25th RCOphth Congress, President's Session paper:25 years of progress in medical retina

The quarter century since the foundation of the Royal College of Ophthalmologists has coincided with immense change in the subspecialty of medical retina, which has moved from being the province of a few dedicated enthusiasts to being an integral, core part of ophthalmology in every eye department. In age-related macular degeneration, there has been a move away from targeted, destructive laser therapy, dependent on fluorescein angiography to intravitreal injection therapy of anti-growth factor agents, largely guided by optical coherence tomography. As a result of these changes, ophthalmologists have witnessed a marked improvement in visual outcomes for their patients with wet age-related macular degeneration (AMD), while at the same time developing and enacting entirely novel ways of delivering care. In the field of diabetic retinopathy, this period also saw advances in laser technology and a move away from highly destructive laser photocoagulation treatment to gentler retinal laser treatments. The introduction of intravitreal therapies, both steroids and anti-growth factor agents, has further advanced the treatment of diabetic macular oedema. This era has also seen in the United Kingdom the introduction of a coordinated national diabetic retinopathy screening programme, which offers an increasing hope that the burden of blindness from diabetic eye disease can be lessened. Exciting future advances in retinal imaging, genetics, and pharmacology will allow us to further improve outcomes for our patients and for ophthalmologists specialising in medical retina, the future looks very exciting but increasingly busy

Management of retinal vascular diseases: a patient-centric approach

Retinal vascular diseases are a leading cause of blindness in the Western world. Advancement in the clinical management of these diseases has been fast-paced, with new treatments becoming available as well as license extensions of existing treatments. Vascular endothelial growth factor (VEGF) has been implicated in certain retinal vascular diseases, including wet age-related macular degeneration (AMD), diabetic macular oedema (DMO), and retinal vein occlusion (RVO). Treatment of wet AMD and visual impairment due to either DMO or macular oedema secondary to RVO with an anti-VEGF on an as needed basis, rather than a fixed schedule, allows an individualised treatment approach; providing treatment when patients are most likely to benefit from it, while minimising the number of unnecessary intravitreal injections. Thus, an individualised treatment regimen reduces the chances of over-treatment and under-treatment, optimising both the risk/benefit profile of the treatment and the efficient use of NHS resource. Streamlining of treatment for patients with wet AMD and visual impairment due to either DMO or macular oedema secondary to RVO, by using one treatment with similar posology across all three diseases, may help to minimise burden of clinic capacity and complexity and hence optimise patient outcomes. Informed treatment decisions and efficient clinic throughput are important for optimal patient outcomes in the fast-changing field of retinal vascular diseases

STEPWISE - STructured lifestyle Education for People WIth SchizophrEnia : a study protocol for a randomised controlled trial

BACKGROUND: People with schizophrenia are two to three times more likely to be overweight than the general population. The UK National Institute of Health and Care Excellence (NICE) recommends an annual physical health review with signposting to, or provision of, a lifestyle programme to address weight concerns and obesity. The purpose of this randomised controlled trial is to assess whether a group-based structured education programme can help people with schizophrenia to lose weight. METHODS: Design: a randomised controlled trial of a group-based structured education programme. SETTING: 10 UK community mental health trusts. PARTICIPANTS: 396 adults with schizophrenia, schizoaffective, or first-episode psychosis who are prescribed antipsychotic medication will be recruited. Participants will be overweight, obese or be concerned about their weight. INTERVENTION: participants will be randomised to either the intervention or treatment as usual (TAU). The intervention arm will receive TAU plus four 2.5-h weekly sessions of theory-based lifestyle structured group education, with maintenance contact every 2 weeks and 'booster' sessions every 3 months. All participants will receive standardised written information about healthy eating, physical activity, alcohol and smoking. OUTCOMES: the primary outcome is weight (kg) change at 1 year post randomisation. Secondary outcomes, which will be assessed at 3 and 12 months, include: the proportion of participants who maintained or reduced their weight; waist circumference; body mass index; objectively measured physical activity (wrist accelerometer); self-reported diet; blood pressure; fasting plasma glucose, lipid profile and HbA1c (baseline and 1 year only); health-related quality of life (EQ-5D-5L and RAND SF-36); (adapted) brief illness perception questionnaire; the Brief Psychiatric Rating Scale; the Client Service Receipt Inventory; medication use; smoking status; adverse events; depression symptoms (Patient Health Questionnaire-9); use of weight-loss programmes; and session feedback (intervention only). Outcome assessors will be blind to trial group allocation. Qualitative interviews with a subsample of facilitators and invention-arm participants will provide data on intervention feasibility and acceptability. Assessment of intervention fidelity will also be performed. DISCUSSION: The STEPWISE trial will provide evidence for the clinical and cost-effectiveness of a tailored intervention, which, if successful, could be implemented rapidly in the NHS. TRIAL REGISTRATION: ISRCTN19447796 , registered on 20 March 2014

Study of ψ(2S) production and cold nuclear matter effects in pPb collisions at √ sNN = 5 TeV

The production of ψ(2S) mesons is studied in dimuon final states using proton-lead (pPb) collision data collected by the LHCb detector. The data sample corresponds to an integrated luminosity of 1.6 nb−1. The nucleon-nucleon centre-of-mass energy of the pPb collisions is (Formula presented.) TeV. The measurement is performed using ψ(2S) mesons with transverse momentum less than 14 GeV/c and rapidity y in the ranges 1.5 < y < 4.0 and −5.0 < y < −2.5 in the nucleon-nucleon centre-of-mass system. The forward-backward production ratio and the nuclear modification factor are determined for ψ(2S) mesons. Using the production cross-section results of ψ(2S) and J/ψ mesons from b-hadron decays, the (Formula presented.) cross-section in pPb collisions at (Formula presented.) TeV is obtained

Measurement of CPCP asymmetries and polarisation fractions in Bs0→K∗0Kˉ∗0B_s^0 \rightarrow K^{*0}\bar{K}{}^{*0} decays

An angular analysis of the decay $B_s^0 \rightarrow K^{*0}\bar{K}{}^{*0}$ is performed using $pp$ collisions corresponding to an integrated luminosity of $1.0$ ${fb}^{-1}$ collected by the LHCb experiment at a centre-of-mass energy $\sqrt{s} = 7$ TeV. A combined angular and mass analysis separates six helicity amplitudes and allows the measurement of the longitudinal polarisation fraction $f_L = 0.201 \pm 0.057 {(stat.)} \pm 0.040{(syst.)}$ for the $B_s^0 \rightarrow K^*(892)^0 \bar{K}{}^*(892)^0$ decay. A large scalar contribution from the $K^{*}_{0}(1430)$ and $K^{*}_{0}(800)$ resonances is found, allowing the determination of additional $CP$ asymmetries. Triple product and direct $CP$ asymmetries are determined to be compatible with the Standard Model expectations. The branching fraction $\mathcal{B}(B_s^0 \rightarrow K^*(892)^0 \bar{K}{}^*(892)^0)$ is measured to be $(10.8 \pm 2.1 {\ \rm (stat.)} \pm 1.4 {\ \rm (syst.)} \pm 0.6 \ (f_d/f_s) ) \times 10^{-6}$

Measurement of forward W and Z boson production in pppp collisions at s=8 \sqrt{s}=8 TeV

Measurements are presented of electroweak boson production using data from $pp$ collisions at a centre-of-mass energy of $\sqrt{s} = 8\mathrm{\,Te\kern -0.1em V}$. The analysis is based on an integrated luminosity of $2.0\mathrm{\,fb}^{-1}$ recorded with the LHCb detector. The bosons are identified in the $W\rightarrow\mu\nu$ and $Z\rightarrow\mu^{+}\mu^{-}$ decay channels. The cross-sections are measured for muons in the pseudorapidity range $2.0 20{\mathrm{\,Ge\kern -0.1em V\!/}c}$ and, in the case of the $Z$ boson, a dimuon mass within $60 < M_{\mu^{+}\mu^{-}} < 120{\mathrm{\,Ge\kern -0.1em V\!/}c^{2}}$. The results are \begin{align*} \sigma_{W^{+}\rightarrow\mu^{+}\nu} &= 1093.6 \pm 2.1 \pm 7.2 \pm 10.9 \pm 12.7{\rm \,pb} \, , \sigma_{W^{-}\rightarrow\mu^{-}\bar{\nu}} &= \phantom{0}818.4 \pm 1.9 \pm 5.0 \pm \phantom{0}7.0 \pm \phantom{0}9.5{\rm \,pb} \, , \sigma_{Z\rightarrow\mu^{+}\mu^{-}} &= \phantom{00}95.0 \pm 0.3 \pm 0.7 \pm \phantom{0}1.1 \pm \phantom{0}1.1{\rm \,pb} \, , \end{align*} where the first uncertainties are statistical, the second are systematic, the third are due to the knowledge of the LHC beam energy and the fourth are due to the luminosity determination. The evolution of the $W$ and $Z$ boson cross-sections with centre-of-mass energy is studied using previously reported measurements with $1.0\mathrm{\,fb}^{-1}$ of data at $7\mathrm{\,Te\kern -0.1em V}$. Differential distributions are also presented. Results are in good agreement with theoretical predictions at next-to-next-to-leading order in perturbative quantum chromodynamics.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://lhcbproject.web.cern.ch/lhcbproject/Publications/LHCbProjectPublic/LHCb-PAPER-2015-049.htm

Model-independent measurement of mixing parameters in D0^{0} → KS0_{S}^{0} π+^{+}π−^{−} decays

The first model-independent measurement of the charm mixing parameters in the decay $D^0 \to K_S \pi^+ \pi^-$ is reported, using a sample of $pp$ collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 1.0 fb$^{-1}$ at a centre-of-mass energy of 7 TeV. The measured values are \begin{eqnarray*} x &=& (-0.86 \pm 0.53 \pm 0.17) \times 10^{-2}, \\ y &=& (+0.03 \pm 0.46 \pm 0.13) \times 10^{-2}, \end{eqnarray*} where the first uncertainties are statistical and include small contributions due to the external input for the strong phase measured by the CLEO collaboration, and the second uncertainties are systematic.Comment: 25 pages, 3 figures. Sign error in x fixed as of v2. All figures and tables, along with any supplementary material and additional information, are available at https://lhcbproject.web.cern.ch/lhcbproject/Publications/LHCbProjectPublic/LHCb-PAPER-2015-042.htm

Home Monitoring for Age-related Macular Degeneration

This article seeks to summarize the history of patient-based monitoring systems for age-related macular degeneration, as well as recent new and emerging technologies in the field of home surveillance.New commercially available products, such as ForeseeHome and Paxos, offer improved modalities for home monitoring of macular degeneration, and home optical coherence tomography provides the potential for further improvement in the future.While traditional Amsler grid monitoring has provided a useful test for patients to monitor their vision, it has found to have limited specificity and sensitivity as a screening tool for neovascular macular degeneration. Technologies such as ForeseeHome offer a new standard of care with improved accuracy in detection neovascularization early in its disease course, allowing for early intervention to improve patient outcomes

Estimating Likelihood of Dementia in the Absence of Diagnostic Data : A Latent Dementia Index in 10 Genetically Informed Studies

BACKGROUND: Epidemiological research on dementia is hampered by differences across studies in how dementia is classified, especially where clinical diagnoses of dementia may not be available. OBJECTIVE: We apply structural equation modeling to estimate dementia likelihood across heterogeneous samples within a multi-study consortium and use the twin design of the sample to validate the results. METHODS: Using 10 twin studies, we implement a latent variable approach that aligns different tests available in each study to assess cognitive, memory, and functional ability. The model separates general cognitive ability from components indicative of dementia. We examine the validity of this continuous latent dementia index (LDI). We then identify cut-off points along the LDI distributions in each study and align them across studies to distinguish individuals with and without probable dementia. Finally, we validate the LDI by determining its heritability and estimating genetic and environmental correlations between the LDI and clinically diagnosed dementia where available. RESULTS: Results indicate that coordinated estimation of LDI across 10 studies has validity against clinically diagnosed dementia. The LDI can be fit to heterogeneous sets of memory, other cognitive, and functional ability variables to extract a score reflective of likelihood of dementia that can be interpreted similarly across studies despite diverse study designs and sampling characteristics. Finally, the same genetic sources of variance strongly contribute to both the LDI and clinical diagnosis. CONCLUSION: This latent dementia indicator approach may serve as a model for other research consortia confronted with similar data integration challenges.CC BY-NC 4.0© 2022 – The authors. Published by IOS Press.Correspondence to: Margaret Gatz, Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA. Tel.: +1 213 740 2212; E-mail: [email protected] of the IGEMS consortium is provided at https://dornsife.usc.edu/labs/IGEMSThis work was supported by US National Institutes of Health (NIH) grants R01 AG060470 to MG and NLP and RF1 AG058068 to Pike, LaDu, and MG and a grant from the Alzheimer’s Association (AARF-17-505302) to CRB. HARMONY was supported by NIH grant R01AG08724 to MG. SATSA was supported by grants NIH R01 AG04563, R01 AG10175, the John D. and Catherine T. MacArthur Foundation Research Network on Successful Aging, the Swedish Council For Working Life and Social Research (FAS) (97:0147:1B, 2009-0795), and the Swedish Research Council (825-2007-7460, 825-2009-6141) to NLP. GENDER was supported by the MacArthur Foundation Research Network on Successful Aging to McClearn and The Axel and Margaret Ax:son Johnson’s Foundation, The Swedish Council for Social Research, and the Swedish Foundation for Health Care Sciences and Allergy Research to Malmberg. OCTO-Twin was supported by grant NIH R01 AG08861 to McClearn. OATS was funded by a National Health &amp; Medical Research Council and Australian Research Council Strategic Award Grant of the Ageing Well, Ageing Productively Program (ID No. 401162), and NHMRC Project Grants (ID 1045325 and 1085606) to PS. OATS participant recruitment was facilitated through Twins Research Australia, a national resource in part supported by a Centre for Research Excellence Grant (ID: 1079102), from the National Health and Medical Research Council. We also acknowledge the contribution to this study of the OATS research team listed at https://cheba.unsw.edu.au/project/older-australian-twins-study. The Danish Twin Registry was supported by grants from The National Program for Research Infrastructure 2007 from the Danish Agency for Science and Innovation, the Velux Foundation, and NIH grant P01 AG08761 to Vaupeland KC. CAATSA was funded by NIH grant R01AG13662 to KEW. MIDUS was supported bythe John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development and by NIH grant P01 AG20166 to Ryff. VETSA was supported by NIH grants R01AG050595 and R01 AG022381 to WSK and CEF. The Cooperative Studies Program of the Office of Research &amp; Development of the US Department of Veterans Affairs also provided financial support for the development and maintenance of the Vietnam Era Twin (VET) Registry. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/22-0472r1).</p