Incidence of Endophthalmitis after intravitreal injections with and without prophylactic antibiotics

2018/2019 Diogo Dias Ramos Incidence o Endoph halmi is a e In a i eal Injec ions wi h and wi hou P ophylac ic An ibio ics Incidência de Endo almi e após Injeções In a í eas com e sem P o ilaxia An ibió ica ma ço, 2019 Mes ado In eg ado em Medicina Á ea: O almologia Tipologia: Disse ação T abalho e e uado sob a O ien ação de: Dou o Manuel Albe o de Almeida e Sousa Falcão T abalho o ganizado de aco do com as no mas da e is a: Oph halmology Re ina Diogo Dias Ramos Incidence o Endoph halmi is a e In a i eal Injec ions wi h and wi hou P ophylac ic An ibio ics Incidência de Endo almi e após Injeções In a í eas com e sem P o ilaxia An ibió ica ma ço, 2019 Dedica ó ia Aos meus pais, José Luís da Sil a Ramos e Ma ia da Conceição San os Dias Ramos, que odos os dias azem dos meus sonhos os seus p óp ios e me mos am que com amo , dedicação e abalho udo se consegue a ingi . Ob igado po ac edi a em em mim, mesmo nos momen os em que não ac edi o em mim mesmo. Aos meus i mãos, Filipa e Gonçalo, po oda a cumplicidade e odos os isos. Ob igado pela companhia nas incon á eis a en u as, sucessos e insucessos. Aos a ós e es an e amília, po odo o conhecimen o e expe iência. Ob igado po cuida em de mim com ca inho e e em o dom da pala a. Aos amigos, po es a em semp e p esen es. Ob igado pelo incen i o e apoio cons an es. Sem ocês nenhuma conquis a ale ia a pena. Mui o Ob igado. 1 Ti le Incidence o Endoph halmi is a e In a i eal Injec ions wi h and wi hou P ophylac ic An ibio ics Au ho s and a ilia ion Diogo Dias Ramos1, Sónia To es Cos a, MD2, Manuel Sousa Falcão, MD, PhD2,3 1FMUP – Facul y o Medicine, Uni e si y o Po o 2Oph halmology Depa men , Cen o Hospi ala de São João, Opo o, Po ugal 3Su ge y and Physiology Depa men , Cen o Hospi ala de São João, Opo o, Po ugal Co esponding Au ho Diogo Dias Ramos Facul y o Medicine, Uni e si y o Po o Al P o He nâni Mon ei o, 4200-319, Po o, Po ugal Tel +351 225 51 3600, Fax +351 225 51 3601 Email: diogo.dias. [email protected] Financial Suppo : None Con lic o In e es : No con lic ing ela ionship exis s o any au ho . Abb e ia ions/ Ac onyms IVI – In a i eal Injec ions; An i-VEGF – An i-Vascula Endo helial G ow h Fac o ; AMD – age- ela ed macula degene a ion; DME – diabe ic macula edema; RVO – e inal ein occlusion; PPV – pa s plana i ec omy; VA – Visual Acui y; logMAR – loga i hm o he minimal angle o esolu ion; CF – coun inge s; HM – hand mo ion; OR – ope a ing oom 2 ABSTRACT Pu pose: To assess he e ec o opical an ibio ic p ophylaxis on he a e o pos -ope a i e endoph halmi is a e in a i eal injec ion (IVI) o an i- ascula endo helial g ow h ac o agen s (VEGF) and co icos e oids and o desc ibe he clinical cha ac e is ics, managemen , and isual ou comes o pa ien s wi h acu e endoph halmi is. Design: Re ospec i e, single-cen e s udy. Pa icipan s: All pa ien s ea ed wi h in a i eal injec ions o a a ie y o e inal pa hologies be ween 1 Oc obe 2014 and 30 No embe 2018 we e included. Me hods: The in a i eal injec ions pe o med du ing a wo-yea pe iod in which opical an ibio ic p ophylaxis was used was compa ed o he numbe o injec ions pe o med o e a wo-yea pe iod wi hou an ibio ic p ophylaxis. Main Ou come Measu e: Incidence o clinical endoph halmi is in he wo di e en g oups. Resul s: Be ween 1 Oc obe 2014 and 30 No embe 2018, 33515 IVI we e pe o med. Du ing his pe iod, 13 cases o pos -IVI endoph halmi is we e iden i ied (incidence a e o 0.0388%; 95% CI, 0.0217-0.0644%) o app oxima ely 1 case o e e y 2578 IVI pe o med. Be ween 1 Oc obe 2014 and 31 Oc obe 2016, when pos -ope a i e opical an ibio ic p ophylaxis was used 14828 IVI we e pe o med and 5 cases o endoph halmi is we e epo ed (0.0337%; 95% CI, 0.0129-0.0739%); be ween 1 No embe 2016 and 30 No embe 2018, when no p ophylaxis was used, 18687 IVI we e pe o med and 8 cases o endoph halmi is we e iden i ied (0.0428%; 95% CI, 0.0202-0.0808%). The e we e no s a is ical di e ences in he incidence a es be ween he wo g oups (p=0.675). The median numbe o days om injec ion o p esen a ion was 7.0 ( ange 2-24 days). Conclusions: The incidence o endoph halmi is a e IVI o an i- ascula endo helial g ow h ac o s o co icos e oids was low. Pos -IVI an ibio ic p ophylaxis did no educe he a e o endoph halmi is. Changing he policy om an ibio ic p ophylaxis o no an ibio ic p ophylaxis was sa e. Keywo ds: endoph halmi is, an ibio ic p ophylaxis, in a i eal injec ion, an i- ascula endo helial g ow h ac o . 3 INTRODUCTION The numbe o in a i eal injec ions (IVI) pe o med has g own exponen ially in he pas decade, becoming he mos commonly pe o med in asi e oph halmic p ocedu e.1,2 In he USA alone, he e was an es ima ed 5.9 million IVI pe o med in 2016.3 Wi h he ins i u ion o in a i eal an i- ascula endo helial g ow h ac o (an i-VEGF) and co icos e oids o he ea men o we age- ela ed macula degene a ion (AMD), diabe ic macula edema (DME) and macula edema seconda y o e inal ein occlusions (RVO) an exponen ial inc ease in he numbe o IVI was obse ed. IVI became he s anda d o ca e o he men ioned diseases.4–7 Howe e , i is impo an o s a e ha all hese diseases a e ch onic diseases ha equi e equen e ea men s. IVI o an i-VEGF agen s a e usually s a ed on a mon hly basis. As ime elapses, di e en ea men s a egies such as p o e na a o “T ea and Ex end” s a egies ha e been employed o y and educe he numbe o injec ions. None heless, some pa ien s may ha e up o wel e injec ions each yea . IVI may induce complica ions, including endoph halmi is, e inal de achmen , and ca a ac .8 In ec ious endoph halmi is is he mos p eoccupying complica ion a e IVI because o i s poo p ognosis esul ing in se e e and i e e sible ision loss.9 Al hough he isk is low, wi h he la ges me a-analysis epo ing a equency o 0.056% (197/350.535 injec ions)10, since we a e alking abou ch onic macula pa hologies wi h epea ed IVI being equi ed, he cumula i e isk a e 2 yea s is o en mo e han 1%.11 By 2004, IVI was a ai ly uncommon p ocedu e and, as such, guidelines a ha ime men ioned he use o p e- and/o pos -injec ion opical an ibio ics.12,13 Despi e he lack o e idence showing any e icacy in p e en ing pos -injec ion endoph halmi is, i was always an accep ed p ac ice o use opical an ibio ics since many clinical ial p o ocols o in a i eal agen s equi ed hem.14,15 Using opical an ibio ics o p ophylaxis up o wel e weeks in one yea can po en ially lead o he selec ion o esis an mic obiologic s ains.16– 18 The widesp ead use o IVI has conside ably inc eased he body o e idence ega ding pos -injec ion endoph halmi is. Many s udies ha e iden i ied modi iable isk ac o s o p e en endoph halmi is ollowing IVI, and guidelines based on cu en bes e idence and p ac ices ha e been published in di e en coun ies.12,19 Howe e , while some ha e been applied in p esen clinical p ac ice, no consensus was es ablished abou he use o opical p ophylaxis wi h an ibio ics. 4 Po idone-iodine wi h s ic an isepsis ules is he only p ophylaxis ha was p o en o ha e an e ec agains endoph halmi is a e in a-ocula su ge y.13,20,21 Some s udies a e s a ing o sugges he lack o ole o opical an ibio ics in he p e en ion o pos -injec ion endoph halmi is.22–24 In ac , ecen s udies e en sugges ed ha opical p ophylaxis wi h an ibio ics may be ha m ul and inc ease he isk o endoph halmi is.16,18,25 The pu pose o his s udy is o assess he e ec o opical an ibio ic p ophylaxis on he a e o pos -ope a i e endoph halmi is a e IVI o an i–VEGF agen s o co icos e oids and o desc ibe he clinical cha ac e is ics, managemen , and isual ou comes o pa ien s wi h acu e endoph halmi is ollowing IVI. PATIENTS AND METHODS STUDY DESIGN: This is a e ospec i e s udy o endoph halmi is a e in a i eal injec ions (IVI) gi en om 1 Oc obe 2014 and 30 No embe 2018 pe o med a Cen o Hospi ala Uni e si á io de São João, Opo o, Po ugal. We compa ed he 25-mon h p io o he suspension o he an ibio ic p ophylaxis ( om 1 Oc obe 2014 o 31 Oc obe 2016) o he immedia ely ollowing 25-mon h pe iod ( om 1 No embe 2016 o 30 No embe 2018) du ing which no p ophylaxis was p esc ibed. This s udy was app o ed by he local E hics Commi ee o Cen o Hospi ala Uni e si á io de São João. Medical eco ds we e used o iden i y he o al numbe o in a i eal injec ions and he se ing in which in a i eal injec ions we e pe o med. The ea men s included in his s udy we e anibizumab (0.5 mg/0.05 mL; Lucen is; No a is Pha ma SAS; Basel, Swi ze land), be acizumab (1.25 mg/ 0.05 mL; A as in; Roche, Basel, Swi ze land), a libe cep (2 mg/0.05mL; Eylea; Baye Pha ma AG; Be lin, Ge many), iamcinolone ace onide (2mg/0,1mL and 4 mg/0.1 mL; Kenalog; B is ol-Mye s Squibb, New Yo k, New Yo k, USA), dexame hasone implan (0.7 mg; Ozu dex; Alle gan SAS, I ine, CA, USA), and he luocinolone ace onide implan (0.19mg; Ilu ien; Alime a Sciences Inc; Hampshi e, UK). Indica ions o in a i eal injec ion included macula edema seconda y o diabe ic e inopa hy, e inal ein occlusion and u ei is, e inal neo ascula iza ion seconda y o diabe ic e inopa hy and enous occlusion and cho oidal neo ascula iza ion om age- ela ed macula degene a ion (AMD), pa hologic myopia, angioid s eaks, and neo ascula glaucoma. 11 cap u ed owing o e o s in coding o cases no epo ed unde es ima ing i s incidence, bu i also has he bene i o de ailed cha pa ien e iew o con i m endoph halmi is’ cases ins ead o elying on billing codes alone. Second, he e ospec i e na u e o his s udy made i impossible o us o con ol o con ounding ac o s. Howe e , his las should no be a signi ican limi a ion since endoph halmi is canno be o eseen by pa ien s o physicians and we belie e selec ion bias wi h espec o an ibio ic p ophylaxis use is imp obable o occu . Despi e hese limi a ions, his s udy has se e al s eng hs. Fi s , we included a la ge numbe o IVI pe o med in a single cen e o e a ai ly sho pe iod. Second, as his in ol ed a single ins i u ion, no di e ence in he s anda dized p epa a ion, ins i u ion o e en physician injec ion p o ocol in e e ed wi h di e ences in endoph halmi is a es. Thi d, he managemen o endoph halmi is a e IVI was homogeneous especially in e ms o an ibio ic IVI, sys emic an ibio ic egimen and PPV. Cen o Hospi ala de São João pe o ms IVI in an ope a ing oom en i onmen and he use o a s e ile d ape, ace mask, su gical ha and s e ile glo es is uni e sal. The e o e, ex apola ion can be made o o he cen e s and coun ies wi h simila condi ions bu ex apola ion o coun ies using di e en echniques equi es ca e ul conside a ion. In conclusion, ou e ospec i e s udy o o e 33515 IVI ound a low a e o endoph halmi is compa able o p io s udies wi hou di e ences be ween pa ien s ha ecei ed and didn’ ecei e p ophylaxis. 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Pos -in a i eal an i-VEGF endoph halmi is in he 16 Uni ed Kingdom: Incidence, ea u es, isk ac o s, and ou comes. Eye. 2012. doi:10.1038/eye.2012.199 44. Mosh eghi AA, Rosen eld PJ, Flynn HW, e al. Endoph halmi is a e in a i eal an i- ascula endo helial g ow h ac o an agonis s: A six-yea expe ience a a uni e si y e e al cen e . Re ina. 2011. doi:10.1097/IAE.0b013e31821067c4 Tables TABLE 1. Incidence o P esumed Endoph halmi is Cases a e In a i eal Injec ions (IVI) o Co icos e oids o An i-Vascula Endo helium G ow h Fac o . All Topical An ibio ic P ophylaxis Yes No Numbe o Cases 13 5 8 Numbe o IVI 33515 14828 18687 Incidence 0.0388 (0.0217-0.0644) 0.0337 (0.0129-0.0739) 0.0428 (0.0202-0.0808) p 0.675 Values a e displayed as absolu e equencies. Incidence is p esen ed in % (95% CI) Compa isons we e made wi h he chi squa ed es o dicho omous da a; he le el o s a is ical signi icance was se a P < .05. TABLE 2. Demog aphics, Managemen and Bac e iology o P esumed Endoph halmi is Cases (n=13) a e In a i eal Injec ions (IVI), in Cen o Hospi ala Uni e si á io de São João. All (n=13) Topical An ibio ic P ophylaxis p Yes (n=5) No (n=8) Demog aphy Sex (F/M) 10/3 4/1 6/2 1.0 Age* (y) 71 (28-94) 61 (28-85) 78 (61-94) 0.092 Sys emic Diseases Diabe es 6 (46.15) 2 (40) 4 (50) 1.0 Hype ension 9 (69.23) 2 (40) 7 (87.5) 0.217 Dyslipidemia 4 (30.77) 0 4 (50) 0.105 Ca diac 4 (30.77) 2 (40) 2 (25) 1.0 Renal 3 (23.08) 2 (40) 1 (12.5) 0.510 Thy oid 3 (23.08) 2 (40) 1 (12.5) 0.510 Ocula An eceden s I idocycli is 1 (7.69) 1 (20) 0 0.385 PHACO 9 (69.23) 4 (80) 5 (62.5) 1.0 Indica ions NAMD 4 (30.77) 0 4 (50) 0.171 DME 3 (23.08) 1 (20) 2 (25) 0.943 Macula edema a e RVO 1 (7.69) 1 (20) 0 0.622 Myopic neo ascula iza ion 1 (7.69) 1 (20) 0 0.622 Mul i ocal cho oidi is 1 (7.69) 1 (20) 0 0.622 Unknown macula edema 2 (15.38) 1 (20) 1 (12.5) 0.833 Macula edema pos -VPP o subluxa ed LIO 1 (7.69) 0 1 (12.5) 0.724 Agen s Ranibizumab 0 0 0 ND Be acizumab 7 (53.85) 3 (60) 4 (50) ND A libe cep 3 (23.08) 1 (20) 2 (25) ND T iamcinolone ace onide 2 (15.38) 1 (20) 1 (12.5) ND Dexame hasone implan 1 (7.69) 0 1 (12.5) ND Fluocinolone ace onide implan 0 0 0 ND Numbe o IVI be o e endoph halmi is 9 (1-38) 4 (3-25) 11 (1-38) 0.724 Ini ial P esen a ion Righ / Le eye a ec ed 9/4 3/2 6/2 1.0 Days o p esen a ion 7 (2-24) 4 (2-16) 16.5 (2-24) 0.171 Vision loss 12 (92.31) 5 (100) 7 (87.5) ND Pain 4 (30.77) 3 (60) 1 (12.5) ND Redness 6 (46.15) 3 (60) 3 (37.5) ND Tyndall 12 (92.31) 4 (80) 8 (100) 0.385 Hypopyon 6 (46.15) 2 (40) 4 (50) 1.0 Co neal Oedema 4 (30.77) 1 (20) 3 (37.5) 1.0 Ocula undus no isible 10 (76.92) 3 (60) 7 (87.5) 1.0 IOP (mmHg) 12.0 (7.0-50.0) 15.0 (10.0-50.0) 12.0 (7.0-17.0) 0.432 Managemen In a i eal an ibio icsa 13 (100) 5 (100) 8 (100) ND In a enous an ibio icsb 13 (100) 5 (100) 8 (100) ND PPV 11 (84.6) 5 (100) 6 (75) 0.487 Bac e iology Vi eous and Aqueous Samples 12 (92.31) 5 (100) 7 (87.5) 1.0 Bac e ial iden i ica ion (cul u e posi i e) 2 (16.67) 2 (40) 0 0.268 Coagulase-nega i e S aphylococci 2 (16.67) 2 (40) 0 ND S ep ococcus mi is 1 (8.33) 1 (20) 0 ND PHACO= phacoemulsi ica ion; NAMD=Neo ascula age- ela ed macula degene a ion; DME= Diabe ic Macula Edema; RVO= Re inal Vein Occlusion; LIO= in aocula lens; IVI= In a i eal Injec ions; IOP= In aocula P essu e; PPV= pa s plana i ec omy Values a e displayed as median ( ange) o con inuous a iables and numbe (%) o ca ego ical a iables; *mean ( ange) was conside ed in his a iables. a Vancomycin 1mg and Ce azidime 2mg. b Vancomycin 1g e e y 12/12h combined wi h Ce azidime 2g e e y 12/12h o en days. Compa isons we e made wi h he Fishe exac es o dicho omous da a. An independen sample es was used o con inuous a iable ollowing a no mal dis ibu ion and i non-no mal a nonpa ame ic Mann-Whi ney es was used; ND= No De e mined; he le el o s a is ical signi icance was se a P < .05; TABLE 3. Visual Acui y (VA) Values and Analysis o P esumed Endoph halmi is Cases (n=13) a e In a i eal Injec ions, in Cen o Hospi ala Uni e si á io de São João. Visual Acui y (logMAR) P e ious VA VA a p esen a ion Final VA All (n=13) 0.70 (0.0-2.0) 3.0 (1.0-3.0)a 1.3 (0.0-3.0) Topical An ibio ic P ophylaxis Yes (n=5) 0.40 (0.0-2.0) 3.0 (1.0-3.0) 1.3 (0.0-3.0) No (n=8) 0.90 (0.3-2.0) 3.0 (2.0-3.0)b 1.3 (0.4-2.0) p 0.171 0.548 1.0 LogMAR = loga i hm o he minimal angle o esolu ion; VA = Visual Acui y Values a e displayed as median ( ange) o con inuous a iables and numbe (%) o ca ego ical a iables; a Limi ed o n=10 (2 cases o ligh pe cep ion and 1 case wi hou in o ma ion we e excluded) b Limi ed o n=5 (2 cases o ligh pe cep ion and 1 case wi hou in o ma ion we e excluded) Compa isons we e made wi h he nonpa ame ic Mann-Whi ney es , used o con inuous a iables; he le el o s a is ical signi icance was se a P < .05. ANEXOS AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 1 OPHTHALMOLOGY RETINA AUTHOR INFORMATION PACK TABLE OF CONTENTS . XXX . • Desc ip ion • Edi o ial Boa d • Guide o Au ho s p.1 p.1 p.2 ISSN: 2468-6530 DESCRIPTION . Oph halmology Re ina, a jou nal o he Ame ican Academy o Oph halmology, se es socie y by publishing clinical and basic science esea ch and o he ele an manusc ip s ha ela e o he sense o sigh . Excellence is pu sued h ough unbiased pee - e iew, he ad ancemen o inno a ion and disco e y, and he p omo ion o li elong lea ning. EDITORIAL BOARD . Edi o -In-Chie And ew Schacha , MD, Cle eland Clinic Founda ion, Cle eland, Ohio, USA Edi o ial Boa d Membe s Ani a Aga wal, MD, Vande bil Uni e si y Medical Cen e , Nash ille, Tennessee, USA Daniel Albe , MD, Uni e si y o Wisconsin a Madison, Madison, Wisconsin, USA Emily Y. Chew, MD, Na ional Eye Ins i u e (NEI), Be hesda, Ma yland, USA Michael F. Chiang, MD, O egon Heal h & Science Uni e si y, Po land, O egon, USA Lynn K. Go don, MD, PhD, Uni e si y o Cali o nia - Los Angeles, Los Angeles, Cali o nia, USA Ma ine Jage , Leids Uni e si ai Medisch Cen um (LUMC), Leiden, Ne he lands Sue Ligh man, MD, PhD, Moo ields Eye Hospi al, London, England, UK Joan W. Mille , MD, Ha a d Medical School, Bos on, Massachuse s, USA S iniVas R. Sadda, MD, Doheny Eye Ins i u e and Uni e si y o Cali o nia – Los Angeles, Cali o nia, USA Sha on Solomon, MD, Johns Hopkins Uni e si y School o Medicine, Bal imo e, Ma yland, USA John T. Thompson, MD, John Hopkins Uni e si y, Bal imo e, Ma yland, USA Elias I. T aboulsi, MD, MEd, Cle eland Clinic Founda ion, Cle eland, Ohio, USA Russell Van Gelde , MD, PhD, Uni e si y o Washing on, Sea le, Washing on, USA Cha les Wyko , G ea e Hous on Re ina Resea ch Founda ion, Hous on, Texas, USA Ma co A ilio Eugenio Za bin, MD, Ru ge s New Je sey Medical School, Newa k, New Je sey, USA Edi o ial S a Dale Faja do, Vice P esiden , Educa ion Me edi h D. 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Please be su e all abb e ia ions/ac onyms a e spelled ou a i s use in he abs ac and again a i s use in he ex . An abb e ia ion/ac onym should appea i s in pa en heses immedia ely a e he e m o ph ase o which i e e s. E e y abb e ia ion used in any able o igu e should be de ined in each co esponding legend. When w i ing he manusc ip , use he ac i e oice whene e possible. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 6 Abs ac Abs ac A s uc u ed abs ac is equi ed o Manusc ip s, AAO Mee ing Pape s, and Sys ema ic Re iews o Me a-Analyses. Fo Repo s only: A 35-wo d uns uc u ed abs ac is equi ed o edi o s'/ e iewe s' iew only and will no publish wi h he epo . Abs ac s o Manusc ip s should no exceed 350 wo ds and should be submi ed on a sepa a e page in he ex . Dele ion o any equi ed sec ion o he abs ac mus be jus i ied in he au ho co e le e . The ollowing 7 sec ions mus appea in he abs ac ; please selec he mos app op ia e heading o each sec ion ( o example, chose ei he “Objec i e” o “Pu pose” o he i s sec ion): Objec i e o Pu pose: Concisely s a e he s udy goal. Design: Iden i y he s udy design using a ph ase such as c oss-sec ional s udy, clinical ial, coho s udy, e c. S udy design ypes a e summa ized in he S udy Design sec ion o his guide. The CONSORT Wo kshee is equi ed o andomized con olled ials. Subjec s, Pa icipan s, and/o Con ols: Desc ibe he pe sons o eyes s udied and he con ols i a sepa a e con ol g oup is included. Me hods, In e en ion, o Tes ing: Desc ibe he p incipal ea men (s), p ocedu e(s), es (s), o obse a ion(s) pe o med. Main Ou come Measu es: De ine he main pa ame e (s) being measu ed (e.g., in aocula p essu e, isual acui y, deg ee o in lamma ion, e c.) Resul s: Summa ize he p incipal measu emen s (da a) ob ained. Conclusions: S a e he conclusion(s) de i ed om he da a analysis. Abs ac s o Sys ema ic Re iews o Me a-Analyses should no exceed 350 wo ds and mus include 5 sec ions ollowing he PRISMA guidelines: Topic: P o ide an explici s a emen o he speci ic clinical ques ion being add essed wi h e e ence o a b ie desc ip ion o he pa icipan s, in e en ions (o exposu es), compa a o s, and ou comes examined. Clinical ele ance: Cha ac e ize he magni ude and impo ance o he condi ion; when ele an , de ine he cu en s anda d o ca e. Me hods: Desc ibe he key eligibili y c i e ia o including s udies in he sys ema ic e iew, key da abases sea ched and sea ch da es, and me hods o assessing he isk o bias in he indi idual included s udies. Resul s: Summa ize he numbe and ype o included s udies and pa icipan s, and ele an cha ac e is ics o s udies; desc ibe he esul s o main ou comes (bene i s and ha ms), p e e ably indica ing he numbe o s udies and pa icipan s o each. I a me a-analysis was done, include summa y measu es and con idence in e als; epo he di ec ion o he e ec o associa ion (i.e., which g oup is a o ed) and size o he e ec using language meaning ul o clinicians and pa ien s. Conclusion: Summa ize he s eng hs and limi a ions o he e idence, you gene al in e p e a ion o he esul s, and impo an implica ions. Abs ac s o T ansla ional Science Re iews a e uns uc u ed and should no exceed 350 wo ds. AAO Mee ing Pape s and Pos e s AAO Mee ing Pape s and Pos e s Oph halmology Re ina has he igh o i s e usal o any manusc ip de i ed om a p esen a ion a he Ame ican Academy o Oph halmology Annual Mee ing. P esen a ions a he Academy's subspecial y day p og ams a e exemp om his equi emen (al hough submissions om such p esen a ions a e welcome). Au ho s seeking publica ion may submi hei manusc ip o he jou nal be o e, du ing, o a e he Annual Mee ing p esen a ion. Please no e on he co e page o he manusc ip ha i is de i ed om an Annual Mee ing pape o pos e . Please be su e o selec "AAO Mee ing Pape " o he "Manusc ip Ca ego y"; please do no use "Manusc ip " in hese ins ances. A manusc ip based on p esen a ion a he AAO Annual Mee ing can be submi ed o o he jou nals i Oph halmology Re ina declines o accep i a e e iew (as documen ed by a ejec ion le e om he jou nal o ice) o i a wai e is g an ed in w i ing by he Edi o -in-Chie . Gene al inqui ies abou AAO annual mee ing abs ac submission may be sen o [email p o ec ed]. Acknowledgmen s The jou nal equi es acknowledgmen o anyone who makes subs an ial con ibu ions o a manusc ip bu does no quali y as an au ho . Please e e o he Au ho ship sec ion o his guide, speci ically ega ding Ghos /Gues Au ho s. The jou nal does no allow ghos au ho s. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 7 The jou nal will also acknowledge hose who e iewed, discussed, edi ed scien i ic con en , e e ed pa ien s, ansla ed e e ences, p o ided ex ensi e s a is ical assis ance, o p o ided essen ial issue, equipmen , o o he ma e ials wi hou which he s udy could no ha e been comple ed. (See: Lich e PR. The au ho wishes o hank. Oph halmology 1988;95:293-4). In such cases, w i en pe mission om he pe son being acknowledged is equi ed. The jou nal does no p in acknowledgmen s o hose who pa icipa ed in s udies (e.g., pa ien s), hose who edi ed o g amma o o ma ing, o hose who p o ided “help ul” o “mo al” suppo o simila collegial aid o he au ho s. The jou nal does no publish acknowledgmen s o indi iduals whose se ice as employees con ibu ed o a s udy, e.g., sec e a ies, clinic coo dina o s, echnicians, oph halmic pho og aphe s, o echnologis s. As igma ism Repo ing As igma ism Fo cla i y and uni o mi y, manusc ip s abou as igma ism should adhe e o e minology and g aphical ep esen a ions o iginally desc ibed by Alpins.1-3 An edi o ial by Reins ein e al ou lines he a gumen o s anda diza ion.4 Fo de ails o he Alpins me hodology and g aphical epo ing, please consul he ollowing esou ces: Alpins N. As igma ism analysis by he Alpins me hod. J Ca a ac Re ac Su g 2001;27:31-49. Alpins NA. Vec o analysis o as igma ism changes by la ening, s eepening, and o que. J Ca a ac Re ac Su g 1997;23:1503-14. Alpins NA. A new me hod o analyzing ec o s o changes in as igma ism. J Ca a ac Re ac Su g 1993;19:524-33. Reins ein DZ, A che TJ, Randleman JB. JRS s anda d o epo ing as igma ism ou comes o e ac i e su ge y. J Re ac Su g 2014;30:654-9. Au ho ship Au ho shipAu ho ship Au ho ship C i e ia The jou nal adhe es o he Uni o m Requi emen s se by he In e na ional Commi ee o Medical Jou nal Edi o s (h p://www.icmje.o g/) o au ho ship. Each au ho mus mee c i e ia o Au ho ship. The ICMJE ecommends ha au ho ship be based on he ollowing 4 c i e ia: Subs an ial con ibu ions o concep ion and design o he wo k; o he acquisi ion, analysis, o in e p e a ion o da a o he wo k; AND D a ing he wo k o e ising i c i ically o impo an in ellec ual con en ; AND Final app o al o he e sion o be published; AND Ag eemen o be accoun able o all aspec s o he wo k in ensu ing ha ques ions ela ed o he accu acy o in eg i y o any pa o he wo k a e app op ia ely in es iga ed and esol ed. I is he esponsibili y o he co esponding au ho o con i m ha each coau ho mee s he equi emen s o au ho ship. These ICMJE o ms should be uploaded du ing he e ision s age. Please no e ha he lis o con ibu ions will publish wi h he manusc ip should i be accep ed. Ghos /Gues Au ho s Please no e ha he jou nal does no allow ghos au ho ship, based on he de ini ion o ghos au ho ship as he ailu e o designa e an indi idual who has made a subs an ial con ibu ion o he esea ch o w i ing o a manusc ip (JAMA 2008;299(15):1800-12). I i comes o ligh ha a subs an ial con ibu ion has no been disclosed, he jou nal shall ad ise he co esponding au ho and wi hd aw he submission. Based on he de ini ion o gues au ho ship as he designa ion and acknowledgmen o an indi idual who has con ibu ed signi ican ly bu does no mee au ho ship c i e ia, any gues au ho s mus (a) p o ide w i en pe mission o he co esponding au ho which is o be uploaded wi h he submission and (b) be lis ed by he co esponding au ho in he acknowledgmen s sec ion (a e ex and be o e e e ences in manusc ip ile) o hei con ibu ion (e.g., James Smi h o s a is ical analysis). I he gues au ho is being acknowledged o w i ing assis ance, i should speci ically add ess i he gues au ho p epa ed a manusc ip d a o he named au ho s o edi o i he named au ho s p epa ed he manusc ip and ecei ed w i ing and o ma ing assis ance om he gues au ho . I no sel - employed, he gues au ho should disclose he name o his/he employe and any unding sou ces. Co esponding Au ho The co esponding au ho is he pe son esponsible o a submission and all communica ion wi h he jou nal ega ding a submission. The co esponding au ho mus no i y he edi o s and edi o ial o ice, ia he submission o m, o he ollowing: Acknowledgmen o any gues au ho , de ined as AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 8 an indi idual who does no mee au ho ship c i e ia bu has made a subs an ial con ibu ion o he esea ch o w i ing o a manusc ip . Con i ma ion ha he e a e no “ghos au ho s,” de ined as an indi idual who has made a subs an ial con ibu ion bu does no quali y as an au ho and has no been disclosed o he edi o . Submission o ICMJE con lic o in e es and copy igh o ms om all au ho s; con lic o in e es o ms a e equi ed and equisi e disclosu es should be epo ed on he manusc ip ’s co e page.Submission o he Con ibu o ship Fo m (see downloadable o ms). Acknowledgmen o unding by he US Na ional Ins i u es o Heal h (NIH). A icles accep ed o publica ion in Oph halmology Re ina om au ho s who ha e indica ed ha he unde lying esea ch epo ed in hei a icles was suppo ed by an NIH g an will be sen by Else ie o PubMed Cen al o public access 12 mon hs a e publica ion. The e sion o he a icle p o ided by Else ie is he inal accep ed e sion a e pee - e iew bu be o e copyedi ing. Con i ma ion ha Ins i u ional Re iew Boa d issues ha e been add essed in he Me hods sec ion o he main manusc ip . Con i ma ion ha he au ho s a e awa e he jou nal occasionally, only a e accep ance o a submission and on a con iden ial basis and wi h no igh s p io o emba go da e, sha es some in o ma ion wi h he Ame ican Academy o Oph halmology public ela ions s a and/o EyeNe s a . A e accep ance o publica ion, au ho s may designa e mo e han one pe son o be con ac ed by eade s. S udy G oup/W i ing Commi ee Au ho ship I s udy g oup/w i ing commi ee au ho ship is used and he co esponding au ho is he s udy chai , please s a e his on he co e page. Howe e , i he/she is no he s udy chai , please enclose wi h he submission a s a emen om he s udy chai ha he g oup au ho ship as s a ed on he co e page and/o membe s o he esponsible w i ing commi ee a e bo h co ec . The jou nal p omo es anspa ency o au ho ship o edi o s, e iewe s, and eade s. Membe s o he g oup can be lis ed in ini ial g oup pape s in p in and in subsequen pape s, ei he by e e ence o an ea lie manusc ip , o a imes o leng h and o ma easons, in online supplemen al ma e ial. Membe s a e app op ia ely acknowledged by he byline “… o he XYZ S udy G oup” o “… on behal o he XYZ G oup.” I you belie e g oup membe s a e mo e app op ia ely acknowledged by including hem as au ho s, each mus mee au ho ship c i e ia and comple e he equi ed ICMJE au ho ship c i e ia, copy igh assignmen , and con lic o in e es o ms. Wi h anspa ency and space limi a ions in mind, he ollowing a e he jou nal’s policies ega ding s udy g oup/w i ing commi ee au ho ship: I an indi idual is au ho ing o a g oup (e.g., a S udy Chai ) i should be lis ed as Hen y A. Fiddle, MD o he Lase ROP S udy G oup Small s udy g oups (≤ 10 membe s) can au ho as he g oup o hey can lis w i ing commi ee membe s names “and he XYZ S udy G oup” as long as all he membe s quali y as au ho s. O he wise, only hose who quali y should be lis ed and he emainde can be acknowledged. Deb a L Hanson, MS; Susan Y. Chu, PhD; Ka en M. Fa izo, MD; John W. Wa d, MD; and he Adul and Adolescen Spec um o HIV Disease P ojec G oup La ge s udy g oups (>10 membe s) should no au ho a pape as an en i y. In la ge g oups i is no likely ha e e y single membe o he g oup o ne wo k con ibu ed as equi ed by he au ho ship c i e ia men ioned abo e. La ge s udy g oups should ei he lis he w i ing commi ee membe s as au ho s and hen “ o he XYZ S udy G oup” o lis “W i ing commi ee o he XYZ S udy G oup*” as he au ho and he names o he w i ing commi ee membe s will be lis ed a he end o he a icle wi h he as e isk. Rega dless, membe s o he w i ing commi ee mus quali y as au ho s and comple e he app op ia e ICMJE au ho ship o ms. Deb a L Hanson, MS; Susan Y. Chu, PhD; Ka en M. Fa izo, MD; John W. Wa d, MD o he Adul and Adolescen Spec um o HIV Disease P ojec G oup OR The W i ing G oup o he DISC Collabo a i e Resea ch G oup* OR The DISC Collabo a i e Resea ch G oup W i ing Commi ee* Any dig ession om hese au ho ship guidelines mus be add essed, p io o submission, ia email o [email p o ec ed]. The Edi o ial Di ec o and/o Edi o -in-Chie will discuss wi h he co esponding au ho on a case-by-case basis. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 9 En e ing Au ho s in o he Submission Sys em En e he i le, i s and las name, email add ess, and coun y o all au ho s. The numbe o au ho s on he submission o m mus ma ch he lis on he i le page. Be su e o indica e which au ho is he co esponding au ho by checking he app op ia e box. All co espondence ega ding a submission mus come om and will be sen o he co esponding au ho only. Au ho o de can be changed by changing numbe o de nex o he au ho 's name, hen clicking "Sa e" o upda e he o de . Please do no ha e s a membe s lis hemsel es as au ho s o he pu pose o uploading iles. NOTE: Once a manusc ip has been submi ed, he o de o au ho ship (including adding o emo ing au ho s) canno be changed wi hou a w i en eques o he Edi o ial O ice om he co esponding au ho . The eques mus include a s a emen ha all au ho s a e in ag eemen wi h he change and signed by all au ho s. Speci ically, i an au ho is emo ed, a le e om ha au ho ag eeing o his/he emo al is equi ed. I he au ho s a e no able o ag ee among hemsel es on au ho ship changes, please wi hd aw he pape . The edi o s and Edi o ial O ice do no a bi a e such deba es. Au ho ship changes canno be submi ed wi h p oo changes. The publishe is no au ho ized o make such changes. Cance Classi ica ions We encou age au ho s o use he Ame ican Join Commission on Cance TNM Classi ica ion scheme when desc ibing pa ien s wi h oph halmic malignancies. AJCC Cance S aging Manual. (7 h ed. New Yo k, NY: Sp inge ; 2009). The classi ica ion scheme can also be ound a h ps://cance s aging.o g/ e e ences- ools/Pages/Wha -is-Cance -S aging.aspx. Clinical T ials and Clinical T ial Regis a ion A clinical ial is de ined as any esea ch s udy ha p ospec i ely assigns human pa icipan s o g oups o humans o one o mo e heal h- ela ed in e en ions o e alua e he e ec s on heal h ou comes. Wi h ega ds o he epo ing o clinical ials, Oph halmology's policies a e simila o he policies o The New England Jou nal o Medicine (NEJM), and The Jou nal o he Ame ican Medical Associa ion (JAMA) which can be iewed a h p://jama.ama-assn.o g/misc/au ho s.d l. Consis en wi h hese policies, p ospec i e clinical ial egis a ion is equi ed. Please s a e in he Me hods sec ion whe e he clinical ial egis a ion in o ma ion is publicly a ailable. Sa is ac o y public da abases include he NIH's h p://www.clinical ials.go and he si e om he In e na ional S anda d Randomized Con olled T ials a h p://www.con olled- ials.com. Fo all manusc ip s ha epo clinical ials, CONSORT guidelines mus be ollowed, including submission o a CONSORT low diag am and checklis . Oph halmology Re ina suppo s he Na ional Ins i u es o Heal h P inciples and Guidelines o Repo ing P eclinical Resea ch. Please e e o he ollowing si e o addi ional in o ma ion: h p://www.nih.go /abou / epo ing-p eclinical- esea ch.h m Con lic o In e es ( inancial disclosu e) Each co-au ho mus comple e an ICMJE Con lic o In e es Fo m and submi i o he co esponding au ho . Al hough he ICMJE o m equi es “po en ial” and “ ele an ” con lic s, o p omo e anspa ency we eques au ho s o epo all inancial ela ionships. Mu ual unds need no be lis ed. Such disclosu e will no a ec he e iew o he manusc ip . Fo u he in o ma ion, please e e o: Liesegang TJ, Schacha AP. Enhanced epo ing o po en ial con lic s o in e es : a ionale and new o m. Am J Oph halmol 2011:151:391-3. Liesegang TJ, Ba ley GB. Towa d anspa ency o inancial disclosu e. Oph halmology 2014;121:2077-9. Liesegang TJ, Ba ley GB. Foo no es, acknowledgmen s, and au ho ship: owa d g ea e esponsibili y, accoun abili y, and anspa ency. Oph halmology 2014;121:2297-8. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 16 Repo ing Re ac i e Su ge y Ou comes and As igma ism As igma ism_Repo ing_links_ o_Repo ing_Re ac i e_Su ge y_Ou comes_and_As igma ismWhen epo ing e ac i e su ge y ou comes, please include 6 g aphs o illus a e he ollowing ( e e ences 1-3): Unco ec ed dis ance isual acui y Change in co ec ed dis ance isual acui y Sphe ical equi alen (a emp ed e sus achie ed) Sphe ical equi alen e ac i e accu acy Sphe ical equi alen e ac ion s abili y Re ac i e as igma ism Desc ip ions o as igma ism should adhe e o e minology and g aphical ep esen a ions o iginally desc ibed by Alpins ( e e ences 4-6). An edi o ial by Reins ein e al ( e e ence 7) p esen s he a gumen o s anda diza ion. Wa ing GO III, Reins ein DZ, Dupps WJ, Kohnen T, Mamalis N, Rosen ES, Koch DD, Obs baum SA, S ul ing RD. S anda dized g aphs and e ms o e ac i e su ge y esul s. J Re ac Su g 2011;27:7- E a um in J Re ac Su g 2011;27:88. Reins ein DZ, Wa ing GO III. G aphic epo ing o ou comes o e ac i e su ge y. J Re ac Su g 2009;5:975-8. Wa ing GO III. S anda d g aphs o epo ing e ac i e su ge y. J Re ac Su g 2000;16:459-66. E a um in J Re ac Su g 2001;17: ollowing able o con en s. Alpins N. As igma ism analysis by he Alpins me hod. J Ca a ac Re ac Su g 2001;27:31-49. Alpins NA. Vec o analysis o as igma ism changes by la ening, s eepening, and o que. J Ca a ac Re ac Su g 1997;23:1503-14. Alpins NA. A new me hod o analyzing ec o s o changes in as igma ism. J Ca a ac Re ac Su g 1993;19:524-33. Reins ein DZ, A che TJ, Randleman JB. JRS s anda d o epo ing as igma ism ou comes o e ac i e su ge y. J Re ac Su g 2014;30:654-9. E a um in: J Re ac Su g 2015;3:129. Repo s Repo s a e ypically submi ed a e in i a ion om he Edi o ial Boa d. Speci ically, some ull-leng h manusc ip s con ain no ewo hy in o ma ion ha can be p esen ed in a mo e concise communique. The Edi o ial Boa d may in i e he au ho s o ab idge hei wo k, aking in o conside a ion sugges ions o e ision in he ini ial e iews, and esubmi he pape as a Repo . Repo s do no exceed 1000 wo ds o include mo e han 5 e e ences, and may ea u e one igu e, g aph, cha , o concise able on he p in e sion. Two addi ional i ems can be included as online supplemen al ma e ial. Please inse “(a ailable a h ps://www.oph halmology e ina.o g/)” a ele an poin (s) in you manusc ip . Please no e ha online supplemen al ma e ial mus con o m o he same equi emen s ega ding legends, abb e ia ions, e c. as o he p in publica ion. A 35-wo d uns uc u ed abs ac is equi ed o edi o s'/ e iewe s' iew only and will no publish wi h he epo . The ex should be in na a i e a he han a s uc u ed o ma . When uploading Repo s, please selec he “Case Repo ” submission ype, selec "Manusc ip o Repo (In i ed)" as he Manusc ip Ca ego y, and include he manusc ip numbe o he o iginal submission on he co e le e . Please include a poin -by-poin esponse o he o iginal e iewe (s)’ ques ions and sugges ions. Please no e ha an acknowledgmen sec ion is ese ed o g an s and unding only. Re iew A icles Sys ema ic Re iews and Me a-analysis Sys ema ic e iews seek o collec and c i ically assess all e idence ha i s p e-speci ied c i e ia o answe a clinical ques ion pe aining o he cause, diagnosis, p ognosis, p e en ion, o he apy o a condi ion. A sys ema ic e iew may con ain a me a-analysis, which uses s a is ical me hods o combine esul s om simila bu independen s udies. Fea u es o a sys ema ic e iew include “a clea ly s a ed se o objec i es wi h p e-de ined eligibili y c i e ia o s udies; an explici , ep oducible me hodology; a sys ema ic sea ch ha a emp s o iden i y all s udies ha would mee he eligibili y c i e ia; an assessmen o he alidi y o he indings o he included s udies, o example h ough he assessmen o isk o bias; and a sys ema ic p esen a ion, and syn hesis o he cha ac e is ics and indings o he included s udies (Higgins JPT, G een S (edi o s). Chap e 1. Coch ane Handbook o Sys ema ic Re iews o In e en ions Ve sion 5.1.0 [upda ed Ma ch 2011]. The Coch ane Collabo a ion, 2011). I is possible o conduc a sys ema ic e iew and me a-analysis o he e idence suppo ing any ype o esea ch ques ion, whe he he ques ion is abou in e en ion e ec i eness o ha m, e iology, p ognosis, diagnos ic accu acy, oxici y, incidence, o p e alence. Whe e in e en ion e ec i eness ques ions a e ypically add essed by andomized con olled ials, mos o he ques ions a e add essed using obse a ional s udies. Sys ema ic e iews may be conduc ed o human o animal s udies, in i o o in i o. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 17 Fo s anda ds and classic e e ences in conduc ing sys ema ic e iews and me a-analyses, please e e o: Ins i u e o Medicine. Finding wha wo ks in heal h ca e: s anda ds o sys ema ic e iews. 2011.Chandle J, Chu chill R, Higgins J, To ey D. Me hodological s anda ds o he conduc o new Coch ane In e en ion Re iews. Ve sion 2.2. 17 Decembe 2012.Higgins JPT, G een S (edi o s). Coch ane Handbook o Sys ema ic Re iews o In e en ions Ve sion 5.1.0 [upda ed Ma ch 2011]. The Coch ane Collabo a ion, 2011. Handbook o Diagnos ic Accu acy Re iews [D a ]Li le J, Higgins JPT (edi o s). The HuGENE™ HuGE Re iew Handbook, e sion 1.0. Guidelines o sys ema ic e iew and me a-analysis o gene disease associa ion s udies (see also Sys ema ic Re iews o Gene ic Associa ion S udies, PLoS Medicine 2009;6(3):e1000028)Sys ema ic Re iews. CRD's guidance o unde aking e iews in heal h ca e. Cen e o Re iews and Dissemina ion, Uni e si y o Yo k, 2009 Fo epo ing sys ema ic e iews and me a-analyses, i you a e submi ing a epo o A sys ema ic e iew and/o me a-analysis o andomized con olled ials, please ollow he PRISMA guidelines o epo ing; A sys ema ic e iew and/o me a-analysis o obse a ional s udies, please ollow he MOOSE guidelines o epo ing. A comple e lis o guidelines o epo ing sys ema ic e iews and me a-analyses can be ound a he Enhancing he QUAli y and T anspa ency O heal h Resea ch (EQUATOR) ne wo k’s websi e. We s ongly ecommend you isi he EQUATOR’s websi e o epo ing guidelines o sys ema ic e iews and me a-analyses o o he s udy designs (e.g., indi idual pa icipan da a, heal h equi y, gene ic associa ion s udies). The Coch ane Collabo a ion also has de eloped S anda ds o he Repo ing o Coch ane In e en ion Re iews. Ti le Page: The i le should clea ly desc ibe he esea ch ques ion and iden i y he epo as a sys ema ic e iew, me a-analysis, o bo h in he sub i le. (Example: An i- ascula endo helial g ow h ac o o neo ascula age- ela ed macula degene a ion - A sys ema ic e iew and me a-analysis.) P cis: The p cis should indica e a new insigh he a icle o e s o a p incipal con o e sy ha is add essed. S uc u ed Abs ac s: Abs ac s o sys ema ic e iews and me a-analysis mus be limi ed o 350 wo ds and include i e sec ions ollowing he PRISMA guidelines: Topic: p o ide an explici s a emen o he speci ic clinical ques ion being add essed wi h e e ence o a b ie desc ip ion o he pa icipan s, in e en ions (o exposu es), compa a o s, and ou comes examined. Clinical ele ance: cha ac e ize he magni ude and impo ance o he condi ion; when ele an , de ine he cu en s anda d o ca e. Me hods: desc ibe he key eligibili y c i e ia o including s udies in he sys ema ic e iew, key da abases sea ched and sea ch da es, me hods o assessing he isk o bias in he indi idual s udies. Resul s: summa ize he numbe and ype o included s udies and pa icipan s, and ele an cha ac e is ics o s udies; desc ibe he esul s o main ou comes (bene i s and ha ms), p e e ably indica ing he numbe o s udies and pa icipan s o each. I a me a-analysis was done, include summa y measu es and con idence in e als; epo he di ec ion o he e ec o associa ion (i.e., which g oup is a o ed) and size o he e ec using language meaning ul o clinicians and pa ien s. Conclusion: summa ize he s eng hs and limi a ions o he e idence, you gene al in e p e a ion o he esul s, and impo an implica ions. No e ha he abs ac con en and conclusions should ag ee wi h wha is in he manusc ip ex . Manusc ip ex The ex should use s anda d jou nal o ma ing and be di ided in o ou dis inc sec ions. The b ie desc ip ions below a e ga he ed om he PRISMA, he MOOSE guidelines, and he S anda ds o he Repo ing o Coch ane In e en ion Re iews. The ex should epo ins i u ional e iew boa d app o al o exemp ion, inancial disclosu es and po en ial con lic s o in e es o he au ho s, and unding sou ces o he e iew. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 18 1. In oduc ion (unlabeled) should p o ide a concise desc ip ion o he condi ion o clinical p oblem add essed by he e iew ques ion, p o ide pe spec i es on he impo ance o i s managemen o pa ien well-being and quali y o li e, and why i is impo an o do he e iew. Always end he in oduc ion wi h a clea and concise s a emen o he s udy's main objec i es o hypo heses. 2. Me hods: The me hods sec ion should include he ollowing subheadings: Eligibili y c i e ia o conside ing s udies o his e iew: s a e eligibili y c i e ia o pa icipan s, in e en ions (o exposu es) and compa a o s, and eligible s udy design(s) i applicable. De ine p ima y and seconda y ou comes o he e iew and s a e whe he an a icle had o epo measu emen o a leas one o he ou comes o be eligible. I so, p o ide a ionale. Sea ch me hods o iden i ying s udies: lis all in o ma ion sou ces sea ched, including da abases, ial egis ies, websi es, di icul - o-access li e a u e (e.g., g ey li e a u e, con e ence p oceedings), e e ence lis s o included s udies, and whe he indi iduals o o ganiza ions we e con ac ed. Fo all sea ches, p o ide he da e o he las sea ch and whe he he e was any ime pe iod o language es ic ion. P esen he exac ull sea ch s a egy (o s a egies) used o a leas one da abase in an Appendix wi h su icien de ail o pe mi eplica ion. Repo which so wa e was used o manage he eco ds iden i ied and eligibili y s a us. S udy selec ion: desc ibe he p ocess o selec ing s udies, how many people we e in ol ed a each s ep o he e iew, whe he any s eps we e done by mo e han one pe son, and i so whe he hey wo ked independen ly and how di e en opinions we e esol ed. Da a collec ion and isk o bias assessmen : Lis and de ine da a i ems ex ac ed om he epo s o included s udies. Desc ibe me hods used o assessing isk o bias o included s udies ( isk o bias is a o mal assessmen o wha is o en conside ed s udy "quali y"), and how his in o ma ion was used in any da a syn hesis. Desc ibe he p ocess o da a ex ac ion and isk o bias assessmen , how many people we e in ol ed a each s ep, whe he any s eps we e done by mo e han one pe son, and i so whe he hey wo ked independen ly and how di e en opinions we e esol ed. Repo he so wa e used o da a collec ion and managemen . Da a syn hesis and analysis: s a e he me hods o combining esul s ac oss s udies, which include quali a i e syn hesis (see Chap e 4, sec ion on "Quali a i e Syn hesis o he Body o E idence; Finding wha wo ks in heal h ca e: s anda ds o sys ema ic e iews) and quan i a i e syn hesis (i.e., me a-analysis). S a e he summa y measu es used o quan i y he ea men e ec o associa ion such as isk a io, odds a io, and di e ence in means. Desc ibe me hods o assessing clinical, me hodological, and s a is ical he e ogenei y (e.g., I2 s a is ic, au- squa ed, s a is ical es ). Desc ibe me hods o addi ional analyses such as me a- eg ession, subg oup analysis, and sensi i i y analysis, i done, indica e which we e p e-speci ied. S a e he s a is ical so wa e used o analysis. Indica e whe he a sys ema ic e iew p o ocol exis s, i so, whe e and how i can be accessed; and i a ailable, p o ide sys ema ic e iew egis a ion in o ma ion including egis a ion numbe . 3. Resul s: P o ide numbe s o s udies e ie ed, sc eened, assessed in ull o eligibili y, included in he e iew, and included in he me a-analysis, wi h easons o exclusion a each s age, ideally wi h a low diag am. P esen cha ac e is ics o included s udies including in o ma ion on he s udy design, pa icipan s, in e en ions (o exposu es) and compa a o s, ou comes, and sou ce o unding, ideally in a able. P esen domain-based isk o bias assessmen o each s udy, ideally in a able o a igu e. Composi e quali y sco es and scales a e discou aged. Fo all ou comes conside ed, i espec i e o he di ec ion o s eng h o he esul s, p esen , (1) simple summa y da a o each g oup, and (2) es ima es o ea men e ec (o associa ion) be ween g oups wi h a measu e o s a is ical unce ain y (e.g., con idence in e als). I me a-analysis was done, epo me a-analy ical esul s ideally wi h a o es plo , numbe o s udies and pa icipan s o each me a-analysis, as well as measu es o s a is ical he e ogenei y. P esen esul s o any addi ional analyses (such as me a- eg ession, subg oup analysis, and sensi i i y analysis) i done. P o ide a hough ul quali a i e syn hesis by analyzing he na u e, s eng hs, and weaknesses o he e idence, and de eloping a deepe unde s anding o how an in e en ion migh wo k (o no ), o whe he a ue associa ion exis s, o whom and unde wha ci cums ances. 4.Discussion: Summa izes he main indings including he s eng h o e idence o each main ou come. P o ide a gene al in e p e a ion o he e idence conside ing hei ele ance o key s akeholde s, including pa ien s, heal hca e p o ide s, esea che s, paye s, and policy make s. A Summa y o Findings o GRADE able is op ional. Discuss limi a ions a s udy and ou come le el AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 19 (such as isk o bias), and a e iew le el (such as incomple e e ie al o iden i ied s udies, epo ing biases). P o ide a gene al in e p e a ion o he esul s in he con ex o o he e idence, and implica ions o p ac ice and u u e esea ch. In he co e le e o he Edi o , please s a e explici ly (1) whe he epo ing guidelines ha e been ollowed, i so, which epo ing guidelines; (2) whe he he exac ull sea ch s a egy (o s a egies) used o a leas one da abase was p esen ed in an Appendix wi h su icien de ail o pe mi eplica ion. Failu e o ollow he epo ing guidelines o upload he sea ch s a egy may esul in delay in e iew o ejec ion o he manusc ip . Please submi a PRISMA wo kshee and diag am as sepa a e iles. Checklis : p isma-s a emen .o g/documen s/PRISMA%202009%20checklis .doc Diag am: p isma-s a emen .o g/documen s/PRISMA%202009%20 low%20diag am.doc T ansla ional Science Re iews T ansla ional Science Re iews aim o p o ide au ho i a i e summa ies o s a e-o - he-a esea ch ha b idges he gap be ween basic and clinical science and which may ha e b oad clinical impac wi hin a ew yea s. Fo example, in he yea s p io o he FDA app o al o an i-VEGF d ugs o ea neo ascula age ela ed macula degene a ion, an a icle in his sec ion migh ha e summa ized he ele an basic esea ch ha suppo ed Phase 1 human s udies o an i-VEGF d ugs ha a e now widely used. Manusc ip s should be b oadly accessible as he in ended audience includes oph halmologis s whose p ima y ocus is usually clinical p ac ice. Please a oid ja gon and do no assume ha labo a o y echniques will be unde s ood by all eade s. T ansla ional Science Re iews a e usually solici ed by he edi o o his sec ion, Ma co Za bin, M.D., Ph.D. Sugges ions o opics a e welcome, howe e , and can be di ec ed o D . Za bin (send sugges ions o [email p o ec ed] and add "TSR" in he subjec line). S a is ics S a is ical me hods mus be iden i ied in able oo no es, illus a ion legends, o ex explana ions. So wa e p og ams used o complex s a is ical analyses mus be iden i ied o enable e iewe s o e i y calcula ions. Fo manusc ip s in which he s udy conclusions in e equi alency in ea men e ec , a sample size calcula ion and powe analysis should be included. Le els o alpha and be a e o s should be clea ly s a ed in he Me hods sec ion o he Abs ac and ex . Au ho s should s a e he clinically signi ican di e ence ha was used o de e mine he powe calcula ion. The jou nal s ongly ad ises s a is ical consul a ion abou da a collec ion and analysis. We ollow The New England Jou nal Medicine’s guidelines o epo ing P alues: Excep when one- sided es s a e equi ed by s udy design, such as in non-in e io i y ials, all epo ed P alues should be wo-sided (excep when one-sided es s a e equi ed by s udy design). In gene al, P alues la ge han 0.01 should be epo ed o 2 decimal places, hose be ween 0.01 and 0.001 o 3 decimal places; P alues smalle han 0.001 should be epo ed as P < 0.001. No able excep ions o his policy include P alues a ising in he applica ion o s opping ules o he analysis o clinical ials and gene ic-sc eening s udies. Fo ables compa ing ea men o exposu e g oups in a andomized ial (usually he i s able in he ial epo ), signi ican di e ences be ween o among g oups should be indica ed by * o P < 0.05, ** o P < 0.01, and *** o P < 0.001 wi h an explana ion in he oo no e i equi ed. The body o he able should no include a column o P alues. S udy Design Au ho s a e asked o desc ibe he design o hei s udy as pa o he s uc u ed abs ac . Doing so se es se e al pu poses. I encou ages au ho s o gi e ca e ul hough o wha hey ha e ac ually done, i p o ides a use ul sho cu o edi o s and e iewe s o ca ego ize he submission, and i gi es he eade a use ul desc ip o o he ype o s udy ha was pe o med. The CONSORT Wo kshee h p://www.conso -s a emen .o g/Media/De aul /Downloads/CONSORT%202010%20Checklis .doc o andomized con olled ials has been equi ed since 1996 and is a ailable online. The ollowing cha (h ps://www.else ie .com/__da a/p omis_misc/OPHTHA_STUDY_DESIGN.docx) p o ides basic in o ma ion ega ding s udy designs. AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 20 Tables Tables equi e subs an ial space; please gi e ca e ul conside a ion o he numbe o ables submi ed and design ables o i on one o ma ed page. The in o ma ion should no be ex ensi ely i e a ed in he ex . Place he in o ma ion in he ex o in a able bu no bo h. Each able mus be i led and numbe ed consecu i ely as men ioned in he ex . Each column mus ha e a heading. Te minology used wi hin ables should be able o s and independen ly, wi hou he equi emen o explana ion om he ex . Use abb e ia ions and ac onyms only i impe a i e o easonable able o ma ing. All abb e ia ions and ac onyms mus be explained in he able legend. Re e ences o ables should be included in he main e e ence lis . I unpublished da a o abs ac need o be e e enced in a able, please place i as a oo no e. Tables o p in publica ion mus be uploaded as indi idual Wo d documen s, one able pe ile. I a able is longe han one page in Mic oso Wo d, i may be oo la ge o p in and would wo k be e as an online-only Supplemen al Table. Online-only Supplemen al Tables mus be uploaded as PDF iles, one able pe PDF ile. Supplemen al Tables mus be uploaded as “e-Componen ” ile ypes o you submission. Video Clips I submi ing ideo as an online supplemen , add a e e ence o i in pa en heses a an app op ia e place wi hin he ex o he manusc ip . Also, add a s a emen o he i le page ha should ead simila o “This a icle con ains a ideo as addi ional online-only ma e ial. The ollowing should appea online-only: Clip 1, Clip 2 and Clip 3.” The ma e ials will be a chi ed wi h he online e sion on he publishe ’s websi e. We do no ha e ideo edi ing so wa e, bu a websi e wi h use ul ips on educing ile size can be ound a h p://www.desksha e.com/Resou ces/a icles/dmc_ReduceFileSize.aspx Maximum: 8 minu es o al. We ecommend se e al smalle clips ha do no exceed 8 minu es. Size: ecommended size 10-50 MB, and he maximum size is 100 MB. File ex ension ypes: .MPG (MPEG-1 o 2), .AVI, .MOV Upload a s ill image o each ideo clip. Audio commen a y o desc ibe he ideo is highly ecommended. Please do no use backg ound music. Wi hin he submission, he e mus be a b ie legend desc ibing con en s o he ideo and indica es he iewing o de . Video iles should be loaded wi h he submission in o he elec onic submission sys em. File names should co espond o ideo legends. On he i le page include “This manusc ip con ains [inse numbe o ideo clips]. Upload wi h submission using he “mul imedia” ile ype. REVIEW PROCESS Re iew and Publica ion P ocess I is he co esponding au ho ’s esponsibili y o check pe iodically he s a us o his/he manusc ip . An email wi h a decision will be sen wi h ins uc ions o he co esponding au ho o go o he online submission si e i a e ision is wa an ed. Each manusc ip submission will be acknowledged in he o de ecei ed in he Edi o ial O ice. The acknowledgmen le e will no e he numbe assigned o he manusc ip . All subsequen inqui ies abou he manusc ip mus indica e he manusc ip numbe . Usually wo and some imes se e al e iewe s and Edi o ial Boa d membe s will pa icipa e in he e iew o a manusc ip . The jou nal does no e eal he iden i y o i s e iewe s bu does p o ide pe inen commen s o he co esponding au ho . Re- e iew may be equi ed a e e ision i , in he judgmen o he Edi o -in-Chie , su icien modi ica ion o he manusc ip o da a jus i ies ano he e iew cycle o i one (o mo e) o he e iewe s eques ed o see he e ision. A poin -by-poin esponse is equi ed o he e iewe s’ commen s. Au ho s should upload wo e sions o he e ised manusc ip – one showing “ ack changes” o show whe e e isions ha e been made and a “clean” copy. Re ised manusc ip s a e due wi hin 60 days. Re ision Submission I in i ed o e ise a manusc ip , he co esponding au ho will ecei e an email ha con ains he e ise decision as well as he e iewe s’ and/o edi o s’ commen s. Log on as an au ho o h ps://www.e ise.com/p o ile/api/na iga e/ORET wi h you use name and passwo d. The manusc ip will be in he au ho menu unde “My submissions ha need e ision” AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 21 Re iew he edi o / e ision commen s and, as app op ia e, make changes o iles based on hese commen s as well as he edi o ial o ice commen s. Sa e wo e sions o he manusc ip ile – one showing “ ack changes” and he o he a clean copy wi h all changes accep ed. When all iles a e e ised, go o h ps://www.e ise.com/p o ile/api/na iga e/ORET. Unde “My submissions ha need e ision” selec “Ag ee o Re ise” o s a he e ision submission. Ins uc ions a e p o ided on how o upload e ised iles and eplace old ones in he “Upload Files” sec ion. The ollowing File Types a e equi ed o submi a e ised a icle: Manusc ip File ( he clean e ised e sion) Re ised Manusc ip File wi h T ack Changes Highligh s (P écis) Au ho Ag eemen (Con ibu o ship Fo m) Con lic o In e es (ICMJE o m, one pe au ho ) Co e Le e Response o Re iewe s (Poin -by-Poin esponse) A inal oppo uni y is p o ided o e iew he comple ed e ised e sion be o e clicking he inal bu on “Comple e Submission.” Please ead and acknowledge he E hics in Publishing s a emen be o e inal submission. I you elec o wi hd aw you pape a he han submi a e ision, please log on o he sys em and selec “Decline o Re ise.” PLEASE REMEMBER: Poin -by-poin esponse: Please include a poin -by-poin esponse o each o he commen s om he e iewe (s), edi o (s), and/o edi o ial o ice. One echnique ha has p o ed use ul bo h o au ho s and he Edi o ial O ice is o c ea e a 3-columned able, in a Wo d ile, o summa ize you e isions. (See empla e h ps://www.else ie .com/__da a/p omis_misc/oph- empla e- o m.docx and sample h ps://www.else ie .com/__da a/p omis_misc/oph-sample- o m.docx.) In he i s column, lis he e iewe 's sugges ion, ques ion, o commen . In he second column, ou line you esponse. I you disag ee wi h he e iewe , please explain you easoning. In he hi d column, speci y whe e in he manusc ip you ha e made any changes. Adding line numbe s o he manusc ip ile and e e ing o speci ic line numbe s will be use ul in de e mining which pa s o he manusc ip changed. Please ensu e ha e isions in he ex a e also changed in any ele an ables o igu es. Re e ences: A i s e ision, please e iew he e e ence o ma s yle guide and ensu e ha e e ences a e in he co ec o ma .To expedi e p ocessing o a e ised manusc ip , please p o ide a pho ocopy o he i le page (including jou nal name, olume numbe , yea , page numbe s) o any wo k ci ed ha was published p io o 1970 in he Uni ed S a es. This in o ma ion can be submi ed as “ ela ed ile.” Figu es: Please no e any changes o igu es in he poin -by-poin esponse.I applicable, he e ision decision le e will p o ide ins uc ions on how o p epa e igu es o mee speci ic a wo k guidelines o he publishe . I you canno mee hese guidelines, con ac he edi o ial o ice be o e submi ing you e isions.Please inse in o he ex a i s men ion o he supplemen al igu es “(a ailable a www.aaojou nal.o g)” as well as speci y on he co e page which igu es a e o be online-only supplemen al ma e ials. Au ho s: Please ensu e he manusc ip i le on he co e page ma ches he i le en e ed in o he submission sys em. Any changes o au ho s equi e w i en explana ion, as de ailed abo e unde “Au ho ship.” File submission: Please upload wo e sions o you e ised manusc ip -- one showing “ ack changes” and one ha is “clean.” Do no submi mo e han one e sion o any o he ile ype unless speci ically eques ed by he edi o ial o ice. Each ile, e ised o no , should be he cu en e sion o he submission. I no done wi h he ini ial submission, ICMJE con lic o in e es o ms om all au ho s and he Con ibu o ship Fo m mus be included a e ision. Rejec ion o Manusc ip s By O he Jou nals Rejec ion by ano he jou nal does no comp omise conside a ion by Oph halmology Re ina. Au ho s a e equi ed o in o m he Edi o -in-Chie o ejec ion by ano he jou nal on he co e le e and include copies o he p e ious e iew commen a y and he au ho s’ esponses. Please use he poin -by-poin esponse empla e: h ps://www.else ie .com/__da a/p omis_misc/oph- empla e- o m.docx. Appeals Rega ding Manusc ip s Rejec ed by Oph halmology Re ina Oph halmology Re ina is able o accep a ela i ely small pe cen age o submissions ecei ed. The e o e, many good manusc ip s ha e o be declined, o en imes despi e a o able pee e iews. I you pape is ejec ed bu he e iews a e accu a e, please do no appeal he decision and eques addi ional e iews. Doing so dis ac s he jou nal's edi o s and e iewe s om e alua ing submissions AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 22 and edi o ial s a om p ocessing o he manusc ip s and is un ai o he au ho s o hose pape s. I , howe e , he e iewe o edi o assessmen s a e in econside ed, he Edi o -in-Chie will en e ain an appeal and eopen he manusc ip 's ile. Any appeal mus be made by he co esponding au ho o he Edi o ial O ice by email p io o esubmi ing he manusc ip . Please do no esubmi un il you o iginal manusc ip is eleased back o you. By wai ing o he manusc ip elease, i ensu es ha you pape is p ocessed unde he same manusc ip numbe , keeping he manusc ip his o y in ac . Occasionally, a manusc ip is ejec ed bu he Edi o ial Boa d o e s he op ion o esubmi a e ised, ab idged e sion as a Repo . Please see he Repo sec ion o de ails. Re e ence managemen so wa e Mos Else ie jou nals ha e hei e e ence empla e a ailable in many o he mos popula e e ence managemen so wa e p oduc s. These include all p oduc s ha suppo Ci a ion S yle Language s yles, such as Mendeley. Using ci a ion plug-ins om hese p oduc s, au ho s only need o selec he app op ia e jou nal empla e when p epa ing hei a icle, a e which ci a ions and bibliog aphies will be au oma ically o ma ed in he jou nal's s yle. I no empla e is ye a ailable o his jou nal, please ollow he o ma o he sample e e ences and ci a ions as shown in his Guide. I you use e e ence managemen so wa e, please ensu e ha you emo e all ield codes be o e submi ing he elec onic manusc ip . Mo e in o ma ion on how o emo e ield codes om di e en e e ence managemen so wa e. Use s o Mendeley Desk op can easily ins all he e e ence s yle o his jou nal by clicking he ollowing link: h p://open.mendeley.com/use-ci a ion-s yle/oph halmology When p epa ing you manusc ip , you will be able o selec his s yle using he Mendeley plug-ins o Mic oso Wo d o Lib eO ice. Da a s a emen To os e anspa ency, we encou age you o s a e he a ailabili y o you da a in you submission. This may be a equi emen o you unding body o ins i u ion. I you da a is una ailable o access o unsui able o pos , you will ha e he oppo uni y o indica e why du ing he submission p ocess, o example by s a ing ha he esea ch da a is con iden ial. The s a emen will appea wi h you published a icle on ScienceDi ec . Fo mo e in o ma ion, isi he Da a S a emen page. AFTER ACCEPTANCE P oo s I he submission is accep ed, he co esponding au ho will ecei e ypese page p oo s online. Each co esponding au ho is expec ed o p oo ead all pages ca e ully and answe all que ies posed by he copy edi o . Page p oo s should be e iewed by mo e han one pe son o enhance accu acy. All page p oo s mus be e u ned o he publishe wi hin 72 hou s o eceip o a oid delay in publica ion. The publishe does no send eminde s; esponding o he publishe wi h esponses o au ho que ies and eques ed changes is he co esponding au ho ’s esponsibili y. The jou nal ese es inal edi o ial app o al o s yle, o ma , and g amma . Rep in s A ep in o de o m will ei he be e-mailed o accompany you copyedi ed manusc ip and page p oo s. You mus e u n his o m o he publishe wi h you co ec ed page p oo s, whe he o no you o de ep in s. The cos o ep in s inc eases signi ican ly i hey a e o de ed a e he ini ial p in un. Rep in s, excep special o de s o 100 o mo e, a e a ailable only o au ho s. Co e Figu es Oph halmology Re ina publishes pho og aphs and images on he co e o he p in ed jou nal. The images a e selec ed by he Edi o ial Boa d. We will conside submissions o co e igu es accompanied by a desc ip i e cap ion om p o essional oph halmic pho og aphe s and clinicians. Co e igu es a e some imes gene a ed om igu es in a icles appea ing in a gi en issue. Images should be isually s iking, echnically excellen , and o app op ia e size o he co e o ma . AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 23 To submi an image o conside a ion as a co e , please send he iles o he edi o ial o ice a [email p o ec ed]. Please use he subjec heade “Co e Image o Oph halmology Re ina” so ha he e-mail is app op ia ely lagged. Send he edi o ial o ice a JPG e sion o he image along wi h a pho og aph i le, pho og aphe and ins i u ional a ilia ion, and equipmen used o cap u e he image. I he pho og aph is app op ia e, he edi o ial o ice will wo k wi h he submi e o gene a e app op ia e ile(s) o publica ion (see echnical conside a ions below). I an image is selec ed o use as a po en ial co e image, Oph halmology Re ina will need a comple ed copy igh ans e o m (see downloadable o ms). Once he o m is ecei ed, he edi o ial o ice will assign he image o a u u e issue. Please be awa e i may be se e al mon hs be o e i appea s in p in . Technical Conside a ions The ou -colo p in ing p ocess used in p oducing he jou nal co e equi es high esolu ion iles o achie e he bes quali y. Should an image be chosen o he co e , he ile(s) should be a ailable as minimally comp essed JPG o ideally uncomp essed (e.g., TIF o PSD) high esolu ion iles o a leas 8"x8" a 300 dpi. Sc een g abs om ideo (e en high de ini ion ideo) do no upscale adequa ely o p in and can appea blu ed; simila ly, ou pu om mos diagnos ic ins umen s do no upscale well and can look pixela ed. Please do no pe o m any pos -p ocessing o he digi al image o he han ligh dus ing and spo emo al. sRGB colo space is ine; do no con e o CMYK as his will be done by he publishe du ing p e-p ess p ocessing. The high esolu ion iles o inal publica ion a e usually oo big o send by e- mail. A web-based la ge ile ans e se ice (e.g., h p://www.yousendi .com) can be used; please con ac he edi o ial o ice (aaojou [email protected] g) i you need assis ance wi h ansmi ing la ge iles. Copy igh Conside a ions Copy igh o image(s) mus be ans e ed o he Ame ican Academy o Oph halmology. The copy igh ans e o m mus be signed by all lis ed au ho s. Please no e ha i he image has al eady appea ed as pa o an a icle in ano he jou nal o in a ex book, he au ho o pho og aphe p obably does no ha e he igh o ans e he copy igh o he AAO. Simila ly, i he image has appea ed as pa o a pho og aphy con es (and especially i i won a p ize), he condi ions o con es pa icipa ion should be cla i ied. The copy igh ans e o m should be submi ed o he edi o ial o ice a [email p o ec ed]. In P ess/Online Release A ailabili y o Accep ed A icle This jou nal makes a icles a ailable online as soon as possible a e accep ance. This conce ns he accep ed a icle (bo h in HTML and PDF o ma ), which has no ye been copyedi ed, ypese o p oo ead. A Digi al Objec Iden i ie (DOI) is alloca ed, he eby making i ully ci able and sea chable by i le, au ho name(s) and he ull ex . The a icle's PDF also ca ies a disclaime s a ing ha i is an unedi ed a icle. Subsequen p oduc ion s ages will simply eplace his e sion. Manusc ip s a e a ailable online as "in p ess" a icles a e comple ing he publishe ’s p oo ing p ocess. The online elease is no a d a e sion since i is p oduced a e all edi o ial and au ho co ec ions a e made; howe e , he e is a disclaime in case a c i ical e o is ound. No ou ine edi ing will occu once an a icle appea s online. The "in p ess" designa ion is emo ed as soon as he mon hly issue is a ailable online. I is he co esponding au ho 's esponsibili y ha all edi ing be done a he ime he o iginal p oo s a e ecei ed om he publishe and ha he publishe is no i ied immedia ely i he au ho s do no wish o ha e he "in p ess" a icle eleased online. All no i ica ions ega ding p oo app o als, p oo co ec ions, o eques s ha an a icle no be eleased "in p ess" p io o publica ion mus come om he co esponding au ho and sen o Ka y Powe s (k.powe s@else ie .com). AUTHOR INFORMATION PACK 8 Feb 2019 www.else ie .com/loca e/o e 24 Da a Sha ing To p omo e anspa ency and oppo uni ies o u he esea ch, au ho s o wo k published in Oph halmology Re ina a e encou aged o p o ide access o ele an da ase s in compliance wi h con empo a y epo ing s anda ds. Au ho s may use domain-speci ic public a chi es ( o example, ClinicalT ials.go , GenBank, P o ein Da a Bank), o gene ic da abases ( o example, Da a e se, D yad, Mendeley, o he Open Science F amewo k, o an ins i u ional eposi o y). Fo addi ional in o ma ion, please consul : Taichman DB, Backus J, Bae hge C, e al. Sha ing Clinical T ial Da a: A P oposal F om he In e na ional Commi ee o Medical Jou nal Edi o s. JAMA 2016;315(5):467-468. AUTHOR INQUIRIES I you ha e ques ions abou he submission p ocess o a e unable o access he sys em, please con ac he edi o ial o ice by e-mail a [email p o ec ed] o by phone a 415-447-0261. Communica ion abou manusc ip s occu p ima ily h ough email and only wi h co esponding au ho s, so i is impo an o au ho s o keep hei con ac in o ma ion (add ess, ins i u ion, phone numbe s, and e-mail add ess) cu en . © Copy igh 2018 Else ie | h ps://www.else ie .com