Estimating the Effect of Student Aid on College Enrollment: Evidence from a Government Grant Policy Reform

In this paper, we investigate the responsiveness of the demand for college to changes in student aid arising from a Danish reform. We separately identify the effect of aid from that of other observed and unobserved variables such as parental income. We exploit the combination of a kinked aid scheme and a reform of the student aid scheme to identify the effect of direct costs on college enrollment. To allow for heterogeneous responses due to borrowing constraints, we use detailed information on parents' assets. We find that enrollment is less responsive than found in other studies and that the presence of borrowing constraints only deters college enrollment to a minor extent.college attendance, educational subsidies, reform, kink regression

Neovascular Age-related Macular Degeneration in the Very Old (=90 Years): Epidemiology, Adherence to Treatment, and Comparison of Efficacy

Purpose. To investigate neovascular age-related macular degeneration (AMD) in patients aged ≥90 years from several perspectives for a comprehensive overview: prevalence, presenting characteristics, treatment adherence, reasons for discontinuation, and efficacy of antivascular endothelial growth factor (VEGF) treatment comparing Ranibizumab and Aflibercept. Methods. In this retrospective chart review, we determined the prevalence and presenting characteristics by reviewing all data for patients referred to our department with treatment-naïve neovascular AMD. By looking at historical cohorts, we determined adherence to treatment, reasons for discontinuation, and treatment outcomes after loading dose, 12 months, and 24 months. Results. Patients aged ≥90 years constituted 7% of the patients. Treatment was discontinued in 51%, primarily because of death and treatment burden. Mean change in best-corrected visual acuity was 3.2, 1.5, and −2.2 ETDRS letters at 4, 12, and 24 months, respectively. Aflibercept was superior to Ranibizumab in visual and anatomic outcomes. After two years of treatment, patients losing ≥15 ETDRS letters made up 19% in the Aflibercept group and 26% in the Ranibizumab group. Conclusions. We propose that the very old patients with neovascular AMD may constitute a distinctive group warranting special attention and possibilities for individualized therapy. Possible differences between anti-VEGF agents need further investigations

Effect of Intravitreal Ranibizumab in the Treatment of Peripapillary Choroidal Neovascularisation

Intravitreal ranibizumab therapy is widely used in treatment of subfoveal choroidal neovascularisation (CNV) in age-related macular degeneration. We wanted to study the effect of intravitreal ranibizumab therapy in peripapillary CNV. A prospective recording of treatment outcomes in twelve eyes (12 patients) with peripapillary CNV with intravitreal injections of ranibizumab was performed. The patients received a series of 3 injections 4–6 weeks apart, and then a new ophthalmic examination was made including OCT and further therapy was given if the peripapillary CNV was still active. Nine patients had idiopathic peripapillary CNV, and in 3 patients it was associated to age-related macular degeneration. Followup had to be at least 6 months. The mean follow-up time was 15.9 (range 9–27) months and the mean number of injections 6.2 (3–10). In 10 patients treatment had resulted in an inactivation of the peripapillary CNV, but 3 of them had reactivation, while 2 patients had no inactivation. Currently, 5 patients are continuous to receive treatment. VA improved in 10 patients. Intravitreal ranibizumab therapy appears to be effective in patients with peripapillary CNV, but in some cases there is repeated reactivation or continuous activity of the peripapillary CNV

Valsalva-Related Subretinal Hemorrhage as a Presenting Symptom of Polypoidal Choroidal Vasculopathy

Purpose. To describe a case of Valsalva-related subretinal hemorrhage as a presenting symptom of polypoidal choroidal vasculopathy (PCV). The patient refrained from treatment against our best advice, and thus this is also a rare case of the natural course of an untreated PCV. Methods. Case report. Results. A 66-year-old female with a respiratory infection coughed intensely until exhaustion, after which she developed visual symptoms on the right eye. Primary care ophthalmologist examined the patient on the same day of the onset of symptoms and referred her to our tertiary medical retinal service for detailed retinal diagnosis including fluorescein and indocyanine green angiography. The right eye had a large subretinal hemorrhage and pigment epithelium detachment in the lower temporal arcade with foveal involvement. Against our best advice, the patient refused treatment. In the following 9 months, the BCVA decreased from 68 to 55 ETDRS letters, the subretinal hemorrhage almost regressed, pigment epithelium detachments persisted, and macular edema, intraretinal cysts, and subretinal fibrosis developed. Conclusions. Although classic Valsalva retinopathy with preretinal hemorrhage in most cases can be managed by careful observation and no treatment, this case demonstrates that Valsalva-related subretinal hemorrhage needs different attention and approach

Evaluation and validity of the Danish version of the Adult Strabismus Questionnaire AS-20

PURPOSE: Assessing health-related quality of life in patients with strabismus is important in evaluating the clinical benefits of strabismus treatment. The purpose of this study was to translate the Adult Strabismus Quality of Life Questionnaire (AS-20) into Danish and evaluate its reliability and validity in adult patients with strabismus in Denmark. METHODS: The AS-20 was translated into Danish in accordance with standard international adopted methods. We presented the questionnaire to 64 adults with strabismus and to 13 non-strabismic adult controls. We tested the reliability of the Danish version by reassuring test–retest reliability, estimated the internal consistency, and analyzed the validity (discriminatory power) of the questionnaire by comparing patient scores with scores from control individuals. RESULTS: The Danish AS-20 produced high level of internal consistency (Cronbach’s α values) for both subscales (psychosocial: 0.95 and functional: 0.85). We found good discriminatory power of the AS-20. The patients scored significantly lower not only on AS-20 composite score (median =63, interquartile range [IQR] =44–79) compared to healthy individuals (median =98, IQR =93–100) (P<0.0001) but also on all individual questions in both subscales (psychosocial: 1–10 and functional: 11–20). CONCLUSION: The Danish version of AS-20 shows high reliability and validity, and in our opinion, AS-20 is therefore a suitable instrument for evaluating self-perceived psychosocial and functional influence of strabismus

Circulating monocytes and B-lymphocytes in neovascular age-related macular degeneration

Sven Magnus Hector,1 Torben Lykke S&oslash;rensen1,2 1Clinical Eye Research Unit, Zealand University Hospital, Roskilde, 2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Background: Individuals with neovascular age-related macular degeneration (AMD) have altered number and distribution of retinal macrophages and show changes in circulating antibodies. We wanted to investigate the corresponding precursors, with subpopulations. We therefore measured monocyte and B-lymphocyte populations in individuals with neovascular AMD.Design: This was an observational case&ndash;control study.Participants or samples: A total of 31 individuals with neovascular AMD and 30 healthy age-matched controls were included.Methods: Patients and controls were interviewed, and ophthalmological examination included visual acuity assessment using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, spectral domain optical coherence tomography (SD-OCT), slit-lamp examination and fundus photography. Moreover, venous blood was drawn and prepared for flow cytometry. Cells were gated and measured for surface markers.Main outcome measures: Relative amounts of monocytes and B-lymphocytes with subsets, as well as selected surface markers, were measured.Results: The two groups did not significantly differ in age, smoking history, body mass index, physical activity or C-reactive protein (CRP). Total monocytes (percentage of all leukocytes) were lower in the neovascular AMD group (median 5.5%) compared with the level in the control group (6.5%; P-value: 0.028). The percentage of intermediate monocytes positive for cluster of differentiation 11b (CD11b) was lower for AMD patients (99.4%) compared with 100% for the control group (P-value: 0.032).Conclusion: We observed lower numbers of monocytes, which show a potentially impaired ability to migrate across the endothelial wall in patients with neovascular AMD. These subtle changes could potentially lead to an imbalance in the recruitment of macrophages into the retina during disease development. Keywords: macular degeneration, choroidal neovascularization, flow cytometr

Effect of aging and lifestyle on photoreceptors and retinal pigment epithelium:cross-sectional study in a healthy Danish population

Photoreceptors and their supporting retinal pigment epithelium constitute the key functional parts of the retina. Here, a study was undertaken to show how aging and lifestyle factors affect the photoreceptor layer and the retinal pigment epithelium and Bruch’s membrane complex (RPE-BM) in vivo in a healthy Danish population using spectral-domain optical coherence tomography. This was a cross-sectional study of healthy humans aged ≥50 years. All participants were interviewed for medical history and lifestyle factors. Maculae of all participants were scanned using spectral-domain optical coherence tomography. The thickness of the photoreceptor layer and the RPE-BM was measured on one eye from each participant. In 150 eyes of 150 participants, it was found that aging was associated with a decrease in the thickness of the photoreceptor layer (−0.143 μm/year, P = 0.031) and an increase in the thickness of the RPE-BM layer (0.100 μm/year, P = 0.029) at the foveal minimum. Regarding lifestyle factors, alcohol intake or BMI were not associated with any significant trend, but physical inactivity and smoking had effects on the photoreceptor layer (decreased thickness) and the RPE-BM layer (increased thickness) indicating an accelerated aging process of the macula. Taken together, aging affects photoreceptors and the RPE-BM, and these aging trends are accelerated in smokers and the physically inactive