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External coherence synonym9/19/2023 ![]() Many aid practitioners remain skeptical of treating accountability, transparency, participation, and inclusion as intrinsic to their conception of development. Debates about the place of the principles.Although these concepts evoke potentially transformative notions of citizen empowerment, they risk being reduced in practice to limited forms of citizen consultation or technocratic reforms that rely on simplistic theories of developmental change. ![]() Aid organizations often treat the four principles as programmatic boxes to be ticked rather than fundamental elements of their work. Yet in actual programming they may only pursue or prioritize selective parts of the set, engendering tensions among the different principles. Aid providers frequently present the four concepts as a unified agenda.Governance specialists often follow a narrower approach, applying the core principles primarily to the quest for greater public sector effectiveness. Democracy and human rights practitioners generally embrace an explicitly political understanding of the four concepts and fear technocratic or purely instrumentalist approaches. They bridge three distinct practitioner communities that emerged from this new direction-those focusing on governance, on democracy, and on human rights. Accountability, transparency, participation, and inclusion represent vital embodiments of the opening to politics that occurred in development work in the 1990s.Identifying and understanding the underlying disease processes that cause foveal photoreceptor disruption may help predict visual prognosis.Īchromatopsia Cone dystrophy Foveal photoreceptor disruption Impending macular hole Occult macular dystrophy Photic retinopathy Poppers maculopathy Posterior vitreous detachment Solar retinopathy Tamoxifen retinopathy Vitreomacular interface disorder Vitreomacular traction.Ĭopyright © 2023 Elsevier Inc. We discuss the differential diagnoses that lead to isolated foveal photoreceptor defects. Visual prognosis depends on the underlying etiology with complete recovery common in the subset of patients with VMI, and ARPE, whereas persistent outer retinal defects are the rule in other conditions. Other causes include photic retinopathy (e.g., from a history of sun gazing or laser pointer exposure), blunt trauma, drug exposure (e.g., poppers maculopathy or tamoxifen retinopathy), and acute retinal pigment epitheliopathy (ARPE). Retinal dystrophies such as cone dystrophy, occult macular dystrophy, and achromatopsia may present with diminution of vision and normal appearing fundus in a younger age group. Vitreomacular interface (VMI) disorders including vitreomacular traction, posterior vitreous detachment, epiretinal membrane, and impending macular hole possibly remain the most common cause. Focal photoreceptor disruption usually involves loss or rarefaction of ellipsoid/interdigitation zone, either in isolation or associated with external limiting membrane or retinal pigment epithelium disruption in the fovea. A detailed history along with high-resolution optical coherence tomography is often helpful to derive a conclusive diagnosis in majority of these cases. A common clinical feature underlying these conditions is the presence of apparently normal fovea or subtle hypopigmented lesion at the foveal or juxtafoveal area. These have been known previously by multiple synonyms including macular microhole, foveal spot, and outer foveal microdefects. Isolated foveal photoreceptor disruption may occur in a variety of hereditary, degenerative, traumatic, and toxic chorioretinal diseases. Fovea centralis, located at the center of the macula, is packed with cone photoreceptors and is responsible for central visual acuity.
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