ObjectivesThis retrospective cohort study aimed to assess the long-term growth and associated risk factors of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) compounds.MethodsTwo hundred and six patients initiating anti-VEGF therapy were followed for 8 years using a treat-and-extend protocol. The study analysed correlations between MA growth (by square root transformation measured in infrared images) and clinical parameters, and genetic variants for AMD in the complement and lipid pathways and the ARMS2 gene.ResultsSeventy-six patients (n = 92 eyes) were included, with a mean age of 73.9 ± 7.9 years. Eyes received an average of 7.1 ± 3.2 anti-VEGF injections per year. The prevalence of MA increased from 28.3% at baseline to 78.3% at 8 years, exhibiting an average annual growth rate of 0.25 ± 0.22 mm. Correlations were found between MA growth and size, and number of atrophic foci at baseline, and the common ARMS2 variant. Eyes with subretinal fluid (SRF) at baseline showed less foveal atrophy at 8 years compared to those with IRF or both IRF and SRF. No correlation was observed between MA growth and genetic variants in the complement and lipid pathways.ConclusionMost eyes with nAMD under 8 years of anti-VEGF therapy developed MA, with significant growth. Correlations with baseline MA characteristics and the ARMS2 variant were identified. Further investigation is needed to understand the potential role of complement as a therapeutic target for preventing macular atrophy in nAMD-affected eyes.

PurposeTo investigate the impact of central serous chorioretinopathy on sleep and mood in patients with acute and chronic central serous chorioretinopathy.MethodsThis cross-sectional study compared sleep and mood differences between central serous chorioretinopathy and control patients recruited from Ophthalmology clinics at the John Radcliffe Hospital, Oxford between 2012 and 2020. Data including visual acuity, type of central serous chorioretinopathy (acute or chronic; aCSC/cCSC), sex, and chronotype were obtained. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI); the Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety (HADS-A) and depression (HADS-D).ResultsA total of 247 age matched controls and 109 patients with central serous chorioretinopathy participated. There were no significant differences in PSQI or HADs (P > 0.05) between the two groups. Females exhibited significantly higher PSQI scores than males both for control and central serous chorioretinopathy groups (P < 0.05). Within the central serous chorioretinopathy group, 88 (81%) had chronic central serous chorioretinopathy and 21 (19%) had acute central serous chorioretinopathy, and an increase in daytime dysfunction was seen in the acute phenotype compared to chronic (P = 0.018).ConclusionIn our study, no significant differences in sleep quality or mood scores were identified in central serous chorioretinopathy patients, when compared to controls. Worsened sleep for females was present when compared to males, both in central serous chorioretinopathy and control groups. Within central serous chorioretinopathy groups, worsened daytime function was observed in acute versus chronic – a larger study would help distinguish the effect of chronicity on sleep.

Background/objectivesIdiopathic intracranial hypertension (IIH) is a disease which threatens vision and causes disabling headaches, affecting women of childbearing age with obesity. It is characterised by raised intracranial pressure (ICP), measured invasively either with lumbar punctures or intracranially-inserted monitors. There is an unmet clinical need to develop non-invasive means to assess ICP. This study aims to utilise the MRI-ICP imaging technique to measure intracranial compliance index and assess its suitability as surrogate biomarker of ICP.Subjects/methodsNine IIH patients and ten age, sex, and body mass index matched healthy controls were recruited. All participants underwent lumbar puncture, visual assessments, detailed headache phenotyping, and MRI-ICP scans to calculate intracranial compliance index at baseline. Following treatment, patients were invited to attend a one-year visit when all assessments were repeated.ResultsThere was significant (p = 0.017) reduction in intracranial compliance index in IIH (mean = 1006.0 cc/mmHg/cm, SD = ± 384.6 cc/mmHg/cm) compared to controls (mean = 1493.0 cc/mmHg/cm, SD = ± 411.8 cc/mmHg/cm), inversely correlating with lumbar puncture opening pressure (r = −0.502, p = 0.029). A significant inverse correlation between compliance index and headache disability was also found (r = −0.458, p = 0.049) and a trend for an association between lower compliance index and increased frequency of headaches (r = −0.430, p = 0.066). This latter became significant (p = 0.018) after accounting for use of analgesics. Following successful treatment, compliance index was increased in all patients at one year (mean of differences = 380.7 cc/mmHg/cm, p = 0.031).ConclusionsThis is the first study to apply the MRI-ICP technique longitudinally in IIH. It illustrates reduced intracranial compliance index in IIH, correlating with opening pressure and headache disability and ameliorating with treatment.

Background/ObjectivesAdaptive optics ophthalmoscopy (AOO) has the potential to provide insights into AMD pathology and to assess the risk of progression. We aim to utilise AOO to describe detailed features of intermediate AMD and to characterise microscopic changes during atrophy development.Subjects/MethodsPatients with intermediate AMD were recruited into PINNACLE, a prospective observational cohort study. Participants underwent flood-illumination AOO using the commercially available rtx1 camera. AOO images were qualitatively assessed and correlated with clinical imaging including optical coherence tomography (OCT) and infrared scanning laser ophthalmoscopy.ResultsThe visibility of cone mosaic was generally compromised in eyes with intermediate AMD. We observed an association between the visibility of cone mosaic on AOO and the detection of a well-defined normal interdigitation zone on OCT. Drusen subtypes were identified on AOO as variations in reflectance at the edge and/or the centre of the druse. The absence of a hyperreflective margin was associated with the loss of the overlying ellipsoid zone on OCT prior to the collapse of the druse. With progressive attenuation of the retinal pigment epithelium and loss of photoreceptor layers, the drusenoid lesion appeared more hyperreflective with very distinctive edges.ConclusionsThis cross-sectional study supports the potential value of AOO for providing information on intermediate AMD and the development of atrophic lesions that cannot be seen in conventional imaging modalities. The ongoing longitudinal PINNACLE study is assessing the significance of the described findings.

BackgroundConstituting ~0.5% of all NHS cataract operations, national provision of immediately sequential bilateral cataract surgery (ISBCS) is limited. Combining offering ISBCS within a novel one-stop see-and-treat (S&T) cataract pathway would offer patients the opportunity for two cataract operations in a single hospital visit. Patient acceptance of ISBCS amongst urban populations has been investigated. However, little is understood about ISBCS acceptance rurally.MethodsRetrospective observational study at the Nightingale Hospital, Exeter investigating patient acceptance of ISBCS within S&T; following the implementation of a S&T cataract pathway entailing a pre-operative patient-clinician telephone consultation and subsequently scheduled single date of assessment and surgery. Patient acceptance and factors potentially influencing decisions were investigated.Results200 patient telephone consultations between 22nd August 2023 and 9th January 2024 were evaluated. 198 (99%) patients referred were suitable for S&T cataract surgery, of whom 109 (54.5%) were deemed eligible for offering ISBCS S&T cataract surgery. Of the eligible participants, 78 (71.56%) favoured ISBCS. No significant differences in age, sex, distance from hospital or refractive data were identified between ISBCS accepting and declining participants.ConclusionsOur results illustrate a high patient acceptance rate (71.56%) of ISBCS within our population in contrast with published national rates. Offering ISBCS within a S&T model would allow patients to benefit from having both cataracts assessed and treated within a single hospital visit.

6 deregulated ion channels were identified" was corrected to read "The 19 FDA-approved drugs that interact with the 5 deregulated ion channels were identified."

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

Background/ObjectivesGlaucoma is the leading cause of irreversible blindness, disproportionately affecting individuals of African ancestry. Limited research has examined the impact of neighbourhood quality and socioeconomic factors on primary open-angle glaucoma (POAG) risk in this population. This study aims to address these gaps by evaluating associations between ocular health and neighbourhood characteristics using geospatial data.Subjects/MethodsWe conducted a case-control study with 5192 African ancestry individuals from the Philadelphia area using data from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Geocoded U.S. Census data were merged with individual-level demographics and neighbourhood-level measures, including air quality, food accessibility, and socioeconomic indicators, to assess their association with glaucoma risk and severity.ResultsThe study included 3039 controls (58.5%) and 2153 POAG cases (41.5%). Higher POAG risk was associated with older age (OR 1.72 per 10-year increase, p < 0.001), male gender (OR 2.04, p < 0.001), lower BMI (OR 0.87 per 10 kg/m2 increase, p = 0.003), and nonuse of alcohol (OR 0.56 for alcohol use, p < 0.001). Low food access was more common in controls (OR 0.86, p = 0.03), and severe POAG cases were associated with lower homeownership rates (OR 0.95 per 10% increase, p = 0.049). However, most socioeconomic and environmental factors (air quality, education, income, occupation, family structure) were not significantly linked to POAG risk or severity.ConclusionSocioeconomic status did not significantly protect against POAG in African ancestry individuals. Individual factors were more influential, suggesting neighbourhood and socioeconomic factors may have a lesser impact than previously hypothesised.