Josefine Fuchs

A 4-Year Longitudinal Study of 555 Patients Treated with Ranibizumab for Neovascular Age-related Macular Degeneration

OBJECTIVE To investigate the visual outcome, pattern of discontinuation, ocular complications, and mortality of patients treated with a variable ranibizumab dosing regimen for neovascular age-related macular degeneration (AMD) for 4 years. DESIGN Retrospective chart review supplemented with clinical examination. PARTICIPANTS Six hundred eyes of 555 patients initiated intravitreal treatment with vascular endothelial growth factor inhibition for neovascular AMD in 2007 in a community-based hospital. METHODS Patient data from a database were retrieved from 2007 through 2011. Descriptive evaluation of the main outcome measures was carried out for the cohort of patients. A group of patients who had been discontinued because of apparent disease inactivity was reexamined. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA; Snellen), number of intravitreal injections, causes of discontinuations, ocular complications, and standardized mortality rate. RESULTS One hundred ninety-two eyes (32%) were still receiving active treatment after 4 years. The mean BCVA in the 192 eyes was unchanged from the start (baseline, 0.30; 4-year follow-up, 0.32; P>0.3). Visual acuity after the third loading dose was associated significantly with the outcome (P<0.0001) and was a better predictor than baseline acuity. The mean number of injections was 5.5 per year. For 408 eyes (68%), discontinuation of treatment was motivated by the following 4 reasons: lack of apparent treatment response (28%), failure to appear at follow-up (11%), death (9%), and disease inactivity (20%, 120 eyes). Treatment was resumed later in 18% of patients discontinued because of inactivity. Sixty-seven eyes were reexamined in 2012 from the group of patients with disease inactivity. The final visual acuity by then had decreased significantly from the time of discontinuation, from 0.38 to 0.15 (P = 0.001). Endophthalmitis occurred in 2 eyes of 7584 injections. A total of 125 patients had died, corresponding to 75% of the mean mortality in the community. CONCLUSIONS One third of the eyes were still receiving active treatment after 4 years and had stable visual acuity. One third of fellow eyes (eyes at risk) started treatment during the 4 years. One fifth of discontinued eyes resumed treatment, indicating that close follow-up should be maintained for patients discontinued because of disease inactivity. The ocular complication rate was 0.2%, and the mortality rate was below expected.

Predictors of 1-year visual outcome in neovascular age-related macular degeneration following intravitreal ranibizumab treatment.

Purpose:  To describe predictors of visual outcome in patients treated with intravitreal ranibizumab for choroidal neovascularisation (CNV) in age‐related macular degeneration (AMD).

Glaucoma blindness in Denmark

Abstract In order to evaluate the prevalence and the incidence of glaucoma blindness in Denmark, all registration forms of persons ≥ 50 years of age at admission, admitted to the Danish Association of the Blind (DAB) between 1955 and 1987 with glaucoma as main cause of blindness, were examined. In 1987 6.7% of DAB‐members ≥ 50 years of age suffered from blindness caused at least partially by glaucoma, equivalent to an estimated prevalence of 45 per 100 000 of the Danish population ≥ 50 years. The estimated annual incidence of blindness due to glaucoma was 7 per 100 000 ≥ 65 years, and in an equal number of patients glaucoma was a contributory cause of blindness. The incidence of blindness due to glaucoma was decreasing in the young age groups (< 65 years) throughout the study period. Glaucoma blindness seems to occur at a later age now than earlier, leaving the patients blind for a shorter time. This pattern may be explained by improved health services but could also be due to a change in the spontaneous course of glaucoma. The proportion of glaucoma blindness in the glaucoma population was estimated to be 4–5%.

Visual outcomes in relation to time to treatment in neovascular age‐related macular degeneration

To study the relation between the interval from diagnosis to initiation of intravitreal injection therapy and visual outcome in neovascular age‐related macular degeneration (nAMD) and to report changes over time in fellow‐eye status.

Hereditary High Hypermetropia in the Faroe Islands

Purpose: To characterize the phenotype of two families with high hypermetropia from the Faroe Islands. Methods: Ophthalmologic evaluation including ultrasound oculometry and anthropometric measurements. Results: Of the 40 examined family members, 15 individuals (8 males, 7 females; ages: 6-77 years; mean: 36.5 years) had small deep-set eyes with high hypermetropia (median: + 16.5 D; range: + 7.75 to + 22), short axial eye length (< 21 mm), and a thickened eye wall. The median corrected visual acuity was 0.4 (0.2-0.9). Ocular complications included angle-closure glaucoma in six eyes, uveal effusion in three eyes, cataract in two eyes, and esotropia with amblyopia in three eyes. An emergency case of uveal effusion and retinal detachment after Yag iridotomy eventually responded to systemic corticosteroids and scleral resection surgery with a slow visual recovery. No associated ocular or systemic malformations were found in the series. In addition to the two examined families, six smaller Faroese families with high hypermetropia are briefly reported. Conclusions: The study highlights the signs and symptoms of a rare hereditary phenotype characterized by a short axial length mainly confined to the posterior segment of the eye, a shallow anterior chamber, and a thickened eye wall. The morphological characteristics predispose for sight-threatening complications such as angle-closure glaucoma, chorioretinal pathology including uveal effusion, and amblyopia. Regular ophthalmic follow-up is therefore of obvious importance in families known to have small eyes/high hypermetropia. An endemic high prevalence in the Faroe Islands suggests the presence of a founder effect, and further genetic research would probably indicate pseudodominant rather than dominant transmission.

Safety study of 38 503 intravitreal ranibizumab injections performed mainly by physicians in training and nurses in a hospital setting

To evaluate and to compare the safety of intravitreal ranibizumab injections performed by physicians and nurses at a single large hospital clinic in Denmark during 5 years.

Refraction in diabetics during metabolic dysregulation, acute or chronic. With special reference to the diabetic myopia concept.

Abstract The influence of diabetic dysregulation on refraction was analysed by a short‐term and a long‐term approach, a) Out of 15 patients admitted due to high blood sugars and followed over weeks, 11 showed refractive fluctuation of 1–6.5 D, in either direction — often with excess hypermetropia, while 4 appeared refractively stable. In those with refractive change a transient increase of lens thickness was suggested from ultrasound measurements, b) Diabetes control was evaluated retrospectively in 74 adult diabetics, mainly based on repeated 24 h urine glucose determinations over a 6‐year period. As a group, those with low myopia did not score worse than those who had stayed emmetropic. Among the myopes, diabetes duration was longer in the subgroup where diabetes preceded myopia onset. — All considered, we found no support for dysregulation per se as an underlying factor behind the ‘diabetic myopia’ previously reported from our clinic.

Glaucoma prevalence in the Nordic countries: estimates based on glaucoma drug consumption

Abstract. Glaucoma prevalences in the 5 Nordic countries are estimated on basis of a) wholesale of glaucoma medicaments (Denmark, Iceland, Norway, and Sweden) and b) registered glaucoma patients receiving free medication (Finland). Prevalences are compared nationally and internationally. The estimated glaucoma prevalence is highest in Norway (2.19% related to the population > 40 years), lowest in Denmark (0.76% in the same age group). The prevalences in Iceland, Finland, and Sweden are 2.0, 1.94, and 1.55%, respectively. We suggest that the relatively large differences in glaucoma prevalence between the countries may be explained by geographical differences in occurrence of capsular glaucoma. The sources of error concerning prevalence estimates based on glaucoma drug consumption are discussed. Pre‐supposing a balance numerically between undetected glaucoma cases and patients receiving glaucoma medication without really having glaucoma, the glaucoma drug sales statistics may be taken as fair indicators of glaucoma prevalence.

Neovascular age-related macular degeneration treated with ranibizumab or aflibercept in the same large clinical setting: visual outcome and number of injections

To study visual outcome and number of annual injections in treatment‐naïve patients with neovascular age‐related macular degeneration (nAMD) before and after a change in first‐line therapy from ranibizumab to aflibercept in a high‐volume clinical practice.

High myopia in Denmark with emphasis on visual loss and fundus changes

The paper read for the Nordic Conference had three sections: The first part was a summary account of a 20-year follow-up of 28 young Danes with high myopia first recorded at the age of 14 years. The second part was a brief presentation of data on high myopia in Denmark over a century, indicating a decrease in prevalence. The final section dealt with an analysis of recent data about blindness from myopia, as apparent from membership applications for the Danish Association for the Blind. The trend seemed to be relatively fewer cases and at a higher age.