tag:theconversation.com,2011:/fr/topics/eye-disease-1714/articleseye disease – The Conversation2022-08-31T16:56:31Ztag:theconversation.com,2011:article/1886212022-08-31T16:56:31Z2022-08-31T16:56:31ZWaste pickers in Lagos tell their stories about a dangerous existence<figure><img src="https://images.theconversation.com/files/481014/original/file-20220825-20-y7xgw3.jpg?ixlib=rb-1.1.0&rect=3%2C3%2C2592%2C1677&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Waste pickers at the Olusosan landfill work in a hazardous environment. </span> <span class="attribution"><span class="source">Lionel Healing/AFP</span></span></figcaption></figure><p>Lagos, Nigeria’s economic hub, with a population of more than <a href="https://worldpopulationreview.com/world-cities/lagos-population">15 million</a>, generates an estimated <a href="https://www.scientific.net/JERA.35.11">12,000</a> metric tonnes of waste daily, which comes to about 4.3 million tonnes of waste annually. This ends up on the streets and in the city’s four officially designated landfills.</p>
<p>These sites support thousands of people who search through what’s discarded for materials with resale value. Our <a href="https://www.tandfonline.com/doi/full/10.1080/00207233.2022.2055344">survey</a> of two landfill sites discovered a total of about 2,800 waste pickers – men and women. </p>
<p>Most landfills have buy-back centres, where the waste pickers sell recyclables such as metal, glass, plastic and paper. We observed that the subsistence incomes of waste pickers fluctuated daily, depending on the volume of recyclable waste delivered to the landfill, its quality, and varying prices. The daily average income of the street waste pickers was N2,075 (US$4.99) while that of the landfill waste pickers was N5,530 (US$13.30). Though this average income is higher than the <a href="https://databankfiles.worldbank.org/data/download/poverty/987B9C90-CB9F-4D93-AE8C-750588BF00QA/AM2021/Global_POVEQ_NGA.pdf">poverty line</a>, the work and the environment are hazardous, and its value is not fully appreciated.</p>
<p>Waste pickers often work without protective gear, unassisted, and without access to primary care or first aid and employment regulations. They operate on the margins of or outside the formal process of managing solid waste, but play vital roles, especially in reuse, recycling and cost recovery. </p>
<p>They work in unsheltered environments and are unprotected from severe heat, sun, rain, and cold weather. These conditions have been linked with <a href="https://doi.org/10.1155/2021/5530064">cardiovascular disorders</a>. Likewise, exposure to dust, micro-organisms and microbial toxins can result in chronic respiratory diseases, <a href="https://pubmed.ncbi.nlm.nih.gov/7569875/">skin problems and gastrointestinal illnesses</a>. </p>
<p>Research on waste pickers has tended to focus on the health risks of their occupation. Our <a href="https://www.tandfonline.com/doi/abs/10.1080/00207233.2022.2055344?casa_token=PHnkskfO9ZIAAAAA:Y7PdgyDp5035bdZXV_0zHELhvZbD98vN9WUZGMDThwEHKpZEm0TfZfnQReqgqRZLAh4wM4DDSPeE">study</a> confirmed that Lagos waste pickers were exposed to occupational health hazards, but also aimed to reveal more about their well-being and their own perspectives. </p>
<p>The findings may help waste management authorities to make landfills a more dignified working environment that sustains waste pickers’ livelihoods without jeopardising their well-being.</p>
<h2>Occupational hazards of waste picking</h2>
<p>For our research, we interviewed 125 waste pickers in Olusosun landfill and 27 in Solous landfill. Olusosun is situated in Ojota, Kosofe Local Government Area and Solous in Egbeda, Alimosho Local Government Area of Lagos state.</p>
<p>We established that waste picking in landfills was mostly done by younger people: 88% of our respondents were aged between 18 and 45. The collection of recyclable materials and items was mostly done by men, while the sorting was mostly by women.</p>
<p>They operated at the landfill because of the abundance and concentration of waste there. In fact, 66% lived at the dumpsite. The majority worked seven days a week. The average number of years they had spent doing this work was seven.</p>
<p>Most of the waste pickers we spoke to had experienced illnesses or injuries. Body pain, bruises and fatigue were the most frequently mentioned conditions.
Most waste pickers had bruises or scars on their hands, arms and feet, mainly from cuts or piercings during sorting. </p>
<p>Other illnesses and injuries were caused by inappropriate posture and prolonged work hours. Many had sore or itchy eyes caused by exposure to smoke from burning garbage and to other hazards like methane gas, sulphur dioxide and carbon monoxide.</p>
<p>The people in our study didn’t use personal protective equipment or go for regular medical checks. </p>
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<p>When we asked about their subjective feelings, we found that the waste pickers were very dissatisfied with their unhealthy working conditions, the extreme poverty they lived in, and the stigmatisation they experienced. Many used alcohol and drugs. Most said they were distressed by their work. </p>
<p>They experienced discrimination, prejudice and social rejection. </p>
<p>Yet with low education levels – 61% were illiterate – they could not find other work. They settled for waste picking as a last resort to earn a living.</p>
<h2>Value of waste pickers</h2>
<p>Nigerian authorities don’t fully appreciate the <a href="https://www.wiego.org/publications/feminizing-waste-waste-picking-empowerment-opportunity-women-children-impoverished-communities">beneficial role</a> of waste pickers. These workers contribute to environmental sustainability by reducing wastes in dumpsites and providing material for recycling and reuse. But they are never considered when waste management policies are designed.</p>
<p>Waste pickers should be recognised in waste management policies and their well-being should be taken seriously.</p>
<p>Waste management authorities, NGOs and multinational organisations must ensure that potable water, sanitary facilities and clinics are provided at landfills. Waste pickers must be allowed to use them free of charge, as is the case in Brazil.</p>
<p>In addition, waste pickers should be encouraged to develop workplace health frameworks to alleviate accidents and risks. </p>
<p>Training to build their capacity and expand their skills, giving them other work opportunities, could reduce their dissatisfaction. </p>
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<p>There is also a need for investment in regular occupational health and safety training through public/private partnerships. Waste pickers should be provided with personal protective equipment and monitored to ensure proper use. Non-compliance should be penalised.</p>
<p>Lastly, the rights of waste pickers must be protected. They should not be stigmatised but treated as essential to waste management.</p><img src="https://counter.theconversation.com/content/188621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olanrewaju Dada does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lagos waste pickers were dissatisfied with their unhealthy working conditions, poverty and stigmatisation.Olanrewaju Dada, Lecturer, Department of Urban and Regional Planning, Olabisi Onabanjo University, Ago-Iwoye, Nigeria, Olabisi Onabanjo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1242622019-10-16T21:57:59Z2019-10-16T21:57:59ZThe blind and visually impaired can help researchers by getting their genes tested<figure><img src="https://images.theconversation.com/files/297399/original/file-20191016-98666-1lztb57.jpg?ixlib=rb-1.1.0&rect=73%2C154%2C4691%2C2906&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gene therapy trials may mean that the next generation of children born with inherited eye diseases have treatment options.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Blind and partially sighted people no longer have to wait passively for a research breakthrough in hope of treatment options. In fact, people living with genetic eye conditions can now actively drive vision research forward — by enrolling in a patient registry and getting their genes tested.</p>
<p>There are <a href="https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment#targetText=Globally%2C%20it%20is%20estimated%20that,people%20are%20blind%20(1).">2.2 billion people living with visual impairment globally</a>. Some are living with inherited retinal diseases that are progressive and can lead to complete blindness. Up until recent years, blind and visually impaired people were told that no treatment is available. This is changing as <a href="https://doi.org/10.2174/1566523217666171116170040">genetic testing is paving the way for a surge of gene therapies</a>.</p>
<h2>My passion for vision research is personal</h2>
<p>My <a href="https://doi.org/10.1523/JNEUROSCI.1647-16.2016">doctoral dissertation</a> at the University of British Columbia was on drug therapy for <a href="https://doi.org/10.1016/S0140-6736(06)69740-7">retinitis pigmentosa</a>. This progressive, blinding eye condition is the most common type of inherited retinal disease. </p>
<p>In people affected by retinitis pigmentosa, the light sensing cells in their retina — photoreceptors — die early. Unlike skin cells that regenerate, the body does not make more photoreceptors once they are damaged.</p>
<p>As a vision scientist affected by retinitis pigmentosa, I am passionate about finding the truth about the disease. Why do photoreceptors die? How can we stop it? How can science and medicine help?</p>
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<img alt="" src="https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=371&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=371&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=371&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=466&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=466&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297405/original/file-20191016-98657-6y043a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=466&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Retinitis pigmentosa causes the light sensing cells, or photoreceptors, in a retina to die early.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>When I was 12 years old, I realized while at summer camp that my night vision was disappearing. In the last two decades, I lost my peripheral vision, contrast sensitivity and depth perception.</p>
<p>I worked in <a href="http://moritzlab.ophthalmology.ubc.ca/">Dr. Orson Moritz’s lab</a> at the UBC department of ophthalmology and visual sciences, which focuses on research using tadpoles that contain known human mutations for retinitis pigmentosa to understand the disease. </p>
<p><a href="https://www.iheart.com/podcast/269-eyes-on-success-rad-29372511/episode/1734-retinitis-pigmentosa-research-aug-16-29372697/">I made an alarming discovery in our animal model</a>: knowing the genetic cause of retinitis pigmentosa is <a href="https://www.jneurosci.org/content/37/4/1039">vital for treatment with one class of drugs — histone deacetylase inhibitors</a>. These determine how genes are switched “on” or “off.”</p>
<p>A similar <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225157/">study in mice</a> showed that the same drug reacted differently to variations in a single mutant gene that also causes retinitis pigmentosa.</p>
<p>Treating retinitis pigmentosa is like extinguishing fire. To stop a fire, you need to know whether it’s water-based or grease-based. If you try to use water to stop a grease fire, the damage gets worse.</p>
<h2>Enrol in a patient registry</h2>
<p>Blind and visually impaired people can advocate for eye health by enrolling in a patient registry. Participation in a registry <a href="https://doi.org/10.1371/journal.pone.0220983">benefits researchers by offering more information</a> about the disease.</p>
<p>In Canada, individuals can self-refer to <a href="https://www.fightingblindness.ca/">Fighting Blindness Canada’s</a> secure, clinical <a href="https://www.fightingblindness.ca/patient-registry/">patient registry</a>. This database is dedicated to connecting people living with retinal eye diseases to clinical trials and research.</p>
<p>When a gene therapy trial arises, researchers draw participants from this database. Since <a href="https://doi.org/10.2174/1566523217666171116170040">gene therapy aims to correct an underlying genetic mistake in DNA that causes disease</a>, knowing the genetic cause of a disease is a criteria for most gene therapy trials.</p>
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<p>Globally, other registries include <a href="https://www.fightingblindness.org/my-retina-tracker">My Retina Tracker</a> in the United States, <a href="https://www.fightingblindness.ie/how-we-can-help/research/target-5000s/">Target 5000</a> in Ireland, <a href="https://myeyesite.org.uk/">MyEyeSite</a> in the United Kingdom, the <a href="https://www.scgh.health.wa.gov.au/Research/DNA-Bank">Australian Inherited Retinal Disease Registry</a> and <a href="http://jegc.org/">Japan Eye Genetics Consortium</a>. In New Zealand, <a href="https://unidirectory.auckland.ac.nz/profile/a-vincent">Dr. Andrea Vincent</a> has established the Genetic Eye Disease Investigation Unit. There is even a <a href="https://www.bcmregistry.org/">Blue Cone Monochromacy Patient Registry</a> for one rare eye condition.</p>
<h2>Blossoming gene therapy trials</h2>
<p>In the last two decades, the number of gene therapy trials has blossomed. Currently, <a href="https://sph.uth.edu/retnet/">250 genes on inherited retinal diseases have been identified</a>. In <a href="http://ir.sparktx.com/news-releases/news-release-details/european-commission-approves-spark-therapeutics-luxturnar#targetText=LUXTURNA%20was%20approved%20by%20the,(%20FDA%20)%20in%20December%202017%20.">2017, the first gene therapy for inherited retinal disease</a> — Luxturna — was <a href="https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/luxturna">approved by the United States Federal Drug Administration</a>.</p>
<p>To date, there are trials for: <a href="https://www.clinicaltrials.gov/ct2/results?term=gene+therapy&cond=retinitis+pigmentosa&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=">retinitis pigmentosa</a>; <a href="https://clinicaltrials.gov/ct2/results?term=Gene+Therapy&cond=Usher&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=">Usher syndrome</a>, a condition that involves hearing and vision loss;
<a href="https://www.clinicaltrials.gov/ct2/results?term=gene+therapy&cond=Achromatopsia&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=">achromatopsia</a>, a disease that causes colour blindness; <a href="https://www.clinicaltrials.gov/ct2/results?term=Gene+Therapy&recrs=ab&cond=X-linked+Retinoschisis&rank=1#rowId0%22%22">X-linked retinoschisis</a>, a dystrophy that causes splitting of the retina and affects mostly in males; and <a href="https://www.clinicaltrials.gov/ct2/results?term=gene+therapy&cond=Age+Related+Macular+Degeneration&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=">age-related macular degeneration</a>, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2623053/">third-largest cause of vision loss worldwide</a>, caused by the interplay between <a href="https://doi.org/10.1146/annurev-genom-090413-025610">genetics and environment</a>.</p>
<p>Enrolment in a patient registry and genetic testing advance the design of gene therapy trials. This in turn benefits blind and visually impaired people. </p>
<p>Research advancement is a concerted effort across the globe — blind and partially sighted people should know they have the power to push it forward.</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/124262/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruanne Vent-Schmidt's doctoral research project was funded by Fighting Blindness Canada.
Ruanne Vent-Schmidt is the Specialist in Peer Support, Advocacy and Research Communications at the Canadian National Institute for the Blind.</span></em></p>Gene therapy trials for inherited retinal diseases are blossoming. Blind and partially sighted people are helping to advance the research.Ruanne Lai, PhD Candidate, Cell & Developmental Biology, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1043922018-12-25T19:31:29Z2018-12-25T19:31:29ZDiseases through the decades – here’s what to look out for in your 40s, 60s, 80s and beyond<figure><img src="https://images.theconversation.com/files/251174/original/file-20181218-27767-hj5zbd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You're another year older but that doesn't have to mean poorer health.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/r4GMAtjuYj0">Lorene Farrugia</a></span></figcaption></figure><p>Many diseases develop and become more likely as we age. Here are some of the most common conditions, and how you can reduce your risk of getting them as you clock over into a new decade. </p>
<h2>In your 40s</h2>
<p>Maintaining a healthy weight can reduce the risk of developing arthritis, coronary heart disease, and other common and related conditions, including back pain, type 2 diabetes, stroke, and many cancers. But <a href="https://www.aihw.gov.au/reports/overweight-obesity/interactive-insight-into-overweight-and-obesity/contents/how-many-people-are-overweight-or-obese">almost one-third of Australians</a> in their 40s are obese and <a href="https://www.aihw.gov.au/getmedia/eed9f208-1d28-439c-aeb8-93509641fc72/20908.pdf.aspx?inline=true">one in five</a> already have arthritis. </p>
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Read more:
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<p>From the age of 45 (or 35 for Aboriginal and Torres Strait Islanders), <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/heart-health-check">heart health checks</a> are recommended to assess risk factors and initiate a plan to improve the health of your heart. This may include <a href="https://www.eatforhealth.gov.au/guidelines">changing your diet</a>, reducing your alcohol intake, increasing your physical activity, and improving your well-being. </p>
<p><a href="https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/management-of-type-2-diabetes/screening,-risk-assessment/identifying-risk-of-diabetes">Checks to identify your risk of type 2 diabetes</a> are also recommended every three years from age 40 (or from age 18 for Aboriginal and Torres Strait Islanders).</p>
<p>If you don’t already have symptoms of arthritis or if they’re mild, this decade is your chance to reduce your risk of the disease progressing. Focus on the manageable factors, like shedding excess weight, but also on improving muscle strength. This may also help to prevent or delay <a href="https://www.iofbonehealth.org/what-sarcopenia">sarcopenia</a>, which is the decline of skeletal muscle tissue with ageing, and back pain. </p>
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<img alt="" src="https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251171/original/file-20181218-27758-n0ioq0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Achieving and maintaining a healthy weight will set you up for decades of better health.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/8SwpPqFeoR4">Sue Zeng</a></span>
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<p>Most people will begin to experience age-related vision decline in their 40s, with difficulty seeing up close and trouble adjusting to lighting and glare. A <a href="https://www.aao.org/eye-health/news/baseline-eye-exam-age-40">baseline eye check</a> is recommended at age 40. </p>
<h2>In your 50s</h2>
<p>In your 50s, major eye diseases become more common. Among Australians aged 55 and above, age-related macular degeneration, cataracts, diabetes-related eye diseases and glaucoma account for more than 80% of <a href="https://www.health.gov.au/internet/publications/publishing.nsf/Content/CA25774C001857CACA257560001B95AB/$File/4.1.1Vis.pdf">vision loss</a>. </p>
<p>A series of health screenings are recommended when people turn 50. These preventive measures can help with the early detection of serious conditions and optimising your treatment choices and prognosis. Comprehensive eye assessments are recommended every one to two years to ensure warning signs are detected and vision can be saved. </p>
<p>National cancer screening programs for Australians aged 50 to 74, are available every two years for <a href="https://www.mja.com.au/journal/2018/209/10/revised-australian-national-guidelines-colorectal-cancer-screening-family">bowel</a> and <a href="http://cancerscreening.gov.au/internet/screening/publishing.nsf/Content/breast-screening-1">breast</a> cancer. </p>
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Read more:
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<p>To screen for bowel cancer, older Australians are sent a test in the post they can do at home. If the test is positive, the person is then usually sent for a colonoscopy, a procedure in which a camera and light look for abnormalities of the bowel. </p>
<p>In 2016, 8% of people screened had a positive test result. Of those who underwent a colonoscopy, <a href="https://www.aihw.gov.au/reports/cancer-screening/national-bowel-cancer-screening-program-2018/contents/summary">1 in 26</a> were diagnosed with confirmed or suspected bowel cancer and one in nine were diagnosed with adenomas. These are potential precursors to bowel cancer which can be removed to reduce your future risk.</p>
<p>To check for breast cancer, women are encouraged to participate in the national mammogram screening program. <a href="https://www.aihw.gov.au/reports/cancer/breastscreen-australia-monitoring-report-2018/contents/summary">More than half (59%)</a> of all breast cancers detected through the program are small (less than or equal to 15mm) and are easier to treat (and have better survival rates) than more advanced cancers. </p>
<h2>In your 60s</h2>
<p>Coronary heart disease, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">chronic obstructive pulmonary disease</a> (a disease of the lungs that makes breathing difficult), and lung cancer carry the <a href="https://www.aihw.gov.au/getmedia/6852bd0e-a9d5-4159-ba19-c42f27a77646/aihw-aus-221-chapter-3-1.pdf.aspx">biggest disease burden</a> for people in their 60s. </p>
<p>If you’re a smoker, quitting is the best way to improve both your lung and heart health. Using evidence-based methods to quit with advice from a health professional or <a href="https://www.quit.org.au/">support service</a> will greatly improve your chances of success. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251173/original/file-20181218-27773-145jf1r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Quitting smoking is the best way to improve your health.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Zff-V01AnrE">Ian Schneider</a></span>
</figcaption>
</figure>
<p>The build-up of plaques in artery walls by fats, cholesterol and other substances (atherosclerosis) can happen from a younger age. But the hardening of these plaques and narrowing of arteries, which greatly increases the risk of heart disease and stroke, is most likely to occur from age 65 and above. </p>
<p>Exercise protects against atherosclerosis and research consistently shows <a href="https://theconversation.com/health-check-how-much-physical-activity-is-enough-in-older-age-103686">any physical activity is better than nothing</a> when it comes to heart health. If you’re not currently active, gradually build up to the recommended 30 minutes of moderate-intensity exercise on most, preferably all, days. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/too-much-salt-and-sugar-and-not-enough-exercise-why-australians-health-is-lagging-61165">Too much salt and sugar and not enough exercise – why Australians' health is lagging</a>
</strong>
</em>
</p>
<hr>
<p>Other potentially modifiable risk factors for stroke include high blood pressure, a high-fat diet, alcohol consumption, and smoking. </p>
<p>Your 60s is also a common decade for surgeries, including joint replacements and cataract surgery. Joint replacements are typically very successful, but are <a href="https://www.racgp.org.au/download/documents/AFP/2010/September/201009mckenzie.pdf">not an appropriate solution for everyone</a> and are not without risks. After a joint replacement, you’ll benefit from physiotherapy, exercise, and maintaining a healthy weight. </p>
<p>The <a href="https://theconversation.com/explainer-what-are-cataracts-63699">treatment for cataracts</a> is to surgically remove the cloudy lens. Cataract surgery is the most common elective surgery worldwide, with very low complication rates, and provides immediate restoration of lost vision. </p>
<h2>In your 70s</h2>
<p>Many of the conditions mentioned above are still common in this decade. It’s also a good time to consider your risk of falls. <a href="https://www.racgp.org.au/afp/2012/december/falls-prevention/#2">Four in ten people in their 70s will have a fall</a> and it can lead to a cascade of fractures, hospitalisations, disability and injury. </p>
<p><a href="https://www.osteoporosis.org.au/what-it">Osteoporosis</a> is one cause of falls. It occurs most commonly in post-menopausal women but almost one-quarter of people with osteoporosis are men. Osteoporosis is often known as a silent disease because there are usually no symptoms until a fracture occurs. Exercise and diet, including calcium and vitamin D, are important for bone health.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251170/original/file-20181218-27749-11ma7pu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exercise and diet can improve bone health.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Y5VBtBgswLQ">Geneva, Switzerland</a></span>
</figcaption>
</figure>
<p>Older people are also vulnerable to mental health conditions because of a combination of reduced cognitive function, limitations in physical health, social isolation, loneliness, reduced independence, frailty, reduced mobility, disability, and living conditions. </p>
<h2>In your 80s and beyond</h2>
<p>Dementia is the second most common chronic condition for Australians in their 80s, after coronary heart disease – and it’s the <a href="https://www.aihw.gov.au/getmedia/6852bd0e-a9d5-4159-ba19-c42f27a77646/aihw-aus-221-chapter-3-1.pdf.aspx">most common for people aged 95 and above</a>. </p>
<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196085">Many people think</a> dementia is a normal part of the ageing process, but <a href="https://www.alz.org/aaic/releases_2017/AAIC17-Thurs-briefing-Lancet-Global-health-policy.asp">around one-third of cases of dementia could be prevented</a> by reducing risk factors such as high blood pressure and obesity at mid-life. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-people-with-dementia-dont-all-behave-the-same-100960">Why people with dementia don't all behave the same</a>
</strong>
</em>
</p>
<hr>
<p>Early diagnosis is important to effectively plan and initiate appropriate treatment options which help people live well with dementia. But dementia remains <a href="https://bmjopen.bmj.com/content/bmjopen/7/2/e011146.full.pdf">underdiagnosed</a>. </p>
<p>Around 70% of Australians aged 85 and above have <a href="https://www.aihw.gov.au/getmedia/8f7bd3d6-9e69-40c1-b7a8-40dca09a13bf/4_2-chronic-disease.pdf.aspx">five or more chronic diseases</a> and take multiple medications to manage these conditions. Effective medication management is critical for people living with multiple conditions because medications for one condition may exacerbate the symptoms of a different coexisting condition.</p><img src="https://counter.theconversation.com/content/104392/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maria Carolina Inacio receives funding from NHMRC (APP1148106) and MRFF (APP1152268). </span></em></p><p class="fine-print"><em><span>Azmeraw Amare, Jyoti Khadka, Sarah Bray, Stephanie Harrison, and Tiffany Gill do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As you age, your body deteriorates and your risk of disease and injury increases. Here’s a decade by decade guide to what you’re up against – and what you can do about it.Stephanie Harrison, Research fellow, South Australian Health & Medical Research InstituteAzmeraw Amare, Postdoc researcher, South Australian Health & Medical Research InstituteJyoti Khadka, Research Fellow, South Australian Health & Medical Research InstituteMaria Carolina Inacio, Director, Registry of Older South Australians, South Australian Health & Medical Research InstituteSarah Bray, Registry of Older South Australians (ROSA) - Project Manager & Consumer Engagement Officer, South Australian Health & Medical Research InstituteTiffany Gill, Senior Research Fellow, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/924122018-02-28T15:08:55Z2018-02-28T15:08:55ZCuring blindness with stem cells – here’s the latest science<figure><img src="https://images.theconversation.com/files/207834/original/file-20180226-122025-lvjau9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/539698657?src=jD-5idkMTgvRJ_GNciXy6g-1-6&size=medium_jpg">Vic29</a></span></figcaption></figure><p>In 2006, Nature published a paper describing how stem cells could be used to <a href="https://www.nature.com/articles/nature05161">restore sight in blind mice</a>. This study, and similar subsequent studies, <a href="http://news.bbc.co.uk/1/hi/health/6120664.stm">created a lot of excitement</a> about the potential of stem cells to cure blindness in humans. Fast forward 12 years and we still don’t seem to be quite there – one notable human clinical trial in Japan was stopped in 2015 due to a <a href="https://ipscell.com/2015/07/firstipscstop/">risk of tumour development</a> in a patient’s eye. So are we any closer to using stem cell therapies to treat blindness, or will we always be “ten years away”?</p>
<h2>Eye spy</h2>
<p>The retina is an important tissue at the back of the eye that senses light and sends visual information to the brain. Eye diseases such as <a href="https://www.nhs.uk/conditions/glaucoma/">glaucoma</a> and <a href="https://www.nhs.uk/conditions/macular-degeneration/">macular degeneration</a> are characterised by damage to retina cells, which can eventually lead to vision loss and blindness. Scientists hope to find a way to replace or preserve damaged retina cells in order to treat these eye diseases.</p>
<p>Stem cells might be useful for this because they can be triggered to turn into any type of cell. In 2010 scientists successfully <a href="https://www.researchgate.net/publication/44577817_Immortalized_Human_Fetal_Retinal_Cells_Retain_Progenitor_Characteristics_and_Represent_a_Potential_Source_for_the_Treatment_of_Retinal_Degenerative_Disease">guided stem cells into becoming retina cells</a> in a laboratory. It is hoped that these cells could later be delivered into the diseased eye to replace or preserve damaged retina cells.</p>
<p>Although scientists have previously had success isolating and maintaining retina stem cells in the laboratory, there is still more work to do before these cells can be routinely delivered to patients for treatment. The first big challenge is figuring out how treatments can safely be delivered into the patient’s eye in the right location. The eye is such a small and fragile organ that injection needles and surgery may cause even greater damage to the eye.</p>
<p>Once a delivery method has been established, the next challenge is deciding how to get the stem cells to communicate with existing retina cells and function properly inside the eye. Getting this to happen is not easy and <a href="https://theconversation.com/stem-cells-show-promise-but-they-also-have-a-darker-side-75029">there are risks</a> that the stem cells may not function correctly and could cause problems, such as inflammation and tumour development, inside the eye.</p>
<p>In addition to these hurdles, scientists also need to overcome the challenge of immune rejection. In the same way that the body might reject a new heart after transplant surgery, stem cells might also get rejected by the body. Stem cell therapies developed from a patient’s own cells have a reduced chance of immune rejection, though they may be more expensive and time consuming to develop. For stem cell therapies developed from donor cells, drugs such as immunosuppressants are likely to be needed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=352&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=352&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=352&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=442&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=442&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207835/original/file-20180226-120971-l0ye4g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=442&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/327062306?src=17BRzdC7__UnetbtmQhgNA-1-1&size=medium_jpg">Tefi/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Building miniature scaffolds</h2>
<p>In order to overcome these challenges, one approach scientists are investigating is the use of biomaterials. Biomaterials are typically materials that have been modified to interact with biological systems. It is hoped that these materials could be used to improve the delivery of stem cell therapy, as well as the integration with existing cells once inside the eye.</p>
<p>An example of this is the use of biomaterial scaffolds. As the name suggests, these are scaffolding-like structures that cells can hold onto in order to improve their chances of growth and survival. Scientists have already successfully developed biomaterial scaffolds that closely resemble the environment of retina tissue. </p>
<p>Attaching the stem cells to these scaffolds before delivery into the eye may improve their chances of communicating with existing cells and functioning correctly once inside. This technique has been successful in <a href="http://online.liebertpub.com/doi/10.1089/ten.tea.2013.0720">studies with mice</a> and some <a href="https://clinicaltrials.gov/ct2/show/NCT02903576?term=stem+cells+scaffold&cond=Macular+Degeneration&rank=1">human clinical trials</a> are already in progress.</p>
<p>Therefore despite the challenges, scientists continue to look for ways to treat debilitating eye diseases. The eye is an incredibly complex and fragile organ, which is why research in this area may take a bit longer than for other parts of the body.</p>
<p>There are still hurdles that need to be overcome, such as the delivery technique of stem cells, their integration with existing cells once inside the eye and the chance of immune rejection. However, ongoing research into the use of biomaterials to improve stem cell integration has had promising results and may overcome some of these initial challenges.</p>
<p>So with continued support of this field of research we can be hopeful that, if the latest clinical trials run successfully, a cure for blindness using stem cells could finally be possible within the next ten years.</p><img src="https://counter.theconversation.com/content/92412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Gater receives PhD studentship funding from Keele University ACORN fund and Faculty of Medicine & Health Sciences.</span></em></p>Stem cell treatments for eye disease always seem to be just on the horizon, but real progress is being made.Rachel Gater, PhD Candidate, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/797582017-08-16T20:12:39Z2017-08-16T20:12:39ZArtificial vision: what people with bionic eyes see<figure><img src="https://images.theconversation.com/files/180439/original/file-20170801-22164-p32p57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Phosphenes are an experience of seeing light without light entering your eye. Bionic eye recipients use these to map out a visual scene. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/peretzpup/3370468814/in/photolist-7TWxyF-RP8uTf-QAMGzc-47E7AL-icZTc9-uPSsJ-93ehaZ-auvtp-7TmEYh-9tdX4y-5K95g6-SiFhHo-4d6w14-QSXt-5MYScE-49F9zo-5C8Tt-9FZCQh-5ZfgX5-7rd3V7-6fwbdv-c4wRgf-RSgzUb-8YKttZ-49F9Yy-61AzpR-LMMHy-dzWfTc-niko6g-qjStVg-SeZcpT-dqSNLT-eyp8bF-WHC2DU-6oQ6E9-Wuydu1-5Gmmru-oTXhug-dZ8JGD-RBE6Eu-94B33h-68QwXh-TwGZAC-4bxUZq-UZx2t2-9v4YMv-86KfQn-8JV4HL-9awR1V-89fbTn">Eugene Peretz/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Visual prostheses, or “bionic eyes”, promise to provide artificial vision to visually impaired people who could previously see. The devices consist of micro-electrodes surgically placed in or near one eye, along the optic nerve (which transmits impulses from the eye to the brain), or in the brain.</p>
<p>The micro-electrodes stimulate the parts of the visual system still functional in someone who has lost their sight. They do so by using tiny electrical pulses similar to those used in a bionic ear or cochlear implant. </p>
<p>Electrical stimulation of the surviving neurons leads the person to perceive small spots of light called phosphenes. A phosphene is a phenomenon of experiencing seeing light without light actually entering the eye - like the colours you may see when you close your eyes.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=570&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=570&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180161/original/file-20170728-32241-1d3j0yj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=570&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The optic nerve transmits impulses to the brain from the retina at the back of the eye.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>These phosphenes in someone with a bionic eye can be used to map out the visual scene. So the vision provided by a bionic eye is not like natural sight. It is a series of flashing spots and shapes the person uses to interpret their environment through training - somewhat like a flashing mosaic.</p>
<p>Currently, the vision provided by a bionic eye is very basic and can be used for tasks such as identifying the location of an object, detecting a person, or <a href="http://www.abc.net.au/news/2014-04-30/bionic-eye-patients-start-first-navigation-tests/5422174">finding a doorway</a>. Researchers hope future bionic eye devices will provide higher resolution vision, but this has inherent challenges. </p>
<h2>How the bionic eye works</h2>
<p>A bionic eye converts images from a video camera (left picture below) to a high-contrast representation (middle picture), of which a portion is selected for further processing. This is the blue-shaded box below, corresponding to the reduced field-of-view of a typical bionic eye. </p>
<p>An external video processor then converts this high-contrast image to electrical stimulation parameters, which are sent to electrodes implanted in the eye. The bionic eye recipient perceives a blurred image (right of the picture) comprised of flashes of light.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=136&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=136&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=136&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=171&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=171&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179393/original/file-20170724-19505-1nx22pe.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=171&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Left - video camera; middle - high contrast representation; right - further processing.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>What recipients actually see</h2>
<p>We know from the experience of our Melbourne patients that activity on the electrodes is <a href="http://iovs.arvojournals.org/article.aspx?articleid=2556019">seen as a series of bright flashes</a> rather than as a steady perception. The world is thus flashing bursts of light arranged to represent the basic shape – like the height and width – and approximate location of an object in front of the camera. Other recipients have <a href="http://www.twincities.com/localnews/ci_28363473/bionic-eye-helps-duluth-man-make-out-his">said this was like</a>:</p>
<blockquote>
<p>looking at the night sky where you have millions of twinkly lights that almost look like chaos.</p>
</blockquote>
<p>Recipients need to use these irregular flashes to interpret the camera image. The field of view (the extent of the observable world) is small – about 30 degrees wide or one hand span at arm’s length – so recipients need to have a good memory to put the whole image together. </p>
<p>Improvements to the external camera and <a href="http://www.afr.com/technology/bionic-vision-a-step-closer-with-the-csiros-new-computing-system-20170717-gxcjgy">video processing</a> are able to assist here. For example, distance-sensing cameras can <a href="http://iopscience.iop.org/article/10.1088/1741-2560/12/1/016003/meta">highlight obstacles</a> such as a rubbish bin on the sidewalk, and thermal cameras can <a href="http://iovs.arvojournals.org/article.aspx?articleid=2563307">highlight human shapes</a>. Right now, the best outcomes rely heavily on patient engagement and rehabilitation.</p>
<h2>Who gets a bionic eye?</h2>
<p>The type of bionic eye that may be an option for patients is dependent on the cause of their vision loss. Retinal bionic eye implants are placed into the eyeball itself, and are only suitable for people who have lost their vision from specific diseases such as inherited types of retinal degeneration known as retinitis pigmentosa and age-related macular degeneration. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-age-related-macular-degeneration-59889">Explainer: what is age-related macular degeneration?</a>
</strong>
</em>
</p>
<hr>
<p>To date, only people with degenerative retinal diseases have been eligible to receive a bionic eye. Three retinal bionic eyes have been approved for commercial sale: the <a href="http://www.secondsight.com/g-the-argus-ii-prosthesis-system-pf-en.html">Argus II</a> developed in the USA, the <a href="https://www.retina-implant.de/en/implant/ri-alpha-ams/">Alpha-AMS</a> in Germany, and the <a href="http://www.pixium-vision.com/en/technology-1/iris-vision-restoration-system">IRIS V2</a> in France. </p>
<p>We ran clinical trial with three people, between 2012 and 2014, using <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115239">a new device developed in Melbourne</a>, Australia. This device may have a safer surgical profile than existing bionic eyes as it is implanted at the back of the eye rather than inside the eye. </p>
<p>Prior to surgery, the Melbourne patients would not have been able to see a hand waving in front of their face. With the bionic eye implant, they were able to locate objects on a table, and <a href="http://www.abc.net.au/news/2014-04-30/bionic-eye-patients-start-first-navigation-tests/5422174">navigate around objects in their path while walking</a>, demonstrating that the implant could provide useful visual information in the real world. We are preparing for a trial of a <a href="http://bionicvis.com/our-products/">second-generation implant in the next year</a>. These are all retinal implants and have mainly been used for people with retinitis pigmentosa. </p>
<p>Implants placed on either the optic nerve or <a href="http://www.monash.edu/bioniceye">directly into the brain</a> may be able to provide benefit to people with a broader range of conditions, such as trauma or glaucoma. Devices for these particular conditions are <a href="http://investors.secondsight.com/releasedetail.cfm?ReleaseID=995211">still in the research phase</a> but are expected to enter human clinical trials in the near future. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-glaucoma-the-sneak-thief-of-sight-64807">Explainer: what is glaucoma, the 'sneak thief' of sight?</a>
</strong>
</em>
</p>
<hr>
<p>The quality of vision with a retinal implant heavily depends on the residual eye health of the patient and the ability to interpret the created phosphenes. The implanted electrodes aim to replicate the function of missing light sensitive cells (photoreceptors). But there must be viable surviving neurons for the electrodes to interact with. </p>
<p>Another complicating factor is that there are many neuron types in the retina but the electrodes are too large to selectively target individual types. For this reason, bionic eyes cannot replicate the sense of colour. In fact, artificial vision is very different from normal vision and takes a lot of getting used to. </p>
<h2>Can image quality be improved?</h2>
<p>At present, there are several approaches to improve image quality. One is to increase the number of implanted micro-electrodes and make them smaller, allowing them to target selective neurons for more independent “pixels” and greater resolution. There are <a href="http://www.sciencedirect.com/science/article/pii/S0142961212005029">newer nanotechnology materials</a> that might allow the electrodes to be small enough to produce high-acuity resolution.</p>
<p>Another technique is to refine the electrical stimulation patterns to better <a href="http://iovs.arvojournals.org/article.aspx?articleid=2529378">focus the stimulation</a> to activate smaller-sized clusters of neurons. We can also artificially increase the resolution by creating “<a href="http://iovs.arvojournals.org/article.aspx?articleid=2212666">virtual electrodes</a>” where electrical current is shared between two or more electrodes. These new stimulation methods could improve stability, reduce blurriness and possibly even provide rudimentary control over colour. </p>
<p>Ultimately, researchers are seeking to understand and <a href="http://www.cell.com/neuron/abstract/S0896-6273(14)00359-6">mimic the neural code</a> the retina uses to communicate with the brain. If the firing patterns of photoreceptors could be replicated, the correct message would be transmitted to the brain. The resulting vision would become significantly more natural.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-people-cant-see-but-still-think-they-can-heres-how-the-brain-controls-our-vision-63323">Some people can't see, but still think they can: here's how the brain controls our vision</a>
</strong>
</em>
</p>
<hr>
<p>Combining these techniques, the level of vision attainable might allow patients to independently navigate around without the use of a guide dog or cane. It could be possible to recognise everyday objects or even emotions on faces of loved ones. As to which approach is ultimately feasible, only time will tell. One thing that is certain is bionic eyes will get better over time.</p><img src="https://counter.theconversation.com/content/79758/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Petoe receives funding from the National Health and Medical Research Council of Australia (NHMRC), the Australian Research Council (ARC), and the Clive and Vera Ramaciotti Foundations.</span></em></p><p class="fine-print"><em><span>Lauren Ayton currently receives funding from the National Health and Medical Research Council of Australia (NHMRC) and the Macular Disease Foundation of Australia. She is also a previous veski Victoria Fellow and Melbourne-Boston Sister Cities Association Hugh Rogers Fellow.</span></em></p><p class="fine-print"><em><span>Mohit Shivdasani receives funding from the National Health and Medical Research Council of Australia (NHMRC) and the Australian Research Council (ARC). </span></em></p>The artificial vision provided by a bionic eye is not like natural sight, and takes a lot of getting used to.Matthew Petoe, Team Leader, Bionic Eye Psychophysics, Bionics InstituteLauren Ayton, Senior research fellow, Department of Surgery (Ophthalmology) University of Melbourne, Centre for Eye Research AustraliaMohit Shivdasani, Senior research fellow, Bionics InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/770902017-05-04T01:46:00Z2017-05-04T01:46:00ZNew drugs on the PBS: what they do and why we need them<figure><img src="https://images.theconversation.com/files/167678/original/file-20170503-21637-4oi5od.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some of the notable additions to the PBS include drugs to treat eye and HIV infections, cystic fibrosis, multiple sclerosis, and cancer.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>This week, the government <a href="http://www.pbs.gov.au/browse/changes">announced the latest additions, amendments, and deletions</a> from the Pharmaceutical Benefits Scheme (PBS): the program through which essential medicines are subsidised for Australian patients. The new medicines on the scheme are reportedly worth <a href="http://www.greghunt.com.au/Media/MediaReleases/tabid/86/ID/4230/Making-310-million-of-new-vital-drugs-available-for-Australian-patients.aspx">A$310 million</a>.</p>
<p>Listing on the PBS is different to a drug being approved for sale by Australia’s drug regulator, the <a href="http://www.tga.gov.au">Therapeutic Goods Administration (TGA)</a>. Once approved by the TGA, it is available to patients and hospitals at the full price. It only becomes subsidised if later listed on the PBS. </p>
<p>Some of the notable additions to the list include drugs to treat eye infections, human immunodeficiency virus (HIV), cystic fibrosis, multiple sclerosis, cancer, and <a href="http://lungfoundation.com.au/wp-content/uploads/2012/06/Idiopathic-Pulmonary-Fibrosis.pdf">idiopathic pulmonary fibrosis</a> – a type of scarring in the lungs. Below is a list of seven most notable new additions to the scheme.</p>
<h2>1. Chloramphenicol eye drops (Chlorsig)</h2>
<ul>
<li><p><strong>Maximum cost to Aboriginal and Torres Strait Islanders: A$0-6.10</strong></p></li>
<li><p><strong>Maximum cost to other patients: A$20.11</strong></p></li>
</ul>
<p>Chloramphenicol is the generic name of an antibiotic drug used to treat eye infections. It has been <a href="http://www.pbs.gov.au/medicine/item/11112W">added to the PBS</a> with the restriction that it is only available to patients who identify as Aboriginal or Torres Strait Islander (ATSI). </p>
<p>The rate of eye infections, like <a href="https://theconversation.com/why-is-trachoma-blinding-aboriginal-children-when-mainstream-australia-eliminated-it-100-years-ago-63526">trachoma</a> (which leads to blindness), is three times higher for ATSI patients than for other Australians. The lower price for ATSI patients is because of extra funding under the government’s <a href="http://www.pbs.gov.au/info/publication/factsheets/closing-the-gap-pbs-co-payment-measure">Closing the Gap PBS co-payment</a> program.</p>
<h2>2. Ivacaftor (Kalydeco)</h2>
<ul>
<li><p><strong>Maximum price from the manufacturer: A$22,547.02</strong></p></li>
<li><p><strong>Maximum cost to the patient: A$38.80</strong></p></li>
</ul>
<p>Ivacaftor – <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=E059E457A00C1B93CA2580D0003CA6C0&agid=(PrintDetailsPublic)&actionid=1">first approved by the TGA in September 2016</a> – is used to treat <a href="http://www.cysticfibrosis.org.au/all/learn/">cystic fibrosis</a>, a genetic disorder that affects the digestive system and lungs of patients. It causes a buildup of thick and sticky mucus in the airways. </p>
<p>There is no cure for cystis fibrosis, but <a href="http://www.kalydeco.com/">ivacaftor</a> acts by better regulating the flow of salts and water in and out of cells, which leads to less mucus buildup. </p>
<p>While <a href="https://www.cysticfibrosis.org.au/media/wysiwyg/CF-Australia/medical-documents/CFA_DataRegistryReport_2014_Final.pdf">around 3,300 people in Australia live with cystic fibrosis</a>, only around 10% of patients will benefit from the drug. This is because patients need to have a specific mutation in their DNA called <em>R117H</em> for the drug to be effective. </p>
<hr>
<p><em><strong>More information - <a href="https://theconversation.com/weekly-dose-kalydeco-the-drug-that-treats-the-cause-of-cystic-fibrosis-not-just-symptoms-76934">Weekly Dose: Kalydeco, the drug that treats the cause of cystic fibrosis, not just symptoms</a></strong></em></p>
<hr>
<h2>3. Blinatumomab (Blincyto)</h2>
<ul>
<li><p><strong>Maximum price from the manufacturer: A$61,975.54</strong></p></li>
<li><p><strong>Maximum cost to the patient: A$38.80</strong></p></li>
</ul>
<p><a href="http://www.pbs.gov.au/medicine/item/11115B-11116C-11117D-11118E-11119F-11120G">Blinatumomab</a> is a new type of immunotherapy – a treatment that <a href="https://theconversation.com/au/search?utf8=%E2%9C%93&q=immunotherapy+">empowers the body’s immune system</a> to fight diseases such as cancer.</p>
<p>The drug is approved for use to treat a specific subset of <a href="http://www.leukaemia.org.au/blood-cancers/leukaemias/acute-lymphoblastic-leukaemia-all">acute lymphoblastic leukaemias</a> (ALL). Around 350 Australians each year are diagnosed with some form of ALL, and it is the most common type of cancer in children.</p>
<p>Blinatumomab was first approved by the TGA in November 2015 but an application to list the medicine on the PBS that same year <a href="http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/psd/2015-11/files/blinatumomab-psd-november-2015.pdf">was rejected</a>. It <a href="https://www.greghunt.com.au/Home/LatestNews/tabid/133/ID/4230/Making-310-million-of-new-vital-drugs-available-for-Australian-patients.aspx">has been reported</a> that the cost for patients before the PBS subsidy was A$127,700 per course of treatment. </p>
<h2>4. Fosaprepitant (Emend IV)</h2>
<ul>
<li><p><strong>Maximum price from the manufacturer: A$115.03</strong></p></li>
<li><p><strong>Maximum cost to the patient: A$38.80</strong></p></li>
</ul>
<p>This drug is used to help patients overcome the nausea and vomiting side-effects
associated with chemotherapy treatment. <a href="http://www.pbs.gov.au/medicine/item/11103J-11107N">Fosaprepitant</a> has been available for doctors to prescribe since 2011, when it was <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/pbac-outcomes/2011-03/positive-recommendations">first recommended</a> to be put on the PBS.</p>
<h2>5. Emtricitabine</h2>
<ul>
<li><p><strong>Maximum price from the manufacturer: A$1,500 - $2,600 depending on the formulation</strong></p></li>
<li><p><strong>Maximum cost to the patient: A$38.80</strong></p></li>
</ul>
<p>Four <a href="http://www.pbs.gov.au/pbs/search?term=EMTRICITABINE&analyse=false&search-type=medicines">formulations of this drug</a> have been added to the PBS as part of a cocktail of medicines used to treat HIV infection. </p>
<p>Emtricitabine acts by stopping the HIV virus from copying itself into human cells. It was first <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=5C59BB9C228068B0CA257FE8004216C7&agid=(PrintDetailsPublic)&actionid=1">approved by the TGA in 2005</a> and other formulations of the drug – such as it being <a href="http://www.pbs.gov.au/medicine/item/10347N">coupled with antiviral Tenofovir</a> under the brand name Truvada – have been listed on the PBS previously. In Australia, there are around <a href="http://www.hivmediaguide.org.au/hiv-in-australia/hiv-statistics-australia/">25,000 people living with HIV</a>.</p>
<hr>
<p><em><strong>More information: <a href="https://theconversation.com/weekly-dose-truvada-the-drug-that-can-prevent-hiv-infection-61525">Weekly Dose: Truvada, the drug that can prevent HIV infection</a></strong></em></p>
<hr>
<h2>6. Daclizumab (Zinbryta)</h2>
<ul>
<li><p><strong>Maximum price from the manufacturer: A$2,231</strong></p></li>
<li><p><strong>Maximum cost to the patient: A$38.80</strong></p></li>
</ul>
<p><a href="http://www.pbs.gov.au/medicine/item/11101G">Daclizumab</a> is used to treat <a href="https://www.msaustralia.org.au/what-ms">multiple sclerosis (MS)</a>, a condition that affects the nervous system and interferes with nerve impulses in the brain, spinal chord, and optic nerves (those responsible for vision). It was first <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=CC481F65EA7BE336CA258060003CA91D&agid=(PrintDetailsPublic)&actionid=1">approved by the TGA in September 2016</a>. </p>
<p>While there is no cure for MS, this drug helps to stop infection-fighting blood cells called <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=11300">T-cells</a> from getting into the brain. This protects the brain from swelling. There are currently around 24,000 Australians who live with MS.</p>
<h2>7. Nintedanib (Ofev)</h2>
<ul>
<li><p><strong>Maximum price from the manufacturer: A$3,385.48</strong></p></li>
<li><p><strong>Maximum cost to the patient: A$38.80</strong></p></li>
</ul>
<p><a href="http://www.pbs.gov.au/medicine/item/11100F-11106M">Nintedanib</a> was <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=0AEB4B2429304039CA2580B2003CA221&agid=(PrintDetailsPublic)&actionid=1">approved by the TGA in September 2015</a>. It is used to treat <a href="http://lungfoundation.com.au/wp-content/uploads/2012/06/Idiopathic-Pulmonary-Fibrosis.pdf">idiopathic pulmonary fibrosis</a>, a condition that causes scarring in the lungs. The amount of scar disease builds up over time. While nintedanib does not cure patients, it provides relief by stopping the enzymes that help create the scarring, thus slowing the disease.</p>
<p>The condition is most prevalent in people over 60 years of age, and <a href="http://lungfoundation.com.au/wp-content/uploads/2012/06/Idiopathic-Pulmonary-Fibrosis.pdf">affects around 2,600 Australians</a>.</p><img src="https://counter.theconversation.com/content/77090/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is affiliated with the Royal Australian Chemical Institute.</span></em></p>An independent expert provides his pick of the most notable drugs added to the PBS on May 1, 2017.Nial Wheate, Senior Lecturer in Pharmaceutics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/618792016-07-07T04:25:07Z2016-07-07T04:25:07ZWhy hacking the nervous system could be the next big medical treatment<figure><img src="https://images.theconversation.com/files/129196/original/image-20160704-19121-mqmssi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The nervous system that commands and controls your body is beautifully constructed, but occasionally things go wrong. Defects in our DNA can cause lead to a range of disorders. Accidents, old age and even poor diet can equally cause havoc. Pharmaceutical therapy can sometimes help but not all conditions can be treated. And, in any case, such therapy is generally less effective with neurological disorders than other diseases.</p>
<p>An alternative treatment that’s been practised for millennia involves electrically stimulating the nervous system. Some early <a href="http://www.jstor.org/stable/41233844">Roman doctors</a> used electric eels to provide shock treatment for pain relief. Almost 2000 years later we use a similar technique with electrical devices called TENS (trans-cutaneous electrical nerve stimulation).</p>
<p>More advanced treatments involve “neuroprosthetic” devices that link directly with the nervous system to replace lost functions. These include pacemakers and sensory prosthetics to replace visual and audio senses for the blind and deaf. Upcoming technology may even hack directly into our autonomous nervous system to treat a range of chronic conditions such as diabetes.</p>
<p>We already have pacemakers that don’t just provide electrical stimulation but <a href="http://us.gsk.com/en-us/media/press-kits/bioelectronics/">also wire-tap</a> our autonomous nerve system to listen in to our subconscious emotions. Closed loop stimulation (CLS) <a href="https://www.dicardiology.com/product/biotronik-brings-closed-loop-simulation-sensor-cardiac-resynchronization-defibrillators">pacemakers and defibrillators</a> use this technique to make the heart beat faster when the patient is experiencing feelings such as fear and excitement, allowing them to enjoy scary movies and better appreciate the critical moments of a date.</p>
<h2>Seeing the light</h2>
<p>Visual prostheses for the blind are potentially even more life-changing. After many decades of development, <a href="http://www.retina-implant.de/en/about/default.aspx">devices are now available</a> that wirelessly connect a chip in the eye to an external video camera and processing system. For people who suffer from retinitis pigmentosa, which causes the light-sensitive retina cells in the eye to gradually die, these devices transfer visual information to the remaining retina cells using electrical stimulation. However, so far, they can only reproduce a crude image that looks like a <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9348136&fileId=S0952523814000212">handful of flashing dots</a>.</p>
<p>The latest revolution in neuroprosthetics has the potential to go far further. And unlike many of the advances in this field that have come from developments in electronics, this new development comes from biological research. In 2003, German scientists researching algae <a href="http://www.pnas.org/content/100/24/13940.full">discovered a protein</a> that could make nerve cells sensitive to light. It led to a new technique known as “optogenetics” that involves using gene therapy to make cells light sensitive. This new technique is significantly more powerful and accurate than previous techniques and makes high-resolution communication with the nervous system possible.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129201/original/image-20160704-19127-1v44f40.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Brain training.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In the case of retinitis pigmentosa, instead of replacing retina cells with a chip, optogenetics allows us to restore the remaining cells’ ability to detect light. Special electronic goggles can then be used to relay optical information in a form that these newly sensitised cells can understand.</p>
<p>The first human patients have now been treated with this <a href="http://www.blindness.org/RetroSense">gene therapy technique</a> in the US. If the method works as expected, the results will transform the patients’ lives. Some groups have claimed that near-normal visual <a href="http://physiology.med.cornell.edu/faculty/nirenberg/lab/papers/PNAS-2012-Nirenberg-1207035109.pdf">return is possible</a>. Others, <a href="http://www.ncl.ac.uk/eee/staff/profile/patrickdegenaar.html#179726">including my own</a>, are a little more cautious but believe it could allow patients to walk without a stick and, in the medium term, perhaps even recognise faces again. We also hope to be able to adapt the technique to a larger group of patients including those blinded by glaucoma and trauma.</p>
<p>Similar progress is hoped for in hearing implants, which can currently allow patients to join in small group conversations but make music sound like death metal performed underwater. Teams in the <a href="http://www.sciencedirect.com/science/article/pii/S0378595515000088">US and Germany</a> are hoping to use optogenetics as a more accurate way of stimulating hearing nerve cells than conventional electrical implants. They hope this could produce devices that offer near-normal music appreciation.</p>
<h2>Conversations with the brain</h2>
<p>Optogenetics also <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320957/">holds the potential</a> to treat tens of millions of people with epilepsy and other brain disorders. Part of the problem with traditional neuroprosthetic techniques is that it is difficult to electrically stimulate the nervous system and record electrical neural activity at the same time. It is like trying to hear someone whisper while shouting at them at the top of your voice. But with optogenetics it is possible to stimulate using light without affecting the electrical recording. This means it is now effectively possible have a conversation directly with the brain. </p>
<p>A key early application is epilepsy. We intend to send signals to sections of the brain exhibiting seizure-like behaviour that tell them to calm down. In the world-leading <a href="http://www.cando.ac.uk/">CANDO project</a>, we hope to be the first team to try this technique in epileptic patients in 2021. If it works, it will be a life-changing treatment to those whom drugs have proved ineffective.</p>
<p>In the coming decades, we will see neuroprosthetics increasingly combined with gene therapies such as optogenetics and possibly even stem-cell therapies. Even traditional pharmaceutical companies are starting to explore the possibilities of <a href="http://us.gsk.com/en-us/media/press-kits/bioelectronics/">bioelectronic medicine</a> –- stimulating the body’s own organs to produce therapeutic biochemicals. The advantage this brings is that it will allow doctors increasingly to personalise treatment, at least for certain conditions.</p>
<p>For those who have been brought up with films such as Blade Runner, we might have expected all humans to now be enhanced and augmented with bionic implants. In reality, we are a long way off this vision of the future. On the other hand, science fiction authors are only beginning to catch up with the reality of genetically enhanced bionics. In the end, nature is difficult to beat, but if we can bring back near-normal function to the disabled it could radically improve their lives.</p><img src="https://counter.theconversation.com/content/61879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Degenaar has received funding from the British Council, EPSRC, Wellcome Trust, MND Society, Macular Society, Newcastle BMRC and eFuturesXD.</span></em></p>The next generation of neuroprosthetics could communicate directly with the brain to tackle diseases such as epilepsy and blindness.Patrick Degenaar, Reader in Neuroprosthesis, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/440322015-06-30T23:01:54Z2015-06-30T23:01:54ZPolarised light and the super sense you didn’t know you had<figure><img src="https://images.theconversation.com/files/86883/original/image-20150630-5856-1v86nzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We already use 'polarised' technology.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/tomconger/3953954574/in/photolist-72p3WA-25Kuaf-25KtYm-8ydTY-8q3oBQ-4mdTxU-9Ciyps-i65SB-jdnuJu-88Aoks-6pzvo-4j4SFN-5FLhLM-54HYXu-8wZRLx-axKXAS-58wCmL-LwSmD-5nrFH2-4YxBEf-uXLwbD-ureUE2-nnnrR-yCVg-51Ltva-yDN5w-voqugP-v6uQ8A-ur51CA-v6CwSr-v6Cvft-voqweX-vo5knR-v6uNFY-rfDgd6-5Mx3Vk-afppYS-4b2nwB-2yxsF5-7P9aJ2-5dUoNZ-eqY9Lt-sQXzv-7vduPD-4ZtuG5-9KnKkn-2w8YnH-6D2QjL-asrrkn-fJRGtz">Tom Conger</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Ever fancied having a superpower? Something you can call upon when you need it, to hand you extra information about the world? OK, it’s not X-ray vision, but your eyes do have abilities that you might not be aware of.</p>
<p>We are all familiar with colour and brightness, but there is a third property of light – the “polarisation” that tells us the orientation in which light waves are oscillating. Animals, like bees and ants, use the polarisation patterns in the sky as a navigation aid. But few people, even in the scientific community, are aware that humans can perceive the polarisation of light with the naked eye.</p>
<p>In <a href="http://rspb.royalsocietypublishing.org/content/282/1811/20150338">research</a> we’ve just published in Proceedings of the Royal Society B, we used an experiment that was originally designed to test the visual abilities of octopuses and cuttlefish to investigate our human ability to perceive this polarised light. </p>
<h2>We already use polarised light</h2>
<p>Imagine a skipping rope is a light wave travelling through space. If you move the rope from side to side, the wave you make is horizontally polarised. But if you shake it up and down you create a vertically polarised wave. Generally, light is a mixture of polarisations, but sometimes – for example in parts of the sky, on your computer screen and in reflections from water or glass – a large percentage of the waves are oscillating in the same orientation. This light is described as being strongly polarised. </p>
<p>You will probably have come across technology that is built around polarised light before. For example, “Polaroid” sunglasses <a href="http://science.howstuffworks.com/innovation/everyday-innovations/sunglass6.htm">work by</a> blocking out polarised light which is reflected from shiny surfaces such as car bonnets or the surface of water. This is possible because light reflected into our eyes from horizontal surfaces is horizontally polarised and the sunglasses have a structure like a picket fence, so they only let in vertically polarised oscillations, blocking out the horizontally polarised bright reflections. Polarised light is at the heart of modern 3D cinema and LCD computer screens, smart phones and tablets.</p>
<p>So if polarised light is actually pretty common outdoors, in your home and in your office – how come you didn’t notice anything special before now? </p>
<h2>Haidinger’s brushes</h2>
<p>Humans perceive polarised light using “Haidinger’s brushes”, a subtle visual effect which appears like a yellow bow-tie at right angles to the polarisation angle. You may also see a bluish bow-tie at right angles to the yellow one. The effect originates within the eye itself and is not an image of a real external object, so Haidinger’s brushes usually fade in a couple of seconds as your brain processes them out. This is one of the reasons that few people notice them day-to-day, and why they have previously been fairly difficult to study.</p>
<p>By using LCD screens capable of constantly refreshing the effect, we were able to make the first measurements of the dynamics of Haidinger’s brushes, confirming the prediction that some individuals would perceive the orientation of the bow-tie to “flip-flop” as the polarisation angle is rotated.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86835/original/image-20150630-5836-14qcwz2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bow-tie in your eye.</span>
<span class="attribution"><span class="source">Shelby Temple</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our results shows that your cornea can dramatically affect how you perceive polarised light. As the optical properties of the cornea vary between individuals, this may also explain why people often report their experience <a href="http://www.nature.com/nature/journal/v250/n5462/abs/250163a0.html">of seeing</a> Haidinger’s brushes differently. </p>
<p>To see Haidinger’s brushes for yourself, look at a blank white portion of an LCD screen on a computer, tablet or phone. Tilt your head from side to side and faint yellow and blue bow-ties, slightly larger than your thumb, should become visible. With practice, you can then see them in the blue parts of the sky at 90 degrees from the sun, particularly at sunrise and sunset. </p>
<p>Skylight polarisation patterns, caused by light scattering in the atmosphere, are such that the long axis of the yellow bow-tie will point approximately towards the sun.</p>
<h2>What’s going on in the brain</h2>
<p>In <a href="http://www.sciencedirect.com/science/article/pii/S0960982212000115">previous studies</a> LCD screens have been used to test polarisation sensitivity in aquatic organisms. Our study tested the limits of human polarisation sensitivity, developing special filters to vary the percentage of polarised light reaching the eye from 0% to 100%. </p>
<p>This was to establish the minimum percentage polarisation at which Haidinger’s brushes could be detected. Among 24 people, the average polarisation sensitivity threshold was 56%. Some people could still see Haidinger’s brushes when the light was less than 25% polarised – not quite as good as cuttlefish but still better than any other vertebrates tested to date.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86885/original/image-20150630-5864-9u7n16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cuttlefish eye test.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/yamyuk/1278998739/in/photolist-2X2cLp-dEWauc-4Xhgdq-6m6eUw-6m6eV9-7kY552-6g39Zd-61U8WR-PZD8h-53c9H1-4eZDq5-Q1beP-4KP8T3-p4GRk-dKoZcB-oWBZW-fQYeSw-5fccVN-txmrK-5fc5dA-89XwZN-5vGonN-89UhWv-PZDdy-2YCacL-9t2sp4-8KCPNj-dynACh-fQYg43-fQMq7R-fQYguq-25Dwk9-4pYQhC-8Zo9vs-26nABF-7KiJvX-aftDRH-7KnGGu-3KjLpq-5Tpnmx-5f7RvP-daGykf-6Ky5ta-8hTbzb-8Es4nE-nipFnW-ninwiZ-4bJwnM-4EfSBF-5tDp7V">Yuk Yam</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>The ability to see Haidinger’s brushes is caused by circularly symmetric organisation of carotenoid pigments in the macula (an area that covers and protects the central part of the retina). Blue light which is oscillating parallel to these pigment molecules is strongly absorbed. White light, which is depleted in blue, appears yellow, which explains the yellow bow-tie effect. The blue parts of the brushes are thought to be generated by the brain in response to the unexpected presence of yellow.</p>
<p>Might it be possible to use our polarisation powers for good? The risk of acquiring <a href="http://www.nhs.uk/Conditions/Macular-degeneration/Pages/Introduction.aspx">age-related macular degeneration</a> has <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.327.2292&rep=rep1&type=pdf">previously been associated</a> with low carotenoid pigment density in the macula. </p>
<p>As AMD is currently the leading cause of blindness in the developed world and finding an early stage diagnostic indicator of this before any actual sight loss is incurred is a research priority. It is our hope that polarisation sensitivity could be used to investigate and ultimately monitor any changes in the organisation of the pigments happening in the early stages of this degenerative eye condition. More work is needed to assess the medical potential of these kinds of tests.</p>
<p>Haidinger’s brushes also provide a demonstration of the physics of light and the anatomy of the human eye. By taking the polaroid layer off an old LCD screen you can make your own simplified version of our test; black and white letters turn into contrasting polarisation angles once the polarising film is removed.</p>
<p>At a <a href="http://www.bnhc.org.uk/festival-of-nature/">recent science festival</a> I tried to get people to take an “octopus eye test” by reading the hidden letters using their polarisation sensitivity alone. It went down a storm, except with one little boy, who was terrified of the accompanying octopus headdress. Time to work on a less intimidating super-costume.</p><img src="https://counter.theconversation.com/content/44032/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Juliette McGregor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s how you can learn to see the normally hidden effects of polarised light that some animals use for navigation.Juliette McGregor, Research Associate , University of LeicesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/418132015-06-24T20:14:16Z2015-06-24T20:14:16ZNature’s lubricant makes your body a well-oiled machine<figure><img src="https://images.theconversation.com/files/86233/original/image-20150624-31507-14x3cub.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We wouldn't get very far without lubricin keeping our joints moving.</span> <span class="attribution"><span class="source">tableatny/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The old adage goes that the human body is a machine. And in many ways that isn’t far from the truth. Like any machine, the human body is made up of many individual parts moving together in a highly coordinated fashion. Parts slide by other parts with every blink and step. And to keep everything running smoothly and undamaged, the machine needs to be well oiled.</p>
<p>Chances are, you have not given much thought to your body’s lubrication. And in many ways, this is testament to just how effective it is at protecting against damage and wear. One reason that the sliding surfaces of the body are so resilient is because of a little known protein called <a href="https://en.wikipedia.org/wiki/PRG4">lubricin</a> which is nature’s most effective “grease”.</p>
<p>Lubricin was discovered coating the surfaces of joint cartilage, and is perhaps the body’s most effective boundary lubricant. The lubricin molecule consists of two adhesive “feet” flanking either end of a long flexible and non-adhesive “string”. It is this dichotomy that is the secret to its effectiveness. </p>
<p>These adhesive feet attach themselves to virtually any surface, forming a loop in the central non-adhesive string. As more and more lubricin attaches to a surface, it self-assembles to form a dense, carpet-like layer of <a href="http://www.ncbi.nlm.nih.gov/pubmed/17142292">lubricating loops</a>. This layer is known as a “polymer brush”, and it cushions surfaces where they contact, reducing friction as they slide.</p>
<h2>Proteins ain’t proteins</h2>
<p>Much of what we know about how lubricin protects joints came from the study of a rare but debilitating genetic disease, camptodactyly-arthropathy-coxa vara-pericarditis syndrome. If you find that to be a mouthful, you can call it <a href="http://www.lifespan.org/research-and-clinical-trials/cacp/about-cacp-syndrome/">CACP</a>.</p>
<p>People afflicted with CACP syndrome suffer a mutation in the lubricin gene that leads to a loss of its lubricating ability. Although at birth the joints of CACP syndrome sufferers show no signs of abnormality and are otherwise healthy, the absence of lubricin’s protection quickly leads to joint disfigurement, pain and eventual loss of mobility. Symptoms first appear in children as young as <a href="http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2014;volume=140;issue=2;spage=221;epage=226;aulast=Nandagopalan">18 months</a>.</p>
<p>CACP symptoms are similar to those of arthritis sufferers – in fact, CACP syndrome is often misdiagnosed as early onset rheumatoid arthritis – and this led researchers to investigate the possible link between lubricin and arthritis pathology. </p>
<p>It’s now known that arthritic joints contain considerably less lubricin than healthy ones. However, recent discoveries have also found that the concentration of lubricin in joints drop considerably following an injury and remains abnormally low for as much as a year post trauma. This drop in lubricin levels may shed light on the strong causal link between osteoarthritis development and a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21884811">history of joint injury</a>.</p>
<p>We now believe that these reduced lubricin levels in arthritic and injured joints contributes to both the onset and degenerative nature of osteoarthritis disease, against which there are few effective treatment options. Fortunately, recent animal studies indicate <a href="https://news.brown.edu/articles/2013/03/lubricin">supplementing injured joints</a> with injections of lubricin can be an effective treatment for preventing osteoarthritis development. It does this by reducing wear and tear to cartilage and the death of cartilage cells, which is a major osteoarthritis risk factor, during the critical healing period.</p>
<h2>Sight for sore eyes</h2>
<p>Although long associated with joints, we are now finding lubricin in some unexpected places, such as <a href="http://www.ucalgary.ca/knes/news/schmidt-eyedrops">the eye</a>. It appears that lubricin is a lubricating component of tears and provides the similar protection to cornea surfaces as it does to joints.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86234/original/image-20150624-31522-bvpvix.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lubricin also plays a role in keeping our eyes from drying up.</span>
<span class="attribution"><span class="source">LMAP/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The company <a href="http://lubris.net/">Lubris Biopharma</a> is currently conducting <a href="http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=112817">clinical trials</a> on a new lubricin treatment for <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dry_eye">dry eye syndrome</a>. </p>
<p>This syndrome affects millions of people worldwide and is a particularly difficult problem to treat. This is because the eye’s natural cleaning process tends to quickly rinse traditional lubricating molecules into the tear ducts. As a result, eye drops need to be administered frequently, often hourly. </p>
<p>Since lubricin adheres so strongly to surfaces, it is very difficult for the eye to remove it from the cornea surface, allowing a single drop to provide a full day’s worth of relief.</p>
<h2>Lube job</h2>
<p>In addition to medical therapies, lubricin’s self-assembling and non-stick properties are promising to usher in significant advances in microfluidic based <a href="http://www.deakin.edu.au/research/stories/2015/04/08/big-breakthrough-for-tiny-diagnostics">lab-on-a-chip technologies</a>, which are being developed to diagnose diseases such as cancer, AIDS and Ebola.</p>
<p>The unwanted adhesion of antibodies and other biomarkers to the surfaces of these devices is a major source of “noise” and a persistent obstacle to maximising the diagnostic sensitivity. Recent research shows that lubricin anti-adhesive coatings rival the current best technologies, and it can be applied to any substrate material without costly and difficult surface pretreatments or grafting chemistries. </p>
<p>Lubricin coatings thus offer better performance and greater functionality without significant increases in manufacturing costs. As researchers continue to assimilate the body’s slick lessons in lubrication, the possibilities and applications of lubricin will surely grow ever wider. </p>
<p>We might not often think about our body’s lubrication system or lubricin. But a deeper understanding of this remarkable protein is helping us treat diseases and produce new therapeutics to help keep us working as a well oiled machine.</p><img src="https://counter.theconversation.com/content/41813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Wren Greene currently recieves funding through an Australian Research Council, Discovery Early Career Researcher Award fellowship to investigate the properties and applications of lubricin </span></em></p>You may not have heard of the protein lubricin, but it’s what keeps your body moving. And now it’s being used to treat disease and produce new therapeutics.Wren Greene, Associate Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.