Longitudinal change of refraction over at least 5years in 15,000 patients

Background: To report the natural, longitudinal history of shifts in refractive errors in different age groups in a large western European cohort over at least 5years in the same patients. Methods: The electronic database of a large regional clinic containing 225,000 patients was searched for records of patients with a follow-up of at least 5years, excluding all patients who had received any surgical interventions in any eye. This search retrieved 15,799 patients aged 3months to 79years (median 37.8years) with refractive follow up of at least 5years (mean 8.8years) and no surgical interventions. Differences in spherical equivalents (sum of sphere +1/2 cylinder) and cylinder between first and last visit in the same patients in only the right eye were calculated, and used as the measure of refractive shift. Subsequently differences in change between the right and left eye were also determined. Results: Refractions were found to be mostly stable from 25 to 39years (n = 3,155 right eyes), with 50% of these patients not changing their refraction. In patients aged 20-24 (n = 825 right eyes), only 39% of the refractions remained stable, whereas 49% experienced a myopic shift. In the age group 40-69years (n = 6,694), 40-45% remained stable, with an increase in hyperopic shifts. Eighty-five percent of all patients had bilateral symmetric shifts, and 61% showed stable cylindrical values. Conclusions: This report documents clinical relevant changes in spherical equivalents in all age groups within 5 to 10years in the largest examined European cohort. Refractive surgery patients in particular should be selected accordingly, and be informed about the physiological changes which might still occur during their lifetim

Inspect, Understand, Overcome: A Survey of Practical Methods for AI Safety

Deployment of modern data-driven machine learning methods, most often realized by deep neural networks (DNNs), in safety-critical applications such as health care, industrial plant control, or autonomous driving is highly challenging due to numerous model-inherent shortcomings. These shortcomings are diverse and range from a lack of generalization over insufficient interpretability and implausible predictions to directed attacks by means of malicious inputs. Cyber-physical systems employing DNNs are therefore likely to suffer from so-called safety concerns, properties that preclude their deployment as no argument or experimental setup can help to assess the remaining risk. In recent years, an abundance of state-of-the-art techniques aiming to address these safety concerns has emerged. This chapter provides a structured and broad overview of them. We first identify categories of insufficiencies to then describe research activities aiming at their detection, quantification, or mitigation. Our work addresses machine learning experts and safety engineers alike: The former ones might profit from the broad range of machine learning topics covered and discussions on limitations of recent methods. The latter ones might gain insights into the specifics of modern machine learning methods. We hope that this contribution fuels discussions on desiderata for machine learning systems and strategies on how to help to advance existing approaches accordingly

Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors

Purpose: To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study. Setting: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. Methods: A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 × 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. Results: Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). Conclusions: Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs. © 2007 ASCRS and ESCRS