All right, so we're going back to Paris again. And this is the Musee d'Orsay, where they took an old train station and made it into a museum. This has all the impressionists in it. So it's, you know, if you like impressionism, this is the place to go. And this is the insides. You see, it's still got the characteristics of an old train station. They've got the glass atrium here. And then all the galleries are on both sides, both up and down. I mean, it's pretty amazing when you just see, you know, 1,000 impressionist paintings. So, and they've, you know, like everything else in France, it's very ornate. This is the ceiling looking back up, extremely ornate. Chandeliers, I mean, not your average train station. So very, very beautiful place. And of course, it's got the murals on the ceiling. So even if you're not looking at the art, you're looking at the building that's housing the art. So it's a pretty cool place. All right, so we're going to talk about the retina today. And again, saying that we said last week, would ogres, onions, and retinas have in common? Layers, OK, layers. So first of all, we just want to look at a picture of a retina. And so we're going ahead and looking at the picture. I want you guys to realize that there are a couple of definitions that you need to know. And so when you're looking at a retina, in terms of the macula, the retina guys define the macula as the area within the arcades. Chris, how do pathologists define the macula? Is the area within the arcades? Well, more than one layer. More than one layer of ganglion cells, exactly. But it pretty much corresponds anyway. I mean, it pretty much is the area within the arcades right here. So that's what we're talking about. All right, so we're talking about layers. And so we're going to start at the vitreous end, and then we're going to go through to the sclerulent. All right, so Brad, here's the vitreous. What's the first layer right here? All right, what's that stand for? All right, so the internal limiting membrane, all right? Sneha, next layer, neurofiber layer. We'll just go across, Rachel. Ganglion cell there. OK, Allie, your plexiform layer, very good. Sorry, guys. You are, I'm Jordan, a third-year med student. Oh, Jordan, OK, we don't pip students. So you're saved for today. All right, back to Chris. Outer nuclear layer. Outer nuclear layer. These, right. Photoreceptor layer. Photoreceptor layer. Book's my brain. Yep, that's good. Allie, it's more specifically part of the coroid, but burial capillaris, exactly. So it's just the innermost part of the coroid. Let me say that that's the point.  This is where a lot of the exchange of nutrients and removal of waste takes place. All right, so we're looking at it a little bit higher power. Now, let's think of it functionally in terms of what's in each layer and what part of it is there. In order to do that, you have to kind of think of the retina as you want to think of it as what happens to a photon of light. So a photon of light comes through. It's refracted by the cornea, refracted by the lens. Eventually hits the retina. Now, it's interesting in that the retina is upside down. Photoreceptors aren't on the inside sticking up, looking where that light's coming through, because they have to be extremely close to the nutrients because it's a really nutrient-rich environment. And so a photon of light comes all the way down here, and it hits some of these little outer segments of the rods and cones. So what happens at that point? Exist a transfer gobs in here. So you get a transistor retinol. You get a hyperpolarization of that membrane. And then it goes through from the outer segments to the inner segments to the cell body here, which lives in the outer nuclear layer. All right, Chris, where does it go from there? Where does that signal? It goes to the inner nuclear layer after that. Where does it synapse? Bipolar cell. But where does the synapse first? Where does the synapse actually take place? Synapse from the rod and cone cell axons to the bipolar cells. It takes place, what's this layer here? Outer plexiform layer. So that's where the synapse takes place. And then that signal goes up to a bipolar cell. So it's right here. Then it comes out of the bipolar cell. And then where does it synapse again? The ganglion cell layer. The ganglion cell. Well, it synapses here first before it gets to the ganglion cell layer. Then it gets to the ganglion cell. And then where does that axon go when it leaves the ganglion cells? Now? To the nerve fiber layer. Nerve fiber layer. Now, where does that axon synapse? The lateral. Exactly. So that axon that lives right here, it goes all the way through the nerve fiber layer. It goes through the optic nerve. It goes through the chiasm, through the radiation, all the way back to the lateral genicular body before it synapses. So that's a really long axon. Anything that interrupts it along that way can cause degeneration eventually of those ganglion cells. All right, now, what part of the retina are we looking at right now, Rachel? Exactly. So you look at the ganglion cell layer here. It's more than one cell layer thick, so you know you're in the macula. There's one other area that's really unique to the macula. Alley, we're looking at these fibers out here in the outer plexiform layer. What's going on with those fibers there? They're going oblique. So what do we call that particular layer? Henley's layer, exactly. So again, we got to train you guys when you do oral voice. Say it with conviction. Henley's layer, Henley's layer. If you let your voice come up, you're guessing. So Henley's layer. So what happens is, if you think about it, in the center of the fovea, that's the point of where we get our maximum vision, and our fine vision, and our detail vision.   And so all those cones are stacked up, and they're trying to get to all those ganglion cells, which are stacked up here, so as a result, some of these fibers are unobliquely. So this cone over here may link up with the ganglion cell clear over here. And so that's what's called Henley's layer, where they run oblique. The reason that that's important is that layer is where sisterhood macular edema occurs. When you get sisterhood macular edema, it's out in Henley's layer. And then again, all these ganglion cell layers are stacked up because they have to take cones that are coming through here. Now if you go to the peripheral retina, peripheral retina is really to help you see your peripheral vision, help you see movement, help you see things going on out here. And so in the peripheral retina, you might have 100 rods funneling into a single ganglion cell. And so the result of that is it summates. I don't know if you've ever been there. You're out. It's like a night, and you see a little light out of the corner of your vision, then you look at it, and it disappears. Because you just, it summates it, so you can see it. And that's important teleologically. You want to see movement. You want to see light. You're out on the tundra.  So you want to be able to see that movement out of the corner of your eye. So in the periphery, again, 100 rods may go into a single ganglion cell. But in the macula, one cone, one bipolar, one ganglion cell. Now there's some other cells that live in this really, really busy layer or near this inner nuclear layer. What are some other cells that live there besides the bipolar cells? Amicron? Amicron cell, OK? Another one. Horizontal cells. Horizontal cell, and one more. Neular cells. And so if you think of the horizontal and the amicron cells, they run aero. They don't run perpendicular. And their purpose is they actually begin to summit and process sight in an early phase. And so you don't actually have a signal go straight through the brain to the lateral genicular body and then the brain. There's processing going on even in the retina. So those amicron cells and those horizontal cells will touch multiple other processes. And they are starting to summit and process visual images right at that point. And then the Mueller cell is almost like a microglial cell. And so it sends its little fibers all the way up almost to the internal membrane and all the way down here. Now, some people call this the external limiting membrane. It's not really a membrane. It's the little junction between the cell bodies right here in the outer nuclear layer before you get the actual cone and rod bodies right there. So very, very busy, busy, busy layer there. So here we have the fovea. This is the center part of the macula. And I think the fovea is like wind parting a wheat field. And so you look at it. You see that it thins out here. And then all you've got is these cone bodies right here. And then the actual cone is here. And so again, Henley's layer runs this way. So these cones right here may link up for those ganglion cells clear out here. That just shows you again Henley's layer and how that's happening. All right. So we're going to start looking at some diseases that affect the retina. Brad, what are we seeing here? So we have a funnest photo of the right eye. We have kind of just almost all four quadrants with flame-shaped hemorrhages. And then it looks like in the macula area we have some exudate as well. So it looks like this is the hypertensive retinopathy. OK. Now what else could this be? It could be diabetic retinopathy. Exactly. So sometimes diabetic retinopathy. If you look at where the hemorrhages are, these superficial hemorrhages are shaped like flames. Why is that? Because they are. Exactly. So remember, the nerve fiber layer turns and then runs parallel to the surface.  And so again, this could be hypertensive retinopathy. But diabetic retinopathy looks like a lot of other things, too. So this technically could be diabetic retinopathy. And it turns out that that was indeed hypertensive retinopathy. Now there are some other things that you can see with hypertensive retinopathy. Sneha, what else can you see beside the hemorrhages and the exudates? Exactly. So if you look right here, look at that optic disc. It's kind of hazy. And so that's a little bit elevated. You can get a swollen disc here. You've got the flame hemorrhages here. Interestingly enough, look at the exudate and the macula. It takes the pattern of a star. And so once again, that corresponds to Henley's layer. So you get this star shape exudate. This actually took this picture of myself. Sadly, this is a nine-year-old kid and came in with headaches.  Turned out she'd had ureteral reflux for years. Nobody knew. And she actually had severe kidney disease and so severe hypertension. So this is what severe hypertension can look like. You can even get papillodema, in addition to the hemorrhages and the macular exudates. And this is really severe. So this was a patient, again, who came in from the ER and came in complaining of headaches. And you can see these people, I mean, not all the time, but not infrequently. You'll get referred from the pressure of 220 over 110. This is what they can look like. Severe disc swelling, loss of the margin, hemorrhage is there, cotton wool spots, ischemia. And so this is severe hypertensive retinopathy. Now, this is a little bit different here. Rachel, what does this look like? What do we call that? Cherry red spot. Why does that occur? You still have some corticopolitis blood flow that you can kind of see through underneath the phobia just because it's thinner than it is now. Exactly, so this is like a window. And so in the center part of the phobia, remember, all those superficial retinofibers have parted it. And so you don't have that ischemic retinoverlying. And so you're looking at normal coreoidal blood flow still, right there, so that's the cherry red spot. So you see a ischemic retin. And the common cause of that is? Serial. Serial, central retinal artery occlusion. What are we seeing right here, Allie? It looks like a more focal area with lightning, the wall spot, the BRAO, ranch. Ranch retinal artery occlusion, exactly. So are most artery occlusions embolic or thrombolec? Embolec, so usually there's an emboli from somewhere. Carotid, aorta, valve, somewhere, a piece of cholesterol, a blood clot, something is getting in there, it's blocking them.  When it goes down further to a branch down here, then you get a branch retinal artery occlusion. So this is a branch retinal artery. What am I showing right here? Hang on. Heck is this. Why would I show you this? Yeah, we're looking surrounding it is nerve tissue. So we're looking at central retinal artery. So this is a central retinal artery coming out of the optic nerve. And this is a person from Utah who loves to go to Crown Burgers and Mucci's and all those other places that I like to take you guys to once a year, and you know, that lovely high fat diet that we all eat. And so this is severe arteriosclerosis. So it's rare that you'll have a central artery occlusion and a normal artery.  But usually what happens is the artery will be narrowed and will be hardened and will be thickened with arteriosclerosis. And then you'll have this narrowed lumen, and then it can block off easier. What is this thing right here, Mike? It's like the vein. So the most common cause of central retinal artery occlusion, I mean, is arteriosclerosis. What's the most common cause of central retinal vein occlusion? Also arteriosclerosis. And so if you think about it, the vein and the artery come through together in the optic nerve when they're coming into the center of the optic nerve head. And so as a result, when you have that big sclerotic artery pressing on the vein next to it, you can actually get stasis, which then leads to a central retinal vein occlusion. So arteriosclerosis is also the most common cause of central retinal vein occlusion, because they come in together into the optic nerve sheath. And this shows you what happens when you have a central retinal artery occlusion. And this kind of illustrates the blood flow to the retina. And Chris, what is the blood flow to the retina? The central retinal artery. Actually, flip that. Exactly. Yeah. So the central retinal artery gives you the inner two thirds. The cori gives you the outer third. So if you look right here, this is patient at central retinal artery. The ganglion cell layer, nerve fiber layer, outer nuclear layer, I mean, inner nuclear layer, and about two thirds of the outer nuclear layer have been wiped out. So that's central retinal artery. Whereas the outer nuclear layer and just a little bit of the inner nuclear layer and the rods and cones get their blood from the coroids. So those are still alive. And so that's carotid blood supply still going up. But it doesn't matter because you've wiped out the retina. So that signal is not transmitted. So the inner two thirds of the retina gets its blood supply from the central retinal artery, the outer third from the cori. And what do we see in right here? Yeah, so it's a pretty obscure view of the entire retina. And so I would, one of the things in my differential would be a CRVO. So this is what they call the blood and thunder retina. I don't know what thunder means, but blood and thunder. So it sounds like a defense, like, ah, the Chicago Bears, blood and thunder defense. So this is where you've got a central retinal vein occlusion, and you get back up all the way through. 360 degrees back up all the way through. So very, very backed up, very dominant. So you have a wreck on the freeway. All the cars get stacked up. What is the difference? Here's now. All right, exactly. So this is a branch vein occlusion. And where does the occlusion occur in a branch vein occlusion? What specific point is susceptible for that to happen? Exactly. So if you look at this, look at this arterial, they used to call this silver wiring. And so you can actually see arterial sclerosis within the arterial here. And it's where the vein comes off and crosses over where that thick artery is. And again, it'll pinch off that vein, and then that vein will block off. So again, arterial sclerosis is the cause of vein occlusion, even in a branch vein. So this, you just have a blockage in one focal area. So this is a branch vein occlusion. This just shows you in a central artery occlusion that goes all the way to the aurisurata. So this is a globe that's cut in half sagittally, optic nerve back here, aurisurata up here. You see hemorrhage diffusely all the way through that globe, central retinal vein occlusion. And when you look at the path, you'll get ischemia with that. You'll get blood backed up with that. And again, it really disrupts the retina. So you can see all the way from the rods and cones to the inner part of the retina. Blood all over, exudate here. It really disrupts the retina. So you get ischemia, you can get on other problems as the blood just doesn't get out of there. And what are we seeing right here, Allie? All right, this is diabetic retinopathy. What is this right here? Very subtle, but there it is. Little cotton wool spot. And so this well, well, pretend that's not there. This would be what we call background retinopathy. But there is, this is getting more into a little bit of even pre-perliferate retinopathy. But this kind of illustrates the different changes in the background retinopathy.  And then what you do is you get these little micro aneurysms forming. So this is a trypsin digest of the blood supply in the retin itself. And you see these little micro aneurysms. So that's the first thing that you see in background diabetic retinopathy is the micro aneurysms. And then you can get the hemorrhages, dot blot, flame hemorrhages. What is all this stuff right here, Mariana? All right, makes it is. All right, so you can also get a tremendous amount of heart exudation. If it's here in the macula, you can imagine that that's gonna cause a lot of issues with the vision. So it's a sign of diffuse leakiness of the vessels. And so you get leakage of all this fluid through there. Eventually some of the fluid gets reabsorbed with the lipids, the proteins, other stuff like that does not get reabsorbed. So it ends up depositing in the retina. So the heart exudate gets deposited in the retina. And this is what it looks like. Here's the retina and cross section again. This is an influx staining material. This is heart exudate. I don't know why they call it heart because they used to call cotton wool spots soft exudates. It's not an exudate, but in any event, it's a heart exudate. So that's what it looks like right there. All right, now, what do we see in here? It looks like I got a bunch of photo, left eye, and you got those cotton wool spots. Cotton wool spots. So if you look at them, they're different. They're not that yellow heart exudate inside the retina. It's almost like it's descriptive.  Why is that? And what causes it? The infarct in the area. Exactly, so it's an ischemic infarct. And so when you look at it right here, what a cotton wool spot is, is it's swollen ganglion cells and nerve fiber layer. So it looks as if it's on the surface of the retina. And when you get that acute blockage, that acute infarct, then it swells. Now, those can go away. They can wax and wane, but unfortunately, permanent damage in that spot. It's tough to pick up. And sometimes if you do a multifocal ERG, really specifically, you can pick up some little areas of damage. And so a cotton wool spot is a focal area of ischemia of the inner retina. Now, you're seeing close up, these are these swollen, sorry, I copied this out of a book. I didn't get a beautiful slide like this. This is swollen ganglion cells here and nerve fiber layer. So that's an ischemic swollen cotton wool spot. What are we seeing right here? Chris? We're seeing, looks like proliferative retina. So we're seeing areas of neovascularization. It looks like PVF kind of a spot. So what do we call this now? This would be part of it. And so we divide it into NVD and NVE. So neovascularization of the disc and neovascularization elsewhere. So this is NVE, neovascularization elsewhere. So you get chronic ischemia. Ischemic factors are produced. They cause abnormal blood vessels to grow. And so you get this neovascularization elsewhere. But also you can get this. Brad, what is this? NVD. NVD, neovascularization of the disc. And we call this the medusas. And remember Medusa from Greek mythology? The lady had all the snakes coming out of her head. So this looks like Medusa right here. You've got all this neovascularization right here. And so this is NVD. Why is that an issue? Exactly, it can bleed, it can cause scarring, it can cause all kinds of problems. Because those abnormal vessels are not mature. They don't have perisites around them. They leak like crazy. And in fact, you can get this. And so you get hemorrhage, you get gliosis, you get traction, you can get a retinal detachment because of this, a traction retinal detachment. And you can even get this. Now what kind of hemorrhage is this called? Boat shape. You see it's flat on top, round on the bottom. Why is that? Exactly, so this is actually pre-retinal. So it's in front of the retina, between the retina and the vitreous. And so the blood will leak down over there. Then it'll have this flat top on top. So this is NVD causing pre-retinal hemorrhage. And so it can cause severe hemorrhage if you don't treat that. What else does this cause, Rachel? Neovascularization of the iris. So we call this rubeosis irritus.  So when you get chronic ischemia, not only does it stimulate abnormal blood vessels to grow inside the retina, but it stimulates abnormal blood vessels to grow on the iris. And so you can get severe neovascularization of the iris. And just remember from last week, you can also get neovascular glaucoma. So here's the blood vessels on the surface of the iris. That membrane is pulling the pigment epithelium around the corner.  What do we call that to the iris? Ectropion UVA, exactly. So it pulls the black border iris anteriorly. So that's from neovascularization. And there you can see where the neovascularization is actually closed the angle. So just like we talked about last week, secondary angle closure glaucoma. Now, diabetes can cause other things going on inside the eye, beside just the retina.  What's going on here? I'm showing a picture of the iris and it looks like there's like, vaculization of it. Exactly, so you can get this focal vaculization of the iris pigment epithelium. They call this lacy vaculization. And that's a sign of diabetes. Arianna, what am I looking at right here? This is pars placata neovascularization, I think, in those red areas. Look closer. What kind of stain is this? So what is PAS stain? Basement membrane. Basement membrane. So what happens in diabetes in the silver body? Exactly, it becomes thickened. So you see this is the basement membrane of the silver body epithelium. Look how thick that is. And so when I was a fellow, I hadn't done my residency yet. So David Appel was too busy doing the IOLs. He didn't want it to pass. So the American board of ophthalmology said, hey, can you send us some good path pictures we can put on boards? And so he said, Nick, you don't get it. So I took a bunch of good pictures and so I actually took a picture just like this and submitted it to the board. And so when I was a senior resident, my picture was on LCAPs. And so I looked at it and I said, we can basement membrane diabetes. I got this cold. And then, as you guys, if you haven't taken these LCAPs yet, you'll love them because LCAPs ask two-part questions. So you look at this, you say, I've got this. This is a diabetic.  What is a slow perineal nerve? What is decreased clearance? And so they asked two-part questions. So it's really not fair. You get it right and then you still don't get it right. So you guys, there are more seniors you'll love taking this. It's great. So this was funny because this picture actually showed up on the boards on the LCAPs when I was a senior. So the good basement membrane of the ciliary body. All right, how do we treat this? Nick, is this? This looks like laser treatment. All right, so it's interesting. When people first started getting lasers, the first ophthalmic laser in the 1960s was a xenon arc laser. This thing would blast a thousand micron thing that would like melt lead. I mean, it was this really, really, really bright spot. And interestingly, when they first started trying to treat neobesquerization of the iris, they would treat the neo itself. The theory being that the laser would actually, you know, seal off the neobesquerization.  Well, of course, people went blind from that. But people were also using the xenon arc in the periphery, blasting neobesquerization in the periphery. And what they found was after that, the neobesquerization on the disc went away. So then they finally figured out, wait a minute, this isn't sealing off the abnormal blood vessels. This is actually treating ischemic retina, which then decreases the ischemic factors, which then causes the neobesquerization to recede. So, you know, right now, of course, we've got the injections that people are using. So we're seeing less laser treatment. But the idea was you would treat the entire peripheral retina to save the central retina. And so you would sacrifice that peripheral retina. But then the neobesquerization on the disc and the macula and all would shrink up and you'd save your central vision. So this is what the laser spots would look like. When you look at it pathologically, you know, when you look now, we use an argon laser. It basically works by being absorbed by pigment. And so here's the normal retina over here. Here's RPE outer retina. Here's where a laser spot is. You see it basically wipes out the RPE and a lot of the external retina. It kind of seals off the cord of capillaries as a result of that. It will decrease the factors that are being put out that cause the blood vessels to grow. Some people also say it might increase oxygenation into the retina from the cori too. But any event that does work when you do peripheral pan-retinal laser photocoagulation for neobesquerization. All right. What? Let's see, did you do that last one? It does work. Chris, what is this? So here we're seeing this as an FA. And here we're seeing this kind of peripheral kind of C-fan appearance. There's capillary non-perfusion and drop-drop discolidant. So we can see stuff like this in sickle cell. You can see this in uterus disease. Kind of be a couple that come to mind right away. Good. So this is, you look at it, that it's dark in the periphery because that retina is totally ischemic. And then right at the border zone between the ischemic retina and the perfuser retina, you get this C-fan neobesquerization. This indeed was a patient with sickle cell. And so we don't see sickle cell much in Utah because we don't have a lot of African-Americans in Utah. But in Chicago, we used to see tons of sickle cell. And basically what happens is, you know, when these RPC sickle, it causes capillary blockage and then causes chronic ischemia. This is actually this knobby appearance you get in the retina. Again, in trypsin digest, this knobby appearance that you get in people with sickle cell. There's a really rare condition called deals disease again that can do that. You know, nowadays it's interesting when you're looking at people treating retinopathy and prematurity with injections, you're sometimes now getting these little C-fans in the area between perfused retina and non-perfused retina and premature infants. And so same idea. All right, this is kind of subtle, the heck is. So it looks like we have an macular hole with maybe a little bit of surrounding sub-retinal fluid. Exactly, so that looks like pretty much a full-thickness macular hole. And then you do see that little cuff of fluid surrounding it. And here's a close-up, what is that thing? It's a fixation rod. Exactly, so sometimes people look at it and say, I don't know, it's that focal. Here you have extra data. So that's actually the fixation rod. Sometimes these people can't hold the eye still so you give them a rod to look at. But again, you see this full-thickness macular hole and this little cuff of edema surrounding it. And I apologize, this is an old AFIP slide I took a picture of because I really, and you don't need nucleotides for macular holes. And so this is kind of the edge of a macular hole and here's the edema that you've got that little cuff of edema next to it. Boy, this is even more subtle. Sneha, what is this? So you see that little kind of sole wrinkling and you see the little accordioning of the vessels and so epiretinal membrane will give you this and so that's a little bit more prominent. So hopefully you wouldn't miss this one. This would be one maybe an intern could see, you know. Hopefully, maybe even a student, I don't know. This would be a student's one.  So you see the wrinkling and you can see again the corkscrewing of the vessels. That's an epiretinal membrane and as it constricts you'll get distortion and the patient will complain of metamorphopsia. Some kind of picture is this that highlights that, Rachel. It's a red-free and so if you do a red-free photograph it really tends to highlight the epiretinal membrane and you can see how the vessels, sometimes they get pulled in to the center or sometimes the peripheral vessels get elongated as they get pulled into this mass right here. Of course, nowadays we've got OCT which just shows it beautifully and so you'll see the wrinkling on the surface of the OCT as you go through the center where that epiretinal membrane is. And again, you can just see again, here's the OCT here, the wrinkling of the retina underlying it. So that's the epiretinal membrane. Now, again, I had to take a picture of this from a book because I don't get a lot of path with an epiretinal membrane on it but sure enough, here's the membrane on the surface of the retina. You know any more, the OCTs are so good compared to the path picture with the OCT anyway. What do we see in here, Allie? All right, so some drusen in the macula. What exactly are drusen? Okay, and where do they live? Well, part of the retina. Under the RPE, and this is a good place to shove this in. A PIMP question that I forgot to even mention. Oh my goodness, a PIMP question. So how many layers does Brooks' membrane have? Brooks' membrane's between the RPE and the Chorate. Five, and what are they? Or the Chorate, and then elastic, two elastic layers, and then collagen in the middle. Flip that last part. Two collagen and elastic. Two collagen and elastic. All right, so the way you remember it, it's a turkey sandwich, bread and bread, you know turkey, collagen, you know really bad turkey sandwich, really hard collagen, and then the elastic layer in the middle is a layer of cheese. And so you've got the elastic layer in the middle, two layers of collagen, then basement membrane of the RPE, basement membrane of the coriocapolaire. So technically, these drusen are actually intra-Brooks because they're really under the basement membrane of the RPE. So sometimes they make PIMP you on that. So you know it's under the RPE, and you can say, well, technically, if you want to impress the attending that's asking, you say, well, technically, it's actually intra-Brooks because it's under the basement membrane, and then they'll go, so you get extra points from it and then they'll stop pimping you, so it's good, you get points for that. So you can see this deposition, and again, it's this waste material, there's a lot of lipofucin in it, there's some lipid in it. It's kind of a buildup of waste materials, if you will, underneath the RPE. And then this is what we call a soft drusen. And so the little focal ones are what we call hard drusen, but you can get more diffuse drusen that we call soft drusen because they're even bigger and have less distinct borders, and this is what they look like.  And these are some softer drusen, just not quite so distinct soft drusen. Here you can see diffuse soft drusen, degenerative RPE cells overlying them, choreo-capillaires down here. You can see where that could cause quite a bit of disruption. Arianna, what are we seeing here? Pigment changes. What else? I know it's kind of subtle because this is a lighter, a lighter fundus. Yeah, so we call this geographic atrophy. So, you know, it's hard to see because it's a lifeless, believe it or not, the RPE is completely wiped out all through here. And then there's some pigment at the edges, and so this is what we call geographic atrophy. So, you don't get neovascularization, but you get the RPE just gets diffusely wiped out and then the retina overlying it, of course, gets wiped out. You look at the pathology here, there's brocks.  It's totally wiped out and as a result, the retina overlying it. Look how it's all vaculated. So, the retina gets completely wiped out overlying it. So, that's geographic atrophy. What are we seeing right here? Like some neovascularization there. What makes you say there's neovascularization? Central red area. So, the other thing you see, see this kind of greenish gray around here, when you get blood under the retina, especially under the RPE, it'll look kind of greenish gray rather than red. So, this is subretinal neovascularization. It can be subretinal, it can even be sub-RPE. And so, this is kind of the most advanced stage of macular degeneration. And again, I had it copy this out of a book. It's beautiful pictures. So, there you see, here's coroid. Here's brooks membrane. Here is RPE really disrupted and some gliosis here. Look, here's a brachium brooks. And here's neovascularization growing up through brooks membrane under the RPE and then forming this gliotic membrane. So, that's subretinal neovascularization. And of course, this is severe. So, this is now broken through under the retina, where it's red. And then the grayish dark one is actually sub-RPE. So, this is subretinal neovascularization. Now, most common cause of subretinal neovascularization is obviously AMD. What's another cause, Chris? That's got trauma. Trauma, you can get a focal coroidal rupture can do that? It's sub-retinal neovascularization. So, HISTO? Yep. Presumably, ocular HISTO can do that too. And so, Sneha, another thing that can cause sub-retinal neo in the macula. How about something looking around this room that's exceedingly common in this room right now? Myopia. So, myopia can cause it too. So, severe myopia. Lots of causes of sub-retinal neo, but of course, the most common one that we see is actually due to macular degeneration. And here you see, this is what we call a disciform scar. So, eventually, when you get that bleeding, you get the astrocytes proliferating, you get gliosis, and you get this scar underneath the retina. So, this will often look white.  All right, what do we see in right here, Rachel? Mesh spots. What do you think this could be? HISTO, since Brad just mentioned it.  These little peripheral punched out lesions, but you can also get macular lesions with this, too. And they say, presumed ocular HISTO because it's, you don't actually go in there and biopsy it and find active HISTO in there. And so, but this is common in the HISTO belt. And it's kind of in the Midwest and upper Midwest, Ohio River Valley, and wherever you get HISTO. Usually, I don't see this much here. I mean, to be honest, I don't see retina. I mean, not a retina specialist, I'm a general ophthalmologist, but I can count the amount of HISTO patients I've seen in the last 30 years on one hand. I mean, I've probably seen three or four. It's a very uncommon, but you get these peripheral punched out lesions, and then you can get subretinal neon and macular lesions. All right, this is kind of weird-looking alley. What do we see in here? You're losing that nice little dimple in that reflex of the phobia, so what do you think could be going on in here? Eema. Eema. All right, so we look at it, and sure enough, this is something now with OCT. You guys may never see. I don't know, do you still have flourishing conferences? Do they still do flourishing at flourishing conferences? All right, so what have we got here? Gotta get that flower petal shape, and so this is classic HISTO and macular edema, and where did we say that the extra date is located? Henley's layer. Henley's layer, sure. There it is, all right, so there's Henley's layer, and sure enough, there's the extra date. We're in the macula, because the ganglion cell layer's more than one cell layer thick, and you can see here's the extra date in Henley's layer, so systoid macular edema. What's the most common causes of systoid macular edema? Diabetes could be, all right, so you get these to call it Irvine Gas Syndrome, so anything that causes breakdown, chronic breakdown of the blood aqueous barrier, eventually you get breakdown of the blood retinal barrier and you can get systoid macular edema, so it can be post-op, what else? Get it from VMT, traction, right? Yeah, good, exactly, so any kind of uveitis, any kind of chronic inflammation can give you systoid macular edema also, so most common things we see is, of course, post-op, because even if it's only in one or 2% of cataract patients that's still a large amount of people, but again, any uveitis, any inflammatory condition in the eye can cause this. Diabetics can get systoid macular edema. All right, boy, that's kind of subtle. Brad, what are we seeing here? We do this next one and that'll help you. That's bullseye. Exactly, so if you go back, sometimes bullseye's are hard to see, and so this is called bullseye maculopathy, and if you do florescine angiogram, now, is that leakage? No. What is it? We do an exact. Exactly, so you get these window defects, and so you'll get choral florescence showing up, and then this dark ozone around it, so what are some of the things that cause bullseye maculopathy? Plaquanil. Okay, so plaquanil's the biggest one now, because we see a lot of people on plaquanil, we worry about that. What else? Bullseye. Exactly, this should be, what are their medications? Hydroxychloroquid. Well, actually, old, old, old antipsychotics could cause this too. Old old antipsychotics and some of the older medicines they used to give people for depression could do these too. So the idea now with plaquanil is we see these people early, and we go ahead and we do a central 10-2 visual field in the center, we do OCT of the macula, we give new multifocal ERGs, we look for early signs because once it gets to this point, the damage is done, so again, the horse is out of the barn, that doesn't do any good to treat it there, so you want to prevent it, so I see a ton of plaquanil people in clinic that we do these testing on every year just to make sure. What do we see in here? So now, kind of these weird-looking streaks, those really aren't blood vessels, what the heck are those? Andruid streaks, or some people call them lacquer cracks, but so where do they occur? Where's the pathology? In Brooks, and so you get a little focal break in Brooks membrane, and these are called andruid streaks, and what's an entity, they always pimp you on boards that could cause this? This is called the plucked chicken skin on the neck. We don't pluck chickens, this is Pseudozathoma elastica, and so that'll cause andruid streaks, sickle cell can cause andruid streaks. What is this, Rachel? Real pale nerve, chalky white. And the vessels appear really attenuated. Really attenuated, what would this be? Exactly, so this is retinitis pigmentosin, if we look further in the periphery, you get what's called bony-spicule pigment, disruption of the pigment, why is that? Well, what happens is the degenerative RPE releases the pigment, the pigment deposits along the vessels, and so that's why you get this bony-spicule pattern. So here is the retin, that's really wiped out, and you get these pigment granules that are depositing around the vessels, so you get that bony-spicule pattern, and that's retinitis pigmentosin, RP. What do we see in here, Ali? Yeah, it looks like a sunny-side-up egg. What gives you that look to the macula? Best disease, and so this is one of those things, nothing else looks like this. And so I tell you, my favorite, Ray Faut was the pathologist in Baylor, he's from Cuba, he has a really good Cuban accent, and his favorite saying for a classic picture is, he's your brother in the train station.   Because only your brother looks like this. And so only is your brother in the train station, only best looks like this. So this is classic best disease, and you see this deposit of this material underneath the RPE here. What do we got here, Ariana? And so what does piece of form mean? Fish-like, so it looks like those little goldfish you'd eat when you were a kid, and the parents would give you to quiet down, so it kind of looks like those little goldfishes on here. So this is what we call Stargardt's disease, or fundus flava maculatum, and it's characterized by a deposition of lipofusum and pigment granules in the RPE. And so that is fundus flava maculatum. Boy, this is not out of focus, Mike. What are we looking at here? So... The media's really hazy, look, there's the disc. And there you see this little area here, and everything's there, it's foggy, so the goal is the headlight in the fog. What is classically producing the headlight in the fog? Seems like a richer sandwich with maybe a beer area. Well, but you wouldn't really see that whitening so much with a vitreous hemorrhage. So this is what that spot looks like when the vitreous clears up. That is active toxox, toxoplasmosis.  And so when you get the active toxa, you get a vitritus associated with it, so you get the headlight in the fog, and then eventually you get this area with these lacunar wiped out areas of pigment that's actually scleral showing through. So that's end-stage toxoplasmosis. When you look at the pathology, here's a little bit of RPE here, and then right where the toxa was, it just wipes out the RPE, wipes out the retina. And so sometimes you'll see, if these people get it activated, you'll see an old scarred lacunar area, and then you'll see this fuzzy area next to it where some of those cysts that have sat there dormant for years come back to life. So that's chronic toxoplasmosis. What could this be, Chris? This is probably some health factors. This kind of looks like a tomato ketchup bonus. Yeah, so people love to describe things with food, so tomato ketchup or pizza retina look. So this is indeed CMV. Now, I didn't, we didn't even know what CMV was when I was a resident, but there was this bizarre disease that these gay guys in California were getting. And so it turned out HIV, AIDS, one of the things you would get is you would get, you know, this chronic CMV retinitis. And so this is actually, again, it's blurry because I actually took this. So I took this as a resident. This is the first case of CMV we ever saw. And what you can see is CMV, it's interesting, it's like a lot of the others are RPE families. You can actually get intra, you know, nuclear and intracellular plasmid conclusions. So you get inclusions both in the nucleus and in the cytoplasm of the retinal cells. Now, fortunately now with people being treated with triple therapy, their immune systems are better, you don't see this as much. But still, even in immunosuppressed people, cancer people who are on chemotherapy, you can sometimes see CMV. And we say goodbye, this is the IMP's pyramid. And this here's that louver, you know, there's the louver there in Paris. It's an IMP's pyramid. And then you've kind of got, interesting, almost this kind of Roman, you know, arch coming into it, almost Germanic Roman, but this is all the Louvre right here and there's IMP's pyramid, which is now the new entrance. Okay, so next week is optic nerves. So no, you're optic nerves, okay? Questions? Well, two minutes over. So yep, you guys are really sweet.


Yeah, everyone else would just be speaking, and we've got a great line of speakers who are actually directly working with NTFP's. And we're very pleased to have these speakers, because they really know what we're talking about. First, Dr. Rajaparachari, little chairman of the IPCC, the Intergovernmental Panel on Climate Change, but also the Director General of the Energy and Research Institute of India's premier environmental institutions. They really know the scene in India, as well as a part of climate change on Earth and agriculture. Then there's Dr. Dhoni Woot, who is a DG at the Ministry of Forestry in Indonesia. Also, he is on the part of council members of the International Network of Boundaries. He'll give us the picture of what's happening in Indonesia, what needs to be done, what is being done, and finally, there's Dr. Hans Friedrich, who is the Director General of the International Network of Boundaries in Rata. Now, with Dr. Friedrich, it's kind of interesting to see how he manages the environment. His background is with the conservation organization, which is also part of this whole discussion. How do we conserve, how do we use, how do we make sure that we're keeping enough stocks in the future? So, with that, if this is my last speech, I don't need to speak for about 10-15 minutes. After that, if there's a question, I'll have a general discussion. I will then try and sum up if there is something that needs to be summed up. Otherwise, if you have any questions, you can ask them. Thank you very much. I'm very happy that we're discussing this subject which is often ignored and doesn't get the kind of attention it deserves. But clearly, if you look at the lives of a large number of people, they are intimately connected with what happens to this whole sector. As a matter of fact, if one goes back maybe 200 years or so, you would find that there's been a progressive and highly measurable decline in our stock of bamboo and data. And that's essentially because there have been substitutes developed for a large number of products and uses that were dependent on the growth of bamboo and data. As a result, communities and societies have neglected what was earlier on an absolutely crucial part of their lives. What's going to be a major influence in the future is going to be climate change, which is essentially human-induced. And as you're aware, the IPCC has brought out three parts of its fifth assessment report. We have yet to bring out the synthesis report which is essentially, as the name suggests, a synthesis of all the three working group reports that have come out so far. And that will be completed at the end of October this year. But I'd like to acquaint you with some of the major findings of the reports that have come out. And these have major implications for all species on the planet Earth, and therefore also on bamboo and data. Firstly, let me say that the warming of the climate system is unequivocally. This is something that is beyond the bounds of any reasonable intellectual or scientific debate. And since the 1950s, many of the observed changes are unprecedented over decades to millennia. So in other words, in a short period of time, we have affected the climate of this planet at a rate that we have not seen for millennia. The atmosphere and oceans are formed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased. Just to give you one indicator, CO2 at the beginning of industrialization was about 280 parts per million in the atmosphere. In May of last year, this figure crossed 400 parts per million. So there's been roughly a 40% increase in the concentration of carbon dioxide in the atmosphere, and you have almost similar increases that have taken place with other greenhouse gases. And most of these are the result of human activities. I also want to highlight the fact that each of the last three decades has been successively warmer at the Earth's surface than any preceding decade since 1850. So as a matter of fact, the last three decades have been the warmest that we have seen, very likely for over 1400 years in terms of the increase that's taken place. So that's quite substantial. 19 centimeters is a very large increase to have taken place since the beginning of the last century. And it's been much faster over the last two decades. I also want to mention that since the early 1970s, glacier mass loss and ocean thermal expansion from warming, to get the explain about 95% of the observed low to deep sea level rise. And if you want to look at how the concentration of greenhouse gases has increased in a geological time frame, then really speaking, the atmosphere concentration of carbon dioxide, methane and nitrous oxide has increased to levels unprecedented in at least 800,000 years. So the previous time when we had these geoconcentrations, which was for very different reasons, was about 800,000 years ago. And it's also true that about 30% of the concentration of greenhouse gases has really gone into carbon dioxide in particular, gone into the ocean. Now that's led to acidification. And this has very serious implications for marine life of all forms. Here again, this may not seem to impact directly on bamboos and Kurata. But the basic fact is that we're all part of an integrated earth system. And therefore one part of the earth is affected, that means the oceans. And that also has implications for land surfaces. Now I also want to mention that Arctic sea ice has been decreasing at a very rapid rate. As a matter of fact, the Arctic has been warming at twice the rate of the rest of the globe. And it's very likely that Arctic sea ice will continue to shrink and thin. And that the northern hemisphere spring snow cover will decrease during the very first century as global mean surface temperature rises. In fact, some models clearly show that we would have a nice free Arctic ocean in September before mid-century. This is particularly so for a scenario. We have got four different scenarios in the IPCC Fifth Assessment Board. And this is particularly true for the scenario, which is essentially a do-nothing scenario. In other words, we continue to increase our emissions of greenhouse gases and really take no action to mitigate them effectively. So you can imagine what this really implies because if Arctic sea ice is well vanished in the month of September before the middle of this century, then that has major implications for temperatures and climatic variables in other parts of the world as well. Let me go to some other aspects. The impacts of climate change, of course, have taken several manifestations. One of them is the fact that crop yields have been more common in terms of negative values than positive. Because with higher CO2 emissions, there is also a fertilization effect that takes place with plants. Because the higher the CO2, generally you would expect much greater growth as a result. But overall, the impact of temperature increase has generally been overwhelming with respect to this fertilization effect. So the point I'm trying to make is that food security is likely to be compromised. And if that happens, you can imagine as you heard from Dr. Kulkarni, a large number of people are dependent from their food, fiber, fodder, on the forests. And therefore, as a result, you would find that there would be in some sense a multiplier effect in terms of food security being compromised, both on account of agriculture being affected negatively. And of course, forests also suffering as a consequence of changes in temperature and other climate variables. Now climate-related hazards also are going to be important because these will directly affect the livelihoods, particularly of the poor. And there would of course also be reductions in copies or destruction of homes and indirectly through, for example, increased food prices and food insecurity. Here I want to highlight that two types of extreme events are going to increase in the future. These are heat waves as well as extreme precipitation events. In fact, the increase in frequency and intensity of these has already been there for the past few decades, but this is going to become far more accentuated in the future. Now when you have, let's say, extreme precipitation events, then that clearly has major implications for ecosystems and their stability. And I'll give you an example. In the case of India, we've got a large area of land which is under the Himalayan system. And what has happened typically is human intervention, which has carried out major deforestation, at least in the upper and medium slopes of the Himalayan range. And at the same time, with an increase in extreme precipitation events, there's been much greater denudation, much greater erosion of soil colour. Now as a result of that, you not only have a sedication of our river systems downstream, but you also have a reduction in the ability of mountain streams and the collection of water along the slopes of the Himalayan range. And that has major implications for forests and ecosystems in general. Now I just want to end by saying that fortunately there is also an enormous opportunity here because forests and bamboos and rattan in particular are great sources of storage of carbon dioxide. And I think under Red Plus, if there is a clear identification of these opportunities and therefore an implementation of projects related to Red Plus, then clearly there would be much greater attraction in the conservation, in the growth and the use of some of these stocks. I might mention, and this is the final point I want to make, that in the Working Group 3 report of the IPCC which has come out, we have placed much greater emphasis on mitigation in the AFOLU sector. AFOLU stands for Agriculture, Forestry and Land Use. And what we have highlighted is the fact that in agriculture there is clearly a great deal of scope for mitigating emissions of greenhouse gases. Reducing deforestation is absolutely crucial and the expansion of forestry area or afforestation is also extremely important. Now if we were to seize some of these mitigation opportunities, then clearly there would be an expansion of the stock of some of the species that we are talking about. And overall there would also therefore be enhancement of human welfare, particularly of societies who are directly dependent on some of these resources. So I think in the future we would have to ensure that there is a combination of adaptation measures as well as mitigation. To deal with the problem of climate change would be based on a clear understanding and a projection of some of the impacts of climate change and therefore translating that into adaptation measures because there is a certain inertia in the system as a result of which climate change will continue even if we bring about radical reduction in emissions today. And that in itself will not be enough, we will also have to start immediately with adequate mitigation measures. And I think the advantage with bamboo and rattan and essentially forestry species is that you can barely out-adaptation as well as mitigation simultaneously by focusing on these species which are really an enormous resource for human society. Thank you very much. Thank you very much Dr. Pichori. We will just move on rapidly moving from the global picture to the national picture with Dr. Pichori who will tell us about what is happening in Indonesia. Thank you very much. First of all I would like to thank Dr. Pichori for sending us an Indonesian strategy on the development of non-timber forest products. I think this is very important for us from the global to the national work we have done so far. We have so many non-timber forest products and then we have to manage and develop the strategy. Since the era of the thousands, Indonesia has shifted the forest management paradigm from timber mismanagement into resource-based management. The reason is only 10% compared to 90% of the total value of non-timber forest products. The consequence is that in the forest management we have to pay more attention not only to timber but also non-timber forest products and all commodities obtained from forests have to cut down. There are three ministerial degrees regarding non-timber forest products. These are number 35, 2007, regarding non-timber forest products from forestry and the number regarding national strategy for the development of non-timber forest products. The addition also the minister of forestry issued very importantly 39, regarding important partnership including on the management of non-timber forest products. Instructing all forest permit orders to give access and partnership to forest village communities on their forest area management. Ladies and gentlemen, the non-timber forest, our daily life for example for food, fire, energy, medicine as well as for climate change, mitigation and adaptation. We have identified more than 565 items of non-timber forest products. Consist of 490 flora and 75 fauna, four in Indonesia's forest which are classified into medicinal and 65 non-timber forest products, simple foundation in Indonesia, it is almost impossible. Indonesia has developed non-timber forest products management strategy. Making development from provincial level as well as textile level and also making cluster of non-timber forest products development to become models non-timber forest products. Clustering development upstream to downstream industry divided into four steps, infrastructure creation. Moshukot also the central provincial and district government level because non-timber forest products strategy. There are the development such as issues on the economic data and formation of potential and utilization. Issue on across sectoral integration and policy and issue on upstream and downstream industry development. Issue on availability of resource cultivation and processing technology and still many others to be resolved I think in the near future. So output for non-timber forest product development in Indonesia then come enhancing the wireless and protecting forest. Creating more job opportunities, increasing number and right day of non-timber forest products and values such as for food, fiber, medicine, energy, better biodiversity conservation and carbon monostabilization as well as the greater system and inflation for anti-abuse development in place. Finally, optimizing non-timber forest product development hopefully will lead to better sustainable forest management and for photos to just basically help with my presentation if you will and it's not a way to relate. What I want to talk to you about is basically NTFP's and ecosystem services. And if we go back to 2002 millenium ecosystem assessment basically define what ecosystem services are, provisions, regulating and one of the most important bonds is presumably food security. Nature provides food. And food is not just, as we've already heard during the opening plenary and again just now in our discussion, not just a question of irrigated agriculture and large grain food crops. Food is also found in other places. For example, some research we did in Atapur in the lower Laos show that all the protein that low people get there basically comes from nature, comes from the wetlands, comes from the forests. It's not bought, it's not grown. It's effectively not timber forest products. In India, NTFP is a major commodity, major business, large markets, lots of money involved. But NTFP is not just a poor man's food. If you look at Japan or Europe, mushrooms are a delicacy, a highly priced delicacy, a very expensive delicacy. So NTFP's are important for food and basically therefore if you think about a forest ecosystem service, again the whole trend over the last hours has been we need to look at the landscape, we need to look at the bigger picture. A forest is not just a stand of timber. It's an ecosystem with a whole range of services that are important and NTFP should be considered when you talk about sustainable management of forest resources. I'm the Director General of INVAR, the International Network for Bamu and Rata. So I want to talk a little bit about bamboo, one of the most important maybe NTFPs and an NTFP that has lots of interesting aspects. Going back to where we started, bamboo is a food source. Bamu's shoots are basically a staple food crop in China. Bamu shoots appear every year. Mosul, which is the prominent species of bamboo in China, has new shoots appearing every spring. And they basically can be harvested. Now there are about 2,000, 3,000 bamboo poles per hectare and the shoots effectively are the same sort of number. You can harvest half of them because basically due to space, nutrition and competition half of them will die otherwise. So it's a good business. Mosul, as I said, density of one and a half to 4,000 per hectare. As you see other bamboo have a much higher density. This is a complication, there are 12,000 different species and the ones that are very dense are basically what we call clump numbers. These are numbers that grow in clumps rather than the mosuls that close in individual species. In individual poles, I should say. But therefore it is a food source. Once the shoots that have not been harvested have grown and this for bamboo is a question of months. I mean a bamboo pole basically is as high as it will ever grow in several months. It then hardens over a couple of years and after four years you can start cutting and then you can cut it again and again and again every year. So it's an amazingly sustainable crop. A bamboo is used, everything is used. There's no way since basically the tops are used for fodder, as you can see smaller bits are used for small items. Waste is used for charcoal, I'll get back to that. And the main thing is the big pole that's used for construction. And when I say construction it's no longer just talking about traditional round pole bamboo housing or furniture. We now make what's called engineered bamboo. These are structural beams, they are wood panels, that basically stand the test of time just like a wood product. So bamboo is becoming a very important traded commodity. The important figures are in 2012 that the export trade of bamboo and other products was 1.8 billion US dollars. And that's a major under estimate. Because this is based on figures in the UN contract database. Not all countries actually list their bamboo products and the main issue is that in many countries bamboo still is sold as wood. So these are figures that we get from the statistics but we know it's non-resting. We're presumably talking about 2.5 billion international trade and only China has an internal market of something like 1, 1.5 billion on top of that. So presumably we're talking about 4 to 5 billion or so, we're not exactly sure. You see the debt, that was basically the economic crisis but it's coming back up and we think that with the interest in Europe and the USA for ecological products bamboo trade will go up drastically. Two other things about bamboo. One, as I mentioned earlier, you can make charcoal out of bamboo and you can use it for an engine. Not just charcoal, you can also use bio gas and basically put it in a digestive. But it is a source of energy, particularly for poor communities which has not really been explored in the fullest and it's a major opportunity and people can grow bamboo on their homestead, around the school, in the lower garden and make it into charcoal. And the other thing, we've already talked a bit about climate change. Sorry, I should go back. The actual value of charcoal is not much better than with charcoal. This has been one of the big debates. The issue is that the raw product is so much more environmentally friendly because bamboo in its natural condition doesn't eat fertilizer, it doesn't need irrigation and it doesn't beat normally with agricultural food crops. The other thing is climate change. We talked a bit about it. This is a graph to give you an idea about the mitigation aspect of bamboo. Bamboo absorbs carbon just like any other plant. But because you cut it so fast and so regularly, over a period of time the absorption capacity is higher than most trees. The other thing is, of course, adaptation. I mean bamboo again because of the fast growth and the effect it's easily harvested and easily maintained is a major opportunity for adaptation to the effects of climate change. So a very important aspect, as Dr. Pachauri said, not really explored the fruits by the convention, and we hope that that will change. Do we know everything about bamboo? No, definitely not. There's still a lot of research to be done. And this is done really by universities, by research institutions, by the scientists. There's also a lot of research being done about how you can actually make money out of bamboo. New designs. These things are sold to the French luxury market at enormous prices. And it's basically weaving from bamboo. And then, of course, there's all the different uses of bamboo. This incident is originally the easier. I thought I should have a picture of your own country. So there's still a lot to be known. A lot to be explored. And one of the issues is that basically, yes, I think Manosh said earlier, bamboo is a crop, but the Ministry of Agriculture don't really see its relevance. Because it's not a food crop. It looks like a tree, but it's not timber. So the Ministers of Forest, we also feel that it's not really their responsibility. It falls a little bit between two stools. And this applies not just to bamboo, but to most NTFPs. So on the basis of that, you've got all these different people actually having an interest in bamboo. Sustainable management of NTFPs requires a lot of collaboration. So just to conclude, or to recap, forests are not just stands of timber. They have many ecosystem functions. NTFPs should be included in sustainable forest management. Bamboo has lots of benefits and values, but not everybody knows about them. NTFPs are neither agricultural crops, nor timber stands. And therefore management of NTFPs requires collaboration and partnerships. Thanks a lot. I'm also pleased that everyone kept within their time. What I'd suggest now is that you can take some questions from the audience, and then maybe have a little time for speakers to address each other's points of answer. First, I'll just start by looking at a couple of questions that you may see provocative, but this is something of interest. Dr. Pochuri, I think I'm interested in working with the IPCC as well as Terry. I mean, you're famous for bringing together or holding together a bunch of scientists who may disagree with everything else and with this sort of primacy of the role of science, do you see any role, I think, for ordinary people and people who talk about NTFPs? Do they have anything to contribute to the discussion or has the discussion become a high-level discussion where all the research is being done and I think it's interesting and I know you're rooting for what ordinary people are. People always talk about the harvest, the medicinal plants. Do they also have something to contribute? Well, I think as far as climate change is concerned, it affects the lives of every human being in all living species on this planet and therefore, even though there's a very high level of scientific knowledge that's required to understand, assess and project climate change, particularly when it comes to looking a hundred years into the future. In actual fact, it has to be brought down to the level of the average person on the street because unless people understand what the realities of climate change are, you're not going to get the kind of response that is required to deal with the problem and this is a major challenge. You know, the scientific community has not really focused in the past on communicating the results of what they're doing. And this is something that we're trying to do now in the IPCC but the IPCC has a very clean structure in its organization. You'd be surprised, our permanent secretary is no more than a dozen people and we really mobilize scientific talent from all over the world for an assessment and these are thousands of people. In fact, those directly involved in the fifth assessment report number a little over 800 authors and review editors. The point I'm trying to make is that the IPCC by itself is not equipped, does not have the capacity to communicate all the science that is carried out by thousands of scientists, 800 of direct authors but there are many others who are so-called contributing authors many many more who are expert reviewers so the numbers all together are very very large. What we need are partner organizations we need organizations like INBAR which can sort of go out and inform their own constituencies of the impacts of climate change. So what I'm suggesting is if you were to pick up the findings of the IPCC reports and then convert them into communications material for different sections of society I think that would serve an extremely vital purpose and we need to do that now and get partners across the globe to be able to do that. Julia, one thing I wanted to ask you you made a list of some of the NTFPs and spoke about how you needed to have priorities How do you prioritize NTFPs knowing that people's livelihoods they get small businesses may suffer if you don't give them priority so how can you take that sort of decision for let's say all the way from Papua to Aceh what is going to be important what is worth looking at because once you get government support there's also money and financials Minister how do you prioritize NTFP nationally provincial level district level so we have four or five indicators into consideration how about the value of the economics value and also about the environment about the social and also about the the existing capacity where they live in this area and many others that we need this kind of and then we finally hit numbers and then by this instrument that we kind of and agrees to be developed nationally or provisionally this is just on the to make prioritization which one earlier than others there are so many NTFPs more than 565 to become the national program we have six greatest stakeholders to be a national program and Hans what problem with bamboo and some things that you are showing is that what are the opposite of aspirationalism you want to use bamboo that's a furniture something until you can afford copper wood you eat stales until you can have chicken wrapped in plastic or to the supermarket these are always seen as things that are or lower classes for undeveloped people how do you convince people that bamboo is something that's important how do you convince them this is worthwhile doing by tea furniture bamboo furniture is solid is that a problem I wouldn't say it's a problem but you are quite right that some people still call bamboo poor I would call it smart I think basically the issue is that what we can do with bamboo now is to make problems that look as good as anything made from traditional materials if you look at some of the flooring that is being made in Central China and sold to Europe it's flooring in any of you wanting to ask the challenge there is that bamboo is not yet cheap I know what you are saying is the products look cheap and in the past that was maybe the case I remember when I was a student yes bamboo was the only thing you could afford the issue is that some of this engineer bamboo the the modern design bamboo is no longer cheap and I think therefore the issue is how do you convince people to basically not buy tea but buy bamboo is a question of awareness rating it's a question of explaining to people why using bamboo actually is much better than using forest and it's you know it's a double value but it's as simple as that because on the one hand you're using a crop which does not affect the environment and using bamboo is good for the crop but the other thing is that using more bamboo means you use less wood so it helps directly to combat deforestation and I think that is an argument that a lot of people will actually understand but it's something that we haven't really got across yet so I think we have to explain that better you know if you go back in time it was Mahatma Gandhi who popularized hand-looked cloth and then of course the best designer, the best marketing people got into the act today you can buy the best textile and you know all the synthetic stuff and produce clothes from them but often well-designed hand-looked clothing costs much more and people attach a much larger value to it so I think what you really need over here please correct me if I'm wrong is the best talent going into the design of products, marketing it and essentially seeing that in people's perceptions there's a premium attached to the use of this so I think this is really a task for designers, advertisers and marketing people so that power perceptions change about bamboo and that will make an enormous difference with the whole cycle of production conversion and marketing Introduce yourselves, say who the question is for and we'll take a few questions before we start. Okay thank you, my name is Danny from C4, Danny and Dylan I've been working with the KVP for the last several years My first question is to Dr. Hans it's very interesting to see from your presentation what bamboo can do what bamboo can be converted I'm wondering is this all innovations in bamboo is it initiated by the government of China or is it initiated by the research or by the profit sector and my second question is to Pa Fatoni but Fatoni it's interesting to see the Ministry of Forestry put attention to this more than 500 NTFPs in Indonesia I'm wondering whether what is the instrument regulations that can lead between these NTFPs from the productions into the processes and into the marketing because bamboo, retan is not only informed Ministry of Forestry but also Ministry of Trade and Ministry of Industry instead of instrument regulations to lead Ministry of Forestry and my last question to Pa Fatoni is this morning our President mentioned the planting of trees in the last 5 years between 2011 and 2014 saying that we have planted 4 billion trees in Indonesia I'm wondering what is the position of NTFPs in those programs do you have any strategies to integrate NTFPs with the tree planting because forest plantation is also quite popular recently thank you Jaya Wahono from Claim Power in Indonesia we comfort bamboo in the electricity in Bangladesh hopefully we will be operational in the end of this year so I hope to invite all of you to come my question to Dr. Pachori if I understand correctly Indonesia is the third biggest polluter in terms of carbon emission is that correct so but in terms of the economy size we are number 16 World Bank says we are number 10 based on GDP but what happens if we double our GDP can the world afford to have Indonesia that double the carbon emission so I guess if we fail to stop the carbon emission and have a renewable energy project here in Indonesia that replace diesel and the coal pipeline then I think the world has to contribute so what is the IPCC is doing to help Indonesia in achieving that thank you I'm Carolyn Buckingham World Resources Institute this is for Dr. Fatemi I'm just wondering about the Indonesian NTFP development strategy and what are the major challenges we've seen that implemented for example are there any restrictions on land that can be used or other things so what are the major opportunities you can see from that my name is Desi I'm from forestry research development agency recent development and currently we are having activities in the Bali province that we trying to develop a model on upstream and upstream sector and the downstream sector on Bambuida stream development and I'm agree with Mr. Hans that sometimes in developing country Bambuida is related with the poor so I'm agree that we have to put some added value on that so I want to know since the in-bar headquarters is in China as we know China is very advanced in the Bambuida industry and development so maybe you could share to us what is the main strategy step if we want to develop on Bambuida stream what is the I mean of course the regulation and also the community but the important thing is how to change the mindset that Bambuida is not for the poor anymore so we can use Bambuida stream as the starting thank you very much I think the point that you made is something that really confronts every society in the world and what we really need to do is to look at what growth and development really represents after all the whole purpose of economic growth and development is to enhance the welfare of the people and if the pattern of growth that we're pursuing is going to impose huge negative externalities including climate change which is going to have impacts then we really need to redefine the path of growth and development and may I say that is entirely feasible in other words we can move along the path by which we mitigate the emissions of greenhouse gases and if you ask me for a country like Indonesia of course you do have the problem of deforestation and that somehow has to be reversed and that requires not only action at the level of Indonesia but perhaps globally and I'm not going to prescribe anything for that but obviously that's an outcome which has to be part of the whole mitigation strategy but what is also important to remember is that if you were to bring about shift towards mitigation on a large scale globally are not pilot all as a matter of fact we've estimated that if we want to limit temperature increase to below 2 degree Celsius by the end of this century then all it implies is a reduction in global GDP of 0.06 percent per year and that lets say in 2013 amounts to 1.7 percent of the global GDP in 2013 now if you look at the benefits in terms of the core benefits which mean higher energy security lower levels of pollution at the local level perhaps even higher employment opportunities and the benefits of avoiding or delaying the worst impacts of climate change then it's totally a win-win situation as one would say it's a no-brainer so I think somehow the global community has to understand the enormous benefits of shifting here towards a path of development that is mitigations oriented because the alternative of no action is going to be so very high in terms of cost that I think human society must make this choice that action and of course Indonesia is not alone in that every society across the globe has to do that and I hope we have the sense we have the wisdom and we have the appreciation of knowledge to be able to do. Thank you I think there were a couple of questions about how did China manage to develop its bamboo industry first let me say I'm not Chinese so what I'm saying is my own interpretation I understand this happened the first thing is this didn't happen overnight a lot of the industry developments we see that have gone to a real high level of quality and quality control have taken maybe 20 years to develop so it's not something that will happen overnight but I think what made possible in China was a combination of governance and local governments have effectively allowed bamboo to be used both as a private investment opportunity as a communal resource to promote basically the use of plantations by the government owned or owned by a consortium of people and thirdly to use bamboo as a means to degrade the lands and unproductive agricultural lands and eroded lands so there was a whole governance aspect that's very important then there was an infrastructure aspect what government has done at a local level has put in place in some cases roads so that bamboo can be transported to a market and provide the opportunity for a private sector to then develop it but the actual work and the actual businesses are private businesses and they basically made use of these sort of facilitative actions by the government loan government to develop an industry that initially had some pitfalls and questions and maybe the quality wasn't right up to standard but is now ironed out most of the problems so it's a combination really of governance, private sector and the third area that I didn't mention which is also very important is research there's a whole network of basically research centers that are focused on bamboo and that are looking at still new opportunities there's a whole discussion about the chemical properties and the pharmaceutical properties of bamboo which we don't really know enough about the possibilities of using bamboo for bioethanol, biobutanol these are very likely developments but there's still research going on how to make natural textiles from bamboo not viscose based but actually natural bamboo products so there's still a lot of research going on and I think it's that partnership between the research, the government and the private sector that made it happen just to get back to the other question about using bamboo in reforestation I can't speak for Indonesia, I let Dr. Fatone answer that one but on a global scale it's one of the things that we are promoting and we are talking about how we can actually introduce the concept of using bamboo to basically look at really badly graded soils we have some experience in India for example an old brickyard, not just one brickyard an old harry that was used for brick making where the soil were completely exhausted completely degraded red earth it started with the green bamboo forest as I said there are experiences in China where basically non-productive land was restored using bamboo and is now an active healthy forest with all the economic benefits that come with it and we are working now in Africa Ethiopia, Ghana and Tanzania to do similar sort of work and using bamboo as one means to help with the kind of basically restoring 20% of degraded land scales by that trend so it's possible, I don't know what the experience in Indonesia is I think that's you Thank you very much Mr. Darin for the regulation across the sector yes, NTFPs I think need regulation across the sectors because not only producing but also and then also marketing we have experiences on how is prepared on the Rantan for example many times on of this year can be exported Rantan material and then the next year is export ban and so on and this is I think we need to integrate between the sectors first government ministry of rest, ministry of home affairs and also create and ministry of industry soon to be together and fortunately now we have also the new national bamboo board and also hopefully very soon on the Rantan also so in this board then all whatever strategy regulation can be discussed integrated between all sectors all stakeholders farmers can benefit from the development of Rantan NTFPs also industries as well as the government I think I agree that we need more simple regulation in order NTFPs can be developed faster which position NTFPs on the plantings national planting program some species should be introduced in this program for example for many years ago we planted what we call it super, one is in the English to come and in the next 5 years I think it will be booming for food and then it will become because in the next 5 years I think it will be booming from this planting movement so I think many species already introduced in this program and also recently the government forcing the provincial government to give some of allocation issues special allocated to the cannot be used other than planting of Bantu so this is I think NTFPs already embracing the justice and so on so this is regulation cross sector in order there is development of NTFPs getting faster and benefited to all and opportunity for NTFPs development strategy I think as I mentioned that many problems still be encountered on the development of the anti-hospital for example for the accurate data and information how many of these are existing in the forest so we need inventory so in order to provide the accurate data management can be carried out better and the second also I think so far many anti-hospital still rely on the natural resources still very small cultivation so I think in the future using this movement then cultivation of the anti-hospital will be encouraged also to have the processing technology in order to because if bamboo not new technology then people image bamboo is the traditional but now I think bamboo already used for many high technology and also for example and also others need when you edit using the advanced technology to provide better image of the non-timber forest products we have a good opportunity because in the next 5 years the government already this is our commitment with cross sector we are going to develop more than 600 forest management unit it means that in the local level and the cycle level should be developed many many and their base in order to produce income for the management unit hence this bamboo is very good for Indonesia also for land rehabilitation because they just really grow naturally along the very slope stream and also non-contractive land for example also grow very well bamboo in Indonesia also I think we have opportunity because more than 40 million people it really depend on the forest products I stay around forest area inside and outside near and next to the forest area I then left forest available over there so if we develop the non-timber forest product then we can benefit to our communities and also the last I think because the government so far provide huge access for the people to forest management the minister already provide more than 5 million hectares allocated to the people in form of community forest and also village forest and also and this form of the this can be utilized also to develop and at peace in the future. Thank you very much. Thank you very much for the opportunity. My name is Intan I'm a consultant from Singapore and I think the presentations are very interesting and I'm going to give some opinions and I think like NTFE are very important and I think for example like local local levels like the lesson from local levels like for example from Google customary forest in Jamiah province and also the Lubukurinian village forest I think this mechanism of promoting NTFE is already integrated into this customary forest scheme of village forest and I think the point that I discover is that sometimes it's difficult for the villagers to find like the market for the product and they rely heavily with intermediaries so and no matter like how beautiful this like woven basket that they can make but it's only going to be you know it's it will be unavailable in the market because it's difficult to find the niche market for this product and especially because of limited access to market information and I think it's also very important to kind of encourage the promotion of NTFE and as well the customary community because for example like customary community in Gugu forest in Jamiah they have this traditional knowledge of these giant trees it harvests the Asian giant bees and they have this traditional knowledge that if you actually clean the surrounding of the forest then the bee will not come and I think it's very important as well to give a greater customary community to our NTFE and I think in responding to opinions about village forest I think like right now the people in the who have adopted the village forest schemes they are worried that they will have limited access to the NTFE because some of the village forest they are actually protected forest so the people are entitled to limited access of NTFE product and I think it will definitely make a difference when you have the village forest located like 10 kilometers away from the village and when the forest is only like just adjacent to the forest it will discourage people who even though they were given the rights to access this NTFE but if the forest are located 10 kilometers away they will not simply store more than harvests that thank you thank you my name is Pibril from Bogor Agricultural University I'm a graduate student from SoftwareFrance.F right before that bamboo is high water absorber good in carbon secrification is it possible using bamboo for green public area in big cities which has problem with diminishing water catchment and air pollution issues thank you You know it's a really good question because again I think using bamboo in urban environments has not really been explored to the extent that you might expect, but it does happen for sure. I think in general it's understood and totally accepted now that green cities are healthier. Cities with vegetation basically provide shade, they provide cleaner air, they provide opportunities for recreation, people feel healthier, it's good for your mental capacity. So cities that are green not just as far as emissions are concerned, or as far as car management are concerned, but cities that actually have green spaces are healthy cities. Can you use bamboo? Depends a little bit. Bamboo grows in the tropics. So to assume that you could do this in Europe or in the States or in Southern Australia, I guess it's not likely. To do this in the tropical belt is definitely possible. There's one challenge I think we have to be aware of. Several species of bamboo, for example the ones that I showed you in China, are what we call running bamboo and the root systems grow very fast. That's fantastic if you arrive in the rural area. It's very good if you're talking about erosion control, slope, stabilization, or general restoration of bad lands. If you're in an urban environment, maybe a different story. So which type of bamboo to use would be a question? Because if you have the bamboo and the root systems go under the surface of the basements, or actually affecting the foundation of buildings, you may create problems that you weren't actually expecting. But using bamboo in an urban environment for modern urban planning definitely is possible. We've been given the signal that we need to close very soon, so I just want to close. A lot of the things that I picked up when people were talking, and I see this in India quite often, it seems as if Indonesia is solving it, is that NTFP is not just bamboo and raktan, but the other NTFP falls between the stools of different ministries, so no one actually owns it. I know in India we had a very interesting situation where bamboo was considered one of the forestry ministries, and thanks to a lot of NGOs and academics working, it was removed, mostly because of people having access to it, then biologically classified as a brass wood, which meant rural people could use it, but then the forestry industry cost interest in it. The agriculture ministry was handed in for a while, but they didn't really care, so they didn't know about it, and then because of other NTFPs, small-scale industry promotion boards started actually, but no one actually owns bamboo, raktan, medicinal plants, but there's money, for example, for medicinal plants, people suddenly get interested, but otherwise no one really owns it, and I think that is one of the problems. That's just something I want to say, would you like to make some closing statements? In terms of access of the villages to the market, why bamboo so far has become like this in China? Because the government, the industry, and the scientists work together, and also develop together, not only the villages, but the government provides, the access provides the technology and so on, so that bamboo becomes a good product, and then happy market it. So I think the most important for us, I think, we have to work together between the government provides the regulation, access, and also the businessmen, the industry people, and also the academia scientists to look at the research on this issue. So in this I think we will be able to develop the NTFPs and benefit to the people. All 565 items are NTFPs. It's really regretting the raw material is belong to the ministry of forestry. So the processing will be in the other ministry, and the predict will be in the other ministry's matter. So that is why we have to work together between sectors, and other NTFPs can be developed, not only by one sector, one ministry, but also all together and working together to become this good product, available raw material, and that industry can produce better, and that market access for the market is very important. So this is, I think, this is why in Rata, for example, we also proposed to Dr. Hans, because Indonesia, 80% of the raw material, good raw material from Indonesia, but from the figure, raw material only 3% of the total value, 97% coming from the finished products and funds products. That is why we have to provide a value in it to high technology in order to gain more value from the raw material to get that with raw material. Dr. Bachari, thank you very much for enjoying this. Thank you very much.