Blindly Research Articles

Environment-friendly glass with high refractive index and radiation resistance

Fiber optic panels (FOP) are extensively utilized in various fields, including low light level night vision and space detection. Currently, there has been an inevitable trend of the development of radiation-resistant fiber optic panels with safety and environment protections, we prepared transparent lead-free radiation resistant glass using CeO2 as radiation stabilizer with high temperature melting process in air atmosphere. The samples were characterized with density test, expansion coefficient tester, prism coupling tester, spectrophotometer, X-ray photoelectron spectroscopy (XPS), X-ray absorption test, bending strength, Knoop hardness and chemical stability analysis. The results indicated that an increase in CeO2 content led to gradual deepening of coloration in the glass samples along with reduced optical transmittance and noticeable redshifts in the UV absorption cut-off edge. Notably, at 2 wt% CeO2 content, the glass exhibited good optical transmittance alongside excellent radiation resistance and high energy X-ray shielding performance. Furthermore, it demonstrated an X-ray absorptivity above 94.5% at 160 KeV. Although the as-prepared lead-free glass showed a slightly lower X-ray absorption rate, its transmittance was greatly improved compared with lead silicate glass, with prominent physical and chemical properties. The lead-free radiation resistant glass with high refractive index meets the requirements of commercial optical fiber panel radiation detector preparation, and the shielding alternative material for observation windows such as diagnostic X-ray and CT rooms. The glass material has broad application prospects in medical, industrial and safety monitoring and other fields with X-ray radiation protection need.

Guidance device for visually impaired people based on ultrasonic signals and open hardware

<span>Visual impairment is a complex challenge that affects people of all ages, and it is estimated that around 2.2 billion people worldwide lack adequate access to medical treatment and support. In Latin America, there is a lack of attention to people with visual disabilities, evidenced by poor urban infrastructure and lack of compliance with inclusion laws. Some projects stand out for the use of prototypes with artificial vision technology, global positioning system (GPS) and smart canes. Therefore, the objective of the project is to use ultrasonic sensors and a low-cost electronic device coupled to canes, for obstacle detection and mobility using an open hardware embedded system. The results confirmed the efficiency in the detection and operation of the ultrasonic sensor by activating the light emitting diode (LED), the buzzer and the vibrating motor according to the programmed distances. Challenges were identified, such as adapting the sensor to the tilt of the cane and the importance of accurate calibration of the ultrasonic sensor. The system met its objectives by detecting objects in a range of 2 to 50 cm and providing sound alerts to improve the perception of blind people.</span>

Vision rehabilitation workforce in Italy: a country-level analysis

BackgroundResearch and monitoring of human resources available for vision rehabilitation services has been a neglected area of work in the past. This study aims to offer an overview of the vision rehabilitation workforce available in Italy, in order to profile the distribution and number of human resources for vision rehabilitation.MethodsData on the available vision rehabilitation professionals were collected from the yearly report on the state of implementation of policies relating to the prevention of blindness, education and vision rehabilitation, according to a law which was passed by the Italian Ministry of Health, Department of Health Prevention. The report presents a review of all professional workers dealing with low vision rehabilitation centers in Italy between January 2005 and December 2019. Data on the distribution and type of services of government-supported low vision centers across the country were also obtained and examined.ResultsOf the 289 low vision rehabilitation workers in 2019, 28% were ophthalmologists, 31% orthoptists, 19% psychologists, 17% nurses and 5% social workers.The health workforce densities across the Italian regions ranged from 1.62 to 0.12 per 100.000. The density of vision rehabilitation workers showed a no growing trend from 2006 to 2015. During the study period, it was found a weak but statistically significant association of workforce density with the number of government-supported low vision centers across the Italian territory (r2 = 0.3, p < 0.05). The vision rehabilitation workforce was not associated with the number of low vision patients who accessed to a vision rehabilitation center (r2 = 0.05, p < 0.0001).DiscussionA critical review has identified the following national situation: need-based shortages of workers in the vision rehabilitation service sector, as well as deficiencies in data sources. Based on our results, we would recommend increasing the development of human resources trained and dedicated to vision rehabilitation and improve data collection and analysis; provide structural enhancements, across all service levels. These considerations may contribute to the enhancement of policy decisions in order to guarantee an adequate vision rehabilitation workforce and meet national rehabilitation needs. Furthermore, this analysis should be used as a lesson learned by other countries, as low-income ones, in order to develop vision rehabilitation services.

Early Surgery and High Dose Steroids in Treating Patients with Indirect Traumatic Optic Neuropathy: A Meta-Analysis and Systematic Review

Introduction: Optic nerve injury is a devastating cause of permanent visual loss after blunt or penetrating injury occurring in up to 7% of head trauma cases. No single treatment strategy and timing of intervention has proved optimal. Timely and appropriate management is key to improving visual outcomes. We compared whether immediate surgical decompression or steroids would lead to improvement of visual outcomes in individuals with indirect traumatic optic neuropathy. Methods: We searched from several online databases and included studies of patients with direct Optic nerve injury, those who received combined treatment with surgery and steroids, and those with delayed initiation of treatment were excluded. Results: The final search yielded eleven eligible studies. Both interventions showed similar results in improvement of visual function (RR 2.35, 95% CI 0.87 to 6.34, p=0.09, I2 0%). Both early and late intervention also showed similar results in improvement of visual function (RR 1.72, 95% CI 0.89 to 3.35, p=0.11, I2 61%). Among patients who underwent early surgical decompression, the rate of visual acuity improvement was 73% with those who underwent transcranial surgery and 69% with those who underwent endoscopic surgery. Conclusion: This study shows that immediate surgical decompression and early high dose steroid administration are equally effective in improving visual function. Patients with no light perception (NLP) and light perception (LP) pre treatment resulted to better visual improvement with steroids while those with counting fingers (CF) and more than CF pre treatment, resulted to better visual improvement with surgical decompression.

Usability of an AI-based independent pedestrian navigation device designed for blind people

Abstract Background 2.2 billion people live with visual impairment (VI) worldwide and face orientation and mobility challenges in various aspects of their lives. Despite technological advancements, the most used mobility solutions for VI are still the walking cane and the guide dog. The objective of this research is to assess the system usability of an AI-based independent pedestrian navigation device (.lumen glasses), designed for blind people. Methods During 31st of October and 2nd of November 2023, 27 visually impaired people living in Bucharest, Romania, tested the .lumen glasses for 1-3 hours during an outdoor navigation task. The glasses use AI to recognize the user’s environment and haptic and audio feedback to guide them. The System Usability Scale (SUS), a 10-item instrument, was used to evaluate the level of usability the participants ascribe to the .lumen glasses. Qualitative feedback was collected as part of the post-test survey and analyzed using thematic analysis. Data were triangulated to identify usability issues. Results The mean age of the participants was 30.3 years old (SD = 12.07, min=21 max =56, range: 48), 55.6% (N = 15) of the participants were male, 96,3% (N = 26) were completely blind, and 81.5% were using a white cane for orientation and mobility. Our findings reveal a mean SUS score of 83.65 (SD = 15.23, range 47.5, min=52.5, max=100) indicating high usability. The thematic analysis revealed 5 themes: (1) auditive and (2) haptic feedback in navigation, (3) hardware (adjustment system &amp; buttons), (4) tutorial &amp; presentation of how the device works and (5) other aspects (usage in combination with other assistive technologies etc.). The participants declared that the glasses are intuitive to use and promote the feeling of safety and independence. Conclusions Data suggest that the .lumen glasses area promising assistive technology for the mobility of VI. Findings are currently used to steer the development and implementation of the AI-based system. Key messages • According to participants’ feedback, .lumen glasses are a scalable AI-based mobility solution that can make navigation and orientation easier for visually impaired individuals. • .lumen glasses designed for the visually impaired individuals are one of the current and limited assistive technology improving the mobility and orientation.

Effectiveness of Internet + E-Coach chronic disease management on blood glucose, lipid levels, liver function, and quality of life in patients with chronic diabetic retinopathy: a comparative study

ObjectiveThis study aims to explore the effect of Internet + E-Coach chronic disease system intervention on fasting blood glucose (FPG), 2-hour postprandial blood glucose(2hPG), fasting serum insulin (FINS), triglyceride (TG), alanine transaminase (ALT) and quality of life in patients with chronic diabetic retinopathy.Methods208 patients with chronic diabetic retinopathy who were treated in the hospital from March 2021 to March 2023 are chosen and separated into two groups by random number Table 104 patients in the control group received routine continuous intervention, and the research group received Internet + E-Coach chronic disease system intervention. The cognition of disease related knowledge, blood related indicators inflammatory factor levels and improvement of life quality between the two groups before intervention, 6 and 12 months after intervention were compared.ResultsBefore the intervention, the comparison between the two groups in disease related knowledge scores, blood glucose, blood lipid, liver function indicators, inflammatory factor, and low vision quality of life scale (CLVQOL) scores was with P > 0.05. After 6 and 12 months of intervention, the research group had significantly higher scores for basic blood glucose intervention, healthy diet, reasonable exercise, and correct medication use compared to the control group (P < 0.05). FPG, 2hPG, TG and ALT in the research group were lower than those in the control group. FINS were higher in the control group, with P < 0.05. Interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and hypersensitive C-reactive protein (Hs-CRP) in the research group were obviously lower than those in the control group (P < 0.05). The scores of far vision, movement and light perception, adjustment ability, reading and fine work, and daily living ability in the research group were higher than those in the control group, with P < 0.05.ConclusionThe intervention of Internet + E-Coach chronic disease system can improve the knowledge of chronic diabetic retinopathy patients about their own condition, stabilize the levels of blood sugar, blood lipid and liver function indicators, reduce the inflammatory reaction of the body, and improve the quality of life.

The sufficiency-based, the de-growth, and the official – Critical remarks of the electricity chapter of the Hungarian national energy and climate plan based on a comparison to alternative scenarios

Hungary relies heavily on fossil and nuclear fuel imports from Russia. An urgent challenge is to develop a more sustainable and more independent energy system. There is a 2019 and a 2023 (draft) version of the National Energy and Climate Plan (NECP) but they arguably do not follow this direction. However, there are also alternative scenarios for Hungary that propose more comprehensive changes. This paper compares the targets proposed by the Hungarian NECPs to those proposed in two alternative studies: the sufficiency-based European-focused CLEVER (Collaborative Low Energy Vision for the European Region) scenario (created by a research team including 26 partner organisations from 20 European countries), and the de-growth-based “This Way Ahead” (TWA) scenario (which is the result of a Hungarian inter-university research, coordinated by the ELTE University's energy geography research group). A new element of this recent study is the simulation of hourly electricity supply and demand in these scenarios using EnergyPLAN to compare import requirements, potential surplus generation, and self-sufficiency. The review shows that the NECPs need to be reconsidered to increase the share of decentralized renewable electricity supply in a way that allows progress without increasing energy use and environmental burdens. Priority must be given to the rapid expansion of wind energy capacity by at least 10–20 times, which should be complemented by biogas-based flexible energy supply.

Hapstick-Figure: Investigating the Design of a Haptic Representation of Human Gestures from Theater Performances for Blind and Visually-Impaired People

Theaters serve as platforms that transport audiences into diverse worlds, offering a collective enjoyment of live performances and a shared cultural experience. However, theater performances have strong visual components, such as physical props and actors’ movements and gestures, which are inaccessible to visually impaired and blind audience members and thus can exclude them from such shared social experiences. We conducted formative interviews with eight blind and visually impaired people about their experiences with barriers to theater performance gestures. We then present Hapstick-Figure, a prototype design to represent and communicate human gestures via a 3D-printed tactile surface. Next, we used Hapstick-Figure as a technology probe in a qualitative evaluation with six of our BVI participants to explore non-visual interpretation and engagement with this prototype. We outline insights into the haptic representation of theater performance gestures and reflections on designing for accessibility in this context.

Rasch analysis of the new general self efficacy scale: an evaluation of its psychometric properties in older adults with low vision

BackgroundWhile general self-efficacy is known to relate to achievement in many areas, it has rarely been evaluated in individuals with low vision. Here we explore the psychometric properties and targeting of the New General Self Efficacy Scale (NGSES) using Rasch analysis in data collected from older adult clinical trial participants with low vision.MethodsParticipants (n = 121) completed pre-intervention telephone questionnaires (i.e., NGSES, Activity Inventory (AI), Beck Depression Inventory (BDI), SF-36, and the Telephone Interview for Cognitive Status (TICS). Rasch analysis using the Method of Successive Dichotomizations (MSD) was applied to NGSES, AI, and BDI datasets to estimate person and item measures, and ordered rating category thresholds.NGSES infit mean square statistics and standard errors were analyzed to test whether data fit Rasch model requirements, and targeting was assessed by comparing distributions of person and item measures. Multiple linear regression evaluated the influence of participant characteristics on NGSES person measures.ResultsThere was a significant difference (p = 0.01) in the distributions of NGSES person measures (mean = 0.85, range -2.1-3.2) and item measures (mean = 0, range -1.0-0.72). Infit mean square statistics and standard errors for item and person measures conformed to expectations of the Rasch model.Greater NGSES person measure was related to lower BDI person measure (β = -0.48, p < 0.0005, 95% CI -0.67—-0.28) and higher AI person measure (β = 0.11, p = 0.047, 95% CI 0.0013 – 0.22) after controlling for cognitive status (TICS). Other variables including SF-36, visual acuity, and patient demographics were not related to NGSES person measure.ConclusionsWhile NGSES person measures estimated from a low vision patient population conformed to basic Rasch model requirements, the significant differences in the person and item measure distributions indicate poor NGSES targeting, specifically a ceiling effect. Therefore, there is limited discrimination between persons at the upper end of the scale. While further work can evaluate how self-efficacy may be associated with other factors in the low vision patient population, the ceiling effect found in this study cautions interpretation of NGSES results for those with high general self-efficacy.Trial registrationPre-registered on clinicaltrials.gov, identifier NCT04926974.

Vision-related quality of life in low-vision patients who underwent epiretinal membrane surgery

Aims: To evaluate the vision-related quality of life (VR-QOL) in patients with low vision, who underwent epiretinal membrane (ERM) surgery with pars plana vitrectomy. Methods: Twenty subjects with unilateral ERM and 20 healthy subjects as CG were included in the study. The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was used. In ERM cases, the two-step 23 G vitrectomy was performed with a similar technique by the same experienced vitreoretinal surgeon. The relationship between the composite score and visual acuity was evaluated. Reliability analysis was performed. Flexible discriminant analysis was performed to group individuals according to the NEI VFQ-25 results. Results: The preoperative best corrected visual acuity (BCVA) in ERM group was 1.04±0.41. Postoperative visual improvement reached statistical significance (p&lt;0.001) and postoperative 6th month BCVA was 0.61±0.41. The composite score was significantly lower in patients with ERM than in CG (p=0.017). The subscale scores were significantly lower in the patients with ERM than in the CG in general vision, ocular pain, near activities and distance activities (p&lt;0.001, p=0.005, p&lt;0.001, p=0.003, respectively). There was a statistically significant correlation between the composite score and visual acuity (R2=0.19, p=0.004). The scale has high reliability (Cronbach's alpha=0.8743). The accuracy of the flexible discriminant function was found to be 100%. Conclusion: The NEI VFQ-25 questionnaire may help to define the effects of ERM surgery since visual acuity does not fully reflect VR-QOL. Impaired binocular vision may be associated with the deterioration of VR-QOL in patients with ERM in the postoperative period.

Developing a Statewide Peer Support Network for Individuals Who Are Blind or Low Vision

Abstract This article looks at experiences of setting up and maintaining peer support groups in two states with long-standing peer support networks for seniors who are blind or low vision (B/LV).

Visual experience shapes bodily representation of emotion.

Philosophers and experimentalists have long debated whether bodily representation of emotion is grounded in our sensory experience. Indeed, we are used to observe emotional reactions expressed through the bodies of others, yet it is still unknown whether this observation influences how we experience affective states in our own bodies. To delve into this question, we developed a naturalistic haptic task and asked a group of early (n = 20) and late (n = 20) blind, as well as sighted individuals (n = 20) to indicate where in the body they perceive changes associated with affective states. Our results show that visual experience shapes bodily representation of emotion. Blind and sighted individuals attribute different importance to body regions in relation to specific emotional states, as sighted people focus more on visceral sensations, while blind report as more relevant the mouth and the hand areas. We also observe differences in the coherence of bodily maps of specific emotions, such as aggressiveness, for which early and late blind are homogenous in reporting the mouth, while sighted subjects demonstrate a scattered pattern of activation across the body. Finally, our findings show that blind people rely on a different organization of affect, as only sighted categorize bodily maps of emotion through the valence and arousal dimensions. In summary, we demonstrate that sensory experience impacts the bodily representation of affect by modulating the relevance that different body parts have in emotional reactions, modifying the weights attributed to interoceptive and exteroceptive signals, and changing how emotions are conceptualized in the body. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Accessible scientific conferences for blind and low vision professionals and researchers: a necessary step for achieving STEMM equity

Scientific conferences and meetings are an integral part of careers in research, medicine, education, and many other professional arenas. Such meetings allow professionals and researchers to share their findings, support expansion of professional networks, enhance professional development, and foster new collaborations. However, barriers throughout the conference experience lead to the exclusion of experts with disabilities, deepening existing inequities in the STEMM (science, technology, engineering, mathematics, and medicine) workforce. This is especially problematic for STEMM experts with blindness or low vision, who remain significantly under-represented throughout the health and science ecosystem.

Research progress of retinal neuroprotective drugs for glaucoma

Glaucoma is a neural degenerative disease characterized by progressive loss of retinal ganglion cells, resulting in irreversible visual field loss, low vision, and total blindness. Despite the fact that the pathological elevation of intraocular pressure is a major risk factor for glaucoma, it is imperative to develop therapies that can prevent and block retinal ganglion cell injury and apoptosis in addition to reducing intraocular pressure. Drug therapy is the primary treatment for glaucoma in most clinical cases. This article provides reference information for the clinical treatment of glaucoma by summarizing and analyzing the medications that have direct optic nerve protection in clinical or preclinical trials, based on the most recent research results from both domestic and international studies.

Integration of auditory and visual cues in spatial navigation under normal and impaired viewing conditions.

Auditory landmarks can contribute to spatial updating during navigation with vision. Whereas large inter-individual differences have been identified in how navigators combine auditory and visual landmarks, it is still unclear under what circumstances audition is used. Further, whether or not individuals optimally combine auditory cues with visual cues to decrease the amount of perceptual uncertainty, or variability, has not been well-documented. Here, we test audiovisual integration during spatial updating in a virtual navigation task. In Experiment 1, 24 individuals with normal sensory acuity completed a triangular homing task with either visual landmarks, auditory landmarks, or both. In addition, participants experienced a fourth condition with a covert spatial conflict where auditory landmarks were rotated relative to visual landmarks. Participants generally relied more on visual landmarks than auditory landmarks and were no more accurate with multisensory cues than with vision alone. In Experiment 2, a new group of 24 individuals completed the same task, but with simulated low vision in the form of a blur filter to increase visual uncertainty. Again, participants relied more on visual landmarks than auditory ones and no multisensory benefit occurred. Participants navigating with blur did not rely more on their hearing compared with the group that navigated with normal vision. These results support previous research showing that one sensory modality at a time may be sufficient for spatial updating, even under impaired viewing conditions. Future research could investigate task- and participant-specific factors that lead to different strategies of multisensory cue combination with auditory and visual cues.

Bridging the Past, or Breaking From It? Leader Continuity Rhetoric and Nontarget Employee Diversity Initiative Support

Organizations launch diversity initiatives to promote diversity within their ranks, improve the work experiences of underrepresented groups, and satisfy growing demands for diversity in workplace settings. While typically welcomed by the target group, diversity initiatives can be compromised when employees who are not the initiative’s targets—for example, men in the case of gender diversity initiatives—withhold their support. Particularly organizations that are mostly composed of nontargets may thus struggle with a lack of support for their diversity initiatives. To understand how organizations can successfully implement diversity initiatives while preserving nontarget support, we take an uncertainty management perspective and examine the interactive effects of diversity practice type (identity-conscious vs. identity-blind) and leader continuity rhetoric (high vs. low vision of continuity) on nontarget support. In Study 1, using data from a 2 × 2 between-person field experiment in a firefighter organization, we find that framing the initiative under a vision of high (vs. low) continuity preserves nontargets’ anticipatory distributive justice in the face of identity-conscious (vs. identity-blind) practices and thereby promotes initiative support. Study 2, a vignette experiment, replicates our findings and shows that other justice dimensions above and beyond distributive justice appear secondary in this context. Our work has important implications for managing the initiation phase of diversity initiatives in organizations primarily composed of nontargets in a way that fosters nontargets’ perceived justice and support.

Pharmacological Advances in Glaucoma Management

Glaucoma is the leading cause of global irreversible blindness, with clinical diagnosis related to population-based low vision standards and subsequently to diminished vision-related quality of life. The main objective of the present study is to review the updates regarding pharmacological advances in glaucoma management. Pharmacological management to reduce intraocular pressure and inflammation and improve retinal ganglion cell survival has a significant impact on the overall management of glaucoma. The changes in the therapeutic pipelines include the targeting of both traditional and novel molecules. New medications in the offing either improve the already established targets or focus on newer avenues to confer better anti-glaucomatous effects with minimal side effects.

Changes in Vitreous and Retina in Pathological Myopia

Myopia is the leading cause of visual impairment and its prevalence continues to increase significantly. Pathological myopia affects 1-3% of the general population and is one of the main causes of low vision and blindness worldwide. Myopic vitreopathy associated with pathological myopia essentially represents fibrous vitreous liquefaction, resulting from both hereditary and degenerative processes. In addition, myopic retinopathy, in which axial elongation plays an important role in pathogenesis, has many unique pathologies. In this review, changes in the vitreous and retina in patients with pathological myopia are discussed.

Changes in Lens Structure in Pathological Myopia, Cataract Surgery and Special Situations

Pathological myopia is a major cause of low vision and blindness worldwide. In patients with pathological myopia, there are changes such as thinning of the lens and increase in equatorial diameter. In various population and clinic-based cohort, case-control and cross-sectional studies, it has been reported that myopic patients have a higher risk of posterior subcapsular cataract, cortical and nuclear cataract. It is known that the modern technique of phacoemulsification and intraocular lens implantation is effective in highly myopic eyes and provides significant improvement in visual acuity. However, complications related to phacoemulsification such as posterior capsule rupture, retinal detachment, progression of existing maculopathy, capsular phimosis, late lens dislocation and transient intraocular pressure elevation occur more frequently in highly myopic patients. As a result, it is extremely important that cataract surgeries of these patients are performed by experienced surgeons and that attention is paid to perioperative and postoperative complications.

8034 Putting the Pieces Together: Carney Complex, A Hyper-Rare Congenital Neoplastic Syndrome

Abstract Disclosure: G. Fontanazza: None. A.R. Conforti: None. K. Bird: None. M. Caplan: None. Intro: Carney complex (CNC) is an autosomal dominant disorder characterized by multisystem neoplasia that primarily affects the thyroid, pituitary, and adrenal glands. Its prevalence is not well established, as only 750 cases have been reported worldwide. This condition arises when an inactivating PRKAR1A gene mutation results in dysregulated cell proliferation and tumorigenesis. Complications include the potential for malignant transformation and systemic manifestations, necessitating comprehensive management and ongoing surveillance of disease progression. Case: The patient is a 58-year-old woman who initially presented as a teenager with complaints of hirsutism, truncal obesity, and violaceous abdominal striae. Initial workup revealed a low-dose dexamethasone suppression test that resulted in a non-suppressed cortisol levels. She also had undetectable adrenocorticotropic hormone (ACTH) levels. Imaging revealed no pituitary masses and demonstrated slight bilateral adrenal enlargement without adenomas. Despite these results, she was empirically treated for presumed pituitary-dependent Cushing's disease and received external beam radiation. Despite treatment, she continued to have episodes of hypercortisolism that were apparent clinically and biochemically. Over time, she developed a cardiac myxoma with six cerebrovascular accidents and multiple benign tumors. As an adult, she underwent extensive endocrine evaluation, which revealed urine cortisol excretion that paradoxically rose in response to dexamethasone. ACTH levels were always undetectable, even when she was significantly hypercortisolemic. Genetic testing revealed a homozygous mutation in the melanocortin-2 receptor (MC2R). Accordingly, she elected to have a bilateral adrenalectomy and was started on hydrocortisone and fludrocortisone. Discussion: The patient exhibited ACTH-independent micronodular adrenal hyperplasia and its most frequent variant, primary pigmented nodular adrenocortical disease. Bilateral pigmented nodular hyperplasia is a finding which can occur in association with CNC and cause episodic hypercortisolism. These patients have been shown to respond to dexamethasone with a paradoxical increase in glucocorticoid excretion. While management requires ongoing surveillance, this patient had not been diagnosed until later in life and did not have regular screening. When speculating on the late detection, her story reflects the parable of the blind men and the elephant: endocrinology managed Cushing's disease, cardiology managed atrial myxoma, and oncology managed osteochondromyxomas. Limited perspective with specialized management and an inability to see the whole picture led to prolonged diagnosis with unfortunate sequelae. This report encourages physicians to develop perspective awareness and to consider the entire picture when treating patients. Presentation: 6/2/2024