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  • 301.
    Westborg, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Optimizing number of postoperative visits after cataract surgery - a safety perspective2013In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 91Article in journal (Other academic)
  • 302.
    Westborg, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Optimizing number of postoperative visits after cataract surgery: Safety perspective2017In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 43, no 9, p. 1184-1189Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate safety perspectives when the standard routine after cataract surgery is no planned postoperative visit.

    Setting: Eye Clinic, Sunderby Hospital, Lulea, Norrbotten County, Sweden.

    Design: Prospective case series.

    Methods: All cataract surgery cases during a 1-year period were included. The study group had the standard routine at the clinic, that is, no planned postoperative visit for patients without comorbidity and uneventful surgery. For the control group, patients who had surgery during 1 month of the 1-year period were chosen. All these patients had a planned postoperative visit. All surgeons involved were experienced. The outcome measures were any planned postoperative visit, any complication and/or adverse event, postoperative corrected distance visual acuity (CDVA), and any postoperative control/contact initiated by the patient.

    Results: The study comprised 1249 patients (1115 in the study group and 134 in the control group). No significant differences in demographics, postoperative CDVA, frequency of planned visits because of ocular comorbidity, or postoperative patient-initiated contacts were found between the 2 groups. Of the 1249 patients, 9% (117 patients) initiated a postoperative contact, of whom 26% (30 patients) also had a scheduled visit. The reasons for the patient-initiated contacts were visual disturbance, redness and/or chafing, pain, and anxiety. An evaluation of all medidal records 2 years postoperatively found no reports of missed adverse events.

    Conclusions: It was possible to refrain from planned,postoperafive visits for patients having uncomplicated cataract surgery. However, preoperatively, patients with comorbidities should be provided with individual planning of their postoperative follow-up. Preoperative counseling is important, and the clinic must have resources to answer questions from patients and be prepared for additional unplanned postoperative visits.

  • 303.
    Westborg, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Rosso, Aldana
    Risk factors for discontinuation of treatment for neovascular age-related macular degeneration2018In: Ophthalmic Epidemiology, ISSN 0928-6586, E-ISSN 1744-5086, Vol. 25, no 2, p. 176-182Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate risk factors for treatment discontinuation for neovascular age-related macular degeneration (nAMD).

    Methods: Data from the Swedish Macula Register and the Skane Healthcare Register are reported on the treatment received by 932 nAMD patients diagnosed 2013-2015. Treatment discontinuation is defined as having a termination visit or lacking a control or treatment visit during the period of 10-14months after the diagnostic visit. The risk of treatment discontinuation during the first year is estimated using a Poisson model and a classification tree.

    Results: 503 eyes (50.9%) discontinued the treatment within the first year. Patients with visual acuity below 60 ETDRS letters (20/60 Snellen) at baseline, serious comorbidities, or treated at the university hospital have a 42% (95% CI 25-61%, P<0.001), 27% (95% CI 13-43%, P=0.001) and 30% (95% CI 15-46%, P<0.001) increased risk to discontinue treatment compared with similar patients. Patients on ranibizumab therapy have a 45% (95% CI 28-63%, P<0.001) increased risk for treatment discontinuation during year 1 compared with patients on aflibercept therapy. The classification tree also shows that patients on ranibizumab therapy and those with low VA at baseline are at a higher risk of terminating treatment.

    Conclusions: Almost half of the patients starting anti-VEGF therapy discontinue treatment during the first year. Patients with risk factors may require additional support to continue with the treatment. Aflibercept therapy could be an alternative to patients at risk of treatment discontinuation.

  • 304.
    Westborg, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Rosso, Aldana
    Risk for low visual acuity after 1 and 2 years of treatment with anti-VEGF. Comparison of different agents: Ranibizumab, Aflibercept, and Bevacizumab2018In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal (Other academic)
    Abstract [en]

    Purpose : To analyze the risk factors for low visual acuity and compare the visual acuity, number of visits and injections received by patients on different anti-vascular endothelial growth factor (anti-VEGF) therapies after one and two years of treatment.

    Methods : Retrospective register-based cohort study from the national Swedish Macula Register (SMR). Treatment naïve eyes and treated exclusively with ranibizumab, bevacizumab or aflibercept, followed for two years. Evaluation of baseline characteristics as age, best corrected visual acuity (BCVA) and type of lesion and treatment drug. The risks of low visual acuity (BCVA ≤60 ETDRS letters) during the first and second year were estimated.

    Results : Mean BCVA were 56.2, 62 and 62.5 ETDRS letters for baseline, year 1 and year 2 respectively. Aflibercept eyes received 5.9 injections year one and 3.9 year two. Bevacizumab and ranibizumab treated eyes received 5.3 and 4.7 injections year one and 3.8 and 3.1 injections year two respectively. The average number of vists in the ranibizumab and bevazicumab groups was slightly higher compared to aflibercept group both year 1 and 2. VA improved on average in all treatment groups. At year one 33% of eyes in Aflibercept and Bevacizumab and 34% in Ranibizumab treated group had a VA of less than 60 ETDRS letters. Number of eyes discontiuning treatment or lost to follow-up after two years were 55% (2016/3678). Low visual acuity were the main reason for discontinuation. Older patients and low baseline VA were risk factors for low VA after one and two years of treatment.

    Conclusions : This study show a shift in treatment regimen in Sweden 2013 with increasing number of injections and an inclination to follow label with fewer visits and more injections instead of PRN (Pro re nata) regimen. Maintenance in mean VA after one and two years is seen in all treatment groups but eyes treated with aflibercept show a slightly better mean VA after one and two years. However, it is worth noticing that those patients have on average a better baseline VA. Treatment are also maintained in a higher degree for aflibercept treated eyes. Risk factors for low visual acuity after one and two years of treatment are, as expected, older patients and low baseline VA.

  • 305.
    Westin, Oscar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Epidemiology and Outcomes in Refractive Lens Exchange Surgery2013Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 306.
    Westin, Oscar
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Koskela, Timo
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Epidemiology and outcomes in refractive lens exchange surgery2015In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 93, no 1, p. 41-45Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess demographics and refractive outcomes in patients undergoing refractive lens exchange surgery (RLE), with a population of cataract patients as a reference.

    METHODS: A RLE cohort from a private eye clinic (n = 675) and a cataract cohort from the outcome registration of the Swedish National Cataract Register were studied and compared from an epidemiological perspective regarding age, gender, preoperative refraction and postoperative refractive outcome.

    RESULTS: The RLE patients were younger (52.1 ± 7.7 versus 73.84 ± 9.32 years) with a smaller percentage of women (45.28% versus 60.46%; p < 0.001) and were more often myopic than the cataract patients. Astigmatism and hyperopia did not differ between the cohorts. Uncorrected visual acuity after RLE equalled the best corrected visual acuity in best cases after cataract surgery. The absolute biometry prediction was more accurate in RLE (0.17 ± 0.27 D versus 0.40 ± 0.58 D; p < 0.001), particularly in patients given a customized toric IOL (0.12 ± 0.27 D; p < 0.05). In cataracts, the Haigis' formula showed higher accuracy than the SRK/T formula (0.39 ± 0.53 D versus 0.43 ± 0.61 D; p < 0.01). Postoperatively after RLE, Laser Epithelial Keratomileusis was performed in 9.04% and Yttrium Aluminium Garnet capsulotomy in 7.41% of the eyes. Other reoperations were performed in three cases, and five postoperative retinal detachments occurred after RLE.

    CONCLUSION: Compared with patients undergoing cataract surgery, we see many similarities, but also many interesting differences in patients undergoing RLE. Basic information about the growing population choosing to undergo RLE can help us plan future ophthalmic care.

  • 307.
    Zhang, Wei
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Chen, Jialin
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Backman, Ludvig J.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Malm, Adam D.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Surface Topography and Mechanical Strain Promote Keratocyte Phenotype and Extracellular Matrix Formation in a Biomimetic 3D Corneal Model2017In: Advanced Healthcare Materials, ISSN 2192-2640, E-ISSN 2192-2659, Vol. 6, no 5, article id UNSP 1601238Article in journal (Refereed)
    Abstract [en]

    The optimal functionality of the native corneal stroma is mainly dependent on the well-ordered arrangement of extracellular matrix (ECM) and the pressurized structure. In order to develop an in vitro corneal model, it is crucial to mimic the in vivo microenvironment of the cornea. In this study, the influence of surface topography and mechanical strain on keratocyte phenotype and ECM formation within a biomimetic 3D corneal model is studied. By modifying the surface topography of materials, it is found that patterned silk fibroin film with 600 grooves mm(-1) optimally supports cell alignment and ECM arrangement. Furthermore, treatment with 3% dome-shaped mechanical strain, which resembles the shape and mechanics of native cornea, significantly enhances the expression of keratocyte markers as compared to flat-shaped strain. Accordingly, a biomimetic 3D corneal model, in the form of a collagen-modified, silk fibroin-patterned construct subjected to 3% dome-shaped strain, is created. Compared to traditional 2D cultures, it supports a significantly higher expression of keratocyte and ECM markers, and in conclusion better maintains keratocyte phenotype, alignment, and fusiform cell shape. Therefore, the novel biomimetic 3D corneal model developed in this study serves as a useful in vitro 3D culture model to improve current 2D cultures for corneal studies.

  • 308. Åsman, Peter
    et al.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Internet-based assessment of medical students' ophthalmoscopy skills2010In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 88, no 8, p. 854-857Article in journal (Refereed)
    Abstract [en]

    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

  • 309.
    Åström, Siv
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Long-term follow-up of pseudoexfoliation, intraocular pressure and glaucoma: epidemiological studies in northern Sweden2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Purpose An age-cohort was studied with long-term follow-up. The population was born in 1915, living in the municipality of Skellefteå in 1981. The purpose was to investigate the prevalence and incidence of pseudoexfoliation (PEX), its influence on intraocular pressure (IOP) and development of open-angle glaucoma (OAG). Another purpose was to estimate the value of screening for glaucoma by comparing the screened group within the cohort with the remaining unscreened group.

    Methods In 1981, 339 (40%) of the 856 individuals in the cohort underwent an eye examination. This screened group was re-examined at seven-year intervals until 2002. At each visit the presence of PEX was registered, IOP was measured and the presence of glaucoma was assessed. After the 21-year follow-up period, glaucoma cases were also searched for in the medical records of the remaining unscreened individuals in the cohort. Proportions of glaucoma were compared between the two groups.

    Results The prevalence of PEX was 23% (95% confidence interval (CI): 20-26%) at the age of 66 and increased to 61% (CI: 50-71%) at the age of 87. The annual incidence of PEX was 1.8% (CI: 1.3-2.4%). The prevalence of OAG increased from 2.1% (CI: 0.8-4.3%) at the age of 66 years to 25 % (CI: 16-35%) at 87 years. The overall annual incidence of OAG was 0.9% (CI: 0.6-1.3%) and for OAG with PEX 2.1% (CI: 1.2-3.3%). PEX increased the risk of developing glaucoma at least four-fold. The incidence of diagnosed OAG in women was higher in the screened group than in the unscreened group (incidence rate ratio (IRR)=1.94, p=0.035). A corresponding difference could not be verified for men (p=0.58). The mean, agedependent, increase in IOP during the 21-year observation period was 0.05 mmHg/year.

    Conclusion The prevalence of PEX in this study population was the highest reported, and it increased with age. The presence of PEX increased the risk of developing OAG four times. In this study a higher proportion of OAG was revealed by screening among women but not among men. The age-related IOP increase was clinically insignificant.

  • 310.
    Åström, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Diagnosed open-angle glaucoma in screened versus unscreened subjects: a long-term age cohort study2014In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, no 6, p. 501-506Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate and compare the cumulative incidence of diagnosed open-angle glaucoma (OAG) in an age cohort of elderly people, of which one group was screened. METHODS: Cohort study comprising all 856 individuals born in 1915 and living in the municipality of Skellefteå in1981. A randomly selected subgroup of the cohort (40%) was repeatedly screened, and suspected OAG cases were followed until 2002 for the development of OAG. Medical records were collected and analysed for OAG. The numbers of OAG cases were compared between the screened group and the remaining part of the cohort (the unscreened group). RESULTS: The cohort consisted of 339 screened and 517 unscreened persons. Before 1981, there were six known cases of OAG in the screened group and nine cases in the unscreened group. During the follow-up from 1981 to 2002, there were 33 new cases in the screened group and 31 new cases of OAG in the unscreened group. The incidence of diagnosed OAG in women was higher in the screened group than in the unscreened group, incidence rate ratio = 1.94 (p = 0.035). In contrast, the cumulative incidence of diagnosed OAG in men was similar in the two groups (p = 0.58). For the whole population, there was no significant difference (p = 0.053) CONCLUSION: In this population with a high prevalence of PEX and increased risk for glaucoma, there was a non-significant difference between the screened and unscreened groups regarding the proportion of diagnosed OAG. The failure to reach significance may be due to the limited sample size. OAG was diagnosed twice as often among women in the screened group than in the unscreened group.

  • 311.
    Åström, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Incidence and prevalence of pseudoexfoliations and open-angle glaucoma in northern Sweden: II. Results after 21 years of follow-up.2007In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 85, no 8, p. 832-837Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To prospectively evaluate the prevalence and incidence of pseudoexfoliation (PEX) syndrome and open-angle glaucoma (OAG) with and without PEX and to evaluate PEX as a risk factor for glaucoma in a population born in 1915 and living in the municipality of Skellefteå in northern Sweden.

    METHODS: A randomized population study comprising 339 individuals. The cohort was followed for 21 years at 7 year intervals. The examination included tonometry, dilated slit-lamp biomicroscopy, optic disc evaluation and, if glaucoma was suspected, a visual field analysis.

    RESULTS: The prevalence of PEX increased from 23%[95% confidence interval (CI): 20-26] at 66 years of age to 61% (CI 50-71) at 87 years. The annual incidence of PEX was 1.8% (CI 1.3-2.4). In the group of subjects with unilateral PEX, 55% converted to bilateral PEX during follow-up. The prevalence of OAG was 2.1% (CI 0.8-4.3%) at 66 years of age and 25% (CI 16-35) at 87 years. Of the glaucoma cases, 59% had PEX. There was no difference in incidence between the sexes. The annual incidence of PEX and OAG did not increase with time. The overall annual incidence of OAG was 0.9% (CI 0.6-1.3%) [0.5% (CI 0.2-0.9) without PEX and 2.1% (CI 1.2-3.3) with PEX]. PEX increased the risk of glaucoma four fold in both sexes. There was no significant difference in mortality between individuals with or without PEX.

    CONCLUSION: PEX syndrome and OAG are common in the north of Sweden. Prevalences increase with age. PEX increases the risk of glaucoma four fold. The consequences of this situation demand guidelines for handling patients with PEX, with or without other risk factors. In order to issue guidelines, more information is needed on the impact of the disease on the general health in the ageing population.

  • 312.
    Åström, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Intraocular pressure changes over 21 years: a longitudinal age-cohort study in northern Sweden2014In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, no 5, p. 417-420Article in journal (Refereed)
    Abstract [en]

    Purpose:  To follow intraocular pressure (IOP) and the influence of pseudoexfoliation (PEX) and cataract extraction in an age-cohort in northern Sweden; patients were followed prospectively for 21 years from age 66 to 87 years.

    Methods:  Three Hundred and thirty-nine individuals, randomly selected from an age-cohort born in 1915 underwent ophthalmological examination including measurement of IOP with Goldmann applanation tonometry, screening for PEX and glaucoma. Follow-up examinations were performed three times with 7-year intervals. Medical records were reviewed for dates of cataract surgery and glaucoma treatment. A linear mixed model was used to analyse the impact of sex, eye (right/left), PEX, cataract extraction and time on IOP.

    Results:  Without cataract surgery, the IOP from age of 66 to 87 years, increased by 0.05 mmHg/year (p < 0.001). If cataract surgery was included in the model, no significant change in IOP over time was found. The estimated contribution of PEX to IOP was +2.05 mmHg (p < 0.001), and the contribution of cataract surgery was −2.13 mmHg (p < 0.001). The mean IOP in women was 1.22 mmHg higher than in men (p = 0.001).

    Conclusion:  A small but statistically significant increase in IOP with age was detected when excluding eyes that had undergone cataract surgery. PEX was associated with a higher IOP and cataract extraction with a lower.

  • 313.
    Åström, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Open-angle glaucoma in screened versus unscreened subjects: a long-term age-cohort studyArticle in journal (Other academic)
  • 314. Öhrstrom, Arne
    et al.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Silicone oil bubbles in ophthalmic viscosurgical devices.2002In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 28, no 3, p. 389-Article in journal (Refereed)
4567 301 - 314 of 314
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