A noninterventional study to monitor patients with diabetic macular oedema starting treatment with ranibizumab (POLARIS)

PURPOSE: Antivascular endothelial growth factor agents are increasingly used in diabetic macular oedema (DME); however, there are few studies exploring their use in DME in real-world settings. METHODS: POLARIS was a noninterventional, multicentre study to monitor 12-month outcomes in patients starting ranibizumab treatment in routine practices. The primary outcome was mean change in visual acuity (VA) from baseline to month 12 (last observation carried forward approach). Other outcomes included mean change in central retinal thickness (CRT) and resource utilization. Visual acuity (VA) outcomes were also stratified by country, baseline visual acuity score (VAS), sex, age and injection frequency. RESULTS: Outcomes were analysed from all treated patients (n = 804) and from first-year completers (patients who had a visual acuity assessment at 12 months; n = 568). The mean (SD) baseline VAS was 59.4 (15.9) letters, and the mean change in visual acuity was 4.4 letters (95% confidence interval: 3.3-5.4) at month 12 (study eye; first-year completers). The mean number of injections (study eye) was 4.9, and the mean number of all visits (any eye) was 10 (58% were injection visits) over 12 months (first-year completers). The mean (SD) baseline CRT was 410.6 (128.8) μm, and the mean change in CRT was -115.2 μm at month 12 (study eye; first-year completers). Visual acuity (VA) outcomes were generally comparable across most countries and subgroups and were greatest in patients with the lowest baseline VAS (≤60 letters). CONCLUSION: POLARIS showed that real-world outcomes in DME patients starting treatment with ranibizumab were lower than those observed in clinical studies, in spite of extensive monitoring

Modeling, design, and optimization of Mindwalker series elastic joint

Weight and power autonomy are limiting the daily use of wearable exoskeleton. Lightweight, efficient and powerful actuation system are not easy to achieve. Choosing the right combinations of existing technologies, such as battery, gear and motor is not a trivial task. In this paper, we propose an optimization framework by setting up a power-based quasi-static model of the exoskeleton joint drivetrain. The goal is to find the most efficient and lightweight combinations. This framework can be generalized for other similar applications by extending or accommodating the model to their own needs. We also present the Mindwalker exoskeleton joint, for which a novel series elastic actuator, consisting of a ballscrew-driven linear actuator and a double spiral spring, was developed and tested. This linear actuator is capable of outputting 960W power and the exoskeleton joint can output 100Nm peak torque continuously. The double spiral spring can sense torque between 0.08Nm and 100Nm and it exhibits linearity of 99.99%, with no backlash or hysteresis. The series elastic joint can track a chirp torque profile with amplitude of 100Nm over 6Hz (large torque bandwidth) and for small torque (2Nm peak-to-peak), it has a bandwidth over 38Hz. The integrated exoskeleton joint, including the ballscrew-driven linear actuator, the series spring, electronics and the metal housing which hosts these components, weighs 2.9kg

Prevalence and incidence of blindness and other degrees of sight impairment in patients treated for neovascular age-related macular degeneration in a well-defined region of the United Kingdom

AIMS: This study aimed to evaluate the incidence and prevalence of blindness, sight impairment, and other visual acuity (VA) states in patients receiving ranibizumab for neovascular age-related macular degeneration (nAMD) in Gloucestershire. METHODS: Serial VA and injection data for all treatment-naive patients receiving their first intravitreal injections of ranibizumab for nAMD in the Gloucestershire National Health Service Ophthalmology department between 2008 and 2010 were extracted from an electronic medical record system. RESULTS: The prevalence of blindness (VA in the better-seeing eye ≤25 Early Treatment Diabetic Retinopathy Study (ETDRS) letters) at the time of first intravitreal injection was 0.8%, increasing to 3.5% after 3 years. The prevalence of sight impairment (VA in the better-seeing eye 26–39 ETDRS letters) increased from 4.1% at baseline to 5.5% after 3 years. The incidence of initiating ranibizumab treatment for nAMD in people aged ≥50 years in Gloucestershire was 111 people per 100 000 population in 2009, and 97 people in 2010. The incidence of patients meeting the visual criteria for blindness and sight impairment registration from treated nAMD in people aged ≥50 years in Gloucestershire was 3.5 and 9.7 people, respectively per 100 000 population in 2010. CONCLUSION: This is the first real-world study on the incidence and prevalence of eligibility for blindness and sight impairment registration in treated nAMD in the UK based on VA data. The incidence and prevalence of eligibility for certification of blindness or sight impairment in patients treated with ranibizumab for nAMD is low in Gloucestershire, with only 3.6% of the incident population progressing to blindness in 2010