Search Results (48)

Background/Objectives: Myopia is a growing global problem. Current preventative treatments are inadequate, and myopia control spectacles intentionally degrade peripheral optical quality over large retinal areas. Variable results have been related to near-peripheral retinal refractive variability and chromatic refractive spread. A narrow paracentral band of collimating apertures created by annuli with plus-add surrounding appropriately small distance-correcting areas is proposed to decrease defocus and dynamic accommodation cues at the most responsive retinal area for controlling axial elongation while optimizing peripheral vision. Methods: Axial lengths (AL), with the contralateral myopic eye serving as the control, were measured in a child with masking after distance and near viewing with a stick-on placed coaxially on a single-vision (SV) spectacle lens during the AL diurnal cycle’s ascending phase only during the experimental sessions at myopia onset and two years later in a case study. The stick-on consisted of a 3.5 mm-wide annular +3D lens containing collimating apertures created by surrounding 1.5 mm-wide circular openings within the stick-on with plus power over the SV minus lens. Results: There was no elongation during near viewing in the child’s eye with the stick-on, while the contralateral control eye without the stick-on elongated. The expected increase in elongation during distance viewing during the child’s AL diurnal cycle’s ascending phase was reduced at age 8 and again at age 10 in the eye with the stick-on compared to the eye without the stick-on. Adaptation was immediate. Central and peripheral visual acuities were no different with or without the stick-on. Conclusions: This proof-of-concept study in a single child at myopia onset and two years later during myopia progression suggests the potential of this novel strategy for reducing short-term axial elongation during distance and near viewing. Stick-ons, clip-ons, electronic and non-electronic spectacles and contact lenses combining near-peripheral collimation with near-peripheral myopic defocus treatment at the narrow near-peripheral retinal area should be further explored for controlling myopia without reduction of peripheral vision. Full article

Nd laser posterior capsulotomy is the standard treatment for posterior capsule opacification following cataract surgery. Although generally considered safe, inadvertent laser impacts on the intraocular lens (IOL) optic may induce permanent surface defects that contribute to postoperative dysphotopsias and reduced visual quality. This experimental study investigated the optical consequences of Nd laser-induced damage on two commercially available hydrophobic acrylic IOLs, focusing on retinal light distribution and optical image quality. Two hydrophobic acrylic monofocal IOL models, the CT LUCIA (Carl Zeiss Meditec) and the AcrySof IQ (Alcon), were mounted on a customized experimental holder and exposed to standardized Nd laser applications consisting of 5, 10, or 15 laser shots. Laser interactions were documented using the PhysioGo.Lite laser platform combined with infrared thermal imaging. Untreated IOLs served as controls. Optical performance was subsequently evaluated using a standardized optical bench according to ISO recommendations. Point spread function (PSF) and modulation transfer function (MTF) analyses were performed to quantify retinal image quality, light scattering, and optical degradation. Retinal light distribution was assessed using a high-resolution projection screen simulating the retinal image. Laser exposure produced permanent focal defects on the anterior optical surface of both IOL models, resulting in measurable optical degradation. Even the lowest laser exposure (five shots) generated detectable alterations in light propagation, characterized by increased peripheral light scattering, enlargement of the PSF halo, reduced central peak intensity, and irregular light distribution across the simulated retinal plane. Descriptively, increasing numbers of laser impacts were associated with more pronounced optical disturbances, particularly in the AcrySof IQ samples. MTF analysis demonstrated a reduction in optical performance across multiple spatial frequencies, indicating deterioration of image contrast and resolving power. Although both hydrophobic acrylic IOL models exhibited optical alterations after laser exposure, descriptive differences in the magnitude and distribution of light scatter suggested a possible influence of material composition, refractive index, and surface microarchitecture. These observations should be considered preliminary because of the limited sample size and absence of inferential statistical analysis. Under the present experimental conditions, Nd:YAG laser-induced pitting was associated with measurable structural and optical alterations in two hydrophobic acrylic IOL models. Surface defects alter retinal light distribution, increase forward light scatter, and reduce optical quality, providing a possible optical mechanism that may contribute to postoperative dysphotopsias, although clinical visual symptoms were not directly evaluated in this study. These findings highlight the importance of meticulous laser focusing on the posterior capsule to minimize inadvertent IOL damage and preserve postoperative visual quality. Further investigations combining optical bench analyses with patient-reported visual outcomes are warranted to better define the clinical significance of laser-induced IOL pitting. Full article

Background/Objectives: High accommodative lag and relative peripheral hyperopic defocus during near work have been proposed as potential contributors to myopia progression. Orthokeratology (OK) reshapes the cornea to provide central correction while inducing peripheral myopic defocus. This prospective 12-month study aimed to evaluate longitudinal changes in peripheral refraction, accommodative lag, and axial length (AL) in myopic children treated with OK. Methods: Children aged 7 to 17 years with low-to-moderate myopia were fitted with spherical (CRT™ STD) or toric (CRT™ DA) OK lenses and followed for 12 months. Horizontal peripheral refraction (vector M, J0, J45) up to ±30°, accommodative lag and non-cycloplegic AL were measured. Results: Forty-seven participants completed the study. Mean AL increased from 24.76 ± 0.87 mm at baseline to 24.86 ±0.85 mm at 12 months (p < 0.001). OK induced a stable, symmetrical redistribution of relative peripheral myopic defocus across visits. The toric design showed more consistent significant variations in the J0 astigmatic component across eccentricities. No significant correlations were found between AL elongation and changes in peripheral refraction (p = 0.194) or accommodative lag (p > 0.05) in the overall sample. However, subjects in the lag variation group showed significant AL increases (p < 0.05), while those in the no lag variation group did not (p > 0.05). Conclusions: OK consistently induces a stable pattern of peripheral myopic defocus. While peripheral defocus and accommodative lag do not linearly correlate with global axial growth, accommodative behavior may be associated with individual differences in axial growth. Biometry remains important for monitoring treatment outcomes. Full article

Background/Objectives: To evaluate subclinical structural and functional retinal alterations in clinically normal myopic eyes using optical coherence tomography (OCT) and automated visual field analysis. Methods: This retrospective observational study included 109 patients aged 18–42 years categorized according to spherical refractive component, while spherical equivalent (SE) was calculated to quantify refractive severity. Only the right eye of each participant was analyzed. Patients were categorized into five refractive groups according to spherical refractive component. All participants underwent comprehensive ophthalmologic examination, axial length (AL) measurement, spectral-domain OCT imaging, and standard automated perimetry. Structural parameters included central retinal thickness (CRT) and OCT-derived nerve fiber layer central thickness (OCT-NFCT). Functional assessment included visual field central zone sensitivity (VF-CZ), peripheral zone defect value (VF-PZ), mean deviation/defect value (VF-MD), and square root of loss variance (VF-sLV). Correlation and regression analyses were performed to evaluate relationships among absolute myopia severity, AL, OCT parameters, and visual field indices. Results: Increasing myopia was associated with significant reductions in CRT (p < 0.001) and significant intergroup differences in OCT-NFCT (p = 0.012). A moderate negative correlation was observed between absolute spherical equivalent/myopia severity and CRT (r = −0.5398, p < 0.001), whereas the association with OCT-NFCT was not statistically significant (p = 0.149). Visual field parameters demonstrated significant deterioration with increasing myopia (all p < 0.001). VF-CZ showed a strong negative correlation with myopia severity (r = −0.8545, p < 0.001), whereas VF-PZ (r = 0.8196, p < 0.001), VF-MD (r = 0.8186, p < 0.001), and VF-sLV (r = 0.7606, p < 0.001) demonstrated strong positive correlations. In multivariable regression analysis, BCVA, AL, and absolute SE were independently associated with VF-CZ, whereas age and absolute SE were independently associated with VF-MD. CRT and OCT-NFCT were not independent predictors of visual field outcomes. Conclusions: Clinically normal myopic eyes demonstrate significant subclinical structural and functional retinal alterations. In this cross-sectional dataset, visual field alterations were detectable across refractive categories and appeared to be more strongly associated with axial elongation and myopia severity than isolated retinal thickness alterations. Combined OCT and visual field assessment may be valuable for early detection and monitoring of subclinical retinal involvement in myopic patients. Full article

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in older adults. An important challenge is the recognition of its early asymptomatic stages and the monitoring of its progression, which requires reliable biomarkers. Growing evidence indicates that AMD-related biochemical changes are reflected in the proteome of tear fluid (TF). Although TF is a non-invasive and easily collectable diagnostic material, its proteomic analysis is complex and costly and therefore has limited clinical value. Methods: In this pilot single-center retrospective cross-sectional study, we developed a new method for dry AMD screening based on analysis of nano-differential scanning fluorimetry (nanoDSF) tear protein denaturation profiles (TDPs) within 15 min. The TDPs were recorded in representative groups of dry AMD patients (37% early, 48% intermediate, 15% geographic atrophy), and in control groups, including patients with refractive abnormalities (basic control), other retinal degenerative diseases (diabetic retinopathy, peripheral retinal dystrophy), or TF-affecting conditions (dry eye syndrome). High-dimensional TDP data were processed using unsupervised machine learning followed by k-means cluster analysis. Results: The presented pipeline distinguished AMD from the basic control with 74% accuracy and a sensitivity of 0.81 without relying on prior labels. The specificity of AMD detection was confirmed by its effective differentiation from diabetic retinopathy (72%; 0.74), peripheral retinal dystrophy (79%; 0.76) and dry eye disease (76%; 0.81). Classifying the AMD group from the entire population of other patients yielded an accuracy of 71% and a sensitivity of 85%, with a false-negative rate of only 15%. Conclusions: This study is a proof of concept for the nanoDSF-based approach, which can be considered a fast, cost-effective, and convenient tool for population screening for dry AMD, suitable for use in preventive medicine and public health. Full article

Childhood myopia progression remains a major global public health concern, and spectacle lenses designed to induce peripheral myopic defocus have emerged as a non-pharmacological strategy for myopia control; however, real-world evidence from European populations remains limited. This retrospective observational study evaluated the 12-month real-world effectiveness of cylindrical annular refractive element spectacle lenses in a Turkish pediatric cohort. Children aged 5–15 years who wore myopia-control spectacle lenses from the CARE platform or single-vision lenses were included. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 12 months. The primary outcomes were 12-month changes in SER and AL. Multivariable generalized estimation equations were applied to account for inter-eye correlation and to adjust for age and gender. A total of 168 eyes were analyzed (85 with single-vision lenses; 83 with myopia-control lenses). After 12 months, the myopia-control group demonstrated significantly slower progression than the single-vision group, with mean SER changes of −0.40 ± 0.92 D versus −0.77 ± 0.74 D and axial elongation of 0.17 ± 0.25 mm versus 0.31 ± 0.30 mm, respectively. Treatment group remained a significant predictor of both refractive progression (p = 0.008) and axial elongation (p = 0.003). Age was independently associated with axial length change (p < 0.001), whereas gender was not. These findings provide real-world European evidence supporting the role of defocus-modulating spectacle lenses in pediatric myopia management. Full article

Purpose: To investigate the distribution and trend of corneal parameters in different age groups without corneal diseases. Methods: A retrospective cross-sectional study. We enrolled 2545 patients (5074 eyes) without corneal diseases (mean age 37.0 ± 26.8, range 4–95) between August 2018 and December 2022. This study aimed to analyze corneal refractive power parameters derived from Fourier transform (minimum spherical refractive power (SphRMin), central regular astigmatism (Asti.Central), peripheral regular astigmatism (Asti.Periph), and irregular astigmatism (Irregul)). The differences in these parameters across age groups were compared, and both linear and nonlinear equations were fitted to model the age-related changes. Results: In people without corneal diseases of all ages, the mean values of SphRMin, Asti.Central, Asti.Periph and Irregul were 7.71 ± 0.28, 0.10 ± 0.062, 0.11 ± 0.068, and 0.028 ± 0.019. There are differences in Asti.Central, Asti.Periph, and Irregul among the different age groups (all p < 0.001). SphRMin, Asti.Central, Asti.Periph and Irregul were correlated with age (all p < 0.001). SphRMin increased before 15 years and decreased after 15 years (p < 0.001). Asti.Central increased up to 19 years, decreased between 19 and 60 years, and then increased after 60 years (p < 0.001). Asti.Periph increased up to 18 years, decreased from 18 to 48 years, and then increased after 48 years (p < 0.001). Irregul increased up to 13 years, decreased from 13 to 30 years, and then increased after 30 years (p < 0.001). SphRMin, Asti.Central, Asti.Periph and Irregul were all correlated (all p < 0.05). Conclusions: We report the mean values of corneal refractive parameters obtained by the Fourier transform in patients without corneal diseases at different ages, its changing trend with age, and important inflection points. This has great clinical implications for the diagnosis of abnormal refractive state corneas and the design of ophthalmic surgery. Full article

Myopia prevalence has risen dramatically worldwide, underscoring the critical need for effective interventions to slow its progression. Recent advancements in spectacle lens technology offer promising solutions, demonstrating significant efficacy in controlling myopia. This review critically examines next-generation spectacle lenses for myopia management, emphasizing their optical principles, mechanisms of action, clinical effectiveness, visual performance, compliance, and safety. Spectacle lenses incorporating technologies such as Defocus Incorporated Multiple Segments (DIMS), Highly Aspherical Lenslet Target (HALT), Diffusion Optics Technology (DOT), and Cylindrical Annular Refractive Element (CARE) lenses show a 40–60% reduction in refractive progression and axial elongation compared to traditional single-vision lenses. These lenses utilize optical strategies like simultaneous myopic defocus, peripheral contrast modulation, and controlled aberrations without compromising visual acuity, contrast sensitivity, accommodation, or binocular vision. High wearer compliance is attributed to excellent visual comfort, minimal adaptation issues, and favorable cosmetic appearance. Long-term studies further confirm sustained efficacy and safety profile. Ongoing research aimed at direct comparative trials, extended follow-up, and individualized lens designs will further define the role of these interventions. Collectively, the evidence positions next-generation spectacle lenses as a promising, evidence-based approach that may become an important component of global myopia management. Full article

Visual skills are increasingly recognized as critical to athletic performance, yet it remains unclear whether participation in specific team sports is associated with enhanced visual function. This cross-sectional study compared visual acuity, peripheral vision, stereoacuity, ocular alignment, and refractive error among 52 participants aged 15–56 years: basketball (n = 10), futsal (n = 9), hockey (n = 12), roller derby (n = 9), and non-athlete controls (n = 12). Standardized assessments included best-corrected visual acuity (logMAR), Hirschberg shift, peripheral perception using a tachistoscope, stereoacuity with the Randot^® test, and non-cycloplegic autorefraction. Group comparisons were conducted using ANOVA, post hoc analyses, and regression models adjusted for age. Significant differences were observed only for visual acuity (F(4, 47) = 4.46, p = 0.003, η² = 0.275): non-athlete controls (0.00 ± 0.08 logMAR) and basketball players (0.02 ± 0.05) showed the best performance, while roller derby athletes demonstrated the poorest (0.16 ± 0.12). No significant group differences were found for peripheral vision, stereoacuity, Hirschberg deviation, or refractive error, and the poorer acuity in roller derby remained after adjustment for age. These findings suggest that participation in team sports does not universally confer superior visual function and that static clinical measures may overlook the dynamic visual–motor strategies that underlie athletic performance. Full article

Objectives: Recent studies have shown that highly aspheric lenslets (HAL) are effective in slowing myopia progression. Moreover, research indicates that an enhancement in choroidal thickness might serve as a biomarker for evaluating the efficacy of myopia control treatments. Therefore, this study examined the short-term effects of HAL and full-field +3.00 diopters (D) myopic defocus on sub-foveal choroidal thickness (SFCHR). Design: Prospective experimental study. Participants: Twenty-five participants aged 20–30 (mean 24.56 ± 2.467) years with a refraction error of emmetropia to −5.0 D (mean −2.255 ± 1.514 D). The contralateral non-dominant eye was used as control for each participant. Methods: The participants watched a movie projected at 6 m for 90 min on two separate occasions while wearing HAL or +3 D full-field myopic defocus lenses on their dominant eye. The control eye wore only a single-vision contact lens with the best-corrected distance vision. Three measurements of AL and SFCHR were captured before defocus, and after 60 and 90 min of defocus for both eyes. The main outcome measures were changes in SFCHR and AL over time. Results: Exposure to HAL and +3 D myopic defocus significantly increased SFCHR in the defocused eyes compared to the baseline (p < 0.001). The increase in SFCHR was 6.62 ± 6.32 µm with the HAL intervention and 7.36 ± 8.83 µm with the +3 D intervention. The difference between the two interventions was not statistically significant (p = 0.595). A significant mean difference of 3.176 ± 1.318 µm in SFCHR increase was observed with +3.00 D full-field defocus in the defocused eyes compared to the control eyes over the measurement period (p = 0.020). Conclusions: Short-term exposure to full-field myopic defocus increased choroidal thickness, which was comparable with that observed in peripheral myopic defocus with HAL, although the effect appears less pronounced. Full article

Background: The aim of this study was to assess a corneal remodeling technique using laser asymmetric keratectomy (C-LAK) treatment, and its outcome for keratoconus suspect (KCS) by evaluating corneal regularity. Methods: In this retrospective case–control study, 34 eyes of 20 patients with KCS were studied before and 1 year after L-LAK. This new technique could ablate the original refractive errors, the thicker peripheral cornea, and myopia induced by LAK simultaneously (crescentic customized ablation). Before and 1 year after the operation, the refraction, UDVA, keratometry, and corneal symmetry evaluated as the total corneal central-thickness deviation (SUM) and the distance between the maximum posterior elevation (best-fit-sphere [BFS]) and the visual axis (DISTANCE) were compared. Results: Twenty patients with KCS aged 41.0 ± 13.5 years were evaluated. Preoperatively, the spherical equivalent (SE, D) −2.57 ± 1.64 and the Kmax was +48.21 ± 0.89 D. At 1 year postoperation, 79.4% (27/34) of the eyes had a UDVA of 20/20 or better. The SE and Kmax (D) were −0.40 ± 0.43, 44.47 ± 1.38 (Ps = 0.001, respectively), the corneal symmetry was better due to the decrease in the SUM (µm) (from 141.88 ± 48.24 to 66.21 ± 15.22) and DISTANCE (mm) (from 1.11 ± 1.14 to 0.46 ± 0.40). No postoperative corneal ectasia appeared. Conclusions: L-LAK made the corneas symmetric by decreasing the SUM and DISTANCE, decreased focal steepening, and showed good 1-year postoperative outcomes. Full article

Objective: This study aims to examine the anterior chamber structure and related factors in 8-year-old children based on data from The Yamanashi Adjunct Study of the Japan Environment and Children’s Study (JECS). Methods: A total of 709 children aged 8 years (350 boys and 359 girls) who participated in the JECS Adjunct Study were included. The right eyes were primarily used for measurements. Optical Coherence Tomography (OCT) was utilized to scan the anterior chambers of the participants’ eyes. The following parameters were measured: Angle Opening Distance (AOD500, 750), Trabecular Iris Space Area (TISA500, 750), Anterior Chamber Angle (ACA500, 750), Peripheral Iris Thickness (IT500, 750), and Peripheral Corneal Thickness (PCT500, 750). The relationships between anterior chamber structure, axial length (AL), spherical equivalent (SE), logMAR (without correction), and body height were analyzed. Results: A significant negative correlation was found between SE and ACA (500: coefficient = −0.19; 750: −0.24), AOD (500: −0.19; 750: −0.24), and TISA (500: −0.17; 750: −0.23) (p < 0.001). Conversely, a significant positive correlation was observed between AL and ACA (500: 0.22; 750: 0.26), AOD (500: 0.25; 750: 0.30), and TISA (500: 0.24; 750: 0.29) (p < 0.001). Boys exhibited a longer AL (boys: girls = 23.30 ± 0.76 mm; girls = 22.79 ± 0.72 mm) and greater CT (500: boys = 812.82 ± 51.94 mm; girls = 784.48 ± 51.81 mm; 750: boys = 776.01 ± 48.64 mm; girls = 751.34 ± 49.63 mm) compared to girls (p < 0.001) despite no significant difference in body height. CT and IT showed no correlation with AL or SE, and visual acuity had minimal correlation with IT and CT. Conclusions: In our cohort of eight-year-old children, the anterior chamber angle structure correlates with ocular structures and refractive error, revealing notable differences between boys and girls. Full article

Purpose: The aim of this study was to compare the one-year efficacy of three spectacle lens designs, highly aspherical lenslets (HALs), horizontally asymmetric peripheral defocus (HAPD) lenses, and standard single vision lenses (SVLs) in slowing myopia progression in school-aged children. Methods: In this prospective, non-randomized study, 57 children, aged 8–17 years, were grouped based on the type of lenses worn: HAL (n = 16), HAPD (n = 21), or SVL (n = 20). Comprehensive ophthalmologic examinations were performed at baseline, 6 months, and 12 months. Outcome measures included spherical equivalent refraction (SER), spherical refraction (SR), cylindrical refraction (CR), and axial length (AL). Data were analyzed using non-parametric tests with significance set at p < 0.05. Results: All groups showed some progression in SER and AL over 12 months. The HAL group demonstrated the smallest median SER change (−0.3 D), compared to HAPD (−0.5 D) and SVL (−0.4 D), though group differences were not statistically significant (p = 0.111). Axial elongation was significantly lower in the HAL group (0.1 mm, IQR: 0.0–0.2 mm) compared to HAPD and SVL (both 0.2 mm, p < 0.0001). CR remained stable in all groups, with no clinically meaningful changes. The HAPD groups showed no advantages over SVL in any parameter. Conclusions: Among the three lens types studied, HAL lenses were the most effective in reducing both refractive and axial myopia progression over 12 months. These findings support their use as a reliable intervention in pediatric myopia control. Full article

Background/Objectives: Peripheral retinal degenerations (PRDs) are structural anomalies in the outer regions of the retina, typically emerging in adolescence and early adulthood. Early detection is crucial, as some PRDs can lead to sight-threatening complications, such as retinal detachment, if left unmanaged. Due to a paucity of research regarding PRDs and their association with axial length (AL) and refractive error (RE) in young Australian adults, this study aimed to investigate the prevalence of PRDs in this population and establish whether AL and RE could help predict the likelihood of PRD occurrence. Methods: A cross-sectional study was conducted on a mixed population (n = 221) of Australian adults aged 18 to 40. Demographic data, RE, AL, and a series of ultra-widefield (UWF) retinal images were obtained from participants’ undilated eyes using the Zeiss Clarus^TM 500. Results: The overall PRD prevalence was 8.15% (n = 442 eyes). Binary logistic regression revealed that a longer AL was a more significant factor in increasing the risk of PRD development across all myopia classifications compared to emmetropia than RE. The likelihood of a PRD was 50% at an AL of 26.9 mm and −6.50D of myopia, and 95% at 29.6 mm and −11.00D. Conclusions: PRD prevalence was lower than reported in other global studies, perhaps reflecting the diverse ethnic makeup of the cohort. While our study supports the conventional understanding that longer ALs, and high myopia are key risk factors for developing a PRD, it also provides new insights into the likelihood of detecting a PRD at a given AL or RE in a mixed population. This information is crucial for eye care practitioners, enabling early identification of at-risk individuals and screening for PRDs that may increase the risk of retinal detachment. Full article

Background/Objectives: The accurate measurement of corneal epithelial thickness (CET) and pachymetry is essential for diagnosing and managing corneal conditions such as keratoconus and for optimizing outcomes in refractive surgery. This study aimed to evaluate the agreement and repeatability of measurements between two anterior segment optical coherence tomography (AS-OCT) devices—OCT REVO FC 130 and Optovue RTV XR Avanti—in healthy individuals. Methods: This prospective, cross-sectional, observational study included 53 healthy participants. High-quality scans were performed using both devices by two trained operators. Agreement between devices was assessed using Bland–Altman analysis and Deming regression, while repeatability and reproducibility were evaluated through intraclass correlation coefficients (ICCs) and test–retest variability (TRT). Results: Both devices demonstrated high repeatability and reproducibility across central and peripheral zones, with ICCs exceeding 0.98 for central pachymetry and stroma measurements. Repeatability and reproducibility were slightly higher for the OCT REVO FC 130 compared to the Optovue RTV XR Avanti, particularly for central measurements. Bland–Altman analysis revealed a mean difference near zero with narrow limits of agreement for most parameters, indicating strong inter-device agreement. Variability in CET measurements was higher, potentially due to the inclusion of tear film in OCT segmentation. Conclusions: The OCT REVO FC 130 and Optovue RTV XR Avanti offer comparable reliability and precision for corneal thickness measurements in healthy eyes, with the REVO demonstrating slightly better repeatability and reproducibility. These findings support the use of either device in clinical practice and research for corneal assessment. Full article