PurposeTo evaluate the effect of artificial tear (AT) application on the repeatability of corneal parameters with three different devices.MethodsIn this prospective, randomized clinical trial, 145 patients were measured with one of three devices in the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Two baseline measurements and four measurements following AT application after 30 s, 2, 5 and 10 min were performed.ResultsForty‐eight eyes were measured with the IOLMaster 700 (Carl Zeiss Meditec AG, Oberkochen, Germany) and Galilei G6 (Ziemer, Port, Switzerland), and 49 with the Pentacam AXL (Oculus, Wetzlar, Germany) (145 total). Repeatability of the mean corneal power (Km) between baseline measurements was high (0.049 ± 0.008 D for IOLMaster, 0.061 ± 0.011 for the Pentacam AXL and 0.065 ± 0.009 for Galilei G6) but significantly variable after 30 s and 2 min for IOLMaster 700 (0.177 ± 0.021 D, p < 0.001 and 0.079 ± 0.009, p = 0.004) and Galilei G6 (0.163 ± 0.020 D, p < 0.001 and 0.119 ± 0.014 D, p = 0.003). Km differed significantly from baseline at 30 s, 2 and 5 min with Pentacam AXL (0.215 ± 0.041 D, p < 0.001; 0.157 ± 0.025 D, p < 0.001 and 0.094 ± 0.012 D, p = 0.007). Variability was highest at 30 s and decreased over time.ConclusionThe use of AT leads to high variability of keratometric measurements for each device. This should be considered after use, and at least 5 min should elapse before measurements.

This meta‐analysis investigates the effectiveness of outdoor activities in reducing the onset of myopia in children and adolescents by analysing changes in axial elongation and spherical equivalent refractive error. Following PRISMA guidelines and registered in PROSPERO (CRD42024592971), the study included randomized controlled trials (RCTs) and observational studies. The eligibility criteria targeted children and adolescents aged 6 to 18 years with varying levels of outdoor exposure. Primary outcomes were axial elongation and spherical equivalent change. Studies were assessed for quality using GRADE and AMSTAR‐2 tools, and data were analysed using Review Manager 5.4, with random‐effects models applied when heterogeneity was significant. Fifteen studies (9 RCTs and 6 observational) were included, with a total of 16 597 participants. Outdoor activities significantly reduced or delayed the onset of myopia, with a mean axial length difference of −0.08 mm per year (95% CI: −0.09 to −0.07) and a spherical equivalent difference of 0.16 diopters per year (95% CI: 0.07 to 0.25). These differences were observed after 1 year of intervention and sustained for up to 3 years, with daily outdoor exposure ranging from 40 to 120 min. Heterogeneity was moderate to high, but sensitivity analyses confirmed the robustness of the results. While higher outdoor exposure appeared more effective in reducing myopia progression, the certainty of this evidence was rated as low due to suspected publication bias, as indicated by the GRADE analysis. Outdoor activities, especially with prolonged exposure to intense light, effectively reduce or delay the onset of myopia in children and adolescents. This study emphasizes the importance of light intensity in maximizing the benefits of outdoor interventions and highlights regional differences in effectiveness, suggesting that environmental factors play a significant role in the outcomes.

PurposeThe purpose of this study was to create a prototype master protocol for benchmarking glaucoma real‐world data (RWD). Benchmarking is part of the digital innovation strategy of the Finnish aces‐rwm ecosystem (automation of care and evaluation of the system with real‐world monitoring).MethodsWe collected glaucoma RWD in 2012–17 at Tampere University Hospital (Tays) and compared them to six published RWD sets (one in Sweden and five in England). Visual field (VF) data at Tays were retrieved from the perimeter, and clinical RWD were collected manually. At baseline, VF data were available in 2511 of 4121 glaucoma patients (61%), of whom 1413 patients (56%) had 5 years of VF follow‐up by 2017 (34% of all 4121 patients). Mean deviation (MD) data were analysed in multiple ways, considering also age and intraocular pressure (IOP).ResultsIn most data sets, higher age was related to faster progression. At Tays, the distributions of progression rates were similar in better and worse eyes. The proportions of eyes at Tays with the medium rate of MD progression (17% for 0.5–1.5 dB/year) and the fast rate (6% for >1.5 dB/year) were similar to the published RWD trial in England. The published datasets show significant variability in how their findings were reported.ConclusionsThis study represents a first step toward the development of a master protocol for real‐world benchmarking of glaucoma care. Further refinement of the protocol will encourage and require national and international collaboration in order to produce comprehensive and comparable real‐world EHR data sets.

Pregnancy induces a variety of changes in the eye. Mapping these changes provides a pathophysiological basis for understanding pregnancy-associated ocular disorders. In this systematic review and meta-analysis, our aim was to determine how pregnancy affects subfoveal choroidal thickness and to explore temporal changes in subfoveal choroidal thickness during pregnancy and postpartum. On April 7, 2024, we searched eight literature databases for studies which used macular optical coherence tomography to evaluate subfoveal choroidal thickness in healthy pregnant women. We identified 26 studies summarizing data from 1935 healthy women, of which 1096 were pregnant and 839 non-pregnant. We found that pregnant women had a subfoveal choroidal thickness which was 31.1 μm (95% CI: 19.4-42.7 μm) thicker than non-pregnant women. No statistically significant changes were observed throughout trimesters. From the 3rd trimester to postpartum, we found a reduction in the subfoveal choroidal thickness at -41.9 μm (95% CI: -68.5 to -15.2 μm). In conclusion, in healthy women without ocular disease, pregnancy is associated with a thicker subfoveal choroid indicating a higher choroidal perfusion. Choroidal thickness remains stable across trimesters and is reduced postpartum, indicating a temporary physiological adaptation during pregnancy.

To examine what direct and indirect societal costs are associated with decreased visual acuity (VA). Nationally representative sample of 8028 Finnish adults aged 30 years or older with survey data and clinical examination including VA assessment was evaluated. These data were linked with multiple national registers to capture health care services utilization during 1999-2013. All direct and indirect costs were calculated using prevalence-based bottom-up approach and adjusted for age, sex, and comorbidities with generalized linear models. The results in 2019 cost level are presented according to VA groups at baseline per person, and with population estimates. Total direct health care costs ranged from 1996 €/year/person for those with VA ≥1.0 to 3277 €/year/person for those with weak (0.32-0.5) VA. The increase in direct costs was notable even before the onset of visual impairment. Indirect costs showed monotonously increasing trend with decreasing VA. At the population level, the additional annual direct costs associated with decreased VA were estimated at 1.9 billion €. Only 2% or less of the additional costs are due to increased direct eye-related secondary health care usage. Estimated additional annual national indirect costs were 1.2 billion €. In addition to those with visual impairment or blindness, health care need, and societal costs are elevated even among those with adequate VA. We conclude, that focusing on prevention of VA decrease would not only help sustain the patients' quality of life but could also reduce the future societal costs.

Proliferative diabetic retinopathy (PDR) poses as a significant threat to patient's vision if untreated or treated insufficiently. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. The advent of anti‐VEGF therapy provided an additional option for the management of this condition. The aim of the presentation is to present the effects of anti VEGF treatment in PDR with special emphasis on the combination: PRP with anti‐VEGF therapy. Results of treatment with these modalities, especially regression of neovascularization, together with the incidence of potential complications will be discussed. Additional aspects of such therapy, such as BCVA improvement and central retinal thickness reduction will also be presented. Potential indications for such treatment will be outlined as well as possible treatment schedules for such management.

Aims/Purpose: The purpose of this case study is to describe the diagnostic process, surgical treatment, and subsequent recovery in a patient who was being monitored for strabismus due to previous thyroid orbitopathy. This case aims to underscore the importance of early diagnosis and timely surgical intervention in the resolution of visual impairments associated with pituitary adenomas.Methods: A 53‐year‐old female, under follow‐up for strabismus due to previous thyroid orbitopathy, was noted to have limitations in certain eye movements and diplopia during a routine consultation. Suspecting an exacerbation of orbitopathy, a computed tomography (CT) scan was ordered. The CT revealed a sellar and suprasellar mass, an incidentaloma not seen in a CT performed five years earlier. Visual field testing was then conducted, revealing bitemporal hemianopia. Further evaluation with magnetic resonance imaging (MRI) was performed to better characterize the lesion. The patient was subsequently scheduled for transsphenoidal surgery to excise the tumor.Results: The patient underwent successful transsphenoidal resection of the pituitary adenoma. Postoperative assessments, including regular visual field testing and MRI scans, indicated a gradual but complete restoration of the visual fields over a three‐month period. Follow‐up showed no recurrence of the tumor, and the patient remained free of visual symptoms.Conclusions: This case illustrates that bitemporal hemianopia caused by pituitary adenomas can be effectively reversed through surgical intervention. Early identification and prompt surgical treatment are essential to prevent permanent visual deficits and ensure full recovery of visual function. This case also highlights the importance of a multidisciplinary approach in the management of complex neuro‐ophthalmological conditions.

Aims/Purpose: The aim of this study is to evaluate different approaches to investigate early alterations in tear biomolecular profiles induced by contact lens (CL) wear. This includes assessing the impact of CL wear on tear volume, osmolarity, and biomolecular composition using Raman spectroscopy.Methods: Two participants of the same sex (male), age (23 years), and with a similar lifestyle wore different CLs for two hours. Ocular analysis was performed at three time points: before CL insertion, immediately after CL removal, and two hours post‐removal. The analyses included tear meniscus height and osmolarity measurements. Tear samples were collected at each time point and analyzed using Raman spectroscopy.Results: Tear volume and osmolarity remained unchanged throughout the study. Raman spectroscopy highlighted notable changes in the biomolecular profile of tears after CL wear, particularly in the 2700‐3200 cm‐¹ spectral window.Conclusions: Among the analyses performed, only Raman spectroscopy revealed significant changes. It highlighted alterations in the biomolecular profile of tears post‐CL wear, particularly in the 2700‐3200 cm‐¹ spectral window associated with C‐H stretching. The ability of Raman spectroscopy to detect these subtle, subclinical changes underscores its value as a non‐invasive tool for analyzing individual responses to CLs. Notably, Raman spectroscopy captures molecular‐level alterations, which form the basis of changes in the physical and functional properties of the tear film, including those measured by tear meniscus height and osmolarity. These changes become detectable by traditional techniques only in a late stage, while molecular‐level alterations can be detected earlier, providing an opportunity for proactive intervention and management.

Aims/Purpose: In response to the global shortage of corneas, alternatives such as cell injection therapy and tissue‐engineered endothelial keratoplasty (TEEK) have emerged, both relying on the mass production of primary cultured corneal endothelial cells (CECs). Cryopreservation of corneas (the primary cell culture source), cultured CECs (in vitro), and TEEK grafts (final products) is crucial to facilitate their industrialization and clinical application. While corneal cryopreservation has long been a challenge, advancements in cryoprotectants warrant a renewed investigation. This study aims to assess various cryopreservation methods for CECs n the three different states.Methods: Ten cryopreservation media and varying cooling rates (‐2°C/min, ‐1°C/min, or ‐0.5°C/min) were first tested on cultured CECs. After thawing, cell survival rates were assessed using Trypan blue staining and an automated cell counter. Subsequently, the best conditions identified for cultured CECs were applied to native CECs adhered to their Descemet's membrane and CECs on TEEKs. Post‐thawing viability was assessed using triple labeling with Hoechst, Ethidium, and Calcein‐AM (Pipparelli et al. IOVS 2011).Results: A gradual cooling rate of ‐1°C per minute and the cryopreservation medium CryoStor CS10 provided the best conditions for in vitro CECs, ensuring an average viability of 91±1% post‐cryopreservation. However, applying the same conditions to native CECs on corneas or CECs on TEEK grafts resulted in a viability of less than 80%. Upon thawing, CECs tended to detach easily from the DM or bio‐engineered grafts, leading to significant areas without cells.Conclusions: Cryopreservation is effective for in vitro cultured CECs but remains very challenging for CECs attached to the DM or TEEKs. The next step will be to address cell attachment issues during cryopreservation.