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Dear Readers,
Public-health action to prevent blindness and visual impairment needs to be evidence-based and cost-effective. International collaboration in promoting multidimensional and multisectoral research is essential for developing eye-care systems that are comprehensive, integrated, equitable, high-quality and sustainable. Further research is needed on ways to capitalize on available evidence. Special emphasis should be placed on evaluating interventions and different strategies for early detection and screening of the causes of blindness and visual impairment in different population groups, including children. This Sitenews uses a general approach to the understanding of Research in eye care including Research Priorities in Worldwide, Research in Government institutions and NGOs, Research Trends from Ophthalmology and also its cover Genetic Research in Ophthalmology, Research and Epidemiology, Eye Research Studies, Ethics of Research, Research Guidelines.

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The Issue Features...
Research in Eye Care
Vol.9 No. 2 May & June 2012
•  Introduction
•  Research Priorities Worldwide
•  Research in Government Institutions/NGOs
•  Research trends in Ophthalmology
•  Genetic Research in Ophthalmology
•  Health Systems Research in Eye Care
•  Research and Epidemiology
•  Eye Research Studies
•  Ethics of research
•  Research Guidelines
•  Featured Organization
•  Featured Personality

•   Past Issues


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  • Basic research is an integral part of a tertiary eye care system. It involves close interaction between clinicians and scientists. There are many questions which remain unanswered in eye care. These problems are identified by the careful observation of the clinicians and passed on to the laboratory. The scientific team designs the study and analyzes the various parameters with the available sample from the patients. Research is carried out to understand the mechanism at the genome, transcriptome and proteome level. It is possible that the outcome of the research could be translated back to the patients in the clinic in terms of early diagnosis or a drug target. 
    The various divisions of basic research have contributed a lot to the understanding of the pathogenesis of infectious and genetic diseases. Molecular genetics focuses on inherited eye diseases including ocular cutaneous albinism, Leber Hereditary optic neuropathy, retinoblastoma, etc. Microbiology is involved in the development of new diagnostic tools for early detection of various infections. Immunology contributes to the understanding the immunological profiles of eye diseases such as leptospiral uveitis and diabetic retinopathy. Pharmacology is interested in pharmacokinetics of ocular drugs. Proteomics explores the possibility of identifying biomarkers in glaucoma and diabetic retinopathy. Stem cell biology has developed methods to characterize stem cells and also used this method to identify buccal stem cells.
    The current issue of the Site News will provide you the glimpse of all the avenues in the basic research and how it will be helpful in a better understanding of disease process and improvement in the treatment methods to attain the goals of the Vision 2020.




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  • RESEARCH FOR VISION 2020

  • We need good quality information to carry out eye care programmes in support ofVISION 2020, to measure (and improve) performance, and to advocate for the resources andsupport needed to succeed. Much of this information can be collected, analysed, and used aspart of our daily work, as many of the articles in this issue show.

  • RESEARCH AND TRAINING PROGRAMMES

  • Research is embedded in the curricula of most postgraduate training programmes; students are expected to complete someform of original work towards a dissertation.This often evokes a range of reactions:“What is the purpose of this exercise? Whydo I have to do research when I just want todo a job? Shouldn’t research rather be leftto experts? I can’t do the course; I have noresearch background!”

  • PRACTICAL RESEARCH: A BASIC OUTLINEFOR MID-LEVEL EYE PERSONNEL

  • Research can dramatically improve the work (534_Indian Medical Association_IMA_PN_Doctors day_2010_Madurai) of mid-level eye health personnel who want to provide the best possible care based on accurate and relevant evidence. For example, Isaac Baba, eye co-ordinator of Bawku Presbyterian Hospital in Ghana, describes a simple research exercise to understand and improve patient satisfaction with the eye care offered in the outpatient department.

  • MORE RESEARCH NEEDED TO ASSESS THE MAGNITUDE OF REFRACTIVE ERRORS WORLD-WIDE


  • OPHTHALMIC RESEARCH PRIORITIES AND PRACTICES IN NIGERIA: AN ASSESSMENT OF THE VIEWS OF NIGERIAN OPHTHALMOLOGISTS

  • This study details the views of ophthalmologists on research priorities and outcomes in Nigeria.

  • RESEARCH OPPORTUNITIES IN VISION: A REPORT OF THE U.S.-INDO WORKSHOPS ON COLLABORATIVE RESEARCH

  • This article reports on two workshops in 2005, one happened in India and the other in the United States, to promote international research in vision and ophthalmology. The workshops were held in February and April and spanned a total of 7 days. They were sponsored by the Association for Research in Vision and Ophthalmology (ARVO) and funded through a cooperative agreement with the National Eye Institute (NEI) of the National Institutes of Health (NIH) and  the Department of Biotechnology (DBT), Government of India. The goal of the workshops, attended by leaders in eye and vision research from the two nations, was to identify and promote U.S.-Indo collaborations and research opportunities to accelerate the ability to understand, prevent, treat, and cure vision disorders. Five core research areas were considered: molecular genetics of eye disease; clinical aspects of genetic eye disease; harmonization of clinical measurement techniques and terminology; translational physiology; and identification,development, and exchange of research resources. It is hoped that, by providing information about the workshops with the larger eye and vision research community, additional ideas and collaborations will emerge.A rapid outcome of the workshops was the signing, on August 24, 2005, of a United States-India Statement of Intent for collaboration on expansion of vision research. The agreement was signed by India’s Secretary of the DBT, Maharaj K. Bhan, and the NIH’s director, Elias A. Zerhouni. Quite simply, the countries officially agreed to combine their vast biomedical and clinical expertise and resources in ophthalmology, for reducing the burden of vision disability and blindness.In addition to joint research projects, the parties foresee opportunities for research training, workshops, and exchanges.

  • THE SERI-ARVO MEETING AND FUTURE CHALLENGES OF OPHTHALMIC RESEARCH IN ASIA

  • The progress of ophthalmology in Asia has paralleled much of its socioeconomic evolution. During theearly years of a nation’s development, scarce resources were usually concentrated on building the basic healthcare infrastructure and developing services needed to cater for the general population. Over time, with increasing affluence and improved health care, resources could be channeled elsewhere towards developing other goals. One such development is the emergence of ophthalmic research in Asia. As in western societies, clinical and basic science research is increasingly seen as being an integral component of a well balanced portfolio in many Asian healthcare institutions. This is reflected by the increasing number of high quality publications in leading eye journals that originate from Asia

  • HOW CAN WE STRENGTHEN OPHTHALMIC RESEARCH IN AFRICA?

  • This article focuses on ideas to Strengthen ophthalmic research in Africa and points out how ophthalmic research is going on in Asia, Europe and Developing countries.



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  • RESEARCH AT NATIONAL EYE INSTITUTE

  • The National Eye Institute (NEI) was established by Congress in 1968 to protect and prolong the vision of the American people. NEI research leads to sight-saving treatments, reduces visual impairment and blindness, and improves the quality of life for people of all ages. NEI-supported research has advanced our knowledge of how the visual system functions in health and disease. Vision research is supported by the NEI through approximately 1600 research grants and training awards made to scientists at more than 250 medical centers, hospitals, universities, and other institutions across the country and around the world. The NEI also conducts laboratory and patient-oriented research at its own facilities located on the NIH campus in Bethesda, Maryland.

  • OPHTHALMIC RESEARCH NETWORK

  • The department is supporting the development of a network of academic eye units called the Ophthalmic Research Network. This will be represented by a new website, which will act as a resource linking academic eye units, primarily in the UK, to create an up-to-date record of current opinion in ophthalmic research, project developments and research outputs. In its current form, the Ophthalmic Research Network has been in operation for over five years and during this time it was highly commended in the 2001 Healthcare IT effectiveness awards. The current website contains a variety of information related to ophthalmology including research projects, publications, guidelines and patient information.



  • THE INTERNATIONAL CENTRE FOR EYE HEALTH

  •  (ICEH) is a Research and Education group based at the London School of Hygiene & Tropical Medicine (LSHTM). Itworks to improve eye health and eliminate avoidable visual impairment and blindness, with a focus on low income populations.
    ICEH research aims to provide information of value for the cost effective implementation of VISION 2020 - the Right to Sight.The research studies encompasses epidemiological studies,  operational research, health economics and qualitative research. Theaim is to contribute to the evidence base for the implementation of cost effective sight-saving and blindness prevention  interventions in low and middle income countries.


  • OPHTHALMIC RESEARCH IN ICMR

  • ICMR in the past decades has carried out numerous studies on the prevalence, epidemiology and treatment of various causes of blindness in the country.

  • RESEARCH GROUPS - SINGAPORE EYE RESEARCH INSTITUTE

  • The Singapore Eye Research Institute (SERI) is the national research institute for ophthalmology and vision research in Singapore, affiliated with the National University of Singapore (NUS). SERI is the focal point of eye research in Singapore, serving as the research arm of the Singapore National Eye Centre (SNEC) and other eye departments including the National University Health Systems (NUHS), and Tan Tock Seng Hospital. It has close working relationships with A*STAR, Duke-NUS Graduate Medical School, the Nanyang Technological University and other biomedical institutions and eye centers in Singapore and throughout the world.

  • THAT MAN MAY SEE - MOST COMMON EYE DISEASES MACULAR DEGENERATION, GLAUCOMA, AND INFECTIOUS DISEASES

  • Research and educational programs are essential to find cures for the most common causes of blindness, macular degeneration and glaucoma, which are currently irreversible, and infectious and inflammatory eye diseases, which have reached epidemic proportions worldwide. To combat these eye conditions, affecting millions of Americans and individuals around the world, UCSF is making a commitment toward medical breakthroughs. That Man May See seeks anchor gifts as well as seed funding for studies leading to the detection, treatment, and potential eradication of these eye disorders.

  • GLAUCOMA RESEARCH FOUNDATIONS

  • The Glaucoma Research Foundation is a national non-profit organization dedicated to finding a cure for glaucoma. Founded in 1978 in San Francisco, the Glaucoma Research Foundation has funded innovative clinical and laboratory research.

  • WHITE PAPER ON TRANSLATIONAL RESEARCH IN OPHTHALMOLOGY AND VISION SCIENCES IN THE EUROPEAN UNION

  • This White Paper emerged from a group of European Centres with active programs integrating laboratory research and dedicated clinical research facilities in Vision and Ophthalmology. The Centers were invited to participate in a Network “Translational Research Centres in Ophthalmology and Vision Sciences” within the European Union. The purpose of this Network is to stimulate the process for translational research between them and to synergize multidisciplinary and interdisciplinary clinical and translational research.

  • CENTRE FOR OPHTHALMOLOGY - INSTITUTE FOR OPHTHALMIC RESEARCH

  • The Institute for Ophthalmic Research is headed by Prof. Dr. med. EberhartZrenner and cooperates closely with the University Eye Hospital (head: Prof. Dr. med. Karl Ulrich Bartz-Schmidt) underthe common roof of the Centre for Ophthalmology. The Institute, founded in 2007, aims at uncovering the causes for degenerative, inflammatory, neoplastic, and vascular diseases of the eye and thevisual pathways at molecular, cellular and systemic level.

  • NGOS A) ARAVIND EYE CARE SYSTEM

  • The research activities at Aravind reflect Aravind's commitment to finding new ways to reduce the burden of blindness. The combination of high clinical load, extensive community participation, and access to a large network of eye hospitals provides ideal opportunities for conducting clinical, laboratory, population-based studies and social and health systems research.

  • B) SANKARA NETHRALAYA

  • Vision Research Foundation’s advanced infrastructure and highly qualified and dedicated research teams make it one of the most respected ophthalmic research centers in the world with a learning and training center accredited to BITS, Pilani and the Dr MGR Medical University. It is engaged in broad spectrum research ranging from basic to more complex areas like Nanotechnology and Stem cell research. The efficacy of Vision Research Foundation’s research endeavors can be gauged by the fact that almost a third of the doctoral/thesis papers submitted in ophthalmic research originate from its research laboratories and an average of 2 research scientists from its laboratories win a Doctorate every year in their chosen area of research, the Vision Research Foundation is also the proud holder of 4 prestigious patents to its credit, including one for Macro DNA chip.

  • C) LV PRASAD EYE INSTITUTE

  • All research at L V Prasad Eye Institute is conducted through its constituent arm, the Hyderabad Eye Research Foundation (HERF), which is recognized by the Indian Government’s Department of Scientific and Industrial Research (DSIR) as a Scientific and Industrial Research Organization (SIRO). HERF continues to compete for and receive grants from all over the world to conduct cutting edge research on  eye.

  • D) SCHEPENS EYE RESEARCH INSTITUTE

  • Schepens Eye Research Institute has research at every stage of development—filling the pipeline—from the critical new ideas that are changing the way researchers around the world look at the future of treatment, to products in late-stage clinical trials, set to make an immediate impact on the lives of people struggling with vision-robbing diseases and injuries.

  • E) JULES STEIN EYE INSTITUTE

  • The Center for Eye Epidemiology (CEE) at the Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, is a coordinating body for expanding and sharing information about vision health. The Center maintains and improves vision health through public health research and intervention.



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  • CAROTENOIDS IN MACULAR HEALTH OF INDIAN EYE

  • Carotenoids are naturally occurring pigments found mainly in plants, algae and photosynthetic bacteria. The red, green and yellow colors are mainly responsible for the presence of these pigments.

  • CATARACT AND VITAMIN C

  • Cataract is a condition, in which the natural crystalline lens of the eye becomes opaque which causes a gradual, painless deterioration of sight. This results in vision impairment or even a complete loss of vision.

  • CONSANGUINITY & EYE DISEASES

  • Consanguinity or kinship ("blood relation", from the Latin word consanguinitas) is characterized by the sharing of common ancestors. Consanguineous persons have at least one common ancestor in the preceding few generations. A consanguineous marriage is one in which two individuals related by blood, such as cousins, get married and have children.

  • TREMATODE INFECTION & GRANULOMA FORMATION – HOW BASIC RESEARCH HELPS IN CONFIRMING THE CLINICAL FINDING?

  • Ocular inflammation or Uveitis in children is a potentially vision threatening condition, the causes vary widely depending upon geographic, environmental and socioeconomic factors and also upon the prevalence of causative agents. Nearly 120 children come to our hospital with uveitis every year. Of 120, nearly 20 % come with granuloma either in subconjunctival space or in anterior chamber. All children who developed such granuloma give history of eye problem after bathingin river or ponds near the river Kaverywhichbrings major water supply to east central part of Tamil Nadu state, suggesting a water-borne infection. Clustering of cases seen in several south Indian villages, over decades suggested a widespread distribution of the etiologic agent.We worked up all these patients clinically to find out the cause. The granulomas were surgically removed and subjected for histopathology,Presence of cuticle of a parasite on histopathology suggested a parasitic disease,possiblytrematodes.

  • RECENT ADVANCES IN CATARACT RESEARCH

  • Cataract is the leading cause of blindness worldwide, accounting for more than 20 million of the world population, a figure estimated to reach 40 million by 2020. The removal of cataract is the most common surgical procedure performed in those over the age of 65 in New Zealand. The Department of Ophthalmology at the University of Auckland hasestablished major research projects involving the clinical and scientific aspects of cataract formation.

  • NEURO-OPHTHALMOLOGY RESEARCH MOVES TOWARD MORE EFFECTIVE TREATMENTS

  • Researchers are gaining insights into the molecular processes behind neuro-ophthalmic diseases with sophisticated science and better imaging.

  • LINKAGE BETWEEN RESEARCH SPONSORSHIP AND PATENTED EYE-CARE TECHNOLOGY.

  • This article focuses on the linkage between the funding of ophthalmologic and related biomedical  research and the development of patented eye-care technology using data on patents granted and the scientific literature cited by those patents.



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  • WHAT ARE THE BIGGEST IMPEDIMENTS IN TRANSLATING GENETIC RESEARCH TO CLINICAL APPLICATIONS?

  • This article points out how genetic research offers great potential to the eye, and also how so many different genes that have been implicated in eye disease and how it will be difficult from an economic perspective to develop a drug for each one

  • GENOMICS PIONEER SAYS OPHTHALMOLOGY LEADS THE WAY IN GENETIC RESEARCH

  • The study of genomics has reached a level in ophthalmology that is still only a distant hope for other medical specialties.

  • TRANSLATIONAL RESEARCH IN OPHTHALMOLOGY – A EUROPEAN PERSPECTIVE

  • Loss of vision is a major threat for the ageing European society as its incidence quickly increases with age. While cataract is handled well by microsurgery, other blinding conditions such as age-related macular degeneration, retinal dystrophies, glaucoma and diabetic retinopathy cannot be treated well. On the other hand, knowledge about endogenous and exogenous factors increases rapidly in basic research, opening new pathways to therapy. It will be increasingly important to foster translational research to bring such new strategies in genetics, proteomics, metabolomics and new drug delivery systems for neuroprotection, stem cell research and optogenetics from bench to bedside. Adequate funding for this translational research has to be ensured. These goals are strongly supported by the European Vision Institute (EVI) and by the European Vision Institute Clinical Research Network (EVICR.net), a clinical research network that comprises more than 70 certified sites to perform clinical studies in the field of ophthalmology and by the European Clinical Research Infrastructures Network (ECRIN). These developments, their aims and accomplishments are described here.

  • TRANSLATIONAL RESEARCH IN OPHTHALMOLOGY

  • Translational Research is a process in which knowledge gained in the laboratory is applied or translated to the diagnosis or treatment of human disease. The National Eye Institute (NEI), Bethesda, Md, by its charter is committed to the eye care and vision of the American people. A major effort of the NEI during the past 25 years has been to foster the development of a cadre of scientists, mainly PhDs, whose research is relevant to the visual system and related diseases.



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  • HEALTH SYSTEMS AND EYE CARE: A WAY FORWARD

  • Health systems strengthening has become a new buzzword in international health. Understanding how health system functions and reacts can be quite complex. In order to clarify what health systems are, the present working paper describes the six main foundations of a health system: human resources, finance, health information, governance, services delivery and consumables and technology. Then through concrete examples, the authors show how general health system can contribute to improve the impact of eye care services. Finally, the authors show how health systems have become a crucial determinant of eye care programmes in developing countries and show how health systems research can generate more evidence that will help eye care managers  make informed decisions.

  • CREATING SYNERGIES FOR HEALTH SYSTEMS STRENGTHENINGTHROUGH PARTNERSHIPS IN PAKISTAN – A CASE STUDY OF THE NATIONAL EYE HEALTH PROGRAMME

  • Blindness and visual impairment are themajor causes of noncommunicable diseases in Pakistan. Twonational population-based blindness surveys conducted in 1988 and 2002–04 demonstrated a reduction inprevalence of blindness from 1.78% to 0.9% with a significant drop in cataract blindness as a result of accelerated nationwide interventions and eye care integration in primary health care. In addition, between 2006 and 2008, 88 facilities were upgraded as a result of the National Eye Health Programme. These measures resulted in a 279% increase in eye outpatient attendances and a 375% increase in eye surgeries performed. Investment in human resources development and policy change contributed significantly to the sustainability of the programme. Key challenges facing the programme include aligning national eye health strategies with health system strengthening informed through health systems research. This paper attempts to document this extraordinary success.

  • HEALTH SYSTEMS RESEARCH - ICEH

  • This is a new and potentially expanding area of research for ICEH. The current study entails evaluating the resilience of eye care providers in Ghana following withdrawal of funding from the NGO sector. The second study, sustainability study of rehabilitation services in fragile states (Cambodia, Liberia, Nepal, Sierra Leone, Somalil and) is reviewing the sustainability practices of Handicap International and its partners based on the lessons learned from case studies. Watch a podcast of ICEH researcher, Karl Blanchet giving an introduction to the sustainability study.

  • OPHTHALMIC SERVICES RESEARCH: TOWARDS INCREASING THE ROLE OF ECONOMIC AND OPERATIONS RESEARCH METHODS IN THE DELIVERY OF EYE CARE SERVICES

  • Article focuses the emerging area of ophthalmic services research may hold the key to reducing the high levels of irreversible and reversible blindnessfound in many parts of the world.



  • PUBLIC EDUCATION AND OPHTHALMIC RESEARCH

  • Ophthalmologistscan play an important role in educating and motivating patients and their carers to prevent the development andprogression of eye diseases.




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  • SINGAPORE EPIDEMIOLOGY OF EYE DISEASES (SEED) CENTRE


  • EPIDEMIOLOGICAL RESEARCH: FROM POPULATIONS THROUGH INTERVENTIONS TO TRANSLATION

  • The National Eye Institute (NEI) is committed to the goal of protecting and improving visual health. To be accomplished successfully, this goal will require a multi-disciplinary approach that encompasses basic, clinical, and public health sciences. The multi-disciplinary approach is embedded in the current National Plan for Eye and Vision Research (2004), wherein this Panel noted that the disease-specific program plans include epidemiological investigations as priorities. Such an approach is an important integration of epidemiology, which is a methodological science, into eye and vision research. For the purposes of this report, the term epidemiology will be used in the broad context, which includes classic observational studies, clinical trials (particularly randomized clinical trials), statistical genetics, and health services research.

  • EPIDEMIOLOGY IN PRACTICE: SCREENING FOR EYE DISEASE

  • The importance of this concept is that screening is never something that shouldbe undertaken casually and it shouldalways be carefully monitored and evaluated.
    Without strict criteria, monitoring isimpossible. Opportunistic screening is aconcept and a term which should be avoided.In a few circumstances it might be appropriate to test casually for a conditionin a patient who has presented with another unrelated condition, but this should rather be called Opportunistic surveillance. Similarly, screening camps are misnamed.The term screening here implies an element of uncertainty which should notbe acceptable when patients are being identified as possible candidates for surgery, either at the base hospital Ð or worse, at the camp itself. The tests at such camps haveto be diagnostic and precise. If they are not, the outcome of cataract surgery may bepoor due to poor case selection. Finally, the use of the term screening test should onlybe used when the test is being used to separate one group of patients from another,where the individuals who test positive go on to more precise diagnostic investigations.


  • EPIDEMIOLOGY AND STATISTICS FOR OPHTHALMLOGIST

  • This book will give ophthalmologists a simple, clear presentation of epidemiologic and statistical techniques relevant to conducting, interpreting, and assimilating the commonest types of clinical research.

  • CATARACT IN THE 21ST CENTURY: LESSONS FROM PREVIOUS EPIDEMIOLOGIC RESEARCH

  • Cataract surgery is currently the most commonly performed ophthalmic procedure in Australia. The purpose of  this paper is to review Australian data on cataract prevalence and risk factors and to project potential future demand for cataract services.



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  • INTERNATIONAL CLINICAL GUIDELINES

  • International clinical guidelines are prepared and distributed by the ICO Clinical Guidelines Committee to serve a supportive and educational role for ophthalmologists worldwide, and are intended to improve the quality of eye care for patients. The ICO International Clinical Guidelines have been adapted in many cases from similar documents (Benchmarks of Care) created by the American Academy of Ophthalmology based on their preferred practice patterns.

  • DEVELOPING A MASTER RESEARCH PLAN: GUIDELINES FOR INSTITUTE OF OPHTHALMOLOGY

  • The guidelines for master research plans promoting development of research in comprehensive eye care and formulation of evidence based strategies to prevent, control and treat blindness.

  • ARVO FUNDING GUIDE

  • ARVO Funding guide lists grants and awards in eye and vision research. Listing of funding organizationsand variety of places to find funding for research, including government sources, foundations and scientific organizations is also mentioned.



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  • THE ARVO FOUNDATION FOR EYE RESEARCH

  • The ARVO Foundation for Eye Research provides continuing education and stable support for original and innovative vision research, particularly research with translational impact that fosters collaboration between clinicians and basic scientists. The Foundation also supports training for new vision research scientists around the world.



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  • ALLVAR GULLSTRAND

  • Allvar Gullstrand (Sweden), is theNobel Prize winner in 1911 for his research on the eye as a light-refracting apparatus. Hedescribed the schematic eye a mathematical model of the human eye based on measurements known as optical constants of the eye. His measurements are still used today.
    Allvar Gullstrand (5 June 1862, – 28 July 1930) was a Swedishophthalmologist.
    Born at Landskrona, Sweden, Gullstrand was professor (1894–1927) successively of eye therapy and of optics at the University of Uppsala. He applied methods of physical mathematics to study  optical images and refraction of light in the eye. For this work, he received the Nobel Prize in Physiology or Medicine in 1911.
    Gullstrand is noted also for his research on astigmatism and for improving the ophthalmoscope and the use ofcorrective lenses after removal of  cataract from the eye.
    He was elected a member of the Royal Swedish Academy of Sciences in 1905, and served on the Academy's Prize Committee for Physics. While serving on the committee, he used his position to block Einstein from receiving a Nobel Prize in Physics for his theory of relativity, which Allvar believed to be wrong.




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