This journal club discussed a study that evaluated the visual outcomes of binocular implantation of a new extended depth of focus intraocular lens called the Supraphob Infocus IOL. The study aimed to assess the safety and efficacy of this lower cost IOL in patients undergoing cataract surgery compared to the FDA approved TECNIS Symfony IOL. The study found that the Supraphob Infocus IOL provided good visual acuity, contrast sensitivity, and stereoacuity outcomes comparable to the TECNIS Symfony IOL. It also induced less ocular aberrations. Based on its safety, efficacy and lower cost, the study concluded that the Supraphob Infocus IOL can
Scleral contact lenses , types, uses in various ocular conditions.
An in-depth and unbiased details of these lenses as a therapeutic and also as a drug - delivery system in modern ophthalmology.
A must read for all Ophthalmologists and Optometrists.
Scleral contact lenses , types, uses in various ocular conditions.
An in-depth and unbiased details of these lenses as a therapeutic and also as a drug - delivery system in modern ophthalmology.
A must read for all Ophthalmologists and Optometrists.
The presentation I have made and uploaded provides you with an in-depth insight into the patterns the strabismus may take following anomalies of extraocular muscles, deformities of the orbital structures,innnervational disturbances.
The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
The presentation I have made and uploaded provides you with an in-depth insight into the patterns the strabismus may take following anomalies of extraocular muscles, deformities of the orbital structures,innnervational disturbances.
The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
National Ocular Biometry Course (NOBC) 2015 An echoslide presentation Anis Suzanna Mohamad
This powerpoint presentation is basically about ocular biometry. Echo presentation is one of the method to deliver infomation that obtain from the course we attend to other staff in our Ophthalmology Department.
Richard L. Lindstrom, MD's "Thoughts on Corneal and Lens based Refractive Surgery to Enhance Near Vision in the USA: 2015" presentation from OIS@ASCRS 2015
introduction into Biometry and it's formulas.pptxQusaiAbusleem1
Biometry is the practice of applying mathematics to biology .
With regard to ophthalmology , there are several biometric systems used for making precise measurements of ocular structures : ultrasound (A- and B-scan , pachymeter) , low coherence interferometry (OCT) , laser interferometry (IOL Master , Lenstar)
These systems are used in measurement of axial length ,keratometry , pachymetry , and retinal thickness , among other things .
The term biometry , as it relates to ophthalmology , typically refers to preoperative measurements made for IOL calculations.
Th e use of premium IOLs requires more specifically than standard monofocal IOLs a thorough clinical and para clinical examination using modern equipments.
We will only mention micro-incision premium IOLs that are used
in our daily practice. All information regarding the characteristics of all available and especially multifocal IOLs are available in the SFO 2012 Report on presbyopia
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Visual outcomes of binocular implantation of a new
extended depth of focus intraocular lens
PHILADELPHIA CITATION
Sinha R, Sahay P, Saxena R, Kalra N, Gupta V, Titiyal JS. Visual
outcomes of binocular implantation of a new extended depth of
focus intraocular lens. Indian J Ophthalmol 2020;68:2111-6.
3. Topic Outline
• Cataract surgeries and intraocular lenses (IOLs) has evolved with the
advances in technology where Premium IOLs in the form of toric
and multifocal implantation have drastically reduced the
dependence of patients on spectacles.
• The Monofocal IOLs target for a clear distance vision whereas visual
requirements for near with monofocal IOLs can be met only with a
monovision correction; however, this may cause a loss of stereopsis,
that might compromise the ultimate binocular visual outcome.
• This led to the development of Presbyopia-correcting IOLs which
included multifocal (bifocal and trifocal), accommodative, or
pseudo-accommodative, and extended depth of focus (EDOF) IOLs.
4. • The Multifocal IOLs commonly has one or two additional focusing
distances for near and intermediate vision. But then, they are often
associated with dysphotic symptoms of haloes and glare with reduced
mesopic and scotopic contrast sensitivity.
• The Accommodative IOL designs achieve good vision at various distances
by changing the optical power of the eye by either forward or a
backward axial movement of the IOL or flexibility in lens thickness or
shape.
• However, these IOLs are mostly out of clinical practice considering the
poor long-term visual outcomes due to the associated posterior capsular
opacification (PCO) and capsular contraction resulting in asymmetric
vaulting and lens tilt.
5. • The EDOF IOLs, since 2016, is considered as a suitable alternative to the
currently available presbyopia-correcting IOLs. They work on the
principle of creating a single elongated focal point, enhancing the range
of vision. At present, TECNIS Symfony IOL (Abbott Medical Optics) is the
only FDA approved EDOF IOL. Supraphob Infocus IOL (Appasamy
associates, Chennai,India) is a new hydrophobic acrylic EDOF IOL with
yellow chromophore.
• This study aims to evaluate the safety and efficacy of the Supraphob
Infocus IOL in patients undergoing cataract surgery in both eyes.
6. • The extended depth of focus IOL (EDOF IOL) is an emerging concept for the
correction of presbyopia.
• It is based on the principle of creating a single elongated focal point to enhance the
“range of vision” or “depth of focus” in patients undergoing cataract surgery.
• The TECNIS Symfony IOL (Johnson and Johnson, Jacksonville, FL) was the first
IOL in this category to be USFDA approved in 2016. It has gained immense
popularity ever since its introduction.
• However, its high cost was a limiting factor.
• This study aimed to evaluate the efficacy and safety of a new hybrid design EDOF
IOL, the Supraphob Infocus IOL (Appasamy associates, Chennai, India) in the
visual rehabilitation of patients with senile cataract. Hence, it was chosen for
today’s journal club discussion.
7. Methods
• Study design: This was a hospital-based prospective interventional
study
• Study duration : December 2017 to July 2018
• Sample size : 104 eyes of 52 patients
• The study protocol adhered to the tenets of the Declaration of
Helsinki and written informed consent was obtained from all
patients
• Study population: Fifty-five patients with visually significant
bilateral cataract, age>40yrs, corneal astigmatism <1D, IOL power
between 15D to 25D.
8. • Inclusion criteria
1. Visually significant bilateral cataract
2. Age >40 years
3. Corneal astigmatism <1D
4. IOL power between 15D to 25D
5. Patient willing for follow-up were recruited.
• Exclusion criteria
1. Cases with any associated ocular comorbidity
2. History of ocular surgery
9. Preoperatively,
• Detailed clinical examination was done including
Visual acuity UDVA (uncorrected distance visual acuity) (ETDRS chart- 4 m),
UNVA (uncorrected near visual acuity) (Jaeger’s chart at 33 cm),
CDVA (corrected distance visual acuity),
Slit-lamp biomicroscopy,
Intraocular pressure (IOP) by non contact tonometry,
Distance and near stereoacuity (Frisby-Davis distance (FD2) stereoacuity test and
Randot SO-002 test)
Ocular aberrometry on iTrace,
Specular microscopy (SP 3000P, Topcon Medical Systems, Inc.)
Dilated fundus examination.
• IOL master 500 (Carl Zeiss,Meditec AG) was used for optical biometry, and the
SRK-T formula was used for obtaining the IOL power. All patients were targeted
for emmetropia.
10. • All patients underwent phacoemulsification surgery by a single surgeon under
topical anesthesia.
• The second eye was operated after a gap of 1 month.
• Phacoemulsification was performed on the Centurion Vision System (Alcon
Laboratories Inc., Fort Worth, TX, USA) through a 2.2 mm incision.
• The incision was enlarged to 2.8 mm for implantation of Supraphob Infocus IOL.
Postoperatively,
• Topical prednisolone phosphate 1% QID and moxifloxacin hydrochloride 0.5%
TDS were prescribed for 1 month and tropicamide 1% BD for 1 week.
• Follow-up was done on day 1, 1 week, 1 month, and 3 months after surgery.
• Visual acuity, contrast sensitivity, aberrometry, specular microscopy, and
stereoacuity was performed at each follow-up.
11. Results
• 55 cases were recruited, but 3 were lost to follow-up after 1 month and hence
excluded.
• Fifty-two patients (104 eyes) with bilateral implantation of Supraphob Infocus
IOL that completed the final follow-up were included in the final analysis.
Baseline – Mean age – 58.4+ 9.3 years
27 male and 25 female patients
Mean UDVA 0.84 + 0.33 log MAR
Mean IOP 13.4 + 2.9 mmHg
Mean Axial length and keratometry were 23.3 + 0.8 mm and
44.2 +1.7D respectively
Mean endothelial cell count was 2580.4 + 243.4 cells/mm2
12. • Postoperatively,
• The mean monocular UDVA improved to 0.17 ± 0.09 logMAR at 1 week, 0.12 ±
0.08 logMAR at 1 month and 0.11 ± 0.08 logMAR at 3 months follow-up .
• At a 3-month follow-up, UDVA of 20/20 was achieved by 62.5% of the eyes, and
20/32 or better was achieved in 96.15% of the eyes.
• All cases achieved a binocular CDVA of 20/20. Spectacle independence for
distance was achieved in 96.15% of the cases for distance work .
• The mean CS was 1.47 ± 0.06 logCS. The distance and near stereopsis was 90.2 ±
24.8 s of arc (arcsec) and 62.5 ± 19.4 arcsec, respectively.
• The mean total higher-order aberration (HOA), point spread function, and
modulation transfer function were 0.30 ± 0.13, 0.07 ± 0.08, and 0.26 ± 0.07,
respectively.
• The mean endothelial cell density at 1 month and 3 months were 2448.4 ± 255.03
and 2418 ± 243.6 cells/mm2, respectively. The mean endothelial cell loss was
6.2% at 3 months follow-up.
• The mean postoperative photopic and mesopic pupil diameter was 2.65 ± 0.44 mm
and as 4.1 ± 0.6 mm .
13. Discussion
Supraphob infocus intraocular lens
• It is a hydrophobic acrylic EDOF IOL with yellow chromophore.
• Its anterior surface has a refractive pinhole design. The posterior
surface has a 360-degree enhanced square edge design with an
aspheric optic.
• Its overall diameter is 13 mm with an optic size of 6 mm.
• It has a central zone of 1.2 mm diameter that has a nano diffractive
optics primarily for near and intermediate vision with an additional
power of 3.5D to focus the objects between 33 cm to 80 cm. Light
rays passing through an area 0.3 microns below the edge of this
central zone undergo an inward bend eliminating the light scatter,
which reduces the chances of glare.
• The haptic has a 0° angulation. Its refractive index is 1.5045.
• The A constant is 118.8, and the IOL is available in the range of
+7.0D to +30.0D with increments of 0.5D
14. • In the current study, most of the patients achieved good visual acuity for distance,
intermediate, and near.
• The mean binocular UDVA achieved with the bilateral implantation of Supraphob
Infocus IOL in the current study (0.03 ± 0.07 logMAR) was comparable to the
results obtained in various other studies conducted with Technis Symfony IOL.
• The CONCERTO study, largest multicentric study on Technis Symfony IOL,
reported a binocular UDVA of 0.03 ± 0.09 logMAR.
• Spectacle independence for distance was achieved in 96% of the cases in the
current study with a negligible residual refractive error (0.04 ± 0.37 D), which was
comparable to the CONCERTO Study and the study by Titiyal et al., which
achieved spectacle independence in 92.1% and 96% of the cases, respectively.
• The distance stereopsis was evaluated using the FD2 test, which is a real depth test
that simulates real-life scenarios and is more suitable for measuring distance
stereopsis. The distance stereopsis achieved by the Supraphob Infocus IOL was
comparable to that achieved by Symfony IOL (90.2 ± 24.8 arcsec on FD2 vs.
103.6 ± 49.1 arcsec on Randot stereo-test).
15. • The near stereopsis, although it was less compared to Symfony IOL (62.5 ± 19.5
arcsec vs. 21.1 ± 2.3 arcsec), was still good enough to perform routine near work.
• Ocular aberration is an important factor determining the final visuala cuity.
Comparing the result of postoperative ocular aberrations obtained in the current
study with those of Technis Symfony IOL, it was observed that the Supraphob
Infocus IOL induces less internal HOAs (0.27 ± 0.13um vs. 0.64 ± 0.43 um).
• In the current study, no correlation was observed between UNVA with the pupil
diameter. This highlights the pupil independent nature of the Supraphob Infocus
IOL in achieving a good intermediate and near vision. Hence, this IOL can be
safely implanted in patients with relatively large pupil diameter.
• Patient satisfaction questionnaire revealed good results for both distance and near
vision with spectacle independence in over 95% of the patients for near activity.
• Dysphotic symptoms like starburst, glare, and halos were noted in <10% of the
patients, which is comparable to most of the other multifocal IOLs.
16. Conclusion
• The Supraphob Infocus IOL can be safely implanted in patients
undergoing cataract surgery with good visual outcomes.
• The visual acuity, contrast sensitivity, stereoacuity, and ocular
aberrations are comparable to the currently used design EDOF IOL.
• Looking at the safety and efficacy of the Supraphob Infocus IOL,
along with its low cost, this IOL can be considered as a potential
alternative to the currently available multifocal or EDOF IOLs.
17. Critical Appraisal
In favor of the study:
• In order to ensure patient satisfaction, this study not only assessed the
monocular and binocular visual acuity , but also evaluated the
outcomes of stereopsis, contrast sensitivity and ocular aberrations.
• The visual outcomes were comprehensively evaluated in this study.
• iTrace was used for aberrometry, it has an advantage over other
aberrometers in providing results individually for corneal and
internal aberrations in addition to the total aberrations.
• A cost effective option was proved to give similar results as the
USFDA approved expensive premium IOL , thus widening the scope
for its applicability in our scenario.
18. Against the study:
• The study has a short follow up perior , hence long term
outcomes of IOL implantation such as development of posterior
capsular opacification could not be assessed.
• The variability in charts used by different authors in previously
reported literature makes it difficult to make a direct comparison
of the results of this study.
20. Next PG Activity
06/10/2020
Case Presentation on
Post-operative Keratoplasty
Presenter- Dr Abhishek GU
Moderator- Dr Sune Sir
Conductor- Dr Vishal Sir