Patients’ attitudes and beliefs to presbyopia and its correction

Objective Presbyopia is the gradual inability to focus near objects with age. This study explores patients’ attitudes and beliefs towards presbyopia including preferred modes of near refractive correction. Methods In the United Kingdom, twenty-four volunteers completed an online questionnaire and attended a structured, recorded focus group. Participants’ age ranged between 36 and 48 years, representing a pre-presbyopic and a presbyopic population. Attitudes and beliefs about presbyopia, its significance, and opinions about current refractive correction including multifocal contact lenses were transcribed and coded using content analysis for overarching themes and patterns. Results Six participants (25%) were already wearing a near visual correction while 18 (75%) were not. Five key primary themes with clear inter-participant similarities were identified as ‘age-related’ (75%), ‘acceptance’ (50%), clear lack of ‘familiarity with the word presbyopia’ (65%), a mixed/ reluctant attitude ‘towards (multifocal) contact lenses’ (62.5%), and ‘comfort and convenience’ of a presbyopic correction (79%) whereby cost is of less importance. Conclusion The need for a reading correction was perceived as a sign of age. Spectacles were the most preferred mode of near vision correction, while comfort and convenience were seen as more important than cost. Patient education about presbyopia is lacking. Multifocal contact lenses are not necessarily the preferred visual correction even if the patient already wears contact lenses for distance

Smartphone ophthalmoscopy: patient and student practitioner perceptions

It can take several years to become proficient at direct ophthalmoscopy; the instrument’s single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient’s perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method

Towards a Natural Social Contract

This open access book states that the societal fault lines of our times are deeply intertwined and that they confront us with challenges affecting the security, fairness and sustainability of our societies. The author, Prof. Dr. Patrick Huntjens, argues that overcoming these existential challenges will require a fundamental shift from our current anthropocentric and economic growth-oriented approach to a more ecocentric and regenerative approach. He advocates for a Natural Social Contract that emphasizes long-term sustainability and the general welfare of both humankind and planet Earth. Achieving this crucial balance calls for an end to unlimited economic growth, overconsumption and over-individualisation for the benefit of ourselves, our planet, and future generations. To this end, sustainability, health, and justice in all social-ecological systems will require systemic innovation and prioritizing a collective effort. The Transformative Social-Ecological Innovation (TSEI) framework presented in this book serves that cause. It helps to diagnose and advance innovation and spur change across sectors, disciplines, and at different levels of governance. Altogether, TSEI identifies intervention points and formulates jointly developed and shared solutions to inform policymakers, administrators, concerned citizens, and professionals dedicated towards a more sustainable, healthy and just society. A wide readership of students, researchers, practitioners and policy makers interested in social innovation, transition studies, development studies, social policy, social justice, climate change, environmental studies, political science and economics will find this cutting-edge book particularly useful. “As a sustainability transition researcher, I am truly excited about this book. Two unique aspects of the book are that it considers bigger transformation issues (such as societies’ relationship with nature, purpose and justice) than those studied in transition studies and offers analytical frameworks and methods for taking up the challenge of achieving change on the ground.” - Prof. Dr. René Kemp, United Nations University and Maastricht Sustainability Institut

The covenant concept in the Qumran community in the light of the earlier covenantal ideas in Israel

The determinative factor which impelled the Qumran community to secede from the main body of Judaism was its concern for the correct and legitimate interpretation of the scriptures. The community's accu¬ sations against its contemporaries are indicative of that fact. Behind such indictments, however, there lay a profound idealism of covenant. The improper use of scripture was a violation of the covenant pledge and resulted in a suspension of the covenant bond through the execution of the impending curse. The community was confronted by a crisis of covenant. The merit and validity of the Sinai covenant had become sus¬ pect. The covenant bond and, indeed, the whole history of salvation lay in the balance. The community solved the dilemma by interpreting its own life as a re-expression of the desert existence of ancient Israel. By renewing its obedience and by living under the conditions of the old covenant, the community would "atone" for the failures of that covenant and thus more worthily represent the true people of God. In this setting too, God's electing and redeeming "grace" would inspire and sustain its renewed sensitivity of allegiance to the covenant. The community of Qumran had become the carrier of Israel's hopes, the vehicle through which its covenant and history of salvation continued and proceeded toward their ultimate fulfillment.There are two distinguishable covenant themes in the texts: the priestly and the apocalyptic.The priestly theme was a conscious attempt to legitimize the prerogatives of the Qumran cult and priesthood. The Qumran priesthood had been set apart to execute its priestly office in the cultic setting of Qumran which had come to supersede the temple of Jerusalem as the new theophanic centre where the "presence" of God made itself known. The priestly theme of covenant was also marked by a legalistic understanding of law. Covenant response, in this context, involved the formal enactment of the legal stipulations of the PentateuchThe apocalyptic theme of covenant differed radically from the formal and legalistic type. The concept of election was concerned with the destiny of the elect in the eschatological fulfillment of history, their participation in the final war against evil, their victory under the leadership of the Davidic Messiah and their sharing in the messianic kingdom of peace to be established near the new temple on Mount Zion. Covenant response, in this context, was an attitude of faith in and reliance upon this redemptive programme of God, revealed through the study of the scriptures. The covenant turned about the concepts of election, providence, redemption and faith. It arose out of the ini¬ tiative of God in election, was projected into the future as an expectation of redemption and claimed man's allegiance of faith in and reliance upon the providence of God.This apocalyptic theme of covenant went hand in hand with a profound esteem for the patriarchs and their covenant. It was the "covenant of the forefathers" which formed the basis for the community's consciousness of election, which gave it a basis of assurance in its destiny of redemption and which became the supreme object of emulation in faithful covenant response

Collaborative action research for the governance of climate adaptation - foundations, conditions and pitfalls

This position paper serves as an introductory guide to designing and facilitating an action research process with stakeholders in the context of climate adaptation. Specifically, this is aimed at action researchers who are targeting at involving stakeholders and their expert knowledge in generating knowledge about their own condition and how it can be changed. The core philosophy of our research approach can be described as developing a powerful combination between practice-driven collaborative action research and theoretically-informed scientific research. Collaborative action research means that we take guidance from the hotspots as the primary source of questions, dilemmas and empirical data regarding the governance of adaptation, but also collaborate with them in testing insights and strategies, and evaluating their usefulness. The purpose is to develop effective, legitimate and resilient governance arrangements for climate adaptation. Scientific quality will be achieved by placing this co-production of knowledge in a well-founded and innovative theoretical framework, and through the involvement of the international consortium partners. This position paper provides a methodological starting point of the research program ‘Governance of Climate Adaptation’ and aims: · To clarify the theoretical foundation of collaborative action research and the underlying ontological and epistemological principles · To give an historical overview of the development of action research and its different forms · To enhance the theoretical foundation of collaborative action research in the specific context of governance of climate adaptation. · To translate the philosophy of collaborative action research into practical methods; · To give an overview of the main conditions and pitfalls for action research in complex governance settings Finally, this position paper provides three key instruminstruments developed to support Action Research in the hotspots: 1) Toolbox for AR in hotspots (chapter 6); 2) Set-up of a research design and action plan for AR in hotspots (chapter 7); 3) Quality checklist or guidance for AR in hotspots (chapter 8)

Towards a Natural Social Contract

This open access book states that the societal fault lines of our times are deeply intertwined and that they confront us with challenges affecting the security, fairness and sustainability of our societies. The author, Prof. Dr. Patrick Huntjens, argues that overcoming these existential challenges will require a fundamental shift from our current anthropocentric and economic growth-oriented approach to a more ecocentric and regenerative approach. He advocates for a Natural Social Contract that emphasizes long-term sustainability and the general welfare of both humankind and planet Earth. Achieving this crucial balance calls for an end to unlimited economic growth, overconsumption and over-individualisation for the benefit of ourselves, our planet, and future generations. To this end, sustainability, health, and justice in all social-ecological systems will require systemic innovation and prioritizing a collective effort. The Transformative Social-Ecological Innovation (TSEI) framework presented in this book serves that cause. It helps to diagnose and advance innovation and spur change across sectors, disciplines, and at different levels of governance. Altogether, TSEI identifies intervention points and formulates jointly developed and shared solutions to inform policymakers, administrators, concerned citizens, and professionals dedicated towards a more sustainable, healthy and just society. A wide readership of students, researchers, practitioners and policy makers interested in social innovation, transition studies, development studies, social policy, social justice, climate change, environmental studies, political science and economics will find this cutting-edge book particularly useful. “As a sustainability transition researcher, I am truly excited about this book. Two unique aspects of the book are that it considers bigger transformation issues (such as societies’ relationship with nature, purpose and justice) than those studied in transition studies and offers analytical frameworks and methods for taking up the challenge of achieving change on the ground.” - Prof. Dr. René Kemp, United Nations University and Maastricht Sustainability Institut

The Association between Foveal Morphology and Macular Pigment Spatial Distribution: An Ethnicity Study

Purpose Macular pigment (MP) spatial distribution varies considerably among individuals. We investigated ethnic variations in MP spatial distribution in relation to foveal architecture. Methods We measured MP optical density (MPOD) using heterochromatic flicker photometry (MAP test, City, University of London) in 76 white, 80 South Asian and 70 black volunteers (18 to 39 years). MPOD spatial profiles were classified objectively as exponential, ring-like or central dip, based on deviations away from an exponential fit. Measurements including total retinal thickness (RT), inner retinal layer (IRL), inner and outer plexiform layer (IPL and OPL) thickness, foveal width and foveal pit slope were taken from Spectralis SD-OCT (Heidelberg, Germany) scans. Results Integrated MPOD up to 1.8° (MPODint) was higher in South Asian (0.84±0.26) and black (0.84±0.31) than whites (0.63±0.24, P0.05). Conclusion We report a significant difference in the amount and distribution of MP between ethnicities that is not explained by variations in foveal morphology

Evaluating a new objective grading software for conjunctival hyperaemia

Background/ Aims: Standardised numeric grading scales are used in ophthalmic practice to improve consistency between clinicians in recording the severity of ocular conditions and to facilitate the monitoring of such changes. We investigated the intra- and inter-observer grading reliability and the agreement between subjective Cornea and Contact Lens Research Unit (CCLRU) and Efron grading scales as well as a new Advanced Ophthalmic Systems (AOS) software which uses an objective approach to grading conjunctival hyperaemia. Methods: One experienced observer graded n = 30 bulbar and n = 26 palpebral conjunctival hyperaemia images to 0.1 increments. Masked grading of randomised images was undertaken for all three methods, on two separate occasions. The agreement within and between the grading methods was assessed between sessions, and compared to the results of a novice observer. Results: There were no statistically significant differences (P > 0.05) between test and retest values. However, repeatability in the grading estimates of both bulbar and palpebral conjunctival hyperaemia was improved using the AOS grading method (R2 = 0.998; Coefficient of Repeatability CoR 0.10–0.13), compared to Efron (R2 = 0.926; CoR 0.62) and CCLRU (R2 = 0.885–0.911; CoR 0.50–0.78). Intraclass coefficient correlations (ICC) improved inter-observer agreement using objective (> 0.995) versus subjective methods (0.853–0.959). Conclusion: These subjective and objective grading methods are not interchangeable. Due to the excellent repeatability and improved agreement between experienced and novice observers, the objective grading method provides a more consistent approach when grading ocular abnormalities and may achieve greater reliability in record keeping and clinical monitoring in the future

Diabetes mellitus and the eye: axial length

Background and aims: The refractive error of the eye is dependent on its axial length. Refractive error is known to fluctuate significantly in poorly controlled diabetic patients. Recently it has been reported that human eyes fluctuate in axial length during the day. However, this change is not detectable in all subjects, suggesting physiological influences such as diet. The purpose of this study was to investigate fluctuations in axial length and blood glucose levels (BGLs) in diabetic patients and control subjects, using partial coherence interferometry. Material and methods: Periodic axial length measurements were taken with an IOLMaster (Zeiss, Oberkochen, Germany) in 21 type 2 diabetic subjects (age 56 ± 11 years), 19 type 1 diabetic subjects (age 38 ± 15 years) and 18 non-diabetic controls (age 46 ± 22 years). Additionally, BGLs were measured using a HemoCue Beta glucose analyser (HemoCue, Ängelholm, Sweden). Measurements were taken between 8AM and 8PM at approximately two hourly intervals. The ocular length variability was mapped against time of day and related to BGLs, age, and the degree of diabetic retinopathy. Results: Axial length variations were found to be significant with time (ANOVA, P=.003) and there was a significant effect for the interaction between group and time of day (ANOVA, P.05) Conclusion: Axial length varies throughout the day in diabetic and control subjects; however, this change does not appear to be significant in every individual. The data suggest a maximum axial length value in the afternoon. Changes in axial length from baseline did not correlate with BGLs, age, or the degree of diabetic retinopathy. Therefore, blood glucose levels may not be the main physiological influence in axial length fluctuations