when the narcissist sees you with someone else. It's been some time since you were with the narcissist. Either you left them or they discarded you. And you met someone else. You started dating someone else. You're happy with this new person. They treat you a lot better than the narcissist did.  And then one day the narcissist either sees you together or becomes aware that you have found someone else. They don't admire or respect your new relationship. They don't take it seriously. They just see it as a joke. It's just something that gives them amusement. They don't really see it as though you've moved on. The narcissist sees you as an object. They see you as being their property. So in their minds, you can't move on. You will always be theirs. Even if they believe that you are in a committed relationship. They see it as though it's only a matter of time until it falls apart. Narcissists do not honour loyalty or commitment. They didn't when they were with you.  It's just a game to the narcissist. They don't take anything seriously. All they care about is getting reactions out of people. Getting supply. They don't care about the consequences of their actions. They don't care about how it might affect other people. They just want what they want. And they will do whatever it takes to get it. They don't honour or respect your new relationship. They just see it as a joke. They see it as though you're just being taken advantage of. You're being tricked and deceived.  Someone who doesn't realise what they're really involved in. Someone who has just blindly entered an unfavourable situation.  People who are just using each other for their own selfish needs. Deep down underneath that pride and arrogance. Underneath their false sense of superiority. They are very envious and jealous of what you have. They wish that it was them. They wish that they could come back to you. But because of how things ended and how you're with someone else now. They know that they can't come back. They know how it would look if they did try to come back to you. So they'll bite their tongue. But secretly, they wish that they could come back. Once you have moved on to someone else. They re-idealise you. They start to realise just how great you are. Because while you were with them, they managed to turn everyone against you. They managed to get everyone around you. To see you as something undesirable or intractive. When someone outside of their group comes in and sees your true value. It becomes a reminder to the narcissist of everything you actually are. Everything you always were. It's like the love-bombing phase all over again. They become infatuated with your glow. Your aura at everything that surrounds you. And in that moment, you are perfect. You are everything they ever wanted. Even though they may have discarded you. They just see it as though they couldn't see it back then. But now that you're with someone else. They have re-idealised you. They have developed this great awareness and understanding of you. There's epiphany or realisation.  One of a kind. Something that they may never find again. But at the same time. They know that they cannot come back to you. Because now you're with someone else. Although they still see you as an object. They still see you as their property. As long as they assume that you're just dating. And not in a relationship. When the narcissist knows that you have engaged in sexual contact with someone else. That is when they no longer see you as their property. That is when the re-idealised phase fades away. And they lose any attachment they once had to you. That is when they quickly forget about you. That is when they are forced to find another source of supply. Unless they don't have any other options. Then they will still continue to pursue you. But as long as they believe that you haven't completely moved on. They will still be lurking in the shadows. They will still be watching you. Because in their minds. You're still theirs. In their minds. You still belong to them. Even if they see you as someone else. They don't take it seriously. They don't see it as though you're actually in a relationship. They still see it as though you're their property. And they just believe that you're being tricked and deceived.  And they believe that your partner is unaware. Of your flaws and imperfections. And aware of your past. Because in their minds. If your partner knew all of your flaws. If they knew everything that happened in your past. They would never love you. They would never want to be with you. Because in their minds. That makes you unlovable. Which is really. Just a projection of how they feel about themselves. Thank you for watching. I hope this video resonated with you. Please like, comment, share and subscribe. Click the bell icon to receive notifications. For my future videos. Check out the new Narc Survivor website. www.narcsurvivor.co.uk When you can read my blog posts. Book coaching sessions. And join our support forum. If you were elected tonight. My PayPal link is in the video description. Coaching inquiries. You can email me at coaching at narcsurvivor.co.uk Thank you for watching and I'll talk to you soon.


What's up, guys? It's Eric Johnson from Airtight Throws Nation. In today's video, we are going to break down half turn in the rotational shot, do's and don'ts. So check it out. Okay, guys. So as I just said in our introduction, we are going to look at the half turn and we're going to look at the do's and don'ts. We've kind of interchangeably called it a half turn a modified wheel 180. It's kind of all the same thing. And what we're going to do is look at when we're training rotational shot putters kind of the why of what we're doing. And I've thought it would be good to just kind of pull up and look at our beginning thrower. So let's take a look. Now, one of the key things that you want to do is set alignment. You're going to notice that the thrower on the right actually has if we going to do what we would call as a center line down the circle. So we're going to go here, right? Middle of the ring would be like here to here, right? And that would be the toes on the line. And so that this guy's toe needs to end up on the other side of the line, which he essentially does. Now, one of the things that you're going to notice is why is he beginning this throw early? Now he's going to pull down and this is actually a thrower that's a pretty good thrower. And I think as he gets used to this, he's going to be throwing much further. But we're in those beginning weeks in this video. We're still in the first, you know, six, eight weeks of learning the rotational throw. They're throwing well on a full throw, but there's a couple of simple things. So number one do is alignment. Make sure you have the alignment set. So again, notice thrower here on the right, he's got himself aligned. Look at this thrower over here, right? And we kind of put the foot here. You see how he doesn't really have this foot on here. Now, if you ever see like a half turn of somebody like Tom Walsh, you're going to notice he kind of sets more in the middle, but that's because he has an offset. So you're going to notice that our thrower here on the left, he's got the alignment wrong. Now, what you're going to see with him as he goes now, watch the upper body and watch this. So one of the things is you're going to see how he sets the foot here, right? And then he sets the foot down here. So he's going to land closed. And so you see that his hips are over here. The block foot isn't open enough and he's leading with the upper body. Now here's the big thing, right? So we've got alignment. That's the do you want to set it up and the don't is don't misalign it. You got to have the right position set up. Now the other thing. So it's going to make it difficult for him to get that foot around. So look at the left leg trail. Why does the left leg trail because look at the upper body, the upper body is opening too much, right? So that's a really important thing. So one of the things we do, we have drills in this system. These guys are learning how to maintain the wrap arm or the block arm, right? At this point, it's going to need to stay closed. They're going to be able to turn. And at this point, that arm should really be kind of folded across the body. So you're going to notice the thrower on the right does the same thing opens too much and see how. So there's an upper body rotation. So watch when he goes here, watch the right foot. He moves the upper body, upper body, upper body, upper body, upper body. And now the right foot starts to move. So see how it's a upper body, lower body. So the do is make sure that the lower body initiates the throw when you're doing a half turn instead of the upper body. And you're going to notice that the thrower on the left does the same thing. Look at the right not moving. He is loading the ball and he comes here, but both these guys, you're going to notice kind of trail, right? So this is because the wrap arm is supposed to be staying back, which is going to kind of create a gathering and an increase in rotation in the middle. So if that's not happening, you're going to wind up taking the slow route to bigger improvement. And that's the thing that we all want to avoid. So when we get here, they do have a good lengthened balance arm, right? Because that's part of the role in the rotational shot. So you can see how this thrower is beginning too early, the foot's up high. And so this thrower is going to know his close and he's going to kind of jump through. So he's actually got pretty good rotation and he stays behind the shot. So he's doing a good job generally of keeping the elbow kind of in this position and the thumb more down and then he's going to kind of jump through it and he's working on learning how to turn further. Now you're going to notice here he had thrower on the left or sorry on the right. He had the delayed foot. Now he starts to rotate, but he's kind of collapsing forward and you're going to see how that elbow kind of comes here and the hands coming up. So he's not going to be able to maintain the push. Now you can see how he's pushing around. Why is he here? And this guy has a decent block, right? But we go back to the very basics. Okay. So what do we want to do more look and this is why I say here's the thing. These are athletes and they're making they're already moving better than what these videos are. So we'll show you an update at some point. What we're trying to do is this is where we would incorporate inside the throwing chain reaction, right? We're going to be teaching them very specific things. We're going to be teaching them drills for how to wrap. We're going to teach them drills for how to properly execute off of, you know, the back leg and initiate the throw, how to get on this, how to open this properly into the right position, right? So that they're not landing closed instead of landing over there, right? The foot needs to be over here and so you notice that they're both very upright, which this one, it's, you know, a little bit closer and things are kind of moving close, but that's why we put them in the net because we're focusing on key positions and focusing on movement rather than trying to throw far because the minute we put these guys into the ring, they tend to start wanting to see how far it's going to go naturally. So that's kind of right. That's the that's of course the goal of our sport. We want to see how far can we throw it and accept that the discipline comes in working on continuing to hit the right positions and then as you get better, of course, the distance is there because you know the throws technically better, not just because you're wanting to see how far it can go. Now, of course, that's nice for everybody, but that's kind of the wrong way to train. So any rate, the key thing that we talk about is setting up alignment. We've got to hold that wrap and we've got to get the lower body always to move first and that when you set up alignment and you're going to understand the wrap, it becomes much easier to do that and here again, just two examples of throws that are too active with the upper body. The wrap is not there and that's what they're learning. So again, the kind of the main goal is that we always talk about. We have to understand that the throw is a chain reaction. So one of the things that we talk about here when we look at a half turn, how many drills would we apply? This is what you should understand about doing drills. You have to train drills or to train specific patterns that rather than a drill, just being a general half turn or a three quarter turn or some some kind of, you know, pivoting action, you have to understand what is this particular athlete need? In this case, both these athletes need some similar things and so we would do a series of what we would call pillar three, four, five and six drills because that's what the half turn incorporates. So hopefully this gives you just some extra insight. Don't be too active with the upper body. Set up the proper alignment and always initiate the legs first in whatever phase of the throw you are throwing in and then the arm positions and everything kind of follow more naturally and in another video, we'll get more in depth, but these were some basic tips to help you guys throw further and help you improve. Now, if you'd like more information, you want to go in depth, check out the link somewhere around this video for the throwing chain reaction system. Be sure to check it out. If you're a member, be sure to log in. There will be a expanded version of this video where we will talk specifically about pillar language drills and whatnot and show you exactly how we're fixing these guys with the system drills. Now, that's not to hold you guys out that aren't members. We'd love to see you join the system. If you'd like more information, check the link somewhere here to sign up. We'd love to see you on the inside and for everybody out there, please like, subscribe, hit that like button and we will see you on the next video.


We got the refrigerator. It was on when we were here for the bio. This house sat empty for a long, long time. There we go. Nasty looking stuff. Catching the, in the order now. Let's see what's in the meat drawer. What have we got here? Is that lunch meat maybe? At one time? That's some type of pork maybe here. Well, it's pretty gross, but I'll tell you, the odor, I think due to the time is not as bad. There's no way I could be here without a full-face respirator on, or at least a half-mass one sum, but the odor keeps catching me every now and again. How has this room gotten your refrigerator scale? This one's up there. It's pretty, pretty gross. Nasty.


Are we live? I think we might be live. But I do not know. This is exciting. I've never done this before. But I can take my introduction still. My name is Kim Diashol. And, ooh, here you see... Here you see, I have Google. My name is Kim Diashol. And I'm an artist from Bergen, Norway, creating art for free use. And I'm testing out my new streaming setup. I've got lights. I've got a microphone. I've got OBS. And I've never done this before. So, yeah. This is indeed exciting. So, I'm just going to see if the YouTube actually works, if I'm actually live now, because I don't quite know. I've never done this before. So, yes, we are live. But do we have a chat? I'm just going to... Oh, we even have a chat. Where can I find the chat on my... Ooh, do you have a hair routine? Yes, I have a hair routine, which is right before the stream. I comb my hair and put some of this Spanish stuff in it. What is it? I don't know. Whoa! Is something wrong with my mic? Can you hear me? Volume is a bit low, so... And it is a bit low. Should I have it higher? And I need to figure out, is the volume better now? Ooh, so many questions all at once. Okay, we will start this in a few seconds, when I figure out how to... Shouldn't there be a... This is confusing! Boom, boom! Is this the guy with the Marilyn Monroe hands? Yes, this is the guy with the Marilyn Monroe hands. I should do my nails before going live, but... I haven't, so... Sorry about that. Looking a lot like Ian Anderson from Yethro Tull today. Yes, Yethro Tull, the best hard rock heavy metal act of 1988. Wasn't it? Something like that. I do like me some Yethro Tull once in a while. And this seems to be working. The only thing that isn't working is that I have no idea how to get the chat up in the OBS. Okay, so one question. First of all, how am I dealing with all the snow these days? Because Norway is snowing down, and... Bergen, where I live, is usually not a very cold and snowy place, but we actually have about 30 centimetres of snow. And I'm down with the cold, but I still had to shovel our little hill so that the cars could drive out today. So I'm exhausted. So that's how I'm dealing with the snow, not well. But I would absolutely love to get to do some mountain walks and do some plein air painting or ink drawing in the snow. It's cold and it's mean and it hurts, but I absolutely love drawing and painting outside, especially in the snow. That's the best. Your thinks about Finland. My thinks about Finland are great. I think Finland is fantastic. I grew up reading the Moomin books, watching Kauris Mekki movies. I love Remedy games, I mean Max Payne and now Alan Wake 2. Alan Wake 2 is magnificent. I like Finland. Your voice is very therapeutic. Oh, thank you. Thank you. Thank you a lot. Interview in 20 minutes. Any advice? Job interview.  I'm not a person who can hold a job. What are your political views, my good friend? I know from your artwork and videos that you are pretty left-wing. I would classify myself as an anarchist. In the real socialist tradition. Supporting a classless society where everyone can have as much freedom to choose our own lives without it infringing on other people's freedom. Yeah, so that's basically it. Be sure your clothes have no stains. Try to sound smart. Be confident. You'll do great whether they hire you or not. Oh, that was the advice for the job interview. That seems like good advice. Do I know? No, I have no idea. Could you draw a 40k ink monster? No, I can't draw a 40k ink monster. I did play a little bit 40k as a kid. I played more fantasy battle. I was painting an ultramarine army. And I really like and admire a lot of the artists of the game's workshop. But I release all my art for free use. Which means that you can go to my website then ungehadhorn.com and you can download my art. And you can print it. You can sell it. You can do whatever you want with it. So me doing that with someone else's intellectual property would be very illegal. So fan art is unfortunately out of the question for me. Except at home for the kids. So when the kids start liking 40k I will probably do some 40k fan art again.  No matter where you're from. But I want to say one thing.   And we live in a pyramid scheme that is presented as if it's freedom. But you do actually have a lot of chance to influence things on a more local level. Most places you do. But it takes a lot of work.   Something like that. I should check out Berserk. I know Berserk very well. I haven't read all of it. I haven't watched all of it. But I absolutely enjoyed what I've seen. What are your pronouns? I'm good with anything. But my bio says he, him. Because after many years of being not comfortable in masculinity, I think. I'm very comfortable with my masculinity today. But I also never, it has never made quite sense for me.  Call me Al. Ooh, do you have a favorite folktale? I actually do. And I've actually, if you go to my YouTube channel, and now we will probably get some, I'll do so that we don't have to get any noise. Why? Now there's no sound on. Maybe we go like... I forgot something. So we will be back very soon. Two seconds. I'll be back. Sorry about that. I forgot that I had a package delivered. Okay, yeah. So I was trying to find Pergisven. The video are done. And it's this one. That night till the morning came I set out running but I take my time Friend of the devil. Piritail. Strange land where the roads stretch as far as I can see without a single turn. After following the roads for a quarter of a year, it comes to a city. In the city there is a church. Outside of the church is a block of ice. Inside the ice is a corpse. Confused, the boy asks the priest and is informed that the man in the ice was a wine server who mixed water and wine so no one wanted to pay for his funeral. If this punishment sounds extreme, know that in medieval times, wine and beer was considered safe to drink as it was purified by the alcohol. But if you mixed it with potentially dirty water, you could end up poisoning people. But the boy also thought the punishment was harsh. The boy spends all his money on paying for the man's funeral. They get the corpse out of the ice, lay him in consecrated soil, sing and ring the bells. The priest tosses a handful of earth over him. Then they laugh and cry as they drink grave or grave beer in his memory. With empty pockets, the boy wanders on. But soon a stranger appears. I'm figuring out OBS while I'm doing this. So this is very helpful for me. I don't know if it is a live that will be staying up because I'm fumbling with all the technology and the equipment and the thingamabobs. The first thing I hear when I join is paying for his funeral. That was the sound from the video I was trying to... I saw the chat a little bit too late. I need to figure all this stuff out. And that's why I'm doing an Ask Me Anything. And I didn't see the chat while the other video was playing too loud. So I need to figure out how to do this in a better way soon. And I will. Thank you Lifi for sending a Super Chat. You can send a Super Chat if you want more lives. I will be doing two lives every week the next few months at least. We will be doing a Thursday live where I will be drawing and you can ask me requests and we'll be having fun. And on Sundays I will be doing a Sunday study live a Sunday study live where I will be working on my fundamental art skills together with you guys. We'll probably continue working with the Bridgeman Anatomy book because I like going through that once in a while and then I'll do something else. Oh! Do you have any favorite horror movie book or any other media? So if you look behind here we have a bookshelf we can even get it in focus I mean it's pretty much it's horror I mean not all of it but pretty much half of it is horror of some time from all of these cheap focus again from all of these cheap dime store paperbacks to bonafide classics and of course a whole ton of HP Lovecraft including volumes of Lovecraft criticism and biographies and different collected editions and minor tales and all that stuff. Which Bridgeman book is it? I now have a collected Bridgeman book it's behind here somewhere and it's got all the different Bridgeman books in it. I grew up with I think I had most of them as a kid but I really Bridgeman's art was extremely influential on me not just because of the books which are slightly difficult books but also because of his influence so few of the artists who really influenced me were artists such as John Buscema Will Eisner Frank Francesetta all of whom had been in Bridgeman's classes and then other artists were Frank Miller Simon Bisley Sam Keith all of which were influenced by people like Buscema Eisner like so everywhere in my artistic upbringing I found the influence of George Bridgeman Thank you so much for the Super Chat. You can send Super Chats and I appreciate that so incredibly much and you can also become a YouTube member and finally figuring out how to do the YouTube membership in a more in a way that rewards you more for joining and for supporting so right now there is a five dollar here that will remain but there will also be like perhaps a 25 dollar here and both of them will get some exclusive videos those will be the same as on my Patreon but it's all in the planning stages okay do you create lore and backstories for your new ink monsters yeah I have only done that as an exercise when making making the videos about them and I used to do that early in the my rise to tiktok fame I did a few videos where I made up short stories for the different ink monsters and that was really fun but I quit doing that because because it was when I was doing both real mythology and I was making stuff up it very quickly became confusing for some viewers but I will hopefully find a way to do something like that again have you read Blood Meridian no I have not are there any anarchist bands, creators you would like to highlight yeah I mean I've been called Alan Moore I really dislike looking like Alan Moore because I don't like looking like anyone else but me but I sometimes hear oh he looks like Alan Moore and the funny thing is I've never been the biggest Alan Moore fan I really appreciate this stuff I really like I mean from hell is magnificent but he's never been my favorite and one of the reasons why is that both spiritually and politically he seems very close to a lot of my ideas and I've had all of these you know my own thoughts around politics and around magic and spirituality and atheism whatever I've sort of developed them on my own and then I once sat down and wrote an article about Alan Moore for a comic book magazine and I started researching him and buying all the books with interviews and stuff like that and reading everything and it was just so much stuff there that I was eerily similar to my own and I didn't like that because I like thinking I'm unique my ego is too big but yeah I would absolutely recommend Alan Moore from that all my favorite artists are people I disagree with I mean Frank Miller is just such an inspiration to me and probably don't agree with him politically or spiritually about much anything do you have a favorite dinosaur yes I'm boring that way because the triceratops triceratopses are magnificent any specific favorite animal would you like to draw I love drawing rats I love drawing wolves and crows and yeah rats, wolves and crows and monkeys what is the currently the favorite drawing you've made let's go here for a while I let me see if I can find something if I go to the Patreon exclusive content here there's a lot of content that I haven't released publicly for pre-use yet because I'm slow but some of that I really like I think I like this one a lot I think this one is cool but not my favorite what else do I like this one is magnificent can we get that to be full screen for a little while but if we do like this we do like this and oh oh oh that didn't work it's not full screen this didn't work at all ah like this yeah I like this one this is probably the drawing that I've spent the most time with let's see if I can figure out how to get the window back for my first proper live which will be tomorrow I hope that I have all this stuff figure out better I'm trying to learn everything at once now let's see if I can find the chat again and answer some more questions did we get another we got another super chat thank you so incredible Chris when working on live music pieces does the rocking out affect the result of the work as in does the music move your body in a way that you can perceive in the final art yes absolutely absolutely and I will try to I will try to find some examples again we're going back to the gallery we can do some of live art that hasn't been released quite yet because it is a bit of struggle sometimes to tag and categorize and get everything out there in good quality ok this is taking too much time so let's go back to not the patron exclusive thing let's go back to the heavy metal concert art and here I will probably find some of it so I can start I can start explaining with some of these pieces this is a drawing I did of Imperial Triumphant during the inferno festival and I really like Imperial Triumphant and I really enjoyed the concert but it was the first concert of the festival and I'm not familiar enough with their music I've listened to one of their albums a few handful of times but I'm not familiar enough with them that I managed to sort of get my body moving in a way where I could lose myself in the art and therefore I like the art but it came out a bit stiffer than I aim for so when I look at these pieces you can like them however much you want but when I look at them I sort of think oh I didn't quite get into the zone and then we had obliteration where I definitely got more into the zone that was fun and then we have my best drawing of Chuck Moll from Dark Funeral I definitely got into the zone oh my best drawing yet of Ishaan from Emperor I think and I absolutely loved that concert this is the keyboardist the guy from Norwegian Shining and I absolutely love that but let me see if I can find some of the ones where I, yeah okay this is Colombian band Massacre and Massacre had a such a magnificent energy on stage and I had no relation to the band from before but I completely lost myself in the music that was the top concert of the festival for me and it was also ironically the physically worst concert for me because it was on the smaller John D stage and I didn't really have room to stand so I was half standing sitting in a really painful way but by getting into the music you just start headbanging and you don't really see or care what's going on on the paper you just lose yourself in that and I just when this concert art stuff works it is like a meditation where for these brief moments eternally long moments of maybe one to three seconds you have no ego you have no self you have no thoughts it's just you and the movement and the music and that's where I create the best live concert art so in order to do that more often I will start headbanging while drawing the music in order to try to provoke that flow state it doesn't always come their mood was magnificent and it definitely had parts of that with very little headbanging but with the physical movement back and forth to the music and Sarkis Tolle solo definitely had some of that Nile was magnificent but Nile was something of a struggle as well but so fun so fun and oh this one of Bataille was just I was so exhausted at that point that you know getting into the zone it was was so it was just effortless so yes the headbanging the movement of the body is incredibly important in the physicality of the art and the connection between the physicality of the body the hand doing the art the eye, the music all of the energy it's all connected and when it all works it is a I said this to Tom Warrior after drawing Triumph of Death because I really like Celtic Frost and I really like our trypticon but I have no relation to Hellhammer because I was too young but drawing drawing Triumph of Death was the highlight of that festival for me and I said to Tom that it was a religious experience I came in a bit skeptical because I had listened to the demos and it's impenetrable noise when you have no relation to it but live I was just able to let go and be loose and lucid and get into the flow and it is a physical at its best it's a physical experience it's a spiritual experience and it's a egoless experience for brief eternal seconds do you know Savard? I do know Scott and I think I am not speaking out of out of Q out of step here when I say that actually Scott and me are planning on doing a monthly stream together and figuring out the date for that it will not happen in January because of time but it will happen in February so stay tuned for the Kim and Scott show the Scott and Kim show this Kim show I don't know though Scott is amazing he is he is an inspiration how he manages to be authentic and tell great stories and just be awesome at every point who way, action through non-action yes absolutely absolutely let us see Schim Schim yes what do you mean from Daoist internal alchemy so there's a lot of my thoughts around what I'm doing when I'm doing live concert art that is specifically inspired by Daoist philosophy and meditation and also from later Shinto Buddhist practices around art and meditation which has been part of my life for a long time do you watch youtube often if so which channels do you watch yes I watch too much youtube these days I've been watching all the how to get big on youtube because I'm planning to do a lot more youtube this year and I'm planning to figure out how to do something that works in the long format for youtube but also is different and also is me so I've been watching too much of that stuff and it's funny but other things I just finished watching Miniminuteman's great takedown of the ancient apocalypse tv series Miniminuteman is a mutual of mine on tiktok and he is an archeologist and he did a really entertaining takedown 4 hour long takedown of why ancient apocalypse or whatever it's called sucks and I enjoy all that stuff I'm a sucker for conspiracy theory and ancient aliens and all that stuff but I do recognize that in reality real archeology is a lot more interesting and is a lot more honoring of the complexity of humanity and so so do you like draw pee? I've seen some draw pee stuff I don't remember much so I don't remember I know I've checked out draw pee but do you have an experience with supernatural things or unexplained things or this seen as magic so when I used the word magic I'm not necessarily speaking in a I'm not necessarily speaking in a way that is paradoxical to my own atheism I have a religious view and I have a spiritual view and I have an atheist view and they go great together and it's not an agnostic view I don't like the word agnostic because I don't really know what it means I don't believe in supernatural things or in in cryptids or anything like that but I have had experiences that are unexplainable but I don't really I know my mind is powerful enough to trick me and I don't really I don't think it matters I think that I think that one of the major faults of a lot of modern atheism which I'm a part of is that it's so easy to discredit supernatural experiences by saying yeah but they didn't happen but whether or not they happened has nothing to do with whether or not they're significant and I think that humans experience a lot of things that are that may be beyond our capabilities to explain with science but they're still significant I mean consciousness is something we can't really explain with science maybe never but it is significant so saying that ooh you think you saw a ghost but that can't be explained by science so that doesn't matter is like saying ooh you think you're conscious but that can't be explained by science so it doesn't matter of course it matters that sounds like an agnostic take from you fuck off sorry I don't know why I've never liked the word agnostic I don't think that fits my philosophy do you know Susumu Hirasawa no I don't I love your art and comments could you please do a picture that reflects new world order only if you're talking about the ministry song if you're talking about conspiracies theory stuff then no I try not to are you an Urura fan yes and I didn't know much about her except that she was from my town and that she made music until I found her on tiktok and she found me on tiktok in I don't know if it was in that order and she commented on a few of my posts and I started checking out her music and she is magnificent such creative being gracious and interesting and funny I've never met her but she seems very cool and I would like to draw one of her concerts someday what are your favorite 3 books ok favorite 3 books I don't read all that much nonfiction and it's been so long since I've read these books but my standard answer would be something like Lord of the Rings American Psycho or perhaps Glamorama and The God of Small Things by Arun Datu something like that may your pants make art of you or for you or will that upset you I love when people have done pan art of me portraits or caricatures I love getting drawn I think that's incredibly fun so please do draw me what made you start art so I was I was one year old when I started drawing and around 3 and a half when I started talking and from an incredibly early age I was expressing myself through my art when I was happy I would draw when I was sad I would draw the sadness when I was angry I would draw angrily so yeah how old are you 43 years old do you listen to rap at all yes I I have a few favourites those are mostly 90s and early 2000s so Rootsmanuva The Roots The Streets Fugees Wutanklan all of that and of newer stuff I am sadly outdated but I try to listen to stuff when I find it I listen to Chancellor Apper and Kendrick Lamar and Missy Elliott and yeah would really like to sculpt you oh that would be fantastic please do do you read Wuxia novels Wuxu novels no sorry I do read many novels I do read horror short stories but it's been a while I read a little bit Lowcroft I've read a whole lot of comics but I don't read many novels I read a lot of non-fiction listen to the artist Poppy I don't think I've even heard of them what's your most memorable ink monster ooh memorable in ink monster let's go back to here and find the ink monster gallery and see if any of them strikes me as memorable yeah this one is very memorable because this was done on a live and someone asked me to instead of doing one ink pot do ink pots all around and find something in between it and I did and I just struggled and I struggled and I was about to give up when suddenly I saw a only mask where I only paste from Japanese art and broom in some a few minutes it was done and then I went to figure out a little bit more about the only and learned that only is one of the possible meanings of the word only or the possible etymology of the word only is the hidden one something that's hiding and this one was hiding for so long and it came up apart from that I mean this one was memorable because I was doing a pun or a joke of people who read the bible run and got accused of being racist and I understand why so I had to reflect and figure out what I had done wrong this one was memorable because it was done while being interviewed about ink monsters this was this is probably my favorite video that I've ever done I'm so satisfied with that the art itself isn't that memorable let me see most memorable most memorable ink monster let me it's very hard because I remember some things about most of them and other I mean others are a bit more vague this one I remember very well and I think this was one of the ones where I had an image in mind and I had to do it a couple of times before it hit this one I remember because this was number thousand so this one was done at the gallery of the black metal artist gal live with an audience while talking about the mythology around umid so that was difficult but I think it worked this one was fun and someone asked me about anarchist artist that I like Charlie Christensen who did Arna Unka of the Swedish comic I think he is anarchist in persuasion and he is magnificent one of my favorites this one was also memorable just because it came so easy and it looks so good it looks planned but it wasn't and also when I did the first video about this I thought I was really funny because I answered a comment asking can you draw a mad unicorn and I the video answering he isn't mad he's just trapped in a mad world and then I paid it over to the mad world music and I thought that was so hilariously funny I thought that was the best joke ever and no one got it everyone was like this is a propound and not that they were wrong I just was judging the tone very wrong I don't always know this one was memorable this was done to a viral sound on tiktok and also I think I did like 3-4 versions before I got this one which is perfect I love it one of my favorites I've done a few ink monsters I've drawn a few I've done a few ink monster I've drawn a few this one changed a lot of my approach to everything because it was about the massacres in or the genocide through the residential school systems in Canada and it was the video about it was embraced by a lot of survivors from that system and that was powerful for me to see that my art could affect people who have gone through something awful should I go back to the chat let's see let's just scroll all the way down I think the most memorable is actually quite easy because the most memorable you'll find it soon I've done too many ink monsters I haven't done oh I've done one ink monster this year this was my first ink monster it's Hugh the Hangry Minotaur and I love him perfect ok so let's see the questions many questions favorite comic book series Sin City by Craig Miller absolutely do you support Israel do I support Israelis do I support the genocide of Palestinians absolutely not Israel is an apartheid state that is practicing a genocide and live-streaming more or less and I have family, distant family in Israel and people I met would don't want to see any harm come to you know and even someone I last met in while he was like yay tall and now he is on active duty in Gaza and these are people I would absolutely not want to see any harm come to but the genocide of Palestinians has to stop the ethnic cleansing of Gaza has to stop and the US of A has to stop blocking the international community from holding Israel the state of Israel the government of Israel accountable for the active war crimes they are doing are you Muslim? atheist and satanist have you ever done digital art? yes definitely I have done quite a lot of digital art shall we look at some of my digital art or do you have any experience with Christian monks and do you think they can have spiritualities that are genuine and resonate with you as a person even if you are not Christian? yes I was talking earlier about Daoist and Shinto Buddhist philosophy influencing my art but the Bible has influenced my art Christian mysticism has influenced my art and my philosophy and these types of experiences religious experiences religious experiences I think are very close to the artistic experiences absolutely valuable to me I saw on your website that you once painted a giant squid attacking some fisherman not the Kraken image what was the story behind that? that sounds like Cthulhu or something what is your favorite let's go back here and see what we can find do like this I've been live for a long time now how long have we been going? if we favorite dragons I think I like this one it's a bit hard to see perhaps will get higher resolution soon I think I like this one I think this is one of my favorite and I got a question about the digital art I used to work digitally for a long time I got a Wacom board in 2004 and for 10 years most of my art was digital and I still have some of that art up on my website old art if you go into other art old art then you can see some of my digital work I this one I like that was a poster I did for a lecture about Satanism in Gothic and conspiracy theory as well I think and this Lovecraft portrait I like a bit goofy and also I did I did a lot of more cartoony art I think I even had a gallery of just cartoony art and most of it digital and it's family friendly it's cool hmm hmm tree wolfish moon that was funny extreme pastry with lemmy and oba I like that one hmm and I like that one so yeah ooh we've been screaming so long that my lights are going out so I think that is um a sign that we have to stop streaming let us see may ask what is Satanism Satanism is a bunch of philosophies and religious movements that are in some way most of them are atheistic and are putting themselves as an opposite to a lot of the more mainstream Christian beliefs because Christianity and Islam and Judaism and other world religions have done incredible evils and and I don't think that's cool so if that's what God does then hail Satan and also it is a reflection of recognizing darkness recognizing death and recognizing joy and my own Satanism is my own it's not Anton Leves Church of Satan it's not the satanic temple it's not anyone else it's just my own I've been making ink monster while watching where can I share with you on instagram or facebook or on my discord but now soon this other light will go out and we will be screaming in darkness and that's not too cool what happened here watching I need to thank you I need to end this live now because the lights are going out I need to figure out a way to actually have the lights on for a whole stream it's let me just answer a few last question it's 9 o'clock in Norway I don't have any spiritual connection to Osatru I do have a very deep connection with the tales of Norse mythology and Norwegian fairy tales share on discord please do that I have very much against religion as institutions that religious any religious institution is survives only so far as it's useful to the structures of power and state and I don't like that but I have nothing against religiosity, spirituality religious people many of my favorite people are religious people with that I will be back with probably another Ask Me Anything tomorrow daytime and then the first proper live stream 7 o'clock Norwegian time tomorrow and I will be drawing your request and as Dio would have said Dio ok bye bye before I say bye bye support on Patreon becoming a member or go to my webshop where you can buy art, merch all of that and you can also support by using my art because all my art is available for free use and you can even sell it and do me a favor and earn money on my art if you can that helps a lot too bye see you tomorrow


Disney has recently been celebrating its 100 years of magic in the entertainment industry. What better way, though, to really put a feather in the cap than to release a new big film for the whole family that's incredibly mediocre across the board? I saw Wish. You probably shouldn't. Alright, so Wish is, oh my gosh, the star from Wish is here. He's floating around. Hey, you got my Wish. He answered my Wish and that was for you to subscribe to the channel. I would love to have you stick around. I post tons of movie content each and every week. Need the bodies. Need the views. Come join me. It's a good time. Thanks, Wish. They hit the button.  As a father with very little going on in my life, I thought it would be fun to take the kids and the wife out to another Disney film. In fact, we really enjoy Disney movies. We like going to the theme parks.  I grew up on Disney. I think many of us have. It's no secret to many, though, that Disney's kind of been slipping in the last five, six, seven years when it comes to quality entertainment. Sure, there's still some decent ones being made. Of course, we have our diamonds in the rough, Aladdin, but there's a lot of bad crap coming out lately, too, and it's disappointing. I know it's not because everything's woke and they're appealing to a certain demographic. There's some of that, sure. Of course, there's always going to be, companies will always try to play to the market or the market that they think is there. There's no question about that, and you can say that it's disingenuous. You can say that it's all for money, and you probably be right. Although there's a lot of people that work at Disney and companies that truly feel passionate about what they're putting out, and you should want to get messages out there. You should want to put your expression on the big screen for others to appreciate or be disappointed by. That's not really the issue I have with Disney. I just find them lazy now. I know that they're capable of doing better, and so remaking all of your animated classics is live action. That that doesn't do any, I don't know why live action, I don't know why I kind of tripped over that, but that doesn't do anything for me. Shot for shot, remaking Lion King, Beauty and the Beast, Aladdin, what are we doing here? At best, you can have a mediocre to serviceable product. You're never gonna beat the originals. Why are you even doing it? Take something like Jungle Book, which the live action is far different than the animated one. That's worth telling. That's a story I'll go out and appreciate and watch because you took it in a different direction. So it can be done. Of course it can be done. Then we move to the animation space. I think that Disney's still putting out good stuff. Pixar had Luca, which I thought was fantastic. Turning red, turned a lot of people off. I enjoyed that one. I liked Elemental. So I'm not this, like, chromogeny Disney socks. They should be burned to the ground sort of individual. I just like a good movie and a good story. And unfortunately Wish is none of that. My kids had no interest in seeing this film. My wife was kind of okay with it, but she doesn't go to the theaters anymore because they're raging dumpster fires of awful people. So she'll wait for it to come out in Disney Plus, which is exactly where this movie probably should have gone to begin with. It looks like a Disney Plus movie. Let's talk about the visuals for starters. Let's talk about the superficial stuff. I do not like the look of this film. One, iota. It's not good looking, okay? And I know Disney has some of the top tier top talented animators across the globe. They put out amazing stuff. Most of their stuff looks fantastic. I don't like Wish's look. It, I see what they're trying to do, right? Disney celebrated its hundred years. This is supposed to be a regal Renaissance-esque throwback to the Peter Pan's, the Bambi's, you know, the Snow White's, the Sleeping Beauties and so on. But they're still using 3D. They're still using, and by 3D I don't mean like you have to wear the glasses. I mean they're still using non 2D animation, but they're trying to pull it off like it is 2D. They're putting a layer of 2D over everything or given the illusion of matte paintings and flat backgrounds. And that's exactly how this comes out. It comes out as flat and unfinished. It just looks terrible. It kind of reminds me of those crappy Netflix animated movies that aren't Klaus, not the good ones. I'm talking about the animated movies that you've never heard of before, that will just randomly show up trendy number one for some reason on Netflix by a company you've never heard of.  Certainly not the end game, but man Wish is just, and the thing that sucks is you can see a pretty looking film in there. You can see a Moana or a Frozen. It has the bones, but then they put this filter on it or something and just ruined it. Just gross. Okay, here's my problem with Wish.  It's just sitting in this incredibly mundane conveyor belt corporate production looking shell.   You can have fun with that like a Fast and the Furious.  And of course there's entertainment if the movie's well done. The worst kind of movie to watch is a movie like Wish, where it's just all there presented exactly how you expect it. There's no twists or turns. You don't see coming a mile away.  And yeah, the audience I was with was they were having a decent time. There was laughs. There was, you know, some sound effects going on from the crowd. But overall it's just so miserably generic. We have, we follow, I have notes here. Asha. Asha is the main character. She's just turned 18. And she lives in this fantastical town that was created by a sorcerer. A man, just a regular guy who really wanted to put good out in the world. And the way he figured out to do it is to actually learn sorcery and he can make magic. And he's the only one. It's forbidden by everyone else. So this guy, played by Chris Pine, who is definitely one of the better parts of this movie. Although the voice actress Ariana, who plays Asha, she does a great job. She has a solid voice. I mean, again, she's just, it's Elsa. It's Anna. It's Moana. They're all interchangeable at this point kind of for me as far as the voice acting goes. It's all very good. But it's also all very familiar. We'll get to that in a second. But yeah, so he kind of built this little utopia where the people in the village are very happy. They're comfortably numb, I guess would be more apt, because he every once in a blue moon will grant a wish from someone. These people can come up to them. They approach them and they say, Hey, I want to give you my wish. And they literally physically give him his wish somehow with an emotional contract of sorts. So they say like, Hey, I want to be able to fly. And he goes, Okay, I got your wish, boo. I'm gonna, I'm gonna put it over here in my secret little area. And you know, we'll see. Maybe it'll come true. Maybe I'll grant that wish someday down the road. You'll just have to hold tight. Oh, but in the meantime, you won't remember this wish. You will completely forget you ever had this dream. It's gone poof. It's it's out of the it's out of the ether. And that's really the message of the story is, Hey, should we rely on others? Should we rely on a fairy godmother is something to grant our wish? Or should we pursue it ourselves? It's a fine, it's a fine message. It's a fine tale. Usually, you know, Disney has nice messages and that that's par for the course. However, outside of that, there's that that's the entirety of the film. Asha, Asha is like, wants to be the apprentice of this guy. She finds out he's sketchy. She's like, he's collecting all these wishes, but he's not really granting them. What is he doing with the wishes? Which is a great question.  They're just kind of floating around like, give them back. Why don't you give them back if you're not going to grant them? But he's got an ego, I guess, and doesn't want to and, you know, so she's going to make a wish on a star.  And that's that's where I die a little bit inside watching.  Obviously, he talks because that's what we do in these movies. He's a deep voice, deep baritone.  I just, I'm sitting in this movie and I wanted to fall asleep like five times. I truly thought it would have been amazing to just sleep in the theater for the first time. For the first time in forever. I just sleep. I would just sleep and it would all be over so much quicker. About 45 minutes into the movie, I just thought, you know what, I could leave. I review movies as a side hobby slash second job, but I don't need to see anymore to know exactly where this is going. There were several times where I thought it just bouncing, but I pushed through. I sat there and suffered with it. Now, do I think you can have a good time with Wish? I guess. If you, if you aren't familiar with literally every single Disney movie or if you're not sick of the playbook by now, sure, you can have an okay time with Wish. I don't foresee anyone coming out of this movie though and going, oh wow, that was incredible or what an amazing film. It is just all around incredibly mediocre. The music is all fine. The voice acting is all good. The, the animation is serviceable. I will say in motion, the fluidity, the way that Asha moves around is fantastic. It just doesn't look interesting. I don't like the lack of color, the lack of poppiness to it. It's just drab. There are some fun callbacks, I guess for some people they might like some of the references to older Renaissance Disney films. It's, you know, it runs at a kind of a slow pace. It's probably, I would say, an hour and a half, hour 45. I don't, I don't know what these movies run anymore. Everything is too long now. Yeah. Hour 35, it says an IMDb. So we have a 90 minute film, which is good.  So no, I would not recommend Wish. This is a movie that you watch in Disney Plus when you have nothing else to do, if you haven't canceled Disney Plus yet, because there's really nothing of value on there either. I just, I'm disappointed with Disney. I wish they would get back to making some decent stuff again. And listen, I like Frozen. I like Frozen too. I like Moana. They all fall into the playbook, right?  But you got to have something more than that. You got to have an interesting character. You got to have a fun villain, like a Gaston or a Scar. You got to have a cool setting. Like that's another thing. Wish is just the most generic, bland town people could live in.  Everything is muted.  Look how far we've come. What a celebration. Instead, it's just a participation. It's just, hey, we're here. We're doing another one. You remember, remember when Elsa pulled her ponytail back and ran up the staircase and like did the shimmy shake at the camera and she's all sassy. And then Moana did the same thing where she kind of threw her hair back and she parted the waters. Well, Asha does this 18 times.  And she's going to be singing up at the stars and moving that hair and the wind's going to be throwing her this way and that. It's so formulaic. I'm done. Give me something different, Disney. Try a little bit harder. Dig a little bit deeper. Princess and the Frog reference. You gotta dig a little deeper. Okay. That's wish. I wish I hadn't wasted my time watching it. I kind of knew from the trailer what I was getting into and yet I still pushed through and said, yeah, let's do this dance. Let's see how far this rabbit hole goes. And it turns out it doesn't go anywhere past the surface.  I expect more from Disney. I think we all do at this point. Let me know if you saw wish though. Is this a wish come true for you? Is this a dream that you were hoping would become a reality from Disney and they would make something so bland and so lame that you could go, yep, this is what I wanted. This is what I paid for. Side note. Side little tangent. I feel very sad for the people that have a decent sized family who went to wish or really any movie at this point in time. Because it is expensive. So I go to the regal. I have a regal pass, 20 some bucks a month, 24 bucks a month. Great, great deal, right? 24 bucks go to as many movies as you want. Anytime I bring a kid though, I have two children or the whole family. I think the price per ticket is $11 or $12 for a regular showing. If you go to IMAX, it's like 18 bucks. 18 bucks for one person. So if I just took my daughter, which we did a double feature just recently, I'm free. She's 12 bucks a ticket. Plus if we get a drink, it's like another $8. I spent like $22 just to take her to one movie. Now do that for a family. Because in the row next to me, there was a father, a wife, and I think three kids. Say one of them has the regal pass and they're covered. That's being generous. You have four bodies there. You're spending 50 some dollars just to get into this movie. Now add an icy for each of them or throw a popcorn in there. They're spending like $100 to see Wish. One of the kids was sleeping. That kid was passed out when the movie started. That's a good use of your money. What a waste. Hey, we got to get out of the house and away from the TV set so that we can sit in a worse location in front of the TV. I don't know. What happened? I know I'm getting older. I just turned 41 today. Happy birthday to me.  God, that's sad. But I do remember back in the day when it was like $4 or $450 for a matinee and it was six or seven bucks for a regular showing. Now there's no matinee price anymore. It's all $11 or $12 and the price of concessions is out of control. I feel bad for families that have to do this. My kids don't care that much to go to the movies anymore which breaks my heart because that used to be my favorite pastime was going to movies and it's just it's dead in the water at this point with all the streaming services and the poor conditions and the overpricing and it's just not there anymore. The magic's gone and that's kind of where Disney's at. The magic is gone. I wish that weren't the case but it is. Anyway, tangent aside, let me know. Put it in the comments if you saw this film, if you have any desire to see it or you're going to be like most and probably wait for it to crap out on Disney+. Please like the video if you haven't. Subscribe if you haven't. I want to get the subscription numbers up this year and into 2024 it's going to be a big push for subscriptions. Subscribe to the channel on YouTube. Jump on the podcast where these also go on Apple and on Spotify. If you really like what I'm doing become a patron at patreon.com slash adam does movies. One man operation would love to have you or you can be a join member on YouTube. There's even a super thanks button under each video on the channel where you can just say hey Adam here's like four bucks. Great job on the video. There's a super thanks for you and those really help. I appreciate it. All right thanks for watching or listening and hopefully I see you next time.


My name is Charles Weber, I'll be speaking about the basics of the glaucoma evaluation and the care of the glaucoma patient. In this lecture, we'll go over the glaucoma exam and important points in that exam are measurement of intraocular pressure, gonioscopy, and a detailed evaluation of the optic nerve head. We'll go over quantified characterization of the optic nerve and the various imaging devices and the reporting styles of those devices and then we'll also finish up with going over visual field testing and the common ways to do that. First component of any patient visit is going to be the history asked of that patient. That would include current complaint from the patient, symptoms, onset, duration, severity and location, past ocular, medical and surgical history, medications and allergies, review of systems, assessing their full general health and not just related to their ocular health as well as their social history which includes tobacco, alcohol and other drug use as well as their occupation and hobbies and any family history of both general medical issues as well as ocular health issues. The general exam, in addition to basic components like assessing visual acuity, will include refraction and that's necessary to perform accurate perimetry to assess the patient's field of vision which we'll get to later. It's also necessary to gauge ocular morphology. For example, with a patient that is farsighted or hyperopic, they'll have potentially an association or higher risk of developing angle closure glaucoma and they may have a smaller disc. This might be the opposite in a patient that's myopic with a larger optic disc and more open or more likely to have open angles. The exam also includes assessment of the external adnexe, the patient's pupils with careful attention for any affurent pupillary defect, confrontation visual fields, ocular motility and slit lamp bimacroscopy. Under the slit lamp, paying close attention to the congenitiva, things that would be perhaps more likely to be seen in a glaucoma patient or at least salient points to be observed, any evidence of congenitival hyperemia, episcleryl venous dilation, hypersensitivity, reactions and characteristic changes associated with ocular allergy, including to topical medications. The presence of any previous surgery, including a filtering bleb and when present, assessing its morphology. Assessment of the episclera and sclera, looking at, in particular, or looking for, sentinel vessels that might suggest an intraocular tumor, thinning of the sclera or an area of staphiloma. Final exam, looking for enlargement of the cornea, endothelial abnormalities such as cruchenberg spindle, keratic precipitates, goutte, beaten bronze appearance of the endothelium, an anteriorly displaced Schwabbe's line, central corneal thickness and pochymetry is an also important thing to look at and will also discuss its measurement in future slides. Examination of the anterior chamber includes an estimation of angle width, comparison between the two eyes, presence of any inflammatory cells, red blood cells and any other material within the anterior chamber. Continuing with the slit lamp exam, it includes examination of the iris, looking at heterochromia areas of atrophy, either generally or sectorally, translumination defects of the iris tissue, both peripherally and more centrally, ectropion UVA, core ectopia, iris nevi, nodules, exfoliative material, neovascularization or any evidence of prior trauma, for example, a sphincter tear. Examination of the lens includes special attention to any lens movement, presence of pseudo exfoliation to the lens capsule or subluxation or areas of zonular injury or loss, and then a dilated assessment of the fundus, including assessment of the optic disc, which we'll discuss in greater detail, any evidence of posterior segment pathology including retinal hemorrhages, vitreous hemorrhages, chorotal effusions, masses, inflammatory lesions, retinal vascular occlusions, diabetic retinopathy and retinal detachment. Intraocular pressure measurement, regardless of the device used, it's important to ensure that that device is in good working order and that it's properly calibrated. There's a number of different ways to measure intraocular pressure and number of different devices. The most commonly used device in the United States in an ophthalmologist's office would be the Goldman intraocular pressure tonometer, and that's depicted here. You'll see on the left hand side of the screen what the mire should properly look like, not too thin, not too thick, and aligned. The alignment is discussed or depicted on the right hand image in the leftmost of those diagrams shows high intraocular pressure, or in other words, the tonometer being too low and needing to be adjusted such that a higher IOP is dialed in. The middle diagram shows too low on the intraocular pressure gauge and on the far right is just right. So just the proper amount of overlap with the inner edges of the rings, just touching one another, giving the correct intraocular pressure measurement. Central corneal thickness and corneal pochimetry is also important in assessment of the glaucoma patient. We know this primarily from the ocular hypertension treatment study, which showed that a thinner cornea conferred a higher risk of glaucoma. The corneal thickness is thought to be more of a biomarker for structural or physical factors involved in the pathogenesis primary opening glaucoma, and is more than simply just an adjustment that's made to intraocular pressure. The figure taken from the OATS data depicted on the right hand side of the screen shows in the far upper left when the risk is assessed by the height of the columns. We can see that with a thinner central corneal thickness and a higher intraocular pressure, there is a higher risk of ultimately developing glaucoma, and those patients followed in the OATS study. As we move to the right in the diagram in each of those rows, there is a reduction in overall prevalence of developing glaucoma as we increase in central corneal thickness. Gonioscopy is also important in the assessment of the glaucoma patient. It's an essential diagnostic tool and examination technique. It's required to visualize the anterior chamber angle due to total internal refraction at the tear-air interface, and depending on the lens used for visualization, we can either observe it directly or indirectly. Depicted in the image on the right hand side of the screen is an indirect view of the anterior chamber angle with a mirrored lens on the surface of the cornea. Direct gonioscopy examples of these lenses are Kepe, Barkhand, Worst, Swan Jacobs, and Richardson. The lens is placed on the surface of the eye, and sealing solution or some other coupling solution is used to fill the space between the gonioscopy lens and the cornea. It gives an erect view of the angle structures and is really mostly used and essential to angle surgery. On the right hand side of the screen, you'll see an example of direct gonioscopy where the goniolens allows us to overcome the total internal refraction for direct observation of the anterior chamber angle. Indirect gonioscopy is more frequently used in clinical examination. It gives an inverted and slightly foreshortened image of the regular mesh work and angle structures. There are two main groups of lenses used in indirect gonioscopy, either flanged or non-flanged. The flanged or goldman type lens requires a coupling gel or viscous fluid. It gives the clearest view, but if there's any pressure applied to the cornea, it can give a distorted anterior chamber angle view and can narrow it artificially. A non-flanged goniolens such as Pozner, Sussman, Zeiss, they give a smaller area of contact which allows for dynamic or indentation gonioscopy and it's coupled merely by the patient's tear film and doesn't require any additional coupling agent. Important points with gonioscopy are first, orienting yourself and recognizing the important angle landmarks. Scleral spur and Schwabbe's line are the most consistent of the landmarks and an easy way to identify Schwabbe's line is with the corneal light wedge which is depicted here in the right hand image. As the two parallel light beams converge, they converge at the peripheral cornea corresponding to Schwabbe's line. This serves as a point of orientation for then going on to identify the other angle structures. Postural to Schwabbe's line is the non-pigmented trabecular mesh work followed by the pigmented trabecular mesh work, the scleral spur and then finally the ciliary body and iris root insertion. It's important also to evaluate for any pathology that's present such as evidence of previous trauma with angle recession, areas of urethral dialysis, peripheral anterior sinecchiae and any other important findings such as neovascularization. There are a variety of different gonioscopy grading systems. The two most common are the Schaefer system and the Spath system. This slide depicts the Schaefer system which describes the angle between the trabecular mesh work and the iris. A grade four angle is a 45 degree insertion of the iris in the angle it forms with the trabecular mesh work. Grade zero is closed angle and then the different grades in between correspond to varying degrees of iris insertion. Spath grading provides greater detail and goes on to describe the peripheral iris contour insertion of the iris root and effects of dynamic gonioscopy. The Spath grading is typically presented in a way that gives a letter as the first capital letter as the first item, a number corresponding to the angle of approach of the iris to the angle structures, a lowercase letter that describes the peripheral iris and then a grade of trabecular mesh work pigmentation. The iris insertion A stands for anterior to Schwab's line, B stands for between the Schwab's line and the scleral spur, C indicates that the scleral spur is visible, D indicates that the deep sclerary body is visible, and E stands for extremely deep with a greater than expected amount of sclerary body visible. Their approach comes with experience to grade this degree of angle and is noted second. Peripheral iris there can be a few different ways to describe its insertion, regular or flat indicating essentially normal presence of iris insertion can be steep or bowed anteriorly or there may be evidence of plateau iris and queer or concave indicates a backward bowing. The trabecular mesh work pigmentation, the assessment of this also comes with experience and frequent viewing of the trabecular mesh work, zero is no pigment going up to grade four which is very intense or broadly distributed pigmentation. The optic nerve exam can be performed clinically in three different ways either with a direct ophthalmoscope, an indirect ophthalmoscope or a silt lamp bio microscope using a posterior pole lens. The direct ophthalmoscope does not provide sufficient detail to detect subtle changes over time, can be useful in screening for glaucomatis optic atrophy but due to its non-depth of detail it does not provide an excellent way to provide assessment in time. The indirect ophthalmoscope can be used to observe cupping and pallor but they're less pronounced in that method and the magnification is inadequate so it's not generally recommended for assessment of the glaucoma patients and the optic nerve head in particular. Silt lamp bio microscope using a posterior pole lens is the best method for examination for the diagnosis of glaucoma. It gives a binocular view and excellent detail and magnification. The cup to disc ratio alone when noting the optic nerve appearance is not adequate. Early changes that can indicate glaucomatis optic neuropathy would include generalized enlargement of the cup, focal enlargement of the cup, vertical elongation of the cup, presence of a disc hemorrhage, an area of nerve fiber layer loss, asymmetry of cupping and beta zone peripapillary atrophy and we'll show some examples of each of those. A general rule is the isn't rule in assessment of the optic nerve which is meant to indicate that the inferior rim is typically the thickest followed by the superior rim followed by the nasal rim and the thinnest portion of the neuro fiber rim is the temporal rim. This is an excellent example of a normal disc. We see a robust retinal nerve fiber layer. The isn't rule is followed. There's no peripapillary atrophy and there's no disc hemorrhage. This is a large normal disc which does have an increased cup to disc ratio but is otherwise healthy. There's a robust nerve fiber layer. It follows the isn't rule. There's no peripapillary atrophy and there's no disc hemorrhage. This shows a disc hemorrhage with a corresponding RFL wedge defect in area of focal thinning. We can see an inferior temporal notch to the neuro fiber rim. There's a corresponding wedge defect in loss of nerve fiber layer in the same area as the disc hemorrhage. Here we see an example of beta zone peripapillary atrophy with notching and there's also alpha zone peripapillary atrophy present as well which is essentially normal. The alpha zone is the temporal zone depicted here. The beta zone is area of peripapillary atrophy is inferior to the nerve fear where there's an arrow depicting the area of notch. There are a few different ways in which we can quantitatively measure the RFL and there's a few different imaging devices to do that. One of which is the confocal scanning laser tomograph. The other is scanning laser polymetry and a third and more most commonly used type in the United States is optical coherence tomography. We'll take a look at each of those. Confocal scanning laser tomography, the most widely available platform for this is the Heidelberg retinal tomograph. There are serial images that are acquired in planar views and those are stacked upon one another after being aligned to give a 3D morphology of the disc and that's what these images are depicting. Any images of unacceptable quality are automatically eliminated by the device. The output looks like this. At the very top of the output in the area with the capital A next to it gives the quality parameters as well as the patient's identification information. The next section below that shows the image of the disc and nerve fiber layer. C shows more fields analysis of the disc morphology and alerts the examiner to areas of possible difference from the normative database and its own internal regression analysis within the software. The RFL contour is depicted at the bottom portion of the output showing any areas of concern as well. Scanning laser polymetry or GDX takes advantage of the fact that there is a difference in the way in which polarized light is reflected by the nerve fiber layer due to its birefringence and can detect areas of nerve fiber layer damage as a result. The GDX output looks somewhat similar to the Heidelberg as well as the OCT output again showing identification information at the top of the output. There is a section showing essentially an ANFOS or fundus image of the disc at the top portion. Finally it shows summary parameters of the RFL showing areas of the birefringence and detection of possible areas of thinning and then this is used to produce an outline of the RFL as well as highlight areas that are substantially different from the normative database. The most widely used imaging technology in the United States for quantitative assessment of the optic nerve and retinal or fiber layer is optical coherence tomography and there's two main groups of this technology. Time domain is the older device which takes longer to acquire its scans and has less detail. Spectral domain uses a spectral interferogram and Fourier transform to essentially acquire more imaging in less time and in greater detail and so gives us a bit more information about the health of the retinal or fiber layer and greater ability to assess change in time. So again time domain OCT slow and relatively inefficient spectral domain OCT fast in higher resolution. The imaging of the optic nerve fed in RFL the output looks similar to this where we see both a vertical and transverse slice through the optic nerve head as well as a created on FOSS image and highlighted areas of possible change from the normative database. Identification information has been eliminated from the top portion of this output as well as the quality parameters have been cut off by this particular example. At the top portion shows various characteristics of the patient's optic disc, its size, the primary area and the average RFL thickness to give a general overview. Detailed sections are depicted in the bottom portion of the output with green representing average or normal thickness of the RFL in areas of yellow or red falling outside of what's considered the normal range. For each of these devices when the imaging report is evaluated it's important to look at the proper patient is identified that you're looking at the output that corresponds to that particular patient that the correct age and date of birth has been placed into the imaging device for proper comparison to the normative database that the scan has sufficient signal strength to give sufficient quality that it's well centered and aligned. If these are not met the output data may be insufficient to make a quality of assessment of the patient's optic nerve and RFL. Moving on to the visual field, so the overall goal of glaucoma management is preservation of the patient's functional vision and quality of life and the most important assessment of that is the visual field. This diagram depicts the hill of vision with greater detail of vision occurring at the fovea which is the point of fixation at the top of the hill and then decreasing detail as we move out in the field of vision and we're trying to do our best to maintain the entirety of this field of vision for each of our patients. The main purposes of perimetry are to identify anyone with an abnormal visual field and then to also provide a quantitative assessment of that patient's visual field whether normal or abnormal and following that over time. There are two major types, automated static perimetry, this would be frequency doubling technology, a Humphrey visual field for example and then manual kinetic and static perimetry using a Goldman type bull perimeter. I'll discuss mostly the Humphrey visual field testing which is the most widely used type in the United States. There are multiple different testing algorithms available on this device. The different algorithms provide pros and cons to each of them. In general the 30-2 is considered too time consuming to do on a regular basis for patients. It suffers from patient fatigue and may have more variability as a result. The 24-2 algorithm is my preferred approach. There are two types that are possible to use for that, CEDA FAST and the CEDA standard. The FAST is adequate for screening but it doesn't tend to do as well in detecting areas of change or mild loss. FAST can be useful in glaucoma suspects when you're generally searching for an area of scatoma in a glaucoma patient or someone suspicious for glaucoma or in someone that just simply cannot sit for a full standard test. The standard is truly best when used in a confirmed glaucoma patient in detecting progression over time as it provides greater detail. The FAST PAC size 5 is available for patients with low visual acuity providing a larger stimulus but still allows us to detect any scatomas due to glaucoma. The 10-2 algorithm is useful in advanced glaucoma when the peripheral vision is sufficiently changed that a 24-2 or wider field may be of insufficient detail of the remaining vision and it's also useful for macular pathologies. The interpretation of the visual field is important similar to the imaging devices to confirm that the proper patient is being examined, that their age has been input appropriately and that you're looking at the proper date of test. Check the testing algorithm, make sure that you're comparing apples to apples that if the patient had a 24-2 CETA standard in the past that that's what you're comparing to that particular exam day. Confirm that there's an appropriately sized target for the patient's visual acuity. Due to the pupil diameter and refraction both of which can affect the quality of the test. Look at the reliability parameters including the fixation losses, false positives and false negatives and then move on finally to looking at the actual output from the visual field test and evaluate the numerical values of each of the different tests. Be mostly at the pattern deviation for glaucoma's field loss. In the assessment of progression it's important to separate real change from ordinary variation. There's some variability in a particular patient from test day to test day and not every visual field is going to look identical in time even if their glaucoma has been stable. Find the likelihood that change has taken place and that that change is related to glaucoma. Run progression algorithms when you're able to. So if a patient has at least two baseline visual fields and the Humphrey visual field test subsequent tests can then be used to run the progression algorithms and allow the computer's automated software to make an assessment of progression.  It should fit if there's progression on visual field that there is also progression on their optic nerve head analysis as well as on your examination of the patient. So in conclusion really overall is the attention to detail is paramount. The clinical examination will allow for the most accurate diagnosis of the glaucoma and the glaucoma subtype and then that will further allow you to risk stratify that patient for possibility of future progression or change in time. Testing characterizes the degree of change that's taken place for that particular patient and then subsequent testing allows for detection of advancing glaucoma's change in visual field loss which is of course important to maintaining that patient's functional vision and quality of life.