***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: IMPORTANCE Panretinal photocoagulation ( PRP ) is the st and ard treatment for reducing severe visual loss from proliferative diabetic retinopathy . However , PRP can damage the retina , result ing in peripheral vision loss or worsening diabetic macular edema ( DME ) . OBJECTIVE To evaluate the noninferiority of intravitreous ranibizumab compared with PRP for visual acuity outcomes in patients with proliferative diabetic retinopathy . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial conducted at 55 US sites among 305 adults with proliferative diabetic retinopathy enrolled between February and December 2012 ( mean age , 52 years ; 44 % female ; 52 % white ) . Both eyes were enrolled for 89 participants ( 1 eye to each study group ) , with a total of 394 study eyes . The final 2-year visit was completed in January 2015 . INTERVENTIONS Individual eyes were r and omly assigned to receive PRP treatment , completed in 1 to 3 visits ( n = 203 eyes ) , or ranibizumab , 0.5 mg , by intravitreous injection at baseline and as frequently as every 4 weeks based on a structured re-treatment protocol ( n = 191 eyes ) . Eyes in both treatment groups could receive ranibizumab for DME . MAIN OUTCOMES AND MEASURES The primary outcome was mean visual acuity change at 2 years ( 5-letter noninferiority margin ; intention-to-treat analysis ) . Secondary outcomes included visual acuity area under the curve , peripheral visual field loss , vitrectomy , DME development , and retinal neovascularization . RESULTS Mean visual acuity letter improvement at 2 years was + 2.8 in the ranibizumab group vs + 0.2 in the PRP group ( difference , + 2.2 ; 95 % CI , -0.5 to + 5.0 ; P < .001 for noninferiority ) . The mean treatment group difference in visual acuity area under the curve over 2 years was + 4.2 ( 95 % CI , + 3.0 to + 5.4 ; P < .001 ) . Mean peripheral visual field sensitivity loss was worse ( -23 dB vs -422 dB ; difference , 372 dB ; 95 % CI , 213 - 531 dB ; P < .001 ) , vitrectomy was more frequent ( 15 % vs 4 % ; difference , 9 % ; 95 % CI , 4%-15 % ; P < .001 ) , and DME development was more frequent ( 28 % vs 9 % ; difference , 19 % ; 95 % CI , 10%-28 % ; P < .001 ) in the PRP group vs the ranibizumab group , respectively . Eyes without active or regressed neovascularization at 2 years were not significantly different ( 35 % in the ranibizumab group vs 30 % in the PRP group ; difference , 3 % ; 95 % CI , -7 % to 12 % ; P = .58 ) . One eye in the ranibizumab group developed endophthalmitis . No significant differences between groups in rates of major cardiovascular events were identified . CONCLUSIONS AND RELEVANCE Among eyes with proliferative diabetic retinopathy , treatment with ranibizumab result ed in visual acuity that was noninferior to ( not worse than ) PRP treatment at 2 years . Although longer-term follow-up is needed , ranibizumab may be a reasonable treatment alternative , at least through 2 years , for patients with proliferative diabetic retinopathy . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01489189 Aims The aims were to compare a novel conjunctival mould used to assist the delivery of intravitreal drugs to a conventional technique with respect to patient , surgeon and cost benefit . Methods A prospect i ve review of 200 intravitreal injections was undertaken , 100 using a ‘ conventional ’ freeh and technique ( group 1 ) and 100 using a novel conjunctival mould ( group 2 ) .  Intraoperative visual analogue scale ( VAS ) pain scores , patient preference , surgeon perception of the ease of insertion of the conjunctival mould were recorded as well as a cost comparison . Results VAS pain score in the conventional group was 2.58 compared to 1.38 in the conjunctival mould group ( p<0.01 ) . The surgeon reported the insertion of the conjunctival mould as easy in 89 cases , moderate in 10 cases , and difficult in one case . The cost saving with a conjunctival mould pack compared to a conventional pack was £ 7.70 ; an annual saving of £ 19 250 for the trust . Conclusions The reduction in the VAS pain score with the conjunctival mould was statistically significant ( p<0.01 ) . The surgeons found that the device , which was easy to insert , offered excellent globe stability and a safe , reproducible entry site and angle of needle insertion Background The dramatic increase in need for anti-vascular endothelial growth factor ( anti-VEGF ) intravitreal therapy in the treatment of retinal disease and the absence of an equivalent increase in ophthalmologists to undertake such intravitreal injections created a patient-safety risk . Timing of intravitreal therapy ( IVT ) is critical to prevent vision loss and local clinics lacked capacity to treat patients appropriately . We aim ed to improve capacity for IVT by nurse injections . Material s and methods A multidisciplinary prospect i ve service-improvement process was undertaken at two adjacent general hospitals in the northwest of Engl and .  IVT injections by nurses were a principal component of solution development . After we had obtained appropriate institutional approval , experienced ophthalmic nurses were trained , supervised , and assessed to undertake IVT . Ophthalmologists directly supervised the first 200 injections , and a retina specialist was always on site . Results Nurses undertook 3,355 intravitreal injections between June 2012 and November 2013 , with minor adverse events ( 0.3 % subconjunctival hemorrhage and corneal abrasion ) . There were no patient complaints at either hospital . Conclusion Experienced ophthalmic nurses quickly learned how to perform such injections safely . IVT by nurses was well accepted by patients and staff . Hospital A trained three nurses sequentially for improved flexibility in scheduling . Novel use of appropriately trained non-medical staff can improve efficiency and access in an overburdened service with time-sensitive disease . Retinal assessment was undertaken by ophthalmologists only . Improved access to IVT is important , as treatment with anti-VEGF therapy reduces blindness at population levels Objectives To investigate the relationship between foveal morphology and self-perceived visual function in patients with neovascular age-related macular degeneration ( AMD ) and whether foveal characteristics are associated with Ranibizumab treatment response on the self-perceived visual function . Methods This prospect i ve cohort study included patients with newly diagnosed neovascular AMD found eligible for treatment with Ranibizumab .  Foveal morphology of both eyes was assessed using spectral-domain optical coherence tomography and all patients were interviewed using the 39-item National Eye Institute Visual Function Question naire ( VFQ ) . Patients were re-interviewed 3 and 12 months after initiation of treatment with Ranibizumab . We evaluated foveal morphology at baseline in relation to VFQ scores at baseline and clinical ly meaningful changes in VFQ after 3 and 12 months . Results VFQ scores correlated with central foveal thickness , central foveal thickness of neuroretina ( CFN ) , foveal RPE elevation , foveal integrity of the photoreceptor inner segment/outer segment junction ( IS/OS ) , and external limiting membrane . In a multiple linear regression model , only best-corrected visual acuity of the better eye ( p<0.001 ) and the IS/OS status in the better eye ( p = 0.012 ) remained significant ( Adjusted R2 = 0.418 ) . Lower baseline VFQ and a baseline CFN within 170–270 µm in the better eye were both associated with a clinical ly meaningful increase in the VFQ scores after 3 and 12 months . An absent foveal IS/OS b and in the better eye was associated with a clinical ly meaningful decrease in the VFQ scores at 12 months . Conclusions Foveal morphology in the better eye influences the self-perceived visual function in patients with neovascular AMD and possesses a predictive value for change in the self-perceived visual function at 3 and 12 months after initiation of treatment . These findings may help clinicians provide patients more individualized information of their disease and treatment prognosis from a patient-perceived point-of-view Background Complicated approval procedures and limited short-term surgical capacities can result in time delays between the definition of a medical indication for ranibizumab treatment in active neovascular age-related macular degeneration ( AMD ) and the starting of treatment . This study aim ed to evaluate changes in visual acuity and central retinal thickness over time , and their consequences for the patients concerned . Methods Sixty-nine patients indicated for first-time ranibizumab treatment and 21 patients with necessary re-treatment were included in the study .  Visual acuity and spectral domain optical coherence tomography ( SD-OCT ) central retinal thickness at the time of the indication examination were compared to values at the first-time treatment and during recurrent ranibizumab treatment . Results For first-time treatment , the delay between indication and treatment was significantly higher for patients with vision loss compared to those without vision loss ( 31.6 ± 20.5 vs. 24.0 ± 8.3 days , p = 0.012 ) . The increase in OCT central retinal thickness was 50.4 ± 92.8 μm for patients with vision loss compared to 5.1 ± 63.4 μm for those without vision loss , p = 0.029 . A 1.1 logMAR line difference in vision loss was significant at p = 0.01 for patients with a delay in treatment of less than or equal to 28 days ( 48/69 patients , 69.7 % ) compared to those with a delay of more than 28 days ( 21/69 patients , 30.3 % ) . Conclusions Even though average visual decay was slow at about one logMAR line over 110 days , individual patients ( 8.7 % ) experienced rapid loss of one or more lines within 21 days . Administrative procedures should therefore be expedited so that delays do not exceed 2 weeks for the sake of vision preservation in individual patients Purpose A recently developed ranibizumab prefilled syringe ( PFS ) eliminates several preparatory steps versus the st and ard vial-based method , and is expected to reduce syringe preparation time ( SPT ) and enhance procedural simplicity for intravitreal injections . Methods Syringe preparation times for the ranibizumab PFS and vial were recorded during st and ard treatment sessions at 2 centers , without r and omization . The duration of each step in preparing the syringe was recorded . At each center , total SPT ( mean total duration of all syringe preparation steps ) for each method was compared using a 2-tailed t test . Results In total , 97 SPTs were analyzed across both centers . Center 1 SPTs were 46 seconds ( PFS ) versus 75 seconds ( vial ; difference , 29 seconds ; p<0.001 ) . Center 2 SPTs were 46 seconds ( PFS ) versus 63 seconds ( vial ; difference , 17 seconds ; p<0.001 ) . This equates to a 27%-39 % reduction in SPT when using the PFS rather than the vial , result ing mostly from the reduced number of syringe preparation steps associated with the PFS . Conclusions Syringe preparation times for ranibizumab intravitreal injections are significantly shorter with the PFS than with the vial . The time saved by using the PFS may benefit physicians and nurses , and the simplicity of the injection preparation process with the PFS is advantageous PURPOSE To evaluate the prevalence and causes of visual impairment in an epidemiologic study of aged , urban individuals in Denmark . DESIGN Cross-sectional study . PARTICIPANTS The study population consisted of 1000 r and omly selected residents aged 60 to 80 years in Copenhagen , Denmark . Of 976 eligible persons , 946 ( 96.9 % ) could be examined . Information about best-corrected visual acuity ( VA ) was obtained from 944 cooperative persons ( 96.7 % ) . METHODS Data from the Copenhagen City Eye Study were used to assess the cause-specific prevalence of visual impairment as defined by the World Health Organization ( WHO ) ( VA worse than 20/60 - 20/400 in the better eye ) and the criteria used most commonly in the United States ( VA worse than 20/40 but better than 20/200 in the better eye ) . Eligible subjects underwent an extensive ophthalmologic examination at The National University Hospital of Denmark . MAIN OUTCOME MEASURES Best-corrected VA and primary causes of visual impairment . RESULTS The prevalence of low vision according to the WHO definition ranged from 2.6 % in subjects aged 70 to 74 years to 4.8 % in subjects 75 to 80 years of age , with an age-adjusted relative prevalence of 1.58 % . Using the U.S. definition , the 
    Output:
    
Non-physician delivered intravitreal therapy  seems feasible and safe