Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4567
Ludi Zhang, William Rojas-Carabali, Shannon Sheriel Choo, Zheng Xian Thng, Yuan Heng Lim, Bernett Lee, Song Wen Jun, Gazal Patnaik, Jyotirmay Biswas, Aniruddha Agarwal, Ilaria Testi, Sarakshi Mahajan, John H Kempen, Justine R Smith, Peter McCluskey, Onn Min Kon, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta, Rupesh Agrawal
<p><strong>Importance: </strong>This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort.</p><p><strong>Objective: </strong>To evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation.</p><p><strong>Design, setting, and participants: </strong>This study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed.</p><p><strong>Exposures: </strong>COTS calculator to guide initiation of ATT in patients with TBU.</p><p><strong>Main outcomes and measures: </strong>Comparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity.</p><p><strong>Results: </strong>Of the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests.</p><p><strong>Conclusions and relevance: </strong>Results of this diagnostic study suggest that the COTS calculator (score ≥4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential
{"title":"Validation of the Online Collaborative Ocular Tuberculosis Study Calculator for Tubercular Uveitis.","authors":"Ludi Zhang, William Rojas-Carabali, Shannon Sheriel Choo, Zheng Xian Thng, Yuan Heng Lim, Bernett Lee, Song Wen Jun, Gazal Patnaik, Jyotirmay Biswas, Aniruddha Agarwal, Ilaria Testi, Sarakshi Mahajan, John H Kempen, Justine R Smith, Peter McCluskey, Onn Min Kon, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta, Rupesh Agrawal","doi":"10.1001/jamaophthalmol.2024.4567","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4567","url":null,"abstract":"<p><strong>Importance: </strong>This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort.</p><p><strong>Objective: </strong>To evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation.</p><p><strong>Design, setting, and participants: </strong>This study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed.</p><p><strong>Exposures: </strong>COTS calculator to guide initiation of ATT in patients with TBU.</p><p><strong>Main outcomes and measures: </strong>Comparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity.</p><p><strong>Results: </strong>Of the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests.</p><p><strong>Conclusions and relevance: </strong>Results of this diagnostic study suggest that the COTS calculator (score ≥4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential ","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4539
Darren A Chen, Jennifer C W Hu, K Matthew McKay
{"title":"Branch Retinal Artery Occlusion in an Adolescent Male.","authors":"Darren A Chen, Jennifer C W Hu, K Matthew McKay","doi":"10.1001/jamaophthalmol.2024.4539","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4539","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4518
Jim Shenchu Xie, Jonathan Trobe, Edward Margolin
{"title":"Considerations Regarding Association of Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy.","authors":"Jim Shenchu Xie, Jonathan Trobe, Edward Margolin","doi":"10.1001/jamaophthalmol.2024.4518","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4518","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4536
Joseph F Rizzo, Jimena Tatiana Hathaway, Madhura P Shah
{"title":"Considerations Regarding Association of Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy-Reply.","authors":"Joseph F Rizzo, Jimena Tatiana Hathaway, Madhura P Shah","doi":"10.1001/jamaophthalmol.2024.4536","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4536","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4493
Shreya A Shah, Jared T Sokol, Karen M Wai, Ehsan Rahimy, David Myung, Prithvi Mruthyunjaya, Ravi Parikh
{"title":"Use of Artificial Intelligence-Based Detection of Diabetic Retinopathy in the US.","authors":"Shreya A Shah, Jared T Sokol, Karen M Wai, Ehsan Rahimy, David Myung, Prithvi Mruthyunjaya, Ravi Parikh","doi":"10.1001/jamaophthalmol.2024.4493","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4493","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4527
Judith C Maro, Richard Platt, Sengwee Toh
{"title":"Considerations Regarding Association of Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy.","authors":"Judith C Maro, Richard Platt, Sengwee Toh","doi":"10.1001/jamaophthalmol.2024.4527","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4527","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4815
Nicholas A V Beare, Geraint Davies
{"title":"Tuberculosis Uveitis-Consumed by Uncertainty.","authors":"Nicholas A V Beare, Geraint Davies","doi":"10.1001/jamaophthalmol.2024.4815","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4815","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4524
Dong Wook Kim, Caroline M Apovian
{"title":"Considerations Regarding Association of Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy.","authors":"Dong Wook Kim, Caroline M Apovian","doi":"10.1001/jamaophthalmol.2024.4524","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4524","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4401
Nabin Paudel, Laura Brady, Petia Stratieva, Orla Galvin, Beverly Lui, Iris Van den Brande, Jean-Pierre Malkowski, Mayvis Rebeira, Simon MacAllister, Tara O'Riordan, Avril Daly
Importance: Age-related macular degeneration (AMD) is a highly prevalent and debilitating retinal condition that affects more than 200 million people globally, with the severe late-stage forms-neovascular AMD (nAMD) and geographic atrophy (GA)-affecting more than 11 million people globally. However, much is unknown about the economic burden of the disease.
Objective: To estimate the economic burden associated with late-stage AMD in Bulgaria, Germany, and the US at the societal level.
Design, setting, and participants: This study used the prevalence approach cost-of-illness economic modeling to estimate costs attributable to late-stage AMD. Data on health care resource utilization, well-being, and productivity were obtained via primary data collection. Additional data required for the model were sourced from available published literature. Data were collected from January 2021 to March 2022, and analyzed from April to July 2022. Participants older than 50 years residing in Bulgaria, Germany, and the US who were diagnosed with late-stage AMD (nAMD or any form of GA) in 1 or both eyes and caregivers who care for people diagnosed with late-stage AMD were recruited through ophthalmological clinics in Bulgaria and Germany and via online newsletters and social media in the US.
Main outcomes and measures: The main outcomes were direct medical costs (disease-related health care expenditures), indirect medical costs (care support and assistive technology), well-being cost (loss of well-being), and productivity cost (loss in productivity due to the diseases for both patient and caregivers).
Results: Of the 128 individuals with late-stage AMD in this study, 80 (62%) were female, and 120 (94%) were aged 60 years or older. Of the 61 caregivers, 43 (70%) were female and 55 (91%) were aged 45 years or older. Estimated per-annum total costs attributable to late-stage AMD were €449.5 million ($512.5 million) in Bulgaria, €7.6 billion ($8.6 billion) in Germany, and €43.2 billion ($49.4 billion) in the US. Across all countries, 10% to 13% of the total cost incurred was attributed to direct medical costs. In Germany and Bulgaria, the biggest contributor to the total economic burden was reduced well-being (67% and 76%, respectively), whereas in the US, loss of productivity (42%) was the biggest contributor.
Conclusions and relevance: The findings of this study indicate a substantial burden of late-stage AMD on patients and caregivers in the US, Germany, and Bulgaria. Across the 3 countries, reduced well-being and loss of productivity were relatively large contributors to the total economic burden. Implementing measures to reduce AMD incidence, delay disease progression, and alleviate humanistic burden may help reduce the economic burden of late-stage AMD.
{"title":"Economic Burden of Late-Stage Age-Related Macular Degeneration in Bulgaria, Germany, and the US.","authors":"Nabin Paudel, Laura Brady, Petia Stratieva, Orla Galvin, Beverly Lui, Iris Van den Brande, Jean-Pierre Malkowski, Mayvis Rebeira, Simon MacAllister, Tara O'Riordan, Avril Daly","doi":"10.1001/jamaophthalmol.2024.4401","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4401","url":null,"abstract":"<p><strong>Importance: </strong>Age-related macular degeneration (AMD) is a highly prevalent and debilitating retinal condition that affects more than 200 million people globally, with the severe late-stage forms-neovascular AMD (nAMD) and geographic atrophy (GA)-affecting more than 11 million people globally. However, much is unknown about the economic burden of the disease.</p><p><strong>Objective: </strong>To estimate the economic burden associated with late-stage AMD in Bulgaria, Germany, and the US at the societal level.</p><p><strong>Design, setting, and participants: </strong>This study used the prevalence approach cost-of-illness economic modeling to estimate costs attributable to late-stage AMD. Data on health care resource utilization, well-being, and productivity were obtained via primary data collection. Additional data required for the model were sourced from available published literature. Data were collected from January 2021 to March 2022, and analyzed from April to July 2022. Participants older than 50 years residing in Bulgaria, Germany, and the US who were diagnosed with late-stage AMD (nAMD or any form of GA) in 1 or both eyes and caregivers who care for people diagnosed with late-stage AMD were recruited through ophthalmological clinics in Bulgaria and Germany and via online newsletters and social media in the US.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were direct medical costs (disease-related health care expenditures), indirect medical costs (care support and assistive technology), well-being cost (loss of well-being), and productivity cost (loss in productivity due to the diseases for both patient and caregivers).</p><p><strong>Results: </strong>Of the 128 individuals with late-stage AMD in this study, 80 (62%) were female, and 120 (94%) were aged 60 years or older. Of the 61 caregivers, 43 (70%) were female and 55 (91%) were aged 45 years or older. Estimated per-annum total costs attributable to late-stage AMD were €449.5 million ($512.5 million) in Bulgaria, €7.6 billion ($8.6 billion) in Germany, and €43.2 billion ($49.4 billion) in the US. Across all countries, 10% to 13% of the total cost incurred was attributed to direct medical costs. In Germany and Bulgaria, the biggest contributor to the total economic burden was reduced well-being (67% and 76%, respectively), whereas in the US, loss of productivity (42%) was the biggest contributor.</p><p><strong>Conclusions and relevance: </strong>The findings of this study indicate a substantial burden of late-stage AMD on patients and caregivers in the US, Germany, and Bulgaria. Across the 3 countries, reduced well-being and loss of productivity were relatively large contributors to the total economic burden. Implementing measures to reduce AMD incidence, delay disease progression, and alleviate humanistic burden may help reduce the economic burden of late-stage AMD.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1001/jamaophthalmol.2024.4801
David W Hutton, Joshua D Stein
{"title":"Holistic Evaluation of the Burden of Eye Disease.","authors":"David W Hutton, Joshua D Stein","doi":"10.1001/jamaophthalmol.2024.4801","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4801","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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