Visual Benefit Research Articles

Visual and ocular surface benefits of mini-scleral contact lenses in patients with chronic ocular graft-versus-host disease (GvHD)

Graft-versus-Host disease is a major complication of allogeneic stem cell transplantation. The eyes are a frequently affected organ with a severe dry eye disease being the hallmark manifestation. This retrospective study evaluates the effect of mini-scleral contact lenses on visual acuity, eye-related quality of life and the ocular surface. 62 eyes of 31 patients were included and visual acuity, ocular surface disease index (OSDI) questionnaire results and Oxford grades before and after mini-scleral lens fitting were compared. Median Snellen fraction with mini-scleral lenses was 20/25 (1st 20/30/3rd 20/20) compared to 20/40 median Snellen fraction with spectacles (1st 20/60/3rd 20/25). Median OSDI scores improved from 73 (1st 41.6/3rd 89) before fitting to 27 (1st 14.5/3rd 56) with mini-scleral lenses. Median Oxford grade decreased from 3 before mini-scleral lens fitting (1st 1/3rd 4.75) to 1 after mini-scleral lens fitting (1st 0/3rd 4). Median time of follow up was 717.5 days. Seven patients (22.6%) discontinued therapy with mini-scleral lenses. Mini-scleral lenses are beneficial for most patients with ocular GvHD as they improve visual acuity, eye-related quality of life and the integrity of the corneal epithelium.

Therapies for Central Serous Chorioretinopathy: A Report by the American Academy of Ophthalmology

To assess the safety and efficacy of the multiple therapeutic modalities for the treatment of central serous chorioretinopathy (CSCR). A literature search of English-language studies in the PubMed database with no date restrictions was last conducted in May 2024. The combined searches yielded 612 citations, 31 of which were selected for full-text review and for inclusion in this assessment. The panel methodologist assigned a level of evidence rating to each study. Six were assigned a level I rating, 23 were assigned a level II rating, and 2 were assigned a level III rating. Studies were categorized based on treatment modalities: laser-based therapy, intravitreal therapy, laser-based therapy versus intravitreal therapy, and systemic therapies. Within those categories, they were separated based on treatments for acute versus chronic CSCR. One level I study showed that photodynamic therapy (PDT) using half-dose verteporfin for acute CSCR led to a significant decrease in subretinal fluid (SRF) with 95% of treated patients having no SRF at 12 months compared with 58% of untreated eyes with acute CSCR (P= 0.001). Anatomically, the mean CFT at 1 year was significantly lower in the treated group (161 ± 65 μm) versus the observation group (278 ± 92 μm) (P= 0.001). A second level I study compared half-dose verteporfin PDT versus 30%-dose verteporfin PDT and found that 94.6% in the half-dose PDT group had no SRF at 12 months compared with 75.4% in the 30%-dose PDT group (P= 0.004). The noninferiority of the 30%-dose PDT compared with half-dose PDT was not demonstrated. The VICI trial was a level I study that found no benefit with the use of mineralocorticoid antagonism with eplerenone for the treatment of chronic CSCR. With respect to the primary outcome of visual acuity (VA), the VICI trial found no significant difference at 12 months: 79.5 letters in the placebo group and 80.4 letters in the eplerenone group (P= 0.24). In general, the results from the other evaluated studies were inconsistent and thus inconclusive. There were no level I studies that supported the role of intravitreal anti-VEGF injections or systemic beta-blockers for patients with CSCR. A small level I study showed potential efficacy of Helicobacter pylori therapy for CSCR. There is evidence to support half-dose PDT for the treatment of acute CSCR regarding anatomic improvement, but less robust evidence supports improvement in VA or sustained anatomic benefit beyond 12 months. Intravitreal anti-VEGF injections and oral beta-blockers demonstrate inconsistent anatomic and visual benefits in patients with CSCR. The mineralocorticoid antagonist eplerenone has not been demonstrated as efficacious for treatment of chronic CSCR. The treatment of H.pylori infection may have some anatomic and visual benefit in the treatment of either acute or chronic CSCR. Acute CSCR resolves spontaneously without treatment in most eyes. Proprietary or commercial disclosure may be found after the references.

IMPROVING PURCHASING DECISIONS THROUGH PERCEIVED FOOD QUALITY: AN SERVICE DOMINANT LOGIC (SDL) APPROACH

This study aimed to investigate the impact of visual and verbal packaging on purchasing choices by assessing the perceived quality of food. One hundred seventy-five respondents were surveyed, specifically consumers who purchase MSME food goods in Banyumas Regency, including food, beverages, crafts, and other packaged items. This study employs AMOS structural equation modelling to examine the proposed research model. The findings indicate that visual and verbal packaging benefits the perceived quality of food and influences consumers' purchasing choices. The variable of perceived food quality has a beneficial influence on purchase decisions and can operate as a mediator between visual and verbal packaging regarding buying decisions. The model is grounded in the Service's Dominant logic and the consumption value theory. According to this theory, consumer behaviour is influenced by cognitive and hedonic evaluations that stem from consumption experiences. These experiences highlight the active involvement of consumers in creating value during their interactions with products, including visual packaging, verbal packaging, and perceived food quality.

Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit.

To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm. Retrospective, monocentric, consecutive case series. Patients with primary MH operated at Lariboisière Hospital, Paris, France. Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed. Postoperative MH closure rate and visual acuity. 74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameterwas 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR. MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.

Factors That Influence Clinician Prescribing of Corticosteroids for Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis: A Qualitative Study.

Treatment with corticosteroids is common for patients with idiopathic and multiple sclerosis-associated optic neuritis (I/MS-ON). Yet, the Optic Neuritis Treatment Trial and meta-analyses confirm that few patients benefit and that visual benefit is of questionable clinical significance, short-lived, and comes with potential harms. The purpose of this study was to uncover the breadth of factors that underlie clinicians' treatment decisions and determine how these factors may influence corticosteroid use for I/MS-ON. We performed semistructured, one-on-one, qualitative interviews with neurologists, neuro-ophthalmologists, and emergency department clinicians at 15 academic and private practices across the United States. The interview guide used the Theoretical Domain Framework and a vignette to explore numerous factors that might influence decision making for definite I/MS-ON. We analyzed transcripts using inductive thematic analysis to generate themes. A total of 22 clinicians were interviewed before thematic saturation was reached: 8 neuro-ophthalmologists, 8 neurologists, and 6 emergency medicine (EM) clinicians (2 physician assistants, 4 physicians). All neuro-ophthalmologists and nearly all neurologists (7 of 8) were aware of risks/benefits of corticosteroid treatment for I/MS-ON. However, neuro-ophthalmologists varied in their corticosteroid treatment recommendation (n = 3 recommended treatment, n = 2 recommended observation, n = 3 recommended shared decision making), whereas all neurologists recommended corticosteroids, indicating that knowledge of corticosteroid risk/benefit alone does not drive decision making. EM clinicians were not aware of risk/benefits of corticosteroid treatment for I/MS-ON and relied on the treatment recommendations of neurologists. Clinicians recommending corticosteroids held personal beliefs that corticosteroids benefit those with worse vision loss, relieve pain, allow earlier return to work, or have easily mitigated side effects. They also perceived that prescribing steroid was the principal method of "doing something," which fit a key provider role. Clinicians who did not recommend corticosteroids or were neutral perceived the risks as nontrivial, considered discussing treatment trade-offs as "doing something" and incorporated patient preferences. Knowledge of risk/benefits of corticosteroids are necessary but not sufficient for evidence-based I/MS-ON practice. Variation in how clinicians treat patients with acute I/MS-ON is influenced largely by psychosocial factors, such as beliefs about corticosteroid risk/benefit trade-offs and the role of the clinician to provide treatment. Interventions to support evidence-based decision making for I/MS-ON treatment will need to provide risk/benefit information to support clinicians with varying levels of expertise, incorporate patient preference, and normalize the option to observe.

The incidence, monitoring coverage and clinical characteristics of hydroxychloroquine retinopathy in the United Kingdom

BackgroundRetinal monitoring is recommended for hydroxychloroquine users to detect pre-symptomatic retinopathy and preserve visual function. However, the incidence of hydroxychloroquine retinopathy and monitoring coverage in the U.K. are incompletely characterised. Moreover, the visual benefits of monitoring for retinopathy – recommended for over 70,000 long-term hydroxychloroquine users in the U.K. - remain unproven.MethodsA national, prospective observational study was undertaken with the British Ophthalmological Surveillance Unit (BOSU). Newly diagnosed cases of hydroxychloroquine retinopathy in the U.K. were reported and data captured using a standardised questionnaire over 3.5 years (July 2018–Dec 2021). The frequency of retinopathy and coverage of monitoring amongst long-term users was estimated. Visual function was compared between asymptomatic individuals detected on monitoring and those presenting with visual symptoms. The clinical characteristics, dosing and management of reported cases were captured.ResultsThe annualised number of incident cases of hydroxychloroquine retinopathy was 29–57, with an annualised frequency of 0.04–0.08% amongst long-term users (~1 in 1247–2625). The coverage of monitoring was approximately 2.6–5.5%. Visual acuity (0.1 vs. 0.22 logMAR; p = 0.007) and visual field mean deviation (−3.73 dB vs. −8.69 dB; p = 0.017) were better preserved in asymptomatic individuals compared to those presenting with visual symptoms.ConclusionThese data support the efficacy of monitoring in the preservation of visual function in patients with hydroxychloroquine retinopathy at diagnosis. The overall population coverage of monitoring was low, consistent with the high proportion of symptomatic patients at diagnosis. This study presents a method for evaluating the yield of monitoring for hydroxychloroquine retinopathy in the U.K.

Feasibility, Accuracy, and Reproducibility of Aortic Valve Sizing for Transcatheter Aortic Valve Implantation Using Virtual Reality.

Detailed visualization and precise measurements of aortic valve dimensions are critical for the success of transcatheter aortic valve implantation and for the prevention of complications. Currently, multislice computed tomography is the gold standard for assessment of the aortic annulus and surrounding structures to determine the prosthesis size. New technologies such as virtual reality (VR) not only enable 3-dimensional (3D) visualization with the potential to improve understanding of anatomy and pathology but also allow measurements in 3D. This study aims to investigate the feasibility, accuracy, and reproducibility of VR for the visualization of the aortic valve, the surrounding structures, and its role in preprocedural sizing for transcatheter aortic valve implantation. Based on the preprocedural multislice computed tomography data, 3mensio measurements and 3D visualizations and measurements using VR software were performed retrospectively on 60 consecutive patients who underwent transcatheter aortic valve implantation at our heart center. There were no significant differences but strong correlations between the VR measurements compared with those performed with the 3mensio software. Furthermore, excellent or good intra- and interobserver reliability could be demonstrated for all values. In a structured questionnaire, users reported that VR simplified anatomical understanding, improved 3D comprehension of adjacent structures, and was associated with very good self-perceived depth perception. The use of VR for preprocedural transcatheter aortic valve implantation sizing is feasible and has precise and reproducible measurements. In addition, 3D visualization improves anatomical understanding and orientation. To evaluate the potential benefits of 3D visualization for planning further cardiovascular interventions, research in this field is needed.

Simultaneous Muraine Sutures and Excimer Laser-Assisted Penetrating Keratoplasty for Acute Keratoconus.

Background: Acute keratoconus (acute KC), which affects approximately 1.6-2.8% of keratoconus (KC) patients, is a pathological condition of the cornea characterized by stromal edema due to entry of aqueous humor through a tear in Descemet's membrane. Methods: We present a novel combination of surgical procedures that allows swifter visual recovery in a consecutive, retrospective case series. The new surgical procedure for acute KC consists of a combination of Muraine corneal sutures to smooth the corneal curvature and Excimer laser-assisted penetrating keratoplasty and was performed in six acute KC patients from 2019 to 2022 at the Department of Ophthalmology, University Hospital of Martin-Luther-University Halle-Wittenberg (UMH), Germany. We monitored data on preoperative status, operative details, intraoperative and postoperative complications and visual outcomes were analyzed. Results: The mean age was 41.5 ± 13.5 years (3 OD, 3 OS). Neurodermatitis was present in 3 patients (50%). All patients received significant visual benefits from the procedure. Preoperative BCVA was hand motion (logMAR 3.0) in all patients; postoperatively, BCVA improved significantly logMAR 0.03 ± 0.09 [range: 0.2-0.4; p < 0.001, FUP 20+/-10 months). Visual acuity remained stable throughout the roughly biannual follow-ups. One patient developed endothelial graft rejection after 2 years. During the last examination, all eyes had clear grafts and stable curvatures, K1 and K2 being 42.43 ± 4.17 D and 44.95 ± 4.07 D, respectively, and mean corneal astigmatism was 2.61 ± 1.74 D. The thinnest corneal thickness was 519 ± 31 µm. A graft size of 8.0 × 8.1 mm was the most beneficial. Conclusions: in patients with acute KC and hydrops, a penetrating keratoplasty with Muraine corneal sutures is successful in terms of graft clarity and visual outcome. Combining the procedures allows quicker visual recovery. Patients with a history of neurodermatitis should have preoperative and postoperative dermatologic treatment and close follow-up for possible complications.

Spatial solar forecast verification with the neighborhood method and automatic threshold segmentation

Numerical weather prediction (NWP) has hitherto been the default tool for providing day-ahead forecasting services to the solar energy industry. Rapid advancements in solar forecasting using NWP call for more appropriate forecast verification procedures. Current solar forecast verification is almost always carried out through ground-based radiometric data collected at point locations. Consequently, spatial features embedded in the gridded NWP forecasts cannot be verified. This study presents the spatial verification of solar irradiance forecasts using the neighborhood method, with the main goal of emphasizing the importance of such verification procedures. By applying spatial smoothing one establishes a way to directly compare the observed and forecast fields, and concurrently, mitigate verification errors that may arise from small-scale spatial displacements. Within this framework, two variants of the neighborhood-based verification, namely, the fraction-field method and the upscaling method, are examined with respect to two reanalysis products, namely, ERA5 and MERRA-2. The results suggest that, in comparison to the upscaling method, the fraction-field method can better quantify forecast performance by providing fractions skill scores. On top of the traditional neighborhood approach, which involves the subjective selection of threshold for dichotomization, an automatic threshold segmentation method based on the three-component skew-normal mixture model is proposed to resolve the issue, which can also lead to substantial time savings in data processing. Given the spatio-temporal attributes and benefits of visualization, spatial verification is anticipated to serve as a complementary practice to the current mainstream point-location forecast verification.

Audiovisual perception of interrupted speech by nonnative listeners.

The purpose of the present study was to examine the influence of visual cues in audiovisual perception of interrupted speech by nonnative English listeners and to identify the role of working memory, long-term memory retrieval, and vocabulary knowledge in audiovisual perception by nonnative listeners. The participants included 31 Mandarin-speaking English learners between 19 and 41 years of age. The perceptual stimuli were noise-filled periodically interrupted AzBio and QuickSIN sentences with or without visual cues that showed a male speaker uttering the sentences. In addition to sentence recognition, the listeners completed a semantic fluency task, verbal (operation span) and visuospatial (symmetry span) working memory tasks, and two vocabulary knowledge tests (Vocabulary Level Test and Lexical Test for Advanced Learners of English). The results revealed significantly better speech recognition in the audio-visual condition than the audio-only condition, but the magnitude of visual benefit was substantially attenuated for sentences that had limited semantic context. The listeners' vocabulary size in English played a key role in the restoration of missing speech information and audiovisual integration in the perception of interrupted speech. Meanwhile, the listeners' verbal working memory capacity played an important role in audiovisual integration especially for the difficult stimuli with limited semantic context.

A Thermo-Responsive MOFs for X-Ray Scintillator.

Thermo-responsive smart materials have aroused extensive interest due to the particular significance of temperature sensing. Although various photoluminescent materials are explored in thermal detection, it is not applicable enough in X-ray radiation environment where the accuracy and reliability will be influenced. Here, a strategy is proposed by introducing the concept of radio-luminescent functional building units (RBUs) to construct thermo-responsive lanthanide metal-organic frameworks (Ln-MOFs) scintillators for self-calibrating thermometry. The rational designs of RBUs (including organic ligand and Tb3+/Eu3+) with appropriate energy levels lead to high-performance radio-luminescence. Ln-MOFs scintillators exhibit perfect linear response to X-ray, presenting low dose rate detection limit (min ≈156.1 nGyairs-1). Self-calibrating detection based on ratiometric XEL intensities is achieved with good absolute and relative sensitivities of 6.74 and 8.1%K-1, respectively. High relative light yield (max ≈39000 photons MeV-1), imaging spatial resolution (max ≈18 lpmm-1), irradiation stability (intensity ≈100% at 368 K in total dose up to 215 Gyair), and giant color transformation visualization benefit the applications, especially the in situ thermo-responsive X-ray imaging. Such strategy provides a promising way to develop the novel smart photonic materials with excellent scintillator performances.

The Effect of Visual Articulatory Cues on the Identification of Mandarin Tones by Children With Cochlear Implants.

This study explored the facilitatory effect of visual articulatory cues on the identification of Mandarin lexical tones by children with cochlear implants (CIs) in both quiet and noisy environments. It also explored whether early implantation is associated with better use of visual cues in tonal identification. Participants included 106 children with CIs and 100 normal-hearing (NH) controls. A tonal identification task was employed using a two-alternative forced-choice picture-pointing paradigm. Participants' tonal identification accuracies were compared between audio-only (AO) and audiovisual (AV) modalities. Correlations between implantation ages and visual benefits (accuracy differences between AO and AV modalities) were also examined. Children with CIs demonstrated an improved identification accuracy from AO to AV modalities in the noisy environment. Additionally, earlier implantation was significantly correlated with a greater visual benefit in noise. These findings indicated that children with CIs benefited from visual cues on tonal identification in noise, and early implantation enhanced the visual benefit. These results thus have practical implications on tonal perception interventions for Mandarin-speaking children with CIs.

How pre-trained large model can help, when SAM meets image restoration

In the process of image capture, degradation is inevitable due to noise, motion, down-sampling and so on. Therefore, image restoration is essential to improve the quality of images to enhance their visual effects and benefit downstream tasks. Adding prior knowledge can help the model better understand the image content and restoration requirements, thus improving the quality and efficiency. Semantic-level prior information can be generated by pre-trained large-scale models, such as segment anything models (SAM), and applied to a large number of downstream tasks. SAM has demonstrated powerful robustness and stability in restoration tasks, such as denoising, super-resolution, low-light enhancement, etc. Meanwhile, as an interactive component, SAM brings more control for users during the repair process. In this paper, we focus on the importance of SAM as prior information and systematically summarize a series of recent works combining SAM prior and low-level image restoration from three perspectives. In addition, we have summarized some potential problems and future directions of SAM.

Osseoscopy-assisted core decompression and debridement in the treatment of avascular necrosis of the femoral head.

Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression (P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.

Visual-articulatory cues facilitate children with CIs to better perceive Mandarin tones in sentences

Children with cochlear implants (CIs) face challenges in tonal perception under noise. Nevertheless, our previous research demonstrated that seeing visual-articulatory cues (speakers’ facial/head movements) benefited these children to perceive isolated tones better, particularly in noisy environments, with those implanted earlier gaining more benefits. However, tones in daily speech typically occur in sentence contexts where visual cues are largely reduced compared to those in isolated contexts. It was thus unclear if visual benefits on tonal perception still hold in these challenging sentence contexts. Therefore, this study tested 64 children with CIs and 64 age-matched NH children. Target tones in sentence-medial position were presented in audio-only (AO) or audiovisual (AV) conditions, in quiet and noisy environments. Children selected the target tone using a picture-point task. The results showed that, while NH children did not show any perception difference between AO and AV conditions, children with CIs significantly improved their perceptual accuracy from AO to AV conditions. The degree of improvement was negatively correlated with their implantation ages. Therefore, children with CIs were able to use visual-articulatory cues to facilitate their tonal perception even in sentence contexts, and earlier auditory experience might be important in shaping this ability.

Strabismus Surgery for Psychosocial Reasons-A Literature Review.

Strabismus surgery may be undertaken for visual benefit, to improve or eliminate diplopia symptoms, or to restore or improve binocular single vision (BSV). In patients without visual symptoms or expected visual benefit, strabismus surgery may still be undertaken if the presence of strabismus causes the patient psychosocial symptoms. To evaluate strabismus surgery undertaken for psychosocial reasons, evidence of postoperative outcomes in this specific cohort is needed. A systematic search of the literature was conducted (1946-2023) to identify evidence where postoperative outcomes were reported for adult patients (age 18 years and above) who had undergone strabismus surgery for psychosocial reasons. Sixty-nine papers were included in the literature review. Most sources of evidence included patients within heterogeneous cohorts of strabismus surgery outcomes, with a range of symptoms and differing surgical aims. In adults who underwent strabismus surgery for psychosocial reasons, improved postoperative ocular alignment and/or improved health related quality of life (HRQoL) were common. Strabismus surgery outcomes appeared to be measured satisfactorily at three months postoperatively. Additional surgical outcomes, including an expanded field of vision, unexpected BSV, improved binocular summation, improved task performance and improved eye movements have been reported, but not fully investigated. There was a lack of consensus on how postoperative success should be defined and measured. A core outcome set for strabismus has been suggested and there is potential to add to the available evidence by investigating which outcome measures are most relevant to those with strabismus and psychosocial symptoms. There is a growing need for robust evidence in this specific subgroup of patients due to a lack of evidence specifically reporting postoperative outcomes in adults with strabismus and psychosocial symptoms.

Emergency Physician Performed Ultrasound-Guided Abdominal Paracentesis: A Retrospective Analysis.

Emergency physicians commonly perform ultrasound-assisted abdominal paracentesis, using point of care ultrasound (POCUS) to identify ascites and select a site for needle insertion. However, ultrasound-guided paracentesis has the benefit of real-time needle visualization during the entire procedure. Our objective was to characterize the performance of emergency physician-performed ultrasound-guided paracentesis using POCUS, their ability to achieve good in-plane needle visualization, and factors associated with procedural success. A POCUS database was retrospectively reviewed for examinations where abdominal paracentesis was performed by an emergency physician at two academic urban emergency departments over a six-year period. Medical records were reviewed for demographics, presenting history, complications, and hospital course. Descriptive statistics were used to summarize the data. 131 patients were included in the final analysis. The success rate for ultrasound-guided paracentesis was 97.7% (84/86 [95% CI: 92-100%]) compared to 95.6% (43/45 [95% CI: 85-99%]) for ultrasound-assisted paracentesis (p=0.503). 58% (50/86) demonstrated good in-plane needle visualization; 17% (15/86) had partial or out-of-plane visualization; and 24% (21/86) did not demonstrate needle visibility on their saved POCUS images. All four procedural failures were performed by first- or second-year residents using a curvilinear transducer, while all procedures using a linear transducer were successful. The most common complications were ascites leak, infection at the site, and minor bleeding. Emergency physicians with training in real-time needle guidance with ultrasound were able to use POCUS to perform ultrasound-guided paracentesis in the emergency department with a high success rate and no fatal complications. Based on our experience, we recommend performing ultrasound-guided paracentesis using a linear transducer, with attention to identifying vessels near the procedure site and maintaining sterile technique.

Health effects of holistic housing renovation in a disadvantaged neighbourhood in the Netherlands: a qualitative exploration among residents and professionals

BackgroundHolistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). In a deprived neighbourhood in Utrecht, the Netherlands, this paper examined residents’ and professionals’ experiences, ideas, and perceptions regarding holistic housing renovation, its health effects, and underlying mechanisms explaining those effects.MethodsSemi-structured in-depth interviews were conducted with 21 social housing residents exposed to holistic housing renovation, and 12 professionals involved in either the physical renovation or social interventions implemented. Residents were interviewed in various renovation stages (before, during, after renovation). Transcripts were deductively and inductively coded using qualitative software.ResultsResidents experienced and professionals acknowledged renovation stress caused by nuisance from construction work (noise, dust), having to move stuff around, and temporary moving; lack of information and control; and perceived violation of privacy. Involvement in design choices was appreciated, and mental health improvement was expected on the long term due to improved housing quality and visual amenity benefits. Social contact between residents increased as the renovation became topic for small talk. Few comments were made regarding physical health effects. The interviews revealed a certain amount of distrust in and dissatisfaction with the housing corporation, construction company, and other authorities.ConclusionsRenovation stress, aggravated by lack of information and poor accessibility of housing corporation and construction company, negatively affects mental health and sense of control. Potential stress relievers are practical help with packing and moving furniture, and increased predictability by good and targeted communication. Social interventions can best be offered after renovation, when residents live in their renovated apartment and the nuisance and stress from the renovation is behind them. Social partners can use the period leading up to the renovation to show their faces, offer practical help to reduce renovation stress, and increase residents’ trust in their organization and authorities in general. This might also contribute to residents’ willingness to accept help with problems in the social domain after renovation.

PREDICTIVE FACTORS ASSOCIATED WITH THE VISUAL PROGNOSIS AFTER SURGERY FOR IDIOPATHIC VITREOMACULAR TRACTION.

To investigate the predictive factors for postsurgical visual prognosis in patients with vitreomacular traction (VMT). This retrospective study enrolled 31 eyes from 29 patients who underwent vitrectomy for idiopathic VMT with a follow-up period of ≥3 months. The VMT was divided into three grades based on optical coherence tomography images: Grade 1 denoted partial vitreomacular separation with foveal attachment; Grade 2 exhibited intraretinal cysts or cleft with grade 1 findings; and Grade 3 was Grade 2 plus the subretinal fluid. Three eyes developed a full-thickness macular hole after surgery, all of which were Grade 3 patients. In the rest 28 eyes, the mean postoperative follow-up period was 23.3 ± 25.8 months. The postoperative central foveal thickness ( P = 0.001) and final best-corrected visual acuity (BCVA; P < 0.001) were both significantly improved from baseline. Fifteen eyes (53.8%) gained ≥ two Snellen lines. Multilinear regression analysis showed that the worse the baseline BCVA ( P = 0.004), or the more advanced the VMT grade ( P = 0.049), the worse the final BCVA. Baseline BCVA was negatively associated with the postoperative visual improvement ( P < 0.001). Those Grade 3 patients with baseline Snellen BCVA of ≥20/40 were more likely to achieve a final Snellen BCVA of ≥20/25 ( P = 0.035). The VMT grade is an important predictive factor for the postsurgical visual prognosis. Surgical intervention should be performed as early as possible for Grade 3 patients to prevent further disease progression and maximize the postsurgical visual benefit.

Drug Approval for the Treatment of Geographic Atrophy: How We Got Here and Where We Need to Go

PurposeTo discuss the clinical trial results leading to the FDA approval of anti-complement therapies for geographic atrophy (GA), perspectives on functional data from the GA clinical trials, and how lessons from the FDA approval may guide future directions for basic and clinical research in AMD. DesignSelected literature review with analysis and perspective MethodsWe performed a targeted review of publicly available data from the clinical trials of pegcetacoplan and avacincaptad for the treatment of GA as well as scientific literature on the natural history of GA and the genetics and basic science of complement in AMD. ResultsThe approval of pegcetacoplan and avacincaptad was based on an anatomic endpoint of a reduction in the rate of GA expansion over time. However, functional data from two phase 3 clinical trials for each drug demonstrated no visual benefit to patients in the treatment groups. Review of the genetics of AMD and the basic science of the role for complement in AMD provides only modest support for targeting complement as treatment for GA expansion, and alternative molecular targets for GA treatment are therefore discussed. Reasons for the disconnect between anatomic and functional outcomes in the clinical trials of anti-complement therapies are discussed, providing insight to guide the configuration of future clinical studies for GA. ConclusionWhile avacincaptad and pegcetacoplan are our first FDA-approved treatments for GA, results from the clinical trials failed to show any functional improvement after one and two years, respectively, calling into question whether the drugs represent a “clinically relevant outcome.” To improve the chances of more impactful therapies in the future, we: i) provide basic-science rationale for pursuing non-complement targets, ii) emphasize the importance of ongoing clinical research that more closely pins anatomic features of GA to functional outcomes, and iii) provide suggestions for clinical endpoints for future clinical trials on GA.