A technique called optical coherence tomography (OCT) has been developed for noninvasive cross-sectional imaging in biological systems. OCT uses low-coherence interferometry to produce a two-dimensional image of optical scattering from internal tissue microstructures in a way that is analogous to ultrasonic pulse-echo imaging. OCT has longitudinal and lateral spatial resolutions of a few micrometers and can detect reflected signals as small as approximately 10(-10) of the incident optical power. Tomographic imaging is demonstrated in vitro in the peripapillary area of the retina and in the coronary artery, two clinically relevant examples that are representative of transparent and turbid media, respectively.

/pdf/optical-coherence-tomography-3zqbp7mpwb.pdf

Optical coherence tomography

Aim: To estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020. Methods: A review of published data with use of prevalence models. Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions were used to construct prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study. Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma. Results: There will be 60.5 million people with OAG and ACG in 2010, increasing to 79.6 million by 2020, and of these, 74% will have OAG. Women will comprise 55% of OAG, 70% of ACG, and 59% of all glaucoma in 2010. Asians will represent 47% of those with glaucoma and 87% of those with ACG. Bilateral blindness will be present in 4.5 million people with OAG and 3.9 million people with ACG in 2010, rising to 5.9 and 5.3 million people in 2020, respectively. Conclusions: Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians.

The number of people with glaucoma worldwide in 2010 and 2020

Optical coherence tomography (OCT) has developed rapidly since its first realisation in medicine and is currently an emerging technology in the diagnosis of skin disease. OCT is an interferometric technique that detects reflected and backscattered light from tissue and is often described as the optical analogue to ultrasound. The inherent safety of the technology allows for in vivo use of OCT in patients. The main strength of OCT is the depth resolution. In dermatology, most OCT research has turned on non-melanoma skin cancer (NMSC) and non-invasive monitoring of morphological changes in a number of skin diseases based on pattern recognition, and studies have found good agreement between OCT images and histopathological architecture. OCT has shown high accuracy in distinguishing lesions from normal skin, which is of great importance in identifying tumour borders or residual neoplastic tissue after therapy. The OCT images provide an advantageous combination of resolution and penetration depth, but specific studies of diagnostic sensitivity and specificity in dermatology are sparse. In order to improve OCT image quality and expand the potential of OCT, technical developments are necessary. It is suggested that the technology will be of particular interest to the routine follow-up of patients undergoing non-invasive therapy of malignant or premalignant keratinocyte tumours. It is speculated that the continued technological development can propel the method to a greater level of dermatological use.

https://link.springer.com/content/pdf/bfm%3A978-3-319-06419-2%2F1.pdf

Optical Coherence Tomography

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61690-0.pdf

Maternal and child undernutrition: global and regional exposures and health consequences

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60937-X.pdf

Maternal and child undernutrition and overweight in low-income and middle-income countries

In this issue of Ophthalmic Epidemiology, colleagues from India and Pakistan, two countries comprising the densely populated and largely impoverished sub-continent, independently document the continuing tragedy of vitamin A deficiency and its impact on sight and life. As both papers note, vitamin A deficiency is a major cause of death and blindness among young children throughout the developing world. UNICEF and the World Health organization have, since the early 1990s, called for global control of the problem, most recently as a major means of achieving the Millennium Development Goals. The World Bank has long noted that vitamin A deficiency control programs, primarily through administration of a single large dose of vitamin A twice a year to children 6 months through 5 years of age, is one of the most cost-effective health interventions in existence. More recently, the Copenhagen Consensus, an annual assessment by leading economists on the best means by which to deploy $50 billion dollars to boost development and alleviate poverty, have placed the prevention of vitamin A and other micronutrient deficiencies at the top of their list. UNICEF, the lead implementing agency, not only supplies over 500 million doses of vitamin A for distribution each year, largely provided with funds from the Canadian Government, but includes official government statistics on coverage rates as one of the key health metrics in their annual “State of the World’s Children” report. Many countries report coverage rates of over 70 percent. While generally hard to believe, some, in fact, achieve them. Carefully conducted repeat prevalence surveys in Indonesia, Bangladesh, Nepal and elsewhere have shown as much as a 95 percent decline in xerophthalmia rates, with presumably, a comparable impact on under-5 mortality (something more difficult to ascertain as variations in climate, famine and infections

The continuing challenge of vitamin A deficiency.

I MUST CONFESS from the start that the timing and nature of health care reform are as speculative as they are inevitable; that "managed care" has as many different stripes as "health care reform," and their balance is subject to the evolving outcome of the health care reform debate; and that all predictions are subject to change at a moment's notice. Why health care reform in the first place? Put simply, because our present system of providing and paying for health services is inefficient, ineffective, and inequitable. As Brody et al1noted, it "provides appropriate high-quality care to a small group, inappropriately complex care to a larger group, and virtually no care at all to far too many." It does not fulfill "Sommer's maxim"2: maximizing the quality years of life at a cost society can afford. We spend more on health care than any other country, whether in

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=ophth&articleId=640889&pdfFileName=archopht_112_11_016.pdf

Health (care) reform, managed care, and ophthalmology

Folk medicines and acute hemorrhagic conjunctivitis.

Erratum: On estimating efficacy in clinical trials (Statistics in Medicine (1991) 10 (45-52))

In September 2016, Bloomberg Philanthropies made a $300 million gift to the Johns Hopkins Bloomberg School of Public Health on the occasion of the school’s 100th anniversary. The gift’s purpose was to improve health in the United States by focusing on 5 areas: addiction and overdose, violence, obesity and the food system, environmental challenges, and risks to adolescent health. All 5 areas of focus are serious health problems facing the nation, with deep connections to economic and social factors; none have quick fixes. In making this gift, Bloomberg Philanthropies sought to stimulate broader and more effective public health responses to these problems. It is no coincidence that the gift arrived at a time of dispiriting headlines about the state of health in the United States. Despite enormous progress during the last century, with major declines in infectious disease, noncommunicable diseases, and injuries, as well as a dramatic increase in life expectancy at birth, progress is stalling. Life expectancy has stopped growing; indeed, it declined for 2 consecutive years. The opioid epidemic is claiming more than 40 000 lives per year, suicide rates are rising, and obesity rates among adults are increasing. These and other issues are complicated by unfortunate shifts in health disparities and by deteriorating physical infrastructure in both urban and rural areas. How can a school of public health support the field of public health in addressing these complex health and social problems? This question is at the heart of the Bloomberg American Health Initiative (hereinafter, the Initiative), the program launched with the new funds. During its first 2 years, the Initiative has convened partners from across the country, both inside and outside of academia, to identify key issues and opportunities for making meaningful progress on each of the 5 targeted public health challenges. Many of these issues and opportunities are captured in the detailed articles included in this supplemental issue of Public Health Reports. Initial areas identified for action included: stigma that impedes treatment seeking and shapes societal beliefs about appropriate community responses to the opioid epidemic; underappreciated connections among intimate partner violence, suicide, and community violence; systems approaches to the obesity epidemic; changes to infrastructure and community design that enhance environmental health; and programs and policies to prevent high-risk young people from becoming disconnected from school and work. Faculty engaged in the Initiative have also identified cross-cutting themes that are critical to success. One theme is the need for relevant evidence to drive policy. However, the kind of evidence produced through academic research and the way that evidence is packaged and communicated do not always meet the needs of policy makers and practitioners. In addition, critical analyses are often limited by inadequate, poorly integrated longitudinal data and lack of useful evaluation of policies and programs. The Initiative is seeking opportunities to develop stronger collaborations between schools and programs of public health and policy makers to coproduce research that will lead to evidence that is accessible, applicable, and impactful. A second theme is that the field of public health alone cannot succeed in addressing problems that reflect deep inequities in our society. This theme is a central insight of the Robert Wood Johnson Foundation’s Culture of Health action framework, in which “health become[s] a national priority, valued and advanced by collaborators among many sectors of society.” A focus on equity, community engagement, and leadership is necessary to address the role of what have been described as “the social, political, and economic foundations that determine population health.” Public Health 3.0, an initiative launched by the US Department of Health and Human Services in 2016, calls for health

https://journals.sagepub.com/doi/pdf/10.1177/0033354918798375

Alfred Sommer

Papers

The continuing challenge of vitamin A deficiency.

Health (care) reform, managed care, and ophthalmology

Folk medicines and acute hemorrhagic conjunctivitis.

Erratum: On estimating efficacy in clinical trials (Statistics in Medicine (1991) 10 (45-52))

The Bloomberg American Health Initiative.