醫者有社會責任去保障公眾健康，我們認為梁卓偉教授和陳家亮教授作為香港兩所醫學院院長責無旁貸。因此，我們呼籲所有醫護人員參與連署，懇請兩位院長履行社會使命發表聲明保障社會大眾的健康和人身安全。

連署連結: https://forms.gle/teMGNCiZPMYatVbh8
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《致香港大學李嘉誠醫學院院長、中文大學醫學院院長的公開信》

梁教授、陳教授道鑒：

　　有鑑於在六月十二日、七月二日及二十一日，香港警察濫用武力以控制群眾。如此行徑實對公眾健康遺害無窮，我們一眾醫療人員對此極為關切。作為香港大學李嘉誠醫學院院長、中文大學醫學院院長，吾等懇請兩位院長細察香港警察控制群眾之手段，以保障公眾健康。

　　據多家本地及國際媒體報導，香港警察於六月十二日，發射多輪催淚彈、橡膠子彈及布袋彈，以驅散聚集在金鐘的示威者。報導提及，警方向示威者發射至少一百五十枚催淚彈，二十輪布袋彈以及數枚橡膠子彈，造成至少七十二人受傷。從多家媒體直播可見，橡膠子彈更直射一名教師眼球，創傷嚴重，對其視力之損害非同等閒。另外，警方亦曾以數枚催淚彈包抄示威者，堵塞其退路；而當示威者被逼退守至中信大廈，警方竟朝人群中央投以催淚彈，造成數以百計的市民受傷及呼吸困難，生死攸關，不容小覷。此外，警方向一名手無寸鐵的市民，近距離發射橡膠子彈，以致其下腹嚴重受傷，情況慘不忍睹。

　　據多份醫學期刊綜述──如《刺針》（Lancet）[1] 及英國醫學期刊（BMJ (Open)）[2]，橡膠子彈乃可致命武器。同時，橡膠子彈不易操控，準確性低，有引致重傷，乃至死亡之風險。多份期刊不約而同指出，橡膠子彈不適宜用於密集人群之管制。

　　然而，香港警察漠視上述已知風險，仍於七月二日及七月二十一日繼續使用此類武器。在七月二十一日，警察更於鄰近民居之地，向群眾發射多輪催淚彈及橡膠子彈，當中更殃及記者。此等武器之禍害影響深重，不單有損呼吸系統，更會導致燒傷、嚴重鈍物創傷及爆炸性創傷。據媒體報導，武器造成至少十四人受傷；更有市民懼於警方之搜捕行動，而未敢求醫，致使受傷數字難以估算。

　　人權醫療組織（Physicians for Human Rights）醫生哈爾（Dr Rohini Haar）在接受紐約時報訪問時指出，警方對市民使用不成比例的武力，實有濫用武力之嫌。早在二零一四年，潘冬平教授[3]亦對香港警察使用催淚氣體情況深表關注，擔心催淚氣體損害市民呼吸系統。可見，催淚彈、橡膠子彈及豆袋彈等武器危害不輕，對香港市民公眾健康的損害不容置疑。

　　兩大醫學學院一直致力培育杏林菁英，不遺餘力。一眾醫療人員亦謹承《希波克拉底誓詞》之教誨，不論病患身份職要，一直為全人類之福祉著想，嚴守不懈。學院循循善誘，吾等縷心刻骨。誓詞薪火相傳，代代不息；缺少對生命健康之尊重，醫療人員何以自立？故此，我們一眾醫療人員懇請院長，發表聲明，呼籲香港警察：

一、避免濫用催淚彈及任何類型子彈，以免導致人命傷亡及其他不可見之損傷。
二、在使用武力時，必須顧及市民安全，並保持專業克制。

　　醫療人員一直存仁心，行仁術；保護市民之健康，乃至生命，吾等責無旁貸。院長為學為醫，高風峻節，茍以吾等同心同德，捍衛市民之生命健康，必見杏林春暖。

　　謹祝
道安

一眾醫療人員謹上
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Dear Professor Leung and Professor Chan,

We are a group of healthcare professionals, some of us being also graduates from the Faculty of Medicine of the University of Hong Kong and the Chinese University of Hong Kong. We are writing to express our gravest concerns over the persistent and serious threats to the health of members of the public posed by weapons deployed in crowd control by the Hong Kong Police Force (HKPF) on 12 June, 2 July and 21 July. We hereby urge the Deans of the sole Faculties of Medicine in Hong Kong to take actions in censuring the HKPF and the Hong Kong Government against the serious health risks in their crowd-control tactics.

On 12 June, as reported by multiple local and international news agencies, the HKPF fired multiple rounds of tear gas, rubber bullets and bean-bag rounds to disperse protesters in Admiralty. Over 150 canisters of tear gas, 20 bean-bag rounds and several rubber bullets have admittedly been directed at protestors which resulted in at least 72 injuries. As evident in the live reports from various media sources, a teacher suffered traumatic ocular injury causing significant vision loss when his eye was hit by a rubber bullet; hundreds of citizens suffered various degrees of injuries and respiratory distress consequential upon the numerous tear gas canisters shot at Citic Tower in Admiralty where protesters were trapped in a life-threatening space filled with tear gas; an unarmed man sustained injury in his lower abdomen when a rubber bullet was directed at him in a short distance.

According to multiple studies and reviews from high impact factor medical journals, in particular the Lancet[1] and BMJ (Open)[2], rubber bullets can be lethal. Their notorious inaccuracy and risk of severe injury and death render them inappropriate and unsafe means of force in crowd control.

However, despite the known risks of these weapons, the HKPF tenaciously deployed them on citizens on 2 July and 21 July. On 21 July, 55 canisters of tear gas, 5 rubber bullet rounds and 24 sponge bullets were admittedly shot, some without immediate warning, at protestors and even at journalists notwithstanding the numerous residential buildings and citizens in the vicinity. The use of these weapons has left members of the public with at the very least, various types of injuries and further, burns, blunt force trauma and explosive injuries. 14 injuries have by far been reported where others did not present themselves to the hospital in fear of the risk of prosecution.

Dr Rohini Haar of Physicians for Human Rights had in a recent interview told the New York Times that the force used by the HKPF was disproportionate and excessive. In Hong Kong, Professor Ronnie Poon had as early as in 2014 expressed openly his earnest concern over both the short term and long term health risks in the use of tear gas in particular to one’s respiratory system when the HKPF first fired tear gas at Hong Kong citizens [3]. It is indisputable that these named weapons put the health of Hong Kong citizens at serious risks.

Doctors have striven to stand by the Hippocratic oath that they remain members of society, the identity of which comes before their profession, with special obligations to all fellow human beings. The two medical schools in Hong Kong have been established accordingly for the nurture of healthcare professionals to serve the public with benevolent hearts and minds. This is the time to honour our oath that human life should deserve the utmost respect and to maintain by all means such noble traditions of the medical profession.

We, as healthcare professionals, therefore implore the Deans of the only Faculties of Medicine in Hong Kong, in the service of humanity with conscience and dignity, to take the lead in safeguarding the public’s health and to issue a statement to urge the Hong Kong Police Force to:

(1) refrain from using tear gas and bullets in any form on protestors to prevent further bloodshed and severe non-reversible injuries; and

(2) exercise due restraint over the use of force when handling protests and at all times, put the safety of Hong Kong citizens at the highest priority.

Regards,
A group of healthcare professionals
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Healthcare professionals have a social responsibility to safeguard the health of members of the public. We believe that, as Deans of the faculties of medicine in Hong Kong, Professor Leung and Professor Chan bear a paramount obligation in this regard. We appeal to all healthcare professionals to join us in this petition to urge the deans to issue a statement to honour their obligation to defend the public from health risks.
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Petition Link: https://forms.gle/teMGNCiZPMYatVbh8
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參考資料/References
[1] Mahajna, A., Aboud, N., Harbaji, I., Agbaria, A., Lankovsky, Z., Michaelson, M., . . . Krausz, M. M. (2002). Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: A retrospective study. The Lancet, 359(9320), 1795-1800. doi:10.1016/s0140-6736(02)08708-1

[2] Haar, R. J., Iacopino, V., Ranadive, N., Dandu, M., & Weiser, S. D. (2017, December 01). Death, injury and disability from kinetic impact projectiles in crowd-control settings: A systematic review

[3] Professor Ronnie Poon Facebook: https://www.facebook.com/138599119760/posts/10152753050039761?s=1014598371&sfns=mo

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術後可調整度數及散光的人工水晶體 RxSight，正式被美國FDA通過，如果未來能在台灣上市，將是眼科醫師與患者的一大福音！

美國食品藥物管理局(FDA)昨(22)日批准了RxSight的光調節水晶體(light adjustable lens)和光傳遞設備(light delivery device, LDD)，這是第一個可以在白內障手術後，對人工水晶體(intraocular lens, IOL)進行小幅度調整的醫療器械系統，幫助患者不戴眼鏡也能擁有良好視力。

白內障通常是由於年紀增長，水晶體變硬或混濁，影響患者視力。也有些是由於外傷性、併發性(如青光眼)、代謝性(如糖尿病)等引起的白內障。

解決療法之一便是進行人工水晶體置換手術，然而許多患者會有些微屈光不正，需要使用眼鏡或隱形眼鏡矯正。

為了替患者解決人工水晶體不當聚焦的問題，RxSight 建構獨特材料IOL，在手術後17至21天，對LDD發出的紫外線進行反應。根據所需調整量，患者在1到2周內接受3或4次光照治療，每次約40-150秒。

白內障手術開始到光療結束，患者必須配戴特殊眼鏡防護紫外線，保護新水晶體免受紫外線照射影響。

FDA批准是基於針對此產品所做的試驗成果，該研究隨機性地在17個研究地點挑選600名患有散光的患者，比較了光調節水晶體與現有的單焦點水晶體。

使用光調節水晶體的患者接受輕度LDD治療，術後6個月的裸眼視力(uncorrected visual acuity, UCVA)達到20/20或更高，是接受單焦點水晶體患者的兩倍。與使用傳統IOL相比，患者平均遠距離裸眼視力在視力表上可多看清楚一行。

75%的患者散光也有所減少，91.8%使用光調節水晶體的患者也達到目標驗光球鏡度數(manifest refraction spherical equivalent)0.5D以內的結果，這與近期LASIK研究中所見屈光準確性相似。

FDA醫療器械暨輻射健康中心(Center for Devices and Radiological Health)眼科和耳鼻喉科部門主任Malvina Eydelman表示，到今天為止，白內障手術常見的屈光不正問題，都還得透過眼鏡矯正。不過這個系統為部分患者提供了一個新的選擇，使醫生在初次手術後，可進行多次，可在辦公室內操作的步驟，對植入的水晶體做些調整，提高不戴眼鏡的視力。

RxSight執行長Eric Weinberg指出，我們很高興全球首個手術後可調式IOL成功到達另一個里程碑，這對期待屈光人工水晶體技術再度突破的患者、外科醫生和驗光師來說，是一個相當令人振奮的機會。我們很感謝所有參與這項工作的人員，包括協助研究的臨床工作人員，以及準備審查監管報告的雙方(RxSight和FDA)工作人員。

感謝 David 提供中文翻譯。
資料來源：
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm586405.htm

The U.S. Food and Drug Administration today approved the RxSight Inc. Light Adjustable Lens and Light Delivery Device, the first medical device system that can make small adjustments to the artificial lens’ power after cataract surgery so that the patient will have better vision when not using glasses.
Cataracts are a common eye condition where the natural lens becomes clouded, impairing a patient’s vision. Following cataract surgery, during which the natural lens of the eye that has become cloudy is removed and replaced with an artificial lens (intraocular lens, or IOL), many patients have some minor residual refractive error requiring use of glasses or contact lenses. Refractive error, which is caused when the artificial lens does not focus properly, causes blurred vision.

“Until now, refractive errors that are common following cataract surgery could only be corrected with glasses, contact lenses or refractive surgery,” said Malvina Eydelman, M.D., director of the Division of Ophthalmic, and Ear, Nose and Throat at the FDA’s Center for Devices and Radiological Health. “This system provides a new option for certain patients that allows the physician to make small adjustments to the implanted lens during several in-office procedures after the initial surgery to improve visual acuity without glasses.”

The RxSight IOL is made of a unique material that reacts to UV light, which is delivered by the Light Delivery Device, 17-21 days after surgery. Patients receive three or four light treatments over a period of 1-2 weeks, each lasting about 40-150 seconds, depending upon the amount of adjustment needed. The patient must wear special eyeglasses for UV protection from the time of the cataract surgery to the end of the light treatments to protect the new lens from UV light in the environment.

A clinical study of 600 patients was conducted to evaluate the safety and effectiveness of the RxSight Light Adjustable Lens and Light Delivery Device. Six months after the procedure, patients on average saw an improvement of about one additional line down the vision chart, for distance vision without glasses, compared to a conventional IOL. Six months after surgery, 75 percent also had a reduction in astigmatism.

The device is intended for patients who have astigmatism (in the cornea) before surgery and who do not have macular diseases.

The device should not be used in patients taking systemic medication that may increase sensitivity to UV light such as tetracycline, doxycycline, psoralens, amiodarone, phenothiazines, chloroquine, hydrochlorothiazide, hypercin, ketoprofen, piroxicam, lomefloxacin and methoxsalen. Treatment in patients taking such medications may lead to irreversible eye damage. The device is also contraindicated in cases where patients have a history of ocular herpes simplex virus.

The FDA approved the Vision Light Adjustable Lens and the Light Delivery Device to RxSight Inc.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency is also responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.