respectively, p = 0.03] 12 months after surgery. Exposed eyes received more injections [median (range)] than matched eyes during the 12 months after surgery [5 (3, 7) vs. 4 (1, 6), injections, p < 0.01].Cataract extraction delivered good visual outcomes in patients treated for CMO secondary to RVOs. More injections were required on average in the 12 months after surgery in eyes undergoing surgery compared to matched controls. [ABSTRACT FROM AUTHOR]