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Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) and typically affects young women with obesity. Patients are at risk of permanent visual loss due to papilloedema. Some require emergency intervention to rapidly reduce papilloedema and preserve vision. The international standard of care for patients with sight-threatening IIH is cerebrospinal fluid (CSF) shunting. However, dural venous sinus stenting (DVSS) is an emerging procedure that is offered at many neuroscience centres internationally as the primary intervention. Currently, there are no randomised controlled trial data supporting the efficacy of any interventional approach for preserving vision in sight-threatening IIH. IIH Intervention is a UK-based two-arm, open-label, multicentre, randomised controlled phase IIb clinical trial with integrated health economic evaluation to compare CSF shunting with DVSS in patients who have confirmed IIH and are at risk of permanent visual loss due to severe papilloedema. The primary outcome is the global thickness of the peripapillary retinal nerve fibre layer (RNFL), an indicator of papilloedema, measured by optical coherence tomography (OCT) over a 6-month period. Secondary outcomes are global thickness of the RNFL over 12 and 24 months, as well as macular ganglion cell layer volume, perimetric mean deviation, headache outcomes, intervention reporting measures (including complications and revisions) and patient-reported outcomes over 6, 12 and 24 months. The protocol was approved initially on 12 December 2022 by West Midlands-South Birmingham Research Ethics Committee (ref: 22/WM/0230). Participants will be required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications. ISRCTN57142415.
Keen interest exists in the relationship between carotid atherosclerosis and primary open-angle glaucoma (POAG), with prior studies yielding inconsistent findings. This study aims to quantify the association between carotid intima-media thickness (CIMT) and POAG using data from a large cohort. In this cross-sectional analysis, we used data from 47 595 participants in the UK Biobank. CIMT was assessed using carotid ultrasound, while POAG was diagnosed based on health records and self-reported information. Logistic regression was used to detect CIMT-POAG association, after adjusting for potential confounders. Additionally, relationships with POAG-related endophenotypes, including intraocular pressure (IOP), macular retinal nerve fibre layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer thickness and retinal vascular features, were examined through linear regression. A greater CIMT, evaluated per SD increment, was associated with a 10% increased risk of POAG (OR 1.10, p=0.004). The CIMT-POAG relationship exhibited an approximately linear pattern (p non-linear=0.797). This association was more pronounced in women (OR 1.18, p=0.003) and in individuals with a high genetic predisposition to POAG (OR 1.14, p=0.004). Furthermore, higher CIMT was significantly correlated with increased IOP (β=0.14, p=0.007) and decreased mRNFL thickness (β=-0.16, p=0.030). Additionally, higher CIMT was found to co-occur with retinal vascular impairments, including a decrease in fractal dimension, an increase in vessel tortuosity and a narrower central retinal arteriole (all false discovery rates<0.05). This study observes an association between increased CIMT and POAG, especially in women and individuals with genetic susceptibility. These findings suggest that CIMT may be a useful biomarker with potential clinical relevance and propose possible vascular mechanisms underlying disease progression.
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To evaluate the safety, efficacy and immunogenicity of biosimilar aflibercept (MYL-1701P) in participants with diabetic macular oedema who completed the 52-week global phase III trial and were enrolled in an extension study. In a 20-week, multicentre, open-label extension study at 15 sites in India, safety and efficacy were assessed in 52 participants who received three doses (2 mg intravitreal) of MYL-1701P either continuing on MYL-1701P (continuation arm) or switching to it from reference aflibercept (switch arm). The primary outcome was safety, assessed by the incidence of treatment-emergent adverse events (TEAEs). The secondary outcome was efficacy and included change in visual acuity (best corrected visual acuity (BCVA) based on Early Treatment Diabetic Retinopathy Study (ETDRS) letters) and central subfield thickness ((CST); by spectral-domain optical coherence tomography). Of the 52 participants enrolled, 46 completed week 76. Participants in both arms had comparable baseline characteristics. Incident TEAEs were noted in 9/29 participants in the continuation arm and 7/23 in the switch arm. No participant reported treatment-induced or boosted antidrug antibodies. The adjusted mean difference in BCVA change between baseline of parent study and week 76 (end of extension study) was -1.20 (2.95) ETDRS letters (90% CI -6.15 to 3.75) and from baseline of extension study to week 20 (week 76-parent study) was 1.59 (1.1) (90% CI -0.26 to 3.43). The adjusted mean difference in CST from baseline of parent study to week 76 was -15.9 (38.07) µm (90% CI -80.47 to 48.62) and from baseline of extension study to its end was 13.53 (16.13) µm (90% CI -13.86 to 40.92). The study had certain limitations, including participation from one geographical area, an open-label design and small number of participants. Despite the limited number of exposures in the switch arm, it still constituted a reasonable exposure, and similar safety, efficacy and immunogenicity profiles were observed between those who continued receiving MYL-1701P and those who switched from reference aflibercept to MYL-1701P in the 20-week extension study of the pivotal trial. NCT04674800, NCT03610646.
To investigate the association between visual impairment (VI) and all-cause mortality in older US adults and to examine the potential mediating roles of physical activity (PA) and depressive symptoms. This prospective cohort study included adults aged 60 years and older from the 2007 to 2008 National Health and Nutrition Examination Survey. VI was defined as either subjective visual impairment (SVI) based on self-reported vision status or objective visual impairment (OVI) defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Cox proportional hazards models adjusted for demographic, anthropometric, socioeconomic and clinical covariates were used to examine the association between VI and all-cause mortality with propensity score matching and subgroup analyses. PA was assessed using a modified International Physical Activity Questionnaire and depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Mediation analyses were performed to estimate direct and indirect effects through PA and depressive symptoms. A total of 2154 participants (mean (SD) age 70.6 (7.1) years; 44.2% male) were included. Over a median follow-up of 145.0 months, 399 (57.8%) deaths occurred in the VI group and 535 (34.6%) in the non-VI group. VI was associated with an increased risk of all-cause mortality after propensity score matching and multivariable adjustment (HR, 1.21; 95% CI 1.04 to 1.41; p=0.012). In subgroup analyses, SVI was significantly associated with mortality (HR, 1.33; 95% CI 1.13 to 1.57; p=0.001), whereas OVI was not. PA mediated 9.4% of the association between VI and all-cause mortality, whereas depressive symptoms did not. In this nationally representative cohort, VI was independently associated with higher all-cause mortality in older US adults. SVI appeared more predictive than OVI, possibly reflecting broader functional vision burden. Reduced PA partially mediated this association, whereas depressive symptoms did not. Residual confounding and measurement error cannot be excluded.
To explore communication challenges in ophthalmic consultations from both patient and clinician perspectives, and to introduce 'Strategic Communication' as a structured, evidence-based approach aimed at enhancing patient-provider interactions and improving clinical outcomes. Multicentre mixed-method study involving online focus discussion groups and surveys. Eight ophthalmologists and eight patients recruited through the Italian national ophthalmic patient association participated in focus groups moderated by a health communication expert. These discussions explored communication challenges and potential solutions, based on participants' experience. Transcripts were thematically analysed by two independent researchers to identify key challenges and actionable insights. In parallel, quantitative data were collected via two structured questionnaires completed by 139 European ophthalmologists and 184 patients. Key themes included patients' limited understanding of their conditions, often influenced by misleading online information, and their strong preference for clear, empathetic communication. Clinicians reported that time constraints in public healthcare limited opportunities for meaningful dialogue, while the involvement of family members further complicated interactions. The 'Strategic Communication' framework, particularly the O.D.I. Method (Observe, Demand, Intervene), emerged as a structured framework for tailoring communication strategies to individual needs. 'Strategic Communication' offers a systematic, conceptual, theory-informed approach to address communication challenges in ophthalmology, with potential relevance for patient-centred care helping structured clinician-patient communication in ophthalmology. The present findings support its practical applicability. Future studies are needed to evaluate its impact on clinical and patient-reported outcomes.
Systemic antihypertensive medications may influence glaucoma-related outcomes through intraocular pressure-dependent and vascular mechanisms. While topical α₂-agonists are established glaucoma therapies, the association between systemic α₂-agonists and glaucoma hazard remains unexamined; we compared their hazard with systemic β-blockers in adults with hypertension. We conducted a multicentre retrospective cohort study using deidentified electronic health records. Adults aged ≥40 years with hypertension and chronic exposure to systemic α₂-agonists or β-blockers were included. Patients with pre-existing ocular hypertension (OHT), primary open-angle glaucoma (POAG), concomitant comparator use, or inadequate ophthalmic follow-up were excluded. We balanced cohorts using propensity score matching (PSM) and assessed the hazard of OHT and POAG at 1, 3, and 5 years. Cox models estimated adjusted HRs (aHRs) with 95% confidence intervals (CIs). Patients treated with α₂-agonists (n=4186) were matched to those treated with β-blockers (n=360 399), resulting in 4152 patients per group after PSM. In Cox models (on the unmatched cohorts) adjusted for demographics, comorbidities, medications, laboratory and biometric measures, socioeconomic indicators and selected procedures, α₂-agonist exposure was associated with a lower hazard of OHT (aHR (95% CI) 0.582 (0.473 to 0.716), 0.559 (0.468 to 0.669) and 0.534 (0.450 to 0.634)) and POAG (aHR (95% CI) 0.359 (0.300 to 0.429), 0.333 (0.282 to 0.392) and 0.334 (0.286 to 0.390)) at 1-year, 3-year, and 5-year follow-up, respectively (all p<0.001). Systemic α₂-agonist use was associated with a substantially lower hazard of glaucoma-related diagnoses compared with systemic β-blocker use. These findings are limited by the observational design, potential residual confounding, and reliance on diagnostic coding. These results warrant further investigation in prospective mechanistic studies and randomised clinical trials.
To estimate the clinic-based frequency of glaucoma among Sahrawi refugees attending humanitarian ophthalmology missions in the Tindouf camps (Algeria), to identify demographic and clinical factors associated with glaucoma and to contextualise the clinic-based frequency of other ophthalmic diseases. We conducted a clinic-based cross-sectional study among Sahrawi refugees during Médicos del Mundo ophthalmology missions. All participants underwent a standardised ophthalmological examination including targeted history, visual acuity assessment, slit-lamp biomicroscopy and intraocular pressure (IOP) measurement. Glaucoma diagnosis relied on structural optic nerve head assessment and elevated IOP, with independent confirmation by a second ophthalmologist. Age-standardised and sex-standardised clinic-based frequencies were calculated using camp population demographics. Multivariable logistic regression identified factors associated with glaucoma. A total of 900 symptomatic care-seeking individuals were examined (56% men; median age 70 years). Overall clinic-based glaucoma frequency was 13.3% (95% CI 11.1% to 15.5%), representing the main disease of interest. After standardisation, the estimated clinic-based frequency was 6.7% (95% CI 3.8% to 9.7%). Older age was independently associated with glaucoma (adjusted OR per year 1.02; 95% CI 1.01 to 1.03; p=0.003). Inverse associations with cataract and keratopathy, likely reflected selection patterns and diagnostic overshadowing. Cataract was the most common coexisting diagnosis (59.8%), followed by keratopathy (9.1%) and retinopathy (3.4%). Among participants, 37.8% (n=340) had severe bilateral visual impairment, and 40.9% (n=368) had monocular vision; 17.5% (n=60/340) of those with bilateral impairment were blind from glaucoma. Glaucoma represents a substantial clinic-based burden among symptomatic Sahrawi refugees attending humanitarian missions, with a high proportion of irreversible visual loss. Other ophthalmic conditions were common but functioned as coexisting causes of visual impairment in this care-seeking sample. These findings highlight the need for pragmatic, context-appropriate strategies for opportunistic glaucoma detection and continuity of care in refugee settings, acknowledging limitations including the non-probabilistic, mission-based sampling and absence of visual-field testing.
To examine organisational leave policies for clinical trial participation in England and compare willingness between the public and healthcare professionals (HPs) under varying leave conditions. Freedom of information (FOI) requests were submitted to 378 public-sector organisations to identify policies supporting leave for clinical trial participation. Parallel cross-sectional surveys of the public (n=503; working-age adults) and HPs (n=110) assessed willingness to participate as a healthy volunteer (HV) or patient (P) in scenarios requiring annual leave (AL) or unpaid leave (UL). Free-text responses were analysed thematically. Group comparisons used χ² tests, and multivariable logistic regression examined predictors of willingness, adjusting for demographic and employment characteristics. Five organisations (1.3%) reported an explicit policy addressing clinical trial leave while 336 (88.9%) reported none. Across all scenarios, public respondents were more willing to participate than HPs, particularly for HV participation using AL (78.9% vs 63.6%; p=0.001). In adjusted analyses, HPs had lower odds of willingness than public respondents for HV-AL (aOR 0.52, 95% CI 0.32 to 0.85), P-AL (aOR 0.67, 95% CI 0.44 to 0.98) and P-UL (aOR 0.61, 95% CI 0.38 to 0.96). Willingness declined when UL was required. No association was observed between Index of Multiple Deprivation decile and willingness. Financial concerns were the main barrier among the public, whereas HPs cited limited availability of AL. There is a widespread lack of organisational policies supporting clinical trial participation leave, and willingness is highly sensitive to whether leave is paid. This is particularly relevant in ophthalmology, where trials often involve repeated, time-intensive visits and reliance on working-age carers. Limitations include non-probability sampling, uncalculated survey response rates, self-reported willingness, a small regionally recruited HP sample and restriction to public-sector FOI data. Employment policy represents an under-recognised structural determinant of clinical trial participation, with implications for ophthalmology research.
This study aimed to identify the factors that influence access to diabetic retinopathy screening (DRS). This is a qualitative case study. Township health units in Shaoguan City, Guangdong Province, China. This study included two representative patient groups (n=15) and five health-staff groups (n=42). Focus group discussions were guided by a female ophthalmologist and other ophthalmology staff to determine the contextual factors influencing DRS uptake in people with diabetes mellitus in Qujiang District, Shaoguan City, southern China. Directly observed treatment and short-course (DOTS) components for the assessment of tuberculosis services were referred to for health structure when themes were extracted using deductive thematic analysis. By referring to DOTS components related to the government, case detection, treatment, drug supply and recording system, we identified 31 factors associated with DRS uptake. Among these, six were from the perspective of service users whereas the remaining 25 were related to providers. From these factors, 10 modifiable themes pertained to policy, financing, interdepartmental coordination, hospital preparedness, primary healthcare staff training and public awareness through health education and quality enhancement of public health services. Two unmodifiable factors were also extracted: discomfort from pupil dilation during the examination and long travel distance to the facility. This analysis identified contextual factors influencing DRS uptake, including policy, financing and public awareness, which, if addressed, could significantly enhance future screening uptake and disease management.
Neonatal survival continues to pose a global health challenge. Skin-to-skin contact (SSC) has been shown to significantly reduce neonatal mortality and offer numerous benefits for both mothers and newborns. However, its implementation varies widely across healthcare settings and is often hindered by practical barriers. This scoping review aims to systematically explore the facilitators and challenges associated with implementing SSC after birth and to synthesise relevant evidence to guide clinical practice. This scoping review will follow the Joanna Briggs Institute methodological framework for scoping studies. A comprehensive search will be conducted across seven electronic databases and grey literature sources. Two review authors will independently perform the screening of studies and data extraction in parallel. Discrepancies will be resolved through consensus or consultation with a third author. A data extraction form will be developed based on key themes related to SSC implementations. The extracted data will be qualitatively analysed and presented in diagrammatic, tabular and narrative summary forms, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Reviews reporting guidelines. All data to be used in this study will be derived from previously published studies, thus rendering the need for ethical approval and informed consent superfluous REGISTRATION: This protocol has been registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/CWPK4).
Treatment of glaucoma is directed towards controlling intraocular pressure (IOP) and the options are many, starting from medical therapy to cyclodestructive surgeries. Drainage devices are a treatment option for glaucoma with a visual prognosis and have a major advantage of long-term success in controlling IOP and better tolerability. The Aurolab Aqueous Drainage Implant (AADI) is devised from a prototype Baerveldt implant. Numerous complications have been reported with the AADI; however, chronic inflammation so far is very rare. In our report, significant uveitis was noted in a patient with primary open-angle glaucoma post failed trabeculectomy after implantation of the AADI, resulting in the formation of annular synechiae and neovascularisation of the iris. There was poor compliance with medications and loss to follow-up owing to COVID-19 restrictions for more than a year. The patient was meticulously managed by intracameral anti-VEGF and synechiae release coupled with cataract extraction and intraocular lens implantation under the cover of steroids.Through this case, we want to emphasise the need for patient compliance towards postoperative medications and, to our knowledge, such dense inflammation following implantation of the AADI has not been reported.
A man in his 30s with a prior diagnosis of presumed primary open-angle glaucoma presented with progressive visual deterioration and headaches. Initial optic disc cupping and the established glaucoma diagnosis suggested glaucomatous optic neuropathy; however, visual field defects respecting the vertical meridian and optical coherence tomography changes inconsistent with glaucoma prompted neuroimaging, which revealed a large invasive pituitary macroadenoma compressing the optic chiasm, later confirmed as a mixed prolactin-secreting and growth hormone-secreting tumour. Following medical treatment, visual function improved and serial MRI confirmed tumour shrinkage. Two years later, slowly progressive nasal retinal nerve fibre layer thinning raised concern for recurrence. Repeated neuroimaging instead demonstrated a secondary empty sella with inferior, V-shaped herniation of the optic chiasm rather than regrowth, with traction being the probable cause of the ongoing axonal loss. This case highlights secondary empty sella-related chiasmal herniation as a diagnostic pitfall following pituitary adenoma treatment.
Fractures of the zygomaticomaxillary complex (ZMC) represent one of the most frequent midfacial injuries and, if untreated, can result in significant functional and aesthetic sequelae. While open reduction and internal fixation is the standard of care for acute fractures, late presentations remain challenging due to bone remodelling and altered anatomical landmarks. Secondary corrective options include skeletal repositioning via zygomatic osteotomy or implant-based camouflage.We present the case of a young female patient with a displaced ZMC fracture left untreated following urgent cranioplasty abroad. Two months later, she underwent corrective surgery using patient-specific cutting guides, osteotomies and custom fixation plates through a swinging-eyelid and intraoral approach. The procedure successfully restored midfacial symmetry and orbital volume.This case highlights the value of patient-specific surgical planning, multidisciplinary collaboration and careful osteotomy technique in the management of post-traumatic delayed ZMC deformities.
In all countries, some population groups experience barriers to accessing eye health services, contributing to health inequities. Outreach is a common strategy used to deliver healthcare services to populations experiencing inequities. This scoping review aims to summarise the nature and extent of the existing literature describing outreach as a service delivery model to improve access to eye health services, particularly among populations experiencing inequities. An information specialist will search academic databases (Medline, Embase and Global Health) without language restrictions to find peer-reviewed articles describing outreach eye health services, published in any country between 1 January 2010 and the search date. Grey literature sources will also be searched. In Covidence, two reviewers will independently screen titles and abstracts and subsequently relevant full texts against the inclusion criteria. Data extraction will also be performed independently by two reviewers in Covidence. This scoping review will summarise the characteristics of the included outreach eye health services, including the type of eye health service delivered, personnel involved, mode of transport, source of funding and whether the service targeted any specific PROGRESS-Plus group (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus). We will present our findings quantitatively using diagrams, tables and graphs. Ethics approval was not sought, as this scoping review will use only publicly available reports. The results of this review will be disseminated through publication in a peer-reviewed journal and will be presented at eye health conferences. It will offer valuable insights for eye health providers, health and social service providers and policymakers who are interested in improving access to eye health services for populations experiencing inequities. This scoping review will inform a project in New Zealand which aims to develop outreach eye health services to populations experiencing inequities, such as unhoused people and refugees. This protocol was registered on the Open Science Framework on 11 November 2025 (https://osf.io/vyz32).
Cataracts are the leading cause of poor vision in Japanese adults. As Japan's population is rapidly ageing, the demand for cataract surgery will continue to increase. Despite this, quantitative research evaluating both supply and demand of cataract surgery is lacking. The objective of this study was to forecast future cataract surgery demand and the supply of ophthalmologists in Japan by region and evaluate the cataract surgery demand-supply balance considering regional differences in demographics and medical resources. Based on the Ministry of Health, Labour and Welfare's 'NDB Open Data', age-specific and sex-specific cataract surgery rates were calculated from the number of billed procedures. These rates were applied to the Ministry of Internal Affairs and Communications' 'Population Estimates' and National Institute of Population and Social Security Research's 'Future Population Projections' to estimate demand for 2030, 2040 and 2050. Future supply of ophthalmologists was estimated using linear regression based on data from the 'Survey of Physicians, Dentists, and Pharmacists'. The demand-supply ratio (demand divided by supply) was calculated for each prefecture. The demand-supply ratio multiplier for each year was calculated using 2022 as the base year. The estimated number of cataract surgeries was 1 929 848 in 2030, 2 373 260 in 2040 and 2 863 733 in 2050, with a significant increase projected for individuals in their 70s and aged 80+. Although most prefectures were expected to see a gradual increase in ophthalmologist numbers, a decrease was projected for some regional areas. Consequently, the demand-supply ratio was projected to increase nationwide, with a larger increase in regional areas, suggesting a widening disparity between regional and metropolitan areas. Demand for cataract surgery would continue to rise, potentially increasing demand-supply imbalances, particularly in regions with ageing populations. Re-examination of the regional allocation of medical resources is necessary to correct disparities in access to treatment. These projections are subject to limitations related to the use of publicly available data and assumptions based on past trends, which may not fully reflect regional practice variation or future changes in surgical capacity.
Refractive errors cause significant preventable visual impairment globally, particularly in underserved areas. Conventional subjective refraction remains the gold standard but proves examiner-dependent, time-consuming and challenging in high-volume settings. The 3nethra Specto, a wearable digital subjective refractometer, offers rapid refractive assessment. This study evaluates its accuracy and repeatability versus conventional methods. A prospective comparative study was conducted on 135 subjects who underwent both conventional subjective refraction and 3nethra Specto assessment. Spherical (S), cylindrical (C) and axis measurements were analysed using power vector transformation (J₀, J₄₅). Primary predictive validity was assessed using univariate general linear models (GLMs) (IBM SPSS V.25.0) with age/sex as covariates. Model fit was evaluated via F-statistics, R² and residual SD. Instrument repeatability used GLM Repeated Measures, agreement assessed via Bland-Altman plots, keeping significance at p<0.05. Patient and examiner feedback on the instrument was captured using the User Experience questionnaire. Of 135 adults (mean age 31.5±8.9 years; 60% male), compound myopic astigmatism predominated (45%). 3nethra Specto measurements closely matched subjective refraction (sphere: -1.02 D vs -0.99 D; cylinder: -0.49 D vs -0.83 D; M: -1.26 D vs -1.24 D). GLM analysis showed excellent predictive validity (all p<0.001; R² 0.914 to 0.994; residual SD 0.084 D to 0.228 D). Bland-Altman plots confirmed 95% limits of agreement of -0.39 D to +0.47 D for M and -0.62 D to +0.64 D for J₀ and -0.32 D to +0.35 D for J₄₅. Device repeatability was high (all F>96, p<0.001; R²≥0.956; residual SD≤0.148 D). Patients rated subjective refraction higher for comfort/enjoyability but found 3nethra more inventive/exciting; examiners preferred 3nethra for efficiency, speed, innovation and ease of use. The 3nethra Specto wearable liquid lens refractor demonstrated excellent agreement and repeatability with traditional subjective refraction across all refractive parameters, confirming clinical equivalence. Positive patient and examiner feedback highlighted its innovation, efficiency and usability. This device offers a reliable alternative for routine refractive assessment in clinical settings.
To assess adherence to retinal screening recommendations and its associated factors among patients with diabetes receiving follow-up care at public hospitals in Ethiopia. A cross-sectional, institution-based study was conducted at public hospitals in Addis Ababa from 27 February to 27 March 2023. Five of the fourteen public hospitals in Addis Ababa were selected for this study. A systematic random sample of 405 adult patients with diabetes mellitus (receiving follow-up care at public hospitals in Addis Ababa was selected. Bivariate and multivariate logistic regression analyses were conducted to assess statistical associations. Statistical significance between the outcome variable and independent variables was determined at a p value of less than 0.05 and a 95% CI. 223 participants (55.1%) adhered to the recommended retinal screening guidelines. Factors significantly associated with adherence to retinal screening recommendations included being an urban resident (adjusted OR (AOR)=2.783; 95% CI 1.022 to 7.583), lack of formal education (AOR=0.242; 95% CI 0.100 to 0.589) and poor knowledge regarding diabetic retinopathy (AOR=0.281; 95% CI 0.171 to 0.462). Slightly more than half (55%) of the participants in this study adhered to the recommended retinal screening guidelines. Urban residence, higher educational attainment and good knowledge of diabetic retinopathy were significant predictors of adherence to retinal screening recommendations. Healthcare professionals should take a more proactive role in educating patients with diabetes about diabetic retinopathy and the importance of retinal screening, with particular emphasis on rural residents and individuals without formal education.
Chronic central serous chorioretinopathy (CSC) can cause progressive and permanent vision loss. Although photodynamic therapy (PDT) is a primary treatment option globally, it is not approved for CSC worldwide, limiting therapeutic access. The REPLAY trial is a phase III, investigator-initiated trial to evaluate the efficacy and safety of reduced-fluence PDT (rf-PDT) for chronic CSC to seek the first regulatory approval globally. This study comprises two cohorts. The 'untreated cohort' is a multicentre, randomised, placebo-controlled, double-masked trial involving 60 patients with untreated, fovea-involving chronic CSC, randomised 2:1 to receive a single rf-PDT or placebo treatment. The 'previously treated cohort' is a single-arm, open-label trial for up to 10 patients with recurrent CSC after PDT. The primary endpoint for both cohorts is the proportion of eyes with a complete resolution of subfoveal fluid at 12 weeks post-treatment, assessed by optical coherence tomography. Secondary endpoints include changes in best-corrected visual acuity, central choroidal thickness, recurrence rates and incidence of adverse events over a 48 week follow-up. The study protocol was approved by the Kyoto University Hospital Institutional Review Board, IRB of Chiba University Hospital, Tokyo Women's Medical University Institutional Review Board and Institutional Review Board of Kansai Medical University Hospital. Written informed consent is obtained from all participants. The results will be disseminated through publication in a peer-reviewed journal and presentations at scientific conferences. jRCT2051230156 (URL: https://jrct.mhlw.go.jp/latest-detail/jRCT2051230156).