Moorfields Eye Hospital

Diabetic macular oedema (DMO) is a leading cause of visual impairment globally. The COVID-19 pandemic significantly disrupted routine clinical care, including regular intravitreal therapy (IVT) for DMO. This study analysed real-world data from patients whose treatments were deferred due to the pandemic 18 months post-disruption. Patients scheduled for initiation or continuation of aflibercept IVT for DMO at a single centre during the March 2020 lockdown were identified and recruited. Clinical data were collected from January 2019 until September 2021. The primary outcome was best corrected visual acuity (BCVA) at the final visit and its predictive factors. A total of 416 eyes from 416 patients were included (random eye/patient). The mean interval between injections increased significantly during the pandemic, with worsening of mean logMAR BCVA [55 days in 2019 (range 25-302), BCVA 0.36; 86 days in 2020 (range 21-681), BCVA 0.41; and 84 days in 2021 (range 24-885), BCVA 0.45]. However, there was no significant difference when comparing mean BCVA at baseline (0.42 ± 0.3) and final visit (0.41 ± 0.3). Significant predictors of final BCVA included baseline BCVA (0.059 logMAR increase per 0.1 logMAR baseline increase, p < 0.001), follow-up duration (0.038 logMAR increase per additional 6 months, p < 0.001), age at baseline (0.037 logMAR increase per decade, p = 0.001), and ethnicity (White ethnicity had 0.061 logMAR better BCVA compared to non-White groups, p = 0.04). Extended intervals between aflibercept injections during COVID-19 did not independently predict worse visual outcomes. Baseline BCVA, age, and ethnicity were significant predictive factors.

Patient-reported pain during intravitreal injection (IVI) may vary by injection quadrant and influence adherence to repeated treatments. Hence, this study aimed to quantify whether patient-reported pain differs by IVI quadrant and identify the least-painful approach. We searched 13 literature databases on 15 October 2025 for clinical studies reporting patient-reported IVI pain stratified by injection quadrant (superotemporal [ST], superonasal [SN], inferotemporal [IT], inferonasal [IN]). Random-effects meta-analyses synthesized mean differences (MD) in 0-10 visual analogue scale (VAS) pain across all six pairwise quadrant contrasts. All eligible studies were included for a qualitative review and a meta-analysis. The review was prospectively registered (PROSPERO CRD420251164189). Seven studies comprising 2048 IVI were included (ST 611, SN 469, IT 556, IN 412). Most injections involved anti-VEGF agents. All injections were performed under topical anesthesia (100%; drops or gel), with no subconjunctival anesthesia reported (0%), and pain was recorded immediately post-procedure using VAS-derived scales. Across all six pairwise contrasts, pooled mean differences between quadrants were small (typically < 1 VAS unit on a 0-10 scale), and all 95% confidence intervals crossed zero. Across quadrant comparisons, pooled pain differences were small and inconsistent; none of the pairwise pooled estimates demonstrated a statistically consistent difference, and between-study heterogeneity was substantial to considerable (I2 generally > 80%). Current evidence does not demonstrate a clearly less painful quadrant for intravitreal injections. Estimates varied across studies and heterogeneity was substantial, limiting confidence in any single average quadrant effect. Efforts to minimize IVI-related pain should prioritize optimized anesthesia protocols, communication, and injection technique, while future studies should standardize pain measurement and quadrant allocation to clarify whether subtle quadrant effects exist. PROSPERO registration:CRD420251164189.

[This corrects the article DOI: 10.3389/fmed.2026.1763735.].

Assessment and management of dry eye disease (DED) in the UK is increasingly taking place outside of specialist ophthalmology settings. While comprehensive, evidence-based international guidance exists, much of it does not reflect the realities of practice in the UK. A panel of experts was brought together to identify areas of consensus on assessment, management, and appropriate referral of DED in the UK National Health Service (NHS). A questionnaire was circulated to a panel consisting of 15 optometrists, ophthalmologists, and corneal specialists with experience and expertise in DED. Based on their responses, consensus statements were developed and underwent two rounds of voting, in which respondents indicated to what extent they agreed with each statement. A core steering panel of seven experts discussed the results and provided further context for the statements. Strong or very strong consensus was reached for 57/62 statements. Statements with very strong consensus included guidance on the minimum symptoms and signs to be assessed on initial presentation and simple guidance for grading the severity of the disease. Statements regarding initial treatment were divided by setting (primary and secondary care), and a strong or very strong consensus was reached on 17/20 statements relating to treatment options in these settings. Statements specific to referral included approximate target timelines, where possible, as well as guidance on key supporting information to help improve the efficiency of patient care. This consensus provides a UK-focused resource to support consistent and effective care for patients with DED within the NHS.

To describe the clinical findings and report the incidence of patients developing non-infectious intraocular inflammation (IOI) following intravitreal faricimab injections (IVFs). A retrospective review of electronic medical records was conducted for patients receiving faricimab intravitreal injections for neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO) at Moorfields Eye Hospital, London, United Kingdom, over a 24-month period. 3985 eyes from 3151 patients were included and underwent a total of 28,535 IVFs (20,982 for nAMD, 7553 for DMO). 57 eyes from 46 patients presented at least one episode of IOI. The 2-year estimated incidence of IOI was 0.20% [95% CI 0.15-0.26] per injection, 1.43% [95% CI 1.08-1.85] per eye and 1.46% [95% CI 1.07-1.94] per patient. Mean visual acuity (VA) was significantly different between the day of IVF (0.48 ± 0.43 logMAR, range: 0-1.8) and the day of IOI diagnosis (0.67 ± 0.52, range: 0-2.3) (p < 0.001). VA after IOI resolution showed no significant difference from baseline (p > 0.99). Intravitreal injections were resumed in 42 eyes. IVFs re-challenge was attempted in 9 eyes, with 5 developing another episode of IOI. This study describes one of the largest reported cohorts of IOI cases following faricimab treatment. It confirms that the incidence of IOI is rare and aligns with the rates of IVF-related adverse effects reported in clinical trials and in recent real-world studies. Overall, faricimab demonstrated a favourable safety profile with good prognosis in cases of IOI.

To assess patterns and institutional variability of anti-angiogenic treatment discontinuation in neovascular age-related macular degeneration (nAMD) within Switzerland, and to examine the association of digital home monitoring with treatment persistence. Retrospective observational analysis combined nationwide health insurance claims data (Helsana, n = 4840) and clinical data from a major tertiary centre (LUKS, n = 1932; nAMD subset n = 1387). Discontinuation was defined as no further injections for 31-365 days after the last intravitreal injection (IVI) and classified as supervised ( ≥ 1 follow-up visit in this period) or unsupervised (no follow-up visits in this period). Variability was evaluated among the 20 largest providers and across seven regions. Digital home monitoring's impact on non-persistence was assessed in the clinical cohort. Substantial heterogeneity was observed. Supervised discontinuation ranged from 20.7 to 45.7% (pooled proportion 32.0%, 95% confidence interval [CI] 30.2-33.9%) and unsupervised from 10.9 to 25.7% (pooled proportion 18.2%, 95%CI 16.8-19.8%) across centres. In the LUKS cohort, 1-year persistence was 93.7%, dropping to 72.7% by year 4, with unsupervised discontinuation rising from 3.0 to 12.5%. In 100 patients using voluntary digital home monitoring non-persistence was less likely (adjusted OR 0.59, 95%CI 0.35-0.98); among those who discontinued, home-monitoring users were more likely to remain under supervision (74% vs 54%). Treatment discontinuation in nAMD is frequent and demonstrates striking institutional and regional variability. The heterogeneity in discontinuation patterns suggests that treatment persistence may be modifiable through targeted, systematic, and patient-centred interventions. Digital home monitoring may be a promising strategy to support engagement and reduce non-persistence.

Glaucoma is a leading cause of blindness worldwide, with the greatest burden in low- and middle-income countries (LMICs) where access to diagnostic services is limited. Portable devices, which are simple to use and comparable to standard tests, may strengthen early detection and referral. This study evaluated selected portable glaucoma assessment devices against standard reference tools in Nigeria and identified which tests or combinations most closely matched a glaucoma diagnosis. In this cross-sectional study at the University of Abuja Teaching Hospital, 312 participants (524 eyes) underwent both portable and conventional testing: Peek CS vs. Pelli-Robson (contrast sensitivity), Peek Acuity vs. LogMAR (visual acuity), iCare vs. Goldmann Applanation Tonometry (GAT) (intraocular pressure), Eyecatcher vs. Humphrey Field Analyzer (visual fields), and Remedio handheld fundus camera vs. slit lamp (optic discs). Agreement, diagnostic accuracy (AUC), completion rates, and patient preference were assessed. Strong correlations were observed between iCare and GAT IOP (r = 0.96), Peek and LogMAR acuity (r = 0.82), and Remedio handheld fundus camera and slit lamp CDR (r = 0.82). The Remedio handheld fundus camera achieved the highest diagnostic accuracy (AUC = 0.91; sensitivity 82.4%, specificity 99.8%). Combining Remedio with Eyecatcher MD (AUC = 0.86) or iCare IOP (AUC = 0.83) also performed well. Portable devices were faster, had higher completion rates, and were strongly preferred by participants, particularly iCare and Eyecatcher. Portable devices showed good agreement with standard tools and high acceptability, supporting their potential role in glaucoma screening in resource-limited settings. Further community-based validation is recommended.