Patient-reported outcome measures (PROMs) reflect patients’ abilities, difficulties and perceptions, but their use in ophthalmic care in Europe is unclear. We conducted a cross-sectional electronic survey among ophthalmologists in the UK, Germany and Switzerland to assess PROM use in routine care, their perceived value and implementation barriers. Only 31% of 112 respondents reported using PROMs, mostly in cataract care, with no differences across countries or clinical settings. Strikingly, perceived usefulness did not predict adoption. Reported barriers included staff and patient burden and uncertainty about instrument choice. To promote routine use of PROMs in ophthalmology, system-level integration and support are needed.

BackgroundTo compare individual ophthalmologists grouped as outliers or non-outliers based on the mean 12-month visual acuity (VA) outcomes for their patients with neovascular age-related macular degeneration (nAMD).MethodsThis prospectively designed database study included treatment-naïve eyes with nAMD starting vascular endothelial growth factor inhibitors between July 2018 and April 2023 in Australia. Ophthalmologists were classified into high outliers, non-outliers and low outliers with a funnel plot of the adjusted mean 12-month VA change. The number of injections, last injection interval and proportion of visits where choroidal neovascularisation was active were compared between the groups.Results38 ophthalmologists who treated a total of 1266 eyes (male, 35%; mean age, 81 years old) were classified into 1 high outlier, 34 non-outliers and 3 low outliers (mean VA change, 7.5, 5.1 and 2.5 letters, respectively). The high outlier gave significantly more injections than the non-outliers (mean, 8.6 vs 7.7; p<0.001), while the low outliers administered significantly fewer injections than the non-outliers (mean, 7.1 vs 7.7; p=0.009). The last injection interval was shortest in the high outlier’s eyes (9.4 weeks), followed by non-outliers’ (10.8 weeks; p=0.04 (vs high outlier’s)) and low outliers’ (11.8 weeks; p=0.22 (vs non-outliers’)). The low outliers’ patients had more visits with intraretinal fluid (59%) than non-outliers’ (29%; p<0.001) and high outlier’s patients (31%; p<0.001).ConclusionThe low outliers’ eyes had fewer injections, a longer treatment interval and more visits with intraretinal fluid. Building a system through which low outliers are anonymously notified of their performance would help improve general quality of care.

Background/aimsHandheld swept-source optical coherence tomography (SS-OCT) was previously used to measure foveal maturity through semiautomated methods in awake premature infants. This study assesses the relationship between foveal maturity and retinopathy of prematurity (ROP) severity.MethodsThis is a prospective, observational study using handheld SS-OCT imaging of premature infants undergoing ROP screening. A semiautomated segmentation algorithm measured foveal angle, total retinal cross-sectional area, and retinal and choroid thicknesses at the fovea and parafovea, excluding significant macular oedema. Measures were correlated with ROP severity using a mixed model approach.Results99 eye imaging sessions from 26 preterm infants were included. Average birth weight was 1057.6±324.8 g. Gestational age and postmenstrual age at imaging were 29.1±3.0 and 36.1±3.8 weeks, respectively. Stage 3 ROP occurred in 16/99 (16.2%) exams. Shallow foveal angle and higher inner retinal fovea/parafoveal (F/P) ratio correlated with more posterior ROP zone (zone 2: 119.2°±20.9° vs zone 3: 96.5°±16.7° and zone 2: 0.6±0.2 vs zone 3: 0.4±0.1, respectively, both p<0.001). Inner retinal F/P ratio was greater in eyes with higher ROP stage (stage 3: 0.6±0.2 vs stage 0 or mature: 0.4±0.2, p=0.03) but this relationship was not seen for outer retina (p=0.29). Larger retinal cross-sectional area coincided with worse ROP stage (stage 3: 1.9±0.06 mm2 vs stage 0 or mature: 1.6±0.04 mm2, p<0.001) and zone (zone 2: 1.6±0.04 mm2 vs zone 3: 1.7±0.04 mm2, p=0.01).ConclusionsSS-OCT semiautomated measurements of inner retinal F/P ratio, foveal angle and retinal cross-sectional area may serve as ROP severity biomarkers.

BackgroundRemote learning during the COVID-19 pandemic caused behavioural changes such as increased screen time and decreased outdoor time. This study aimed to investigate myopia progression in children during the COVID-19 pandemic.MethodsThis was a retrospective observational study performed among 2064 patients ages 2–17 with cycloplegic refractions in the months of January 2019–March 2021 at a tertiary children’s hospital. Exclusion criteria were a medical history of relevant connective tissue diseases, myopia control treatment, pseudophakia and aphakia.ResultsThe overall cohort (n=2064) had a mean spherical equivalent (SE) of 0.12±3.70 D in 2019, −0.07±3.95 D in 2020 and −0.49±3.85 D in 2021. The change in mean SE (0.42 D) from 2020 to 2021 was 2.2 times greater than the change (0.19 D) from 2019 to 2020 at baseline. In the cohort of return patients, there was a significant difference in myopic shift between years (F-ratio=14.4, p<0.00001), and a significant change from 2020 to 2021 (p=0.00008) but not from 2019 to 2020. When observing the prevalence of myopia grouped by age, 8-year-old and 17-year-old patients had the greatest increase compared with baseline. When grouped by refractive error, low myopia children (−0.5 D to −3.00 D) displayed the greatest change in mean SE 2020–2021.ConclusionsThere was a substantial increase in myopia progression for children in the Chicagoland area after the period of COVID-19 changes. The behavioural changes of home confinement and online learning during the pandemic may explain these findings.