To assess associations of myopic macular degeneration (MMD) with intraocular pressure (IOP). The project included the population-based Beijing Eye Study (n=3335 participants; age: 40+ years), Ural Eye and Medical Study (n=5589; age: 40+ years), Ural Very Old Study (n=566; age: 85+ years) and Ural Children Eye Study (n=4325; age: 6+ years) and Central India Eye and Medical Study (n=4514; age: 30+ years). MMD was defined according to the Meta-analysis for Pathologic Myopia Study Group. The study population included 35 778 eyes (18 328 individuals) (age: 46.9±23.1 years; range: 6-100 years) (axial length: 23.2±1.0 mm; range: 18.08-34.20 mm). Longer axial length was associated with higher IOP (ß:0.03; p<0.001) with adjusting for age (ß:0.01; p<0.001), sex (ß:-0.19; p=0.006) and MMD-stage (ß:0.47; p<0.001). Intereye axial length difference correlated (r2=0.11) with higher intereye difference in IOP (ß: 0.03; p<0.001) after adjusting for age (ß: 0.06; p<0.001), sex (ß: -0.07; p<0.001) and higher intereye difference in MMD-stage (ß: 0.32; p<0.001). Higher intereye IOP difference correlated (r2=0.03) with higher intereye axial length difference (ß: 0.03; p<0.001) after adjusting for age (ß: -0.15; p<0.001), but not with intereye difference in MMD-stage (p=0.90). Higher intereye difference in MMD-stage was associated (r2=0.10) only with higher intereye axial length difference (ß: 0.32; p<0.001) and sex (ß: 0.01; p=0.04). Higher intereye difference in MMD prevalence (defined as MMD-stage 3+) correlated with intereye axial length difference (ß: 0.24; p<0.001) and female sex (ß: 0.02; p=0.006) but not with intereye IOP difference (p=0.14). Although IOP was associated with longer axial length, MMD stage and MMD prevalence were not significantly related to IOP, neither in an interindividual comparison nor in an intraindividual intereye comparison. The data point against a therapeutic IOP reduction as a measure to reduce development or progression of MMD.
To evaluate the efficacy and safety of low concentration atropine eye drops for reducing progression of myopia in children in the UK. Multicentre, double masked, superiority, placebo controlled, randomised trial. National Health Service hospital eye services and academic institutions at five UK centres. 289 children aged 6-12 years with myopia between -0.50 and -10.0 dioptres (D). Participants were allocated in ratio of 2:1 to atropine or placebo. One eye drop of preserved atropine 0.01% or placebo daily for two years. The primary outcome was spherical equivalent refractive error of both eyes measured by autorefractor under cycloplegia after two years. Secondary outcomes included change in axial length, best corrected distance and near visual acuity, reading speed, pupil diameter, spectacle correction, adverse event rates, quality of life, and tolerability. Outcomes were collected every six months. An electronic monitoring system was used to assess adherence. 192 participants were included in the atropine group and 97 in the placebo group, with an average age of 9.3 years (standard deviation (SD) 1.7 years). 207 (72%) reported white ethnicity, 161 (56%) were girls, and the mean level of myopia was -2.87 D (SD 1.71 D). A total of 235 (81%) participants completed the study, with primary outcome data available for 230 (80%) participants: 151 (79%) in the atropine group and 79 (81%) in the placebo group. Atropine eye drops were more effective than placebo in reducing myopia progression (mean difference 0.33 D, 95% confidence interval (CI) 0.17 to 0.49 D, P<0.001). Prespecified subgroup analyses did not show differences according to age, ethnicity, sex, or severity of myopia. Changes in central axial length were significantly less in the atropine group versus placebo group: mean difference 0.14 mm (95% CI 0.07 to 0.21, P<0.001). There were no differences in other secondary outcomes, except pupil diameter, which was greater in the atropine group (0.36 mm, 95% CI 0.17, 0.55, P<0.001), and no differences in frequency of adverse events or in tolerability measures. No serious adverse events were related to the trial drugs. Low concentration atropine (0.01%) eye drops significantly reduced progression of myopia and were well tolerated compared with placebo in children in the UK. ISRCTN registry ISRCTN99883695, ClinicalTrials.gov NCT03690089.
Congenital cataract is the commonest cause of preventable child blindness in the world. It affects 1: 3000 babies, 60% of whom will have bilateral disease. Although screening of the newborn red-reflex with an ophthalmoscope is recommended, there are questions over this technique's accuracy, particularly in non-specialist hands. Several studies in enriched paediatric eye clinic populations have demonstrated superior accuracy when a digital image of the the eye's reflection to infrared light is evaluated. This study uses a prototype infrared digital camera to test the hypothesis that the sensitivity and specificity of newborn screening using evaluation of the "infrared-reflex" image is superior to the standard red-reflex examination using ophthalmoscopy. 140,000 newborn babies will be recruited into the study from at least 13 maternity units in England over an 18 month period. Babies will have both the standard red-reflex assessment and evaluation of the infrared-reflex using a prototype device. Since specialist gold-standard evaluation of every participant is impractical, bespoke data linkage requests to NHS England will be made. Data from the red-reflex evaluation and the presence of codes relating to cataract diagnosis and/or treatment in Hospital Episode Statistics (HES) will be retrieved for each participant a minimum of 6 months after their birth. This data will be used to calculate relative and absolute sensitivity and specificity for each screening test and comparison of accuracy using the McNemar test. Secondary outcome measures will include comparison of accuracy in different ethnic groups and screener usability scores. Anticipated impact Confirmation of the hypothesis will support development of a commercial screening device and the possible revision of newborn screening recommendations. Trial registration The study is registered with clinicaltrials.gov: NCT05282147. Cloudiness of the lens of the eye, called a cataract, is the commonest cause of avoidable child blindness in the world, affecting 1 in 3000 UK infants. Surgery is required within 3 months to prevent permanent visual impairment. Although all babies born in the UK are screened for cataract soon after birth, late diagnosis continues to be a problem. Eye screening is currently performed by midwives shining a specialist torch (ophthalmoscope) into the eye to assess the red-reflex, like the “red eye” seen in flash photos. Cataract causes a dark shadow on the red-reflex. The test is difficult because bright white light constricts the pupils and makes the baby close their eyes. Assessment of the eye's reflection to infrared light (the "infrared-reflex") has been shown to be more accurate than the red-reflex for detecting cataract in children. Unlike white light, infrared light does not cause pupil constriction and eye closure. A digital camera "neocam" has been specially developed for this study to image the newborn "infrared-reflex". This study will compare the accuracy of red-reflex and infrared-reflex evaluation in 140,000 newborn babies recruited from at least 13 maternity units across England. All babies will have both the standard screening test and digital eye imaging with the study device. Babies who have a potential abnormality on either screening test will be referred for specialist examination. Hospital records will be used to identify those babies subsequently diagnosed with cataract. A more accurate screening test could prevent life-long disability and reduce costs to the NHS and society. This study will allow a future estimation of what these savings might be and whether changing to a digital imaging screening service in the UK might be justified. Potentially this could impact eye screening world-wide to prevent childhood blindness from cataract.
To characterise the distribution of retinal non-perfusion and its relationship with neovascularisation elsewhere (NVE) and visual acuity (VA) in referable diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA). Eyes with treatment-naïve moderately severe non-proliferative DR (NPDR) to proliferative diabetic retinopathy (PDR) (Diabetic Retinopathy Severity Scale (DRSS) level 43-60) with available UWFA were included in this study. Total and zonal non-perfusion and NVE area were manually delineated across concentric zones (central 1-10 mm, extended posterior >10-20 mm and mid-peripheral >20-30 mm diameter). The Non-Perfusion Index (NPI) was calculated as the ratio of non-perfused area to total area per zone. Associations between NPI, NVE, DR severity and best-recorded VA (BRVA) were assessed. A total of 133 eyes (60.9% NPDR, 39.1% PDR) were analysed. The highest NPI occurred in the mid-periphery (20-30 mm) and posterior pole (15-20 mm) zones, with nasal preponderance. NVE was most frequently observed in the posterior pole (66%) and nasal quadrants. Central and mid-peripheral NPI correlated with NVE area in corresponding zones, showing quadrant-specific associations. Receiver operating characteristic analysis identified a total NPI threshold of 0.23 to differentiate PDR from NPDR (area under the curve=0.798), with the lowest threshold in the superior quadrant. Neither NPI nor NVE area correlated with BRVA. NVE represents a localised response to adjacent ischaemia predominantly affecting the nasal and extended posterior retina. NPI threshold of 0.23 distinguishes proliferative from non-proliferative stages, with the superior quadrant showing greater susceptibility to NVE at lower ischaemic levels. No significant correlation found between NPI, NVE area and visual acuity.
Accurate paediatric refraction is essential for detecting and managing vision issues, including latent hyperopia, amblyopia, accommodative esotropia, and progressive myopia. Cycloplegic agents are critical for obtaining precise measurements in children, yet their use varies due to professional, regulatory, and systemic barriers. In Malaysia, where refractive services are divided between the public and private sectors, limited data exist on how eye care professionals implement cycloplegic refraction in paediatric practice. This cross-sectional study employed a self-administered questionnaire to survey licensed ophthalmologists, optometrists, and opticians within a 50-km radius of Kuala Lumpur. Participants were recruited through electronic invitations and purposive field visits. Descriptive statistics summarised paediatric refraction practices by profession and sector, and exploratory chi-square, Fisher's Exact, and trend analyses assessed sectoral differences. Among 222 respondents (61.3% private; 38.7% public), analysis revealed a statistically significant sectoral divide in practice patterns (p < 0.001). Public-sector optometrists administered cycloplegia to 82.3% of children aged 5-9 years, compared with 15.7% in private practice, representing an Odds Ratio of 24.97 (95% CI 10.35-60.21; χ² = 63.84, df = 1, p < 0.001). Private opticians reported 0% cycloplegia use across all age groups, while 79.5% of private optometrists who never used cycloplegia cited 'prohibited by law.' Public ophthalmologists commonly delegated refraction, with only 8.3% performing refraction in children aged 5-9 years. Free-text responses highlighted additional barriers, including workflow constraints, limited training, and misconceptions about the role of cycloplegia. Paediatric refraction practices in Kuala Lumpur vary substantially across sectors and professional groups. Despite its clinical importance, cycloplegia remains under-utilised-particularly in private practice. These exploratory findings highlight the need to improve access to cycloplegic agents, clarify professional scope, and address legal and institutional barriers as priorities for strengthening paediatric eye care in Malaysia.
To evaluate the conversion rate of glaucoma suspects to glaucoma in a tertiary eye centre in Singapore over 5 years. This is a retrospective cohort study of 101 glaucoma suspects followed up in a tertiary outpatient clinic at National University Hospital over 5 years from their first presentation. The cumulative incidence of conversion to glaucoma diagnosis and intervention was recorded. Risk factors for glaucoma conversion were calculated using Cox proportional hazard analysis, and cost analysis for glaucoma monitoring was performed. The probabilities of glaucoma suspects developing a clinical diagnosis of glaucoma at 1-, 2-, 3-, 4- and 5-years were 17.8%, 22.3%, 23.0%, 25.6% and 25.6%, respectively. Significant risk factors for conversion include: (1) family history of glaucoma (hazard ratio [HR] = 6.46, 95% confidence interval [CI] 1.72-24.21; p = 0.006), (2) intraocular pressure [IOP] >21 mmHg (IOP 22-24 mmHg, HR = 8.60, 95% CI 1.64-45.01; IOP > 24 mmHg, HR = 22.36, 95% CI 4.94-101.25; p = 0.011 and p < 0.001 respectively) and (3) age >75 years (HR = 6.28, 95% CI 1.88-20.93; p = 0.003). The mean annual direct cost incurred by a glaucoma suspect through their follow-up period (up to 5 years) was USD 336.97 ± USD 157.37. About 1 in 4 glaucoma suspects progressed to glaucoma over 5 years. Positive family history of glaucoma, IOP >21 mmHg and age >75 years were independent risk factors for conversion. Further guidelines to ensure more cost-effective healthcare resource allocation are advisable.
To describe the clinical characteristics and outcomes of intraocular inflammation (IOI) following intravitreal faricimab injection in a real-world setting. This retrospective single-centre cohort study evaluated eyes developing IOI following intravitreal faricimab injection. Clinical characteristics, SUN-graded inflammatory features, intraocular pressure (IOP) changes, and time to resolution were analysed. A total of 14 eyes from 13 patients developed IOI following intravitreal faricimab injection, corresponding to an incidence of 0.13% per injection. All eyes developed anterior chamber inflammation, with two-thirds also demonstrating associated vitritis. Fifty percent (7/14 eyes) presented with an IOP > 21 mmHg. Overall, IOP increased from baseline in 11/14 eyes (79%), with 5 eyes (36%) demonstrating a clinically significant rise of ≥10 mmHg. The severity of acute anterior uveitis and vitritis correlated positively with time to resolution, whereas the presence of hypertensive uveitis did not significantly affect resolution time. The mean time to resolution was approximately two months. This study provides a comprehensive characterisation of post-faricimab IOI, including detailed SUN-graded phenotyping, IOP outcomes, and recurrent inflammatory episodes. Greater inflammatory severity was associated with prolonged resolution time, while hypertensive features did not appear to influence inflammatory recovery.
To determine the sensitivity of ultra-widefield imaging (UWFI) for detecting retinal breaks in primary rhegmatogenous retinal detachment (RRD) and to evaluate its utility for preoperative localisation. We included adults with primary RRD who underwent PPV and had preoperative UWFI. Intraoperative scleral indentation served as reference standard. Breaks were classified by morphology and by a fovea-centred, right-eye standardised clock-hour system. The primary outcome was causative-break detection on UWFI and quadrant-level sensitivities were secondary. Among 363 eyes with primary RRD, 9 were excluded for vitreous haemorrhage, leaving 354 eyes for analysis. The causative break was detected on UWFI in 208 eyes (58.8%). All breaks were identified on UWFI in 148 eyes (41.8%). Compared with the not-detected group, the detected group was younger (57.8 ± 9.5 vs 61.3 ± 11.6, P = 0.003), had a higher phakic rate (84.6% vs 78.0%, P = 0.041), and showed a smaller detachment extent (1.88 ± 0.72 vs 2.08 ± 0.87 quadrants, P = 0.025). Horseshoe tears were more common in the detected group (80.3% vs 57.5%, P < 0.001), while round holes were more frequent in the not-detected group (42.5% vs 16.8%, P < 0.001). Overall sensitivity for all breaks was 49.1% (308/627). Detection was highest in the temporal quadrant (69.2%) and lower in the nasal (45.9%), superior (45.2%), and inferior (33.0%) quadrants. Clock-hour analysis peaked at 9 to 10 o'clock and was lowest at 5 to 6 o'clock, indicating better temporal and poorer inferior detection. UWFI alone has limited sensitivity for detecting retinal breaks in patients undergoing retinal detachment repair. UWFI may complement but not replace scleral indentation in perioperative evaluation.
To characterise structural optical coherence tomography (OCT) biomarkers at intermediate age-related macular degeneration(iAMD) stage able to differentiate the progression to neovascular AMD(nAMD) or to geographic atrophy (GA) in a high-risk iAMD population showing conversion at 1-year follow-up. multicentre, retrospective, longitudinal study including patients with iAMD at baseline who developed late AMD (nAMD or GA) during the 1-year follow-up. Patients were enroled in three retinal referral institutions: (1) San Raffaele University, Milan, Italy; (2) IRCCS Bietti Foundation, Rome, Italy; (3) University of Paris Est, Creteil, France. Logistic regression model (LRM) analyses were performed to evaluate the prognostic ability of the studied biomarkers in discriminating between nAMD and GA conversion. We included 154 eyes (154 patients, mean age 80 ± 7 years old) with iAMD at the baseline. Eighty-eight eyes(57%) progressed to nAMD, whereas 66 eyes(43%) progressed to GA. Eyes that progressed to nAMD were characterised by a higher double-layer sign(DLS) prevalence (p < 0.001), whereas eyes that progressed to GA were characterised by greater height and diameter of the greatest drusen (p < 0.001 and p = 0.001, respectively), higher presence of HRF(p = 0.008), and iRORA(p < 0.001). LRM confirmed that DLS is a significant risk factor for nAMD conversion (OR:3.626, p = 0.037), whereas height of greatest drusen (OR:0.983, p = 0.003), presence of HRF (OR:0.147, p = 0.009), and presence of iRORA (OR:0.052, p < 0.001) were more associated with GA conversion. Structural OCT biomarkers at the iAMD stage could help clinicians to distinguish between patients who will develop nAMD in comparison to GA. Our findings can contribute to the better management of patients with iAMD.
To compare efficacy, safety, and surgical success of standalone Preserflo MicroShunt (PMS) implantation versus PMS combined with phacoemulsification in open-angle glaucoma (OAG). A retrospective cohort study included consecutive OAG patients who underwent standalone or combined PMS surgery with 0.04% mitomycin C at a tertiary centre. Primary outcomes were intraocular pressure (IOP), glaucoma medications, and surgical success at 2 years. Success was defined as ≥20% IOP reduction with IOP <18 mmHg (criterion 1) or ≥30% reduction with IOP <18 mmHg (criterion 2). A total of 173 eyes (113 standalone, 60 combined) were analysed. Mean IOP decreased from 22.1 ± 5.8 mmHg to 12.5 ± 3.1 mmHg ( - 39.4%) in the standalone group and from 20.6 ± 6.7 mmHg to 14.2 ± 4.0 mmHg ( - 33.0%) in the combined group (p = 0.023; 95% CI -3.16 to -0.25), with similar medication use in both groups. Success rates were 76.1% versus 61.7% for criterion 1 (p = 0.084) and 70.0% versus 41.7% for criterion 2 (p = 0.001). Kaplan-Meier analysis showed higher cumulative success in standalone surgery (criterion 1: HR 1.77, p = 0.044; criterion 2: HR 2.40, p = 0.0003). Complications occurred in 38.2% of eyes (36.3% standalone, 41.7% combined), with only 6.4% requiring surgical intervention. Both standalone and combined PMS implantation achieved significant IOP and medication reductions with acceptable safety. However, standalone PMS appears to offer superior mid-term IOP control and higher surgical success, supporting its use in advanced glaucoma cases requiring maximal pressure reduction.
Evidence is required on the relative effectiveness of sulphonylureas, dipeptidyl peptidase-4 inhibitors or sodium-glucose cotransporter 2 inhibitors added to metformin for people with type 2 diabetes mellitus. To assess disparities in the initiation of second-line antidiabetic treatments prescribed among people with type 2 diabetes mellitus in England according to ethnicity and social deprivation. To compare the effectiveness of sulphonylureas, dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter 2 inhibitors added to metformin for people with type 2 diabetes mellitus who require second-line treatment in routine clinical practice. To examine heterogeneity in the comparative short-term (12 months) effectiveness of sulphonylureas versus dipeptidyl peptidase-4 inhibitors combined with metformin on levels of glycated haemoglobin across the entire target population and subpopulations of decision-making relevance. To assess the comparative effectiveness of sulphonylureas, dipeptidyl peptidase-4 inhibitors or sodium-glucose cotransporter 2 inhibitors added to metformin according to individual risk-factor profiles of multiple long-term conditions. To calibrate the RAPIDS microsimulation model to UK data and then use the resultant RAPIDS-UK model to predict probabilities of long-term complications for people with type 2 diabetes mellitus in England after second-line treatment with sulphonylureas, dipeptidyl peptidase-4 inhibitors or sodium-glucose cotransporter 2 inhibitors added to metformin. We included adults with type 2 diabetes mellitus who initiated second-line antidiabetic treatment with sulphonylureas, dipeptidyl peptidase-4 inhibitors or sodium-glucose cotransporter 2 inhibitors added to metformin monotherapy. We used data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics and the Office of National Statistics. We applied target trial emulation and instrumental variable analyses to reduce the risks of biases, including confounding. The primary outcome was change in mean glycated haemoglobin (mmol/mol) at 1-year follow-up. Secondary outcomes: change in mean body mass index, systolic blood pressure, estimated glomerular filtration rate and time to major adverse kidney event, major adverse cardiovascular event, heart failure hospitalisation, eye disease, amputation and all-cause mortality. We assessed treatment effect heterogeneity according to multiple long-term conditions. We used a microsimulation model to report the impact on long-term complications. After the instrumental variable analysis, the mean 95% confidence interval differences in glycated haemoglobin change between baseline and 1 year were: -2.5 mmol/mol (-3.7 to -1.3) for sodium-glucose cotransporter 2 inhibitors versus sulphonylureas, and -3.2 mmol/mol (-4.6 to -1.8) for sodium-glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors. Sodium-glucose cotransporter 2 inhibitors were more effective in reducing body mass index and systolic blood pressure compared to either sulphonylureas or dipeptidyl peptidase-4 inhibitors. Sodium-glucose cotransporter 2 inhibitors were also more effective at reducing mean glycated haemoglobin at 2-year follow-up, at reducing body mass index and systolic blood pressure at 1- and 2-year follow-ups and at reducing the hazards of heart failure hospitalisation (vs. dipeptidyl peptidase-4 inhibitors) and ≥ 40% decline in estimated glomerular filtration rate (vs. sulphonylureas). We did not find evidence of treatment effect heterogeneity by baseline cardiovascular disease status or multiple long-term condition profiles. The microsimulation model found that sodium-glucose cotransporter 2 inhibitors led to lower predicted incidence of end-stage kidney disease, heart failure and eye disease. Public and patient involvement translation workshop participants provided valuable insights on how best to share our findings. We could only partially evaluate the main instrumental variable assumptions. We found that sodium-glucose cotransporter 2 inhibitors were better than dipeptidyl peptidase-4 inhibitors and sulphonylureas at improving important risk factors and at reducing the risk of complications among a general population of people with type 2 diabetes mellitus. Newer antidiabetic treatments should be evaluated. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128490. In the United Kingdom, around 4 million people have been diagnosed with type 2 diabetes, which causes high levels of sugar (glucose) in the blood. Most people start treatment with a drug called metformin, but some will later need to take additional drugs when metformin is not effective enough. We do not know drugs are best to use with metformin. We looked at the health care information routinely collected about people with type 2 diabetes when they use the National Health Service. We used the information collected between 2015 and 2021 to investigate which treatments worked best. We included 75,739 people in our study, all of whom received one of the three drug types below in addition to metformin: sulphonylureas (e.g. Diamicron) dipeptidyl peptidase-4 inhibitors (e.g. Januvia) sodium–glucose cotransporter 2 inhibitors (e.g. Forxiga). There was a lot of variation across different groups of general practices in the treatment they prescribed. We found that sodium–glucose cotransporter 2 inhibitors were more effective than sulphonylureas or dipeptidyl peptidase-4 inhibitors in reducing blood sugar levels, body mass index and blood pressure and preventing hospitalisation due to heart failure. For other outcomes (like preventing or delaying heart attack, stroke or death), there was no clear difference between drug types. Our results show that using sodium–glucose cotransporter 2 inhibitors alongside metformin may help patients manage some of the common symptoms and side effects of their diabetes. However, some of these effects are quite small. There will be people whose personal circumstances mean that the drug they are taking works especially well for them. Where we did not see a significant difference between drug types, this may be because we did not have data for enough people over a long enough period.
The eye is a recognized source of biomarkers for cardiovascular and neurodegenerative disease risk. Here we characterize the breadth of these associations and identify biological axes that may mediate them. Using UK Biobank data, we developed a multi-omic analysis pipeline integrating physiological, radiomic, metabolomic and genomic information. We trained retinal adversarial autoencoders to represent optical coherence tomography images and color fundus photographs as 256-dimensional embeddings. Retinal adversarial autoencoder-derived embeddings were associated with a range of cardiovascular and neurodegenerative diseases, including ischemic heart disease, cerebrovascular disease, Parkinson's disease and dementia. Examining associations across diverse omics datasets, we provide evidence linking ophthalmic imaging features to neurological and cardiovascular anatomy and function, lipid metabolism and gene sets associated with neurodegenerative pathology. Collectively, our findings show that ophthalmic features reflect complex, multisystem biological processes and reinforce the role of the eye as a composite indicator of systemic health.
Visual field testing is essential for monitoring field defects, but traditional devices are bulky and resource intensive. This study evaluated the agreement and usability of the RetinaLogik RVF100 virtual reality perimetry device compared with the Humphrey visual field analyzer (HVF) among Filipino adults. A comparative cross-sectional study. Participants were Filipino adults presenting to 2 major eye centres in the Philippines from January to October 2024. A total of 46 participants (76 eyes) were included. Participants were categorized as normal, glaucoma, or other diagnoses (e.g., optic neuritis, ocular hypertension). Both devices tested visual fields using the 30-2 grid, measuring mean deviation (MD), pattern standard deviation (PSD), fixation losses (FL), false positives (FP), false negatives, and test duration. Agreement was assessed using Bland-Altman analysis and Pearson correlation. Pointwise analyses with heatmap visualizations were also used. Usability was evaluated using a postexamination Likert-scale questionnaire. RVF100 demonstrated strong agreement with HVF (MD: r = 0.979, PSD: r = 0.837; p < .0001). The Bland-Altman analysis showed a mean difference in sensitivity of -1.06 decibels (dB) (95% CI: -4.2 to 2 dB). RVF100 had shorter test durations (5.41 vs 6.96 min; p < 0.001), fewer FL (1.79% vs 5.59%; p < 0.001), and slightly higher FP rates (3.44% vs 1.92%; p < 0.001). Usability results showed 90% preferred RVF100 over HVF for comfort (86.4%) and engagement (95.3%). RVF100 is a comparable alternative to HVF, offering comparable accuracy with improved patient comfort. Further research is warranted to assess its efficacy in detecting early and advanced disease stages and in broader populations.
Increasing reports of plastic accumulation in human tissue have raised concerns about potential adverse health outcomes. Evidence of negative effects of nanoplastics is heterogeneous and provides limited insights into the underlying pathogenic toxicity mechanisms in humans. In the present study, carboxylate-modified fluorescently labelled polystyrene nanoparticles (PS NPs) were used to investigate uptake and cytotoxicity in three different hepatic models of varying complexity, including HepG2 cells, IHH cells, and human precision-cut liver slices (hPCLS). The results show model- and dose-dependent effects on hepatocytes. 74.2% ± 13.4% of the IHH cells showed PS NPs uptake at 0.1 μg/mL, which is considerably lower than the estimated plastic concentration in human blood (1.8-4.7 μg/mL). The viability of IHH cells decreased to 10.6% ± 9.1% after exposure to 100 μg/mL for 48 h. Early signs of hepatic injury were found in hPCLS at high concentrations. No changes were observed in the redox state and mitochondrial respiratory parameters of HepG2 cells after exposure. The PS NPs exposure experiments show uptake across all three hepatic models and toxic effects in IHH cells and hPCLS. Overall, the study highlights the need for physiologically relevant human tissue models to understand the impact of nanoplastic pollution on human health. Particles of plastic described as microplastics (MP) and nanoplastics (NP) are accumulating in the environment from a range of sources, including the fragmentation of large plastic items during use and after disposal. NPs are invisible to the naked eye and can enter the human body by consuming food and drinks and breathing air containing these particles. Once inside the body, NPs can reach and accumulate in the organs and body tissues. This study used three models of the liver to test what happens after exposure to polystyrene NPs. It shows that polystyrene NPs can accumulate in the liver cells even at low exposure levels and can also cause damage and death of liver cells at higher levels. The study adds to the scientific evidence of harmful effects of NPs on human health, the environment, and economies and pushes for policies towards a sustainable future.
Selective laser trabeculoplasty (SLT) has increasingly been used as a first-line glaucoma treatment. To better understand its impact on the Canadian patient and health care system, a cost-effectiveness analysis was performed to compare SLT against topical eye medications for patients with newly diagnosed open-angle glaucoma. Using a Markov model with a 20-year horizon from a health care payer perspective, the incremental cost-effectiveness ratio (ICER) of treating newly diagnosed mild open-angle glaucoma with SLT and medication was calculated. A discount rate of 1.5% was applied to all costs and health outcomes. Sensitivity and probabilistic analyses were performed to test the uncertainty of the model. The base case analysis indicated that patients who received the SLT treatment had a lower health care system cost of $1,671.48 and a higher quality-adjusted life year of 0.09 per patient compared with the medication treatment. As a result, the SLT treatment dominates medication treatment. The one-way cost-effectiveness sensitivity analysis showed that SLT dominates the medication treatment at all discount rates between 0% and 3%. The largest effects on the ICER value were variations in medication utility of ocular hypertension and mild glaucoma state, and SLT utility of mild glaucoma state, based on the tornado diagram. Probabilistic sensitivity analyses also demonstrated that the SLT treatment dominated the medication treatment. Our model suggests that SLT as the initial treatment strategy for glaucoma patients and investment in SLT could lead to improved clinical outcomes, costs, and resource utilization within the Canadian health care system.
A fundamental question in cognitive science is how information from internal memory is combined with external sensory input when making decisions. We hypothesized that previously learned and currently perceived information trade-off against each other, such that information from one source reduces the gathering and usage of information from the other. To test this hypothesis, we designed a two-armed bandit task where each arm is composed of both learned and perceived elements. We monitored participants' gathering of perceptual information using eye tracking. Participants' choices and gaze deployment showed a trade-off between the impact of learned and perceived information. The more a participant utilized internally stored learned information, the less they gathered perceptual information, and vice versa. To understand the factors underlying the trade-off, we developed a computational model of participants' information gathering. This showed that the trade-off results from the faster gathering of learned information, which makes it less valuable to invest effort in gathering additional perceptual information. Preliminary findings also suggested that an individual's tendency to primarily rely on one source of information is a stable individual trait. These findings contribute to the understanding of how humans use learning and perception in forming decisions.
Emergency nurses are frequently the first point of contact for patients presenting to the emergency department (ED) with the symptoms of acute psychosis. Altered perception, fear and disorganised thinking can impair communication and precipitate distress, which may lead to agitation or aggressive behaviour, placing patients and staff at increased risk of harm. In these circumstances, verbal reasoning alone may be ineffective. Evidence indicates that non-verbal communication, such as body posture, eye-level alignment, proximity and tone of voice, can have a pivotal role in these situations by promoting calm and conveying safety, thereby preventing escalation to coercive or restrictive measures. Drawing on research and trauma-informed care principles, this article explores how emergency nurses can adapt Safewards interventions such as soft words, talk down and reassurance into effective non-verbal communication strategies in their practice. The authors provide guidance on embedding non-verbal de-escalation in routine ED nursing practice, highlighting approaches that are transferable to a wide range of mental health-related presentations and have the potential to improve safety, preserve dignity and strengthen therapeutic engagement in emergency care.
Social connection is essential for well-being, yet people often avoid interacting with strangers due to concerns about conversation quality or a lack of shared interests. This study investigates whether the Happy to Chat badge can act as a behavioural nudge to promote social connectedness. Using a nationally representative online sample of 1,738 adults in England (via YouGov), we tested whether wearing the badge influences perceptions of friendliness, trustworthiness, and interest in conversation, as well as social behaviours such as smiling, eye contact, nodding, and willingness to initiate a chat. Results show that badge wearers are perceived as significantly more friendly, trustworthy, and open to conversation, and are more likely to receive social acknowledgements, although wearing the badge did not significantly increase others' intention to initiate conversation. Age and gender effects were also observed, with older and female targets generally receiving more favourable social responses. These findings suggest that while the badge effectively promotes social recognition, it may be insufficient on its own to overcome deeper psychological barriers to initiating conversations with strangers. This paper confirms the effectiveness of the Happy to Chat badge as a nudge to promote social connectedness within communities and highlights its practical implications.
Introduced in 2014 and revised in 2018, the entropic brain hypothesis has accrued a wealth of supportive evidence. The hypothesis states that-along a dimension of the size of phenomenal consciousness-expansive states reliably exhibit increased brain entropy whereas the inverse applies for states of no or reduced consciousness. Examples of expansive states include expert meditation, flicker light stimulation, near-death-like experiences, atypical breathing, rapid-eye-movement sleep, the pre-ictal aura, unmedicated early psychosis and psychedelic drug states. Examples of states of no or reduced consciousness with low brain entropy, include disorders of consciousness, deep sleep, the anesthetized state, seizure, post-stroke, ageing, cognitive impairment, and neurodegenerative illness. It is shown that the entropic brain has convergent, correlative, predictive, discriminative and external validity. Regarding its predictive validity, increased brain entropy under psilocybin (in a supportive context) predicts subsequent improvements in mental health (improved wellbeing 1-month post-dose). Regarding its discriminative validity, changes in brain entropy selectively index the breadth of subjective experience versus alternative dimensions, such as arousal. Regarding portability/external validity, an entropy-related function is applied in generative artificial intelligence. In conclusion, the entropic brain is a useful model of conscious states.