Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial

Background
Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure, but to our knowledge no placebo-controlled trials have assessed visual function preservation, and the observation periods of previous (unmasked) trials have typically been at least 5 years. We assessed vision preservation in patients given latanoprost compared with those given placebo.

Methods
In this randomised, triple-masked, placebo-controlled trial, we enrolled patients with newly diagnosed open-angle glaucoma at ten UK centres (tertiary referral centres, teaching hospitals, and district general hospitals). Eligible patients were randomly allocated (1:1) with a website-generated randomisation schedule, stratified by centre and with a permuted block design, to receive either latanoprost 0·005% (intervention group) or placebo (control group) eye drops. Drops were administered from identical bottles, once a day, to both eyes. The primary outcome was time to visual field deterioration within 24 months. Analyses were done in all individuals with follow-up data. The Data and Safety Monitoring Committee (DSMC) recommended stopping the trial on Jan 6, 2011 (last patient visit July, 2011), after an interim analysis, and suggested a change in primary outcome from the difference in proportions of patients with incident progression between groups to time to visual field deterioration within 24 months. This trial is registered, number ISRCTN96423140.

Findings
We enrolled 516 individuals between Dec 1, 2006, and March 16, 2010. Baseline mean intraocular pressure was 19·6 mm Hg (SD 4·6) in 258 patients in the latanoprost group and 20·1 mm Hg (4·8) in 258 controls. At 24 months, mean reduction in intraocular pressure was 3·8 mm Hg (4·0) in 231 patients assessed in the latanoprost group and 0·9 mm Hg (3·8) in 230 patients assessed in the placebo group. Visual field preservation was significantly longer in the latanoprost group than in the placebo group: adjusted hazard ratio (HR) 0·44 (95% CI 0·28–0·69; p=0·0003). We noted 18 serious adverse events, none attributable to the study drug.

Interpretation
This is the first randomised placebo-controlled trial to show preservation of the visual field with an intraocular-pressure-lowering drug in patients with open-angle glaucoma. The study design enabled significant differences in vision to be assessed in a relatively short observation period

Securing the smart grid

The availability of electricity is fundamental to modern society. It is at the top of the list of critical infrastructures and its interruption can have severe consequences. This highly important system is now evolving to become more reliable, efficient, and clean. This evolving infrastructure has become known as the smart grid; and these future smart grid systems will rely heavily on ICT. This infrastructure will require many servers and due to the nature of the grid, many of these systems will be geographically diverse requiring communication links. At the heart of this ICT infrastructure will be security. At each level of the smart grid from smart metering right through to remote sensing and control networks, security will be a key factor for system design consideration. With an increased number of ICT systems in place the security risk also increases. In this paper the authors discuss the changing nature of security in relation to the smart grid by looking at the move from legacy systems to more modern smart grid systems. The potential planes of attack for future smart grid systems are identified, and the general anatomy of a cyber-attack is presented. The authors then introduce the various threat levels of different types of attack and the mitigation techniques that could be put in place for each. Finally, the authors' introduce a Phasor Measurement Unit (PMU) communication system (operated by the authors) that can be used as a test-bed for some of the proposed future security research.