Jens Rovelt

This systematic review and meta‐analysis aimed to compare aqueous chlorhexidine (AqCHX) with povidone‐iodine (PI) for ocular antisepsis in preventing post‐procedural endophthalmitis (primary outcome) and to evaluate antimicrobial efficacy and patient‐reported pain (secondary outcomes). A systematic search of PubMed, Embase and Web of Science was conducted on 26 November 2024 and updated on 25 June 2025. Randomised controlled trials (RCTs) and non‐randomised studies (NRS) comparing AqCHX with PI for ocular antisepsis were included. Risk of bias was assessed using RoB 2 for RCTs and ROBINS‐I for NRS. Meta‐analyses were conducted using random‐effects models. Endophthalmitis and microbiological culture positivity were reported as odds ratios (ORs), binary pain outcomes as risk ratios (RRs) and continuous pain outcomes as standardised mean differences (Hedges' g), each with 95% confidence intervals (CIs). The certainty of evidence was assessed using GRADE. Eight studies were included, comprising four RCTs and four NRS. Across three large NRS, endophthalmitis rates were low in both groups (0.024% with AqCHX vs. 0.025% with PI), with no statistically significant difference between AqCHX and PI (OR 0.80; 95% CI 0.54 to 1.19; I ² = 0%). For microbiological culture positivity, pooled results from three RCTs and one NRS showed no significant difference between AqCHX and PI (OR 1.06; 95% CI 0.61 to 1.83; I ² = 0%). The risk of pain or pain‐related ocular symptoms was lower with AqCHX than with PI (RR 0.22; 95% CI 0.14 to 0.33; I ² = 0%) and pain intensity also favoured AqCHX, although heterogeneity was substantial (Hedges' g = −1.83; 95% CI −2.54 to −1.13; I ² = 77.3%). Certainty of evidence was rated as moderate across all outcomes. AqCHX showed comparable effectiveness to PI for ocular antisepsis while being associated with better tolerability. However, conclusions regarding endophthalmitis are limited by the reliance on NRS and the very low event rate, leaving uncertainty about the magnitude of any difference between treatments. Further well‐designed, adequately powered studies are needed to clarify their comparative effectiveness and tolerability.

Background: Glaucoma is a progressive, age-related optic neuropathy and a leading cause of irreversible blindness worldwide. Ensuring timely diagnosis and equitable access to surgical care is therefore essential to prevent avoidable vision loss. Methods: Nationwide registry-based data on hospital-based glaucoma diagnoses and surgical procedures over an 11-year period were analyzed and stratified by treatment region and area of residence. Population data were age-stratified to allow calculation of standardized diagnosis and surgery rates per 10,000 population aged ≥ 60 years. Regional comparisons were performed, and demographic projections for populations aged ≥ 60 years were generated using an exponential smoothing state space model. Results: Geographic variation in glaucoma care was observed, despite broadly similar demographic profiles across regions. Surgery-to-diagnosis ratios among individuals aged ≥ 60 years differed markedly between regions. Relevant for future healthcare planning, age forecasting suggests an increase in people aged ≥ 60 years over the coming years. Conclusions: Geographic disparities in glaucoma surgical care may persist even in well-resourced healthcare systems. Centralization of surgical services may contribute to differences, although explanations such as variation in referral patterns and clinical decision-making cannot be excluded. These findings highlight a broader, internationally relevant challenge: aligning glaucoma care delivery with shifting demographic needs.

Purpose: To examine the association between refractive errors and self‐reported visual function and visual concern, considering self‐perceived present eyesight, concerns about vision, accomplishing less and limitations in daily activities in an eye‐healthy cohort. Methods: A cross‐sectional design was used, drawing upon data from a Danish eye and vision cohort, Project FOREVER. Data included refractive measurements and questionnaire responses from participants aged 18 years and above. Logistic regression was applied to investigate the association between self‐reported visual function, visual concern and refractive measurements. Refraction was grouped based on spherical equivalent values. Participants were defined as eye‐healthy without the presence of self‐reported eye disease and a visual acuity of 0.8 or above. Results: Analyses were done on data from 42 741–42 879 participants (considering only complete responses for each model) and showed that high refractive errors (≤ −6 D and ≥ +6 D) were significantly associated with diminished self‐reported visual function and visual concern. High myopia was associated with lower self‐perceived present eyesight (OR = 1.89, 95% CI: 1.69–2.11, p < 0.001), increased vision concerns (OR = 1.78, 95% CI: 1.59–1.99, p < 0.001), reduced self‐perceived accomplishment (OR = 1.14, 95% CI: 1.01–1.28, p < 0.05) and greater vision‐related limitations (OR = 1.44, 95% CI: 1.28–1.61, p < 0.001). High hypermetropia was similarly associated with lower self‐perceived present eyesight (OR = 4.23, 95% CI: 3.05–5.87, p < 0.001), increased vision concerns (OR = 2.15, 95% CI: 1.51–3.07, p < 0.001), reduced self‐perceived accomplishment (OR = 2.83, 95% CI: 1.99–4.01, p < 0.001) and greater vision‐related limitations (OR = 2.78, 95% CI: 1.94–3.97, p < 0.001). Conclusion: The present findings demonstrate a statistically significant negative correlation between high refractive errors and self‐reported visual function as well as decreased visual concern. They provide a new perspective on the impact of high refractive errors and highlight the importance of further research aimed at preventing their development.

Purpose: To examine the association between the presence of dry eye disease (DED) symptoms when using BAK‐preserved artificial tears (AT) compared to preservative‐free AT.Methods: In this cross‐sectional study, we used data collected as part of Project ‘Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability’ (FOREVER). To analyse the strength and direction of associations, we used binomial logistic regression models adjusted for age, sex, smoking and eye diseases. The analysis was conducted on responses regarding AT formulations and seven distinct DED symptoms from 67 951 participants in Project FOREVER, including 8039 AT users.Results: Our analysis showed statistically significant higher odds ratios (ORs) of experiencing itching and blurred vision among users of BAK‐preserved AT compared to preservative‐free AT users, with ORs of 1.26 (95% CI 1.01–1.58) and 1.28 (95% CI 1.02–1.60), respectively. Additionally, a borderline significant trend indicated an increased number of DED symptoms in the BAK‐preserved AT group compared to preservative‐free AT users. Furthermore, our study provided a comprehensive overview of AT usage patterns within the cohort, illustrating the proportion of users for each type of AT.Conclusion: Our findings suggest that BAK‐preserved AT may worsen DED symptoms. We found higher ORs for experiencing itching and blurred vision as well as a tendency towards experiencing a higher number of symptoms when using BAK‐preserved AT compared to preservative‐free AT. Further longitudinal studies with additional questions on AT usage and clinical assessments are needed to validate these findings and optimize AT formulations for safer, effective DED management.

Background: Ocular comorbidity in atopic dermatitis (AD) is known, but ocular surface disease (OSD) symptoms do not always result in a physiciańs diagnosis. Objective: To investigate the occurrence of OSD symptoms and self-reported vision and health in a general population and explore their association with AD. Methods: A cross-sectional questionnaire study using the nationwide population-based FOREVER cohort of Danish adults. The occurrence of OSD symptoms, self-reported vision and health, and their association with AD were investigated using logistic regression models. Results: A total of 57,464 (85%) out of 67,178 participants completed the questionnaire. 1,298 had current AD, 5,198 had a history of AD, and 50,968 never had AD. The occurrence of one or more OSD symptoms was associated with both current (adjusted odds ratio, 1.19; 95% confidence interval, 1.05–1.34; P = 0.006) and previous AD (1.16; 1.09–1.23; P < 0.001), compared to those who never had AD, after adjusting for age, sex, smoking status, and atopic comorbidities (asthma and rhinitis). Participants with current and previous AD also rated their overall health “worse” (1.29; 1.16–1.43; P < 0.001) (1.12; 1.06–1.18; P < 0.001), compared to those who never had AD. Conclusions: The occurrence of OSD symptoms and worse self-rated vision and health are associated with AD in a general population.

Purpose: To characterise the retinal vasculometry of a Danish eye and vision cohort and examine associations with systolic blood pressure (BP), diastolic BP, mean arterial BP, and intraocular pressure (IOP).Design: Longitudinal study.Methods: The retinal vasculature of fundus images from the FOREVER (Finding Ophthalmic Risks and Evaluating the Value of Eye exams and their predictive Reliability) cohort was analysed using a fully automated image analysis program. Longitudinal associations of retinal vessel morphology at follow‐up visit with IOP (baseline and follow‐up) and BP (follow‐up) were examined using multilevel linear regression models adjusting for age, sex and retinal vasculometry at baseline as fixed effects and person as random effect. Width measurements were additionally adjusted for the spherical equivalent.Results: A total of 2089 subjects (62% female) with a mean age of 61 (standard deviation 8) years and a mean follow‐up period of 4.1 years (SD 0.6 years) were included. The mean arteriolar diameter was approximately 20% thinner than the mean venular diameter, and venules were about 21%–23% less tortuous than arterioles. BP at follow‐up was associated with decreased arteriolar diameter from baseline to follow‐up. After adjusting for baseline IOP, IOP at follow‐up was associated with increased arteriolar tortuosity above baseline (0.59%, 95% CI 0.08–1.10, p‐value 0.024).Conclusion: In a Danish eye and vision cohort, variations in BP and alterations in IOP over time were associated with changes in the width and tortuosity of retinal vessels. Our findings contribute novel insights into retinal vascular alterations over time.

Glaucoma is a neurodegenerative disease that affects the retinal ganglion cells (RGCs). The main risk factor is elevated intraocular pressure (IOP), but the actual cause of the disease remains unknown. Emerging evidence indicates that metabolic dysfunction plays a central role. The aim of the current study was to determine and compare the effect of universal hypoxia on the metabolomic signature in plasma samples from healthy controls (n = 10), patients with normal-tension glaucoma (NTG, n = 10), and ocular hypertension (OHT, n = 10). By subjecting humans to universal hypoxia, we aim to mimic a state in which the mitochondria in the body are universally stressed. Participants were exposed to normobaric hypoxia for two hours, followed by a 30 min recovery period in normobaric normoxia. Blood samples were collected at baseline, during hypoxia, and in recovery. Plasma samples were analyzed using a non-targeted metabolomics approach based on liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS). Multivariate analyses were conducted using principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA), and univariate analysis using the Wilcoxon signed-rank test and false discovery rate (FDR) correction. Unique metabolites involved in fatty acid biosynthesis and ketone body metabolism were upregulated, while metabolites of the kynurenine pathway were downregulated in OHT patients exposed to universal hypoxia. Differential affection of metabolic pathways may explain why patients with OHT initially do not suffer or are more resilient from optic nerve degeneration. The metabolomes of NTG and OHT patients are regulated differently from control subjects and show dysregulation of metabolites important for energy production. These dysregulated processes may potentially contribute to the elevation of IOP and, ultimately, cell death of the RGCs.