To assess the repeatability and reproducibility of post-mortem central corneal thickness (CCT) measurements made by the portable iVue spectra-domain (SD) optical coherence tomography OCT (Optovue Inc, Fremont, CA) system in humans, and to prospectively establish the time-course of CCT after death. In a prospective multicenter setting, CCT measurements were obtained from 58 human eyes at the following 16 time-points after death: immediately (within 2 h), and at each hour by the next 17 h. The range of CCT values for each subject was determined and longitudinal data were used to illustrate the variation in open and close eye mode. All measurements were made by two independent and well-trained examiners for session. Main outcome measures were intraclass correlation coefficients (ICC), repeatability and reproducibility coefficients, and coefficients of variation of the average central (0–2 mm). Overall, a total of 5,568 OCT measurements were performed by examiners. The repeatability coefficient varied from 0.3 to 1.7% and the reproducibility coefficient varied from 0.3 to 1.6% throughout the entire experimental time frame. Furthermore, the values of the different ICCs were also high during the different postmortem intervals, thus demonstrating the excellent repeatability and reproducibility of the present OCT approach. When CCT measurements were analyzed longitudinally, corneal thickness showed different behavior based on the open or close eye mode. The present study demonstrates that portable OCT imaging can be reliably used for corneal pachymetric measurements in supine subjects and during the post mortem period, i.e. without visual fixation and normal physiology/architecture of examined tissues.

Recently, Baggish et al 1 published a call for a paradigm shift in decision making, dealing with a troublesome issue: competitive sport participation among athletes with heart disease. Several arguments in favor of a progressive introduction of a shared decisionmaking approach, even in this field of medicine, seem to be robust and they move on a well-defined path walked down by physicians in their everyday medical activities. The long way from the paternalism to autonomy (of both patient and physician) has reached a point of no return: no medical activity may, nowadays, be performed on a patient without exhaustive information and a valid consent. 2 From here, the shared decision approach takes its step 3 to fostering an active engagement of patient and physician with a clear preliminary definition of ethical values at stake. Although a very interesting approach, our similitude between athletae and aegroti is functional to raise the following question: may we consider the medical safeguard of health identical in an illness context and in the highest level of fitness, as for competitive athletes? The authors suggest a counseling process involving the athlete and also a wider group of care providers, or to better say stakeholders, including, when appropriate, coaches, sponsoring schools, and sport organizations. This statement seems to better clarify the good at stake: social values more than physical or psychological ones. The end goal of the shared decision approach is the magnificence of the patient's autonomy, being the final decision driven by individual values and stakes deeply rooted in a person, or in his or her parents when a minor. Third party involvement in the counseling introduces other stakes, which may result apart from the key point of the process that has to be the athlete's health (physical, psychological, and social well-being according to the World Health Organization definition). Albeit, people surrounding the athlete might have an important role supporting his or her final decision in such a delicate situation, a third party should never be allowed to take part in a procedure regarding a personal value as health is. The contrast between the universal aim of guidelines, born to make medical activities uniform, and the shared decision process, fostering a personalized approach, appears to be evident. As stated by the authors, the December 2015 IIa and IIb recommendations acknowledge uncertainties from a clinical and legal point of view, widening the potential shared decision horizon. However, the lack of a robust piece of evidence in this scenario, although inborn in science, represents a challenge for the cardiology and sport medicine communities, being an insurmountable obstacle toward a personalized decision for laymen. This breakpoint brings to subjective interpretation of the risk, not only from the athlete, which is righteous in his autonomy, but also from sport organizations/