Controversies in the Use of MIGS

Abstract Minimally invasive glaucoma surgery (MIGS) has fulfilled an unmet need in the management of glaucoma. This chapter highlights some controversial issues regarding the use of MIGS in clinical practice, including (1) whether there is sufficient evidence to advocate combining MIGS with cataract surgery over cataract surgery alone, (2) the merits and drawbacks of different approaches to trabecular bypass and canal-based MIGS procedures, (3) the effect of MIGS on endothelial cell loss, (4) suprachoroidal MIGS devices and whether there is still a role for these procedures, and (5) a comparison between subconjunctival MIGS and trabeculectomy. Several questions are still left unanswered and hopefully, further research and more clinical experience with these new technologies will help improve surgical outcomes for patients

An investigation of Breast Feeding Self Efficacy and its Relationship with exclusive breast feeding

Child nutrition in different aspects is important in the first years especially the first two years after birth. The most important feature of this period is that the physical and cerebral damage of malnutrition after this period is not compensable. Successful breastfeeding not only depends on psychological and social factors, but also depends on the physiological conditions that can affect the onset of lactation. In addition, other factors are involved in the duration of breastfeeding including: age and maternal education, family income, the first time to decide for breastfeeding, First time feeding, maternal skill and breastfeeding self-efficacy. The aim of this study, was to determine breastfeeding self efficacy and its relationship with exclusive breast-feeding. In this descriptive study, the data collection instrument, was a questionnaire consisted of the demographic characteristics and standard items of breastfeeding self efficacy. The number of participants in this study was 331 persons that selected continuously from the Primiparous women at Shahid Akbarabadi hospital in Tehran. The findings of this study showed promising results in all samples studied, standard deviation and mean score of breastfeeding self-efficacy in exclusive breast-feeding group was 53.64±9.8 and in non exclusive breast-feeding group was 46.11±9.23, which showed that the mothers with exclusive breast-feeding, had higher breastfeeding self-efficacy scores than those fed with the non-exclusive. Therefore according to the reported reduced rate of breast feeding in the recent years, it is necessary to provide appropriate strategies in order to increase breastfeeding self efficacy, especially in primiparous mothers in order to increase breastfeeding rates

Visual field changes in professional wind versus non-wind musical instrument players in the Philadelphia orchestra

Purpose: We compare the prevalence of glaucoma in professional wind versus non-wind instrument players in the Philadelphia Orchestra. Visual field changes in individuals with glaucoma and glaucoma suspects were evaluated, and the results were correlated with cumulative practice time. Methods: In this cross-sectional, observational study, fifty-one Philadelphia Orchestra musicians were enrolled and categorized as wind or non-wind instrument players. All study participants underwent screening fundus photography. Participants with optic discs suspicious for glaucoma underwent further evaluation, including standard automated visual field perimetry and a comprehensive eye examination by a glaucoma specialist. Results: Of the 51 musicians enrolled, 9 of the 21 wind instrument players (43%) and 8 of the 30 non-wind instrument players (27%) were suspected of developing glaucoma in at least one eye (P = 0.25), with examinations performed on 12 of the 17 returning musicians (71%) for further confirmation. Wind instrument players exhibited significantly higher Octopus visual field mean defect scores (1.08 ± 1.5 dB) than non-wind instrument players (−0.43 ± 0.7 dB; P < 0.001). There was a significant association between cumulative hours playing wind instruments and visual field mean defect (P < 0.001). Conclusion: Among members of the Philadelphia Orchestra, the difference in prevalence of glaucoma suspicious optic discs between wind and non-wind instrument players was not significant. The clinical significance of the greater visual field mean defect found in wind instrument players, and the association between the degree of visual field mean defect and the cumulative practice-time of playing wind instruments, needs further investigation