Jakob Grauslund

Background: Manual diabetic retinopathy (DR) grading may prefer certain regions and underestimate others. It is unclear if inexperienced graders' initial marking strategy reflects a specialist's marking pattern. Aims: By the virtual ocular learning platform (VIOLA), we evaluated if initial DR‐lesion markings among inexperienced graders spatially corresponded to a specialist‐based lesion map. Materials and Methods: We used retinal 6‐field VIOLA images with at least 500 DR‐lesion markings covering all DR‐levels (0–4) according to the international clinical diabetic retinopathy (ICDR) scale. We divided images into quadrants and counted the initial three markings per lesion type, per image, per grader. A retinal specialist served reference for annotation of all DR‐lesions. The primary outcome was difference in spatial distribution of DR‐markings across quadrants relative to the reference, further characterised with spatial metrics. p ‐Value < 0.05 indicated statistical significance. Results: Across 24 images, 97 graders marked 16 925 DR‐lesions: 1633 microaneurysms (MA), 3228 haemorrhages, 1549 hard exudates (HE), 3081 cotton wool spots (CWS), 3844 intraretinal microvascular abnormalities (IRMA), 1832 new vessels (NV) and 1758 panretinal photocoagulation scars (PRP). A difference was observed across all lesion types ( χ ² ‐test, p < 0.001) relative to the reference lesion map. Discussion: Most lesion types demonstrated high sensitivity, but low PPV, indicating a liberal marking approach. Distribution of initial markings from inexperienced graders spatially misaligns with a specialist‐derived lesion map across all lesion types. Conclusion: As the ICDR‐scale depends on identifying the most severe lesion type, systematically inconsistent search strategies may pose a risk for overlooking important lesions under time constraints. The results support the promotion of attention guiding during DR‐training.

Purpose: Diabetic retinopathy (DR) screening is essential to prevent vision loss, yet rising diabetes prevalence threatens to outpace ophthalmology capacity. Artificial intelligence (AI) systems can triage retinal images to reduce clinician workload, but economic evidence from high‐income, tax‐funded health systems remains limited. This study presents a cost‐minimisation analysis (CMA) of clinician grading labour comparing deep‐learning models (DLM)‐assisted screening versus human‐only DR screening. Methods: This CMA evaluates two Danish healthcare settings differing in DR prevalence: In tertiary diabetes centres with DR grade 2–4 prevalence of 41% and in publicly contracted private ophthalmology practices with DR grade 2–4 prevalence of 6%. Costs were estimated from the healthcare‐system perspective over a one‐year horizon, including clinician time and wages for image assessment and verification. Sensitivity analyses explored variations in staff time, DR prevalence, DLM false‐positive rate, and reimbursement effect. Results: In the tertiary‐centre setting (23 696 screens), total annual grading‐labour costs were €282 192 for AI‐assisted versus €421 425 for human‐only screening (33% reduction). In private practice (84 494 screens), the AI‐assisted pathway costs were €569 692 versus €1 502 698 (62% reduction). Savings were driven by reduced ophthalmologist time on cases the DLM classified as DR negative. Across all sensitivity analyses, the AI‐assisted strategy remained cost‐saving. Conclusion: AI‐assisted DR screening was cost‐minimising in both high‐ and low‐prevalence settings within Denmark's tax‐funded health system, with greater savings in lower‐prevalence populations. Tariff structures strongly influence payer impact, suggesting that reimbursement models must align with efficiency gains to realise health‐system savings from AI triage in routine DR screening.

Background This scoping review aims to explore existing clinical trials on the association between semaglutide use and the occurrence of retinal vascular events to detect any potential safety concern. Summary The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. A search was performed across PubMed, Embase via Ovid, ClinicalTrials.gov, and Google Scholar on April 16th, 2025, and Marts 5th, 2026. We aimed to detect clinical trials reporting retinal vascular events while investigating the effect of semaglutide in patients with type 2 diabetes or obesity. Reports on optic ischemic neuropathy were included as a reference outcome, to evaluate whether the method used in the review might be capable of detecting rare ophthalmic vascular adverse events, and thereby a potential safety signal. Key Messages Thirteen randomized clinical trials (predominantly double-blind and placebo-controlled) were included, comparing 17,478 individuals treated with semaglutide and 17,334 placebos. A total of 15 retinal vascular events were reported in the semaglutide groups compared with four events in placebo arms. In large, long-term trials (SELECT, SOUL, FLOW), incidence rates were consistently low but numerically higher in semaglutide-treated patients, ranging from 0 to 0.33 events per 1,000 person-years versus 0 to 0.05 in placebo groups. In trials with active comparators, rates ranged from 0 to 5.99 events per 1,000 person-years in semaglutide groups and 0 to 3.52 in comparator groups. For ischemic optic neuropathies, six events were reported among 11,757 semaglutide-treated patients versus one event among 11,105 placebo-treated individuals; in trials with active comparators, two versus one event were reported. In conclusion, retinal vascular events, especially retinal arterial occlusions, showed a higher pattern of reporting in the semaglutide arm across clinical trials, the majority of which were randomized placebo-controlled-trials. Optic ischemic neuropathies were also found to be higher on the semaglutide-arm. These findings support the need for further investigation through large-scale registry studies.

Purpose: Diabetic retinopathy (DR) is a frequent long‐term complication of diabetes. While hemodynamic changes are known risk factors for DR, the effect of coronary artery bypass grafting (CABG) on the development of DR is poorly investigated. We aimed to examine the short‐ and long‐term effects of CABG on DR development or progression in a national cohort. Methods: This longitudinal, register‐based matched cohort study included individuals with diabetes aged 18 years or older from the Danish Registry of Diabetic Retinopathy (DiaBase). We included individuals with and without CABG in a 1:2 match, based on sex, year of birth, type of diabetes and level of DR. We then evaluated the effect of CABG on short‐ (0–12 months) and long‐term (above 24 months) development and progression of DR in adjusted Cox proportional hazard regression models. Results: Among 3633 individuals in the two groups (median aged 68 years with 82.4% males), CABG was not associated with short‐term development (hazard ratio (HR) 1.14, 95% confidence interval (CI) 0.71–1.82) or progression (HR 1.13, 95% CI 0.75–1.70) of DR. Nor did it result in long‐term development (HR 1.06, 95% CI 0.76–1.49) or progression (HR 1.10, 95% CI 0.78–1.55) of DR. However, the individuals from the CABG group had a lower chance of long‐term DR‐regression (HR 0.56, 95% CI 0.38–0.83). Conclusion: Although CABG is associated with a 44% lower chance of long‐term DR‐improvement, it did not increase the short‐ or long‐term risk of DR development or progression. Hence, we did not find evidence that individuals undergoing CABG should receive additional DR screening postoperatively.

Purpose: Diabetic retinopathy (DR) is a leading cause of blindness in the working‐age population. Screening is essential to identify and treat sight‐threatening stages prior to irreversible visual loss. This study aimed to train and validate an automated algorithm to identify no or minimal DR, potentially saving resources for specialist evaluation. Methods: We included 307 wide‐field images (Optomap, Dunfermline, Scotland) classified by a certified retinal expert according to the International Clinical Diabetic retinopathy (ICDR) scale. The expert manually annotated 26 995 diabetic‐related retinal lesions using the Computer Vision Annotation Tool (CVAT). A segmentation model was trained to detect lesions using a 70/15/15 split for training, tuning, and validation. A classification model used the outputs of the segmentation model as input features for a decision tree classifier, categorizing patients into Group 0 (DR level 0–1) or Group 1 (DR level 2–4). Classifier hyperparameters and input feature selection were optimized based on binary classification performance using cross‐validation. The classifier was evaluated on 48 validation images and further validated with 200 images graded by up to four independent certified graders. Results: The area under the curve was 0.94 for the 48 validation images, with specificity, sensitivity, and kappa values of 0.89, 0.93, and 0.83, respectively. For the 200 expert‐validated images, the values were 0.91, 0.98, 0.82, and 0.79, respectively. Conclusion: The combined method of segmentation followed by feature count analysis shows promising results for binary DR classification in Optomap wide‐field images without requiring a large dataset for model development.

Background: Structural and metabolic changes in the retina may serve as biomarkers in central nervous system disease. Optical coherence tomography studies have shown structural changes in the retina of patients with multiple sclerosis (MS). We aimed to find whether retinal oxygen levels are affected in MS patients and/or eyes with optic neuritis when compared with healthy subjects or unaffected fellow eyes. Methods: We compared oxygen saturation in retinal blood vessels in MS patients and healthy controls. Oxygen saturation of haemoglobin was measured in retinal blood vessels with a spectrophotometric non‐invasive retinal oximeter. Twenty‐nine patients with MS, of whom 12 had a history of optic neuritis, were examined. Data were compared between the affected and non‐affected optic neuritis eyes and 29 healthy individuals in a case‐control study. Results: Retinal vessel oxygen saturation was significantly increased in MS patients compared with healthy controls. Arteriolar saturation was 96.2% ± 3.6% in the MS cohort (mean ± SD, n = 29) and 93.8% ± 3.7% ( n = 29, p = 0.017) in the healthy cohort. Venular saturation was 64.2% ± 5.0% in the MS cohort ( n = 29) and 59.3% ± 6.0% ( n = 29, p = 0.001) in the healthy cohort. Oxygen saturation in retinal venules in MS patients was higher in eyes with known optic neuritis (65.1% ± 4.1%; mean ± SD, n = 10) than in unaffected fellow eyes (62.3% ± 6.3%, p = 0.049). Conclusions: The results suggest that retinal oxygen metabolism is affected in MS patients and optic neuritis. Non‐invasive retinal oxygen imaging may be an objective biomarker in MS and optic neuritis and useful in the study of its pathophysiology. Further studies are needed to confirm and expand these findings.

The global demand for intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) therapy continues to rise, straining ophthalmic capacity worldwide. Task shifting from physicians to trained non‐physician healthcare professionals has emerged as a potential strategy to expand service delivery. This systematic review summarizes current evidence on the safety, implementation, training and patient experiences associated with non‐physician‐delivered intravitreal injection services. We systematically searched 13 scientific literature databases for studies of anti‐VEGF injections performed by non‐physicians. Data were extracted on safety outcomes, implementation, training, supervision and patient‐reported experience. Results from individual studies were qualitatively reviewed according to these four organizational themes. Sixteen studies comprising 100 150 injections were included, primarily from the United Kingdom and Scandinavia. All injectors completed structured training under an ophthalmologist's supervision. Complication rates were very low, including 0.015%–0.07% for endophthalmitis which were comparable to physician‐led benchmarks. Implementation of non‐physician‐delivered intravitreal injection services increased clinical capacity by 25%–85%, reduced waiting times and costs, and maintained safety and efficiency. Patients reported high satisfaction, confidence and acceptance of non‐physician‐delivered injections. Non‐physician‐delivered intravitreal injection services are safe, feasible and well accepted when supported by structured training and robust governance frameworks. This task‐shifting model offers a scalable solution to meet growing global demand for anti‐VEGF therapy. Standardized international training and certification frameworks may further enhance safety and sustainability.