Øystein Kalsnes Jørstad

• Langslet, Gisle; Kollstad, Synne; Jørstad, Øystein Kalsnes; Erke, Maja Gran; Retterstøl, Kjetil & Holven, Kirsten Bjørklund (2026). Retinal findings in familial hypercholesterolemia: An exploratory case-control study. Atherosclerosis Plus. ISSN 2667-0909. 65. doi: 10.1016/j.athplu.2026.100571. Fulltekst i vitenarkiv
• Ryan, Stephen James; Jørstad, Anna-Katharina; Moe, Morten Carstens; Skjelland, Mona Elisabeth; Roy, Ansar & Rowe, Fiona J. [Vis alle 8 forfattere av denne artikkelen] (2026). Validation of the Vision Impairment Screening Assessment in acute stroke care: a prospective diagnostic accuracy study. European Stroke Journal. ISSN 2396-9873. 11(5). doi: 10.1093/esj/aakag053. Fulltekst i vitenarkiv
• Løkken, Jacopo Francesco Taraldsrud; Moe, Morten Carstens; Sæther, Erik Magnus & Jørstad, Øystein Kalsnes (2026). Beyond drug price: A comparison of overall costs of anti-vascular endothelial growth factor therapy alternatives for neovascular age-related macular degeneration in Norway. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.70069. Fulltekst i vitenarkiv
• Ackermann, Bryan Calder; Junker, Niklas; Friedrich, Maximilian; Jørstad, Øystein Kalsnes; Moe, Morten Carstens & Augustin, Victor Aristide [Vis alle 8 forfattere av denne artikkelen] (2026). The effect of syringe design and cannula dimensions on time-force curve in intravitreal injection across different drug viscosities: area under the curve and peak injection force. International Journal of Retina and Vitreous (IJRV). 12. doi: 10.1186/s40942-026-00833-2. Fulltekst i vitenarkiv Vis sammendrag

  Background New intravitreal medications can offer longer treatment duration by using higher drug concentrations, which, in turn, increase viscosity. There is also a trend toward having smaller-gauge cannulas, which require a higher injection force. While the ophthalmologist cannot control viscosity, the choice of syringe may affect the force needed to administer the drug. This study compared two standard 1-ml syringes (BD Plastipak™ and Braun Injekt®-F) with a syringe featuring a reduced plunger diameter (Zero Residual™ 0·2 mL silicone oil-free syringe) for injecting a variety of fluids with viscosity that mimics commonly used intravitreal formulations. Methods Injection force over time was measured for each combination of the three syringes, four fluids, and two cannulas (30 G and 33 G), and the results were compared using a two-way ANOVA, followed by Tukey’s post-hoc test. Plungers of the 1ml syringes had a diameter of approximately 4.70mm, while the smaller syringe had a plunger diameter of 2.48mm. Of the 1ml syringes, one was silicone oil lubricated (BD Plastipak™). The tested fluids were chosen to simulate bevacizumab (Balanced Salt Solution), pegcetacoplan (13.8 mg/0.1 ml of PEG-40,000), a high-viscosity solution (40 mg/0.1 ml of PEG-400), and a very high-viscosity solution (Tween 80 diluted with BSS). Results The Zero Residual syringe required significantly lower injection forces, as quantified by both the area under the curve (AUC) and peak force. These effects became more pronounced when using smaller-diameter cannulas and increasingly viscous fluids. The BD Plastipak needed lower forces than the Braun Injekt-F. Conclusions While silicone-oil lubrication reduced injection force, its effect was modest compared with that of plunger diameter, which was the primary determinant of the injection force required for a given viscosity and cannula diameter.

• Sauesund, Ellen Steffenssen; Brunborg, Cathrine; Jørstad, Øystein Kalsnes; Moe, Morten Carstens; Erke, Maja Gran & Fosmark, Dag Sigurd [Vis alle 7 forfattere av denne artikkelen] (2026). Implementation of diabetic retinopathy screening in the Oslo region, Norway: a 3-year pilot study. Frontiers in Medicine. 13. doi: 10.3389/fmed.2026.1748289. Fulltekst i vitenarkiv
• Moe, Morten Carsten; Hal, Bas van; Melo, Gustavo Barreto & Jørstad, Øystein Kalsnes (2026). Time for refrigerated syringes of biologics to reach room temperature before intravitreal injection. Eye (London. 1987). ISSN 0950-222X. doi: 10.1038/s41433-026-04414-3. Fulltekst i vitenarkiv
• Ryan, Stephen James; Jørstad, Øystein Kalsnes; Skjelland, Mona; Pesonen, Maiju; Simonsen, Claus Z. & Bek, Toke [Vis alle 50 forfattere av denne artikkelen] (2026). A Randomized Trial of Tenecteplase in Acute Central Retinal Artery Occlusion. New England Journal of Medicine. ISSN 0028-4793. 394(5), s. 442–450. doi: 10.1056/nejmoa2508515. Fulltekst i vitenarkiv Vis sammendrag

  Background: Central retinal artery occlusion can result in permanent vision loss. Effective treatment is lacking. Methods: We conducted a phase 3, double-blind, double-dummy, randomized, controlled trial involving adults with acute, nonarteritic central retinal artery occlusion who had symptom onset within 4.5 hours before treatment. Patients were assigned, in a 1:1 ratio, to receive intravenous tenecteplase (at a dose of 0.25 mg per kilogram of body weight) and oral placebo or intravenous placebo and oral aspirin (at a dose of 300 mg). The primary end point was vision recovery, defined as a best corrected visual acuity (BCVA) in the affected eye at 30 days of up to 0.7 logMAR (logarithm of the minimum angle of resolution; equivalent to ≥20/100). Key secondary visual end points were a BCVA of up to 0.5 logMAR (equivalent to ≥20/63), mean improvement in BCVA, and perimetry score at 30 days. Key safety end points included symptomatic intracranial hemorrhage, major bleeding, and death. Results: A total of 78 patients at 16 sites in six countries underwent randomization, with 40 assigned to receive tenecteplase and 38 to receive aspirin. At 30 days, 8 patients (20%) in the tenecteplase group and 9 patients (24%) in the aspirin group had vision recovery (risk difference, −3.7 percentage points; 95% confidence interval, −22.0 to 14.7; P=0.69). The outcomes with regard to the secondary visual end points did not differ substantially between the groups. There was a greater incidence of adverse events in the tenecteplase group, including one fatal intracranial hemorrhage. Conclusions: Intravenous tenecteplase administered within 4.5 hours after onset of central retinal artery occlusion did not result in significantly greater vision recovery at 30 days than oral aspirin but was associated with serious safety concerns. (Funded by Oslo University Hospital and others; TenCRAOS ClinicalTrials.gov number, NCT04526951; EU Clinical Trials number, 2024-517606-29-00.)

• Blaser, Frank; Sudmann, Thea Melsen; Bro, Tomas; Barthelmes, Daniel; Said, Sadiq & Todorova, Margarita G. [Vis alle 8 forfattere av denne artikkelen] (2025). Visual field testing and fitness to drive in Europe: A cross-country comparison against a potential reference standard. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.70038. Fulltekst i vitenarkiv
• Sudmann, Thea Melsen; Jeber, Anne Kathinka; Brækhus, Anne; Klungsøyr, Ole; Rowe, Fiona J. & Jørstad, Øystein Kalsnes (2025). The impact of different spectacle designs on the European visual field requirements for driving. Journal of optometry. ISSN 1888-4296. 19(1). doi: 10.1016/j.optom.2025.100582. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Spectacles can obstruct the peripheral visual field (VF) and interfere with formal requirements for driving. The European VF standards can be assessed with perimetry using the European Driving Test (EDT). This study aimed to evaluate the impact of different spectacles on the EDT, and their compliance with the European VF standards for driving. Methods This cross-sectional study included 30 participants (15 males and 15 females) with normal VF. Participants underwent binocular EDT perimetry with three different spectacles. The number of missed test points were recorded and the vertex distance (VD), pupillary distance, and eye dominance were measured. Statistical comparisons were conducted using a generalized linear mixed model, with significance set at p < 0.05. Results Peripheral VF loss was observed in 11 (37 %) participants (10 males) with spectacle B and in six (20 %) participants (five males) with spectacle C, whereas only one participant had a single missed test point with spectacle A. Participants with spectacle-related VF loss had significantly greater VD than those without. Moreover, there were a higher number of missed test points on the side of the dominant eye. Conclusions Spectacles with thin frames and temples had a negligible impact on the peripheral VF, whereas thicker frames and temples could compromise compliance with the VF standards. VF loss was associated with greater VD, which can explain why male participants exhibited more artefacts. These findings emphasize the need to consider spectacle design in fitness-to-drive assessments with perimetry and raise awareness of potential VF restrictions associated with certain eyewear.

• Sommer-Lind, Filip; Subhi, Yousif; Vergmann, Anna S.; Lövestam-Adrian, Monica; Andersen, Nis & Borrelli, Enrico [Vis alle 47 forfattere av denne artikkelen] (2025). Consensus on age-related macular degeneration course curricula for general ophthalmologists and non-ophthalmologist clinical staff: A Delphi study. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.70006. Fulltekst i vitenarkiv
• Simonsen, Emma; Lund, Lars Christian; Ernst, Martin Thomsen; Hjellvik, Vidar; Hegedüs, Laszlo & Hamann, Steffen [Vis alle 10 forfattere av denne artikkelen] (2025). Use of semaglutide and risk of non-arteritic anterior ischemic optic neuropathy: A Danish–Norwegian cohort study. Diabetes, obesity and metabolism. ISSN 1462-8902. 27(6), s. 3094–3103. doi: 10.1111/dom.16316. Fulltekst i vitenarkiv Vis sammendrag

  Aims To investigate the putative association between semaglutide and non-arteritic anterior ischaemic optic neuropathy (NAION). Materials and Methods Data from national health registries in Denmark (2018–2024) and Norway (2018–2022) were used to compare NAION risk in individuals with type 2 diabetes initiating semaglutide versus sodium-glucose co-transporter 2 inhibitors (SGLT-2is). A supplementary self-controlled analysis examined NAION risk among all semaglutide users. National estimates were pooled using a fixed-effects model. Results We identified 44 517 users of semaglutide for the management of type 2 diabetes in Denmark and 16 860 in Norway, with a total of 32 NAION events observed. The unadjusted incidence rate of NAION was 2.19/10 000 person-years among Danish semaglutide initiators, compared to 1.18 among SGLT-2i initiators. In Norway, the corresponding rates were 2.90 and 0.92, respectively. After adjustment, the pooled hazard ratio (HR) was 2.81 (95% confidence interval [CI] 1.67–4.75), and the incidence rate difference (IRD) was +1.41 (95% CI +0.53 to +2.29) per 10 000 person-years. Estimates were consistent across both countries but higher and less precise in Norway (HR 7.25; 95% CI 2.34–22.4) compared to Denmark (HR 2.17; 95% CI 1.20–3.92). Results remained consistent across sensitivity and supplementary analyses, with a stronger association observed in a post hoc per-protocol analysis (HR 6.35; 95% CI 2.88–14.0). In the supplementary self-controlled study, symmetry ratios (SRs) for NAION were 1.14 (95% CI 0.55–2.36) in Denmark and 2.67 (95% CI 0.91–8.99) in Norway. Conclusions The use of semaglutide for managing type 2 diabetes is associated with an increased risk of NAION compared with the use of SGLT-2is. However, the absolute risk remains low.

• Sverstad, Alexander; Kristianslund, Olav; Petrovski, Goran; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2024). A proof-of-concept study of a prototype needle that mitigates intraocular pressure rise following intravitreal injection. International Journal of Retina and Vitreous (IJRV). 10(1). doi: 10.1186/s40942-024-00590-0. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To determine the feasibility of a prototype needle that enhances vitreous reflux (VR) to control intraocular pressure (IOP) in intravitreal injection (IVI). Methods We created an eye model to compare IVI using a standard 30-G needle with four different versions of a 30-G prototype needle with one to four surface grooves that enhanced VR. We injected 50, 70, and 100 µl saline through porcine sclera or 460-µm-thick rubber and measured the peak and 3-second pressure before we extracted the needle and measured the 10-second pressure. Results 50-µl injection through sclera with the standard needle resulted in mean (SD) pressure of 58.6 (3.8) mmHg at peak, 52.8 (4.7) mmHg at 3 s, and 39.6 (18.0) mmHg at 10 s. The prototype needle lowered the pressure; four grooves resulted in mean (SD) pressure of 29.4 (5.6) mmHg at peak, 22.0 (3.7) mmHg at 3 s, and 7.2 (6.6) mmHg at 10 s. 70-µl and 100-µl injections through sclera with the standard needle resulted in mean (SD) pressure of 68.8 (3.6) and 86.0 (6.0) mmHg at peak. Similar to 50-µl injection, the prototype needle lowered the pressure for 70-µl and 100-µl injections. At 10 s, we observed varying leakage at the injection site for sclera but not for rubber. Conclusions The study provides proof of concept for a needle design for which surface grooves enhance VR and counteract the effect of IVI on IOP. The safety and efficacy of the prototype needle must be studied further in a clinical trial.

• Sauesund, Ellen Steffenssen; Hertzberg, Silvia Nanjala Walekhwa; Jørstad, Øystein Kalsnes; Moe, Morten Carsten; Erke, Maja Gran & Fosmark, Dag Sigurd [Vis alle 7 forfattere av denne artikkelen] (2024). A health economic pilot study comparing two diabetic retinopathy screening strategies. Scientific Reports. 14(1). doi: 10.1038/s41598-024-66405-2. Fulltekst i vitenarkiv Vis sammendrag

  To compare two screening strategies for diabetic retinopathy (DR), and to determine the health-economic impact of including optical coherence tomography (OCT) in a regular DR screening. This cross-sectional study included a cohort of patients (≥ 18 years) with type 1 or 2 diabetes mellitus (T1D or T2D) from a pilot DR screening program at Oslo University Hospital, Norway. A combined screening strategy where OCT was performed in addition to fundus photography for all patients, was conducted on this cohort and compared to our existing sequential screening strategy. In the sequential screening strategy, OCT was performed on a separate day only if fundus photography indicated diabetic macular edema (DME). The presence of diabetic maculopathy on fundus photography and DME on OCT was determined by two medical retina specialists. Based on the prevalence rate of diabetic maculopathy and DME from the pilot, we determined the health-economic impact of the two screening strategies. The study included 180 eyes of 90 patients. Twenty-seven eyes of 18 patients had diabetic maculopathy, and of these, 7 eyes of 6 patients revealed DME on OCT. When diabetic maculopathy was absent on fundus photographs, OCT could not reveal DME. Accordingly, 18 patients (20%) with diabetic maculopathy would have needed an additional examination with OCT in the sequential screening strategy, 6 (33%) of whom would have had DME on OCT. In an extended healthcare perspective analysis, the cost of the sequential screening strategy was higher than the cost of the combined screening strategy. There was a weak association between diabetic maculopathy on fundus photography and DME on OCT. The health economic analysis suggests that including OCT as a standard test in DR screening could potentially be cost-saving.

• Husum, Yngvil Solheim; Moe, Morten Carsten; Fagerland, Morten; Eriksen, Erik Fink & Jørstad, Øystein Kalsnes (2024). Zoledronic acid as adjuvant therapy in neovascular age-related macular degeneration: a randomised controlled pilot study. BMJ Open Ophthalmology. 9(1). doi: 10.1136/bmjophth-2024-001964. Fulltekst i vitenarkiv Vis sammendrag

  Aims To assess the feasibility of a study protocol for a randomised controlled trial of zoledronic acid (ZA) as adjuvant therapy for neovascular age-related macular degeneration (nAMD). Methods In this 1-year, randomised, double-blinded, placebo-controlled pilot study, nAMD patients were allocated 1:1 to receive intravenous ZA 5 mg or placebo at baseline and after 6 months in addition to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy following a treat-and-extend regimen. Bevacizumab was the first-line anti-VEGF drug, but eyes with refractory nAMD were switched to aflibercept. The primary outcome was mean change in best-corrected visual acuity (BCVA). Results 40 participants enrolled in the study, with 20 allocated to each treatment group. 38 participants received both study infusions, and all participants completed the final assessment. Mean (SD) change in BCVA was 7.5 (9.5) letters in the ZA group and −0.5 (11.5) letters in the control group; the between-group difference was 8.0 letters (95% CI: 1.5 to 15.0 letters). There were no between-group differences in mean change in central retinal thickness, refractory nAMD proportion or mean number of injections. Conclusion It is feasible to conduct a randomised controlled trial of ZA as adjuvant therapy for nAMD in terms of recruitment and adherence to the pilot study protocol. We found a possible visual benefit of ZA that is worth further investigation. To clarify the relationship between ZA and the need for intravitreal injections, we recommend amending the protocol by omitting switching of the anti-VEGF drug. Due to the limited sample size of the pilot study, the estimates of treatment effect are not meant to be confirmatory and should be interpreted with caution. Trial registration number 2019-001492-37 (EudraCT), 04304755 (NCT).

• Sudmann, Thea Melsen; Torblaa, Anna; Austeng, Dordi Kristine; Reshodko, Irina; Rehm, Johannes & Bro, Tomas [Vis alle 10 forfattere av denne artikkelen] (2024). Validation of the European visual field standards for driving: A driving simulator-based study. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.16783. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To determine whether we could establish evidence-based pass/fail criteria for perimetry in the context of the European visual field standards for driving. Methods This two-centre, cross-sectional study included participants with binocular visual field loss that had led to revocation of a group-1 driving licence. The participants underwent cognitive and binocular visual testing, including the European Driving Test (EDT), a perimetry algorithm that adheres to the European visual field standards. We used a high-fidelity driving simulator to compare the driving ability of these participants with healthy controls. Two driving instructors classified each driving test as passed or failed. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) determined the ability of perimetry to discriminate between passed and failed driving tests. Results The study included 70 participants with visual field loss and 37 controls. A non-significantly higher proportion of controls passed the driving test (75% vs. 63%; p = 0.22). In ROC analysis, contrast sensitivity performed best (AUC of 0.73), followed by NEI VFQ-25 (AUC of 0.64). Peripheral visual field (AUC of 0.56) and central visual field (AUC of 0.47) performed weaker. Combining the central and peripheral visual field, and their interaction, increased AUC to 0.63. Conclusion Perimetry was a poor predictor of simulator-based driving test result, and we could not establish appropriate pass/fail criteria for the European visual field standards. Because perimetry is not an accurate diagnostic tool for fitness to drive, a practical driving assessment should be performed in case of doubt.

• Agra, Lydianne Lumack do Monte; Sverstad, Alexander; Chagas, Thiago A; Araujo, Rodrigo H.; Oliveira, Larissa & Kristianslund, Olav [Vis alle 11 forfattere av denne artikkelen] (2023). Accuracy, Precision, and Residual Volume of Commonly Used Syringes for Intravitreal Injections and the Impact on Intraocular Pressure. Ophthalmology Retina. ISSN 2468-7219. 7(10), s. 892–900. doi: 10.1016/j.oret.2023.06.003. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To compare accuracy, precision, and residual volume of commonly used syringes for intravitreal injections (IVIs) and to assess the intraocular pressure (IOP) rise by variations in volumes delivered. Design Experimental laboratory study. Subjects No subjects were involved in this study. Methods We tested 8 syringe models with 2 different needle setups, with 2 different solutions (distilled water or glycerin) and target volumes (50 and 70 μL). To obtain the delivered and residual volumes, we weighed the syringe-needle setups with scale before liquid withdrawal, with liquid, and after liquid release. We also created an experimental eye model to determine the transient rise in IOP following stepwise 10-μL increases in injection volumes. Main Outcome Measures Delivered and residual volumes, IOP rise. Results We tested a total of 600 syringe-needle setups. Becton Dickinson (BD) Ultra-Fine (0.34 ± 0.28 μL), Zero Residual (1.53 ± 1.15 μL), and Zero Residual Silicone Oil-free (1.40 ± 1.16 μL) syringes showed the lowest residual volume (P < 0.001) in comparison with the others (range: 24.86 ± 1.78 μL for Injekt-F to 51.97 ± 3.37 μL for Omnifix-F). The most accurate setups were (percentage deviation from target volume): Zero Residual Silicone Oil-free (+ 0.70%), Zero Residual 0.3 ml (+ 4.49%), BD Ultra-Fine (+ 7.83%), Injekt-F (9.42%), Norm-Ject (+ 15.88%), Omnifix-F (+ 16.96%), BD Plastipak Brazil (+17.96%), and BD Plastipak Spain syringes (+ 19.41%). There was a statistically significant difference between the Zero Residual Silicone Oil-free syringe and all other syringes (P < 0.0001), except for the Zero Residual 0.3-ml syringe (P = 0.029). The coefficient of variation was low for all syringes. The modeled IOP rise ranged from 32.3 (standard deviation [SD], 1.4) mmHg for 20-μL injection volume to 76.5 (SD, 1.0) mmHg for 80-μL injection volume. For the standard 50-μL injection volume, the peak pressure was 50.7 (SD, 0.1) mmHg, and the pressure rise duration was 28 (SD, 2) minutes. Conclusions There were significant differences in accuracy and residual volume between syringes, whereas they showed a high precision. Volume excess results in a considerable increase in IOP rise after injection. These findings may provide a relevant overview to clinicians and to both device and drug manufacturers regarding pharmacoeconomic, safety, and efficacy issues.

• Sauesund, Ellen Steffenssen; Jørstad, Øystein Kalsnes; Brunborg, Cathrine; Moe, Morten Carsten; Erke, Maja Gran & Fosmark, Dag Sigurd [Vis alle 7 forfattere av denne artikkelen] (2023). A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results. Biomedicines. 11(4). doi: 10.3390/biomedicines11041222. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway. Methods: This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR. Results: The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis &gt; 5 years for T1D and &gt;1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group. Conclusions: This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).

• Jørstad, Øystein Kalsnes; Foss, Stian; gjølberg, torleif; mester, simone; Nyquist-Andersen, Mari & Sivertsen, Magne S. [Vis alle 10 forfattere av denne artikkelen] (2023). Pharmaceutical compounding and storage of faricimab in a syringe for intravitreal injection do not impair stability and bi-specific binding properties. International Journal of Retina and Vitreous (IJRV). 9(1). doi: 10.1186/s40942-023-00507-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Intravitreal injection (IVI) of antibody biologics is a key treatment approach in ophthalmology. Pharmaceutical compounding and storage of prefilled syringes for IVI must take place without impairing the structure and function of the biologics. This study investigated the effect of withdrawing and storing the therapeutic antibody faricimab (Vabysmo, Roche, Basel, Switzerland) in the Zero Residual silicone oil-free, 0.2-mL syringe (SJJ Solutions, The Hague, the Netherlands). Methods To assess the effect of syringe withdrawal on faricimab, we compared samples from syringes prepared at day 0 with samples taken directly from faricimab vials. To assess the effect of syringe storage on faricimab, we kept prefilled syringes in the dark at 4 oC for 7, 14, or 37 days and compared samples from these syringes with day 0. We measured protein concentration (with spectrophotometry), stability and integrity (with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), size-exclusion chromatography (SEC), and melting temperature (Tm)), as well as binding of faricimab to its cognate antigens: vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2) (with enzyme-linked immunosorbent assay (ELISA)). Results Faricimab migrated in line with its expected molecular mass under both reducing and non-reducing conditions for all time points when analyzed with SDS-PAGE, without any sign of degradation products or aggregation. The SEC elution profiles were identical for all time points. There were slight variations in Tm for different time points compared to day 0 but without consistent relationship with storage time. ELISA did not detect differences in VEGF-A or Ang-2 binding between time points, and faricimab did not bind the neonatal Fc receptor. Conclusions Withdrawal and storage of faricimab in syringes for up to day 37 did not impair the structure and bi-specific binding properties of the therapeutic antibody.

• Husum, Yngvil Solheim; Bråten, Ragnhild Haugli; Sæther, Erik Magnus; Moe, Morten Carsten; Kristiansen, Ivar Sønbø & Jørstad, Øystein Kalsnes (2023). Intravitreal anti-vascular endothelial growth factor therapy for retinal diseases in Norway from 2011 to 2021: A combined registry and survey study. Acta Ophthalmologica. ISSN 1755-375X. s. 1–11. doi: 10.1111/aos.16598. Fulltekst i vitenarkiv
• Melo, Gustavo Barreto; Santos, Lucas Andrade; Agra, Lydianne Lumack do Monte; Meyer, Carsten; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2023). Accuracy and residual volume of intravitreal injection syringes in administration of very small volumes. Eye (London. 1987). ISSN 0950-222X. doi: 10.1038/s41433-023-02670-1. Fulltekst i vitenarkiv Vis sammendrag

  Intravitreal injections (IVIs) are widely used to deliver therapeutic agents for various retinal conditions. The syringe accuracy is a critical factor in achieving optimal treatment outcomes and minimizing potential risks in IVIs, such as unpredictable variation in drug volume (and thereby therapeutic effect) and intraocular pressure (IOP) rise [1,2,3,4,5]. Smaller volumes than the typical 0.05 mL, albeit harder to deliver with common 1-mL syringes, could mitigate the impact on IOP and drug wastage. In this study, we evaluated the accuracy and residual volume of three syringe models that can potentially administer very small volumes intravitreally.

• Blom, Kathrine; Jørstad, Øystein Kalsnes; Faber, Rowan Thomas; Stene-Johansen, Ingar; Holberg-Petersen, Mona & Hermansen, Nils Olav [Vis alle 7 forfattere av denne artikkelen] (2022). Primary vitrectomy or intravitreal antibiotics followed by early vitrectomy for acute endophthalmitis: A prospective observational study. Acta Ophthalmologica. ISSN 1755-375X. 101(1), s. 100–108. doi: 10.1111/aos.15207. Fulltekst i vitenarkiv Vis sammendrag

  Background/aims To compare outcomes of acute endophthalmitis (EO) managed with either primary vitrectomy (PV) or primary intravitreal antibiotics (vancomycin and ceftazidime) followed by early vitrectomy (PIAEV) combined with polymerase chain reaction (PCR)-based diagnostics. Methods This was a prospective, comparative observational study of acute EO cases admitted to a regional vitreoretinal service over 18 months. Depending on whether immediate vitrectomy (within 6 h) was achievable, the EO cases were treated with either (1) PV or (2) PIAEV. Microbiology samples were collected either (A) before or (B) after administration of intravitreal antibiotics. The samples were analysed with broad-range 16S PCR and culture. Results The study included 41 EO cases. There were 19 post-injection EO, 18 post-cataract EO, three post-vitrectomy EO, and one blebitis-related EO. Fifteen of 19 PV cases and 15 of 21 PIAEV had a clinically meaningful improvement in best-corrected visual acuity (BCVA) of at least 15 letters at 3 months (p = 0.58). One patient was lost to follow-up. Twenty-three cases were culture- and PCR-positive, and seven additional cases were culture-negative but PCR-positive (p = 0.02). PCR increased the diagnostic yield for samples collected both before and after administration of intravitreal antibiotics. Conclusion Primary vitrectomy or PIAEV allowed for vitrectomy for all cases of acute EO in a large region. Most eyes in both groups achieved a clinically meaningful improvement in BCVA. By combining culture with PCR in connection with the vitrectomy procedure, intravitreal antibiotics could be injected before microbiological sampling, thereby improving the door-to-treatment time without sacrificing microbial identification.

• Jacobsen, Henrik Holvin; Jørstad, Øystein Kalsnes; Moe, Morten Carsten; Petrovski, Goran; Pripp, Are Hugo & Sandell, Tiril [Vis alle 7 forfattere av denne artikkelen] (2022). Noninvasive Estimation of Pulsatile and Static Intracranial Pressure by Optical Coherence Tomography. Translational Vision Science & Technology. 11. doi: 10.1167/tvst.11.1.31. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To explore the ability of optical coherence tomography (OCT) to noninvasively estimate pulsatile and static intracranial pressure (ICP). Methods: An OCT examination was performed in patients who underwent continuous overnight monitoring of the pulsatile and static ICP for diagnostic purpose. We included two patient groups, patients with idiopathic intracranial hypertension (IIH; n = 20) and patients with no verified cerebrospinal fluid disturbances (reference; n = 12). Several OCT parameters were acquired using spectral-domain OCT (RS-3000 Advance; NIDEK, Singapore). The ICP measurements were obtained using a parenchymal sensor (Codman ICP MicroSensor; Johnson & Johnson, Raynham, MA, USA). The pulsatile ICP was determined as the mean ICP wave amplitude (MWA), and the static ICP was determined as the mean ICP. Results: The peripapillary Bruch's membrane angle (pBA) and the optic nerve head height (ONHH) differed between the IIH and reference groups and correlated with both MWA and mean ICP. Both OCT parameters predicted elevated MWA. Area under the curve and cutoffs were 0.82 (95% confidence interval [CI], 0.66–0.98) and -0.65° (sensitivity/specificity; 0.75/0.92) for pBA and 0.84 (95% CI, 0.70–0.99) and 405 µm (0.88/0.67) for ONHH. Adjusting for age and body mass index resulted in nonsignificant predictive values for mean ICP, whereas the predictive value for MWA remained significant. Conclusions: This study provides evidence that the OCT parameters pBA and ONHH noninvasively can predict elevated pulsatile ICP, represented by the MWA. Translational Relevance: OCT shows promise as a method for noninvasive estimation of ICP.

• Hertzberg, Silvia Nanjala Walekhwa; Jørstad, Øystein Kalsnes; Petrovski, Beata Eva; Bragadottir, Ragnheidur; Steffensen, Leif Arthur & Moe, Morten Carsten [Vis alle 8 forfattere av denne artikkelen] (2022). Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(19), s. 1–16. doi: 10.3390/ijerph191912603. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To describe the trends in hospital utilization and economic outcomes associated with the transition from laser to intravitreal injection (IVI) therapy for diabetic retinopathy (DR) at Oslo University Hospital (OUH), which provides the largest retina service in Norway. Methods: This descriptive study analyzed hospital administrative data and determined the average utilization and treatment proportions of laser therapy, IVIs and vitrectomy for each patient per year. The Chi-square test was used to compare resource use between treatment groups. From an extended healthcare perspective, the annual cost per patient was calculated using Norwegian tariff data from 2020 and the National Medication Price Registry for patients seen between 2010 and 2018. Bootstrapping was performed to generate 95% confidence intervals for the cost per patient per year. Results: Among the 1838 (41% female) patients treated for DR between 2005 and 2018, OUH provided on average 1.09 laser treatments per DR patient and 0.54 vitrectomies per DR patient in 2005, whose utilization declined to 0.54 and 0.05 treatments per DR patient, respectively, by 2018. Laser treatments declined from 64% to 10%, while vitrectomies declined from 32% to 1%. In contrast, IVI treatments increased from 4.5% to 89% of the total share, representing an average increase, from 0.08 injections per patient in 2005 to 4.73 injections per patient in 2018. Both the increasing number of DR patients and the shift in the type of treatment increased the economic costs of treating DR from a total of EUR 0.605 million (EUR 2935 per patient) in 2010 to EUR 2.240 million (EUR 3665 per patient) in 2018, with IVIs contributing considerably to these costs. Conclusions: Despite the decline in the use of vitrectomies, the transition from laser to IVI therapy for DR increased the healthcare resource utilization and economic costs of its treatment over the observed time. A main cost driver was the need for long-term IVIs, in addition to the drug cost itself. Trade-offs can be achieved through effective alternative IVI delivery or appropriate drug choice that balances patient needs with the economic burden of treating DR.

• Sverstad, Alexander; Torheim, Eirik A. & Jørstad, Øystein Kalsnes (2022). A multi-lumen glaucoma stent with titratable pressure-lowering effect: A proof of concept study. Translational Vision Science & Technology. 11:22(9), s. 1–6. doi: 10.1167/tvst.11.9.20. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To explore the feasibility of a glaucoma stent with a titratable pressure-lowering effect. Methods: This was an in vitro study. We created a resin stent with a micro-precision three-dimensional printer. It represented a cylinder with one primary and two secondary lumina. The inner opening of each secondary lumen was sealed with a membrane. We used a surgical eye model to simulate implantation of the stent and a laser procedure analogous to argon laser trabeculoplasty (ALT) to ablate each membrane. To study the fluid dynamics, we used a high-precision syringe pump and measured the steady-state pressure for one, two, and three lumina in parallel at flow rates of 2.5, 5.0, and 10.0 µL/min. Results: The stent could be implanted into the eye model and visualized in the anterior chamber angle. Coloring the membrane facilitated laser membranotomy, and a 0.1-second laser pulse with 250-mW power was enough to ablate one membrane. The steady-state pressure for one lumen increased linearly with increasing flow rate, in accordance with the Hagen–Poiseuille equation. Two and three lumina in parallel decreased the pressure by factors of 2.1 and 3.2, respectively, in accordance with the electronic–hydraulic analogy and Ohm’s law applied to parallel resistors. Conclusions: The study presents proof of concept for a glaucoma stent with multiple lumina, which can be separately opened with an ALT-like procedure to induce a predictable, stepwise increase in pressure-lowering effect. Translational Relevance: The glaucoma stent in this experimental study can be reproduced in a biocompatible material and further studied in vivo.

• gjølberg, torleif; Lode, Heidrun Elisabeth; Melo, Gustavo B.; mester, simone; Probst, Christine & Sivertsen, Magne S. [Vis alle 9 forfattere av denne artikkelen] (2022). A Silicone Oil-Free Syringe Tailored for Intravitreal Injection of Biologics. Frontiers in Ophthalmology. 2. doi: 10.3389/fopht.2022.882013. Fulltekst i vitenarkiv
• Sudmann, Thea Melsen; Jonsdottir, Thora Elisabet; Rowe, Fiona J & Jørstad, Øystein Kalsnes (2022). National application of the European visual field standards for driving: A survey study. BMJ Open Ophthalmology. 7(1), s. 1–6. doi: 10.1136/bmjophth-2021-000904. Fulltekst i vitenarkiv Vis sammendrag

  Aims To provide an overview of how the European visual field standards for driving (specified in Commission Directive 2009/113/EC) are applied and determine whether individuals with visual field defects are treated equally across Europe. Methods One ophthalmic expert from each of 32 European countries was invited to participate in an electronic survey. They were presented with threshold and Esterman perimetry results of 15 cases of visual field defects and asked to classify each case as either passed or failed in reference to their national standards. The results were compared with the European Driving Test Group 1 (EDT1), which is a new perimetry algorithm that adheres to the recommendations by the Eyesight Working Group. Fleiss’ kappa was used to determine the inter-rater agreement. Results Twenty-five countries responded. Three of 15 cases were passed by all. Full agreement on a failed case was not reached. Denmark graded most leniently and passed 12 cases. Bulgaria, Romania and Slovakia graded most strictly and passed five cases. The Fleiss’ kappa score was 0.52 (95% CI 0.49 to 0.55). Only Slovenia was in full agreement with the EDT1. Fifteen countries endorsed specific perimetric tests for assessing fitness to drive. Five of these also defined pass/fail criteria. Conclusion The directive fails to establish a uniform approach to the visual field requirements, as evident by moderate pass/fail agreement between the national experts. Because the visual standards for driving are enforced differently, identical visual field loss can result in either revocation or approval of a driving license.

• Jørstad, Øystein Kalsnes; Jonsdottir, Thora Elisabet & Meling, Eva Ødegaard (2022). Forskjellsbehandling av en- og toøyde i førerkortregelverket. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(4). doi: 10.4045/tidsskr.22.0031. Fulltekst i vitenarkiv
• Hertzberg, Silvia Nanjala Walekhwa; Moe, Morten Carstens; Jørstad, Øystein Kalsnes; Petrovski, Beata Eva; Burger, Emily Annika & Petrovski, Goran (2022). Healthcare expenditure of intravitreal anti-vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema. Acta Ophthalmologica. ISSN 1755-375X. 100(8), s. e1630–e1640. doi: 10.1111/aos.15151. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The aim of this study was to estimate the 1-year costs associated with treating diabetic macular oedema (DME) patients using current intravitreal anti-vascular endothelial growth factor (anti-VEGF) biologics compared with the dexamethasone implant. Methods We conducted a descriptive cost-evaluation analysis using data from Oslo University Hospital and literature to compare three different intravitreal drugs for DME: bevacizumab, aflibercept and dexamethasone. Stratification of patients into ‘Naive’ or ‘Switch’ group was based on treatment history. We estimated the costs from healthcare and ‘extended’ healthcare perspectives. Sensitivity analysis evaluated the impact of various parameters. Results The average injections per patient per year for the Naive group (bevacizumab), Switch group (aflibercept) and dexamethasone were 9.5, 9.1 and 3.0 respectively. From a healthcare perspective, the 1-year costs for the Naive group were 15% lower (bevacizumab, €3619), and for the Switch group, 23% higher (aflibercept, €5226) compared with dexamethasone (€4252). The ‘extended’ healthcare perspective showed the cost per patient per year for bevacizumab remained nominally lower in the Naive group, while dexamethasone remained lower for the Switch group (€5116 for dexamethasone, compared to €4987 for bevacizumab and €6537 for aflibercept). Conclusions From a primary healthcare perspective, the dexamethasone as a first-line DME treatment may increase economic costs in settings where bevacizumab is used off-label. Treating resistant DMEwith dexamethasone may reduce the costs and treatment burden compared with switching to aflibercept.

• Gjølberg, Torleif Tollefsrud; Frick, Rahel; Mester, Simone; Foss, Stian; Grevys, Algirdas & Høydahl, Lene Støkken [Vis alle 11 forfattere av denne artikkelen] (2022). Biophysical differences in IgG1 Fc-based therapeutics relate to their cellular handling, interaction with FcRn and plasma half-life. Communications Biology. 5(1), s. 1–17. doi: 10.1038/s42003-022-03787-x. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Antibody-based therapeutics (ABTs) are used to treat a range of diseases. Most ABTs are either full-length IgG1 antibodies or fusions between for instance antigen (Ag)-binding receptor domains and the IgG1 Fc fragment. Interestingly, their plasma half-life varies considerably, which may relate to how they engage the neonatal Fc receptor (FcRn). As such, there is a need for an in-depth understanding of how different features of ABTs affect FcRn-binding and transport behavior. Here, we report on how FcRn-engagement of the IgG1 Fc fragment compare to clinically relevant IgGs and receptor domain Fc fusions, binding to VEGF or TNF-α. The results reveal FcRn-dependent intracellular accumulation of the Fc, which is in line with shorter plasma half-life than that of full-length IgG1 in human FcRn-expressing mice. Receptor domain fusion to the Fc increases its half-life, but not to the extent of IgG1. This is mirrored by a reduced cellular recycling capacity of the Fc-fusions. In addition, binding of cognate Ag to ABTs show that complexes of similar size undergo cellular transport at different rates, which could be explained by the biophysical properties of each ABT. Thus, the study provides knowledge that should guide tailoring of ABTs regarding optimal cellular sorting and plasma half-life.

• Holmøy, Trygve & Jørstad, Øystein Kalsnes (2021). Den første norske doktorgraden om multippel sklerose. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(5), s. 1–9. doi: 10.4045/tidsskr.20.0993. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Wigers, Andreas R.; Marthinsen, Pål Bache; Evang, Johan Arild & Moe, Morten Carstens (2021). The Value of Macular Optical Coherence Tomography in Watchful Waiting of Suprasellar Masses: A 2-Year Observational Study. Journal of neuro-ophthalmology. ISSN 1070-8022. 41(4), s. e516–e522. doi: 10.1097/WNO.0000000000000993. Fulltekst i vitenarkiv
• Pihl-Jensen, Gorm; Meling, Eva Ødegaard; Skogen, Karoline; Jørstad, Øystein Kalsnes & Holmøy, Trygve (2021). En kvinne i 40-årene med ensidig tåkesyn og smerter ved øyebevegelse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(9), s. 1–7. doi: 10.4045/tidsskr.20.0932. Fulltekst i vitenarkiv
• Eidet, Jon Roger; Akopian, Maja; Olstad, Ole Kristoffer; Jørstad, Øystein Kalsnes; Moe, Morten Carsten & Petrovski, Goran [Vis alle 7 forfattere av denne artikkelen] (2021). The acute phase response protein SERPINA3 is increased in tear fluid from the unaffected eyes of patients with unilateral acute anterior uveitis. Journal of Ophthalmic Inflammation and Infection. 11(1), s. 1–10. doi: 10.1186/s12348-021-00249-z. Fulltekst i vitenarkiv Vis sammendrag

  Background To identify candidate tear fluid biomarkers in patients with unilateral acute anterior uveitis (AAU) that can aid in the differentiation between these patients and patients with bacterial keratitis or healthy controls. Methods Thirteen patients (40.1 ± 16.2 years of age) with unilateral AAU, seven patients with unilateral bacterial keratitis (40.2 ± 15.3 years of age), and 14 healthy subjects (41.1 ± 11.6 years of age) were included. The tear proteome of affected eyes was compared with that of the unaffected eye or healthy controls. Proteins were identified by liquid chromatography tandem mass spectrometry and enzyme-linked immunosorbent assay. Results Relative protein ratios were detected and calculated for 272 unique proteins. Compared with healthy controls and the unaffected eye, the top upregulated proteins in AAU eyes were submaxillary gland androgen regulated protein 3B (SMR3B) and SMR3A. Similarly, the top upregulated proteins in bacterial keratitis were S100 calcium-binding protein A9 and orosomucoid 2. The acute phase response protein Serpin Family A Member 3 (SERPINA3) was increased in the healthy eye of AAU patients (P = 0.019) compared with healthy controls. Laser flare measurements in affected eyes of AAU patients showed positive logarithmic correlation with SERPINA3 in tear samples of the unaffected eye (P = 0.022). The use of SERPINA3 as a tear biomarker yielded a sensitivity of 85% and a specificity of 71% in detecting patients with AAU in the study population. Conclusions The acute phase response protein SERPINA3 was increased in tear samples of unaffected eyes of patients with unilateral AAU compared with healthy controls. This study highlights SERPINA3 as a potential biomarker for AAU. Future research should explore the dynamic properties of SERPINA3 in the tear fluid of active and quiescent uveitis eyes.

• Husum, Yngvil Solheim; Skogen, Karoline; Brandal, Petter; Rønning, Pål Andre; Wigers, Andreas Reidar & Evang, Johan Arild [Vis alle 7 forfattere av denne artikkelen] (2021). Bilateral calcification of the optic nerve sheath: A diagnostic dilemma. American Journal of Ophthalmology Case Reports. 22, s. 1–4. doi: 10.1016/j.ajoc.2021.101106. Fulltekst i vitenarkiv
• Husum, Yngvil Solheim; Moe, Morten Carstens; Bragadottir, Ragnheidur & Jørstad, Øystein Kalsnes (2021). Switching to aflibercept versus continuing bevacizumab for treatment-resistant neovascular age-related macular degeneration: a one-year comparative observational study. Acta Ophthalmologica. ISSN 1755-375X. 99(8), s. 1–6. doi: 10.1111/aos.14825. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To compare outcomes of a treatment algorithm that allows for switching treatment-resistant neovascular age-related macular degeneration (nAMD) eyes to aflibercept with continuing bevacizumab. Methods Retrospective study of nAMD patients who initiated treatment in 2012 (aflibercept unavailable) and 2018 (aflibercept available). Eyes were included in the case of residual macular fluid after a minimum of 4 monthly bevacizumab injections. Only eyes in the 2018 group could then switch to aflibercept. Results The study included 40 eyes from 2012 and 88 eyes from 2018. Patient characteristics were similar across the groups at baseline and 4 months. In 2018, 59 eyes (67%) were switched to aflibercept after 4 months. Mean change in BCVA from 4 months to one year was +2.8 letters in 2018 versus −1.7 letters in 2012 (p = 0.043). Mean change in BCVA from baseline to one year was +9.4 letters in 2018 (p < 0.001) and +4.4 letters in 2012 (p = 0.073). Mean change in CRT from 4 months to one year was −36 µm in 2018 versus −23 µm in 2012 (p = 0.373). Mean change in CRT from baseline to one year was −100 µm in 2018 (p < 0.001) and −75 µm in 2012 (p < 0.001). Mean number of injections given in one year was 11.8 in 2018 versus 10.4 in 2012 (p < 0.001). After one year, a majority of eyes in both groups still received treatment at 4-week intervals. Conclusion The study suggests that the possibility of switching eyes with treatment-resistant nAMD to aflibercept leads to a modest visual benefit compared with continuing first-line bevacizumab therapy.

• Sivertsen, Magne S.; Lode, Heidrun Elisabeth; Gjølberg, Torleif Tollefsrud; Petrovski, Goran; Andersen, Jan Terje & Jørstad, Øystein Kalsnes [Vis alle 7 forfattere av denne artikkelen] (2021). Cluster of symptomatic silicone oil droplets following intravitreal injections: A 1-year observational study. BMJ Open Ophthalmology. 6:e000764(1), s. 1–5. doi: 10.1136/bmjophth-2021-000764. Fulltekst i vitenarkiv Vis sammendrag

  Objective To describe a cluster of symptomatic intravitreal silicone oil (SiO) droplets following intravitreal injections (IVIs) and assess the effect of switching to a SiO-free syringe. Methods and analysis Observational quality registry study of patients receiving IVI at a large Norwegian ophthalmology centre between April 2018 (start of cluster) and November 2019 (1 year after switching to SiO-free syringes). At onset, anti-vascular endothelial growth factor drugs were administered using SiO-containing insulin syringes. From November 2018, SiO-free syringes were implemented. Spontaneously reported symptomatic SiO cases were confirmed by slit-lamp examination. A follow-up interview was performed after 1 year, assessing visual complaints. The prevalence of non-symptomatic cases was assessed in a sample of 50 eyes from 50 consecutive IVI patients. Results Among 13 429 IVIs, 50 eyes of 46 patients (29 women) with symptomatic intravitreal SiO droplets were identified. Forty-one patients reported floaters at regular appointments, whereas five patients contacted the department regarding symptoms between scheduled appointments. After 1 year, 34 patients (79%) still experienced floaters, 21 (49%) reported reduced symptoms and 3 (7%) reported worsened symptoms. Eighteen patients (42%) reported being bothered, and eight (18.6%) reported that their lives were negatively affected by the floaters. Among 50 non-symptomatic eyes that had received IVI during the same period, intravitreal SiO was found in 34 (68%). No cases of symptomatic intravitreal SiO droplets were identified after switching to SiO-free syringes. Conclusion Symptomatic intravitreal SiO following IVI can cause significant and prolonged distress for affected patients. It can be avoided by using SiO-free syringes.

• Bøhler, Anders Djupesland; Strøm, Marianne Ekornes; Sandvig, Kjell Ulrik; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2021). Acute macular neuroretinopathy following COVID-19 vaccination. Eye (London. 1987). ISSN 0950-222X. doi: 10.1038/s41433-021-01610-1. Fulltekst i vitenarkiv
• Eidet, Jon Roger; Jørstad, Øystein Kalsnes; Fostad, Ida; Olstad, Ole Kristoffer; Sørland, Ragnhild Ø. & Moe, Morten Carsten [Vis alle 8 forfattere av denne artikkelen] (2020). Unilateral acute anterior uveitis is associated with ipsilateral changes in the tear fluid proteome that involves the LXR/RXR pathway. Journal of Ophthalmic Inflammation and Infection. 10. doi: 10.1186/s12348-020-00204-4. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To determine whether unilateral acute anterior uveitis (AAU) induces ipsilateral changes in the tear fluid proteome. Methods Five patients (25–77 years old) with unilateral AAU were included. Tear fluid samples were obtained using Schirmer’s test strips. The healthy eye served as control. Proteins were identified by liquid chromatography tandem mass spectrometry. Results Two hundred forty-two tear fluid sample proteins were identified, of which 75 were present in at least three patients. Nine proteins were at least 1.5-fold increased, whereas eight were at least 1.5-fold decreased in tears from the diseased eye compared with the healthy eye. APOBEC3A was significantly increased (1.43-fold; P = 0.04), whereas TGM2 was significantly decreased (− 1.21-fold; P = 0.03) in tears from the diseased eye relative to the healthy eye. Ingenuity Pathway Analysis identified LXR/RXR (P < 1.02E−4) as a top canonical pathway. Conclusion Unilateral AAU induced detectable changes in the ipsilateral tear fluid proteome and involvement of the inflammation-associated LXR/RXR pathway.

• Jørstad, Øystein Kalsnes & Eriksen, Kathrine Olaussen (2020). Multiple vitelliform lesions as a retinal manifestation of Alport syndrome. Case Reports in Ophthalmology. 11(1), s. 79–84. doi: 10.1159/000505948. Fulltekst i vitenarkiv Vis sammendrag

  Alport syndrome is associated with various ocular phenotypic features, including several retinal manifestations. The purpose of this case report was to describe a case of multiple vitelliform lesions in Alport syndrome. This particular finding has, to our knowledge, not been reported previously. A 63-year-old man with known Alport syndrome presented with symptomatic, bilateral anterior lenticonus. Fundoscopic examination revealed multiple vitelliform lesions, which were symmetrically distributed at the posterior poles. Additional retinal findings included an irregular foveal contour and central macular thinning in both eyes, as well as a multilayered retinoschisis in the left eye. The underlying pathophysiology of the vitelliform lesions may be a dysfunctional Bruch’s membrane.

• Jacobsen, Henrik Holvin; Sandell, Tiril; Jørstad, Øystein Kalsnes; Moe, Morten Carsten; Ringstad, Geir & Eide, Per Kristian (2020). In vivo evidence for impaired glymphatic function in the visual pathway of patients with normal pressure hydrocephalus. Investigative Ophthalmology and Visual Science. ISSN 0146-0404. 61:24(13), s. 1–11. doi: 10.1167/IOVS.61.13.24. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Impaired ability to remove toxic metabolites from central nervous system may be an important link between cerebral and ophthalmic degenerative diseases. The aim of the present study was to compare the glymphatic function in the visual pathway in patients with idiopathic normal pressure hydrocephalus (iNPH), a neurodegenerative dementia subtype, with a reference group. Methods: We compared 31 subjects with Definite iNPH (i.e., shunt-responsive) with 13 references in a prospective and observational study. After intrathecal injection of the magnetic contrast agent gadobutrol (Gadovist, 0.5 mL, 1.0 mmol/mL, Bayer Pharma AG), serving as a tracer, consecutive magnetic resonance imaging (MRI) scans were obtained (next 24–48 hours). The normalized MRI T1 signal recorded in the cerebrospinal fluid (CSF) and along the visual pathway served as a semi-quantitative measure of tracer enrichment. Gadobutrol does not penetrate the blood-brain barrier and is thus confined to the extravascular space. Overnight measurements of pulsatile intracranial pressure were used as a surrogate marker for the intracranial compliance. Results: The tracer enriched the prechiasmatic cistern similarly in both groups, but clearance was delayed in the iNPH group. Moreover, both delayed enrichment and clearance of the tracer were observed in the visual pathway in the iNPH subjects. The enrichment in the visual pathway and the CSF correlated. Individuals with elevated pulsatile intracranial pressure showed reduced enrichment within the visual pathway. Conclusions: There was delayed enrichment and clearance of a tracer in the visual pathway of iNPH patients, which suggests impaired glymphatic function in the visual pathway in this disease.

• Blom, Kathrine; Bragadottir, Ragnheidur; Sivertsen, Magne S.; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2020). Does pharmaceutical compounding of vascular endothelial growth factor inhibitors for intravitreal use alter the risk of post-injection endophthalmitis? Ocular immunology and inflammation. ISSN 0927-3948. s. 1–5. doi: 10.1080/09273948.2020.1820530. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To investigate the safety of pharmaceutically compounded syringes for intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) drugs. Methods Single center, retrospective chart review. From 2015 to 2019, Oslo University Hospital, Norway gradually implemented pharmaceutical compounding and splitting of bevacizumab, ranibizumab, and aflibercept vials into multiple prefilled syringes for intravitreal use. Medical records of all post-injection endophthalmitis (PIE) cases in this 5-year period were reviewed. The incidences of PIE associated with compounded and clinician-withdrawn syringes were compared. Results In 5 years, the total number of anti-VEGF injections was 112,926; 68,150 procedures (60%) utilized compounded syringes, and 44,776 procedures (40%) utilized clinician-withdrawn syringes. A total of 11 PIE cases were identified (incidence 0.10 per 1000; 95% CI 0.05–0.17). Five PIE cases were associated with compounded syringes (incidence 0.07 per 1000; 95% CI 0.03–0.17); 3 of these were culture positive. Six PIE cases were associated with clinician-withdrawn syringes (incidence 0.13 per 1000; 95% CI 0.06–0.29); 2 of these were culture positive. The relative risk of PIE following procedures utilizing compounded versus clinician-withdrawn syringes was 0.55 (95% CI 0.17–1.79; p = 0.32). Conclusion Use of compounded anti-VEGF drugs in a large clinical setting was not associated with an altered risk of PIE. The finding adds to the evidence that splitting of vials into prefilled syringes for intravitreal injections is safe, provided that an appropriate pharmaceutical compounding procedure is strictly followed.

• Jørstad, Øystein Kalsnes; Jonsdottir, Thora Elisabet; Zysset, Stefan & Rowe, Fiona (2020). A traffic perimetry test that adheres to the European visual field requirements. Acta Ophthalmologica. ISSN 1755-375X. s. 1–7. doi: 10.1111/aos.14633. Fulltekst i vitenarkiv
• Blom, Kathrine; Jørstad, Øystein Kalsnes & Bragadottir, Ragnheidur (2019). Endophthalmitis in Oslo, Norway. Acta Ophthalmologica. ISSN 1755-375X. s. 1–5. doi: 10.1111/aos.14028. Fulltekst i vitenarkiv
• Bro, Tomas; Derebecka, Magdalena; Jørstad, Øystein Kalsnes & Grzybowski, Andrzej (2019). Off-label use of bevacizumab for wet age-related macular degeneration in Europe. Graefe's Archives for Clinical and Experimental Ophthalmology. ISSN 0721-832X. 258, s. 503–511. doi: 10.1007/s00417-019-04569-8. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe. Methods The study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire. Results Answers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0–80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered. Conclusions There was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.

• Jelin, Elma; Wisløff, Torbjørn; Jørstad, Øystein Kalsnes; Heiberg, Turid & Moe, Morten Carsten (2019). Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study. BMJ Open Ophthalmology. 4(1), s. 1–8. doi: 10.1136/bmjophth-2019-000353. Fulltekst i vitenarkiv Vis sammendrag

  <i>Objective</i> - To prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment.<p> <p><i>Methods and analysis</i> - Corresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses.<p> <p><i>Results</i> - The study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below ‘acceptable’ (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5.<p> <p><i>Conclusion</i> - After 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.

• Kristiansen, Ivar Sønbø; Bråten, Ragnhild Haugli; Jørstad, Øystein Kalsnes; Moe, Morten Carsten & Sæther, Erik Magnus (2019). Intravitreal therapy for retinal diseases in Norway 2011-2015. Acta Ophthalmologica. ISSN 1755-375X. s. 1–7. doi: 10.1111/aos.14262. Fulltekst i vitenarkiv Vis sammendrag

  Purpose During the past decade, intravitreally administered biologic drugs have advanced the treatment of retinal diseases, such as wet age‐related macular degeneration (AMD), diabetic macular oedema and retinal venous occlusions. The drugs as well as the necessary disease management imply considerable economic burden on healthcare systems. This Norwegian study documents the rates of use of intravitreal therapies and intercounty variation over a 5‐year period. Methods We collected data from the Norwegian Patient Register for all episodes of care encompassing intravitreal therapy during the period 2011–2015. For each episode, we received information on patient age, sex, county of residence, diagnosis and name of drug injected. Results During the study period, 21 277 patients had in total 236 857 episodes of care. The number of intravitreal injections doubled from 2011 to 2015, reaching 63 601 injections in 2015, of which 77% were for diagnosed wet AMD. In 2015, the age‐adjusted number of episodes varied from 19 to 55 per 1000 population aged 50+ across Norway's 19 counties. The age‐adjusted number of patients treated per 1000 population aged 50+ varied from 5.22 to 8.35. Conclusion The use of intravitreal injections increased rapidly with wet AMD as the most frequent diagnosis and with varying utilization across Norway's 19 counties. The causes of the varying use of intravitreal therapies could not be established but may reflect variation in disease prevalence, treatment capacity, travel distance to the nearest ophthalmic service and lack of national treatment guidelines. The geographic variation in utilization may challenge policy goals of equitable care and warrants further studies.

• Eidet, Jon Roger; Biernat, Donata; Dahlberg, Daniel; Wiedmann, Markus & Jørstad, Øystein Kalsnes (2019). Foster Kennedys syndrom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(10), s. 1–4. doi: 10.4045/tidsskr.18.0719. Fulltekst i vitenarkiv
• Lode, Heidrun Elisabeth; Gjølberg, Torleif Tollefsrud; Foss, Stian; Sivertsen, Magne S.; Brustugun, Jørgen & Andersson, Yvonne [Vis alle 9 forfattere av denne artikkelen] (2019). A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes. Scientific Reports. 9:18021(1), s. 1–10. doi: 10.1038/s41598-019-54226-7. Fulltekst i vitenarkiv Vis sammendrag

  Intravitreal injections of antibody-based biologics targeting vascular endothelial growth factor (VEGF) are highly effective and have markedly decreased the risk of visual impairment associated with prevalent retinal diseases, such as neovascular age-related macular degeneration and diabetes macular oedema. The diseases are chronic in their nature, and most patients need long-term therapy to suppress disease activity. We previously reported a compounding method for repackaging and storage of aflibercept (Eylea), a commonly used anti-VEGF biologic, in silicone oil-coated plastic syringes without compromising drug stability or activity. In addition to improving safety and time spent per patient, compounding of anti-VEGF biologics enables single-dose vials to be split into multiple syringes, thereby considerably reducing waste and drug expenses. However, symptomatic silicone oil droplets may deposit in the eye's vitreous body after repetitive injections. To fully avoid this complication, we here report on a novel pharmaceutical compounding method using silicone oil-free syringes and a 33 G × 9 mm Low Dead Space Needle hub injection needle. We evaluate the method for three anti-VEGF biologics commonly used in ophthalmology: aflibercept, ranibizumab (Lucentis) and bevacizumab (Avastin). Our results show that compounding and storage for one week does not compromise the functional activity of the biologics and allows for safe and cost-effective compounding of anti-VEGF biologics for intravitreal injections in prefilled silicone oil-free syringes.

• Jacobsen, Henrik Holvin; Ringstad, Geir; Jørstad, Øystein Kalsnes; Moe, Morten Carsten; Sandell, Tiril & Eide, Per Kristian (2019). The Human Visual Pathway Communicates Directly With the Subarachnoid Space. Investigative Ophthalmology and Visual Science. ISSN 0146-0404. 60(7), s. 2773–2780. doi: 10.1167/iovs.19-26997. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Explore in vivo whether there is direct communication between the cerebrospinal fluid (CSF) and extravascular compartment of human visual pathway structures. Methods: A prospective and observational study included 10 subjects who underwent intrathecal gadolinium–enhanced magnetic resonance imaging (MRI) for suspected CSF circulation disorder, but with a negative result and with no known ophthalmic diseases. After precontrast T1-weighted MRI, 0.5 mL of gadobutrol (Gadovist, 1.0 mmol/mL) was injected intrathecally. Gadobutrol distributes in the extravascular space, and served as a CSF tracer. Consecutive MRI scans were obtained throughout 24 to 48 hours. To assess gadobutrol contrast enrichment, regions of interest (ROIs) were placed at multiple locations along the visual pathway, from the primary visual cortex to the eye's vitreous body. CSF tracer dependent T1 signal was measured in each ROI. A linear mixed-model was used for statistical analyses. Results: CSF tracer enrichment was found within the optic nerve, optic chiasm, optic tract, and primary visual cortex (P < 0.001). Peak tracer enrichment in the visual pathway generally occurred after 24 hours and was preceded by peak enhancement in the prechiasmatic cistern after 4 to 6 hours. Conclusions: The results indicate direct communication between CSF of subarachnoid space and the extravascular space of the human visual pathway. Extravascular entry of the CSF tracer is a prerequisite for a glymphatic system, the present findings may suggest its presence. The existence of a glymphatic system in the human visual pathway could bring novel perspectives on the pathophysiology and treatment of ophthalmic diseases.

• Jørstad, Øystein Kalsnes; Steffensen, Leif Arthur; Eriksen, Ketil; Bragadottir, Ragnheidur & Moe, Morten Carsten (2019). Thirteen years of intravitreal anti-vascular endothelial growth factor therapy: the promises and burdens of a paradigm shift told from the perspective of the largest retina service in Norway. Acta Ophthalmologica. ISSN 1755-375X. s. 1–6. doi: 10.1111/aos.14177. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To describe the first 13 years of anti‐vascular endothelial growth factor (anti‐VEGF) therapy from the perspective of a public ophthalmic department serving a local community of almost one million people. Methods Retrospective registry study. Data from Oslo University Hospital, Norway were collected from 2006 through 2018. Hospital episode statistics were searched for episodes of care encompassing intravitreal anti‐VEGF procedures. Patient‐specific ID numbers, diagnoses, and drug codes were registered. In general, bevacizumab was used as first‐line treatment, with aflibercept reserved for resistant cases from 2013. Results The number of unique patients treated per year increased from 130 in 2006 to 3428 in 2018. In 2018, 2488 (73%) patients had also received treatment the previous year. The number of yearly injections increased from 228 in 2006 to 25 570 in 2018. In 2018 the diagnosis macular degeneration constituted 69% of injections, diabetic retinopathy constituted 15%, retinal vein occlusion constituted 13%, and other diagnoses constituted 3%. In the same year 49% of injections were with bevacizumab, 46% with aflibercept, 4% with ranibizumab, and 1% with dexamethasone implants. The bevacizumab to aflibercept ratio was almost 1:1 for macular degeneration and diabetic retinopathy; for retinal vein occlusion the ratio was 13:7. Conclusion In 13 years there was an approximately 100‐fold increase in the number of yearly intravitreal injections. A majority of patients received long‐term treatment. Macular degeneration was the most common diagnosis. Using bevacizumab as first‐line treatment, with aflibercept reserved for resistant cases from 2013, eventually resulted in a nearly 1:1 ratio in drug usage.

• Sivertsen, Magne S.; Strøm, Erik Heyerdahl; Endre, Kim Magnus Advocaat & Jørstad, Øystein Kalsnes (2018). Anterior Ischemic Optic Neuropathy Due to Calciphylaxis. Journal of neuro-ophthalmology. ISSN 1070-8022. 38(1), s. 54–56. doi: 10.1097/WNO.0000000000000581. Fulltekst i vitenarkiv
• Sivertsen, Magne S.; Jørstad, Øystein Kalsnes; Grevys, Algirdas; Foss, Stian; Moe, Morten Carsten & Andersen, Jan Terje (2018). Pharmaceutical compounding of aflibercept in prefilled syringes does not affect structural integrity, stability or VEGF and Fc binding properties. Scientific Reports. 8(1). doi: 10.1038/s41598-018-20525-8. Fulltekst i vitenarkiv Vis sammendrag

  Macular edema due to neovascular age-related macular degeneration, diabetes or retinal vein occlusion can cause central vision loss. Intravitreal treatment with antibody-based biopharmaceutical compounds designed to neutralize vascular endothelial growth factor (VEGF) has proven to be an efficient strategy to ameliorate macular edema and restore visual acuity. At the same time, the use of anti-VEGF drugs places an economic burden on the health care system; the drugs are expensive, and repeated injections are usually required to maintain the therapeutic effect. Thus, there is an unmet need for more cost-effective procedures. We here describe how the most recently approved anti-VEGF drug, aflibercept, can be compounded into prefilled sterile syringes and stored for up to 4 weeks without compromising its quality, stability or functional properties, including VEGF and neonatal Fc receptor (FcRn) binding. The novel compounding method for repackaging of aflibercept in sterile plastic syringes can greatly reduce both cost and time spent per patient in the injection room.

• Jørstad, Øystein Kalsnes; Faber, Rowan Thomas & Moe, Morten Carsten (2017). Two-year functional and anatomical results after converting treatment resistant eyes with exudative age-related macular degeneration to aflibercept in accordance with a treat and extend protocol. Acta Ophthalmologica. ISSN 1755-375X. 95(5), s. 460–463. doi: 10.1111/aos.13480. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To study the effects of converting to aflibercept in accordance with a treat and extend (T&E) strategy in eyes with treatment resistant exudative agerelated macular degeneration (AMD). Methods: Two-year prospective study of eyes with exudative AMD and persistent macular fluid despite monthly treatment with ranibizumab or bevacizumab. Eyes were converted to 2.0 mg aflibercept in accordance with a T&E protocol. Results: Fifty eyes from 47 patients were included. At baseline, the mean central retinal thickness (CRT) was 273 lm and mean best-corrected visual acuity (BCVA) 0.25 logarithm of the minimal angle of resolution (logMAR). The mean number of aflibercept injections the first year was 9.2. After 1 year, there was a reduction in mean CRT to 228 lm (p < 0.001); 22 eyes (44%) had a dry macula; and the mean BCVA was 0.24 logMAR (p = 0.531). The mean number of aflibercept injections the second year was 8.0 (p = 0.013 compared to first year). After 2 years, 24 eyes (48%) received treatment more frequently than every eighth week. The mean CRT was 225 lm (p < 0.001 compared to baseline); 31 eyes (62%) had a dry macula; and mean BCVA was 0.32 logMAR (p = 0.005 compared to baseline). Five eyes did not complete 2 years of aflibercept treatment after failing to improve. Conclusion: A majority of eyes showed improved anatomic outcomes. There was a small decrease in mean BCVA after the second year of treatment. About half of the eyes required treatment. This research has been published in Acta Ophtalmologica. © 2017 Wiley

• Sand, Mari Kathrine; Stubhaug, Tore Taksdal & Jørstad, Øystein Kalsnes (2017). Atypisk optikusnevritt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(10), s. 731–731. doi: 10.4045/tidsskr.16.1063. Fulltekst i vitenarkiv
• Tazmini, Kiarash; Meling, Torstein Ragnar; Skattør, Thor Håkon; Jørstad, Øystein Kalsnes & Jørgensen, Anders Palmstrøm (2017). A woman in her 50s with chronic fatigue syndrome, sepsis and hyponatraemia. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(5), s. 372–377. doi: 10.4045/tidsskr.16.0896. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Grory, Brian Mac; Preterre, Cécile; Lebranchu, Pierre; Ryan, Stephen James; Jørstad, Øystein Kalsnes & Moe, Morten Carstens [Vis alle 16 forfattere av denne artikkelen] (2026). Intravenous thrombolysis for acute central retinal artery occlusion: Protocol for a systematic review and individual participant data meta-analysis of randomized controlled trials. doi: 10.1371/journal.pone.0342739. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Meling, Eva Ødegaard & Moe, Morten Carstens (2025). Transition to high-dose aflibercept and intraocular pressure risk: A two-step approach to injection volume at Oslo University Hospital. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.17571. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes & Lee, Andrew G. (2025). Pupil Wizard: an app to enhance knowledge of pupillary abnormalities. Eye (London. 1987). ISSN 0950-222X. doi: 10.1038/s41433-025-03763-9. Fulltekst i vitenarkiv
• Ryan, Stephen James; Jørstad, Øystein Kalsnes; Skjelland, Mona; Simonsen, Claus Z; Bek, Toke & Blauenfeldt, Rolf Ankerlund [Vis alle 65 forfattere av denne artikkelen] (2025). Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS): Protocol for a randomized-controlled trial. doi: 10.1177/23969873251344199. Fulltekst i vitenarkiv Vis sammendrag

  Rationale: Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt reperfusion, is associated with a high risk of permanent blindness. There is currently no evidence-based, effective treatment for CRAO. Methods and design: TenCRAOS is an investigator-initiated, international, multicenter, randomized controlled, double-dummy, double-blind, phase III trial testing tenecteplase (TNK) 0.25 mg/kg + placebo versus acetylsalicylic acid (ASA) 300 mg + placebo. The target population is patients diagnosed with CRAO and a best-corrected visual acuity (BCVA) of ⩾1.0 logarithm of the minimum angle of resolution (logMAR), corresponding to a decimal BCVA of ⩽0.1 or a fraction BCVA of ⩽6/60, who can be treated within 4.5 h. Sample size: Assuming a difference in proportion of participants reaching the primary endpoint of 20% in the placebo/ASA treatment group versus 50% in the TNK/placebo group, we need 78 participants to reach 80% power to detect the difference on a 5% significance level. Outcomes: The primary outcome is the proportion of participants with BCVA of ⩽0.7 logMAR in the affected eye at 30-day follow-up, corresponding to a decimal BCVA of ⩾0.2 or fraction BCVA of ⩾6/30, representing a clinically relevant improvement of BCVA of ⩾0.3 logMAR (or 15 letters). Secondary efficacy outcomes include proportion of participants with BCVA of ⩽0.5 logMAR, corresponding to a decimal BCVA of ⩾0.32 or fraction BCVA of ⩾ 6/19, self-reported vision-targeted health status, quality of life, and modified Rankin Score at 30 and 90 days. Safety outcomes include symptomatic intracranial hemorrhage, major bleeding, and mortality. Exploratory analyses include assessment with optical coherence tomography with angiography and transorbital ultrasound. Discussion: TenCRAOS intends to assess the efficacy and safety of systemic TNK within 4.5 h of CRAO onset.

• Jørstad, Øystein Kalsnes; Hansen, Stine; Strand, Harald; Røsby, Oddveig; Brokstad, Ruth Therese & Rønning, Pål Andre (2024). Leber Hereditary Optic Neuropathy Case Report: Clinical Presentation and Treatment with Idebenone Reinforce the Evidence for m.3866T>C as a Causative Variant. Case Reports in Ophthalmology. 15(1), s. 506–510. doi: 10.1159/000539445. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Leber hereditary optic neuropathy (LHON) is a mitochondrial disorder that typically presents with painless, central visual loss, hyperaemia of the optic nerve head, and peripapillary telangiectasias. Most LHON cases are due to one of three variants, but several less common variants also exist. We describe a clinical case of LHON associated with the variant m.3866T>C, which is possibly linked to LHON. Case Presentation: A 59-year-old Caucasian woman experienced acute, bilateral, and painless visual loss. She reported cigarette smoking, and elevated phosphatidylethanol suggested harmful alcohol consumption. Her best-corrected visual acuity (BCVA) was 20/100 for the right eye and 20/50 for the left eye. She could only read the Ishihara demonstration plate, and threshold perimetry demonstrated reduced central sensitivity bilaterally. Her optic nerve heads were hyperaemic, with peripapillary telangiectasias. The visual symptoms and clinical findings suggested LHON. Magnetic resonance imaging demonstrated a tuberculum sella meningioma and two cerebral aneurysms, which we regarded as incidental findings. Genetic testing did not identify common LHON variants but a rare homoplasmic variant, m.3866T>C, which studies suggest might cause LHON or act in synergy with other variants to increase the disease penetrance. After initiating test-of-treatment with idebenone 900 mg per day, the patient’s BCVA improved to 20/32 for both eyes and then stabilized. Conclusion: This case strengthens the evidence for m.3866T>C as a causative LHON variant. The case also raises the question as to whether this particular variant can respond favourably to treatment with idebenone.

• Nilsen, Henning Yu; Jørstad, Anna-Katharina; Ryan, Stephen James; Moe, Morten Carsten; Grimstad, Kristoffer & Aamodt, Anne Hege [Vis alle 8 forfattere av denne artikkelen] (2023). En kvinne i 60-årene som ikke lenger gjenkjente det hun så. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(16), s. 1419–1423. doi: 10.4045/tidsskr.23.0198. Fulltekst i vitenarkiv
• Husum, Yngvil Solheim; Skogen, Karoline; Brandal, Petter; Rønning, Pål Andre; Wigers, Andreas Reidar & Evang, Johan Arild [Vis alle 7 forfattere av denne artikkelen] (2022). Idiopathic Duro-Optic Calcification. Journal of neuro-ophthalmology. ISSN 1070-8022. 44(1). doi: 10.1097/WNO.0000000000001722. Fulltekst i vitenarkiv
• Eriksen, Kathrine Olaussen; Wigers, Andreas R.; Wedding, Iselin Marie; ERICHSEN, ANNE KJERSTI; Barøy, Tuva & Søberg, Kristoffer [Vis alle 7 forfattere av denne artikkelen] (2022). A novel homozygous variant in the SPG7 gene presenting with childhood optic nerve atrophy. American Journal of Ophthalmology Case Reports. 26. doi: 10.1016/j.ajoc.2022.101400. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To describe a case of hereditary spastic ataxia (HSP) presenting with childhood optic nerve atrophy and report a novel homozygous variant in the SPG7 gene. Observations A 57-year-old man suffering from progressive optic nerve atrophy since childhood eventually underwent genetic testing. A targeted whole exome gene sequencing panel for optic neuropathy identified a novel homozygous variant in the SPG7 gene, c.2T > G, p.(Met?), which likely abolished production of paraplegin, an inner mitochondrial membrane protein. Subsequent neurologic examination revealed subtle signs of spastic paraplegia and ataxia in keeping with the genetic diagnosis of SPG7. Conclusion and importance Spastic paraplegia 7 (SPG7) is an autosomal recessive form of the neurodegenerative disorder HSP. Pure HSP is characterized by spastic paraparesis in the lower limbs, whereas complicated HSP presents additional neurological manifestations. This case report adds to the evidence that SPG7 can present with childhood optic nerve atrophy, preceding the characteristic SPG7 manifestations. SPG7 should be considered in the workup of suspected hereditary optic neuropathy.

• Faraj, Sayed; Bathen, Marianne Etzelmüller; Galeckas, Augustinas; Myrold, Andreas; Stene-Johansen, Ingar & Jørstad, Øystein Kalsnes [Vis alle 7 forfattere av denne artikkelen] (2022). Retinal injuries in seven teenage boys from the same handheld laser. American Journal of Ophthalmology Case Reports. 27. doi: 10.1016/j.ajoc.2022.101596. Fulltekst i vitenarkiv Vis sammendrag

  This paper presents retinal injuries in 10 eyes of seven teenagers who had been playing with a handheld laser. They reported different degrees of visual symptoms in the form of central scotomas. Clinical examination revealed light burns in the maculae and disruption of the retinal layers on OCT. One patient developed secondary choroidal neovascularization (CNV), which was successfully treated with intravitreal ranibizumab. For some of the patients, the injuries led to permanent visual sequela. This devastating case series emphasizes the need for awareness among minors, parents and communities about the danger of playing with handheld lasers.

• Blom, Kathrine; Bragadottir, Ragnheidur; Sivertsen, Magne S.; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2022). Re: Writing committee for the Post-Injection Endophthalmitis Study Group, et al.: The influence of universal face mask use on endophthalmitis risk after intravitreal anti-vascular endothelial growth factor injections (Ophthalmology. 2021;128:1620–1626). Ophthalmology (Rochester, Minn.). ISSN 0161-6420. 129(5), s. 1620–1626. doi: 10.1016/j.ophtha.2022.01.017. Fulltekst i vitenarkiv
• Ryan, Stephen J; Falkenberg, Helle Kristine; Moe, Morten Carsten; Jørstad, Anna-Katharina; Jørstad, Øystein Kalsnes & Aamodt, Anne Hege (2022). StrokeVis – The Oslo study of visual impairment after Stroke. Fulltekst i vitenarkiv
• Sudmann, Thea Melsen; Brækhus, Anne & Jørstad, Øystein Kalsnes (2022). Helsekravene til førerkort – på riktig vei med ny teknologi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(16). doi: 10.4045/tidsskr.22.0607. Fulltekst i vitenarkiv
• Blom, Kathrine; Bragadóttir, Ragnheiður; Sivertsen, Magne S.; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2021). Mask use by patients in the context of COVID-19 can increase the risk of postinjection endophthalmitis. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.14945. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Jonsdottir, Thora Elisabet; Zysset, Stefan & Rowe, Fiona J. (2021). A traffic perimetry test that adheres to the European visual field requirements for group 2 drivers. Acta Ophthalmologica. ISSN 1755-375X. s. 1–2. doi: 10.1111/aos.14742. Fulltekst i vitenarkiv
• Blom, Kathrine; Bragadottir, Ragnheidur; Sivertsen, Magne S.; Moe, Morten Carsten & Jørstad, Øystein Kalsnes (2021). Mask use by patients in the context of COVID-19 can increase the risk of postinjection endophthalmitis. Acta Ophthalmologica. ISSN 1755-375X. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Kongsrud, Anne; KINGE, BETTINA; Fossen, Kristian; Basit, Samy & Forsaa, Vegard Asgeir [Vis alle 8 forfattere av denne artikkelen] (2021). Choosing Wisely: recommendations from the Norwegian Ophthalmological Society. Acta Ophthalmologica. ISSN 1755-375X. 99. doi: 10.1111/aos.15080. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Sivertsen, Magne S.; Andersen, Jan Terje & Moe, Morten Carsten (2020). Kan ampullene med covid-19-vaksine utnyttes bedre? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 20.1039. doi: 10.4045/tidsskr.20.1039. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Moe, Morten Carsten; Eriksen, Ketil; Petrovski, Goran & Bragadottir, Ragnheidur (2020). Coronavirus disease 2019 (COVID-19) outbreak at the Department of Ophthalmology, Oslo University Hospital, Norway. Acta Ophthalmologica. ISSN 1755-375X. 98(3), s. e388–e389. doi: 10.1111/aos.14426. Fulltekst i vitenarkiv
• Wankel, Vibeke Dons; Bondø, Grete & Jørstad, Øystein Kalsnes (2019). Wankel og medarbeidere svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(1), s. 10–11. doi: 10.4045/tidsskr.18.0951. Fulltekst i vitenarkiv
• Innerdal, Cato; Ekstrand, Julian Raffael; Wankel, Vibeke Dons & Jørstad, Øystein Kalsnes (2019). Visual field requirements for driving in Europe: the risk of inaccurate interpretation of visual field findings when using the binocular Esterman programme. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.14071. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Wigers, Andreas Reidar; Marthinsen, Pål Bache; Evang, Johan Arild & Moe, Morten Carsten (2019). Could optical coherence tomography add to the history of the pituitary incidentaloma? Acta Ophthalmologica. ISSN 1755-375X. 97(8), s. e1157–e1158. doi: 10.1111/aos.14151. Fulltekst i vitenarkiv
• Meling, Eva Ødegaard; Jørstad, Øystein Kalsnes & Kerty, Emilia (2018). En tenåring med akutt bilateralt synstap. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(12). doi: 10.4045/tidsskr.17.0802. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes; Meling, Eva Ødegaard; Heimdal, Ketil Riddervold & Kerty, Emilia (2018). Leber Hereditary Optic Neuropathy Caused by a Mitochondrial DNA 10663T>C Point Mutation and Its Response to Idebenone Treatment. Journal of neuro-ophthalmology. ISSN 1070-8022. 38(1), s. 129–131. doi: 10.1097/WNO.0000000000000598. Fulltekst i vitenarkiv
• Jørstad, Øystein Kalsnes (2018). Synskravene til førerkort :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(16), s. 1511–1512. doi: 10.4045/tidsskr.18.0559. Fulltekst i vitenarkiv
• Sudmann, Thea Melsen; Jørstad, Øystein Kalsnes; Klungsøyr, Ole & Brækhus, Anne (2026). A Study of the European Visual Field Standards for Driving: Cross-Country Practices, Spectacle Frame Effects, and Correlation with Driving Ability. Universitetet i Oslo. ISSN 9788234808326. Fulltekst i vitenarkiv Vis sammendrag

  Visual field measurements with perimetry may cause unnecessary withdrawal of driving privileges Across Europe, drivers who may not meet the visual requirements for driving should undergo assessment by an ophthalmic specialist. Accurate assessment of the visual field requires standardized perimetry. However, the European Commission Directive 2009/113/EC does not specify which perimetry algorithm should be used or how results should be interpreted in terms of pass–fail criteria for driving eligibility. This lack of guidance risks inconsistent standards and unequal assessment practices between countries. In Norway, legislation advises on the use of the Esterman test. This perimetry test has been criticised for not having a sufficient correlation to actual driving skills. This thesis A Study of the European Visual Field Standards for Driving: Cross-Country Practices, Spectacle Frame Effects, and Correlation with Driving Ability aimed to investigate how the European Commission directive 2009/113/EC is enforced in member states, to investigate how a new perimetry program called European Driving Test (EDT) would be affected if participants performed the test wearing different spectacle designs and finally, how well visual field loss measured with the EDT corresponded to actual driving skills, to establish evidence based passed-failed-criteria. Findings from the studies show that the same visual field loss may cause loss of driving privileges in one country but not another, that certain spectacle frames cause visual field obstructions that alone might conflict with driving privileges, and that even with the new EDT test, perimetry is unfit for predicting driving eligibility and should not be used alone in determinations on fitness to drive in individuals with visual field loss. Instead, the thesis advocates for individual assessments, including practical driving assessments.

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