Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
This issue will continue to order cheap toradol online running knee pain treatment be the subject of numerous studies in the years to purchase toradol 10 mg with amex best pain treatment for shingles come toradol 10 mg low cost menses pain treatment urdu. The first case is presented by an expert in cooperation with the health Tand safety committee, while the second describes the application of a participatory ergonomics approach. The latter first met with a few committee members to find out their inten tions and their perception of the problem. His initial meetings with the workers at the hanging stations helped redefine the in the bottom of a basket and to bend over problem. Workers also reported often For example, when they have to hang small being in a hurry. Observing the work made it possible to To avoid frequent trips between the take stock of demanding postures and other conveyor and the basket of small compo risk factors. Arms have to be lifted high, nents, many workers fill a cardboard box especially when taking large-sized objects with a large number of components, hold from the row at the top of a pallet, or when ing the box with one hand while hanging hanging small objects at shoulder level or with the other (Fig. The back is also taxed as a result of effort required to hold the box and the fact the flexion required to pick up components that all the hanging is done with one hand Ergonomic improvement of work: concrete cases 47 notably, to raise certain baskets when they are nearly empty. This eliminates the static muscular work required to hold the box, results in fewer trips to the basket because the box contains more components, and gives the worker two hands free for hanging components; Fig. Assembly of surge arrestors Thus, the catch-up phenomenon is an aggravating circumstance. After analyzing Analyzing this work station serves as an the situation, the ergonomist asked to meet illustration of a participatory ergonomics with members of the work group to inform approach involving the establishment of an them of his diagnosis and to work with ergonomics work group. The mandate of them to find concrete solutions for chang this committee, composed of six people and ing the job. Workers were already well aware of some risk factors, but had not considered the first work station this committee chose the difficulty of holding a box in their arms to study was the assembly of surge (static muscular work) or the catch-up arrestors. In fact, this station, which the phenomenon, which aggravates all postures company plans to reorganize shortly, is and efforts. To practice preven the committee, together with the ergono tion, the committee members found it mist, looked at several possible solutions important to formulate their recommenda and came up with three changes that could tions before proceeding with reorganiza be implemented quickly and economically. Thus, accident frequency was not a Other measures will be considered later on, deciding factor in this case. The Overview of the first product consists of a moulded plastic base three work stations in which the worker places and screws of the mini assembly line together components. The bases are routed manually from one work station to another through tracks attached Fig. The final prod A look at the uct is used as a surge arrestor for telephone reorganization planned lines. Priority was also the physical layout of the work tables and given to the screwing of fuses the circulation of the product. These actions are tee planned to broaden this perspective by performed with the arms conducting an in-depth analysis of the raised in front of the body, actual product assembly activity. Most of the workers pushing efforts to bend identified the shoulder as the most painful when screwing in forward. Note how company, kept the assembly and emptying bringing the tracks of the bases on trays. The second prototype closer to the worker and proposed maintaining the assembly on installing a pantograph tracks with the addition of a chute at the reduces stress on the end of the table, to facilitate the emptying shoulders and the of the bases. The chute and the tracks of amount of effort fered the advantage of eliminating tray required for handling. Following the prototype tests, the screwing workers opted for assembly on tracks with a chute as the system best adapted to their work. At the same time, the committee made sure that the chute system would not affect product quality. The committee was also able to simulate Regarding the use of the screwdriver, the the assembly of surge arrestors according to committee suggested moving the tracks the reorganization. This simulation made it closer to the worker, which would reduce possible to anticipate certain risk factors the amplitude of shoulder postures and associated with the use of trays. At this step, the manager, the engineer tion analysis to evaluate the impact of the in charge of thereorganization and the team improvements on work activity. The discussion said they appreciated the extended work focused initially on the worst actions, cycle, the individualized stations, the pan beginning with the circulation of the bases tograph for the tool, the chute system and and the assembly support. In ios were developed, two of which were terms of posture risk factors, observations selected for testing in the department. An effective prevention strategy must eliminate the danger at the source while at the same time helping workers who are already affected. Ergonomic improvement of working conditions remains one of the most effective intervention routes, since it goes to the source by targeting the reduction or elimination of risk factors. First, it is important to understand what is going on, to get rid of any biases, to find out the facts. Then, it is necessary to address and evaluate the seriousness of the situation prevailing in the workplace. If the situation is acceptable, it may be sufficient to simply remain alert and ready to intervene at the slightest sign of deterioration. The reader will no doubt have noted that, in the chapter describing how to detect a problem, there are no exposure standards to help decide whether or not a problem exists. Likewise, it is also not realistic to draw up a list of possible solutions, and even less so, to develop a guide indicating under what circumstances each of these solutions can be used effectively. In this regard, reading Chapter 4 may leave the reader yearning for more, since the possible options it offers are very general. The concrete examples presented at the end of the chapter, however, explain how the ergonomic approach can be applied. The first focuses on identifying the problem, while the second provides methods for correcting it.
Lutein and docosahexaenoic acid prevent cortex lipid peroxidation in streptozotocin-induced diabetic rat cerebral cortex discount toradol 10 mg with mastercard alpha pain treatment center berwyn il, Neuroscience 166 purchase genuine toradol on line pain treatment in pregnancy, 271-278 order 10mg toradol with visa pain treatment center southaven ms. Intake of lutein-rich vegetables is associated with higher levels of physical activity, Nutrients 7, 8058-8071. Lutein intake at the age of 1 year and cardiometabolic health at the age of 6 years: the Generation R Study, Br J Nutr. Molecular evidence that oral supplementation with lycopene or lutein protects human skin against ultraviolet radiation: Results from a double-blinded, placebo-controlled, cross-over study, Br. Overall skin tone and skin-lightening-improving effects with oral supplementation of lutein and zeaxanthin isomers: a double-blind, placebo-controlled clinical trial, Clin. A focus on resveratrol and ocular problems, especially cataract: From chemistry to medical uses and clinical relevance, Biomed. Age-related changes in the kinetics of human lenses: prevention of the cataract, Int. Plasma lutein and zeaxanthin and the risk of age-related nuclear cataract among the elderly Finnish population, Br. Plasma lutein and zeaxanthin and other carotenoids as modifiable risk factors for age-related maculopathy and cataract, Invest. The gender differentiated antioxidant effects of a lutein-containing supplement in the aqueous humor of patients with senile cataracts, Exp. Lutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration: A meta analysis, Invest. Role of lutein supplementation in the management of age-related macular degeneration: meta-analysis of randomized controlled trials, Ophthalmic Res. Changes following supplementation with lutein and zeaxanthin in retinal function in eyes with early age relatedmacular degeneration: a randomised, double-blind, placebo controlled trial, Br. Consuming a buttermilk drink containing lutein-enriched egg yolk daily for 1 year increased plasma lutein but did not affect serum lipid or lipoprotein concentrations in adults with early signs of age-related macular degeneration, J. Comparison of daily intake of lutein+zeaxanthin, serum concentration of lutein/zeaxanthin and lipids profile between age-related macular degeneration patients and controls, Beij. Dietary and lifestyle risk factors associated with age-related macular degeneration: a hospital based study, Indian J. Antioxidant properties of lutein contribute to the protection against lipopolysaccharide-induced uveitis in mice, Chin. Neuroprotective effect of an antioxidant, lutein, during retinal inflammation, Invest. Evidence of lower macular pigment optical density in chronic open angle glaucoma, Br. The association of consumption of fruits/vegetables with decreased risk of glaucoma among older African-American women in the study of osteoporotic fractures, Am. Lower macular pigment optical density in Foveal Involved Glaucoma, Ophthalmology 122, 2029-2037. Application of lutein and zeaxanthin in nonproliferative diabetic retinopathy, Int. Macular pigment optical density and its relationship with serum and dietary levels of lutein and zeaxanthin, Arch. Macular pigment optical density measured by dual-wavelength autofluorescence imaging in diabetic and nondiabetic patients: a comparative study, Invest. Protective effects of various antioxidants during ischemia-reperfusion in the rat retina, Graefe?s. Anti-inflammatory effects of lutein in retinal ischemic/hypoxic injury: in vivo and in vitro studies, Invest. Effect of lutein on retinal neurons and oxidative stress in amodel of acute retinal ischemia/reperfusion, Invest. Resonance raman measurement of macular carotenoids in retinal, choroidal, and macular dystrophies, Arch. It is important to examine the fetal face and skull during prenatal ultrasound examinations because abnormalities of these structures may indicate the presence of other, more subtle anomalies, syndromes, chromosomal abnormalities, or even rarer conditions, such as infections or metabolic disorders. The prenatal diagnosis of craniofacial abnormalities remains diffcult, especially in the frst trimester. A systematic approach to the fetal Received: May 29, 2018 skull and face can increase the detection rate. When an abnormality is found, it is important Revised: June 30, 2018 Accepted: July 3, 2018 to perform a detailed scan to determine its severity and search for additional abnormalities. Invasive prenatal diagnostic Elizabeth Hospital, Gascoigne Road, techniques are indicated to exclude chromosomal abnormalities. In particular, the prevalence of facial clefts and commercial use, distribution, and reproduction in any medium, provided the original work is properly craniosynostosis is around 0. Whenever a craniofacial abnormality is found, it is important to perform a detailed scan to screen for additional anomalies. Further investigations, including invasive prenatal diagnostic techniques, may be indicated for chromosomal studies or molecular testing. The prenatal diagnosis of some abnormalities, such as craniosynostosis, remains 2019 Jan;38(1):13-24. Nonetheless, over-diagnosis should be avoided because structures are examined . The skull has an oval shape and most fetuses with isolated brachycephaly or dolichocephaly continuous echogenic structure interrupted only by narrow have normal outcomes. The main purpose of this review is to provide up-to-date information on prenatal sonography of craniofacial abnormalities, with the goal of increasing diagnostic accuracy. H Skull the size, shape, integrity, and bone density of the skull can be assessed when the head size is measured and when the brain Table 1. Abnormal ultrasonographic features of the skull and associated abnormalities Feature Abnormal feature Abnormality Size Small Microcephaly Large Macrocephaly Shape Not oval, like a lemon, Spina bifda, trisomy 18, or strawberry, or cloverleaf skeletal dysplasia Integrity Defect in the skull bone with Encephalocele protrusion of brain tissue Fig.
In the United States toradol 10mg overnight delivery pain treatment center of the bluegrass, an estimated of 50 sleep sensors and making sense of feedback they provide? Abstracting with of interviews with 5 sleep experts discount 10 mg toradol with visa pain treatment shingles, surveys with 87 and credit is permitted purchase toradol with visa pain management treatment for spinal stenosis. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request interviews with 12 people that have used sleep sensing permissions from Permissions@acm. We find that: from seven sensors found in smartphones and found it was possible to predict aspects of sleep quality to between 81-. Self-trackers can better understand and improve their sensing, but not on the feedback that would be provided to overall sleep habits when feedback from sleep sensors users. They found there are a number of issues, including discomfort, battery life, and inability for users to modify Our findings examine the state of sleep sensing feedback data. From build upon this prior work by focusing on the feedback sleep our results, we derive design recommendations that consider sensors provide and how users interpret and take action on users needs and connect them to evidence-based strategies the feedback. The authors also stressed the negatively when fitness trackers incorrectly infer a particular importance of supporting long-term sleep tracking to identify physical activity and consequently, do not give users credit trends to help people create personalized sleep goals. Finally, Lullaby captures We extend such work by examining the strengths and environmental factors. Our results indicate that sleep Lullaby provides comprehensive information of users sleep sensing enables or interferes with making sense of sleep environment. Our discussion provides design recommendations environmental factors that may affect sleep . We analyzed all 683 reviews for people using sleep sensing devices to track their sleep, we 1) these five dedicated sleep devices. Similar to our data To gain an understanding of the factors contributing to sleep saturation process for the smartphone app reviews, we read health, we conducted a literature review of sleep research and reviews in decreasing order of word count, analyzing data interviewed five experts in the field of sleep medicine (E1 until we felt we reached data saturation. E1 is a Neurology professor and board certified sleep tended to be longer than the smartphone app reviews. E2 is a professor in Psychiatry & Behavioral three authors coding this dataset reached saturation at Science, co-director of a sleep research center, and editor of different word counts for some of the devices. E4 is a professor in a and all 78 Misfit Shine reviews, totaling 5451 fitness tracker department of Family and Child Nursing and focuses on reviews. App Reviews (6986 reviews) Experts were familiar with commercial sleep sensors and the iPhone apps Smart Alarm Clock (87), SleepBot (171), MotionX feedback they provide. During the interview, (2452), Misfit Shine (78), Jawbone Up3 (808) experts were asked to comment on feedback examples and discuss how they use patient-generated sleep sensing data. Survey Demographics (87 people) We analyzed the sleep expert interviews with support from Gender Women (50), Men (37) Age min 18, max 73, mean 33. Reviews of Sleep Sensing Products Tracker type smartphone app (3), fitness tracker (56), dedicated device (3), Other (12) We collected and analyzed product reviews from the most widely-used commercially available sleep sensing Interview Demographics (12 people) technologies to gather a user perspectives on sleep sensing Gender Women (8), Men (4) feedback. Our Currently tracking (9), discontinued (3) inclusion criteria consisted of: 1) smartphone apps using tracking? For iTunes review dataset informed the list of questions to survey self reviews, we reached data saturation at 280 word count, trackers using sleep tracking technologies. The 29-question analyzing 475 reviews out of a total of 2000 possible survey focused on: 1) reasons why people track their sleep, reviews. For Google Play reviews, we reached data 2) which sleep sensing devices people use and why those saturation at 500 word count, analyzing 377 out of a total of devices, 3) the type of information people wanted to collect, 14581 possible reviews. Combining both sources, we 4) how people make sense of the feedback from sleep sensing analyzed 852 app reviews. We gathered a total of 87 responses (demographics in broken down into three stages: Stage 1, which is also known Table 1). We interviewed the 12 which people cannot control the patterns through which they cycle replied to our request (demographics in Table 1). We through the stages or how many hours they spend in a conducted interviews over the phone or in person. The data captured from these sensors is Our analysis consisted of an iterative affinity diagramming used to classify and identify sleep stages. In Step 3, we created our survey based on the themes generated In non-clinical settings, a wearable, accelerometer based from the two previous steps. In Step 4, we analyzed the sensor, known as an Actigraph, has become a popular, survey data and merged it with the themes identified from clinically validated tool for continuous sleep tracking . In Step 5, we applied Patients wear an Actigraph to help identify wake-up, sleep the 7 themes from the expert data to the themes generated times, and the amount of movement throughout the night. This step trimmed but data or feedback is not accessible to patients for their own our themes 64 to 30. These sensing that required affinity analysis, the data was split between technologies use accelerometers, heart rate monitors, three authors. Each author analyzed their subset of the breathing rate, and microphone sensors to infer sleep. We then came together to merge, discuss, and iterate However, these technologies have not been clinically on themes. For We now summarize the findings from our literature review example, Montgomery-Downs et al.
The deficit in cataract surgery in England and Wales and the dehyde-3-phosphate dehydrogenase cheap 10 mg toradol fast delivery pain treatment center nashville. Journal of Biological Chemistry purchase 10mg toradol visa pain medication for dogs metacam, escalating problem of visual impairment: epidemiological modeling of 274 buy genuine toradol online pain treatment center of illinois, 19525?19531. American Journal of Epidemiology, 144, ular damage to extracellular matrix and other tissue proteins in diabetes, 496?500. Journal of Epidemiology and Community inhibits hydrogen peroxide-induced oxidation of the rat lens. Do aspirin-like analgesics in vitro and in vivo impair ascorbate regeneration and increase as protect against cataract? Prevention of oxidative damage to rat lens by pyr cells: a potential role for aldose reductase in vascular remodeling. Trolox protects rat hepatocytes against oxyradical damage induced protein modifications. Free Radical Research Communica and the ischemic rat liver from reperfusion injury. Aldose reductase in glucose toxicity: a potential glycation and high molecular weight aggregate formation by aspirin target for the prevention of diabetic complications. Inhibition of cataracts of carotenoids, retinoids, and tocopherols in human lenses. Relationship in humans between ascorbic acid consumption vention by pyruvate: implications in cataract prevention. Free Radical and levels of total and reduced ascorbic acid in lens, aqueous humour, Research, 29, 315?320. Oxidative stressandantioxidantfunction in damage to lens alpha-crystalline: prevention by pyruvate. Gregory Grunberg, Managing Director at Longitude Capital, and Chen Yu, Managing Partner at Vivo Capital, joined as new Board members. Jonathan Silverstein, Partner and a Co-Head of Global Private Equity at OrbiMed, will hold a Board observer seat. Kala is a clinical stage pharmaceutical company focused on innovative nanoparticle-based treatments for ocular diseases affecting both front and back of the eye. Contact: Kari Watson MacDougall Biomedical Communications (781) 235-3060 kwatson@macbiocom. Physicians should System Requirements: claim only the credit commensurate with the extent of their participation in the activity. Full disclosure of faculty/planners and their commercial relationships, if any, follows. Remove the Activity with the following commercial interests in the form of Consultant/Advisory Board: Evaluation/Credit Request page from the printed supplement or print the Activity Abbott Medical Optics; Acucela Inc; Aerie Pharmaceuticals, Inc; Alcon; Allergan; Evaluation/Credit Request page from the Digital Edition. Scan and return via e-mail ArcScan, Inc; Bausch & Lomb Incorporated; Carl Zeiss Meditec, Inc; CenterVue SpA; to cme-nyee@nyee. Your certifcate will be sent to the Clarity Medical Systems, Inc; ElutiMed; Envisia Therapeutics; Equinox; Eyelight, Inc; e-mail address you provide on the Activity Evaluation/Credit Request form. Gore & Associates, Inc; Honoraria from Please take this post test and evaluation online by going to tinyurl. Upon registering and successfully completing the post test, your Aerie Pharmaceuticals, Inc; Alcon; Allergan; Carl Zeiss Meditec, Inc; Glaukos certifcate will be made available online and you can print it or fle it. Pharmaceutical Co, Ltd; Thea Pharmaceuticals Limited; and Transcend Medical, Inc; Contracted Research: Abbott Medical Optics; Alcon; Allergan; Merck & Co. Consultant Ophthalmologist Moorfelds Eye Hospital and the London Claremont Clinic Are We Operating Earlier in Glaucoma? Dr Palmberg: Dr Barton, is the role of surgery changing in the United Kingdom and Europe as well? Furthermore, the percentage appearing procedures than with traditional surgeries, and also wish to to be worsening was just approximately at the level of noise have freedom from daily topical medication(s). These data support the previous observation by Dr Barton: I agree, but it will come down to effcacy. Today, the 3-dB Gain 3-dB Loss 5 Years, dB trabecular disruption procedures include trabecular ablation? Although there are exceptions, this is the patient we feel Dr Samuelson: I tend not to use the tissue-disruptive confdent is unlikely to progress over time. However, I have found that gonioscopy-assisted transluminal trabeculotomy can be very Dr Ahmed: I agree. Quigley once estimated that trabeculectomy, if Dr Palmberg: Let us move on to suprachoroidal drainage applied to all patients with glaucoma, would cause blindness devices. The CyPass device is now available in the United due to complications for roughly the same number of States15 and also in select countries in Europe1 (Figure 3). Other complications were uncommon and evenly distributed Trabecular Disruption between groups. This is generally considered A modifcation of the CyPass procedure has been described, to be an important point of resistance to aqueous humor in which viscoelastic is frst injected in the suprachoroidal outfow. The CyPass device outfow resistance in collector channels and the episcleral Microstent design (A), its proximal end correctly 35 positioned within the anterior chamber venous system. For this reason, I use iStent in the same and cataracts, 2103-2112, Copyright types of patients for whom I use CyPass, that is, those with 2016, with permission from Elsevier. I have performed 2 to 3 dozen of experience of performing a perfect surgery only to have these procedures, which are very straightforward. It is an even a perfect placement can lead to complications, such elegant choice because it accesses a completely distinct as hyphema, transient choroidal effusion with myopic shift, fltration pathway.
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The eyes begin to cheap 10 mg toradol with mastercard neck pain treatment guidelines develop 22 days after conception quality 10mg toradol pain treatment video, with the formation of optic grooves in the early brain tissue buy toradol 10 mg with visa pain treatment center milwaukee, from which eventually two buds (optic vesicles) may be seen on either side of the forebrain. Eventually these vesicles expand laterally, making stalk-like connections with the developing nervous system. The optic nerves Like the brain, the optic nerves are covered with the pia, arachnoid and dura maters. This partial separation of the nerve fibres from each eye allows the left side of the brain to interpret the left visual field, and the right side of the brain to interpret the right visual field. This enables the slightly different information coming from each eye to be interpreted together, to facilitate depth perception, and results in the highly complex process that psychologists call visual perception. This involves not just seeing but also being able to make sense of what has been perceived. Any lesion occurring in one or both optic nerves as they leave the eye will cause a loss of vision. The optic chiasma lies just above the pituitary gland, so any enlargement of this gland will put pressure on the crossed fibres, causing a bilateral temporal loss of vision (bitemporal hemianopia). You can find out more about loss of vision due to damage to the optic pathways in Miller et al. To d o Give three possible causes of partial loss of vision occurring as a result of optic nerve damage at the chiasma or following the separation of the nerve fibres as they proceed to the visual cortex of the brain. Loss of vision occurring as a result of damage to the optic pathways is not generally an ophthalmic problem, but patients who complain primarily of a loss of vision are generally seen in the ophthalmic department where the health of the retina may be ascertained and the visual fields recorded for diagnostic purposes. Protective effect on the corneal epithelium and remaining efficiency at the anterior chamber for three different kinds of viscoelastic devices. Caceci on the anatomy and physiology of the eye and development of the eye in invertebrates. The conjunctival glands of Krause and Wolfring, situated in the upper and lower fornices, are responsible for secreting what? What anatomical structures are involved in the conventional drainage route from the eye? Name the two main layers of the retina 22 Basic anatomy and physiology of the eye 14. The fibres from the optic nerve cross over at an area lying just above the pituitary gland. Understanding how light is refracted within the eye is key to understanding the visual needs of our patients, particularly when it comes to obtaining accurate intraocular lens readings and understand ing spectacle prescriptions and associated visual difficulties. Essential learning If you normally work with cataract patients, it is essential that you begin to get a grasp of the following: G the vocabulary common when discussing refraction. G Some of the pitfalls associated with inaccurate measurements prior to cataract surgery, or the insertion of a lens of the incorrect power (see Chapters 5, 6 and 7). Refraction of light by the eye to produce good, unaided vision (by focusing the light on to the retina) is dependent on the power of the cornea, the lens and the length of the eye. All the individual transparent areas of the eye contribute to bending and focusing the light rays on the retina. Snell and Lemp (1998) state that the power of the whole normal (emmetropic) eye is about 58 dioptres (see Dioptre in Appendix 2); the cornea has a refractive power of about 42 dioptres and is responsible for more than two-thirds of this refractive ability. In addition it should be recognised that the tear film, aqueous humour, lens and vitreous all contribute to refraction of the light rays so that they normally come to a focus at the macula. The signifi cance of the lens is that it can change its dioptric power by contraction and relaxation of the ciliary muscle. This is because the lens becomes thicker (more convex) when the ciliary muscle contracts and thinner when it relaxes. Contraction of the ciliary muscle releases the tension on the zonule fibres, allowing the lens to increase its curvature. This process of changing the lens shape is called accommodation, and it allows distant and near objects to be focused on the retina. The amount by which the lens can change in power reduces with age about 8 dioptres at the age of 40 and only 1?2 dioptres at the age of 60 (Snell and Lemp, 1998). Focusing the eye for near vision this involves: Pupil constriction: Smaller pupil diameters result in an increased depth of focus and an improved retinal image. Convergence: this is when the eyes turn slightly inwards towards the nose, and it ensures that the image is projected on to the fovea of each eye, aiding binocular vision and increasing 3-D perception (stereopsis). Accommodation: When we look at objects near to us, diverging light rays reach our corneas so the eye requires more refractive power to focus the light on to the retina (but parallel light rays come from objects in the distance). In order to do this, the ciliary muscles contract, making a smaller ring, and taking the tension off the suspensory ligaments. This means the lens becomes smaller and fatter and moves slightly backwards, to increase refraction. The ciliary muscles are innervated by the autonomic nervous system, and accommodation is controlled automatically by the brain. You can read more about the process of accommodation at the websites of Georgia State University HyperPhysics and Ted Montgomery. Emmetropia (normal sight) the refractive components of the normal eye are able to focus light from a distant object (parallel light) on the retina accurately, so that the person is able to see distant objects clearly without spectacles. When a person is young and has normal accommodation they will also be able to read without spectacles.