Type of publication:

Conference abstract

Author(s):

*Sanjana E.; *Ball E.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 305-306), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Certification of visual impairment (CVI) provides an indication of the incidence of sight loss. In England, between 2022/2023, there were 20,330 new CVI registrations, a three percent decrease compared to 2019/20. CVI involves individuals being registered as sight impaired (SI) or severely sight impaired (SSI) and is determined by the patient's visual acuity and visual field defect severity. This study aimed to provide an indicator of the number of patients seen in the primary care setting who were referred to the Hospital Eye Service (HES) between 01 July 2023 and 31 July 2024, without receiving CVI. Method(s): A retrospective study that analysed 680 new patients, assessed between July 2023 and July 2024, was retrieved via the Trust's electronic clinical noting software, Medisightc, to identify the number of patients who were referred to ECLO for CVI registration at their first appointment with the Doctor. All patients referred via community ophthalmic services or community optometrists with advanced glaucomatous visual field loss were included within this study and their demographics, including age and sex, family history, referral pathway, visual acuity, intraocular pressure (IOP) measurements, cup-disc ratios (CDR), mean deviation values for visual field defects with corresponding severity grading, glaucoma diagnosis and CVI severity (SI or SSI) were analysed. Each patient's visual field defect severity grading was determined by utilising the Hodapp-Parrish- Anderson (HPA) Visual Field Criteria of Glaucoma Severity. Three patients were excluded from this study due to their preexisting comorbidities rendering them unsuitable for inclusion, such as AMD and retinal vascular diseases. One patient suffered from advanced dementia, so visual field testing was not possible. However, this patient's presenting IOP and disc appearance was sufficient to stage the severity of their glaucoma. Result(s): Among the 680 new patients assessed within HES, between 01 July 2023 and 31 July 2024, 3% (n =20) were referred to ECLO services for CVI. The average patient age was 77 years old and 55% (n =11) of the 20 patients who received CVI were male. Furthermore, among the 20 patients analysed within this study, 35% (n =7) were referred without receiving CVI by Community Health Eye Care (CHEC), 55% (n =10) were referred by their community optometrist and 10% (n =3) were referred internally by an ophthalmologist. All patients included within this study presented with a CDR of 0.8 or worse in at least one eye. Consequently, only 15% of patients were recorded as having moderate VF damage in their right eye, compared to 70% of patients having severe VF damage in their right eye. Comparatively, only 5% of patients suffered moderate VF damage in their left eye, opposed to 85% suffering from severe VF damage. 6 patients were certified as SI and all remaining were severely sight impaired. Eighty five percent of patients were diagnosed to have POAG (n =17). Ten percent were diagnosed to have NTG (n =2) and one patient was diagnosed with aqueous misdirection. Conclusion(s): CVI is a means of identifying patients in need of support and social care and it is an important health indicator to the local and national level in the United Kingdom. Health policies prioritise prevention and CVI data provides information on preventable causes of blindness. The incidence of SI or SSI is an indicator of the effectiveness of policies and the need for reforms. Visual impairment from glaucoma is asymptomatic, unlike other causes, such as Age-Related Macular Degeneration and Diabetic Retinopathy. Improved patient education, robust screening programmes within the community setting and strengthening the workforce and health infrastructure at different tiers of healthcare is the need of the hour. The role of timely referral to the HES, awareness amongst health professionals on the benefits of CVI registration and a continuous dialogue between the community and HES cannot be over-emphasised.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Sathiaraj S.; Mahon E.; Hanumunthadu D.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 243), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Central Serous Retinopathy (CSR) is a common retinal condition that primarily affects young individuals, characterised by fluid accumulation beneath the retina, leading to blurred vision and potential long-term retinal damage. Traditionally, CSR has been managed through observation, with treatments like photodynamic therapy (PDT) and laser therapy carrying the risk of central vision damage, particularly with repeated use. This study investigates the efficacy of sub-threshold PASCAL laser therapy in CSR, comparing outcomes across grid, focal, and combined laser treatments. Additionally, the study explores whether this treatment provides a solution to the visual disturbances and anxiety related to potential vision loss in young patients, addressing both clinical outcomes and patient quality of life. The study will also suggest an appropriate technique of using grid format of subthreshold laser with Landmark settings on the PASCAL laser. Method(s): Inclusion: 50 patients from each centre with confirmed diagnosis of CSR on FFA/ICG Exclusion: AMD/ other macular, retinal and Optic nerve disease were excluded to reduce bias in outcome Methodology: All patients with confirmed diagnosis had Vision, OCT done at every visit- Baseline, 1, 3 and 6-12 months. It also included a shorts PROMS questionnaire at the end of treatment. Patients were treated with focal, grid and combined approach on PASCAL laser and results were subgrouped. Focal treatment was applied to point of leak on dye test and grid was applied to the pachychoroid seen on OCT and fundoscopy imaging PROMs explored subjective vision, visual symptoms post laser and satisfaction level on a scale of 1-10. Hypertension, use of steroids and type of personality were explored in the study. Technique of laser: Grid approach combining the OCT for pachychoroid spectrum and Colour fundus to visualise dilated choroid. Will be described with fundus photos in future if approved. The use of landmark laser in sub threshold will be elaborated in detail. Result(s): Our findings suggest that subthreshold PASCAL laser therapy is a safe and effective alternative, offering significant benefits for patients with chronic or recurrent CSR by minimizing the risk to central vision. The results show that sub-threshold laser treatment led to significant reduction in subretinal fluid, as confirmed by OCT imaging. At 6 months, 85% of patients demonstrated complete or near-complete resolution of subretinal fluid. Visual acuity improved in 78% of patients, with a mean improvement of 2 lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Recurrence rates were lower with only 12% of patients experiencing a reoccurrence of CSR within the follow-up period. No significant retinal damage or vision-threatening complications were observed in any patient. PROMS reinforced the above outcome. The results also explore and make suggestion on the correct use of grid and focal laser in this pachychoroid spectrum disease. It emphasises on the correct technique of use of sub threshold grid laser using colour fundus and OCT scans. Conclusion(s): PASCAL sub threshold laser using the modality of focal and grid laser can be used to address CSR effectively. Sub-threshold laser therapy is a promising and safe treatment option for patients with chronic or recurrent CSR. It provides a non-invasive approach that offers significant improvement in retinal fluid resolution and visual acuity, with a low risk of complications. Further long-term studies are needed to confirm the durability of these results and to refine treatment protocols for optimal patient outcomes.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Williams K.; Iqbal N.; *Sathiaraj S.; *Jha N.;

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 241), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Meta-Analysis to address and bridge the gap in current NHS Guidelines on the Use of Continuous Glucose Monitors (CGM) in Type 1 and Type 2 Diabetes with Significant Retinopathy The current NHS England guidelines allow the use of CGM for patients with Type 1 diabetes who meet certain criteria such as: Frequent episodes of severe hypoglycaemia or hypoglycaemia unawareness. Frequent hospital admissions for hypoglycaemia. Pregnant women with Type 1 diabetes. Children and young people with Type 1 diabetes who may benefit from continuous monitoring. Type 2 diabetes patients may also be eligible for CGM, particularly those who have difficulty managing their blood glucose or are on insulin therapy, though this may require a referral to a specialist. Method(s): This meta-analysis includes randomised controlled trials (RCTs), cohort studies, and observational studies from 2015 to 2023 involving T1DM and T2DM patients with significant retinopathy. A total of 12 studies were selected, with sample of 1200 participants (600 T1DM and 600 T2DM). Data focused on three key outcome measures: Visual outcomes: Retinopathy progression and visual acuity changes. Glycaemic control: HbA1c levels, time in range, glucose variability. Lifestyle changes: Dietary adherence, physical activity, and quality of life Inclusion Criteria Adults with T1DM or T2DM and significant retinopathy as determined by ophthalmological examination. CGM use as part of diabetes management. Result(s): The studies included a mix of RCTs (5 studies) and cohort studies (7 studies), totalling 1200 participants, with an average age of 58 years and diabetes duration of 15 years. The mean baseline HbA1c across studies was 8.3%. Retinopathy Progression: CGM was associated with a 30% reduction in the risk of retinopathy progression compared to conventional blood glucose monitoring (p =0.02). This reduction was particularly significant in patients with moderate to severe retinopathy, supporting previous findings from the Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS), which demonstrated that tight glycaemic control slows retinopathy progression in T1DM and T2DM patients (DCCT Research Group, 1993; UKPDS Group, 1998). Visual Acuity: Those with HbA1c levels below 7% showed a trend toward stabilization or slight improvement in visual acuity (p =0.08), suggesting that effective glycaemic management through CGM may help preserve vision in individuals with DR (Wong et al., 2016). Retinal Imaging: Retinal imaging revealed improvements in retinal microvascular health in 18% of CGM users, compared to only 8% in the control group (p =0.05), supporting the hypothesis that tighter glucose control helps prevent further retinal damage (Simo et al., 2014). Glycaemic Control: HbA1c: The use of CGM resulted in a significant reduction in HbA1c (mean reduction of 0.9%), improving glycaemic control (Heinemann et al., 2015). Time in Range: CGM users spent 71% of the day within the target glucose range (70-180 mg/dL) compared to 55% in the control group (p < 0.001), aligning with findings from other studies indicating that CGM increases time in target range and reduces glucose variability (Bergenstal et al., 2018). Glucose Variability: CGM users showed a 14% reduction in glucose variability (measured by standard deviation), highlighting the role of CGM in minimizing glycaemic fluctuations (p =0.03)(Rodriguez et al., 2017). Lifestyle Changes: Dietary Habits: Patients using CGM reported better dietary adherence, with 65% following recommended dietary guidelines, compared to 52% in the control group (p =0.01). This is consistent with evidence that CGM promotes better diabetes self-management by providing real-time feedback on the effects of food on blood glucose levels (Vigersky et al., 2012). Physical Activity: CGM users increased their weekly physical activity by 22%, compared to 12% in those using SMBG (p =0.04). Quality of Life: Patients using CGM reported improved quality of life, including reduced anxiety about hypoglycaemia and better diabetes management (p =0.03), supporting findings that CGM can positively impact mental well-being (Bergenstal et al., 2018). Conclusion(s): The meta-analysis suggests extended CGM use, ophthalmologist collaboration and patient education.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Kirtley F.; *Williams K.; *Husain S.;

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 224-225), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Sudden loss of vision, especially when accompanied by loss of colour vision, a relative afferent pupillary defect (RAPD), and visual acuity dropping below 6/60, is an alarming symptom that often leads clinicians to suspect optic neuropathy, particularly conditions like Anterior Ischemic Optic Neuropathy (AION) or Posterior Ischemic Optic Neuropathy (PION). However, retinal conditions such as Paracentral Acute Middle Maculopathy (PAMM) and Acute Macular Neuroretinopathy (AMN), especially Type 2 AMN, can present with similar symptoms, causing diagnostic confusion. This poster explores classic findings on Optical Coherence Tomography (OCT) and OCT Angiography (OCTA) along with visual fields that can aid in distinguishing between optic neuropathy and retinal diseases, guiding appropriate management and treatment. Method(s): The study included 10 patients with a mean age of 62 years, ranging from 47 to 75 years, with an equal gender distribution (5 males and 5 females). The average initial visual acuity was 5/60, ranging from 1/60 to 6/60. All patients presented with sudden vision loss, and 9 (90%) had a relative afferent pupillary defect (RAPD). Seven patients (70%) reported loss of colour vision, and many had a history of hypertension, hyperlipidaemia, or were on statins. The initial differential diagnosis included PION in 3 patients, AION in 4 patients, and demyelination in 3 patients. Some patients were treated with high-dose steroids (60 mg/day) for suspected(GCA) or as stroke cases due to vascular risk factors. OCT and OCTA findings revealed characteristic differences between the conditions. Result(s): The final diagnoses confirmed that 4 patients had PAMM, identified by hyperreflective lesions in the inner retinal layers on OCT, particularly in the parafoveal region. 3 patients were diagnosed with AMN, based on outer retinal hyperreflective lesions and macular ischemia identified on OCTA. The remaining 3 patients were diagnosed with optic neuropathy, 2 with PION and 1 with AION, based on OCT and OCTA findings, which did not show the characteristic retinal findings of PAMM or AMN. Regarding treatment, 5 patients were started on high-dose steroids (60 mg/day) for suspected GCA, but there was no significant improvement in the PAMM and AMN patients, where retinal ischaemia, rather than optic nerve ischemia, was the underlying issue. All patients were on statins, with 8 (80%) on increased doses due to hyperlipidaemia, and 7 (70%) were on antihypertensive therapy. Patients diagnosed with PAMM and AMN were managed conservatively with observation and treatment for underlying conditions, such as controlling hypertension and hyperlipidaemia, and did not require systemic steroids or biologics. Follow-up at 6 months showed that 6 out of 7 patients with PAMM and AMN had stable or slightly improved vision, with one patient showing slight worsening but remaining stable overall. Conclusion(s): OCT and OCTA imaging provide critical diagnostic information, revealing characteristic findings of retinal ischemia in PAMM and AMN. High-dose steroids, initially prescribed for suspected giant cell arteritis (GCA) or ischemic optic neuropathies, were ineffective for PAMM and AMN, as these conditions are driven by retinal ischemia rather than optic nerve ischemia. This underscores the importance of accurate diagnosis to avoid unnecessary treatments and potential harm, as steroids can worsen PAMM by increasing blood pressure. Patients with PAMM and AMN, when managed conservatively with observation and treatment for underlying conditions, demonstrated stable or improved visual outcomes. This contrasts with optic neuropathy patients who showed minimal improvement with steroids, highlighting the significance of early differentiation for optimal management. Additionally, this study emphasizes the cost-effectiveness of OCT and OCTA. These imaging techniques provide a less expensive, non-invasive alternative to MRI and CT scans, offering quicker and more accurate diagnoses. By reducing the need for more costly imaging and unnecessary treatments, OCT and OCTA contribute to both improved clinical outcomes and reduced healthcare costs. Therefore, their use in diagnosing acute onset retinal conditions mimicking optic neuropathy can significantly enhance patient care while ensuring cost savings for healthcare systems.

DOI: 10.1038/s41433-025-03831-0