To explore the effect of the Affordable Care Act (ACA) on disparities in access to health care based on disability status, as well as age, income, race, and ethnicity.
In this study, I used logistic ...regression to analyze nationally representative data from 128 000 respondents to the US National Health Interview Survey from 2008 to 2010 and 2015 to 2017. Outcome variables were uninsurance over the previous 12 months, delayed or forgone health care for reasons of cost, and having a regular provider at a doctor's office or health clinic.
Over the period when the ACA was implemented, large existing disparities in access to health care were reduced for people with certain types of disabilities, young adults aged 19 to 25 years, and low-income families.
The ACA improved overall access to health care and reduced some disparities, but substantial disparities persist. Disability status remains associated with much greater risk of delayed or forgone care, and mental health disability is associated with greater likelihood of uninsurance.
The ACA partially achieved its goals and must not be weakened or rolled back. Further policy efforts are needed to address the remaining disparities.
To determine the horizontal extent of the binocular visual field (BVF) in subjects with horizontal strabismus and whether the BVF falls below the driving standard.
Adults with congenital esotropia ...and infantile exotropia ≤45 Prism Dioptres (PD), and subjects with orthotropia were recruited. The manifest angle of deviation was measured using a simultaneous prism cover test. Monocular Visual Field (MVF) and BVF were measured using the Esterman visual field test. Subjects with diplopia or a manifest angle of strabismus that varied by>8PD or the present of a vertical tropia >8PD were excluded.
Forty-nine subjects were included: 10 with orthotropia, 20 with exotropia and 19 with esotropia. The horizontal extent of BVF (degrees) was significantly smaller in esotropes (122.8 ± 18.8) than in orthotropes (141 ± 6.6) or exotropes (138.3 ± 8.3) (p < 0.01). In 6 (31.6%) subjects with an esotropia, the BVF was below the driving standard. The horizontal extent of the visual field (VF) of the amblyopic eyes of patients with esotropia (98.70 degrees, SD 19.76) and exotropia (104.75 degrees, SD16.93) were significantly smaller than those with orthotropia (121.00 degrees SD 3.16) by 22.3 degrees (p = 0.004) and 16.25 degrees (p = 0.045), respectively. The difference between the summation of MVFs and the BVF was significantly greater in orthotropes (100.6 ± 2.7) than in exotropes (68.9 ± 34.4) and esotropes (74.2 ± 20.7) (p < 0.01).
The horizontal extent of BVF is significantly smaller and more variable in adults with congenital esotropia and may fall below the driving standard.
Largest study on visual fields in subjects with horizontal strabismus including an orthotropic control group who do not have diplopia and who would otherwise meet the driving standard. Visual field quality was high but limitation is that visual field repeatability was not undertaken.
The findings of this study would suggest that people with an esotropia should be offered the opportunity to have a binocular visual field test before applying for a driving license. The DVLA may want to consider requesting people with an esotropia to have a binocular visual field test as is a requirement with other ophthalmic conditions such as glaucoma.
To provide a solution for average paraxial lens power (A
P) of a lens. Orthogonal and oblique sections through a lens of power Formula: see text were reduced to a paraxial representation of lens ...power followed by integration. Visual acuity was measured using lenses of different powers (cylinders of - 1.0 and - 2.0D) and axes, mean spherical equivalent (MSE) of S + C/2, A
P and a toric correction, with the order of correction randomised. A digital screen at 6 m was used on which a Landolt C with crowding bars was displayed for 0.3 s before vanishing. The general equation for a symmetrical lens of refractive index (n), radius of curvature R, in medium of refractive index n1, through orthogonal (Formula: see text) and oblique meridians (Formula: see text) as a function of the angle of incidence (Formula: see text) reduces for paraxial rays (Formula: see text) to Formula: see text. The average of this function is Formula: see text providing a solution of Formula: see text for A
P.For central (p = 0.04), but not peripheral (p = 0.17) viewing, correction with A
P was associated with better visual acuity than a MSE across all tested refractive errors (p = 0.04). These findings suggest that Formula: see text may be a more inclusive representation of the average paraxial power of a cylindrical lens than the MSE.
Extracellular vesicles (EVs), specifically exosomes, carry a cell-type dependent cargo that is transported to the recipient cell and translated in the presence of a required machinery. Differences in ...the cargo carried by the corneal and conjunctival-derived EVs could be the agent that triggers the transdifferentiation of these two cell populations. Therefore, this study investigates the role of EVs in triggering the plasticity of corneal and conjunctival epithelial cells and identifies prospective miRNA and genes responsible for maintaining ocular surface homeostasis. The EVs were extracted from the conditioned media (after starving) of corneal epithelial (hTCEpi) and conjunctival (HCjE-Gi) cell lines using ultracentrifugation. HCjE-Gi cells were cultured with hTCEpi-derived EVs and vice-versa. The EVs were characterized as exosomes using Nanosight and Flow cytometry. KRT3 and KRT12 were used as associated corneal markers, whereas KRT7 and KRT13 were used as associated conjunctival markers with ΔNp63 as a differentiation marker. Shift of these markers was an indication of transdifferentiation. The cargo of the extracted exosomes from both the cell types was explored using next-generation sequencing. The hTCEpi-derived EVs induced conjunctival epithelial cells to express the corneal-associated markers KRT3 and KRT12, losing their conjunctival phenotype at both the mRNA and protein level. Simultaneously, HCjE-Gi-derived EVs induced corneal epithelial cells to express the conjunctival associated markers KRT7 and KRT13, losing their corneal phenotype. This process of differentiation was accompanied by an intermediate step of cell de-differentiation showed by up-regulation in the expression of epithelial stem cell marker ΔNp63, also shown on the ex vivo human cadaveric donor corneas. miRNA molecules (total of 11 including precursor and mature) with significant differences in their relative abundance between the two populations (
< 0.05) were found and investigated. miR-9-5p expression was higher in HCjE-Gi cells and HCjE-Gi-derived EVs when compared to hTCEpi cells and hTCEPi-derived EVs (
< 0.001). The results suggest that EVs released by the two cell types have the ability to influence the transdifferentiation of human conjunctival and corneal epithelial cells. miR-9-5p could have a role in stem cell homeostasis and cell differentiation via
gene.
While for the ApP, the average is the average of orthogonal and oblique paraxial rays, that is, ApP=average orthogonal and oblique paraxial power F¯ApP(orthogonal+oblique), ...F¯ApP(orthogonal+oblique)=C14+C14+C2−C14, ApP=F¯ApP(orthogonal+oblique)=C14+C24. ...the ApP is equal to half the SE if calculated in cross cylinder form, that is, ApP=SE2. If a refractive error, however, does comprise a true spherical component, then the average of that component is of course the sphere. ...for a refractive power that contains a sphere, the ApP=Sphere+C4 and the SE=Sphere+C2 and the difference between the ApP and SE is equal to C4 . The ApP as a scalar measure is more inclusive and appears to be associated with better visual acuity than the SE, although further clinical trials are needed particularly in different age groups and conditions.
Descemet membrane endothelial keratoplasty (DMEK) preparation is technically demanding and is a limiting factor for uptake of this kind of surgery. Supply methods that simplify the procedure for ...surgeons are key to increasing uptake. This study compares two different shipping protocols for DMEK.
An 8.5 mm DMEK graft was punched, marked and loaded for transportation in two different conditions: (A) endothelium trifolded inwards in organ culture conditions (n=7) and (B) endothelium rolled outwards in hypothermic conditions (n=7). Tissues were shipped from Italy to the UK, then analysed for orientation, endothelial cell density, denuded areas, cell mortality, triple viability staining (Hoechst/ethidium homodimer/calcein AM (HEC)), immunolocalisation of ZO-1 and Na/K-ATPase proteins, visualisation of actin filaments using phalloidin and histological analysis using H&E on paraffin-embedded sections.
All tissues clearly showed the mark used for graft orientation. After shipping in condition A, there was an increase in cell mortality of 8.1% and in denuded areas of 22.4%, whereas for condition B there was an increase in cell mortality of 14.2% and in denuded areas of 34.3% after shipping. HEC staining revealed areas of viable cells and apoptotic cells, with large denuded areas found in the periphery for condition B and within folds for condition A.
Prestripped preloaded DMEK grafts retained sufficient viable cells for transplantation, with condition A (endothelium-in) offering the advantage of greater flexibility of use due to a longer shelf-life. HEC analysis provides further detailed information as to the status of DMEK grafts and should be used in future similar studies.
To illustrate the role of corneal angiography in the clinical assessment and surgical treatment of patients with complex corneal neovascularization (CoNV).
A case series of 3 patients with CoNV is ...presented whose management was guided by indocyanine green (ICG) and fluorescein corneal angiography. In the first case, there was recurrent lipid exudation into an intrastromal cleft from CoNV; in the second, there was progressive exudation from CoNV at the graft-host interface; in the third, CoNV was associated with rejection after deep anterior lamellar keratoplasty.
In the first case, angiography helped to identify and treat the feeder vessels and stop further leakage. In the second case, it was possible using angiography to differentiate CoNV arising from iris and limbal vasculature enabling angiographic-guided fine-needle diathermy with cessation of exudation. In the third case, angiography revealed the location of CoNV in the host-graft interface after deep anterior lamellar keratoplasty, rather than within the corneal stroma.
Corneal angiography is a useful diagnostic tool to guide medical and surgical management of CoNV by enabling the localization of vessel depth and topography.
The aim of this study was to describe a novel technique for descemetorhexis that combines the advantages of stable anterior chamber (AC) associated with ophthalmic viscosurgical devices and optimal ...surgical visualization seen with air to overcome the issues of poor Descemet membrane (DM) visibility or AC instability when each is used alone.
This study is a description of a new surgical approach.
We describe a new technique for performing descemetorhexis. The simultaneous presence of cohesive ophthalmic viscosurgical device and air in the AC offers optimal DM visualization and guarantees a stable AC during this surgical step. It does not require an additional incision for an AC maintainer.
The described technique may facilitate the surgical step of descemetorhexis, offering improved AC stability and better visualization of the DM. It may reduce early postoperative graft detachment due to the presence of residues of the recipient's diseased DM.
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