IN OPHTHALMOLOGY
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Dutch centre knocks down barriers between doctors and patients
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Diet high in fruit associated with lower risk of neovascular AMD
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Vitamin E Supplementation and Cataract: Randomized Controlled Trial
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Statin Use Linked with Lower Risk of Age-Related Maculopathy
Robodog helps blind see in shops
Courtesy of Vladimir Kulyukin PhD
ROBOTS that guide visually impaired people through complex places, such as grocery stores or airports, may be close to becoming a reality. In fact, researchers in the US have a working proof-of-concept prototype that not only guides blind people through grocery stores, but also takes them directly to the products they want to buy.
"In most of the media coverage of our technology it is referred to as a robotic seeing eye dog, which is a misnomer. The device is not intended to replace seeing-eye dogs."
"Many aspects of this technology are in place," said Vladimir Kulyukin PhD from Utah State University. He and his colleagues in the Computer Science Assistive Technology Laboratory of Utah State University have built a prototype robot that allows blind test subjects to do grocery shopping unassisted.
Shopping for groceries provides extra challenges to the visually impaired because products are often moved to different shelves, or cancelled, meaning blind people can’t find the items they want unless they ask somebody. It's the sort of effort that white canes or guide dogs can't help with. "In most of the media coverage of our technology it is referred to as a robotic seeing eye dog, which is a misnomer. The device is not intended to replace seeing-eye dogs," Dr Kulyukin told EuroTimes.
Blind people have a special relationship with their dogs, plus the dogs are able to guide them in outdoor environments. The robotic guide is intended for specific enclosed environments such as airports or large shops.
Radiofrequency tracking robotic base
The main part of the robot consists of computer equipment and a radiofrequency tracking devices mounted on a commercial robotic base. The person using it would first use a Braille list that has the names of items in the store available for purchase, along with code numbers. For instance, Colgate toothpaste might be number 23. Users would then use the computer keyboard to type in the code numbers for the products desired. Then the robot plans a path and goes to that item in the store. The user holds onto the robot and is guided through the store, directly to the shelf sections that have the desired products. A voice from some small speakers tells the user when it is about to turn left or right.
The second part of the device is a series of small discs that are mounted on shelf sections throughout the store. The discs contain information about the product it sits next to. The robot senses the discs, and directs the user to the correct product. "Those discs are radio frequency identification tags, RFID. They are very small and are so-called passive sensors," Dr Kulyukin explained. The need for radio frequency identification tags is another reason the device would not be used outside, it would be next to impossible, and costly, to place the discs everyplace they would be needed.
Hopefully, some day soon, the robotic device "might be added to the fleet of assistive devices in grocery stores," he said. In the US, numerous large chain stores, such as Wal-Mart, have assistive devices available for people with mobility impairments. Devices include wheelchairs and special carts to help with shopping.
While the prototype has passed various tests, the robotic device is not yet available in stores. "Right now we’ve approached a grocery store that belongs to a large chain. If they give us permission to use their floor for trial tests, we will deploy it in their grocery store 24 hours a day, seven days a week," he said.
Another environment the robots might be useful in is airports. They could help blind people find terminals, restaurants and pubic toilets. It could even be made into a cart with a seat that the person would ride to their destination within the airport.
The prototype robotic device cost US$15,000 to make. However, once it is mass produced the cost should come down to about $5,000 each, Dr Kulyukin said. There are 11-million visually impaired people in the US.
Robots can be versatile helpmates.
Because most customers in a shop are sighted and don't need the device, the robot may have some additional capabilities in the future. To make the device more appealing to stores, it can help staff move goods around.
"It can, for example, be used to help grocery stores automate their internal delivery operations. You can pile boxes on the robot, or attach a cart to it then the robot will be carting them all over the store. It will optimise internal delivery operations. And when it needs to guide somebody, it'll guide somebody," Dr Kulyukin said.
"It can be used to help grocery stores automate their internal delivery operations.”
As far as he knows, this is the first robotic guide device of its kind for the blind, though there have been other types of robotic guides developed.
One such robot guide is the RHINO robot, which was used for a while at the Deutsches Museum, Bonn, a contemporary technology museum, in Bonn, Germany. RHINO, a mobile robot, took visitors around the museum and stopped at specific displays. Recordings described what the displays were. On request, the robot would even provide visitors with additional details of exhibits. The RHINO robot was developed by researchers at the Rheinische Friedrich- Wilhelms University at Bonn, and the Carnegie Mellon University in the US.
Pippa Wysong
Dutch centre knocks down barriers between doctors and patients - In one of the most innovative outpatient cataract surgery clinics in Europe, patients get to watch live surgery while they wait their turn, pre-op and post-op patients all mix in the same room.
The Ambulatory Surgical Centre at the Rotterdam Eye Hospital is a dramatic departure from the standard layout of day case cataract clinics, but according to Bart Zijlmans MD, consultant ophthalmologist and coordinator at the centre, it is an enormous success.
"It's very efficient and it works well. Everything is standardised and everybody knows what he or she is doing. The patients are interested in watching the surgeries in progress. The camera in the operating room didn't make any difference to me as a surgeon. The first time I did an operation with the camera I was vaguely aware of it. By the second operation I forgot completely that the patient's family was watching the surgery as it happened," he said.
"I like that we're doing a series of standard procedures, that it is the same type of surgery, so we don't lose time changing equipment or operating theatres, or waiting for other personnel to arrive. I'd invite any ophthalmologist or ophthalmic nurse to come visit us whenever they want to see for themselves how efficiently the system works," said Dr Zijlmans.
Mrs Leonie van Dijk-Kool, RN, CRNA, team leader at the Ambulatory Centre echoes his thoughts."When we heard that patients could watch surgeries live whilethey wait for their turn, we thought 'that's even worse, people will be getting sick everywhere and it will make them even more nervous.' But no, we were wrong. The patients are fascinated and they enjoy it," said Mrs Van Dijk-Kool, in a presentation to the Moorfields' Bicentenary Scientific Meeting in London.
Diet high in fruit associated with lower risk of neovascular AMD
Consumption of fruit — specifically bananas and oranges — may help ward off the development of neovascular age-related macular degeneration, data from a large cohort study suggest. Other dietary elements tracked in the study — intake of vegetables, antioxidant vitamins and carotenoids — were not strongly associated with either early or neovascular AMD, the study’s authors said.
Eunyoung Cho, ScD, and colleagues at Harvard Medical School and Brigham and Women’s Hospital in Boston prospectively studied 77,562 women enrolled in the Nurses Health Study and 40,866 men enrolled in the Health Professionals Follow-Up Study. All participants were at least 50 years of age at baseline and had no diagnosis of AMD or cancer for at least 18 years for the women and at least 12 for the men. Intake of fruit and vegetables was assessed up to 5 times for women and up to 3 times for men during the follow-up period.
The researchers identified 329 women and 135 men with incident cases of early AMD and 217 women and 99 men with neovascular AMD during the course of the study. Visual acuity in all these subjects was 20/30 or worse primarily because of AMD.
Fruit intake was inversely associated with the risk of neovascular AMD, the researchers found. Participants who consumed three or more servings of fruit a day had a pooled multivariate relative risk of 0.64 compared with those who consumed less than 1.5 servings of fruit daily. These findings were similar for both sexes. A nonsignificant inverse association between fruit intake and early AMD was found.
In examining whether specific fruits were related to the risk of neovascular AMD, “only higher intakes of oranges and bananas achieved statistical significance,” the authors said in the June issue of Archives of Ophthalmology. Banana intake was also inversely related to early AMD, the researchers found. The pooled multivariate relative risk for participants who consumed three or more servings per week of banana was 0.67 compared with those who consumed less than two servings per month, they reported.
In this study, the authors said, intakes of antioxidant vitamins or carotenoids either from food or from food and supplements were not strongly related to AMD risk. Vegetable intake was also not related to development of either early or neovascular AMD in men or women.
Follow-up studies are needed to confirm the researchers' findings.
June 2004
Statin Use Linked with Lower Risk of Age-Related Maculopathy
NEW YORK (Reuters Health) Aug 26 '03 - Statins may help prevent age-related maculopathy (ARM), according to the results of a preliminary report published in the August issue of the British Journal of Ophthalmology.
In a nested case-control study, Dr. Gerald McGwin, Jr., of the University of Alabama at Birmingham, and colleagues examined the association between statins and ARM. They compared 550 patients with newly diagnosed ARM with 5500 age-matched non-ARM controls.
The researchers found that subjects with ARM were 50% less likely to have filled a prescription for a statin than were controls. This association was not observed for other types of cholesterol-lowering drugs.
Subjects with ARM were also significantly more likely to have hypertension, vascular disease or diabetes. No differences in the frequency of lipid metabolism disorders or arterial disease were seen between the ARM subjects and controls.
Based on these findings, a "cause and effect" relationship between ARM and statin use cannot be concluded, the researchers point out.
"Further research is necessary to more fully understand the pathophysiology of ARM and the precise role, if any, of cholesterol," Dr. McGwin's team writes. Specifically, a randomized clinical trial is needed "to evaluate the effectiveness of statins in lowering the risk and/or rate of progression of ARM."
Br J Ophthalmol 2003;87:1121-1125.
No clinical benefit for LASEK over PRK, study finds
Laser epithelial keratomileusis and photorefractive keratectomy provide similar visual acuity results and cause similar levels of pain postoperatively, according to a study in military personnel. No clinical advantage to LASEK over PRK was noted in the study, although the epithelial healing patterns of the two procedures differed.
Amir Pirouzian, MD, and colleagues at the Travis Air Force Base in California prospectively enrolled 30 active-duty military personnel with mild to moderate myopia in a study comparing the two procedures. All patients underwent LASEK in one eye and PRK in the other. Which surgical procedure was first and which eye received which procedure were randomized. Primary outcome measures included subjective pain levels and the rate of corneal epithelial defect recovery. Follow-up was during the first week and up to 30 days postoperatively.
No significant differences were found in subjective pain levels between the two procedures on postop days 1, 2 or 3 or in visual acuity on postop days 3, 7 or 30. A statistically significantly smaller median epithelial defect was seen in the LASEK-treated eyes compared to the PRK-treated eyes on day 1 (P < .001). But by postop day 3, the PRK-treated eyes showed significantly smaller epithelial defects than the LASEK-treated eyes (P < .001). By postop day 7, no epithelial defects were seen in any eyes.
The study is published in the January issue of Archives of Ophthalmology
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Page last updated on Monday, 29 August 2005 17:20:25