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Purpose: The aim of this study was to examine the impact of self‐tonometry on clinicians' decision in glaucoma treatment. Materials and Methods: Medical records of 133 patients who had performed self‐tonometry using iCare® Home between January and December 2019 were retrospectively reviewed. Inclusion criteria were as follows: age over 18 years, all types of glaucoma, as well as ocular hypertension and glaucoma suspect, compliance with tonometer manufacturer's recommendations and monitoring over at least 2 days. The data consisted of age, gender, diagnosis, visual field index, rate of progression and type of treatment pre‐ and post‐intraocular pressure (IOP) phasing. The following IOP measurements were used to calculate the mean and maximum IOP, and range over each day and consecutive days: Goldmann applanation tonometry (GAT) measurements from referral and training visits and iCare® Home measurements made by the trainers and the patients themselves. A total of 90 patients were included. Results: Clinicians were satisfied with the actual treatment in 54.4% of the cases. There was a statistically significant difference between the clinicians' decision to maintain same treatment or to escalate therapy for all the mean and maximum IOPs measured on each single day and over a 2‐ or 3‐day period (p < 0.002). Conclusion: Our results suggest that the presence of high IOP values obtained with self‐tonometry supports an intensification of glaucoma treatment. Self‐tonometry provides clinicians with an important complement for clinical decision‐making, and under‐ or over‐treatment may be avoided for the benefit of patients. [ABSTRACT FROM AUTHOR]

Tool wear monitoring in machine process is essential for quality assurance, efficiency improvement, and cost reduction. Data-driven methods based on deep learning have become an effective solution for tool wear monitoring, but in actual cutting process, multiple sensors are often used for high-frequency sampling to obtain multi-level information, so that tool wear data has multi-channel spatial structure and time series characteristics, respectively. Therefore, aiming at the distribution of tool wear data, a one-dimensional residual structure is designed and a novel hybrid model integrating bi-directional long short-term memory (BLSTM) network is proposed, which is suitable for tool wear monitoring, named Re-BLSTM. Considering the spatial distribution of tool wear signal, a residual structure is constructed based on one-dimensional convolution neural network (1-D CNN) to realize abstract feature extraction and signal denoising, while gradient vanishing and degradation problem can be solved as the deeper of network. Additionally, batch normalization (BN) layer and dropout operation are introduced to form a pre-activation structure, which can alleviate the over fitting problem caused with the increase of model parameters; Subsequently, in view of the temporal correlation of feature, long-term dependence of concatenated feature is explored by integrating BLSTM and the learning range is also expanded. To verify the performance of the proposed model, experiments are carried out compared with several state-of-the-art method. The results show the effectiveness and generalization of the proposed method. [ABSTRACT FROM AUTHOR]

Instance segmentation in remote sensing (RS) imagery aims to predict the locations of instances and represent them with pixel-level masks. Thanks to the more accurate pixel-level information for each instance, instance segmentation has enormous potential applications in resource planning, urban surveillance, and military reconnaissance. However, current RS imagery instance segmentation methods mostly follow the fully supervised paradigm, relying on expensive pixel-level labels. Moreover, remote sensing imagery suffers from cluttered backgrounds and significant variations in target scales, making segmentation challenging. To accommodate these limitations, we propose a semantic attention enhancement and structured model-guided multi-scale weakly supervised instance segmentation network (SASM-Net). Building upon the modeling of spatial relationships for weakly supervised instance segmentation, we further design the multi-scale feature extraction module (MSFE module), semantic attention enhancement module (SAE module), and structured model guidance module (SMG module) for SASM-Net to enable a balance between label production costs and visual processing. The MSFE module adopts a hierarchical approach similar to the residual structure to establish equivalent feature scales and to adapt to the significant scale variations of instances in RS imagery. The SAE module is a dual-stream structure with semantic information prediction and attention enhancement streams. It can enhance the network's activation of instances in the images and reduce cluttered backgrounds' interference. The SMG module can assist the SAE module in the training process to construct supervision with edge information, which can implicitly lead the model to a representation with structured inductive bias, reducing the impact of the low sensitivity of the model to edge information caused by the lack of fine-grained pixel-level labeling. Experimental results indicate that the proposed SASM-Net is adaptable to optical and synthetic aperture radar (SAR) RS imagery instance segmentation tasks. It accurately predicts instance masks without relying on pixel-level labels, surpassing the segmentation accuracy of all weakly supervised methods. It also shows competitiveness when compared to hybrid and fully supervised paradigms. This research provides a low-cost, high-quality solution for the instance segmentation task in optical and SAR RS imagery. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the accuracy of the intraocular pressure ( IOP) measured by healthy subjects with icare® Home and to observe the IOP fluctuation and pattern of IOP fluctuation in healthy subjects over three consecutive days. Methods Sixty healthy subjects were recruited to the study. IOP was measured by the subjects themselves and by study staff using icare® Home tonometers on visits 1 and 2, as well as by study staff using Goldmann applanation tonometry ( GAT). Furthermore, the subjects measured their IOP at home for three consecutive days. Results Twenty-three per cent of the study eyes were excluded in the statistical analysis due to dropout or non-compliance to the schedule. Approximately 70% of the icare® Home measurements were within 3 mmHg of the GAT measurements. Ten to 16% of the study eyes had IOP peaks outside office hours. Sixty-three per cent of the study eyes had different IOP patterns on consecutive days. Conclusion Rebound self-tonometry appears to be accurate and could be used to monitor short- and long-term IOP variations. The difference between IOP patterns on consecutive days raises questions as to the certainty of a single IOP measurement as a measure of treatment effect. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the reliability of intraocular pressure measured by patients with glaucoma themselves using a new hand-held tonometer and to observe whether the intraocular pressure (IOP) variations have the same pattern on different days while glaucoma treatment is constant. Methods Eighty-seven patients diagnosed with open-angle glaucoma or ocular hypertension were recruited to the study. Intraocular pressure measured using Goldmann applanation tonometry (GAT) was compared with IOP measured using tonometry at baseline and on the second visit. Patients measured their IOP at home using the hand-held tonometers. Results The mean difference between GAT and iCare® values varies from 0 to 1 mmHg. Seventy-eight per cent of iCare® measurements were within 3 mmHg of the GAT measurements. Approximately 64% of the study eyes had higher IOP in the morning than in the afternoon/evening. Circadian patterns differed between consecutive days in 47% of the study eyes. There were IOP peaks outside office hours in up to 16% of the study eyes. Conclusion Measurements made using rebound self-tonometry are accurate and could be used to complement the investigation of patients with glaucoma. Intraocular pressure curves provide valuable data usable when adapting glaucoma treatment. [ABSTRACT FROM AUTHOR]

The interpretation of optical and synthetic aperture radar (SAR) images in remote sensing is general for many tasks, such as environmental monitoring, marine management, and resource planning. Instance segmentation of optical and SAR images, which can simultaneously provide instance-level localization and pixel-level classification of objects of interest, is a crucial and challenging task in image interpretation. Considering that most current methods for instance segmentation of optical and SAR images rely on expensive pixel-level annotation, we develop a weakly supervised instance segmentation (WSIS) method to balance the visual processing requirements with the annotation cost. First, we decompose the prior knowledge of the mask-aware task in WSIS into three meta-knowledge components: fundamental knowledge, apparent knowledge, and detailed knowledge inspired by human visual perception habits of "whole to part" and "coarse to detailed." Then, a meta-knowledge-guided weakly supervised instance segmentation network (MGWI-Net) is proposed. In this network, the weakly supervised mask (WSM) head can instantiate both fundamental knowledge and apparent knowledge to perform mask awareness without any annotations at the pixel level. The network also includes a mask information awareness assist (MIAA) head, which can implicitly guide the network to learn detailed information about edges through the boundary-sensitive feature of the fully connected conditional random field (CRF), facilitating the instantiation of detailed knowledge. The experimental results show that the MGWI-Net can efficiently generate instance masks for optical and SAR images and achieve the approximate instance segmentation results of the fully supervised method with about one-eighth of the annotation production time. The model parameters and processing speed of our network are also competitive. This study can provide inexpensive and convenient technical support for applying and promoting instance segmentation methods for optical and SAR images. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine a threshold waveform score (WS) for the best score value (BSV) in the Ocular Response Analyzer (ORA). Methods: Retrospective study. One hundred and thirty-three healthy adults were recruited. Measurements were done with the ORA 2.04. Results: Two hundred and sixty-six eyes were analyzed. Mean age was 56.49 ± 15.97 years. The mean waveform score of the BSV was 7.39 ± 1.32. The waveform scores ranged from 2.8 to 9.7. Kolmogorov-Smirnov test for normality was significant ( p ≤ 0.0001). Linear regression showed a significant positive correlation between IOPg (measured with the ORA) and IOP measured with Goldmann applanation tonometry ( p ≤ 0.0001), as well as significant negative correlation between the difference IOPg-IOP Goldmann and waveform score of the BSV values. Threshold estimation considering 95 % confidence interval was 7.23. Meanwhile, threshold estimation considering the difference IOPg-IOP Goldmann, for 3 mmHg, was 6.7. Conclusions: When using the ORA device, we recommend that clinicians try to obtain several waveform score measurements of 7 or above. Waveform scores lower than 7 may render less reliable results. [ABSTRACT FROM AUTHOR]

. Purpose: High intraocular pressure (IOP) and glaucoma are often suspected in patients with mucopolysaccharidosis (MPS). To determine corneal hysteresis (CH) and IOP in children with mucopolysaccharidosis I-Hurler (MPS I-H) and MPS VI. Methods: Clinical measurements with ocular response analyzer (ORA). Results: In seven patients, five with MPS I-H treated with stem cell transplantation (SCT), and two with MPS VI, one treated with SCT and the other with enzyme therapy, the IOP was examined with ORA. Ocular response analyzer measurements were made at a median age of 8.7 years in the patients with MPS I-H and at a median age of 9.3 years in the patients with MPS VI. Earlier measurements had raised suspicion of high IOP in one patient. The ORA showed an increased CH and a falsely high IOP values in all 14 eyes. The recalculated IOPs were normal in all 14 eyes. Mild to severe corneal opacities were present in all 14 eyes. Optic disc areas, borders and cupping were clinically normal in the 12 of 14 eyes that were possible to examine. Severe corneal opacities hampered optic disc evaluation in the older patient with MPS VI. Three eyes in two patients had normal thickness of the retinal nerve fibre layer measured with scanning laser polarimetry with corneal compensation (GDx VCC). No patient was diagnosed or treated for glaucoma. Conclusion: The IOPs are often falsely high because of an increased resistance of the cornea and correlate to the extent of corneal clouding. In this small, cross-sectional study, it appears that corneal resistance is directly correlated with corneal clouding, although a longitudinal study that evaluates resistance as the cornea clears with treatment would provide more direct evidence that corneal deposits are directly related to resistance. A correct measured IOP can avoid unnecessary medical or surgical hypotensive treatment. [ABSTRACT FROM AUTHOR]

Purpose: Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. The IOP can be decreased by pharmaceutical treatment, laser [selective laser trabeculoplasty (SLT)] treatment, or surgery. Prostaglandin analogues have been postulated to share action mechanisms with SLT and to possibly diminish the effects of SLT treatment. The aim of the current study was to investigate the effects of prostaglandin analogues in inflammation and IOP reduction after SLT treatment. Methods: Prospective nonrandomized study. One hundred and eighteen patients were included in the study. Inclusion criteria: Glaucoma (open-angle or pseudoexfoliation glaucoma) patients who will be treated with SLT. Inflammation was measured with a laser flare meter (Kowa FM-500). Measurements were made before SLT and then 2 h, 1 week, and 1 month after SLT treatment. IOP was also checked at the same time intervals. The SLT treatment was performed over 90°. All patients were divided into two groups: those receiving prostaglandins analogues and those treated with nonprostaglandin analogues. Results: Inflammation before and after SLT showed no significant difference between the groups at all the time intervals studied ( t-test, before: P=0.16; 2 h: P=0.14; 1 week: P=0.12; and 1 month: P=0.36). IOP reduction showed no significant difference between the groups ( t-test, P=0.31). Conclusions: SLT treatment effects do not seem to be influenced by the use of prostaglandin analogues. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the tolerability and intraocular pressure (IOP) reducing effect of the first preservative-free prostaglandin tafluprost (Taflotan®) in patients exhibiting ocular surface side-effects during latanoprost (Xalatan®) treatment. Methods: A total of 158 patients were enrolled in this open-label multicentre study. Eligible patients had to have at least two ocular symptoms, or one sign and one symptom, during treatment with latanoprost. At baseline, the patients were directly switched from latanoprost to preservative-free tafluprost for 12 weeks. The patients were queried for ocular symptoms, and ocular signs were assessed by using tear break-up time, Schirmer’s test, fluorescein staining and evaluation of conjunctival hyperaemia and blepharitis. In addition, HLA-DR and MUC5AC in conjunctival impression cytology specimens were analyzed, and a drop discomfort/quality of life (QoL) questionnaire was employed. IOP was measured at all visits. Results: Preservative-free tafluprost maintained IOP at the same level after 12- weeks treatment (16.4 ± 2.7 mmHg) as latanoprost at baseline (16.8 ± 2.5 mmHg). During treatment with preservative-free tafluprost, the number of patients having irritation/burning/stinging (56.3%), itching (46.8%), foreign body sensation (49.4%), tearing (55.1%) and dry eye sensation (64.6%) decreased to 28.4%, 26.5%, 27.1%, 27.1% and 39.4% correspondingly. The number of the patients with abnormal fluorescein staining of cornea (81.6%) and conjunctiva (84.2%), blepharitis (60.1%), conjunctival hyperaemia (84.2%) and abnormal Schirmer’s test (71.5%) was also reduced significantly to 40.6%, 43.2%, 40.6%, 60.0% and 59.4% correspondingly. The tear break-up time improved significantly from 4.5 ± 2.5 seconds to 7.8 ± 4.9 seconds. A reduction in the number of patients with abnormal conjunctival cells based on HLA-DR and MUC5AC was also detected. Conclusions: Preservative-free tafluprost maintained IOP at the same level as latanoprost, but was better tolerated in patients having signs or symptoms while on preserved latanoprost. Preservative-free tafluprost treatment resulted in improved QoL, increased patient satisfaction and drop comfort. [ABSTRACT FROM AUTHOR]

Glaucoma care consists of lifelong monitoring of patients. To perform an IOP curve with self-tonometry, patients need to visit the clinic for approximately 45 min. Even if our calculation is non-exhaustive, IOP curves obtained with self-tonometry prove to be a cost-efficient method that we highly recommend in daily glaucoma care. [Extracted from the article]

Aim: This prospective study assessed the long-term ocular and visual outcomes of children with mucopolysaccharidoses type I Hurler syndrome (MPS IH) who were treated with haematopoietic stem cell transplants (HSCT).Methods: Clinical ophthalmological assessments were performed on eight patients at the St Erik Eye Hospital, Huddinge, Stockholm, Sweden, from 2001-2018: The median age at diagnosis and HSCT were 12.2 (range 5.0-16.4) and 16.7 (8.0-20.4) months. The last eye examination was at a median of 13.4 (6.3-19.0) years and follow-up lasted a median of 12.0 (5.0-17.4) years.Results: Poor visual acuity, poor night vision and, or, photophobia were reported by six children. The best corrected visual acuity at the last visit was a median of 0.4 and 0.5 in the right and left eye and had declined significantly in two patients. Corneal opacities had increased despite HSCT in five patients. High hyperopia, at a median of +6 Dioptres, occurred in all patients and stiff corneas in all four patients that were measured. The patients' corrected intraocular pressures were normal. Retinal degeneration was identified in two patients.Conclusion: Despite HSCT, the long-term follow-up of patients with MPS IH showed reduced visual acuity due to corneal opacities or retinal degeneration. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding a case series of patients with mucopolysaccharidosis in the previous issue of the journal.

PURPOSE: The aim of this study was to investigate the influence of blink rate on lacrimal drainage capacity in different age groups. METHODS: The drop test for lacrimal drainage capacity was recently described by us. In the drop test, drops of 10 μl, 15 μl or 20 μl of lukewarm saline are repeatedly instilled in the tear film during three minutes. Excessive saline solution is then removed and the volume drained by the lacrimal passages is calculated. The drop test was performed in 40 individuals of two age groups, 10-30 years and 60-80 years. The drop test results were recorded when the subjects tried to blink at frequencies of 90 and 180 blinks/three minutes. RESULTS: The drop test results were significantly higher in the young than in the old subjects. At the lower blink rate, the lacrimal drainage capacity was 363 μl/3 min. in the young and 155 μl/3 min. in the old subjects. At the higher blink rate, the lacrimal drainage capacity was 520 and 200 μl/3 min., respectively. The increases in lacrimal drainage capacity with increasing blink rate were significant in both age groups. CONCLUSION: The lacrimal drainage capacity increased with increasing blink rate in both younger and older subjects. The lacrimal drainage capacity was significantly lower in the old age group at each blink frequency, indicating that other factors than blink rate are responsible for the lower lacrimal drainage capacity in older age. [ABSTRACT FROM AUTHOR]

Increased tissue stiffness is a hallmark of cancer and promotes tumor progression. It is hypothesized that decreased tumorous stress may aid or sensitize chemotherapies. To overcome extracellular matrix (ECM) stiffening and fulfill sensitized chemotherapy in one nanosystem, a reactive oxygen species‐activatable nanoenzyme (SP‐NE) based on a dendritic polyglycerol scaffold, integrating collagenase and paclitaxel (PTX) prodrug, is constructed. The dense and tough ECM is highly remitted by SP‐NE in the tumor microenvironment (TME) mimicking gelatin hydrogel models, which causes cell shrinkage, disorders cytoskeletal constructions, and subsequently enhances chemotherapeutic efficacy. ECM softening via SP‐NE downregulates mechanotransduction signaling pathways of integrin‐focal adhesion kinase (FAK)‐Ras homolog family member A (RhoA) implicated in cytoskeletal assembly, and integrin‐FAK‐phosphorylated extracellular signal regulated kinase (pERK 1/2) mediating mitosis. Notably, this programmed nanosystem in human breast MCF‐7 tumor‐bearing mice models displays a significant relief of ECM stress from 4300 to 1200 Pa and results in 87.1% suppression of tumor growth at a low PTX dosage of 3 mg kg−1. The attenuated expression of the key players RhoA and pERK 1/2 involved in cellular mechano‐sensing is further verified in vivo. This study thus provides a new and potential nanoplatform to selectively decrease TME stiffness for enhanced chemotherapy. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of 90‐ and 360‐degree selective laser trabeculoplasty (SLT) as primary or supplement therapy in patients with glaucoma and ocular hypertension (OHT). Methods: Patients (>30 years old) with OHT, primary open‐angle glaucoma (OAG), pigmentary glaucoma or pseudoexfoliative glaucoma were enrolled in a prospective randomized clinical trial. Patients were sequentially randomized to either 90‐ or 360‐degree SLT. Their intraocular pressure (IOP) was monitored. Results: The survival periods (in days) of the two extents (90 or 360 degrees) of treatment were not statistically significantly different (p = 0.85); only pretreatment IOP level could predict survival of treatment (p = 0.02). Conclusion: The 90‐degree SLT is as effective as 360‐degree SLT. Further studies are warranted to confirm the findings. High baseline IOP could be a factor that predicts treatment success. [ABSTRACT FROM AUTHOR]

Purpose: Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. The IOP can be decreased by pharmaceutical treatment, laser [selective laser trabeculoplasty (SLT)] treatment, or surgery. Prostaglandin analogues have been postulated to share action mechanisms with SLT and to possibly diminish the effects of SLT treatment. The aim of the current study was to investigate the effects of prostaglandin analogues in inflammation and IOP reduction after SLT treatment.Methods: Prospective nonrandomized study. One hundred and eighteen patients were included in the study.Inclusion Criteria: Glaucoma (open-angle or pseudoexfoliation glaucoma) patients who will be treated with SLT. Inflammation was measured with a laser flare meter (Kowa FM-500). Measurements were made before SLT and then 2 h, 1 week, and 1 month after SLT treatment. IOP was also checked at the same time intervals. The SLT treatment was performed over 90°. All patients were divided into two groups: those receiving prostaglandins analogues and those treated with nonprostaglandin analogues.Results: Inflammation before and after SLT showed no significant difference between the groups at all the time intervals studied (t-test, before: P=0.16; 2 h: P=0.14; 1 week: P=0.12; and 1 month: P=0.36). IOP reduction showed no significant difference between the groups (t-test, P=0.31).Conclusions: SLT treatment effects do not seem to be influenced by the use of prostaglandin analogues. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of different levels of visual field defect in glaucoma on utilities and to test if utilities could be assessed using a general questionnaire such as the EQ-5D. Methods: A cross-sectional study in 199 patients with ocular hypertension or open-angle glaucoma grouped into 5 severity stages according to visual field defects was performed in 4 specialized ophthalmic centres. Descriptive analysis was performed for the sample and by stage, and the effect of vision loss on utility was investigated with multiple step-wise regression analysis. Results: The mean age of the sample was 70 and the mean MD in the worse eye was −13.1 dB (SD 10.2). Visual acuity (VA) was 0.63 and 0.87 in the worse and better eye, respectively, and the mean utility was 0.80 (SD 0.23). Utility decreased with increasing glaucomatous damage, ranging from 0.84 for mild disease to 0.72 for severe damage (MD −2.5 to −28.1), but the difference between the groups was not statistically significant when controlling for co-morbidity, except for the most severe stage (p < 0.01). In multiple regression analysis, visual field in the better eye was significantly correlated with utility, and there was an indirect correlation between visual field in the worse eye and utility: the effect of total VA on utility was significant, and MD in the worse eye was correlated with total VA. Conclusions: Utility is strongly correlated with overall vision. Our results suggest a relationship between glaucomatous damage and utility, and patients with severe damage have a significantly lower utility. However, this should be further investigated in larger samples that include more patients with moderate-severe bilateral damage. [ABSTRACT FROM AUTHOR]

Purpose: To assess resource utilization and costs associated with glaucoma management in France and Sweden. Methods: A total of 267 patient records (121 in France, 146 in Sweden) with diagnoses of primary open-angle glaucoma (POAG) and ocular hypertension (OH), treated medically, were reviewed for a 2-year period (beginning during 1997−99) for relevant clinical and resource utilization data. Economic data were applied to estimate treatment costs. Results: The annual cost of treating glaucoma was estimated at SEK5305 (€531)/patient in Sweden and €390/patient in France. In both countries, medication costs comprised about half of the total costs. Surgical procedures and hospitalizations represented greater proportions of total cost in France (7.0% and 9.6%, respectively) than in Sweden (3.7% and 0.6%, respectively). Conclusion: Medication costs represent a high proportion of total treatment costs. These findings highlight the relative importance of medical therapy and of assessing the cost-effectiveness of medications in glaucoma. [ABSTRACT FROM AUTHOR]