Latest news with #ActaOphthalmologica
Medscape
11-06-2025
- Health
- Medscape
Minor Increase in Stroke Risk After Anti-VEGF Eye Injections
Intravitreal injections of anti-VEGF were associated with a small but significant increase in the risk for stroke among patients with neovascular age-related macular degeneration. The risk was higher with aflibercept and bevacizumab than with ranibizumab and declined 60 days after the last injection. METHODOLOGY: Researchers analyzed data from two Swedish national registries from 2007 to 2019 to investigate whether intravitreal anti-VEGF injections (ranibizumab, aflibercept, and bevacizumab) for age-related macular degeneration were associated with an increased risk for stroke. They identified patients with neovascular age-related macular degeneration who developed stroke or transient ischemic attack within 90 days of receiving an intravitreal anti-VEGF injection and matched them with individuals who experienced stroke but did not receive such treatment. The number of days between the last injection and the occurrence of stroke was categorized into three intervals: 0-30 days, 31-60 days, and 61-90 days. TAKEAWAY: Among 33,585 patients with neovascular age-related macular degeneration receiving anti-VEGF injections, 936 (approximately 2.8%) experienced a stroke within 90 days of the last injection. Patients who received anti-VEGF injections were at a 27% higher risk for stroke within 90 days of the last injection than those who did not receive the treatment (risk ratio [RR], 1.27; 95% CI, 1.22-1.33). The risk for stroke was elevated in the first 0-30 days (RR, 1.38; 95% CI, 1.15-1.66) and 31-60 days (RR, 1.40; 95% CI, 1.09-1.79) after the last injection but declined thereafter. Aflibercept showed the highest risk (RR, 1.36; 95% CI, 1.23-1.52), followed by bevacizumab (RR, 1.26; 95% CI, 1.10-1.46), whereas ranibizumab demonstrated the lowest risk profile. IN PRACTICE: 'For patients with nAMD [neovascular age-related macular degeneration] in need of anti-VEGF treatment who have a history of cerebrovascular events, have atrial fibrillation or hypertension, and who are smokers, it seems prudent to try to reduce stroke risk factors,' the researchers reported. SOURCE: Inger Westborg, of the Department of Clinical Sciences/Ophthalmology at Umeå University in Umeå, Sweden, was the corresponding author of this study, which was published online on June 7, 2025, in Acta Ophthalmologica . LIMITATIONS: The variations in the risk for stroke between anti-VEGF agents should be interpreted with caution, as the data could not determine whether differences were caused by confounding by indication or actual differences in risk. Information on smoking status was only available for the patients who experienced stroke. DISCLOSURES: This study received support through a grant from Region Stockholm, Sweden. One author disclosed serving as an advisory board member for various pharmaceutical companies.
Medscape
15-05-2025
- Health
- Medscape
Safe Driving Possible Despite Loss of Visual Field
People with a reduced visual field due to glaucoma or stroke who regained their licenses after passing a simulator-based assessment showed similar driving performance on the road as that of their peers with normal vision. METHODOLOGY: Researchers in Sweden investigated the driving performance of people with a reduced visual field who regained their licenses after passing a simulator-based assessment and compared it with that of younger and similarly aged individuals with normal vision. They matched people with a reduced visual field (n = 72; mean age, 66 years) on the basis of sex and familiarity with the environment to control individuals with normal vision of similar (n = 70; mean age, 67 years) and younger (n = 70; mean age, 26 years) ages; the group with reduced visual field failed to meet the standard of an approved visual field defined by Swedish law. All participants underwent standardized driving tests conducted by certified examiners at 39 traffic offices nationwide who were blinded to their allocation; examiners evaluated participants' knowledge about vehicles, adherence to traffic rules, and traffic safety using the Swedish national driving test protocol. TAKEAWAY: The pass rates achieved by the reduced visual field, similarly aged, and younger aged groups were 68%, 66%, and 81%, respectively, with no significant difference between the groups; driving habits, the number of tested checkpoints, and interventions were also comparable across groups. Among people with a reduced visual field, no difference in pass rate was observed with regard to the type of diagnosis. Older age was linked to a significantly lower likelihood of passing the test ( P < .05), with younger drivers showing better attentiveness than older drivers, regardless of having a reduced visual field. IN PRACTICE: 'The results clearly indicate that individuals with VFL [visual field loss] can be safe drivers, performing at least as well as matched, normally sighted controls,' the researchers wrote. 'Simulator and on-road tests are critical tools for individualized assessment, challenging the sole reliance on perimetry for licensing decisions. These findings support the inclusion of practical on-road driving tests as a regulatory option for individuals with VFL, promoting mobility while maintaining road safety.' SOURCE: This study was conducted by Tomas Bro of the Department of Biomedical and Clinical Sciences at Linköping University, Linköping, Sweden. It was published online on May 9, 2025, in Acta Ophthalmologica . LIMITATIONS: Data on loss of visual field were collected at the time of application for the simulator test, leading to inconsistencies in the availability and recency of these perimetric results, with some findings being at least 4 years old. DISCLOSURES: The study was supported by grants from Stiftelsen Promobilia. No other disclosures were reported by the authors.
