Understanding pictures and drawing by the visually challenged

Richard Baldwin is a Professor of Computer Information Technology at Austin Community College in Austin, Texas, USA.

Prof Baldwin first became involved in the issues confronting blind students when a blind-from-birth student named Amanda Lacy enrolled in an object-oriented programming course that he taught. Ms. Lacy successfully completed that course and two others that he taught. Knowing that she was a very good student, he became concerned upon learning that she was having difficulty in a physics course. Being an engineer by training, he volunteered to tutor her in the physics course. This led to the two of them spending about four hours per week in tutoring sessions for the past couple of years.

Prof. Baldwin quickly learned that neither the physics lectures nor the physics textbook were accessible to Ms. Lacy. She had stopped attending lectures because she was unable to follow along. The electronic copy of the textbook that she had been provided contained hundreds of equations and pictures that were incompatible with her assistive tools: a screen reader and a Braille pad.

Prof. Baldwin began by authoring an online physics tutorial titled “Accessible Physics Concepts for Blind Students” (available here) to help Ms. Lacy through the first semester physics course. Although it took more than one semester for her to complete the course, she did complete it and made an A in the course.

While authoring the online physics tutorial, Prof. Baldwin came to realize that unlike sighted students, blind students were unable to draw and submit graphical homework assignments, such as vector diagrams with any accuracy. Although there are several outstanding free drawing programs available on the web, all or at least most of them require the user to manipulate a mouse. Therefore, they are not accessible to blind students. As a result, Prof. Baldwin wrote a drawing program named SVGDraw01 that is fully accessible for blind students. The theme for this program is “if you can imagine it, you can draw it.” The program is freely available for downloading here.

Later, Prof. Baldwin decided to tackle the inaccessible pictures and diagrams in textbooks. One technique that blind students can use to understand the content of diagrams and pictures is to emboss them using any of several available embossing techniques. Basically, embossing an image means to create a tactile document containing raised lines or raised dots that describe the salient features of the image.

Originally, Prof. Baldwin hoped to make it possible for blind students to emboss their own textbook images. So far, that is still a dream for several reasons. The most common format of electronic textbook is the Adobe pdf format. Without the purchase of expensive software (and probably not even then), it is impossible for a blind student to successfully extract most of the images in a pdf file intact. While there are numerous programs available that claim to extract the images from pdf files, in most cases each image ends up in several different files that must be reassembled for embossing.

After coming to that realization, Prof. Baldwin decided to direct his attention to the many technical issues that make it very difficult for even a sighted person to convert a typical bitmap file into an embossed image that is meaningful to a blind student.

There are about 16-million good reasons why the embossed version of a full-color bitmap image often fails to produce satisfactory tactile results. Begin with the fact that the embossing process often discards the information content from more than 16-million colors ending up with what is effectively black and white, or possibly black and white with two or three shades of gray in between, depending on the embossing method.

Follow the loss of color information with the fact that, unless the original image is very small, the spatial sampling is probably reduced by a factor of 5 to 10 in the embossed image with little or no consideration being given to frequency aliasing that occurs in a brute-force spatial re-sampling process.

The bottom line is that it is very difficult to emboss full-color bitmap images and end up with high-quality tactile images.

Different embossing methods produce different physical outputs. Many of the older Braille printers have a graphics mode that allows pictures to be displayed by raising a subset of individual Braille dots to a standard height. The dot separation on those printers ranges from ten dots per inch to perhaps 17 dots per inch. Compare this with the typical 96 dots per inch of an image on a computer monitor and you will understand the issues regarding spatial sampling mentioned above. When the image is re-sampled down to a level that is consistent with the number of dots in an embossed image, much of the detail simply disappears.

Newer Braille printers have dot resolutions of up to 25 dots per inch, which is still very low in comparison with onscreen images. Some of them can also raise dots to variable heights to simulate gray scale imaging. Although there is no published information as to how many “gray levels” can be understood by an experienced blind user of an embosser with variable dot height. Prof. Baldwin estimates that such a user can probably recognize black, white, and perhaps three gray levels in between.

Typical embossing techniques either convert the 16 million colors in a bitmap image to black and white through the application of a single intensity threshold, or convert the 16 million colors to black, white, and several shades of gray through the application of several intensity thresholds. The result is that many colored pixels that are clearly distinguishable in the original image become indistinguishable in a four or five-level gray scale version of the image. Detail that depends on the recognition of different colors simply disappears. Therefore, many of the salient features of the image are often lost in the embossing process.

Prof. Baldwin has developed a mathematical image processing algorithm which, in many cases, preserves much more detail than the typical intensity-based gray scale approach. This algorithm converts the original image to either black and white or black and white plus three levels of gray, based not on absolute colors, but rather based on changes in color. The result is that images processed using this algorithm tend to have black outlines that define the salient features of the original image. In many cases, this produces more meaningful embossed images than the typical approach based on the direct conversion of color intensity to gray scale.

Prof. Baldwin’s solution to the spatial sampling issue is to make it possible in his programs to subdivide an enhanced image into panels, which can be individually embossed and then assembled into a poster-size tactile image. While not an ideal solution, short of developing an embossing method with an improved dot resolution, that is the best he has to offer.

Prof. Baldwin and Ms. Lacy have packaged the image enhancement algorithm in a free computer program designed specifically for use with embossers that support a single dot height and accept Duxbury graphics files in the .sig format as input. This program is named JpgToSig-A-01. It accepts any of several different bitmap image files as input and writes the enhanced version of the image into an output sig file. While it is possible for blind students to use the program, it is primarily targeted for use by teachers and others who assist blind students.

Prof. Baldwin has also packaged the algorithm in a free computer program named ShapeExtractor02 that is designed for use with any embossing method that can accept jpeg image files as input. This program accepts any of several different bitmap image files as input and writes the enhanced version of the image into an output jpeg file. Both of these programs can also be freely downloaded here along with the program named SvgDraw01. Note that all three of these programs require the Windows operating system.

These programs can be used with bitmap images from any source. However, in the world of education for blind students, the images that need to be embossed are often contained in electronic pdf versions of course textbooks. Prof. Baldwin uses the following procedure to assist Ms. Lacy in embossing images from her physics textbook.

1. Open the pdf file in the free version of Adobe Acrobat and locate the image of interest.
2. Use the zoom capability of Acrobat to make the image as large as possible while still fitting on the screen.
3. Hold down the shift key and press the Print Screen key. This saves the current screen image on the clipboard.
4. Open any of many available image editing programs such as the program named Lview Pro.
5. Paste the clipboard into the image editor.
6. Crop the image out of the surrounding material retaining only the material necessary to contain the image.
7. Save the cropped image.
8. Open either JpgToSig-A-01 or ShapeExtractor02 and follow the usage instructions to convert the image to the desired black and white or black, white, and gray format.
9. Save the enhanced image in an output file and emboss it using the embossing method of choice.

Ms. Lacy is now enrolled in her second physics course and plans to complete several more.

- As told by Prof Baldwin

A Tale of One Aim

It began at the age of four when my teacher, Mrs. Ireland noticed that I bend too much over books and copies to read and write. My parents were advised to have my eyes tested, and it was then told to us that I had an incurable genetic disorder called Retinitis Pigmentosa, which could lead me to total blindness.

My sight deteriorated fast. After failing in the half yearly exams of class seven, I had to leave my beloved school – La Martiniere Boys. That place is so dear to me even today, that I still feel a sweet pain for leaving it. I used to cry to get back to that school, and often had dreams of continuing to study there. I terribly missed my teachers, my friends, the atmosphere and the building.

Living at home was not so easy. I used to hide from my neighbors because everyone kept asking if I had decided to leave school and studies. I was filled with shame. If I was caught at home during the school hours, I made all kinds of pretexts. But even though I tried my best, my neighbors eventually got to know the truth. I was considered a liar, a spoilt chap, a bad influence, and an ignorant. I was strictly chastised that quitting studies was bad, but no one ever told me how I could study with low vision.

I felt so shamed for having left school that I started avoiding relatives and neighbours, and confined myself at home. When I was forced to meet a relative, I went in front of him with an artificial smile and empty confidence, all the while fearing that my ignorance and sightlessness could soon be caught.

Music enters my life

It was then that we discovered Mr. Tej Singh Tak, who was blind and taught vocal music at Bhatkhande Music Institute (Deemed University). We talked with him, and it was decided that I would learn singing. It wasn't that I was good at singing. I liked listening to songs, but making a career in that field seemed a horrible idea to me.

I started learning vocal music, though I kind of despised it. Mr. Tak indicated, and another blind teacher advised me with good intentions, that singing would be a difficult task for me. People tried to tell me that such a talent is God’s gift, and that I should try to learn instrumental music instead. But surprisingly, in spite of the negative vibes, I had started to enjoy singing. I made up my mind to practice and be a good singer.

In pravashika (the first class), I was the only one to pass with third division; some got the second division, but most students got the first.

At this time, I also started playing the harmonium and the Spanish guitar. Saving from money meant for buying clothes for Eid, I bought a tampura and practiced singing. My teachers started feeling that I was showing some improvement, and in prathama, I got the second division. For a few months, I learnt guitar from a teacher, and then started teaching it back to him. I was hugely intoxicated with light music, and made up my mind to become a playback singer. My aim was Bollywood.

Mr. Tak made me recognize the six Braille dots, and embossed English letters so that I could learn Braille. My private education went on, but I focused mainly on becoming a Bollywood singer. My first opportunity of singing on stage was at a marriage party. The orchestra director told me that my singing was horrific. Later, I participated in a singing competition held in Lucknow. That too was termed horrific, though much better than the previous performance.

My singing practice continued. My family members and neighbors were troubled by my practicing before sunrise. I kept changing my place of practice, but the complaints kept flowing. A boy once told me that as he was going out during the wee hours, he had heard my riaz and had run away with fright, thinking that someone had got murdered!

The sound of success

After a few months, I took part in another singing competition, and this time, I was selected for the final round. It was a huge achievement for me; the person who read my name from the list even mocked at my blindness, but I just patted him and jumped with joy. As I got on to the stage in the final round and sang the first line, the audience started clapping, which continued to cheer me throughout the song. I received a medal in that competition!

I participated in several singing competitions after that, and received prizes. My name started featuring in the newspapers. In madhyama, I scored 80 per cent in the practical, which were the highest in Bhatkhande. Mr. Tak was proud of me, and another teacher actually started sending students to me so that I could teach them singing.

Once, a neighbour of mine whom I call Baba since my childhood, asked me to sing at a function. I went with my guitar and karaoke cassette. I entered the auditorium, but had to come out because of the hall, because of the loud noise. Loud noise has always troubled me. Sometimes, I had to jab cotton pieces in my ears when I sang on stage.

Observing me step out of the auditorium, Baba got worried. He had spoken very highly of me to everyone. He thought that I was nervous about singing in front of the audience. I assured him, “Do not worry. The moment they announce my name, I will be on the stage. And I will certainly give my best performance.”

I sang on the music of karaoke cassette. Baba’s wife wept with joy to see the audience uncontrollably cheering. One of the directors of Lucknow Durdarshan (local TV station) told Baba that she wanted me to sing songs of sugam sangeet on television. I could not meet her and some others because I had left for home since I felt unwell. Excessive noise had again worked cruelly on my ears.

The Rise and the fall

People told my parents that I was an ‘out-of-control’ boy. I too felt that I was moving faster than I had expected, and that that day was not far when I would win a Filmfare Award for singing! I turned my attention to locating people who could help me release an audio album. Those days, I was so happy that my dream appeared to be unfolding into reality in a dreamlike manner! When you get the feeling of rushing towards success, the pressure of excitement and joy becomes really difficult to handle.

My father felt that I would destroy myself, so deep was I involved in reaching to my goal. I had bitter arguments with him several times, which I deeply regret now, but then, I had fancied that music for me was what water is to fish, or the soul is to the body. If you had ever seen the manner I argued with my father those days, you would have certainly hated me. He was only telling me to reduce the time I gave to singing, and devote more time to studies. But I did not realize that I had become selfish for my aim. If I had not been drunk in the passion of ‘success’, I would have certainly obeyed him for my own good. I had become a selfish and helpless slave to the passion for singing.

Before getting on the stage, I used to bombard my brain with all the negativity that I had faced. That was my way of bringing out the best in me. The overflowing enthusiasm and sullen pride triggered by this bombardment used to merge with the intoxication of music, making it a fantastic combination, making me feel like the ‘King of Kings’. Stage-fright only pepped up my adrenaline! I knew how difficult it is to make a single person clap on your singing ability – and here I was, with hundreds adoring my singing talent. I was able to make them dance; I was able to make them cry.

The cheers of the audience robbed me of my peace and bliss. I do not know when I actually slipped into the dark pool of arrogance. The seed of arrogance was sown, and a nasty plant had started to sprout. My friends tried to tell me about my arrogant ways, but I was beyond all that. I was rendered ignorant and blind not by Retinitis Pigmentosa, but by an inflamed ego.The deceptive feeling of being “the King of Kings” was like the effect of a dreadful drug.

The new bright change

Luckily, I managed to grasp the seriousness of the situation. I realized that I was hurting people who loved me, who cared for me. I had rebelled against my own father, who had nothing but the best intentions for me in his advice, and was arrogant to my sweet companions who truly wished me well.

I decided to quit singing, faster than what it takes for an eye to blink. It was a cold evening and the spring of my life when I was coming out of Bhatkhande, knowing well that I would never return to it. The setting of the sun seemed to raise fresh energy into my life. I knew nothing about my future, but I felt the tides of joy that one feels when he stops being susceptible to negative emotions.

A stream, when gushing forth from within a mountain, does not seem to know its path. It just knows that it will carve a path for itself.

Now, as the burden of ambition and the darkness of ego had vanished, everything was new and clear to me. I was sure that life had not stopped for me; rather, it was at the edge of a new, bright change. What that change was and what I will do was hidden by time. I had entered adulthood, but I enjoyed the bliss of childhood. I was free; my mind was clear, I could see the world with open eyes and I could feel that my heart wished to tell me something sweet.

---

Shadab Husain, Lucknow, India, with a little editorial help from Ms Hema Vijay, Chennai, India.

The Hero

That Monday morning, we were going for an interview in a multinational company. You probably know how excited, happy and nervous freshers are on their first interview.

Our batch consisted of five students, and almost all of us were quite bright and sharp. We had demonstrated remarkably well at computers and had sharpened our soft skills in the personality development course which was designed for us. Our teachers at the Indian Confederation for the Blind used to say that our batch is the best; we all have extraordinary talents and skills.

I was confident that I will give my best performance. The same spirit was in Alice, Meena and Ritu. But Vibhore did not seem to have this feeling. He was the only student in our batch who had only studied up to matriculation, otherwise we all were graduates. More to it, his English communication too was not so good.

We reached the interview venue a little before time. The human resources person, who arrived late in the interview room, greeted us warmly. He humoured with us to make us feel comfortable, and it did alleviate our nervousness to a certain extent. He inquired our names, and then asked whether we wanted to be interviewed in a group or separately. We decided to have a group interview.

Alice was the first one to be asked the typical interview question: “Tell me something about yourself.” She stammered in the beginning, but once she got into the flow, she went on to tell about her education, hobbies and achievements, which were pretty impressive.

Meena was asked to tell her achievement. “I feel that the greatest achievement of my life is that I am happy and undeterred despite my visual impairment. I have learnt how to work against odds, and this makes me feel that I can achieve a lot in life.”

This answer of Meena earned praises from the HR and we too appreciated it.

Ritu, on being asked her weakness, said that “I feel that I am unduly passionate about work. Sometimes this passion compels me to do more than I feel I have the stamina of doing.”

It impressed the HR probably due to the genuine spirit with which it was spoken.

Now it was my turn. “How do you pronounce it {Ghazenfar}?” inquired the HR, trying to take my name looking at my CV. I pronounced my name and tried to clearly emphasize each syllable and vowel. “G-H-A-Z-E-N-F-A-R.” The HR was still unable to pronounce my name, and preferred to address me by my second name, Khan.

I was asked to tell about any unusual event of the recent past. I told how we celebrated the birthday of one of our friends. “We did not wish him for the entire day because we had planned to cut the cake on his bike. That poor guy was worried to think that we don’t remember his birthday. But we wanted to give him a surprise, and that could have only happened after our classes, so we waited till the evening.” “A creative idea – cutting the birthday cake on a bike!” said the HR, appreciably.

Vibhore’s turn came. He too was asked to tell about an unusual incident. Instead of his cheerful expressions, which had impressed many, his face wore a dull look due to nervousness. He tried to speak, but neither his grammar nor his pronunciation were good at all. He stammered, and abruptly halted in the middle – probably feeling how poor his performance is. The HR, who had a remark for all of us, seemed to feel it unnecessary to say anything for Vibhore. I felt sorry for him, and could not properly enjoy the high appreciation I had received by the HR. 

All of us were offered jobs. Well, everyone, except Vibhore.

As we came out, I was thinking hard how to encourage Vibhore, when I heard a cheerful voice calling my name from behind, “Ghazenfar! You have cracked the thing!”

It was Vibhore. He had brought refreshments for all of us to celebrate our victory. I knew that his joy was caused neither due to frustration, nor was it to kill the sadness of his failure. The life in his heart had caused it. His never-give-up spirit had made him so happy. And I must confess here that I felt jealous to see his happy state of mind, despite his failure at the interview. I was able to sense the same jealousy in the shocked expressions of all the job-getters. I got highly inspired by him and craved to get his positive energy.

Vibhore had an uncommonly courageous heart throbbing in his chest. Such people never give up, because they focus on the real, larger picture of life. Failing in interviews or examinations are small matters for them. They know that this world offers so many more opportunities that failing in a few fields would not be able to deter them. Getting sad over a failure is pretty natural. But such people soon overcome their sadness, and keep going ahead.

Now Vibhore runs two booming petrol pumps, has three cabs running in a company and few of the employees under him earn quite like us. But he could never clear an interview.

Tell me who is the hero?

-----
Shadab Husain works in the front office at Chhatrapati Shahuji Maharaj Medical University, Lucknow. He has an MA in English literature, and has pursued a diploma in computer applications as well as a personality development course. He also writes a blog on personality development and improving English at PersonalityAndEnglish.blogspot.com.

Implanted neurons fuse with pre-existing brain wiring in the lab

Among the many hurdles to be cleared before human embryonic stem cells can achieve their therapeutic potential is determining whether or not transplanted cells can functionally integrate into target organs or tissues.

Writing in the Proceedings of the National Academy of Sciences (PNAS) , a team of Wisconsin scientists reports, in a study funded by the US National Institutes of Health, that neurons, forged in the lab from blank slate human embryonic stem cells and implanted into the brains of mice, can successfully fuse with the brain's wiring, and both send and receive signals.

Neurons are specialized, impulse conducting cells that are the most elementary functional unit of the central nervous system. The 100 billion or so neurons in the human brain are constantly sending and receiving the signals that govern everything from walking and talking to thinking. The work represents a crucial step toward deploying customized cells to repair damaged or diseased brains, the most complex human organ.

"The big question was can these cells integrate in a functional way," says Jason P. Weick, the lead author of the new study and a staff scientist at the University of Wisconsin-Madison's Waisman Center. "We show for the first time that these transplanted cells can both listen and talk to surrounding neurons of the adult brain."

The Wisconsin team tested the ability of their lab grown neurons to integrate into the brain's circuitry by transplanting the cells into the adult mouse hippocampus, a well-studied region of the brain that plays a key role in processing memory and spatial navigation. The capacity of the cells to integrate was observed in live tissue taken from the animals that received the cell transplants.

Weick and colleagues also reported that the human neurons adopted the rhythmic firing behavior of many brain cells talking to one another in unison. And, perhaps more importantly, that the human cells could modify the way the neural network behaved.

A critical tool that allowed the UW group to answer this question was a new technology known as optogenetics, where light, instead of electric current, is used to stimulate the activity of the neurons.

"Previously, we've been limited in how efficiently we could stimulate transplanted cells. Now we have a tool that allows us to specifically stimulate only the transplanted human cells, and lots of them at once in a non-invasive way," says Weick.

Weick explains that the capacity to modulate the implanted cells was a necessary step in determining the function of implanted cells because previous technologies were too imprecise and unreliable to accurately determine what transplanted neurons were doing.

Embryonic stem cells, and the closely related induced pluripotent stem cells can give rise to all of the 220 types of tissues in the human body, and have been directed in the lab to become many types of cells, including brain cells.

The appeal of human embryonic stem cells and induced pluripotent cells is the potential to manufacture limitless supplies of healthy, specialized cells to replace diseased or damaged cells. Brain disorders such as Parkinson's disease and amyotrophic lateral sclerosis, more widely known as Lou Gehrig's disease, are conditions that scientists think may be alleviated by using healthy lab grown cells to replace faulty ones. Multiple studies over the past decade have shown that both embryonic stem cells and induced cells can alleviate deficits of these disorders in animal models.

The new study opens the door to the potential for clinicians to deploy light-based stimulation technology to manipulate transplanted tissue and cells. "The marriage between stem cells and optogenetics has the potential to assist in the treatment of a number of debilitating neurodegenerative disorders," notes Su-Chun Zhang, a UW-Madison professor of neuroscience and an author of the new PNAS report. "You can imagine that if the transplanted cells don't behave as they should, you could use this system to modulate them using light."

Source

Editorial note: Outcome from this research will have a major role to play in retinal diseases, since retina is considered to be a part of the brain, and most stem cell treatments have not been successful due to issues with connectivity of the newly formed retinal cells derived from stem cells, with the functional ones that preexist in the retina. 

Of disclosing ‘disability’ before marriage

There was a time when my mother and sister were searching a bride for me. I had insisted to have my visual ‘disability’ (as others call it) be totally disclosed. People initially showed interest and willingness in my proposal, but the moment my Retinitis Pigmentosa-caused blindness was disclosed, either they did not carry the issue further or politely tendered their refusals.

My parents and sister used to feel sorry for this, and they found it difficult to tell me that I again am being refused for the fear that I will get disheartened. But I had not committed a guilty or shameful act due to which I was facing rejections, so I saw no reason to get disheartened. Indeed, the fact that people were interested in me until my blindness was disclosed was a positive point for me. I have not caused my blindness; it is caused due to reasons beyond my control, then why to feel sorry over it? Yet, I must confess that sometimes I used to feel dejected, but there was light at the end of the tunnel.

We had a very old friendship with a family. They used to frequent us often, and once all of a sudden my mother kept my marriage proposal to them. They gladly agreed, the mother of my supposed wife merrily telling us “What is the use of asking? My daughter is yours, we know your son, he is our child, everything is settled.”

Both the families came in the mood to have a great celebration. Marriage celebrations or their preparations seem to be so divine that we feel as if everyone, even our bloodthirsty enemies, are loving and blessing us in their hearts. The noteworthy thing was that we had visited each other so much that it was clear that they know about my blindness. Moreover, my sister too has RP, and they had helped her often. Yet my sight problem was impressed upon them. But they just did not listen to us and even told my sister not to talk about that issue again as if it was hurting them.

Marriage is a big thing. Everything was clear but I felt some uneasiness and requested to talk with the girl because I did not want to take chances.

We went to meet them. It turned out that they were not taking my sight problem seriously because they were thinking that I have enough sight to do my work on my own. For instance, they knew that I work on computers and move around the city and out of the city independently (at the time these talks were taking place I was out of station). But the astonishing thing was that they could not realise that in the course of time I have become blind.

I told her mother point-blank: “I can only see light. I am looking towards your face because of your voice. I use screen reading technology to work on computers. And I use a cane when I walk alone. I cannot see.”

She gave a pause. That pause clearly expressed that she was broken. (Later, I came to know from my mother that her hands were shaking at that time.) Then I talked with the girl who had already known about the new condition I was in. She sounded perplexed and disinclined.

Their reaction, though, was normal. Anyone would have reacted in a similar manner after knowing about my blindness. My marriage date was to be fixed, but now they needed time and told us that they were unaware that I had lost my sight. I thought that the game was over.

But I was wrong.

Days passed. One good evening, the mother of the girl-who-could-be-my-wife came to our home and started showering praises on me. She talked to me in a tearfully sympathetic tone, though I had not needed it. Apologising from her expressions and tone, she told us that her daughter was not willing to marry me. I was thankful because if this condition had disclosed after marriage, I would have been in great trouble.

At my home, I gave a small party to my friends, and called it ‘In the name of my cancelled marriage’! It was meant to truly celebrate life; it was not one of those Bollywood parties in which bottles are uncorked, there is false enjoyment all around, and the main character ineptly tries to forget his grief in the make-believe. Thankfully, we really enjoyed our party, and since my room is quite separated, we made a lot of noise until the early hours of the morning.

Days passed. Wham! The mother of   the girl-who-could-be-my-wife told us that her daughter wants to marry me! She was deeply moved by that honesty stuff. Earlier too, that delicate creature had cried and prayed for me a lot, on hearing that I have become blind. Her family members, too, had prayed and cried, and now the girl was willing to marry me. It was a U-turn!

Can you even guess what happened after that? Celebrations, excitement, religious and cultural rituals... no, nothing of the sort.

I was not very impressed with prayers and tears. (Though I always beg for God’s mercy and crave for prayers of His creations.) I had earlier told my sister that they have the right to reject me, but acceptance after rejection will not affect me.

I remained a bachelor.

I started to train myself to lead an unmarried life. I found many people (including two blind men) who were very sufficiently leading a lonesome life and asked myself: “If they can do it, why cannot I?”

Living alone is difficult, but not impossible. Loneliness humbles you, brings forth your good qualities and teaches you how to be happy in need. It is a lovely teacher which urges you to be independent of all except God.

I was not pessimistic to adopt such an approach; I only tried to be practical. Had I been pessimistic, I would have told my family members not to search a bride for me because “I want to live alone.” Besides, I have a small rule of life, which is to try to be happy in an unnatural or adverse situation, but never to willingly prolong or embrace it. True, bearing pain patiently brings forth our good qualities, but this does not mean that we don’t take steps to eliminate it.

I lived and enjoyed the present without caring about the future. I pursued my hobbies (reading, writing and travelling) and tried not to miss a chance to improve myself.

Days passed. The final shot readers! One fine evening I was introduced to a girl by my mother and sister to whom I told each and everything about my sight. It is close to midnight now, and guess what....that girl is with me because thankfully she is my wife!

-----
Shadab Husain works as a receptionist at Chhatrapati Shahuji Maharaj Medical University, Lucknow. He has an MA in English literature, and has pursued a diploma in computer applications as well as a personality development course. He also writes a blog on personality development and improving English. To visit his blog, click PersonalityAndEnglish.blogspot.com.

FDA approves Eylea for patients with Age-related Macular Degeneration

Regeneron Pharmaceuticals, Inc. has announced that the U.S. Food and Drug Administration (FDA) has approved Eylea (aflibercept) Injection, known in the scientific literature as VEGF Trap-Eye, for the treatment of patients with neovascular (wet) Age-related Macular Degeneration (AMD) at a recommended dose of 2 milligrams (mg) every four weeks (monthly) for the first 12 weeks, followed by 2 mg every eight weeks (2 months).

The approval of Eylea was granted under a Priority Review, a designation that is given to drugs that offer major advances in treatment, or provide a treatment where no adequate therapy exists.  This approval was based upon the results of two Phase 3 clinical studies.  In these studies, Eylea dosed every eight weeks, following three initial monthly injections, was clinically equivalent to the standard of care, Lucentis® (ranibizumab injection) dosed every four weeks, as measured by the primary endpoint of maintenance of visual acuity (less than 15 letters of vision loss on an eye chart) over 52 weeks.  The most common adverse reactions (frequency of 5% or more) reported in patients receiving Eylea were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and increased intraocular pressure.  The adverse event profile was similar to that seen with ranibizumab.

As per the experts, Eylea offers the potential of achieving the efficacy that the ophthalmic world had come to expect from the current anti-VEGF agents, but with less frequent injections and no monitoring requirements. This, as per these experts, may reduce the need for costly and time-consuming monthly office visits for patients and their caregivers.

About Eylea™ (aflibercept) Injection:

Vascular Endothelial Growth Factor (VEGF) is a naturally occurring protein in the body.  Its normal role in a healthy organism is to trigger formation of new blood vessels (angiogenesis) supporting the growth of the body's tissues and organs.  However, in certain diseases, such as wet age-related macular degeneration, it is also associated with the growth of abnormal new blood vessels in the eye, which exhibit abnormal increased permeability that leads to edema. Scarring and loss of fine-resolution central vision often results.  

Eylea, known in the scientific literature as VEGF Trap-Eye, is a recombinant fusion protein, consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to the Fc portion of human IgG1 and formulated as an iso-osmotic solution for intravitreal administration.  Eylea acts as a soluble decoy receptor that binds VEGF-A and placental growth factor (PlGF) and thereby can inhibit the binding and activation of these cognate VEGF receptors.

Eylea is indicated for the treatment of patients with neovascular age-related macular degeneration (wet AMD).  Eylea is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.

The recommended dose for Eylea is 2 mg administered by intravitreal injection every four weeks (monthly) for the first 12 weeks (3 months), followed by 2 mg once every eight weeks (2 months).  Although Eylea may be dosed as frequently as 2 mg every four weeks (monthly), additional efficacy was not demonstrated when Eylea was dosed every four weeks compared to every eight weeks.

There is a potential risk of arterial thromboembolic events (ATEs) following use of intravitreal VEGF inhibitors, including Eylea, defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause).  The incidence of ATEs with Eylea in clinical trials was low (1.8%).

Serious adverse reactions related to the injection procedure have occurred in less than 0.1% of intravitreal injections with Eylea and include endophthalmitis, traumatic cataract, and increased intraocular pressure.

About the VIEW 1 and VIEW 2 Clinical Studies:

The safety and efficacy of Eylea were assessed in two randomized, multi-center, double-masked, active-controlled studies in patients with wet AMD.  A total of 2412 patients were treated and evaluable for efficacy (1817 with Eylea) in the two studies (VIEW 1 and VIEW 2). In each study, patients were randomly assigned in a 1:1:1:1 ratio to one of four dosing regimens: 1) Eylea administered 2 mg every eight weeks following three initial monthly doses Eylea 2Q8); 2) Eylea administered 2 mg every four weeks Eylea 2Q4); 3) Eylea 0.5 mg administered every four weeks Eylea 0.5Q4); and 4) ranibizumab administered 0.5 mg every four weeks (ranibizumab 0.5Q4).  Patient ages ranged from 49 to 99 years with a mean of 76 years.

In both studies, the primary efficacy endpoint was the proportion of patients who maintained vision, defined as losing fewer than 15 letters of visual acuity at week 52 compared to baseline.  Data are available through week 52.  Both the Eylea™ (aflibercept) Injection 2Q8 and 2Q4 dosing groups were shown to have efficacy that was clinically equivalent to the ranibizumab 0.5Q4 group for the primary endpoint.

Select results of the VIEW 1 and VIEW 2 studies as described in the full Prescribing Information for the Eylea 2 mg every four weeks and Eylea 2 mg every eight weeks dosing groups as compared to ranibizumab dosed monthly group are shown below.

To check the efficacy outcomes at week 52 in VIEW 1 and VIEW 2 Studies, please click on the source below. 

Safety of Eylea:

Eylea™ (aflibercept) Injection is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in Eylea.

Intravitreal injections, including those with Eylea, have been associated with endophthalmitis and retinal detachments.  Proper aseptic injection technique must always be used when administering EYLEA.  Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with Eylea.  Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors.  Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately. There is a potential risk of arterial thromboembolic events (ATEs) following use of intravitreal VEGF inhibitors, including Eylea, defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause).  The incidence of ATEs with Eylea in clinical trials was low (1.8%). Serious adverse reactions related to the injection procedure have occurred in less than 0.1% of intravitreal injections with Eylea including endophthalmitis, traumatic cataract, and increased intraocular pressure. The most common adverse reactions (greater than or equal to 5%) reported in patients receiving Eylea were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and increased intraocular pressure.

To see the full prescribing Information for Eylea, please click here.

Regeneron is collaborating with Bayer HealthCare on the global development of Eylea.  Bayer submitted an application for marketing authorization in Europe for wet AMD in June 2011.

Bayer HealthCare will market Eylea outside the United States, where the companies will share equally the profits from any future sales of Eylea.  Regeneron maintains exclusive rights to Eylea in the United States.

Source

First human induced Pluripotent Sem cell therapy eyed in 2013

A clinical study into the use of lab-grown retina cells to treat age-related macular degeneration (AMD) has been slated for fiscal 2013, a senior staffer of the research body planning to undertake the project said Saturday.

The project might be the world's first to use induced pluripotent stem cells, or iPS cells, for the treatment of human diseases. 

The study will initially target several patients with the eye disease whose vision cannot be sufficiently restored through existing medication. It will then be expanded to include earlier-stage patients once the safety of the iPS cell treatment can be determined.

Source