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Purpose: Consumption of sugar-reformulated products (commercially available foods and beverages that have been reduced in sugar content through reformulation) is a potential strategy for lowering sugar intake at a population level. The impact of sugar-reformulated products on body weight, energy balance (EB) dynamics and cardiovascular disease risk indicators has yet to be established. The REFORMulated foods (REFORM) study examined the impact of an 8-week sugar-reformulated product exchange on body weight, EB dynamics, blood pressure, arterial stiffness, glycemia and lipemia. Methods: A randomized, controlled, double-blind, crossover dietary intervention study was performed with fifty healthy normal to overweight men and women (age 32.0 ± 9.8 year, BMI 23.5 ± 3.0 kg/m) who were randomly assigned to consume either regular sugar or sugar-reduced foods and beverages for 8 weeks, separated by 4-week washout period. Body weight, energy intake (EI), energy expenditure and vascular markers were assessed at baseline and after both interventions. Results: We found that carbohydrate ( P < 0.001), total sugars ( P < 0.001) and non-milk extrinsic sugars ( P < 0.001) (% EI) were lower, whereas fat ( P = 0.001) and protein ( P = 0.038) intakes (% EI) were higher on the sugar-reduced than the regular diet. No effects on body weight, blood pressure, arterial stiffness, fasting glycemia or lipemia were observed. Conclusions: Consumption of sugar-reduced products, as part of a blinded dietary exchange for an 8-week period, resulted in a significant reduction in sugar intake. Body weight did not change significantly, which we propose was due to energy compensation. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether the 1-day postoperative intraocular pressure (IOP) check following routine uncomplicated phacoemulsification is necessary in patients with pre-existing glaucoma and ocular hypertension (OHT), if acetazolamide prophylaxis is used. To investigate the practice of U.K. glaucoma specialists in IOP rise prophylaxis and follow-up regimes.Patients and Methods: The IOP 1-day postoperatively was analysed against the last recorded IOP before phacoemulsification in a cohort of patients with glaucoma or OHT who underwent uncomplicated phacoemulsification cataract surgery between December 2009 and September 2012, where it was routine practice to give acetazolamide postoperatively. U.K. and Eire Glaucoma Society members were surveyed via an online questionnaire to analyse practice among U.K. glaucoma specialists.Results: One hundred and seven eyes were studied: 99 with glaucoma and 8 with OHT. The mean IOP change was -0.8 mm Hg with only two eyes measuring >30 mm Hg postoperatively (2%). Both these eyes received 750 mg acetazolamide. Eighteen (17%) eyes had an IOP rise of at least 30%. In the survey of practice there were 65 respondents. Twenty-one (32%) respondents did not use IOP prophylaxis. Only 17 (26%) of respondents routinely reviewed their patients 1-day postoperatively.Conclusion: Our prophylactic acetazolamide regime does not completely eliminate the risk of an IOP >30 mm Hg on day 1 post routine phacoemulsification in glaucoma/OHT patients. Patients with pre-existing glaucoma, despite acetazolamide prophylaxis, will require IOP management decisions on the first postoperative day after uncomplicated phacoemulsification surgery. U.K. expert practice is non-uniform with regard to IOP prophylaxis, and the 1-day review, and further discussion and formulation of consensus appears necessary. [ABSTRACT FROM AUTHOR]

BACKGROUND: Controversy surrounds the effectiveness of dietary guidelines for cardiovascular disease (CVD) prevention in healthy middle-aged and older men and women. OBJECTIVE: The objective was to compare effects on vascular and lipid CVD risk factors of following the United Kingdom dietary guidelines with a traditional British diet (control). DESIGN: With the use of a parallel-designed randomized controlled trial in 165 healthy nonsmoking men and women (aged 40-70 y), we measured ambulatory blood pressure (BP) on 5 occasions, vascular function, and CVD risk factors at baseline and during 12 wk after random assignment to treatment. The primary outcomes were differences between treatments in daytime ambulatory systolic BP, flow-mediated dilation, and total cholesterol/HDL cholesterol. Secondary outcomes were differences between treatment in carotid-to-femoral pulse wave velocity, high-sensitivity C-reactive protein, and a measure of insulin sensitivity (Revised Quantitative Insulin Sensitivity Check Index). RESULTS: Data were available on 162 participants, and adherence to the dietary advice was confirmed from dietary records and biomarkers of compliance. In the dietary guidelines group (n = 80) compared with control (n = 82), daytime systolic BP was 4.2 mm Hg (95% CI: 1.7, 6.6 mm Hg; P < 0.001) lower, the treatment effect on flow-mediated dilation [-0.62% (95% CI: -1.48%, 0.24%)] was not significant, the total cholesterol:HDL cholesterol ratio was 0.13 (95% CI: 0, 0.26; P = 0.044) lower, pulse wave velocity was 0.29 m/s (95% CI: 0.07, 0.52 m/s; P = 0.011) lower, high-sensitivity C-reactive protein was 36% (95% CI: 7%, 48%; P = 0.017) lower, the treatment effect on the Revised Quantitative Insulin Sensitivity Check Index [2% (95% CI: -2%, 5%)] was not significant, and body weight was 1.9 kg (95% CI: 1.3, 2.5 kg; P < 0.001) lower. Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg (95% CI: 1.0, 3.9 mm Hg) of the fall in blood pressure. CONCLUSION: Selecting a diet consistent with current dietary guidelines lowers BP and lipids, which would be expected to reduce the risk of CVD by one-third in healthy middle-aged and older men and women. This study is registered at www.isrctn.com as 92382106. [ABSTRACT FROM AUTHOR]

Background: Emerging cellular markers of endothelial damage and repair include endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs), respectively. Effects of long-chain (LC) n-3 (omega-3) polyunsaturated fatty acids (PUFAs) and the influence of genetic background on these markers are not known. Objective: We investigated effects of fish-oil supplementation on both classical and novel markers of endothelial function in subjects prospectively genotyped for the Asp298 endothelial nitric oxide synthase (eNOS) polymorphism and at moderate risk of cardiovascular disease (CVD). Design: A total of 84 subjects with moderate risk of CVD (GG: n = 40; GT/TT: n = 44) completed a randomized, double-blind, placebo-controlled, 8-wk crossover trial of fish-oil supplementation that provided 1.5 g LC n2 3 PUFAs/d. Effects of genotype and fish-oil supplementation on the blood lipid profile, inflammatory markers, vascular function (by using peripheral artery tonometry), and numbers of circulating EPCs and EMPs (by using flow cytometry) were assessed. Results: There was no significant effect of fish-oil supplementation on blood pressure, plasma lipids, or plasma glucose, although there was a trend (P = 0.069) toward a decrease in the plasma triglyceride concentration after fish-oil supplementation compared with placebo treatment. GT/TT subjects tended to have higher concentrations of total cholesterol and low-density lipoprotein cholesterol, but vascular function was not affected by either treatment or eNOS genotype. Biochemical markers of endothelial function were also unaffected by treatment and eNOS genotype. In contrast, there was a significant effect of fish-oil supplementation on cellular markers of endothelial function. Fish-oil supplementation increased numbers of EPCs and reduced numbers of EMPs relative to those with placebo treatment, which potentially favored the maintenance of endothelial integrity. There was no influence of genotype for any cellular markers of endothelial function, which indicated that effects of fish-oil supplementation were independent of eNOS genotype. Conclusion: Emerging cellular markers of endothelial damage, integrity, and repair appear to be sensitive to potentially beneficial modification by dietary n 23 PUFAs. This trial was registered at www.controlled-trials.com/isrctn as ISRCTN76272133. [ABSTRACT FROM AUTHOR]

Background: Soft tissue fibrosis is a common consequence of breast cancer treatment and chronic lymphoedema. It can compromise function and quality of life, but research regarding interventions is limited. Aims: To assess the efficacy of using JoViPitPak® (JoviPak Corporation) to influence soft tissue fibrosis change by looking at tissue density, perceived cosmesis and perceived breast pain. Methods: This case series examined four breast cancer patients with stage 2 lymphoedema, post lumpectomy surgery and radiation therapy. All patients were instructed in manual lymphatic drainage (MLD) and utilised elastic compression for breast oedema before receiving treatment for soft tissue fibrosis. Treatment consisted of using JoViPitPak®, a compression garment developed specifically for treatment of soft tissue fibrosis, which was worn upon the breast under elastic compression for two hours each day for three weeks. Pre- and post-treatment fibrosis was assessed with tissue tonometry, perception of cosmesis was assessed with a questionnaire, and breast pain was measured using an analogue pain scale. Results: Patients demonstrated decreased tissue density, increased perceived cosmesis and a decrease in perceived breast pain. Conclusion: The JoViPitPak® was efficacious in reducing the effects of soft tissue fibrosis. Additional randomised studies are warranted to further assess the efficacy of this treatment approach. Declaration of interest: None. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify the barriers to case-finding for primary open angle glaucoma (POAG) as perceived by community optometrists in the United Kingdom (UK). Methods: An anonymous, online survey to investigate the current mode of optometric practice for the detection of POAG was developed. The survey included a free-text question relating to barriers to case-finding for the disease. Optometrists on the Association of Optometrists (AOP) electronic database were invited to participate. The survey was open for 16 weeks between April and July 2008. Results: A total of 1680 responses was received to the survey, of which 1293 (77%) answered the free-text question relating to perceived barriers. Eighty-eight per cent of these reported one or more barriers to the detection of glaucoma in the community, most commonly: time constraints limiting the options for repeat testing and lack of financial remuneration to perform the additional tests required. Barriers were less frequently reported in Scotland, with 23.4% of optometrists reporting no barriers compared to only 12% in England, 6% in Northern Ireland and 4% in Wales. Conclusion: In general, UK optometrists believed that their ability to detect POAG in the community is hampered by time and financial constraints. However, barriers were significantly fewer in Scotland, where optometrists have different contractual terms of service with the NHS than their counterparts in the rest of the UK. [ABSTRACT FROM AUTHOR]

Purpose: Glaucoma is reportedly more frequent in people living in urban areas and more than 91% of the world's population live in areas with air pollution above WHO recommended limits. However, few studies have examined the association between air pollution and risk of glaucoma. Methods: UK Biobank participants aged 40–69 years old completed a detailed baseline questionnaire and underwent ophthalmic and air pollution assessments. Ambient particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) concentration was estimated. Eye measures including self‐reported glaucoma status, corneal compensated intraocular pressure (IOPcc), Goldmann‐correlated intraocular pressure (IOPg) and thickness of retinal layers were collected. Total average thickness of the retinal nerve fibre layer (mRNFL), ganglion cell‐inner plexiform layer (mGC‐IPL), ganglion cell complex (mGCC) and total macular layer were obtained from spectral‐domain optical coherence tomography (SD‐OCT). Multivariable regression models were used to evaluate associations between PM2.5 concentration with self‐reported glaucoma, IOP and retinal layer thickness. Results: In multivariable regression analysis, participants resident in areas with higher PM2.5 concentration were more likely to report a diagnosis of glaucoma (OR = 1.13, 95% CI 1.08 to 1.19, per interquartile range [IQR] increase). Higher PM2.5 concentration was associated with thinner mGC‐IPL (β = −0.47 µm, 95% CI −0.56 to −0.39, per IQR increase), mGCC (β = −0.21 µm, 95% CI −0.33 to −0.09, per IQR increase) and total macular thickness (β = ‐0.36 µm, 95% CI −0.56 to −0.15, per IQR increase), while a thicker mRNFL (β = 0.25 µm, 95% CI 0.18 to 0.32, per IQR increase) was observed. There was no relationship between PM2.5 concentration and IOP that was biologically relevant (IOP: β = 0.06 mmHg, 95% CI 0.03 to 0.09, per IQR increase; IOPcc (β = 0.08 mmHg, 95% CI 0.01 to 0.15, highest versus lowest quartile). Conclusion: In this large adult population, higher PM2.5 concentration was associated with a self‐reported diagnosis of glaucoma, and thinner inner retinal layers, consistent with structural changes seen in glaucoma. No biologically relevant relationship was observed for either IOPcc and IOPg. This suggest that PM2.5 concentration may be a potential modifiable risk factor for glaucoma that is independent of IOP. [ABSTRACT FROM AUTHOR]

Aim: Assess current practice and views regarding checking Goldmann applanation tonometers for calibration errors in the United Kingdom. Design: Questionnaire survey. Methods: A total of 100 ophthalmology residents from England, Wales, and Scotland attending the 2004 Congress of the Royal College of Ophthalmologists, UK, responded to a structured questionnaire. They were asked the following: how often they used different tonometers between clinical sessions; how often they checked their tonometers for errors; and who they felt was responsible for checking tonometers for calibration errors. Results: All respondents were using a different Goldmann tonometer for each clinic: 85% never check tonometers for errors; only 7% perform checks at the start of each clinical session; and 8% would only check the tonometer for calibration errors if they had suspicious or unexpected measurements. A total of 70% of respondents felt that calibration checks are not part of their responsibility. They believe that either nursing staff or other hospital staff should carry out calibration checks and ensure that tonometers are accurate. The remaining 30% felt that calibration checks should be carried out by the doctor using the tonometer. Conclusion: Despite evidence that Goldmann tonometers lose accuracy during routine use in clinical practice, only a minority are checking the tonometers for calibration errors. There is no consensus as to who should be responsible for ensuring that tonometer calibration is maintained. We recommend that tonometers should be checked for calibration errors at least on a monthly basis by individuals identified by departmental protocols. [ABSTRACT FROM AUTHOR]

Focuses on the early detection of glaucoma in Great Britain. Use of ophthalmoscopy and tonometry in the diagnosis of the disease; Signs and symptoms of the disease; Risk factors of glaucoma.

Purpose To assess the impact of flicker length on retinal vessel dilation. Methods Seven healthy individuals underwent manual shygmomanometry, non‐contact tonometry (Keeler Pulsair, UK) and dynamic retinal diameter measurements using the retinal vessel analyser (ImedosSystems, Germnay). In order to evaluate the influence of flicker length on vessel dilation each subject was measured with 5 protocols of varying flicker length. Protocols consisted all of 50 second baseline measurements followed by 3 cycles of either 5 sec, 7 sec, 10 sec or 20 sec flicker provocation and 80 second recovery, whereas the fifth protocol consisted of 50 sec baseline, 50 sec flicker provocation and 120 sec recovery (single cycle). All protocols were administered on the same day but in random order with a minimum of 5‐10 minutes recovery between protocols. Results Most of the flicker induced dilation (~85%) is reached within the first 7 to 10sec post provocation start independent of flicker length. Any additional flicker provocation does not significantly increase arterial dilation (ANOVA p>0.05). However, venous dilation does increase with increasing flicker lengths but at a slower rate compared to the initial ten seconds. Conclusion Through administering the different protocols it becomes apparent that the vessel dilation due to flicker light provocation is a two stage process: the first being the immediate reaction to accommodate increased metabolic demand and the second being the maintenance reaction to address prolonged demand. This two stage process could be useful in assessing patients with various ocular and systemic vascular insufficiencies and potentially be a more useful marker than the absolute dilatory response. [ABSTRACT FROM AUTHOR]