presentation risks

How to Make Risk Management Presentations Engaging and Actionable Across Your Organization

Life is full of risk. We face risks from the moment we wake up in the morning until we fall asleep at night. Will the alarm fail to sound? Will I get into a car accident on my way to work? Will I catch a virus when I go to dinner? Heck, there’s a risk— no matter how small— that we will die in our sleep during each night.

Risk is simply an inherent element of everything we do, and business is no exception. Will a vital employee quit, or will there be a labor shortage? What will happen in the stock market, and how will it impact the economy? What if there is an accident or a lawsuit involving the company? What happens if a new product fails? What actions will be taken in the event of a security breach or equipment failure?

We might not be able to prevent risk, but we can manage it. Managing business risk requires identifying and understanding risks while seeking ways to reduce risk in a way that also supports other business goals.

Companies heavily invest every year in ways to mitigate and respond to risk. But how do they make sure everyone is on board? 

There might be a variety of ways to communicate a risk management plan to all the relevant players, but a visual presentation can be effective in not only presenting the risk management plan, but also ensuring that it is engaging and actionable across your organization.

What to include when you prepare a risk management plan:

A written risk management plan for business should not only include a listing of possible risks, but it also should feature plans to manage risk and respond to incidents.

• Identify risks

Risk management refers to a variety of business aspects, both internal weaknesses, and external threats. Like much in life, knowing is half the battle, and therefore identifying risks is key in addressing them. 

Risk management should be considered before embarking on any new task or project, and everyone connected to a business should be encouraged to identify additional risks. Not only should the risk itself be considered, but companies also should identify possible consequences to better prepare to address each one.

• Minimize risks

A variety of strategies are available to manage and minimize risks once they are identified. One popular method of mitigating risk involves the 4Ts:

• Transfer risk by assigning a responsible team or party to each identified risk.
• Tolerate risk by monitoring it before taking further action.
• Treat risk by taking actions that reduce the likelihood that it will occur.
• Terminate risk by adopting or amending processes that eliminate it.
• Assign roles

Staff members should be assigned to each potential risk or risk category. These individuals will be responsible for mitigating their assigned risks, as well as reporting and responding to applicable incidents. A list of these roles should be included in the risk management plan.

• Plan recovery

Each risk included in the management plan must be followed by a strategy for preventing and addressing issues. An effective risk management plan will include a compilation of business projects, the risk applicable to each and an operational plan to respond and recover from incidents. Part of that plan also should include updating mitigation efforts following an incident to prevent it from repeating.

• Communicate plan

A risk management plan can’t be effective unless everyone within a company is on board. In addition to presenting the plan to principle players, be sure that it is also published somewhere that the full risk management plan can be accessed and understood by anyone within the company at any time.

• Rinse and repeat

The most effective risk management plans are living documents, continually updated with new or changed risks and new strategies to address them. Each risk outlined in the plan should be periodically reevaluated and new risks identified. The plan also should be monitored along with staff turnover to ensure no tasks fall through the cracks.

Tips to make risk management presentations engaging and actionable across your organization:

Audience engagement is vital to a successful risk management training presentation. After all, if staff and executives are asleep they will hardly become familiar with the plan and their assigned roles.

• Include visual assets

About 90 percent of human thought is visually-based. Therefore, it’s no shocker that including visual assets within a presentation is one of the most effective strategies for engaging all types of audiences . 

Releasing the risk management plan through a visual presentation is a great start, but the content within the slide deck is just as important. After all, the average PowerPoint slide includes 40 words , which is entirely too many. Instead, include more images, videos and animations within a financial risk management presentation or any other risk management training presentations.

• Illustrate data

Data is one of the most convincing sorts of content that can be presented to an audience. As anyone can attest— at least in most cases— numbers don’t lie. In fact, they can tell their own stories. A crowded slide full of stats and figures is a quick way to send your audience off to Dreamland. 

Instead, illustrate your data through infographics. Beautiful.ai offers a host of various infographics through our smart slide templates. Just input your data and watch our artificial intelligence-powered presentation software design the infographic accordingly. Choose from infographics like scattergraphs , process diagrams , pie charts and bar graphs to tell the story of different risks and strategies to address them.

• Tell a story

According to the 2018 State of Attention survey, almost 90 percent of respondents said a strong narrative or story backing a presentation is critical in maintaining audience engagement. Sure, facts and data can persuade audiences and get them on board, but only if people are paying attention. 

Stories have kept audiences engaged since before recorded history. Tell the story of your risk management plan by including real-life examples or by creating a character for hypothetical scenarios. Those unsure how to incorporate a story into the structure of their presentation can look to Beautiful.ai’s various presentation templates for inspiration.

• Include your audience

If you really want to keep your audience engaged with your risk management presentation slides, be sure you talk with people, not at them. Include your audience in your presentation by asking questions, taking surveys or presenting group activities. Of course, the first step is identifying who makes up that audience. You won’t necessarily present the same content to an executive board as to a room full of new hires.

One effective way to engage an audience with a risk management plan presentation from the very start is through a pre-presentation quiz or survey that gauges how much participants already know about risk management, like this example from the U.S. Small Business Association. Not only will the activity engage the audience, but it will alert participants to what they don’t know from the very start. Other engagement tools include Q&A sessions, humor and gamification.

As mentioned, the average PowerPoint slide consists of 40 words… way too many to keep audiences engaged. Remember, your presentation should be based on an outline of your plan, not a verbatim recitation of it. 

Not only are uncluttered slides more effective, but shorter presentations also are more effective than longer ones, based on both audience attention and respect for time. Especially when delivering a risk management board presentation, it’s vital to respect your audience’s time. Beautiful.ai’s library of presentation templates can serve as a guideline to effective presentation lengths for a variety of topics.

Samantha Pratt Lile

Samantha is an independent journalist, editor, blogger and content manager. Examples of her published work can be found at sites including the Huffington Post, Thrive Global, and Buzzfeed.

5 Examples of Risk Matrix PowerPoint Visualization

Last Updated on February 21, 2024 by Anastasia

One way to perform and document a risk analysis and assessment is using the risk matrix diagram. This simple visualization matrix is a management method that helps you present possible risks, and define the risk levels. As a result, you can support management decision-making and plan activities to mitigate those risks.

Explore our Business Performance PPT Reports category on the website for more resources to boost your presentation impact.

If you don’t invest in risk management, it doesn’t matter what business you’re in, it’s a risky business. Gary Cohn

Risk Matrix analysis can be easily visualized in a PowerPoint presentation. Your presentation will look more creative if you use a consistent and clear risk matrix diagram for visualization of the new company’s competitors or changes in government policy.

Remark: You can get all presented icons and slide examples in the Risk Matrix Diagram PPT set .

This visual framework is part of other management strategy tools such as SWOT, Porter Forces, and PEST. You may check this article “ 7 Visual Frameworks for Strategy Analysis Presentation ” for more examples.

Why use a Risk Matrix?

The purpose of risk management is to anticipate and control risks so as to minimize their threats and maximize their potential. The risk matrix diagram will help you to create a memorable presentation of those risks. Using a diagram illustration you can visualize with colors all risk categories and focus attention on the main subject. Risk Matrix graphics can be handy presenters who need to show risk assessment or different states of consequence process.

In this blog, we propose examples of creating and presenting risk matrix diagrams , which will help you to make the possible risks visible.

You’ll find a few variations of showing the Risk Matrix Diagram on the slide:

• showing risk types in the form of a list
• illustrating levels of probability and impact
• presenting probability and severity risk levels
• creating a risk matrix with a place for notes

Let’s start our journey over the Risk Matrix Diagram illustrations examples. See how you can show it creatively so that your audience will be focused on your presentation.

#1: Presenting Types of Risk with Creative Bullet Points

In the beginning, you may want to introduce types of risk:

• Economic risk
• Social risk
• Risk related to the use of various technological advancements
• Risk related to natural forces, so unpredictable sometimes
• Political risks covering country leaders’ actions, various lobbying on a government level, federal agencies regulations, etc.

But instead of putting those risks as a standard bullet point list, consider the example below: The first and easiest way to show various types of risk – use a simple list. This diagram includes all kinds of risks, illustrated with icons and colors. The icons for each stage will help your listeners to focus their attention on one or another point.

 #2: Illustrating Risk Probability and Impact

The next example is a typical risk matrix diagram, consisting of 4 parts. Each of them includes an eye-catching icon, therefore it can be employed for any audience: starting from students to your business partners.

#3: Adding Description to Risk Matrix

This type of risk matrix slide includes a place for the description of each point of risk. The advantage of this diagram is various symbols that illustrate emotions, so you can easily show risk analysis results.

#4: Showing Risk Probability and Severity Levels

This full-slide risk matrix diagram will help you to conduct a detailed analysis. You can identify your severity and probability risks. A colorful matrix will help you show all levels of risk:  low, medium, and high. With such a diagram template, you can easily illustrate the most dangerous risks and keep listeners attention on it.

#5: Creating Risk Matrix in Minimalist Style

If you like minimalism in your slides, then you can choose such type of risk matrix: white rectangles with colored outlines and simple icons.

Recap of four presented Risk Matrix visualizations

We presented here a bunch of ideas on how you can talk about risk without boring your audience with text-only slides. Get inspired by the examples we mentioned:

• agenda for showing all types of risk
• diagram with a minimalist style with the icons of emotions
• showing risk severity and probability in a big matrix with hand-drawn symbols
• templates for illustrating risk probability and impact

Why use diagrams for the risk matrix concept?

A risk matrix diagram is a simple mechanism to increase the visibility of risks. It is a basic management tool that is useful for strategic planning. Risk provides the objective metric to help the decision-making process. That’s why the risk matrix has been widely adopted by many businesses. The risk matrix diagram focuses on the highest-priority risks and presents complex risk data in a visual chart. 

What’s inside the Risk Matrix Template collection?

We created a collection of risk matrix diagrams in various versions and added iconic symbols for 5 types of risk. All icons are fully editable, so you can change their color and resize them without losing the image quality.

The slide set contains:

13 Matrix PPT Slide Layouts for Two-Dimensional Risk Assessment:

• Explanation of the risk matrix concept.
• Diagrams for 2×2, 3×3, and 5×5 matrices with description areas.
• 30 icons for various 5 types of risk, risk severity, and risk probability levels, in flat and handwritten styles.

All examples above are part of the infoDiagram PowerPoint Diagrams collection. It contains vector graphics that can be easily edited and added to other presentations:

Risk Matrix Diagram

Explore our YouTube channel for more creative ideas:

2 thoughts on “5 Examples of Risk Matrix PowerPoint Visualization”

Brilliantly executed read about the Risk Matrix. The slide show is a great visual aid.

thanks Jennifer! We’re glad our blog is useful for you.

Comments are closed.

How to Perform Risk Assessment in PowerPoint

Creating a PowerPoint presentation requires creativity and attention to detail. However, it is equally important to recognize the potential risks that come with presenting information to an audience. In this article, we will explore the importance of risk assessment in business presentations and provide a step-by-step guide on how to perform risk assessment in PowerPoint.

Table of Contents

Understanding the Importance of Risk Assessment in Business Presentations

Risk assessment is the process of analyzing and evaluating potential risks to determine their impact on the success of a business presentation. This process helps to identify potential hazards or weaknesses that could affect the intended outcome of a presentation, and provides the opportunity to develop risk management strategies to mitigate these risks. Failure to undertake reasonable risk assessments can lead to negative consequences that can impact the credibility and reputation of a business.

One of the key benefits of conducting a risk assessment is that it allows businesses to anticipate potential problems and prepare for them in advance. This can help to minimize the impact of any issues that may arise during a presentation, and ensure that the presentation runs smoothly. Additionally, risk assessments can help businesses to identify opportunities for improvement and innovation, by highlighting areas where they may be able to take calculated risks to achieve better outcomes.

It is important to note that risk assessment is an ongoing process, and should be revisited regularly to ensure that businesses are prepared for any new risks that may arise. By regularly reviewing and updating risk assessments, businesses can stay ahead of potential problems and ensure that they are always prepared to deliver successful presentations.

Step-by-Step Guide to Performing Risk Assessment in PowerPoint

The following steps can be followed to perform risk assessments in PowerPoint:

• Identify potential risks in your PowerPoint presentation by analyzing the content and context in which it will be presented.
• Assess the probability and severity of these identified risks.
• Evaluate the potential impact of the identified risks on the success of the presentation.
• Develop risk management strategies or solutions to mitigate the identified risks.
• Implement and maintain risk management strategies, and continuously evaluate their effectiveness.

It is important to note that risk assessment should be an ongoing process throughout the development and delivery of the presentation. As new information or changes arise, it is necessary to reassess and adjust risk management strategies accordingly. Additionally, it is recommended to involve other stakeholders or team members in the risk assessment process to ensure a comprehensive evaluation of potential risks.

Identifying Potential Risks in Your PowerPoint Presentation

Potential risks in a PowerPoint presentation can vary depending on the context and nature of the presentation. Common risks may include technical difficulties, inaccurate data or information, and poor communication. Identifying these risks can help you to take proactive measures to improve the quality and success of your presentation.

Another potential risk in a PowerPoint presentation is the use of inappropriate or offensive language or images. It is important to consider your audience and ensure that your presentation is respectful and appropriate for the setting. Additionally, not properly citing sources or using copyrighted material without permission can also pose a risk. By being aware of these potential risks and taking steps to mitigate them, you can ensure that your presentation is effective and well-received.

Analyzing and Evaluating Risks Using PowerPoint Tools and Features

Microsoft PowerPoint provides a variety of tools and features that can be used to analyze and evaluate risk in a presentation. These tools can include built-in templates, charts and graphs, and data analysis tools that can help you to identify potential weaknesses or areas of concern in your presentation.

One of the most useful features of PowerPoint for analyzing and evaluating risks is the ability to create interactive simulations. These simulations can help you to visualize potential scenarios and their outcomes, allowing you to make more informed decisions about risk management. Additionally, PowerPoint’s collaboration tools make it easy to share your presentation with others, allowing for feedback and input from multiple stakeholders.

Another important aspect of using PowerPoint for risk analysis is the ability to customize your presentation to suit your specific needs. By tailoring your presentation to your audience and the specific risks you are analyzing, you can ensure that your message is clear and effective. This can be achieved through the use of custom graphics, animations, and other visual aids that help to convey complex information in a clear and concise manner.

Tips and Best Practices for Effective Risk Assessment in PowerPoint

Effective risk assessment in PowerPoint requires a systematic and structured approach. To ensure that your assessment is effective, consider the following tips:

• Understand the context and purpose of your presentation before beginning your assessment.
• Collaborate with others in your team or organization to gather different perspectives and insights on potential risks.
• Document your assessment and risk management strategies in a comprehensive report.
• Regularly evaluate the effectiveness of your risk management strategies and make adjustments as necessary.

Another important tip for effective risk assessment in PowerPoint is to identify and prioritize the most critical risks. This can be done by considering the likelihood and potential impact of each risk, as well as the resources available for risk management.

It is also important to communicate the results of your risk assessment to relevant stakeholders, such as senior management or clients. This can help to ensure that everyone is aware of the potential risks and the strategies in place to manage them.

How to Communicate Risks to Your Audience Using PowerPoint Slides

Communicating potential risks to your audience can be challenging, but PowerPoint can be an effective tool to help you communicate these risks in a clear and concise manner. Consider using charts, graphs, and other visuals to make your message more easily understandable. Additionally, be sure to explain the risks in a way that your audience can understand, rather than using technical jargon that may be confusing.

Another important aspect to consider when communicating risks is to provide context. Your audience needs to understand the severity of the risk and how it may impact them. Providing examples or case studies can help illustrate the potential consequences of not taking the risk seriously.

It’s also important to be transparent and honest when communicating risks. If there is uncertainty or unknown factors, be upfront about it and explain what steps are being taken to address these uncertainties. This can help build trust with your audience and show that you are taking the risks seriously.

Common Mistakes to Avoid While Conducting Risk Assessment in PowerPoint

While conducting risk assessments in PowerPoint, it is important to avoid common mistakes that can undermine the effectiveness of your assessment. Some common mistakes include failing to identify all potential risks, failing to document your assessment and risk management strategies, and failing to regularly evaluate the effectiveness of your strategies.

Another common mistake to avoid while conducting risk assessments in PowerPoint is failing to involve all relevant stakeholders in the process. It is important to gather input from all parties involved in the project or activity being assessed, as they may have unique insights into potential risks and risk management strategies. Additionally, failing to communicate the results of the risk assessment and risk management strategies to all stakeholders can lead to confusion and misunderstandings.

Integrating Risk Management Strategies into Your PowerPoint Presentation

Integrating risk management strategies into your PowerPoint presentation can help to ensure that your presentation is successful and meets the intended objectives. Examples of risk management strategies include contingency planning, regular practice sessions, and creating backup copies of your presentation materials. These strategies can help to prevent or overcome risks and improve the overall quality of your presentation.

Another important risk management strategy to consider is audience analysis. Understanding your audience’s needs, interests, and expectations can help you tailor your presentation to better meet their needs and increase engagement. This can involve conducting surveys or focus groups, researching your audience’s demographics and industry, and incorporating relevant examples and case studies into your presentation. By taking the time to analyze your audience, you can reduce the risk of delivering a presentation that misses the mark and increase the likelihood of achieving your desired outcomes.

Assessing the Impact of Risks on Your Business Goals with PowerPoint

The impact of risk on your business goals can be significant. In PowerPoint, you can use data analysis tools and indicators to assess the impact of potential risks on your business goals. Additionally, regular evaluation of your strategies can help to identify areas in which you can improve your risk assessment and management.

One important aspect of assessing the impact of risks on your business goals is to consider the potential financial losses that could occur. By using financial modeling tools in PowerPoint, you can estimate the potential financial impact of different risks on your business. This can help you to prioritize your risk management efforts and allocate resources more effectively.

Another key factor to consider when assessing the impact of risks on your business goals is the potential impact on your reputation. Negative publicity or damage to your brand can have long-lasting effects on your business, and it’s important to consider these risks when developing your risk management strategies. In PowerPoint, you can use visual aids and charts to help you analyze the potential impact of different risks on your reputation and develop strategies to mitigate these risks.

The Role of Data Analysis in Conducting Successful Risk Assessments with PowerPoint

Data analysis plays an important role in conducting successful risk assessments with PowerPoint. By using data analysis tools within Microsoft PowerPoint, you can identify patterns and trends in your presentation that can help to identify potential risks. Additionally, data analysis can help to determine the effectiveness of risk management strategies and make adjustments accordingly.

Creating a Comprehensive Risk Assessment Report using PowerPoint Templates

After performing a risk assessment in PowerPoint, it is important to document your findings and strategies in a comprehensive report. PowerPoint provides a variety of templates that can be used to create a comprehensive and visually appealing risk assessment report.

Collaborating with your Team for a More Effective Risk Assessment on PowerPoint

Collaborating with your team or organization can provide different perspectives on potential risks, and help to develop more effective risk assessment strategies. In PowerPoint, you can use collaboration tools to solicit feedback and input from others in your team or organization, which can help to create a more comprehensive and effective risk assessment plan.

Measuring the Effectiveness of Your Risk Assessments with Key Performance Indicators (KPIs) on PowerPoint

Measuring the effectiveness of your risk assessment strategies is important to determine whether your objectives have been met. In PowerPoint, you can use key performance indicators (KPIs) to measure the effectiveness of your strategies. An effective risk assessment plan should produce positive outcomes, such as improved communication and successful achievement of presentation objectives.

In conclusion, performing risk assessment in PowerPoint is essential for ensuring the success of your business presentation. By following a systematic and structured approach, using PowerPoint tools and features, and integrating risk management strategies, you can effectively identify and mitigate potential risks and increase the overall quality of your presentation.

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Big Presentation? 7 Tips To Help You Take Risks and Wow Your Audience

Published: Oct 07, 2014

Anyone who has ever seen the movie "Ferris Bueller's Day Off" will remember that, while Matthew Broderick played the lead, the show was (almost) stolen by Ben Stein's portrayal of a boring, monotonous, soul-sucking Economics teacher. He delivered his lines ("Bueller? Bueller? Bueller?") as if he had been lobotomized, and his students sat there suffering through his droning, willing themselves to stay awake. (His lecture on the Smoot-Hawley Tarrif Act was particularly dreadful.) Who didn't  suffer? Ferris Bueller and his best buddy Cameron Frye, who had both cut school that day!

While you probably – hopefully – aren't as dull as Ben Stein, chances are you tend to play it safe and even boring when making a presentation. If you're like most people, your goal is just to get through the pitch or speech; you're not thinking about how to help your audience enjoy it, or even enjoy it yourself. But if you want to shift from simply surviving to coming out on top in the survival of the fittest, most memorable speaker standings, you'll need to mix things up a bit.

It's all scary anyway, right? So why not at least show your audience a good time! And you just mind find that once your audience is nodding and smiling at you, you're having a good time, too.

Here are seven strategies to take your presentations and public speaking to the next level: 

Create a compelling opening  

  "Hello, my name is _________ and I am so happy to be here today" IS an opening, but not a memorable one. If you really want to capture your audience's attention, start with a story, a statistic, a piece of pop culture—something that gets your listeners hooked right away. Remember: you only have once chance to make a powerful first impression.

Add humor appropriately  

There are few worse ways to damage your credibility than with a joke gone horribly wrong in front of a crowd. But that doesn't mean you shouldn't attempt to use humor. Just keep these two tips in mind:

1. Don't ever tell the audience that you are about to tell them a joke— just tell it, and if they laugh, great. If they don't, it was just a story.

2. If someone's going to be the butt of a joke, it should be you. But make sure youdon't sacrifice your personal or professional credibility in the process. 

Get your audience involved  

Think of them as participants rather than listeners. Engage them in the presentation by asking them questions (not just waiting for them to ask you questions). Take a poll. Ask them to talk with the person sitting next to them about your topic, and then share a key point from their discussion. Get them into groups and give them an activity. Have them fill in a handout with key words. Let them vote on something. Remember: your audience wants to be engaged with you, so you're better off engaging them on your terms and your timing. 

Use images, not text  

A PowerPoint slide deck filled with text and bullets lulls your audience to sleep. But enhanced by colorful and evocative images, that same presentation will keep your audience's attention. In addition, it gives you the opportunity to tell an intriguing story of what the pictures demonstrate, which will make you a more compelling speaker to listen to. 

Make your punctuation audible  

Remember when we learned about using periods, commas, exclamation points and question marks for writing? They're also valuable for speaking. A period signals that your voice should go down to end a sentence. A comma is a place to take a pause. An exclamation point should signal adding some power and volume to your tone of voice. And a question mark? (Do I really need to answer that?) 

Walk around the room, but don't wander  

If you really want to add some polish and pizazz to your presentation, plan to stand up, move around and use the space. This will help you connect to audience members who are in the back and along the sides of the room, as well as get some energy flowing. It also signals to you’re audience that they should pay attention because you're coming to check on them! But you need to use your space strategically. Pick a few key transitions between ideas or main points, and plan to walk 3-5 steps during those. The idea is for you to get physically closer to different groups of people in the room, and bridging to a new idea is the perfect time to do that. But make sure you don't wander purposelessly. This will make you look nervous, and it will make your audience feel nervous, too.

End with a bang  

The Law of Recency says that we remember most what we heard last. Make sure your audience leaves your presentation with a powerful last and lasting final impression. "Uh, I guess that's it!" doesn't fit the bill. Try a compelling call to action, a rhetorical question, or a meaningful quotation to leave your audience both satisfied and wanting more!

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Self-Assessment • 18 min read

How Good Are Your Presentation Skills?

Understanding your impact.

By the Mind Tools Content Team

How do you feel when you have to make a presentation? Are you well prepared and relaxed, confident that your performance will have the desired impact on your audience? new score

Or is the thought of standing on a podium, holding a microphone, enough to give you stage fright?

Enjoy it or not, presenting – in some form – is usually a part of business. Whether you get up in front of formal audiences on a regular basis, or you simply have to make your voice heard in a meeting, you're using presentation skills.

Many believe that good presenters are born, not made. This is simply not true . Sure, some people are more relaxed and comfortable speaking in front of others – but everyone can learn the skills and techniques they need to increase their level of confidence and performance when presenting.

From sales pitches to training lectures, good presentation and public speaking skills are key to many influential roles in today's business world. The good news about presenting is that you can improve with practice.

So do you have the skills you need to do a good job? And how effective are you when you have to "perform?" Take this short quiz to help you assess your skills.

Instructions

For each statement, click the button in the column that best describes you. Please answer questions as you actually are (rather than how you think you should be), and don't worry if some questions seem to score in the "wrong direction." When you are finished, please click the "Calculate My Total" button at the bottom of the test.

Becoming a Better Presenter

Effective presentations are a mixture of a variety of elements. You have to know what your audience wants. You need to prepare good, interesting, engaging content. You must be confident in presenting the material, you have to know how to manage your environment successfully, and you need to make sure that your message has maximum impact.

Balancing all four elements is no easy task. And, when combined with the natural anxiety often felt before giving presentations, it's no wonder that many people struggle with this skill. In fact, fear of public speaking is extremely common.

However, you don't have to remain fearful and stressed by the thought of giving a presentation. With the right tools and material, along with planning and preparation, you can present with energy and confidence.

Let's now look in detail at those four key elements of effective presentations:

• Understanding your audience.
• Preparing your content.
• Delivering confidently.
• Controlling the environment.

Understanding Your Audience

(Questions 2, 5, 9)

The success of most presentations is generally judged on how the audience responds. You may think you did a great job, but unless your audience agrees with you, that may not be the case. Before you even begin putting your PowerPoint slides together, the first thing you need to do is understand what your audience wants. Try following these three steps:

Determine who the members of the audience are.

Find out what they want and expect from your presentation. What do they need to learn? Do they have entrenched attitudes or interests that you need to respect? And what do they already know that you don't have to repeat?

Create an outline for your presentation, and ask for advance feedback on your proposed content.

When what you say is what your audience wants or needs to hear, then you'll probably receive positive reinforcement throughout your presentation. If you see nods and smiles, or hear murmurs of agreement, for example, then this will motivate you to keep going and do a great job.

When your audience is satisfied, it doesn't matter if your delivery wasn't absolutely perfect. The primary goal of the people listening to your presentation is to get the information they need. When that happens, you've done a good job. Of course, you want to do a great job, not just a good job – and that's where the rest of the tips can help.

Preparing Your Content

(Questions 6, 11, 13, 14)

The only way to satisfy your audience's needs and expectations is to deliver the content they want. That means understanding what to present, and how to present it. Bear in mind that if you give the right information in the wrong sequence, this may leave the audience confused, frustrated, or bored.

If you provide the information in a well-structured format, and you include various techniques to keep the audience engaged and interested, then they'll probably remember what you said – and they'll remember you.

There are a variety of ways to structure your content, depending on the type of presentation you'll give. Here are some principles that you can apply:

Identify a few key points -  To help the audience retain the messages you're giving them, use the chunking principle to organize your information into five to seven key points.

Don't include every detail -  Good presentations inspire the audience to learn more, and ask further statements to maximize their understanding of the issue.

Use an outline -  At the beginning, tell your audience what you intend to cover, and let them know what to expect. This helps build anticipation and interest from the start.

Start and end strongly -  Capture people's interest as soon as you begin, and leave them with a message they won't forget. It's tempting to put all of your effort into the main body of the presentation. However, if you don't get people's attention at the start, they'll probably lose interest, and not really hear the rest anyway.

Use examples -  Where possible, use lots of examples to support your points. A lecture is often the least interesting and engaging form of presentation. Look for ways to liven things up by telling stories, talking about real-life examples, and using metaphors to engage your audience fully.

A special type of presentation is one that seeks to persuade. Monroe's Motivated Sequence , consisting of five steps, gives you a framework for developing content for this kind of presentation:

1. Get the attention of your audience - Use an interesting 'hook' or opening point, like a shocking statistic. Be provocative and stimulating, not boring or calm.

2. Create a need - Convince the audience there's a problem, explain how it affects them – and persuade them that things need to change.

3. Define your solution - Explain what you think needs to be done.

4. Describe a detailed picture of success (or failure) - Give the audience a vision; something they can see, hear, taste, and touch.

5. Ask the audience to do something right away - Get the audience involved right from the start. Then it's usually much easier to keep them engaged and active in your cause.

To brush up on your skills of persuasion, look at The Rhetorical Triangle . This tool asks you to consider your communication from three perspectives: those of the writer, the audience, and the context. It's a method that builds credibility and ensures that your arguments are logical.

Delivering Confidently

(Questions 1, 4, 7, 10)

Even the best content can be ineffective if your presentation style contradicts or detracts from your message. Many people are nervous when they present, so this will probably affect their delivery. But it's the major distractions that you want to avoid. As you build confidence, you can gradually eliminate the small and unconstructive habits you may have. These tips may help you:

Practice to build confidence – Some people think that if you practice too much, your speech will sound rehearsed and less genuine. Don't necessarily memorize your presentation, but be so familiar with the content that you're able to speak fluently and comfortably, and adjust as necessary.

Be flexible – This is easier to do if you're comfortable with the material. Don't attempt to present something you just learned the previous night. You want to know your material well enough to answer statements. And, if you don't know something, just admit it, and commit to finding the answer.

Welcome statements from the audience – This is a sign that a presenter knows what he or she is talking about. It builds audience confidence, and people are much more likely to trust what you say, and respect your message.

Use slides and other visual aids – These can help you deliver a confident presentation. The key point here is to learn how much visual information to give the audience, and yet not distract them from what you're saying.

Keep your visuals simple and brief – Don't use too many pictures, charts, or graphs. Your slides should summarize or draw attention to one or two items each. And don't try to fit your whole presentation onto your slides. If the slides cover every single detail, then you've probably put too much information on them. Slides should give the overall message, and then the audience should know where to look for supporting evidence. Manage your stress – Confidence has a lot to do with managing your stress levels. If you feel particularly nervous and anxious, then those emotions will probably show. They're such strong feelings that you can easily become overwhelmed, which can affect your ability to perform effectively. A little nervousness is useful because it can build energy. But that energy may quickly turn negative if nerves build to the point where you can't control them.

If you have anxiety before a presentation, try some of these stress management tools:

Use physical relaxation techniques , like deep breathing and visualization, to calm your body and ease your tension.

Use imagery to help keep calm, and visualize yourself delivering a successful presentation.

Learn strategies to build your self-confidence in general. The more assured you are about yourself and your abilities, the better you'll feel when you get up in front of people, and say what you want to say.

When you present with confidence and authority, your audience will likely pay attention and react to you as someone who's worth listening to. So "pretend" if you need to, by turning your nervousness into creative and enthusiastic energy.

For other tips on delivering confidently, see Delivering Great Presentations , Speaking to an Audience , Managing Presentation Nerves , and our Skillbook Even Better Presentations .

Controlling the Environment

(Questions 3, 4, 8, 12)

While much of the outside environment is beyond your control, there are still some things you can do to reduce potential risks to your presentation.

Practice in the presentation room – This forces you to become familiar with the room and the equipment. It will not only build your confidence, but also help you identify sources of risk. Do you have trouble accessing your PowerPoint file? Does the microphone reach the places you want to walk? Can you move the podium? Are there stairs that might cause you to trip? These are the sorts of issues you may discover and resolve by doing one or two practice presentations.

Do your own setup – Don't leave this to other people. Even though you probably want to focus on numerous other details, it's a good idea not to delegate too much of the preparation to others. You need the hands-on experience to make sure nothing disastrous happens at the real event. Test your timing – When you practice, you also improve your chances of keeping to time. You get a good idea how long each part of the presentation will actually take, and this helps you plan how much time you'll have for statements and other audience interactions.

Members of the audience want you to respect their time. If you end your presentation on time or early, this can make a huge, positive impression on them. When speakers go over their allowed time, they may disrupt the whole schedule of the event and/or cause the audience unnecessary inconvenience. Be considerate, and stick to your agenda as closely as possible.

Presenting doesn't have to be scary, or something you seek to avoid. Find opportunities to practice the tips and techniques discussed above, and become more confident in your ability to present your ideas to an audience. We all have something important to say, and sometimes it takes more than a memo or report to communicate it. You owe it to yourself, and your organization, to develop the skills you need to present your ideas clearly, purposefully, engagingly, and confidently.

This assessment has not been validated and is intended for illustrative purposes only. It is just one of many that help you evaluate your abilities in a wide range of important career skills.

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Trina Mattingly

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Hello, This was really an excellent overview with concise instructions, using clear communication methods. I found the article to be captivating and poignant. Thank You

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11 ways to present top risks to the board

When approaching the challenge of risk reporting, there are a number of key questions risk leaders may want to ask themselves: how do you present top risks to the board, what’s the best way of engaging with them, and what information do they need to know?

These questions have been at the centre of risk reporting discussions held by our network of risk managers, who regularly interact with each other about the challenges they face when trying to communicate with different levels of the business about the risks they face.

To summarise the range of practical insights exchanged by Risk Leadership Network members about their experiences reporting on risks to the board, we have highlighted 11 key pieces of advice below.

1. Most boards like it to the point

Know your board members and be aware of how knowledgeable they are about risk-related matters. Do they have a lot of knowledge or not? Are they especially into risk? This may impact how you report to them.

2. Mitigate the need for detail

Organising pre-meetings with board members who want to receive a more detailed overview of the risks facing the business can help you mitigate the effect of their influence.

The risk report should be a catalyst for an informed discussion on risk, as opposed to a simple box-ticking exercise that just creates administrative burden for board members.

3. Get feedback

Get feedback from the board and CEO on what they are looking for.

Depending on the business and its reporting structure, this may not always be possible, so focus instead on what is most important for the board:

• What risk information will help them execute their current strategy?
• What assurance can you give them about the control environment of key risks?
• Check the information you are presenting against the question that the board will inevitably ask: so what?

4. Focus on KRIs

A risk report focused on high-level aggregated KRIs and appetite can give the board a better view of which risks and opportunities the company should focus on right now.

5. Include emerging risks

Include emerging risks and horizon scanning findings. This can provide an insight into which direction the organisation should be looking at, as well as helping the risk team to apply a strategic lens to the business' key risks and opportunities.

6. Don’t focus on long-term risks

The biggest and most important risks to a company will often be those long-term threats and opportunities that the board are aware of; hence the same risks could be presented over and over again. Unsurprisingly, the board will not need (nor want) to hear about these repeatedly.

7. Highlight risks you want the board to consider

Highlight the risks you want the board to discuss and those you need guidance on.

These could be:

• New and emerging risks, or risks related to new strategies
• Ways to enhance your risk management maturity or simplify your current approach
• Risk appetite/risk tolerance
• Whatever you believe would be relevant for them and helpful for management/you.

8. Talk in plain English

The board will want to talk about the business in plain English – without reference to special risk techniques, templates or terminology.

Ultimately, if you can tell them something they didn't know, then you've already added value.

Take two or three risk topics they intuitively understand, bring in the risk owner, and try to frame the risk as a problem statement with a clear gap, while referring to a few internal data points or facts that they may not be aware of.

This tends to result in lively discussion, a focus on practical actions and an ongoing review of progress.

9. Break up the discussion into manageable pieces

Break up any prolonged interaction and discussions with the board into manageable pieces that are very focused on the purpose of the session.

10. Strike a balance

Regular reporting needs to strike a balance between qualitative and quantitative, historic and forward-looking, summary and detailed, financial and non-financial risks.

Deep dives should be called out separately to regular reporting.

Likewise, more strategic sessions should focus on a much longer time horizon and focus and strategic risks.

11. Use visuals

Boards (and risk and audit committees) prefer visual presentations of top risks. Risk dashboards, highlighting key actions to be taken or already in place, are a good start.

Actions and decisions should come out of these meetings.

Are you an in-house risk leader who would benefit from collaborating with a global network of senior risk professionals? All our collaborations are bespoke and tailored to our members needs - so let us know what your risk reporting priorities are , and we'll look for an appropriate opportunity. 

Related posts you may be interested in.

Three ways to improve your emerging risk management framework

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Presentation Design: The Importance Of Taking Risks

• By: Leslie Belknap

As a public speaker, you are a natural risk taker. Expressing yourself in front of a group of people is no easy task. Every time you speak in public, you increase (at least slightly) the risk of public embarrassment.

Most presenters research, edit, and rehearse to minimize the inherent risks associated with speaking in public. These are all great exercises for presenters, however public speakers should not aim to strip their presentations of every risky element. On the contrary, presenters should actively look for opportunities to take some chances with their presentations.

Instead of taking the safe route with your presentation design , be bold and unexpected with your slides. The same goes for your content. Use your content to make a noteworthy statement. If you are just going to drag-and-drop a few charts and throw some bullet point updates on your slides, skip the presentation and send an email instead.

If you are going to get up in front of people, don’t waste their time, or your time. Give your audience an experience that will keep them awake and hanging on your every word. When you take the  go big, or go home attitude with your presentation design and content, you might ruffle a few feathers, however if you are strategic with the risks you choose to take, you will most likely win over your skeptics with your courage and creativity.

For example, a few year ago, the Ethos3 team created a deck on the topic of The Importance of Taking Risks . Recently, the Ethos3 presentation design team redesigned  The Importance of Taking Risks.  The presentation content is not a safe reiteration of traditional advice on risk-taking. The redesign of the slides is risky, but also striking departure from the design of the earlier deck.

You can view the entire presentation below, but first check out a few before and after slides.

Which one do you like better – the predictable before design, or the slightly wild  after design?

Either way, go find your own risks to take. Your risks might not resemble the risks shown in these slide – they will be your own versions of living  on the wild side. The possibilities are endless.

Additional Resources:

3 Presentation Tips From “Hooked: How To Build Habit-Forming Products”

Breathe New Life Into Your Old Presentations

Leslie Belknap

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• v.17(12); 2021 Dec

Ten simple rules for effective presentation slides

Kristen m. naegle.

Biomedical Engineering and the Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America

Introduction

The “presentation slide” is the building block of all academic presentations, whether they are journal clubs, thesis committee meetings, short conference talks, or hour-long seminars. A slide is a single page projected on a screen, usually built on the premise of a title, body, and figures or tables and includes both what is shown and what is spoken about that slide. Multiple slides are strung together to tell the larger story of the presentation. While there have been excellent 10 simple rules on giving entire presentations [ 1 , 2 ], there was an absence in the fine details of how to design a slide for optimal effect—such as the design elements that allow slides to convey meaningful information, to keep the audience engaged and informed, and to deliver the information intended and in the time frame allowed. As all research presentations seek to teach, effective slide design borrows from the same principles as effective teaching, including the consideration of cognitive processing your audience is relying on to organize, process, and retain information. This is written for anyone who needs to prepare slides from any length scale and for most purposes of conveying research to broad audiences. The rules are broken into 3 primary areas. Rules 1 to 5 are about optimizing the scope of each slide. Rules 6 to 8 are about principles around designing elements of the slide. Rules 9 to 10 are about preparing for your presentation, with the slides as the central focus of that preparation.

Rule 1: Include only one idea per slide

Each slide should have one central objective to deliver—the main idea or question [ 3 – 5 ]. Often, this means breaking complex ideas down into manageable pieces (see Fig 1 , where “background” information has been split into 2 key concepts). In another example, if you are presenting a complex computational approach in a large flow diagram, introduce it in smaller units, building it up until you finish with the entire diagram. The progressive buildup of complex information means that audiences are prepared to understand the whole picture, once you have dedicated time to each of the parts. You can accomplish the buildup of components in several ways—for example, using presentation software to cover/uncover information. Personally, I choose to create separate slides for each piece of information content I introduce—where the final slide has the entire diagram, and I use cropping or a cover on duplicated slides that come before to hide what I’m not yet ready to include. I use this method in order to ensure that each slide in my deck truly presents one specific idea (the new content) and the amount of the new information on that slide can be described in 1 minute (Rule 2), but it comes with the trade-off—a change to the format of one of the slides in the series often means changes to all slides.

Top left: A background slide that describes the background material on a project from my lab. The slide was created using a PowerPoint Design Template, which had to be modified to increase default text sizes for this figure (i.e., the default text sizes are even worse than shown here). Bottom row: The 2 new slides that break up the content into 2 explicit ideas about the background, using a central graphic. In the first slide, the graphic is an explicit example of the SH2 domain of PI3-kinase interacting with a phosphorylation site (Y754) on the PDGFR to describe the important details of what an SH2 domain and phosphotyrosine ligand are and how they interact. I use that same graphic in the second slide to generalize all binding events and include redundant text to drive home the central message (a lot of possible interactions might occur in the human proteome, more than we can currently measure). Top right highlights which rules were used to move from the original slide to the new slide. Specific changes as highlighted by Rule 7 include increasing contrast by changing the background color, increasing font size, changing to sans serif fonts, and removing all capital text and underlining (using bold to draw attention). PDGFR, platelet-derived growth factor receptor.

Rule 2: Spend only 1 minute per slide

When you present your slide in the talk, it should take 1 minute or less to discuss. This rule is really helpful for planning purposes—a 20-minute presentation should have somewhere around 20 slides. Also, frequently giving your audience new information to feast on helps keep them engaged. During practice, if you find yourself spending more than a minute on a slide, there’s too much for that one slide—it’s time to break up the content into multiple slides or even remove information that is not wholly central to the story you are trying to tell. Reduce, reduce, reduce, until you get to a single message, clearly described, which takes less than 1 minute to present.

Rule 3: Make use of your heading

When each slide conveys only one message, use the heading of that slide to write exactly the message you are trying to deliver. Instead of titling the slide “Results,” try “CTNND1 is central to metastasis” or “False-positive rates are highly sample specific.” Use this landmark signpost to ensure that all the content on that slide is related exactly to the heading and only the heading. Think of the slide heading as the introductory or concluding sentence of a paragraph and the slide content the rest of the paragraph that supports the main point of the paragraph. An audience member should be able to follow along with you in the “paragraph” and come to the same conclusion sentence as your header at the end of the slide.

Rule 4: Include only essential points

While you are speaking, audience members’ eyes and minds will be wandering over your slide. If you have a comment, detail, or figure on a slide, have a plan to explicitly identify and talk about it. If you don’t think it’s important enough to spend time on, then don’t have it on your slide. This is especially important when faculty are present. I often tell students that thesis committee members are like cats: If you put a shiny bauble in front of them, they’ll go after it. Be sure to only put the shiny baubles on slides that you want them to focus on. Putting together a thesis meeting for only faculty is really an exercise in herding cats (if you have cats, you know this is no easy feat). Clear and concise slide design will go a long way in helping you corral those easily distracted faculty members.

Rule 5: Give credit, where credit is due

An exception to Rule 4 is to include proper citations or references to work on your slide. When adding citations, names of other researchers, or other types of credit, use a consistent style and method for adding this information to your slides. Your audience will then be able to easily partition this information from the other content. A common mistake people make is to think “I’ll add that reference later,” but I highly recommend you put the proper reference on the slide at the time you make it, before you forget where it came from. Finally, in certain kinds of presentations, credits can make it clear who did the work. For the faculty members heading labs, it is an effective way to connect your audience with the personnel in the lab who did the work, which is a great career booster for that person. For graduate students, it is an effective way to delineate your contribution to the work, especially in meetings where the goal is to establish your credentials for meeting the rigors of a PhD checkpoint.

Rule 6: Use graphics effectively

As a rule, you should almost never have slides that only contain text. Build your slides around good visualizations. It is a visual presentation after all, and as they say, a picture is worth a thousand words. However, on the flip side, don’t muddy the point of the slide by putting too many complex graphics on a single slide. A multipanel figure that you might include in a manuscript should often be broken into 1 panel per slide (see Rule 1 ). One way to ensure that you use the graphics effectively is to make a point to introduce the figure and its elements to the audience verbally, especially for data figures. For example, you might say the following: “This graph here shows the measured false-positive rate for an experiment and each point is a replicate of the experiment, the graph demonstrates …” If you have put too much on one slide to present in 1 minute (see Rule 2 ), then the complexity or number of the visualizations is too much for just one slide.

Rule 7: Design to avoid cognitive overload

The type of slide elements, the number of them, and how you present them all impact the ability for the audience to intake, organize, and remember the content. For example, a frequent mistake in slide design is to include full sentences, but reading and verbal processing use the same cognitive channels—therefore, an audience member can either read the slide, listen to you, or do some part of both (each poorly), as a result of cognitive overload [ 4 ]. The visual channel is separate, allowing images/videos to be processed with auditory information without cognitive overload [ 6 ] (Rule 6). As presentations are an exercise in listening, and not reading, do what you can to optimize the ability of the audience to listen. Use words sparingly as “guide posts” to you and the audience about major points of the slide. In fact, you can add short text fragments, redundant with the verbal component of the presentation, which has been shown to improve retention [ 7 ] (see Fig 1 for an example of redundant text that avoids cognitive overload). Be careful in the selection of a slide template to minimize accidentally adding elements that the audience must process, but are unimportant. David JP Phillips argues (and effectively demonstrates in his TEDx talk [ 5 ]) that the human brain can easily interpret 6 elements and more than that requires a 500% increase in human cognition load—so keep the total number of elements on the slide to 6 or less. Finally, in addition to the use of short text, white space, and the effective use of graphics/images, you can improve ease of cognitive processing further by considering color choices and font type and size. Here are a few suggestions for improving the experience for your audience, highlighting the importance of these elements for some specific groups:

• Use high contrast colors and simple backgrounds with low to no color—for persons with dyslexia or visual impairment.
• Use sans serif fonts and large font sizes (including figure legends), avoid italics, underlining (use bold font instead for emphasis), and all capital letters—for persons with dyslexia or visual impairment [ 8 ].
• Use color combinations and palettes that can be understood by those with different forms of color blindness [ 9 ]. There are excellent tools available to identify colors to use and ways to simulate your presentation or figures as they might be seen by a person with color blindness (easily found by a web search).
• In this increasing world of virtual presentation tools, consider practicing your talk with a closed captioning system capture your words. Use this to identify how to improve your speaking pace, volume, and annunciation to improve understanding by all members of your audience, but especially those with a hearing impairment.

Rule 8: Design the slide so that a distracted person gets the main takeaway

It is very difficult to stay focused on a presentation, especially if it is long or if it is part of a longer series of talks at a conference. Audience members may get distracted by an important email, or they may start dreaming of lunch. So, it’s important to look at your slide and ask “If they heard nothing I said, will they understand the key concept of this slide?” The other rules are set up to help with this, including clarity of the single point of the slide (Rule 1), titling it with a major conclusion (Rule 3), and the use of figures (Rule 6) and short text redundant to your verbal description (Rule 7). However, with each slide, step back and ask whether its main conclusion is conveyed, even if someone didn’t hear your accompanying dialog. Importantly, ask if the information on the slide is at the right level of abstraction. For example, do you have too many details about the experiment, which hides the conclusion of the experiment (i.e., breaking Rule 1)? If you are worried about not having enough details, keep a slide at the end of your slide deck (after your conclusions and acknowledgments) with the more detailed information that you can refer to during a question and answer period.

Rule 9: Iteratively improve slide design through practice

Well-designed slides that follow the first 8 rules are intended to help you deliver the message you intend and in the amount of time you intend to deliver it in. The best way to ensure that you nailed slide design for your presentation is to practice, typically a lot. The most important aspects of practicing a new presentation, with an eye toward slide design, are the following 2 key points: (1) practice to ensure that you hit, each time through, the most important points (for example, the text guide posts you left yourself and the title of the slide); and (2) practice to ensure that as you conclude the end of one slide, it leads directly to the next slide. Slide transitions, what you say as you end one slide and begin the next, are important to keeping the flow of the “story.” Practice is when I discover that the order of my presentation is poor or that I left myself too few guideposts to remember what was coming next. Additionally, during practice, the most frequent things I have to improve relate to Rule 2 (the slide takes too long to present, usually because I broke Rule 1, and I’m delivering too much information for one slide), Rule 4 (I have a nonessential detail on the slide), and Rule 5 (I forgot to give a key reference). The very best type of practice is in front of an audience (for example, your lab or peers), where, with fresh perspectives, they can help you identify places for improving slide content, design, and connections across the entirety of your talk.

Rule 10: Design to mitigate the impact of technical disasters

The real presentation almost never goes as we planned in our heads or during our practice. Maybe the speaker before you went over time and now you need to adjust. Maybe the computer the organizer is having you use won’t show your video. Maybe your internet is poor on the day you are giving a virtual presentation at a conference. Technical problems are routinely part of the practice of sharing your work through presentations. Hence, you can design your slides to limit the impact certain kinds of technical disasters create and also prepare alternate approaches. Here are just a few examples of the preparation you can do that will take you a long way toward avoiding a complete fiasco:

• Save your presentation as a PDF—if the version of Keynote or PowerPoint on a host computer cause issues, you still have a functional copy that has a higher guarantee of compatibility.
• In using videos, create a backup slide with screen shots of key results. For example, if I have a video of cell migration, I’ll be sure to have a copy of the start and end of the video, in case the video doesn’t play. Even if the video worked, you can pause on this backup slide and take the time to highlight the key results in words if someone could not see or understand the video.
• Avoid animations, such as figures or text that flash/fly-in/etc. Surveys suggest that no one likes movement in presentations [ 3 , 4 ]. There is likely a cognitive underpinning to the almost universal distaste of pointless animations that relates to the idea proposed by Kosslyn and colleagues that animations are salient perceptual units that captures direct attention [ 4 ]. Although perceptual salience can be used to draw attention to and improve retention of specific points, if you use this approach for unnecessary/unimportant things (like animation of your bullet point text, fly-ins of figures, etc.), then you will distract your audience from the important content. Finally, animations cause additional processing burdens for people with visual impairments [ 10 ] and create opportunities for technical disasters if the software on the host system is not compatible with your planned animation.

Conclusions

These rules are just a start in creating more engaging presentations that increase audience retention of your material. However, there are wonderful resources on continuing on the journey of becoming an amazing public speaker, which includes understanding the psychology and neuroscience behind human perception and learning. For example, as highlighted in Rule 7, David JP Phillips has a wonderful TEDx talk on the subject [ 5 ], and “PowerPoint presentation flaws and failures: A psychological analysis,” by Kosslyn and colleagues is deeply detailed about a number of aspects of human cognition and presentation style [ 4 ]. There are many books on the topic, including the popular “Presentation Zen” by Garr Reynolds [ 11 ]. Finally, although briefly touched on here, the visualization of data is an entire topic of its own that is worth perfecting for both written and oral presentations of work, with fantastic resources like Edward Tufte’s “The Visual Display of Quantitative Information” [ 12 ] or the article “Visualization of Biomedical Data” by O’Donoghue and colleagues [ 13 ].

Acknowledgments

I would like to thank the countless presenters, colleagues, students, and mentors from which I have learned a great deal from on effective presentations. Also, a thank you to the wonderful resources published by organizations on how to increase inclusivity. A special thanks to Dr. Jason Papin and Dr. Michael Guertin on early feedback of this editorial.

Funding Statement

The author received no specific funding for this work.

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What Is Breech?

When a fetus is delivered buttocks or feet first

• Types of Presentation

Risk Factors

Complications.

Breech concerns the position of the fetus before labor . Typically, the fetus comes out headfirst, but in a breech delivery, the buttocks or feet come out first. This type of delivery is risky for both the pregnant person and the fetus.

This article discusses the different types of breech presentations, risk factors that might make a breech presentation more likely, treatment options, and complications associated with a breech delivery.

Verywell / Jessica Olah

Types of Breech Presentation

During the last few weeks of pregnancy, a fetus usually rotates so that the head is positioned downward to come out of the vagina first. This is called the vertex position.

In a breech presentation, the fetus does not turn to lie in the correct position. Instead, the fetus’s buttocks or feet are positioned to come out of the vagina first.

At 28 weeks of gestation, approximately 20% of fetuses are in a breech position. However, the majority of these rotate to the proper vertex position. At full term, around 3%–4% of births are breech.

The different types of breech presentations include:

• Complete : The fetus’s knees are bent, and the buttocks are presenting first.
• Frank : The fetus’s legs are stretched upward toward the head, and the buttocks are presenting first.
• Footling : The fetus’s foot is showing first.

Signs of Breech

There are no specific symptoms associated with a breech presentation.

Diagnosing breech before the last few weeks of pregnancy is not helpful, since the fetus is likely to turn to the proper vertex position before 35 weeks gestation.

A healthcare provider may be able to tell which direction the fetus is facing by touching a pregnant person’s abdomen. However, an ultrasound examination is the best way to determine how the fetus is lying in the uterus.

Most breech presentations are not related to any specific risk factor. However, certain circumstances can increase the risk for breech presentation.

These can include:

• Previous pregnancies
• Multiple fetuses in the uterus
• An abnormally shaped uterus
• Uterine fibroids , which are noncancerous growths of the uterus that usually appear during the childbearing years
• Placenta previa, a condition in which the placenta covers the opening to the uterus
• Preterm labor or prematurity of the fetus
• Too much or too little amniotic fluid (the liquid that surrounds the fetus during pregnancy)
• Fetal congenital abnormalities

Most fetuses that are breech are born by cesarean delivery (cesarean section or C-section), a surgical procedure in which the baby is born through an incision in the pregnant person’s abdomen.

In rare instances, a healthcare provider may plan a vaginal birth of a breech fetus. However, there are more risks associated with this type of delivery than there are with cesarean delivery. 

Before cesarean delivery, a healthcare provider might utilize the external cephalic version (ECV) procedure to turn the fetus so that the head is down and in the vertex position. This procedure involves pushing on the pregnant person’s belly to turn the fetus while viewing the maneuvers on an ultrasound. This can be an uncomfortable procedure, and it is usually done around 37 weeks gestation.

ECV reduces the risks associated with having a cesarean delivery. It is successful approximately 40%–60% of the time. The procedure cannot be done once a pregnant person is in active labor.

Complications related to ECV are low and include the placenta tearing away from the uterine lining, changes in the fetus’s heart rate, and preterm labor.

ECV is usually not recommended if the:

• Pregnant person is carrying more than one fetus
• Placenta is in the wrong place
• Healthcare provider has concerns about the health of the fetus
• Pregnant person has specific abnormalities of the reproductive system

Recommendations for Previous C-Sections

The American College of Obstetricians and Gynecologists (ACOG) says that ECV can be considered if a person has had a previous cesarean delivery.

During a breech delivery, the umbilical cord might come out first and be pinched by the exiting fetus. This is called cord prolapse and puts the fetus at risk for decreased oxygen and blood flow. There’s also a risk that the fetus’s head or shoulders will get stuck inside the mother’s pelvis, leading to suffocation.

Complications associated with cesarean delivery include infection, bleeding, injury to other internal organs, and problems with future pregnancies.

A healthcare provider needs to weigh the risks and benefits of ECV, delivering a breech fetus vaginally, and cesarean delivery.

In a breech delivery, the fetus comes out buttocks or feet first rather than headfirst (vertex), the preferred and usual method. This type of delivery can be more dangerous than a vertex delivery and lead to complications. If your baby is in breech, your healthcare provider will likely recommend a C-section.

A Word From Verywell

Knowing that your baby is in the wrong position and that you may be facing a breech delivery can be extremely stressful. However, most fetuses turn to have their head down before a person goes into labor. It is not a cause for concern if your fetus is breech before 36 weeks. It is common for the fetus to move around in many different positions before that time.

At the end of your pregnancy, if your fetus is in a breech position, your healthcare provider can perform maneuvers to turn the fetus around. If these maneuvers are unsuccessful or not appropriate for your situation, cesarean delivery is most often recommended. Discussing all of these options in advance can help you feel prepared should you be faced with a breech delivery.

American College of Obstetricians and Gynecologists. If your baby is breech .

TeachMeObGyn. Breech presentation .

MedlinePlus. Breech birth .

Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term . Cochrane Database Syst Rev . 2015 Apr 1;2015(4):CD000083. doi:10.1002/14651858.CD000083.pub3

By Christine Zink, MD Dr. Zink is a board-certified emergency medicine physician with expertise in the wilderness and global medicine.

Three Tips For Presenting Risk To The Board

Sometimes it’s hard to know when to report risks to your board. Major corporations will typically include within their proxy statements promises that senior management will frequently update the board about risks. Some companies — including Staples, American Express, Alliance Data Systems and SLM (the former Sallie Mae) — even touch on those policies in their filings.

Yet many companies don’t have formal protocols, or predetermined triggers for reporting — or “escalating” — risks to the board.

Leaving it up to managers to escalate risks to the board isn’t necessarily a bad thing, say directors and risk management professionals. It does, however, require board directors to instruct executives clearly about the kind of risks about which they expect to be notified.

As boards of directors become increasingly interested and involved in enterprise risk management, it’s important you have the tools necessary to present risks in a concise and effective manner. This will enable better decision making at the top, as well as solidify your seat at the table among leadership — ensuring success for your organization and your career.

How to Present Risks to Your Board:

Here are three tips for presenting risk to your board of directors and how the right risk management technology can help:

Highlight how risks are interrelated

Risks don’t stand alone, and neither should risk data. You need to make clear to the board how one risk affects the next so all parties can adequately problem solve — rather than create even bigger risks that might result from operating in silos. However, this is tough to do if all your critical risk information is locked away in disparate spreadsheets or different departments.

Risk management technology exists so organizations can consolidate risk and insurance data from across the enterprise; surface relevant information from wherever it’s hiding; connect it with other internal and external data; and then normalize the data so it’s all relatable. With the right functionality, integrated risk management technology can exploit its deep connection to expansive risk and insurance data and automatically create real-time visuals that take into account the full spectrum of risk.

Show what’s working…and what’s not

Equally important to showing how risks are interrelated is the ability to show how risk mitigation programs are performing. This can help the board to prioritize spending on mitigation efforts; understand the actual return on such investments; and even realize the value you bring to the organization by creating programs and offering tangible insight into what is working and what is not.

Not only does risk management technology provide eye-catching data visualizations — in the form of dashboards, charts and graphs — to help illustrate program effectiveness, but it allows for the automatic benchmarking of both internal and external claims in real time. This allows you and the board members to determine which programs are making an impact and deserve further attention, as well as how your organization’s claims (i.e. workers’ compensation claims) stack up against others. Learn more about how to manage the right risks at the right time in our white paper .

Talk with the board, not at the board

The best presentations are conversations. If you want to make an impact in the boardroom, you need to engage board members in conversation — not just spout off facts about key risks or your overall risk program. That means if board members have questions, you should have answers…and on the spot.

Risk management technology can make visualizing data dynamic — allowing users to instantly (and easily) manipulate images and drill deeper with more specific queries for any type of information. The data visualizations are comprehensive and up-to-date; have many layers; and are easy to produce on the fly and in the moment. These capabilities are vital when presenting risk to board level stakeholders. Risk management technology takes the myriad data and turns it into actionable priorities. This is extremely helpful when trying to convey a meaningful story to the board.

Out-of-date tools equal inadequate analysis

If you don’t have the right tools, presenting to the board can be a real challenge. Frankly, the spreadsheets and presentation software that many organizations continue to use cannot meet today’s demands. Rudimentary exhibits for boards and executive management do not enable effective discussion or understanding of risks and risk relationships.

These non-technical tools do not aggregate the cumulative cost of risks and interdependencies of risks, nor do they have the ability to drill-down on objects and show additional, related information as needed.

When presenting to your board of directors, expectations are high and effective communication is critical. With typically a very short presentation time available, you need to be able to provide a convincing and clear picture of the significant risks to your company’s objectives. Risk management technology can clearly highlight the interrelationships of the risks that are impacting your organization, show mitigation activities for key risks and facilitate meaningful conversation between you and the board.

“The reason there isn’t any standard is because it doesn’t make sense to have a pick list. The organization has to decide which drivers are relevant to them,” says Russell McGuire, director of enterprise risk services at risk consulting and software firm Riskonnect

Why Legacy Technology Should Frighten the C-Suite

Besides being kept up to date with risk information, the C-suite also needs be well aware of how legacy technology is holding its business back, and understand that the potential damages of archaic technology far exceed “mere inconveniences” for employees faced with resulting cumbersome and inefficient processes.

Now that you know the best ways to present information to your board, here are the top three frightening realities that stem from using legacy risk management technology to keep board members informed:

Legacy System Fright #1: Heightened Security Risks

Data breaches are becoming the way of the world. Cybersecurity is consistently named a top risk for businesses, with cybercrime costing the global economy an estimated $445 billion annually, according to a report from the Center for Strategic and International Studies called,  “Net Losses: Estimating the Global Cost of Cyber-Crime.”

Organizations that fall prey to data breaches can face huge losses in the form of compromised reputation, legal damages and declines in revenue and shareholder value. As such, organizations must look for ways to minimize the impact of a cybersecurity breach on their businesses—and deploying secure technology is one obvious solution.

But legacy systems of any kind—including those used for risk, insurance and claims—are often a deterrent to security, rather than a solution. First, they lack the additional security controls offered by more modern technology, including those that are cloud-based. Second, they often distract IT departments away from cybersecurity efforts because they must devote so much time to updating or patching countless applications in order for them to work on an internal server.

The right advanced risk management technology, however, will offer  end-to-end security , including controls like:

• Password policies that can be defined to fit client standards including timeouts, length, and password strength
• Client defined/assigned security roles for users–down to the field level–to prevent unauthorized access to any part of your system including objects, reports, page layouts and views, and specific fields
• Server protection at top tier data center facilities with adequate physical access controls
• Firewalls with tightly controlled perimeters, intrusion detection systems and proactive log monitoring
• Third party validation services that attest to the secure nature of the software

Further, truly  Integrated Risk Management Technology  can actually consolidate or reduce the amount of applications being used (from enterprise risk management and Sarbanes-Oxley solutions, to claims management and compliance and regulatory management solutions, to health and safety management solutions)—creating tremendous efficiencies for the IT department.

Less time spent managing multiple applications might mean more time devoted to broader and more meaningful cybersecurity efforts. Plus, fewer applications likely means less risk of one or a multitude of those applications causing a breach or falling out of compliance.

Legacy System Fright #2: Low Quality Data

Data quality is top of mind for most executives as they want to avoid making and being held accountable for poor decisions based on erroneous or incomplete data. Still, in a recent KPMG study,  84% of CEOs indicated they’re concerned about the quality of the data on which they base their decisions .

Legacy risk management systems can contribute to this data distrust. Often, such systems are unable to seamlessly import or export real-time data, particularly in standardized formats that would make sense to any stakeholder across the enterprise.

In addition, data can rarely be integrated. This means different data sets don’t “talk to each other,” and changes to one set of data won’t be reflected in another set of data—even if the data is ultimately related and does in fact affect each other. It also means data typically must be updated manually or “re-keyed” multiple times.

These limitations translate into “rear-view mirror data” at best, and entirely inaccurate data at worst. Either way, trends are difficult to identify, and confident decision-making is a struggle—whether that decision making is on behalf of risk, safety or claims managers, or the leadership overseeing their programs and initiatives.

Inaccurate and untimely data aside, legacy system data is also difficult to report—almost always necessitating the manual creation of graphs and charts from static data representing a fleeting snapshot in time. As such, creating reports is time consuming, and the data within those reports is further out of date by the time it reaches decision makers’ hands—also hindering confident decision making.

Conversely, Integrated Risk Management Technology can surface relevant risk information from wherever it’s hiding in an organization and analyze it, connect it with other internal and external data, and normalize it securely in the cloud. It also makes risk data dynamic—updated and visualized in real time. Questions can be asked and answered on the spot, in the same meeting, rather than weeks at a time elapsing while a new report is crafted. With such advanced technology, actionable intelligence is as easy to create as it is to consume.

Legacy System Fright #3: Unproductive Workforce

All too often, the benefits of employee engagement and productivity are considered “soft” or “intangible,” when really, hard costs and definite ROI can in fact be attributed to unproductive and productive workforces respectively.

For instance, investment in technology beyond a legacy system might seem like a “nice to have” from leadership, because of course, they want the best for their people. But when leadership only views such an upgrade as means to save employees from inconveniences—instead of as solution that will lead to cost cutting and revenue generation across the business—making the case for investment can be difficult.

A productive workforce  is not  employees just “whistling while they work” and pleasantly checking the boxes on their to-do lists each day. A productive workforce is innovative—in ways that technology cannot and never will be. Yet, to be productive, employees need the resources and tools to do the parts of their job that make them unproductive.

Look at it this way, the inefficiencies spurred by legacy systems can hinder IT from working on preventing security breaches, even though the hefty costs associated with a breach and its potential negative impact on any organization have already been discussed above.

Similar inefficiencies can also mean claims managers are spending more time processing claims than actually investigating them, hindering them from detecting expensive fraudulent claims or uncovering claims trends that could lead to a reduction in the frequency or severity of claims and associated costs.

The same could be said for risk and safety managers: Legacy systems might be forcing them to be reactive rather than proactive–resulting in heightened incident, insurance and legal costs to name a few. No…employee productivity is not just a feel good initiative. The costs of unproductivity are very real.

Integrated Risk Management Technology enables productivity, however–driving innovation by automating and streamlining administrative tasks so employees have more time to do higher-value work; as well as by supplying them with higher quality data and visibility into that data to improve decision making at all levels across the organization.

In conclusion, while the realities posed by legacy systems can in fact be frightening, advanced risk management technology now exists that can turn an organizational nightmare into a dream come true.

Parts of this article were originally published on Agendaweek.com .

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Presentation attack: What it is and how to detect it

Learn how bad actors use a victim’s biometric data to commit fraud, and how identity verification tools can stop this..

May 01, 2024

What is a presentation attack?

A presentation attack occurs when a bad actor, or fraud perpetrator, uses someone else’s physical characteristics or biometric data, commonly known as “spoofs,” to impersonate someone else. Biometric verification is a method to combat spoofs— it compares a person's physical characteristics to verify their identity.

This type of fraud can take different forms known as presentation attack instruments. The most common presentation attack instruments fraudsters leverage? Fake fingerprints or printed photos. 

As more of our lives shift online and as identity thieves grow more sophisticated, the risk of presentation attacks grows. Fraudsters may use this data to commit all kinds of theft. They may sign up for a mobile banking app or a line of credit online in an attempt to steal money from either a platform or an individual. 

How can you mitigate the risk of presentation attacks? 

Mitigating presentation attacks requires robust identity verification . Verifying identities can include three different types of identity information from a customer: data source, documents, and liveness. 

Data source: a verification solution should check a customer’s identity across authoritative data sources such as financial institutions and banks, credit bureaus, or phone records that are governed by regulatory rules.

Documents: A wide variety of identity documents can be used for verification. You’ll need a solution that can confirm the authenticity of a customer’s government-issued documents. For example, a robust solution will make sure a document is not just a printout or a digitally edited document. 

Liveness: In addition to verifying the authenticity of someone’s identity documents, you can help mitigate the risk of presentation attacks through facial mapping technology. Facial mapping can verify that the person’s ID document photo matches the face they present during their liveness verification. Plaid Identity Verification uses advanced image processing and machine learning to combat fraud. This includes biometric presentation attack detection through pixel changes, deep fakes, masks, and more to catch fraudsters using photographs and spoofs.

When you use all three verification methods in concert, you can be more sure that new users are who they say they are: the user has provided legitimate identity data, possesses legitimate identity documents that match their provided identity data, and has confirmed that they are a real, live person providing this information in real-time.

How does Plaid Identity Verification handle presentation attacks? 

Identity Verification starts with data source verification, which: 

Matches user-entered details, like their address and government ID number,  against authoritative sources. 

Simultaneously, assess device behavior and how users enter their PII to assess familiarity and detect risky behavior typical of fraudsters and bots. 

Uniquely, Identity Verification also uses some of this data to confirm an online footprint, like email and social media accounts. 

Identity Verification then takes a photo of a government-issued ID document, like a passport or driver’s  license, and: 

Confirms the authenticity of the document using advanced machine learning to ensure it isn’t just a printout. 

Ensures the information on the document matches the data on that document to the data entered in the data source verification step using sophisticated OCR. 

And, finally, Identity Verification requests a liveness check in the form of very short videos, like a GIF. This: 

Uses complex machine learning algorithms to ensure that the person is real and not a person holding up someone else’s photo to their face. 

Uses face-matching algorithms to ensure the person matches the face on their government-issued ID document. 

Unlike other ID verification providers, Plaid Identity Verification prevents presentation attacks by asking users to record short videos, rather than simply uploading a photo. Users with slow or unreliable internet connections may fall back to a photo, but Plaid Identity Verification applies the same advanced algorithms to ensure the photos represent a real, live person, by looking at lighting, pixel changes, depth, and more. 

It’s worth noting that ID verification is just one area where the threat of presentation attacks exists—any biometric scanners, like building access controls, biometric employee time clocks, and others are at risk for presentation attacks. That said, they have different requirements, and as a result, the solution may be different. 

Ultimately, Identity Verification uses best-in-class fraud detection combined with a  conversion-optimized funnel to reduce risk and improve new user sign-up rates relative to other solutions.

Find out how much identity verification is worth to your organization

Prevent fraud, win users, and protect your bottom line

Active vs. passive presentation attack detection

Balancing security with user convenience requires some trade-offs, but Identity Verification is optimized for a secure, convenient online identity verification process. 

Active Presentation Attack Detection (PAD) 

Active PAD requires users to perform actions to confirm their liveness, identity, and authenticity. For example, Plaid Identity Verification requires users to take several very short actions, such as looking left or smiling at their phone camera, to prevent a presentation attack. This method works well because new users can complete their identity verification entirely online, from their homes, in just a few minutes.  

Passive Presentation Attack Detection (PAD)

Passive PAD relies on specialized equipment, rather than a series of actions, to confirm someone’s identity and liveness. Specialized cameras, for example, look at lighting, depth sensing, infrared, and other characteristics to confirm someone’s authentic identity. 

Passive PAD is most useful in situations where absolute speed is critical, like building access.  However, because it requires specialized hardware far beyond a standard phone or laptop camera, a passive PAD is often not a good solution to online identity verifications. 

What are the risks of a presentation attack? 

How easy are presentation attacks to perpetrate? The threat of a presentation attack can range in severity, usually based on both the ease of committing fraud and the value of the target. But apps using ID verification solutions also need to balance the need for fraud protection against the need for usability among their customers. 

Plaid designed Identity Verification to balance those needs, in part by relying on artificial intelligence to handle presentation attack detection behind the scenes. Applications connected to users’ bank or credit card accounts must have fraud protection, especially when it does not add any burden to the new user sign-up funnel. 

Robust protection with your customer in mind

The risk of sophisticated presentation attacks has been growing as more people complete identity verifications online from their mobile devices. Because mobile cameras aren’t yet sophisticated enough to handle passive presentation attack detection natively, and because requiring in-person identity verification can be onerous. Sophisticated, active presentation attack detection is the best option for accurately verifying identities online. 

Coupled with documentary and data source verifications where people must also possess their physical ID documents, with a face that matches their liveness verification, Identity Verification provides robust protection against presentation attacks—all without sacrificing user experience.

→ Ready to combat presentation attacks? Learn more about Plaid IDV or fill out the form below to talk to a Plaid representative. 

Talk to Plaid about preventing presentation attacks

By submitting this form, I confirm that I have read and understood Plaid’s Privacy Statement .

This form goes to our sales team. If you have questions about connecting your financial accounts to a Plaid-powered app, visit our consumer help center for more information.

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Risk assessment powerpoint presentation slides

Identify risks and hazards that have the potential to harm any process or project. Use content-ready Risk Assessment PowerPoint Presentation Slides to analyse what can go wrong, how likely it is to happen, what potential consequences are, and how tolerable the identified is. With the help of ready-made risk assessment PowerPoint presentation slideshow, use control measures to eliminate or reduce any potential risk related situation. This deck comprises of various templates to control risks such as types of risks, risk categories, identify the risk categories, stakeholder engagement, stakeholders risk appetite, risk tolerance, procedure, risk management plan, risk register, risk identification, risk assessment, risk analysis, risk response plan, risk response matrix, risk control matrix, risk item tracking, risk impact and probability analysis, risk mitigation strategies, qualitative risk analysis, quantitative risk analysis, risk management process, risk management steps, and more. These templates are completely customizable. You can easily edit the color, text, icon and font size as per your need. Add or remove content, if needed. Grab this easy-to-understand risk assessment PowerPoint templates to figure out what could cause harm to the project, whether the hazards could be eliminated or not, what preventive measures should be taken to control the risks. Download risk assessment PPT slides now to execute the project easily. Behave in a down to earth fashion with our Risk Assessment Powerpoint Presentation Slides. Give them a glimpse of your fact based approach.

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Presenting risk assessment PowerPoint deck with slides. This complete presentation comprises of total of 57 PPT slides. It covers all the aspects of the topic and includes all the major elements such as graphs and charts to make the work easy. This presentation has been crafted with an extensive research done by the research experts. Our PowerPoint professionals have incorporated appropriate diagrams, layouts, templates and icons related to the topic. The best part is that these templates are completely editable. Customize the colour, text and icon as per your need. Click the download button below to grab this risk assessment presentation deck.

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Slide 1 : This slide introduces Risk Assessment. State Your Company Name and get started. Slide 2 : This slide presents Content showcasing- Introduction: Risk Management- Introduced, Types of Risk, Risk Categories, Identify Risk Categories. Procedure for managing the Risk: Risk Planning, Risk Identification, Risk Assessment, Risk Monitoring, Risk Tracking. Stakeholders Engagement: Risk Appetite, Risk Tolerance. Tools & Practices: Risk Impact Analysis, Impact &Probability Analysis, Risk Mitigation Strategies, Qualitative Analysis, Quantitative Analysis. Slide 3 : This slide presents Introduction showcasing- Risk Management- Introduction, Types of Risk, Risk Categories, Identify Risk Categories. Slide 4 : This slide shows Risk Management- Introduction displaying- Resources, Assessment of Risks, Identification of Risks, Prioritization of Risks, Realization of Opportunities, Probability and/or impact of unfortunate events. Slide 5 : This slide showcases Types of Risks- Internal Risks divdided into Strategic: Governance, Strategic Planning, Ethics & Values, Stakeholder Relations. Operational: Access to Services, Processes, Business Interruption, Emergency Response. Enablers: People, Financial, Technology, Infrastructure. External Risks: Demand, Regulatory, Economical, Socio- Political, Environment. Slide 6 : This slide shows Types Of Risks in matrix form with the subheadings- Operational: Cost Overrun, Operational Controls, Poor Capacity management, Supply Chain Issues, Employee Issues incl. fraud, Bribery and Corruption, Regulation, Commodity prices. Strategic: Demand Shortfall, Customer retention, Integration problems, Pricing pressure, Regulation, R & D, Industry or sector downturn, JV or partner losses. Financial: Debt and interest rates, Poor Financial management, Asset losses, Goodwill and amortization, Accounting problems. Hazard: Macroeconomic, Political Issues, Legal Issues, Terrorism, Natural disasters. Slide 7 : This slide shows Risk Categories with the following subheadings- Product Design: Product Performance, Design. System/ Software: Data Accuracy, Security. Manufacturing: Assembly, Tools. All Other: Consumer service, Environment. Project Management: Team work, Product cost. Quality: Quality system, Sigma Levels. Slide 8 : This slide displays Identify The Risk Categories with- Risk Score by Risk Category. Slide 9 : This slide shows Stakeholder Engagement with- Stakeholders Risk Appetite, Risk Tolerance. Slide 10 : This slide shows Stakeholders Risk Appetite matrix showing Forming Risk Appetite in terms of impact and likelihood. Slide 11 : This slide shows Risk Tolerance table with Cost, Schedule, Scope, and Quality as subheadings in terms of ordinal scale of- Very Low, Very High, Low, Moderate, High. Slide 12 : This slide shows a Risk Tolerance Bubble graph showing- Business Continuity Problems, Supplier Default, Loss Of Key Partnerships, IT Problems, Poor Project Management, Product Or Service Quality, Loss Of Key Managers. Slide 13 : This slide shows Procedure displaying- Risk Planning, Risk Register, Risk Identification, Risk Tracking, Risk Monitoring, Risk Assessment. Slide 14 : This slide showcases Risk Management Plan in tabular form showing- Type Of Risk, Outcome, Existing Risk Treatment Actions In Place, Rating, Additional Resources, Target Date, Person Responsible, Proposed Risk Treatment Actions To Mitigate Risk. Slide 15 : This slide shows Risk Register showcasing- Type Of Risk, Description Of Risk, Risk Reduction Strategy, Contingency Plans, Risk Owner, Probability, Impact. Slide 16 : This slide presents a Risk Identification matrix showing- Terminate, Treat, Tolerate, Transfer in terms of Consequences & Likelihood. Slide 17 : This slide shows Risk Assessment with Risk Rating Guide displaying- Impact: Performance, quality, cost or safety impacts resulting in major redesign and program delay, Performance, quality, cost and/or safety impacts resulting in minor redesign and schedule adjustment, Performance, quality, cost and safety requirements met within planned schedule. Probability: Major uncertainties remain, No or little prior experience or data, Infrastructure and/or resources not in place, Some uncertainties remain, Some experience and data exist, Infrastructure in place but under-resourced, Few uncertainties remain, Significant experience and data exist, Infrastructure in place and fully, and Likelihood of Occurrence: E. Probability of once in many years D. Probability of once in many operating months C. Probability of once in some operating weeks B. Probability of weekly occurrence A. Probability of daily occurrence Likelihood of detection: Detectability is very high, Considerable warning of failure before occurrence, Some warning of failure before occurrence, Little warning of failure before occurrence, Detectability is effectively zero Consequences: No. direct effect on operating service level, Minor deterioration in operating service level, Definite reduction in operating service level, Source deterioration in operating service level, Operating service level approaches zero. as Risk Scoring System. Slide 18 : This slide shows Risk Assessment with Risk Scoring Results table in terms of- Insignificant, Minor, Moderate, Major, Catastrophic, Consequences, Likelihood. A. Almost Certain, B. Likely, C. Possible, D. Unlikely, E. Rare. Slide 19 : This slide presents Risk Analysis – Simplified Format in tabular form showing- New operating system may be unstable, Communication problems over system issues, We may not have the right requirements, Requirements may change late in the cycle, Database software may arrive late, Key people might leave, Likelihood of Risk Item Occurring, Impact to Project if Risk Item Does Occur, Priority (Likelihood * Impact) as Risk Items (Potential Future Problems Derived from Brainstorming). Slide 20 : This slide Risk Analysis- Complex showcasing- Description of Risk, Risk Analysis, Risk Rating, Control Measures, (Detail any existing Controls), Risk Rating, Risk Analysis(with additional controls), Additional Control, (Detail additional to be implemented Controls). Slide 21 : This slide shows Risk Response Plan showcasing- Responding to Risk consisting of- Mitigate, Avoid, Transfer, Accept, Exploit, Enhance, Share, Accept, Negative Risk, Positive Risk. Slide 22 : This slide shows Risk Response Matrix displaying- Interface Problems, User Backlash, System Freezing, Hardware Malfunctioning, Risk Event, Response, Contingency Plan, Trigger, Who is responsible. Slide 23 : This slide shows a Risk Response Matrix displaying- Avoid: Design Changes Different Site Conditions Labor Productivity Unrealistic Schedule Transfer, Retain: Weather Delays, Defective Work, Equipment Failure, Labor dispute / Strike. Slide 24 : This slide shows Risk Control Matrix. Slide 25 : This slide shows Risk Tracker in tabular form. Slide 26 : This slide shows Risk Item Tracking with- Risk Items, Risk Resolution, Monthly Ranking. Slide 27 : This slide shows Tools & Practices with the following subheadings- Quantitative Analysis, Qualitative Analysis, Risk Mitigation Strategies, Probability & Impact Assessment, Risk Impact Analysis. Slide 28 : This slide shows Risk Impact and Probability Analysis showcasing- Cost: Manageable by exchange against Internal budgets, Increases threaten viability of project, Require some additional funding from Institution, Requires Significant additional funding from Institution, Requires Significant reallocation of Institutional funds (or borrowing). Time: Slight slippage against internal targets, Delay jeopardises viability of project, Slight slippage against key milestones or published targets, Deley affects key stakeholders – loss of confidence in the project, Failure to meet key deadlines in relation to academic year or strategic plan. Quality: Slight reduction in quality/scope, no overall impact, Project outcomes effectively unusable, Failure to include certain ‘nice to have’ elements, Significant elements of scope for functionality will be unavailable, Failure to meet the needs of a large proportion of stakeholders with Impact Scale. Slide 29 : This slide presents Risk Impact & Probability Analysis with- Performance, Probability Of Risk Occurring, Schedule, Impact Assessment, Cost. Slide 30 : This slide shows Risk Mitigation Strategies showcasing- Technical Risks, Cost Risks, Schedule Risks. Slide 31 : This slide presents Risk Mitigation Plan with- Category, Identified Risk, Mitigation Plan. Slide 32 : This slide presents Qualitative Risk Analysis table. Slide 33 : This slide presents Quantitative Risk Analysis table. Slide 34 : This slide shows Risk Management Process dispalying- Identify Risk Exposures, Respond to Risk, Avoid, Accept, Monitor & Report Results, Quantify Risk Exposures, Learn and Improve, Learn and Improve, Quantify Risk Exposures, Risk Transfer, Risk Reduction. Slide 35 : This slide displays Risk Management Steps- Establish the context, Risk Assessment, Risk Identification, Risk Analysis, Risk Evaluation, Risk Treatment, Communication and Consultation, Monitoring Review. Slide 36 : This is a Risk Assessment Icon Slide. You can use the icons as per need. Slide 37 : This is a Coffee break image slide to halt. You can change the slide content as per need. Slide 38 : This slide is titled Additional Slides to move forward. You can alter the slide content as per need. Slide 39 : This is a Bubble chart slide. State specifications, comparison of products/entities here. Slide 40 : This is a Column chart slide. State specifications, comparison of products/entities here. Slide 41 : This is an Area chart slide. State specifications, comparison of products/entities here. Slide 42 : This is Our Mission slide with Vision, Mission and Goal. State them here. Slide 43 : This is Our Team slide to state team specifications, information, structure etc. Slide 44 : This is a Financial score slide. State financial aspects, information etc. here. Slide 45 : This is an About Us slide. State company specifications here. Slide 46 : This is a Comparison slide in a creative sand glass imagery form to compare two entities etc. Slide 47 : This is a Puzzle image slide. State information, specifications etc. here. Slide 48 : This is a Timeline slide. State milestones, highlights etc. here. Slide 49 : This is a Target image slide. State targets, information, specifications etc. here. Slide 50 : This is a Location slide of world map image to show global presence, growth etc. Slide 51 : This is a Venn diagram image slide. State information, specifications etc. here. Slide 52 : This is a Post It Notes slide to mark reminders, events or anything important. Slide 53 : This is a Silhouettes image slide. State people related information, specifications etc. here. Slide 54 : This is a Lego image slide. State information, specifications etc. here. Slide 55 : This is a Bulb or Idea image slide to state information, specifications etc. Slide 56 : This is a Magnifying Glass image slide to show information, specifications etc. Slide 57 : This is a Thank You slide with Address# street number, city, state, Contact Number, Email Address.

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What It Takes to Give a Great Presentation

• Carmine Gallo

Five tips to set yourself apart.

Never underestimate the power of great communication. It can help you land the job of your dreams, attract investors to back your idea, or elevate your stature within your organization. But while there are plenty of good speakers in the world, you can set yourself apart out by being the person who can deliver something great over and over. Here are a few tips for business professionals who want to move from being good speakers to great ones: be concise (the fewer words, the better); never use bullet points (photos and images paired together are more memorable); don’t underestimate the power of your voice (raise and lower it for emphasis); give your audience something extra (unexpected moments will grab their attention); rehearse (the best speakers are the best because they practice — a lot).

I was sitting across the table from a Silicon Valley CEO who had pioneered a technology that touches many of our lives — the flash memory that stores data on smartphones, digital cameras, and computers. He was a frequent guest on CNBC and had been delivering business presentations for at least 20 years before we met. And yet, the CEO wanted to sharpen his public speaking skills.

• Carmine Gallo is a Harvard University instructor, keynote speaker, and author of 10 books translated into 40 languages. Gallo is the author of The Bezos Blueprint: Communication Secrets of the World’s Greatest Salesman  (St. Martin’s Press).

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Risk Management

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Risk is unavoidable, but this doesn't mean that risk can't be planned for. To make better-calculated strategic choices, set clear expectations and always be prepared for different outcomes, use our Risk Management presentation. This presentation allows you to roll with the punches at all times and outline ways to monitor and control unpredictable events.

Slide highlights

Go over your risk assessment with this slide. List the hazards, and explain why and how they may affect your venture, propose precautions, introduce risk management strategy and obtain feedback to make necessary changes.

One of the risk assessment tools to consider is the risk assessment matrix . Identify risks, calculate consequences, determine risk rating, create an action plan, then plug data into your risk assessment matrix.

Introduce your risk mitigation plan to your audience with this slide. A risk mitigation plan helps to eliminate or minimize the impact of the hazards events and develop options and actions to enhance opportunities and reduce threats.

According to Risk Management , there are three categories of risk:

• Preventable risksn – these are internal risks, arising from within the organization, that are controllable and ought to be eliminated or avoided. Examples of preventable risks include the risks from employees' and managers' unauthorized, illegal, unethical, incorrect or inappropriate actions and the risks from breakdowns in routine operational processes.
• Strategy risks – companies voluntarily accept some risk in order to generate superior returns from their strategies. "A bank assumes credit risk, for example, when it lends money; many companies take on risks through their research and development activities," the experts say.
• External risks – some risks arise from events outside the company and are beyond its influence or control, such as natural and political disasters and major macroeconomic changes. External risks require unique approach. Because companies cannot prevent such events from occurring, their management must focus on identification and mitigation of their impact.

Application

To develop a risk management strategy, use this six-step process, recommended by business solution platform, EDC:

• Identify the risk – identify risks with regular brainstorming sessions that involve staff from all departments. The experts say it's crucial to look at current risks and have the vision to identify future risks.
• Analyze the risk – conduct an in-depth risk analysis. It can be difficult if you don't have all the information, but the checklist can best prepare you to identify those risks and how they can potentially impact your business in both operational and financial terms.
• Prioritize the risk – a large list of risks can be overwhelming, so it's critical to prioritize the risks so you can address the most pressing of them first. Once you have the checklist, go one step further and classify risks as high, medium or low.
• Assign responsibility to the risk – ensure there is someone in the organization that's going to own and oversee the risk management. "Determining who will be responsible is an internal company decision; it could be someone who works in a specific risk area who is best suited to tackle the risk or an arbitrary choice. It's a best practice to develop a risk management team consisting of both internal and, if applicable, external people in your supply chain," the experts say.
• Respond to the risk – develop a strong risk management plan that covers: risk management team, market information and market entry information, contracts and getting paid, quality and performance systems and processes, insurance and cash flow protection.
• Monitor the risk – things will change in your company and so will the risks. "As these changes occur, it's critical to update your plan to ensure that you don't become complacent or lose sight of potential threats to your business. Incorporating an ongoing review of your risk management plan into the company's planning activities will ensure you are on top of any potential risks," the EDC team says.

When COVID-19 crept up on the world, companies like Apple ended up being "especially vulnerable because of their large customer base in China and the dependence of their supply chain on Chinese manufacturers," Amiyatosh Purnanandam, professor of finance at the Ross School of Business, University of Michigan, writes in his article for Forbes .

Tim Cook named the impact of coronavirus as a significant source of uncertainty in the company during Q1 2020 earnings call. At the time, Apple had restricted employee travel and shut one store in China due to the virus outbreak, and was cutting back on retail store hours in China as well.

Purnanandam meditates on the question of what can the managers do to control risks that are not even identifiable? "Unlike exchange rates or commodity prices, there are no market-based derivatives contracts that can be used to hedge such a threat," Purnanandam writes. He's answer is cash balance. Cash balance is the best vaccine against unpredictable events such as the pandemic, Purnanandam writes. Moreover, he believes that cash is actually the best hedge against any risk that cannot be identified or quantified ahead of time. So in case of Apple, a $200 billion pile of cash is what makes it resistant to the risk.

15 Things Only People Who Believe in Taking Risks Will Relate To

Posted: June 5, 2024 | Last updated: June 5, 2024

1. Boredom is your biggest enemy.

Routine? No, thank you. You crave novelty and excitement, always seeking out new experiences and challenges. The thought of being stuck in a monotonous routine fills you with dread. You’d rather try something new and fail than never try at all.

2. You see failure as a stepping stone, not a roadblock.

Every misstep is a learning opportunity, a chance to grow and improve. You’re not afraid of making mistakes because you know they’re essential for progress, as Harvard Business Review points out. You embrace setbacks with a resilient spirit, always ready to dust yourself off and try again.

3. You’re drawn to the unconventional.

The road less traveled is your preferred path. You’re not afraid to challenge the status quo and defy expectations. You’d rather stand out than blend in, always seeking out unique opportunities and unconventional solutions. Your creativity thrives in uncharted territories.

4. You’re fueled by passion, not fear.

You don’t let fear dictate your decisions. Instead, you follow your passions, even when they lead you into uncharted territory. You’re willing to put yourself out there, to be vulnerable, and to pursue your dreams with unwavering determination. Your heart guides you, not your anxieties.

5. You trust your gut instincts.

You don’t always have all the answers, but you trust your intuition to guide you in the right direction. You listen to that inner voice, even when it contradicts conventional wisdom. You believe in your own judgment and aren’t afraid to take a chance based on your gut feeling. Your intuition is often your most valuable compass.

6. You thrive under pressure.

While other people crumble under stress, you thrive. You embrace challenges as opportunities to prove yourself, to push your limits, and to achieve the extraordinary. You’re at your best when the stakes are high, always ready to rise to the occasion. Your resilience and determination shine brightest under pressure.

7. You’re a master of improvisation.

You don’t get flustered when things don’t go according to plan. Instead, you adapt and improvise, finding creative solutions on the fly. You’re not afraid of the unexpected, always ready to embrace change and turn it to your advantage. Your flexibility and resourcefulness make you a valuable asset in any situation.

8. You believe in the power of positive thinking.

You approach challenges with an optimistic outlook, always looking for the silver lining. You believe in your own abilities and the potential for success, even when faced with adversity. Your positive attitude is contagious, inspiring everyone around you to follow your lead. Your optimism is a driving force behind your accomplishments.

9. You embrace the thrill of the unknown.

Uncertainty doesn’t scare you; it excites you. You relish the adventure of exploring uncharted territories and discovering new possibilities. The unknown is a blank canvas for you to create your own masterpiece. You’re always seeking out new experiences, eager to learn and grow through exploration and discovery.

10. You value freedom above all else.

You crave autonomy and independence, refusing to be bound by convention or societal expectations. You make your own rules and chart your own course, always striving to live life on your own terms. Your freedom is your most prized possession, and you guard it fiercely. You’d rather risk it all than compromise your autonomy.

11. You’re not afraid to speak your mind.

You value authenticity and honesty, even when it’s unpopular. You’re not afraid to express your opinions, challenge the status quo, or stand up for what you believe in. You’d rather be true to yourself than conform to other people’s expectations. Your voice is your weapon, and you use it to make a difference.

12. You’re constantly pushing your limits.

You never settle for mediocrity. You’re always striving to be better, to achieve more, and to push the boundaries of what’s possible. You challenge yourself physically, mentally, and emotionally, always seeking out new ways to grow and evolve. Your personal growth is a lifelong journey, and you embrace it with enthusiasm.

13. You inspire other people to take risks.

Your courage and determination are contagious. You inspire those around you to step out of their comfort zones, to chase their dreams, and to embrace the unknown. Your example shows them that anything is possible when you have the courage to take a risk. You’re a catalyst for change, empowering other people to live life to the fullest.

14. You’re always looking for the next adventure.

You’re not content with simply existing; you want to live life to the fullest. You’re always planning your next adventure, whether it’s a trip around the world, a new business venture, or a personal challenge. Your thirst for adventure is insatiable, always driving you towards new horizons.

15. You believe in the power of dreams.

You’re not afraid to dream big and chase after your wildest aspirations. You believe that anything is possible if you have the courage to pursue it. Your dreams are your fuel, your motivation, and your guiding light. You’re a testament to the power of the human spirit, always striving to make your dreams a reality.

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Data Mapping to Identify High Lead Exposure Risk Locations in the U.S.

There is no level of lead exposure that is known to be without risk. While average blood lead levels in the United States have declined, millions of children and adults are still exposed to various sources of lead, especially in underserved communities. Significant disparities in lead exposure remain along racial, ethnic, and socioeconomic lines. We understand many sources of lead exposure, for example paint in older homes, but limited data on sources and blood lead levels across the country make it difficult to identify communities that may have disproportionate exposures. (For more information, see the Federal Action Plan to Reduce Lead Exposure .)

EPA’s Lead Strategy , or the Strategy to Reduce Lead Exposures and Disparities in U.S. Communities, focuses on eliminating these disparities through identification and reduction of lead exposures with science-based coordinated approaches and stakeholder engagement. The Agency’s commitments under the Lead Strategy include developing and applying a “blueprint” for identifying locations with high potential lead exposure risk. This blueprint is to be shared with internal and external public health partners for broader applicability and capacity building in the United States.

EPA’s Lead Strategy aligns with, and supports the 2018 Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts (Action Plan) , a product of the President’s Task Force on Environmental Health Risks and Safety Risks to Children . The research goal (Goal 4) of the Action Plan includes, “Generate data, maps and mapping tools to identify high exposure communities or locations and disparities for prioritization efforts to reduce children’s blood lead levels.” The President’s Task Force priority activities for 2024-2028 include specific commitments on the lead mapping blueprint and pilot studies. To address the Agency’s commitments, EPA scientists are working collaboratively with federal and state partners to identify and address locations with high lead exposures.

Publications

• This paper presents an innovative science-based approach EPA developed and applied to identify areas with high prevalence of children’s elevated blood lead levels. Identifying locations with the highest percentage of elevated blood lead levels, and the contributing sources and exposures of those EBLLs, can assist with prioritizing actions to reduce, prevent, and mitigate lead exposure risk as called for in the Federal Lead Action Plan. EPA and Michigan Department of Health and Human Services are using the results of this paper to inform lead actions.
• In this publication, EPA identifies Ohio census tracts with high prevalence of children’s elevated blood lead levels and further evaluates lead exposure indices used as proxies for identifying hotspots. The study further tests and demonstrates the science-based approach that EPA developed with Michigan data. The published results were consistent with Ohio Department of Health targeted testing plans for lead screening and confirmed previous findings, that old housing and demographics are reasonable predictors of lead exposure.
• Led by EPA’s Office of Research and Development with collaborating partners from Department of Housing and Urban Development, Centers for Disease Control and Prevention, and Agency for Toxic Substances and Disease Registry, this paper identifies states and counties with highest potential lead exposure risk from old housing sources of lead, expanding the MI and OH papers methodology to national scale.
• Since data on blood lead levels and lead sources are not available for all communities, these methodologies can help states and others use available data to identify areas for further investigation and action.
• While lead data mapping and analyses continue to evolve, the results of this study support using available lead indices to identify potential high lead exposure risk locations in the absence of blood lead data and can inform further analyses for prioritizing actions.
• This paper summarizes and presents the state-of-the-science of publicly available methods, data (i.e., blood lead data, lead exposure indices, and environmental data), and maps for identifying U.S. lead exposure risk hotspots.
• It discusses Federal collaborations and remaining challenges and presents the concept for a systematic approach (i.e., blueprint) utilizing data across agencies.
• This paper lays out how EPA, in collaboration with other federal agencies such as the Centers for Disease Control and Prevention, Food and Drug Administration, and Department of Housing and Urban Development, is committed to preventing lead exposure and its health effects.
• It includes a section on "targeting lead exposure hotspots” and discusses how Federal scientists are working to improve publicly available maps of lead exposure risk, using geospatial modeling and analyses to support the agencies’ related goals.

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• 2022 Tools and Resources Webinar: Data Mapping and Analyses to Identify U.S. Locations with High Lead Exposures
• Learn About Lead
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• Renovation, Repair and Painting Program
• Evaluating & Eliminating Lead-Based Paint Hazards
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• En español: Plomo

Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention

• Open access
• Published: 04 June 2024

Cite this article

You have full access to this open access article

• John Litt   ORCID: orcid.org/0000-0002-3103-0064 1 ,
• Anthony L. Cunningham   ORCID: orcid.org/0000-0002-6744-5667 2 ,
• Francisco Arnalich-Montiel   ORCID: orcid.org/0000-0002-1229-2018 3 , 5 &
• Raunak Parikh   ORCID: orcid.org/0000-0002-8412-307X 4  

1 Altmetric

Herpes zoster (HZ) is caused by reactivation of latent infection of varicella zoster virus (VZV) in sensory (cranial, dorsal root) ganglia. Major risk factors for HZ are increasing age and immunosuppression. HZ ophthalmicus (HZO) is a subset of HZ with involvement of the ophthalmic division of the fifth cranial trigeminal nerve. Approximately 4–20% of patients with HZ develop HZO. Approximately 50% of patients with HZO develop ocular disease, among whom up to 25% develop chronic or recurrent disease. Common manifestations of ocular disease include conjunctivitis, keratitis, and uveitis, whereas optic neuropathy and retinitis are uncommon. Due to the potential for vision impairment, ocular involvement requires urgent ophthalmic consultation. Early recognition and timely treatment with antivirals may prevent ocular complications. HZO is preventable by vaccination against HZ. Vaccine efficacy/effectiveness studies have been largely conducted for HZ with few studies assessing HZO. Both the recombinant adjuvanted vaccine (RZV) and live-attenuated vaccine (ZVL) significantly reduce the incidence of HZ and HZO in older adults. RZV is more effective than ZVL. Data on the effectiveness of vaccines for prevention of recurrent disease in patients with HZO are limited; however, vaccination is recommended. Despite recommendations to vaccinate individuals likely to benefit from an HZ vaccine, coverage for adults remains suboptimal. Barriers to vaccination include patient beliefs about HZ or HZ vaccines, and factors related to healthcare providers. In particular, the lack of a recommendation from their primary care physician is often cited by patients as a reason for remaining unvaccinated. By encouraging vaccination against HZ, physicians not only prevent HZ and HZO but also potential vision loss due to HZO.

Graphical abstract available for this article.

Plain Language Summary

Shingles, also known as herpes zoster, is a common and painful rash that develops when the virus that causes chickenpox in children reactivates, most often in adults. When shingles affects the eye or the area surrounding the eye, it is called herpes zoster ophthalmicus, or HZO for short. Up to one-fifth of people with shingles have HZO, and this risk increases with age and in people with other conditions that affect their immune system. Common signs and symptoms include a rash on the face, pain, fever, and headache, as well as symptoms in the eye, such as discomfort, redness, and discharge. HZO has the potential to cause permanent vision loss, and because of this, it is important that people with symptoms are referred to an eye doctor (“ophthalmologist”) as soon as possible. Early diagnosis of HZO is essential for effective treatment and prevention of the more serious complications it can cause. Treatment within 3 days of the symptoms occurring, with medications known as antivirals, can shorten the duration of a shingles episode and help relieve the pain. To help prevent the risk of shingles and its subtypes like HZO, vaccination is recommended. Two vaccines are currently approved for the prevention of shingles in adults. Although these vaccinations are recommended, some people do not have them for various reasons, which include their own personal beliefs about vaccinations or that their doctor has not recommended it to them. It is important that vaccinations against shingles are recommended to all patients eligible to receive one.

Avoid common mistakes on your manuscript.

Digital Features

This article is published with digital features, including a graphical abstract, to facilitate understanding of the article. To view digital features for this article, go to https://doi.org/10.6084/m9.figshare.25737087 .

Introduction

Herpes zoster (HZ), or shingles, is caused by reactivation of latent infection with the varicella zoster virus (VZV) in sensory (cranial, dorsal root) ganglia long after primary infection in childhood [ 1 , 2 , 3 ]. HZ ophthalmicus (HZO) is defined as HZ involvement of the ophthalmic division of the fifth cranial nerve by VZV after reactivation [ 1 ]. HZO can result in serious, long-term ocular complications, including permanent moderate or severe vision loss. Therefore, due to the risk of complications, ocular involvement requires urgent ophthalmic consultation. It is increasingly accepted that early recognition of HZO is key to effective treatment and the prevention of severe complications [ 2 ].

HZ and HZO can be prevented by vaccination. Without vaccination, 30% of all adults, and 50% of those aged 85 years or older, will develop HZ [ 4 ]. However, vaccination with live-attenuated (ZVL) or non-live recombinant adjuvanted vaccine (RZV) significantly reduces the incidence of HZ in older adults who are at high risk of the disease [ 5 , 6 , 7 , 8 ]. In a network meta-analysis, RZV was more effective than ZVL and prevented more than 90% of HZ cases in adults aged ≥ 50 years [ 9 ].

The aim of this review is to describe the burden and complications associated with HZO and to discuss strategies for recognizing, treating, and preventing HZO. The review is based on a PubMed search for the period January 1, 2013, to February 27, 2024. The search was designed to identify English language articles that contained the terms “zoster” and “ophthalm*” in the title and/or abstract and pertained to adults. Case reports, pediatric studies, and preclinical studies were excluded. A total of 112 citations met these criteria and were reviewed by the authors (Fig.  1 ). Original research studies, preferably including large numbers of eyes or patients, were preferred. For treatments or preventive interventions, large randomized trials and real-world studies were preferred. Additional articles and treatment guidelines were identified and recommended by individual authors.

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Search strategy

Epidemiology

The incidence of HZ increases with age; this age-related increase is related to a decline in VZV-specific cellular immunity [ 10 ]. A meta-regression analysis of data from 59 studies in 29 countries estimated the worldwide incidence of HZ to be 5.15/1000 persons among individuals aged 50–54 years and 11.27/1000 persons among those aged 85 years and older [ 11 ]. Among patients with HZ, HZO is present in approximately 4–20% of individuals [ 12 , 13 , 14 , 15 , 16 , 17 ].

Consistent with the epidemiology of HZ, the reported incidence of HZO also increases with age (Fig.  2 ). In a retrospective US study of data from a large commercial claims database, the incidence of HZO was estimated to range from 13.2 to 32.3 cases per 100,000 person-years among adults aged 21–50 years and from 54.6 to 131.6 per 100,000 person-years in those aged > 50 years [ 16 ]. The analysis included 633,474 cases of HZ, of which 7.9% (49,745) contained codes for HZO. Approximately 70% of HZO cases occurred in individuals aged > 50 years. Over the study period, the incidence of HZO increased by 3.6% each year [ 16 ].

Incidence rates of herpes zoster ophthalmicus in the USA (1994–2018) by age [ 16 ]

HZ and HZO are more common in women than in men [ 11 , 18 , 19 , 20 ]; in the analysis by Kong et al. [ 16 ], the annual incidence of HZO in women and men was estimated to be 44.5 and 33.1 cases per 100,000 person-years, respectively.

The occurrence of HZO may vary by ethnicity. For example, in the USA, the incidence of HZO is highest among White individuals and is lower among African American, Asian, and Hispanic individuals [ 16 ]. The incidence of HZO has also been reported to be lower in Pacific Islanders compared with non-Pacific Islanders [ 21 ].

In terms of patients hospitalized for HZ, a nationwide analysis found that 12% of HZ-related hospitalizations in Denmark were caused by HZO [ 22 ].

Risk Factors

Specific risk factors for HZO have not been reported; however, several risk factors for HZ in general are well established and presumably also apply to HZO. Most cases of HZ (approximately 90%) occur in immunocompetent individuals [ 13 ]. A meta-analysis of 88 epidemiologic studies showed that the strongest positive associations (risk factors) with HZ were for immunosuppression via human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); hematologic malignancy or solid organ malignancy; transplantation or drugs; family history; physical trauma; and increasing age [ 23 ]. Lesser positive associations were observed for female sex, psychological stress, and comorbidities, including diabetes mellitus, rheumatoid arthritis, cardiovascular disease, renal disease, systemic lupus erythematosus, and inflammatory bowel disease. Of note, Black race was associated with a low risk of developing HZ [ 23 ]. Patients receiving disease-modifying antirheumatic drugs, especially Janus kinase inhibitors, are also at increased risk of HZ/HZO [ 24 , 25 ].

Severe manifestations of HZO are associated with immunosuppression. For example, HZO is a frequent complication in patients with HIV/AIDS (observed in 22.1%) [ 26 , 27 ], and although it is a rare complication of HZO, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) may progress rapidly in patients with HIV/AIDS [ 28 , 29 ]. The presence of uncommon manifestations (including ARN, optic neuritis, orbital apex syndrome, panuveitis, and cellulitis complicated by sepsis) was significantly associated with immunosuppression and diabetes among 50 patients with HZO, verified by polymerase chain reaction (PCR) assays [ 17 ].

Two large retrospective cohort studies have shown a small (14–15%) but significant increased risk of HZ after COVID-19 [ 30 , 31 ]. In addition, some but not all observational studies have reported an increased risk of HZ in general [ 32 , 33 , 34 ] and HZO in particular [ 35 , 36 , 37 , 38 ] after COVID-19 vaccination [ 39 , 40 ]. A large US healthcare claims database containing data from 1,959,157 patients who received at least one dose of a COVID-19 vaccine showed no increased risk of HZO after receipt of any COVID-19 vaccine [ 40 ].

Clinical Presentation

HZ manifests as a painful unilateral vesicular rash with a dermatomal distribution. Clinical signs and symptoms of HZO include a facial herpetic rash, usually associated with but sometimes preceded by neuropathic pain, fever, and headaches (Fig.  3 ). The rash develops 2–3 days after these early signs and forms blisters that ooze fluid for several days before crusting [ 1 , 2 , 41 , 42 ]. Extension of the rash to the tip of the nose (Hutchinson’s sign) indicates involvement of the nasociliary branch and increases the likelihood of ocular involvement because of shared innervation [ 42 ].

Progression over time and complications of herpes zoster ophthalmicus [ 29 , 41 , 48 , 53 , 54 , 56 , 59 , 82 ]. IOP intraocular pressure, HZO herpes zoster ophthalmicus

Ocular involvement develops in approximately 50% of patients with HZO and may result in inflammation of any structures of the eye. Ocular manifestations include components of viral infection; inflammatory and immune reactions; vascular and neural inflammation; and tissue scarring, leading to the clinical syndromes of conjunctivitis, keratitis, uveitis, episcleritis, scleritis, retinitis, retinal necrosis, and optic neuritis (Table  1 ) [ 17 , 43 , 44 , 45 , 46 , 47 ].

Eyelid/Conjunctiva

In patients with HZO, the eyelids and conjunctiva typically become involved within 1–2 weeks after the rash appears [ 48 ]. Characteristic vesicles appear on the eyelids, lid margins, and/or bulbar conjunctiva, and are often accompanied by blepharitis. Unilateral conjunctivitis, sometimes with petechial hemorrhages, and periorbital edema may also occur. Chronic inflammation of these structures can lead to late complications such as conjunctival or skin scarring, resulting in dry eye, lid malposition, and trichiasis, in which eyelashes grow toward the eye [ 49 ].

Episclera/Sclera

Inflammation of the episclera (episcleritis) or sclera (scleritis) may occur during the first week, presenting as localized redness [ 48 ].

The cornea may be affected in various ways in patients with HZO [ 41 , 48 ]. Initially, the epithelium is affected, causing superficial punctate keratitis (SPK) within 1 week of onset, progressing to pseudodendrites. Pseudodendrites resemble raised branching “stuck on” plaques with tapered ends and are distinct from herpes simplex virus (HSV) dendrites, which have terminal bulbs [ 50 ].

Later in the disease course, deeper layers of the cornea may be affected [ 41 , 48 ]. Anterior stromal keratitis may develop within 1–2 weeks, appearing as multiple fine, granular, whitish infiltrates often beneath pre-existing dendrites or SPK as well as coin-shaped (nummular) lesions [ 41 ]. Deep stromal keratitis may develop within 1 month to years, featuring stromal inflammation/infiltrates leading to corneal thinning and scarring [ 41 , 48 ]. Involvement of the endothelial layer (endotheliitis) may lead to corneal edema and is usually associated with anterior chamber inflammation (anterior uveitis), known as keratouveitis when both the cornea and uvea are involved [ 51 ].

Neurotrophic keratopathy, marked by reduced corneal sensation, may develop within 1 month to years of the onset of HZO due to neurologic damage, leading to chronic corneal ulcers that do not respond to conventional treatment [ 41 , 48 ]. A nonhealing ulcer is at risk of secondary bacterial infection and can result in corneal thinning and perforation, necessitating tectonic corneal transplantation [ 52 , 53 ]. A retrospective study showed that over a median follow-up of 6.3 years, neurotrophic keratopathy developed in 6.7% of patients with HZO, with the highest hazard 1–2 years after the onset of HZO [ 54 ]. The occurrence of corneal punctate epithelial erosions in patients with HZO is a risk factor for decreased corneal sensitivity [ 55 ].

Anterior uveitis may occur either alone or in combination with keratitis (keratouveitis), with an onset typically 2–4 weeks after the onset of HZO [ 48 , 56 ]. Uveitis often results in elevated intraocular pressure (IOP) upon presentation due to inflammation of the trabeculum, a mesh-like structure found in the eye’s anterior chamber angle that helps regulate the outflow of aqueous humor. Signs and symptoms of anterior uveitis in patients with HZO include ocular pain and hyperemia, blurred vision, ciliary injection, keratic precipitates, detection of “cells” and “flare” in the anterior chamber, and posterior synechia [ 43 ]. Chronic uveitis can lead to late-stage sequelae such as iris atrophy or an irregular pupil.

With respect to the posterior segment, HZO may result in ARN, which manifests as patches of peripheral retinitis that merge rapidly, accompanied by occlusive vasculitis and vitreous inflammation [ 29 , 48 ]. The acute phase of ARN may persist for 6–12 weeks [ 29 ] and often leads to retinal detachment within 3 weeks to 5 months of onset (Lau et al. [ 57 ] cited in Hoogewoud et al. [ 58 ]). As noted above, immunocompromised individuals are at particular risk of PORN [ 29 ].

Other Complications

Other ocular complications of HZO include rare cranial nerve palsies, affecting nerves such as the seventh, third (most commonly), fourth, and sixth cranial nerves, which may resolve rapidly or take up to 6 months to improve significantly [ 59 ]. Orbital inflammation and myositis, along with optic neuritis, may also occur in patients with HZO, albeit rarely, and may be the first signs of HZO in the absence of a vesicular rash [ 60 ]. Postherpetic neuralgia is characterized by dermatomal pain persisting for over 3 months after the rash subsides, often accompanied by symptoms such as allodynia, reduced sensation, and paresthesia.

Differential Diagnosis

Other diseases can imitate HZO, including herpes simplex infection of the eyelid, cornea, or retina; anterior uveitis due to cytomegalovirus; contact dermatitis (from plants); or reactions to active ingredient or excipients in topical medications [ 2 , 29 , 61 ].

The differential diagnosis of HZO can be divided into the following categories, depending on presentation:

Neuralgia . If patients experience only pain, tension headache, migraine, cluster headache, and giant cell arteritis must be ruled out.

Rash . While a vesicular rash is often associated with HZO, it is crucial to also consider other potential causes like contact dermatitis, impetigo, and HSV infection. Distinguishing between HSV and HZO can pose challenges; while both may present with a vesicular rash, HSV typically affects multiple dermatomes rather than being confined to one. Additionally, classic corneal dendrites are seen in HSV infection, whereas pseudodendrites are characteristic of HZO.

Ocular findings without a rash . In cases of periorbital swelling and ptosis, consider preseptal cellulitis, orbital tumor, and cavernous sinus thrombosis. Other possibilities include corneal abrasion, toxic reaction to active ingredients or preservatives in topical medication, infectious keratitis as Acanthamoeba keratitis also produces pseudodendrites, the different causes of interstitial keratitis, and infectious and non-infectious causes of uveitis including all the different types of Herpesviridae .

Key points regarding HZO are presented in Table  2 .

Vision Impairment

Moderate vision loss is not uncommon in patients with HZO, whereas severe vision loss is uncommon and complete loss of vision is rare (Table  1 ). Multivariate analysis of data from 869 patients treated at a single ophthalmology center over one decade showed that moderate vision loss (seen in 19.8% of eyes) was associated with uveitis, White race, and best corrected visual acuity at the time of presentation, whereas severe vision loss (seen in 7.6% of eyes) was associated with uveitis, immunosuppression, visual acuity at the time of presentation, and older age [ 46 ]. In a longitudinal study of patients with HZO, increasing age, positive Hutchinson’s sign, absence of corneal sensation, presence of corneal epithelial lesions, and uveitis were significantly associated with vision loss [ 62 ]. Among these factors, uveitis was the best predictor of vision loss in a multivariate analysis [ 62 ].

Recurrent and Chronic HZO

A significant proportion of patients with HZO experience chronic or recurrent disease (up to 25% of patients overall) [ 63 , 64 ]. A retrospective review of data from 130 patients with HZO showed that 24% of patients (31/130) had chronic disease and 15% (19/130) had recurrent ocular complications. In this series, 80% of patients with HZO ( n  = 104) had ocular manifestations, the most common of which were epithelial keratitis (46%), conjunctivitis (38%), and endothelial keratitis (12%) [ 63 ]. Patients with chronic HZO experienced symptoms for a mean of 304 days (range 66–1575 days), compared with 13 days (range 3–50 days) in patients with acute HZO. Most patients with recurrent disease (18/19) also had chronic disease. The most common recurrent manifestations were stromal keratitis (i.e., corneal infiltrates losing transparency; 50%), epithelial keratitis (i.e., pseudodendritic corneal ulcers; 29%), endotheliitis (i.e., corneal edema and loss of transparency; 13%), and conjunctivitis/scleritis (8%) [ 63 ]. In this study, through multivariate analysis, recurrent ocular disease was significantly associated with epithelial keratitis, stromal keratitis, increased IOP, and chronic HZO. Of note, sex, age, and immune status were not associated with chronicity or recurrence. The authors did not report whether skin involvement manifested during recurrences.

Recurrence of HZO has been associated with cataract surgery [ 65 ]. Among 57 patients with a history of HZO (38 with recurrent disease), 23 patients experienced a recurrence after undergoing cataract surgery. Postsurgical recurrence was associated with more frequent recurrent episodes and shorter periods of disease quiescence prior to surgery [ 65 ].

Importance of Early Diagnosis and Referral

HZO is a clinical diagnosis that generally does not require confirmatory laboratory testing. Swabs of skin or ophthalmic lesions for PCR analysis should only be considered when the diagnosis is uncertain, for example in patients with zoster sine herpete or recurrent anterior uveitis. Early referral of a characteristic painful rash in an ophthalmic distribution to an ophthalmologist is essential to help prevent long-term, irreversible damage from complications related to HZO [ 66 ].

Patients may present with a history of systemic symptoms such as prodromal symptoms (headache, fever, malaise), skin rash, dermatomal pain, paresthesia, and discomfort, and ocular symptoms such as pain, redness, watering, photophobia, and blurred/decreased vision [ 48 ]. A diagnosis of HZO should be considered in patients presenting with a papular or papulovesicular rash in the area innervated by the first division of the fifth cranial nerve, especially if the onset of rash was preceded by tingling and pain exacerbated by touch, accompanied by complaints of a headache and feeling generally unwell [ 2 ].

Early signs and symptoms of HZO (itching, tingling, or pain in the affected area) may become apparent several days before the characteristic HZ rash develops [ 2 , 42 ]. In rare cases, a rash may not develop (termed “zoster sine herpete”) and ocular manifestations of HZO may occur without skin lesions, which increases the difficulty of diagnosing the condition [ 2 , 42 , 67 ]. Ocular symptoms are often non-specific, may include hyperemia, lacrimation, and blurred vision, and usually appear days after the rash [ 42 , 68 ]. Involvement of the skin supplied by the nasociliary nerve (Hutchinson’s sign) is the main trigger for ophthalmologist referral [ 66 ]; however, although this is a traditional teaching, it is not always reliable. Referral to an ophthalmologist should also be triggered by conjunctival or ciliary pain, changes in vision (diplopia, photophobia, or decreased acuity), and/or abnormal extraocular movements suggesting paralysis of the third, fourth, or sixth cranial nerve.

Patients with HZO should undergo a complete ophthalmologic examination including a slit lamp examination, determination of IOP, and cranial nerve examination. Referral times have not been widely reported. Median time from rash to clinical presentation and subsequent referral to an ophthalmologist was 5 days in a New Zealand study [ 46 ]. A recent analysis of a US claims database found that 75.8% of patients saw an eye care provider within 7 days of being diagnosed with HZO [ 69 ].

Patients with signs or symptoms of herpes zoster oticus (Ramsay Hunt syndrome) should be referred to an otorhinolaryngologist.

Importance of Early and Appropriate Treatment

The general goals of treatment for HZ, including HZO, are to limit the intensity and duration of HZ-associated symptoms, promote the healing of lesions, and improve health-related quality of life [ 70 ]. Specific goals of therapy in patients with HZO include limiting the extent of involvement of ocular structures, preserving vision, and preventing recurrence. To these ends, prompt initiation of antiviral therapy (within 72 h of the onset of HZO symptoms) can prevent ocular complications [ 71 , 72 ]. Ophthalmologic consultation is recommended for all patients with HZO. An algorithm showing management of patients with HZO is shown in Fig.  4 .

Treatment algorithm for collaborative care between primary care provider and ophthalmologist [ 2 , 48 , 53 , 77 , 118 , 119 ]. a Involvement of the skin supplied by the nasociliary nerve. b Ideally ≤ 72 h after onset of rash, but beyond 7 days if new lesions are present in patients with complications, such as herpes zoster ophthalmicus, or at risk of complications, such as immunocompromised patients. c Topical ophthalmic corticosteroids should not be used in the absence of antiviral agents

While initiation of antivirals within 72 h of symptom onset is preferred, initiation of antiviral therapy beyond 72 h after onset is considered to be reasonable (in European consensus guidelines) as long as viral replication is ongoing as indicated by the presence of new lesions in patients with complications or at risk of complications, such as those with ophthalmic disease or those who are immunocompromised [ 48 , 70 ]. An analysis in New Zealand showed that, although only one-third of patients presented to their general practitioner within 3 days of HZ symptom onset, a higher proportion of patients with HZO did so (45%) when compared with patients with HZ affecting other dermatomes (31%) [ 73 ]. A recent analysis of a US claims database showed that nearly 60% of patients with HZO received systemic antiviral therapy within 7 days of the diagnosis [ 69 ].

Antivirals used to treat HZO include oral acyclovir, valaciclovir, and famciclovir [ 48 , 70 ]. In disseminated HZ or in immunocompromised patients, intravenous (IV) acyclovir is indicated; if the disease is resistant to acyclovir, IV foscarnet may be considered. Early initiation of antiviral therapy limits disease progression in patients with HZO. In a small study ( N = 86) in which acyclovir was initiated within 72 h of the onset of rash, 30% of patients developed chronic ocular complications, as compared with ≥ 50% of untreated patients from other studies (Hoang-Xuan et al. [ 74 ] cited in Cohen and Kessler [ 75 ]). A retrospective analysis of data from patients with HZO who had ( n = 202) and had not ( n = 121) received antivirals showed that antiviral treatment was associated with a significantly lower incidence of neurotrophic keratitis within 6 months [ 76 ]. In addition, serious inflammatory conditions (stromal keratitis, corneal edema, scleritis, uveitis, and glaucoma) were associated with a delay in initiating antiviral therapy among treated patients [ 76 ]. A systematic review of data from randomized controlled trials of antiviral treatments for HZO concluded that famciclovir 500 mg three times daily or valacyclovir 1000 mg three times daily are both reasonable alternatives to acyclovir 800 mg five times daily because of the less frequent administration [ 77 ]. Occurrence of ocular manifestations was similar across individual trials (famciclovir vs. acyclovir and valacyclovir vs. acyclovir).

In addition to antiviral and analgesic agents, systemic and topical ophthalmic corticosteroids may be prescribed as adjunctive anti-inflammatory agents, but this is controversial [ 70 ]. The American Academy of Ophthalmology (AAO) recommends topical corticosteroids be used judiciously with close monitoring for stromal keratitis and uveitis. A survey of US ophthalmologists participating in the Zoster Eye Disease Study (ZEDS) showed that a majority (63.4–69.1%) of specialists used the combination of a topical corticosteroid plus prolonged antiviral therapy for the treatment of stromal keratitis in both recent-onset and chronic HZO [ 78 ]. However, corticosteroids should not be used in the absence of antiviral medications because they are immunosuppressants and corticosteroid monotherapy may promote viral replication and result in acute retinal necrosis [ 70 ]. The incidence of acute retinal necrosis is fortunately rare (i.e., 1 case per 1.6–2.0 million population per year) [ 79 ].

Acute retinal necrosis is a rapidly progressive ophthalmologic emergency and may spread to the contralateral eye [ 70 ]. Although no data are available from randomized trials to guide management, immediate treatment of acute retinal necrosis with IV acyclovir followed by oral therapy to complete a 3- to 4-month course of antiviral treatment has been recommended to arrest viral replication and prevent the involvement of both eyes [ 70 , 80 , 81 ]. Intravitreal antiviral agents (foscarnet, ganciclovir) have also been recommended [ 29 , 82 ]. For optic neuropathy or orbitopathy, IV acyclovir is used at a dosage of 10–15 mg/kg three times daily for 2–3 weeks. The treatment for retinitis is similar, with the addition of several months of oral antiviral therapy [ 83 ].

There are no data from randomized, placebo-controlled studies to support the use of long-term suppressive treatment with oral antiviral agents. Prolonged antiviral therapy is being investigated in an ongoing trial (ZEDS; NCT03134196) in the HZO setting [ 84 ]. This randomized, double-blind trial has enrolled 652 patients and will determine whether treatment with valacyclovir 1000 mg daily for 1 year reduces the incidence of ophthalmic complications in patients with HZO [ 85 ]. Eligible patients are immunocompetent adults who have had an episode of HZO with dendriform epithelial keratitis, endothelial keratitis, stromal keratitis, and/or iritis within the previous year. The study is expected to be completed in 2024 [ 85 ].

After the initial diagnosis of HZO, follow-up visits are required on the basis of clinical presentation. If there is no ocular involvement, follow-up for optometric assessment in 10–14 days should be considered [ 48 ]. If there is ocular involvement, the follow-up interval is dependent on type of ocular involvement and severity: the AAO recommends following up every 1–7 days during the acute episode, then monitoring at 3- to 12-month intervals thereafter to detect the presence of delayed complications (e.g., ocular hypertension, cataracts, and corneal scarring) [ 53 ]. Overall, 48.7% of patients with HZO had at least one follow-up visit within 30 days of the initial diagnosis, and 38.6% of patients with HZO had a follow-up appointment with an ophthalmologist within 1 year of the initial diagnosis [ 69 ].

Importance of Prevention

Prevention of HZ in general is an effective means of preventing HZO, given that HZO is a subtype of HZ involving one specific nerve and dermatome. Previously, two vaccines were approved in several countries for the prevention of HZ in adults; a live-attenuated vaccine (zoster vaccine live; ZVL) was licensed in 2006 (Zostavax, Merck & Co., Inc.) [ 86 ], and subsequently, an adjuvanted recombinant zoster vaccine (RZV; Shingrix, GSK), which contains the main target of CD4 + T cell-mediated responses to latent VZV (glycoprotein E) and a liposome-based adjuvant (AS01 B ), was approved in 2017 [ 87 ]. Pivotal studies for both vaccines were conducted to assess efficacy in prevention of HZ and did not report on HZO specifically. Effectiveness regarding prevention of HZO has been reported in real-world effectiveness studies.

Efficacy in Preventing HZ

When administered as a single dose in a randomized, multicenter, phase 3 trial, the efficacy of ZVL relative to placebo for prevention of HZ was 69.8% in adults aged 50–59 years [ 6 ] and 51.3% in adults aged ≥ 60 years [ 5 ]. The efficacy of ZVL waned during a long-term follow-up study of patients enrolled in phase 3 trials and was estimated to be 21.1% at 7–11 years post vaccination [ 88 ]. As a live vaccine, ZVL is generally contraindicated in immunocompromised individuals [ 89 ]. The most common adverse reactions reported in pivotal clinical trials of ZVL were injection-site reactions (64% in persons aged 50–59 years and 48% in those aged ≥ 60 years) [ 90 ]. The most common systemic adverse reactions included headache and pain in the extremities. Most local and systemic adverse reactions were mild in intensity.

A two-dose schedule of RZV is indicated for the prevention of HZ in adults aged ≥ 50 years and also in adults aged ≥ 18 years who are at increased risk of HZ (e.g., immunocompromised individuals) [ 91 , 92 ]. The efficacy of RZV for prevention of HZ relative to placebo in adults aged ≥ 50 years and ≥ 70 years, respectively, was 97.2% and 91.3% in randomized, controlled, multicenter, phase 3 trials [ 7 , 8 ]. A combined analysis of data from these trials showed that 1 of 13,881 vaccinated individuals and 7 of 14,035 placebo recipients experienced ophthalmic disease during approximately 4 years of follow-up [ 93 ]. Long-term follow-up of patients aged ≥ 50 years vaccinated with RZV in the phase 3 trials has shown that vaccine efficacy against HZ was 81.6% for approximately 6–10 years post vaccination [ 94 ]. As a subunit vaccine, RZV can be administered to immunocompromised individuals [ 91 ]. As a result, a series of clinical trials have examined the efficacy of the vaccine in this diverse high-risk group of patients. RZV had a vaccine efficacy of 68.2% in preventing HZ in autologous stem cell transplant recipients aged ≥ 18 years [ 95 ] and 87.2% in patients with hematologic malignancies according to a post hoc analysis [ 96 ].

In individuals aged ≥ 50 years who received RZV in clinical trials, the most common solicited local adverse reactions were pain (78%), redness (38%), and swelling (26%), and the most common solicited general adverse reactions were myalgia (45%), fatigue (45%), headache (38%), shivering (27%), and fever (21%) [ 91 ]. Most of these reactions were not long-lasting (median duration of 2–3 days). Reactions reported as severe lasted 1–2 days. In adults ≥ 18 years who are immunodeficient or immunosuppressed as a result of disease or therapy, the safety profile was consistent with that observed in adults ≥ 50 years.

Efficacy/Effectiveness Against HZO

Two meta-analyses have examined the effectiveness of vaccines against HZ and complications. A systematic review of data from 9,536,086 patients in 22 cohort and case–control studies showed that, on the basis of two studies with data on ZVL for the prevention of HZO, ZVL had 30% efficacy in preventing HZO [ 97 ]. A network meta-analysis by Tricco et al. [ 98 ] including data from a randomized controlled trial of 13,900 patients comparing the efficacy of RZV and placebo in older adults showed that the efficacy of RZV was significantly superior to that of placebo in the prevention of HZO (vaccine efficacy 88%).

Real-world observational studies from the USA have evaluated vaccine effectiveness in the prevention of HZO. In a retrospective cohort study in Medicare beneficiaries aged ≥ 65 years, the effectiveness of ZVL in preventing HZO was estimated to be 31% during the first 3 years post vaccination and 21% after ≥ 4 years [ 15 ]. The effectiveness of ZVL in prevention of HZO in adults aged > 50 years was estimated to be 71% during the first years post vaccination, and subsequently decreased to 12% at 8–10 years of follow-up in a prospective study that included 1.5 million individuals [ 99 ]. For the 10-year period, effectiveness of ZVL in prevention of HZO was 37% [ 99 ].

RZV effectiveness in Medicare beneficiaries aged ≥ 65 years against HZO was reported to be 67% in a study that included 15 million individuals with approximately 7 months of follow-up since vaccination [ 100 ]. RZV effectiveness against HZO in adults aged ≥ 50 years was evaluated in two large observational studies of commercial health insurance databases with a median follow-up period of 2 years after vaccination. In one of these analyses, which included approximately 5 million individuals, vaccine effectiveness against HZO was estimated to be 89% in adults aged > 50 years [ 101 ]. In the other analysis, the overall incidence of HZO in vaccinated and unvaccinated individuals was estimated to be 11.9 and 72.1 cases per 100,000 person-years, respectively [ 102 ].

The effectiveness of HZ vaccines in individuals with a prior history of HZO has not been assessed or reported.

Current Guidance for HZ Prevention

Over the past two decades, recommendations for preventing HZ in older adults with vaccines have evolved. Initially, ZVL was the only vaccine available. For example, in 2008, the US Advisory Committee on Immunization Practices (ACIP) recommended ZVL for all individuals older than 60 years [ 4 ]. Subsequently, after the US Food and Drug Administration approval of RZV, ACIP recommended that all adults aged ≥ 50 years receive RZV regardless of whether they had previously received ZVL [ 4 , 103 ]. ACIP recommends RZV in preference to ZVL because of the greater apparent efficacy of RZV in clinical trials and because of diminished efficacy of ZVL over time [ 103 ]. More recently, with the approval RZV in immunocompromised individuals, ACIP recommends RZV for prevention of HZ and related complications in immunodeficient and immunosuppressed adults aged ≥ 19 years [ 104 ]. Australian [ 105 ], Canadian [ 106 ], and German [ 107 ] authorities also recommend RZV in preference to ZVL. The AAO recommends vaccination against HZ in patients aged ≥ 50 years and also that ophthalmologists collaborate with primary care physicians, internists, dermatologists, and other healthcare professionals to recommend vaccination against HZ in patients aged ≥ 50 years [ 108 ].

Patients with HZ are at risk of recurrent disease. While there are limited data on the effectiveness of vaccines in individuals with a history of HZ, vaccination is recommended; however, guidance varies as to when vaccination should occur. ACIP recommends that vaccination can occur after resolution of acute HZ [ 103 ], whereas the Australian Technical Advisory Group on Immunisation (ATAGI) recommends that vaccination is delayed for ≥ 12 months after an episode of HZ (or ≥ 3 months for immunocompromised individuals) [ 105 ].

There is concern that vaccination against HZ in individuals with a history of HZO may be associated with exacerbation or recurrence of HZO, with a few cases being reported following ZVL [ 109 , 110 ] and RZV [ 111 , 112 ] administration. A recent study reported an increased risk of exacerbation or recurrence in the 56-day period after vaccination with RZV (adjusted hazard ratio 1.64; 95% confidence interval 1.01–2.67; p  = 0.04) [ 113 ]; there was no significant increase during the 28- or 42-day periods post vaccination [ 113 ]. The AAO notes that individuals with a history of HZO may be at risk of recurrent eye disease after vaccination and recommends that these individuals are examined by their ophthalmologist within several weeks before and after vaccination against HZ [ 108 ]. Moreover, since cell-mediated immunity is stimulated during and after an episode of HZ, vaccination is not urgent immediately after resolution of symptoms and should be delayed until eye disease is well controlled [ 108 ]. As only limited data are available on the use of HZ vaccines in individuals with a history of HZO, clinicians should use professional judgment when considering the resolution of HZO symptoms and immune status of a given patient in light of current recommendations.

An increase in HZ vaccination would be expected to reduce the burden of HZ, including HZO. Despite the recommendations, vaccination coverage for adults, including HZ vaccination, remains suboptimal. Barriers to vaccination against HZ include diverse phenomena that can be categorized as patient beliefs about HZ (low perceived risk of HZ, or the belief that one rarely gets sick or has immunity to HZ already), beliefs about HZ vaccines (concerns about effectiveness, adverse effects, or possible allergic reactions, or the belief that HZ vaccines can cause shingles), and factors related to healthcare providers (such as not having discussed the need for HZ vaccination with their primary care physician or difficulty getting to see a primary care physician) [ 114 ]. In particular, a prominent reason cited by patients when declining HZ vaccination is the lack of a recommendation by their primary care physician [ 115 , 116 ].

Primary care physicians should be proactive and recommend HZ vaccination to all eligible patients rather than waiting for a patient’s request. Patients who regularly receive influenza vaccines have increased uptake of HZ vaccines [ 117 ]; therefore, a convenient time to recommend and administer an HZ vaccine would be when a patient is attending a clinic to receive a seasonal influenza vaccine. Practice nurses are ideally situated to identify patients who are eligible for vaccination.

Conclusions

In summary, because HZO is a potentially sight-threatening condition and a significant proportion of patients with HZO experience chronic or recurrent disease, referral to an ophthalmologist for treatment and follow-up is necessary in patients who present with HZ and ocular signs and symptoms or nasociliary branch involvement. Prompt initiation of antiviral treatment and timely follow-up is necessary to limit progression of HZO and complications. Effective vaccines are widely available and recommended for the prevention of HZ and HZO in adults. Primary care physicians should prioritize vaccination of eligible patients as part of a comprehensive vaccination program in adults.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Litt, J., Cunningham, A.L., Arnalich-Montiel, F. et al. Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention. Infect Dis Ther (2024). https://doi.org/10.1007/s40121-024-00990-7

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