Excellent Vision Research Articles

The Physiology of Cornea

The cornea has important functions such as protecting the structures within the globe, contributing to the refractive power of the eye, and focusing the light rays on the retina with minimum scattering. Although the neurobiological complexity of the retina and the dynamic movement of the lens are absent in the cornea, it is one of the most critical components of the perfect visual system, thanks to its transparency. In order to provide sustainable transparency in the cornea, which is very important for visual function, it is possible with the intense metabolic activity in the cornea and the perfect operation of the balanced ion liquid pump. The cornea provides excellent vision thanks to the structure and functions necessary for its unique function to continue regularly. This review focuses on cornea and tear film structure and physiology.

CsPbBr3:Na with an Adjustable Bandgap, Improved Luminescence Stability, and its Application in WLEDs with Excellent Color Quality and Vision Performance

AbstractIt is still a great challenge to obtain multicolor tunable luminescence and improve the stability of luminescence through reasonable design of materials in the field of white light‐emitting diodes (WLEDs). In particular, it is more important to improve the luminescence intensity and stability of blue‐emitting materials. Here, the properties of CsPbBr3, CsPbBr3:Na, and NaPbBr3 are investigated theoretically by using density functional theory (DFT). Based on the DFT theoretical calculation results, it is assumed that unexpected performance may be achieved by replacing Cs in CsPbBr3 with Na or passivating the surface of CsPbBr3 with Na. As expected, the tunable luminescence from blue to green is successfully achieved from CsPbBr3:Na, and the stability is improved. After experimental optimization, the obtained CsPbBr3:Na (CPBN‐4) with high luminescence stability is used as blue‐emitting materials to construct the WLED devices with excellent color quality (CRI 92) and correlated color temperature of 9582 K.

Analysis of the effects of visual quality under different light conditions in different intraocular lenses: Study pilot

AbstractPurpose: To compare the effects on visual function and quality of life in cataract patients undergoing cataract surgery between different extended depth of focus (EDOF) lenses, when subjected to different illumination conditions.Methods: Observational, prospective, cross‐sectional pilot study with a total of 31 eyes of 15 patients undergoing uncomplicated phacoemulsification cataract surgery with Tecnis Eyhance, Isopure1.2.3 and Vivity intraocular lenses. All patients underwent a complete preoperative examination. They were also evaluated on different days under mesopic and photopic conditions.Results: Thirty‐one eyes of 15 patients (70.5 ± 8.6) were included in the study. Statistically significant values were obtained when comparing intermediate visual acuity (VA) between mesopic and photopic illumination conditions for the Isopure and Eyhance lenses with a value of 0.021 and the Isopure lens with Vivity with 0.001. In photopic conditions at intermediate distance a significant value was obtained between Vivity and Eyhance with a value of 0.02 and in mesopic conditions at intermediate distance between Vivity and Isopure with a value of 0.001. Between the different lenses, no significant values were obtained between the photopic and mesopic conditions. No significant values were found for pupillometry and halometry in mesopic conditions either.Conclusions: All three intraocular lenses provided excellent distance vision in both photopic and mesopic conditions with no statistically significant differences. But in intermediate distance, significant differences were found between photopic and mesopic conditions between the Isopure lens and the Vivity and Eyhance lenses. Therefore, the Isopure lens has worse intermediate VA values in mesopic than the other lenses. There were also no significant differences in near vision in pupillometry and halometry.

Effectiveness of reducing corneal astigmatism after combined high-frequency LDV Z8 femtosecond laser-assisted phacoemulsification and arcuate keratotomy.

Purpose: In this retrospective study, the efficacy of the FEMTO LDV Z8 Femtosecond Laser-Assisted Cataract Surgery (Femto Z8 FLACS) and the Femtosecond laser Arcuate Keratotomy (FSAK) in decreasing the corneal astigmatism was investigated. Methods: During FLACS, FSAK was positioned with the help of the FEMTO LDV Z8 laser at a diameter of 8.5mm and an 80% depth. Before and 3months after surgery, the astigmatism of the cornea was measured with the aid of Pentacam. The variables influencing the efficacy of FSAK were assessed using the multiple regression analysis technique. Vector analyses were carried out. To determine the net corneal alterations, the with-the-wound and against-the-wound variations were computed along the FSAKs' meridian. Results: This study investigated 80 eyes from 62 participants. The average keratometric astigmatism value was 0.92 ± 0.44 diopters (D). The average keratometric astigmatism decreased to 0.61 ± 0.45 D 3months following FSAK compared to preoperative corneal astigmatism (p < 0.05). Additionally, there was a considerable decline in the percentage of eyes with ±0.5 D and ±1.0 D astigmatism, which reduced 3 months after surgery by 58% and 85%, respectively (p < 0.05). Conclusion: The FEMTO LDV Z8 laser can create an effective and precise arcuate keratotomy with an excellent safety profile, rapid recovery, and vision stability.

ITO-activated reconfigurable micro-lens array for dynamic reversible focusing and collimation

Micro-scale optical components with varifocal manipulation, play a crucial role in imaging and display technology, beam shaping, optical switching, and wavefront-analysis. In order to provide dynamic reversible functionality, these lenses require varifocal capability. Herein, we demonstrate droplet-based micro-lens array for continuous shape regulation from focusing to collimation. Based on high transmittance of 80.41% at 808 nm wavelength and photothermal effect of surface plasmon wave, these ITO-activated microlenses can be dynamically reconfigured and thus display reversible focusing state of convex profile and collimation state of plane profile. As a result, the excellent vision of varifocal ability is unprecedentedly tuned from 155 µm to 1300 µm within a short time of 30 s. Meanwhile, these tunable micro-lenses accurately control the focal length by changing the irradiation duty ratio of laser pulse. Therefore, we demonstrate the fundamental characteristics and promising opportunities of ITO-activated microlenses for fluid-based refractive optical system. • Cormorant eye-inspired reconfigurable microlens arrays display reversible focusing state. • ITO-activated microlenses actuated by remote NIR exhibit the high transmittance. • Photothermal effect of surface plasmon wave facilitates light-responsive microlens arrays behaving varifocal ability. • ITO-activated microlens is promising as a novel remote-driven refraction optical system.

Minimally Invasive ICG Sentinel Lymphonodectomy in Vulvar Cancer in 10 Steps

<h3>Study Objective</h3> To create a didactic video demonstrating the surgical steps of incorporating the ICG (indocyanine green) method in sentinel node lymphonodectomy in vulvar cancer. <h3>Design</h3> Sentinel lymphonodectomy is commonly advised in unifocal vulvar cancer of less than 4cm of size and without clinically suspicious groin lymph nodes. Radioactive tracer use has been considered to be mandatory with the additional optional use of blue dye. ICG improves this approach since it is easily detectable and reproducible. The video shows the minimally invasive ICG Sentinel lymph node procedure in 10 steps to aid clinicians in reproducing this technique. <h3>Setting</h3> Tertiary referral center. <h3>Patients or Participants</h3> Vulvar cancer patients suitable for Sentinel lymphonodectomy. <h3>Interventions</h3> In this video we use clips of intraoperative video footage recorded with an ICG exoscope for open surgery (Vitom-ICG, Karl Storz, Germany) with its different video modes applied. Since the Exoscope is used predominantly to capture the video sequences, most of the video shows magnified views of the operating field. Additional video clips have been inserted to show the operating room setting. <h3>Measurements and Main Results</h3> Combining ICG and radioactive tracer is useful in sentinel detection and removal in vulvar cancer patients. <h3>Conclusion</h3> The use of ICG in conjunction with Technetium radioactive tracer in Sentinel lymphonodectomy in vulvar cancer provides excellent vision of the lymph vessels and lymph nodes and allows for minimally invasive and accurate detection and preparation of the Sentinels.

A vision of excellence

A vision of excellence

Clinical Outcomes after Bilateral Implantation of Trifocal Diffractive Intraocular Lenses and Extended Depth of Focus Intraocular Lenses.

The purpose of this retrospective study is to investigate clinical outcomes of bilateral implantation of diffractive trifocal intraocular lenses (IOLs) and extended depth of focus IOLs in Koreans. The clinical outcomes of cataract surgery with bilateral implantation of PanOptix, FineVision, Symfony, and MiniWell were evaluated. Uncorrected distant, intermediate (80 cm, 60 cm), near (40 cm) visual acuity, defocus curve, manifest refraction, contrast sensitivity, and higher-order aberrations, quality of vision, spectacle independence, and subjective satisfaction at postoperative 3 months were assessed. A total of 136 eyes in 68 patients were included in the analyses. PanOptix and FineVision performed better visual acuity compared to Symfony and MiniWell at 40 cm distance. Defocus curve showed broad range of vision in PanOptix and FineVision with visual acuity of more than 0.1 logarithm of the minimum angle of resolution at −2.5 diopter (D) of defocus power, while Symfony and MiniWell presented excellent intermediate vision without a dip at defocus power of −0.5 D to −1.0 D. Glare, halo, and starburst were significantly less in MiniWell compared to others. In conclusion, all four IOLs presented satisfactory clinical outcomes. PanOptix and FineVision provided good near and intermediate vision, while Symfony and MiniWell provided good intermediate vision. MiniWell induced little dysphotopsia.

Simultaneous Presbyopia and Astigmatism Correction with a Novel Trifocal Toric Intraocular Lens-A One-Year Follow-Up.

The current investigation evaluates the efficiency of the trifocal toric Liberty 677MTY intraocular lens (IOL) in correcting preoperative corneal astigmatism in cataract patients demanding spectacle independence. The retrospective evaluation included 28 eyes of 15 patients with preoperative corneal astigmatism of at least 1.0 Dioptre (D). All patients were followed up for one year postoperatively. Residual refractive errors and visual acuities at multiple distances were measured. Binocular visual acuity and contrast sensitivity defocus curves were plotted. Visual functions and patient satisfaction were assessed. The efficiency of astigmatism correction was determined using the vector analysis method. The mean spherical equivalent refraction (SEQ) improved from 2.72 ± 1.62 D to 0.10 ± 0.48 D. The cylindric refraction decreased from 1.18 ± 0.45 D to 0.16 ± 0.31 D. Vector analysis proved efficient astigmatism correction with a centroid of 0.10 ± 0.34 D at 161°. Ninety-two percent of eyes resulted within 0.5 D from the target refraction. Visual acuities were 0.1 logMAR or better from +1.0 to −3.5 D defocus values. Visual tasks could be performed without major difficulties. Our patients were highly satisfied. Refractive and visual outcomes with the investigated presbyopia-correcting toric IOL are predictable and the lens provides excellent trifocal vision.

30 years of ocular proton therapy, the Nice view

PurposeRadiotherapy with protons (PT) is a standard treatment of ocular tumors. It achieves excellent tumor control, limited toxicities, and the preservation of important functional outcomes, such as vision. Although PT may appear as one homogenous technique, it can be performed using dedicated ocular passive scattering PT or, increasingly, Pencil Beam Scanning (PBS), both with various degrees of patient-oriented customization. Materaial and methodsMEDICYC PT facility of Nice are detailed with respect to their technical, dosimetric, microdosimetric and radiobiological, patient and tumor-customization process of PT planning and delivery that are key. 6684 patients have been treated for ocular tumors (1991–2020). Machine characteristics (accelerator, beam line, beam monitoring) allow efficient proton extraction, high dose rate, sharp lateral and distal penumbrae, and limited stray radiation in comparison to beam energy reduction and subsequent straggling with high-energy PBS PT. Patient preparation before PT includes customized setup and image-guidance, CT-based planning, and ocular PT software modelling of the patient eye with integration of beam modifiers. Clinical reports have shown excellent tumor control rates (∼95%), vision preservation and limited toxicity rates (papillopathy, retinopathy, neovascular glaucoma, dry eye, madarosis, cataract). ResultsAlthough demanding, dedicated ocular PT has proven its efficiency in achieving excellent tumor control, OAR sparing and patient radioprotection. It is therefore worth adaptations of the equipments and practice. ConclusionsSome of these adaptations can be transferred to other PT centers and should be acknowledeged when using non-PT options.

Robotic abdominal resection of tailgut cysts - A technical note with step-by-step description.

AimHere, we describe a step‐by‐step standardized technique for tailgut cyst resection using a single‐docking robotic approach.MethodEach step of the technique is illustrated using a composite collection of four operative patient videos to demonstrate the advantages and feasibility of this technique. The robot platform utilised is Da Vinci Xi.ResultsFive female patients have undergone this operation in our unit. The size of tumours ranged from 12 to 45 mm. Median operating time was 100 min (range 90–150). Mean blood loss in all the patients was less than 50 ml. There were no major intraoperative complications. One patient had a postoperative presacral collection which required radiological drainage. Length of stay in all patients was one day.ConclusionsThis technique using a single‐docking robotic approach appears safe and feasible. The robotic approach results in improved dexterity and more accurate dissection, better retraction and excellent vision which improves the ease of operating in the pelvis. Therefore, this approach can be replicated for use in a wide variety of patients with tailgut cysts.

The neurobiology of nutraceuticals combined with light exposure, a case report in the course of retinal degeneration

The present article presents a case report and discusses the neurobiology underlying the potential neuro-repair induced by combined administration of phytochemicals in a patient undergoing photo-bio-modulation (PBM), which improves anatomical and clinical abnormalities in the course of age-related macular degeneration (AMD). After combined treatments the patient with nutraceuticals and PBM had noticeable improvement of retinal tissue with excellent vision for her age and no worsening of corneal guttae, which was present at the time of diagnosis. The present treatment was tailored, based on translational evidence, to improve the autophagy pathway, which is a key determinant in the onset and progression of AMD. In fact, treatment with specific patterns of light exposure combined with specific phytochemicals, may synergize in improving the microanatomy of the retina by restoring its neurobiology. The combination of light exposure, at selective wavelengths, with the effects produced by the intake of specific phytochemicals to treat AMD is reported here as "Lugano Protocol". Such a clinical protocol represents an "in progress" development backed up by translational research. In fact, recent evidence indicates that, specific phytochemicals, when administered in combination may promote anatomical and functional integrity within the retina. These in turn synergize with analogous effects produced by specific wavelengths, when administered at specific time intervals. The synergism between specific light and combined phytochemicals is discussed at molecular level, where recent data indicate how these treatments, when delivered according to specific patterns, may enhance autophagy in the retina. The improvement of retinal morphology and visual acuity, observed in this case report is thoroughly discussed in the light of the key role of autophagy in regulating the integrity of the retinal epithelium. Despite exciting, and consistent with translational evidence, the clinical report of a disease modifying effect during AMD owns the inherent limit of a case report, which requires wide validation in large number of patients. The potential effectiveness of "Lugano protocol" may apply to other types of retinal degenerations, where common alterations in the autophagy pathway do occur. Thus, such a therapeutic approach may extend to a common late stage of retinal trans-synaptic degeneration, where maladaptive plasticity during several types of retinal degenerative disorders eventually converge.

A Vision for Excellence in Physical Therapy Education

A Vision for Excellence in Physical Therapy Education

A comparison of clinical outcomes and optical performance between monofocal and new monofocal with enhanced intermediate function intraocular lenses: a case-control study

BackgroundTo compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs.MethodsSixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTFRMS) was measured in the optical bench study.ResultsThe mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between − 1.00 D to − 3.00 D of defocus. The ICB00 IOL had higher MTFRMS values at between − 0.50 D to − 2.00 D of defocus compared to the ZCB00 IOL.ConclusionsThe ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.

Correlation between keratometry and corneal incision before and after phaco surgery.

Cataract is a common cause of vision loss and blindness in humans. After surgical management of cataract, all efforts should be focused on reducing postoperative astigmatism thus providing an excellent vision to patients. To determine the relationship between corneal incision and refraction changes before and after phacoemulsification surgery in 300 patients undergoing cataract surgery in Khatam hospital in Mashhad, Iran from January 2017 to April 2018. Three hundred patients (144 women and 156 men) with cataract undergoing phacoemulsification surgery were recruited in this cross-sectional study. Refraction, keratometry and visual acuity measurement were performed before surgery. Then, a steep-based incision in the cornea was made without stitches. A 3.2 mm corneal incision was made at two supratemporal and temporal sites. The patients were followed-up for one and six months, and one year after surgery monitoring their vision and refraction, and performing keratometric measurements. The mean age of the patients was 65.7±9.54 years (age range, 42-84 years). No major complications were observed. The greatest mean of changes in corneal power was in the supratemporal incision (1.28±0.6). Keratometry had a significant relation with the incision (p.

Perspective for change: establishing the need for clinical instructor competencies in physical therapist education

Current issue: Clinical instructors (CIs) are instrumental in the development of competent, entry-level physical therapist graduates. Despite this key role, CIs are often deficient in formal knowledge of the learning sciences that influence quality of clinical education experiences. Clinical education stakeholders also lack a standardized and consistent approach to defining and assessing clinical teaching skills, resulting in an inability to provide adequate feedback and growth opportunities for CIs. Perspective: A gap exists between qualitative descriptions of clinical teaching behaviors and the ability to objectively assess those behaviors in CIs. Grounded in the Model of Excellence in Physical Therapist Education, this perspective calls attention to and proposes steps toward excellence in clinical education. Defining essential competencies of clinical teaching in the physical therapy profession requires a systematic approach. The competencies established through this approach then become the foundation for creating a meaningful assessment tool of CI performance. Implications for clinical education: Developing educator competencies and a related assessment tool for CIs allows for the provision of meaningful feedback, the creation of targeted professional development programs, and opportunities for recognition of clinical teaching excellence. Without effective CIs, new graduates may be inadequately equipped to contribute to the profession’s vision of educational excellence.

General characteristics of civil service systems

The article is devoted to highlighting the general features of different systems of civil service organization. The relevance of the study is due to the fact that Ukraine's participation in globalization and European integration processes reflects the need to study the experience of states that make up the Western legal tradition, which should focus on civil service systems, based on the tasks of the state in democratic societies. Ukraine.&#x0D; It is noted that in the postmodern era there is a need to rethink the classical models of civil service organization, analysis of modern systems of such organization and the formulation of generalized conclusions, their systematization. The purpose of the article is to systematize and generalize the various systems of civil service organization: classical, mixed and modern, available in the European political space.&#x0D; The focus is on the identification of three classic systems of civil service organization that are immanent to the states of the European community: career, job and mixed. The prevalence of the career model in these states is indicated, however, the states do not focus on the characteristics of such a model, using the contamination of individual features of each of these systems. There are such features of the career system of the civil service as strict compliance with the statutory requirements as a condition for career growth of the employee; disregard for experience in the private sector; features of remuneration and pension provision of civil servants; regulation of subordination relations; normative consolidation of rules of conduct for civil servants, etc.&#x0D; The defining feature of the modernization model of the civil service is the management of purely public interests and demands. The transient model assumes belonging to models with open orientation. The postmodernist model is an excellent vision, illuminating a new categorical apparatus (individual values, humanistic principles, openness).&#x0D; A characteristic feature of the mixed model is the contractual relationship between a public employee and a government agency.&#x0D; The significance of the main provisions and conclusions of the study is determined by the possibility of their use in public administration in Ukraine.

Visual performance with multifocal contact lenses and progressive addition spectacles

PurposeAs presbyopia occurs, new visual demands create a need for clear vision at multiple distances. Many spectacle wearers adapt into progressive addition lenses (PAL) in order to see clearly at distance, intermediate, and near. A multifocal contact lens provides the ability to see at these same distances without the prismatic effects of a spectacle lens or the peripheral obstruction of a spectacle frame. No studies have been done to date comparing the effect of these types of presbyopic vision correction on a variety of tests of visual performance representative of everyday tasks. MethodsA battery of visual performance tasks were completed by subjects while wearing their habitual PAL spectacles. These subjects were then fit with a multifocal contact lens and wore lenses for 2 weeks or more before completing the tasks again. These functional vision tests included assessments of coincidence anticipation timing, peripheral search and hand-eye coordination, and dynamic visual acuity. Following functional vision testing, subjects completed a preference survey comparing both types of refractive correction while performing common activities of daily living. ResultsPerformance on the majority of the tests of visual performance were equivalent (P < 0.05) when comparing PAL spectacles and multifocal contact lenses. Survey results demonstrated a preference for multifocal contact lenses overall. ConclusionPAL spectacles are widely prescribed for presbyopic patients. The findings of this study suggest that in addition to providing excellent vision, multifocal contact lenses provide functional vision performance equal to PAL spectacle wear and patients may prefer them over PAL spectacles.

Staying fit: a must to be a successful Neurosurgeon

&#x0D; &#x0D; &#x0D; When I decided to be a neurosurgeon, I was told that my professional life is going to be very short. At the start you would begin late as it takes long to be a competent one and later due to stress of life and work, soon you would feel either exhausted or due to physical issues would soon stop operating.&#x0D; &#x0D; &#x0D; &#x0D; Well this doomsday prediction for a career neurosurgeon may discourage new enthusiasts, the seasoned practitioner however knows what it takes to continue your career graph go up for long.&#x0D; Neurosurgeons need a blend of skills and personal qualities like a high degree of manual dexterity, good hand-eye co-ordination, excellent vision and visuo-spatial awareness, good organisational ability and effective decision-making skills. To achieve this professional requirement and to keep going strong, we need a healthy body and a problem-solving mind.

The effectiveness of the auditing of the Financial and Administrative Audit Bureau on government agencies in Jordan

In line with the Bureau's strategic vision of sustainable professional oversight excellence to enhance public accountability, consolidate concepts of disclosure and transparency, and assist the public sector to work efficiently and effectively, based on the provisions of Article (119) of the Jordanian Constitution, and Article (22) of the Audit Bureau Law No. (28) of 1952 and its amendments, which The President of the Audit Bureau shall submit an annual report to the National Assembly, both the Senate and the Representatives, that includes his opinions and observations, and a statement of the most important violations committed and the responsibility resulting therefrom, with the start of each regular session of the National Assembly, or whenever the House of Representatives requests him to do so.