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PurposeThis study aims to evaluate whether the use of citicoline oral solution could improve quality of life in patients with chronic open-angle glaucoma (OAG).DesignRandomized, double-masked, placebo-controlled, cross-over study was used. Patients were randomized to one of the two sequences: either citicoline 500 mg/day oral solution-placebo or placebo-citicoline 500 mg/day oral solution. Switch of treatments was done after 3 months; patients were then followed for other 6 months. Follow-up included 3-month, 6-month, and 9-month visits.OutcomesThe primary outcome was the mean change of “intra-patient” composite score of the Visual Function Questionnaire-25 (VFQ-25). after citicoline oral solution vs placebo at 6-month visit as compared with baseline.MethodsThe trial was multicenter, conducted at 5 European Eye Clinics. OAG patients with bilateral visual field damage, a mean deviation (MD) ranging from − 5 to − 13 dB in the better eye, and controlled IOP were included. VFQ-25 and SF-36 questionnaires were administered at baseline and at 3-, 6-, and 9-month visits. A mixed effect model, with a random effect on the intercept, accounted for correlations among serial measurements on each subject.ResultsThe primary pre-specified outcome of the analysis reached statistical significance (p = 0.0413), showing greater improvement after citicoline oral solution. There was an increase in the composite score in both arms compared to baseline, but it was significant only for the placebo-citicoline arm (p = 0.0096, p = 0.0007, and p = 0.0006 for the three time-points compared to baseline). The effect of citicoline was stronger in patients with vision-related quality of life more affected by glaucoma at baseline.ConclusionsThis is the first placebo-controlled clinical study evaluating the effect of a medical treatment aiming at improving vision-related quality of life in glaucomatous patients.

AimsTo provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG).MethodsParticipants with OAG in the Thessaloniki Eye Study (cross-sectional, population-based study in a European population) were included in the analysis. Visual impairment was defined as mean deviation (MD) equal to or worse than −12dB and blindness as MD equal to or worse than −24dB. Additional thresholds for visual impairment were tested. For each participant maxTRoP_VI was defined as the rate of progression which would not lead to visual impairment during expected lifetime. MaxTRoP_BL was defined accordingly. Both parameters were calculated for each OAG subject using age, sex, MD and life expectancy data. The eye with the better MD per subject was included in the analysis.ResultsAmong 135 subjects with OAG, 123 had reliable visual fields and were included in the analysis. The mean age was 73±6 years and the median MD was −3.65±5.28dB. Among those, 69.1% would have a maxTRoP_VI slower than −1dB/year and 18.7% would have a maxTRoP_VI between −1 and −2dB/year. Also, 72.4% would have a maxTRoP_BL slower than −2dB/year. For all tested thresholds for visual impairment, approximately 86% of the OAG study participants would not be able to tolerate a rate of progression equal to or faster than −2dB/year.ConclusionsThe majority of patients with glaucoma in our study would have a maximum tolerable rate of progression slower than −1dB/year in their better eye. Patient-tailored strategies to monitor the visual field are important, but raise the issue of feasibility with regard to the number of visual field tests needed.

PurposeTo identify factors associated with retinal capillary density as measured with Confocal Scanning Laser Doppler Flowmetry (Heidelberg retina flowmeter (HRF)) in the Thessaloniki Eye Study (TES).MethodsParticipants of the TES (age ≥60 years, cross-sectional population-based study) were assessed for active capillary density in the superior and inferior peripapillary retina using the HRF. Pixel-by-pixel analysis was performed to quantify the percentage of zero flow pixels (ZFPs; surrogate for % retinal area with non-active capillaries). Multivariable regression analyses were performed to assess the association of non-active vascular density with ophthalmic and systemic variables. Glaucoma, late age-related macular degeneration and diabetic retinopathy subjects were excluded.Results1189 subjects were included in the analysis. Older age (per year) was associated with higher percentage of ZFP in both the superior (slope estimate (SE)=0.0020) and the inferior (SE=0.0019) peripapillary retina (p<0.0001). History of migraine was associated with lower percentage of ZFP (SE=−0.0166) compared with no history of migraine in the superior peripapillary retina only (p<0.05). Higher intraocular pressure ((IOP) per mm Hg) and height (per cm) were associated with higher percentage of ZFP in the inferior peripapillary retina only (SE=0.0012, p<0.05 and SE=0.0005, p<0.05, respectively). The group consuming vegetables one to three times per week compared with the group consuming vegetables at least once a day had higher percentage of ZFP only in the inferior peripapillary retina (SE=0.0080, p<0.05).ConclusionAt a population level, our study revealed associations of older age, higher IOP and taller height with lower active retinal capillary density and of migraine with higher capillary density. Looking further into these associations may provide insight into disease mechanisms.

A 45-year-old man presented with clinical manifestations of foveomacular retinitis, including visual symptoms and foveal lesions characteristic of solar retinopathy, but repeated questions failed to elicit a history of sun gazing. Cross-sectional retinal images produced by optical coherence tomography revealed localized loss of retinal pigment epithelium cells in both eyes. A different pattern of reflectivity at the level of the photoreceptor layer was observed between the right and left eye, reflecting asymmetry in tissue damage. This case is described to provide additional evidence that solar retinopathy and foveomacular retinitis are the same entity and may also have common optical coherence tomography findings.

This paper addresses the problem of safe and efficient navigation in remotely controlled robots operating in hazardous and unstructured environments; or conducting other remote robotic tasks. A shared control method is presented which blends the commands from a VFH+ obstacle avoidance navigation module with the teleoperation commands provided by an operator via a joypad. The presented approach offers several advantages such as flexibility allowing for a straightforward adaptation of the controller's behaviour and easy integration with variable autonomy systems; as well as the ability to cope with dynamic environments. The advantages of the presented controller are demonstrated by an experimental evaluation in a disaster response scenario. More specifically, presented evidence show a clear performance increase in terms of safety and task completion time compared to a pure teleoperation approach, as well as an ability to cope with previously unobserved obstacles.

This paper reports on insights by robotics researchers that participated in a 5-day robot-assisted nuclear disaster response field exercise conducted by Kerntechnische Hilfdienst GmbH (KHG) in Karlsruhe, Germany. The German nuclear industry established KHG to provide a robot-assisted emergency response capability for nuclear accidents. We present a systematic description of the equipment used; the robot operators' training program; the field exercise and robot tasks; and the protocols followed during the exercise. Additionally, we provide insights and suggestions for advancing disaster response robotics based on these observations. Specifically, the main degradation in performance comes from the cognitive and attentional demands on the operator. Furthermore, robotic platforms and modules should aim to be robust and reliable in addition to their ease of use. Last, as emergency response stakeholders are often skeptical about using autonomous systems, we suggest adopting a variable autonomy paradigm to integrate autonomous robotic capabilities with the human-in-the-loop gradually. This middle ground between teleoperation and autonomy can increase end-user acceptance while directly alleviating some of the operator's robot control burden and maintaining the resilience of the human-in-the-loop.