| 1. |
- Pennells, Lisa, et al.
(författare)
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Equalization of four cardiovascular risk algorithms after systematic recalibration : individual-participant meta-analysis of 86 prospective studies
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 40:7, s. 621-
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Tidskriftsartikel (refereegranskat)abstract
- Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at ‘high’ 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29–39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22–24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44–51 such individuals using original algorithms, in contrast to 37–39 individuals with recalibrated algorithms.Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.
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| 2. |
- Weinstein, John N., et al.
(författare)
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The cancer genome atlas pan-cancer analysis project
- 2013
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 45:10, s. 1113-1120
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Forskningsöversikt (refereegranskat)abstract
- The Cancer Genome Atlas (TCGA) Research Network has profiled and analyzed large numbers of human tumors to discover molecular aberrations at the DNA, RNA, protein and epigenetic levels. The resulting rich data provide a major opportunity to develop an integrated picture of commonalities, differences and emergent themes across tumor lineages. The Pan-Cancer initiative compares the first 12 tumor types profiled by TCGA. Analysis of the molecular aberrations and their functional roles across tumor types will teach us how to extend therapies effective in one cancer type to others with a similar genomic profile. © 2013 Nature America, Inc. All rights reserved.
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| 3. |
- Lewis, Peter, 1971-, et al.
(författare)
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Dynamic Visual Acuity in the Peripheral Visual Field Using Gabor Patches
- 2010
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Konferensbidrag (refereegranskat)abstract
- Purpose:To evaluate dynamic visual acuity (DVA) in the peripheral visual field. This ability is important within the areas of sports, traffic safety, as well as for people with low vision; specifically those with central visual field loss. In this study we investigated both static- and dynamic visual acuity in the periphery of normally sighted observers using Gabor patches. Methods:DVA and static visual acuity (SVA) was measured on the right eye of normally sighted emmetropes. Stimuli consisted of high-contrast Gabor patches; sine wave gratings multiplied by a Gaussian hull with a diameter of 2º, with the sine gratings drifting at 1, 2, and 4 degrees per second. Stimuli were presented, using MATLAB and Psychophysics Toolbox, on one of seven CRT monitors at the following retinal eccentricities: 10, 20 and 30 degrees, nasally and temporally as well as in the fovea. Subjects were informed to maintain fixation on a central fixation object during measurements at eccentric locations. An Adaptive Bayesian algorithm was employed to determine resolution thresholds at each eccentricity. Results:The results show a trend towards both better static- and dynamic visual acuities for the temporal visual field at retinal eccentricities 20° and 30° compared to nasally. There appears to be a more rapid decrease in both static- and dynamic visual acuity with increasing eccentricity for the nasal visual field. In addition, we did not find any difference in DVA and SVA in the peripheral visual field for the velocities used in this study. Conclusions:Results of these first preliminary measurements suggest that dynamic visual acuity measured with drifting Gabor patches is greater in the temporal visual field for eccentricities 20 degrees or larger. To confirm these results more measurements need to be performed on a lager sample of subjects.
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| 4. |
- Lewis, Peter, 1971-
(författare)
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Improving Peripheral Vision Through Optical Correction and Stimulus Motion
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The loss of central vision subsequent to macular disease is often extremely debilitating. People with central field loss (CFL) must use other peripheral areas of the retina in order to see; areas with inferior resolution capacity, which are also affected by off-axis optical errors. The overall aim of the work encompassed by this thesis was to identify and evaluate methods of improving vision for people with CFL; with focus on the effects of off-axis optical correction and stimulus motion on resolution acuity and contrast sensitivity.Off-axis optical errors were measured using a commercially-available COAS-HD VR open-view aberrometer. We used adaptive psychophysical methods to evaluate grating resolution acuity and contrast sensitivity in the peripheral visual field; drifting gratings were employed to measure the effect of motion on these two measures of visual performance. The effect of sphero-cylindrical correction and stimulus motion on visual performance in healthy eyes and in subjects with CFL was also studied; in addition, the effect of adaptive optics aberration correction was examined in one subject with CFL.The COAS-HD aberrometer provided rapid and reliable measurements of off-axis refractive errors. Correction of these errors gave improvements in low-contrast resolution acuity in subjects with higher amounts of oblique astigmatism. Optical correction also improved high-contrast resolution acuity in most subjects with CFL, but not for healthy subjects. Adaptive optics correction improved both high and low contrast resolution acuity in the preferred retinal locus of a subject with CFL. The effect of stimulus motion depended on spatial frequency; motion of 7.5 Hz improved contrast sensitivity for stimuli of low spatial frequency in healthy and CFL subjects. Motion of 15 Hz had little effect on contrast sensitivity for low spatial frequency but resulted in reduced contrast sensitivity for higher spatial frequencies in healthy subjects. Finally, high-contrast resolution acuity was relatively insensitive to stimulus motion in the periphery.This thesis has served to broaden the knowledge regarding peripheral optical errors, stimulus motion and their effects on visual function, both in healthy subjects and in people with CFL. Overall it has shown that correction of off-axis refractive errors is important for optimizing peripheral vision in subjects with CFL; the use of an open-view aberrometer simplifies the determination of these errors. In addition, moderate stimulus motion can have a beneficial effect on contrast sensitivity for objects of predominantly low spatial frequency.
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| 5. |
- Lewis, Peter, 1971-, et al.
(författare)
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Naso-temporal Asymmetry of Peripheral Static and Dynamic Visual Acuity
- 2011
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Konferensbidrag (refereegranskat)abstract
- SummaryStatic and dynamic visual acuity was evaluated in the peripheral visual field on normally sighted emmetropes. The results show a significant asymmetry for both static and dynamic visual acuity between the nasal and temporal visual fields. IntroductionIt is well known that visual performance thresholds decrease rapidly with increasing retinal eccentricity1. This reduction in performance can be attributed to both optical factors and reduced neural sampling2-3; the latter being the predominant limiting factor in the peripheral retina3. Previous studies have shown that slowly moving stimuli are more easily resolved than stationary stimuli in the peripheral retina4. There is little evidence published regarding resolution thresholds for moving stimuli in more than a few limited directions in the visual field. In this study, static visual acuity (SVA) and dynamic visual acuity (DVA) thresholds were measured at 10° intervals both nasally and temporally on healthy, young emmetropes. DVA was measured at angular velocities of 1 °/s and 2 °/s using drifting Gabor patches. DiscussionStatic and dynamic visual acuity was measured on the right eye of emmetropic subjects. Results for SVA showed significantly better resolution in the temporal visual field compared with the nasal visual field at eccentricities 20° and beyond. The mean difference in acuity at 20° was approximately 0.2 LogMAR and at 30°, 0.3 LogMAR. The difference between the thresholds for DVA showed a similar naso-temporal asymmetry; the reduction in DVA paralleling the decrease in SVA for eccentricities 10° and beyond. No significant differences were observed between averaged results of SVA and DVA for the eccentricities tested in this study. ConclusionsThe results of this study confirm previous research conducted by Frisén (1987) showing better resolution for static stimuli presented in the temporal visual field compared to the nasal visual field. We have found that this is also true for DVA.
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| 6. |
- Lewis, Peter, 1971-, et al.
(författare)
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Resolution of static and dynamic stimuli in the peripheral visual field
- 2011
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Ingår i: Vision Research. - : Elsevier BV. - 0042-6989 .- 1878-5646. ; 51:16, s. 1829-1834
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Tidskriftsartikel (refereegranskat)abstract
- In a clinical setting, emphasis is given to foveal visual function, and tests generally only utilize static stimuli. In this study, we measured static (SVA) and dynamic visual acuity (DVA) in the central and peripheral visual field on healthy, young emmetropic subjects using stationary and drifting Gabor patches. There were no differences between SVA and DVA in the peripheral visual field; however, SVA was superior to DVA in the fovea for both velocities tested. In addition, there was a clear naso-temporal asymmetry for both SVA and DVA for isoeccentric locations in the visual field beyond 10 degrees eccentricity. The lack of difference in visual acuity between static and dynamic stimuli found in this study may reflect the use of drift-motion as opposed to displacement motion used in previous studies.
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| 7. |
- Lewis, Peter, 1971-, et al.
(författare)
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The Effect of Refractive-Correction on Peripheral Low-Contrast Resolution Acuity
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: High-contrast resolution acuity in the peripheral retina has been shown to be sampling-limited, however, a recent study indicates that peripheral low-contrast resolution acuity (PLCRA) is degraded by imposition of optical defocus. On the other hand, it has not been investigated whether refractive errors present in the peripheral field of normal, emmetropic eyes are sufficient to degrade PLCRA. The aim of this study was to evaluate the effect of peripheral refractive-correction on PLCRA in young emmetropes.Methods: Low-contrast (10 %) resolution acuity was measured off-axis (20° nasal visual field) on the right eyes of 10 emmetropic subjects (age 22 ± 2 years), both with and without peripheral refractive correction. Central and peripheral refractive errors were acquired using an open-field COAS-HD VR aberrometer. Stimuli, consisting of low-contrast Gabor patches with a visible diameter of 2°, were presented on a CRT monitor situated 3.0 meters from the subjects. Resolution thresholds were determined using a 2-alternative forced-choice Bayesian algorithm.Results: All the subjects had off-axis astigmatism (against-the-rule) at 20° in the nasal visual field ranging from -1.00 DC to -2.00 DC; of which four had -1.00 DC, three had -1.25 DC, one had -1.50 DC and the remaining two had -2.00 DC. Two of the subjects with -1.25 DC had -0.50 DS to -0.75 DS spherical errors; the rest had purely cylindrical errors. The mean uncorrected and corrected low-contrast resolution acuities for all subjects were 0.92 logMAR and 0.86 logMAR respectively. This shows an improvement in resolution acuity of 0.06 logMAR (p = 0.028) after correction of off-axis refractive errors. However when grouped according to the amount of astigmatism, the -1.00 DC group showed no difference in acuity with correction, the -1.25 DC, -1.50 DC and -2.00 DC groups improved on average by 0.05, 0.14 and 0.16 logMAR respectively.Conclusions: Correction of off-axis refractive errors had a positive effect on low-contrast resolution thresholds in the peripheral visual field on the emmetropic subjects in this study. Moreover, the effects become appreciable only for those subjects having larger degrees of astigmatism. This suggests that optical factors influence peripheral visual tasks involving low-contrast. There may be benefits in correcting even moderate amounts of off-axis refractive errors, especially for people who rely on optimal peripheral visual function.
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| 8. |
- Hernández-Moreno, Laura, et al.
(författare)
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Cost‐effectiveness of basic vision rehabilitation (The basic VRS‐effect study): study protocol for a randomised controlled trial
- 2020
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Ingår i: Ophthalmic & physiological optics. - : John Wiley & Sons. - 0275-5408 .- 1475-1313. ; 40:3, s. 350-364
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose To investigate the cost-effectiveness of a basic vision rehabilitation service (basic-VRS) in Portugal. We designed a parallel group, randomised controlled trial whose aim is to compare the effects and costs of ?usual low vision care? with a ?basic-VRS intervention? on self-reported visual ability and other psychosocial and health-related quality-of-life outcomes. Methods The trial will recruit participants that meet the following inclusion criteria: (1) visual acuity between 0.4?1.0 logMAR in the better-seeing eye, (2) cause of vision loss is diabetic retinopathy or age-related macular degeneration, (3) 18 years or older and iv) live in the community (not in nursing homes or other type of institution). Participants will be randomised to one of the study arms consisting of immediate intervention and delayed intervention. The delayed intervention group will receive ?usual care? or no intervention in the first 12 weeks. Visual acuity, contrast sensitivity and retinal structure will be assessed during the study. Results The primary outcome measure is visual ability, which will be evaluated with the Massof Activity Inventory, we expect that the intervention will raise the overall person measure or visual ability. Reading, health-related quality-of-life, anxiety and depression and social support will be also assessed. The analysis will be undertaken on an intention-to-treat basis. A cost-effectiveness analysis will be performed to provide information about the cost per unit of utility. To evaluate the cost-effectiveness of the intervention we will adopt the perspective of the healthcare system. Conclusion This study will provide additional evidence about the effects of basic-VRS on self-reported visual ability. Findings from this study should also contribute to better planning of low vision provision and, consequently, may contribute to reduce barriers to basic-VRS.
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| 9. |
- Lewis, Peter, 1971-, et al.
(författare)
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Contrast sensitivity in eyes with central scotoma : effect of stimulus drift
- 2018
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Ingår i: Optometry and Vision Science. - : Wolters Kluwer. - 1040-5488 .- 1538-9235. ; 95:4, s. 354-361
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Tidskriftsartikel (refereegranskat)abstract
- SignificanceIn the field of visual rehabilitation of patients with central visual field loss, knowledge on how peripheral visual function can be improved is essential. This study presents measurements of peripheral dynamic contrast sensitivity (with optical correction) for off-axis viewing angles in subjects with central visual field loss.PurposeSubjects with central visual field loss (CFL) rely on a peripheral preferred retinal locus (PRL) for many visual tasks. It is therefore important to ascertain that contrast sensitivity (CS) is maximized in the PRL. This study evaluates the effect of stimulus motion, in combination with optical correction, on CS in subjects with CFL.MethodsThe off-axis refractive errors in the PRL of five young CFL subjects were measured with a COAS open-view Hartmann-Shack aberrometer. Low-contrast (25% and 10%) and high-contrast resolution acuity for stationary gratings was assessed with and without optical correction. High-contrast resolution was also measured for gratings drifting at 7.5 Hz (within a fixed Gaussian window). Furthermore, resolution CS was evaluated for both stationary and moving gratings with optical correction for a total of 2-3 spatial frequencies per subject.ResultsHigh-contrast resolution acuity was relatively insensitive to stimulus drift motion of 7.5 Hz, whereas CS for gratings of 0.5 cycles per degree improved with drift for all subjects. Furthermore, both high- and low-contrast static resolution improved with optical correction.Conclusions Just as for heathy eyes, stimulus motion of 7.5 Hz enhances CS for gratings of low spatial frequency also in the PRL of eyes with CFL. Concurrently, high contrast resolution is unaffected by the 7.5 Hz drift, but improves with off-axis optical correction. This highlights the importance of providing optimal refractive correction for subjects with CFL, and that stimulus motion can be used to further enhance CS at low spatial frequencies.
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| 10. |
- Lewis, Peter, 1971-, et al.
(författare)
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Dynamic Stimulus Presentation Facilitates Peripheral Resolution Acuity
- 2013
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Ingår i: Investigative Ophthalmology and Visual Science. - 0146-0404 .- 1552-5783. ; 54
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Peripheral high-contrast resolution is sampling limited; the center to center spacing between ganglion cells ultimately limiting visual performance (Thibos et al., 1987). Although retinal image motion in the fovea has a detrimental effect on visual acuity, previous studies have suggested that retinal image motion may be advantageous in the peripheral visual field (Bex et al., 2003; Brown, 1972; Macedo et al., 2010). The aim of this study was to evaluate the effect of drift motion on peripheral resolution acuity.Methods: Peripheral high-contrast resolution acuity in a group of 26 subjects (age 23.5 ± 3.2 years) was initially determined using a 2-alternative forced-choice Bayesian algorithm; the threshold value defined as the spatial frequency resulting in a 75% correct response rate. The stimuli used to measure static visual acuity were stationary Gabor-patches with a visible diameter of 2° and were presented at 20° in the nasal visual field. We determined the percentage correct response rate for varying velocities using drifting Gabor patches of the same spatial frequency as determined during measurement of static visual acuity. The sine-wave gratings drifted within the Gaussian envelope at one of 10 angular velocities, varying from 0.2 to 2.0 degrees/second in 0.2 degrees/second steps.Results: Results showed an overall improvement in the subjects’ performance for all velocities. There was a significant difference in the percentage of correct responses between static stimulus presentation and for velocities of between 0.4 to 1.2 degrees/second (p < 0.05, One-way repeated measures ANOVA with Bonferroni post hoc tests). The average “correct response” for static stimulus presentation was 76 ± 2 %, improving to at least 85 % for velocities between 0.4 to 1.2 degrees/second. At velocities greater than 1.2 degrees/second performance was still better than for static stimulus presentation, but showed a gradual decline with increasing speed.Conclusions: In line with previous studies stimulus motion has a positive effect on peripheral high-contrast resolution acuity. Presenting moving stimuli may benefit patients who rely on peripheral visual function, such as those with central visual field loss subsequent to AMD.
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