Current Barriers to Eye Care

Barriers to care penetrate all aspects within our healthcare system and ophthalmology is no exception. The World Health Organization (WHO) estimates 2.2 billion people worldwide have vision impairment, half of which are due to preventable causes and/or remain untreated. In the United States, 6 million people are reported to have visual impairment and over one million people are blind.2 The leading causes of blindness within the United States are macular degeneration, cataract, glaucoma, and diabetic retinopathy.3 Management of these diseases require access to early detection, therapeutic intervention, and follow up care at regular intervals; for example, nearly half of Americans predicted to have glaucoma remain undiagnosed.4This unfathomable disparity in diagnosis emphasizes a desperate need to reflect on the obstacles that prevent patients from initiating and maintaining appropriate eye care. Here, we examine multiple domains of demographic and socioeconomic factors that influence access to care of common eye diseases in the United States in effort to inform future interventions and to improve eye health for all people

Association of chronic central serous chorioretinopathy with subclinical Cushing\u27s syndrome.

Purpose: To report the clinical course of a patient with central serous chorioretinopathy (CSCR) secondary to subclinical hypercortisolism before and after adrenalectomy. Observations: A 50-year-old female patient with multifocal, chronic CSCR was found to have an adrenal incidentaloma and was diagnosed with subclinical hypercortisolism. Patient elected to undergo minimally-invasive adrenalectomy and presented at 3 months after surgery without subretinal fluid. Conclusions and importance: Subclinical Cushing\u27s Syndrome (SCS) may present an underrecognized risk factor for developing chronic CSCR. Further investigation is needed to determine the threshold of visual comorbidity that may influence surgical management

Conditional Metastasis of Uveal Melanoma in 8091 Patients over Half-Century (51 Years) by Age Group: Assessing the Entire Population and the Extremes of Age

PURPOSE: To evaluate cumulative incidence of metastasis at specific timepoints after treatment of uveal melanoma in a large cohort of patients and to provide comparison of conditional outcomes in the youngest and oldest cohorts (extremes of age). METHODS: Retrospective analysis of 8091 consecutive patients with uveal melanoma at a single center over a 51-year period. The patients were categorized by age at presentation (0-29 years [n = 348, 4%], 30-59 years [n = 3859, 48%], 60-79 years [n = 3425, 42%], 80 to 99 years [n = 459, 6%]) and evaluated for nonconditional (from presentation date) and conditional (from specific timepoints after presentation) cumulative incidence of metastasis at five, 10, 20, and 30 years. RESULTS: For the entire population of 8091 patients, five-year/10-year/20-year/30-year nonconditional cumulative incidence of metastasis was 15%/23%/32%/36%, and the conditional incidence improved to 6%/15%/25%/30% for patients who did not develop metastasis in the first three years. For the extremes of age (0-29 years and 80-99 years), the nonconditional cumulative incidence of metastasis revealed the younger cohort with superior outcomes at 8%/15%/19%/27% and 21%/29%/29%/29%, respectively (P \u3c 0.001). The conditional incidence (at one-year and two-year timepoints with metastasis-free survival) showed persistent superior younger cohort survival (P \u3c 0.001, P = 0.001), but no further benefit for patients with three-year metastasis-free survival at 4%/12%/16%/24% and 7%/18%/18%/18%, respectively (P = 0.09). CONCLUSIONS: Non-conditional metastasis-free survival analysis for patients with uveal melanoma revealed the youngest cohort to have significantly better survival than the oldest cohort, and this persisted into one-year and two-year conditional metastasis-free survival but diminished at the three-year conditional timepoint

Challenges in measuring performance of collaborative R&D projects

While measuring the performance of collaborative research and development (R&D) projects is critical for both practitioners and academics, it is rarely straightforward in practice. Based on firsthand experience of the performance measurement practice within an extensive, long-term, Swedish innovation programme named Smart Built Environment, this chapter provides a reflective account of the setup and challenges experienced. The programme was launched in 2016 and is a long-term initiative of up to 12 years. Backed by three state research agencies, it is, to date, the single largest investment in innovation, R&D in digitalisation made in the Swedish built environment sector. This chapter is written as a collaborative autoethnography, with three out of the five authors having had firsthand experience of the specific measurement initiative analysed. The chapter describes how the visionary objectives of the programme, related to sustainability, time, cost and business logics, were developed and operationalised in practice. Furthermore, it is explained how several emergent challenges related to ambiguity in goal formulation, adaptation to contingencies of moving targets and temporal scope, and development of a multiplicity of assessment methods, were managed

Sec-dependent membrane protein insertion: sequential interaction of nascent FtsQ with SecY and YidC

Recent studies identified YidC as a novel membrane factor that may play a key role in membrane insertion of inner membrane proteins (IMPs), both in conjunction with the Sec-translocase and as a separate entity. Here, we show that the type II IMP FtsQ requires both the translocase and, to a lesser extent, YidC in vivo. Using photo-crosslinking we demonstrate that the transmembrane (TM) domain of the nascent IMP FtsQ inserts into the membrane close to SecY and lipids, and moves to a combined YidC/lipid environment upon elongation. These data are consistent with a crucial role for YidC in the lateral transfer of TM domains from the Sec translocase into the lipid bilayer