Background: Optical coherence tomography (OCT), multifocal electroretinography (mfERG) and full-field electroretinography (ffERG) give important information about retinal structure and function. Purpose: To collect normative data of macular Cirrus Spectral domain (SD)-OCT assessments and of mfERG measurements of healthy children (papers I and II). To assess the macular thickness with Cirrus SD-OCT and the retinal function with ffERG in 6.5-year-old children born extremely preterm and in children born at term (papers III and IV). Methods: Study participants aged 5-15 years and living in Uppsala County were randomly chosen from the Swedish Birth Register (papers I and II). In papers III and IV, the study participants consisted of children born extremely preterm and children born at term – all were aged 6.5 years. In paper III, the children were living in Stockholm and Uppsala health care regions and, in paper IV, in Uppsala health care region only. Macular thickness was assessed with Cirrus SD-OCT and macular function with mfERG, using the Espion Multifocal system and DTL-electrodes. The retinal function was assessed with ffERG and DTL-electrodes, using the Espion Ganzfield system. Results: Altogether, 58 children participated in paper I and 49 children in paper II. In paper I, the repeatability and reproducibility of the OCT assessments were good. In paper II, the results of the mfERG measurements were in accordance with retinal cone density and there were no significant differences between the right and left eyes. In paper III, 134 preterm children and 145 children born at term constituted the study population. The central macular thickness was significantly thicker in the preterm group than in the control group. Within the preterm group, gestational age (GA), former retinopathy of prematurity (ROP) and male gender were all important risk factors for an increased macular thickness. In paper IV, 52 preterm children and 45 control children constituted the study population. Significantly lower amplitudes and prolonged implicit times of the combined rod and cone responses, as well as of the isolated cone responses, were found in the preterm group when compared with the control group. In paper IV, there was no association between GA, ROP or male gender and the ffERG assessments. Conclusion: Normative data of Cirrus SD-OCT and mfERG assessments were reported. The results of the assessments were reliable. Children aged 6.5 years, born extremely preterm, had a significantly thicker central macula and both rod and cone function were significantly reduced in comparison to children born at term. ROP had an influence on retinal structure but not retinal function in the present cohorts. Our results suggest that retinal development is abnormal in children born extremely preterm. Long-term follow-up studies are necessary in order to evaluate the functional ophthalmological outcome in this vulnerable population of children growing up today.

<p>Two different principles were studied. 1st - statistical analysis techniques were used to obtain medical results from a patient population. 2nd - the patient population was used to study the statistical analysis techniques. </p><p>Medical conclusions: latanoprost and timolol treatment showed a statistically significant and clinically useful mean IOP-reduction in a typical worldwide clinical trial population. Latanoprost reduced the IOP 1.6 mm Hg more than timolol. The IOP-reduction was maintained with timolol and slightly enforced with latanoprost up to 6 months of treatment. The mean IOP-reduction was maintained during 2 years of latanoprost treatment. The overall risk of withdrawal due to insufficient IOP-reduction with latanoprost was 8%. </p><p>The statistical methodological issues are of a general and reoccurring character in trial design of the IOP-reduction: should the statistical hypothesis testing be based on the mean intraocular pressure (IOP) or the proportion of patients who reach a specific IOP level, should the estimate of the IOP or IOP-reduction be based on single eyes, mean of bilaterally eligible and identically treated eyes or the difference between an eye with active treatment and a placebo treated contralateral eye, and is mean of replicated recordings useful? Statistical methodological conclusions: the most effective response variable varies with the selected patient population. Therefore, the trial design process should include a comparison of the variability, test power and required sample size for the possible response variables in a sample of the target population. At minimum a statistical consideration should be done.</p>

<p>In a prospective population-based study in Stockholm County, 1998-2000, the incidence of retinopathy of prematurity (ROP) was investigated and was found to be 36% in prematurely-born infants with a birth weight of ≤ 1500 grams. Compared to a study performed ten years ago, the overall incidence was unchanged, but was reduced in “mature” infants and increased in immature ones. The incidence of ROP was 25% in infants with a gestational age of ≤ 32 weeks at birth. The main risk factors for ROP were the gestational age at birth, followed by the birth weight. Current guidelines for ROP screening in Sweden were modified.</p><p>A 10-year follow-up study of the ophthalmological findings in prematurely-born children, previously included in a prospective population-based incidence study of ROP, was performed. The children were compared with full-term ones. </p><p>Prematurely-born children ran a four times higher risk of refractive errors than full-term ones. The cryotreated children had the highest risk, but those without ROP also had more refractive errors than the full-terms. Within the group of prematurely-born children, the cryotreated ones had the highest prevalence of myopia, astigmatism and anisometropia, but no difference was found regarding hypermetropia.</p><p>The visual acuity of prematurely-born children was poorer than that of the full-terms. The cryotreated children and those with neurological complications had the most marked reduction, but the children without ROP and neurological findings also had a poorer visual outcome than the full-terms. The prevalence of visual impairment was 1.8% among the prematurely-born children, and was due to ROP in half the cases and cerebral lesions in the others. </p><p>The cryotreated children had constricted peripheral visual fields compared to the untreated prematurely-born and full-term children. The central visual fields tended to be reduced in the prematurely-born children compared to the full-terms, but no difference was observed within the preterm group.</p>

Two different principles were studied. 1st - statistical analysis techniques were used to obtain medical results from a patient population. 2nd - the patient population was used to study the statistical analysis techniques. Medical conclusions: latanoprost and timolol treatment showed a statistically significant and clinically useful mean IOP-reduction in a typical worldwide clinical trial population. Latanoprost reduced the IOP 1.6 mm Hg more than timolol. The IOP-reduction was maintained with timolol and slightly enforced with latanoprost up to 6 months of treatment. The mean IOP-reduction was maintained during 2 years of latanoprost treatment. The overall risk of withdrawal due to insufficient IOP-reduction with latanoprost was 8%. The statistical methodological issues are of a general and reoccurring character in trial design of the IOP-reduction: should the statistical hypothesis testing be based on the mean intraocular pressure (IOP) or the proportion of patients who reach a specific IOP level, should the estimate of the IOP or IOP-reduction be based on single eyes, mean of bilaterally eligible and identically treated eyes or the difference between an eye with active treatment and a placebo treated contralateral eye, and is mean of replicated recordings useful? Statistical methodological conclusions: the most effective response variable varies with the selected patient population. Therefore, the trial design process should include a comparison of the variability, test power and required sample size for the possible response variables in a sample of the target population. At minimum a statistical consideration should be done.

In a prospective population-based study in Stockholm County, 1998-2000, the incidence of retinopathy of prematurity (ROP) was investigated and was found to be 36% in prematurely-born infants with a birth weight of ≤ 1500 grams. Compared to a study performed ten years ago, the overall incidence was unchanged, but was reduced in “mature” infants and increased in immature ones. The incidence of ROP was 25% in infants with a gestational age of ≤ 32 weeks at birth. The main risk factors for ROP were the gestational age at birth, followed by the birth weight. Current guidelines for ROP screening in Sweden were modified. A 10-year follow-up study of the ophthalmological findings in prematurely-born children, previously included in a prospective population-based incidence study of ROP, was performed. The children were compared with full-term ones. Prematurely-born children ran a four times higher risk of refractive errors than full-term ones. The cryotreated children had the highest risk, but those without ROP also had more refractive errors than the full-terms. Within the group of prematurely-born children, the cryotreated ones had the highest prevalence of myopia, astigmatism and anisometropia, but no difference was found regarding hypermetropia. The visual acuity of prematurely-born children was poorer than that of the full-terms. The cryotreated children and those with neurological complications had the most marked reduction, but the children without ROP and neurological findings also had a poorer visual outcome than the full-terms. The prevalence of visual impairment was 1.8% among the prematurely-born children, and was due to ROP in half the cases and cerebral lesions in the others. The cryotreated children had constricted peripheral visual fields compared to the untreated prematurely-born and full-term children. The central visual fields tended to be reduced in the prematurely-born children compared to the full-terms, but no difference was observed within the preterm group.

A high frequency of retinitis pigmentosa (RP) is found in Northern Sweden. In an inventory of autosomal recessive RP patients in Västerbotten County, a great number of cases with a unique phenotype was noticed, denoted Bothnia Dystrophy (BD). The aim of the study was to describe the phenotype, to determine the chromosomal location, and to identify the gene. Patients typically show night blindness from early childhood. Symptoms of defect macular function with a decrease of visual acuity can appear in early adulthood. The retinal fundus shows irregular white spots in a central, and parafoveal pattern along the arcades. Centrally areolar maculopathy develops and round circular atrophies are observed in the periphery. The disease was shown to be associated with a missense mutation in the RLBP1 gene resulting in an amino acid substitution (R234W) in the cellular retinaldehyde-binding protein (CRALBP). The R234W mutation was found in a homozygous state in 61 patients affected with BD. Ten patients were heterozygous for the R234W mutation, and presented a similar phenotype. No additional mutations in the coding sequence or exon-intron junctions were found. CRALBP is localised in retinal pigment epithelium (RPE), and Müller cells of the retina. In the RPE, CRALBP functions as a carrier protein for endogenous retinoids. Dark adaptometry and electrophysiologic testing showed an initial loss of rod function followed by a progressive reduction of the cone responses in older ages. A compromised rod function, dysfunction of the Müller cells, and indications of a disturbed function of the inner retina were found. With prolonged dark adaptation, a gradual increase in retinal sensitivity to light and an improvement of the ERG components occurred. The findings indicate a prolonged synthesis of photopigments, retardation of the visual process in the retinal pigment epithelium and a loss of retinal cells probably starting at a relative early age in BD. To evaluate the subjective visual function in BD patients, a battery of objective tests of visual function and composite score of the 25-item NEI-Visual Function Questionnaire (VFQ-25) were analyzed. We found that weighted distance logMAR visual acuity (WVA), had the strongest association with subjective visual function, and that there was a considerable loss of subjective and objective visual function with increasing age in BD patients. The prevalence of BD is as high as 1:3600 in Västerbotten County. The possibility that recycling of retinoids localized in the RPE might be impaired in BD might give future therapeutic possibilities. Due to the large and clinically well-characterized set of patients with this disease, they constitute a suitable study group.

Bakgrund: Alla diabetiker erbjuds screening av ögonbottnen för diabetesretinopati så att den ska kunna upptäckas och behandlas i tid. Enligt Region Skånes riktlinje för screening av diabetesretinopati kan en traditionell funduskamera eller en wide field ka-mera som täcker 80 procent av näthinnan användas, något som hittills enbart Optos kan. Syftet med studien var att undersöka hälso- och sjukvårdspersonalens uppfattningar om Optos i samband med screening av diabetesretinopati. Metod: Femton ögonmottagningar visade sig använda Optos. Av dessa deltog tio i tvär-snittsenkätstudien. En webbenkät utformades bestående av öppna och multiple-choice frågor. Fritextsvaren analyserades med innehållsanalys som resulterade i ett antal kategorier och respektive svarsfrekvenser. Resultat: Optos uppfattades som en användar- och patientvänlig metod vilken kan öka tillgängligheten. Skärpan i Optomap uppfattades vara god, men något sämre än i fun-dusbilderna. Några uppfattade Optos som en bra metod för screening av diabetesretino-pati. Andra ansåg att användning av Optos skulle innebära en patientrisk. Då den sämre centrala skärpan skulle kunna leda till underdiagnosticering alternativt att Optomaps stora täckningsgrad skulle kunna vara anledning till en överdiagnosticering. Ett stort externt bortfall begränsar studieresultatets generaliserbarhet. Slutsats: Uppfattningar huruvida Optos anses vara lämpligt att användas i samband med screening av diabetesretinopati går isär och lämpliga användningsområden behöver definieras närmare. / Background: Screening for retinopathy is offered to all diabetics to allow detection and treatment on time. According to a regional guideline for screening of diabetic retino-pathy traditional fundus camera may be used or a wide field camera picturing 80 % of the retina, something nowadays only Optos can do. Aim of this study was to investigate health personnel’s attitude towards Optos in the context of diabetic retinopathy screening. Methods: Fifteen eye clinics using Optos were identified and ten of those took part in this survey. Self-administered questionnaires with multiple-choice and open questions were used. Free text answers were analysed using context analysis with determination of frequencies for the evolving categories. Results: Optos was perceived as being user and patient friendly, as well as being able to increase accessibility. Optomap had good but digital fundus pictures better perceived acuity. According to some was Optos a good method for screening of diabetic retino-pathy and inappropriate according to others apprehending a patient risk. Expecting underdiagnosis due to less central acuity alternatively overdiagnosis due to Optomap covering 80 % of the retina. High drop-out rate eventuates limited validity. Conclusions: Diverging attitudes emerged whether Optos is suitable for screening of diabetic retinopathy. Its appropriate use needs to be defined in further detail.

Syfte: Syftet med den här studien var att jämföra Digital Eye Strain-symptom mellan läsning på papper och mobiltelefon. Att undersöka om det som tidigare studier har visat i skillnad mellan läsning på papper och en datorskärm även gäller mobiltelefoner och hur mycket våra ögon påverkas när det gäller ansträngning, trötthet och andra ögonrelaterade symptom.  Metod: Deltagarna (n=16) fick läsa i 20 minuter tyst, antingen på papper eller en smartphone-skärm. Avståndet fick de själva bestämma. De läste samma bok med samma typsnitt och storlek på båda medierna. Direkt efter de hade läst i 20 minuter fick de fylla i ett frågeformulär som bestod av tio frågor kring deras upplevda ögonsymptom under uppgiften. Resultat: Studien visade på signifikanta skillnader i medelvärdet mellan papper och mobiltelefon på tre av symptomen: suddig syn vid tittande på texten (p=0,016), ansträngda ögon (p=0,023) samt trötta ögon (p=0,015). I alla tre fallen var symptompoängen högre efter läsning på mobilskärm än efter läsning på papper. Det fanns ingen signifikant skillnad mellan de övriga sju symptomen. Det var även en signifikant skillnad i läsavstånd med ett betydligt mindre avstånd till mobiltelefonen än till pappret. Slutsats: Studien visar att symptomen efter användning av mobiltelefon upplevs som svårare än efter läsning på papper. De tre symptom som skilde sig signifikant var alla högre efter läsning på mobilskärmen. / Purpose: The purpose of this study was to compare Digital Eye Strain DES-symptoms after reading on a printed hardcopy versus a smartphone. To understand if results obtained from earlier studies that have showed DES when reading in from computer also applies to smartphones. Methods: 16 participants in the study were asked to read a Swedish book quietly for 20 minutes, either on a hardcopy or on a smartphone. The participants were told to use their normal working distance while reading from book or smartphone. They read the same book with the same textsize and font in both conditions. Directly after reading the participants completed a written questionnaire that consisted of ten questions about their level of ocular discomfort during the task.   Results: This study showed significant differences in mean symptom scores between printed hardcopy and smartphone on three of the symptoms; blurred vision while viewing the text (p=0,016), eyestrain (0,023) and tired eyes (0,015). In all three cases the symptoms were higher during smartphone use. No significant differences were found between the other seven symptoms. There were a significant difference in reading distance, smartphone were held closer than the hardcopy. Conclusion: This study shows that the symptoms after smartphone use is perceived as more severe than after reading on a hardcopy. The three symptoms that showed a significant difference were all higher after smartphone use.

Syfte: Syftet med den här studien var att undersöka om Spontaneous Eye Blink Rate (SEBR) skiljde sig åt vid läsning på utskrivet papper, surfplatta eller smartphone. Det jämfördes också huruvida fullständiga och ofullständiga blinkningar skiljde sig åt vid läsning på de olika medierna. Metod: Deltagarna (n=29) fick läsa tre olika texter på utskrivet papper, surfplatta och smartphone samtidigt som de filmades. I efterhand granskades samtliga videos två gånger för att räkna fullständiga blinkningar, ofullständiga blinkningar och totalt antal blinkningar (SEBR). Resultat: Den här studien visade att där finns en signifikant skillnad av totalt antal blinkningar vid läsning på utskrivet papper och surfplatta (p=0,03), där blinkningar/minut sjönk med 14,9% vid läsning på utskrivet papper, jämfört med surfplatta. För ofullständiga blinkningar fanns en statistiskt signifikant skillnad mellan utskrivet papper och surfplatta (p=0,02), där antalet ofullständiga blinkningar/minut ökade med 30,0% vid läsning på surfplatta, jämfört med utskrivet papper. Vid läsning på surfplatta och smartphone fanns en signifikant skillnad gällande ofullständiga blinkningar (p=0,01), där antalet ofullständiga blinkningar/minut ökade med 42% vid läsning på surfplattan, jämfört med smartphone.  Slutsats: Spontaneous Eye Blink Rate skiljer sig vid läsning på papper och surfplatta. Ofullständiga blinkningar är flest vid läsning på surfplatta. Inga signifikanta skillnader finns mellan utskrivet papper och smartphone. / Purpose: The purpose of this study was to evaluate whether Spontaneous Eye Blink Rate (SEBR) differ when reading on hard copy, tablet or smartphone. Complete and incomplete blinks were also evaluated to see if there were any differences regarding the hard copy, tablet and smartphone.  Methods: The participants read three different texts on hard copy, tablet and smartphone while they were being filmed. Afterwards, each video was analysed twice in order to count complete blinks, incomplete blinks and total blink rate (SEBR). Results: This study showed that there is a significant difference in total blink rate between reading on hard copy and tablet (p=0.03), where blinks/minute decreased by 14.9% for the hard copy condition. There was also a significant difference in incomplete blinks regarding the two devices (p=0.02), where incomplete blinks increased by 30.0% when reading on tablet. Tablet and smartphone reading also resulted in a significant difference, where incomplete blinks increased  by 42% when reading on tablet (p=0.01). Conclusion: Spontaneous Eye Blink Rate differ when reading on hard copy and tablet. Incomplete blinks increase when reading on tablet. No significant differences are found between hard copy and smartphone.

I nuläget finns det begränsat med forskning hur det går för de personer som opererar bort ett öga. Detta kan medföra att ögonsjuksköterskan ger otillräcklig information till patient och anhöriga i samband med att det är aktuellt att bära protes. Därför var det av intresse att undersöka den synrelaterade livskvaliteten hos personer som genomgått en ögonamputation. Syftet var att belysa synrelaterad livskvalitet hos personer som genomgått en ögonamputation och har en ögonprotes. Studien är en tvärsnittsstudie med deskriptiv design. Datainsamlingen omfattade frågeformuläret NEI-VFQ-25 med tilläggsfrågor, där deltagarna var vuxna personer som genomgått en ögonamputation de senaste fem åren. Resultatet visade att deltagarna hade lägre synrelaterad livskvalitet än personer i kontrollgruppen från H70-studien 2014/2015 med och utan påverkan på synförmågan. Mest besvär hade deltagarna med sidoseende och aktiviteter både på nära och långt håll. Resultatet av studien kan ge ögonsjuksköterskan fördjupad kunskap som kan användas i personcentrerad vård som stöd för att uppmuntra personen som genomgått en ögon amputation och att på bästa sätt hantera sin nya livssituation. Forskning omfattande synrelaterad livskvalitet hos samtliga vuxna personer i Sverige som genomgått en ögonamputation och har ögonprotes vore av intresse, eftersom resultatet baseras på en grupp patienter vid en ögonklinik. / At the moment there is little research about the outcome of people who have had an eye surgically removed. This may result in an ophthalmic nurse giving insufficient information to patients and relatives. Therefore, it would be interesting to investigate the vision related quality of life in relation to the eyesight of persons who have undergone an eye amputation. The purpose was to illustrate the vision related quality of life of people who have been subject to an eye amputation and have an eye prothesis. The study is a cross-sectional study with a descriptive design. The data collection was conducted using the questionnaire NEI-VFQ-25 together with supplementary questions which was sent to adults who have undergone an eye amputation in the last five years. The results showed that eye amputees had lower vision-related quality of life than participants in a control group from the H70 study 2014/2015 with and without visual symptoms. The biggest inconvenience for the participants was peripheral vision and both near activities and distance activities. The results of the study can provide the ophthalmic nurse with a deeper knowledge to be used working with personcentered care and provide thourough information to support persons how has went through an eye amputation to manage their new life situation. Further research on eye amputees vision-related quality of life nationally is needed because the result is based on a limited study group.