EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy.

After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.

Accommodative state of young adults using reading spectacles.

We examined the accommodative state of young adults wearing +2D and +3D reading spectacles under normal conditions and with the elimination of accommodative cues. Subjects' refractions were measured with an infrared PowerRefractor. Power of the vertical meridian was recorded for subjects viewing far and near targets in free space and through a Badal lens apparatus with and without reading spectacles. Additionally, refractive measurements were taken after subjects wore +2D reading spectacles for 30 min (post-adaptation). In free viewing and viewing through the Badal lens, subjects uniformly over-accommodated relative to the target while wearing reading spectacles (i.e., with the spectacles, they focused at a plane in front of the target). Subjects in the first post-adaptation test showed no significant difference in accommodation between viewing a near target with and without +2D spectacles after having read with them for 30 min, though they had without post-adaptation. Subjects in the second post-adaptation test were not significantly differently accommodated before and after reading when binocularly viewing a near target with +2D reading spectacles. The results imply that no adaptation of the subjects' accommodative postures while viewing visual targets occurred as a result of a 1/2 h near work task with the spectacles. The over-accommodation of subjects using reading spectacles while they are performing visual tasks shows the necessity of measurement if their true accommodative posture is to be determined.

Compensation of corneal horizontal/vertical astigmatism, lateral coma, and spherical aberration by internal optics of the eye.

Both the anterior surface of the cornea and the internal optics (the posterior cornea, crystalline lens) contribute to the aberration of a wavefront passing through the eye. Artal, Guirao, Berrio, and Williams (2001) reported that the wavefront aberrations produced by the internal optics offset, or compensate for, the aberrations produced by the cornea to reduce ocular wavefront aberrations. We have investigated the wavefront aberrations of the cornea, internal optics, and complete eye on both the population and individual level to determine which aberrations are compensated and probable paths leading to that compensation. The corneal and ocular aberrations of 30 young subjects at relaxed accommodation were measured with the Topcon Wavefront Analyzer, which simultaneously measures refraction, corneal topography (videokeratoscope), and wavefront aberrations (Hartmann-Shack sensor). We found strong evidence for compensation of horizontal/vertical (H/V) astigmatism (Zernike term Z5) lateral coma (Z8) and spherical aberration (Z12). H/V astigmatism compensation is scaled for each individual, suggesting that it is actively determined by a fine-tuning process. Spherical aberration shows no individual compensation, suggesting that is a passive result of genetically determined physiology. Lateral coma shows individually scaled compensation, some of which may be attributable to eccentricity of the fovea.