A systematic review of clinical practice guidelines for childhood glaucoma

Objective: To conduct a systematic review to identify and critically appraise clinical practice guidelines on the assessment, diagnosis and management of childhood glaucoma. Methods and analysis: A systematic literature search of databases and professional websites for clinical practice guidelines published on eye conditions between 2010 and April 2020 in English was conducted. Identified guidelines were screened for relevance to childhood glaucoma and exclusion criteria applied. Guidelines that passed the screening and quality appraisal with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and, if they achieved a mean score of ≥45 and ≥3 on subsets of 9 and 5 AGREE II items, respectively, were selected for inclusion and data extracted using a standardised form. Results: Following screening and critical appraisal, three guidelines were included for data extraction. None of the three guidelines was specifically developed for childhood glaucoma. A consistent recommendation was that children should undergo some form of eye screening examination or a comprehensive eye assessment to detect paediatric eye disease. Children at high risk of childhood glaucoma should undergo additional screening. One clinical practice guideline recommended interventions for childhood glaucoma consisting of tube surgery and topical beta-blockers or carbonic anhydrase inhibitors. Recommended interventions for childhood glaucoma were based on low-quality to moderate-quality evidence or expert opinion. Conclusion: Based on our selection criteria, we did not identify any high-quality clinical practice guidelines specifically targeted at childhood glaucoma. This is compounded by the lack of high-quality evidence on childhood glaucoma

The Case for Extended Screening Intervals for People With Diabetes and No or Minimal Retinopathy at Baseline

Invited commentary

Effective refractive error coverage in adults aged 50 years and older - estimates to monitor progress towards the World Health Organisation's 2030 target

Background In 2021, WHO Member States endorsed a global target of a 40-percentage-point increase in effective refractive error coverage (eREC; with a 6/12 visual acuity threshold) by 2030. This study models global and regional estimates of eREC as a baseline for the WHO initiative. Methods The Vision Loss Expert Group analysed data from 565 448 participants of 169 population-based eye surveys conducted since 2000 to calculate eREC (met need/[met need + undermet need + unmet need]). A binary logistic regression model was used to estimate eREC by Global Burden of Disease (GBD) Study super region among adults aged 50 years and older. Findings In 2021, distance eREC was 79·1% (95% CI 72·4–85·0) in the high-income super region; 62·1% (54·7–68·8) in north Africa and Middle East; 49·5% (45·0–54·0) in central Europe, eastern Europe, and central Asia; 40·0% (31·7–48·2) in southeast Asia, east Asia, and Oceania; 34·5% (29·4–40·0) in Latin America and the Caribbean; 9·0% (6·5–12·0) in south Asia; and 5·7% (3·1–9·0) in sub-Saharan Africa. eREC was higher in men and reduced with increasing age. Global distance eREC increased from 2000 to 2021 by 19·0%. Global near vision eREC for 2021 was 20·5% (95% CI 17·8–24·4). Interpretation Over the past 20 years, distance eREC has increased in each super region yet the WHO target will require substantial improvements in quantity and quality of refractive services in particular for near vision impairment

A systematic review of clinical practice guidelines for childhood glaucoma.

OBJECTIVE: To conduct a systematic review to identify and critically appraise clinical practice guidelines on the assessment, diagnosis and management of childhood glaucoma. METHODS AND ANALYSIS: A systematic literature search of databases and professional websites for clinical practice guidelines published on eye conditions between 2010 and April 2020 in English was conducted. Identified guidelines were screened for relevance to childhood glaucoma and exclusion criteria applied. Guidelines that passed the screening and quality appraisal with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and, if they achieved a mean score of ≥45 and ≥3 on subsets of 9 and 5 AGREE II items, respectively, were selected for inclusion and data extracted using a standardised form. RESULTS: Following screening and critical appraisal, three guidelines were included for data extraction. None of the three guidelines was specifically developed for childhood glaucoma. A consistent recommendation was that children should undergo some form of eye screening examination or a comprehensive eye assessment to detect paediatric eye disease. Children at high risk of childhood glaucoma should undergo additional screening. One clinical practice guideline recommended interventions for childhood glaucoma consisting of tube surgery and topical beta-blockers or carbonic anhydrase inhibitors. Recommended interventions for childhood glaucoma were based on low-quality to moderate-quality evidence or expert opinion. CONCLUSION: Based on our selection criteria, we did not identify any high-quality clinical practice guidelines specifically targeted at childhood glaucoma. This is compounded by the lack of high-quality evidence on childhood glaucoma

The Galaxy Zoo survey for giant AGN-ionized clouds: past and present black hole accretion events

Some active galactic nuclei (AGN) are surrounded by extended emission-line regions (EELRs), which trace both the illumination pattern of escaping radiation and its history over the light travel time from the AGN to the gas. From a new set of such EELRs, we present evidence that the AGN in many Seyfert galaxies undergo luminous episodes 0.2–2 ×105 years in duration. Motivated by the discovery of the spectacular nebula known as Hanny’s Voorwerp, ionized by a powerful AGN which has apparently faded dramatically within ≈ 105 years, Galaxy Zoo volunteers have carried out both targeted and serendipitous searches for similar emission-line clouds around low-redshift galaxies. We present the resulting list of candidates and describe spectroscopy identifying 19 galaxies with AGN-ionized regions at projected radii rproj \u3e 10 kpc. This search recovered known EELRs (such as Mrk 78, Mrk 266 and NGC 5252) and identified additional previously unknown cases, one with detected emission to r = 37 kpc. One new Sy 2 was identified. At least 14/19 are in interacting or merging systems, suggesting that tidal tails are a prime source of distant gas out of the galaxy plane to be ionized by an AGN. We see a mix of one-and two-sided structures, with observed cone angles from 23◦ to 112◦. We consider the energy balance in the ionized clouds, with lower and upper bounds on ionizing luminosity from recombination and ionization-parameter arguments, and estimate the luminosity of the core from the far-infrared data. The implied ratio of ionizing radiation seen by the clouds to that emitted by the nucleus, on the assumption of a non-variable nuclear source, ranges from 0.02 to \u3e12; 7/19 exceed unity. Small values fit well with a heavily obscured AGN in which only a small fraction of the ionizing output escapes to be traced by surrounding gas. However, large values may require that the AGN has faded over tens of thousands of years, giving us several examples of systems in which such dramatic long-period variation has occurred; this is the only current technique for addressing these time-scales in AGN history. The relative numbers of faded and non-faded objects we infer, and the projected extents of the ionized regions, give our estimate (0.2–2×105 years) for the length of individual bright phases

Dust in Spiral Galaxies: Comparing Emission and Absorption to Constrain Small-Scale and Very Cold Structures

The detailed distribution of dust in the disks of spiral galaxies is important to understanding the radiative transfer within disks, and to measuring overall dust masses if significant quantities of dust are either very opaque or very cold. We address this issue by comparing measures of dust absorption, using the galaxy-overlap technique in the optical, with measures of the dust grains' thermal emission from 50-2000 micron using ISOPHOT on board ISO and SCUBA at the JCMT. We examine three spiral galaxies projected partially in front of E/S0 galaxies --- AM1316-241, NGC 5545, and NGC 5091 (for NGC 5091 we have only optical and ISO data). Adopting an empirical exponential model for the dust distribution, we compare column densities and dust masses derived from the absorption and emission techniques. This comparison is sensitive to the amount of dust mass in small, opaque structures, which would not contribute strongly to area-weighted absorption measures, and to very cold dust, which would contribute to optical absorption but provide only a small fraction of the sub-mm emission. In AM1316-241, we find global dust masses of 2-5 x 10^7 M_solar, both techniques agreeing at the 50% level. NGC 5545 has about half this dust mass. The concordance of dust masses is well within the errors expected from our knowledge of the radial distribution of dust, and argues against any dominant part of the dust mass being so cold or opaque. The 50-2000 micron data are well fitted by modified Planck functions with an emissivity law beta=-2, at 21 +/- 2 K. We also present 12 micron ISOCAM observations of these pairs.Comparison of H-alpha and 12 micron images of NGC 5545 indicate that ISOCAM images are reliable tracers of star formation.Comment: 16 pages, 4 tables, 8 figures, in press for October Astronomical Journa

Feasibility and patient acceptability of a novel artificial intelligence-based screening model for diabetic retinopathy at endocrinology outpatient services: a pilot study

The purpose of this study is to evaluate the feasibility and patient acceptability of a novel artificial intelligence (AI)-based diabetic retinopathy (DR) screening model within endocrinology outpatient settings. Adults with diabetes were recruited from two urban endocrinology outpatient clinics and single-field, non-mydriatic fundus photographs were taken and graded for referable DR ( ≥ pre-proliferative DR). Each participant underwent; (1) automated screening model; where a deep learning algorithm (DLA) provided real-time reporting of results; and (2) manual model where retinal images were transferred to a retinal grading centre and manual grading outcomes were distributed to the patient within 2 weeks of assessment. Participants completed a questionnaire on the day of examination and 1-month following assessment to determine overall satisfaction and the preferred model of care. In total, 96 participants were screened for DR and the mean assessment time for automated screening was 6.9 minutes. Ninety-six percent of participants reported that they were either satisfied or very satisfied with the automated screening model and 78% reported that they preferred the automated model over manual. The sensitivity and specificity of the DLA for correct referral was 92.3% and 93.7%, respectively. AI-based DR screening in endocrinology outpatient settings appears to be feasible and well accepted by patients

Systematic review of clinical practice guidelines for uveitis

To facilitate the integration of eye care into universal health coverage, the WHO is developing a Package of Eye Care Interventions (PECI). Development of the PECI involves the identification of evidence-based interventions from relevant clinical practice guidelines (CPGs) for uveitis.A systematic review of CPGs published on uveitis between 2010 and March 2020 was conducted. CPGs passing title and abstract and full-text screening were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and data on recommended interventions extracted using a standard data extraction sheet.Of 56 CPGs identified as potentially relevant from the systematic literature search, 3 CPGs underwent data extraction following the screening stages and appraisal with the AGREE II tool. These CPGs covered screening for, monitoring and treating juvenile idiopathic arthritis (JIA)-associated uveitis, the use of adalimumab and dexamethasone in treating non-infectious uveitis, and a top-level summary of assessment, differential diagnosis and referral recommendations for uveitis, aimed at primary care practitioners. Many of the recommendations were based on expert opinion, though some incorporated clinical study and randomised controlled trial data.There is currently sparse coverage of the spectrum of disease caused by uveitis within CPGs. This may partially be due to the large number of conditions with diverse causes and clinical presentations covered by the umbrella term uveitis, which makes numerous sets of guidelines necessary. The limited pool of CPGs to select from has implications for clinicians seeking guidance on clinical care strategies for uveitis.</jats:p

On the stability of standing waves of Klein-Gordon equations in a semiclassical regime

We investigate the orbital stability and instability of standing waves for two classes of Klein-Gordon equations in the semi-classical regime.Comment: 9 page