Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Yadav S.; *Owoniyi M.; *Sanjana E.; Makwana T.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 191-192), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: The current cataract surgery consent form primarily focuses on the surgeon's perspective of potential complications, often neglecting the patient's emotional and visual experiences during the procedure. This audit aimed to explore the importance of informing patients about the potential visual experiences they might encounter during cataract surgery. By incorporating this information into the consent process, the goal was to enhance patient understanding, alleviate anxiety, and reduce distress during the surgery. This study was discussed with a patient focus group to understand their concerns about cataract surgery, particularly regarding anxiety and the unknown aspects of the procedure. Patients emphasised the lack of information about potential visual phenomena, like flashes of light and shimmer, which contributed to their anxiety. Method(s): To evaluate the impact of preoperative information about potential intraoperative visual phenomena on patient anxiety during cataract surgery and to compare outcomes between patients who were informed about these visual disturbances and those who were not Study Design: A prospective audit was conducted involving two groups of patients undergoing cataract surgery at a single surgical centre over a defined period (6months). One group received preoperative information about the possibility of visual phenomena during surgery, while the other group was not informed. Group Classification: Group 1 (Informed group): This information was included in the preoperative counselling session and added to the consent forms. Group 2 (Non-informed group) Data Collection: Patient Survey: The survey included questions about their emotional state, whether they were surprised or distressed by any visual phenomena, and how well they felt prepared for the surgery. Apprehension Scoring: Likert scale (non continuous) along with open-ended questions to gather qualitative feedback on patient experiences and Visual Analogue Score (continuous) was also used. Result(s): Preliminary data suggests that a significant number of patients experience distress due to the visual phenomena during cataract surgery. Incorporating this information into the consent forms is expected to better prepare patients for the procedure, thereby improving their overall experience and reducing unnecessary anxiety. Informed Group: The group that was informed about potential visual disturbances prior to surgery reported significantly lower levels of anxiety during the procedure. The mean apprehension score for this group was 2.1 +/- 0.8, with 72% of patients rating their apprehension as mild or minimal (scores 1-2). Statistical analysis revealed a significant difference in apprehension scores between the informed and non-informed groups (p < 0.01). Non-informed Group: The non-informed group showed a higher level of distress, with a mean apprehension score of 3.8 +/- 1.2. A larger proportion of patients in this group (43%) reported moderate to high distress (scores 4-5). The difference in distress between the two groups was statistically significant (p < 0.001). Chi-Square Test Results: The chi-square test indicated a significant difference in the frequency of patients reporting surprise or discomfort related to visual phenomena, with 55% of the non-informed group expressing surprise, compared to just 20% in the informed group (chi2 =14.68, p < 0.01). Confidence Interval: The 95% confidence interval for the mean difference in apprehension scores between the informed and non-informed groups was (1.3, 2.4), suggesting a moderate -large effect size in the reduction of patient anxiety when preoperative information was provided. Conclusion(s): Statistical analysis substantiated that reduction in anxiety was clinically and statistically significant(p < 0.01). Cataract surgery remains a common procedure in ophthalmology in elderly patients, many with diverse co-morbidities. A proposal is advanced to revise the informed consent documents and preoperative counselling protocols to include comprehensive details about the potential visual phenomena that patients may encounter postoperatively. An enhanced cataract consent framework should be regarded as an integral aspect of evidence-based, patient-centred care, ensuring patients are thoroughly educated and psychologically prepared for surgery.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Rao P.; *Perera L.; Garikapati N.; *Godbole K.; *Zaw S.-N.; *Mathew N.M.; Veeramani P.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 271), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Intravitreal injections of anti-VEGF drugs have revolutionised the management of wet age related macular degeneration (ARMD), retinal vein occlusion (RVO) and diabetic maculopathy over the last 18 years in the UK. In the year 2022 over 677,000 intravitreal injections were performed in England alone (4796 per 100,000 population). In the UK over 75% of intravitreal injections are performed by allied health professionals such as nurses, optometrists and orthoptists. Although anti-VEGF injections are only NICE approved for 4 main conditions (wet ARMD, retinal vein occlusion, diabetic maculopathy and myopic choroidal neovascular membrane(CNV))often clinicians are faced with clinical presentations that mimic the 4 main indications thereby making the clinical decision to treat or not treat a particular patient with anti-VEGF injections difficult. Method(s): We have retrospectively reviewed the case records of patients attending rapid access clinics and intravitreal injection clinics over a 4 year period to identify macular and retinal conditions that mimic the four major NICE approved indications for intravitreal anti-VEGF injections. Result(s): We identified 12 such clinical conditions: 1) Adult vitelliform macular degeneration 2) Peripapillary pachychoroid syndromes 3) Central serous retinopathy 4) Intraretinal fluid overlying the old disciform macular scars 5) Retinal pigment epithelial rips involving the fovea 6) Old BRVO/ CRVO with extrafoveal macular oedema/ thickening 7) Macular oedema/ haemorrhage secondary to a macroaneurysm 8) Peripapillary CNV without involvement of the macula 9) Macular oedema secondary to epiretinal membrane 10) Inactive CNV: slow growing lesion with minimal fluid leakage and stable vision. 11) Transient foveal oedema due to microaneurysms close to foveola 12) Macular oedema mistaken for vein occlusions and Diabetic maculopathy a) Post operative cystoid macular oedema (CMO) b) CMO in hereditary dystrophies c) Drug (toxic) related macular oedema. Conclusion(s): We have identified the most common macular / retinal conditions for which anti-VEGF therapies are not necessarily of benefit. In a large cohort of injection patients it is not unusual to find some patients with other varied pathologies receiving anti-VEGF injections with limited or no benefit. We believe that it is important to highlight these varied pathologies to all clinicians to avoid inappropriate treatments. We demonstrate each category of patients with evidence on multimodal imaging to support the diagnosis and also of suboptimal outcomes.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Rao P.; *Zaw S.-N.; Garikapati N.; *Godbole K.; Veeramani P.; *Perera L.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 244-245), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: With emergence of new imaging technology adult vitelliform macular degeneration (AVMD) is being diagnosed with increasing frequency over the last two decades. The condition is often mistaken for wet age-related macular degeneration (ARMD) when the vitelliform material starts scrambling showing pseudo fluid in optical coherence tomography (OCT) scans. In addition, in some AVMD patients the vitelliform lesions in fact do develop choroidal neovascularisation (CNV) requiring urgent intravitreal injections. We aim to highlight the prevalence, natural progression and treatment options for patients presenting with AVMD. Method(s): We have retrospectively analysed 123 eyes of 82 patients of AVMD presented to this department over the last 4 years. Result(s): We identified 44 females and 38 males, 41 patients with bilateral involvement at presentation. The clinical findings varied from a classical sub foveal yellow lesion to partial empty spaces within the lesion, to complete atrophic scar following resorption of all the colloid material. The presenting Visual acuity in the worse eye also varied from 6/9 to HM according to the stage of degeneration they presented with. Thirty-nine patients were asymptomatic and AVND was an incidental finding in one of their eyes. We have obtained serial optical coherence tomography (OCT) scan to monitor the progress whenever possible. All patients had OCT, optical coherence tomographic angiography (OCTA), and fundus autofluorescence (FAF). Some patients in addition underwent fundus fluorescein angiography (FFA) and indocyanine green angiography (ICG) when a choroidal neovascular membrane (CNVM) was suspected. Sixty nine of 82 patients did not need any active interventions. Fourteen patients were already taking antioxidant supplementations. Thirteen patients have developed significant subretinal fluid (SRF) and were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. On further reviewing of the OCTA scans and FFA only 10 of 13 showed active CNVM. The other 3 patients only had passive subretinal fluid with no evidence of CNVM. Therefore only 12 % of AVMD patients seem to have developed wet ARMD in our series. Response to the anti-VEGF injections was suboptimal in AVMD patients with CNV compared to a case of conventional wet ARMD. This unfavourable response was most likely due to pre-existing long standing atrophic and degenerative changes. Contrary to earlier publications, based on family history alone we did not find any strong evidence of autosomal dominance inheritance therefore we prefer to call it a degenerative rather than dystrophic condition. Conclusion(s): With increasing use of OCT imaging by optometrists and primary care physicians more patients are being diagnosed with macular pathology, AVMD is one such condition. Most of these patients do not need any active interventions or long term follow ups in hospital clinics. Our study shows only 12% of AVMD patients go on to develop CNV requiring intravitreal anti-VEGF injections. As our cohort shows it may not be unusual to mistake passive fluid lakes within vitelliform lesions for active wet ARMD. It is important for clinicians to be aware of the possibility of AVMD with passive subretinal fluid and not to resort to unnecessary long term intravitreal anti-VEGF injections. As we have shown even in cases of AVMD with secondary CNV the prognosis is poor for long term retention of central vision.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

Nayak D.; Iqbal N.; Makwana T.; Sathiaraj S.; Olagunju A.; Yadav S.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 208-209), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: To evaluate the accuracy of IOL power determination using new generation super formulas in IOL-cal.com in comparison to traditional formulas such as SRK/T, Hoffer Q, and Holladay 1 for cataract surgery patients, particularly those with challenging biometric characteristics to optimise visual outcome. Method(s): Study Design: Prospective study involving 100 patients undergoing cataract surgery. Preoperative Measurements: Axial length (AL) measured using optical biometry. Corneal curvature (K) measured using keratometry or corneal topography. Anterior chamber depth (ACD) measured to assess proper IOL power. IOL Power Calculation: IOL-cal.com: Integrated tool using multiple formulas (Ladas/ Kane, SRK/T, Hoffer Q, Holladay 1) based on patient-specific measurements. Traditional formulas for comparison: SRK/T, Hoffer Q, and Holladay 1. Surgical Procedure: Phacoemulsification with monofocal IOL implantation in the capsular bag. Primary Outcome Measure: Mean Absolute Prediction Error (MAE) of postoperative refractive outcomes at 6 weeks. Secondary Outcome Measures: Proportion of patients achieving postoperative refraction within +/-0.5 D of target refraction. Rate of residual astigmatism at 6 weeks post-surgery. Statistical Analysis: Descriptive statistics, paired t-tests or ANOVA, chi-square tests for categorical variables, significance set at p < 0.05. Result(s): Mean Absolute Prediction Error (MAE): IOL-cal.com demonstrated a significantly lower**Mean Absolute Prediction Error (MAE)**when compared to traditional IOL power calculation formulas, with a p-value < 0.05. This indicates that IOL-cal.com provided more accurate predictions of postoperative refractive outcomes. The tool particularly excelled in predicting refractive outcomes for patients with**short eyes**(<22 mm) and**long eyes**(>26 mm), showing improved precision in both these challenging biometric categories. Refractive Outcomes: A higher percentage of patients in the IOL-cal.com group achieved a refractive outcome within +/-0.5 dioptres (D) of the target refraction (82%) compared to the traditional formula group. The percentage of patients achieving this target refraction was 75% for the SRK/T formula, 71% for the HofferQ formula, and 73% for the Holladay 1 formula. These results suggest that IOL-cal.com is more effective at helping patients achieve a closer match to their target refractive outcome. Residual Astigmatism: The incidence of significant residual astigmatism (greater than 0.75 D) was lower in the IOL-cal.com group, with only 12% of patients showing significant astigmatism after surgery. In contrast, the SRK/T formula showed a residual astigmatism rate of 18%, the Hoffer Q formula had a rate of 20%, and the Holladay 1 formula had a residual astigmatism rate of 19%. These findings indicate that IOL-cal.com was more effective in minimizing postoperative astigmatism, particularly in comparison to traditional formulas. Conclusion(s): The use of IOL-cal.com for intraocular lens (IOL) power determination offers significant advantages over traditional formulas like SRK/T, Hoffer Q, and Holladay 1 by providing more accurate and consistent results. This online tool integrates multiple advanced IOL power calculation formulas and tailors them to individual biometric parameters, such as axial length, corneal curvature, and anterior chamber depth. By adjusting for these factors, IOL-cal.com enhances the likelihood of achieving a refractive outcome that closely matches the target refraction, significantly reducing the Mean Absolute Prediction Error (MAE) and minimizing residual astigmatism after cataract surgery. IOL-cal.com proves especially useful in challenging cases, such as patients with extreme axial lengths, irregular corneal curvature, or those who have previously undergone refractive surgery. These situations often complicate traditional IOL power calculations, but IOLcal.com's ability to account for such complexities ensures more precise outcomes. Its user-friendly interface, combined with its ability to integrate multiple formulas, makes it a highly valuable tool for cataract surgeons. The tool's enhanced accuracy and ability to improve refractive outcomes position it as an essential resource for optimizing cataract surgery, particularly for complex or high-risk cases.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Iqbal N.; *Jenyon T.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Airbag systems are integral to passenger safety during road traffic accidents (RTAs), yet their deployment can also result in significant ocular trauma. The cornea, a vital structure responsible for focusing light onto the retina, relies on its endothelial layer to maintain transparency through fluid regulation. Damage to these endothelial cells can lead to corneal oedema and visual impairment. This report describes a unique case of bilateral endothelial decompensation following airbag-induced blunt trauma, highlighting the need for vigilance in recognising potential ocular complications in such scenarios. Method(s): We present a case of an 89-year-old male who presented with bilateral corneal decompensation following airbag deployment during a road traffic accident. Result(s): Ocular examination revealed multi-level ocular injury with severe bilateral corneal oedema. This was managed with topical steroids, mydriatics and, antibiotic therapy. At one month follow up the left eye had persistent corneal oedema. Specular microscopy was performed which confirmed endothelial cell loss making the patient a candidate for a corneal endothelial graft. We observed blunt trauma from airbag deployment causing endothelial cell loss and subsequent corneal decompensation. Conclusion(s): Common ocular traumas, such as corneal abrasions, hyphaema, and subconjunctival haemorrhage, are often readily identifiable. In contrast, endothelial damage can be subtle, leading to delayed symptoms such as blurred vision and corneal oedema. Clinicians should maintain a high index of suspicion for endothelial damage in patients presenting with post-accident ocular trauma and consider early referral to specialist services in such cases.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Nayak D.; Mahon E.; *Olagunju A.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 239-240), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Central Retinal Vein Occlusion (CRVO) can lead to significant vision impairment due to macular oedema and retinal ischemia. The traditional approach to managing macular oedema in CRVO has included anti-VEGF therapy, but recent studies have highlighted the potential role of sub-threshold macular grid laser (using Pascal). This audit aims to compare the efficacy of sub- threshold macular grid laser with anti-VEGF injections in CRVO treatment, focusing on both objective and subjective vision outcomes, OCT findings, and comparing the use of YAG laser versus stab laser for treatment. Method(s): A retrospective audit was performed involving 30 patients with CRVO. The patients were divided into two treatment groups: Sub-threshold Pascal macular grid laser (15 patients) Anti-VEGF therapy (15 patients) Inclusion criteria included patients with persistent macular oedema after CRVO. Exclusion criteria included other retinal conditions or severe diabetic retinopathy. Follow-up was performed for 6 months. Visual acuity was measured using Snellen charts, and subjective improvements in vision were recorded. OCT was used to assess macular oedema, retinal thickness, and other retinal changes. Result(s): Visual Acuity: Anti-VEGF group: The mean visual acuity improved from 20/ 200 at baseline to 20/80 at 6 months. However, only 60% of patients in this group reported subjective improvement in vision. Sub-threshold Pascal macular grid laser group: The mean visual acuity improved from 20/200 to 20/100 at 6 months, with 80% of patients showing subjective improvement in vision. Notably, the patients who received the subthreshold laser reported higher levels of satisfaction with their vision in daily tasks, particularly in reading and near-vision activities. OCT Findings: Anti-VEGF group: OCT showed a significant reduction in macular oedema in 80% of the patients, with 70% showing near-normal macular thickness by the 6-month follow-up. Sub-threshold Pascal macular grid laser group: OCT showed a more consistent reduction in macular oedema, with 90% of patients showing complete or partial resolution of oedema. The retinal thickness improved more rapidly in the laser group, and the improvement in retinal structure was sustained at follow-up. Subjective Outcomes: Anti-VEGF group: Visual function improvement was reported by 60% of patients, with some patients experiencing difficulty with near-vision tasks despite the improvement in macular oedema. Sub-threshold Pascal macular grid laser group: 80% of patients in the laser group reported significant subjective improvements, particularly in visual clarity and comfort. These patients also experienced less visual distortion and better daily functionality, highlighting the benefit of laser treatment in improving overall visual quality. Use of YAG Laser vs. IVI: Laser: 10 patients in the sub-threshold grid laser group were treated with YAG laser. These patients reported a higher level of comfort and fewer adverse effects, including a lower incidence of retinal haemorrhages. Visual outcomes were comparable to those of patients treated with anti-VEGF therapy, with a faster resolution of macular oedema Complications: Anti-VEGF group: Two patients developed transient intraocular pressure increases, which were managed with topical medications. No other significant complications were reported. Sub-threshold Pascal macular grid laser group: The YAG laser group had no significant complications, while mild retinal haemorrhages were observed in two patients who received the anti-VEGF. These resolved without further issues, and no cases of retinal damage or macular atrophy occurred. Conclusion(s): Anti-VEGF therapy showed better outcomes in terms of reducing macular 0edema and improving visual acuity, but the sub-threshold Pascal macular grid laser treatment group demonstrated superior patient satisfaction and long-term structural improvements. Patients in the laser group had better subjective visual function, including improved near vision and reduced visual distortions, which is a critical aspect of daily living. The laser treatment, particularly with PASCAL yellow/ YAG laser, was associated with fewer complications and better overall visual quality compared to the stab laser. The laser demonstrated a clear advantage in patient comfort and fewer adverse effects compared to the stab laser, making it the preferred choice for sub-threshold macular grid laser in CRVO.

DOI: 10.1038/s41433-025-03831-0

Type of publication:

Conference abstract

Author(s):

*Godbole K.; *Rao P.; Garikapati V.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 271-272), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: To highlight the variations in the age of onset, disease progression and final treatment outcomes of Sorsby dystrophy in men and women. Method(s): Ten eyes of 5 patients presented to our centre over a period of 19 years (2005-2024) were included in this study. All patients were symptomatic and presented with subfoveal choroidal neovascular membranes in at least one eye. All patients had optical coherence tomography (OCT) scans, Fundus fluorescein angiography and genetic testing to confirm the diagnosis. All were positive TIMP 3 missense mutation chromosome 22. The treatment regime included oral steroids, photodynamic therapy(PDT) and intravitreal anti-vascular endothelial growth factor (vegf) injections. Result(s): Age: Average age at presentation was 34 years for females and 46 years for males. Sex: 3 females and 2 males from 2 unrelated families. Follow up period: Ranged from 3 to 19 years with average follow up period of 11.7 years. Three eyes received Argon laser, 2 received PDT, one oral steroid, 6 eyes had intravitreal anti-Vegf injections and 3 eyes had combination treatments. Argon laser treatment proved to be least effective with high rate of recurrences of choroidal neovascular membranes with subsequent loss of central vision. Anti-Vegf treatments were universally effective. Final Visual acuity varied from Hand movements to 6/6. Both male patients deteriorated rapidly, lost vision in both eyes and were registered blind within just 2 years of presentation. Whereas the three female patients on the contrary fared much better retaining useful vision for decades after their male counterparts lost their vision. Conclusion(s): In spite of the common gene defect, the age of onset and final visual outcomes seem vary widely between men and women. These variations were not reported previously. The disease manifested on average 12 years earlier in females than their male counterparts but the females achieved better visual outcomes. Females also required fewer intravitreal injections. Males also suffered severe form of maculopathy and lost all useful vision within 2 years of onset of disease. Smokers did much worse, and treatments proved less effective. These new findings would help to deliver the prognosis more accurately when counselling patients. Male members of the Sorsby family may also benefit from a closer monitoring.

DOI: 10.1038/s41433-025-03831-0

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