Eyelid Movements Research Articles

Design and Usability Study of a Point of Care mHealth App for Early Dry Eye Screening and Detection.

Significantly increased eye blink rate and partial blinks have been well documented in patients with dry eye disease (DED), a multifactorial eye disorder with few effective methods for clinical diagnosis. In this study, a point of care mHealth App named "EyeScore" was developed, utilizing blink rate and patterns as early clinical biomarkers for DED. EyeScore utilizes an iPhone for a 1-min in-app recording of eyelid movements. The use of facial landmarks, eye aspect ratio (EAR) and derivatives enabled a comprehensive analysis of video frames for the determination of eye blink rate and partial blink counts. Smartphone videos from ten DED patients and ten non-DED controls were analyzed to optimize EAR-based thresholds, with eye blink and partial blink results in excellent agreement with manual counts. Importantly, a clinically relevant algorithm for the calculation of "eye healthiness score" was created, which took into consideration eye blink rate, partial blink counts as well as other demographic and clinical risk factors for DED. This 10-point score can be conveniently measured anytime with non-invasive manners and successfully led to the identification of three individuals with DED conditions from ten non-DED controls. Thus, EyeScore can be validated as a valuable mHealth App for early DED screening, detection and treatment monitoring.

Interrupted Versus Running Sutures for Amniotic Membrane Fixation in Cases of Resistant Infected Corneal Ulcers

Background: Infected corneal ulcers that don't show any healing within two weeks despite proper medical treatment are considered resistant and need surgical intervention [1] the amniotic membrane transplantation has been used to treat resistant corneal ulcers because it acts as a bioactive substratum that accelerates epithelial healing [2].
 Aim of the Work: comparison between interrupted and running sutures for amniotic membrane fixation in cases of resistant infected corneal ulcers.
 Patients and Methods: This prospective, comparative, interventional randomized study was carried out on 40 eyes with resistant infected corneal ulcers. They underwent amniotic membrane transplantation as an adjunctive to the medical treatment. Divided into 2 groups: group A (interrupted suture group) and group B (running suture group). The duration of study was 12 months.
 Results: The duration of healing in group A ranged from 25 to 40 days with mean duration of 34.25±4.94 days, while in group B the duration of healing ranged from 20 to 40 days with mean duration of 31.0±6.61 days. UDVA didn’t improve in 65% of cases in group A and 45% of cases in group B.
 Conclusion: Amniotic membrane transplantation is an adjunctive surgical procedure for the management of infectious corneal ulcer by promoting wound healing and reducing inflammation. We noticed that the running suture adhered the amniotic membrane firmly to the entire corneal surface so it accelerated the corneal epithelial healing and made it less affected with eyelid movement and less annoying to patient.

Videographic analysis of blink dynamics in patients with chronic progressive external ophthalmoplegia, myogenic ptosis, and facial nerve palsy using smartphone camera: A comparative analysis.

Congenital myogenic ptosis (CMP), chronic progressive external ophthalmoplegia (CPEO), and facial nerve palsy (FNP) are among the disorders which can seriously affect the blink dynamics of patients. Smartphone videography is a simple, convenient, and inexpensive way to capture eyelid movement. This study has measured and compared a variety of blink dynamics in these patients compared to healthy controls using 2-dimensional smartphone videography to enhance the utility of this method in both clinical and research settings. A total of 30 adult participants with a complaint of impaired eyelid movements including 10 with CMP, 10 with CPEO, and 10 with unilateral FNP, as well as 10 healthy controls were recruited. Using a smartphone camera with a resolution of 240 frames per second in 720 p, various blink dynamics were measured. All case groups had significantly lower values of peak and average closing velocities, average opening velocity, and palpebral aperture and significantly higher values of eyelid closing duration, compared to controls. FNP participants also had significantly lower values in the full blink rate and peak opening velocity (POV) measures, and CPEO patients showed significantly lower values in the POV. Other measures were not statistically significantly different compared to healthy controls. Our results indicated that all patients with CMP, FNP, and CPEO had different blinking dynamics compared to healthy controls, which is consistent with previous studies. Smartphone videography has achieved sufficient resolution and frame-rate to provide valuable information and anatomic details for clinical and research purposes. Further studies could utilize smartphone videography for further investigation and confirmation of the methodology in various conditions.

A-355 Eyescore, A Point of Care Smartphone App for Early Dry Eye Diagnosis and Management

Abstract Current diagnosis of dry eye disease (DED) has significant challenges with limited accuracy and poor correlation of clinical symptoms. The goal of this study is to develop a smartphone App, namely “EyeScore”, to provide a point of care (POC) and digital solution for early diagnosis of DED. The authors tested the hypothesis of measuring eye blink rate and partial blink count as early clinical biomarkers for the calculation of so called “eye healthiness score”, which allows a convenient, rapid eye exam at home with low resource settings. EyeScore uses an iPhone as an imaging and sensing device for in-App recordings of eyelid movements. The use of facial landmark recognition and eye aspect ratio (EAR) enabled comprehensive digital analysis of video frames for determination of the eye opening/closed states. The smartphone videos from 10 DED patients and 10 healthy controls were tested to optimize EAR derived thresholds for accurate measurements of blink rates and partial blink counts. The authors formulated a clinically relevant algorithm for the calculation of “eye healthiness score”. This 10-point scale score can be easily measured anytime with a non-invasive manner and remotely shared with the patient's eye doctor. As a result, both patients and doctors can monitor the eye conditions over time. Our results showed that EyeScore confirmed the diagnosis of all 10 DED patients. Importantly, Eyescore also identified three individuals with “pre-DED” conditions from 10 healthy controls, demonstrating its potential clinical values for early diagnosis and management of DED. Materials and Methods An Apple MacBook Pro installed with iOS software (iOS 16.1.2) and Xcode 14.0 was used for coding and debugging. Visionkit SDK from Apple Developer was adopted to extract coordinate data from six eye facial landmarks. EAR values were calculated based on the previously published formula, with a dynamic EAR developed as a threshold for the measurement of blink rate and half blink count. For eye healthiness score, a 10-point formula was formulated (0–3, normal; 4–5, Pre-DED; 6–10, DED) with several contributing factors including blink rate, half blink count, eye discomfort and demographic characteristics. Results A total of 20 iPhone videos from DED patients and healthy controls were analyzed and evaluated with EyeScore App. All DED patients obtained scores above 7, confirming their DED diagnosis. On the other hand, three controls obtained scores of 4 or 5, suggesting they were in the Pre-DED state with no noticeable clinical DED symptoms. All other controls obtain scores blow 3 with normal eye conditions. All tests were performed with the consents from the test participants. Conclusions Smart phone-based platform offers great potentials for point of care diagnostic methods. A POC enabled EyeScore App has been successfully developed for early diagnosis of DED. In the future, the authors plan to test EyeScore with a large-scale sample set of DED patients and controls to further validate the accuracy and predictability of eye healthiness score for its broader clinical applications.

Simultaneous Reconstruction of Smiling Eye Using V-Shaped Long Latissimus Dorsi Muscle Transfer in Patients with Flaccid Facial Paralysis.

Various neurovascular free muscle transfers for smile reconstruction in patients with facial paralysis have been reported. However, these methods focused on perioral smiling rather than eye smiling. Although the lower eyelid does not contribute significantly to eyelid closure, dynamic reanimation of the upward movement of the lower eyelid with bulging of the malar region during smiling is important in smile reconstruction. The authors present a novel procedure for smiling eye and perioral smiling. The V-shaped latissimus dorsi muscle flap containing the descending branch (DB) of the thoracodorsal nerve (TDN) was used. Muscle A (15 to 17 cm), which is located along the main trunk of the DB, is much longer than muscle B (10 to 12 cm), which is along the branch of DB. A distal stump of the TDN involved in muscle B was prepared. The true trunk and distal stump of the TDN were sutured to the contralateral facial and ipsilateral masseteric nerves, respectively. The central region of muscle A was positioned at the lateral part of the lower eyelid; the distal end of long muscle A was affixed to the temporal region, which enabled periocular movements and narrowing of the palpebral fissures alongside perioral smiling when muscle A contracted. Nine patients with complete flaccid facial paralysis were treated. All patients attained muscle contraction induced by the ipsilateral masseteric and contralateral facial nerves. The smiling eye appearance was observed in 7 of 9 patients. This procedure simultaneously improves paralytic ectropion at rest and aids eyelid closure and enables early voluntary smile and a later spontaneous smile.

Kinematics of the Upper Eyelid and the Globe During Downward Excursion With Comparative Analysis in Patients With Thyroid Eye Disease.

To analyze the kinematics of the upper eyelid and the globe on downward excursion for potential use in monitoring thyroid eye disease (TED) progression in an objective manner. Ten normal volunteers and 10 patients with TED were studied. A high-speed (240 fps) digital camera with a coaxial light source set at a constant distance from the subjects' eyes was used to record the excursion of the upper eyelid and the globe from extreme upgaze to extreme downgaze. Clinical data, including age, gender, race, thyroid function tests, Vision, Inflammation/Congestion, Strabismus/motility restriction, Appearance/exposure score (primary surgeons' preference of TED grading system), exophthalmometry, and eyelid measurements were collected for all patients with TED. Frame-by-frame analyses of the videos were performed using Python software (version 3.6) and the Open Source Computer Vision Library. Temporal resolution was obtained by measuring the number of frames from initiation of eyelid and globe movement from extreme upgaze (t 0 ) to extreme downgaze (t f ). Spatial resolution was obtained by measuring the number of pixels the eyelid margin and the globe traversed from t 0 to t f . The data were then plotted on a graph to calculate the velocity of the upper eyelid and the globe during downward excursion. Velocimetric calculations using high-speed photography suggests that downward excursion of the upper eyelid, and the globe occurs in 2 phases: the acceleration phase and the deceleration phase. Comparative analysis of slow-motion videography demonstrates that patients with TED were found to have attenuation in the early acceleration phase of upper eyelid excursion compared with normal subjects. In patients with TED, the difference in velocity between the eyelid and the globe occurs in the early deceleration phase. The upper eyelid normally synchronizes intimately with the globe during downward eye movement. Data from this study reveal that attenuation mostly in the early deceleration phase of eyelid movement relative to the globe accounts for the dynamic eyelid lag seen on clinical examination. Further analysis is needed to show if a quantified von Graefe sign can be used as an objective means of monitoring progression in TED.

ACTIVITY IN BARREL CORTEX RELATED TO TRACE EYEBLINK CONDITIONING.

In mammals several memory systems are responsible for learning and storage of associative memory. Even apparently simple behavioral tasks, like Pavlovian conditioning, have been suggested to engage, for instance, implicit and explicit memory processes. Here we used single whisker tactile trace eyeblink conditioning (TTEBC) to investigate learning and its neuronal bases in the mouse barrel column, the primary neocortical tactile representation of one whisker. Behavioral analysis showed that conditioned responses (CR) are spatially highly restricted, they generalize from the principal whisker only to its direct neighbors. Within the respective neural representation, the principal column and its direct neighbors, spike activity showed a learning-related spike rate suppression starting during the late phase of conditioning stimulus (CS) presentation that was sustained throughout the stimulus-free trace period (Trace). Trial-by-trial analysis showed that learning-related activity was independent from the generation of eyelid movements within a trial, and set in around the steepest part of the learning curve. Optogenetic silencing of responses and their learning-related changes during CS and Trace epochs blocked CR acquisition, but not its recall after learning. Silencing during the Trace alone, which carried major parts of the learning-related changes, had no effect. In summary, we demonstrate specific barrel column spike rate plasticity during TTEBC that can be partially decoupled from the CR, the learned eye closure, a hallmark of implicit learning. Our results, thus, point to a possible role of the barrel column in contributing to other kinds of memory as well.Significance StatementAssociation learning relies on different memory systems. The Pavlovian eyeblink reflex conditioning paradigm already involves the generation of a new movement ('move the eyelid', implicit memory), and to learn the task contingencies ('know the rule of the game', explicit memory). Using this paradigm, we study the involvement of whisker-related mouse primary somatosensory cortex (S1) in different memory systems. With recording and causal stimulation techniques, we found spike plasticity in S1 during presentation of the conditioned stimulus that is causal for implicit learning. Notably, however, blocking learning-related changes during stimulus-free trace period did not impair implicit memory. We conclude that S1 activity is related to the implicit and at least one other memory system, presumably the explicit one.

Reconstruction of Medial Canthal Ligament With Autogenous Fascia Lata Graft.

An eyelid malignant tumor invading the medial canthus is a serious eyelid disease that requires extensive resection and complex destruction. The medial canthus ligament is especially difficult to repair because its reconstruction often requires special materials. In this study, we described our reconstruction technique using autogenous fascia lata. Data from 4 patients (4 eyes) who had medial canthal ligament defects after Mohs resection of eyelid malignant tumors were reviewed from September 2018 to August 2021. The reconstruction of the medial canthal ligament using autogenous fascia lata was performed in all of the patients. If combined with the upper and lower tarsus defects, autogenous fascia lata was split into 2 branches to repair the tarsal plate. The pathologic diagnosis was basal cell carcinoma in all patients. The mean follow-up time was 13.6±3.51 months (range, 8-24mo). There was no tumor recurrence, infection, or graft rejection. All patients achieved good eyelid movement and function and were satisfied with their medial angular shape and cosmetic contour. Autogenous fascia lata is a good material to repair medial canthal defects. It is easy to take and effectively maintains eyelid movement and function with satisfactory postoperative effects.

Numerical Simulation of Mixed Convection Cooling of Electronic Component within a Lid-driven Cubic Cavity Filled with Nanofluid

Abstract This study investigates the effect of the movement of a moving lid on the heat transfer and cooling of three isothermal blocks inside a cubic enclosure filled with a Cu-water nanofluid. The study's geometry is three-dimensional with three blocks which are assumed to have a fixed hot temperature TH. The study considers two cases for the movement of the upper lid: one where the lid moves in the longitudinal direction, and another where it moves in the transverse direction. The dimensionless governing equations considering the boundary conditions are solved by implementing the finite volume approach with the power low as a resolution scheme. The study varies several factors such as the shape of the nanofluid, the shape factor of the blocks (3L/4, L/2, and L/4), the number of cold walls, the Richardson number (0.01 to 10), the volume fraction of nanoparticles (0 to 0.06), at a fixed Grashof number (104). The results indicate that decreasing the Richardson number improves the heat transfer coefficient's performance. Also, the study finds that longitudinal movement provides better block cooling compared to transverse movement. Additionally, changing the height of the blocks from L/4 to 3L/4 resulted in a decrease in heat transfer inside the cavity. As stated, the research aimed to investigate the impact of different directions of lid movement on the cooling of heater blocks, with the goal of enhancing the thermal performance and heat transfer efficiency of various technical engineering equipment.

Prosthodontic Rehabilitation of Ocular Defect Using Customized Ocular Prosthesis

The eyes play an important role in determining a person's facial profile. It causes distress to the patient when his or her eyes are lost. In order to enhance self-esteem and social acceptance, eye prosthesis restores the appearance of the face. There are various materials and techniques used in the fabrication of an ocular prosthesis. Among the advantages of custom ocular prostheses over stock eye prostheses are better eyelid movements, even pressure distribution, which reduces trauma to the tissues, and improved fit, comfort, and aesthetics. An ocular prosthesis can be customized to appear more natural by customizing the size, shape, and color of the iris, pupil, and sclera. This article illustrates the rehabilitation of eyes using custom-made eye cells.

A Quantitative Approach to Telemedicine Assessment of Ptosis and Ocular Motility for Patients with Myasthenia Gravis (P7-8.011)

<h3>Objective:</h3> The study assessed the capability to quantify eye movements and lid position in patients with MG. <h3>Background:</h3> Ptosis and diplopia are nearly uniformly present in patients with myasthenia gravis (MG). In the telemedicine setting, the unique presence of video capture lends use of emerging implementation of image-processing techniques that could provide precise, standardized assessment of ocular motility abnormalities. <h3>Design/Methods:</h3> We utilized video recordings of the ADAPT teleMG study performed. Six subjects underwent standardized video examinations on two occasions 2–3 days apart. We performed a hybrid algorithm combining deep learning with computer vision to give quantitative metrics of ptosis and ocular motility. <h3>Results:</h3> All videos and still images could be used for analysis despite limitations of low resolution dictated by internet bandwidth and cameras of the examiner and subject. The hybrid algorithm detected the distance between pupil and upper eyelid for ptosis and misalignment of the left and right pupil for diplopia assessment. The algorithm automatically detected the pupillary and lid margins with error of 2 pixels in average. Lid, pupil, and iris detection did not differ based on skin or iris color. We were able to detect ocular misalignment in subjects complaining of diplopia. The method worked both on a fixed image and video in real-time allowing capture of the dynamic changes during the examination. <h3>Conclusions:</h3> We were able to use standard Zoom recordings of lid and eye movements and quantitate them using a hybrid deep learning computer vision algorithm. The system introduces modern image processing technique that are quick and robust to recover quantitative metrics that are independent of the examiner and would work on most video resolutions. The approach has the potential to quantitate ocular motility abnormalities and could be used to monitor patients. <b>Disclosure:</b> Mr. Lesport has nothing to disclose. Dr. Joerger has nothing to disclose. The institution of Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cabaletta Bio. Dr. Kaminski has stock in ARC Biotechnology. The institution of Dr. Kaminski has received research support from National Institutes of Health. Dr. Kaminski has received publishing royalties from a publication relating to health care. Helen Girma has nothing to disclose. Ms. McNett has nothing to disclose. Dr. Abu-Rub has nothing to disclose. Prof. Garbey has stock in Care Constitution, LLC. Prof. Garbey has a non-compensated relationship as a CEO with Care Constitution, LLC that is relevant to AAN interests or activities.

Ocular Surface Metrics in Blepharospasm Patients After Treatment With Botulinum Toxin Injections.

The purpose of this study was to assess blepharospasm patients regarding the effect of botulinum toxin in ocular surface parameters. A prospective study was performed in blepharospasm patients treated with onabotulinumtoxinA. A smartphone (iPhone 6S, Apple) and custom-made software were used to record the eyelid movements for 3 minutes in a standardized manner. Optical coherence tomography of the tear meniscus was used to assess the tear meniscus area. Tear break-up time and the Ocular Surface Disease Index questionnaire were also evaluated. Patients were assessed before and 15 days after botulinum toxin injections. Forty eyes of 20 patients were evaluated. The frequency of the spontaneous eyelid movements was significantly reduced after treatment (23.18 ± 12.85 movements/min vs. 9.29 ± 6.87 movements/min; p < 0.0001). Significant increases in the tear meniscus area (0.020 ± 0.015 mm 2 vs. 0.057 ± 0.104 mm 2 ; p = 0.01) and in break-up time (4.2 ± 1.2 seconds vs. 5.1 ± 1.3 seconds; p = 0.03) were observed 15 days after treatment. A significant reduction in the Ocular Surface Disease Index (59.05 ± 19.04 vs. 21.2 ± 19.5; p < 0.0001) was also observed. Significant changes in the tear meniscus area, break-up time, and Ocular Surface Disease Index after treatment reflect the effect of botulinum toxin on the lacrimal pump and in the improvement of dry eye symptoms. Reduction of eyelid spasms after treatment in blepharospasm patients was demonstrated using a smartphone and custom-made software. Thus, beyond relieving eyelid spasms, botulinum toxin injections were associated with subjective and objective improvement of dry eye parameters in patients with blepharospasm.

Myasthenia gravis in current status: epidemiology, types, etiology, pathophysiology, symptoms, diagnostic tests, prevention, treatment, and complications - correspondence.

Myasthenia gravis in current status: epidemiology, types, etiology, pathophysiology, symptoms, diagnostic tests, prevention, treatment, and complications - correspondence.

“COMPARISON OF PERIBULBAR ANESTHESIA WITH POSTERIOR SUBTENON'S ANESTHESIA IN MANUAL SMALL INCISION CATARACT SURGERY (MSICS)”

Background: Cataract-related blindness is a huge problem in India, not only in terms of human suffering but also in terms of economic loss and social impact. For cataract extraction, retrobulbar anaesthesia was widely employed. Because of its substantial difculties, retrobulbar anaesthesia was replaced with peribulbar. Despite a two injection method Peribulbar anaesthesia has a very high failure rate. Subtenon's anaesthesia is becoming more popular in this situation, Because of its faster onset in delivering anesthesia, akinesia and patient compliance. A cross- Methods: sectional study in ophthalmology department at Sri Siddhartha Medical College, Tumkur was conducted over a period of 18 months in 150 MSICS participants , with 75 participants in each group. The efcacy and safety of two types of anaesthesia in MSICS were compared in terms of intraoperative analgesia, akinesia, lid movements, and complications. Out of Results: 75 participants in each group percentage with grade 0 pain in posterior subtenon's group was 64(83 %) as compared to 6( 8%) in peribulbar group. Among all 20 (27%) participants of peribulbar group and 2 (3%) of posterior subtenon's group had attained complete akinesia. Both the groups had experienced similar amount of lid movements. Occurrence of complications like chemosis and sub conjunctival hemorrhage was noted more in posterior subtenon's group when compared to peribulbar group

Enhanced Ionic Polymer-Metal Composites with Nanocomposite Electrodes for Restoring Eyelid Movement of Patients with Ptosis.

The present study aims to use enhanced ionic polymer-metal composites (IPMC) as an artificial muscle (a soft-active actuator) to restore eyelid movement of patients with ptosis. The previous eyelid movement mechanisms contained drawbacks, specifically in the lower eyelid. We used finite element analysis (FEA) to find the optimal mechanism among two different models (A and B). In addition to common electrodes of IPMC (gold and platinum), the bovine serum albumin (BSA) and microcrystalline cellulose (MCC) polymers, with optimal weight percentages of carbon nanotube (CNT) nanofiller, were also utilized as non-metallic electrodes to improve the efficiency of the IPMC actuator. In both models, IPMC with nanocomposite electrodes had higher efficiency as compared to the metallic electrodes. In model A, which moved eyelids indirectly, IPMC with MCC-CNT electrode generated a higher force (25.4%) and less stress (5.9 times) as compared to IPMC with BSA-CNT electrode. However, the use of model A (even with IPMCs) with nanocomposite electrodes can have limitations such as possible malposition issues in the eyelids (especially lower). IPMC with MCC-CNT nanocomposite electrode under model B, which moved eyelids directly, was the most efficient option to restore eyelid movement. It led to higher displacements and lower mechanical stress damage as compared to the BSA-CNT. This finding may provide surgeons with valuable data to open a window in the treatment of patients with ptosis.

System and Method for Driver Drowsiness Detection Using Behavioral and Sensor-Based Physiological Measures.

The amount of road accidents caused by driver drowsiness is one of the world's major challenges. These accidents lead to numerous fatal and non-fatal injuries which impose substantial financial strain on individuals and governments every year. As a result, it is critical to prevent catastrophic accidents and reduce the financial burden on society caused by driver drowsiness. The research community has primarily focused on two approaches to identify driver drowsiness during the last decade: intrusive and non-intrusive. The intrusive approach includes physiological measures, and the non-intrusive approach includes vehicle-based and behavioral measures. In an intrusive approach, sensors are used to detect driver drowsiness by placing them on the driver's body, whereas in a non-intrusive approach, a camera is used for drowsiness detection by identifying yawning patterns, eyelid movement and head inclination. Noticeably, most research has been conducted in driver drowsiness detection methods using only single measures that failed to produce good outcomes. Furthermore, these measures were only functional in certain conditions. This paper proposes a model that combines the two approaches, non-intrusive and intrusive, to detect driver drowsiness. Behavioral measures as a non-intrusive approach and sensor-based physiological measures as an intrusive approach are combined to detect driver drowsiness. The proposed hybrid model uses AI-based Multi-Task Cascaded Convolutional Neural Networks (MTCNN) as a behavioral measure to recognize the driver's facial features, and the Galvanic Skin Response (GSR) sensor as a physiological measure to collect the skin conductance of the driver that helps to increase the overall accuracy. Furthermore, the model's efficacy has been computed in a simulated environment. The outcome shows that the proposed hybrid model is capable of identifying the transition from awake to a drowsy state in the driver in all conditions with the efficacy of 91%.

Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis

In patients with severe blepharoptosis, the function of the levator muscle is usually weak. Even if a large amount of levator is resected, under-correction and recurrence often occur postoperatively. Frontalis suspension is the first choice for severe ptosis; however, the external orbital lifting force of the frontalis causes non-physiological eyelid movement. Conjoint fascial sheath (CFS) is a fibrous tissue which can provide dynamic movement of upper eyelids and has been applied for the treatment of mild and moderate blepharoptosis in recent years. This study aims to assess the efficacy and safety of CFS suspension combined with levator muscle advancement for treating severe blepharoptosis. A retrospective study included 44 patients (60 eyelids) with severe ptosis who underwent the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 (MRD1) were measured. Surgical outcomes, symmetry results and complications were evaluated postoperatively. At the 12–18 months follow-up, adequate or normal correction was achieved in 56 eyelids (93.3%), and 37 patients (84.1%) presented good or fair symmetry results. The most common complication was conjunctival prolapse, which was observed in six eyelids (10.0%), followed by lid fold deformity and under-correction. No exposure keratitis was recorded. In conclusion, the modified technique can physically elevate the eyelid with limited tissue injury and is effective for the correction of severe ptosis. Both satisfactory functional and esthetic results were achieved, and severe complications (such as exposure keratitis) were not observed.

Smartphone and custom-made software to assess the effect of botulinum toxin in essential blepharospasm: Initial results.

It is challenging to assess essential blepharospasm (EB) patients objectively because they exhibit chaotic patterns of abnormal eyelid movements. Previously employed objective approaches used systems with low levels of accuracy systems or were too complex to be applied in routine clinical practice. We aimed to develop a practical tool using a smartphone camera and custom-made software to objectively assess the therapeutic effects of botulinum toxin in blepharospasm patients. Thirty-four patients with EB were evaluated before and 15 days after receiving onabotulinumtoxinA injections. The control group was composed of 19 age-matched healthy individuals. A smartphone (iPhone 6 S; Apple) was used to record spontaneous eyelid movements for 3min, after which eyelid movement frequency was analysed using custom-made software. Before treatment, eyelid movement frequency was significantly higher in the EB group (21.55 ± 13.30 movements/min) compared to the control group (8.26 ± 8.89 eyelid movements/min; p< 0.001). The frequency of spontaneous eyelid movements was significantly reduced after treatment in the EB patients (8.46 ± 6.32 eyelid movements/min; p< 0.001). After treatment, no statistically significant difference in eyelid movement rate was observed between the EB patients and the control group (p= 0.32). Assessment of the spontaneous eyelid movements obtained with the smartphone camera and analysed with the custom-made software enabled us to objectively measure the therapeutic effects of botulinum toxin in patients with blepharospasm. Further refinement of this system could enable customized and fine adjustments to botulinum toxin doses based on each patient's needs.

RETRACTED: Mixed convective heat transfer in a power-law fluid in a square enclosure: Higher order finite element solutions

Incorporation of momentum gradients produced due to inertial motion of the lid along with the presence of temperature differences in the configuration make the physical problem more significant. The joint variation of momentum and thermal diffusion in diversified natural liquids is recognized as mixed convection. Valuable attention has been received by such a phenomenon in different areas of science and technology such as in wind current–based solar receivers, electronic instruments, control of emergency shutdown in reactors, thermal exchangers, oceanic currents, control of atmospheric pollution, and so on. So, the main focus is to contemplate hydrothermal characteristics of a power-law fluid contained in a square cavity with the movement of the upper lid and being thermally adiabatic. The other extremities are considered to be at rest, and the base wall is prescribed with uniform/non-uniform temperature distributions. The governing formulation of the problem is handled by executing a finite element approach. Hybrid meshing is performed for domain discretization, and weak variational formulation is utilized for formulation discretization. Second-degree polynomials are employed as the interpolation function, providing information about velocity and temperature distributions at boundary and intermediate nodes. The system of finalized non-linear equations is resolved by using the Paradiso software. The results for velocity and temperature distributions are attained comparatively for uniformly and non-uniformly heated profiles. The kinetic energy and average Nusselt number are also computed against flow concerning variables. From the attained graphical and tabular data, it is deduced that by increasing the Reynolds number, inertial forces dominate over buoyancy forces and the effect of lid movement is prominent on flow characteristics. It is also inferred that for the shear thickening case and for all values of the Reynolds number, the average Nusselt number shows a constant behavior.

Predicting separation errors of air traffic controllers through integrated sequence analysis of multimodal behaviour indicators

Predicting separation errors in the daily tasks of air traffic controllers (ATCOs) is essential for the timely implementation of mitigation strategies before performance declines and the prevention of loss of separation and aircraft collisions. However, three challenges impede accurate separation errors forecasting: 1) compounding relationships between many human factors and control processes require sufficient operation process data to capture how separation errors occur and propagate within controller-in-the-loop processes; 2) previous human factor measurement approaches are disruptive to controllers’ daily operations because they use invasive sensors, such as electroencephalography (EEG) and electrocardiography (ECG), 3) errors accumulated in using the tasks and human behaviors for estimating system dynamics challenge accurate separation error predictions with sufficient leading time for proactive control actions. This study proposed a separation error prediction framework with a long leading time (>50 s) to address the above challenges, including 1) a multi-factorial model that characterizes the inter-relationships between task complexity, behavioral activity, cognitive load, and operational performance; 2) a multimodal data analytics approach to non-intrusively extract the task features (i.e., traffic density) from high-fidelity simulation systems and visual behavioral features (i.e., head pose, eyelid movements, and facial expressions) from ATCOs’ facial videos; 3) an encoder-decoder Long Short-Term Memory (LSTM) network to predict long-time-ahead separation errors by integrating multimodal features for reducing accumulated errors. A user study with six experienced ATCOs tested the proposed framework using the Phoenix Terminal Radar Approach Control (TRACON) simulator. The authors evaluated the model performance through two types of metrics: 1) point-level metrics, including precision, recall, and F1-score, and 2) sequence-level metrics, including alignment accuracy and sequence similarity. The results showed that 1) the model using the task and visual behavioral features significantly improved the prediction performance compared to the model using one single feature (eyelid movements), with an improvement of up to 26.95% in alignment accuracy for 10s-ahead prediction; 2) the model that combined task and visual behavioral features had a higher or comparable performance to models with different hybrid features, achieving an alignment accuracy of 82.38% for 50s-ahead error prediction; and (3) the proposed method outperformed three baseline models – Convolutional Neural Network (CNN), Gated Recurrent Unit (GRU), and classic LSTM – by 8.21%, 3.47%, and 3.14% in alignment accuracy, respectively, for predicting 50s-ahead separation errors. These results suggest that the proposed model can effectively predict separation errors in air traffic control.