Anna Stage Vergmann

Purpose: To investigate the association between accelerated biological ageing, measured by Phenotypic Age (PhenoAge) and PhenoAge Acceleration (PhenoAgeAccel), and features of early and intermediate age‐related macular degeneration (AMD) in a population‐based cohort. Methods: This cross‐sectional study used data from the National Health and Nutrition Examination Survey. Biological age was estimated using the PhenoAge algorithm, a composite of routine blood biomarkers and chronological age, and PhenoAgeAccel was defined as the residual from regression of PhenoAge on chronological age. Retinal outcomes were drusen ≥500 μm (primary outcome), drusen ≥125 μm and pigmentary abnormalities. Associations were evaluated using logistic regression adjusted for biological sex, race/ethnicity, smoking, body mass index and diabetes. Results: A total of 5322 participants were included (mean age 59.4 ± 12.4 years; 50.4% female). Drusen ≥500 μm were present in 4.1%, drusen ≥125 μm in 10.2% and pigmentary abnormalities in 5.6%. PhenoAgeAccel > + 3 years was associated with higher odds of drusen ≥500 μm (OR: 1.56, 95%CI: 1.07–2.27, p = 0.022), whereas no association was observed for <−3 years. Each 1‐year increase in PhenoAgeAccel was associated with higher odds of drusen ≥500 μm (OR: 1.02, 95%CI: 1.00–1.04, p = 0.022). PhenoAgeAccel > + 3 years was also associated with drusen ≥125 μm (OR: 1.29, 95%CI: 1.00–1.65, p = 0.049), but not with pigmentary abnormalities. Conclusion: Accelerated biological ageing was associated with increased drusen burden, but not pigmentary abnormalities, suggesting that early structural features of AMD may reflect broader systemic ageing processes.

Purpose: This study characterized and assessed vision‐related quality of life (VRQoL) in patients with neovascular age‐related macular degeneration (nAMD) who discontinued treatment with intravitreal anti‐vascular endothelial growth factor (anti‐VEGF), comparing them to those undergoing treatment. Secondarily, it explored reasons for treatment discontinuation against medical advice. Methods: This survey‐based cross‐sectional study used data collected for the Danish study, “Identification of Patient‐Reported Barriers in Treatment for nAMD” (I‐OPTA) at Odense University Hospital, Denmark. I‐OPTA included a self‐developed questionnaire and the National Eye Institute Visual Function Questionnaire‐25 (NEI‐VFQ‐25). Main outcomes were demographics, treatment details, NEI‐VFQ‐25 scores, and reasons for treatment discontinuation against medical advice. Linear regression models investigated the impact of variables on the composite NEI‐VFQ‐25 score. Results: The study included 172 (32.6%) patients who had discontinued treatment and 356 (67.4%) patients who were undergoing treatment; 10 (5.8%) discontinued against medical advice. Discontinued patients were older (median 81.0 years, p ‐value = 0.004), had lower best‐corrected visual acuity (BCVA) in the worse‐seeing eye ( p ‐valuep ‐value = 0.001) and lived alone ( p ‐value = 0.044). Discontinued patients showed lower scores in all NEI‐VFQ‐25 domains except ocular pain. Higher BCVA correlated with a higher composite score of NEI‐VFQ‐25. Reasons for discontinuation against medical advice included treatment burden and perceived inefficacy. Conclusion: Patients who discontinued treatment for nAMD report lower VRQoL, with lower BCVA in the worse‐seeing eye, older age, living alone, and unilateral treatment possibly contributing to treatment discontinuation. Future studies on visual acuity and retinal fluid in this group could guide decisions on treatment discontinuation, emphasizing patients' quality of life.

Purpose: To define the curriculum content for two interactive learning courses on age‐related macular degeneration (AMD): (1) an advanced course tailored for general ophthalmologists and (2) a basic course for non‐ophthalmologist healthcare staff. This initiative aims to establish a national consensus on the educational framework for AMD management among general ophthalmologists in Denmark. Methods: We conducted a three‐round Delphi study. The Delphi panel consisted of 33 ophthalmologists (28 retinal specialists from Denmark and five internationally recognized retinal specialists), eight non‐ophthalmologist healthcare staff (six optometrists, one ophthalmic nurse and one clinic assistant) with experience in managing patients with AMD. To ensure national representation, we recruited panel participants from all five Danish regions. Results: Response rates were 85%, 73% and 71% for Delphi rounds 1, 2 and 3, respectively. In the first round, participants suggested a total of 390 potential curriculum components and learning goals: 211 components for the advanced course and 179 for the basic course. After the third round, the panel reached consensus on an AMD curriculum, which included 46 topics for the advanced course (e.g., OCT interpretation: signs of disease activity versus atrophic changes) and 15 topics for the basic course (e.g., visual requirements for driving). Conclusion: This study reached consensus on the curricula for courses on AMD for general ophthalmologists and non‐ophthalmologist healthcare staff. This forms the basis for developing instructional, virtual, interactive courses that can support the development and maintenance of competencies related to AMD, both in Denmark and abroad.

Rationale In 2023, the U.S. Food and Drug Administration approved pegcetacoplan (SYFOVRE) as the first therapeutic option for geographic atrophy (GA), a previously untreatable condition associated with age-related macular degeneration. Following this, avacincaptad pegol (Izervay) was also approved for GA treatment, further expanding therapeutic options. Objectives This article aims to give an overview of the clinical outcomes of GA treatment and to discuss which patient groups may benefit most from these therapies. Methods A review of the literature was conducted using the databases PubMed, Cochrane Library, and ClinicalTrials.gov. The search yielded six relevant studies. Conclusions The management of geographic atrophy has advanced with therapies like pegcetacoplan and avacincaptad pegol showing clear benefits in slowing lesion growth. However, safety concerns, such as neovascular complications, persist. Photobiomodulation and dietary supplementation provide alternative options with modest benefits, particularly in the early stages. Larger studies are needed to confirm long-term safety, efficacy, and optimal treatment strategies.

Background: Diabetic macular edema (DME) is a prevalent exudative maculopathy, and anti-vascular endothelial growth factor (anti-VEGF) therapy is the first-line choice for treatment. Faricimab, a novel anti-VEGF and anti-angiopoietin-2 bispecific agent, has recently been approved for the treatment of DME. In this study, we systematically reviewed the real-world evidence of the efficacy of faricimab for the treatment of DME. Methods: We searched 11 databases for eligible studies. Study selection and data extraction were made independently by two authors in duplicate. Eligible studies were reviewed qualitatively. Results: We identified 10 eligible studies that summarized data from a total of 6054 eyes with a mean follow-up of between 55 days and 12 months. Five studies reported outcomes in a population of both treatment-naïve and previously treated eyes, and five studies reported outcomes exclusively in relation to eyes that were previously treated. Faricimab improved the best-corrected visual acuity and macular thickness. The extension of the treatment interval was possible in 61–81% of treatment-naïve eyes and 36–78% of previously treated eyes. Conclusions: Faricimab for DME yields clinical outcomes similar to those known from previous anti-VEGF treatments but with extended treatment intervals, thus lowering the burden of therapy for patients. Long-term real-world studies are warranted.

Many important abnormalities of the vitreous, retina and choroid are predominantly located in the peripheral retina. In some retinal diseases with both central and peripheral manifestations, pathological structural or vascular changes can be apparent in the periphery before they are detectable in the central retina. Conventional optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) imaging only cover the most posterior 30° of the retina. Wide-field OCT (WF-OCT), though offering detailed cross-sectional imaging of the peripheral retina, is not yet systematically used in clinical practice. This narrative review provides a presentation of the utilisation of WF-OCT and WF-OCT-A in the diagnosis and monitoring of a variety of ophthalmological diseases and discusses the advantages and limitations of the technology. With the rapidly developing technology, multiple WF-OCT and WF-OCT-A devices are now commercially available and enable the clinician to obtain scans within a field of view up to 200°. As detailed in this review, several studies have shown promising results in the application of WF-OCT and WF-OCT-A in diseases of the retina, choroid and vitreous, such as retinal vein occlusion, diabetic retinopathy, ocular oncology, paediatric ophthalmology, uveitis and lesions of the vitreo–retinal interface. In conclusion, WF-OCT and WF-OCT-A can reliably produce high-quality, non-invasive images of the vitreous, retinal, and choroidal structures and vascularity covering the posterior pole as well as the mid and far periphery. These methods can be a valuable part of a multimodal imaging approach in the management of a variety of ocular conditions. Future studies are warranted to investigate the patient outcome benefits of implementation of WF-OCT and WF-OCT-A imaging in a real-life clinical setting.

Purpose: To investigate whether individuals with long‐term reduced stereopsis were able to obtain the same level of surgical skills in simulated vitreoretinal surgery on the Eyesi Surgical Simulator as individuals with normal stereopsis. Methods: Twenty‐four medical students were recruited and divided into two groups according to their degree of stereopsis: Group 1 ( n = 12) included subjects with normal stereopsis (60 arcsec or lower) and Group 2 ( n = 12) included subjects with reduced stereopsis (120 arcsec or higher). Stereopsis was tested using the TNO test (Lameris Ootech BV, Nieuwegein, the Netherlands). The participants were trained in virtual reality‐simulated vitreoretinal surgery and continuously measured using a test with solid validity evidence and a pre‐defined pass–fail score. All data were analysed using the Wilcoxon rank sum test. Results: We observed no differences in overall performance scores for any of the four modules. The participants with reduced stereopsis used 5.8 more attempts in bimanual training ( p = 0.04), 8.8 more attempts in removal of posterior hyaloid ( p = 0.04), 9.1 more attempts in navigation training ( p = 0.20) and 0.3 fewer attempts in removal of internal limiting membrane ( p = 0.69). Conclusion: The final performance scores on the Eyesi Surgical Simulator were independent of the degree of stereopsis. However, the number of attempts to achieve the pre‐defined pass–fail score increased significantly with reduced stereopsis in two of four modules. These results indicate that a high degree of stereopsis is not necessary to become proficient in microsurgery but may prolong the learning curve.

The port delivery system (PDS) of anti-VEGF therapy provides continuous delivery of ranibizumab (RBZ). In October of 2021, the American Food and Drug Administration (FDA) approved the PDS with RBZ as a treatment option for neovascular age-related macular degeneration (nAMD). As the field of PDS with RBZ is progressing rapidly, this narrative review provides a much-needed overview of existing clinical trials as well as ongoing and upcoming trials investigating PDS with RBZ. The phase 2 LADDER trial reported that the mean time to first refill with RBZ PDS 100 mg/ml was 15.8 months (80% CI 12.1–20.6), and pharmacokinetic profiling revealed a sustained concentration of RBZ in serum and aqueous humor. Later, the phase 3 ARCHWAY trial reported that PDS with RBZ (100 mg/ml) refilled every 24 weeks was non-inferior to monthly intravitreal injection (IVI) with RBZ (0.5 mg) in patients with nAMD over 9 months and 2 years. However, patients with PDS had a higher rate of adverse events including vitreous hemorrhage and endophthalmitis. Patients indicate high treatment satisfaction with both PDS and IVI, but the lower number of treatments with PDS was reported as a preferred choice. Several ongoing and future clinical trials, of which details are discussed in this paper, are further exploring the potentials of PDS with RBZ. We conclude that the PDS provides continuous deliverance of RBZ and that clinical efficacy levels are non-inferior to IVI therapy for nAMD. Yet, a higher rate of adverse events remains a concerning detail for widespread implementation. Future studies are warranted to better understand which patients may benefit best from this treatment approach, if long-term efficacy can be sustained, and if safety of PDS can be further improved.