| 1. |
- Åsman, Peter, et al.
(author)
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Internet-based assessment of medical students' ophthalmoscopy skills
- 2010
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420 .- 1755-375X .- 1755-3768. ; 88:8, s. 854-857
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Journal article (peer-reviewed)abstract
- Purpose: Ophthalmoscopy is an important skill in undergraduate medical education. The use and outcome of a novel Internet-based method for assessing motor skills-related aspects of ophthalmoscopy skills in medical students are described. Methods: A total of 139 students in Malmö and 255 students in Umeå were assessed during four consecutive semesters. An optic disc photograph was obtained in each student. At assessment each student was asked to examine the eye of a fellow student. Fifteen disc photographs were displayed on a computer screen. One of the photographs was from the fellow student. The remaining images had been randomly selected. The student was asked to identify the optic disc of the fellow student from the 15 photographs on the screen. In one semester, the time spent on this by each student was recorded. Results: All students completed the task. The average pass ratio was 96.4% (ranging from 94.0% to 98.0%). Median student times were 5.53 mins in Malmö and 6.36 mins in Umeå. Conclusions: This is the first automated, Internet-based assessment of an ophthalmic motor skill performed in co-operation between universities. The method used bears more similarities to real-life ophthalmoscopy than methods that use model eyes. Time investments and infrastructure demands were comparatively low. The method was designed for stand-alone assessment of ophthalmoscopy or as an objective structured clinical examination station, but it may also be used during the learning process. The collaboration between universities was easily transformed into routine practice and similar projects should be encouraged to increase the standardization of assessment
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| 2. |
- Fahnehjelm, Kristina Teär, et al.
(author)
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Ocular characteristics in 10 children with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency : a cross-sectional study with long-term follow-up.
- 2008
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420 .- 1755-375X .- 1755-3768. ; 86:3, s. 329-337
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Journal article (peer-reviewed)abstract
- PURPOSE To present long-term ocular complications and electroretinographic (ERG) findings in children with long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency - a life-threatening metabolic disease - and the relation to age at diagnosis, treatment and other clinical parameters. METHODS Ten children with LCHAD deficiency underwent repeated ophthalmological evaluations including ERG. RESULTS All 10 children developed chorioretinal pathology. Regardless of age at diagnosis, initiation of treatment and age at examination, inter-individual differences were present. Profound chorioretinal atrophy, severe visual impairment and progressive myopia had developed in two teenagers. Milder chorioretinopathy with or without subnormal visual acuity was present in all other children. ERG was pathological in seven children. The chorioretinopathy often started in the peripapillary or perimacular areas. In one patient, unilateral visual impairment was associated with fibrosis. CONCLUSION Early diagnosis and adequate therapy might delay but not prevent the progression of retinal complications. Late diagnosis with severe symptoms at diagnosis, neonatal hypoglycaemia and frequent decompensations may increase the progression rate of the chorioretinopathy. LCHAD deficiency, a potentially lethal disease, is sometimes difficult to diagnose. Unusual chorioretinal findings should alert the ophthalmologist to the long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, especially if there is a history of neonatal hypoglycaemia or failure to thrive.
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| 3. |
- Lundström, Mats, et al.
(author)
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The outcome of cataract surgery measured with the Catquest-9SF
- 2011
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In: Acta Ophthalmologica Scandinavica. - : Wiley-Blackwell. - 1395-3907 .- 1600-0420 .- 1755-375X .- 1755-3768. ; 89:8, s. 718-723
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this study was to use the Catquest-9SF to measure cataract surgery outcomes, and to use Rasch analysis to test the psychometric properties of this questionnaire, including its validity and responsiveness. Methods: Patients were recruited as consecutive cataract surgery patients during 1 month at six surgical units in Sweden (via the National Cataract Register). The patients completed the questionnaire before surgery and 3 months after. The Catquest-9SF data were assessed for fit to the Rasch model using version 3.63.2 of the WINSTEPS software (Winsteps.com, Beaverton, OR, USA). Both preoperative and postoperative questionnaires were included in the analysis. The responsiveness to cataract surgery was calculated as the effect size. Results: Completed questionnaires before and after surgery were received from 846 patients. The Rasch analysis showed that the category thresholds were ordered. All items fit a single overall construct (infit range 0.79-1.40; outfit range 0.74-1.40). The ability to discriminate different strata of person ability was good, with a real patient separation of 2.58 and patient separation reliability of 0.87. The questionnaire showed unidimensionality and was largely free from differential item functioning. The item difficulty was reasonably well targeted to both preoperative and postoperative patient ability. The Catquest-9SF Rasch score correlated significantly with visual acuity, and cataract surgery resulted in a significant improvement with an effect size of 1.8. Conclusion: The Catquest-9SF shows excellent psychometric properties, as demonstrated by Rasch analysis. It is highly responsive to cataract surgery, and its brevity (nine items) makes it well suited for use in daily clinical practice
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| 4. |
- Grönlund, Marita Andersson, 1959, et al.
(author)
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Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern Europe.
- 2010
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In: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X .- 1395-3907 .- 1600-0420. ; 88:2, s. 227-34
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Journal article (peer-reviewed)abstract
- PURPOSE: This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe. METHODS: We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed. RESULTS: Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02). CONCLUSIONS: In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.
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| 5. |
- de Verdier, Kim, et al.
(author)
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Children with blindness – major causes, developmental outcomes and implications for habilitation and educational support : a two‐decade, Swedish population‐based study
- 2018
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420 .- 1755-375X .- 1755-3768. ; 96:3, s. 295-300
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Journal article (peer-reviewed)abstract
- PurposeThe aim was to describe the population of children with congenital or early infancy blindness in Sweden, with regard to causes of blindness and prevalence of neurodevelopmental impairments.MethodsMedical, psychological and pedagogical records of Swedish children with congenital or early infancy blindness (total blindness or light perception at the most) born in 1988–2008 were analysed regarding year of birth, gender, cause of blindness, gestational age, associated neurological disorders/syndromes, associated neurodevelopmental impairments, cognitive level and type of school placement.ResultsA total of 150 individuals, 80 girls and 70 boys, were identified, corresponding to a prevalence of 7/100 000. Five causes of blindness dominated, constituting 76% of all represented aetiologies: retinopathy of prematurity (ROP), optic nerve hypoplasia (ONH), Leber congenital amaurosis (LCA), optic nerve atrophy (ONA) and microphthalmia/anophthalmia. Nearly three of four children in the study population had at least one additional disability besides blindness; the most common being intellectual disability (ID) and autism spectrum disorder (ASD). More than half of the population had more than one additional disability. Autism spectrum disorder (ASD) was most common in children with ONH, ROP, LCA and microphthalmia/anophthalmia.ConclusionIn children born within the last decades, isolated blindness is uncommon and the rate of multidisabilities is high. Autism spectrum disorder (ASD) seems to be more strongly associated with specific aetiological subgroups. Further development of the support to families and schools should be based on knowledge about the considerable heterogeneity of the population of children with blindness, and the common occurrence of coexisting neurodevelopmental disorders, especially ID and ASD.
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| 6. |
- Petursdottir, Dyrleif, et al.
(author)
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Strabismus, stereoacuity, accommodation and convergence in young adults born premature and screened for retinopathy of prematurity
- 2022
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In: Acta Ophthalmologica Scandinavica. - : John Wiley & Sons. - 1395-3907 .- 1600-0420 .- 1755-375X .- 1755-3768. ; 100:3
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Journal article (peer-reviewed)abstract
- Purpose The aim of the study was to evaluate strabismus, stereoacuity, accommodation and convergence in prematurely born young adults; screened for retinopathy of prematurity in the neonatal period and compare with term-born individuals of the same age. Materials and methods The study participants included 59 prematurely born individuals with a birthweight of <= 1,500 grams and 44 term-born controls, all born during 1988-1990 in Stockholm County, Sweden. Ocular alignment was assessed with a cover test, stereoacuity with the TNO stereo test and the amplitude of accommodation and the near point of convergence with the Royal Air Force Rule. Results Seven of 59 (12%) preterms had manifest strabismus, 4/59 (7%) had esotropia and 3/59 (5%) exotropia. One of 44 (2%) controls had esotropia; no other controls had manifest strabismus. Stereoacuity was within normal limits in 38/59 (64%) preterms and 43/44 (98%) controls, p < 0.01; the difference remained after excluding those with strabismus. A neurological complication at 2.5 years of age was the strongest risk factor for subnormal stereoacuity within the preterm group after excluding those with strabismus. The mean amplitude of accommodation was poorer in the preterms than the controls in better (p < 0.05) and worse eyes (p < 0.05). The preterms were more likely to have an amplitude of accommodation below the minimum, according to Hofstetter's equation. There were no differences between the groups regarding the near point of convergence. Conclusion Prematurely born young adults had a higher prevalence of strabismus, reduced stereoacuity and worse amplitude of accommodation than term-born controls.
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| 7. |
- Jóhannesson, Gauti, 1979-, et al.
(author)
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Introduction and clinical evaluation of servo-controlled applanation resonance tonometry
- 2012
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420 .- 1755-375X. ; 90:7, s. 677-682
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Journal article (peer-reviewed)abstract
- Purpose: In recent years, Applanation Resonance Tonometry (ART) has been suggested for intraocular pressure (IOP) measurements. The manual version of ART (ARTmanual) has been further developed, and to improve usability, an automatic servo-controlled prototype (ARTservo) has been proposed. The aim of this study was to assess the limits of agreement (LoA) of ARTmanual and ARTservo as compared with the reference method, Goldmann Applanation Tonometry (GAT).Methods: This was a prospective single-centre study on 152 eyes from 77 subjects. It was designed according to International Standard Organization’s (ISO) requirements for tonometers (ISO 2001). Intraocular pressure was measured six times/method in a standardized order. The ART technique has two available analysis procedures: a dynamic one that measures IOP during the indentation phase and a static one that causes a Goldmann-like measurement during two seconds of full applanation. The 95% LoA was defined as ±1.96 × standard deviation of difference against GAT.Results: Mean IOP for GAT was 19.1 mmHg (range: 10–37 mmHg). The 95% LoA of ARTmanual was ±4.5 mmHg for both dynamic and static analyses. The 95% LoA of ARTservo was ±5.7 mmHg for dynamic and ±4.9 mmHg for static analyses.Conclusions: This study confirms that the ART methodology is feasible. The further developed ARTmanual fulfilled the ISO standard with both the dynamic and the static analysis techniques. ARTservo with static analysis was close to fulfilling the standard but failed to do so in the highest IOP range. ARTservo has the potential to greatly improve usability if further development is completed.
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| 8. |
- Lundqvist, Britta, 1954-, et al.
(author)
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Gender-related differences in cataract surgery outcome : a 5-year follow-up
- 2008
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420 .- 1755-375X. ; 86:5, s. 543-548
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Journal article (peer-reviewed)abstract
- PURPOSE: A prospective, longitudinal, population-based cohort study was performed to analyse gender-related differences in subjective and objective visual function 5 years after cataract surgery. METHODS: All patients (n = 810) who underwent cataract surgery during a 1-year period (1997-98) at Norrlands University Hospital in Umeå, Sweden, were studied with visual acuity (VA) data and questionnaires (VF-14) before and after surgery, as well as 5 years later. Five hundred and thirty patients (177 men, 353 women) answered the questionnaire, constituting 90% (530/590) of the survivors. Four hundred and sixty-seven (156 men, 311 women) also underwent an eye examination. RESULTS: The women were significantly older (P = 0.009) and were more often operated on both eyes (P = 0.005). Before surgery and postoperatively, the women had a significantly lower age- and VA-adjusted VF-14 score (P = 0.000 and P = 0.036, respectively). This difference was not significant 5 years after surgery (P = 0.16). Five years after surgery, a significantly larger proportion of women had a decline of more than 0.1 logarithm of the minimum angle of resolution of the better-seeing eye (P = 0.013). There were no significant gender-related differences in the operated eye. CONCLUSION: Female cataract surgery patients assess their visual function worse than males after adjustment for age and VA preoperatively and postoperatively. These differences were not significant 5 years after surgery although the men had better best-corrected visual acuity (BCVA) of their better eye. It is important to be aware of gender-related differences in perception when performing questionnaire-based outcome studies.
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| 9. |
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| 10. |
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| 11. |
- Bengtsson, Boel, et al.
(author)
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Test-retest variability for standard automated perimetry and short-wavelength automated perimetry in diabetic patients
- 2008
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In: Acta Ophthalmologica. - : Wiley-Blackwell. - 1755-375X .- 1755-3768 .- 1395-3907. ; 86:2, s. 170-6
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Journal article (peer-reviewed)abstract
- PURPOSE: To assess limits for significant improvement or deterioration of visual fields in diabetic patients based on short-term test-retest variability in subjects with different degrees of retinopathy.METHODS: Fifty patients with diabetic retinopathy ranging from level 10 to 75 [according to the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale] were tested repeatedly with both standard automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) with short intervals. The association between visual field loss and degree of retinopathy outside fovea was analysed. Test-retest variability of global and local visual field indices and prediction limits for significant change were calculated.RESULTS: The amount of visual field loss was significantly associated to the degree of retinopathy, with a correlation coefficient of -0.51 for SAP (P = 0.0003) and -0.45 for SWAP (P = 0.002). Global test-retest variability was smaller with SAP than with SWAP (P < 0.0001). For both SAP and SWAP, local test-retest variability was considerably smaller at test points with normal sensitivity than at test points with reduced sensitivity (P < 0.0001). Paracentral test points within 10 degrees of eccentricity had less variability than peripheral points (P < 0.0001), implying that smaller change is required to reach statistically significant improvement or deterioration at initially normal and paracentral points than at depressed points and peripherally located test points.CONCLUSION: Our results propose that SAP, as well as SWAP, can be useful for monitoring visual function outside fovea in diabetic patients with various degrees of retinopathy. We report a preference for SAP because of less variability generally. Limits for significant improvement or deterioration have been assessed but need future validation in a longitudinal study.
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| 12. |
- Mathew, Jessica, et al.
(author)
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Lamellar changes in the keratoconic cornea
- 2015
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420 .- 1755-375X. ; 93:8, s. 767-773
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Journal article (peer-reviewed)
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| 13. |
- Agardh, Elisabet, et al.
(author)
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Stable refraction and visual acuity in diabetic patients with variable glucose levels under routine care
- 2011
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In: Acta Ophthalmologica. - : Wiley-Blackwell. - 1755-375X .- 1755-3768. ; 89:2, s. 107-110
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Journal article (peer-reviewed)abstract
- PURPOSE: To investigate how refraction and visual acuity may vary in patients with diabetes under routine care.METHODS: Fifty-three eyes of 53 patients with various degrees of diabetic retinopathy were examined prospectively on four different occasions within a month. Refraction, best-corrected visual acuity (expressed as logMAR score) and blood glucose were measured on each occasion. Intraindividual variability was calculated as the range between the highest and lowest measurements. Associations between blood glucose levels and each of the other variables were tested by linear regression analysis for each patient.RESULTS: Refraction was completely stable in 43 patients and changed only slightly in 10, in whom the mean intraindividual variability of the spherical equivalent was 0.4 dioptres. Visual acuity test results were also highly reproducible. Mean intraindividual variability in visual acuity was 0.08 logMAR. Mean haemoglobin A1c (HbA1c) was 7.3 ± 1.5% but individual blood glucose levels ranged from 2.8 to > 22.2 mmol/l. Intraindividual variability ranged from 0.5 to 18.1 mmol/l, with a median of 6.0 mmol/l for the entire group. There were no associations between refraction or visual acuity and blood glucose levels or inter- or intraindividual glucose variations.CONCLUSION: Refraction and visual acuity test results were highly reproducible and stable in patients with reasonably well controlled diabetes but variable blood glucose levels under routine care.
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| 14. |
- Andersson, Sabina, et al.
(author)
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Comparison of clinicians and an artificial neural network regarding accuracy and certainty in performance of visual field assessment for the diagnosis of glaucoma.
- 2013
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 91:5, s. 413-417
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Journal article (peer-reviewed)abstract
- Purpose: To compare clinicians and a trained artificial neural network (ANN) regarding accuracy and certainty of assessment of visual fields for the diagnosis of glaucoma. Methods: Thirty physicians with different levels of knowledge and experience in glaucoma management assessed 30-2 SITA Standard visual field printouts that included full Statpac information from 99 patients with glaucomatous optic neuropathy and 66 healthy subjects. Glaucomatous eyes with perimetric mean deviation values worsethan -10 dB were not eligible. The fields were graded on a scale of 1-10, where 1 indicated healthy with absolute certaintyand 10 signified glaucoma; 5.5 was the cut-off between healthy and glaucoma. The same fields were classified by a previously trained ANN. The ANN output was transformed into a linear scale that matched the scale used in the subjective assessments. Classification certainty was assessed using a classification error score. Results: Among the physicians, sensitivity ranged from 61% to 96% (mean 83%) and specificity from 59% to 100% (mean 90%). Our ANN achieved 93% sensitivity and 91% specificity, and it was significantly more sensitive than the physicians (p < 0.001) at a similar level of specificity. The ANN classification error score was equivalent to the top third scores of all physicians, and the ANN never indicated a high degree of certainty for any of its misclassified visual field tests. Conclusion: Our results indicate that a trained ANN performs at least as well as physicians in assessments of visual fields for the diagnosis of glaucoma.
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| 15. |
- Bengtsson, Boel, et al.
(author)
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Performance of time-domain and spectral-domain Optical Coherence Tomography for glaucoma screening.
- 2010
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; :Nov
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Journal article (peer-reviewed)abstract
- Purpose: To investigate the measures of validity for selective or population screening of the time-domain Stratus and the spectral-domain Cirrus Optical Coherence Tomography (OCT) imaging techniques in a population-based sample and in clinical glaucoma patients at different stages of glaucoma. Patients and methods: A random sample of 307 subjects living in two rural areas in southern Sweden, and a random sample of 394 clinical glaucoma patients were selected. A large battery of examinations, including Stratus and Cirrus OCT was performed. OCT retinal nerve fibre layer (RNFL) thickness analyses for average thickness, quadrant and clock-hour sectors were compared with normative significance limits available in the instruments. Results: The population-based sample included 129 healthy and nine glaucoma subjects, and the sample of clinical glaucoma patients included 138 patients. Specificity and positive predictive values were generally better with Stratus than for Cirrus, and sensitivity was generally better with Cirrus. With the average RNFL thickness parameter, Stratus reached 100% specificity and a positive predictive value of 100% and 68% sensitivity in the whole group of the clinical glaucoma patients, but sensitivity was only 28% among the earliest stage glaucoma patients. Sensitivity increased considerably when relying on the quadrant sector parameter, while specificity decreased only marginally. Conclusion: Stratus, with high specificity and positive predictive values, seemed to be best of choice for screening purposes, while Cirrus, with high sensitivity, was the better choice for early detection.
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| 16. |
- Bizios, Dimitrios, et al.
(author)
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Machine learning classifiers for glaucoma diagnosis based on classification of retinal nerve fibre layer thickness parameters measured by Stratus OCT.
- 2010
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 88, s. 44-52
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Journal article (peer-reviewed)abstract
- Abstract. Purpose: To compare the performance of two machine learning classifiers (MLCs), artificial neural networks (ANNs) and support vector machines (SVMs), with input based on retinal nerve fibre layer thickness (RNFLT) measurements by optical coherence tomography (OCT), on the diagnosis of glaucoma, and to assess the effects of different input parameters. Methods: We analysed Stratus OCT data from 90 healthy persons and 62 glaucoma patients. Performance of MLCs was compared using conventional OCT RNFLT parameters plus novel parameters such as minimum RNFLT values, 10th and 90th percentiles of measured RNFLT, and transformations of A-scan measurements. For each input parameter and MLC, the area under the receiver operating characteristic curve (AROC) was calculated. Results: There were no statistically significant differences between ANNs and SVMs. The best AROCs for both ANN (0.982, 95%CI: 0.966-0.999) and SVM (0.989, 95% CI: 0.979-1.0) were based on input of transformed A-scan measurements. Our SVM trained on this input performed better than ANNs or SVMs trained on any of the single RNFLT parameters (p
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| 17. |
- Edén, Ulla, et al.
(author)
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Aniridia among children and teenagers in Sweden and Norway.
- 2008
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 86, s. 730-734
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Journal article (peer-reviewed)abstract
- Purpose: To investigate patients under the age of 20 with aniridia in Sweden and Norway in order to estimate the prevalence of aniridia, to describe clinical signs and identify complications in the young, which will help improve diagnostic tools and treatment. Methods: A thorough search for patients with aniridia (of all ages) was performed. Sixty-two of the 181 patients were under the age of 20. Fifty-two of them were examined and they constituted the study population. Patient history was obtained and all participants underwent clinical ophthalmologic examination, including photography. Blood samples were taken for mutation analysis. Results: Epidemiological data are only based on the results in Sweden. The age-specific prevalence in Sweden was 1:47 000, male/female ratio was 0.57, mean age 12 years and median age 14 years. The proportion of sporadic cases including WAGR (Wilms tumour, Aniridia, Genitourinary abnormalities, Mental Retardation) and Gillespie syndrome (aniridia, cerebellar ataxia and mental retardation) was 48%. In the entire study population (Sweden and Norway), the mean visual acuity (VA) was 0.2 (range 0.04-0.9). We found VA < 0.3 in 80% and <0.1 in 18% of the patients. Twenty-two patients (42%) had one or more of the sight threatening complications such as cataract/lens luxation, corneal clouding or glaucoma. Conclusion: Descriptions of aniridia in the younger are rare. This study shows that aniridia seems to be more common than previously estimated and that some complications appear early in life. Watchfulness as regards these complications and regular examinations are essential even in the youngest.
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| 18. |
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| 19. |
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| 20. |
- Gustavsson, Carin, et al.
(author)
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Profile of intraocular tumour necrosis factor-α and interleukin-6 in diabetic subjects with different degrees of diabetic retinopathy.
- 2013
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 91:5, s. 445-452
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Journal article (peer-reviewed)abstract
- Purpose: To assess and correlate the levels of inflammatory mediators in the eyes from non-diabetic and diabetic subjects without retinopathy (NDR), with non-proliferative diabetic retinopathy (NPDR) or with proliferative diabetic retinopathy (PDR) to corresponding erum levels. Methods: The levels of interleukin 1β, interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were analysed by an ELISA-mimicking technique in the vitreous from 26 diabetic subjects with active PDR and 27 non-diabetic subjects, or by a multiplex bead assay in the aqueous humour from 35 diabetic subjects with NDR/NPDR and 40 non-diabetic subjects. Intraocular protein production was estimated in vitreous specimens by calculating a vitreous/serum ratio. Results: In the vitreous, IL-6 was higher in diabetic [157.5 (25.0-1401.0) pg/ml; median (min-max)] than in non-diabetic subjects [44.0 (5.0-4425) pg/ml; p = 0.021]. The vitreous/serum ratio was high (55.5:1 and 16:1, respectively), suggesting intraocular production. TNF-α was lower in diabetic [18.0 (8.0-46.0) pg/ml] than in non-diabetic subjects [22.0 (13.0-47.0) pg/ml; p = 0.034], but the vitreous/serum ratio was elevated in both groups (2:1 and 3.4:1, respectively). TNF-α levels were higher in serum from diabetic subjects [9.0 (5.0-53.0) pg/ml versus 6.7 (3.0-11.0) pg/ml; p < 0.001]. Aqueous levels of inflammatory mediators did not differ between diabetic subjects with NDR/NPDR and non-diabetic subjects despite elevated TNF-α in serum [27.8 (6.8-153.7) pg/ml versus 16.4 (4.1-42.4) pg/ml; p = 0.021]. Conclusion: Intraocular inflammation seems to be involved in PDR but does not seem to be prominent in early retinopathy stages, i.e. NDR or NPDR. Diabetic subjects have an overall increased inflammatory activity compared to non-diabetic subjects, as demonstrated by increased serum levels of TNF-α.
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| 21. |
- Hammar, Björn, et al.
(author)
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Dystrophia Helsinglandica : a new type of hereditary corneal recurrent erosions with late subepithelial fibrosis
- 2009
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In: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 87:6, s. 659-667
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Journal article (peer-reviewed)abstract
- Purpose: To describe the phenotype of an autosomal-dominant corneal dystrophy with an early onset of recurrent corneal erosions and development of subepithelial fibrosis in the cornea, and also to exclude genetic linkage to known corneal dystrophies with autosomal-dominant inheritance and clinical resemblance. Methods: We describe the medical history and clinical findings in individuals from a seven-generation family with recurrent corneal erosions. A total of 43 individuals were evaluated by ophthalmological examination. Genomic DNA was prepared from peripheral blood and polymorphic microsatellite markers were analysed to study haplotypes surrounding genes causing corneal dystrophies with similar phenotypes. Results: Erosive symptoms usually lasted for between 1 and 10 days. By the age of 7 almost all of the affected individuals suffered from recurrent corneal erosions. The attacks generally declined in frequency and intensity from the late 20s, but all examined individuals had developed subepithelial fibrosis by the age of 37. The fibrosis generally started in the mid periphery and was followed in some family members by central fibrosis and the development of gelatinous superficial elevations. Only a marginal reduction of visual acuity was seen in a few individuals. The affected individuals did not share haplotypes for genetic microsatellite markers surrounding genes that are known to cause autosomal-dominant corneal dystrophies. Conclusion: We describe a new type of autosomal-dominant corneal disorder with recurrent corneal erosions and subepithelial fibrosis not significantly affecting visual acuity.
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| 22. |
- Hammar, Björn, et al.
(author)
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Dystrophia Smolandiensis: a novel morphological picture of recurrent corneal erosions
- 2010
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 88:4, s. 394-400
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Journal article (peer-reviewed)abstract
- Purpose: The aim of this study was to describe morphological changes in Dystrophia Smolandiensis, a corneal disease that is characterized by recurrent corneal erosive episodes and the formation of central corneal keloid-like opacities in approximately half of those affected. Methods: The corneas of seven affected individuals were examined using in-vivo confocal microscopy. Specimens of one primary corneal graft, one regraft and one biopsied keloid-like region - all obtained from members of a large family with the disease - were re-examined with a light microscope. Sections were stained with Congo red and analysed immunohistochemically for fibronectin and S100A4. Results: Light microscopic examination revealed epithelial hyperplasia, absence of Bowman's layer and subepithelial fibrosis. Fibronectin was expressed in the area of subepithelial fibrosis, and the keratocytes in this area generally expressed S100A4. The biopsy specimen stained positive for Congo red, suggesting an amyloid deposit. In-vivo confocal microscopy confirmed epithelial abnormalities, loss of Bowman's layer and significant alterations of the subbasal nerve plexus in affected individuals. Conclusion: The morphological picture in Dystrophia Smolandiensis is novel for a condition dominated by recurrent corneal erosions at the clinical level. Although no single morphological feature unique to the disease could be found, the general morphological pattern of pathology (true keloid formation, absence of Bowman's layer, subepithelial fibrosis and abnormal subbasal nerves) probably reflects a novel phenotypic expression of the healing response to recurrent erosion of the corneal epithelium. However, the pathogenesis of Dystrophia Smolandiensis remains to be elucidated fully.
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| 23. |
- Heijl, Anders, et al.
(author)
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Nordic research in ophthalmology.
- 2005
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In: Acta ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420. ; 83:3, s. 278-88
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Journal article (other academic/artistic)abstract
- Nordic ophthalmologists and vision scientists are active in many fields of eye research. This is most evident at the biannual Nordic Congress of Ophthalmology, most recently held in Malmö in June 2004. The authors here review some of the research in vision and ophthalmology presented at this meeting or published recently by Nordic scientists. This paper does not represent a comprehensive review of all Nordic research in the field, but attempts to give an overview of some of the activities underway in eye research in this part of the world.
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| 24. |
- Heijl, Anders, et al.
(author)
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Rates of visual field progression in clinical glaucoma care.
- 2013
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 91:5, s. 406-412
-
Journal article (peer-reviewed)abstract
- Purpose: To investigate rates of visual field progression and factors associated with progression rate in open-angle glaucoma in clinical glaucoma care. Methods: We performed a retrospective chart review of all patients with manifest primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) followed ≥ 5 years with ≥5 SITA Standard fields. Exclusion criteria were minimal. Demographics, intraocular pressure values (IOP), treatment and treatment changes, and visual field (VF) data were recorded. VF progression rates were calculated as slopes of mean deviation (MD) over time. Results: Five hundred and eighty-three patients were eligible. Three hundred and sixty-seven (62%) had POAG and 221 (38%) PEXG. Median MD at study start was -10.0 dB. Mean follow-up time was 7.8 years (SD ± 1.2); mean number of VF tests was 8.9 (SD ± 2.8). Progression rates varied very much among patients with a mean of -0.80 dB/year (SD ± 0.82; median rate, -0.62), and 5.6% of patients progressed at rates worse than -2.5 dB per year A negative slope of MD values was observed in 89% of patients. Mean IOP of all visits decreased over the study period from 20.15 to 18.10 mmHg. Higher age and mean IOP, and more intensive treatment were associated with more rapid progression, while PEXG and IOP variation were not, if treatment intensity was taken into account. Conclusion: Rates of visual field progression in manifest glaucoma with field loss in ordinary clinical care were highly variable. Progression rates rapid enough to influence quality of life were common.
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| 25. |
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| 26. |
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| 27. |
- Hellgren, Karl-Johan, 1971-, et al.
(author)
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Functional and structural change in diabetic eyes. Interim results from an ongoing longitudinal prospective study
- 2013
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In: Acta Ophthalmologica. - : Wiley-Blackwell. - 1755-375X .- 1755-3768. ; 91:7, s. 672-677
-
Journal article (peer-reviewed)abstract
- Purpose: To presents results after 18months of follow-up of a longitudinal study aiming at exploring the correlation between diabetic retinal vascular lesions and functional change.Methods: Patients were consecutively recruited from attendees to the screening program for diabetic retinopathy. Subjects are followed every sixth month for the first 3years and thereafter annually up to 5years. Progression of diabetic retinopathy is evaluated using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale and improvement/deterioration in visual fields by predefined significance limits for change.Results: Of 81 subjects, with no/mild/moderate diabetic retinopathy included, 76 have passed the 18-month visit. At that time, retinal progression by two steps according to the ETDRS scale had occurred in two subjects. Visual acuity was -0.14 logMAR and had decreased with two letters (0.04 logMAR) (p<0.001) from baseline. The global visual field index mean deviation was almost unchanged with a negligible improvement of 0.03dB (p=0.79). In 21 subjects, repeated significant deterioration was seen in 10% of all points tested in the field, while almost no improved points were noted. The two subjects with retinal progression were not among those 21 with indication of perimetric progression.Conclusions: This is, to our knowledge, the first longitudinal study evaluating change of visual fields in a representative diabetic cohort with no or mild/moderate retinopathy. In this interim report, we demonstrate deteriorated perimetric sensitivity in subjects already at 18months of follow-up. The results will have implications for evaluating change in visual function in future clinical trials.
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| 28. |
- Hougaard, Jesper Leth, et al.
(author)
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The nerve fibre layer symmetry test: computerized evaluation of human retinal nerve fibre layer thickness as measured by optical coherence tomography
- 2004
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420. ; 82:4, s. 410-418
-
Journal article (peer-reviewed)abstract
- Purpose: To present and test a new interpretative concept, the nerve fibre layer symmetry test (NST), for computerized evaluation of retinal nerve fibre layer thickness (RNFLT) as measured by optical coherence tomography (OCT) in glaucoma. Methods: The NST concept was constructed and tested in a pilot study. A total of 32 healthy and 40 age-matched glaucomatous eyes were included and examined by OCT, computerized perimetry, RNFL/disc photography, tonometry and a general ophthalmologic examination. Results: The observed NST sensitivity and specificity were high, at 38/40 eyes (95%) and 32/32 eyes (100%), respectively, and 40/40 eyes (100%), and 31/32 eyes (97%), respectively, when correcting the OCT RNFLT measurement for the influence of variability in image signal/quality. The NST sensitivity was 8-10% higher than the single most sensitive traditional OCT RNFLT parameter; this difference was not statistically significant in this small sample. Conclusion: The NST showed high specificity and sensitivity for detection of RNFLT attenuation indicating early to severe glaucoma. Although promising, the NST needs to be further developed and validated in larger study samples and in patients with various stages of glaucomatous damage.
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| 29. |
- Kobelt, G, et al.
(author)
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Cost-effectiveness analysis in glaucoma: what drives utility? Results from a pilot study in Sweden
- 2006
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420. ; 84:3, s. 363-371
-
Journal article (peer-reviewed)abstract
- Purpose: To investigate the effect of different levels of visual field defect in glaucoma on utilities and to test if utilities could be assessed using a general questionnaire such as the EQ-5D. Methods: A cross-sectional study in 199 patients with ocular hypertension or open-angle glaucoma grouped into 5 severity stages according to visual field defects was performed in 4 specialized ophthalmic centres. Descriptive analysis was performed for the sample and by stage, and the effect of vision loss on utility was investigated with multiple step-wise regression analysis. Results: The mean age of the sample was 70 and the mean MD in the worse eye was -13.1 dB (SD 10.2). Visual acuity (VA) was 0.63 and 0.87 in the worse and better eye, respectively, and the mean utility was 0.80 (SD 0.23). Utility decreased with increasing glaucomatous damage, ranging from 0.84 for mild disease to 0.72 for severe damage (MD -2.5 to -28.1), but the difference between the groups was not statistically significant when controlling for co-morbidity, except for the most severe stage (p < 0.01). In multiple regression analysis, visual field in the better eye was significantly correlated with utility, and there was an indirect correlation between visual field in the worse eye and utility: the effect of total VA on utility was significant, and MD in the worse eye was correlated with total VA. Conclusions: Utility is strongly correlated with overall vision. Our results suggest a relationship between glaucomatous damage and utility, and patients with severe damage have a significantly lower utility. However, this should be further investigated in larger samples that include more patients with moderate-severe bilateral damage.
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| 30. |
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| 31. |
- Lövestam Adrian, Monica, et al.
(author)
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Multifocal electroretinography amplitudes increase after photocoagulation in areas with increased retinal thickness and hard exudates.
- 2010
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 88, s. 188-192
-
Journal article (peer-reviewed)abstract
- Abstract. Purpose: This study aimed to evaluate local response on multifocal electroretinography (mfERG) and to assess retinal thickness with optical coherence tomography (OCT) after focal laser treatment in areas with retinal oedema and exudates in patients with diabetic retinopathy. Methods: Twelve diabetes patients (aged 60 +/- 14 years, diabetes duration 16 +/- 8 years) treated with focal or grid photocoagulation in areas with retinal oedema and/or exudates underwent mfERG and OCT before and 3 months after treatment. The average thickness (in mum) in any of the nine sectors (defined according to the ETDRS) treated with photocoagulation was measured. Amplitudes and implicit times were analysed in corresponding areas on the mfERG. Results: Mean mfERG amplitudes increased after photocoagulation (21.5 +/- 8.0 nV/deg(2) versus 16.8 +/- 6.1 nV/deg(2); p = 0.012), whereas no difference was seen in implicit times. Mean OCT values in the treated regions were lower at follow-up (272 +/- 23 mum versus 327 +/- 79 mum; p = 0.013). No correlation was seen between changes in mfERG response and changes in OCT values. The decrease in retinal thickness was correlated with the number of laser spots applied (p = 0.002). Conclusions: Focal argon laser treatment is effective in reducing retinal thickness. In addition, treated areas tend to show improved retinal function as demonstrated by increased amplitudes on mfERG.
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| 32. |
- Ponjavic, Vesna, et al.
(author)
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Reduced full-field electroretinogram (ERG) in a patient treated with methotrexate.
- 2004
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In: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420. ; 82:1, s. 96-99
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Journal article (peer-reviewed)abstract
- Purpose: To examine retinal function in a patient with decreased vision possibly due to treatment with methotrexate. Methods: Ophthalmological examination included testing of visual acuity (VA), fundus inspection, fundus photography and kinetic perimetry. Retinal function was tested objectively with three electrophysiological methods: full-field electroretinography (ERG), multifocal electroretinography (mfERG) and electro-oculography (EOG). Results: A 13-year-old boy with psoriasis arthritis had been treated with methotrexate on a weekly basis for 8.5 years. After terminating treatment, his VA, which was reduced to 0.3 in both eyes initially, improved during the following 3 years but did not return to normal. No visual field defects were found with kinetic perimetry. The rod and cone responses in the full-field ERG were markedly reduced in b-wave amplitude initially, but grew slowly to nearly normal values 3 years later. After withdrawal of the drug, the mfERG demonstrated normal responses in the macular region. The Arden index in the EOG was normal. Conclusion: Chronic treatment with methotrexate may affect VA, and may reversibly reduce rod and cone function. In patients who use systemic medication and whose vision is reduced, objective evaluation of retinal function with electrophysiological methods is recommended.
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| 33. |
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| 34. |
- Selvander, Madeleine, et al.
(author)
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Cataract surgeons outperform medical students in Eyesi virtual reality cataract surgery: evidence for construct validity.
- 2013
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 91:5, s. 469-474
-
Journal article (peer-reviewed)abstract
- Purpose: To investigate construct validity for modules hydromaneuvers and phaco on the Eyesi surgical simulator. Methods: Seven cataract surgeons and 17 medical students performed capsulorhexis, hydromaneuvers, phaco, navigation, forceps, cracking and chopping modules in a standardized manner. Three trials were performed on each module (two on phaco) in the above order. Performance parameters as calculated by the simulator for each trial were saved. Video recordings of the second trial of the modules capsulorhexis, hydromaneuvers and phaco were evaluated with the modified Objective Structured Assessment of Surgical Skill (OSATS) and Objective Structured Assessment of Cataract Surgical Skill (OSACSS) tools. Results: Cataract surgeons outperformed medical students with regard to overall score on capsulorhexis (p < 0.001, p = 0.035, p = 0.010 for the tree iterations, respectively), navigation (p = 0.024, p = 0.307, p = 0.007), forceps (p = 0.017, p = 0.03, p = 0.028). Less obvious differences in overall score were found for modules cracking and chopping (p = 0.266, p = 0.022, p = 0.324) and phaco (p = 0.011, p = 0.081 for the two iterations, respectively). No differences in overall score were found on hydromaneuvers (p = 0.588, p = 0.503, p = 0.773), but surgeons received better scores from the evaluations of the modified OSATS (p = 0.001) and OSACSS (capsulorhexis, p = 0.003; hydromaneuvers, p = 0.017; phaco, p = 0.001). Conclusions: Construct validity was found on several modules previously not investigated (phaco, hydromaneuvers, cracking and chopping, navigation), and our results confirm previously demonstrated construct validity for capsulorhexis and forceps modules. Interestingly, validation of the hydromaneuvers module required OSACSS video evaluation tool. A further development of the scoring system in the simulator for the hydromaneuvers module would be advantageous and make training and evaluation of progress more accessible and immediate.
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| 35. |
- Selvander, Madeleine, et al.
(author)
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Virtual reality cataract surgery training: learning curves and concurrent validity.
- 2012
-
In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 90, s. 412-417
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Journal article (peer-reviewed)abstract
- Purpose: To investigate initial learning curves on a virtual reality (VR) eye surgery simulator and whether achieved skills are transferable between tasks. Methods: Thirty-five medical students were randomized to complete ten iterations on either the VR Caspulorhexis module (group A) or the Cataract navigation training module (group B) and then two iterations on the other module. Learning curves were compared between groups. The second Capsulorhexis video was saved and evaluated with the performance rating tool Objective Structured Assessment of Cataract Surgical Skill (OSACSS). The students' stereoacuity was examined. Results: Both groups demonstrated significant improvements in performance over the 10 iterations: group A for all parameters analysed including score (p < 0.0001), time (p < 0.0001) and corneal damage (p = 0.0003), group B for time (p < 0.0001), corneal damage (p < 0.0001) but not for score (p = 0.752). Training on one module did not improve performance on the other. Capsulorhexis score correlated significantly with evaluation of the videos using the OSACSS performance rating tool. For stereoacuity < and ≥120 seconds of arc, sum of both modules' second iteration score was 73.5 and 41.0, respectively (p = 0.062). Conclusion: An initial rapid improvement in performance on a simulator with repeated practice was shown. For capsulorhexis, 10 iterations with only simulator feedback are not enough to reach a plateau for overall score. Skills transfer between modules was not found suggesting benefits from training on both modules. Stereoacuity may be of importance in the recruitment and training of new cataract surgeons. Additional studies are needed to investigate this further. Concurrent validity was found for Capsulorhexis module.
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| 36. |
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| 37. |
- Wittström, Elisabeth, et al.
(author)
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Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open-angle glaucoma and neovascular glaucoma.
- 2010
-
In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 88, s. 86-90
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Journal article (peer-reviewed)abstract
- Purpose: To evaluate patients with central retinal vein occlusion (CRVO) and neovascular glaucoma (NVG) using electrophysiology in order to gain better understanding of visual outcome and risk factors, such as previously diagnosed primary open-angle glaucoma (POAG). Methods: Eighty-three patients (83 eyes) initially presenting with CRVO and examined with full-field electroretinography (ERG) within 3 months of the thrombotic event were analysed retrospectively regarding treatment, risk factors and visual outcome. In addition, 30 patients initially presenting with NVG caused by CRVO were also investigated regarding risk factors using electrophysiology in order to determine the cause of their visual impairment. Results: Nineteen (23%) of the 83 patients initially presenting with CRVO had been diagnosed previously with POAG. Ninety-five per cent (18/19) of all the patients with previously diagnosed glaucoma developed ischaemic CRVO. Thirty-four per cent of the patients initially presenting with CRVO (28/83) developed NVG. Sixty-eight per cent (13/19) of the patients with previous glaucoma developed NVG, compared to 23% (15/64) of the patients without previous POAG. In the patients who initially presented with NVG, full-field ERG demonstrated a remaining retinal function of both cones and rods, indicating that the main cause of visual impairment is ischaemia of the ganglion cell layer. Conclusion: Glaucoma is a significant risk factor for developing ischaemic CRVO and subsequent NVG. The presence of POAG in CRVO worsens visual outcome. NVG is associated with preserved photoreceptor function, thus indicating ischaemia of the ganglion cell layer as the primary cause of visual impairment. This emphasizes the importance of prompt treatment of ischaemia and elevated intraocular pressure in these patients.
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| 38. |
- Xu, Can, et al.
(author)
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Transscleral visible/near-infrared spectroscopy for quantitative assessment of haemoglobin in experimental choroidal tumours.
- 2012
-
In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 90, s. 350-356
-
Journal article (peer-reviewed)abstract
- Purpose: To study the feasibility of using transscleral visible/near-infrared spectroscopy (Vis/NIRS) to estimate the content of haemoglobin in choroidal tumour phantoms of ex vivo porcine eyes. Methods: Thirty enucleated porcine eyes were prepared with a tumour phantom made by injecting a suspension of gelatine, titanium dioxide and human blood into the suprachoroidal space. The blood concentrations used were 2.5%, 25% and 50%, with 10 eyes in each group. Alternating Vis/NIRS measurements were taken over the phantom inclusion and on the opposite (normal) side of each eye. For statistical analysis, a genetic algorithm was utilized to suppress insignificant wavelengths in the spectra. The processed spectra were then used to build a regression model based on partial least squares regression and evaluated by twofold cross-validation. Results: Ultrasonography revealed that all phantoms were localized within the suprachoroidal space with no penetration through the retina. The largest mean diameters of the phantoms with 2.5%, 25% and 50% blood were 15.5, 15.2 and 15.7 mm, respectively (p > 0.05). The largest mean thicknesses were 4.5, 4.5 and 4.8 mm, respectively (p > 0.05). Statistical analysis of the spectral data showed that it was possible to correctly discriminate between the normal side and the tumour phantom side of the eyes in 99.88% of cases. The phantoms could be correctly classified according to their blood concentrations in 99.42% of cases. Conclusions: This study demonstrates that transscleral Vis/NIRS is a feasible and accurate method for the detection of choroidal tumours and to assess the haemoglobin content in such lesions.
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| 39. |
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| 40. |
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| 41. |
- Edén, Ulla, et al.
(author)
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Epidemiology of aniridia in Sweden and Norway.
- 2008
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 86, s. 727-729
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Journal article (peer-reviewed)abstract
- Purpose: To investigate the epidemiology of aniridia in the populations of Sweden and Norway. Methods: A thorough search for aniridia patients has been performed in Sweden and Norway. All participants had a clinical ophthalmological examination documented through photography. Blood samples were taken for mutation analysis and pedigrees were established. Results: A total of 181 patients with aniridia were identified in the two countries. This gives an age-specific prevalence of 1:72 000 in the entire region, 1:70 000 in Sweden and 1:76 000 in Norway. A total of 124 individuals (69%) were examined. Male/female ratio was 0.94 (Sweden 0.85 and Norway 1.2). Mean age of the examined patients was 29 years and median age 25 years. We did not find any significant age difference between the two countries. The mean visual acuity (VA) was 0.19 (Sweden 0.19 and Norway 0.18).The number of families with more than one affected member was 31 and the number of sporadic cases was 40. Conclusion: We have done a thorough search of the literature, but we have found no earlier studies describing aniridia in an entire country and only a few reports from larger areas. We assume that most aniridia patients have been found and the aniridia prevalence of 1:72 000 can be regarded as well supported. Further studies on other aspects of aniridia are in progress, and information from these can contribute to guidelines for the care of patients with this rare but serious disease.
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| 42. |
- Ehinger, Berndt, et al.
(author)
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Allvar Gullstrand (1862-1930) - the Gentleman with the Lamp.
- 2011
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 89, s. 701-708
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Journal article (peer-reviewed)abstract
- This is a biography of Allvar Gullstrand (1862-1930) on the occasion of the centennial of his 1911 Nobel Prize in physiology or medicine. We reviewed pertinent literature and we did archival studies at the Uppsala University Library and the Regional State Archives at Lund as well as the Nobel Archives at the Royal Swedish Academy of Sciences in Stockholm. Allvar Gullstrand was a brilliant scientist with an exceptional personality. He gave mathematical descriptions of the dioptric system of the human eye with unprecedented accuracy, and he invented and designed ophthalmological instruments of far-reaching importance. The two most valuable ones are the slit lamp and the reflexless ophthalmoscope. Both are in everyday use by any ophthalmologist in the world. Allvar Gullstrand is so far the only ophthalmologist who has been given a Nobel Prize for work in ophthalmology, and he deserved it well.
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| 43. |
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| 44. |
- Fosmark, Dag S., et al.
(author)
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Increased retinopathy occurrence in type 1 diabetes patients with increased serum levels of the advanced glycation endproduct hydroimidazolone
- 2009
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 87:5, s. 498-500
-
Journal article (peer-reviewed)abstract
- Purpose: We aimed to investigate associations between serum levels of the advanced glycation endproduct methylglyoxal-derived hydroimidazolone (MG-H1) and retinopathy in a sample of patients with type 1 diabetes. Methods: We conducted a cross-sectional study in a Scandinavian ophthalmology outpatient clinic on 61 randomly selected patients with type 1 diabetes. Blood samples and retinal photographs were taken at the same visit. Serum levels of hydroimidazolone immunoreactivity were determined using an immunoassay, and levels of retinopathy were determined from seven standard field stereo photographs of each eye according to the ETDRS method. Results were compared between patients with and without retinopathy. Results: Hydroimidazolone quartiles were significantly associated with retinopathy (p = 0.013). The most profound increase in occurrence of retinopathy was observed from the lowest to the second-lowest hydroimidazolone quartile. Adjusted for duration of diabetes using logistic regression, a significant difference in the presence of retinopathy was found when comparing the lowest quartile with the rest (p = 0.022). Conclusions: In our patients with type 1 diabetes, serum levels of hydroimidazolone were found to be associated with retinopathy. This is in keeping with findings in a larger sample of patients with type 2 diabetes.
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| 45. |
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| 46. |
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| 47. |
- Heijl, Anders, et al.
(author)
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Intraocular pressure reduction with a fixed treatment protocol in the Early Manifest Glaucoma Trial.
- 2011
-
In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 89, s. 749-754
-
Journal article (peer-reviewed)abstract
- Purpose: To evaluate: (i) the relationship between intraocular pressure (IOP) reduction attained with a fixed treatment protocol and the untreated IOP level; (ii) the consistency of IOP reduction over time; and (iii) whether there is a threshold pretreatment IOP level below which IOP reduction might be less effective. Results are based on 128 patients with glaucoma with field defects, who were randomized to the treatment arm of the Early Manifest Glaucoma Trial (EMGT). Methods: The EMGT fixed treatment protocol consisted of 360 degrees laser trabeculoplasty and topical betaxolol eye drops B.I.D. Treatment was unchanged as long as progression did not occur. Analyses assessed the initial IOP reduction after 3 months and also the mean reduction based on all follow-up values; IOP changes over time were evaluated with linear regression analysis. Factors influencing initial and mean IOP reduction were also explored using linear models. Results: Mean age at baseline was 68 years, and untreated baseline IOP ranged from 13 to 30.5 mmHg. On average, eyes with higher baseline IOP experienced larger pressure reductions than eyes with lower baseline IOP, whether expressed in mmHg or as percentages. Each mmHg of higher baseline IOP was associated with approximately 0.6 mmHg larger IOP reduction. IOP changed little over time, with 66% of patients changing less than 0.5 mmHg/year, and only 13% (17/128) changing >1.0 mmHg/year. The treatment protocol did not achieve any average IOP reduction in eyes with baseline pressures
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| 48. |
- Heijl, Anders
(author)
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Perimetry, tonometry and epidemiology: the fate of glaucoma management.
- 2011
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 89:4, s. 309-315
-
Journal article (peer-reviewed)abstract
- This is the lecture that I gave when I was awarded Acta Ophthalmologica's gold medal and honorary award at the Nordic Ophthalmological Congress in Reykjavik in August 2010. I was inspired by Jared Diamond's famous book: Guns, Germs, and Steel, The Fates of Human Societies. Diamond is professor of geography and physiology at the University of California, Los Angeles. In this book, which won the Pulitzer Prize, the author explains why the European civilization took over the world. This was all because of predetermined factors of biological nature, environmental differences that were strengthened by feedback loops, and resulted in technological innovation and superiority. In this presentation, I write about the development of glaucoma knowledge and management. I suggest that the development might have been predetermined, just waiting for more facts to be unveiled by research. The technologies tonometry and perimetry have been fundamental as has epidemiological techniques and controlled trials. The new and increased knowledge about glaucoma must now be translated to improvements of clinical glaucoma care. The glaucoma scientists of today and tomorrow will continue to reveal as yet unknown facts, maybe in a predetermined way, but nevertheless of benefit to all patients with glaucoma.
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| 49. |
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| 50. |
- Hougaard, Jesper Leth, et al.
(author)
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Glaucomatous retinal nerve fibre layer defects may be identified in Stratus OCT images classified as normal.
- 2008
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 86:5, s. 569-575
-
Journal article (peer-reviewed)abstract
- Purpose: We aimed to compare the retinal nerve fibre layer (RNFL) in different Stratus optical coherence tomography (OCT) images in glaucoma eyes with RNFL thickness values within normal limits. Methods: We studied the Stratus OCT high-resolution standard protocol for assessment of peripapillary RNFL thickness. The four glaucoma eyes presented (with reproducible visual field defects, mean deviations from - 3.49 dB to - 0.49 dB and structural loss on RNFL and/or disc photography) had results within the 95% normal limits for all OCT parameters (full circle, quadrant or clock hour mean RNFL thickness). We qualitatively compared the RNFL in pseudo-colour and grey-scale images defined by the Stratus OCT software with what appeared to be the RNFL when not defined automatically (and in raw data OCT images). Results: A localized RNFL defect was identified in conventional 495-nm RNFL photographs in all four patients. Obviously, in these selected eyes, the atrophy was not picked up by the OCT RNFL border algorithm, and at the corresponding location a localized RNFL atrophy (narrowing of the high signal intensity RNFL) was either not or just barely detectable in pseudo-colour OCT. However, defects seemed to be present in OCT grey-scale and raw data images in all four eyes. Conclusions: Our observations suggest that OCT images obtained in glaucoma eyes that are misclassified by the standard statistical analyses of Stratus OCT may contain information indicating RNFL defects. Thus, the current diagnostic ability of OCT in glaucoma can probably be extended.
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