The disadvantages of a small pupil include a greater risk of complications retained cortex, which can lead to inflammation and create a nidus for infection and capsular phimosis. If they do not or if the iris is extremely flaccid, however, then I prefer to place a Malyugin Ring, which gives eight points of contact compared with the four or five from iris hooks and which decreases the risk of iris bombé and iris incarceration into wounds. Both viscoelastics will maintain the pupillary diameter. When the pupil’s size is maintained, the OVDs remain in the eye with a low bottle height and aspiration flow rates of 25 mL/min or less. In eyes with IFIS, the main problems occur with high aspiration flow rates and with high inflow. In my experience, Healon5 (Abbott Medical Optics Inc.) and Discovisc (Alcon Laboratories, Inc.) are especially useful for small pupils. It is essential to understand the various properties of the different viscoelastics (cohesive vs dispersive vs adaptive). When the injections are used in conjunction with OVDs, the surgeon can manage most cases of IFIS. The intracameral injections by themselves will often open the pupil enough for cataract surgery to proceed. The tools for managing small pupils include preservative-free intracameral solutions such as epi-Shugarcaine (3 mL preservative-free lidocaine 4%, 4 mL preservative- and bisulfite-free 1:1,000 epinephrine, and 9 mL BSS Plus ), ophthalmic viscosurgical devices (OVDs), iris hooks, and iris rings. SURGICAL PLANNINGĪs always, the surgical plan should include backup strategies for the different etiologies. IFIS presents its own surgical challenges (see the article on page 41 by Samuel Masket, MD). The goal is to decrease the risk of capsular phimosis, which may be a factor in late, spontaneous subluxation of the IOL-capsular bag complex. It is important to enlarge the pupil enough to permit the creation of an appropriately sized (5.5 mm) capsulorhexis so that the surgeon can use devices to stabilize the capsule if necessary (eg, Malyugin Ring and Mackool Cataract System ). In these cases, the size of the pupil is frequently associated with the zonular problems. In addition to small pupils, the eyes of patients with PXF often exhibit brittle capsules and zonular weakness (Figure). Afterward, the pupil still may not dilate well. Patients with chronic uveitis, for example, often have posterior synechiae that must be broken mechanically (a cyclodialysis spatula or other blunt instrument will suffice). The surgical approach varies with the cause of the small pupil and the presence of comorbities (eg, glaucoma). How should cataract surgeons proceed when the pupil is small? THE CAUSE MATTERS Moreover, small pupils are quite common in patients who are taking α-1 inhibitors and/or nutritional supplements that contain saw palmetto to treat an enlarged prostate, and these therapies can induce intraoperative floppy iris syndrome (IFIS). They also occur in patients with pseudoexfoliation (PXF) syndrome, uveitis, narrow-angle glaucoma, and diabetes. Small pupils are found among the elderly. The result can be increased inflammation, Soemmering rings, and possibly capsular phimosis. Although modern cataract techniques, especially chopping techniques, allow surgeons to consider removing a cataract without enlarging the pupil, the complication rate is higher when the pupil remains small, and completing the cortical cleanup may be problematic. Investing in New Devices for Cataract SurgeryĪ number of situations require the management of a small pupil. What to Do When Customers Criticize You Online The Impact of Mergers and Acquisitions on Industry’s Relationship With Ophthalmologists Sidebar: Are Changes to the CE Marking Process Imminent? Pharmacologic Approaches to the Small Pupil The Ocular Surface: Where Research Meets and Greets BusinessĬataract Surgery in an Eye With Blunt Trauma, Glaucoma, and Zonular WeaknessĪ Healthy Tear Film Equals a Happy PatientĬataract Surgery On Eyes With Small Pupils
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Heder hopes the film normalizes deaf families and feels universal. “When see someone not responding or not following directions,” Heder says, “it can go to a really bad place - it can escalate very quickly.” Emilia Jones, Troy Kotsur, Marlee Matlin and Daniel Durant in “CODA." (Apple TV+) Officers often lack proper training to communicate with someone who is deaf, she says. Heder says she wanted the scene to address what happens when deaf people encounter law enforcement. They don’t hear the radio and the situation builds up to a gripping scene.Īs tension grows, the father and son are unaware of what’s happening. In one scene, the father and son go out to the boat without Ruby and get radioed in by the harbourmaster, who is trying to get their attention. “ The reason he named it Deaf Boater is if he ever had an encounter with the Coast Guard, would see the name of the boat and know that in a boarding situation, he might not be responding.” “He had a boat that he named Deaf Boater,” Heder says. Rossi had the same last name as the characters in the movie and was the daughter of a deaf fisherman - a moment Heder referred to as “movie magic.” When creating the movie, Heder says she was looking to hire interpreters when someone on set recommended a CODA named Heather Rossi. He felt that he didn’t exist or know exactly who he was, Heder says. She says film producer Jack Jason, a long-time interpreter to deaf actress Marlee Matlin, described his childhood as being “an electrical wire”- a conduit delivering information between these two points. “ oftentimes feel more connected to deaf culture than to hearing culture,'' she says, “and there's this strange limbo that they exist in where they're a part of both worlds, but also a part of neither.” The CODAs Heder spoke to when creating this film all reported feeling a sense of importance.ĬODAs grow up in a deaf culture where American Sign Language (ASL) could be their first language, Heder says. Teenage Ruby feels trapped by her family and responsibilities, Heder says, but she also gets a lot of self-worth from her role as an interpreter. “That’s what the movie is about,” Heder says, “it’s like once you remove yourself from your comfort zone of your identity within the people you love - how do you find your own voice?” Siân Heder directs Emilia Jones and Ferdia Walsh-Peelo in “CODA." (Apple TV+) “It’s a story about the end of childhood.”Īt the end of the movie, Ruby singing Joni Mitchell’s “Both Sides, Now” on stage represents a turning point in her life, figuring out her identity outside her deaf culture. “CODA does have a double meaning in the title because it’s Children of Deaf Adults, but it’s also the end of a piece of music, '' Heder says. High schooler Ruby, the only hearing member of the family, is torn between following her passion of singing and helping her loved ones. The movie “CODA” - ‘Child of Deaf Adults’ - premieres this Friday in theatres.ĭirected by Siân Heder, the film is about a culturally deaf family who runs a fishing business in Gloucester, Massachusetts. Apple Original Films is re-releasing “CODA” in theaters for free in major cities across the U.S. Editor's note: This segment was rebroadcast on Feb. There are so many different currencies and upgrade paths and progress bars that I’m honestly overwhelmed by them. There is a lot of town-building, management-sim style gameplay systems in this game. After spending several hours with it this weekend, I am surprised at how much of my time was spent managing my elder-god-worshipping cult, rather than venturing out into the action gameplay. Coming from a publisher I trust, like Devolver Digital, helps too.Ĭult of the Lamb manages to hit every single one of these bullet points, which means I have been super excited to dig into it since it was announced. Oh, and if your game has a weird, absurdist sense of humor then I am willing to check it out. A cute art style is a great place to start, and I am always down to try out something that claims to have Hades-like combat. There are a few things that will always get me interested in a video game. Geek to Geek Media was provided with a review copy of this title. Recommended for fans of: Action Roguelikes, Management Sims, Adorable Animals, and Ritual Sacrifice.
All the templates are designed based on the latest trends and follow the web design best practices. With Nicepage, you get to create websites with the largest library of templates that are all latest and ready-to-use. Because when an element is not tied to the primary page structure, it can cause accessibility and readability issues, so test properly when you use freehand designs. Note that while the freehand building is best for creating unique designs, it has its risks also. You can use the natural drag and drop and freehand positioning of Nicepage to freely place design elements on the pages and create unique designs - all without writing any code.Īll the output is mobile-friendly, so you can create a design for desktop screen size, and that will be adjusted accordingly to other screen sizes as well. With this, you can create overlapping elements and free sizing in your design. Intuitive freehand positioning is the key feature of Nicepage. Here’s a quick rundown of all the Nicepage useful features. Let’s now see all the features of this builder… Nicepage Website Builder Features It also supports landing pages, website mockups, and static sites. With Nicepage, you can design and develop WordPress themes, HTML/HTML5 templates, CSS templates, WooCommerce themes, Joomla templates, and single-page templates. It also has an extensive range of pre-built templates to choose from. And with its latest features of Freehand positioning, you can build any modern web design you can think of. Nicepage is an excellent website-building tool where you don’t have to write a single line of code. While Artisteer is focused on automatically creating templates for WordPress and Joomla CMS with its AI backend, Nicepage is a pure drag and drop builder with a ton of advanced features. Artisteer was launched in 2007, and Nicepage in 2018. Nicepage builder is developed by the team at Artisteer, where they have experience of over a decade. With its flexible templates, freehand positioning, responsive design, and handy widgets, you can build high-quality templates and websites. Nicepage is an advanced drag-and-drop website builder designed for web designers and developers. |
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