Purpose: To examine the association between the presence of dry eye disease (DED) symptoms when using BAK‐preserved artificial tears (AT) compared to preservative‐free AT.Methods: In this cross‐sectional study, we used data collected as part of Project ‘Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability’ (FOREVER). To analyse the strength and direction of associations, we used binomial logistic regression models adjusted for age, sex, smoking and eye diseases. The analysis was conducted on responses regarding AT formulations and seven distinct DED symptoms from 67 951 participants in Project FOREVER, including 8039 AT users.Results: Our analysis showed statistically significant higher odds ratios (ORs) of experiencing itching and blurred vision among users of BAK‐preserved AT compared to preservative‐free AT users, with ORs of 1.26 (95% CI 1.01–1.58) and 1.28 (95% CI 1.02–1.60), respectively. Additionally, a borderline significant trend indicated an increased number of DED symptoms in the BAK‐preserved AT group compared to preservative‐free AT users. Furthermore, our study provided a comprehensive overview of AT usage patterns within the cohort, illustrating the proportion of users for each type of AT.Conclusion: Our findings suggest that BAK‐preserved AT may worsen DED symptoms. We found higher ORs for experiencing itching and blurred vision as well as a tendency towards experiencing a higher number of symptoms when using BAK‐preserved AT compared to preservative‐free AT. Further longitudinal studies with additional questions on AT usage and clinical assessments are needed to validate these findings and optimize AT formulations for safer, effective DED management.

Purpose: To evaluate the test performance of the QUARTZ (QUantitative Analysis of Retinal vessel Topology and siZe) software in detecting retinal features from retinal images captured by health care professionals in a Danish high street optician chain, compared with test performance from other large population studies (i.e., UK Biobank) where retinal images were captured by non-experts. Method: The dataset FOREVERP (Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability, Pilot) contains retinal images obtained from a Danish high street optician chain. The QUARTZ algorithm utilizes both image processing and machine learning methods to determine retinal image quality, vessel segmentation, vessel width, vessel classification (arterioles or venules), and optic disc localization. Outcomes were evaluated by metrics including sensitivity, specificity, and accuracy and compared to human expert ground truths. Results: QUARTZ’s performance was evaluated on a subset of 3,682 images from the FOREVERP database. 80.55% of the FOREVERP images were labelled as being of adequate quality compared to 71.53% of UK Biobank images, with a vessel segmentation sensitivity of 74.64% and specificity of 98.41% (FOREVERP) compared with a sensitivity of 69.12% and specificity of 98.88% (UK Biobank). The mean (± standard deviation) vessel width of the ground truth was 16.21 (4.73) pixels compared to that predicted by QUARTZ of 17.01 (4.49) pixels, resulting in a difference of -0.8 (1.96) pixels. The differences were stable across a range of vessels. The detection rate for optic disc localisation was similar for the two datasets. Conclusion: QUARTZ showed high performance when evaluated on the FOREVERP dataset, and demonstrated robustness across datasets, providing validity to direct comparisons and pooling of retinal feature measures across data sources.

Purpose: To characterise the retinal vasculometry of a Danish eye and vision cohort and examine associations with systolic blood pressure (BP), diastolic BP, mean arterial BP, and intraocular pressure (IOP).Design: Longitudinal study.Methods: The retinal vasculature of fundus images from the FOREVER (Finding Ophthalmic Risks and Evaluating the Value of Eye exams and their predictive Reliability) cohort was analysed using a fully automated image analysis program. Longitudinal associations of retinal vessel morphology at follow‐up visit with IOP (baseline and follow‐up) and BP (follow‐up) were examined using multilevel linear regression models adjusting for age, sex and retinal vasculometry at baseline as fixed effects and person as random effect. Width measurements were additionally adjusted for the spherical equivalent.Results: A total of 2089 subjects (62% female) with a mean age of 61 (standard deviation 8) years and a mean follow‐up period of 4.1 years (SD 0.6 years) were included. The mean arteriolar diameter was approximately 20% thinner than the mean venular diameter, and venules were about 21%–23% less tortuous than arterioles. BP at follow‐up was associated with decreased arteriolar diameter from baseline to follow‐up. After adjusting for baseline IOP, IOP at follow‐up was associated with increased arteriolar tortuosity above baseline (0.59%, 95% CI 0.08–1.10, p‐value 0.024).Conclusion: In a Danish eye and vision cohort, variations in BP and alterations in IOP over time were associated with changes in the width and tortuosity of retinal vessels. Our findings contribute novel insights into retinal vascular alterations over time.

Purpose: To assess a new method for inferring glaucoma status using prescriptions data. Methods: The study population comprised all individuals living in Denmark in the period 1995 to 2018 and included 6,930,571 individuals. We used information from The National Prescription Registry on claimed prescriptions as the basis for our study (N = 223,592). We inferred glaucoma status using data on claimed prescriptions, in-hospital ICD-10 diagnoses, and in-hospital glaucoma surgeries. We infer glaucoma status in three ways using the prescription pattern: glaucoma inferred by (i) the use of a first claimed prescription, (ii) the use of a second claimed prescription with a gap of at least 90 days, and (iii) the use of a third claimed prescription for glaucoma medication, again with a gap of at least 90 days between prescriptions. Furthermore, we compared the results with alternative indications for glaucoma, namely in-hospital ICD-10-diagnosed glaucoma and in-hospital glaucoma surgery. Results: We first determined that glaucoma status could be inferred from claimed prescription data and found that a single claimed prescription was highly correlated with the more restricted composite measure of glaucoma (R² = 0.80, p <0.0001), with a kappa coefficient of 80%. Focusing on individuals with a confirmed in-hospital glaucoma diagnosis, we found a high sensitivity of 88% using anti-glaucomatous prescriptions as a surrogate marker for primary open-angle glaucoma (POAG). We then derived several descriptive insights. The prevalence of glaucoma increased during the period from 1996 to 2018, while the incidence was constant. We also found a decreasing trend in the ratio of the number of people diagnosed annually in hospitals to the number of people filling prescriptions. This indicated a relative increase in the number of patients treated or managed in the secondary sector. Finally, using data on diagnoses and claimed prescriptions, we found that the proportion of total noncompliant patients, i.e., patients who do not claim their prescription at any time in the study period (two decades) was at most 11.8%. This share is calculated on the basis of diagnosed patients who did not have surgery. The results was not sensitive to the glaucoma inference rule. Conclusion: Anti-glaucomatous medicine prescriptions can be used to infer glaucoma status, with useful implications for epidemiological research. The sensitivity is particularly high for primary open-angle glaucoma (POAG).