Louise O'TOole

To investigate the relationship between posterior vitreous detachment (PVD) status and fibrovascular membrane (FVM) angio-fibrotic transformation following anti-VEGF therapy in advanced proliferative diabetic retinopathy (PDR), and their combined impact on disease progression and visual outcomes. This prospective real-world study enrolled 165 treatment-naïve PDR patients with vitreous hemorrhage (VH) and FVM who received intravitreal anti-VEGF injection followed by panretinal photocoagulation(PRP) when possible. PVD status and FVM characteristics were monitored during a median follow-up of 13.0 months. Cox proportional hazards and Kaplan-Meier analyses evaluated factors influencing visual prognosis and timing of surgical intervention. FVM fibrosis occurred in 43% of patients, with distinct PVD-dependent patterns: predominantly in complete PVD cases, moderately in partial PVD, and rarely without PVD. Multivariate analysis identified macular involvement as the strongest risk factor for poor visual outcomes (HR=3.65), while PVD (HR=0.37) and FVM fibrosis (HR=0.023) were strongly protective. Patients with both PVD and FVM fibrosis maintained stable vision longest (median 28.5 months) and demonstrated significantly longer surgery-free survival (28.3 months) compared to those without either condition (3.2 months, p<0.0001), who frequently presented with vitreoschisis and recurrent VH disproportionate to visible FVM grade. PVD status critically determines the clinical manifestation and prognosis of post-anti-VEGF FVM fibrosis in PDR. This PVD-dependent pattern challenges the conventional view that FVM fibrosis inevitably leads to “Crunch syndrome” and creates a risk stratification framework that can guide individualized surgical timing decisions, potentially improving functional outcomes in advanced PDR.

Response to Letter in regards to Addressing Technical Failures in a Diabetic Retinopathy Screening Program [Letter]

Purpose: Diabetic retinopathy (DR) is a preventable cause of blindness detectable through screening using retinal digital photography. The Irish National Diabetic Retina Screening (DRS) programme, Diabetic RetinaScreen, provides free screening services to patients with diabetes from aged 12 years and older. A technical failure (TF) occurs when digital retinal imaging is ungradable, resulting in delays in the diagnosis and treatment of sight-threatening disease. Despite their impact, the causes of TFs, and indeed the utility of interventions to prevent them, have not been extensively examined. Aim: Primary analysis aimed to identify factors associated with TF. Secondary analysis examined a subset of cases, assessing patient data from five time points between 2019 and 2021 to identify photographer/patient factors associated with TF. Methods: Patient data from the DRS database for one provider were extracted for analysis between 2018 and 2022. Information on patient demographics, screening results, and other factors previously associated with TF were analyzed. Primary analysis involved using mixed-effects logistic regression models with nested patient-eye random effects. Secondary analysis reviewed a subset of cases in detail, checking for causes of TF. Results: The primary analysis included a total of 366,528 appointments from 104,407 patients over 5 years. Most patients had Type 2 diabetes (89.2%), and the overall TF rate was 4.9%. Diabetes type and duration, dilate pupil status, and the presence of lens artefacts on the camera were significantly associated with TF. The Secondary analysis identified the primary cause of TF was found to be optically dense cataracts, accounting for over half of the TFs. Conclusion: This study provides insight into the causes of TF within the Irish DRS program, highlighting cataracts as the primary contributing factor. The identification of patient-level factors associated with TF facilitates appropriate interventions that can be put in place to improve patient outcomes and minimize delays in treatment and diagnosis.

Background The Age-Related Eye Disease Study 2 (AREDS 2) proved the benefit of vitamin and mineral supplementation in preventing advanced age-related macular degeneration (AMD). AREDS 2 supplements are indicated for patients with either bilateral intermediate AMD (AREDS category 3) or unilateral neovascular AMD (AREDS category 4). Aims The aims of this telephone survey were to identify the rate of adherence of patients to AREDS 2 supplements and the factors associated with non-compliance in these patient groups. Methods A patient telephone survey was conducted in an Irish tertiary care hospital. Patients were identified by chart review, and their AREDS categorization was reconfirmed. A telephone consultation was conducted with each patient to assess their compliance with the micronutrient supplements. Results We identified 120 patients who met the AREDS criteria for supplementation. Of these, 103 patients were graded as category 4, and 17 patients were graded as category 3. Almost a fifth (18%) were current smokers. Under two-thirds (60%) of the patients were taking AREDS 2 supplements. Of the remainder, 83% of patients did not recall being advised of their benefit. The cost was cited by 10% of patients as a reason for non-compliance. Conclusion The ophthalmologist not only has a duty of care to treat the neovascular complications of AMD, but they must also strive to improve patient compliance with AREDS supplements. The cessation of smoking needs to be actively promoted in order to stop preventable vision loss in patients with AMD.

Background: The annual conference of the Irish College of Ophthalmologists (ICO) is a key calendar event for ophthalmology research in Ireland. Aims: We investigated whether there were identifiable trends across various domains for the last twelve ICO meetings. Our objectives were to assess subspeciality and training centre representation, as well as the characteristics of the first author to include gender and stage of training. Methods: A retrospective analysis of paper and poster presentations from the ICO annual conference yearbooks was conducted. The representation of subspecialties, affiliated institutions, and gender distribution were noted for both categories. For paper presentations, the author’s career stage, full-text publication rates, and impact factors were also determined. Results: A total of 306 paper presentations and 306 poster presentations were analysed. The subspecialty of retina had the highest representation within both sections. The overall mean publication rate was 38% (range, 6–39%), with a mean journal impact factor of 2.02. No statistically significant differences in gender noted with regard to poster, paper, or publications (p < 0.9, p < 0.1, p < 0.7, respectively). Conclusions: This is the first review of all research contributions to the ICO conference. We found that there is a need to promote research in some underrepresented subspecialities and training centres. No significant gender bias was found. There is scope to improve the publication conversion rate; this would allow for greater dissemination of the research presented at the ICO meeting.