bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgery after corneal grafts
Authors: Karmiris Efthymios
Published: January 2024

There is one available donor per 70 patients so we need to identify those whose vision would benefit from corneal transplantation and minimize risks that could jeopardize corneal graft survival possibility1.

The two leading causes of graft failure post Penetrating Keratoplasty (PKP) are graft rejection and secondary glaucoma development. The existence of preoperative glaucoma increases two to three times the chances of graft rejections in any corneal transplantation2,3. The 10‐year Cornea Donor Study also confirmed that pre‐existing glaucoma is a risk factor for graft failure4. The 3‐year graft survival rate has been shown to be 71% in patients with preop glaucoma and 89% in patients without preop glaucoma5.

In cases following Descemet Striping Endothelial Keratoplasty (DSAEK), Ocular Hypertension (OHT) ranges in otherwise healthy eyes from 29 to 47% and increases to 43 to 54% in cases with pre‐existing glaucoma or high‐risk eyes. Glaucoma can be presented in up to 15% in post‐DSAEK cases which increases twice the relative risk of rejection. Concurrent gonio‐synechiolysis is considered an additional risk factor whereas 18.6% of high IOP cases considered as secondary to steroid administration. Acute raise in IOP can be attributed in pupillary block at an estimated rate of 13%6,7.

In cases of Descemet Membrane Endothelial Keratoplasty (DMEK) OHT or intraocular pressure (IOP) elevation is presented to 6.5 up to 11.1% and de novo glaucoma can be found from 2.8 to 6.5%, whereas progression of pre‐existing glaucoma is less than 2.5%8. In cases with simultaneous DMEK and cataract surgery there is greater likelihood of post‐op OHT or glaucoma. In DMEK cases the early postoperative increase in pressure is usually due to a combination of anterior (inferior) and posterior (superior) pupillary blocks when patient is sitting upright9.

The late post‐DMEK IOP increase is attributed to Blockage of TM by inflammatory cells, PAS formation or steroid use. However, steroid‐induced glaucoma post‐DMEK is not as common as that in post‐PKP or post‐DSAEK due to the shortest steroid regime post‐DMEK cases. Treatment methods include medical treatment, trabeculectomy or tubes. Some cases with Xen®10 and Micropulse cyclodidode11 laser have been reported in endothelial cases, however with little degree of evidence.

Controversy still exists to which surgical procedure is the best for graft survival and IOP control, as well as when is the best time of the surgery in patients with pre‐existing glaucoma, before, simultaneously or after, and if needed, graft surgery. Certainly a “try not to create glaucoma” strategy needs always to be followed by not producing additional iatrogenic risk factors with improved technique(s) and by respecting the tissue(s).
Macular pigment profile characteristics and stability over periods of up to 25 years
Authors: Robson Anthony G. , Van Kuijk Frederik , Pauleikhoff Daniel , Moreland Jack
Published: January 2024

This study compares the foveal and total retinal macular pigment (MP) amount in healthy subjects and examines the stability of MP spatial distribution profiles, measured almost annually for periods of up to 25 years.

Measurements of MP spatial distribution profiles were made by 51 subjects using the psychophysical technique of minimum motion photometry, utilizing a moving bichromatic grating (test 460 nm, comparison 580 nm). Two foveal fields (0.9° and 2.2° diameter) and 11 annular segments (eccentricities from 0.8° to 7.5°) were used. The total amount of MP within the central 15 degrees was estimated by numerical integration and compared with foveal values. Four subjects with widely different MP profiles underwent almost annual testing for periods of 19–25 years. Eleven of the same subjects and 19 others underwent 2‐wavelength autofluorescence (AF) assessment of MP using a scanning laser ophthalmoscope (incident radiation 488 nm and 514 nm), allowing quantification of the peak relative optical density, distribution and total complement of MP over the central 21 degrees.

Detailed examinations revealed widely different MP distribution profiles using motion photometry and/or 2‐wavelength fundus autofluorescence. There was a lack of correlation between peak MP optical density at the fovea and assessments of the total complement of MP within the central 15 or 21 degrees. Serial psychophysical assessments over periods of 19–25 years in 4 cases demonstrated a high degree of stability at all macular locations including the fovea; plots of peak MP optical density against time showed minimal positive and negative gradients (<0.0003).

The total amount of macular pigment cannot be accurately estimated from foveal or central values. Widely different MP distribution profiles in healthy subjects demonstrate a high degree of long‐term stability, relevant to investigations that aim to monitor MP or fundus autofluorescence in disease or in studies that aim to modify MP through dietary supplementation.
Different techniques in transscleral cyclophotocoagulation
Authors: Palarie Natalia
Published: January 2024

Transscleral cyclophotocoagulation (TSCPC) is a minimally invasive laser procedure used to reduce intraocular pressure in patients with glaucoma. By selectively coagulating the ciliary body, TSCPC reduces the production of aqueous humour and lowers intraocular pressure. TSCPC can be performed using various laser delivery methods, including “pop”‐titrated (PT–CPC), “slow‐burn” (SB‐CPC), and micropulse techniques (MP‐CPC).

MP‐TSCPC has been shown to be effective in lowering IOP in patients with mild to moderate glaucoma, but may be less effective in patients with more advanced glaucoma or those with higher baseline IOP levels. PT/SB‐CPC, on the other hand, has been shown to be effective in lowering IOP in patients with refractory glaucoma who have not responded to other treatment options. Although there is a lot of research on the efficacy and safety of TSCPC, there is still limited data available, particularly comparing different TSCPC techniques.

The present talk will summarize our experience with different TSCPC techniques, including patient selection, potential risks and benefits.
Application of gonioscopy‐assisted transluminal trabeculotomy (GATT) in the management of refractory glaucoma in Poland
Authors: Kosior‐Jarecka Ewa
Published: January 2024

Goniotomy assisted transluminal trabeculotomy (GATT) is a kind of ab interno angle procedure. GATT spares conjunctiva and sclera, so it is a real mini invasive glaucoma surgery (MIGS). MIGS techniques are typically used in cases of early and moderate open angle glaucoma.

The aim is to present the possibility of GATT application in the selected types of refractory glaucoma or secondary open angle glaucoma which are believed to be difficult in management.

The results of GATT application in refractory glaucoma, inflammatory glaucoma and silicon oil glaucoma will be presented with the evaluation of IOP lowering potential in short term observation. Additionally, selected clinical cases will be showed.
Negative and positive dysphotopsia
Authors: Grzybowski Andrzej
Published: January 2024

Dysphotopsia are responsible for complaints of that small percentage of pseudophakic subjects who are not satisfied with their vision. They are divided into negative and positive. Positive dysphotopsia (PD) are described by patients as glare, light streaks, light arcs, flashes of light, and starbursts produced by an external light source, whereas negative dysphotopsia (ND) is a dark temporal peripheral arc‐shaped shadow or line.

PD are related to the nature of the inserted intraocular lens (IOL). The incidence rate of PD at 1 year after cataract surgery is 0.2–2.2%, and there have been no reports of PD in intraocular surgeries other than cataract surgery to date. The cause of ND is unknown, and many concepts trying to explain its pathophysiology were proposed, including a small pupil, an axial space behind the iris, and a sharp optic edge, the increased angle kappa, the nasal location of the pupil relative to the optical axis, with in‐the‐bag IOLs (and not in ciliary sulcus‐, anterior chamber‐, or scleral suture‐fixated IOLs), and a correlation with coverage of the anterior capsule edge, interaction between the anterior capsulorhexis with the intraocular lens, shorter eyes and a higher implanted IOL power, position of the haptic, and neuroadaptive component.
Sterile donor tomography for improvement of refractive results after keratoplasty
Authors: Hamon Loïc , Quintin Adrien , Bofferding Max , Mäurer Stephanie , Langenbucher Achim , Daas Loay , Seitz Berthold
Published: January 2024

Purpose: Any corneal microsurgeon may have inadvertently transplanted a donor corneal tissue with (subclinical) keratoconus or prior keratorefractive surgery, which typically leads to postoperative refractive surprises and cannot always be detected in the eye bank with only slit lamp. Given the increased number of keratorefractive procedures performed in the last decades, eye banks will soon have to face this problem more intensively. Thus, the efficiency and reliability of anterior segment optical coherence tomography (AS‐OCT) as a non‐invasive and sterile screening method in the eye bank to detect corneal grafts with curvature and/or thickness abnormalities was assessed.

Methods: 1315 donor corneal tissues mounted in sterile tissue cultivation flasks were imaged using an AS‐OCT. The corneal tissues were preserved in organ culture medium I and transferred into organ culture medium II (containing dextran T‐500 6%) for deswelling at least 24 h prior to measurement and keratoplasty. Depth raster scans were performed through the posterior surface of the corneal tissues within a 7 mm central zone to create 3D volume data. The volume data set was preprocessed to eliminate flask reflections artefacts and to define the region of interest (ROI). Subsequently, the adaptation of a sphero‐cylindrical surface model was carried out with raytracing. Thus, the radii of curvature for the front and back surfaces can be determined and a corneal thickness map is generated.

Results: The mean steep/flat front surface radius was 7.46 ± 0.29 (5.07–9.29)/7.69 ± 0.24 (6.70–9.50) mm, the corresponding values for the back surface being 6.47 ± 0.32 (5.00–8.00)/6.80 ± 0.31 (5.81–8.00) mm and the mean central thickness was 610 ± 84 (379–1457) μm. Abnormalities (beyond ±2 or ± 3 SD) were found in 140 or 34 corneas (10.6% or 2.6%) for anterior surface curvature, 120 or 38 corneas (9.1% or 2.9%) for the posterior surface, and 55 or 16 corneas (4.2% or 1.2%) for thickness.

Conclusions: The AS‐OCT provides an objective, sterile and semi‐automated screening method to identify corneal morphological and refractive alterations (e.g. keratoconus, status post PRK/LASIK) and further optimize corneal donor selection in the eye bank. Corneal donors with curvature or thickness abnormalities ±3 SD do not have to be discarded but can be used for posterior lamellar keratoplasty or tectonic keratoplasty.
It is our joint task to translate into reality a more equal and connected world for women scientists in all their diversity
Authors: Ou Yvonne , Audo Isabelle , Votruba Marcela , Tassignon Marie‐José , Soubrane Gisèle
Published: January 2024

It is our joint task to translate into reality a more equal and connected world for women scientists in all their diversity. Our round table will foster discussion among delegates on the following topics:

Share your clinical experience…

Share your research experience….

Discuss your ambitions….

Facilitate an informal exchange with the wider EVER community….
WOMEN in EVER is supporting women researchers, clinicians, and academic staff in their career development with a goal to prepare them for leadership roles in the scientific community
Authors: Votruba Marcela , Tassignon Marie‐José , Soubrane Gisèle , Ou Yvonne , Audo Isabelle
Published: January 2024

WOMEN in EVER is supporting women researchers, clinicians and academic staff in their career development with a goal to prepare them for leadership roles in the scientific community.

Globally, only 33 per cent of researchers are women. Women and girls represent half of the world's population and, therefore, also half of its potential. Gender equality, besides being a fundamental human right, is essential to achieve peaceful societies, with full human potential and sustainable development. It is our job to translate into reality a more equal and connected world for women scientists in all their diversity.
This WOMEN in EVER session is connecting early‐career and leading women scientists from all over Europe to tackle the underrepresentation of women in science by increasing visibility
Authors: Tassignon Marie‐José , Soubrane Gisèle , Ou Yvonne , Audo Isabelle , Votruba Marcela
Published: January 2024

This WOMEN in EVER session is connecting early‐career and leading women scientists from all over Europe, to tackle the under‐representation of women in science by increasing visibility.

Distinguished women scientists and clinicians will meet here to connect and to inspire young women scientist about how successful careers in Ophthalmology and Vision Science look like – this is a great opportunity to acknowledge the contribution women scientists make in Ophthalmology.

Strategies of empowerment for women:

Developing ability for critical thinking

Fostering decision‐making and action through collective processes

Ensuring equal participation in developmental processes

Enhancing self‐esteem and self confidence in women.

Women are still underrepresented in science. Even though half of the first semester students in Europe are female, the ratio is getting less equal with each upper qualification level. For example, the female share among the highest‐paid professorships is about 20%. However, it has already been shown that mixed teams achieve better results due to the different perspectives, meaning that gender equality in science is mandatory and has a positive effect on research quality.
Protocolization of data collection by OCT
Authors: Jimeno Jose Carlos Pastor
Published: January 2024

New technologies have made it possible to demonstrate the existence of ocular biomarkers of many of the neurodegenerative diseases, contributing to their diagnosis, classification and even to the control of responses to treatments. This SIS aims to update some of the ocular findings of diseases such as Multiple Sclerosis, Alzheimer's, or Amyotrophic Lateral Sclerosis.

Essential aspects of techniques such as OCT and eye‐tracker will be addressed. Emphasis will be placed on the standardization of OCT for a correct application in neuro‐ophthalmology and on the possible uses of eye‐tracker systems to give information on alterations in eye movement control systems.
Saffron and glaucoma. Effects of active components of an old natural neuroprotector
Authors: Fernández‐Albarral José A.
Published: January 2024

Glaucoma is a neurodegenerative disease characterized by the loss of retinal ganglion cells (RGCs). An increase in the intraocular pressure is the principal risk factor but controlling this pressure does not always prevent glaucomatous damage, so other harmful factors would be implicated in this pathologic process. Several mechanisms have been proposed that leads to the RGC death in glaucoma, including glutamate excitotoxicity, aggregation of misfolded proteins, mitochondrial dysfunction, oxidative stress, neurotrophic deprivation, and neuroinflammation, among others. Therefore, early diagnosis of neurodegeneration, understanding of its pathogenic mechanisms, and the development of new neuroprotective therapies represent major challenges for treating this disease.

During the inflammatory process that occurs in glaucoma, retinal glial cells, both microglia and macroglia (Müller cells and astrocytes), become activated and release factors that can be neuroprotective in some cases and neurodegenerative in others. Cytokine‐ and chemokine‐mediated signalling engages in the neuroinflammatory process that leads to retinal ganglion cell (RGC) damage in glaucoma. Thus, a substance with anti‐inflammatory activity may protect against RGC degeneration.

Increasing evidence from both experimental models and clinical studies in patients supports the neuroprotective effect of saffron components in neurodegenerative conditions and in retinal neurodegenerative pathologies, due to its important anti‐inflammatory, anti‐apoptotic, and antioxidant properties.

This talk overviews the published studies that analysed the neuroprotective and anti‐inflammatory effects of saffron and its main components in both clinical trials and experimental models of glaucoma. All findings indicate that oral administration of saffron extract could be beneficial in glaucoma by decreasing the neuroinflammation associated with increased intraocular pressure, reducing microglial activation, regulating the production of proinflammatory cytokines, and preventing retinal ganglion cell death.
Vaccine induced uveitis
Authors: Willermain Francois
Published: January 2024

Recently, the COVID epidemic and its associated vaccination campaign have brought back the notion that uveitis could be induced by vaccination. Vaccine‐induced uveitis was, however, described as early as 1987. Although the reported incidence is rare, uveitis has been described with all type of vaccine. Direct infection, molecular mimicry and adjuvant effects are the three mechanisms that can lead to vaccine induced uveitis. Clinically all forms of uveitis have been described, with generally a good prognosis. Importantly, in the case of COVID vaccination, the risk of developing uveitis might be higher in patients with previous episode of non infectious uveitis.
Brolucizumab and other anti‐VEGF induced intraocular inflammation
Authors: Gonzalez‐Lopez Julio J.
Published: January 2024

Anti‐vascular endothelial growth factor (VEGF) agents, such as bevacizumab, ranibizumab, and aflibercept, are widely used in the treatment of various retinal diseases. Recently, brolucizumab, a novel anti‐VEGF agent, has been introduced in the market for the treatment of neovascular age‐related macular degeneration. However, the use of some anti‐VEGF agents has been associated with an increased risk of intraocular inflammation.

In particular, brolucizumab has been reported to be associated with a higher incidence of intraocular inflammation compared to other anti‐VEGF agents. The inflammation can manifest as anterior uveitis, vitritis, or even occlusive retinal vasculitis, and lead to severe and permanent visual loss in some cases. Although the exact mechanism of this phenomenon is not fully understood, it is believed to be related to the immune response triggered by the injection of foreign proteins into the eye.

The clinical presentation of intraocular inflammation can range from mild symptoms, such as ocular discomfort and blurry vision, to severe visual loss. Prompt and appropriate management of intraocular inflammation is crucial to preserve vision in patients receiving anti‐VEGF agents. Early detection of inflammation and prompt initiation of anti‐inflammatory treatment can prevent further damage to the eye.

In cases of mild to moderate inflammation, close monitoring and topical or systemic anti‐inflammatory medication may be sufficient to control the inflammation and prevent visual deterioration. Cessation of the causative anti‐VEGF treatment may be necessary to prevent further exacerbation of the inflammation. In such cases, the patient may need to be switched to an alternative treatment option for their underlying condition.

Overall, clinicians should maintain a high level of vigilance for the development of intraocular inflammation in patients receiving anti‐VEGF therapy. Close monitoring, early detection, and appropriate management of inflammation can help preserve vision and minimize the potential complications associated with these agents.
Combined cataract and glaucoma surgery
Authors: Tatham Andrew
Published: January 2024

Cataracts and glaucoma commonly co‐exist, largely due to both being associated with older age. The crystalline lens can however cause glaucoma by phacomorphic or phacolytic processes, or by contributing to pupil block leading to primary angle closure. Medical and surgical treatments for glaucoma can also result in accelerated cataract formation. Cataract surgery in patients with glaucoma provides an opportunity to reduce medication burden and improve intraocular pressure control but has a higher risk than surgery in non‐glaucomatous eyes. Special consideration should be given to those with pseudoexfoliation (e.g. zonular instability), advanced glaucoma (e.g., risk of pressure spike and wipe out) or in those with short axial length or angle closure (e.g., shallow anterior chamber and risk of malignant glaucoma). Cataract surgery in eyes with previous subconjunctival glaucoma surgery is a particular challenge as it increases the risk of wound healing and failure of the filtering procedure. This presentation will outline steps for success in cataract surgery in patients with glaucoma and will also present recent evidence regarding the efficacy of phacoemulsification combined with minimally invasive glaucoma surgery (MIGS).
TFOS lifestyle report: Effects of the digital environment on the ocular surface and adnexa
Authors: Nowińska Anna
Published: January 2024

This presentation summarizes the findings of the Digital Environment Subcommittee of the recent Workshop of the Tear Film & Ocular Surface Society, entitled “A Lifestyle Epidemic: Ocular Surface Disease” (www.tearfilm.org). Digital environments are common in modern life and involve extensive screen time, often exceeding 4 h a day. Examples of digital devices include professional items, such as networked wayfinding systems or connected workstations, but also personal computers, televisions, and mobile phones. Although the prevalence of digital eye strain is very high, reaching 97% across the world, currently there is a lack of an agreed definition and established diagnostic criteria for the condition. Symptoms of digital eye strain are heterogeneous and non‐specific, may overlap with other ocular diseases, and include ocular tiredness, blur, ocular soreness, eye strain, ocular pain, burning, ocular dryness, and light sensitivity. They produce significant, chronic, and frequent discomfort that can affect the quality of life and reduce work and school performance. Although there is a large demand for treatments to relieve symptoms of digital eye strain, interventions are not well established. Proposed methods, such as incorporating rest breaks and the 20/20/20 rule, improving blinking, oculomotor exercises, and optimizing the work environment will be discussed. Also, the influence of such interventions as refractive correction, blue‐blocking filters, ocular surface disease management approaches to improve tear film quality and/or quantity and nutritional supplementation will be presented based on current, best evidence data. In conclusion, considering the ubiquitous use of digital technology, screening for digital eye strain should become incorporated into routine ocular assessments. The unified definition and diagnostic criteria proposed in the TFOS report will help standardize and improve the quality of future epidemiological studies.
TFOS lifestyle report: Effects of cosmetic products and procedures on the ocular surface and adnexa
Authors: Sullivan Amy Gallant ,   the Cosmetics Subcommittee of the TFOS Lifestyle Workshop
Published: January 2024

This presentation summarizes the findings of the Cosmetics Subcommittee of the recent Workshop of the Tear Film & Ocular Surface Society, entitled “A Lifestyle Epidemic: Ocular Surface Disease” (www.tearfilm.org). The Cosmetics Subcommittee report addresses how the use of eye cosmetic products and procedures is a lifestyle challenge, which may aggravate or induce the development of ocular surface and adnexal disease. The history, psychology, social aspects and market value of eye makeup are reviewed, as are the adverse effects associated with numerous cosmetic ingredients, products and procedures. For example, many eye makeup ingredients may act as allergens, carcinogens, endocrine disruptors, immunosuppressive agents, mutagens, toxins and/or tumour promoters. This report also highlights the regulations for eye cosmetic use, and provides a systematic review concerning the ocular impact of eyelash growth products.
TFOS lifestyle report: Effects of elective medications and procedures on the ocular surface and adnexa
Authors: Messmer Elisabeth M. ,   the Elective Medications and Procedures Subcommittee of the TFOS Lifestyle Workshop
Published: January 2024

This presentation summarizes the findings of the Elective Medications and Procedures Subcommittee of the recent Workshop of the Tear Film & Ocular Surface Society, entitled “A Lifestyle Epidemic: Ocular Surface Disease” (www.tearfilm.org). Elective medications and/or procedures are “elected” by patients to improve disease and/or cosmetic appearance to enhance quality of life. They include topical ophthalmic and periocular medications, systemic medications, ophthalmic surgical procedures of the peri‐orbit, the lids, the conjunctiva, the cornea as well as the lens, non‐ophthalmic surgical procedures such as neurosurgery, bariatric surgery and radiation, and a number of non‐surgical ophthalmic procedures and devices. This report describes the impact of these medications and/or procedures on the ocular surface, discusses possible pathogenetic mechanisms involved, and proposes management options.
Deciphering cell fates of the human cornea with a multi‐omics meta atlas
Authors: Zhou Huiqing (Jo)
Published: January 2024

The human cornea is a transparent tissue composed of several layers that allow light to enter the eye. Disruption of the function of various cells in different layers can give rise to diseases that affect the transparency of the cornea. Understanding the precise cell fates of the cornea and the underlying molecular mechanisms is pivotal for dissecting the pathology of corneal diseases and exploring treatments and regeneration. Currently, there is a lack of a precise cell fate map for the human cornea. In this study, we constructed a multi‐omics meta‐atlas to define cell fates in the human adult and embryonic cornea, by integrating publicly available datasets. This multi‐omics meta‐atlas is comprised of RNA‐seq data representing genome‐wide gene expression profiles and ATAC‐seq data annotating regulatory genomic regions that control gene expression in single‐cells of the cornea. We identified the key transcription factors and combinations that determine cell fates in the human cornea, with gene regulatory network analyses using the meta‐atlas. Some of these transcription factors are functionally validated. We also applied this meta‐atlas to analyse single cells of the cornea derived from keratoconus patients and showed an expansion of corneal stromal stem cells as a potential disease mechanism. In conclusion, this study provides an extensive reference of cell fates of the human cornea that can be used to dissect disease mechanisms. This meta‐atlas also provides insights for therapeutic discovery and molecular blueprints for corneal regeneration.
Diagnosis and management of secondary glaucoma: Dural fistula and intracranial hypotension
Authors: Plant Gordon
Published: January 2024

Glaucoma can occur as a secondary disorder in two situations. Firstly, where there is episcleral venous hypertension. In cases of dural fistula the diagnosis is straightforward: presentation, diagnosis and management will be discussed. In other situations the aetiology of episcleral venous hypertension is controversial, such as the Radius Maumenee syndrome. Secondly there has been recent interest in the importance of the pressure gradient across the lamina cribrosa. The occurrence of papilloedema in cases of low intra‐ocular pressure is well established while glaucomatous optic nerve damage in cases of intra‐cranial hypotension is controversial. The evidence will be reviewed.
Late detection of glaucoma and the relationship with deprivation: Lessons from big data from hospital eye services in England
Authors: Rathore Mehal , Kelly Stephen R. , Crabb David P.
Published: January 2024

Purpose: We aim to confirm the association between multiple deprivation and late diagnosis of glaucoma in England and to determine whether multiple deprivation is associated with rapid VF progression.

Methods: A total of 602 439 records were obtained by retrospectively extracting Humphrey VFs from electronic medical records (EMRs) from five hospital eye service (HES) clinics in England in 2015. Index of Multiple Deprivation (IMD; a UK government measure for deprivation) was calculated from residential postcodes and patients were stratified into IMD “deciles”. A patient was defined as having advanced VF loss if their Humphrey mean deviation (MD) was worse than −12 dB in the worse eye at their initial visit. At least ≥6 VFs and MD of worse than −1 dB per year were necessary to define a patient as having rapid VF progression.

Results: In the most and least deprived IMD deciles, respectively, 18 (291/1616) and 11% (765/6951) of patients, had advanced VF loss at diagnosis, indicating a clear association. In the most and least deprived deciles, respectively (reference = fifth decile), the age‐corrected odds ratios (OR) for having advanced VF loss at entry into HES were 1.42 (95% Confidence Interval [CI]:1.21 to 1.67, p = 0.001) and 0.75 (95% [CI]: 0.66 to 0.85, p = 0.001). In the 15 094 patients with follow‐up data (median [interquartile range] of 6.9 [4.5,10.0] years) the proportion having the attribute of rapid VF progression did not differ across the IMD spectrum (age‐corrected ORs not differing from the reference value for the most and least deprived IMD decile. [p = 0.19 & p = 0.22]).

Conclusion: Large‐scale VF data from English glaucoma clinics suggests deprivation is linked to the glaucoma severity at the time of diagnosis. Deprivation does not appear to be linked to a higher chance of having rapid VF progression, suggesting that hospitals provide equitable care for glaucoma patients.

Keywords: visual field, index of multiple deprivation, late presentation of glaucoma.
Neuroinflammation: The missing link between pain and immunity
Authors: Ferrari Giulio , De Micheli Massimo
Published: January 2024

The density of corneal nerves in the cornea is the highest of the entire body. Most ocular surface diseases/injuries affect corneal neurons and are followed by a process named neurogenic inflammation, which eventually leads to pain, activation and recruitment of leukocytes and neoangiogenesis. On the other hand, leukocytes affect nerve physiology by secreting pro‐inflammatory cytokines and neuropeptides. The clinical outcome of the neuroinflammatory process is two‐faced. While immune activation is beneficial to prevent/control infections and ensure prompt wound healing, a prolonged and/or excessive neuroinflammatory response can have catastrophic consequences on corneal integrity and vision, or induce chronic pain. Clearly, a better understanding of these complex processes can have a deep impact on the treatment of highly prevalent ocular disorders, such as dry eye or infectious keratitis.
Intraocular lens power calculation after corneal refractive surgery
Authors: Stopyra Wiktor
Published: January 2024

Challenges in IOL power calculation in eyes after corneal refractive surgery are caused by difficulties in accurately determining corneal refractive power and in predicting the effective lens position. Three factors contribute to inaccurate corneal refractive power estimation ‐ inaccurate measurement of anterior corneal curvature by standard keratometry or corneal topography, inaccurate calculation of total corneal power from the anterior corneal curvature can result from using the standardized value for the refractive index of cornea (1.3375) and finally changes in posterior corneal curvature. There are three categories of methods proposed based on the use of historical data acquired prior to the corneal refractive surgery (formulas using only historical data, no historical data or a combination of historical data and current data). The most frequently used methods of IOL power calculation in eyes after corneal refractive surgery are discussed and their accuracy are compared. The latest studies and meta‐analyses in this area are presented. Despite availability of new measurement technologies and development of new IOL calculation formulas, further advances are needed to improve outcomes of cataract surgery in eyes that have undergone corneal refractive surgery.
Live imaging of photoreceptor outer segment phagocytosis in zebrafish
Authors: Nevala Noora Emilia , Partinen Jenni Susanna , Yoshimatsu Takeshi , Ihalainen Teemu Olavi , Nymark Soile
Published: January 2024

Retina depends on retinal pigment epithelium (RPE) for its survival. To maintain normal functionality, photoreceptors renew 10% of their outer segments every day and this process requires efficient phagocytosis of the aged photoreceptor fragments by the RPE. Phagocytosis is a dynamic process with strong circadian regulation, but detailed understanding on the regulation of the process and differences between photoreceptor types is presently inadequate. Previous studies have been carried out mainly with in vitro models and cell cultures, and therefore, the dynamics of the phagocytosis process in the context of a living animal has remained elusive. Here, we present an approach that utilizes transgenic zebrafish lines with fluorescently tagged photoreceptor and RPE cells for in vivo imaging of their interactive functions in a living animal.

Zebrafish is one of the most accessible animal models to study retinal physiology in vivo and currently the only vertebrate model that can be used to image retinal tissue dynamics in real time. By utilizing already existing low‐pigmented zebrafish lines and microinjecting plasmids coding for photoreceptor and RPE cell membrane targeted tags, we have created low‐pigmented fish with fluorescent RPE cells and the outer segments of the different photoreceptor types. Here, we first show with histological sections how the plasmids are expressed in the correct photoreceptor types and RPE cells in larval zebrafish eyes. Then, we present our in vivo imaging approach where we anesthetise and mount the zebrafish to a confocal microscope. Our results using time‐lapse imaging demonstrate how we can follow the interaction between photoreceptors and RPE in live animals in resolution that enables detecting the movement of photoreceptor outer segment fragments in the subretinal space. Taken together, our study introduces a new approach to investigate the dynamics of phagocytosis of different photoreceptor types by the RPE in real time in a living animal.
Treatment of corneal ulcers in neurotrophic keratopathy
Authors: Kontadakis Georgios
Published: January 2024

By definition the cause of the ulcer in neurotrophic keratopathy is the impaired corneal innervation. Ophthalmic surgery, local medication, or systemic conditions are possible causes that lead to the development of this condition. In this talk the treatment options will be discussed, which include both medical and surgical alternatives. Treatment initially targets improvement of corneal lubrication with artificial tears, punctal plugs or contact lens fitting. Anti‐inflammatory agents are also helpful. Autologous serum drops for the addition of growth factors, insulin drops, and other epitheliotropic factors can stimulate healing. Surgical options include tarsorrhaphy, amniotic membrane transplantation, conjunctival flaps and corneal neurotization. In each case, a stepwise approach can be utilized, based on the stage of the keratopathy on presentation.
Specific corneal epithelial cell markers in congenital aniridia
Authors: Szentmáry Nóra , Amini Maryam , Suiwal Shweta , Fries Fabian N. , Nastaranpour Mahsa , Seitz Berthold , Li Zhen , Chai Ning , Ludwig Nicole , Stachon Tanja
Published: January 2024

Congenital aniridia is a rare panocular disease in which almost all structures of the eye are affected. The observed corneal abnormalities are called aniridia‐associated keratopathy (AAK). AAK is characterized by progressive limbal stem cell deficiency (LSCD), epithelial thinning and erosions, corneal ulceration, vascularization, inflammation and pannus formation. Although in some aspects AAK resembles other types of LSCD, through its specific genetic origin, alterations in corneal epithelial cell gene expression differ from other types of corneal diseases. Primary limbal epithelial cells of aniridia subjects lack expression of KRT3 and KRT12 mRNA and protein, and DSG1, ADH7, FABP5, CRABP2, SPINK7 and ALDH1A1 mRNA expression is decreased in these cells. However, miRNA 138‐5p expression is upregulated. This epithelial behaviour can also be mimicked using an siRNA based aniridia primary limbal epithelial cell model.
Artificial intelligence in cataract and refractive surgery
Authors: Grzybowski Andrzej
Published: January 2024

Artificial intelligence (AI) technology is proving to be promising in the field of healthcare, especially in the areas relying on big data and image‐based analysis. In Ophthalmology, AI was already tested in majority of subspecialities, including cataract and refractive surgery. There were interesting studies showing the benefits of using AI algorithms in early keratoconus detection, to predict the outcomes of laser refractive surgery, and to cataract surgery training and monitoring. Moreover, AI models using fundus images to diagnose and grade cataract have been developed. New intraocular lens (IOL) formulas are applying big data and computational methodologies to achieve better prediction of targeted refraction and simplify the IOL selection process. Recent developments in AI have shown their potential possibility for the diagnosis and management of paediatric cataract using slit‐lamp images.
Visually evoked potentials in Neuro‐Ophthalmology
Authors: Plant Gordon
Published: January 2024

The first major development in the visually evoked potentials (VEP) was the move from flash to pattern stimulation in the 1970's. The neurophysiological basis of the responses to flash and to pattern stimuli will be reviewed to explain the superiority of the pattern VEP. The following questions will be considered:

Why were the early findings in multiple sclerosis so influential?

In what situations does the pVEP continue to be useful clinically, with particular emphasis on the classification of optic neuritis?

Should VEP and ERG always be carried out in combination?

When is flash VEP useful?

Is there a role for a chromatic VEP?
Ocular surface inflammation in congenital eye diseases
Authors: Bremond‐Gignac Dominique
Published: January 2024

Ocular surface in children present specificities especially for paediatric diseases. Anterior segment dysgenesia and congenital panocular diseases affect ocular surface. The ocular surface may present congenital opacities as in congenital glaucoma or Peters anomaly. In other diseases as aniridia, limbal insufficiency is evolutive with age creating Aniridia Associative Keratopathy (AAK). The interest of deep phenotyping with molecular genetics opens a wide range of better understanding of congenital ocular diseases. Mechanisms and physiopathology of induced inflammation will be developed.
Basic mechanisms and clinical implications of ocular surface inflammation
Authors: Ferrari Giulio
Published: January 2024

Basic mechanisms and clinical implications of ocular surface inflammation.

The pathopyhsiology of ocular surface inflammation is complex and involves a number of actors. Beside the immune system, a key role is emerging for the vasculature (both blood and lymph vessels), central and peripheral nervous system. From the old dogma of a cornea completely devoided of immune cells, a lot has been learned about how leukocytes, neurons and vessels interact and how imbalances in their function(s) may affect the onset and outcome of blinding diseases such as corneal burns or ocular graft versus host disease.
Viral ocular surface inflammation
Authors: Rousseau Antoine
Published: January 2024

Viral infections of the ocular surface (OS) may cause chronic, and/or recurrent inflammation that disrupt OS homeostasis, impact quality of life, and potentially impair vision through loss of corneal transparency and/or regularity. In this presentation, we'll review basic and clinical findings underlying OS inflammation in the context of the 3 most common viral pathogens affecting the OS, i.e. Adenovirus, Herpes Simplex virus type 1 and Varicella Zoster Virus.

During its acute replicative phase, adenoviral keratoconjunctivitis may trigger severe acute conjunctival inflammation, leading to transmucosal exudation and fibrinous pseudo‐membrane formation. If left untreated, the latter induce conjunctival fibrosis with extensive loss of goblet cells. In a second phase of the disease, antigen‐driven immune‐mediated mechanisms may cause chronic corneal subepithelial infiltration.

In the context of HSV and VZV keratitis, OS inflammation is caused by a combination of specific immune response to viral replication, causing stromal infiltration, and neovascularisation and ii) non‐specific inflammatory processes caused by corneal innervation alterations that impact tear secretion and osmolarity. While clinical disease is most often unilateral, unaffected side may display subclinical alterations, including decrease in corneal sensitivity and corneal nerve density, and decrease in endothelial cell density.

Management of viral ocular surface inflammation involves a combination of strategies aiming at controlling viral replication, decrease associated inflammatory/immune response and restore OS homeostasia.
Pharmacokinetics and contact lenses: Drug release, delivery and fate
Authors: del Amo Eva Maria
Published: January 2024

Topical ocular instillation is the most common route of administration for ophthalmic drugs. Despite being an easy way of drug administration, the ocular drug bioavailability is low (<4% in the anterior chamber), and the duration of therapeutic effect is short, requiring frequent instillations.

Controlled drug delivery systems such as contact lenses allow drug release onto the ocular surface for a longer time, which may improve ocular drug bioavailability and duration of action. Furthermore, such topical formulations may have the potential to deliver the drug to the posterior segment of the eye. Nevertheless, the ocular drug pharmacokinetics is not very well known, with a few studies published on contact lens delivery systems. In this presentation, we will take a closer look at this, describing the drug absorption and disposition processes in the eye, and clarifying some wrong assumptions. Research on drug release in tear fluid, corneal and non‐corneal absorption routes, and ocular drug disposition in the anterior and posterior segments are considered along with the quantitative pharmacokinetic data available up to now.

Overall, this talk aims to provide better understanding on ocular pharmacokinetics and on the key aspects to consider when designing in vivo pharmacokinetics studies using contact lens delivery systems.

Keywords: ocular pharmacokinetics, topical ophthalmic administration, non‐corneal absorption, contact lenses.
Deep learning in early keratoconus/corneal ectasia
Authors: Langenbucher Achim
Published: January 2024

Machine learning algorithms have been gaining tremendous relevance in the last decade in more or less all disciplines in medicine. In most cases supervised learning techniques are used to perform classification or graduation of diseases. Early detection of keratoconus in a screening environment is crucial as in this stage several therapeutic options such as collagen crosslinking or intracorneal ring implantation are available which could prevent further progression of the disease. In this talk we focus on new techniques of automatic identification of ectatic corneal diseases such as keratoconus in an early stage based on anterior segment optical coherence measurements with the Casia 2 tomographer. A neural network approach is implemented and fed with data of corneal front surface height and curvature, back surface height and curvature, and thickness data (in total 5 data layers) and the similarity of the measurement to normal or abnormal situation is provided. Performance data are shown for our training, validation, and test dataset.
Blood‐derived trophic factors for the treatment of ocular surface diseases
Authors: Versura Piera
Published: January 2024

The use of blood‐derived products (Eye Drop of Human Origin—EDHO; in Italian: Emocomponents for Not Transfusional Use, EUNT) for the treatment of various ocular surface diseases has become increasingly utilized in ophthalmic practice over the years. In particular, they are recommended as a third line option, when conventional tear substitutes, or active drugs, such as corticosteroids or Cyclosporine A, result unsuccessful in controlling either signs and, perhaps most importantly, subjective symptoms of discomfort and pain. The rationale for their use is based on the stimulation of cell proliferation and migration through the supply of metabolically active substances, in particular growth factors, and definitely mimicking the function of natural tears.

EDHO have been used for the treatment of various ocular surface diseases, including dry eye, persistent corneal epithelial defect, corneal ulcer, neurotrophic keratitis, ocular surface burn, recurrent corneal erosion and limbal stem cell deficiency. However, the therapeutic potential of these products is still to be fully explored, as randomized clinical trials and internationally recognized harmonized guidelines are still needed to provide better evidence, improve quality of the final products and lead to a more widespread use of these therapies in daily clinical practice. The autologous source is still quite popular, although allogeneic sources appear to be a promising innovation. These might offer the solution of obtaining in advance products tailored for each patient and ocular surface disease, at scalable concentrations based on the severity of the disease and clinical parameters. There remain many unanswered questions regarding what might be considered optimal treatment, sketched as “The 5 Ws (and 2 H) for blood based eye drops”, to quote a review from our group (doi: 10.3390/jcm8091478). This presentation will discuss: 1. who is the patient to be treated, in terms of disease type, severity, and stage?; 2. Why is an EDHO needed, in terms of a target indication?; 3. When is it appropriate to prescribe an EDHO therapy?; 4. Where are EDHO be dispensed, and is a national/regional program a feasible solution to optimize resources?; 5. What is the EDHO of choice, which source and preparation are targeted for a given patient? And further: 1. how is EDHO standardized in terms of processing to ensure an optimal dilution, solvent, dispenser, storage time?; 2. How is EDHO delivered to the ocular surface, in terms of form, dose‐size modulation, length of treatment?

An interdisciplinary work with transfusional medicine specialists is imperative to share information and competences, to achieve a better clinical management.