Time spent outdoors in childhood related to myopia among young adults in the Swedish ABIS cohort.

PURPOSE: Elucidate the prevalence of myopia among young adults from a birth cohort of Swedish children and its relationship to possible risk factors during their childhood. METHODS: Five thousand two hundred young adults, mean 23.4 years and 58% females, participating in the prospective birth cohort All Babies in Southeast Sweden (ABIS) answered a questionnaire including questions regarding health and physical activity, spectacle use, myopia and age at first optical correction. Questionnaires at previous follow-ups at ages 2-3, 5-6 and 8 years included information on type of housing, time outdoors, screen time and hours of reading. Myopia prevalence and associations with potential risk factors were analysed in univariate and multivariate regression models with Bonferroni's correction of p-values. RESULTS: In the ABIS Swedish birth cohort of young adults, the prevalence of myopia was 29%. A univariate logistic regression showed a higher odds ratio for myopia with female gender (OR 1.59; p < 0.05) and a completed and started university education (OR 1.52; p < 0.05). Significantly lower odds ratios were found for hours spent outdoors at 8 years of age (OR 0.82; p < 0.05). Multivariate logistic regression showed a higher odds ratio for myopia in females (OR 1.52-1.57; p < 0.05) and completed and started university education (OR 1.34-1.49; p < 0.05) in all models. In a model including accommodative effort, measured in diopter hours at 8 years of age, hours spent outdoors were associated with a lower odds ratio for myopia (OR 0.86; p < 0.05). No association could be detected between myopia and the type of housing or near work. CONCLUSION: The prevalence of myopia among young adults in a Swedish birth cohort was lower or unchanged compared to previous data. Female gender, higher education and less time spent outdoors in childhood were associated with an increased risk of developing myopia. Recommendations from child health services and schools should be given to stimulate children to spend enough time outdoors.

Endophthalmitis following cataract surgery and effect of different intracameral antibiotic regimes in Sweden 2011 - 2017. A national registry study.

PURPOSE: To study the incidence, predictive factors, aetiology and visual consequences of postoperative endophthalmitis (PE) in relation to three intracameral antibiotic regimes. SETTING: Swedish National Cataract Register (NCR) entries from 2011 through 2017. DESIGN: Observational retrospective study. METHODS: PE incidence, influencing factors, bacteriology and visual outcome were analyzed with regard to the three major prophylactic IC protocols. RESULTS: The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per intracameral regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin and 0.017% (20 cases in 121 045 surgeries) for combined cefuroxime-ampicillin. Incidences were not statistically significantly different from one another. Gram-positive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with intracameral cefuroxime than with moxifloxacin, p = 0.006 or cefuroxime-ampicillin, p < 0.001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, p < 0.001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-ampicillin, 60.0%, p = 0.015, or with moxifloxacin, 88.2%, p < 0.001. Visual outcome worse than 20/200 were similar in the groups ranging from 42.0% to 53.7%. CONCLUSION: No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in aetiology and bacterial sensitivity were found between the prophylactic intracameral treatments.

[2.6 million cataract surgeries: 31 years with the Swedish National Cataract Register 1992-2022]. / 2,6 miljoner kataraktoperationer.

This review summarizes data collected by the Swedish National Cataract Register (NCR), which by the end of 2022 contained data on more than 2.6 million cataract surgeries between 1992-2022. During these 31 years, the cataract surgery rate (CSR) rose from 3 700 to 14 407. The coverage of NCR is very high, including 93% of all cataract procedures in Sweden during the last decade. A clear trend is that the procedure is performed in eyes with increasingly high visual acuity. The proportion of patients with Snellen 0.5 or worse in the first eye at surgery has decreased from 88% in 2007 to 69% in 2022. Patient Reported Outcome Measures (PROM) have been registered with the Catquest-9SF questionnaire since 2008, demonstrating stable favorable outcomes. Surgical complications have decreased; endophthalmitis has decreased from 0.10% to below 0.02%, and posterior capsule rupture from 2.8% to 0.6%.

Padel an increasing cause of sport-related eye injuries in Sweden.

PURPOSE: The objective of this study was to determine the current Swedish epidemiology of sport-related eye injuries and to analyse the effect of the increased popularity of the racquet sport padel. METHODS: This was a retrospective, register-based, cohort study of medical records in the county of Jönköping, Sweden. All individuals with a sports-related eye injury needing healthcare between January 2017 and December 2021 were included. For these individuals, data about background, consequences and treatment of the injuries were obtained. RESULTS: During the 5-year study period, 255 patients sought care for sports-related eye injuries at the ophthalmological clinics in Jönköping County. Floorball caused the largest proportion of eye injuries (39%) followed by padel (20%) and football (15%). However, the proportion of injuries caused by padel increased during the study period to be the dominating cause in 2021. Compared to floorball, patients with eye injuries from padel were older and had female gender to a higher extent. The ball caused almost all injuries from padel; the majority occurred in the right eye. Most the eye injuries from padel were mild or moderate but 4% had severe consequences with an imminent risk of long-term complications. CONCLUSIONS: In a short time period, padel has become the leading cause of sports-related eye injuries in Sweden. To reduce the number of eye injuries, protective eyewear could be recommended.

Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register.

PURPOSE: To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS: Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS: For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS: The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.

Treatment burden on patients receiving intravitreal anti-VEGF for wet age-related macular degeneration.

PURPOSE: The aim of this study was to map the treatment burden for patients with wet age-related macular degeneration (wAMD). METHOD: Patients with ongoing treatment with anti-VEGF for wAMD at a Swedish eye unit underwent a survey about the time spent receiving treatment, caregiver assistance, way of transportation, self-rated vision and negative experiences associated with the treatment such as discomfort, anxiety or transportation problems. Information about current visual acuity, number of treatments and current treatment intervals were obtained from medical records. RESULTS: The study included 93 patients with an average age of 79.9 years, 68% were women. The average interval between treatments was 7.3 weeks, and 26% had active treatment in both eyes. On average, patients had to spend 2.7 h (2.4-2.9: 95% CI) per treatment and a caregiver assisted the patient in 58% of cases. Caregivers spent on average 2.6 h (2.5-2.8: 95% CI) per visit, and 19% needed to take time off work. The majority (91%) of patients did not experience any transportation problems associated with treatment. A multivariate logistic regression analysis showed a significantly lower odds ratio for discomfort with higher self-rated vision and a significantly higher odds ratio for discomfort with longer treatment intervals. DISCUSSION: Anti-VEGF treatment is an effective treatment for wAMD. However, the relatively short treatment intervals place a considerable burden on patients and their relatives regarding time. Although the patients in this study had to spend a lot of time to receive treatment, the majority did not experience any problems associated with treatment.

Two point four million cataract surgeries: 30 years with the Swedish National Cataract Register, 1992-2021.

The present review summarizes data collected by the Swedish National Cataract Register (NCR), which by the end of 2021 contained data for more than 2.4 million cataract surgeries between 1992 and 2021. During these 30 years, the cataract surgery rate rose from 3700 to 12 800. The coverage of NCR is very high including 93% of all cataract procedures in Sweden between 2010 and 2021. Independently of demographic changes, the proportion of operations of patients age 60 to 79 has increased while the proportion of 80 to 90+ has decreased. The median visual acuity of the first eye planned for surgery was 0.1 decimal in 1992 and has increased to 0.5 decimal in 2021. Patient-reported outcome measures have been registered with the Catquest-9SF questionnaire since 2008, demonstrating intervention at an earlier stage, but consistently favorable outcomes. Surgical complications have decreased; endophthalmitis has decreased from 0.10% to below 0.02%, and posterior capsule rupture from 2.8% to 0.6%.

Relatively Stable Prevalence of Myopia among Swedish Children Aged 4 to 7 Years between 2015 and 2020.

SIGNIFICANCE: The global increase of myopia has caused a lot of debate the last years. Previous research of myopia in the Nordic population has shown diverse results, and only a few Swedish studies have been published in the subject the last two decades. PURPOSE: This study aimed to analyze trends in the prevalence of myopia in a population of Swedish children. METHODS: A retrospective analysis of medical records for children between 4 and 7 years of age in a region in Sweden was performed. The inclusion criterion was a first glasses prescription for myopia between 2012 and 2020. Children with other eye diseases or syndromes affecting the eye and vision were excluded. Age, sex, uncorrected visual acuity, and cycloplegic refractive values were extracted. The number of myopic children was compared with population data to calculate incidence and estimate prevalence. RESULTS: During the study period, 427 children between 4 and 7 years old in an average population of 17,200 children were prescribed glasses for myopia. The incidence for myopia increased from 0.11% in 2012 to 0.39% in 2020 ( P < .05). In 2015 to 2020, the prevalence of myopia for the same age group increased from 0.5 to 1.2% ( P < .05). Linear regression of the prevalence of myopia showed a significant increase in the age group of 7 years ( ß = 0.2%, R2 = 0.82, P ≤ .05). CONCLUSIONS: This study found a relatively stable prevalence of myopia among Swedish children aged 4 to 7 years between 2015 and 2020. The prevalence of 1.6% among 7-year-old children is not higher than in previous Scandinavian studies.

The effects of visual-field loss from panretinal photocoagulation of proliferative diabetic retinopathy on performance in a driving simulator.

BACKGROUND: The purpose of this study was to compare driving-simulator performance of participants with visual-field loss (VFL) from panretinal photocoagulation (PRP) of proliferative diabetic retinopathy (PDR) with a normally sighted control group. Furthermore, we investigated the effects of VFL of different extent on driving. METHODS: Data on performance and safety from a traffic-simulator test for 27 participants with VFL from PRP of PDR were retrospectively compared with data from 83 individuals without visual deficits in a cross-sectional study. Individuals with diabetes that regained their driving licences after a successful simulator test were then followed in a national accident database. RESULTS: Diabetes participants passed the test in 56% of the cases. Compared with the control group, diabetes participants had more risky "failed to give way" events and longer reaction times. Failed diabetes participants had lower mean sensitivity in the superior visual field than those who passed. None of the participants with a regained licence were involved in a motor vehicle accident during the 3-6-year follow-up after the simulator test. CONCLUSIONS: Diabetes participants had worse performance and safety than the controls. However, even individuals with VFL from PRP might drive safely, which highlights the need for individual assessments in licencing issues.

The Effects of Visual Field Loss from Optic Disc Drusen on Performance in a Driving Simulator.

The purpose of this study was to compare the driving simulator performance of participants with visual field loss (VFL) from optic disc drusen (ODD) with a normally sighted control group and a group of individuals with glaucoma. Data on performance and safety from a traffic simulator test for five participants with VFL from ODD were retrospectively compared with data from 49 male individuals without visual deficits in a cross-sectional study. VFL of the ODD group was also compared with a group of 20 male glaucoma participants who had failed the same simulator test. Four individuals with ODD regained their driving licences after a successful simulator test and were then followed in a national accident database. All participants with ODD passed the test. No significant differences in safety or performance measures were detected between the normally sighted participants and the ODD group despite severe concentric visual field constrictions. Compared with failed glaucoma male participants, the ODD group had even lower mean sensitivity in the peripheral and peripheral inferior field of vision. None of the four participants with a regained licence were involved in a motor vehicle accident during a 3-year follow-up period after the simulator test. Despite having severe VFL, participants with ODD had no worse performance or safety than controls. As even individuals with severe VFL might drive safely, there is a need for individual practical assessments on licencing issues.

The Effects of Visual Field Loss from Stroke on Performance in a Driving Simulator.

SIGNIFICANCE: Visual field loss is a common consequence of stroke and often precludes driving. However, legal visual requirements for drivers' licenses are largely without scientific basis. PURPOSE: This study aimed to examine the effects of different types of homonymous visual field loss after stroke on simulated driving. METHODS: Data on performance and safety from a traffic simulator test for 153 participants with withdrawn drivers' licenses due to visual field loss from stroke were retrospectively compared with data from 83 healthy individuals without visual deficits in a cross-sectional study. The 93 individuals in the stroke group who regained their driving licenses after a successful simulator test were then followed in a national accident database. RESULTS: Sixty-five percent of the stroke participants passed the simulator test (95% confidence interval, 57 to 72%). Younger patients were more successful than older. However, classification by neither type of homonymous visual field loss nor side of visual field loss was predictive of driver safety. Participants with hemianopia had their lateral lane position dislocated to the nonaffected side of the visual field. None of the participants with a regained license were involved in motor vehicle accidents 3 to 6 years after the test. CONCLUSIONS: In this large cohort, driver safety could not be predicted from the type of homonymous visual field loss. Even individuals with severe visual field loss might be safe drivers. Therefore, it seems reasonable to provide an opportunity for individualized assessments of practical fitness to drive in circumstances of licensing issues. This study demonstrates the potential of using a standardized driving simulator test for such assessments of fitness to drive.

Worldwide ophthalmological research production 2000-2020, with special focus on the Nordic contribution.

PURPOSE: To explore the trends in worldwide ophthalmic research production over a 21-year period in relation to journals, contributing countries and dominating topics with special focus on the Nordic region. METHODS: Articles published between 2000 and 2020 in 20 top-ranked ophthalmology journals were included. Number of articles and impact points were measured per country for each year. The most frequently occurring keywords were calculated worldwide and for the top five contributing countries and the Nordic countries. Trends were explored using linear regression. RESULTS: The analysis included 65 220 articles. Linear regression showed an increase with 56 articles per year (ß = 56.3, R2 = 0.72, p-value < 0.01). The United States published the most articles, comprising 35% of the worldwide total, followed by the United Kingdom (9%) and Japan (7%). Population-adjusted productivity revealed that Iceland was the most prolific country with 10 articles per million inhabitants/year. Singapore was second and Denmark third with corresponding numbers of nine and seven. Analysing regional trends, Asia had the largest increase in yearly number of articles (ß = 29.1, R2 = 0.89, p-value < 0.01). The strongest positive trend was observed in China (ß = 15.7, R2 = 0.94, p-value < 0.01). The Nordic countries contributed with 3.6% of worldwide ophthalmological papers. Among these, Denmark was the only country with a significant positive trend in impact points per million inhabitants per year (ß = 0.6, R2 = 0.54, p-value < 0.01). The most frequently occurring eye disease within the whole time frame was myopia (5.8%) followed by macular degeneration (5.4%) and glaucoma (5.3%). Linear regression showed a significant increase in the proportion of articles about diabetic retinopathy (ß = 0.2%, R2 = 0.88, p-value < 0.01) a significant decrease in the proportion in articles about cataract (ß = -0.1%, R2 = 0.70, p-value < 0.01) and myopia (ß = -0.1%, R2 = 0.67, p-value < 0.01). CONCLUSIONS: The worldwide ophthalmic research productivity has maintained a growing trend from 2000 to 2020. While North America and Europe are the major contributors, the scientific activity in Asia and especially China is growing impressively. With the current progress, Asia is forecast to outweigh Europe in 2025 and North America in 2033. Diabetic retinopathy was the most common eye disease in ophthalmologic papers in 2020, and also the topic with the strongest positive trend during 2000-2020.

Self-Perception and the Relation to Actual Driving Abilities for Individuals With Visual Field Loss.

Background: In Sweden, individuals with visual field loss (VFL) have their driving license withdrawn. The literature clearly indicates that individuals with VFL are unsafe drivers on a group level. However, many drivers with VFL can be safe on an individual level. The literature also suggests that self-perception, beliefs, and insights of one's own capabilities are related to driving performance. This study had three aims: (1) To investigate self-perceived driving capability ratings for individuals with VFL; (2) to compare these ratings between groups with different medical conditions associated with VFL (stroke, glaucoma, and diabetes); and (3) to relate the self-perception ratings to actual driving performance in an advanced driving simulator. Methods: Participants comprised 723 individuals whose driver's license had been withdrawn because of VFL and 92 normally sighted elderly individuals. All participants completed a background survey, rated difficulties with different traffic situations, rated their strengths and weaknesses as drivers, and rated aspects that were important for causing traffic accidents. Of the VFL group participants, 264 also completed a simulator-based driving test that they knew could lead to renewal of their driving license. VFL participants and normally sighted was at the same age when they completed the simulator driving test. Results: Overall, individuals with VFL rated their capabilities as high on all instruments and scales used, even higher than the elderly normally sighted control group. The only VFL etiology group that rated lower than other groups was the diabetes group. Safety orientation and internal control orientation values were best at discriminating between VFL participants in terms of self-perception of driving performance. Participants categorized as "high" in terms of safety skills and internal control were more modest in their ratings. Finally, participants who passed the simulated driving test did not differ from those who failed, in any of the self-perception measures. Conclusion: Self-perception ratings among individuals with VFL were higher than those of normally sighted elderly individuals. Self-assessed skills did not predict driving performance. Groups with different VFL etiologies rated similarly. Self-ratings of driving abilities cannot be used to assess actual driving performance. Actual driving tests (on road or in the simulator) are necessary to discriminate between safe and unsafe drivers with VFL.

Benjamin Esterman (1906-1994) and the binocular visual field scoring grid that became a world standard for assessing driver eligibility.

The visual field grid developed by the ophthalmologist Benjamin Esterman (1906-1994) is today an accepted standard for assessing driver eligibility in many parts of the world. However, little is published about the scientific process that led to the test or about the person who developed it. The aim of this article is to portray the ophthalmologist Benjamin Esterman, and to discuss the visual field grid with his name and its current role in assessing driving eligibility.

Shared burden is always lighter - Peer-review performance in an ophthalmological journal 2010-2020.

PURPOSE: There are concerns in the academic publishing community that it is becoming more difficult to secure reviews for scientific manuscripts. This study examines trends in editorial and peer review processes in an ophthalmological journal over the last decade. METHODS: A retrospective analysis was performed of editorial data from the journal Acta Ophthalmologica containing all manuscript submissions between 2010 and 2020. RESULTS: The number of yearly submissions grew between 2010 and 2019 from 1014 to 1623, and in 2020, the number of submissions increased to 2449. In total, the number of submissions increased by 142% between 2010 and 2020. Similarly, the proportion of desk-rejected manuscripts increased from 48% to 67% during the period 2010-2020. The number of invitations needed to obtain one review showed an increase from 1.9 to 2.6 between 2010 and 2019, but remained stable between 2019 and 2020. However, the number of reviewers per reviewed manuscript, reviewed manuscripts per reviewer and time from invitation to completed review assignment remained almost constant between 2010 and 2020. Researchers based in North American were disproportionally often invited to review (18%) compared to their share of published articles (7%), and they also declined review invitation more frequently compared to scholars in other parts of the world. CONCLUSIONS: The study revealed an increase in submitted manuscripts to an ophthalmological journal over the last decade, with a further increase during the COVID-19 pandemic. The number of reviewer invitations needed to obtain one review grew during the study period but remained constant between 2019 and 2020, despite a vast increase in submitted manuscripts. Hence, the burden for unique reviewers did not increase. Instead, the proportion of desk-rejected manuscripts grew, and the reviewer pool expanded, which allowed the annual average number of reviews by individual reviewers to remain stable.

The effects of visual field loss from glaucoma on performance in a driving simulator.

BACKGROUND: To examine the effects of different stages of visual field loss (VFL) from advanced glaucoma on performance in a driving simulator. METHODS: Data on performance and safety from a traffic simulator test for 104 participants with withdrawn driver's licences due to visual field loss from advanced glaucoma were compared with data from 83 individuals without visual deficits in a cross-sectional study. Individuals with glaucoma that regained their driving licences after a successful simulator test were then followed in a national accident database. RESULTS: Glaucoma participants passed the test in 71% (95% confidence interval 61-79%) of the cases. Younger participants were more successful than older. No significant differences on safety or performance measures were detected between glaucoma- and normally sighted participants. Compared with passed glaucoma participants, failed glaucoma participants had more collisions, more critical failed to give way events, longer time headways, and longer reaction times. This group had also a higher extent of central visual field loss. None of the participants with a regained licence were involved in a motor vehicle accident during the 2 to 4 year follow-up after the simulator test. CONCLUSION: Severity of glaucoma predicts driver safety on a group level. However, even individuals with severe visual field loss from glaucoma might drive safely, which highlights the need for individual assessments for licencing purposes.

[Hampered by an eyelid - Swedish immigrants to the United States debarred for trachoma in the early 20th century]. / Ögonlocket krossade drömmen om Amerika.

PURPOSE: To investigate Swedish immigrants to the United States debarred for medical reasons, with particular focus on trachoma. METHOD: Annual official reports of debarred immigrants have been compiled to compare reasons for debarment among Scandinavian immigrants vs. immigrants from all countries. Individual cases of trachoma among Swedish immigrants have been searched for in contemporary newspaper articles and combined with personal sources such as passenger lists and church records. RESULT: Between 1900-1925 about 1% of 850 000 Scandinavian immigrants to the United States were debarred, compared to 2,3% for migrants from all nations. The most common reason for Scandinavians to be debarred was likelihood to become a public charge, which included both poverty and several chronic diseases (46%). The share of individuals with contagious diseases among the debarred was 8%. Mental defects accounted for 3 %, the same number as trachoma during the time this was reported 1908-1925. Three cases of Swedes debarred from emigration due to trachoma are presented.  Conclusion: Scandinavian immigrants could be debarred due to trachoma but were less affected than other nationalities by the restrictions launched in the late 19th century.  Keywords: Emigration, trachoma, Ellis Island, debarment.

The future is old - Patients with topical ocular hypotensive treatment in the Nordic region between 2008 and 2017 with projections for 2040.

PURPOSE: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. METHODS: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. RESULTS: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (-9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). CONCLUSIONS: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypotensive treatment is estimated to have increased with an additional 50% due to a growing number of ageing individuals. This will lead to higher costs, not only for medications but also for diagnosing, monitoring and other aspects of glaucoma care.

Worth changing? Clinical effects of switching treatment in neovascular age-related macular degeneration from intravitreal ranibizumab and aflibercept to bevacizumab in a region in southern Sweden.

PURPOSE: To examine the clinical effects of switching intravitreal drug treatment from the approved vascular endothelial growth factor inhibitors, ranibizumab and aflibercept, to off label use of bevacizumab in patients with wet age-related macular degeneration. METHODS: This retrospective study scrutinized medical records of patients with wet age-related macular degeneration who switched therapy to bevacizumab due to a policy decision. Best corrected visual acuity, central retinal thickness, and number of injections before and 1 year after the switch was compared. The non-inferiority margin of best corrected visual acuity was five Early Treatment Diabetic Retinopathy Study letters. RESULTS: A switch from ranibizumab was evaluable in 93 eyes and from aflibercept in 19 eyes. Neither of the groups had a significant non-inferior visual acuity 16 month after the switch. Mean best corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters was 63.8 (95% confidence interval: 61.3-66.4) before and 62.2 (95% confidence interval: 59.3-65.1) after in the ranibizumab group and 68.2 (95% confidence interval: 63.3-73.1) before and 67.7 (95% confidence interval: 62.8-72.6) after in the aflibercept group. Mean central retinal thickness in micrometers decreased from 254 (95% confidence interval: 247-261) to 250 (95% confidence interval: 225-275) in the ranibizumab group and from 265 (95% confidence interval: 255-276) to 262 (95% confidence interval: 251-273) in the aflibercept group. The treatment was changed again after the switch in 18% of the patients in the ranibizumab group and 19% in the aflibercept group and these subjects were excluded from the analyses. CONCLUSION: In patients with neovascular age-related macular degeneration, a switch from ranibizumab or aflibercept to bevacizumab seems possible without a significant decrease in visual acuity in most patients.