Alexander Karl-Georg Schuster

Myopia is a childhood-onset condition driven by excessive axial ocular elongation, associated with increased risk of sight-threatening complications and irreversible visual impairment. Despite rising global prevalence, epidemiological data on long-term trends in Europe remain limited. This study examines temporal trends in myopia prevalence and axial length (AL) across European adult birth cohorts. We conducted a comparative birth-cohort analysis using harmonised data from 28 population-based studies (n = 81,828) across nine countries participating in the European Eye Epidemiology (E3) Consortium. Myopia prevalence (overall, by severity, and sex) were estimated using individual participant data random-effects meta-analysis. AL distributions were assessed by estimating percentiles across birth cohorts. Myopia prevalence more than tripled across 20th-century birth cohorts, rising from 18.0% (95% confidence interval [CI]: 15.2%, 21.3%) in the 1900s to 61.4% (95% CI: 55.5%, 66.9%) in the 1990s (p < 0.001), with increased prevalence across all severity levels. Standardised to the 2024 European population, myopia prevalence was estimated at 42.7% (95% CI: 40.2%, 45.1%). Myopia prevalence was similar between males and females overall. AL was longer in successive decades (1920–1970) across all population centiles (p < 0.001), indicating a population-wide shift. Myopia prevalence and AL have increased markedly across European birth cohorts throughout the twentieth century, affecting all severity levels and both sexes. These findings underscore the importance of preventive strategies targeting modifiable environmental risk factors, alongside continued evaluation of interventions intended to slow myopia progression, as continued increases may strain healthcare systems and society.

The choroid is critical for maintaining vision and implicated in several ocular diseases, being the sole source of nutrients and waste removal for the outer retina. Genetic discovery can help elucidate the pathways through which choroidal features influence disease risk. Our meta-analysis of genome-wide association studies (n= 78,682 participants) identified 30 genomic regions, including 20 novel loci, associated with choroidal thickness. Findings suggest inflammatory and vascular processes drive choroidal thickness, with overlapping mechanisms shared with refractive error. Genome-wide independently significant SNPs accounted for 18.7% of the genetic variance in choroidal thickness. Mendelian randomisation analyses showed a causal effect of age-related macular degeneration on choroidal thickness, and suggest a bidirectional causal effect between choroidal thickness and primary angle-closure glaucoma. These findings provide insight into the shared genetic architecture and biological pathways linking choroidal thickness and related diseases.

Objectives: Children with large optic discs are frequently referred to as glaucoma suspects. The aim of this study was to longitudinally analyze and compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and minimum rim width (BMO-MRW) of large optic discs in children (LOD-C), normal sized optic discs in children (NOD-C) and large optic discs in adults (LOD-A) in order to evaluate longitudinal structural stability and intergroup differences in optic nerve head morphology. Methods: Briefly, 85 LOD-C, 72 NOD-C and 78 LOD-A were included. Large optic discs were identified based on a Bruch’s membrane opening (BMO) area threshold of ≥2.5 mm². pRNFL thickness and minimal rim width (BMO-MRW) of optical coherence tomography (OCT) were compared between baseline and follow-up examination at a median of 1.4 [1.0; 2.5] years. Results: Mean global pRNFL thickness and BMO-MRW did not significantly change during the follow-up period. LOD-C showed a significant increase in pRNFL thickness in the superonasal segments, NOD-C in the nasal segments. pRNFL and BMO-MRW of LOD-A decreased during the follow-up period. However, there was a higher variance of pRNFL thickness change in LOD-C as compared with NOD-C in the superotemporal and inferonasal segments. Four optic discs in the LOD-A group showed a glaucomatous conversion, whereas none of the discs of LOD-C or NOD-C progressed to glaucoma. Conclusions: Children with large optic discs presented with stable pRNFL and BMO-MRW and without clinical progression to glaucoma at follow-up. A careful interpretation of the OCT measurement results is necessary when assessing pediatric large optic discs, as growth and remodelling may impair the accuracy of segmentation and automated classification algorithms.

Background/aims: Childhood myopia is a growing global concern, associated with significant burdens. This study aimed to identify evidence gaps and unmet needs in childhood myopia management through a European Delphi panel involving eye care professionals (ECPs) with expertise in childhood myopia management and payers (ie, individuals with experience in health technology assessment, healthcare funding, drug pricing and/or reimbursement decisions). Methods: A modified Delphi method was employed, involving two rounds of online questionnaires followed by a final virtual workshop. The panel included 12 ECPs and 13 payers from seven European countries. Consensus was defined as ≥70% agreement among panellists. Results: Consensus was achieved on all 37 statements across six categories: disease background, clinical burden, psychosocial/humanistic burden, economic burden, treatment options and unmet needs. Key findings included recognition of ethnicity and age as crucial factors in evaluating childhood myopia, as well as the minimal clinically important difference for progression reduction. The panel emphasised the need for long-term studies on the efficacy and safety of myopia treatments, especially their impact on reducing future complications. The impact of high myopia on quality of life and economic burden was also highlighted. Regarding unmet needs, despite some known factors, the exact mechanisms behind myopia development remain unclear. There is a need for comprehensive epidemiological data on European childhood myopia and regulatory-approved pharmacological treatments in Europe. Conclusions: Consensus was reached among European ECPs and payers on the evidence gaps and unmet needs in childhood myopia management. These findings can guide future research to establish the best strategies for childhood myopia management and mitigate the burden.

Glaucoma is a leading cause of irreversible blindness in Africa, with disease burden exacerbated by limited access to eye care, shortages of trained ophthalmologists, and socioeconomic disparities. This review synthesizes prospective and interventional studies evaluating glaucoma management modalities and associated clinical outcomes in an African population. Trabeculectomy remains the predominant surgical intervention, achieving success rates of approximately 80%, with enhanced outcomes when augmented with anti-metabolites such as mitomycin-C or 5-fluorouracil. Laser-based interventions, including selective laser trabeculoplasty and transscleral cyclophotocoagulation, demonstrate moderate to high efficacy in reducing intraocular pressure, while nonpenetrating surgeries such as deep sclerectomy, viscocanalostomy, and canaloplasty provide substantial pressure reduction with fewer complications. Pediatric interventions, notably goniotomy, show efficacy in lowering intraocular pressure, although region-specific evidence remains limited. Evidence on pharmacological intervention remains scarce, fragmented, with high rates of non-adherence frequently reported, highlighting the need for rigorously-designed outcome-oriented studies to inform clinical practice. Adoption of newer surgical and laser techniques is constrained by cost, limited equipment, and insufficient subspeciality expertise. Improving glaucoma outcomes in Africa will require strategic expansion of access to effective treatments, strengthen local surgical capacity, and prioritize evidence-based research. Collectively, these efforts will provide a more robust framework to optimize glaucoma management and reduce the burden of irreversible blindness across the continent.

Objectives: This study aims to analyze the association between systemic inflammation and clinical outcomes in patients with macular edema secondary to retinal vein occlusion (RVO). Methods: A retrospective analysis of 68 patients with acute RVO, in whom cardiovascular risk factors were assessed, was conducted. Laboratory determinations included levels of C-reactive protein (CRP) and homocysteine to explore the systemic inflammatory status. Optical coherence tomography (OCT) parameters and visual acuity (LogMAR) were collected at baseline. Follow-up visual acuity was determined after 12 months. The number of intravitreal anti-VEGF injections and the performed laser treatment were assessed after 12 and 24 months. Associations of inflammatory markers with clinical outcomes were analyzed by correlation analysis, and patients with or without evidence for inflammation were compared. Results: At baseline, the mean foveal retinal thickness (FRT) was 591 ± 277 µm, the mean average central retinal thickness (CRT) was 580 ± 227 µm, and the mean average central retinal volume (CRV) was 12 ± 3 mm³. The level of CRP at baseline was significantly associated with increased FRT, average CRT, and average CRV (p = 0.024; p = 0.027; p = 0.003). CRP levels were also associated with a lower BCVA at baseline and after 12 months (p = 0.018; p = 0.006). In patients with elevated homocysteine levels, a trend towards a higher number of required laser treatments was observed. No association between increased inflammatory parameters and the number of required intravitreal injections was detected. Conclusions: Systemic inflammation is associated with the severity of macular edema secondary to RVO. CRP concentrations could represent a prognostic marker for the course of the patient’s visual acuity.