Intraocular pressure in a cohort of healthy Eastern European schoolchildren: variations in method and corneal thickness

BACKGROUND: Intraocular pressure (IOP) in the developing eye of a child is not always easy to measure and there is no technique that is known to be the most accurate for the young eye. Measurements are needed on many cohorts of children with different tonometers to determine how the values correlate between instruments, whether corneal parameters affect readings and whether correlations between age and IOP values can be discerned. The aim of this study was to undertake a comparative analysis of three different tonometers on a group of healthy children to see whether differences exist and whether these may be related to central corneal thickness and/or radius of curvature. In addition, the study adds to the relatively small body of literature on IOP in the growing eye which will collectively allow trends to be identified and ultimately norms to be established. METHODS: IOP was measured on 115 eyes in a group of Polish children, aged between 5-17 years (mean±standard deviation [SD] 11.3±3.0 years) using three different tonometers: non-contact (NCT), the ICare and Goldmann applanation (GAT). Readings obtained were compared between instruments and with central corneal thickness and radius of curvature. RESULTS: The ICare tonometer provided statistically higher IOP values (16.9±3.4 mmHg) than the GAT (14.7±2.9 mmHg) regardless of corneal thickness and whether or not a correction factor was applied. A correlation was found between central corneal thickness (CCT) and IOP values obtained with all three tonometers but only the IOP values detected with the ICare tonometer showed a statistically significant correlation with radius of curvature (p<0.004). No correlations with age or gender were found for IOP values measured with any of the instruments. CONCLUSIONS: IOP measurements on children vary significantly between instruments and correlations are affected by the corneal thickness. Further studies on children are needed to determine which instrument is most appropriate and to derive a normative IOP scale for the growing eye

Does your electronic butler owe you a duty of confidentiality?

As artificial intelligence (AI) advances the legal issues have not progressed in step and principles that exist have become outdated in a relatively short time. Privacy is a major concern and the myriad of devices that store data for wide ranging purposes risk breaches of privacy. Treating such a breach as a design defect or technical fault, does not reflect the complexities of legal liability that apply to robotics. Where advanced levels of AI are involved, such as with electronic butlers and carers used increasingly to assist vulnerable and ageing populations, the question of whether a robot owes a duty of confidentiality to the person for whom they are caring is becoming ever more pertinent. This question is considered in detail and it is concluded that a duty may be owed in some cases. After a brief introduction (I.) the article picks up on the aspects of legal agency and AI (II.) and examines robots as social beeings (III.), their relation- ship to duty (IV.) as well as their capacity as "extended cognition" (V.). These aspects are then brought in con- text with issues of data protection (VI.) and the general relationship between civil law, ethics and robotics (VII.) before conclusions (VIII.) are drawn

A critique of the regulation of data science in healthcare research in the European Union

The EU offers a suitable milieu for the comparison and harmonisation of healthcare across different languages, cultures, and jurisdictions (albeit with a supranational legal framework), which could provide improvements in healthcare standards across the bloc. There are specific ethico-legal issues with the use of data in healthcare research that mandate a different approach from other forms of research. The use of healthcare data over a long period of time is similar to the use of tissue in biobanks. There is a low risk to subjects but it is impossible to gain specific informed consent given the future possibilities for research. Large amounts of data on a subject present a finite risk of re-identification. Consequently, there is a balancing act between this risk and retaining sufficient utility of the data. Anonymising methods need to take into account the circumstances of data sharing to enable an appropriate balance in all cases. There are ethical and policy advantages to exceeding the legal requirements and thereby securing the social licence for research. This process would require the examination and comparison of data protection laws across the trading bloc to produce an ethico-legal framework compatible with the requirements of all member states. Seven EU jurisdictions are given consideration in this critique

Patient data ownership

Response of article in JAMA advocating patient data ownershi

Lens internal curvature effects on age-related eye model and lens paradox

The gradient index (GRIN) model is the most accurate way to represent the eye lens which, because of its growth mode, is a lamellar, shell-like structure. The GRIN is thought to provide optical properties that counteract age-related changes in curvature that would otherwise create an increasingly myopic eye: the so-called lens paradox. This article investigates how fine-tuning the refractive index and the internal curvatures of the lenticular indicial contours may prevent the ageing eye from becoming myopic. A system matrix approach is applied for analysis of a shell model with 200 shells to obtain the paraxial characteristics of the eye model

Gradient moduli lens models: how material properties and application of forces can affect deformation and distributions of stress

The human lens provides one-third of the ocular focussing power and is responsible for altering focus over a range of distances. This ability, termed accommodation, defines the process by which the lens alters shape to increase or decrease ocular refractive power; this is mediated by the ciliary muscle through the zonule. This ability decreases with age such that around the sixth decade of life it is lost rendering the eye unable to focus on near objects. There are two opponent theories that provide an explanation for the mechanism of accommodation; definitive support for either of these requires investigation. This work aims to elucidate how material properties can affect accommodation using Finite Element models based on interferometric measurements of refractive index. Gradients of moduli are created in three models from representative lenses, aged 16, 35 and 48 years. Different forms of zonular attachments are studied to determine which may most closely mimic the physiological form by comparing stress and displacement fields with simulated shape changes to accommodation in living lenses. The results indicate that for models to mimic accommodation in living eyes, the anterior and posterior parts of the zonule need independent force directions. Choice of material properties affects which theory of accommodation is supported

Treatment of human lens epithelium with high levels of nanoceria leads to reactive oxygen species mediated apoptosis

Nanoceria (cerium oxide nanoparticles) have been shown to protect human lens epithelial cells (HLECs) from oxidative stress when used at low concentrations. However, there is a lack of understanding about the mechanism of the cytotoxic and genotoxic effects of nanoceria when used at higher concentrations. Here, we investigated the impact of 24-hour exposure to nanoceria in HLECs. Nanoceria’s effects on basal reactive oxygen species (ROS), mitochondrial morphology, membrane potential, ATP, genotoxicity, caspase activation and apoptotic hallmarks were investigated. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX) studies on isolated mitochondria revealed significant uptake and localization of nanoceria in the mitochondria. At high nanoceria concentrations (400 µg mL−1), intracellular levels of ROS were increased and the HLECs exhibited classical hallmarks of apoptosis. These findings concur with the cells maintaining normal ATP levels necessary to execute the apoptotic process. These results highlight the need for nanoceria dose-effect studies on a range of cells and tissues to identify therapeutic concentrations in vitro or in viv

Cyclodextrin enhances corneal tolerability and reduces ocular toxicity caused by diclofenac

With advances in refractive surgery and demand for cataract removal and lens replacement, the ocular use of nonsteroidal anti-inflammatory drugs (NSAIDs) has increased. One of the most commonly used NSAIDs is diclofenac (Diclo). In this study, cyclodextrins (CDs), α-, β-, γ-, and HP-β-CDs, were investigated with in vitro irritation and in vivo ulceration models in rabbits to reduce Diclo toxicity. Diclo-, α-, β-, γ-, and HP-β-CD inclusion complexes were prepared and characterized and Diclo-CD complexes were evaluated for corneal permeation, red blood cell (RBCs) haemolysis, corneal opacity/permeability, and toxicity. Guest- (Diclo-) host (CD) solid inclusion complexes were formed only with β-, γ-, and HP-β-CDs. Amphipathic properties for Diclo were recorded and this surfactant-like functionality might contribute to the unwanted effects of Diclo on the surface of the eye. Contact angle and spreading coefficients were used to assess Diclo-CDs in solution. Reduction of ocular toxicity 3-fold to16-fold and comparable corneal permeability to free Diclo were recorded only with Diclo-γ-CD and Diclo-HP-β-CD complexes. These two complexes showed faster healing rates without scar formation compared with exposure to the Diclo solution and to untreated groups. This study also highlighted that Diclo-γ-CD and Diclo-HP-β-CD demonstrated fast healing without scar formation