Tag: Vision

Green eyeglasses reduce pain-related anxiety in fibromyalgia patients, study shows

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Newswise — NEW ORLEANS — Wearing special green eyeglasses for several hours a day reduces pain-related anxiety and may help decrease the need for opioids to manage severe pain in fibromyalgia patients and possibly others who experience chronic pain, according to a study being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“Our research found that certain wavelengths of green light stimulate the pathways in the brain that help manage pain,” said Padma Gulur, M.D., lead author of the study and executive vice chair of Duke Anesthesiology and Duke Health, Chapel Hill, North Carolina. “There is an urgent need for additional treatments to reduce the use of opioids among patients with fibromyalgia and other types of chronic pain, and green eyeglasses could provide an easy-to-use, non-drug option.”

Few alternatives to opioids — especially non-drug options — exist for patients with severe and chronic pain conditions such as fibromyalgia, which causes pain all over the body. Fibromyalgia affects about 4 million U.S. adults, according to the Centers for Disease Control and Prevention.

Pain and anxiety share similar biological mechanisms. Additionally, fear of pain exacerbates anxiety, often leading to increased opioid use, said Dr. Gulur.

The researchers studied 34 fibromyalgia patients who were randomized to wear various shades of eyeglasses four hours a day for two weeks: 10 patients wore blue eyeglasses, 12 wore clear eyeglasses and 12 wore green eyeglasses. Patients who wore green eyeglasses were four times more likely to have reduced anxiety than those in the other groups, which saw no reduction in anxiety.

“We found that although their pain scores remained the same, those who wore the green eyeglasses used fewer opioids, demonstrating that their pain was adequately controlled,” said Dr. Gulur. “We would recommend the green eyeglasses treatment for those with fibromyalgia and are studying patients with other chronic pain conditions to determine if it would be beneficial.”

The eyeglasses are specially formulated to filter a specific wavelength on the green light spectrum, said Dr. Gulur. She noted that most patients who wore the green eyeglasses reported feeling better and asked to keep wearing them.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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American Society of Anesthesiologists (ASA)

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October 23, 2022
How to Develop a Company Vision and Values

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Opinions expressed by Entrepreneur contributors are their own.

I’m sure you’ve read about the importance of having company values and a mission or vision statement. But why is it important and how do you establish them? When I first started my business with one client and a couple of employees, I didn’t have the structure in place. But as we grew and added more clients and staff, I realized the importance of having a roadmap so that everyone was on the same page. I might have had a vision in my mind about where I thought we were going, but I needed to share that vision and get input from my team on where they wanted to go as well.

Brainstorm what you want and what you don’t

After I made some key leadership hires, we met together as a group and did a lot of brainstorming. We thought about everything we wanted to be and what we didn’t want to be. We looked at our staff and our clients, people we admired and looked up to and tried to reverse-engineer their characteristics (can you tell I’m passionate about reverse-engineering?) We agreed that we wanted to be more like “this,” and we wanted to work with clients that are more like “that.” We used these to create our values. Why didn’t we like working with certain people? Because they were jerks — that’s where one of our four core values of “Make it Fun, Don’t Be a Jerk” came from.

Once we came up with our mission and core values, we put a system in place to make sure those values became part of our workplace culture. We created a Slack channel to recognize people who live up to those values. Anyone can publicly recognize anyone else by giving them a shoutout for something they’ve done. Then at our biweekly company-wide meetings, we select a few people who were nominated and give them a financial award. I used to think mission, values and vision were just things they taught business school, but it’s real and I’ve seen the positive impact it’s had on our company.

Related: Five Top Tips for Crafting Mission and Vision Statements with Meaning

I was an SEO expert but didn’t have a lot of experience as a CEO of a fast-growing company. At this point, I decided to work with a coach who recommended that I develop a “vivid vision,” something that outlines where I see myself and the company three years into the future. He recommended that I go to a place that inspires me and just sit there and try to put the vision that I had in my head on paper. I chose to go to a nice hotel in Beverly Hills.

I spent the afternoon sitting in a nice coffee shop where they had a piano player, beautiful paintings on the wall, people coming in and out and nice cars pulling up. It inspired me, and I came up with three pages of bullet notes. I used adjectives that described the specific details of what each part of the vision looked like. Creating a vivid vision doesn’t need to be a whole book — just write a few bullet points of your dreams and goals. Describe in detail what the office looks like, how many people you employ, your revenue and perhaps even the awards you have received. The point is to create a visual for the rest of your employees so that they can envision the future in the same way you do. This way everyone is aligned and clear on where you are going as a company.

Related: The Key to Finding Your Company’s Mission? It’s in Your ‘Also.’

Making the dream a reality

After my time at the coffee shop, I got on a call with our director of communications to discuss what I had come up with, and then she wrote it into our vivid vision story. The mission and values were created with the leadership team. The vision was something that I needed to develop myself, as the CEO. It’s written in the present tense, three years from now, as if it is already accomplished. We decided on a three-year vision as 5-10 years seemed too far in the future to be realistic. From here, it went to our creative team to make it come to life with visuals and images. Once it came to life visually, our engineering team then took it and turned it into a web page that is live on our website for anyone to see. That includes our employees, our clients, our bankers and our competitors. We’re radically transparent, and we’re very clear about where we’re going,

Related: How to Engage Employees Through Your Company Vision Statement

We just created our vivid vision last year, and there are already aspects of the vision that are coming to fruition. I think there’s a lot to be said for being intentional about direction and then just watching the manifestation happen. As everyone starts to understand where we’re going, it starts happening. As the CEO, I couldn’t possibly do it all on my own, but I can instill the vision into the team and with them to make that vision a reality.

We have our vision for the next three years. We won’t change it or lower our expectations if we miss a target. We have set our sights high and will work towards achieving or surpassing those goals. We also review our vision once a quarter. We like to do this at our leadership retreat, where we get high-level reports on how things are going.

If you haven’t put together a mission or vision for your company, perhaps it’s time to take action. If you think it’s only something for large corporations or only something they talk about in business school, I hope my experience can help change that perception. Having a clear vision and a specific mission helps define the purpose of the organization. It makes sure you are working towards the right goals and helps you direct resources to the appropriate place. When everyone is working towards the same goal, it increases productivity. It gives employees a sense of unity. When employees understand the vision, it motivates them to work hard to achieve the goals that have been laid out. It takes some time to put together, but the results are more than worth it. I don’t think I’ve ever worked in another company that has a better culture because of the way we initially structured our vision and mission.

Related: 4 Essentials for Making Your Company Mission Thrive

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Jason Hennessey

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October 19, 2022
Gene Therapy Rapidly Improves Night Vision in Adults with Congenital Blindness

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Newswise — PHILADELPHIA—Adults with a genetic form of childhood-onset blindness experienced striking recoveries of night vision within days of receiving an experimental gene therapy, according to researchers at the Scheie Eye Institute in the Perelman School of Medicine at the University of Pennsylvania.

The patients had Leber Congenital Amaurosis (LCA), a congenital blindness caused by mutations in the gene GUCY2D. The researchers, whose findings are reported in the journal iScience, delivered AAV gene therapy, which carries the DNA of the healthy version of the gene, into the retina of one eye for each of the patients in accordance with the clinical trial protocol. Within days of being treated, each patient showed large increases, in the treated eye, of visual functions mediated by rod-type photoreceptor cells. Rod cells are extremely sensitive to light and account for most of the human capacity for low-light vision.

“These exciting results demonstrate that the basic molecular machinery of phototransduction remains largely intact in some cases of LCA, and thus can be amenable to gene therapy even after decades of blindness,” said study lead author Samuel G. Jacobson, MD, PhD, a professor of Ophthalmology at Penn.

LCA is one of the most common congenital blindness conditions, affecting roughly one in 40,000 newborns. The degree of vision loss can vary from one LCA patient to another but all such patients have severe visual disability from the earliest months of life. There are more than two dozen genes whose dysfunction can cause LCA.

Up to 20 percent of LCA cases are caused by mutations in GUCY2D, a gene that encodes a key protein needed in retinal photoreceptor cells for the “phototransduction cascade”—the process that converts light to neuronal signals. Prior imaging studies have shown that patients with this form of LCA tend to have relatively preserved photoreceptor cells, especially in rod-rich areas, hinting that rod-based phototransduction could work again if functional GUCY2D were present. Early results with low doses of the gene therapy, reported last year, were consistent with this idea.

The researchers used higher doses of the gene therapy in two patients, a 19- year-old man and a 32-year-old woman, who had particularly severe rod-based visual deficits. In daylight, the patients had some, albeit greatly impaired, visual function, but at night they were effectively blind, with light sensitivity on the order of 10,000 to 100,000 times less than normal.

The researchers administered the therapy to just one eye in each patient, so the treated eye could be compared to the untreated eye to gauge treatment effects. The retinal surgery was performed by Allen C. Ho, MD, a professor of Ophthalmology at Thomas Jefferson University and Wills Eye Hospital. Tests revealed that, in both patients, the treated eyes became thousands of times more light-sensitive in low-light conditions, substantially correcting the original visual deficits. The researchers used, in all, nine complementary methods to measure the patients’ light sensitivity and functional vision. These included a test of room navigation skills in low-light conditions and a test of involuntary pupil responses to light. The tests consistently showed major improvements in rod-based, low-light vision, and the patients also noted functional improvements in their everyday lives, such as “can [now] make out objects and people in the dark.”

“Just as striking was the rapidity of the improvement following therapy. Within eight days, both patients were already showing measurable efficacy,” said study co-author Artur V. Cideciyan, PhD, a research professor of Ophthalmology at Penn.

To the researchers, the results confirm that GUCY2D gene therapy to restores rod-based photoreceptor functions—and suggest that GUCY2D–LCA patients with more severe rod-based dysfunction are likely to benefit most dramatically from the therapy. The practical message is that there should be an emphasis on rod vision measurements at screening of LCA candidates and in monitoring them throughout a treatment trial.

The findings, the researchers said, also underscore the remarkable fact that in some patients with severe congenital vision loss, the retinal cell networks that mediate vision remain largely alive and intact, and need only the resupply of a missing protein to start working again, more or less immediately.

The ongoing clinical trial is registered at clinicaltrials.gov as trial NCT03920007.

Support for the research was provided by Atsena Therapeutics, Inc., the developer of the GUCY2D gene therapy; the National Institutes of Health (R01 EY11522); and by a CURE Formula grant from the Pennsylvania Department of Health.

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Perelman School of Medicine at the University of Pennsylvania

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October 10, 2022
3D map reveals DNA organization within human retina cells

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Newswise — National Eye Institute researchers mapped the organization of human retinal cell chromatin, the fibers that package 3 billion nucleotide-long DNA molecules into compact structures that fit into chromosomes within each cell’s nucleus. The resulting comprehensive gene regulatory network provides insights into regulation of gene expression in general, and in retinal function, in both rare and common eye diseases. The study published in Nature Communications.

“This is the first detailed integration of retinal regulatory genome topology with genetic variants associated with age-related macular degeneration (AMD) and glaucoma, two leading causes of vision loss and blindness,” said the study’s lead investigator, Anand Swaroop, Ph.D., senior investigator and chief of the Neurobiology Neurodegeneration and Repair Laboratory at the NEI, part of the National Institutes of Health.

Adult human retinal cells are highly specialized sensory neurons that do not divide, and are therefore relatively stable for exploring how the chromatin’s three-dimensional structure contributes to the expression of genetic information.

Chromatin fibers package long strands of DNA, which are spooled around histone proteins and then repeatedly looped to form highly compact structures. All those loops create multiple contact points where genetic sequences that code for proteins interact with gene regulatory sequences, such as super enhancers, promoters, and transcription factors.

Such non-coding sequences were long considered “junk DNA.” But more advanced studies demonstrate ways these sequences control which genes get transcribed and when, shedding light on the specific mechanisms by which non-coding regulatory elements exert control even when their location on a DNA strand is remote from the genes they regulate.

Using deep Hi-C sequencing, a tool used for studying 3D genome organization, the researchers created a high-resolution map that included 704 million contact points within retinal cell chromatin. Maps were constructed using post-mortem retinal samples from four human donors.

The researchers then integrated that chromatin topology map with datasets on retinal genes and regulatory elements. What emerged was a dynamic picture of interactions within chromatin over time, including gene activity hot spots and areas with varying degrees of insulation from other regions of DNA.

They found distinct patterns of interaction at retinal genes suggesting how chromatin’s 3D organization plays an important role in tissue-specific gene regulation.

“Having such a high-resolution picture of genomic architecture will continue to provide insights into the genetic control of tissue-specific functions,” Swaroop said.

Furthermore, similarities between mice and human chromatin organization suggest conservation across species, underscoring the relevance of chromatin organizational patterns for retinal gene regulation. More than a third (35.7%) of gene pairs interacting through a chromatin loop in mice also did so in human retina.

The researchers integrated the chromatin topology map with data on genetic variants identified from genome-wide association studies for their involvement in AMD and glaucoma, two leading causes of vision loss and blindness. The findings point to specific candidate causal genes involved in those diseases.

The integrated genome regulatory map will also assist in evaluating genes associated with other common retina-associated diseases such as diabetic retinopathy, determining missing heritability and understanding genotype-phenotype correlations in inherited retinal and macular diseases.

The study was supported by the NEI Intramural Research Program, grants ZIAEY000450 and ZIAEY000546.

Reference: Marchal C, Singh N, Batz Z, Advani J, Jaeger C, Corso-Diaz X, and Swaroop A. “High-resolution genome topology of human retina uncovers super enhancer-promoter interactions at tissue-specific and multifactorial disease loci.” Published October 7, 2022, Nature Communications. DOI:10.1038/s41467-022-33427-1

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This press release describes a basic research finding. Basic research increases our understanding of human behavior and biology, which is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process— each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic research. To learn more about basic research, visit https://www.nih.gov/news-events/basic-research-digital-media-kit.

NEI leads the federal government’s efforts to eliminate vision loss and improve quality of life through vision research…driving innovation, fostering collaboration, expanding the vision workforce, and educating the public and key stakeholders. NEI supports basic and clinical science programs to develop sight-saving treatments and to broaden opportunities for people with vision impairment. For more information, visit https://www.nei.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/.

NIH…Turning Discovery Into Health®

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NIH, National Eye Institute (NEI)

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October 7, 2022
Study casts doubt on routine use of anesthesiologists in cataract surgery

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Newswise — Ophthalmologists may be able to safely cut back on having anesthesiologists or nurse anesthetists routinely at bedside during cataract surgery, which accounts for more than two million surgeries per year in the U.S., according to a study publishing Oct. 3 in JAMA Internal Medicine.

A team of researchers from UC San Francisco examined Medicare claims for 36,652 patients who had cataract surgery in 2017 and found the use of anesthesia care was substantially higher for cataract surgery when compared to patients undergoing other elective, low-risk outpatient procedures—such as cardiac catheterization or screening colonoscopy. However, they found that these patients experienced fewer systemic complications—such as myocardial infarction or stroke—than did patients undergoing the other low-risk procedures. These results held true even in cases where anesthesia experts were not present for the cataract surgery, suggesting that for many cataract patients, it may be reasonable to consider doing the procedure without routine anesthesia support.

“It’s important to note we only looked at systemic complications and not ophthalmologic outcomes from the procedure,” noted senior study author Catherine Chen, MD, MPH, UCSF associate professor in Anesthesia and Perioperative Care and researcher at the Philip R. Lee Institute for Health Policy Studies. “We are evaluating those next, but it would be premature to say we should change practice now based on this study. Hopefully we can get a conversation going, though.”

Some type of anesthetic and possibly sedation is needed for cataract surgery, Chen noted, but the question is who should be present for administration and intraoperative monitoring of these patients. In the past, cataract surgery carried a much higher risk of complications, which helps explain the historic and legacy use of anesthesiologists and/or certified registered nurse anesthetists (CRNA).

“The risk of the procedure itself used to require general anesthesia with paralysis and inpatient admission. Over time, ophthalmologists improved their technique so it [cataract surgery] is much safer and can be done on an outpatient basis,” said Chen. “Often the patient just needs a topical anesthetic such as numbing drops in the eyeball, and, at UCSF anyway, a little fentanyl and midazolam, which are agents a sedation nurse can administer safely.”

A Question of Resources

The study found that, for cataract surgery, 90% of U.S. Medicare patients have an anesthesia provider at the bedside compared to a range of <1% to 70% at bedside for other low-risk elective procedures. In contrast, fewer cataract surgery patients experienced systemic complications within seven days (7.7%) than patients undergoing other low-risk procedures (range, 13% to 52%).

Approximately 6% of ophthalmologists never used anesthesia providers, 77% always used anesthesia providers, and 17% used them for only a subset of patients. Patients of those ophthalmologists who never used anesthesia providers had a 7.4% rate of systemic complications.

There is no specific guidance from professional associations on whether to include an anesthesia expert during cataract surgery, but other countries do not routinely use them, to no ill effect, Chen noted.

With U.S. anesthesiologists being asked to staff an increasing number of non-OR procedures, such as endoscopic or interventional radiology procedures where patients tend to be much sicker and the procedure potentially more invasive, there often aren’t enough of these specialists go around, Chen said.

“Add to this a general shortage of anesthesiologists since COVID, and it’s clear we need to ensure staff resources are used efficiently,” said Chen.

In an upcoming study, Chen and her colleagues will look at both systemic and ophthalmologic outcomes stratified by whether patients received care from an anesthesia provider during cataract surgery. While the current study used a sample of 5% of Medicare claims, the upcoming study will use 20% of claims.

“It’s certainly possible that by having an anesthesiologist there, the patients are calmer and possibly less likely to move, and so the ophthalmologic outcomes could be better—so we are working on those studies now,” Chen said. “Where I think where we could end up, when the results are in, is that instead of automatically defaulting to include an anesthesiologist, we stratify patients by risk so that their level of sedation and anesthesia support matches their likelihood of complications.”

Co-authors and funding: Please see paper for additional co-authors and funding disclosures.

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University of California, San Francisco (UCSF)

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October 3, 2022