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Nirodhini Narendran,1,2 Clare Bailey,3 Louise Downey,4 Richard Gale,5 Ajay Kotagiri,6 Ian Pearce,7 Christina A Rennie,8 Sobha Sivaprasad,9 James Talks,10 Peter Morgan-Warren,11 Jackie Napier,11 Carolyn O’Neil,11 Timothy Seeborne11 1The Royal Wolverhampton NHS Trust, Wolverhampton, UK; 2School of Life & Health Sciences, Aston University, Birmingham, UK; 3University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; 4Hull University Teaching Hospitals NHS Trust, Hull, UK; 5York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK; 6South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK; 7Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; 8University Hospital Southampton NHS Foundation Trust, Southampton, UK; 9NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK; 10Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; 11Bayer plc, Reading, UKCorrespondence: Nirodhini Narendran, Ophthalmology Department, New Cross Hospital (Part of the Royal Wolverhampton NHS Trust), Wolverhampton Road, Wolverhampton, WV10 0QP, UK, Email niro.narendran@nhs.netPurpose: The inclusion of ranibizumab biosimilars into National Health Service England commissioning recommendations published in 2022 created a need for expert guidance to optimize treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) who otherwise may not have received first-line ranibizumab. This article provides a consensus treatment pathway supporting timely identification and management of a suboptimal response to these therapies, thereby aiming to facilitate clinically meaningful outcomes and efficient management of service capacity under specific circumstances where ranibizumab biosimilars may be initiated as a first-line treatment.Methods: Two structured round-table meetings of UK medical retina specialists were held in person and virtually on September 22 and November 3, 2022, respectively. These meetings were organized and funded by Bayer.Results: The panel provided guidance on the implementation of an early treatment optimization pathway in cases where ranibizumab biosimilars are used as a first-line treatment, including recommendations on patient suitability and capacity requirements, and criteria for identification and strategies for management of a suboptimal response. The panel discussed the role of aflibercept treatment and its potential benefits and outlined recommendations on switching ranibizumab biosimilar suboptimal responders to an aflibercept treat-and-extend regimen, where appropriate.Conclusion: Developed by a retinal expert panel, this early treatment optimization pathway provides guidance to facilitate optimal long-term patient outcomes while addressing capacity and resourcing constraints in circumstances of first-line ranibizumab biosimilar use for nAMD, including how aflibercept may be used in cases with a suboptimal response. Therefore, this fills an important gap in guidance on navigating the new treatment landscape.Keywords: anti-VEGF agents, capacity, consensus pathway, ranibizumab

Purpose: The current study aims to elucidate the differences in the timing of the management of operative supracondylar humerus fractures (SCHF) based on whether or not the patient is transferred between facilities. Methods: This was a prospective cohort study of patients with surgically treated SCHF conducted at a level I pediatric trauma center. The management of these fractures was compared based on their presenting facility (pediatric trauma center versus another facility). Primary outcomes were time to orthopaedic consult, time to surgery, need for open reduction, and operative times. Secondary outcomes include the need for repeat imaging, transfer time, transfer vehicle, and transfer distance. Results: A total of 146 (78 female) patients with an average age of 5.70 (±2.12) years were included in the study. Time from initial presentation to orthopaedic consult (P ​

Nikhil Sharma,1 Eilidh Martin,1 Edward Ian Pearce,1 Suzanne Hagan,1 Christine Purslow,2 Jennifer P Craig3 1Glasgow Caledonian University, Glasgow, Scotland, UK; 2Christine Purslow – School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, UK; 3Jennifer P Craig – Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New ZealandCorrespondence: Nikhil Sharma, Email Nikhil.Sharma@gcu.ac.ukAim: The primary aim of this study was to compare how eyecare professionals in disparate regions of the world diagnose and manage Demodex blepharitis. A secondary aim was to explore interprofessional differences in diagnostic and management practices.Methods: Ophthalmologists and optometrists from India and Australia/New Zealand, were invited to complete an online survey on Demodex blepharitis. Clinical practice patterns relating to patients with Demodex blepharitis, with details of how they investigate and manage Demodex blepharitis in clinical practice, were collected along with clinician demographics and general perceptions on eyelid health. Mann–Whitney U, and Fisher’s exact tests were used for statistical analysis.Results: A total of 261 eyecare professionals completed the survey, comprising 207 from India (84% optometrists) and 54 from Australia and New Zealand (91% optometrists). Almost 70% of practitioners across the 3 countries recognized Demodex blepharitis as a cause of ocular discomfort, yet only 45% reported attempting to identify Demodex in their patients. There were significant differences noted in clinical practice between those in Australasia and India. Perceived prevalence of Demodex blepharitis also differed (60% in Australasia vs 27% in India; p< 0.01), as well as, the choice of slit lamp magnification used to detect the mites (25x in Australasia vs 16x in India; p = 0.02), preferred treatment option to manage Demodex blepharitis (tea tree oil in Australasia vs Standard lid hygiene in India; p = 0.01), treatment duration (from 3– 4 weeks to over 12 weeks in Australasia vs 3– 4 weeks in India; p = 0.02) and treatment application frequency (once daily in Australasia vs twice daily in India; p = 0.01).Conclusions: This study highlights differences in clinical evaluation and treatment practices between eyecare professionals in India and Australasia. Overall, practitioners in Australia and New Zealand were more evidence-based in their investigation and management. However, in both regions, interprofessional differences in perceived optimal treatment duration and frequency were reported.Keywords: Demodex blepharitis, practitioners’ perspective, ocular surface, dry eye