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Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes--to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health--the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners--excluding those with diagnoses normally connected to increased mortality--was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term impact of half-fluence photodynamic therapy (PDT) on chorioretinal architecture in chronic central serous chorioretinopathy (cCSCR) through novel choroidal vascularity index (CVI) versus previously established subfoveal choroidal thickness (SFCT)., Methods: This post-hoc analysis included prospectively collected swept-source optical coherence tomography (SS-OCT) images of a total of 29 cCSCR and fellow eyes (FE), acquired before, one and 12 months after PDT. CVI, total choroidal area (TCA), luminal area (LA) and stromal area (SA) were calculated using validated binarization technique. Central macular thickness (CMT), SFCT and subretinal fluid (SRF) were assessed. Longitudinal changes following PDT and associations between all parameters were investigated., Results: CVI, TCA, LA, SFCT and CMT significantly decreased at month 1 (all p < 0.001). From month 1 to 12, CVI (p < 0.001) and LA (p = 0.01) increased but remained significantly lower than at baseline (p = 0.001 and p < 0.001). SFCT and CMT remained stable (all p = 1.0). SA and all FE parameters showed no significant changes at any time point. Comparing affected and FE, there were significant CVI differences at baseline (p < 0.001), month 1 (p = 0.01) and 12 (p < 0.001). SRF was significantly associated with higher CVI (p < 0.001), LA (p = 0.031), SFCT (p = 0.038)., Conclusion: Half-fluence PDT significantly affects choroidal architecture, with sustained CVI and SFCT reductions 12 months post-treatment. Use of CVI as both a treatment response and disease activity marker is merited. There is a large discrepancy between CVI and SFCT, suggesting they each represent different anatomic responses. CVI proves to be a more specific and reliable CSCR biomarker than previously established SFCT., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: Patients with unilateral treatment-naïve exudative neovascular age-related macular degeneration (nAMD) were examined for the presence of nonexudative macular neovascularization (neMNV) in their fellow eye using a multimodal imaging approach. This is intended to determine the sensitivity of individual imaging methods, namely, indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA)., Methods: In this retrospective cross-sectional study, ICGA images of the nonexudative eye were analyzed for the presence of plaques. SS-OCTA outer retinal segmentations were evaluated for neovascular flow in en-face scans and/or color-coded flow in B-scans. The findings were matched with a double-layer sign (DLS) or pigment epithelium detachment (PED) on conventional OCT., Results: In total, neMNV was diagnosed in the fellow eye of 40 of 241 patients (17%) using a multimodal imaging approach employing both ICGA and SS-OCTA. 25 eyes (10%) showed neMNV in both modalities, while 7 (3%) were only detected by ICGA and 8 (3%) by OCTA alone. The sensitivities of ICGA therefore were 80% (32/40) and 83% (33/40) for OCTA. Of the 40 eyes with neMNV, OCT revealed DLS in 25/40 (63%) and PED in 17/40 (43%) of the cases., Conclusion: None of the modalities alone could detect all neMNV in the partner eye of Caucasians with unilateral treatment-naïve exudative nAMD. ICGA and OCTA showed comparable sensitivity. The combination of ICGA, OCTA, and OCT provides the most comprehensive screening for this AMD subtype., Competing Interests: Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Viennese ethics committee and with the 1964 Helsinki declaration and its later amendments. Informed consent: This study was approved by the Viennese ethics committee, City of Vienna, approval number EK-17-083-0517. Due to its retrospective nature, the study has been granted an exemption from requiring written informed consent by the Viennese ethics committee. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In the wake of the COVID-19 pandemic in 2020, older people across Europe have adjusted their daily activities as personal risk avoidance and as an amendment to policy recommendations and restrictions. In this study, we use multilevel logistic regressions to examine to what extent sociodemographic factors are associated with activity reduction among the older population (50+) in Europe and whether these associations are moderated by governmental policy responses to COVID-19. By combining data for~35,000 respondents from the SHARE Corona Survey on reported changes in daily activities and stringency of restrictions at the national level, we find that older age, poorer health and being female versus male were (consistently) associated with greater activity reduction across all activities both in countries with weak and in those with strong restrictions. Associations between education, employment and living situation, on the one hand, and activity reduction, on the other, were weaker and less consistent. We conclude that differences between sociodemographic groups are rather similar for countries with weak and those with strong restrictions and hence argue that group-specific policy recommendation are relevant independent of stringency recommendations.

Objective: The aim of this study was to compare the quality of care received by treatment-naïve patients with neovascular age-related macular degeneration (nAMD) who received intravitreal aflibercept therapy before the coronavirus disease 2019 (COVID-19) pandemic with patients who received the same therapy during the pandemic., Methods: Data, including best corrected visual acuity (BCVA) as the logarithm of the minimum angle of resolution (logMAR) and anatomical outcomes at diagnosis and at each follow-up, was collected on 297 treatment-naïve patients who received intravitreal aflibercept. Therapy-naïve patients who started therapy at least 24 months prior to the first pandemic-related lockdown and were thus treated exclusively prior to the pandemic (n = 123) were compared with patients who started therapy within 12 months prior to the first lockdown and were thus treated during the pandemic (n = 174). Both groups were followed over a two-year period., Results: In patients treated before the COVID-19 pandemic, VA remained stable (0.58 ± 0.41 logMAR) compared to baseline (0.54 ± 0.34 logMAR; p = 0.228) until the end of the observation period. In patients treated during the COVID-19 pandemic, BCVA dropped below the baseline (0.56 ± 0.35 logMAR) within 24-month of follow-up (0.79 ± 0.43 logMAR; p = 0.010). Compared to the patients treated prior to the COVID-19 pandemic, the latter group showed a significantly worse VA at the 6-month (p = 0.041), 12-month (p = 0.040), 18-month (p = 0.024), 21-month (p = 0.035), and 24-month (p = 0.004) follow-up. Additionally, the group treated during the COVID-19 pandemic received significantly fewer aflibercept injections (3,94 ± 1,9 vs. 3,30 ± 1,6; p = 0,007) and fewer follow-up examinations (2,71 ± 1,2 vs. 2,16 ± 0,9; p < 0,001) in the second year compared to the group that was treated before the COVID-19 pandemic., Conclusion: We confirmed significantly worse VA outcomes in the group of nAMD patients treated during the COVID-19 pandemic. Impeded access to care could be attributed to the restrictions imposed owing to the COVID-19 pandemic., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht./The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: The aim of the study is to analyze the swept source-optical coherence tomography angiography (SS-OCTA) characteristics of polypoidal lesions in Caucasian patients., Methods: In this retrospective observational case series, 43 polypoidal lesions in 32 eyes of 32 patients were diagnosed using indocyanine green angiography (ICGA) and compared to SS-OCTA at a tertiary medical retina center (Clinic Landstra ß e, Vienna Healthcare Group, Austria) between June 2017 and March 2020. Vascularity was identified by color-coded B-scan SS-OCTA while morphology was described as revealed by en face SS-OCTA after alignment with ICGA-confirmed findings., Results: In total, SS-OCTA detected all polypoidal lesions, as identified by ICGA. On B-scan SS-OCTA, circumscribed flow was detected in 33 (76.7%) polypoidal lesions and diffuse flow in 10 (23.3%) lesions. On en face SS-OCTA, polypoidal lesions appeared morphologically as 19 tangled vessel balls (44.2%), 6 tangled vessel balls next to dilated vessels (13.9%), 8 vascular dilatations (18.6%), and 8 ill-defined vascular networks (18.6%), leaving 2 lesions (4.6%) undetected. Circumscribed flow was significantly associated with tangled vessel balls ( p = 0.005)., Conclusion: This study highlights the importance of a multimodal imaging approach, including SS-OCTA, for the evaluation of polypoidal lesions. Our findings suggest a morphological heterogeneity of vascular patterns in Caucasian patients with polypoidal lesions, as pictured by SS-OCTA., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Daniel Ahmed-Balestra et al.)

Purpose: To describe characteristics of indocyanine green (ICG) angiographic plaques in the nonexudative fellow eye of White patients with unilateral treatment-naïve exudative neovascular age-related macular degeneration through optical coherence tomography (OCT) and OCT angiography (OCTA)., Methods: In this retrospective cross-sectional study, nonexudative eyes with ICG angiographic plaques were analyzed by OCT B-scans for the sensitivity of a double-layer sign, a pigment epithelium detachment, outer retinal atrophy, hyperreflective dots, and subretinal hyperreflective material (SRHM). The ICG angiographic plaque was matched with a macular neovascularization in OCTA en face scans and color-coded B scans., Results: In total, 35 ICG angiographic plaques in 33 of 291 (11%) nonexudative eyes were diagnosed. OCT revealed 27 double-layer sign (78%), eight pigment epithelium detachment (23%), 8 outer retinal atrophy (23%), eight hyperreflective dots (23%), and one subretinal hyperreflective material (3%). OCTA confirmed a macular neovascularization in 28 plaques (80%): 7 (20%) in en face scans, 3 (9%) in color-coded B scans, and 18 (51%) in both. The area size in OCTA was significantly smaller than that of ICG angiography ( P = 0.002)., Conclusion: The diagnosis of an ICG angiographic plaque in nonexudative fellow eyes of Whites with unilateral treatment-naïve exudative neovascular age-related macular degeneration was highly suggestive of a typical macular neovascularization type 1 as characterized by OCT and OCTA., Competing Interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. All authors declare that they have no conflict of interest related to this submission. The authors have not published or submitted any related papers from this study. Neither was the paper presented at a meeting.

Purpose: A model was calculated during the first Austrian coronavirus disease-2019 (COVID-19) pandemic lockdown to estimate the effect of a short-term treatment interruption due to healthcare restrictions on visual acuity (VA) in neovascular age-related macular degeneration (nAMD). The model was compared to the real-life outcomes before treatment re-started., Methods: Retrospective data-collection of 142 eyes in 142 patients receiving repeated intravitreal injections with anti-VEGF at a retina unit in Vienna in a personalized pro-re-nata regimen prior to the COVID-19 associated lockdown, when treatment was deferred between March 16 and May 4, 2020. During the lockdown, the preliminary data was integrated into pre-existing formulae based on the natural course of the disease in untreated eyes in the long term. Patients were re-scheduled and treated after gradually opening operating rooms. The calculation model was compared to the effective VA change., Results: The model calculated an overall VA loss of 3.5 ± 0.8 letters early treatment diabetes retinopathy study (ETDRS) ( p  < 0.001 [95% CI:3.3;3.6]) on average compared to 2.5 ± 6 letters ETDRS ( p  < 0.001 [95% CI:1.5;3.5]) as measured with a mean treatment delay of 61 ± 14 days after previously scheduled appointments. The total difference between the model exercise and the real-life outcomes accounted for 1 ± 5.9 letters ETDRS ( p  = 0.051 [95% CI: 0.1;1.9])., Conclusion: The herein presented calculation model might not be suitable to estimate the effective VA loss correctly over time, although untreated eyes and eyes under therapy show similarities after short-term treatment interruption. However, this study demonstrated the potentially negative impact of the COVID-19 pandemic lockdown on patients compromised by nAMD.

Introduction: We aimed to evaluate visual and anatomical outcomes among eyes with neovascular age-related macular degeneration (nAMD) that were persistent to intravitreal aflibercept therapy compared to those that were nonpersistent to therapy., Methods: We audited 648 treatment-naïve eyes of 559 patients regarding visual acuity (VA) given as the logarithm of the minimum angle of resolution (logMAR) and anatomic outcomes at baseline and at each subsequent follow-up visit for up to 5 years. Nonpersistence was defined as a visit-free interval of > 6 months., Results: Among the enrolled eyes, 405 were persistent to the therapy and 243 (37%) were nonpersistent, of which 161 (66%) eyes returned for further therapy after a gap of clinical care. In the nonpersistent group, we observed a decline from 0.58 ± 0.35 to 0.92 ± 0.57 logMAR (p = 0.01) after 60 months. Compared with the persistent group, the nonpersistent group had worse visual outcomes at their 33-month (p = 0.03), 42-month (p = 0.01), 51-month (p = 0.001) and 60-month (p = 0.01) visits. Additionally, 5/405 (1.2%) eyes in the persistent group and 8/161 (5.0%) eyes in the nonpersistent group developed an end-stage disease with a subfoveal fibrosis during the observational period (p = 0.013)., Conclusion: We found that eyes with nAMD that were nonpersistent to intravitreal aflibercept therapy experienced statistically significantly worse VA compared to eyes persistent to therapy within 3 years. Moreover, eyes in the nonpersistent group had a four-fold higher risk of developing a fovea-involving fibrosis. Considering the potential irreversible deterioration with respect to best-corrected VA within nAMD, strategies need to be developed for patients at risk of nonpersistence to therapy., (© 2022. The Author(s).)

Introduction: To evaluate the effect of a 9-week treatment deferral due to healthcare restrictions caused by Austria's first governmental lockdown associated with the coronavirus disease 2019 (COVID-19) pandemic on visual acuity (VA) in eyes compromised by exudative neovascular age-related macular degeneration (nAMD) after 1 year., Methods: Retrospective data collection of 98 eyes (98 patients) with a treatment discontinuation at a tertiary eye care center (Clinic Landstraße, Vienna Healthcare Group, Austria) between March 16 and May 4, 2020. Prior to the lockdown, patients received multiple intravitreal injections (IVI) of anti-vascular endothelial growth factor with a personalized treatment interval for 3 years on average and at least three IVI after the lockdown., Results: When the treatment interval doubled to 117.6 ± 31.4 days in spring 2020, patients lost 2.2 ± 4.6 ETDRS letters (p = 0.002) on average before reinitiating therapy. In total, 4.1 ± 8.1 letters (p < 0.0001) were lost despite continuous individual re-treatment over the course of the next year. In a univariate analysis, the extended interval time remained statistically significant (p < 0.0001), indicating a larger VA reduction within intervals with increasing interval time in days., Conclusion: The short-term treatment interruption had a persistent negative impact on the VA course of eyes under therapy after 1 year. Continuous therapy independent of the underlying treatment regimen remains of utmost importance in exudative nAMD. Our data should create awareness to regulators regarding future decisions despite the global pandemic., (© 2021. The Author(s).)

The purpose was to demonstrate the diagnostic and therapeutic feasibility of swept source-optical coherence tomography angiography (SS-OCTA) by picturing neovascular changes secondary to a rare white dot syndrome following long-term intravitreal ranibizumab (IVR). A 28-year-old Caucasian myopic female presented with visual loss in her right eye only. The clinical examination and multimodal imaging including spectral domain (SD)-OCT, blue-peak autofluorescence, fluorescein, and indocyanine green angiography (HRA Spectralis, Heidelberg Engineering; Heidelberg, Germany) as well as SS-OCTA (DRI Triton, Topcon; Tokyo, Japan) led to the diagnosis of idiopathic punctate inner choroidopathy with secondary subfoveal choroidal neovascularization (CNV). In addition to oral corticosteroids, a pro re nata regimen with IVR was initiated and guided by repeated SD-OCT and SS-OCTA. Six IVR were administered based on functional SS-OCTA en face scans illustrating vessel transformation and downsizing of the CNV area while SD-OCT B-scans were inconclusive as indirect signs of activity were absent throughout the follow-up period. SS-OCTA provided new possibilities for monitoring vessel development. IVR was managed based on vessel density as displayed by SS-OCTA., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by S. Karger AG, Basel.)

Objectives This study aimed to investigate whether change from the construction industry to work in other industries at age 45-55 years lowered risks of disability benefits (DB) later in life (60-64 years of age). We hypothesized that risks would be lowered the most among those changing from the heaviest occupations. Methods The study included men employed in the construction industry during 1971-1993. We selected workers from the largest occupational groups in heavy (concrete workers and painters) and less heavy (drivers, electricians and foremen) occupations. The occurrence of DB in 1990-2015 was retrieved from national registers. Regression analyses were used to calculate relative risks (RR) of DB at 60-64 years, comparing those working in other industries to those still in the construction industry at the age of 45, 50 and 55 years. Results Shifting out of from the construction industry was related to lowered DB risks at 60-64 years in all selected occupations. Effects were most pronounced among those who, at 55 years of age, worked in an industry other than construction, with significantly reduced RR for DB among concrete workers [RR 0.63, 95% confidence interval (CI) 0.51-0.77], electricians (RR 0.61, 95% CI 0.47-0.77) and foremen (RR 0.78, 95% 0.63-0.96). Conclusions Risks for DB at 60-64 years of age were reduced among those who changed from construction work to other industries. Notable reductions were observed among workers originating from both heavy and less heavy occupations, and future studies should explore other factors, in addition to heavy workload, as motivators for leaving the construction industry.

Purpose: To compare the lesion sizes of macular neovascularization (MNV) imaged with spectral-domain (SD) and swept-source (SS) optical coherence tomography angiography (OCTA) as well as indocyanine green angiography (ICGA)., Methods: In this prospective, observational case series, patients showing a secured diagnosis of MNV on ICGA or Fluorescein Angiography, were imaged by SD-OCTA and SS-OCTA on the same day. Lesion size was measured on 3 × 3-mm 2 and 6 × 6-mm 2 scans using the Maestro 2 SD-OCTA (Topcon Corporation, Tokyo Japan) and the Triton SS-OCTA device (Topcon Corporation, Tokyo Japan) and compared to ICGA (Spectralis HRA, Heidelberg, Germany)., Results: Twenty eyes from 20 patients (11 females, 55%) were enrolled. The neovascularization area measured on 6 × 6-mm 2 SD-OCTA was lower compared to that outlined on SS-OCTA, however, not reaching statistical significance (p = 0.094). Regarding 3 × 3-mm 2 measurements, the median lesion sizes between the two OCTA devices were comparable (p = 0.492). Indocyanine green angiography depicted a larger lesion area than both OCTA devices, however, not reaching statistical significance., Conclusion: SD-OCTA tends to show smaller areas of MNV extension than SS-OCTA regarding 6 × 6 mm 2 scans. The lesion size of MNV can be very well compared between the different devices, emphasizing the use of OCTA for monitoring neovascular area. Lesion measurements on SS-OCTA correlate better with ICGA than SD-OCTA., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the capability of swept source-optical coherence tomography angiography (SS-OCTA) in the detection and localization of treatment-naive macular neovascularization (MNV) secondary to exudative neovascular age-related macular degeneration (nAMD)., Methods: In this prospective, observational case series, 158 eyes of 142 patients were diagnosed with exudative nAMD using fluorescein (FA) and indocyanine green angiography (ICGA) and evaluated by SS-OCTA in a tertiary retina center (Rudolf Foundation Hospital Vienna, Austria). The main outcome measure was the sensitivity of SS-OCTA compared to the standard multimodal imaging approach. Secondary outcome measure was the anatomic analysis of MNV in relation to the retinal pigment epithelium., Results: En-face SS-OCTA confirmed a MNV in 126 eyes (sensitivity: 79.8%), leaving 32 eyes (20.2%) undetected. In 23 of these 32 eyes (71.9%), abnormal flow in cross-sectional SS-OCTA B-scans was identified, giving an overall SS-OCTA sensitivity of 94.3%. Eyes with a pigment epithelium detachment (PED) ≥ 300  μ m had a smaller probability for correct MNV detection ( p =0.015). Type 1 MNV showed a trend ( p =0.051) towards smaller probability for the correct detection compared to all other subtypes. Other relevant factors for the nondetection of MNV in SS-OCTA were image artifacts present in 3 of 32 eyes (9.4%). SS-OCTA confirmed the anatomic localization of 93 in 126 MNVs as compared to FA (sensitivity: 73.8%). There was no influence of age, gender, pseudophakia, visual acuity, central foveal thickness, or subfoveal choroidal thickness on the detection rate of MNV., Conclusions: SS-OCTA remains inferior to dye-based angiography in the detection rate of exudative nAMD consistent with type 1 MNV and a PED ≥300  µ m. The capability to combine imaging modalities and distinguish the respective MNV subtype improves its diagnostic value., Competing Interests: All authors declare no conflicts of interest related to this submission., (Copyright © 2021 Daniel Ahmed et al.)

This study investigates how the probability to live alone has developed among working age individuals with and without disabilities in Sweden during the period 1993-2011 when extensive political reforms to improve the integration of disabled individuals in society were implemented. The results show that individuals with disabilities are approximately twice as likely to be living alone when compared to individuals without disabilities. People with disabilities were also more likely to report low life satisfaction, and this was especially true among individuals with disabilities living alone. Men and women with disabilities also tend to experience longer periods of living as a one-person household than non-disabled people. Over time we find no indications of reduced differences in family outcomes between disabled and non-disabled individuals but rather evidence to the contrary. These differences are interpreted as being the result of the disadvantage disabled individual's experience in the partner market and that people with disabilities are less successful in forming partnerships that can lead to cohabitation and family formation. The results thus show how disabled individuals still face societal barriers that limit their possibilities to find and sustain relationships that result in stable cohabitation despite increased efforts to improve their inclusion in Swedish society., (© The Author(s) 2020.)

Aims: This study investigated mortality in disability pensions due to common mental disorder, and variation over time after first receiving disability pension. Methods : Objectives were explored in 301,863 construction workers (97.2% men) recruited through healthcare examinations from 1971-1993. By linking with the Swedish National Insurance Agency registers, disability pensions until 2014 were identified. Common mental disorder was defined as disability pension diagnosis due to anxiety, stress-related disorders or moderate depression. Mortality was calculated in all-psychiatric diagnosis and diagnostic sub-groups, and compared to persons without disability pensions, using Poisson regression. Additional analyses were stratified by age at follow-up. Results : In total 6030 subjects received disability pensions based on psychiatric diagnoses, and 2624 constituted common mental disorder. Analyses in an all-psychiatric diagnosis displayed increased mortality risks in men (relative risk 3.6; 95% confidence interval 3.3-3.9) and women (relative risk 2.1; 95% confidence interval 1.6-2.6). Common mental disorder was associated with mortality, especially in men (relative risk 2.5; 95% confidence interval 2.2-2.8). Increased relative risks in alcohol and substance abuse were also observed. Results in analyses stratified by age at follow-up displayed persistent high relative risks for mortality in older ages (75-89 years) in men in all-psychiatric disability pensions diagnosis (relative risk 2.8; 95% confidence interval 2.1-3.7) and common mental disorder diagnosis (relative risk 2.6; 95% confidence interval 1.8-3.6), compared to men without disability pensions. Similar results were found in women, but few cases lowered the precision of estimates. Conclusions : This study shows that disability pension based on common mental disorders, often regarded as a 'lighter' psychiatric diagnosis, is a risk for early mortality in construction workers, even several years after first receiving disability pension.

Purpose: Optical coherence tomography angiography (OCTA) is used to assess vascular abnormality in advanced stage vitelliform macular dystrophy (VMD2)., Methods: Multimodal imaging including spectral domain (SD) OCT, autofluorescence (AF), fluorescein (FA) and indocyanine green angiography (ICGA) as well as optical coherence tomography angiography were performed., Patients: Two eyes in one young patient with diagnosed vitelliform macular dystrophy were investigated for progressive visual dysfunction., Results: Optical coherence tomography angiography identified neovascular formation within the outer retina and the choriocapillaris respectively while all other imaging methods were inconclusive., Conclusion: Optical coherence tomography angiography was superior to conventional angiography in the detection of choroidal neovascularization (CNV) in advanced retinal disorders like vitelliform macular dystrophy.

Diabetic maculopathy (DM) is a microvascular dysfunction clinically characterized by microaneurysms (MA) leading to edema and central visual deprivation. This prospective explorative study investigated 27 eyes of 17 patients with DM by fluorescein/indocyanine green angiography (FA/ICGA; SPECTRALIS HRA-OCT, Heidelberg Engineering) and by swept source-optical coherence tomography angiography (SS-OCTA; DRI-OCT Triton Plus, Topcon) to identify clinically relevant MAs. The SS-OCTA cubes were split into the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) according to the automated segmentation. The images of all modalities were superimposed for alignment by an Early Treatment Diabetic Retinopathy Study grid overlay and compared to each other. In total, the mean number of MAs in FA was 33.4 ± 22 (standard deviation) (median 27.5 [q1:21.75;q3:38.25]), in ICGA 24.9 ± 16.9 (17.5 [14;35]), in the SCP 6.5 ± 3.7 (5.5 [3.75;9.25]) and in the DCP 18.1 ± 10.5 (18.5 [10.75;23.5]). Mixed effects models between ICGA and the DCP were borderline significant (p = 0.048; 95% confidence interval 0.21 to 13.49), whereas all other imaging methods differed significantly. Quantitative analysis of MAs in DM showed a plausible agreement between ICGA and the DCP in SS-OCTA. These findings contribute to the imaging methodology in DM.

Background: Type 2 macular neovascularization (MNV) is supposed to be a rare condition in age-related macular degeneration (AMD). The main purpose of this study was to assess accompanying factors of type 2 MNV in AMD., Methods: Retrospective data analysis of eyes previously diagnosed with neovascular AMD in a tertiary eye care center (Medical Retina Unit, Rudolf Foundation Hospital, Vienna, Austria) between June 2008 and December 2017. Drusen subtypes, fibrosis, atrophy and subfoveal choroidal thickness (SFCT) of both eyes in patients with type 2 MNV lesions were categorized based on multimodal imaging., Results: Type 2 MNV was diagnosed in 27 (3.2%) of 835 eyes (749 patients). Drusen characteristics in type 2 MNV were observed as followed: drusen < 63 μm in 2 eyes (7.4%), drusen ≥63 μm in 10 eyes (37%), subretinal drusenoid deposits (SDD) in 8 eyes (29.6%), cuticular drusen in 2 eye (7.4%) and no drusen were evident in 10 eyes (37%). Drusen distribution in 23 fellow eyes was detected as followed: drusen < 63 μm in 2 eyes (8.7%), drusen ≥63 μm in 9 eyes (39.1%), SDD in 5 eyes (21.7%), cuticular drusen in 1 eye (4.3%) and no drusen were evident in 9 eyes (39.1%). Mean SFCT was 140 ± 49 μm in affected eyes and 152 ± 41 μm in the fellow eyes. Patients with drusen or SDD were significantly younger (mean 70.88 ± 6.85, p = 0.04) than patients without deposits (mean 77.40 ± 5.74)., Conclusions: Type 2 MNV remains a rare entity in AMD. It was frequently seen in the absence of drusen, a hallmark of AMD. These findings contribute to the heterogeneity of phenotypes related to pure type 2 lesions.

Aims: Study objectives were to investigate how changes in social insurance legislation influenced the incidence of disability pension. Methods: The study included 295,636 male construction workers who attended health examinations between 1971 and 1993, aged 20-60 years and without previous disability pension. Via the Swedish National Insurance Agency national register we identified 66,046 subjects who were granted disability pension up until 2010. The incidence rates were calculated and stratified according to age and diagnosis. Results: The incidence rate of disability pension was fairly stable until the 1990s when large variations occurred, followed by a strong decreasing trend from the early 2000s to 2010. Trends in incidence rates, stratified by age and diagnosis, showed a consistent decrease in cardiovascular disease for all age groups. In subjects aged 30-49 years there was a high peak around 2003 for musculoskeletal diseases and psychiatric diseases. For the age group 50-59 years, musculoskeletal diagnosis, the most common cause of disability pension, had a sharp peak around 1993 and then a decreasing trend. In the 60-64 age group, the incidence rate for psychiatric diagnosis was stable, while incidence rates for musculoskeletal diagnosis varied during the 1990s. Conclusions : There are considerable variations in the incidence rate of disability pension over time, with different patterns depending on age and diagnosis. Changes in social insurance legislation, as well as in administration processes, seem to influence the variation .

Purpose: To evaluate normalized short-wavelength fundus autofluorescence (SW-FAF) imaging changes over time as a predictive parameter for the retinal pigment epithelium (RPE) function in eyes compromised by acute central serous chorioretinopathy (CSCR) after indocyanine green angiography-guided verteporfin (Visudyne®, Novartis Pharma, Basel, Switzerland) photodynamic therapy (PDT) with a half-fluence rate (25 J/cm 2 )., Methods: Quantitative data of SW-FAF grey values (SW-FAF GV) from a 350  μ m (SW-350) and 1200  μ m (SW-350) and 1200  t -test was calculated to explore the differences of SW-350 and SW-1200 between one month and the long-term follow-up., Results: Mean differences (95% CI) in SW-FAF GV between 1 month and 7 years after half-fluence PDT were 0.07 ± 0.11 for SW-350 ([95% CI: -0.002; 0.14], p =0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p =0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p =0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p =0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21]., Conclusion: After 7 years, normalized SW-FAF GV were significantly lower in eyes with resolved acute CSCR treated with reduced-fluence PDT compared to the follow-up after 1 month without correlation to explicit pattern changes or structural damages. Half-fluence PDT remains a safe and considerable treatment option in acute CSCR., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Martin Stattin et al.)

Purpose: To evaluate 7-year visual and anatomical outcomes of intravitreal injections (IVI) with antivascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD) based on a personalized pro re nata (PRN) regimen., Methods: Anonymized data of 124 consecutive eyes in 121 patients with treatment-naïve nAMD were initially collected in 2010. Of those, 45 received anti-VEGF IVI at least every 6months until 2017 in one single center in Austria and hence were retrospectively analyzed. All eyes had been initiated on a loading dose of 3 monthly IVI with different anti-VEGF agents followed by a PRN regimen in the first year. At year 2, monitoring as well as therapeutic intervention could be prolonged every 2weeks up to intervals of 3months without capping treatment. Primary outcome measure was the change of visual acuity (VA) assessed by Early Treatment Diabetic Retinopathy Study charts at 4 meters (ETDRS) in letters-counting every correctly read letter-and converted to Snellen. Secondary outcome measures were number of injections and change of central retinal thickness (CMT) from baseline., Results: Mean baseline VA was 20/63 + 1 (0.63 ± 0.26 ETDRS) and declined to 20/100 + 2 (0.45 ± 0.33) with an overall loss of 9 letters ETDRS after 7years ( p  = 0.001). An average of 3.5 ± 1.9 IVI was given per year and eye. Mean CMT at baseline was 322 ± 95  μ m, decreased by 52  μ m, decreased by 52  μ m, decreased by 52  μ m, decreased by 52  μ m to 270 ± 70  μ m within the first year, and remained below baseline at year 7 (271 ± 106  μ m; p  = 0.001). An average of 3.5 ± 1.9 IVI was given per year and eye. Mean CMT at baseline was 322 ± 95  μ m, decreased by 52  μ m to 270 ± 70  μ m within the first year, and remained below baseline at year 7 (271 ± 106  μ m; p < 0.001)., Conclusions: Our data confirm an absolute vision loss in eyes compromised by nAMD after 7 years of continuous VEGF inhibition. The visual decline was significantly related to baseline VA as well as the number of injections. We suggest following patients thoroughly independent of the initial VA and a greater incentive for the physician to treat., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2020 Martin Stattin et al.)

Purpose: To assess the relationship between signs of activity in exudative neovascular age-related macular degeneration (nAMD) following anti-vascular endothelial growth factor (anti-VEGF) treatment and morphology of choroidal neovascularization (CNV) based on neovascular density as imaged using swept source-optical coherence tomography angiography (SS-OCTA) in a qualitative manner., Methods: A single-cohort retrospective data analysis from one tertiary eye care center. Seventy-seven eyes of 72 patients were included and their charts reviewed which had been started on intravitreal injections with anti-VEGF for nAMD at least one year prior to enrollment. Clinically active disease was evaluated by slit-lamp fundus examination and spectral domain-OCT B-scans. Morphological appearance in SS-OCTA was characterized based on 5 different criteria and subsequently divided into 3 groups: predominantly hyperdense, minimally hyperdense, and hypodense lesions., Results: Fifty-eight eyes (75%) were considered clinically active and 19 eyes (25%) clinically inactive. CNV was depicted in 71 eyes (92%) by SS-OCTA and separated accordingly into predominantly hyperdense (32%), minimally hyperdense (34%), and hypodense lesions (34%). A borderline significant difference in the probability of neovascular activity for predominantly hyperdense lesions compared to hypodense lesions was detected ( p =0.05)., Conclusions: Hyperdense choroidal neovascularization based on qualitative assessment of flow density showed a significant relation to active disease. Inactivity could not be matched adequately. This study demonstrated the potential usefulness of SS-OCTA for guidance of treatment in age-related macular degeneration.

Purpose: To present a patient with stellate nonhereditary idiopathic foveomacular retinoschisis on one eye and peripheral retinoschisis without foveal affection on the other eye., Methods: A case report with complete workup of family history and clinical examination, including multimodal imaging with optical coherence tomography and angiography, fluorescein angiography, and infrared fundus imaging. Genetic testing for gene mutation XRLS1 was performed., Results: A white woman with unremarkable medical history presented with stellate foveal splitting of the outer plexiform layer on the right eye and peripheral splitting of the outer plexiform layer on both eyes. All known allegeable trigger factors for the existence of a hereditary or acquired foveomacular retinoschisis were ruled out either by clinical presentation or genetic testing. This led to the diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis with central involvement only present on one eye., Conclusion: Although peripheral schisis of the outer plexiform layer is often concomitant with central splitting in X-linked juvenile retinoschisis, this is the first known report of nonhereditary cleavage of the outer plexiform layer of the peripheral retina without central affection in a patient with documented stellate nonhereditary idiopathic foveomacular retinoschisis on the other eye. These findings suggest an accurate bilateral examination of the peripheral retina while confirming the diagnose of stellate nonhereditary idiopathic foveomacular retinoschisis.

Purpose: To compare the detection rate of choroidal neovascularization (CNV) in treatment-naive neovascular age-related macular degeneration by swept source optical coherence tomography angiography (SS-OCTA, Topcon's DRI Triton) working at 1,050 nm wavelength versus fluorescence angiography., Methods: Cross-sectional analysis of 156 eyes (107 neovascular age-related macular degeneration and 49 dry AMD) in 98 patients, previously diagnosed by multimodal imaging using fluorescein (FA) and indocyanine green angiography (Heidelberg's Spectralis) in a tertiary retina center, evaluated by SS-OCTA 4.5 mm × 4.5 mm and 6 mm × 6 mm macular cubes. Main outcome measures were sensitivity and specificity of SS-OCTA in AMD. Potential factors influencing CNV detection rate were analyzed., Results: Swept source optical coherence tomography angiography detected CNV in 81 of 107 eyes, resulting in a sensitivity of 75.7%. In 49 eyes with dry AMD, no CNV could be identified (specificity 100%). A statistical significance was calculated for nondetection of treatment-naive CNV by SS-OCTA in pigment epithelial detachment over 400 μm (P = 0.0238)., Conclusion: Topcon's SS-OCTA was not able to detect all CNV lesions. Large pigment epithelial detachments were associated with signal loss. Fluorescence angiography still remains the gold standard, but the tested SS-OCTA device can be considered as a feasible additional diagnostic tool in AMD.

This case illustrates that hematologic disorders must be considered as a potentially life-threatening cause for vision loss. Proper laboratory workup and timely interdisciplinary approach are essential to ensure the best possible care for ophthalmic patients. Historically, before the use of bone marrow biopsy, the ophthalmologist was often asked to assist in the diagnosis of leukemia. Since ophthalmological symptoms may be the initial presenting signs of leukemia as highlighted in this case, the ophthalmogist is still of crucial importance.

Purpose: Placental growth factor (PlGF) has been implicated as a contributor to resistance against anti-VEGF therapy. The purpose of the present study was to analyze the systemic levels of PlGF, VEGF-A, and VEGF-B in patients with neovascular age-related macular degeneration (AMD) after treatment with aflibercept, ranibizumab, or bevacizumab., Methods: Totals of 19 patients were treated with intravitreal aflibercept, 19 with ranibizumab, and 18 with bevacizumab. The cytokine levels were measured by ELISA just before the injection, and 7 days and 1 month thereafter. Age- and sex-matched participants (n = 22) served as controls., Results: The median PlGF plasma concentration at baseline was <12.0 pg/mL in the control group as well as in all three anti-VEGF treatment cohorts. After intravitreal aflibercept injection, a significant upregulation of systemic PlGF could be observed in all treated patients (38.0 [31.0-44.0] pg/mL after 1 week [P < 0.001] and 16.0 [0.0-19.0] pg/mL [P = 0.005] after 4 weeks). No significant effects on plasma PlGF concentrations could be detected in those treated with ranibizumab and bevacizumab. The systemic VEGF-A levels were significantly reduced 1 and 4 weeks after intravitreal aflibercept (P < 0.001, P < 0.001) and bevacizumab (P < 0.001, P < 0.01) injections. No significant effects on plasma cytokine concentrations could be observed in the ranibizumab cohort. No significant effects on systemic VEGF-B could be observed in any of the treatment groups., Conclusions: In this study, we report a significant systemic upregulation of the proangiogenic cytokine PlGF after intravitreal administration of aflibercept. This might represent a counter-regulatory response to antiangiogenic therapy.

Objectives: The objective of this study was to investigate the occurrence of disability pensions over time among workers with physically demanding jobs., Methods: The occurrence of disability pension was prospectively studied between 1980-2008 among 325 549 Swedish construction workers. The risks for disability pension and years lost of working life were compared among 22 occupational groups, adjusting for age, body mass index, height, and smoking habits., Results: The risk varied considerably among blue-collar workers. For example, rock workers had double the risk of disability pension [relative risk (RR) 2.16, 95% confidence interval (95% CI) 1.96-2.39] compared to electricians. Most working years lost due to disability pensions (about 75%) were found among men >50 years, mainly due to musculoskeletal and cardiovascular diseases. The years of working life lost due to disability pension varied from 0.7 (salaried employees) to 3.2 years (rock workers) among occupational groups., Conclusion: Work environment is an important predictor for disability pension among construction workers with those in physically heavy jobs having the highest burden of disability. If the purpose is to increase labor force participation for workers with heavy jobs, strategies to reduce physical demands at work among elderly workers are important.