Background: Virtual clinics (VCs) have proven to be an effective solution for the increasing strain on Medical Retina (MR) services, although imaging quality issues (IQIs) persist. Our aim was to compare the quality of two ultra-wide-field (UWF) imaging modalities (Optos and Clarus) in real-world MR-VC settings. Methods: We conducted a real-world, prospective study. Data were collected from 6 Moorfields NHS Trust MR-VCs between September and October 2024. We obtained patient demographics and characteristics, primary diagnosis, UWF imaging types and images obtained, and follow-up outcomes. Results: Optos (California RG/RGB, and Monaco) was used for 56.7% (n = 152) and Zeiss Clarus 500 for 43.3% (n = 116) of the total cohort (n = 268). No statistically significant difference (p = 0.14) was found between the two in terms of the rates of IQIs. FAF (p = 0.001) acquisition was significantly higher when Optos was used. Of the patients affected by IQIs, 10 were examined in a face-to-face clinic (F2FC). No difference in IQI rates was observed when pathology-related poor image quality was considered (p = 0.561). A significantly (p = 0.001) higher rate of F2F follow-ups was found for red-flag pathologies and unexplained vision loss, with a statistically significantly higher rate of virtual follow-ups for non-red-flag pathologies (p = 0.001). Conclusions: A total of 7.5% of the clinical decisions were impacted by IQIs; 11.1% of F2FC follow-ups. Neither UWF imaging modality type was inferior in terms of IQI rates. FAF acquisition was higher with Optos, likely representing greater user-dependency for Clarus. The outcomes were not influenced by FAF acquisition, indicating that routine acquisition is not required in MR-VCs and instead should be obtained when clinically required.

(2020). The future of virtual reality in cataract surgical training. Expert Review of Ophthalmology. Ahead of Print.

Aim: To evaluate the real-world effectiveness, durability, and safety of faricimab 6 mg in eyes with treatment-refractory retinal vein occlusion (RVO)-associated macular oedema (MO) in the United Kingdom (UK). Methods: This was a retrospective, single-centre observational study of eyes with RVO that were switched to faricimab after prior treatment with previous anti-vascular endothelial growth factor (anti-VEGF) agents. Baseline demographics, treatment history, pinhole visual acuity (VA), optical coherence tomography (OCT) biomarkers, and injection intervals were recorded. Eyes were treated using a treat-and-extend regimen without a loading phase. Functional, anatomical, durability, and safety outcomes were assessed over follow-up. Results: A total of 22 eyes from 22 patients were included, with a mean (SD) age of 67.9 (11.9) years and a mean (SD) RVO duration of 201.4 (153.1) weeks. Eyes had received a mean (SD) of 20.8 (16.9) prior anti-VEGF injections. The mean (SD) follow-up was 45.7 (15.8) weeks, with a mean (SD) of 5.9 (2.3) faricimab injections. There was no significant change in pinhole VA (53.5 (18.5) vs. 55.0 (18.8) letters, p = 0.08). The central subfield thickness (CST) reduced from 407.6 (102.1) to 377.0 (186.5) µm, and the maximum central retinal thickness from 483.6 (103.1) to 442.2 (187.2) µm, although these changes were not statistically significant (p > 0.05). The proportion of eyes with subretinal fluid (SRF) decreased from 18.2% to 4.5%, and intraretinal fluid (IRF) from 100% to 81.8%. Injection intervals between the first and second faricimab injections increased significantly from 4.9 (1.4) to 7.7 (3.4) weeks (final injection interval, p = 0.004). Six eyes (27.3%) discontinued faricimab, with three (13.6%) requiring an intravitreal dexamethasone implant following a suboptimal response. One eye (4.5%) developed transient intraocular pressure elevation; no cases of intraocular inflammation or endophthalmitis were observed. Conclusions: In this heavily pre-treated, chronic RVO cohort, switching to faricimab without a loading phase resulted in stable visual acuity, modest but non-significant anatomical improvements, and a significant extension in treatment intervals. These findings suggest that faricimab may provide durability benefits and disease stabilisation in treatment-refractory RVO, although functional gains may be limited in chronic disease. Further prospective studies are required to define optimal switching strategies.